COVID-19, nuclear war, and global warming: lessons for our vulnerable world
Authors: James E Muller, David G Nathan
Journal: The Lancet (2020)

The COVID-19 pandemic teaches lessons we must embrace to overcome two additional existential threats: nuclear war and global warming. Health professionals need to send a message to those whose lives we have vowed to protect: all three threats result from forces of nature made dangerous by triumphs of human intelligence, and all three can be solved by human intelligence.1Ghinai I McPherson TD Hunter JC et al.First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.Lancet. 2020; 395: 1137-1144Summary Full Text Full Text PDF PubMed Scopus (374) Google Scholar, 2Ervin RR Glazier JB Aronow S et al.Human and ecologic effects in Massachusetts of an assumed thermonuclear attack on the United States.N Engl J Med. 1962; 266: 1127-1137Crossref PubMed Scopus (38) Google Scholar, 3Lown B Chivian E Muller J Abrams H The nuclear-arms race and the physician.N Engl J Med. 1981; 304: 726-729Crossref PubMed Scopus (32) Google Scholar, 4Abrams HL Inadvertent nuclear war.Lancet. 1988; 2: 559-560Abstract PubMed Scopus (1) Google Scholar, 5Watts N Amann M Arnell N et al.The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (877) Google Scholar Albert Einstein warned that "the unleashed power of the atom has changed everything save our modes of thinking and we thus drift toward unparalleled catastrophe".6The New York Times ArchivesThe Einstein letter that started it all; a message to President Roosevelt 25 years ago launched the atom bomb and the atomic age.https://www.nytimes.com/1964/08/02/archives/the-einstein-letter-that-started-it-all-a-message-to-president.htmlDate: Aug 2, 1964Date accessed: June 10, 2020Google Scholar The nuclear threat plus global warming led the Bulletin of the Atomic Scientists to advance the Doomsday Clock to 100 seconds before midnight—the closest ever—just before the pandemic. Although it may seem overwhelming to contemplate additional threats during COVID-19, we must address all three since they are the greatest dangers ahead. Their origins and solutions are remarkably similar. COVID-19 is the most visible. Had the outbreak happened before air travel, the mutant virus would have remained in China and spread slowly, if at all. Today, we face a permanent threat of future pandemics—genes will continue to mutate and planes will continue to fly. Nuclear war is the least visible threat, as well hidden as the virus of a bat in a cave near Wuhan. It is, however, the most likely to have an immediate, devastating impact. In a city hit with a nuclear weapon, by intent or by accident, there would be no decisions about which patient to treat with the remaining ventilator.2Ervin RR Glazier JB Aronow S et al.Human and ecologic effects in Massachusetts of an assumed thermonuclear attack on the United States.N Engl J Med. 1962; 266: 1127-1137Crossref PubMed Scopus (38) Google Scholar, 3Lown B Chivian E Muller J Abrams H The nuclear-arms race and the physician.N Engl J Med. 1981; 304: 726-729Crossref PubMed Scopus (32) Google Scholar, 4Abrams HL Inadvertent nuclear war.Lancet. 1988; 2: 559-560Abstract PubMed Scopus (1) Google Scholar Global warming is the threat most certain to generate future harm, although human suffering will spread more slowly than with nuclear war or a pandemic.5Watts N Amann M Arnell N et al.The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (877) Google Scholar The global response to COVID-19 is a source of hope. Scientists launched an inspiring counterattack on the coronavirus. Clinicians, often risking their own lives, rushed to bedsides. The struggles against these threats teach valuable lessons. First, each threat must be recognised. Second, political leaders must respect truth and defer to expertise. Third, the threats are global and require global cooperation. Fourth, we all have to focus on our collective survival, and that includes care for the least privileged. The world need not be the same after the pandemic. It can be better. A COVID-19-induced awakening can arrest our drift toward catastrophe. Health professionals, uniquely aware of the threats, have an obligation to enhance understanding of the requirements for survival in the 21st century. JEM is a co-founder of International Physicians for Prevention of Nuclear War, the organisation awarded the 1985 Nobel Peace Prize. DGN is a co-founder of Physicians for Social Responsibility. We declare no competing interests.