A New 9/11? Let’s not make the same mistakes: Thoughts on COVID-19 and our response as a society
Disclaimer: I am immensely privileged. Neither the Coronavirus itself, nor the economic fallout that is fast approaching are likely to affect me much, at least directly. I will pass through this entire crisis relatively unscathed. However, much as it might feel so in a world of quarantine and self-isolation, I am still no island — I have friends and family who are either quite elderly or suffer from other health conditions that could render them much more vulnerable to the virus. I also have friends who have seen their pay cut or have been laid off entirely due to the economic collapse. The points advanced below do not arise from personal interest but about a care for the well-being of society and the preservation of hard-won liberties.
Representative Barbara Lee is rightly praised for being the only member of Congress, in either the House or the Senate, to vote against the Authorization for Use of Military Force (AUMF), a sweeping and historic piece of legislation rammed through Congress in a panic just three days after 9/11. It gave President Bush carte blanche to use “all necessary and appropriate force” to go after whomever he determined might be connected with the 9/11 attacks. Lee’s vote required enormous courage, to take a dissenting opinion at a time when it was barely safe, let alone popular, to do so. It must be stressed that Lee did not take her position out of principled pacifism; rather (emphasis is mine): “she voted no not because she opposed military action but because she believed the AUMF, as written, granted overly-broad powers to wage war to the president at a time when the facts regarding the situation were not yet clear.” With the advantage of hindsight, we now see Rep. Lee was right: the AUMF has formed the legal basis for the endless war on terror we’re now trapped in, justifying military operations from Georgia to Djibouti to the Philippines. Notwithstanding Bin Laden’s death and Al-Qaeda’s demise as a serious threat, there is no prospect of that authorization being repealed. Government’s are reluctant to relinquish such a power like that once it is granted.
I am neither a medical nor a publicly policy expert and therefore I don’t claim to know what the best policy solution is to the current Coronavirus outbreak. I do, however, have serious doubts about whether the specific policy of a mass, state-enforced lockdown, which will unquestionably destroy our economy and erode our civil liberties, is a proportionate and wise one. What especially worries me is that we are not allowing enough Barbara Lees to voice their doubts and that we are making rash decisions ‘at a time when the facts are not yet clear’, simply out of feeling that “something must be done”. We all want to save lives and we all especially regret any unavoidable death. To suggest otherwise — specifically, to suggest that those who disagree with the specific policy actions chosen by our government are somehow callous or uncaring of human life — is absurd. Not only is it false and cruel, it can be dangerous by creating a chilling effect that suppresses other dissenting voices. It is also not true that those of us skeptical of the government’s approach are simply intransigent libertarians who would be against any lockdown in any circumstances. If the bubonic plague returned tomorrow or a giant meteor was poised to crash into our planet, that would be a different matter. The question, as was the one that faced Barbara Lee, is one of proportionality: is this a proportionate response given what we know of the threat and how sure can we be of its efficacy.
We still know very little about the Coronavirus and, consequently, we have little certainty that the extreme measures being put in place — curfews, lockdowns, shuttering of businesses — will arrest its spread. We’re told that 90 million people will die globally (which we are reminded works out to “15 Holocausts”, in case we weren’t taking the raw numbers seriously enough) unless we do something. But these estimates are based on fatality rates whose reliability we ought to treat with cautious skepticism. Earlier this month the World Health Organization announced the COVID-19 fatality rate was 3.4%, but just ten days later infectious disease experts revised that number down to 1.4%. It could be even lower, for reasons I discuss now.
The problem is that the data that goes into computing a fatality rate is inherently self-selecting. With a global shortage of testing kits, healthcare systems are — sensibly — not testing all patients at an equal rate. Tests are reserved for those with the most severe symptoms. While such a rationing system makes for excellent healthcare policy, it makes for poor statistical analysis, since it means that the data distribution we arrive at is skewed towards the particularly severe cases — those more likely than average to result in death. There could be, and likely are, many millions more people out there whom the virus has infected but who either exhibit no symptoms at all or symptoms so mild that they don’t bother seeing a doctor and hence don’t get picked up in the data. If indeed many of us have already contracted COVID-19, it could mean firstly that it’s too late for a lockdown to have any effect, and secondly that a lockdown might not be warranted because the fatality rate is in fact quite low.
What a good statistician would like is a random sampling of a very large group of coronavirus patients, which controls for age, sex, and other factors which may distort the results. For quite some time, the closest we had to that is figures from the Diamond Princess cruise ship, where, by chance, we have a closed population wherein everyone was tested, regardless of symptoms. Even this case is imperfect since at 700 infected passengers it is much too small a sample size and, moreover, there are compelling reasons for why cruise ship passengers might not be reflective of the general population. With those caveats in mind, when you extrapolate the Diamond Princess data onto the age distribution of the general population and account for uncertainty in both directions, you get a fatality rate of between 0.05% and 1%. In the last few days, we have received more comprehensive data from Iceland, a country which has led the way on both the scale of its testing and on its emphasis on “randomized screening” to avoid the self-selection bias. Their data points to a fatality rate of just 0.29%.
Two things to say about these numbers: firstly, even at the high end, they are lower than some of the initial estimates that helped fuel the doomsday scenario predictions online. Secondly, they cover a huge range. At the low-end the fatality rate may be comparable to the seasonal flu, and at the high end it could be a genuinely worrisome threat. We simply don’t know. Yet the uncertainty is never apparent listening to the pronouncements coming from government officials. Implied in the tone and severity of the heavy-handed measures being put into place is that the lethality of the virus is a foregone conclusion and that these extreme measures will work to contain it. There is little actual evidence to support either assumption. Note that skepticism about this data is applicable both to fears of outright death and to fears that we will ‘overwhelm’ the healthcare system. If many more of us already have the virus than the numbers are letting on, and we haven’t overwhelmed the healthcare system, that undermines the argument that we need to take drastic steps to prevent such a thing happening in the future.
The other point to be made about the COVID-19 figues is that even among those who certainly do die, it is not clear that we are not over-attributing the cause of death to Coronavirus alone. Deaths purportedly claimed by COVID-19 over the past month mostly comprise the very elderly (70+) and the immuno-compromised. What we can’t say, as the BBC’s Health Correspondent put it, is “is to what extent [those] deaths would have happened without coronavirus.” Most HIV patients, for example, don’t actually die of the HIV virus itself — what kills them are so-called “opportunistic infections” — diseases which may have been latent in their body even before they contracted HIV, and which a healthy person could have overcome, but which rapidly overwhelm their weakened immune system. Colloquially, we probably wouldn’t say that such an individual died “from influenza” or “from a fungal infection” — rather we would say they died from HIV. For some reason in the case of COVID-19, we’re eager to give full credit to the flu-like infection, even in cases where its virulence was only possible because the victim’s immune system was already vitiated by another chronic illness.
Take, for example, the UK’s youngest COVID-19 victim, Craig Ruston. He had been battling for years with Motor Neuron Disease, a quite severe condition, before contracting the Coronavirus. His chronic illness does not in any way make his passing any less tragic, but it does add important context and challenges the truth value of the claim that he “died from Coronavirus”. Alternatively, look at the data from a single day in New York. 932 people were classified as dying of Coronavirus, and yet, on closer inspection, we see that 748 of those already arrived with so-called “comorbidities”, serious underlying health conditions such as cancer and lung disease, which means that while it is true that they died with Coronavirus, it’s not obvious that they died of it.
Even worse, we may be classifying people as having died of COVID-19 when they didn’t even have the virus at all. CDC guidelines issued just last week conclude that “ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty.” In other words, not even every COVID-19 fatality has been confirmed positive for the disease.
Different approaches to identifying “cause of death” can yield dramatically different statistics. The contrast between Germany and Italy is an illustrative example because the two countries are otherwise relatively similar in terms of geography, demographics, and the capacity of their healthcare system. Germany reports a CFR (Case Fatality Rate) of 0.9% while Italy reports a whopping 9%. Why the difference? It turns out that “German hospitals do not routinely test for the presence of coronavirus in patients who are dying or who have died of other diseases. Italy, by contrast, is performing posthumous coronavirus tests on patients whose deaths might otherwise have been attributed to other causes (emphasis mine).” In other words, while the high death toll in Italy is horrifying, it’s quite possible that these are people who would have died this year anyway from some other malady. This is important because the hugely expensive and intrusive measures governments are now taking are premised and justified on the idea that they will save millions of lives of people who would not otherwise die but from the virus.
Every single day in this country almost 8,000 Americans do in fact die — being alive is a fatal disease — and so the hysterical news headlines of a “surge” in “COVID related” deaths to “400 a day” need to be placed into that context. Unless we are seeing a rise in excess deaths — that is, mortality significantly above and beyond what is normal for this time of year — then those raw numbers are not in themselves justification for the extreme measures being taken by the government. Perhaps that data does exist (though if it did it would be contrary to what this CDC tracker tool shows), but we ought to demand that it be presented before so tamely agreeing to a shutdown of our economy. The same is true of claims that these measures are needed to prevent an overwhelming of the hospital system. Again, the truth is that it is not out of the ordinary for hospital systems to get overwhelmed, especially during a particularly severe flu season. The 2017–18 flu season was unusually brutal, and the influx of patients put huge strain on public and private health services. Without enough beds, some patients had to be treated in hallways outside operating rooms or, when even those filled up, in makeshift tents set up outside the hospital. Of course this too was a tragedy, and no one would like to see more resources put into healthcare than I would, but we did not shut down our economy then, so what exactly is the justification for doing it now? To reiterate, we critics are not saying that the economy and our freedom of movement are sacred cows that can never be sacrificed — rather we want to know what are the reasons for their sacrifice and do we in fact have reliable data to back up those reasons. For now, at least, both are wanting.
Several US states have enacted ‘stay-at-home’ orders and required all ‘non-essential’ businesses to close. 1 in 5 Americans are in quarantine and this number is likely to rise as more governors follow the herd. The economic pain these measures will inflict is very real. We are driving the country towards a recession, if we are not in one already. Unemployment claims last week surged to 6.6 million, the largest week-on-week change since or during the 2008 financial crisis. Economists now predict a total of 47 million (!) job losses and an unemployment rate of 32%. Those are astonishing figures, which, if turn out to be even close to accurate, will make the 2008–09 recession, which in total caused a mere 9 million job losses, look like a picnic. As is the case in all economic catastrophes, the first and hardest hit are the most vulnerable in society — those already on low income and living paycheck to paycheck. It is easy to charge those warning of economic collapse as prioritizing wealth over people’s lives, but that is an unfair and narrow-minded interpretation. The ‘economy’ is not an abstract thing — rather it is the summed lived experience of individuals. It is people’s livelihoods, and therefore it is people’s lives too. An economic collapse does not just mean a dip in the stock market — it means crushed dreams, lost hope, and a general rupturing of social fabric. Poverty is strongly correlated with long-term poor health, especially for the very young. It’s not a question of lives versus money — it’s in fact lives versus lives.
The truth is that for the privileged intelligentsia (myself included) and those in positions of power, i.e. those with any real influence over policy, the recession will be something that happens to other people. We will read about it in the news and perhaps notice a dip in our investment portfolios but on the whole we will be mere spectators to the carnage. Not so for the average Joe, who could see his job disappear, his already meager savings dwindle to nothing, and his family broken apart (financial woes are the second-leading cause of divorce). Perhaps that is why we so readily reach for economic shutdown as a tool to stem another kind of catastrophe, which is more egalitarian in its distribution of suffering.
The other delusion being sold is that the recession we have brought upon ourselves will be temporary, and that within a year or two things will return to normal. While it is quite possible — given that neither core infrastructure nor credit systems have weathered damage — that consumption will bounce right back once the lockdown is lifted (the so-called V-shaped recovery), that might already be too late for many people. Small businesses do not sit on vast cash reserves that can tide them through several months of no revenue; the type of workers who lose their jobs in a recession like this often take years to find another one and many just give up altogether, no longer contributing to unemployment figures (which will only count those actively seeking work) but now wholly left out of society. A derisory $1200 check is not going to see them through this. Suicides, especially among men, spiked during the last economic crisis and haven’t really leveled off since. Is all of this worth it? Perhaps it still is, but I for one would like to be sure and it doesn’t sound like we are weighing the tradeoffs thoughtfully. What I instead see is mostly knee-jerk reactions from politicians who always want to be seen to be doing something even if that thing is not wise policy.
Besides the economic fallout, the other, much graver threat looming is that to our civil liberties. Keep in mind, it is always the case, even when a virus is not on the loose, that confining people to their homes will save many lives. The present lockdown has cut the traffic fatality rate in half. If we acquiesce to this lockdown in principle, there is no telling how long it might last or if it might get reimposed at a later date because of another COVID outbreak or perhaps because of some totally unrelated reason. The AUMF, remember, was supposed to be about going after the 9/11 terrorists — now, two decades later, it is being invoked to justify sending troops to occupy oil fields in Syria. Governments will never let a good crisis go to waste and we mustn’t allow one of the takeaways from this crisis be that politicians can choose to put us under house arrest whenever they (with the approval of some subset of unchallenged scientific experts) choose to. Preying on people’s fears, especially about an invisible, uncertain, global threat, is the surest way to get the population to give up their liberties. By not questioning the rationale for the lockdown in the first place, we risk giving governments a blank check to extend or reimpose it whenever they please, for as long as they please. We deserve to be told why it is being done, and what the explicit trade-off is.
We need to be wary of what comes next — it will always be in the name of promoting public safety. We are already seeing some more dystopian ideas enter public discourse. Proposals to track our whereabouts and contacts have been floated; A no less prominent person than Bill Gates has taken the opportunity to push a ‘digital certificate’ — that is, a chip implanted under your skin, to verify whether you have been vaccinated or not. Who knows if you will soon be asked to produce an immunity passport whenever you want to leave your house. Not all of these ideas will become reality, but some might, and more will if we give in to panic and swallow government fear-mongering. Liberty is rarely taken from a population in one fell swoop — instead it is chipped away at, bit by bit, over many years. Each deprivation in itself is a small cost to the individual, but summed across an entire population it can be a great loss. That is in contrast to a death, which concentrates its entire loss on one individual and her loved ones. Weighing the two kinds of costs against one another can be tricky and not something our paleo-evolved brains are going to naturally be good at. We should be skeptical of anyone offering a quick and obvious answer.
The radical path we are on is not the only one available to us. Japan and Sweden, both free, intelligent, law-governed countries, have decided to not to impose such a heavy handed lockdown and don’t look to be doing any worse off than we are in terms of Coronavirus mortality. It will be interesting to see after all this if they indeed end up with more excess deaths. If they don’t, do you think our politicians will then admit their mistake? I wouldn’t hold my breath. They will declare victory all the same and attribute to causation (the lockdown caused the virus to dissipate) what was merely correlation (the virus was going to dissipate anyway but now we have a wrecked economy to boot).
Any response to a public health challenge will have tradeoffs and I don’t pretend to have the answer. What I do advocate is that 1) we are frank about what we know and don’t know and that 2) we are explicit about the tradeoffs we are making. The tradeoffs must be made, so either we will make them explicitly as a society, or they will be made implicitly by a select few in power, whose internal (and often unconscious) biases and prejudices about who to help will not be challenged. In my anecdotal experience, the elderly in our society are, rather admirably in light of the fact that they are the ones most susceptible to dying from Coronavirus, the ones least giving in to panic and least willing to upend daily life. It would be interesting to poll that demographic and ask how many of them believe we should crash the economy and strangle civil liberties to (maybe) contain a virus that might kill some small percent of them. I suspect we might be surprised by the results. The tragic truth is that lots of people die every year, often from quite preventable causes. In the US, 435K people die annually from tobacco smoking, 111K die from poor diet, and 43K die from car accidents. One can easily imagine quite straightforward government measures to prevent these deaths — measures far less draconian from those we are now enacting to prevent a much less certain outcome. And perhaps we should be doing more and sacrificing more convenience to prevent those deaths. Let’s have the debate before lurching down a path we might regret.
