Pandemic ethics: Never again – will we make Covid-19 a warning shot or a dud?

by Anders Sandberg

The Covid-19 pandemic is not the end of the world. But it certainly is a wake-up call. When we look back on the current situation in a year’s time, will we collectively learn the right lessons or instead quickly forget like we did with the 1918 flu? Or even think it was just hype, like Y2K?

There are certainly plenty of people saying this is the new normal, and that things will never be the same. But historically we have adapted to trauma rather well. Maybe too well – we have a moral reason to ensure that we do not forget the harsh lessons we are learning now.

Warning shots

The availability heuristic makes humans unwilling to consider events that have never occurred before to them or in remembered history. This is a serious problem for mitigating big, unprecedented risks since before they happen few care about them (and afterwards it may be too late).

Sometimes smaller disasters are salient enough to trigger remedies. If the disasters are devastating enough there may be an immunization-like response where society responds with a “never again” and begins to reduce the risk seriously.

This may have happened in regards to medical atrocities during World War II (and to a lesser degree genocide in general): legal and ethical frameworks were drawn up, treaties and institutions emerged, and arguably the risk was reduced. At least Europeans may have learned the lesson, leading to the formation of the EU. Other cases are less reassuring or less clear-cut: the Cuban missile crisis, economic depressions, the Chelyabinsk meteor, etc. Still, the missile crisis led to the establishment of the Moscow-Washington hotline and the Partial Test Ban Treaty even if it did not end the Cold War.

When do we learn?

When do we learn the lesson? This may be a psychological problem.

In the case of the 1993 severe Missouri-Mississippi floods home-owners within the 100-year flood-plains did not update their risk estimates (as evidenced by house prices): they already had a view on the risk. But prices in 500-year flood-plains that were affected or safe regions did update: home-owners there may have recognized the risk and updated their probability and damage estimates (possibly also to take into account costs of community-wide disruptions).

Past experience with hurricanes can affect future decisions to evacuate. While many demographic and psychological factors influence the decision (and can be stronger), past experience with hurricanes that did not cause appreciable harm to oneself tended to lead to lower perception of hurricane probability and damage severity – while having experienced harm led to the opposite perception and hence a higher likelihood of evacuating. People in the outskirts of the affected area may think they had experienced the full force when they actually did not, gaining “false experience”.

But while personal experience may be powerful the way it is interpreted may be even more powerful in shaping future reactions. This why community responses may matter more than individual responses: they affect the behaviour of the un-affected and can involve constructing collective risk responses.

Forgetting

Collective forgetfulness also matters. The Y2K problem was serious and was defused through a lot of diligent work. Still, spy satellites stopped working, Japanese nuclear plant systems glitched, more than 150 pregnant women were given incorrect results from a test for Down’s Syndrome. Yet many today think it was a hype or hoax. Here the combination of inflated fears that did not come true, lack of understanding of the problem, and bad management of public concern contributed to a general feeling of “it was probably nothing”.

The 1918 influenza pandemic caused enormous death and damage but quickly lost its salience (until the 1990s, when globalisation made pandemics more salient again). Indeed, the rapid forgetting puzzled even people at the time. Martin Kettle suggested:

In the face of such figures, it seems unbelievable that we forget or look away. Yet we do. Perhaps that is because, unlike equality for women, a disease has no ultimate prize to win and celebrate. Perhaps it is because, while wars have victors, pandemics leave only the vanquished, as Spinney puts it. Perhaps too, as the critic Walter Benjamin once argued, silences about public horrors can permit human societies to cope with collective recovery and to progress. Or perhaps, as Spinney also reflects, the Spanish flu has been consigned to the footnotes because its onslaught did not occur in public but in private, behind closed doors in millions of homes.

The lack of narrative maybe contributed to historians ignoring it in favour of the much more tangible World War I. It may also have been the impossibility of imagining the sheer number affected, and that the disease did not strike particular groups. In the end there were no monuments built to the victims.

Even the SARS coronavirus outbreak in 2002-4 was largely ignored outside professional epidemiology once it was over. The Chinese live animal markets stayed open, even though even undergraduate microbiology textbooks mentioned the risk of a recurrence.

Preparing for the worst case

Since many risks come with a heavy-tailed distribution of sizes, most instances are going to be far, far smaller than the worst-case one should try to plan for, so the planning will most of the time appear vastly overblown. At least in this case we can point to the smaller cases and extrapolate the existence of large cases motivating the effort.

There is a fundamental problem with mitigation actions against unprecedented risks. If mitigation succeeds it is likely that the risk will appear minor and the mitigation effort overblown (like Y2K). A truly successful intervention may remove the risk altogether. This produces an appearance of unfalsifiability, not unlike the story of the man throwing paper around himself on the street to scare of tigers: “But there are no tigers here!” “See! It works!”

Covid-19

Where does this leave us with Covid-19? It is plausible that after the whole situation resolves many people will reinterpret it as an overreaction – especially if interventions actually work well – and tired from the whole rigmarole choose to ignore it, even if it was disastrous.

If physical distancing works, we will underestimate severity of Covid and blame decisionmakers for wrecking the economy and our convenience due to fear-mongering hype and bad models. If it fails, we will blame them for wrecking the economy and our convenience for nothing.

If health care systems are not overloaded (regardless of what efforts are made) the conclusion will again be that it was a flash in the pan and our systems are resilient. If they are overloaded it is also likely that many will explain the failure in terms of their favourite explanations: the left will blame austerity and profit motives, economic liberals inflexible regulations, nationalists globalisation.

There is also a risk that less useful mitigation methods become prevalent since they signal concern with a risk. Like 9/11 led to massive “security theatre” that did not improve actual security but indicated that the problem is taken seriously, we may end up with “hygiene theatre” that calms nerves but actually does not reduce risk. An example may be airport thermal screening, which seems useful but is not effective enough. If people keep the Wuhan shake but stop washing their hands little will have been achieved.

Our moral duty to remember the lesson

These are predictable reactions. Given that we have good reasons to think that the wrong or no lessons will be generally learned from the current situation – involving the sickness and death of large number of people, heroic efforts of people fighting the disease, vast amounts of suffering, annoyance and cost – and that not learning well from it will likely cause equal or larger amounts of misfortune in the future, it is ethically relevant that we pre-commit to actually learn the lessons that need to be learned.

What kind of lessons do we need to learn? The basic ones are what strategies work and does not work, whether in epidemiological strategy, social life or how to handle the experience personally. That different countries have approached the issue of containment and mitigation in very different ways give us a valuable chance to compare what worked and what did not – and why. There are lessons about the use of social media and handling the economy, as well as the promise and perils of rapid scientific investigation and emergency medical hacking. Comparing to find best practices is extremely useful.

In order to learn we need to document. Asking everybody to write a Covid journal might be cute, but the real goal must be to document the things that would otherwise be lost: perceptions at particular points in time, ephemera, information that later will turn embarrassing or contradict the official story. Some of it is boring but important: how was the response managed in country X? Others are the oral stories of projects, and why they succeeded and failed.

After it has been documented it needs to be shared. Notes need to be compared, data compiled and scrutinized. Curators will be needed. Some have it as their job, others may do it out of love, outrage or curiosity. There is a need to discuss lessons individually and collectively even when we want to forget.

The final part of learning lessons come from having people and organisations actually bringing up the lessons and not letting go until they have been learned. If policy X is robustly better than policy Y, that needs to be loudly and clearly told. If someone has demonstrated a best practice or a clever solution, the world needs to know. If there are fundamental disagreements and uncertainties, make them clear so they can hopefully be resolved or understood till next time.

In the end, we better build some hard-to-ignore monuments to the people who died or performed heroically, to shore up our collective memory. Li Wenliang may be a good symbolic martyr to remember (especially the key lesson about openness being necessary for a rapid response).

It is to a large degree a real moral choice whether Covid-19 becomes a warning shot that teaches us useful things for the time when a truly dangerous pathogen emerges (or is made) or just a massive distraction that is soon conveniently forgotten… until it is too late. Given the stakes, it matters to remember well.