tl;dr: Lockdowns are not the only form of intervention available. They are among the broadest, most severe, and most visible, but they do not represent a balance of interests. They index on minimizing two specific, measurable, short-term outcomes (SARS-CoV-2 infections and deaths caused by Covid-19) while their potential harms are more difficult to measure, more diffuse, and unfold over a longer time span. Just last week, for example, the Lancet published a study showing that we risk 1.2 million additional maternal and under-5 child deaths in the next six months in low and middle income countries if their health systems are re-geared to focus primarily on saving the lives of Covid patients.
In anglophone public discourse today, it seems that only the political right is complaining about the lockdowns meant to flatten the curve of Covid-19 infections and deaths. The right does so primarily under the banner of freedom (…to engage in economic activity, not to wear a mask, to get a haircut, to only look after oneself with no duties to society more broadly). This has, I believe, made it difficult for other people to ask, conscientiously, whether lockdowns serve the common good. In The Righteous Mind, Jonathan Haidt looks at how moral foundations theory is applied to assessing whether a particular action is ethically or morally correct:
Haidt points out that those on the political right are more likely to privilege arguments based on authority, loyalty, and sanctity, while those on the left are more likely to rely on arguments where fairness and care are central. There’s plenty of overlap, of course, but he argues that the general division crosses many cultures. And he suggests that a sixth “moral taste bud”, liberty / oppression, is invoked in different ways across the political spectrum.
Before sharing some thoughts on why concerns about justice could reasonably lead one to question the wisdom of lockdowns, a few starting points that I treat as axiomatic:
- My reflections are not primarily or even secondarily about the economy. Much angst has been expressed about the economic and fiscal impacts of lockdowns, but I think talking about the economy per se is a red herring. The economy does not matter for its own sake. The economy matters because it is the main way we distribute goods to individuals in society. Human wellbeing is much more important than the economy itself.
- Acute respiratory distress syndrome caused by Covid-19 is a horrific way to die, and the virus that causes Covid-19 is highly communicable in standard social conditions.
- The risk of the starkest medical effects of Covid-19 increase rapidly with age, particularly over 60, and for those with other underlying health issues. Those lives matter, but our response should not privilege those lives over other lives — policymakers are more likely to have elderly relatives than low income school aged children, for example.
- I am not a virologist or economist or public health expert or epidemiologist. But I am an informed citizen who wants my fellow citizens (and the community as a whole) to thrive.
- A shared set of facts, and respect for expertise, is necessary but not sufficient to make good decisions about what to do in this situation. Any politician who claims simply to be “following the science” is shirking the burden they asked for — making informed decisions about how to govern a society where the collective interest must be placed ahead of self interest. This is the social contract that gives government legitimacy, after all!
- I think it’s disingenuous to pretend that every preventable death can or should be prevented at any cost. If that were true, we would cap automobile speeds at 15mph (or 25km/h) globally. Doing so would save the grand majority of the 1.2m annual automobile deaths around the world, along with most of the 20–50m serious injuries they cause. We don’t do that because we have decided that preventing those easily measured harms would come at too great a cost to the broader society. Public policy — the social contract itself — is about balancing those trade-offs.
- I believe that political disagreement is a good thing: it’s how we discover competing interests, and there’s no reason it can’t be done while acknowledging the good faith of the person with whom one disagrees. I think it’s generally useful when engaging in political discussions to ask ourselves “what facts could I learn that would change my opinion?” If there’s nothing on your list, you’re not actually having a discussion…and that there should be social rewards for people changing their mind in response to new facts. I don’t have all the answers. I’m not certain I’m right. I am writing this both to collect my own thoughts and as a prompt for discussion. In the process of reading widely, I’ve learned some things that have changed my opinion, and I sincerely hope that will continue happening. This is probably especially important in a period where there’s still a lot we don’t know about the disease (or, for that matter, about macroeconomics full stop), and keeping an open mind is useful.
Now, on to my reflections:
The orthodox policy response to this pandemic — society-wide lockdowns — is aimed primarily at delaying and/or reducing deaths caused directly by complications of the SARS-CoV-2 virus. As policy responses go, it has the benefit of being extremely clear: you should stay home and interact only with people in your own household apart from a short list of exemptions. Yes, it leaves some edge cases and ambiguities and room for differences of interpretation — is yoga in the park okay, or just running? — but those are exceptions to what is essentially clear guidance. And the general consensus, currently, is that lockdowns _have_ succeeded in flattening the curve. Healthcare systems in some places (like New York City and northern Italy) have come close to the breaking point, but, again, those are exceptions. With new cases and deaths currently dropping in most of the global north, tentative steps are being taken to ease these restrictions, though with politicians consistently warning us that if cases start to climb again, we face the reimposition of lockdown.
The question I want to pose is this: is that threat (and, in the absence of a vaccine, that likely eventuality) a just one? Put another way: is it fair at a societal level, or does it just feel safe?
As an immediate reaction to an unknown threat, I personally believe lockdowns were a rational and even justified response. We needed time to understand the epidemiology of the virus, and to forestall the broader harms that would come from a collapse of the healthcare system. We know more now, though, than we did in February or March. We know more about the disease itself, but we also know more about the effects of the lockdown as a particular form of intervention — on individuals and on society. Many of them are more difficult to measure than daily case rates or fatalities, and they will unfold over years or decades, but they still deserve consideration if we are interested in adopting just and sustainable policies that minimize the harms caused both directly and indirectly by the novel coronavirus. So let me try to sketch out what they seem to be, including data where I’ve been able to find it. I’m focusing here on domestic impacts, since that’s where policies are crafted and implemented. That is not to say that there aren’t stark global effects of focusing primarily on reducing covid mortality, e.g. the Lancet study linked in the tl;dr above.
There is increasing evidence that children are particularly at risk as a result of lockdowns, in ways that could have lifelong consequences. Lockdowns appear to be driving an increase in child sexual abuse, in person and online. In the first two weeks of US lockdowns, the US National Sexual Assault Hotline reported a 22% increase in calls. And Australia’s e-Safety Commissioner disclosed last week that abusers have developed a grooming manual that takes particular advantage of lockdown conditions to facilitate online sexual abuse of children.
More broadly, school shutdowns have a huge impact on children’s future prospects. Unesco estimates that 1.5 billion children were affected by school closures. That creates challenges for all students, but the risks are particularly stark for those from underprivileged families. Extended (or repeated) school closures will significantly hamper the lifelong opportunities available to poorer children. The causes are manifold:
- Better resourced school districts (and independent schools) seem to have been able to shift to distance learning more quickly than their poorer counterparts, giving their students an instant advantage. A month into the lockdown in the UK, The Sutton Trust reported that only a third of children had taken part in online lessons — there’s a link to the full report below.. The gap has narrowed somewhat since, but it has by no means closed.
- With less access to the technology necessary for effective remote learning (broadband internet and a dedicated device), poorer children will fall behind their better-resourced peers. A sobering report from the Northwest Evaluation Association based on their experience with summer learning programmes suggests that during this shutdown period alone children who lack steady instruction face a 30% drop in reading gains and a 50% drop in math gains compared to a normal school year. Some catching up is possible, of course, but if disruptions happen again in the next school year, the chances of closing the gap fall precipitously. This Sutton Trust report details the various ways social mobility will be harmed by school closures.
- Schools don’t only train children’s minds; they also help children develop and practice healthy social skills. I haven’t seen any quantitative research on this, though I’m sure future generations will be able to treat this as a natural experiment in the impact of schooling on longer-term anti-social behavior rates.
- For disadvantaged children in many rich countries, free school meals offer a necessary supplement to what they receive at home. Those children will have an even harder time catching up, even if schools aren’t disrupted by future lockdowns.
If severe Covid-fighting interventions (like lockdowns) caused job losses to be randomly scattered through society, their justness might not need to be considered. But the job losses aren’t random, or aren’t random yet. Jobs higher up the income spectrum are more readily performed remotely, and the industries hit most severely by lockdowns — hospitality, entertainment, travel, and tourism — offer incomes below the median in most countries. A recession or depression will doubtless be felt throughout the economy, but the immediate impact of the lockdown was most felt by those most at risk. Last week Jerome Powell, chair of the US Federal Reserve, reported that “Among people who were working in February, almost 40 percent of those in households making less than $40,000 a year had lost a job in March alone. This reversal of economic fortune has caused a level of pain that is hard to capture in words, as lives are upended amid great uncertainty about the future.” [emphasis added].
Job losses brought on by the lockdown will affect the welfare of children in addition to adults. This summary of research on the social impacts of job losses during a recession is depressing but worth reading. Recession-based job losses decrease “health and mortality outcomes, children’s [cognitive development and] educational achievement, and subjective well-being”…and not just during the recession itself: job losses that immediately followed the 2008 financial crisis were still causing the same level of harm in August 2011. There is evidence that these impacts can even span generations. This study found that sons whose fathers lost their jobs (when the sons were ages 11 to 14) have earnings as adults that are reduced by approximately 9 percent.
Lockdowns, likewise, make other vulnerable groups significantly more vulnerable, in ways that are likely to cast long shadows over survivors’ lives for years to come. Last week the UN warned of a growing mental health crisis as a result of the pandemic. To be sure, some of that is related to widespread anxiety about health risks (though even that, I would argue, is exacerbated by lockdowns and other disproportionate, society-wide public health interventions). The bulk of the mental health risk, though, is a result of isolation and economic uncertainty. I haven’t yet seen numbers on suicide rates, but we should watch those closely. “Social isolation, reduced physical activity and reduced intellectual stimulation,” it notes, “increase the risk of cognitive decline and dementia in older adults.” When lockdowns first started, I saw several memes along the lines of “Don’t complain: your grandparents were called to war. You’re only being asked to sit on your sofa.” But that ignores the fact that humans are social animals (even me, and I’ve loved not needing to find excuses for why I want to hang out at home alone every night). There’s a reason we isolate people from society punitively. We’ve all been experiencing that, and the pain it causes individuals is real and deserves recognition.
There is also evidence that lockdowns have increased domestic violence. A few weeks into the UK lockdown, domestic abuse killings had more than doubled, a rate of increase that seems consistent with US reports. Depression, anxiety, suicide, and domestic abuse cause misery and death for many, and trauma for those who survive.
So, what are our alternatives?
These are some of the many hidden, long-term, broadly-felt costs of lockdowns as a response to the threat of Covid-19. Even if we were confident the threat would subside by Q1 2021, I think we would need to have a much broader societal discussion about those costs before using lockdowns whenever there’s a threat of a new wave of infections. But we aren’t confident that this will be over by early (or even late) 2021. There are two broad routes to emerging from the shadow of this pandemic: either we decrease the number of people susceptible to infection (either through vaccination or recovery) OR we discover antiviral treatments that are both effective and affordable enough to improve the prognosis for the ~5% of those infected who develop severe problems. There are some reasons to hope for rapid progress toward a vaccine, but as with all vaccines: until something works, nothing works. Likewise, there are some treatments that are promising, but nothing that gets us close to considering severe Covid cases manageable.
In that context we need to shift from crisis-response interventions (which assume we only need to get through the next 10 weeks) to sustainable interventions (assuming we need to get through the next 2–5 years). Repeated lockdowns are not sustainable for 2–5 years, so we need to start finding better solutions now.
This Atlantic piece on harm reduction is good food for thought. It is my personal opinion (and far from a factual claim) that when public policy conflicts with human nature, human nature always wins. Outlawing homosexuality doesn’t stop gay sex: it just increases the trauma experienced by gay people and their families and friends. And telling gays to stop having sex during the AIDS crisis wasn’t ever going to work, so we had to create the idea and praxis of safe sex for ourselves. Likewise, telling grandparents they can’t hug their grandchildren under any circumstances only increases the misery in the world, without making a meaningful difference to the overall number of lives that Covid will claim on a 5-year time horizon. Yes, I just used sodomy and grandma hugs as two sides of the same coin. Because they are.
What is the safe sex equivalent for Covid? First, it will require accepting some deaths from Covid-19 (see my capping car speeds at 15mph example above). Those should be kept as low as possible without causing the other societal harms outlined here…and I’m sure there are many I have missed. Second, we need to have an open discussion about the relative riskiness of different activities, along with situation-specific mitigation. No man wanders around wearing a condom all the time, for example, and while best practice might be to perform oral sex with a condom or a dental dam, I have never in my whole life met someone who has tried that more than once.
I don’t have data on those risk levels, but we need them. And the key will be to stop pretending the goal is to drive risk to zero. Perhaps dining at a restaurant indoors with 6 feet between tables decreases transmission rates by 30%, with dividers between indoor tables pushes it down by 40%, and dining outdoors reduces risk by 60%. Then we need to decide what level of risk we are willing to tolerate without driving restaurants out of business for five years. Likewise, maybe wearing masks in dense indoor areas like a concert or an airplane is shown to reduce transmission rates in a meaningful way, while wearing them outdoors has only a marginal impact. Perhaps test trace and isolate is effective at limiting transmissions in certain phases, whereas in others it will be sufficient for everyone to take their temperature each morning before leaving the house, and isolating the entire household for two days whenever one person has a fever, until the whole household can be tested. Collectively, we can find a set of measures that allow us to keep people in school and work while leaving our health systems capable of treating the severe Covid cases.
Overall, we don’t need public health theater: we need both an informed citizenry and leaders who encourage individuals to make responsible decisions for themselves, with social reinforcement aiding with norm-setting.
I want to end on an optimistic note. I think there are many good things that can come out of this moment of collective global crisis. Some of them are small. Things like knowing our neighbors, and looking after them. I’ve noticed an interesting side effect of maintaining 2m (or 6ft) distance. People seem, instinctually, to feel that it’s rude to veer into the street to avoid coming too close to someone walking the other way on the pavement. And to smooth over that feeling of rudeness, more and more people seem to be saying “good morning” (or its equivalent) to one another. Likewise many people have, for the first time, thought to check that an elderly or infirm neighbor isn’t feeling overly isolated. Life would be more pleasant if these small habits of community were to continue.
There are bigger things, too, though they’re beyond the scope of my current musings. The most important, to my mind, is thinking in a more sustained and coherent way about how the economy can serve the common good.
That tweet is flippant and elides important nuances, but the point it makes is a fair one. For the past four decades, domestic income and wealth inequality has been growing to truly startling levels. The global economy roughly tripled in size between 1980 and the start 2020, while the population grew by roughly 75%. A big chunk of that growth has lifted billions of people in the global south out of abject poverty. In developed economies, though, almost all the growth has been taken by the top of the socioeconomic ladder. Two generations into the neoliberal experiment, the idea that it will trickle down should be shelved. For those not at the top of the pile, there have been stagnant incomes, increased precariousness, decreased opportunities for social mobility, and (in many places) shorter life expectancies.
The rising tide has NOT lifted all boats, and in the current storm, some boats are clearly at greater risk of going under than others. The left has, for far too long, failed to offer something better than post-war welfare statism: less racist, less sexist, less extractive, less exploitative, more just, more sustainable. Doctors and nurses have rightly earned universal praise for their brave work on the front lines of the pandemic, but the majority of people whose occupations have put them at risk are far lower on the economic scale: grocery clerks, police and other first responders, bus drivers, postal workers, gig economy drivers. When we turn our efforts to recovery and reform, I hope we can search for policy solutions (be they institutional or redistributive) that show a preferential option for the poor, so that in the next forty years prosperity is more evenly shared across society.
