Incarnadine
The Mirror & the Light

The Basic Question of the Moment

I feel as if the most basic question of our worldwide moment remains unclear.  And how one answers that basic question implies radically different behaviors.

That basic question is:  Is the coronavirus an infection we should all/most anticipate getting at some point or is it an infection that can be avoided?

Back in February I read that Atlantic article that said option A, which has been my underlying assumption all along.  But it became obvious in April that many people were under the impression that number two was true.  In recent weeks I've seen very little that clarifies this basic question, and even the public health experts I've asked have largely been unable to answer it satisfactorily.

Let's call Option A the one where everyone or most everyone can expect to be infected.  That means this is largely an event in the natural history of our species that we have to get through.  Five percent of humanity may die.  A significant number will be seriously ill, some with lasting lifetime effects.  While a large percentage (according to the best data currently available) will have no or few symptoms.

Back in the first quarter of the year you read and heard debate about two approaches to Option A--either spike early and get it over with or flatten the curve so the medical system doesn't crash and has time to prepare.  Most nations chose the latter public health approach.

On Option A the purpose of the public health measures is to manage the crisis.  Manage it so we can prepare.  Or so health systems don't crash.  Or to try to delay most infections until a time we have a better treatment or better yet develop a vaccine.  Or try to manage so that the most vulnerable aren't impacted unjustly. 

On Option A  the recent lockdowns could be understood as temporary measures in order to prepare the health care system for the inevitable and are not justified once those preparations are in place.  Or another version of Option A is that they are justified until treatment is available.  But a common feature of Option A is the measures must be weighed significantly with other factors.

On Option B the purpose of the public health measures is to avoid getting the virus all together.  So the lockdowns would be justified in being longer.

A goal of Option B would be to keep as many people alive a possible.  That might also be a goal of Option A, but with the larger goal of maintaining a social order that can see us through a horrible event.

The two options suggest different behaviors as well, at least for some.  For example, if you can avoid the virus all together (Option B), and particularly if you are vulnerable, then you should minimize your risk. 

But, if you can't avoid the virus and will eventually get it no matter what you do unless you live permanently as a hermit (Option A), then you might engage in more risk.  Some might go so far as to try to get it and get past the crisis, some of those because they are taking the chance of being in the large percentage that is asymptomatic and some for other reasons.   Some might conclude that if they have a good chance of getting sick and dying, then they will want to enjoy their life and not be stuck at home.  I've had a 95 year old say as much to me acknowledging that they don't have that much longer to live regardless.

In some of the classic pandemic literature you see that the worse the crisis became that  some people began to live more openly, enjoying life precisely because the times were grim and there was risk that they would not survive.

Of course, even on Option A, some will try to hold off on running the risks of being exposed till a better treatment is available. 

Note: John Rawls developed the veil of ignorance to be a thought experiment, but here we are in a real life version.

On Option B many normal social functions would be curtailed for a longer period of time.  On Option A they would not, as they would be needed to help through the crisis.  On Option A  you will want more social solidarity in order to help with the care and grieving.  For example, I think of my institution--the church.  If a great deal of illness and death is inevitable, then you will want the church engaging in all of its functions of care and support and performing its rituals of grief and consolation.  

Another example, some of the leading choral music organizations last week recommended that choral singing largely be avoided until this is a vaccine in order to minimize infection.  But that approach only makes sense if you are confident that Option B is correct.  If Option A is correct, then singing together will be an important part of human solidarity helping the grieving through the crisis.

On Option A you will want to do your best to try to minimize the other traumas and disruptions (including but not only economic) brought about by the virus.  Whereas on Option B you will tolerate more disruption to society.

On Option B you would trade even some long term damages to society, the economy, child development, mental health, other health factors, etc. in order to minimize the death toll.  Whereas on Option A you would want to minimize all those long term damages in order to help humanity to more quickly recover from the horror of the crisis.

So, it really seems that this most basic question is the uncertainty we most need to figure out if we are to know collectively what we are to do and individually what risks we should take.

Comments

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bud cassiday

I certainly do not have a ready answer, but a couple of issues come to mind that you might factor in. We do not have an scarcity of resources, but they are distributed vastly unequally. A drastic reallocation of resources would help factors of 10 more people than it hurt. Another is that time MAY be an ally, that is, in time an effective treatment may be developed, so the the severity of the complex illness and/or death toll may be reduced than if we all decided to get infected at covid-19 parties. Or better yet, a safe and effective vaccine. A fb friend says more knowledge about the disease may make it safer for people to be infected later rather than sooner due to better treatments and drugs. Dying is most certainly more difficult than not having college football in the fall.

Scott Jones

One thing to make clear. I don't think A or B is a choice. It is a fact, just one we haven't discovered yet.

Deb Kirwan offered that there are three options, and I think she is correct, so I will need to revise my analysis.

Option A would be that infection is inevitable for most/all and that no effective treatment or vaccine is developed in a timely manner.

Option B would be that infection was inevitable except that we do develop an effective vaccine or treatment in a timely fashion.

Option C would be that infections can be avoided for the majority of people with proper health measures.

Though A and B share a fact about the virus in common, B and C are closer to one another in what measures they justify.

Option C does have some difficulty in how to conceptualize however. One possibility is that we permanently change the way we live, thus avoiding everyone getting infected. Another would be that the virus peters out for some reason. Another might have been that we had successfully contained it early on.

Of note: In March while I was operating under the assumption of inevitability, I was at least holding out hope for the most optimistic versions of C--that it wouldn't end up being as big a factor and the public health measures would only be short term either because we did contain it or it petered out like SARS.

So, I now wonder if the key question is not actually a fact about the virus. Maybe the key question is "Can we develop an effective treatment or vaccine in timely fashion?" Deb suggested this as well.

Which, if so, is an even more difficult question because it can only be answered in time and we will only know what was right with hindsight.

Scott Jones

I had been contemplating trying to write something up to clarify the various possibilities conceptually, and reading this article today finally spurred me to do that:

https://www.theatlantic.com/ideas/archive/2020/05/take-shutdown-skeptics-seriously/611419/?fbclid=IwAR1mLESxxDRjfvm6bHrSrAwEn7HrrcnVJSgHQeS2-1mT8NrPhEXluOLcLPw

Regarding the lockdown critics, many are morally inarticulate even when they do have a reasonable point they could be making.

Scott Jones

Even if we revise the question to the one above about a vaccine in a timely fashion, it still seems that for each individual a basic question remains--Is this virus something I should expect to have at some point or expect to avoid? I know when I talk to people I get interestingly different answers to that. Some I talk to all assume they will have it at some point or already have. While others seem shocked by the very notion. How you answer that does affect what choices you will make.

Scott Jones

Listening to this podcast to learn more about the issues with singing. Dr. Amesh Adalja of Johns Hopkins basically identifies that we are dealing with Option A.

Scott Jones

I forgot the link: https://www.youtube.com/watch?v=tGzh4r5qxTw&feature=emb_title

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