COVID-19: We Would Do It All Again

by Thomas Scarborough

'Compound Risks and Complex Emergencies.' PNAS.

Staying in a South African township in the autumn of 2021, once a week an old woman in worn out clothes slipped into the house unannounced, and sat down. She sat quietly for four hours, until lunch was served. She quietly ate her lunch, and left. I was curious to know the reason for her visits.

Her son, she said, had lost his work through the pandemic. He had been supporting her, and she could not now afford to feed herself. She couldn’t keep the lights burning after dark. She couldn’t even pay for candles—let alone the rest. Every day, she would slip quietly into a house like this, she said, and wait for a meal.

This was a direct result of a COVID-19 lockdown. Not that lockdowns are all the same, or have the same effects. The University of Oxford has developed a Stringency Index, which monitors a wide range of measures adopted by governments across the world, in response to the pandemic.

Without weighing up the rationale behind them, it is clear that these various measures have had grievous effects.

It is estimated that more than 200 million jobs were lost worldwide, in 2020 alone. The United Nations’ International Labour Organisation estimates that 8.8 percent of global working hours were lost, which is equivalent to 255 million full-time jobs. This is without considering the knock-on effects—apart from which, such losses are seldom made up in the years which follow.

According to the World Economic Forum, 38 percent of global cancer surgery was postponed or cancelled in the early months of the pandemic. The backlog, they said, would take nearly a year to clear. Of course, one can’t afford to postpone or cancel cancer surgery. Many surgeries were stopped besides—in fact, millions of surgeries per week.

Frustrations and the pressures of life under lockdown brought about huge increases in certain types of crime. Gender-based violence soared. The United Nations General Secretary reported a ‘horrifying global surge’. Scattered statistics confirm it. Many cities reported increases in gender violence of more than 30%. Some reported more than 200%. The effects of such violence never go away.

The lockdowns, in all their complexity and diversity, had negative effects on personal freedoms, supply chains, mental health, inequalities, and any number of things—and since everything is related to everything, almost anything one may think of was skewed.

Of course, not all of the effects of lockdowns were negative. Drug arrests plummeted in various places. Break-ins, not surprisingly, decreased as more people stayed home. In South Africa, a ban on liquor sales quickly emptied out hospital emergency rooms. Most importantly, it is thought that very many lives were saved from COVID-19.

How many lives were saved? This is hard to tell. Imperial College London judged that ‘the death toll would have been huge’—which is, there would have been millions more deaths. Surely this is true. At the same time, they noted that there are ‘the health consequences of lockdowns that may take years to fully uncover’—and paradoxically, the many attempts to stall the pandemic may have prolonged it.

How do we calculate the advantages and disadvantages of a pandemic response? It is, in fact, frightfully difficult. One needs to identify the real issues—or some would say, select them. One needs to weigh all relevant factors—however that might be done. There is a place, too, for the human trauma, whatever its logical status may be, and this is hard to quantify. 

At the end of the day, however, it all comes down to priorities.

An absolute priority during the pandemic was life. No matter how many or how few, lives should be saved. This emphasis is easy to see. Almost any graph which has traced the pandemic shows two lines: the number of cases, and the number of deaths. Other effects of the pandemic are by and large excluded from everyday graphs and charts—which is not to say that they are completely overlooked.

What does one mean, then, by loss of life? One means rapid loss of life, of the kind which overcomes one in the space of a few days from hospital admission to death. Such death, in most published instances, has been an almost complete abstraction—a number attached to COVID-19—signifying the priority of death pure and simple.

At the end of the day, the avoidance of rapid loss of life was the absolute priority in this pandemic. All other priorities were demoted, or put on hold, even repudiated as side-issues. Ought life to have been given absolute priority? Who can say? It has to do with human, cultural, and social values, as we find them, in the early 21st century.

The fact is that life—or the possibility of losing it quickly—was the immutable priority. Therefore, we would do it all again.

Poem: Speculating on Providence

Posted by Chengde Chen

Woodcut by Hans Schäufelein, Augsburg 1513.
Christ and Mary as intercessors /
God the Father shooting plague arrows.

 

Besides the known causes of the Covid pandemic

I suspect that God had a few more intentions

A coincidence cannot be counted as providence

But causality deserves logical proof nevertheless

 

He must have wanted to help us fight climate change

Otherwise why did Covid bring a hidden green hope?

We had almost lost our confidence in reducing CO2

The pandemic dropped it decisively to an ideal level

 

Galileo’s telescope showed Jupiter’s satellite system

Letting people 'see' how the solar system works

Isn’t Covid like a low-carbon possibility experiment

Demonstrating the non-inevitability of global warming?

 

He must have wanted us to cope with the lockdown

Otherwise why did Covid arrive behind the Internet?

People of the Net can be isolated without isolation

Meeting across the Earth redefines time and space

 

The lights of myriad families light up screens wherever

The digitalised joys or sorrows are shared whenever

Without the personal contacts in this semi-real space

The half-dead world may have been dead completely!

 

He must have also wanted Covid to warn science

Otherwise why was it as massacring as bio-weapons?

If a virus can turn the world upside down like this

Won’t genetic engineering threaten our existence?

 

Inside those labs capable of manipulating molecules

They are full of the scientific urge to take such risks

Human self-destruction has been a matter of time

Can the Creator not worry if His work is to be wasted?

 

It's hard to say if these were really His thinking

But, believing or not, you'd better so assume

So as to understand the philosophy of providence –

Turning empirical logic into the rationality of faith!

 

(Chengde Chen is the author of Five Themes of Today: philosophical poems, and of the novel: The Thought-read Revolution. chengde.chen@hotmail.com )

Staring Statistics in the Face

By Thomas Scarborough

George W. Buck’s dictum has it, ‘Statistics don’t lie.’ Yet the present pandemic should give us reason for pause. The statistics have been grossly at variance with one another.

According to a paper in The Lancet, statistics ‘in the initial period’ estimated a case fatality rate or CFR of 15%. Then, on 3 March, the World Health Organisation announced, ‘Globally, about 3.4% of reported COVID-19 cases have died.’ By 16 June, however, an epidemiologist was quoted in Nature, ‘Studies ... are tending to converge around 0.5–1%’ (now estimating the infection fatality rate, or IFR).

Indeed it is not as simple as all this—but the purpose here is not to side with any particular figures. The purpose is to ask how our statistics could be so wrong. Wrong, rather than, shall we say, slanted. Statistical errors have been of such a magnitude as is hard to believe. A two-fold error should be an enormity, let alone ten-fold, or twenty-fold, or more.

The statistics, in turn, have had major consequences. The Lancet rightly observes, ‘Hard outcomes such as the CFR have a crucial part in forming strategies at national and international levels.’ This was borne out in March, when the World Health Organisation added to its announcement of a 3.4% CFR, ‘It can be contained—which is why we must do everything we can to contain it’. And so we did. At that point, human activity across the globe—sometimes vital human activity—came to a halt.

Over the months, the figures have been adjusted, updated, modified, revised, corrected, and in some cases, deleted. We are at risk of forgetting now. The discrepancies over time could easily slip our attention, where we should be staring them in the face.

The statistical errors are a philosophical problem. Cambridge philosopher Simon Blackburn points out two problems with regard to fact. Fact, he writes, 'may itself involve value judgements, as may the selection of particular facts as the essential ones'. The first of these problems is fairly obvious. For example, ‘Beethoven is overrated’ might seem at first to represent a statement of fact, where it really does not. The second problem is critical. We select facts, yet do so on a doubtful basis.

Facts do not exist in isolation. We typically insert them into equations, algorithms, models (and so on). In fact, we need to form an opinion about the relevance of the facts before we even seek them out—learning algorithms not excepted. In the case of the present pandemic, we began with deaths ÷ cases x 100 = CFR. We may reduce this to the equation a ÷ b x 100 = c. Yet notice now that we have selected variables a, b, and c, to the exclusion of all others. Say, x, y, or z.

What then gave us the authority to select a, b, and c? In fact, before we make any such selection, we need to 'scope the system'. We need to demarcate our enterprise, or we shall easily lose control of it. One cannot introduce any and every variable into the mix. Again, in the words of Simon Blackburn, it is the ‘essential’ facts we need. This in fact requires wisdom—a wisdom we cannot do without. In the words of the statistician William Briggs, we need ‘slow, maturing thought’.

Swiss Policy Research comments on the early phase of the pandemic, ‘Many people with only mild or no symptoms were not taken into account.’ This goes to the selection of facts, and reveals why statistics may be so deceptive. They are facts, indeed, but they are selected facts. For this reason, we have witnessed a sequence of events over recent months, something like this:

• At first we focused on the case fatality rate or CFR
• Then we took the infection fatality rate into account, or IFR
• Then we took social values into account (which led to some crisis of thought)
• Now we take non-viral fatalities into account (which begins to look catastrophic)

This is too simple, yet it illustrates the point. Statistics require the wisdom to tell how we should delineate relevance. Statistics do not select themselves. Subjective humans do it. In fact, I would contend that the selection of facts in the case of the pandemic was largely subconscious and cultural. It stands to reason that, if we have dominant social values, these will tend to come first in our selection process.

In our early response to the pandemic, we quickly developed a mindset—a mental inertia which prevented us from following the most productive steps and the most adaptive reasoning, and every tragic death reinforced this mindset, and distracted us. Time will tell, but today we generally project that far more people will die through our response to the pandemic than died from the pandemic itself—let alone the suffering.

The biggest lesson we should be taking away from it is that we humans are not rational. Knowledge, wrote Confucius, is to know both what one knows, and what one does not know. We do not know how to handle statistics.

COVID-19: Let It Be

Miguel Opazo, Pest, 2017

Posted by Thomas Scarborough and Martin Cohen

Jeffrey Kluger, the editor at large for TIME magazine, observed last week, ‘There’s nothing quite like the behavior of panicky humans.’  He was writing in the context of the COVID-19 pandemic.

Is the panic -- or should we say, alarm -- justified?

The initial response to the disease, although stumbling and slow in some respects, was by and large the correct one: get a fix on the disease.  What are we dealing with?  What is its character?  The next steps, then, were textbook containment and mitigation.  Since then, of course, the pandemic has developed other dimensions, though not as a direct result of the disease. Rich Lesser, the CEO of a global management consultancy, wrote in Fortune magazine last week, ‘It started as a health crisis, within days became a real economic crisis, and is now on a swift path to becoming a massive fiscal challenge.’

There would seem to be two assumptions in the early -- and continuing -- response to the pandemic: under no circumstances sickness, yet if there is, complete control.  All over the world, we find language which reveals an ‘uncompromising’, ‘relentless’, and ‘aggressive’ approach -- an ideal plan which is not to make any concessions to the disease.  And always, in the statistics, one finds a column marked ‘deaths’, to which all control would seem to defer.  The aim is zero deaths, zero deaths, zero deaths.  In fact the biggest opprobrium for any government in the midst of the pandemic is the death rate.

The COVID-19 pandemic has two important features: the seriousness of the pandemic, and the character of the disease.

About the seriousness of the pandemic, mortality stood last week at about 3% -- if one calculates the ratio of total confirmed cases to deaths.  Yet for a number of reasons, this is quite uncertain.  For example, various academic papers have estimated that more than 80% of cases are undetected.  This reduces 3% to 0.6%.  Some place mortality far lower -- the Centre for Evidence-Based Medicine placed it at 0.14% last week.  The World Health Organization calculated that in China, the 'real' mortality rate for ‪COVID-19‬ was 0.7% of reported cases, where only 5% of cases were reported. That's a 0.035% death rate.

While various kinds of ‘experts’, media, and ‘modellers’ have been plugging in figures as high as 10% for ‪Corona virus‬ fatalities, one professor of public health, John Ionnidis of Stanford University, suggests ‘reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%’.  Compare the lower figure.  He explains his reasoning, too, saying that the one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its unfortunate, quarantined passengers.

‘The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher…’  

Writing for Stat magazine, he adds,

‘Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%.’

If we assume that the ‘case fatality rate’ among individuals infected by the virus is 0.3%, and 1% of the U.S. population gets infected, this would translate to about 10,000 deaths. This sounds a huge number, but is within normal flu toll.

Even the one thing everyone agrees -- that we have to flatten the curve to spread out the load of cases (and avoid overburdening health services) -- Ionnidis casts doubt on.  Spreading the infections out over a longer period of time is better?  Not necessarily.  It ‘may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period.’  For Ionnidis, the policy response, not the virus, is the perturbing part, as ‘with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions not just millions, of lives may be eventually at stake.’

The point is that fatalities, although they are tragic and traumatic in every case, are comparatively small, although, the numbers sound alarming given the large population which may be affected.

As for the character of the disease, it has some well-defined features.  It is now certain that it is far more dangerous to those who are more advanced in years, from about age 60, certainly from age 70.  It is far more dangerous for those with pre-morbidities, or compromised health, or concurrent infections, among other things.  This makes the picture far more varied than the simplest scenario of containment and mitigation.  Also, methods of containment and mitigation themselves are very varied, and may be greatly helped with fairly simple -- and far from extreme -- measures.

Given this brief survey, and assuming that it is broadly true -- what would the philosophers have said?

The Delphic maxim proclaimed, ‘Nothing to excess,’ while Aristotelian philosophers emphasised the Golden Mean -- the middle way between extremes of excess and deficiency.  Socrates said, ‘Choose the mean, and avoid the extremes on either side, as far as possible.’  In short, they sought a general holism.  With this in mind, they might well have cautioned us against a reductionist response to the crisis, and to take all factors into account and to balance them.  Protect the elderly, defend the vulnerable, comfort the distressed, yet for the rest, accept the tragic inevitability of illness and death among us, maintain the life and pulse of society -- and let it go.  Let it be.

A more holistic view suggests, too, that we should think, not only of the present pandemic, but of the past and the future.  As with all pandemics, there is a bigger picture.  Where have we come from, that this has happened to us now?  Where are we going to, as we shape the society of the future?  And what if it had been worse?  Pandemics are always embedded in background conditions.  One needs to consider economic and financial systems, urban planning, health care, lifestyle choices, communications -- in fact, the entire order of the day.

Above all, it is a reductionist response which drives us to the totalising ambition of no illness, and certainly, zero deaths -- and in the midst of this, the suppressed premise of our age: preserve life at all costs.  Less than a hundred years ago, religious congregations all over the world would pray for healing through God’s angel of death, if he should so will.  That prayer has now been expunged.  Death is not a constant companion today, as it sometimes was in the past, but an enemy to be defeated at all costs.  If only one knew what one were hoping to save.  It would seem that not many do -- and that in itself may be a large part of the panic, the alarm.  There has to be a way of living that triumphs over stalking death.

It remains to be seen whether ‘the behaviour of panicky humans’ can be sustained today.   At the moment, we are all locked into a more or less unified response to the pandemic, by the decisions of governments the world over -- and they in turn are judged by their peers.