I am researching and writing this primer to take a big-picture look at the COVID-19 epidemic. I announced it on Facebook in June and invited questions from my friends. What I originally envisioned as a single essay has now developed into an ongoing series of indefinite duration! Now that I have examined the pandemic from biological, medical, epidemiological, and social perspectives, today I consider the upshot: “So … what should we do now?!” How shall we resolve the three-way tug of war involving public health, the economy, and political peace? How should we conduct our lives until the virus is under control?
I. A Tricky Balance
President Trump tweeted, “We cannot let the cure be worse than the problem itself.” 2
Most people would agree with President Trump’s rationale. The keyword in this sentiment is “worse”, which is frustratingly hard to define. It depends on the costs and benefits of action vs. inaction.
Let’s suppose at its simplest level that cost is measured strictly in terms of human lives lost. One research team estimates that strict public health measures could save about a million American lives this year while causing around 100,000 poverty-related deaths. That is a nightmarish ethical dilemma. On balance, though, playing it safe with public health measures like stay-at-home orders would be justified. 3 The problem is that prevented deaths are invisible. Virtually nobody would celebrate the million lives saved, while the actual recession-related deaths would make headlines daily.
I got curious to look up the countries that had done best at protecting their economies, those that had done best to minimize infections, and those that had struck the best balance. The results surprised me. In the long run, there is no tradeoff. The countries that have done best at keeping their COVID-19 deaths down are actually those with the most successful economies now. 4 Although “lockdown” is a difficult short-term process, it allows for an earlier return to normalcy and therefore greater long-term recovery.
If numbers were the only consideration, the solution would seem “obvious”. With a truly rigorous, highly-enforced social lockdown for 2 – 4 weeks, we could put this pandemic behind us. That scenario alarmed us in March, but by now another 2 – 4 weeks would not feel shocking.
There’s another factor, though: political will. I’d be willing to horde groceries and stay home for a couple more weeks. I know that many of you would too, even some conservatives in small states. But we also know how ferocious the resistance would be. People would refuse to comply; the stricter the order, the harder it would be to enforce. The short-term pain would be undeniable. Some people would feel so angry and oppressed that they would develop permanent vendettas or even go Rambo on us. The emotional costs of such drastic action would simply be too high. Unfortunately, the longer this goes on, the more time the pandemic has to grow exponentially.
If the short-term and long-term solutions are at odds with each other, how else can we find the right balance?
II. Suggestions from the Left and Right
I seem to see two competing visions emerging.
A. The “Experts'” or “Liberal” Solution
- Monitor hotspots
- Locally tailor protocols, including face mask mandates, business closures, and prohibitions of mass gatherings, where and when appropriate
- Increase the number and speed of tests where needed
- Improve contact tracing and quarantine procedures
- Wait for a vaccine
A good example of this model is California’s stay-at-home order, which was one of the first statewide responses in the United States and which is regularly updated. California counties are ranked on a heat spectrum (yellow < orange < red < purple < blue) which is now defined by availability of ICU beds. Business activities and freedom of movement are more strictly restricted in hotter spots. The state also recently launched the CA Notify app. When someone who uses the app tests positive for SARS-CoV-2, she can alert the app. Users who spend extended periods of time in proximity to her will then get notifications on their phones.
B. The “People’s” or “Conservative” Solution
- Preemptively quarantine the vulnerable
- Let everyone else get back to life as usual
- Face masks and social distancing up to personal conscience
- Wait for herd immunity
The conservative model is expressed in the Great Barrington Declaration. The preamble to this declaration indicates that its proponents are more concerned about government orders than the virus. The plan calls itself “Focused Protection” because it would focus on protecting nursing home residents and other vulnerable patients, while keeping children in school because they are much less susceptible. Many experts do not find focused protection to be feasible; flu pandemics illustrate that is not possible to effectively identify or quarantine the vulnerable population. 5 In fact, the apparent mass appeal of the Great Barrington Declaration is that it is extremely simple. The declaration is short and abstract, more a set of goals than a plan of execution.
III. My Humble Suggestions
This primer has discussed benefits and drawbacks to various prongs of the liberal and conservative approaches. Business lockdowns cause their own pain, and mandates lead to political friction. A vaccine could be years away in some parts of the world. With indiscriminate reopenings, we might reach herd immunity before a vaccine is available, but that process would kill tens of millions of people and would overwhelm hospitals to the point of causing millions more non-COVID deaths.
Some compromise will be necessary and optimal. 6 Compromise requires looking at this pandemic as a political problem, not strictly a medical or economic one. The political controversy is the main factor that tends to be left out when people discuss solutions. No plan is acceptable if it leads to violence or permanent vendettas. And no single plan will be acceptable to everyone.
Here are some abstract political principles that guide my thoughts.
- “I’ll explain my position and respect yours.”
- In a democracy, we define what is “right” by the people’s choice, even when it’s based on false premises. That is frustrating, but it’s a price we pay.
- The more controversial a decision is, the more locally it should be made.
- Consider externalities
Externalities are a fancy way of saying costs or benefits that one person’s decisions have on society around him. Most economics classes teach that an economy is most efficient when people are charged for the messes they make or rewarded for the messes they clean up. I’m a little surprised that I haven’t heard this topic being discussed widely this year in response to the pandemic.
When I consider these principles in sum, I conclude that each person, family, business, and government should assume the right and the responsibility for its own decisions. Here are some applications that would follow from this existential approach.
The people’s primary freedom is the right to decide how to carry out their lives. Face masks, social gatherings, and business closures should mostly be individual decisions. In fact, this already is true in reality. It’s difficult to enforce mandates on individuals, so people already are acting according to their own judgment.
In order to guide people’s actions, governments have a responsibility to educate: to provide data, science, and recommendations with justifications. Most people will choose to do the right thing and respect sensible recommendations. For instance, governments everywhere have been consistent about their advice to wear face masks. Even without a mandate, 85% of Americans already report that they regularly wear face masks voluntarily, including 76% of Republicans. 7 For conservatives, it’s that last step of the requirement that gets the blood boiling. Thus, the benefits of requiring face masks probably does not greatly outweigh the political ill-will.
Aristotle described three forms of persuasion: logos, pathos, and ethos. As someone trained in the sciences, I respond to logos: facts and logic. However, I recognize that most people base their values primarily on ethos (who is delivering the message) supported secondarily by pathos (emotions), then perhaps justified after the fact by heavily filtered evidence. In the United States, for instance, 1/3 to ½ of the nation is conservative. This constituency has decided that Anthony Fauci, Joe Biden, and all Democrats are bad guys. Many conservatives won’t listen to a word that Dr. Fauci or Governor Whitmer says, no matter how well it is supported by science. To reach conservative citizens, public health agencies must recruit conservative spokespeople. I can hardly think of a better example than Dolly Parton. This beloved red-state icon donated $1 million to the Moderna vaccine. In fact, federal agents have already suggested enlisting her as a spokesperson to encourage mask wearing in Knox County, TN. 8 What we need now is a concerted bipartisan campaign to encourage staying at home and avoiding gatherings as a patriotic call of duty, if not a legal command. Let’s start comparing the sacrifices that we ordinary citizens make to those of soldiers and policemen, part of a higher cause.
COVID-19 liability is a hot topic this year, and it should play an important part in our response. Ideally, people, and especially businesses, should be held liable for medical costs if they cause infections by high-risk behavior. Of course, the problem here is that it’s almost impossible to trace the origins of each transmission. A practical middle-ground would be a liability-reward system based on tolls, taxes, and subsidies. Maybe businesses can pay for population density permits on their property, with a discount if they require on-site rapid testing. Perhaps customers can pay a little extra by the minute or the mile to enter stores, ride buses, and the like. The proceeds from these tolls can fund medical treatment, vaccine and face mask giveaways, and rapid tests.
If a government does force a business to close, it ought to compensate for lost profits. In fact, I believe that it’s reasonable to interpret the 5th Amendment to the US constitution as requiring such payback: “nor shall private property be taken for public use, without just compensation.” In this pandemic, closing a business to mitigate the spread of a virus is a “public use”, and forcing an establishment to close is “taking” the property for that use. This business would continue paying its employees and vendors with the government bailout. On the hook for the costs, the government would have incentive to become extremely judicious with its closures.
There are a few more COVID-specific principles to help us make common sense decisions.
- A higher current level of infections justifies more restricted behavior.
- Stricter regulations are only sustainable over smaller places or shorter times.
- The more vulnerable the person, or the people he meets, the more care is warranted.
States treat counties differently depending on their rates of new cases, rates of positive tests, percentage of ICU capacity available, etc. I made a 1% rule of thumb for myself. When the pandemic started, I vowed to stay out of areas where more than 1% of the population is actively infected. Today, it so happens that my neighborhood, city, county, state, and even the entire US is more than 2% actively infected. I obviously can’t “stay out” of these regions, but these levels tell me that it’s time to “stay in” as much as possible. While I can commit to locking down at home for a couple of days, it’s unreasonable to expect self-quarantine for months on end. It’s completely unrealistic to expect the whole world to hunker down for a year. I do find it reasonable to stay home for Christmas this year. It’s a sacrifice I’m willing to make because it feels like the right thing to do.
I don’t understand the rationale behind curfews, and I’m not sure anyone has evidence that they do any good. In fact, I would propose that businesses in high-risk zones should stay open 24 hours. Then customers could spread themselves out throughout the day. Hell, we could even offer graveyard shift discounts.
It would be possible to end this pandemic within a month, but only with a coordinated and strictly enforced worldwide shutdown. If the pandemic were strictly a medical issue, or even a medical / economic issue, this solution would be a slam dunk. But we all know it’s draconian and unrealistic. Some people would suffer great loss, some would resent the lockdown for the rest of their lives, and some don’t even believe that the virus is real. Different people are swayed by different emotions or evidence, and some pay no heed to evidence at all. But they are all part of the democratic decision-making machine.
There is room for individualized response. In fact, that may be the only way to keep political tensions under control. We must allow some latitude for people and businesses to make their own choices.
On the flipside, freedom bears responsibility. Charge an extra $1 for a movie ticket in Canada, or 25% for bus fare in New York, and then let people decide what they’re willing to pay for. Use the proceeds for COVID-related medical expenses and to support businesses that have closed their doors.
In this way, everyone would come around in their own time. Even vocal conservatives will take care when they begin to feel more threatened by the virus than by human watchdogs.
- lumaxart, CC BY-SA 2.0 https://creativecommons.org/licenses/by-sa/2.0, via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Working_Together_Teamwork_Puzzle_Concept.jpg (accessed 12/17/20). ↩
- Donald Trump, Twitter, 3/22/20, 8:50 PM, https://twitter.com/realDonaldTrump/status/1241935285916782593 ↩
- Olga Yakusheva, “The Cure is Not Worse than the Disease – A Humanitarian Perspective”, SSRN (8/07/2020, pre-print awaiting peer review), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3638575 (accessed and saved 10/01/20). ↩
- Joe Hasell, Which countries have protected both health and the economy in the pandemic? – Our World in Data (9/01/2020; accessed, saved, and archived 11/27/20). ↩
- Julian Tang et al., “Expert reaction to Barrington Declaration, an open letter arguing against lockdown policies and for ‘Focused Protection’”, Science Media Centre (10/06/2020), expert reaction to Barrington Declaration, an open letter arguing against lockdown policies and for ‘Focused Protection’ | Science Media Centre (accessed, saved, and archived 12/16/20). ↩
- Dr. Sandro Galea as quoted by Amelia Thomson-DeVeaux, “Republicans And Democrats See COVID-19 Very Differently. Is That Making People Sick?” Five Thirty-Eight (8/27/2020), https://fivethirtyeight.com/features/republicans-and-democrats-see-covid-19-very-differently-is-that-making-people-sick/ (accessed, saved, and archived 10/23/20). ↩
- Stephanie Kramer, “More Americans say they are regularly wearing masks in stores and other businesses”, Pew Research Center (8/27/2020), https://www.pewresearch.org/fact-tank/2020/08/27/more-americans-say-they-are-regularly-wearing-masks-in-stores-and-other-businesses/ (accessed, saved, and archived 10/22/20). ↩
- Cole Sullivan, “Federal report: Tennessee needs mask mandate, should enlist Dolly Parton to help”, WBIR News (7/21/2020), https://www.wbir.com/article/news/health/coronavirus/federal-report-tennessee-needs-mask-mandate-should-enlist-dolly-parton-to-help/51-7a3c938a-6f82-4760-ae91-963e4f0c66d3 (accessed, saved, and archived 12/29/20). ↩