Disease in a Time of Uncertainty
Opinion + AnalysisHealth + WellbeingPolitics + Human Rights
BY Nick Evans 19 FEB 2020
If you’re reading this, there’s a good chance you’ve heard of the outbreak of coronavirus, officially called “SARS-CoV-2”, that has caused disease primarily in Wuhan, China.
The virus, which causes a disease called coronavirus disease 2019 (COVID-19), has spread to 25 countries, infected more than 73,000 people, and caused 1,873 deaths. The World Health Organization has declared the outbreak a “Public Health Emergency International Concern” and more than 50 countries — against the WHO’s advice — have implemented travel restrictions and quarantines in an attempt to prevent the spread of the disease.
There’s been a lot of worry about this coronavirus, but arguably the thing that is driving this worry is uncertainty. It can’t be the deaths alone – fewer than 1,900 people have died of COVID-19. In contrast, since October, 14,000 people in the USA alone have died of influenza.
Unlike the 1918 influenza pandemic or the 2009 influenza pandemic, both of which killed young people faster than normal flu, the people who are dying of COVID-19 are typically old, have pre-existing diseases that make them vulnerable to pneumonia (one of the main ways COVID-19 kills you), or are heavy smokers.
Despite its rapid increase in cases in China — driven, in part, by a change in definition of how they count cases — the number of cases elsewhere has stayed relatively low.
A reported 2.5 per cent of the patients diagnosed in China have died, yet fewer than 0.4 per cent of patients elsewhere in the world have died – a bit more than seasonal flu, but not much, and not as widely.
So why the fear? And why the fantastical conspiracies: tens of thousands dead but hidden in China; a laboratory escape; or even a biological weapon? There are surely a lot of reasons: the actions of the Chinese government during the 2003 SARS outbreak; general distrust of China in a media responding to Washington’s belligerence; and some enterprising grifters out to make their name or make a buck.
Still, these all take hold in an environment of uncertainty. And in ethics, how we deal with uncertainty is a tricky case. A classic example of why uncertainty can be tricky from the perspective of ethics goes something like this.
Say I ask you to play a game: I roll a normal dice; if it lands 1-5, you get $1; if it lands on a 6, you pay me $2. To many people this seems like a good deal. Five chances to win; one to lose. You should expect, mathematically, to win 50c each game. But what if I pull out a weird, many sided dice with 120 sides. If the dice land 1-119, you get $1. But if it lands 120, I get $59. It might feel different, but the expectation (again, mathematically) remains the same.
Now imagine a huge dice in which that one chance of a loss was $10,000, or even $1 million… Part of the reason it feels different is psychological. After all, $59, or $10,000 is so much more than $2, and so even though your chances of losing are decreasing, the pit in your stomach at the thought of losing $10,000 is probably a lot more. Moreover, you’re risking that for $1 each time. Sounds like playing with fate, and you might not want to play with fate when fate could take your house if it wins.
Another part of the reason it feels different is that we don’t often encounter — or at least don’t recognise — extreme cases in our lives where we face a small chance of a huge loss. My colleagues and I have looked at this phenomena in the case of things like laboratory safety, or industrial regulations. But the same goes for things like pandemics.
Coronaviruses circulate in animal populations, usually certain species of bat, and typically don’t infect humans.
Occasionally a virus does, often through an intermediate species, and the results can be bad. It can be really hard to figure out how bad, though. So we don’t know when these viruses will appear, or how bad they are going to be.
Given that, it can be really easy to get complacent before the fact, and even easier to overreact after the outbreak starts. This leads us to take drastic actions such as to violate human rights in the name of protecting public safety (or at least appearing to protect safety), even when those actions are shown to be ineffective. But this is because instead of winning a dollar, preparedness costs us that dollar. It’s hard to get governments to spend dollars today that might not benefit us until 2030, but if we wait until we need it, we could lose everything.
It turns out that the best solution to these scary, uncertain diseases is to invest, as a society, day to day. That costs resources, but it’ll help out when the “big one,” the next 1918 flu, comes. COVID-19 is unlikely to be that kind of pandemic, but even it is testing global health systems.
We need, as a society, to get better at dealing with the uncertain, by investing in preparedness today.
Better healthcare systems; more nurses, doctors, and scientists; a more aware community; local plans for infection control that match the plans of national governments; and protections for people in quarantine so they don’t lose their livelihoods or, as is the case in some countries, have to pay for their own quarantine when they aren’t even sick.
These investments cost governments money. They cost us taxes. But if you’re scared of COVID-19, with all its uncertainty, you should be much more scared that we’re not doing the ordinary, everyday things that’ll keep us safe.
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