Like just about everyone else on the planet, I've been at home with my thoughts a lot lately. I've had a lot of them. The problem is that so has everyone else. Indeed, there's been an outbreak of written opinion nearly as large as the outbreak of the coronavirus, SARS-CoV-2, itself. And, also similar to the SARS-CoV-2, I don't care for a lot of it.
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| Dusting Off the Old Plans? |
The litany that follows here eventually leads me to a more serious set of points I think I have something to say about as we contemplate life during and after this pandemic.
I started talking with students in my classes about SARS-CoV-2 back in January of this year as efforts to deal with the outbreak in Wuhan, China were first starting to make front pages around the world. I mentioned an obscure table-top bioterrorism exercise in June 2001 put on by the Center for Strategic and International Studies in Washington, D.C. entitled Dark Winter. The core of that exercise was the release of a weaponized version of smallpox into the ventilation system of an Oklahoma City shopping mall. Smallpox has a lengthy asymptomatic incubation period. As the scenario unfolded, more than two weeks passed before authorities understood the gravity of the situation. By then it was too late for a large number of people, many of whom had traveled to other parts of the country. One of the more macabre aspects of the exercise was the decision to seal off (quarantine) Oklahoma City; essentially letting smallpox run its course there in an effort to prevent its spread elsewhere.
Dark Winter was fictional, but what we've been observing unfold in response to SARS-CoV-2 has a depressing number of similarities; slow, sometimes draconian, responses by states, each of which generates unpalatable choice sets for decision-makers, not the least of which are tensions inherent in measures possibly facilitating economic collapse.
A sizeable portion of my irritation with all of it is how woefully ill-prepared we seem to have been for this. The Trump Administration deserves a lot of criticism for their incompetent response to the SARS-CoV-2 to date-- more on that later. Table-top exercises like Dark Winter are numerous and their recommendations often collect dust on bookshelves. And, no matter how realistic, Hollywood movies like 2011's Contagion are never used as preparedness templates. However, I am dumbfounded by the lack of preparedness given the experience of a real outbreak of communicable disease, SARS-CoV-1 in the winter of 2003; a particularly nasty coronavirus with a much higher mortality rate (11%) than the current version (1-3%). When patients began showing up in Southern Ontario hospitals from East Asia, the outbreak quickly overwhelmed the healthcare system in ways that would be familiar to everyone watching SARS-CoV-2 crush systems in Italy, New York, and elsewhere.
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| Close, But Not Quite Real |
After a shade less than 9000 cases and 800 deaths worldwide from SARS-CoV-1, it looks to me like we more or less patted ourselves on the back, declared victory, and assumed we'd be able to tackle the next one in the same way. Here I have more grumpy questions than anything else. Most of the press accounts of the frantic search for treatments and vaccines for SARS-CoV-2 has focused on the speed with which the pharmaceutical industry has pivoted to this new contagion.
I'm not so impressed and have the strong sense that everyone in the medical establishment, and the political leadership that funds it, took their eye off the ball. In many ways, I don't entirely scoff at what seems like irrational behaviour by our fellow humans. Much has been done to undermine confidence.
Where are the stockpiles of "personal protective equipment" that jurisdictions all over the world are now fighting with each other to secure? What about research and development into anti-virals and therapies to deal with coronaviruses? I want to know why research into these things never generated results? Is is because the only profit motive for pharmaceutical firms is to develop treatments for toe fungus? Or did governments allow research funding into these things dry up?
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| Not the National Stockpile |
Where are the stockpiles of "personal protective equipment" that jurisdictions all over the world are now fighting with each other to secure? What about research and development into anti-virals and therapies to deal with coronaviruses? I want to know why research into these things never generated results? Is is because the only profit motive for pharmaceutical firms is to develop treatments for toe fungus? Or did governments allow research funding into these things dry up?
I followed SARS-CoV-1 very closely in 2003. Indeed, I was on travel at that time and remember a distinct sense of dread passing through Pearson International Airport, not really sure of the threat level. We should have seen SARS-CoV-2 coming,... anyone who says we never could have prepared for, or foreseen it, must have been asleep in 2003.
Data, Data, Data
As part of this preparedness rant, I am also aghast at the lack of testing being done, particularly among those who might be walking around as asymptomatic carriers. We know virtually nothing about this group of people; how many, why are they asymptomatic, or to what degree they've been vectors for those who are sick. We need more denominators for all the data that's being displayed on CNN's Infection Ticker every day.
In the absence of those denominators, I'm not surprised public health authorities have emphasized social-distancing and isolation. No one seems to be collecting the kind of data (antibody tests, as well) that would facilitate a more sophisticated approach that segmented us by risk of serious illness. Instead, we are flying blind with a blunt instrument strategy mostly premised on educated guesses; guesses that it will work, "flatten the curve" and reduce the strain on the healthcare system. What comes next is just as important.
Oh,... then again, most of our professional athletes have been able to get tests upon request. Thank goodness for that... Just one indicator of where our societal priorities reside.
In the absence of those denominators, I'm not surprised public health authorities have emphasized social-distancing and isolation. No one seems to be collecting the kind of data (antibody tests, as well) that would facilitate a more sophisticated approach that segmented us by risk of serious illness. Instead, we are flying blind with a blunt instrument strategy mostly premised on educated guesses; guesses that it will work, "flatten the curve" and reduce the strain on the healthcare system. What comes next is just as important.
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| No Tests? No Problem |
Oh,... then again, most of our professional athletes have been able to get tests upon request. Thank goodness for that... Just one indicator of where our societal priorities reside.
Socio-Economic Solitudes
SARS-CoV-2 was tailor-made for 24-hour cable news. I'm fed up. As mindless as President Trump has been in responding to the crisis, the critiques of the media have more than once left me baffled. I'm tired of the CNN Infection Ticker prominently displayed all day on 1/4 of my television screen. I want to know what's going on, but there's a sensationalism to all of this that grates. Bodies in refrigerator trucks. Interviews with over-stressed, under-equipped doctors and nurses. Cameras in the faces of grieving family members. Enough. The same things irritate me in wartime as well, so I suppose this is no different. But, there's a fine line between reporting the gravity of what's going on and exploiting it. In my view, that line has been crossed too many times already.
However, it's not the sensationalism of 24hr news that routinely pops my cork. Instead, it's the obvious socio-economic divisions that SARS-CoV-2 is laying bare. I've decided that most of the advice dispensed by public health officials and infectious disease experts is for rich people. Indeed, he evidence mounts that social-distancing and quarantines are for rich people. Hence, my point above about the merits of adopting a more sophisticated approach.
As I flip through the coverage on 24hr cable every night, I am struck by how many of the people offering advice on how to quarantine, social-distance, home-school your kids, pass the time etc, are doing so from $5 million Manhattan apartments. Every time I see this kind of interview, I think about how that advice might go down with a single-mom with two kids in a one-bedroom apartment just a couple of miles the other side of the East River? What if one of the main meals your child received each day came from their school? What if you were already working two jobs just to live paycheck-to-paycheck? How long will a $1000 stimulus check from Washington last?
Consider Detroit, Michigan where low urban density and a terrible public transportation system ought to contribute to social distancing and the fight against the virus. Instead, Detroit has been pounded by SARS-CoV-2, and disproportionately among the city's African-American population, many of whom have experienced decades of unequal access to healthcare and are therefore more at risk to becoming seriously ill with COVID-19.
A similar pattern is playing itself out in Chicago and Milwaukee.
As I flip through the coverage on 24hr cable every night, I am struck by how many of the people offering advice on how to quarantine, social-distance, home-school your kids, pass the time etc, are doing so from $5 million Manhattan apartments. Every time I see this kind of interview, I think about how that advice might go down with a single-mom with two kids in a one-bedroom apartment just a couple of miles the other side of the East River? What if one of the main meals your child received each day came from their school? What if you were already working two jobs just to live paycheck-to-paycheck? How long will a $1000 stimulus check from Washington last?
Consider Detroit, Michigan where low urban density and a terrible public transportation system ought to contribute to social distancing and the fight against the virus. Instead, Detroit has been pounded by SARS-CoV-2, and disproportionately among the city's African-American population, many of whom have experienced decades of unequal access to healthcare and are therefore more at risk to becoming seriously ill with COVID-19.
A similar pattern is playing itself out in Chicago and Milwaukee.
The Economic and Psycho-Social Price
I'll just be blunt about my next point. I am not certain the economic price we are paying to combat SARS-CoV-2 will be justified if in doing so we create a psycho-social and economic catastrophe that lasts generations. In late March, Dr. David Katz got ripped in some quarters for asking this exact question in a NYT Op-Ed, possibly because the headline too closely approximated Trump's premature comments about "opening up" by Easter.Since we are way behind in the data-gathering that would allow us to adopt a more sophisticated strategy in combating SARS-CoV-2, I am all for social-distancing and self-isolation... for now.
How long I am willing to put up with this, or a second round of it, is another question. Social-distancing and self-isolation need to start showing results within a 4 to 6 weeks or I think public good-will toward these measures will quickly change. And then, I question whether the public will tolerate a second round.
We are not comfortable with thinking about trade-offs around human life. But we do it all the time. Indeed, Italian and NYC doctors are doing it as I write, rationing the allocation of ventilators to those whose prospects for recovery are greatest. The mere fact that professional athletes seem to have had access to scarce testing kits suggests we value some life more than others. Broaden that and think about the divergence in this equation between the rich, developed world and the poorer, developing world. The world does not treat all life equally.
One of the problems I have with the public response to SARS-CoV-2 is that too little consideration has thus far been given to the longer-term socioeconomic and psychological consequences of all of this. In the last two weeks, more than 10 million unemployment claims were filed in the United States. Think about that. More than 10 million. Many millions more are on the way. No stimulus package is large enough to deal adequately with all of this.
Public health authorities are, rightly, calling the shots. This is as it should be,.... for now. In the longer-term, and in the absence of a vaccine or therapeutics, we are going to have to figure out how to live with this. That includes the uncomfortable acceptance a degree of mortality. Donald Trump is the absolute worst spokesperson for anything connected to SARS-CoV-2. I am not endorsing his view that the country should be opened up by Easter. Trump needs to shut up.
However, those who are currently enforcing social-distancing and self-isolation are going to have to grapple with some harsh realities in the next month or so. Neither SARS-CoV-2 nor the economic disruption caused by fighting it are existential threats to humanity. But, the long-term implications of socioeconomic disruption will soon need to be balanced against current measures for fighting SARS-CoV-2. Unless you are 90+yrs old, you have no recollection of the Great Depression. At its peak, 25% of America was unemployed. Very few people alive today appreciate how societally catastrophic it was or the sense of national emergency it created. Indeed, its hard to appreciate, or overstate, the social and political upheaval the Great Depression generated.
In my lifetime, I don't think unemployment has ever been above 10-11% and that includes the deep recession of the early 1980s and the aftermath of the 2008 Financial Crisis. Some of the more dire estimates of unemployment flowing from SARS-CoV-2 shut-downs have suggested 30% unemployment.
I don't think enough people have grappled with that yet.
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| Scale Doesn't Even Go to 30% |
Mr. Trump and other optimists are hoping for what economists call a V-shaped recovery; in other words, a quick rebound. Mr. Trump's electoral motivations for that hope are too transparent.
But, economies don't just switch back on after 30% unemployment. Moreover, this isn't just a U.S., Canadian, or European problem. It's global. Consider China, which by many accounts has finally got a grip on SARS-CoV-2 in and around Wuhan and has relaxed a number of movement restrictions. How does China restart its economy? There's no domestic consumer economy to speak of in China, certainly not one that could sustain significant economic growth. China needs to export. It needs consumers overseas to buy its stuff. With its main markets in Europe and North America under some form of lock-down, who is China going to sell to?
The point is we need to devote as much thinking to an exit strategy as to the immediacy of combating the virus. Some European states will soon be lifting some restrictions. But with a vaccine likely unavailable for at least 12 months, what strategies will be put in place to combat the second virus wave everyone expects? Airlines, restaurants, and retailers are not going to magically open to throngs
of customers once this first wave is over. Getting customers confident to mingle with each other again is going to take some time. Any snap-back of movement restrictions to combat a second virus wave could face resistance from a weary public and do even more damage economically.
Trump's general lack of empathy for anyone other than himself makes him incapable of articulating a sophisticated argument around this. Telling the nation that he wants things open again by Easter was foolish. But I fear that the media's drumbeat of critique of Trump's foolhardy remarks have precluded much serious, but necessary, discussion of both the trade-offs involved in combatting SARS-CoV-2 and a longer-term strategy for living with it.
The 10 million Americans who've already filed for unemployment benefits are among the lucky and do not include the large numbers of part-time or "gig economy" workers that don't qualify for unemployment benefits. The stimulus package passed by Congress on March 26 will help some of those workers, but not for long. April rent was already in the bank for many workers as lock-downs went into effect and businesses closed. What happens when May's rent and bills are due and there's no money in the bank? What about the psycho-social distress brought on by all of this in the 80% of American households living paycheck-to-paycheck or the 47% who cannot absorb an unexpected $400 expense?
I guess we could earmark additional stimulus funds for mental health, the prevention of domestic violence, or post-traumatic stress disorder. Those are just three expanding problems flowing from our virus fight.
We will eventually eradicate SARS-CoV-2, but thinking clearly about the price we are willing to pay on the road to doing so is a discussion we ought to be more fully engaging, if for no other reason than that SARS-CoV-2 will not be the last pandemic humanity confronts.
But, economies don't just switch back on after 30% unemployment. Moreover, this isn't just a U.S., Canadian, or European problem. It's global. Consider China, which by many accounts has finally got a grip on SARS-CoV-2 in and around Wuhan and has relaxed a number of movement restrictions. How does China restart its economy? There's no domestic consumer economy to speak of in China, certainly not one that could sustain significant economic growth. China needs to export. It needs consumers overseas to buy its stuff. With its main markets in Europe and North America under some form of lock-down, who is China going to sell to?
The point is we need to devote as much thinking to an exit strategy as to the immediacy of combating the virus. Some European states will soon be lifting some restrictions. But with a vaccine likely unavailable for at least 12 months, what strategies will be put in place to combat the second virus wave everyone expects? Airlines, restaurants, and retailers are not going to magically open to throngs
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| Can't Wait for the Service Cart |
Trump's general lack of empathy for anyone other than himself makes him incapable of articulating a sophisticated argument around this. Telling the nation that he wants things open again by Easter was foolish. But I fear that the media's drumbeat of critique of Trump's foolhardy remarks have precluded much serious, but necessary, discussion of both the trade-offs involved in combatting SARS-CoV-2 and a longer-term strategy for living with it.
The 10 million Americans who've already filed for unemployment benefits are among the lucky and do not include the large numbers of part-time or "gig economy" workers that don't qualify for unemployment benefits. The stimulus package passed by Congress on March 26 will help some of those workers, but not for long. April rent was already in the bank for many workers as lock-downs went into effect and businesses closed. What happens when May's rent and bills are due and there's no money in the bank? What about the psycho-social distress brought on by all of this in the 80% of American households living paycheck-to-paycheck or the 47% who cannot absorb an unexpected $400 expense?
I guess we could earmark additional stimulus funds for mental health, the prevention of domestic violence, or post-traumatic stress disorder. Those are just three expanding problems flowing from our virus fight.
We will eventually eradicate SARS-CoV-2, but thinking clearly about the price we are willing to pay on the road to doing so is a discussion we ought to be more fully engaging, if for no other reason than that SARS-CoV-2 will not be the last pandemic humanity confronts.
Price to Civil Liberties
Some of my gravest concerns about the unfolding SARS-CoV-2 fight concern the longer-term impact on civil liberties. There is a lot of be worried about, particularly given what we've seen in terms of the decline of liberalism around the world in the last several years. In short, the state, and those who lead them, have never seen a crisis they didn't use as an excuse to expand the state. Our lack of enlightened leadership makes me even more nervous.
Who puts the genie back in the bottle? And when?
I've been concerned about the growth of authoritarianism for some time. Indeed, I offered a new seminar on the topic in Fall 2019, an experience about which I wrote in this blog. Part of my motivation for that course was a complacency about the power of the state creeping into what students were saying and writing. I acknowledge that part of my skepticism about the power of the state is ideological, but it's also borne of having been old enough to understand what I was watching as the Cold War came to an end.
State power can, and should, be harnessed for collectively fighting things like SARS-CoV-2. At moments like this, only the state can marshal and coordinate resources to deal with national emergencies. However, when is the emergency over? Are there limitations, sun-set clauses, on the emergency? Enlightened leadership will willingly cede emergency powers. I'm quite certain we are not in a period of enlightened leadership and I'm anxious about whether powers given to the state under these emergency conditions will be temporary.
Unfortunately, I see more evidence than not that many states will be too happy to maintain indefinite state's of emergency, long after the actual threat of SARS-CoV-2 has passed. China, Hungary, Russia, the United States?
Part of the complacency I've been detecting in students is in what I view as a misplaced faith in the power of the state to act in some enlightened manner. I'm not sure where that faith comes from? Decades of relative peace and prosperity? A detached sense of how difficult it is to achieve that? A belief that the state is a responsible care-taker? Perhaps. I'm worried that fear of SARS-CoV-2 will turn the public inward, forcing a retreating to the temporary safety of the state, permanently acquiescing to the state's power.
All the rhetoric flowing out of Donald Trump about the "Deep State" is a sort of rubbish form of skepticism about state power. There is no "deep state" trying to unseat Trump. There are, however, plenty of historical examples of state power being wielded for less-then-enlightened purposes. I'm anxious that a generation that has only known peace in their lifetimes, no sense of history about the totalitarianism of the early 20th Century, and who willingly live their lives online in full view of the state are at risk of a collective shrug of the shoulders around state power in the aftermath of this pandemic.
Given Donald Trump's demonstrated propensity for arbitrary, capricious decision-making, I am not confident he won't seize upon this emergency to expand his powers. He would not be the first president to welcome additional power to the Executive branch; each of the World Wars, the Great Depression, Vietnam War, the War on Terrorism, the response to the 2008-09 Financial Crisis have all resulted in new powers given to parts of the federal government. SARS-CoV-2 will be no different. Indeed, Donald Trump has already declared himself a wartime president. And this particular state of war has the potential to extend itself for some time as the fight to eradicate SARS-CoV-2 morphs into the emergency powers needed to get the economy running again.
As I wrote in the two previous posts in this blog, I think President Trump's response to the SARS-CoV-2 emergency have been shambolic, transforming what I thought could be an easy victory in November into what now (still) looks to me like certain defeat. I think Trump had a chance to cement a victory in November by transforming himself into a normal president, a president the American public looked to for leadership, sincerity, and honesty about what's happening. He's done none of that.
I am worried by the kinds of draconian measures deployed in other countries-- notably China, Singapore, South Korea-- to combat SARS-CoV-2. I have some faith that South Korea will eventually place some civil liberties restrictions on the surreptitious data gathering from mobile devices and deployed so effectively in their contact tracing efforts. On the other hand, I am quite confident that the same tactics in China will simply be woven into their existing state-surveillance apparatus to further suppress free expression and movement.
However, the growth of the surveillance state is not the exclusive domain of China. As anyone whose followed the saga of Edward Snowden since 2013 knows, the surveillance state is alive and well in many places. What's troubling me at the moment are the capacities of private firms like Google and Apple to monitor our individual compliance with social distancing, stay-at-home, and do-not-travel orders by tracking us via our mobile devices. That Google is "anonymizing" these COVID-19 Community Mobility Reports gives me no comfort. Moreover, technology is increasingly being deployed by our fellow citizens to report alleged violations of social distancing rules. I want everyone to comply as well, but the use of technology to rat people out like this is not what I have in mind.
Finally, there has been significant discussion that one possible means of opening the economy in stages is to find ways to certify people have recovered or are immune to COVID-19. This is already happening in China where so-called "immunity certificates" via color-coded QR codes on smart phones must be presented at check points, building entries, etc to pass without restriction. Those immunity certificates would be issued by doctors who would in turn share your medical records with authorities monitoring the movement of people. Think this some outlandish tactic reserved for authoritarian states? Think again. Both the United Kingdom and Germany are already working on them.
The civil liberties implications of all this are sobering. Much as the public traded away all kinds of information about themselves in exchange for flying after 9/11, and even more so if you enlisted in a frequent traveller program, we are now confronting the possibility of having to trade significant health information just to be able to work.
Let that sink in.
Finally, all of this is taking place against a backdrop of declining public faith in the power of the institutions of government to actually govern. If SARS-CoV-2 had arrived 20yrs ago, there would still be recriminations of al kinds around how it was being handled. But this level of crisis management on top of the populist rage against the institutions of government, to say nothing of the postwar
architecture that has facilitated cooperation and collaboration, is genuinely worrisome. As many others have argued, and I have echoed in this blog, Donald Trump did not create the anti-establishment populist zeitgeist that brought him to the White House. He is instead a manifestation of a rage that can be found all over the planet. Enter SARS-CoV-2.
Thus far, prospects for a global coming together in response to it all are bleak, typified by the competition among jurisdictions for scarce medical supplies and the "go-it-alone" approach to everything from travel restrictions to how to jump-start the global economy.
I generally try and make posts to this blog that will stand the test of time. Posts tend to be longer and less frequent than newspaper opinion pieces, and my goal is to have most of what I say be relevant six months or more from now.
This is one post I hope I'll look back on and say I had it all wrong.
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| I'm From the Government and I'm Here to Help |
I've been concerned about the growth of authoritarianism for some time. Indeed, I offered a new seminar on the topic in Fall 2019, an experience about which I wrote in this blog. Part of my motivation for that course was a complacency about the power of the state creeping into what students were saying and writing. I acknowledge that part of my skepticism about the power of the state is ideological, but it's also borne of having been old enough to understand what I was watching as the Cold War came to an end.
State power can, and should, be harnessed for collectively fighting things like SARS-CoV-2. At moments like this, only the state can marshal and coordinate resources to deal with national emergencies. However, when is the emergency over? Are there limitations, sun-set clauses, on the emergency? Enlightened leadership will willingly cede emergency powers. I'm quite certain we are not in a period of enlightened leadership and I'm anxious about whether powers given to the state under these emergency conditions will be temporary.
Unfortunately, I see more evidence than not that many states will be too happy to maintain indefinite state's of emergency, long after the actual threat of SARS-CoV-2 has passed. China, Hungary, Russia, the United States?
Part of the complacency I've been detecting in students is in what I view as a misplaced faith in the power of the state to act in some enlightened manner. I'm not sure where that faith comes from? Decades of relative peace and prosperity? A detached sense of how difficult it is to achieve that? A belief that the state is a responsible care-taker? Perhaps. I'm worried that fear of SARS-CoV-2 will turn the public inward, forcing a retreating to the temporary safety of the state, permanently acquiescing to the state's power.
All the rhetoric flowing out of Donald Trump about the "Deep State" is a sort of rubbish form of skepticism about state power. There is no "deep state" trying to unseat Trump. There are, however, plenty of historical examples of state power being wielded for less-then-enlightened purposes. I'm anxious that a generation that has only known peace in their lifetimes, no sense of history about the totalitarianism of the early 20th Century, and who willingly live their lives online in full view of the state are at risk of a collective shrug of the shoulders around state power in the aftermath of this pandemic.
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| No Toilet Paper Here |
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| Toddlers Can Be Destructive |
I am worried by the kinds of draconian measures deployed in other countries-- notably China, Singapore, South Korea-- to combat SARS-CoV-2. I have some faith that South Korea will eventually place some civil liberties restrictions on the surreptitious data gathering from mobile devices and deployed so effectively in their contact tracing efforts. On the other hand, I am quite confident that the same tactics in China will simply be woven into their existing state-surveillance apparatus to further suppress free expression and movement.
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| The Deep State, 90s Style |
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| Big Brother Just Wants a Few Minor Details |
The civil liberties implications of all this are sobering. Much as the public traded away all kinds of information about themselves in exchange for flying after 9/11, and even more so if you enlisted in a frequent traveller program, we are now confronting the possibility of having to trade significant health information just to be able to work.
Let that sink in.
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| Who Puts Me Back in the Bottle? |
architecture that has facilitated cooperation and collaboration, is genuinely worrisome. As many others have argued, and I have echoed in this blog, Donald Trump did not create the anti-establishment populist zeitgeist that brought him to the White House. He is instead a manifestation of a rage that can be found all over the planet. Enter SARS-CoV-2.
Thus far, prospects for a global coming together in response to it all are bleak, typified by the competition among jurisdictions for scarce medical supplies and the "go-it-alone" approach to everything from travel restrictions to how to jump-start the global economy.I generally try and make posts to this blog that will stand the test of time. Posts tend to be longer and less frequent than newspaper opinion pieces, and my goal is to have most of what I say be relevant six months or more from now.
This is one post I hope I'll look back on and say I had it all wrong.
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