Against Coronavirus Nihilism

The coronavirus nihilist is someone who emphasizes the prevention of coronavirus-related deaths over and above of all other social costs, cultural costs, economic costs, and health costs of the #StayHomeSaveLives strategy. Examples of coronavirus nihilism are everywhere. Coronavirus nihilists are politicians, Medium censors, cable news personalities, white collar Zoomers, Instacarters, public health experts, and anyone who is by default indignant and angry when confronted with the idea that broad-based lockdowns might be ill-advised. Generally speaking, the life of and livelihood of a typical coronavirus nihilist is not as at risk as the lives and livelihoods of the working class and very poor.

Coronavirus nihilism rears its ugly head when Gov. Cuomo says that the New York lockdown would be worth it if “just one life” were saved. This is stupid. It is on display when Dr. Fauci says we can “relax social distancing” once there are “no new cases, no deaths.” This is also stupid. Surely Gov. Cuomo and Dr. Fauci meant to be political. But it doesn’t make these statements less stupid. They are dangerous and dumb expectations to set when bracing the nation for a months-long battle that will kill many thousands and, more likely than not, never go away.

Deep down, there probably aren’t too many coronavirus nihilists; instead, you will find victims of pride, fear, naiveté, and cowardice … just like all of us. It’s hard to think for yourself when we have a serious and deadly pandemic on our hands. This is moreover the case when scenes of death and destruction are splayed across our screens. Nuance generally is not the modus operandi of journalism, nor even of subject matter experts: to a carpenter, everything looks like nail. It is hard for us to think in matters of degree in the best of times, and these are hardly the best of times. As always, we cling to stylized narratives that make sense to us and confirm our own sense of identity. The #StayHomeSaveLives or #FlattenTheCurve hashtags are not so much long-term strategies as they are stories to make ourselves feel better. Are you surprised that most would not bother to inspect the legitimacy of the science behind the hashtags?

The coronavirus nihilist gets the airtime, and is happy to pronounce that we will prevent 50,000, or 500,000, excess fatalities with a lockdown. But when faced with dire statistics of 25 million unemployed, or when shown that simpler assumptions than those found in epidemiological models imply that millions of women and children now live in a forced domestic hell, or almost certainly that millions of lonely souls are surrendering to drugs and alcohol … the coronavirus nihilist gets uncomfortable. While the COVID-19 deaths are in our face, the lockdown hides its miserable tally.

Coronavirus nihilists do not like to think about relative risks; theirs is a world of absolutes, “no new cases.” Before coronavirus, we biked to work in busy traffic everyday. It’s a healthy habit, but risky. Before coronavirus, only 50% of us got a flu shot each year. Sure, making the vaccine mandatory would have prevented illness and death, but hey, it’s a free country. But come coronavirus, our perception of risk suddenly shifted. Come coronavirus, if you sunbathe on a public beach, you’re a psychopath.

How did we get here? Starting over one month ago, a coronavirus consensus formed, characterized by the #FlattenTheCurve and #StayHomeSaveLives stories. It goes something like this: because this new virus was unusually dangerous, it would overwhelm the hospital system if left to spread unchecked. So the only prudent thing to do is to enact a broad-based shutdown of person-to-person contact. This would save lives in two ways, we were told. Mostly, it was clearly conveyed at the time, “flattening the curve” of the virus’ spread would allow everyone to have access to timely medical care, infected or not. Staying home would also slow the spread of the disease until we could procure better treatment, tests, protective equipment, and, in time, a vaccine.

Now, in the middle of April, hospitals are as empty as ever, are furloughing workers, and are worried about their finances. If the primary justification for #FlatteningTheCurve was to prevent overwhelmed hospitals, then by and large we have succeeded. We can move on to Phase II. For Phase II, common sense demands better explanations than the hospital overload argument for continued lockdown. If we are trying to balance “Life, Liberty and the pursuit of Happiness,” the latter two categories are getting short shrift. Let’s not forget that the default status for America is personal liberty, and that the burden of proof is on politicians to force citizens into something else.

To be fair, better explanations can be found, such as that further sequestering might give us more time to develop better treatments, tests, protective equipment and, potentially, a vaccine. But there are still some problems with these “postponement” justifications. Better treatment options may be discovered, but they are likely to be marginal improvements. There are no magic bullets like antibiotics for viral infections like COVID-19. Another problem with the “postponement” justification is that no one knows when, or even if, we will be able to develop a vaccine. Never bet against human ingenuity and the mother of invention, but the fact is we still do not have a vaccine for even deadlier viruses.

We can’t bury this virus anymore; it is a deadly genie out of its bottle. Perhaps this would have been feasible if we had started our response months earlier, if the United States were one hundred times smaller, and if Americans didn’t like to travel or mingle so much in the normal course of things. But we have over half a million confirmed cases already–and likely many millions more that are undetected. It seems probable that nature will run its course and that we will all be exposed to the virus sooner or later. Maybe we will get lucky and the disease will exhibit seasonality, making for a happier summer. Maybe will will discover a vaccine in 2020. We don’t know.

But we do know some things that make our sitation look more manageable. The evidence is clear, for example, that COVID-19 is not a mortal threat for the young and healthy. We know also that assessments of its all-age lethality have trended downwards. As many as 10-85 times more people have COVID-19 than have been confirmed by testing, meaning that it is not as deadly as we first thought. Initial estimates of COVID-19 killing 2 or 3 out of every 100 persons it infects were grossly overstated. Best-guess infection fatality rates are now in the range of 1 to 5 persons out of every 1,000 it infects. That is still up to five times worse than the seasonal flu. This isn’t good, but it is about an order of magnitude better than we had thought just a month ago when we used the uncertainty around mortality as a “better-safe-than-sorry” justification to enact severe restrictions on public movement.

Across countries, statistics are consistent in showing that the virus primarily preys upon the frail and elderly. One of the top epidemiologis in the UK, Neil Ferguson, estimates that up to two out of three COVID-19 related fatalities may have died this year even if they hadn’t contracted the virus. In Massachusetts, the average age at death is 80. In Italy, 84 out of every 100 coronavirus-related deaths are over 70 years of age, and 99 out of every 100 had complicating preexisting conditions like diabetes or respiratory issues. In Europe, as many as a third or more of fatalities are in nursing homes, where life expectancy is around one year after admission.

Pointing out that most COVID-19-related deaths are already on death’s door is, to say the least, proceeding on unsteady ethical ground. But the proposition that we should balance medical intervention with common sense about how many years of life we are actually saving is not a controversial opinion. It is a hallmark of medical ethics. Deep down, when pushed hard on the matter, even the coronavirus nihilist would agree that we would think twice about performing a long and dangerous operation on a ninety year-old, but we would do it without hesitation on a nine year-old. These are widely shared ethics.

We should likewise apply this principle to gauge the appropriateness of a long and dangerous medical operation on society writ large, such as the one we are engaged in now. All life is precious, full stop. And so we should utilize the best treatments that we can to prolong precious life, and prepare our medical system accordingly. But we should treat all human life with the dignity it deserves, including and up to the recognition that in some cases we cannot prevent death, nor should we try at any cost to do so. And the costs of this long and dangerous procedure are enormous. When we remove church, school, courts, culture, and the workplace, we don’t just temporarily tamp down markets. Rather, we remove essential organs of the body of society. If the body of society is ill, so are its people, and I fear that countless millions are ill.

This balance is a moral conundrum, and not helping matters is the false dichotomy of the coronavirus nihilists, of “lives saved” vs. “the economy.” First, none of us can “save lives.” We can save years of life, but we must quantify the amount of life we save, alongside its quality. The other side of the issue, “the economy” needs to be expanded, to say the least. As Dr. Joseph A. Lapido puts it, it seems like “the economy” encompasses “everything else that matters: livelihoods that allow people to feed and shelter their families; civil liberties; the education of children; social well-being, including the prevention of loneliness, isolation and domestic violence; and all other other medical conditions, from cancer and heart disease to dental emergencies.”

The economic costs of the lockdown mask the human tragedy behind each number: lost dreams, lost initiatives, lost business, lost health, lost relationships, and lost culture. People, disproportionately the working classes of course, worry about how they are going to get by. Health costs of lockdown are less apparent, but nonetheless real. Medical patients will cancel scheduled check-ups. Some will be so paralyzed by fear that they will stop filling their prescriptions. Stress and anxiety caused by new work and childcare arrangements will rise. An increase in depression, loneliness, alcoholism, drug abuse, and domestic abuse are almost certain byproducts of forced home arrest. Quite frankly and quite simply, we must recognize that millions are now in a living hell because of these strict policies. But because of coronavirus nihilism, only one side’s speculations are given weight in this monumental debate. Why isn’t there a domestic abuse researcher in the White House Press Room, right alongside the epidemiologist, presenting her projections?

The magnitude of these costs are huge, simply because America is huge. Plus, many of costs of lockdown have already been borne out in reality, and aren’t just graph lines on a model projecting into the future. While the costs of the virus have gotten amazing PR from a frenzied media, the costs of lockdown are relatively hidden and not discussed. As of today, for every one COVID-19 related death (around 33 thousand), there are around 750 freshly unemployed (25 million), and 10,000 locked in their homes (330 million Americans). Is all of this cost of lockdown truly, when you really, really think about, the lesser misery when compared with the COVID-19 deaths and misery? But moreover, can, like a divine judge with a divine balance, we expect our democratically elected leaders to answer this unanswerable question for us all?

The alternative is to leave it, chiefly, up to free adults to decide for themselves what risk they want to take. Americans have already drastically changed their behavior, and I would expect this to continue regardless of what the governors say. Witness Sweden, which has not mandated broad-based lockdowns, but instead has relied on social cooperation and enacted common-sense measures like sequestering the at-risk and banning large gatherings. Sweden reports more COVID-19 related fatalities than their Scandinavian neighbors, but Sweden has not faced the fate of death and destruction many predicted for them one month ago. Admittedly, Sweden is a more trusting society than America. But Sweden, that paragon of Scandinavian feel-goodedness, is seemingly willingly trade a short-term increase in fatalities, tragic as it is, to prevent more fatalities in the future and prevent drastic economic and social upheaval. Sweden’s economy has still taken a hit of course, but its unemployment rate is around half of Norway’s. A lot of misery saved there.

Somewhere in between Sweden and us, there is a better compromise. I’m bothered that so few of us want to seriously engage with the complexities of the balancing act, properly calibrated. Most choose to parrot the coronavirus consensus, when I question whether we are actually doing more good than harm. And most Americans have been wiling to sacrifice their personal liberty on inconclusive evidence.

But the brutal reality is, even if we were to have this debate, we wouldn’t reach a decent compromise. While I may not think that society should be locked down right now, especially not for the young and healthy, given the murkiness of the facts multiplied by the murkiness of the ethics, others may reasonably disagree. And when you combine this with the attention-grabbing tendencies of a hysteric press corps and the cover-your-ass syndrome of politicians, I don’t see how we are going to debate our way out of this moral conundrum.

We need a path forward that will accommodate both sides of the debate, so that we don’t just shout over each other about who is more evil. This path hopefully involves a vaccine sooner than later. Hundreds of billions of dollars of capital should be poured into its research. Likewise whatever it takes should be spent to increase personal hygiene and personal protection. But even greater sums should be spent on testing, testing, testing. Even if it is imperfect, widespread testing will give people peace of mind when they know they do not have the disease or have already developed immunity to it. And it will let those who have the disease self-isolate until they have developed immunity. In some ways, it is the most ethical way forward. Otherwise, we are asking citizens to emerge from lockdown into a brave new world, where the ethics of business-opening, dating, high-fiving, grandma-visiting, concert-going, and face-to-face conversing all provoke deep uncertainty and angst. Ethical problems are practical problems, and widespread testing is the way to adjudicate the ethical dilemmas we will face going forward.

There is a lot we don’t know. If ICUs are ever overloaded or the true infection fatality rate ends up being closer to 1% instead of 0.1% as I would estimate, then more stringent measures will be justified. If it turns out that the virus exhibits strong seasonality, then a springtime shutdown of human-to-human contact until the weather warms will look smarter. If we see deadly regional flare-ups like in Italy and New York, shutdowns may be able to control the spread. Every region will be different, and matters of degree will be necessary everywhere. A decentralized approach to handling re-opening the economy is smart.

One way that COVID-19 patients die is by something called a cytokine storm. Essentially what happens is that the patient’s immune system, mysteriously and for complex reasons, goes into overdrive. Inflammation of the lungs prevents the patient from getting air, and the patient suffocates to death. I see the current mass hysteria, and proselytizing of the coronavirus nihilists, as society’s version of the cytokine storm. The proper feedback loops that should moderate our response to the crisis have been removed by self-righteous politicians and single-minded experts. Going forward, I’m not sure how we can fix these feedback loops, but I know that free societies like America’s will fare better than our socialist Chinese brethren. We need contrarian opinions, multidisciplinary thinkers, amateur scientists, debate, and pushback. Even if it will pose a countless ethical dilemmas, we need our citizens, ultimately, to band together and to take personal responsibility for their well-being. We need responsible adults to adjudicate risk for themselves, their loved ones, and their communities, instead of relying on the coronavirus nihilists to do it for them.