The high cost of waiting for rationality
We compare Covid-19 mortality to other diseases or, in fact, whatever else springs to mind: road accidents, suicide or drowning. We calculate the many zeros of economic damage, talk about a sense of proportion and analyse how many more lives could be saved if only all this money could be spent elsewhere. Sigh.
Indeed, why save expensive lives, when we have those cheaper lives to save: on the roads, atop bridges, at the beaches? Or, maybe, don’t save them at all? It’s a tough world we live in.
This creates a moral dilemma. If you cannot care for both: lives and economic well-being — which gets the priority? Assuming form the get-go something must be sacrificed, this ill-conceived question presents a false choice between two foundational values of the western world: the sanctity of life as taught by religion and indeed many other systems of though; and capitalism’s right to free-enterprise, which praises the opportunity to own, create and accumulate wealth as nothing short of a human right. Damned if you do, damned if you don’t.
Attempting to frame the problem rationally is welcome, surely, or isn’t it? Is it at all possible? After all, a public conversation on a formula: Value of a Human Life vs. The Cost of Saving This Human Life makes for utterly tone-deaf PR. Just try arguing that the high cost of redesigning and fixing a poorly designed airliner is more valuable than the loss of human life after the airliner crashes and see where that gets you. Even Boeing didn’t have the guts.
Yet, the approach to Covid-19 taken by many countries is oddly reminiscent of kicking the can further down the road. And the cost of this exercise indeed is becoming increasingly hard to bear.
Waiting for Godot
Most countries’ approach to Covid-19 relies on a single measure — lockdowns. The issue is that lockdowns are not going to succeed in stopping the pandemic.
As early as February we had reports, that significant part of Covid-19 cases were showing no symptoms. Early news from East Asia also indicated that the these asymptomatic carriers are able to transmit the disease to others. Add these two together, and you get a recipe for exponential spread.
It is infinitely probable at least one infectious case will slip through the cracks after the lockdown ends. You don’t need a major in epidemiology to understand that. Without reliable means to capture this silent threat, it would take as little as two weeks for this single case to turn into a hundred, and in a month we’d be in the tens of thousands. Lockdown does not alter this dynamic in any way, merely postpones it: a stopgap.
Perhaps this could be a viable approach — just keep quarantining everyone — old and young, sick and heathy — until a vaccine is developed and majority of the population (around 70%, by current estimates) are inoculated or acquire the immunity to the disease in nature’s own, all natural way — by catching the virus and developing the antibodies themselves. The caveat — it will be another 12 months before we can all leave home again. And then there’s the cost.
Many countries have spent weeks locked down, and we can already see that this stopgap comes priced at double digits: a projected double digit fall in per cent of annual GDP and a double digit rise in unemployment rate. It might take a roomful of economists a month to crunch the numbers on the total economic impact of a quarantine that lasts a year, but we can safely place our bets on red even as the roulette is still spinning — it sure as hell won’t be cheap.
Lockdown is an extremely expensive way to address a pandemic like Covid-19, and its effects are very short-lived. The moment we open things up again, it’ll have had no effect. So why are we trying to out-wait the disease, barricaded in our couch forts?
Abundance of Caution
Lockdown did seem, at one point, the right thing to do. When the epidemic first started, after failing to solve the problem in tried and tested ways of shooting the messenger, China locked down entire regions, restricting movement for millions of people. The undetected early spread in China (and later — Italy) had led droves of viral patients to understaffed and ill-equipped hospitals, resulting in a surprise shock to the national healthcare system. It wasn’t the severity of the disease alone, that inflated the death-toll — healthcare systems became the unwitting accomplice, simply by being underprepared. Doctors could not care for all the patients who would have lived, given proper care. Lockdown helped reduce the damage and tame the spread.
China was also busy saving face with censorship and creative use of statistics, at least somewhat successfully at that — recent findings suggest mortality rates reported by China are deflated. Needn’t act all surprised — a country doesn’t get rated fourth to last on the World Press Freedom Index for no reason.
Then the virus exploded in Europe. Italy landed face-first in the mud as the bright media lights were illuminating the scene. The world took notice: shortly after regional and, later, national lockdown in Italy other countries followed suit with similar measures. China, by that time, was reporting 0 new infections per day. Things weren’t good, especially in Europe, but the idea that the lockdown might be a good solution has caught on. Crucially, situation in most countries differed from that in Italy. Their health systems might have been underprepared, but they were not under siege.
When it comes to the decision of lockdown or no-lockdown, government heads around the world had little choice. With the news cycle churning out attention grabbing headlines on an invisible killer at your doorstep, appear to be irresponsible is the last thing a savvy politician needs. And so, everyone closed the doors, some even nailing shut the windows — for good measure. “Abundance of Caution” is the name of this game.
It is true, that at the very beginning measures like mandatory quarantine for travellers, limiting the size of public gatherings and other restrictions was the right thing to do. It helped avoid a potential healthcare crisis and gave time to activate the necessary contingency plans. And as the lockdowns were in place, governments should have been hard at work organising a better response. A response, which combines a wide variety of targeted measures: improved preparedness of the healthcare system, public health guidelines, frictionless access to accurate virologic (showing current infection rates) and serologic (showing immunity, or past infections) testing, tools and policies for better control of confirmed cases (including silent ones), perhaps some restriction of movement for people who are at higher risk for severe illness. A response, which may also be expensive, but has a lasting effect.
But few countries did. What should have been a mean to an end, became the “end” itself.
What’s the plan Doc?
Some countries are better than others at implementing individual measures, but even now, few have a coherent plan. Majority of the world has put up their camps in opposing ends of the line: some ignoring the risk altogether until it was too late to do anything but lock everything down; and others reacting in a knee-jerk fashion — swiftly, but with little thought that perhaps early timing merits a different course of action. “Erring on the side of health and safety”. Or, perhaps, hiding behind universally accepted values to cover up the leadership impotence at a time of unavoidable loss. We each see what we want to see. Still wondering why rational though is having such a hard time penetrating this conversation?
It is inevitable, that many governments needed time to fully grasp the situation. It is tolerable that it took a while to crank the government apparatus into action. Indeed, I sympathise with individual government administrators, many of whom find themselves completely unrehearsed, in the most difficult roles of their careers. There is, however, little excuse for naivety in leadership.
The havoc that was wrecked on the economy in the past month was not about the steep price of fixing the Covid-19 crisis. What we are enduring is The High Cost of Waiting: for effective, scalable and affordable approach for the challenge we face. And we are all silently complicit in trying to wait this one out. Fingers crossed, knock on wood.
Surely, fixing this mess will not be free, and some of us might not survive. We cannot change that. But we can abandon an approach that forces us to continue sacrificing: health for wellbeing, or wellbeing for health, when both can be salvaged, even if not unscathed. We’re all in a hole, alright? Stop digging already!
So forget the moral dilemma. It is false.
Questions that make a difference today are: how much time has to be bought, and most importantly — how do we spend that time wisely?
