What would a precautionary approach to the coronavirus look like?:

A briefing

[By Dr. Rupert Read, UEA, scholar of the Precautionary Principle, UEA; 7 March 2020.]

Executive summary

• There has never been a major global pandemic in our age of globalised hyper-mobility. This unprecedentedness of our situation is a powerful reason for powerfully employing the Precautionary Principle to reduce our collective exposure to this coronavirus: an exposure which is grave.
• Applying a precautionary approach to COVID-19, so as to stay ahead of the virus, requires much stronger protective measures than have thus far been used, most importantly:
• Pre-emptively reducing physical hyper-connectivity, by way of arresting most air travel (and cruise travel, and some long-distance rail and road travel), and encouraging not just individuals but also geographic communities to self-protect and where necessary self-isolate, pre-emptively and not only reactively.
• There is much chatter in the media about whether we are ‘over-reacting’ to the coronavirus outbreak. This briefing document proposes that in fact we are still under-reacting.

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Are the historical precedents helpful when thinking about COVID-19?

Answer: Not very. It is highly-likely that these precedents are, rather, tending to give us false reassurance. COVID-19 may well become a pandemic inducing human deaths in unprecedented numbers — even our Government’s own figures already confirm this. The point is that there has not been a pandemic of this order in living memory. And since the last comparable pandemics — such as Spanish flu after World War One — the world has changed radically… The world has become radically more physically connected over the last century. This is a key reason why we should be preparing for the possibility, which seems to be potentially unfolding, that COVID-19 will spread with a speed (and then deadliness) for which we have no precedents.

The only way in which we could start to co-create a situation in which the historically-based estimates for infection-rates and -speeds become useful is if we recreate a much less physically inter-connected world, and rapidly. That is a key precautionary recommendation: an emergency reduction in hyper-mobility.

The question that therefore needs asking is: Why we are we allowing the continuation of that hyper-mobility, that exposes us and those we love to dire risk? The exposure to severe potential risk that we now face means that the burden of proof should switch: the burden of proof should now be on those who wish to justify the continuation of globalised hyper-mobility; the default expectation instead should be that, to protect ourselves (to protect humanity) from a potentially very-harmful series of events, we’ll stop that risk factor: i.e. we’ll curtail hyper-mobility.

In technical terms: pandemics, which in any case are ‘fat-tailed’, are liable to become fatter-tailed as physical inter-connectivity / hyper-mobility increases — which it has drastically, since all the relevant partial-precedent pandemics.

To protect our most vulnerable from COVID-19, especially our elders (see below), it is clear that we should temporarily reduce physical connectivity. If our minds are set on protection, that is what we will do, how we will care.

Why is COVID-19 an obvious case for the application of precautionary reasoning?

Answer: 1) For the reason already given: a pandemic in a hyper-physically-connected world is a new phenomenon. Therefore we cannot know in advance how it will operate, and how big it may become, and how fast. A purely evidence-based approach is therefore inadequate. Instead, we have to err on the side of safety.

2) Additionally, however, we can add in the main emerging facts about COVID-19, all of which fatten the potential tail still further: a serious worry is that some cases of ‘cured’ persons see a recurrence of the illness; more seriously, there is the worry that the illness appears far more contagious than flu; more seriously still, that the death rates from the illness appear far higher than those of flu; and, most seriously of all, that there appears to be a long ‘latency’ period in the virus while the host is already contagious. I.e. It appears that it is possible to have the virus for perhaps up to 14 days, perhaps significantly longer, without symptoms but while potentially transmitting it to others. This last point makes it obvious that (i) the numbers in reality infected with the coronavirus, in areas where it has penetrated, are always bound to be much higher than the number who have tested positive for it and that (ii) conventional containment strategies based upon isolating those who are known to be ill with the virus and those who have come into contact with them are virtually bound to fail.

Putting the above points together makes it clear that the only way that the virus could possibly be contained is by moving well ahead of the leading known edge of the virus. We have to stay ahead of COVID-19; for, an evidence-based approach only to containment and delay — i.e. an approach depending on identifying cases, identifying super-spreaders, identifying those who they have had contact with, etc. — is bound to be inadequate. A precautionary approach would look to close down potential routes of COVID-19 penetration into new places before such penetration en masse had been achieved. The question therefore is redoubled: Why have we not already been stopping air flights from areas with infection? (And why are we still sending flights from here into areas as yet uninfected? Including internally within a country like the UK: we ought to be seeking to ensure that those areas with minimal penetration by the virus thus far (e.g. Wales) stay that way.) If we were serious about containing and delaying the virus, this is the kind of thing we would do.

But if COVID-19 is already in a country, as it is in the UK, isn’t it too late?

Answer: no. Because warmer weather / summer, which may slow down the virus, is not that far off; and because any delay is helpful, in enabling us to get proactive and protective systems in place, including the hunt for a vaccine.

Furthermore, it is crucial to reiterate that the national boundary is not the only relevant boundary above the household level. Once COVID-19 has penetrated a nation, then we should look to minimise the number of communities within that nation that it breaks into. The more the virus gets established in a country, the more granular we need to get in protecting those communities, those areas, not so far penetrated by it.

Communities should where necessary self-isolate, just as (infected, and some vulnerable) individuals are already doing. It is not enough for individuals/families to be seeking to protect themselves. Because if others within the community are not doing the same, then the threat will come closer and closer to those who are self-protecting, and many will not be able to remain effectively safe unless they go into complete seclusion (which is often impossible or undesirable for other/obvious reasons unless absolutely unavoidable.). The point here is similar to the well-known point about ‘herd immunity’ being maintained (e.g. by nearly everyone being vaccinated); it only takes a relatively small percentage of defectors, to undermine that herd-immunity and introduce a disease to a community. Communities need to self-protect at community level, to guard against such ‘defection’.

Geographic communities should therefore where necessary be enabled and wiling to self-protect against infection-risks. It goes without saying that this needs to be done in a sensitive, entirely non-violent, non-prejudiced way. But it needs to be done. The longer we keep on allowing untrammelled long-distance travel, the more rapidly we expose ourselves (and especially, our elders) to this high-risk gamble. It is only because we have become so used in a globalised world to letting anyone (who can pay) travel as far as they want whenever they want that the point I have just made seems strange to us. But in this new emergency, such hyper-mobility no longer makes sense.

What are the stakes?

Answer: Taking the case of Britain: the Government has officially estimated up to 500000 deaths in this country. But remember: this is a ‘fat-tailed’ process. The Government itself has estimated that 80% might become infected, and estimates of up to 60% are highly credible. Death rates might be as high as 4%; it is not possible for the Government to know that they will be no higher than 1%. That means that a worst-case scenario sees 2 million dying in this country. That number is very unlikely to be reached, thankfully; but it cannot be dismissed entirely; and, if we are unlucky and ineffective, a million deaths is plausible, if we do not take sufficient preventative action. Moreover there is massive skewing in the data on age-related vulnerability. The oldest may be dying at rates of c.20%. This means that a worst-case COVID-19 outbreak will without doubt kill a parent or grandparent of many readers (or indeed: some older readers). Let’s not beat about the bush: if we do not act with sufficient precautionary care and speed here, we are putting our own parents and grandparents at direct risk of death. If both your parents and all four of your grandparents are still alive today, there may only about a 50/50 chance that that will still be so, after this pandemic has taken its full course.

Finally, we ought to consider a point neglected in nearly all presentations of this coronavirus thus far: that in places that end up being particularly hard-hit by coronavirus, some kind of partial societal collapse cannot be ruled out. This might conceivably occur in Iran, for instance, which is suffering particularly bad fatality-rates ; it is more likely if COVID-19 hits countries hard that are already severely weakened (perhaps Yemen, Syria, Bangladesh, various African countries). Such a process would obviously be ‘fat-tailed’. In other words: it is likely that deaths from COVID-19 will number in the tens of millions; it is entirely conceivable that they will number in the hundreds of millions — and, if one adds in indirect deaths consequential upon COVID-19, from possible breakdowns in societal organisation etc. (e.g. breakdown in stretched sewerage systems, water systems, food systems, power systems), then a death-toll in the hundreds of millions becomes more clearly conceivable/feasible — and definitely needing to be maximally guarded against and prepared against.

Is the window for serious precautionary action still open?

Answer: Yes; but it closes a little more each day that our action is insufficient. We ought ideally to have undertaken the kinds of measures I indicate below some time ago:

What kinds of measures would we take if we were serious about protection and precaution against COVID-19?

Answer: There are many such measures that are being or should be undertaken. But among those which are not yet generally being implemented are precautionary measures to stay ahead of the virus that would include the following, and should be considered or rolled out asap:

>The shutting down of all but emergency transport of people from countries which have infections, and partial shutdowns within such countries. In particular, the pre-emptive shutting down of most air travel (and of most cruises). For it is mass air travel which, obviously, is the newest ingredient in a pandemic. Why wouldn’t we carry out this shutdown, to reduce the spread or at least the rate of spread of a disease which will without doubt otherwise kill some of our own elders? (As an environmentalist, it pains me to add (but the truth demands that I must) that, as Iran is now doing, we need also to be shutting down some public transport, in particular between infected and less- or un-infected communities.)

>A massive, swift public information campaign about precautions that individuals, households, businesses and communities should take. This should include official documentation through every door, and that information should include some of the information given here in the present document. It should also include Councils etc being empowered to inform (and where necessary to implement self-protective measures for) their communities.

>Treat cold and flu cases as if they were COVID-19 cases until proven otherwise in the following sense: persons who think they have a cold or flu should self-isolate as much as possible, should definitely not associate with large numbers of others, especially vulnerable others, etc.

>Because of the huge skew on age-vulnerability, there should be some skew as to what precautionary measures we take with regard to different age-ranges. Example: Schools shouldn’t be shut prematurely. BUT golf clubs, country clubs, the House of Lords, bingo halls etc are early candidates for closure.

Isn’t this analysis ‘alarmist’?

Answer: Some, especially those who are making profits from prolonging business as usual for a little longer, will undoubtedly say so. But I don’t mind receiving some opprobrium, if that helps to inject the urgency into this debate that it actually requires, to save lives. And on the question of ‘alarmism’, let’s recall Churchill’s elementary but crucial distinction between alarmism and raising the alarm. Churchill was accused, by appeasers of being “alarmist”. He made clear in response that he was raising the alarm by telling the truth about a real and rising risk that we were facing. His concern of course proved justified. What you really don’t want to do, in a creeping crisis like the one that we are inhabiting, is to err on the side of being complacent. Far better to err on the side of ‘over-reacting’. Because the worst we’ll do if we ‘over-react’ is to create a recession or something similar. Whereas the worst we’ll do if we under-react is to unnecessarily facilitate the deaths of tens or hundreds of millions of people, including perhaps our own parents or grandparents, not to mention the President of the United States and both his potential Democratic rivals (because all three of those men are in or close to the most-vulnerable age range, and may have double-digit exposure to death-risk from coronavirus).

Furthermore, it should be borne in mind that, given that a pandemic now appears overwhelmingly likely, taking the kind of precautions that I have outlined now reduces the likelihood of a panicky disorderly larger shut-down of our system a little later.

This is the essence of precautionary reasoning: in cases where there is chronic uncertainty about a threat, but when we are exposed to potentially very-high stakes downsides from it, it is necessarily better to err on the side of caution by doing what may get called ‘overreacting’ to it. Better safe than sorry, ought to be our motto, when confronting COVID-19. And erring on the side of safety requires of us the kind of radical precautionary measures outlined above.

The world (and to some extent this country) is finally starting to get serious about responding adequately to COVID-19. We should have done so much faster; not having done so has cost lives and will cost more. And we should go further: We should already for example have stopped most flights from countries like Italy, Iran and China to this country, as a precautionary measure. It is profoundly unwise to be behind the clock; we need to try, as I argued earlier, to be one-step ahead of the virus rather than always trying to play catchup with it.

Finally then, to those who are calling those of us raising the alarm on COVID-19 ‘alarmists’, we should say in response: the unnecessary deaths that are occurring and will occur as a result of complacency and of a failure to understand the ‘fat-tailed’ nature of this crisis are in part your responsibility.

But isn’t the truth that this outbreak might turn out to be not that bad?

Answer: Yes! If we are fortunate, and the percentage of the populace eventually infected turns out toward the low end of current estimates (say 20%) and the percentage of those infected dying dips down below 1%, we could well get away with less than 10 million deaths worldwide, even if we don’t take any of the strong measures outlined above. BUT (i) even ‘just’ (sic) several million deaths is still quite a lot!; and (ii) the chance that we may get lucky with coronavirus is, for the reasons central to this document, simply NOT a good reason for not taking strong precautious action. For there is an asymmetry here: the best-case scenario is that things don’t get that bad; the worst-case scenario is that more people die in this pandemic, in this age of ultra-connectivity / hyper-mobility, than have died in any pandemic in human history. We must lean hard therefore toward preventing worst-case scenarios.

What about the longer-term prospects and perils raised by the coronavirus?

Answer: As I’ve argued, it is high time (it is past time!) for a more precautionary culture to be developed, and COVID-19 makes this point clear. This coronavirus could become endemic / could resurge after the summer (Bear in mind that it was the second, autumn wave of the Spanish flu that proved most fatal). If this coronavirus recedes during the summer, we need to use that time to prepare thoroughly for the potential second save, and not to be so slow in taking precautionary measures against it as, in countries like the UK, we have been this time, thus far.

Why has there been such resistance to accepting the severity of the potential threat posed by COVID-19?

Answer: It is very hard for human beings to imagine things radically outside their experience. A ‘normalcy bias’ makes us very poor at being ready for ‘black swan’ events. Uncertainty, ‘fat tails’ and precaution are little understood. Crude, over-simplified versions of ‘evidence-based’ analysis predominate.

There has been no true global pandemic with high mortality within the lifetimes of virtually anyone now alive, i.e. since Spanish flu. And since then we have, as humans, become more and more pleased with ourselves, more and more confident that our technology, science and understanding are such that we are allegedly near-invulnerable to threats from the mere natural world.

Such hubris comes before a fall. It feels cognitively dissonant to contemplate that tens or possibly hundreds of millions of people may be about to die…But such cognitive dissonance is NOT something to be trusted; it is little more than an outdated habit. We are not in the habit of having to face situations where megadeaths are likely. We need to shake off our complacency, if we are now to adequately prepare for this escalating crisis. (A similar point applies, a fortiori in fact, to the climate- and ecological- crisis. It is profoundly unprecedented so we are naturally unprepared for it; it is so vast as to be almost unimaginable; we cannot picture it actually playing out in the kinds of ways that scientists and system-thinkers are warning us that it will unless we take radical precautious action. But our difficulty in imagining it is not a good reason for not acting with swift and strong precaution to seek to stop it from worsening; on the contrary.)

The tragedy is that many of these deaths CAN be stopped. We DO have the power to prevent them.

But only if we are finally willing to get serious about taking wide, deep and rapid precautionary action.