Pandemic Response
2020-04-19
I seem to have ended up writing a series of pieces about the pandemic, how it has progressed, and what we should do. I’ve tried to write predictions for the future in each one, as circumstances change. Generally, I’ve complained about a lack of ethics and action in our response to the situation. Instead of being a broken record on every post, I’ve written this to clearly state what I want to see; what we need to do.
The Ethics of Lockdown
The point of the lockdown is to prevent deaths from covid-19. The people who die from covid-19 have been repeatedly shown to be old, or immuno-compromised. The young are not affected in the slightest. Anyone below age 55 is almost guaranteed to not require hospitalization. 65+ is where it starts to get dangerous, and each year of age above that increases the odds of not doing so well. As with every single disease ever.
However, this pandemic will never go away. Like H1N1, Influenza A,B,C, rhinovirus, or any number of other infections fast-mutating diseases, it will just be part of the global pathogen landscape. We cannot eradicate it. We cannot hide from it. We will all be exposed to it, one way or another. A lockdown is pointless, and dangerous, and irresponsible. We should have never done it.
Usually, speaking about the practical impacts of this leads to accusations of inhumanity. Do I want to see old people die? They’re people too, we should save them, it’s unethical to throw any segment of humanity to the wolves to save the rest, and so forth.
But let’s step to the other half of that argument.
Let’s pretend you’re 85 years old. You have health conditions that will very likely kill you in the next few years. You could die literally any day now, and you really don’t know when it will happen. Then this pandemic happens. Now your odds of death are pretty bad. Then, let’s say someone comes to you with a magic button. If you press this button, you will be guaranteed not to die from covid-19 (although anything else could still kill you), but as soon as you press it, the lives of ten families will be destroyed. They’ll lose their jobs, their savings, their education, maybe even their homes. Do you press it?
Of course not. But that’s the math we’re looking at; if we hold down this lockdown button, we’re dooming families everywhere in order to save the elderly. If this were a trolley problem, we’d have selected to save one by maiming a dozen others.
Or perhaps think of it this way. Let’s say you and ten other people are gathered in a room, and told that if each of you chops off their right arm, it will save one elderly person from death due to covid-19. You will never meet them, you will never know them, but if you all decide to do it, you’ll save them. If anyone says no, it won’t work. Do you chop off your arm?
Of course not. Fucking up your health and ability to provide for yourself for the sake of a chance of saving someone at the end of their life anyway? That’s insane.
This is actually a fairly well-studied problem - after all, organ donations are scarce, but people who need them are plentiful. There are a lot of situations where lives hang in the balance, and you have to come up with a way to decide who lives and who dies. There’s a fairly comprehensive podcast that dove into the ethics behind this, but if you don’t want to listen to it, then the quick answer is that ethicists have fairly generally agreed that we should optimize not for how many lives are saved, but by how many Quality-Adjusted Life Years can be gained. For instance, if you perform some action which reduces the quality of everybody’s life by 1%, you’ve done a lot more damage than if you saved a single life. But if you let one person die rather than sacrifice 1% of one person’s quality of life, that was probably unethical.
What we’re doing now is certainly more than 1% damage to everyone’s life, in order to save ~3-5million elderly, who each don’t have more than 10QALY each. What we’re doing is unethical, at least to me.
The Prescription
I spend a lot of time whining about how things are treated, but I haven’t actually laid out (in this blog) what i want to see. So let’s have it.
We can’t beat this sitting down. Wars are not won by staying home. Famines are not overcome by refusing to work. A pandemic cannot be defeated that way either. We need to work, the only reason we’re afraid of this thing is because we lack critical resources neccessary to prevent avoidable deaths. We need trained doctors, nurses, radiologists, phlebotomists. We need ventilators, intubators, PPE, medication for secondary infections, monitoring machines, beds, and money to pay for all of it. You don’t get these things by putting everyone on house arrest, they need to work.
Virus bonds - During war, the US has (traditionally, although not anymore) raised funds not through taxation or directly stealing it, but by offering war bonds. Citizens can give money to the feds, and receive a war bond. The bond guarantees that they’ll get their money back, with interest, after the war is over. That’s a good system, one that respects people’s freedom, but still funnels money to where it’s needed.
We should do the same with "virus bonds". Issue various \(50 to \)10k virus bonds at roughly a 1.5% yearly interest, to be paid off in 30 years, sold to citizens. There’s instability in the market, and investors have shown they really want to back the dollar. So let them back the dollar. This should raise a good chunk of money for the other bullet points, and prevent foreign debt from paying for it.
Mass production - We need a lot of physical goods, listed above. Those are generally not made in America, currently. But for reasons of national security, I think we can all agree we should make it ourselves. Spin up our industry, put people to work, open factories, make it happen. Private industry should know how to make things, and this is the perfect time to put them to work.
I’d like to see a federal buy program, offering a flat price for a set amount of units of each good required. No bids. Any company that can produce a pallet of goods that meet the QA requirements for the item will be paid the flat price for it. Any company making subpar products that they claim have passed the QC parameters, but don’t work, will face heavy fines. The price per unit can be set by congress, and I’m sure it will be too high and some corruption will occur, but it’s better than buying from China.
The feds will handle purchasing, but not warehousing. For instance, let’s say you’re a company in Montana that can produce latex gloves. Instead of sending your product to a federal stockpile, you are directed by the feds to send pallets to specific medical centers. You might send one pallet to Hospital A, and five to Hospital B. The feds will not handle shipping, nor warehousing. Producers will ship directly to end-users. Regional medical services can coordinate further however they like. The actual beaurocracy of this can vary, it might be better to let specific states handle the logistics instead of the fed. The point of it is that government pays to start the industry and points to where the product should go, but doesn’t control the process.
Mobilization - As above, we need lots of people. Not just factory workers, but medical personnel. We can’t build them in a factory, but we can sure get pretty close with crash-courses. During wartime, corpsmen and surgeons were trained en masse to deal with the influx of wounded. Those wounds were more straightforward, but more varied than what we’re dealing with now. Fortunately for us, covid-19 presents very regularly, and looks pretty much the same every time it happens.
We should open training camps for volunteers to become state or federal "covid practitioners" - nurses, doctors, etc that are trained specifically for handling covid-19 cases. Recognize symptoms, triage stage of illness, estimate QALY remaining, administer treatments. They don’t need to know how to treat cancer, or lacerations, or anything else - they only need to know how to handle covid-19. They should be paid a state or federal stipend (coming out of that virus bond system) and provided with housing if their house is too far away from their clinic. Treat them like more independent soldiers - they are trained to do a job, they are provided with what they need to do it.
After the worst passes, these covid practitioners should have a sort of "GI bill" attached that provides them with a bit of money every month for having participated.
