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 & 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.