Just like the Right over-reacted to 9/11, is the Left making a similar mistake?
[This piece is being updated as more data comes in]
Ben Franklin warned us in the opening days of our experiment in democracy: “Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”
This quote was widely cited by progressives in the U.S. in the wake of 9/11, to argue against infringements of our civil liberties due to overblown fears of terrorism. Yes, these thinkers argued, 9/11 was a watershed and horrific act of terrorism. But it didn’t warrant a wholesale change to our way of life or infringing our civil liberties because the actual harm done, about 3,000 lives lost, was tragic but not massive in terms of the many other threats facing us.
Looking back almost twenty years, to the early 2000s, those debates are still vivid to me. I am a lifelong progressive and I didn’t support the war in Afghanistan, because there was a profound lack of evidence that that country or its leadership was directly linked to 9/11 (no, Bin Laden did not admit on tape from a hiding place in Afghanistan that he orchestrated the bombings; that was an obvious fake), or that invading Afghanistan would do anything to stop future terrorism. We are still in Afghanistan almost twenty years later in America’s longest (and unjust) war.
I didn’t support the war in Iraq because it was clear from the beginning that the case for war, revolving around weapons of mass destruction, was extremely weak. I marched against the Iraq War in 2003, in Santa Barbara, California, where I lived at the time. It turned out to be an even bigger mistake and tragedy than the war in Afghanistan, costing thousands of American soldiers’ lives, up to a million or more Iraqi lives, and $trillions in taxpayer dollars.
Nor did I support “the war on terrorism” more generally. These various wars were all unjustified over-reactions to a limited but real threat of terrorism, which caused orders of magnitude more harm than the 9/11 attacks themselves.
An international criminal law enforcement approach, using existing and frequently used tools to hunt down the perpetrators that were still alive, and to apprehend wrongdoers plotting further attacks, would have been a far more effective and just response to the 9/11 attacks.
I thought a lot about threat assessment at that time, and concluded that the Right in the U.S. were both overly fearful (brain studies have shown that conservatives react more fearfully to perceived threats than progressives) and also, among some elements of the Right, hyping the threat of terrorism for various reasons that fit into a preexisting agenda to expand U.S. military dominance in the Middle East and around the world. Later evidence has strongly supported the view that the U.S. military response to 9/11 was massively misguided.
Flashforward to the present and the same kind of debate regarding threat assessment and appropriate responses has unfolded with respect to coronavirus. But often from the opposite side of the political spectrum. For example, it’s been mostly Democratic governors who have chosen the most extreme policy mitigation to coronavirus: economic lockdowns.
Are we now at a point where progressives are falling prey to their own fears and allowing massive over-reach by government and infringement of our basic civil liberties like the right to vote, the right to protest, the right to gather, the right to work, the right to travel, freedom of speech, the right to worship? All because of worries about the virus that should not warrant such infringements of essential civil liberties.
On the right side of the aisle, our president has just banned all immigration and talked about the office of the president having “total authority” in handling the coronavirus, joining other would-be dictators in vastly expanding the power of the federal government — all in the name of responding to the virus.
In addition to civil liberties being infringed, the lockdowns have brought an economic crisis that is already more serious than the worst of the Great Depression in the 1930s. We have record levels of unemployment, with 22 million U.S. workers filing for unemployment payments in the last month alone [May 17, 2020 update: it’s now up to 36 million and counting], and bankruptcies of businesses of all types will surely follow. Just a few months ago we had reached a 50-year nation-wide low for unemployment.
Hawaii, where I live, now has the highest unemployment in the nation, at 37%. With more than 1/3 of Hawaii’s labor force now unemployed, this is the highest in recorded history for the U.S.
In short, we are in the thick of economic devastation for regular Americans like you and I, all caused directly by political leaders choosing to shut down our economies. Economic devastation leads directly to health devastation in many ways, as I discuss below.
Many negative human health impacts are caused by economic lockdowns
This level of economic disaster, plus prolonged stay-at-home mass quarantines, will likely lead to substantial increases in many causes of death like heart disease and cancer, particularly in nations with poor safety nets. A 2019 study of Brazil during the 2012–2016 economic recession found an increase of 0.5 deaths per 100,000 population for each 1% increase in unemployment during the recession, translating to a total excess deaths of 31,415 in the four-year recession.
Comparing to the U.S., we now have (as of May 2020) over 20% unemployment, quadrupling from just two months ago.
Lockdowns in the U.S. don’t affect just Americans. They also affect people in developing countries who rely on remittances (payments sent by immigrant workers in the U.S.). As of late April, the World Bank projected a 20% reduction in global remittances. That’s a huge loss of income for people most in need.
Lung disease, suicide, drug overdoses, and other major causes of death are also exacerbated during hard economic times. Tough times and far more time spent at home by whole families also leads inevitably to increased domestic violence and child abuse.
Loneliness is also a killer, with recent studies finding it is a bigger cause of death in the U.S. than obesity or air pollution. It was already an epidemic before the pandemic and now it constitutes its own pandemic due to self-imposed and government-policy imposed isolation. Loneliness as a serious health issue and cause of death impacts mostly the same population that is most vulnerable to the coronavirus: the elderly and, in particular, nursing home populations.
Perhaps the biggest global impact of lockdowns will be a massive uptick in starvation and poor nutrition. A United Nations report from late April found an additional 130 million globally are now at risk of “acute food shortages” by the end of the year. The New York Times article summarizes:
This hunger crisis, experts say, is global and caused by a multitude of factors linked to the coronavirus pandemic and the ensuing interruption of the economic order: the sudden loss in income for countless millions who were already living hand-to-mouth; the collapse in oil prices; widespread shortages of hard currency from tourism drying up; overseas workers not having earnings to send home; and ongoing problems like climate change, violence, population dislocations and humanitarian disasters.
Homicides and accidents are likely to decrease dramatically because of stay-at-home orders, so it’s not all bad news. There is also research suggesting that many causes of death declined for some reason during the Great Depression, but it’s also not clear how that research applies to the very different world we live in today.
It does seems clear , however, that the response to the virus is going to cause far more harm, in terms of lives lost and increased human hardship, short and long-term damage to the economy, and a rollback, perhaps also long-term, of civil liberties, than the virus itself will cause.
What is the real threat from coronavirus and what should our leaders do?
The best available evidence now suggests that coronavirus is a real but far from existential threat and doesn’t require sledgehammer policy solutions like lockdowns. A policy scalpel may do just as well in the large majority of cases. My mantra lately is this: why use a sledgehammer when a scalpel will do?
A now prominent voice calling for a more surgical approach to mitigation is Dr. David Katz from Yale Medical School. A May podcast (https://www.richroll.com/podcast/dr-david-katz-517/) with Rich Roll should be required listening for anyone interested not just in coronavirus policy, but in effective public policy in general, and in effective communication of complex and controversial issues. Katz gets the tone just right and should convince many of the merits of a surgical rather than sledgehammer approach.
The scalpel approach to coronavirus is to achieve physical distancing, hand washing, mask wearing, and other measures that reduce and stop the spread of the virus, but without causing massive economic and social harm. Voluntary measures can achieve most of these goals without killing the economy or our civil liberties, or causing far more deaths from other causes like cancer, heart disease, lung disease, etc.
Sifting through the data and debates over coronavirus is a daunting task. But as with all policy debates it comes down to weighing imperfect data about the present and the future, and weighing costs and benefits of different policies as best we can given this imperfect data.
I’m a policy lawyer by trade so I do this kind of weighing of costs and benefits all the time in my day job. I’m not a medical professional so I give all due deference to medical professionals in interpreting medical data, where I have no expertise. But I am scientifically literate (I have a background in biology and cognitive science) and I can read scientific papers (I even write them sometimes, like this one and this one).
I can also, through my training as a policy lawyer, bring to bear the tools of my trade in helping to frame the right questions about tradeoffs of various policies to mitigate the coronavirus threat. All policies require looking at the costs and benefits, the pros and cons.
No goal should be pursued “at any cost” because we live in a complex society where everything is connected and any policy will have numerous effects, some foreseeable and some not foreseeable.
Currently, almost every U.S. state has imposed some variety of economic lockdown and extreme measures for social/physical distancing, accounting for 97% of the population in the U.S. We are now, collectively, debating whether the threat of the virus has been contained enough to warrant reopening in a phased manner, cautiously, intelligently.
Various countries around the world are already cautiously reopening their economies. Austria, Denmark, Germany, and even Spain, one of the hardest hit countries, are starting to reopen. Reopening schools is one of the first steps being taken in many places.
But some countries never even shut down, at least not much, Sweden and Japan being the most prominent examples. (More about Sweden below).
So what is the actual threat from coronavirus? And does the threat warrant the economic lockdowns and curbing of civil liberties imposed in the U.S. and around the world, which are effectively sledgehammers that risk killing the patient to cure it? It’s still too soon to make any definitive statements but we can look at data trends over time.
The death rate is steadily declining as more data comes in
A very encouraging trend is the steadily decreasing fatality rate. Early estimates pegged the fatality rate of covid19 at about 3.4%, scarily higher than the 0.1% fatality rate of the common flu in the U.S. These early figures got me, and just about everyone else who read them, very concerned about the threat of coronavirus.
However, a peer-reviewed study published in late March by a team out of Stanford found that the global “infection fatality rate” (IFR) was about 0.67%, based on available data at that time. This study and other data began to allay my worst fears considerably.
As more tests are performed the fatality rate goes down because there are larger numbers in the numerator that dilute the deaths occurring (“naive” fatality rate is calculated simply by dividing the deaths into the infection number). Germany, which has had some of the best testing rates, was at a fatality rate of just 0.74% by the end of March.
A more recent but not yet peer-reviewed study by the same team from Stanford, looking at Santa Clara County in California, found that the infection rate is probably 50 to 85 times higher than data from positive tests alone have found. The new study used what’s known as seroprevalence or antibody testing. When antibodies are found it shows that that person had the infection at some previous time. Normal coronavirus tests look for the virus itself rather than the antibodies.
These new seroprevalence numbers showing potentially much higher community infection rates are scary from one perspective, because they show that the virus may already be spreading far wider than thought. But it’s actually very good news, if the data is accurate, in terms of the highly important fatality rate.
This is the case because the “infection fatality rate” (IFR) is the number of infections divided by the fatalities. This is a different measure than the better-known “case fatality rate” (CFR) that divides those who test positive by the fatalities.
The pre-print Stanford study (Bendavid et al. 2020) just mentioned found that the IFR for Santa Clara County is only 0.1 to 0.2%, which is comparable to nationwide flu IFR numbers. Bendavid and his coauthors state:
These [antibody] prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50–85-fold more than the number of confirmed cases. … The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.
There is considerable debate already about the validity of these new findings, but everyone should agree that we need more studies on seroprevalence in order to find out how harmful the virus really is and how close we are to herd immunity — which is our best hope for community mitigation before a vaccine is developed and widely available.
Nature magazine ran a nice summary of the Stanford study and others like it that are ongoing, including studies by Germany and the World Health Organization.
And here’s a great critique (an informal peer review) of the Stanford study, highlighting some potentially serious problems with its methodology and thus its conclusions.
A similar interesting but inherently imperfect study from Massachusetts General Hospital, reported on by the Boston Globe, also not peer-reviewed yet, found almost 1/3 of a 200-person antibody survey had antibodies. Again, this is both good and bad — bad because it shows that the virus has spread widely in at least some places already; but good because it shows that perhaps the large majority of people who get it don’t even know they get it. And this, again, lowers the fatality rate of the virus to something more on par with seasonal flu.
Similar testing by Los Angeles County and the University of Southern California, also preliminary, yielded very similar numbers as in Santa Clara County, finding antibodies in about 40 times the number of people who had tested positive for the virus, and an Infection Fatality Rate of just 0.09% to 0.15%. This is about 40 times lower than the previous estimate of 4% — very goods news from a fatality rate perspective.
Another, again preliminary, study of New York state that came out in late April found that 14% of New Yorkers had antibodies and 21% of New York City residents had antibodies, continuing the clear trend of far greater community spread — but mostly without symptoms — than previously estimated.
A peer-reviewed study of New York City coronavirus hospitalizations found that fully 90% of those hospitalized had at least one, and in most cases, two co-morbidities. This means that the victims were already suffering some other major health issue, which either weakened them and made them vulnerable, or at least in some cases, may have been the true cause of hospitalization or death rather than the virus itself (it’s very difficult sometimes to tell what the actual cause of death is when there are many things wrong with a patient).
These data show a clear trend at this point toward far lower fatality rates than previously estimated, but also far greater community spread than previously estimated. This suggests that the virus is very contagious but not any more lethal than the seasonal flu. (I want to emphasize again a big asterisk to these data and these possible conclusions form the data, since they are still preliminary).
Sweden as a “control” group to compare scalpel policies to sledgehammer policies
Looking at Sweden and its policies more closely, it is a remarkable “control” for the grand global experiment being conducted on how to mitigate the risk of coronavirus. Sweden never imposed mandatory lockdowns except for social gatherings over 50 people and closing universities and secondary schools. Their infection rates and death rates have, remarkably, stayed within the European average.
Their infection rate is slowly declining in late April, as the figure below shows. But they are far from being out of the woods yet.
Sweden includes in its death rates all deaths that are associated with coronavirus, rather than only deaths thought to have been caused by the virus. This means that comparing Sweden to its peers with lower death rates isn’t a good apples to apples comparison because those neighbors include only deaths thought to have been caused primarily by the virus, rather than co-morbidities.
Johan Norberg, a Swedish fellow of the U.S.-based libertarian Cato Institute, states in a commentary on Sweden’s current state:
The Swedes who have died from the coronavirus did not die due to lack of hospital beds or ventilators. Thanks to a rapid increase in intensive care unit capacity, 20 percent of Sweden’s ICUs are unoccupied. Stockholm has built a new field hospital, already equipped to receive hundreds of COVID-19 patients, including 30 ICU beds. So far it has not had to open. The average age of the dead has been 81, which is close to our average life expectancy.
Thus far, it seems, Sweden’s mostly-voluntary “scalpel” policy model seems to be working as well as most other European nations, and it is likely that they will sooner achieve herd immunity under their policy approach than will mandatory lockdown nations. And they are not causing economic devastation in their attempts to mitigate the spread of the virus.
When should states start reopening?
All 50 states have made statements regarding their plans for reopening, summarized here. The White House has announced a 3-phase process to help guide each state in reopening, with Phase 1 reopening to occur after certain criteria are met, focusing on downward trajectories for 14 days in key metrics. Phase 1 opening calls for all vulnerable individuals to continue to shelter in place, continue physical distancing when in public, and don’t allow gatherings of more than 10 people.
Many states have their own criteria for a phased reopening, including two groups of Democratic states (one consisting of West Coast states and another of northeastern states) that have joined in regional cooperation to phase in a reopening.
Reopening should clearly be a state-level decision in most cases, and even a county-level decision in some cases like where I live, an isolated island county (Big Island of Hawaii). But coordination with closely-tied states makes a lot of sense given our interconnected world.
My hope is that now, with new infection rates leveling off and declining in almost every jurisdiction, we can collectively step back and reassess what happened, and start to cautiously, intelligently, reopen our economies.
So, what happened exactly?
In sum, we have reasonably good data now showing that the threat of coronavirus can be contained and managed without sledgehammer policies. Scalpel not sledgehammer policies should be the preference in most jurisdictions. The more data comes in the more the threat seems to be less than initially feared — in most areas. It is certainly the case that some areas, like New York and New Jersey, and Italy, were hit very hard. And more draconian policies may have been justified in those areas.
But most areas have not been hit that hard and we have good reason to believe that we could have flattened the curve with far less draconian policies in most areas.
Why has the global Left rushed to embrace draconian policies that they would have abhorred if imposed by governments against other threats, like the threat of terrorism, for example?
It seems to me this is happening because medical professionals and many scientists are recommending such draconian measures, and the Left is going along placidly for the most part because of a misperception that science is a kind of monolithic source of unerring truth. And also because of a misapplication of the Precautionary Principle, which is so-named because of the preference for taking precautionary action in the face of imperfect evidence.
The unfortunate fact is that science is not unerring and scientists make mistakes — but hopefully such mistakes are corrected as new data arrives, and that’s always been the practice of good scientists. Scientists also don’t always consider the full range of implications of proposed policies when they’re asked to help make public policy. The Precautionary Principle applies to actions taken as well as to actions not taken. And in this way it becomes basically the same as the Hippocratic Oath applied society-wide: “First, do no harm.”
Franklin got it right: We shouldn’t be so quick to give up essential liberties for temporary safety — particularly when authoritarians in our country and around the world are so quick to pounce on perceived fears and exploit them.
And when the harm caused by knee-jerk responses to the perceived threat from the virus are so large (increased starvation, massive unemployment, bankruptcies, increases in heart disease, cancer, depression, suicide, domestic abuse, etc.) it is even more important to think clearly about appropriate policy solutions. Unfortunately, too many of our leaders in the U.S. — mostly Democratic governors at this time — have quickly opted for extreme lockdown policies, and much of the country is now paying the price.
