Quotes & Commentary #77: Camus

Quotes & Commentary #77: Camus

Really, however, it is doubtful if this could be called a victory. All that could be said was that the disease seemed to be leaving as unaccountably as it had come. Our strategy had not changed, but whereas yesterday it had obviously failed, today it seemed triumphant.

—Albert Camus

We humans are vulnerable to a variety of cognitive illusions, not the least of which is the illusion of control. The idea that an event is completely out of our control is extremely difficult for us to accept, apparently; and so our brain tricks us into thinking that we are the ones pushing the buttons. This can take many benign and amusing forms. For example, many of us repeatedly push the call elevator button or the crosswalk signal while waiting, with the idea that we can somehow speed it up. Or we leave the pit of an avocado in some guacamole, thinking we can prevent it from going bad. 

This behavior often leads to superstitions, especially in situations when chance plays a major role. For example, baseball is notorious for the great many superstitions which abound, as players recruit supernatural intervention to reduce the role of chance. Fundamentally, these superstitions all make the mistake of confusing correlation for causation. So if a batter eats sixteen carrots and then hits a home run, he may conclude that the home run was due to the carrots.

And this process can take place on a societal scale. The classic example is, perhaps, the rain dance—an attempt to control weather patterns through ritual. Indeed, the idea that humans can influence the natural order through carefully prescripted and repeated gestures is arguably one of the psychological roots of religion. 

The reason that I am bringing all of this up is that I believe we can observe this process quite clearly in our response to the coronavirus. All of us badly want to feel as though we can control the spread of the virus, and this has led to some sensible and, I suspect, some far less sensible solutions. I have observed several people in my neighborhood who put little bags on their dogs’ feet. Only slightly less ridiculous are the shoe disinfectant mats being sold online. Even the practice of wiping down our groceries with bleach strikes me as more ritualistic than sensible. 

Indeed, considering that we can get the virus just from breathing in particles, then all this trouble to disinfect surfaces does seem rather suspect to me. I cannot help thinking that, by the time you touch an infected surface, you will have breathed in the virus ten times before. (And by the time you get it from your dog’s paws, you will have gotten it one hundred times before.)

Just as in superstition, irrational virus precautions can take place on a societal as well as an individual scale. The most notorious example of this I have seen was the bleaching of a Spanish beach, in the coastal town of Zahara de los Atunes. While undoubtedly causing significant environmental damage, the benefits to coronavirus control seem doubtful in the extreme. As another doubtful measure, I would offer Governor Cuomo’s decision to disinfect New York City’s subway system every night. Again, if the virus can be breathed in, then the threat from contaminated surfaces may be entirely redundant.

More generally, I think it is fair to say that we do not completely understand the pattern of coronavirus spread. A few days after announcing the nightly subway cleaning—a massive and expensive effort, which displaces the homeless and may impede some people’s commutes—Cuomo announced the results of a study on 600 people who were diagnosed with the virus in a hospital. He was surprised to find that only 4% had used public transportation. The large majority were not working. This result is puzzling. If mere exposure to the virus was enough, then one would expect the essential workers—especially those on public transport—to constitute a far larger portion of cases, since they come into contact with far more people.

Perhaps we have overestimated the importance of mere exposure, then, and underestimated the importance of “viral dose.” (Please keep in mind that I am in no way an expert, and this is pure speculation on my part!) This means that a long amount of time spent with one infected person could matter more than a passing proximity with several. If this is the case, then forcing people to stay in their homes, even if they have symptoms (which was the policy here in Spain), may be somewhat counterproductive, since it would increase the viral dosage of any co-residents.

This would also mean that prohibitions on outdoor exercise were not sensible. Indeed, over two weeks after finally letting children go outside in Spain, no noticeable uptick has been observed (despite complaints that people were not maintaining the correct distance). Other evidence points in this direction as well. This Chinese study could only find one single case of an outdoor transmission, and instead found that the vast majority of outbreaks took place inside the home.

Globally, the data also seems to indicate that we do not fully understand the relevant variables. The virus seems to be striking some countries hard while leaving others mostly untouched, in a pattern that is not easily explained either with governmental action or weather. The case of Spain and Portugal seems especially baffling, as Spain’s small neighbor has so far suffered five times fewer fatalities per habitant as Spain. And this, in spite of never having imposed mandatory stay-at-home orders or closing all non-essential businesses. Though Portugal is given credit for acting early, the two countries entered into a state of alarm at about the same time, closing schools and restaurants the same week. Yet the contrast is striking. 

If we are going to effectively combat this virus, then I think this means doing our best to resist the illusion of control. This is because the cognitive illusion blinds us to the real effectiveness of our strategies. If we embark on a maximal strategy—doing everything we can think of to stop the virus—and the virus indeed abates, we may conclude that it takes a maximal strategy to beat the virus. But in that case, we may end up like the carrot-eating batter, drawing false conclusions from a mere correlation. And since so many individual measures are rolled into a maximal strategy, we remain in the dark as to which specific measures are the most helpful, which are basically useless, and which are counterproductive.

This information is vital if we are to achieve anything resembling a functional economy. Our goal should be to uncover which measures have the lowest cost-benefit ratio—inexpensive and minimally inconvenient strategies which effectively curb the virus. If indeed masks work, then widespread mask usage would be such a strategy, since they do not significantly disrupt normal life and cost mere pennies to produce. If it is not too late, increased security measures for senior care homes would be another such strategy, since age is a major risk factor.

Perhaps the easiest way to determine such measures would be surveys. Governor Cuomo has already demonstrated the knowledge that can be gained by surveying incoming hospital patients. Indeed, we probably should have been doing so from the beginning, allowing a more detailed picture to emerge of which activities tend to increase risk. Widespread serological testing for antibody prevalence can also be easily supplemented with detailed surveys. With any luck, certain patterns will emerge from this data, which will point us in the right direction.

Another way to find out more about how and where the virus spreads would be to turn our testing capacity away from patient diagnosis and towards investigative studies. This would mean testing representative samples from relevant populations, to ascertain the prevalence of the virus in different areas and professions. Such testing may reveal useful patterns in the virus’s spread. Contact tracing—once we have the ability to do so—can be similarly used as an investigative tool.

But as it stands now, I often get the impression that officials (here in Spain at least) are like a blindfolded boxer, swinging left and right hopping to connect with the target. The result is rather incoherent. For example, when people were finally allowed outside to walk and run, the officials decided to impose time constraints for these activities. I am not sure what they hoped to gain from this. But the result has been that everyone rushes out the door as soon as the clock strikes, and the streets are consequently packed.

Adding to this, officials decided not to open the parks, so there is less space for walking. To compensate, they tried converting several roads in the city into pedestrian zones. But I cannot help wondering: how is a pedestrian zone any safer than a park? Last weekend we were treated to the absurd spectacle of joggers squeezed into a narrow, tapped-off zone, jogging in one big circle around Madrid’s Retiro park, which remained closed. 

Such policy mistakes are harmless enough, I suppose. But I think we need to be very wary of what this blind swinging can lead to. Traumatic events can provoke a panicked response that can do more damage than the threat we are trying to avoid. America’s last traumatic event—the September 11th attacks—provoked some very sensible changes, like increased airport security, but also set off a series of interventionist wars that cost far more lives than the original attacks themselves. Such wars seem rather absurd to many of us now; but at the time, when the threat of terrorism seemed to overshadow every other consideration, we were willing to react with a maximal strategy.

Does this crisis present us with a similar danger? I think it may. And if so, we need to do our best to avoid the coronavirus equivalent of an Iraq War, and focus on finding strategies equivalent to bomb screenings and reinforced cockpit doors—easy, cheap interventions that can save lives, rather than a giant quagmire that only adds another problem on top of the one we already have. If we are the blindfolded boxer, we need to focus on removing the blindfold, rather than swinging as hard as we can.

Quotes & Commentary #76: Thucydides

Quotes & Commentary #76: Thucydides

Reckless audacity came to be considered the courage of a loyal ally; prudent hesitation, specious cowardice; moderation was held to be a cloak for unmanliness; ability to see all sides of a question inaptness to act on any. The advocate of extreme measures was always trustworthy; his opponent a man to be suspected.

—Thucydides

In my previous post I bemoaned the conversion of a public health crisis into yet another partisan fight—with those on the left for the lockdown, and those on the right against it. In this regard, I think it is striking to reread this passage of Thucydides, as it encapsulates a common occurrence in times of crisis: the preference for extreme measures over moderation, for decisiveness over prudent hesitation.

The reason for this is our very human need to feel safe and secure. Having a plan, especially a drastic plan, is one of the ways we accomplish this. Carrying out extreme measures at least gives us the illusion of control; and control is what everyone craves in an emergency. But I do not think we should let this very human need prevent us from being critical, open-minded, and moderate. These are good qualities in the worst of times as well as in the best of times.

My main concern is that I think that too many people—especially on the left—are advocating long, strict lockdowns as the only possible option. Calls to reopen are being dismissed as irresponsible or even nefarious, and respected epidemiologists like David Katz (who advocates more measured policies) can only get a hearing on Fox News and Bill Maher’s show. This makes me worry that the left is backing itself into an ideological corner, insisting that lockdowns are the only way to fight this virus.

There is certainly a noble impulse in this: valuing human life over profit. But I think that the situation is far more complex than this dichotomy implies. A narrative is starting to emerge that it is our evil corporate overlords (Elon Musk, most notoriously) who want us to return to work in order to satisfy their greed. Already in Georgia, people are compiling lists of businesses which are reopening with the intention of blacklisting them for doing so. But are we really willing to vilify people for reopening when remaining closed would mean bankruptcy, financial ruin, and losing their livelihoods? The anti-corporate, pro-lockdown messaging is ignoring the simple truth that the economic effects of the lockdowns will hurt the poor far, far more than they will hurt the rich. 

Granted, we could and should be doing much more to help the poor and disadvantaged during this time. Also granted, our economy was rife with structural inequalities before all of this, which ought not to have been there to begin with. But we must work with the economy we have and with the options that are politically possible—not with the economy we should’ve had and the things we should be able to do. And we also must be sure that our policies are shaped by prudence rather than fear or ideology.

So here is my worry: if the left (of which I consider myself a member) becomes the party of lockdowns, this may not appear so wise in retrospect. This is because the efficacy of our anti-virus measures is still very much an open question; and it is thus very possible that some of our policies will have done more harm than good.

As a prime contender for this, I would submit school closures. As I noted in my previous post, young children seem both safe from, and hardly able to transmit, the virus. The idea that they were major transmitters was an educated guess, and it seems to have been wrong. Keeping children out of school, however, will undoubtedly be harmful to their development and detrimental to their futures. And it will most certainly do the most harm to the poorest among us. Furthermore, keeping children home puts more pressure on parents, and may take some doctors and nurses out of commission.

At the very least, I think it is wrong to close schools in a “better safe than sorry” mentality, without very thorough consideration of the costs and benefits. As a teacher myself, I can say with confidence that virtual learning is no substitute for being in the classroom. If my students must miss class, I want to be sure that it is to protect them, and not simply to make us feel safer. I am not willing to sacrifice their education to satisfy my panic.

Here is the trouble with a total lockdown: it combines so many different measures into one sweeping global approach that we have no opportunity to see which specific parts of the lockdown—closing restaurants, canceling concerts, calling off school—have the highest cost-benefit ratio. It simply cannot be taken for granted that a total lockdown is the single best strategy going forward. In the absence of more data about the virus’s lethality and total spread, we cannot even be confident that it was even a wise strategy to begin with. (A study by the Wall Street Journal—which admittedly has its own biases—found that there was no correlation at all between coronavirus mortality and the speed of lockdown in U.S. states.)

The case of Sweden should give lockdown advocates pause. Sweden has become notorious for its lax coronavirus measures. Shops and restaurants are open, and life carries on without masks or gloves. Meanwhile, most other European countries instituted strict lockdowns. Spain had one of the strictest lockdowns of all. Parks were closed, and people were not allowed to go on walks or to exercise outside. All non-essential businesses were shuttered, and people could only leave the house to go to the pharmacy and the supermarket. Police patrolled the streets, giving out hundreds of thousands of fines, and making hundreds of arrests, in enforcement of the lockdown.

If lockdowns were really an effective way of controlling the virus, then one might expect Spain to have a substantially lower death rate. On the contrary, Spain has suffered twice as many deaths-per-million as Sweden. Indeed, Sweden is in the ballpark of Ireland and Switzerland, two countries that took swift, decisive action to shut down their economies. And Sweden’s “curve” seems to be leveling out anyway. To say the very least, it has not been an unmitigated disaster in the country. 

Admittedly, if you compare Sweden to its Scandinavian neighbors, Finland and Norway, you can see that their lax policy seems to have resulted in a higher mortality rate. Does this prove that Sweden has taken the wrong course? I think we should not rush to judgment. First, it is easily possible that, as Finland and Norway open up, their death rates will climb to approach Sweden’s. Furthermore, by minimizing the damage done to their economy, there is a very real possibility that Sweden inflicted less total harm on its society.

(We also should not rush to declare New Zealand’s tough policies a success, which for the moment seems to have eliminated coronavirus from their shores. While this is impressive, it remains to be seen whether this was the best strategy for the long-term, since it is possible that it will only make it that much more difficult to reestablish open channels with the outside world.)

My own personal fear—which apparently is not shared by many—is that the left will put itself in a bad position if it becomes the party of the lockdown. At the present moment, there is an awful lot of fear of this new virus. But in six months, when the elections roll around, what will be at the forefront of people’s minds: the virus, or the economic depression?

My guess is that, as time goes by, fear of the virus will fade, and concern for ruined businesses, blasted retirement accounts, and lost careers will only grow more acute. So far, it seems that Republicans have shifted most decisively in the direction of economic concern, with Independents shifting somewhat in that direction, while Democrats have hardly budged.

Such flagrantly political concerns should not guide our policy. Concern for human welfare should. And I am afraid that we may be developing myopic and unrealistic ideas about the lockdowns in this regard. First, somewhere along the line, many people seemed to have forgotten that our original idea of “flattening the curve” was to prevent the healthcare system from being overwhelmed. The idea was never that we would absolutely prevent people from getting sick. Unless we are willing to stay inside until a vaccine is widely available—an unknown timeline, but still many months away—we are simply going to have to accept some risk from the virus.

Now, perhaps some rich countries could afford to stay shut up indoors until we have a vaccine. And maybe this would benefit these rich countries (though I doubt it). However, I think such a prolonged and severe period of economic inactivity would be horrendous for poorer countries. Telling people to stay inside is simply not feasible where people live in shacks and have no savings. And governments in poor countries could not afford drastic social policies to keep their people fed, especially during a severe depression. (Remember that a depression in richer countries means a depression everywhere.) A months-long lockdown could easily result in food shortages in many parts of the world, which might claim significantly more lives than the virus itself. 

What is more, prolonged economic depression has serious political repercussions. Economic instability easily translates into political instability, and political instability easily translates into violence—even war. The 2008 financial crisis has already had an awful effect on worldwide politics, eventually resulting in waves of populist right-wing parties, and a growing polarization which has resulted in increasingly dysfunctional governments. And this is only to speak of rich countries.

In countries already struggling with low standards of living and ineffective governments, what will be the results of an economic crisis much more severe than 2008? Will every government be able to take the pressure? We must keep in mind that, if any government fails, the consequences will be bad for everyone. As we have learned, power vacuums leave the door open for the most dangerous among us to gain control.

For those of us on the left, I think it behooves us to examine the complete picture, and not to fall into easy rhetoric about workers being sacrificed for the economy. These are the hard facts: the virus is here to stay; and if the economy is not working, it will be very, very hard on millions of people—especially poor people all around the world. Our governments could and should do more to alleviate the economic suffering. But many countries around the world simply do not have the resources to do so, and a severe depression will only make this more true. Of all people, we on the left should know that poverty hurts and kills, and we cannot afford to turn this into yet another purity test.

The hardest truth of all, perhaps, is that we are in a horrible situation that requires us to make painful compromises. An ideology that promises easy answers and readily-identifiable villains will not get us very far.

Quotes and Commentary #75: Franklin

Quotes and Commentary #75: Franklin

So convenient a thing is it to be a reasonable creature, since it enables one to find or make a reason for everything one has a mind to do.

—Benjamin Franklin

Our brain has an astounding ability to formulate justifications for believing things that we want to believe. As I have already remarked, the current pandemic—a major historical event—seems to have changed nobody’s mind. Socialists are calling for universal healthcare, capitalists are calling for corporate bailouts, and in general the old battle political lines are as strong as ever.

Indeed, at a time one might expect people to turn towards experts, I have observed some even embracing—of all things!—anti-vaccination. Really, if a pandemic cannot convince somebody that viruses really do cause disease and that we ought to prepare for them, then I do not see much hope for reasoned debate.

Considering that our collective response to a novel virus has somehow turned into a partisan fight, then I do think there is ample reason to suspect that many of us are not reacting rationally. And there are powerful emotional reasons for this. Specifically, I think that we have been impaled on the twins horns of fear and foolhardiness.

A part of our brains is terrified of contagion and disease, while another part is prone to wishful thinking. And it seems that these two emotional reactions are coming to dominate the two sides of the political spectrum: the left is fearful, while the right is foolhardy. The problem is that I think both emotions lead to irrational and unsustainable responses.

Giving into fear means embracing long and even indefinite lockdowns. Better to be safe at home than putting oneself and others outside at risk. And of course this is not wholly unreasonable: the coronavirus is real, and it has taken lives. My concern is that the original justification for the lockdowns is being forgotten. The idea of “flattening the curve” was to prevent our healthcare systems from being overwhelmed, which was a real danger in places like Madrid and New York City. The idea was that, if we flatten the curve, we will save lives—not by reducing the total number of infections, but by spreading out the infections so our healthcare system could handle them.

But somehow this thinking got lost, and I am afraid that there are many who think we can somehow eliminate the virus altogether by staying inside. The virus will be there, waiting, whenever we leave our homes. A virus has no timeline and infinite patience. So unless we are willing to wait until a vaccine has been invented, mass-produced, and widely distributed—which will be such a long time that it could cause unprecedented economic harm—then the only reason to wait, as far as I can see, is to make sure our hospitals will be able to handle the influx of patients. In places where the healthcare system is not nearly at maximum capacity, I do not see what would be gained by an extra month of waiting inside, other than allowing people to feel safe a little longer.

Demanding long, strict lockdowns even in areas where the virus is not widespread strikes me as a response motivated primarily by fear. And the problem with fear is that it gives you tunnel-vision, focusing all your attention on the source of danger, and reorienting all of your priorities around the new threat. This can lead to some obviously irrational behavior—in nearly all of us.

For example, a person may refuse to walk across a bridge because of his fear of heights, but may smoke cigarettes and drink heavily (much more serious risk factors for health) on a regular basis. Collectively we may focus frantic attention on a mining disaster that kills dozens—launching inquiries and investigations and instituting reforms—while we completely ignore hospital-acquired infections, which kill tens of thousands year after year. The human brain is wired to respond to immediate threats, and especially the kinds of threats (like violence and disease) that shaped our evolution. Much more serious threats, which kill through slower and less spectacular means, are easier to ignore. (Global warming is probably the best example of this.) 

The problem with our great fear of the virus is that I think it may cause us to neglect the costs of our containment measures. The success of a country’s policies cannot be measured in the number of its coronavirus cases and deaths alone. A profound and prolonged economic depression will both reduce lifespans and, directly and indirectly, also cause deaths. But the suffering caused by the depression will be slower, longer, less spectacular, and thus less scary. However, such damage is just as real, and it is just as much a consequence of our policies.

As I have argued before, a truly moral response to the crisis requires that we try to reduce harm as much as possible, all across the board. Fearfully focusing our attention exclusively on the coronavirus will lead us to be not only irrational, then, but potentially immoral.

Let me give a concrete example of this. From what I can tell, there is a growing amount of evidence that young children are in negligible danger from the virus. Moreover, according to this study performed in Australia, children are apparently not even a significant source of contagion. Indeed, in Switzerland they are apparently confident enough that children do not pose a danger that they have given young kids permission to hug their grandparents.

If it is true that children neither pose nor suffer a significant risk, then that would make many of our school closures questionable at best. In Spain, for example, schools will not reopen until the fall. But keeping kids out of school does serious, lasting harm to them—harm that disproportionately falls on poorer students, and harm that must also be taken into account when we make policies. (Also, Spain’s policy of keeping children confined in their homes for 6 weeks also seems hard to justify in this light.)

My point is not to advocate for school reopenings, per se (though it does seem reasonable to me), but to make the more general point that the current environment of fear makes even a rational discussion about school closures impossible. Instead of balancing the risks and rewards to students, many on the left seem to instinctively dismiss such conversations as frivolous and irresponsible. I do not think this is a productive mindset.

The mirror image of fear is foolhardiness, and I can sense it taking hold in certain sections of the right. We see it most clearly in the demonstrations in front of state capitals, in which participants deliberately flout safety guidelines in order to demand an economic reopening, often for pretty superficial reasons (like a haircut). It seems that many people still believe that the virus is not a significant threat and does not require any special action. But judging from what happened both here in Madrid and in my own state of New York, I think there is ample evidence that this virus is, minimally, a significantly greater threat than the seasonal flu. A policy of “do-nothing” is clearly inadequate when bodies are outstripping coffin-production and morgue capacity.

Foolhardiness also leads to another kind of cognitive blindness: wishful thinking. We all have the tendency to grasp at any data which supports our hoped-for conclusions. We can see this at work in a viral video of a certain Dr. Daniel Erickson (since removed from YouTube), who claimed that the data showed that coronavirus was, in fact, already widespread and far less deadly than the flu. But his argument was a product of wishful thinking, and rested on a basic error of statistics—extrapolating from a non-representative sample.

Erickson used our current coronavirus test records to extrapolate to the entire population. This does not take into account the obvious fact that most testing is done on people who are sick or who otherwise suspect they may have the virus. Our testing records, then, will obviously show much higher rates of coronavirus than the general population. Extrapolating from this data is simply nonsense. However, this video gained traction in rightwing circles and was even used on Fox News to argue against the lockdown.

A rational and moral response will be neither fearful nor foolhardy, but will take measures to minimize the total harm to society—both from the virus and the economic downturn. This is easier said than done, of course, especially in the world of politics. Personally, I think this is the ideal time to try out something like Universal Basic Income, which I think would ease the economic pressure and also give us more flexibility in combating the virus. But sadly this does not seem likely.

Given the real possibilities, then, I think that it is our obligation to cut the best path we can through both fear and foolhardiness, balancing the risk posed by the virus against the risk posed by a major economic depression. This means that we cannot let our fear of the virus be the only factor we consider; but we also cannot let wishful thinking cloud our judgment.

Acting rationally means fighting against the universal human tendency to give in to our hopes and fears. Both hope and fear, in different ways, distort the real danger.

Quotes & Commentary #74: Kahneman

Quotes & Commentary #74: Kahneman

We are prone to overestimate how much we understand about the world and underestimate the role of chance.

—Daniel Kahneman

Kahneman’s book, Thinking, Fast and Slow is one of the most subtly disturbing books that I have ever read. This is due to Kahneman’s ability to undermine our delusions. The book is one long demonstration that we are not nearly as clever as we think we are. Not only that, but the architecture of our brains makes us blind to our own blindness. We commit systematic cognitive errors repeatedly without ever suspecting that we do so. We make a travesty of rationality while considering ourselves the most reasonable of creatures.

As Kahneman repeatedly demonstrates, we are particularly bad when it comes to statistical information: distributions, tendencies, randomness. Our brains seem unable to come to terms with chance. Kahneman gives the example of the “hot hand” illusion in basketball—when we believe a player is more likely to make the next shot after making the last one—as an example of our insistence on projecting tendencies onto random sets of data. Another example is from history. Looking at the bombed-out areas of their city, Londers began to suspect that the German Luftwaffe was deliberately sparing certain sections of the city for some unknown reason. However, mathematical analysis revealed that the bombing pattern was consistent with randomness.

The fundamental error we humans commit is a refusal to see chance. Chance, for our brains, is not an explanation at all, but rather something to be explained. We want to see a cause—a reason why something is the way it is. We do this automatically. When we see videos of animals, we automatically attribute to them human emotions and motivations. Even when we talk about inanimate things like genes and computers, we cannot help using causal language. We say genes “want” to reproduce, or a computer “is trying” to do such and such. 

A straightforward consequence of this tendency is our tendency to see ourselves as “in control” of random outcomes. The best example of this may be the humble lottery ticket. Even though the chance of winning the lottery is necessarily equal for any given number, people are more likely to buy a ticket when they can pick their own number. This is because of the illusion that some numbers are “luckier” than others, or that there is a skill involved in choosing a number. This is called the ‘illusion of control,’ and it is pervasive. Just as we humans cannot help seeing events as causally connected, we also crave a sense of control: we want to be that cause.

The illusion of control is well-demonstrated, and is likely one of the psychological underpinnings of religious and superstitious behavior. When we are faced with an outcome largely out of our control, we grasp at straws. This is famously true in baseball, especially with batters, who are notoriously prone to superstition. When even the greatest possible skill cannot guarantee regular outcomes, we supplement skill with “luck”—lucky clothes, lucky foods, lucky routines, and so on.

The origins of our belief in gods may have something to do with this search for control. We tend to see natural events like droughts and plagues as impregnated with meaning, as if they were built by conscious creatures like us. And as our ancestors strove to influence the natural world with ritual, we imagined ourselves as causes, too—as able to control, to some extent, the wrath of the gods by appeasing them.

As with all cognitive illusions, these notions are insulated from negative evidence. Disproving them is all but impossible. Once you are convinced that you are in control of an event, any (random) success will reinforce your idea, and any (random) failure can be attributed to some slight mistake on your part. The logic is thus self-reinforcing. If, for example, you believe that eating carrots will guarantee you bat a home run, then any failure to bat a home run can be attributed to not having eaten just the right amount of carrots, at the right time, and so on. This sort of logic is so nefarious because, once you begin to think along these lines, experience cannot provide the route out.

I bring up this illusion because I cannot help seeing instances of it in our response to the coronavirus. In the face of danger and uncertainty, everyone naturally wants a sense of control. We ask: What can I do to make myself safe? Solutions take the form of strangely specific directives: stay six feet apart, wash your hands for twenty seconds, sneeze into your elbow. And many people are going further than the health authorities are advising—wearing masks and gloves even when they are not sick, disinfecting all their groceries, obsessively cleaning clothes, and so on. I even saw a man the other day who put little rubber bags on his dog’s paws, presumably so that the dog would not track coronavirus back into the house. 

Now, do not get me wrong: I think we should follow the advice of the relevant specialists. But there does seem to be some uncertainty in the solutions, which does not inspire confidence. For example, here in Europe we are being told to stand one meter apart, while in the United States the distance is six feet—nearly twice as far. Here in Spain I have seen recommendations for handwashing from between 40 and 60 seconds, while in the United States it is 20 seconds. It is difficult to resist the conclusion that these numbers are arbitrary. 

If Michael Osterholm is to be believed—and he is one of the United States’ top experts on infectious disease—then many of these measures are not based on hard evidence. According to him, it is quite possible that the virus spreads more than six feet in the air. And he doubts that all of our disinfecting has much effect on the virus’s spread, as he thinks that it is primarily not through surface contact but through breathing that we catch it. Keep in mind that, a week or so ago, we were told that we could stop it through handwashing and avoiding touching our own faces.

Telling people that they are powerless is not, however, a very inspiring message. Perhaps there is good psychology in advocating certain rituals, even if they are not particularly effective, since it can aid compliance in other, more effective, measures like social distancing. Rituals do serve a purpose, both psychological and social. Rituals help to focus people’s attention, to reassure them, and to increase social cohesion. These are not negligible benefits. 

So far, I think that the authorities have only been partially effective in their messaging to the public. They have been particularly bad when it comes to masks. This is because the public was told two contradictory messages: Masks are useless, and doctors and nurses need them. I think people caught on to this dissonance, and thus continued to buy and wear masks in large numbers. Meanwhile, the truth seems to be that masks, even surgical masks, are better than nothing (though Osterholm is very skeptical of that). Thus, if the public were told this truth—that masks might help a little bit, but since we do not have enough of them we ought to let healthcare workers use them—perhaps there would be less hoarding. 

Another failure on the mask front has been due to bad psychology. People were told only to wear masks when they were sick. However, if we follow this measure, masks will become a mark of infection, and will instantly turn wearers into pariahs. (What is more, many people are infectious when they do not know it.) In this case, ritualistic use of masks may be wise, since it will eliminate the shame while perhaps marginally reducing infection rates.

The wisest course, then, may indeed involve a bit of ritual, at least for the time being. In the absence of conclusive evidence for many of these measures, it is likely the best that we can do. I will certainly abide by what the health authorities instruct me to do. But the lessons of psychology do cause a little pinprick in my brain, as I repeatedly wonder if we are just grasping at a sense of control in a situation that is for the most part completely beyond our means to control it.

I certainly crave a sense of control. Though I have not been obsessively disinfecting everything in my house, I have been obsessively reading about the virus, hoping that knowledge will give me some sort of power. So far it has not, and I suspect this is not going to change.

Quotes & Commentary #73: Keynes

Quotes & Commentary #73: Keynes

It is a great fault of symbolic pseudo-mathematical methods of formalizing a system of economic analysis . . . that they expressly assume strict independence between the factors involved and lose all their cogency and authority if this hypothesis is disallowed.

—John Maynard Keynes

I ended my last commentary by swearing to leave off thinking about the coronavirus. Alas, I am weak. The situation is bleak and depressing; it has affected nearly every aspect of my life, from my free-time to my work, my exercise routines and my relationships; but it is also, if one can be excused for saying so, quite morbidly absorbing.

What especially occupies me is how those in charge will weigh the costs and benefits of their policies. Because the threat posed by coronavirus is so novel, because these decisions involve human life, and because it is difficult not to feel afraid, I think there is a certain moral repugnance that many feel toward this kind of thinking. However, as I argued in my previous post, I think truly moral action will require a thorough appraisal of all of the many potential consequences of action and inaction. This will make any choice that much more difficult, and I do not envy those who will have to make it. 

As anyone familiar with the famous trolley problem knows, moral dilemmas often involve numbers. If the actor has to choose between a lower and a higher number of victims, one must choose the lower number. However, there are several refinements of the problem which show the limitations of our moral intuition. For example, respondents are willing to divert a runaway trolley onto a track where it will kill one person rather than five; but respondents are unwilling to push an enormously fat bystander onto the tracks to save five people. We seem to be willing to think in purely numerical terms only about those involved ‘in the situation’ and unwilling to do so with those we perceive as ‘outside the situation.’

Well, in case we are facing, virtually everyone is ‘inside the situation’; so this leads us to a numerical treatment. But of course this is not so simple. What should we be measuring and comparing, exactly? I raised the question in my last post about this calculus of harm, and how it seems impossible to compare different types and levels of harm. As hospitals get overwhelmed, however, and care begins to be rationed, doctors are forced to make difficult choices along these lines, giving treatment to patients with the highest chances of recovery. Politicians are now faced with a kind of society-level triage.

One obvious basis of comparison is the number of lives lost. This is how we think of the trolley problem. But I think there is a case for also considering the number of lived years lost. What is ethically preferable: allowing the death of one person, or allowing the lifespans of 10 people to be reduced by 20 years each? I cannot answer this question, but I do think that the answer is not easy or self-evident. Reducing somebody’s lifespan may not be ethically on a par with letting someone die, but it is still quite a heavy consideration.

Further down the line, ethically speaking, is quality of life. Though it seems egregious to weigh death against quality of life issues, in practice we do it all the time. Smoking, drinking, and driving carry a risk, and a certain number of people will die per year by engaging in these activities; but we accept the cost because, as a society, we apparently have decided that it is “worth it” in terms of our quality of life. But of course, this comparison is not exactly appropriate for the case of coronavirus, since we ourselves make the decision to smoke or drive, whereas the risk of coronavirus is not voluntary. Thus, to save lives we should be willing to accept a greater loss in quality of life in this case, since we cannot control our exposure to the risk.

How exactly we choose to weigh or balance these three levels of damage—lives lost, lives shortened, and lives made worse—is not something I am prepared to put into numbers. (I suppose some economist is already doing so.) But I think we are obligated to try to at least take all of them into account.

Now, the other set of variables we must consider are empirical. On the medical side, these are: the lethality of the virus and the percentage of the population likely to get infected. On the economic side there are obvious factors like unemployment and loss in GDP and so forth. There are also factors such as loss in standard of living, homelessness, and the poverty rate; and still more difficult to calculate variables like the rate of suicide and drug addiction likely to result.

One major problem is that we know all of these variables imperfectly, and in some cases very imperfectly. To take an obvious datum, there is the virus’s lethality rate. From the available numbers, in Italy the fatality rate appears as high as 8%, while in Germany it is as low as 0.5%. This huge range contains a great deal of uncertainty. On the one hand, there is a good case that Germany gives a more accurate picture of the virus’s lethality, since they have done the most testing, about 120,000 a day; and logically more testing gives a more accurate result. However, we should remember that the virus’s lethality rate is not a single, static number. It affects different demographics differently, and it also depends on the availability of treatment. All of these factors need to be taken into account to establish the virus’s risk.

Complicating the uncertainty is the fact that the virus can create mild or even no symptoms, thus leaving open the question of the total number of cases—a number that must be known to determine the lethality rate. Asked to offer an estimate of the total number of infected people in Spain (the registered number is about 45,000 as of now), mathematicians offered estimates ranging from 150,000 to 900,000—and, of course, these are little more than educated guesses. If the former figure is correct, it would put the lethality at around 2%, while if the latter is correct the lethality is about 0.4%: another big range. 

Now that Spain is receiving a massive shipment of tests from China, our picture of the virus will likely become much more accurate in the coming days and weeks. (Actually, many of these tests are apparently worthless, so nevermind.*) However, one crucial datum is still missing from our knowledge: the total number who have already had the virus. To ascertain this, we will need to test for antibodies. It appears we will begin to have information on this front soon, as well, since the UK has purchased a great deal of at-home antibody tests. I believe other countries are following suit. Not only is this data crucial to accurately estimating the virus’s threat, but it is also of practical value, since those with antibodies will be in far less danger either of catching or of spreading the disease. (In the movie Contagion, those with antibodies are given little bracelets and allowed to travel freely.)

The New York Times has created an interesting tool for roughly estimating the potential toll of the virus. By adjusting the infection and fatality rate, we can examine the likely death toll. Of course, these rough calculations are limited in that they make the mistake Keynes highlights above—they assume an independence of variables. For example, the calculator shows how the coronavirus would match up with expected cancer and heart disease deaths. But of course more coronavirus deaths would likely mean fewer deaths from other causes, since many who would have died from other causes would succumb to coronavirus. (Other causes of death like traffic accidents may also go down because of the lockdown.) The proper way to make a final estimate, I believe, would be to see how many total deaths we have had in a year, and then compare that total with what we would reasonably expect to have had without the coronavirus.

As you can see, the problem of coming up with a grand calculation is difficult in the extreme. Even if we can ultimately ascertain all of the information we need—medical, economic, sociological—we will still have only an imperfect grasp of the situation. Indeed, Keynes’s warning is quite pertinent here, since every factor will be influencing every other. Unemployment affects access to health care, an overwhelmed health care system will be less effective across the board, and the fear of the virus alone has economic consequences. This makes the ‘trolley problem’ model misleading, since there are no entirely independent tracks that the trolley can be moving on. Any decision will affect virtually everyone in many different ways; and this makes the arithmetical approach limited. 

Trump has said that the cure cannot be worse than the disease. Obviously, however, the decision is not a simple choice between economic and bodily well-being. This is what makes the decision so very subtle and complicated. Not only must we weigh sorts of damage in our ethical scales, but we also must be able to think synthetically about the whole society—the many ways in which its health and wealth are bound up together—in order to act appropriately.

Once again, I do not envy those who will have to make these choices.

Quotes & Commentary #72: Mill

Quotes & Commentary #72: Mill

The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.

—John Stuart Mill

Like so many people on this fragile green globe, I have been thinking about this novel crisis. I find myself quite constantly frustrated, largely because we suddenly find ourselves in the position of reacting to a threat of unknown potency using uncertain means. I argued in my last post that our shift from total indifference to all-consuming concern cannot constitute a rational response. In this post I hope to explore what a rational, and ethical, response must comprise.

Governments around the world are in the tragic position of having to choose between saving a relatively small (but ever-growing) portion of the population from severe damage, and inflicting less acute damage on a much larger portion of the population.

In making decisions like this, I believe the only ethical principle that we turn to is the principle of utility. However, I do not think John Stuart Mill’s strong version—our duty is to promote happiness as much as possible—is feasible, at least not for individuals. My main criticism of such a formulation is that it would lead to basically unlimited duties on a person. Can a thoroughgoing utilitarian really enjoy a quiet tennis match when she could be, say, working in a soup kitchen? I do not think we can embrace an ethic that would demand a population of saints; and, besides, such an ethic would be self-defeating if actually put into practice, since each person who is trying to create the most happiness would, themselves, potentially be miserable. 

Thus, when it comes to individual behavior, I think that a negative version of utilitarianism applies: that we ought to try to refrain from activities that cause pain, harm, or unhappiness. Playing a tennis match, then, is alright; but breaking someone’s arm is not. This, I believe, is the standard that should be applied to individuals.

A government, however, is different; and different standards apply. A government has the obligation not only to avoid doing harm, but to actively reduce misery as much as possible. Unlike an individual—who could not live with an unlimited obligation to reduce unhappiness—a government, as an institution, does not have to balance its own happiness against others’, and so has a greater ethical obligation.

With this principle in view, the requirement for an ethical action on the government’s part would be to reduce suffering as much as possible. Of course, creating an exact calculus of harm is difficult at best. How can you compare, say, one death and a hundred million headaches? Yet since we must act, and since we ought to act as ethically as possible, we have little choice but to make do with a certain amount of imprecision.

Another source of imprecision is, of course, that we cannot know the future, and we know even the present only imperfectly. Because of this ignorance, every act can have unforeseen consequences. This is why we cannot evaluate an action on the ends it achieves alone, but must consider what could be reasonably known about the probable consequences of an action at the time it was taken. This means we have to have a certain ethical lenience for actions taken at a low state of knowledge, especially if the best available knowledge was consulted at the time. 

Aside from the test of morality, there is also a related test of rationality. To be rational means to be consistent. This means the same standard is applied to all of our actions, and that there are no special categories. An irrational ethic is necessarily an imperfect ethic, since it means at least some of its actions are less ethical than others. Many of our society’s injustices are cases of irrational ethics: holding people to different standards, giving out different rewards or punishments for the same actions, and so on.

I am trying to define what a rational, ethical response means, exactly, because I think very soon we will have to make more nuanced decisions about this crisis. So far the primary approach has been to institute lockdowns, with the idea of slowing the virus’s spread. Even though I think there is a strong argument that Western governments were culpably unprepared, locking things down now may be a rational response given the potential threat of the virus. But if we find that even thirty or forty days in confinement is not enough to put the virus on the defensive, then we will have to begin to weigh the social costs more carefully. Just as the real effectiveness of a lockdown remains to be seen, so is the social price still undetermined.

At the moment we are just coming to grips with the virus, and we are belatedly adopting a “better safe than sorry” policy. We are tracking the rising death tolls of the virus and focusing our attention quite exclusively on this crisis. This may be rational, considering the novelty of the virus and the currently unknown threat that it may pose. But as the crisis wears on, we will be forced to consider other factors. There is, after all, no guarantee that forty, fifty, or even sixty days of lockdown will make it safe for people to return to their daily lives. Michael Osterholm (an expert on infectious diseases) expects that the virus will be around until there is a vaccine, and that a vaccine will take 18 months at minimum.

Now, perhaps extraordinary measures and unlimited resources can reduce the time until we arrive at an effective vaccine. That is unknown. My worry is that a lockdown will begin to have very real negative effects on quite a huge number of people; and this will almost certainly happen before the vaccine is available. We in Madrid are one week into our lockdown so far. At the moment, the streets are mostly empty, and they are constantly patrolled by police who can give enormous fines for breaking curfew. Today I heard a loud and violent argument down the street as one person harassed another person for doing something outside (they were out of view). I can hear neighbors occasionally quarrelling through my window.

Arguments and tantrums are the least of our worry. A protracted lockdown will exacerbate mental health problems (some of which are quite serious) and put pressure on marriages, as the spike in Chinese divorces shows. In Spain, open air sport, like going on a walk or a run is forbidden. (Meanwhile, tobacco stores remain open, even though smoking is known as one of the risk factors of the disease.) How will this ban affect children if it is protracted? And how long are we prepared to keep children out of schools? Not only will they be learning less, but social interaction is crucial to childhood development. (Osterholm is skeptical of the school closures, since he thinks that there is little evidence that children are significant vectors of the disease, and many health personnel with children might be forced to stay home. The demographic data from Spain—which doubtless overestimates the fatality rate across the board, since testing has been limited—seems to bear him out.)

In Spain, the government has, at yet, not waived rental payments. For people living from paycheck to paycheck, and who have been laid off, what will they do on April 1st when rent is due? Even if we are released on April 12, how many people will be completely out of work at that time? How many people risk losing their jobs and their homes? If and when coronavirus has disappeared completely, it may take a damaged economy years to return to normal. How will people get by if thousands of businesses go bankrupt and unemployment remains high for the long term?

Economic damage may sound fanciful compared with a health crisis, but it translates into a reduced—sometimes a drastically reduced—quality of life for millions. In the scale of human suffering, poverty is not negligible. Yet if such considerations seem petty, we must also consider something that Nicholas Kristoff (among others) has written about extensively: the rise of “deaths of despair” among America’s working class. These deaths can result from drug overdose or suicide, and they have been on the rise because of the worsening plight of working class America. We must consider, then, that economic damage does not only reduce the quality of life for millions, but it can translate directly into fatalities.

More generally, economic failure has a pronounced effect on life expectancy, even if you try to control for other factors. To quote from Bryson’s book on the body: “Someone who is otherwise identical to you but poor—exercises as devotedly, sleeps as many hours, eats a similarly healthy diet, but just as less money in the bank—can expect to die between ten and fifteen years sooner.” So economics indeed translates into years of life. 

Now, I am not advocating against the lockdown. As I said before, given our available information, it may be a good and rational response. I am saying that, in the long run, an ethical evaluation requires that we consider the complete social costs of these measures. Just as importantly, if the coronavirus is, indeed, here to stay, then a rational response requires that we act consistently towards this risk.

This is what I mean. At the moment, coronavirus deaths are treated as a special category. This may be rational if we can eliminate the threat in a reasonable amount of time. But if we cannot eliminate this threat, and it is, indeed, here to stay for a year or more, then I am not sure that this attitude can be rationally sustained. A rational ethic will require us to see the coronavirus as one of many potential causes of death—more dangerous, perhaps, but no more or less acceptable than any other cause of death. 

After this long and perhaps silly post—which I hope will be the last thing I devote to the virus for a time—I will end on a more practical note. 

From what I observe, I fear that we may not be learning quite the right lessons from China’s success. Donald McNeil (a science reporter for the New York Times) explains that the lockdown in China was only the necessary and not the sufficient reason for the country’s recovery. The lockdown was complemented by widespread testing and the government’s ability to isolate people from one another. A small town in Italy, , was similarly able to halt the virus by testing all of its residents and isolating the infected. Mike Ryan, an expert at the World Health Organization, has recently offered the same advice—that a lockdown without other measures is not enough. Here in Spain, the testing resources are severely limited, and only available for serious cases (although this will change soon). People with mild symptoms are not isolated but are being told to stay in their homes, which could potentially mean infecting their whole family. I hope, then, that we can not only learn from China’s strictest measures, but also their most intelligent. 

Quotes & Commentary #71: Kahneman

Quotes & Commentary #71: Kahneman

Those who know more forecast very slightly better than those who know less. But those with the most knowledge are often less reliable. The reason is that the person who acquires more knowledge develops an enhanced illusion of her skill and becomes unrealistically overconfident.

—Daniel Kahneman

Daniel Kahneman’s book—Thinking, Fast and Slow—is one long demonstration of the severe limitations of our human brain. He catalogues a variety of cognitive illusions and shows how they lead to persistently irrational behavior—so pervasive that we usually do not even notice it.

One of Kahneman’s best sections is on the limitations of expert judgment. He is devastating on the subject of political pundits—whose predictions Kahneman describes as worse than random—as well as on certain professions such as stock brokers. There are, in fact, many areas of human endeavor in which the final outcome is determined largely by chance, but which our brain insists on seeing as a contest of skill or produced by predictable causes. In reality, the world is far more unpredictable, uncontrollable, and unknowable than we all like to believe.

Now, Kahneman does not discount the possibility of real expertise. This would be an absurd position, as anyone who has played an expert chess player knows. In a great many situations experience and knowledge lead to increased effectiveness. But there are also many situations in which this is not the case. The key difference is whether the environment is regular or not. In a regular environment—one showing predictable patterns, such as when playing chess—then expertise is a major advantage. But in situations that are not regular, and which do not follow any predictable pattern (such as the stock market), the predictions of experts can be worse than random.

This seems like a particularly timely reminder during this coronavirus crisis. Suddenly we find ourselves in a novel situation, without historical precedent, and we naturally and logically turn to experts. But the experts that I have heard seem to sharply disagree on many important things.

A simple example is school closures. While some consider it wise, since children can serve as vectors for diseases, others consider it unwise, since the danger posed to children by the coronavirus is small and many healthcare workers have children (and so might be able to work less if schools were closed). Something else to consider is whether it might benefit the community as a whole if children developed immunity to the virus, thus negating their ability to serve as vectors. If they are at extremely low risk, then this could save many lives. Michael Osterholm seems to think that it is a bad idea, while most governments are coming to the opposite conclusion.

To give you two highly divergent cases of expert disagreement, consider Neil M. Ferguson and John P. A. Ioannidis. Ferguson is one of the world’s foremost experts on epidemics, whose titles are so extensive that I will not even repeat them here. His speciality is in mathematical models of infectious diseases; and his models predict quite bleak outcomes. He predicts one to over two million deaths in the United States, depending on the policies adopted. He recommends a policy of suppression—basically, a maximum of social distancing, locking down the population—in order to prevent the worst case-scenario. If we want to save as many lives as possible, then we will have to seriously disrupt society until a vaccine is developed, which may take quite a long time. (Ferguson himself recently seems to have come down with the disease.)

Ioannidis—the director of the Stanford Prevention Research Center—has a very different message. He emphasizes how much we still do not know about the virus, and how potentially foolish our methods of dealing with it may turn out to be. To take a basic datum, we are still quite in the dark regarding the lethality rate of the virus. It is tempting to take the total number of cases and then divide it by the total number of deaths, and get an answer. But there is reason to suspect that this would severely distort the results. For one, many countries have limitations on tests, and so the total number of infected will seem artificially low. And even if tests are widely available, we still cannot know how many people may be asymptomatic or have such mild symptoms that they never register.

To determine this we would need to conduct large-scale, randomized tests of the population, to see whether subjects have either the active virus or antibodies against it. To my knowledge, no such test has been done. Without such data, we really have no hopes of establishing the lethality of this novel coronavirus, because we cannot know how many people get mild or asymptomatic cases. In Italy and Spain, the virus appears to be extremely deadly. However, this is almost undoubtedly a result of several factors: for example, both countries have elderly populations; and testing is limited to those with serious cases. (Another interesting factor is that many younger people live with their parents in these two countries.)

If you look at South Korea or Germany—where testing is more widely available—the evidence seems much more reassuring. The Spanish newspaper El País calls the low mortality rate in Germany a “medical enigma,” partly because Germany’s population is roughly as old as Spain’s. But it is entirely possible that it is a more accurate picture of the virus than other countries. In Spain there are 625 tests per million people; in Germany they have 4,000 and in South Korea over 5,000 per million. Logically, the greater the testing capacity, the more accurate the mortality rate. Furthermore, it is worth noting that even the best testing capacity might lead to misleadingly high mortality rates, since again tests are usually given to people with symptoms; thus the number of asymptomatic cases remains largely a guess. 

The only situation in which an entire population was tested, to my knowledge, was the Diamond Princess cruise ship. Of the roughly 700 infections aboard, there were 7 deaths, giving a lethality rate of about 1%, and about 20% of the roughly 3,700 people aboard tested positive. (About 50% of those who tested positive were asymptomatic.) If 20% of, say, the United States got ill, and 1% of that 20% died, this would translate to 700,000 deaths. This is obviously bad. However, the case of the cruise ship has several factors that would make it seem a worst case-scenario. For example, cruise ships are more densely populated than even the biggest cities, more time is spent in common areas, and air is commonly recycled; thus, the total infection rate of the virus would be unusually high. Further, the population of cruise ships is significantly skewed towards the elderly, which would make the death rate unusually high as well.

Ioannidis argues that if we adjust our numbers to account for these significant differences, then the total number of deaths in the United States will be 10,000. In his words: “This sounds like a huge number, but it is buried within the noise of the estimate of deaths from ‘influenza-like illness.’” And it is worth remembering that in a bad flu season 70-80,000 people die in a year. 

One can point to the dire situation in Italy as a counterargument, of course. But it is worth noting that a virus does not have to be particularly lethal to overwhelm the medical system; it just has to be quite infectious. This is what is known as the R0 number: the average number of viral transmissions per person. We believe the seasonal flu to have an R0 number of around 1, meaning that each sick person gets an average of one other person sick. But if the seasonal flu had a much higher R0 number, it could be enough to flood emergency rooms like we are seeing. This is because more total people would be infected in a much smaller window of time. Thus, the evidence still appears quite inconclusive as to the real lethality rate. 

A great many other things are currently uncertain. Can we get infected more than once? How will changing weather affect the virus? And how infectious is the novel coronavirus, exactly? Without essential data such as these, we are all essentially flying blind.

Another problem is that the intense focus on the virus may only exacerbate our ignorance, not remedy it. Naturally, headlines focus on the growing numbers of cases and the growing number of the dead. Yet if the news suddenly began to track deaths from heart attacks or traffic accidents, the results would also seem catastrophic. Even on a normal day in America, the news can make it seem as if we are living in a war zone. The ugly reality—which we normally prefer not to think of—is that tens of thousands of people die every day, for all sorts of reasons. The question cannot be resolved by simply measuring the cases that come to our attention. We need to measure vulnerability and lethality against the relevant total, and not as simply a number that keeps rising.

We are thus faced with a difficult choice. If we underestimate the virus, and Ferguson is correct, we will condemn many people to die. But if the numbers used in Ferguson’s models are wrong—and we have no way of knowing this yet—then the measures intended to counteract the virus may inflict more harm than benefit, maybe much more. The virus is an unknown quantity, but so is the damage that could result from government lockdowns. Are we locking unhappy wives in with their abusive husbands? Are we inflicting severe psychological harm on vulnerable people? And if the economy cannot bounce back from this disruption, what will happen to those whose situation was already precarious? And these are just the immediate effects—not the economic or social fallout. The scale of such potential negative results is currently unforeseeable.

The major refrain of our reaction has been to “flatten the curve.” The basic idea is simple. The healthcare system can only attend to a very limited number of severe cases at any one time. So if we get an onslaught of cases in one sharp peak, then there will be no hope of using our limited resources to save what lives we can. This seems simple enough, but I think it leaves out some important considerations. First, the graphic that is normally represented is completely out of scale. The potential peak is not just twice as high as the dotted line, but many times as high (we do not know exactly how high yet). To spread out the curve to below the dotted line, we will require not just eight weeks of intervention, but many months. Can we impose a lockdown for half a year or more?

Another consideration is one brought up by Ioannidis. If our health care systems are, indeed, overwhelmed regardless of our interventions, then our interventions may only succeed in extending the time that our healthcare systems are overwhelmed. To speak in terms of the curves, “flattening the curve” is only a good idea if we can get it below the dotted line. If we cannot get the curve under the dotted line—as is already the case in Italy and in some parts of Spain—then we will only protract the period during which hospitals are over capacity. This means that there will be more time that victims of trauma, heart attacks, strokes, and so on will be unable to get treatment, which can result in more total lives lost. After all, we must deal with all of our usual health problems on top of this. People will still need to give birth.

Here is a piece of pure speculation—from somebody who is in no way an expert. In the 1918 flu pandemic, one reason the disease became so deadly is because of a natural selection process. Normally, mild strains of viruses are preferentially spread, since those with milder symptoms are out and about, spreading the virus, and those who are infectious stay put. But if a lockdown creates a similar situation as the First World War—wherein mild cases stay put (since we are in lockdown and they were in the trenches), while severe cases are the ones which spread via hospitals—then we may be preferentially selecting for more severe forms of the virus. Admittedly, I have not heard anyone respectable express this worry.

I have, however, heard experts express the worry that, by locking people in their homes, we are potentially shooting ourselves in the foot. This would be because it prevents the least vulnerable from developing immunity, which would go a long way in making the entire population less susceptible. This is called “herd immunity,” and it is the strategy urged by David L. Katz (another expert, the founding director of the Yale-Griffiths Prevention Center). His main point is that it is not sensible to shut down all of society if only certain members of society are seriously vulnerable, or in his words that a more “surgical” approach is needed. (Also, certain interventions, such as sending college kids to live with their older parents, do not seem sensible from any perspective.)

My worry is that governments are incentivized to badly underreact and then badly overcorrect. They underreact because each government wants calm, happy, and prosperous citizens, and disrupting life for a seemingly small threat is not politically advantageous. They will overreact because, in the face of a threat that can no longer be ignored, governments must be seen as maximally responsible. What is more, with heavy government intervention, any successful diminution in cases can be claimed as government success. Thus, governments are incentivized to take the most extreme measures available. Anything short of that will appear cavalier in retrospect if the disease is as bad as it may indeed be; and even if it is not as bad, any success will go to the credit of the government.

But everything in life is a tradeoff. Morally speaking, the government must weigh the damage inflicted by the virus against the damage inflicted on the suppression measures. And if both of these are totally unknown quantities—which seems to be the case—what then? We are past the point where we can say “better safe than sorry.” We risk being both sorry and unsafe. 

My own feeling at the moment is one of intense frustration. The governments of Europe and the United States have given conflicting messages to its citizens and have been content to react rather than prepare. Given the sharp shift from blasé indifference to emergency measures, I can only conclude that we are not in a situation like that of an expert chess player, but more like that of a stock broker—trying our best to predict the unpredictable. As Bill Bryson goes at lengths to show, we are still quite astonishingly ignorant about a great many things in our own bodies, including disease. And as Ioannidis explains, we are still quite in the dark even when it comes to something as humble as the seasonal flu or common cold. We only have rough estimates of flu related deaths, because we cannot filter out other common diseases such as colds; and it is also possible to have multiple infections at once.

In any case, to me it seems quite clear that the government’s wild pivot from indifference to emergency cannot constitute a rational response. To act as if the virus is unimportant one moment and the only important thing on earth the next is not evidence of clear thinking. We are in a hurry to embrace policies whose effectiveness, sustainability, and collateral damage are unknown to combat a virus whose danger is undetermined. While we are all collectively obsessing over the coronavirus (since lately it is impossible to think of much else), perhaps it is wise to remember another of Kahneman’s findings: “Nothing in life is as important as you think it is when you are thinking about it.”

Quotes & Commentary #70: Graeber

Quotes & Commentary #70: Graeber

Economies around the world have, increasingly, become vast engines for producing nonsense.

—David Graeber

Humans are strange creatures: we can twist any event to reinforce the beliefs that we already hold. One would hope that this were not the case; after all, the entire premise of science is that experiences can correct beliefs. But it seems that this is not always the case. The coronavirus crisis is showcasing this tendency in all its irrational glory. Everyone—from progressives to conservatives—is convinced that this crisis reveals why the other side was wrong. Yet this mental phenomenon does not even have to take a political form. Exercise fanatics, for example, will use the crisis to reinforce their obsession, while doomsday preppers must feel awfully vindicated right about now.

I suppose I should join this crowd and offer my own little pet theory. A few months ago I read the book Bullshit Jobs, by David Graeber, and was entranced. It describes a widespread phenomenon: that many people harbor the secret conviction that their job is absolutely pointless. Reading this was an immense emotional vindication for me, since I myself had worked a job that I found to be pointless, and I experienced many of the harmful psychological effects that Graeber describes. But the problem is more than psychological. I think all of us have run into people whose jobs seem to serve little to no socially beneficial function. This can take many forms. A secretary whose only job is to answer the phone three times a day; an administrator whose job is to get college professors to upload their syllabuses into a central database; or the many hundreds of thousands of people employed in the United States processing health insurance claims.

Now that so many sectors of the economy are essentially shut down, perhaps this will give us an opportunity to reflect on which jobs are bullshit and which are not. I am not suggesting, of course, that everyone who has been sent home has a useless job. To the contrary, I think that most parents with kids at home would agree (I hope) that teachers have quite a challenging and important job. Likewise, now that we are sorely missing the pleasures of bars and restaurants, we must be grateful to all the people who made that possible. During this dark time, the humble cashiers in our grocery stores have become heroes. And this is not to mention the garbage collectors, police officers, and above all the doctors and nurses.

My point is that so many jobs which are commonly seen as low-skill and which are thus badly paid are now the ones we are relying on, or missing, most of all. Meanwhile, the sorts of jobs that are lampooned in Graeber’s book—the corporate lawyers, the college administrators, the creative vice presidents—I suspect are not sorely missed. Perhaps, then, this will motivate us in the future to better compensate those in these normally overlooked professions. Of course, I must pause and remind myself of the basic economic principle of supply and demand. The market is not a moral machine (fortunately or unfortunately); and rewards are not given away for merit.

Still, we have the means to make people’s lives easier. One way—popularized most recently by Andrew Yang—is Universal Basic Income: simply giving every citizen a certain amount of money each month that would be enough to cover basic expenses. In attenuated form, this is what the government is already proposing to do during the crisis: mailing every American a check for $1,000 dollars to help the many people who are out of work. David Graeber is also in favor of the idea, partly because it would allow so many people to escape the world of bullshit work. That is, having a financial cushion would give people the freedom to leave their work when they feel they are not doing anything productive or valuable. And this freedom would make a big difference in the job market in general, since it would give employees far more negotiating power. Jobs would have to be reasonably appealing if they wished to attract people who already had enough money to live on. Thus, this could benefit those with highly-paid but useless work, as well as those with badly-paid but useful work.

Maybe it is inappropriate to think of utopian schemes while we are in the midst of a crisis. And of course I am guilty of the same sin of seeing the situation through my own ideology. I ended my review of Graeber’s book by calling for a movement dedicated towards the expansion of leisure time. Ironically, nowadays I greatly miss the freedom to go to work. When you actually believe that you are contributing to society, working becomes a great source of meaning in your life. A world without work is not one I want to live in. But if we can dream for a few moments, I would ask you to imagine a world where work is more flexible, more negociable, and more meaningful. Will this crisis edge us in that direction? Perhaps I can be indulged for a moment of optimism at a time when all the news is bad news.

Quotes & Commentary #69: Keynes

Quotes & Commentary #69: Keynes

It is astonishing what foolish things one can temporarily believe if one thinks too long alone, particularly in economics (along with the other moral sciences), where it is often impossible to bring one’s ideas to a conclusive test either formal or experimental.

—John Maynard Keynes

I have been thinking a lot about Keynes lately, and not only because I am reading a massive biography of his life. Keynes is one of those perennial thinkers whom we can never seem to escape. He exerted enormous influence during his lifetime and dominated economic thought and policy for thirty years after his death. Then, as inevitably happened, the Keynesian orthodoxy became too successful for its own good. His ideas came to be taken for granted, and his innovations became the conventional wisdom that the cleverest economists of the next generation came to reject. This ushered in the age of Neoliberalism—with Margeret Thatcher, Ronald Reagen, and Milton Friedman as the great standard-bearers—and the decline in Keynesian thought.

And yet, whenever there is a serious problem with the economy, everyone instinctively returns to Keynes. It was he who most convincingly analyzed the sources of economic recession and depression, and then plotted a way out of it. He was writing, after all, in the wake of the Great Depression.

To oversimplify the basic idea of Keynes’s analysis, it is this: High unemployment leads to a lack of demand, and a lack of demand can push financial systems beyond the breaking point. Put another way, the economy can be envisioned as an enormously complex machine that is composed of millions of cogs. Some cogs are small, some are large, and all are connected—either proximally or distantly. If one small cog stops working, then it may cause some local disturbances, but the whole machine can continue to chug along. But if too many cogs fail at the same time, the machine can come to a grinding halt.

As the coronavirus shuts down huge sections of the economy, this is exactly the scenario we are facing. Waiters, bartenders, actors, musicians, taxi drivers, factory workers—so many people face lay-offs and unemployment as businesses prepare to shut down. Besides this, if we are locked into our homes, then there are now far fewer places where people can spend their money, even if they have money to spend. It is inevitable that some people will not be able to afford rent, that some businesses will go under, and that much of the money that is available to circulate will remain unused in bank accounts. People are not going to be buying houses, or cars, or dogs, or much of anything in the coming weeks (besides toilet paper, of course).

Now, in a capitalist economy, anyone’s problem is also my problem, since buying and spending are so intimately related. The money you spend eventually becomes the money I receive, and vice versa. Thus, if there is a increase in unemployment (limiting the money you receive), an increase in bankruptcies (limiting the money the banks receive), and a decrease in spending (limiting the money I receive), then we have a recipe for serious economic contraction. A wave of bankruptcies inevitably puts pressure on banks; and if banks begin to collapse, then we are in grave trouble. Whether or not we like to admit it, banks provide an essential service in the economy, one which we all rely on. To return to my crude cog analogy, the banks are some of the biggest cogs of all; and if they stop turning, nothing else can move.

Keynes’s solution to this dilemma was essentially to use the government’s almost limitless ability to borrow money, and inject as much cash into the economy as possible. In other words, the idea is to stimulate demand, so that people can continue to spend money. It is an idea that has been criticized by so-called ‘responsible’ people for generations. Can the government really afford to go into so much debt during a recession? Can such artificial measures actually prop up an ailing economy? Can we tolerate such a huge degree of government involvement in a liberal society?

Republicans—and to a lesser extent, even Democrats—have been sharply critical of Keynesian economics over the years. When Obama wanted a stimulus package for the 2008 financial crisis, he faced endless opposition and criticism from the Republican party. And now that we are facing an economic crisis on a comparable scale, the Republicans are turning without hesitation to Keynes: hundreds of billions in stimulus, and even resorting to mailing checks to every American. One could hardly imagine a more straightforwardly Keynesian solution than this. Keynes had this to say about how the government could deal with a recession:

If the Treasury were to fill old bottles with banknotes, bury them at suitable depths in disused coalmines which are then filled up to the surface with town rubbish, and leave it to private enterprise on well-tried principles of laissez-faire to dig the notes up again (the right to do so being obtained, of course, by tendering for leases of the note-bearing territory), there need be no more unemployment and, with the help of the repercussions the real income of the community, and its capital wealth also, would probably become a good deal greater than it actually is. It would, indeed, be more sensible to build houses and the like; but if there are political and practical difficulties in the way of this, the above would be better than nothing.

This is the closest that Keynes got to the notion of simply giving people money. Paying people for absolutely useless work is better than nothing, since at least then people are being paid; and if they are being paid, they can spend their money; and if they spend their money, I can get paid; and so on. If this were a different kind of crisis—a kind where we did not have to practice social distancing—then perhaps we could imagine large-scale infrastructure projects as a way of combating recession. But now, we must resort to the even more radical idea of paying Americans to do nothing. Maybe Andrew Yang’s notion of a universal basic income is not so far after all?

Well, here is where I must warn my readers (all three of you) that I am really quite clueless when it comes to economics, so everything written here must be read in that spirit of ignorance. However, I think that Keynes’s quote is also quite relevant for non-economic reasons. As so often true in economics, we are facing an entirely novel situation. This is a crisis without precedent, and that means that all of our ideas of how to cope with the crisis are untested. The closest historical precedent to the coronavirus is the 1918 flu pandemic; and yet there are important differences between both the disease and the historical situation. We are thus operating without ‘conclusive tests,’ in Keynes’s words, of our ideas. It remains to be seen which country’s approach will be the wisest.

In the meantime, Keynes is an example for us to follow: an intellectual who responded to a historical crisis with both ingenuity and rigor. Let us hope there are many more like him.

Quotes & Commentary #68: Bryson

Quotes & Commentary #68: Bryson

“It’s remarkable that bad things don’t happen more often. According to one estimate reported by Ed Yong in the Atlantic, the number of viruses in birds and mammals that have the potential to leap the species barrier and infect us may be as high as 800,000. That is a lot of potential danger.”

—Bill Bryson

This past Christmas, my mother gave me Bill Bryson’s new book on the human body as a present. It was an excellent gift: I spent half my Christmas break totally absorbed in it. The book is fascinating for several reasons. For one, there is an awful lot that most of us do not know about our own bodies—which itself is funny to think about. But perhaps we are better off not knowing, since the book also highlights how many things could potentially go wrong in the intricate functioning of our mortal frames. The existence of life is a miracle in its own right; and the existence of highly complex life—such as us (or so we like to flatter ourselves)—is a miracle of exponential proportions. So many things have to go right in order for you and me to be here.

That means it is easy for things to go wrong. And a viral infection—when malicious genetic code hijacks our cells—is one way that this marvelous process can get disrupted. One of the best chapters in Bryson’s book is on diseases. When I read the chapter, not too long ago, it seemed to be mainly about things from the distant past that used to menace our species. Bryson discusses typhoid and typhus, smallpox and ebola, and of course the Spanish flu of 1918. Most of these illnesses strike us nowadays as historical curiosities, rendered obsolete by the invention of vaccines and effective antibiotics. But Bryson sounds a note of warning in the chapter that now seems quite prescient. He quotes Michael Kinch, a specialist on drug discovery of Washington University, as saying:

The fact is, we are really no better prepared for a bad outbreak than we were when Spanish flu killed tens of millions of people a hundred years ago. The reason we haven’t had another experience like that isn’t because we have been especially vigilant. It’s because we have been lucky.

I vividly remember reading that passage, and scoffing. Surely, I thought, we must be far better prepared than they were back in 1918, when medicine and technology were so comparatively primitive. I was wrong. Bryson deserves kudos for his writing, as this current crisis has completely borne out his warnings. We are in far more danger than we like to think, and we are basically not prepared for it.

One rather stunning fact—stunning because we so rarely think of it—is how many people normally die from the seasonal flu. In the United States alone, it is between 30-40,000 per year, and that number gets much bigger during particularly bad years. According to Bryson’s book, in the 2017-18 flu season, upwards of 80,000 people died of the flu. These numbers are stunning, especially considering the massive international response that is already underway to slow the spread of this new coronavirus, which has so far taken far fewer lives. Perhaps we should always be practising social distancing… 

The primary issue, at the moment, is essentially this: our society was not built to handle large-scale infectious diseases with fatality rates significantly higher than the seasonal flu. We do not have enough hospital beds, nurses, doctors, respirators, masks, or anything else. Our entire way of life—hanging out in bars, going to concerts, flying from country to country—is premised on being largely free from dangerous infectious diseases. We really did not know how lucky we were. Our situation was highly anomalous in human history, and it will take months before we can return to it.

What is most frustrating, for me, is the degree to which the situation is out of my hands. Everyone craves a sense of control. In a crisis, we want to know what we can do to protect ourselves, or to contribute to a common cause. Right now, these actions are rather humble: wash your hands, stay at home as much as possible, self-isolate if you show symptoms. This is all well and good; but we naturally want to know what is the scale of the danger and how long this immense disruption will last.

At this point, the information available is far from clear. The more articles I read, the more contradictory the information seems. Some are predicting infection rates of up to 80% of the population, while others predict 20%. Some predict that the disease will turn out to be less deadly than it seems, while others are predicting a complete global disruption lasting for months. It also seems unclear (to me, at least) whether children are effective vectors of the virus. Judging from the school closures, many believe yes; but I also have read that there is little available evidence.

Our best tool in fighting pandemics are vaccines. But unfortunately vaccines can take quite a long time to develop. It is not as easy as I (naively) thought. Many trials must be performed to ensure that the vaccine is effective and safe for the general population, and this takes time: months and months. If we cannot immunize ourselves artificially, then, the only possibility is to develop a herd-immunity the hard way: by getting the disease itself. This is a frightening prospect. That route would entail a great deal of suffering and death. But how long can we wait in our homes? In short, I am unclear how we are going to get out of this mess.

Meanwhile, I am fairly stuck in my little apartment in Madrid, one of the new epicenters of the virus. We have only had three days of isolation, and it is not so bad thus far. I began an exercise routine that I can do in my room, and my brother and I have been cooking a lot of hearty meals. But I really cannot see how everyone will be able to keep this up for the long-term, either economically or psychologically. Without extraordinary government measures, I do not think that people could stay in their homes much longer than one month without a great many people facing serious financial strain. Even in the best case scenario, the consequences for the economy seem quite grave. And this is putting aside the social pressure to resume normal life, which will increase from day to day.

At present, I swerve wildly from optimism to pessimism. What I want most of all is a return to normalcy. Never has my old life seemed so desirable! The strangest thing about this crisis is that it went from trivial to serious so quickly. Everyone seems to have been caught unawares. But even Bill Bryson—a popular writer with no specialized training—was able to see potential danger once he looked into the research. If only our experts had been as intelligent and as anxious as he.