fear of death

COVID-19 has refocused the world’s attention, however briefly, on the transient nature of life. The threat of death hangs in the air, and many people fear the worst.

Fear comes from two places: what we know and what we don’t know. Most coronavirus fears at this point belong to the latter camp.

A year or two from now, this coronavirus will no longer be designated “novel.” Members of the medical community at this moment are sciencing the heck out of the problem and will in due course convert the unknown fear into a known fear, devising the most effective treatment regimen, which may or may not include a vaccine. But for the time being, this elusive superbug is tearing around the world at will, and no one knows how to stop it.

When faced with scary diseases or ailments, people often try to mitigate their fears by doing the math, calculating the odds of death or serious injury and deciding how to feel about those odds.

Data scientists advising the White House last week predicted a best-case scenario of 100,000 to 240,000 deaths resulting from COVID-19. (That estimate has since been revised downward.) The worst-case scenario, if the country had not embraced the ongoing community efforts to slow the disease’s progress, would have generated 1.5 million to 2.2 million deaths.

To put that in context, about 2.8 million people died in the United States in 2017, according to the Centers for Disease Control and Prevention. The biggest killers were, in descending order, heart disease (647,457 deaths), cancer (599,108), accidents and unintentional injuries (169,936), chronic lower respiratory disease (160,201), stroke (146,383), Alzheimer’s disease (121,404), diabetes (83,564), influenza and pneumonia (55,672), kidney disease (50,633) and suicide (47,173).

Coronavirus fears appear to be well-founded. Had Americans done nothing, COVID-19 would have wiped out more people than heart disease and cancer combined.

Here’s the tricky question: How afraid should we be going forward?

The world has seen persistent coronavirus infections before. Severe acute respiratory syndrome, better known as SARS, is related to COVID-19 and captured the world’s attention in 2003 when it spread across the globe, but with far fewer cases. The case mortality rate of SARS patients is about 10%, but the World Health Organization has recorded no instances of SARS since 2004. The disease, for now, has disappeared.

As a result, we are not appreciably afraid of SARS.

Middle Eastern respiratory syndrome, commonly known as MERS or “camel flu,” has a far higher mortality rate in the range of 35%. MERS first appeared in 2012, and while the virus is still around, it doesn’t spread far or fast, resulting in only a few hundred diagnosed cases worldwide every year.

So, likewise, we do not fear MERS.

The latest research on COVID-19, published last week in the medical journal The Lancet Infectious Diseases, suggests a case mortality rate of 0.66%. In other words, of every 100,000 people who contract the virus, 660 will die. Compare that ratio to the flu, which kills about 100 out of 100,000. COVID-19 is several times more deadly than the flu, and medical researchers say, like the flu, it could return seasonally.

Afraid?

In time, probably not. Precautions taken collectively could knock down that ratio even further, and a mortality rate of less than 1% in the long term won’t carry enough weight to significantly alter the gravity of the great American machine.

In the end, the real tragedy of COVID-19 will not be that we lost so many lives, but that those deaths could not sufficiently motivate us to break free of the inertia of a routine that consistently ignores our mortality.

Insulated in the fat of our 80-year life expectancy, Americans eagerly await a return to a sense of normalcy, when we won’t have to daily confront the reality of ever-present death, when we once again can perpetually put off any serious discussions of our feelings as they relate to a finite existence.

Accepting the willful delusion that death always comes tomorrow degrades the quality of our todays. It’s a lie that causes only pain.

In a recent New York Times editorial, Dr. Sunita Puri, who directs palliative medicine at the University of Southern California’s Norris Cancer Center, writes about the pain we cause each other by refusing to talk about death.

Part of a fleet of doctors across the country now caring for coronavirus patients, Puri writes:

“Our collective silence about death, suffering and mortality places a tremendous burden on the people we love, and on the doctors and nurses navigating these conversations. We should not be discussing our loved one’s wishes for the first time when they are in an ICU bed, voiceless and pinned in place by machines and tubes.

“Talking about death is ultimately talking about life — about who and what matters to us, and how we can live well even when we are dying. Rather than being motivated by fear and anxiety, we can open these discussions from a place of care and concern.”

COVID-19 has given us opportunity and incentive to talk about death. The disease has for a short time forcibly removed so many of the distractions of daily life, allowing us time to engage in meaningful conversation.

Don’t waste this chance. You and the people you love aren’t going anywhere anytime soon, and these things need to be said.

No conversation is more necessary for ensuring the quality of your life going forward than a frank discussion of your eventual death with the people who matter most to you.

Do it now.