FEBRUARY 2020 – What Coronavirus can teach us about pain (and addiction.)

By now everyone’s heard of CoVID-19, the novel Coronavirus. It’s been a few years since we have had a real epidemic, let alone a pandemic. I want to take a few minutes here though and ask you to consider the similarities… and differences between this infectious public health threat and what we have been dealing with in America for the past 50 years that we’ve just gotten so used to that we hardly pay attention to it anymore. I’m talking about the ‘epidemic’ of chronic diseases such as high blood pressure and diabetes. I’m talking about dependence on prescription medications such as opioids and sedatives. I’m talking about the far more prevalent substance abuse problems of tobacco and alcohol.

Screen Shot 2020-03-17 at 9.39.53 AM

I don’t mean to downplay the individual significance of a coronavirus infection to a person or family member affected by it. I’m talking about things from a public health standpoint here. As of now, so far as we know, there have been a little less than 100,000 cases reported (and 2,000 deaths). Worldwide. 7.7 billion people. Current case fatality estimates range from 0.0something to 4%.

Obstructive sleep apnea?  Almost a billion people worldwide have it, and it increases total mortality rates by something on the order of 60%.

Alcohol abuse? Depending on how you define it, that ranges from 100 million to 1.2 billion people. In the United States alone, nearly 90,000 people a year die from alcohol-related causes.

Tweets about cancer and heart failure just don’t get as many likes. Why is that, when they are so much more likely to take us out?  There are layers upon layers of reasons of course, some of which have to do with our increasingly short attention spans and inundation with immediate-access news or gossip. What I want to focus on though is threat perception.

You’ve heard the old story about boiling a frog slowly (if you’re into that kind of thing.) I’m a terrible fly fisherman for a lot of reasons, but one of them is I can’t really stand still long enough for the fish to stop paying attention to me. Point being, most of us sentient life forms get used to things in our environment and they lose the element of threat. Time course has a lot to do with that. Wildebeest panic and stampede when the cheetahs show up but far more wildebeest die from starvation. They just don’t see it coming.

And that’s kind of where we’re at now. Everyone sees this new virus (unless you are super-intelligent and have gotten rid of your TV, computer, smart phone, etc.) and is stampeding. What about child abuse, junk food and groundwater pollution? When will we perceive the real threats to our communities, nation and world?


I sort of got sidetracked there and I’m out of time now to talk about what I started out to actually, which is to point out the curious difference between human behavior when it comes to infectious disease agents (and vectors, if you know your epidemiology lingo) versus the agents of chronic disease. Here’s a hint: only one of those two scenarios leads to aversive action.

The other thing I wanted to talk about is how epidemics end. Basically, there are two scenarios. In the first, the pathogen or problem is so aggressive and deadly that it wipes out the population. In the other, the population wins… by developing immunity (natural, or vaccination.) So, how do we cultivate immunity to the really serious problems threatening us? More to follow…