The Prognosis

October 2020 | Pandemic

By David Cayley

WN: There are recent posts and others here, that inform you about David Cayley. Cayley is a powerful prophet crying, perhaps in the wilderness. . .

excerpts:

It is striking how often historical events arrive with their meanings plainly legible. When Napoleon clattered by Hegel’s window in Jena, in October 1806, the philosopher famously perceived in the emperor’s appearance “the soul of the world . . . seated on a horse.” The thought that fit the moment was ready for its occasion. In summer 1914, when Europe went to war “like a sleepwalker,” as the economic historian Karl Polanyi later recalled, it enacted a fate it was already dreaming. In our time, 9/11 declared its significance almost the instant it happened, as if everyone had just been waiting. With the ruins of the World Trade Center still smoking, the patent meaning of the towers’ collapse was easily parsed in the next morning’s papers: it was the end of every decadence, the beginning of a new unity, a new discipline, a new age. And so it seems to have been with the pandemic.

Everyone appeared to know right away what COVID‑19 meant. Some, like George Monbiot in the Guardian, heard “nature’s wake‑up call to a complacent civilization”; others sensed the advent of a bigger, more caring government; a few even welcomed the chance to test drive a new health-security state, to be better prepared for even worse pandemics in the future. But everyone agreed that the world “had changed forever,” that a judgment had been passed on our heedless way of life, and that a new social condition — a “new normal,” as so many have said — was dawning.

What has impressed me about the coronavirus is the extent to which its fearsome reputation has eclipsed and occasionally exceeded its actual effects. This is not to deny that some of these effects have been, in places, quite terrible. It is only to point out that the myth of the pandemic — the story that already clothed it upon arrival — has sometimes had more influence on policy than the facts of the matter, which are more difficult to ascertain. Two events seem to have had an outsized influence. The first was the announcement by the director of the World Health Organization on March 11 that the spread of COVID‑19 should be considered a pandemic. The word hit with extraordinary force. A National Post headline encapsulated the reaction: “PANIC,” it simply said, in a font so big and bold that it occupied a good part of the front page. At the time it was written, this headline was not an accurate description of things in Canada. Aside from the play on words — pan‑ic, pan‑dem-ic — it can only have been an instruction or permission. From that day on, the virus became the almost exclusive preoccupation of daily newspapers, as if, suddenly, there were nothing else in the world but the contest of it versus civilization.

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Some voices were more cautious. John Ioannidis of the Stanford School of Medicine, a recognized expert in the fields of epidemiology, population health, and biomedical data science, warned of “a fiasco in the making” if draconian political decisions were taken in the absence of evidence. A number of other equally qualified doctors and medical scientists followed suit. The epidemiologist Knut Wittkowski, formerly at New York’s Rockefeller University, recommended that the disease be allowed to spread through the healthy part of the population as rapidly as possible. John Oxford, a virologist at Queen Mary University of London, warned that what we were experiencing was “a media epidemic.” In Canada, a former chief public health officer in Manitoba, Joel Kettner, phoned CBC Radio’s Cross Country Checkup on March 15 to warn against overreaction and to point out that “social distancing” was a largely unproven technique. “We actually do not have that much good evidence,” Kettner said. While it might work, he went on, “we really don’t know to what degree, and the evidence is pretty weak.” Such opinions — contrary to the headline news — were easily available to those who sought them out, but they made little dent in the emerging consensus. Kettner, for example, was treated with strained courtesy by Cross Country Checkup host Duncan McCue and then dismissed with little follow‑up. The larger narrative had already developed such momentum, and such an impressive gravity, that marginal voices had little effect.

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Behind claims that our political leaders are following science lies a fateful confusion. Does science mean merely the opinions of those with the right credentials, or does it refer to tested knowledge, refined by careful observation and vigorous debate? My impression is that when the premier of Ontario says he is following science, he is referring to the former — the opinions of his expert advisers — but, at the same time, invoking the aura of the latter — verifiable knowledge. The result is the worst of both worlds: we are governed by debatable positions but can make no appeal to science, since the general population has been convinced, in advance, that we are already in its capable hands.

This is a dangerous situation on two counts. First, it disables science. What is best understood as a fallible and sometimes fraught quest for reliable evidence becomes instead a pompous oracle that speaks in a single mighty voice. Second, it cripples policy. Rather than admitting to the judgments they have made, politicians shelter behind the skirts of science. This allows them to appear valiant — they are fearlessly following science — while at the same time absolving them of responsibility for the choices they have actually made or failed to make.

But did we not quietly make equivalent decisions about others, all the while hiding the fact that we were making them?

Science, in other words, has become a political myth — a myth quite at odds with the messy, contingent work of actual scientists. What suffers is political judgment. Politicians abdicate their duty to make the rough and ready determinations that are the stuff of politics; citizens are discouraged from thinking for themselves. With science at the helm, the role of the citizen is to stand on the sidelines and cheer, as most have done during the present crisis.

♦

The decisions made at the beginning of this pandemic will have consequences that reverberate far into the future. These will include unprecedented debt, deaths from diseases that have gone undiagnosed and untreated during the COVID‑19 mobilization, lost jobs, stalled careers and educations, failed businesses, and the innumerable unknown troubles that have occurred behind the closed doors of the lockdown. Whether these harms outweigh the benefits of flattening the curve is a moral question, not a scientific one. It would remain a moral question even if the Imperial College wizards had had an infallible crystal ball and could have given us an accurate forecast.

A great part of the panic this past spring was about saving our health care system and not putting overwhelmed doctors into the position where they would have to decide who lived and who died in hospital wards. But did we not quietly make equivalent decisions about others, all the while hiding the fact that we were making them? If someone loses a business, in which they have invested everything, and then their life falls apart, have they not been sacrificed or triaged, just as surely as the old person who we feared might not get a ventilator? Moral decisions are difficult, but they should at least be faced as moral decisions.

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The media onslaught had two great effects. The first was to transfer all agency to the virus. Governments took the measures that closed businesses and immured people in their homes — measures that really were unprecedented — but these steps were never treated as problematic or debatable, because constant reiteration of the threat posed by the virus made them seem unquestionably necessary. It was not the government that had turned the world upside down. It was the virus’s doing.

In many ways, we’ve been practising for this day.

The second great effect was to establish a war psychology. That we were fighting a war, that the virus was a mighty and relentless adversary, that we must win no matter the cost — these all quickly became commonplace ideas. People love war, just as much as they hate it, and a war against an invisible foe, belonging to no race, nation, or class, was ideal. It generated solidarity; it fortified purpose; it empowered heroism; it provoked repentance. How careless we were, we said, before our invisible enemy reminded us of the things that really matter. How brave are the nurses and grocery clerks who serve on the “front lines.” Political careers have been rehabilitated, without the slightest taint of opportunism touching those who were thus revived. The becalmed government of Doug Ford suddenly had the wind back in its sails. The prime minister, hopelessly impaled by contradictions that his sunny ways had failed to overcome, became once again a healer, a generous and resolute friend, a stern father. “Enough is enough,” he reprimanded his wayward children. “Go home and stay home.” Does it sound cynical to say this? Of course it does, even if, by now, the magic has already worn off a little. Who undermines confidence in the government, or questions its motives, during a war?

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The fundamental difficulty with assessing the mass quarantine lies in the distinction between correlation and cause. The lockdowns may have little effect on the progress of the disease, as Ben-Israel tried to show, but since they occurred at the same time, they can always be assigned the credit when infections begin to diminish. Controlled study of the question would be fiendishly difficult, if not impossible, and so the whole matter must remain moot. There is no “settled science.” The question then arises: Why were we so quick to adopt such a debatable policy, and why has it been so widely acclaimed?

In many ways, we’ve been practising for this day. Consider the growing emphasis placed on safety. When I was young, people did not urge one another to “be safe,” but now it is a synonym for “see you later.” Many children have entirely lost their independence in the name of safety. Houses and cars have been fortified and securitized. Surveillance has expanded. And every new increment in safety has quickly become mandatory. It’s incredible to recall that the old CBC building on Jarvis Street in Toronto, where I worked for many years, had minimal security and more or less open public access until the late 1980s, when a frightening intruder caused some alarm. Then, in 1992, we moved to the new broadcasting centre, where gates barred the public from work areas, key cards were required for access, and we were asked to display our dog tags at all times (though few did). Immediately the former regime began to seem almost unthinkably unsafe. Good enough had turned into zero tolerance.

Risk consciousness has run on a parallel track. The idea itself is old — traders began sharing the risks of dangerous ventures millennia ago — but it has become more pervasive and more mathematical in our time. Expecting parents, long before they ever meet their child, know the probability of various conditions for which he or she may be at risk. People are regularly checked for diseases they don’t yet have, because they are at risk of getting them. We are, as the health researcher Alan Cassels once joked, pre-diseased. This fosters what might be called a hypothetical cast of thought: a habit of living in the future or acting in advance. It also accustoms people to thinking of themselves in statistical terms rather than as unique individuals. Risks pertain not to individuals but to a population, a hypothetical entity composed of statistical figments that resemble each other in some way. “My risk,” in other words, does not pertain to me personally — I remain terra incognita — but rather to my statistical doppelgänger. When awareness of risk, in this sense, reaches a certain intensity, a habit of thought forms. People are primed for impending risks. It makes sense when we are told that we have to act now, before we know anything for sure, because, if we wait, it will surely be too late.

The decisions made at the beginning of this pandemic will have consequences that reverberate far into the future. These will include unprecedented debt, deaths from diseases that have gone undiagnosed and untreated during the COVID‑19 mobilization, lost jobs, stalled careers and educations, failed businesses, and the innumerable unknown troubles that have occurred behind the closed doors of the lockdown. Whether these harms outweigh the benefits of flattening the curve is a moral question, not a scientific one. It would remain a moral question even if the Imperial College wizards had had an infallible crystal ball and could have given us an accurate forecast.

A great part of the panic this past spring was about saving our health care system and not putting overwhelmed doctors into the position where they would have to decide who lived and who died in hospital wards. But did we not quietly make equivalent decisions about others, all the while hiding the fact that we were making them? If someone loses a business, in which they have invested everything, and then their life falls apart, have they not been sacrificed or triaged, just as surely as the old person who we feared might not get a ventilator? Moral decisions are difficult, but they should at least be faced as moral decisions.

Experience shows that all of these new [government] powers, once assumed, will not be readily relinquished.

Whenever I have seen the costs of total mobilization compared with the benefits, the costs invariably come out as substantially greater — sometimes by several orders of magnitude. For example, the epidemiologist Jayanta Bhattacharya, of Stanford University, and the economist Mikko Packalen, of Waterloo University, have argued in The Spectator that infant mortality will increase dramatically during the economic downturn induced by the shutdown, resulting in as many six million deaths over the next decade. Other studies predict increased deaths from cancer and tuberculosis, as preoccupation with COVID‑19 interrupts diagnosis, treatment, and vaccination programs. Yes, these studies are speculative and may rest on questionable assumptions, but in this respect they are just like the many coronavirus models that have induced such fear. They may also involve invidious, fanciful, or impossibly abstract comparisons where one is asked — to take an instance I recently heard — to choose between “saving Granny” and “saving the economy.”

My point is not that a particular model is right or wrong. The variety of plausible scenarios indicates that we are in a condition of ignorance and uncertainty — a condition that should not be hidden by the pretense that science is lighting the way. Nevertheless, such models, as in the case of Bhattacharya and Packalen’s work, can remind us that in saving some, we may have abandoned many others, and that the ones saved will often be those who are already in the best position to protect themselves, while the abandoned will often be the weakest or most vulnerable. Put another way: political deliberation may have stopped — transfixed by the threat of the virus — exactly where it should have started.

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Risk has another aspect that is relevant to the present moment. In 1986, the German sociologist Ulrich Beck described a “risk society” — a social formation that amounts to an ongoing science experiment with risks we can neither assess nor control. We have no other Earth on which we can conduct a nuclear war and observe the consequences; no spare atmosphere that we can heat up experimentally to see how things turn out. This is a terrifying situation, and it has the consequence of making us extremely risk averse. At the mercy of towering risks that we can barely comprehend, we become all the more zealous in attempting to contain more manageable ones. At least we can try to “wrestle the virus to the ground,” as multiple politicians and editorial boards have put it this year.

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A ready example is the quantification of life in the news media. Catastrophes are measured by their death toll. Lives “saved” are a gauge of success. “Saving lives,” boasts Toronto’s Sunnybrook Hospital, ”one innovation at a time.” These lives are an aggregate, an abstraction. We do not need to know anything about any of them to know that their conservation is an unrestricted good. They are an amount — captured by a new metric, gross national lives. In New York, Andrew Cuomo typified this attitude when he said in March, “I want to be able to say to the people of New York: I did everything we could do. . . . And if everything we do saves just one life, I’ll be happy.” There is an echo here, conscious or not, of the Talmudic teaching that whoever saves a single life saves the whole world. At the very least, the governor’s remark must be understood as a religious statement, since as a political statement it is almost criminally irresponsible. And that is my point.

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The old, as I have discovered, are barely permitted to speak about their age without getting a pep talk in return. This makes it difficult to take the losses inflicted by the virus gracefully, even when they are unavoidable. Better to pretend with Cuomo that we will fight to the last ditch. This inability to face death, or to speak frankly about it, makes even the manifest destruction created by the lockdown seem preferable.

The most terrible aspect of the obsession with saving lives, for me, has been the way the old have been left to die alone during these past few months. This is unconditionally wrong. To justify it as an unfortunate, temporary trade-off — or as a necessity in service to the greater good — misses something fundamental. The dying should be accompanied and held, comforted and mourned by those they have loved and who have loved them. No calculus of health and safety should limit this defining obligation: it simply belongs to us as human beings. That safety has supervened over humanity in this way helps illustrate the substitution of lives for persons. Persons are unique — each will be born and die only once, and the respect due to these two great passages is absolute. There are fates worse than death, and one of them is the bullying of the old into the self-serving belief that we have incarcerated and abandoned them for their own good.

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So this is the heritage: the possibility that the deaths averted by lockdowns will be offset by the deaths caused by them; spectacularly indebted governments whose deficits may threaten basic state functions; increased surveillance; reduced civil liberty; lost jobs and ruined careers; a frightened, more pliable citizenry; and an economy that has shrunk in the worst possible way by casting off the poorest and the weakest — a terrible irony for long-time advocates of degrowth, including me.

Mass quarantines and social distancing measures are easier to begin than to end. Such policies, once undertaken, assume lives of their own and tend to become the reason for their own existence. They generate the fear they ostensibly address: if we weren’t in danger, we wouldn’t be “sheltering in place” or “keeping two metres apart” or wearing masks or giving restaurants our personal details for potential contact tracing. When this all began, we were told that we must protect our health system from overload and our doctors from agonizing decisions about who should get scarce resources. Even when hospitals were not overtaxed here, I have met people, still under the influence of the initial panic, who believe they were. Nevertheless, the lockdown persisted long past the time when there was any reason to fear that our hospitals would be swamped.

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