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Dr. Joseph Dillard is a psychotherapist with over forty year's clinical experience treating individual, couple, and family issues. Dr. Dillard also has extensive experience with pain management and meditation training. The creator of Integral Deep Listening (IDL), Dr. Dillard is the author of over ten books on IDL, dreaming, nightmares, and meditation. He lives in Berlin, Germany. See: integraldeeplistening.com and his YouTube channel.

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Toward an Integral Response to Coronavirus

Joseph Dillard

We are now leaving an age of vast complacency and entering a time of unexpected high risk that most of us have never previously encountered in our lives. To those born into entitlement, immediate gratification, and a politically correct culture used to blaming others or circumstances for misfortune, this will be a time of ascendency for fear porn and catastrophic drama. Under pressure, people tend to melt down, regress, and turn into incoherent blobs of early prepersonal self-interest. When entire societies are addicted to noospherically-oriented work and entertainment, the shock of encountering authentic physical threats and discomforts with no easy solution is going to be confusing at best and an occasion for prepersonal acting out at worst.

Can Integral offer any realistic, meaningful alternative? Another framing of crisis is opportunity. It is time for us to be thinking about how Integral might offer something positive to a mass of panicked, confused people across the globe.

A good rule of thumb is that 95% of all fears are false or overblown, but 5% will kill you. Discriminating between the two is the real challenge. How do we know when we are unnecessarily scaring ourselves or ignoring some genuine threat? A good example is global warming, where each side is quite convinced the other is brain dead. We don't want to get caught in the same position regarding Coronavirus, and it looks right now as if reality is not going to let us.

As of March 7th, Northern Italy - half the country - has been put under quarantine. If present trends continue, the health care system in Italy will collapse in two weeks. Rates of infection in the US are following the trend lines seen in China, S Korea, Japan, and Italy. Will air travel within the US and globally be disrupted? Will we see massive shortages? Such thoughts, fantasies a week ago, are real possibilities now. Because the asymptomatic incubation period is so long - some 14 days - there is no guaranteed way to avoid the spread of this highly contagious virus short of moving into a cave in Tibet or living like a nomad for three months in a camper-trailer. It is now predicted that 40-70% of the global population will get coronavirus, with most not knowing they are carriers, or merely coming down with flu-like symptoms. For those over 60 or who are immune-compromised, it's the real deal: pneumonia-like symptoms requiring critical care, which may well not be available. The social and economic consequences are going to be tremendous and will overwhelm the ability of some nations to respond. Experts are saying an effective vaccination is 12 to 18 months away.

Liz Specht, a PhD in biology and the associate director of Science and Technology for the Good Food Institute, has provided a cogent analysis[1]:

• We can expect that we'll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.
• We're looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.
• As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won't slow significantly until hitting >>1% of susceptible population.
• What does a case load of this size mean for healthcare system? We'll examine just two factors—hospital beds and masks—among many, many other things that will be impacted.
• The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).
• Let's trust Italy's numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks*—in other words, turnover will be *very* slow as beds fill with COVID19 patients).
• By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)
• If we're wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.
• If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.
• As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let's ignore that for now.
• Alright, so that's beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).
• There are about 18M healthcare workers in the US. Let's assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I'm playing conservative at every turn.)
• As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.
• One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.
• How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.
• Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can't force trade in our favor.
• Now consider how these 2 factors—bed and mask shortages—compound each other's severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.
• HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it's only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.
• We could go on and on about thousands of factors—# of ventilators, or even simple things like saline drip bags. You see where this is going.
• Importantly, I cannot stress this enough: even if I'm wrong—even VERY wrong—about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.
• Undeserved panic does no one any good. But neither does ill-informed complacency. It's wrong to assuage the public by saying “only 2% will die.” People aren't adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.
• I'm an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I've been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.
• Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we're seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.
• But I have no reason to think they'll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don't mock decisions like canceling events or closing workplaces as undue “panic”.
• These measures are the bare minimum we should be doing to try to shift the peak—to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.
• And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
• Worst case, I'm massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.
• One more thought: you've probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.
• Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.
• But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.
• That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we're talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.
• This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.

China, after quarantining Hubai province with some 57 million people, and its capital, Wuhan, which has a population of 11 million, for at least two months, and showing an impressive decline in new cases of coronavirus, is now finding it reintroduced by travelers entering the country. Could the shutting down of air travel in and out of China be possible? Could the shutting down of commercial global air travel be possible? When we think about the highly infectious nature of this disease and then consider the conditions we experience at airports and on board airplanes, a combination of public intention and national policies may make such an incomprehensible possibility a reality.

You have to decide for yourself whether the information and possibilities listed above and that you encounter in the media is fear mongering or not. What is over-reaction and what is not? We know that most cases of coronavirus will be mild or non-lethal, and that only those over sixty or who have immune systems that are jeopardized in several ways are likely to die. But even considering those realities, epidemiologists are now predicting millions of global deaths.

In the light of this information we are tempted to throw up our hands and say, “What's the use? Que sera sera! Whatever will be, will be! However, how is such a response Integral? It isn't. It is the same resignation to “fate” practiced by the Greeks and Romans. Have we or have we not evolved since then?

What might an integral response to coronavirus look like?

It will be multi-perspectival, which means that it will take into account the perspectives of each developmental level in tailoring responses and responsiveness. An integral response will also rely upon those lines which are most knowledgeable and capable at dealing with this variety of crisis. That would mean deferring to the judgment of medical and epidemiological experts. For those who challenge this conclusion, to what would you propose we defer? Intuition? Scripture? Politicians? Religious beliefs? Our own personal world view? To defer to the judgment of medical and scientific authorities is not the same as concluding that they are correct, infallible, or that the results of doing so may not be disastrous. Instead, it is to say that we are embarking on a mass experiment in who survives and fares well in this crisis and who does not: those who follow the advice of those most knowledgeable about this threat or those who choose some other alternative. We already have some results of that experiment; we can either learn from them or ignore them at our own risk.

An Integral response will also take into account all four-quadrants. In the interior individual quadrant of feeling, thought, and intention, it will involve objectifying first emotional reactivity and then our reasoning about our circumstances. We cannot skip directly from emotional objectivity to trans-rational objectivity; we first have to deal with the crisis on a rational level in order to first include it and then transcend it. In order to do so, we need to squarely face our catastrophic expectations and worst-case scenarios, including the death of our loved ones, which for many of us is a worse outcome than our own death.

What are your catastrophic expectations? What is your worst-case scenario? What steps do you have to take for preparing for them?

At the least, we need to make a plan and talk it over with our families and loved ones. Surface their fears; help them to also make a plan involving at least the interior individual and collective as well as the exterior individual quadrants. Whether or not the plan is realistic or ends up being necessary or not, simply making one and sharing it is a huge comfort for most people. That sharing with others and helping others to devise their own plan, is a lower right quadrant response to the crisis.

At this point I do not find it unrealistic to expect and plan for a global depression lasting years. It may not happen, but seriously considering that possibility and making a plan that addresses all four quadrants seems reasonable at this point. While voiding contact with others is often recommended, this is probably not very realistic and tends to generate a tendency to view others with apprehension. Psychologically, if not physically, that is probably going to do more harm than good. The reality is that there is over a 50% chance that we will catch coronavirus and we have something like a 2-3% chance of dying from it, with those rates skyrocketing if we are over sixty or have compromised immune systems.

My wife Claudia and I, who are both in high-risk groups, are getting our affairs in order and considering what would be required to deal with coronavirus at home if the hospitals are overwhelmed. We want to have systems in place so we can forget about them and focus on being available to help those less prepared, both emotionally and physically, than ourselves. Everybody has to die of something, some day. If the coronavirus is our undoing, at least we can exit while attempting to be of service to others.

Integralists can focus on maintaining a four-quadrant perspective, empathizing with the perspective of whomever we are dealing with, while modeling good problem-solving abilities, equanimity, thankfulness, and support. These are not only integral capabilities, but the best aspects of human nature, shining through in the midst of adversity.

NOTES

[1] Tyler Durden, "All Hospital Beds In The US Will Be Filled With Patients 'By About May 8th' Due To Coronavirus: Analysis", www.zerohedge.com, 03/07/2020.