Leaders across the globe have taken decisive, effective action toward containing the threat of C19. Their guidance, as well as the presence of a common threat and higher purpose of warding off illness, has inspired many to unite in collective pursuit of this greater good. Although some governments are now moving toward loosening restrictions, some are also discussing elimination (i.e., reduction to near-zero incidence of disease or infection in a defined geographical area) or even eradication of C19 (permanent elimination). For examples of these conversations, see Australia, New Zealand,China, and the United States. These objectives may be virtuous, but they are not without potentially derailing challenges.
As the threat of C19 becomes more manageable by the healthcare systems, such elimination-oriented goals are likely to be too divisive to energize the support and effort required to sustain them. Awarding disproportionate attention to C19 and prioritizing one human ill above all others will reveal inconsistencies in the way we appraise human life and will further compromise much-needed unity.
The main drivers of such inconsistency are the sheer collective effort and repeated lockdowns required to eliminate C19. It remains unpopular to suggest that C19 might not require such severe responses and global shutdowns. Nobody wants to put an easy target on their moral character by discounting the worst fears of many vulnerable populations—particularly when there is much more to learn about this virus and its consequences.
Yet, C19 may not be a universal threat that kills indiscriminately and efficiently. Experts used available data (or lack thereof) to voice their skepticism of draconian responses in absence of sufficient information. At this time, case fatality estimates are around 1-2% for symptomatic patients (also see lower estimates, a discussion of complexities involved in C19 death rate estimation, and an analysis of deaths in Italy). C19 is particularly deadly to the elderly and those whose immune systems are compromised by pre-existing health conditions. These properties make it different from the 1918 Spanish flu pandemic, which was merciless and fatal to young and healthy, too. A large majority of the C19 cases are mild or asymptomatic, and 97% or more of the people who have contracted it recover.
To be clear, C19 is serious. Prompt restrictions allowed many countries to ‘flatten the curve’ and bring the infection to manageable levels. Because of these positive outcomes, more ambitious objectives to eliminate or even to eradicate C19 may now sound inspiring. However, elimination-oriented objectives cannot create the same level of societal unity as more modest goals simply to manage the virus. It would need to energize single-minded collective action that is persistent enough to get societies through multiple waves of C19, or to the point when a vaccine or antiviral medication becomes universally available.
In light of the high recovery rate of C19 and its predictable dangers to vulnerable populations, it becomes difficult to sustain the rhetoric that elimination is the greater good that warrants diverting a large share of society’s resources. Aiming for no further deaths from one illness, while accepting increasing levels of risk from others is unsustainable. It inconsistently prioritizes some lives over others. The strictest measures, if ongoing, will only protect the vulnerable now.
But given that most societies have limited resources, this prioritization will impose costs on the lives and livelihoods of those who will be vulnerable later for other reasons. These may include patients who do not receive treatments and diagnoses on time because they are avoiding health care facilities, students whose education has been interrupted, young people who struggle to find jobs in a crippled economy, workers who lost their income, and the families supported by them. Numerous mental illnesses will arise from the economic strain, increased surveillance, shaming and mistrust, the threat of re-occurring lockdowns, and the restrictions against our most natural of human impulses to engage with others and socialize. Moreover, halting all varieties of progress made when individuals come together (technological innovations, medical discoveries for health conditions not related to C19, environmental solutions) will likely delay critical advancements. These, too, lead to life years lost, not to mention quality life years lost for the vulnerable and non-vulnerable alike.
Societies already accept certain death risks to preserve freedom and thriving economies. Consider, for example, flu. In contrast to flu, C19 is certainly more contagious, far more serious, and is far more likely to overwhelm the healthcare systems. However, both are viral and deadly. Strict social distancing and shutdowns during flu season would save even more lives as fewer people would contract it. Yet, we do not halt international trade, and we certainly do not arrange our schedules to accommodate flu seasons on both the northern and southern hemispheres. Similarly, prohibition would effectively reduce the number of innocent deaths from activities such as flying or driving, too, but few would endorse such bans. We accept a level of risk, because of the many inconveniences such extreme actions in perpetuity would entail.
If strategies to eliminate or even eradicate C19 reveal inconsistencies in the way that we assess human life, what is the alternative?
Answering that question may require us to tolerate some number of future deaths due to C19. Such mental calculations may elicit feelings of disgust and bring condemnation upon those who consider them. Yet, we already accept a certain death rate from various other menaces to public health, and we do so without moral accusations.
To minimize C19 deaths without compromising the lives of others, we need to be able to share our concerns freely. We can move beyond the simplistic, binary template where our arguments are filed away as being either pro-lives or pro-economy. The economy certainly means riches for some, but first and foremost, the economy is lives; it is creation, jobs, trade, and progress, and it is education, cooperation, and trust. The open discussion we need invites consideration of all lives, lives now and future lives. To engage in such exchanges, we must humbly recognize the limits of our knowledge and expertise, and acknowledge our own inconsistencies that influence the way we view life, the economy, and risk.
Without showing appreciation for all lives, the new reality of extreme shutdowns will remain divisive. C19 is not seen as a common enemy. Prioritizing elimination above all other ills of life, and sacrificing the well-being of the vulnerable later to eliminate risk to the vulnerable now, may create division rather than unity, precisely at the time when unity is needed.