(Warning: this will be upsetting; you will not want to read this if you are already stressed.)

[This piece was written in late February 2020, before there was widespread social distancing in place, under the assumption that no such distancing would happen at scale. I'm keeping it here for posterity.]

First, a disclaimer — I'm far from an expert, have no special knowledge, and only know the same things as everyone else reading the news. But I have to plan ahead and am decent at extrapolating from human nature, and try to anticipate problems. So this is the situation I am trying to plan for, in the U.S.

It will be like 500 9/11s.

This thing will be far worse than most people think. A few examples of what that means:

• Over a million dead in the U.S. by July 4.
• Every American will know someone who dies in the next three months, with the death rate rising to double baseline mortality by May, and possibly higher.
• Entire swaths of the economy — hospitality, restaurants, education — will change as profoundly as air travel did post-9/11.
• The most likely historical antecedents point to martial law in many places, and the possible complete suspension of the election and partial or total inoperation of major civil society institutions.
• Every single person will be in a state of PTSD or trauma, except a few people who didn’t lose anyone, and the omnipresent friction of these states will leave everyone on edge.
• Those who are ill from other causes will be deprioritized, leaving lingering or even chronic and life-threatening conditions for millions.
• Those pushed into extreme duress by the denial of healthcare services to their loved ones or themselves will increasingly resort to violence.
• Part of what will drive desperation will be the way that those who lose a loved one will have to witness it; they will be denied healthcare that is available but being triaged to others in front of them.
• Misinformation and rumors will accelerate as institutions are weakened, and violence, bias and exclusion will ramp up greatly. Existing social schisms will deepen even as people forge survivor bonds across conventional social barriers.
• We have no cure and no vaccine and do not know when or if we will, and do not know if we can be reinfected by the virus, especially as it already has at least two strains.
• Our models of risk management are based on things like natural disasters, where even those displaced or those forced to be refugees can usually eventually reach a state of disengagement from the immediate threat. There will not be a place to disengage from this threat. The hopelessness of knowing there is no respite will overwhelm many.
• While this is going on, we will still have ordinary natural disasters and climate change impacts that continue and demand lifesaving resources that will have been depleted.
• Healthcare workers will be beyond exhausted and traumatized, and there is no way to know how long they’ll be needed to perform at unsustainable levels.

Even ordinary, healthy, resilient people will struggle with this combination. Anyone who is more vulnerable in any way will be pushed to their breaking point.