A few people now have expressed surprise verging on dismay about my questioning of the wisdom of trying to suppress Covid-19 as aggressively as we are attempting. I already wrote a post about modelling back in March, and you could probably tell from my last paragraph that I felt the danger of an over-reaction was under-appreciated. I still do feel that, so, perhaps as an exercise in intellectual and moral navel-gazing as much as anything, I will lay out some reasons here.
Back in 2010 when we were all wet behind the ears and worried mainly about things like austerity and whether George Osborne would cancel science, Jon Butterworth wrote a nice post explaining why we should have run the LHC even though there was a tiny risk that something bad and completely unexpected might have happened. The current situation reminds me of it, so I will shamelessly reverse the concept here. Apologies to Jon, but I remember it being a useful device:
Future path 1
July 2032: An influenza pandemic is declared. After an in-depth inquiry into the long-term effects of the lockdowns of 2020, most countries decide against implementing such measures again. Life expectancy for the year 2032/33 is 9 months shorter than it had been in 2031, and it is estimated that around 15 million people die from the pandemic over the course of 18 months. Despite this, progress on many fronts including research, health, inequality and international cooperation is barely interrupted, and within two years life expectancy is once again continuing its upward trend, exceeding what it had been in 2031. Then, some time later…
April 2049: A novel and contagious airborne filovirus is discovered circulating in West Africa by the global pandemic early warning system. The strong research infrastructure in the region means the virus is quickly isolated and studied in the local synchrotron facility to establish its protein structures. A deep understanding of the human immune system together with advanced protein simulations performed on quantum computers indicate that the new virus will have an infection fatality rate close to 35%. Fortunately those same simulations are immediately able to suggest several candidate drugs to treat the disease. Rapid drug trials based on systems biology and 3D bioprinting mean that treatments are available within 6 weeks, and the common global safety standards and manufacturing base, together with the worldwide free healthcare system, mean that they are available to every one of the planet’s 9 billion citizens. Despite this, 50 million people will die from the disease over the next five years before it is eventually eliminated by a well organised international vaccination program by the end of 2060.
Future path 2
July 2032: An influenza pandemic is declared. After the success of the lockdowns of 2020, policy makers know that the correct way to respond to a pandemic is to vigorously enforce social distancing, close schools and business and suspend all non-essential activities. The interventions are a success, and the pandemic is over within 18 months, having killed an estimated 12 million people. The economy took a short term dip, but it soon recovers, and things can’t be that bad because Amazon becomes the first $4 trillion company by the end of 2032. Unfortunately the world will suffer from a shortage of researchers, engineers and doctors for the next decade as education is disrupted, and research projects are held back or cancelled. Another problem is that although the economy as a whole recovers, regional inequality is exacerbated after only just recovering from the crisis of 2020. Some areas are further disconnected from global infrastructure, and this leads to a wave of protectionist politics and a retreat from international cooperation as nations blame each other for the fall out from the pandemic. Then, some time later…
June 2049: A large outbreak of a mysterious new disease is occurring in West Africa. Despite the fact that the local research facilities operate on a shoestring budget, doctors quickly estimate that the new disease has an infection fatality rate above 60%. Nobody writes articles arguing that things might be ok because the true value might only be one third of this. Quantum computers exist, but their main purpose is to drive online marketing for the tech firms that dominate the world economy. The world is fragmented and unequal, and cooperation is limited. The result is that nearly 1 billion people die from the new disease over the next two years, and a further 400 million die from starvation. The civil unrest that spans most of the next decade eventually leads to a war between the USA and China…
It’s important to say that what protects us from a possible future disaster is progress across a wide range of domains in ways that none of us are able to anticipate yet. I don’t know if quantum computers or synchrotrons or 3D printing really will be vital in the future, or if some other piece of technology or knowledge will supersede them. I do know that we won’t only need technological progress, but also progress in areas like education, systems of laws, politics and economics. And pandemics are far from the only risks we face; one of the other notable events of 2020 is that a long period comet appeared in the night sky at very short notice. Had the parameters of its orbit been slightly different, we would not now be worrying about Covid-19, and the only reason we even had a few months notice that comet NEOWISE was coming was that we’d collectively thought it interesting to build a space telescope whose original purpose was to map the Milky Way in infra-red. Even ignoring the worst scenarios like wars, comets and climate change, life expectancy grows by 1-3 months per year, and anything that delays that improvement will cost a great number of lives. Viruses are not the only things that grow exponentially.
I feel that the collective reaction to the pandemic is a moral one as much as anything: how can we do enough when so many are dying? Doing anything extra that might help must be better than not doing it, right? But we risk forgetting that we have been robustly fighting pandemics all our lives as part of the progressive society we build and maintain. We all pay it forward in a system where people get healthcare, important research is carried out, laws are reviewed and children are educated so they can do the same in the future. This time around we have been able to come up with treatments within months, and hopefully a vaccine within a year. Those who get sick are able to be treated, at least in places with universal healthcare. It is those structures that protect us from pandemics and worse – including the pandemics we never had – so we should treasure them and be extremely cautious about doing things that risk disrupting them <cough>brexit<\cough>. In our approach to Covid we have morally weighed peoples’ contributions to society against their status as consumers of risk, but are we sure we have valued those contributions highly enough?
I also have a strong personal experience that informs my view that our reaction is disproportionate and has caused too much harm. My mother died over the summer after a very long illness. We had known last December that there were no more treatment options and that this was likely to be our last year together. It was never going to be a good year, but my plan was to spend as much time in London as possible. Instead of that, Mum’s last months were spent even more isolated and fearful than they would anyway have been. Mum was somehow able to hold on long enough that I could travel to London, but you can imagine my view of the voices on social media who insisted that the lockdown should have continued. I will spare the details of the restrictions we faced even in our last hours, and the staff in the hospice were beyond great, but I don’t think some of the rules were very humane or helpful in preventing illness, and I do not have the sense that those who made the rules were concerned with our well being. This sensation transfers to the wider public health policy makers and advocates, I don’t feel that they are concerned with our best interests and welfare, they just have a single metric they want to hit. It is horribly similar to recent one dimensional political narratives on austerity, immigration and brexit; deliver the target at all costs, who cares what harm we cause on the way? It is all a bit Bến Tre.
Morality can tell us what our collective objectives are, but it cannot tell us how to achieve them. Unless you consider Covid itself to be a moral objective – and I do not – we are morally required to consider the overall effect of our choices. Perhaps my fears are misplaced and all this really will provide the best possible outcome. But given the limitless harm that is being risked to society, we should demand a very good answer to the question “how do you know?”