The COVID-19 sword of Damocles

A continuum exists in how to address the COVID-19 virus.  On one end are those wanting to quickly phase out the lockdown ("a cure worse than the disease") despite the mounting deaths.  Opposed are Americans so terrified that nothing less than total eradication of the virus will suffice.

The first view typically rests on an economic cost/benefit analysis including "human despair" that may be short of death — for example, unemployment-induced domestic violence (and see here and here).  The justification for continued draconian measures, at least outside "hotspots" like New York City, is, however, less clear.  This rationale is especially questionable given the low odds of catching the diseases and being hospitalized — the most recent pertinent data are 40.4 per 100,000 (but 131.6 for those 65+, a figure comparable to hospitalization rates for the seasonal flu).  Moreover, many infected display no symptoms or recover at home, so they are statistically invisible, so the true infection rate of 40.4 per 100,000 is likely too high.

The mortality rate, the bottom line in assessing risk, is exceedingly complex and varies as new data are uncovered and past figures are re-calculated.  The overall rate is estimated to be 5.84%, but this is highly age-related, varies enormously by state (1,282.2 per million in New York vs. 12.1 per million in Wyoming), and depends on other health factors such as obesity and heart illness.  Yet such is the nature of the complicated data, that others (including Dr. Anthony Fauci) suggest that the mortality rate may be as low as 1%, a figure still substantially greater than the "normal" seasonal flu.  All in all, then, the objective scientific data — the overall low incidence of infection, its selective impact, and the low death rate of those infected — hardly justify the type of hysteria in which, for example, a hair salon operator is jailed for conducting business.

What, then, accounts for the frenzy?

Let's begin by noting that carnage per se does not entirely explain the panic.  The super-deadly 1918 Spanish Flu pandemic is well known, but more relevant was the "Hong Kong flu" of 1968, a far more lethal pox than today's Asian import.  Though largely forgotten, in 1968, the H3N2 (its technical name) pandemic killed 100,000 Americans (plus a million more worldwide), a figure that exceeds the death toll of both the Vietnam and Korean Wars.  Moreover, the U.S. population in 1970 was 209 million versus 330 million today, so adjusted for population, the number killed was 136,000.  For unclear reasons, however, the 1968 "Hong Kong" flu passed almost unnoticed when it hit, conceivably overshadowed by the Vietnam war and widespread urban rioting.  Closer in time was the epidemic of 1957 that killed 116,000 and the 2009 flu epidemic — H1N1 — that affected 60.8 million Americans.  The estimated death toll was around 12,000.

Part of the explanation for the panic (outside a few hotspots like New York City and northern New Jersey) lies in the predictability of deadly infection, not its absolute incidence.  The power of controllability to calm fear is well illustrated by how few Americans ever worried over AIDS once transmission mechanisms were uncovered.  Since the HIV/AIDS epidemic exploded in the 1980s, some 700,000 Americans have died of AIDS, but few Americans are panicked by the carnage.  Escaping AIDS merely entails avoiding dangerous homosexual sexual behavior and shooting up drugs, behaviors that nearly all Americans readily avoid.  Thus understood, safety is guaranteed, so there is no anxiety or depression regardless of HIV/AIDS rates.

This distinction between controllable and almost random lethality helps explains why highlighting overall U.S. morality statistics fails to calm the panic.  For those terrified of going to Whole Foods, it makes absolutely no difference if the 2017 death toll from heart illness was 647,457 or, for that matter, 1,000,000 or 10,000,000!  Nobody suddenly contracts heart disease by shopping at Whole Foods.  Of the ten major causes of death in 2017 tracked by the CDC, the only transmittable one is influenza and pneumonia (55,672 cases in 2017), and even here, potential victims exercise substantial individual controllability via flu shots or seeing a doctor early on.

COVID-19, at least currently, is different, as public health officials insist, because it can be mitigated by avoiding crowds, frequent hand-washing and wearing masks.  But such personal actions are hardly guarantees, given the iffy underlying science.  For example, one recent report from New York City found that two thirds of those admitted to hospitals were, as per official decree, self-quarantined  by staying home.  Only a small percentage worked away from home, and a tiny number took public transportation.  In other words, the official wisdom may have been inaccurate, so who can be trusted?  

Potential unknown dangers lurk everywhere even if the actual hazard is exceedingly remote.  Yes, you may barricade yourself, wear a hazmat suit, and order out meals, but the Typhoid Mary delivery person may deposit the virus on the pizza box.  Your non-medical grade mask only protects others from you, not vice versa, so the infected person who jogs past you in the park may be a killer (and even medical grade face masks can be dangerous counterfeits, or else protective for you yet unsafe for others). You cannot banish a spouse or child, and each might inadvertently bring the pox home. Keep in mind, that it will be months before a cure can be found, and given the millions of possible opportunities for infection, only a single incident can be deadly.

The panic also reflects is the unavailability of the traditional, and most effective solution—escape. Rich Italians during the Renaissance practiced villeggiatura—fleeing the city to a country farm or villa and waiting for the pestilence to subside. Given the frequency of plagues, building isolated rural villas flourished and undoubtedly help calmed frayed nerves.

Alas, hardly possible in today's travel-friendly world. When the epidemic first appeared, for example, many affluent New Yorkers fled to their seemingly safe vacation homes, but few city residents enjoy this costly option and, more important, the influx could hardly exclude asymptomatic carriers who would then infect escapees. The epidemic's worldwide ubiquity also precludes easy refuge. An inexpensive Dominican Republic resort is hardly a safe haven--who can guarantee a virus-free staff, and local medical facilities may be inadequate. This physical escape option also assumes that the sanctuary will admit you.

Make no mistake, the carnage is real, tragic and Pollyanna obliviousness is not the cure but, that being said, this is not the apocalypse. Especially troublesome is how sky-high anxiety levels undermine rational cost-benefit public debate. It is easy to understand why those suffering from cabin fever are confused by often uncertain epidemical CDC data. Statistics about the extremely low odds of infection for those under 65 and in decent health are meaningless to habitual lottery players or the innumerate. Terror may be especially likely for those fantasizing ending life as an anonymous corpse rotting in a refrigerated truck in a Queens New York parking lot thanks to briefly encountering a McDonald's employee. Though it might bring momentary therapeutic relief, mindlessly lashing out at President Trump for insufficient testing, stockpiling too few ventilators, White House disorganization, recommending drinking Clorox, or just "rejecting science" solves nothing.

Image credit: Pixabay public domain.

A continuum exists in how to address the COVID-19 virus.  On one end are those wanting to quickly phase out the lockdown ("a cure worse than the disease") despite the mounting deaths.  Opposed are Americans so terrified that nothing less than total eradication of the virus will suffice.

The first view typically rests on an economic cost/benefit analysis including "human despair" that may be short of death — for example, unemployment-induced domestic violence (and see here and here).  The justification for continued draconian measures, at least outside "hotspots" like New York City, is, however, less clear.  This rationale is especially questionable given the low odds of catching the diseases and being hospitalized — the most recent pertinent data are 40.4 per 100,000 (but 131.6 for those 65+, a figure comparable to hospitalization rates for the seasonal flu).  Moreover, many infected display no symptoms or recover at home, so they are statistically invisible, so the true infection rate of 40.4 per 100,000 is likely too high.

The mortality rate, the bottom line in assessing risk, is exceedingly complex and varies as new data are uncovered and past figures are re-calculated.  The overall rate is estimated to be 5.84%, but this is highly age-related, varies enormously by state (1,282.2 per million in New York vs. 12.1 per million in Wyoming), and depends on other health factors such as obesity and heart illness.  Yet such is the nature of the complicated data, that others (including Dr. Anthony Fauci) suggest that the mortality rate may be as low as 1%, a figure still substantially greater than the "normal" seasonal flu.  All in all, then, the objective scientific data — the overall low incidence of infection, its selective impact, and the low death rate of those infected — hardly justify the type of hysteria in which, for example, a hair salon operator is jailed for conducting business.

What, then, accounts for the frenzy?

Let's begin by noting that carnage per se does not entirely explain the panic.  The super-deadly 1918 Spanish Flu pandemic is well known, but more relevant was the "Hong Kong flu" of 1968, a far more lethal pox than today's Asian import.  Though largely forgotten, in 1968, the H3N2 (its technical name) pandemic killed 100,000 Americans (plus a million more worldwide), a figure that exceeds the death toll of both the Vietnam and Korean Wars.  Moreover, the U.S. population in 1970 was 209 million versus 330 million today, so adjusted for population, the number killed was 136,000.  For unclear reasons, however, the 1968 "Hong Kong" flu passed almost unnoticed when it hit, conceivably overshadowed by the Vietnam war and widespread urban rioting.  Closer in time was the epidemic of 1957 that killed 116,000 and the 2009 flu epidemic — H1N1 — that affected 60.8 million Americans.  The estimated death toll was around 12,000.

Part of the explanation for the panic (outside a few hotspots like New York City and northern New Jersey) lies in the predictability of deadly infection, not its absolute incidence.  The power of controllability to calm fear is well illustrated by how few Americans ever worried over AIDS once transmission mechanisms were uncovered.  Since the HIV/AIDS epidemic exploded in the 1980s, some 700,000 Americans have died of AIDS, but few Americans are panicked by the carnage.  Escaping AIDS merely entails avoiding dangerous homosexual sexual behavior and shooting up drugs, behaviors that nearly all Americans readily avoid.  Thus understood, safety is guaranteed, so there is no anxiety or depression regardless of HIV/AIDS rates.

This distinction between controllable and almost random lethality helps explains why highlighting overall U.S. morality statistics fails to calm the panic.  For those terrified of going to Whole Foods, it makes absolutely no difference if the 2017 death toll from heart illness was 647,457 or, for that matter, 1,000,000 or 10,000,000!  Nobody suddenly contracts heart disease by shopping at Whole Foods.  Of the ten major causes of death in 2017 tracked by the CDC, the only transmittable one is influenza and pneumonia (55,672 cases in 2017), and even here, potential victims exercise substantial individual controllability via flu shots or seeing a doctor early on.

COVID-19, at least currently, is different, as public health officials insist, because it can be mitigated by avoiding crowds, frequent hand-washing and wearing masks.  But such personal actions are hardly guarantees, given the iffy underlying science.  For example, one recent report from New York City found that two thirds of those admitted to hospitals were, as per official decree, self-quarantined  by staying home.  Only a small percentage worked away from home, and a tiny number took public transportation.  In other words, the official wisdom may have been inaccurate, so who can be trusted?  

Potential unknown dangers lurk everywhere even if the actual hazard is exceedingly remote.  Yes, you may barricade yourself, wear a hazmat suit, and order out meals, but the Typhoid Mary delivery person may deposit the virus on the pizza box.  Your non-medical grade mask only protects others from you, not vice versa, so the infected person who jogs past you in the park may be a killer (and even medical grade face masks can be dangerous counterfeits, or else protective for you yet unsafe for others). You cannot banish a spouse or child, and each might inadvertently bring the pox home. Keep in mind, that it will be months before a cure can be found, and given the millions of possible opportunities for infection, only a single incident can be deadly.

The panic also reflects is the unavailability of the traditional, and most effective solution—escape. Rich Italians during the Renaissance practiced villeggiatura—fleeing the city to a country farm or villa and waiting for the pestilence to subside. Given the frequency of plagues, building isolated rural villas flourished and undoubtedly help calmed frayed nerves.

Alas, hardly possible in today's travel-friendly world. When the epidemic first appeared, for example, many affluent New Yorkers fled to their seemingly safe vacation homes, but few city residents enjoy this costly option and, more important, the influx could hardly exclude asymptomatic carriers who would then infect escapees. The epidemic's worldwide ubiquity also precludes easy refuge. An inexpensive Dominican Republic resort is hardly a safe haven--who can guarantee a virus-free staff, and local medical facilities may be inadequate. This physical escape option also assumes that the sanctuary will admit you.

Make no mistake, the carnage is real, tragic and Pollyanna obliviousness is not the cure but, that being said, this is not the apocalypse. Especially troublesome is how sky-high anxiety levels undermine rational cost-benefit public debate. It is easy to understand why those suffering from cabin fever are confused by often uncertain epidemical CDC data. Statistics about the extremely low odds of infection for those under 65 and in decent health are meaningless to habitual lottery players or the innumerate. Terror may be especially likely for those fantasizing ending life as an anonymous corpse rotting in a refrigerated truck in a Queens New York parking lot thanks to briefly encountering a McDonald's employee. Though it might bring momentary therapeutic relief, mindlessly lashing out at President Trump for insufficient testing, stockpiling too few ventilators, White House disorganization, recommending drinking Clorox, or just "rejecting science" solves nothing.

Image credit: Pixabay public domain.