'Saving lives' - the 'data-driven' approach to managing a pandemic
Lives or dollars? - a utilitarian balancing act, which only purpose is to create the impression that government cares ... writes Tred MagillWednesday, February 5, 2020
"I am not going to put dollars, above human lives" said New York State Governor Andrew Cuomo , making it clear he was not going to follow Trump's guidelines and re-open the economy. If lives were really so much more valuable than dollars, why did governments not prepare for a pandemic that was known to happen, sooner or later?
In 2003, the SARS corona-virus jumped from bats to humans in China and then spread to 26 countries. There was a close call in 2012 when MERS, another bat corona-virus, started infecting humans. In 2013, Chinese scientists found SARS-like viruses in fruit bats that could infect human cells; and in 2016, the World Health Organization put corona-viruses among the top eight known viral threats requiring more research. Here in South Africa, I guess the rich were too busy getting rich and the politicians were more interested in plundering our SEOs, than investing in the health of the people.
Now that it's happened, the response is lockdown ... resulting in the derogation of our fundamental rights and destruction of the economy.
A few days earlier, Cuomo reassured healthy New Yorkers that even if they were not infected, they were going to have to stay at home to save someone else's life; because although they might be asymptomatic, they still risk infecting someone else. He does this without knowing whether or not any individual is, in fact a risk - his approach, as all government approaches, is statistical. They're all watching 'the data', to see when the 'curve flattens', to judge, not if, but when the damage to the economy outweighs the cost in lives.
There is no cure for the virus, so your survival lies in human intervention or the natural capability of your body. If you land up in hospital, the treatment is symptomatic - they do the best they can to keep you alive; and if that fails, leave you to die ... alone, because nobody is permitted to say goodbye, for fear of spreading the virus.
There are two strategies to manage the virus.
One is to allow the virus to spread naturally. This will result in many infections, leading to deaths and recoveries; with a level of herd immunity in the recoveries. As the herd immunity grows in an increasing percentage of the population, the virus dies out because it doesn't find enough hosts to proliferate. The economy suffers because many people are ill and can't work, but it still ticks over ...
The other strategy is human intervention, by lockdown. This slows the rate of infection but also slows down the natural development of herd immunity. This cannot eliminate the virus unless the lockdown is maintained until the development of a vaccine and everyone is inoculated, which then has the same effect as herd immunity; reducing (by vaccine) the number of hosts in which the virus can spread. Finally, when everyone is inoculated 12 to 18 months later, lockdown can be lifted ... and normality resumes ... by which time the economy is destroyed.
The net effect of that is to artificially save lives at the cost of human rights and economic collapse.
So, if like Governor Cuomo, the South African government is intent on saving every life possible, then we are all going to stay under lockdown until a vaccine is developed and we're all inoculated. That however, is unsustainable, because people simply cannot survive without the basics of food, water, shelter, etc. Ask the poor, lining the roadside looking for work - it's death by virus, or death by hunger.
The moment the government lifts the lockdown, they are effectively letting the virus loose to kill more people. And that has to happen sometime because lockdown is not sustainable indefinitely.
The inescapable conclusion is that governments will determine a balance, between the cost in lives and the cost to the economy. In crude terms, how many lives lost, is the livelihood of the survivors worth?
So, while I have very strong democratic sympathies, I find Governor Cuomo's approach rather disingenuous. Sooner or later he is going to put 'dollars above lives' .... or if you want to look at it another way - the livelihood of those who don't need hospital care, against the lives of those who do. It's a typically utilitarian balancing act.
Interestingly, Sweden decided not to go down the lockdown route, keeping faith in its people to make their own responsible choices about social distancing and face masks, while keeping the economy open, along with schools and restaurants.
Anders Tegnell, the epidemiologist at the heart of that brave strategy, claims that the country is now weeks away from herd immunity: " We are doing two major investigations. We may have those results this week or a bit later in May. We know from modelling and some data we have already – these data are a little uncertain – that we probably had a transmission peak in Stockholm a couple of weeks ago, which means that we are probably hitting the peak of infections right about now. We think that up to 25% of people in Stockholm have been exposed to corona-virus and are possibly immune. A recent survey from one of our hospitals in Stockholm found that 27% of staff there are immune. We think that most of those are immune from transmission in society, not the workplace. We could reach herd immunity in Stockholm within a matter of weeks."
There is no cure for the virus, so treatment is simply managing the symptoms, particularly lung failure, which appears to be the primary cause of death. A sudden 'surge' in hospital admissions, places an unusual demand on health services and resources, for which we were not prepared; and so people are dying ... which exposes the government's inability to provide the health care. If you didn't get a ventilator and died, you might have been saved ... but you might also have died anyway.
There are also those that argue that lockdown will result in more loss of life, than letting people get on with life. A group of doctors have written to President Cyril Ramaphosa, appealing for a relaxation of the lockdown, saying: "We see far greater harm to our healthcare system and our economy by further delaying the inevitable spread of the virus. The ongoing 'hard lockdown' will likely cause far greater suffering in the short and long term than the pandemic itself" ... and there was an "ill-founded fear" the virus was fatal and the lockdown would purge the country of it.
So, if you're going to survive the pandemic, it will be at the indiscriminating hand of natural selection, or the availability of a human intervention .. neither of which are guaranteed.
As an individual, your best chance of survival is to get the virus early when ventilators available, or stay at home when lockdown is lifted; because the government is not really concerned with your life ... no, the government is concerned with managing resources.
Writing for Newstatesman , Lawrence Freedman says that herd immunity, "a policy tantamount to doing nothing to contain the spread of the virus" was actually the UK government's initial strategy, subsequently abandoned upon a report from Imperial College London about the number of deaths that might result: "... the combination of public revulsion at the government’s apparent readiness to let tens of thousands get sick and die, combined with a frightening report published by Imperial College London about what would happen if stronger measures were not adopted (with a death toll of up to 250,000), forced the government to embrace new containment strategies."
He goes on: "There is a real concern among scientists and politicians that the country might succeed in seeing off the first wave of infections through extraordinary efforts, only to be faced with a more devastating second wave. Given the time taken to prepare and test a reliable vaccine, the more the first wave leaves a large proportion of the population with a natural immunity, the better placed we are to cope with a resurgence of Covid-19. There is a potential trade-off between protecting as many people as possible from the first wave and being best prepared for the second."
Without digging into the details, it seems clear that Trump's policy response is not much different; but as usual, he's not backing down .... he's doubling down and sticking to his guns.
Governments are not motivated by lives or deaths - individuals don't matter! Rather, it is motivated by its capacity to manage the spread of the virus, enough so that State facilities are not overwhelmed, so that it can appear to have done everything possible ... so maintaining control and preserving the political status quo. Or, on the other hand, it will resume economic activity and justify the deaths that will inevitably pile up.
It only needs to convince a 'critical mass' that will do its work for it by peer-pressure and shaming others for their selfish, divergent opinions. "You could literally kill me by not wearing a mask. How cruel and irresponsible is that?" says Governor Cuomo, sitting on one side of the argument.
Government's all claim to be 'guided by science' and 'the data' but have forgotten about evolution; and that humans are mammals with an evolutionary history and it is the virus that kills, not people. The virus is not an 'evil' and 'menacing' thing that seeks to destroy humans. Covid-19 is a product of nature, just as we are ...
Hence, the messaging: 'Every life matters' and "we're all in this together", are slogans to shame the 'selfish' with peer pressure, to keep us at home. It cares about everyone, but in so doing cares about absolutely nobody at all. - (219)