Some Common Sense, I hope, About the Covid-19 Crisis

Over the past weeks, I've come to the conclusion that we aren't asking the right questions about this and are looking for answers in the wrong places. I apologize that this might be a little long and I hope that you will find it worth your time to read it. I also apologize if I come across as harsh or unfeeling. Please hold your judgment until you've heard me out.

The gist of this, upfront, is that we need to think of this in terms of unavoidable trade-offs, not absolutes ... and that the answers are likely to come from ethicists, not economists, or scientists, and certainly not from politicians. Economists, scientists, and politicians, of course, have a hugely important role to play in refining the terms of the calculus, executing the conclusions, and leading adherence to appropriate courses of action, but the actual answers to the trade-offs are not in their realms.

Let's begin with the dimensions of the problem. As of this writing, the total number of confirmed infections, worldwide, is about 300,000 and reported deaths attributable to the disease are under 30,000. Everyone understands that these numbers will get much worse, in absolute terms, but until we know the size of the denominator (actual total infections), we can't really evaluate the relative impact of the numerator (total related deaths). The world's total population is more than 7Billion. These Covid numbers may turn out to be small or very large in that immense context. We just don't know.

Whatever the total number of deaths turns out to be, the loss to family, friends, ultimately to all of us, is tragic. But, also ultimately, death does come to all of us, at some point. We can't erase the fact of death. Thus, we can't really establish as our goal reducing the numerator of this Covid ratio to zero; some of these deaths would occur...sooner or later...anyway. Instead the objective should be to gather and interpret robust data to produce ratios (deaths over infections over the total population) that we are prepared to tolerate.

Next, let's be realistic about the notion of "flattening the curve". I may have missed an important element here, but this seems to be not mostly about reducing the total number of infections (the total area under the curve), but rather about reducing the height of the curve's apex so that the pace of infections at any one time does not overwhelm the existing health care infrastructure. That, by itself, is a very worthwhile goal. The consequence of this, however, is to elongate the duration of the period during which those same total number of infections occur. That, in turn elongates the period of other costs.

I'm now venturing far out on the limb by invoking the ancient notion of medical triage...making often instantaneous judgments about which persons should receive the benefit of medical attention. Not everyone has the same likelihood of recovery, however much of the finite health care resources may be devoted to them. Rationing is an unavoidable response even in contemporary emergency room care. The Covid pandemic just raises triage's profile. Again, we can't establish the erasure of death as the standard.

Thus, I think the core issue is one of trade-offs. We do them everyday in every conceivable decision process, usually without even adverting to that thought process. Here, the trade-offs are especially dramatic, and especially unavoidable. At what cost to human economic and social behavior are we willing to achieve some benefit in reduced or more easily paced infections?

Consider this thought experiment: If the issue were not just about the shape of the curve, but ultimately about its area and if we could reduce total infections to zero by reducing all human economic and social behavior to zero, would we do it? Of course not. Within days, in any modern, urban environment, everyone would starve ... on their way to becoming completely impoverished. Those (few) in more rural environments, closer to food sources, might last a little longer. But the fragile civilization compact would unravel even faster as uncontrollable civil unrest and violence would take many lives before starvation took the rest. So, zero is not the answer. Having everyone die is not a good trade-off for hypothetically saving some.

I'm making the following numbers up, of course, but the directional relationships must apply. If we permitted 100% of pre-crisis economic and social behavior to continue, let's say there might be 50 million deaths worldwide: a horrifying number. If we cut back to 75% of pre-crisis activity, the loss of life might be 10 million; if 50%, 3 million; if 25%, maybe just 500,000. What is the right answer, then, between zero and 100%?

Economists and scientists can refine the values of the costs and benefits that go into this calculus; and they should; they must. We need their insights and expertise to reduce the costs and increase the benefits as much as possible. But in no case are the costs zero and the benefits infinite. Politicians are especially prone to engage in that error. However refined the values of these terms are, the right answer about their trade-off is in the realm of moral leadership: religious leaders, ethicists, and philosophers. In a very important sense, all of us have a stake in arriving at this conclusion as we acknowledge that there are few if any absolutes, only relatives.

So, as a first step, require politicians to avoid the illusion of absolutes and insist on their recognition of costly (maybe too costly) benefits. Next celebrate the prospect of human ingenuity to reduce those costs and increase those benefits, whether that ingenuity is driven by altruism or by the profit motive. Right now, I don't think we need Nobel prize worthy achievements as much as we need speedy economic workarounds and new and enhanced disease therapies in both cases motivated by the prospect of vast fortunes. Lastly, acknowledging my willingness to accept risk, generally, I venture my own relative conclusion: we are currently headed in a direction of far too much cost for the benefit we can reasonably expect. I believe we need to move the economic and social behavior meter up some notches closer to where we were only some weeks ago.

Thanks for reading me to the end.