An early Covid retrospective
It is too early for the pandemic retrospective that Nicholas Christakis’ Apollo Arrow promises to claim to be describing “the profound and enduring effects of the coronavirus on the way we live.” Christakis actually admits in the preface: “The COVID-19 pandemic is still a moving target. . . Much is currently unknown – biological, clinical, epidemiological, social, economic and political. . . . It’s hard to know for sure what’s going to happen. And there is much that only the passage of time will reveal. . . “Because of these unknowns, the result of the book is little more than a repetition of what a normally alert reader has read in the media since the beginning of the pandemic. That said, repeating isn’t necessarily a bad thing for the less-than-usual observant reader looking for a one-stop presentation of conventional wisdom about the pandemic.
The evolution of conventional wisdom
While this fall’s conventional wisdom was quickly written only last summer, it has already moved beyond the book’s reasoning on several fronts. Take, for example, the extremely consistent issue of school closure. To his credit, Christakis takes a somewhat prudent position for the summer, pointing out the likely social, economic, and psychological costs of school closings for children. Even so, he advocates closing schools to protect the general public.
But that was based on the unknowns of the past summer. Today’s expert opinion in Europe suggests that schools are not an important mode of transmission and scientific opinion in the US seems to be catching up with that view. Despite the mounting evidence, many U.S. government officials continue to advocate closing schools. Just follow the science.
Again and again Christakis presents anti-COVID guidelines as binary options: The guidelines are either all activated or deactivated. There is no reason for such reductionism.
Recent studies suggest that even adult teachers are safer than previously thought: Children, especially younger children, do not transmit the virus as effectively as adults. While there is still an increased risk of infection, evidence suggests that an adult teacher is at much lower risk in a classroom with eight-year-old children than in a room with the same number of adults. Normal precautions – distance, masks, hand washing, increased ventilation – can reduce the residual risk even further.
Despite the unknowns of age and COVID this summer, Christakis is numb to the implications that the risk of infection varies with age. Rather than considering the possibility of individual choices and institutional measures to protect the elderly selectively – including the selective isolation of vulnerable older people – he politely reiterates the criticism that recognizing an increased risk for older people only reflects the attitude that “it just are old people dying ”and this society should just accept its“ sacrifice ”. Little is said about policies that selectively protect the elderly while allowing the less vulnerable to continue their lives and work, and about jobs that help preserve the elderly and the rest of society.
Again and again Christakis presents anti-COVID guidelines as binary options: The guidelines are either all activated or deactivated. There is no reason for such reductionism. There is a continuum of political responses between complete closure and behaving as if everything were normal. Anti-COVID guidelines don’t have to be the blunt tool they have proven in so many states.
His simple all-or-nothing approach misleads Christakis, for example, when he argues that the cost-benefit analysis easily justifies the draconian shutdown policy adopted last spring in response to the pandemic. (Remember, there is evidence that cost-benefit analysis does not necessarily affect the balance against intervention.) Christakis writes:
Those kind of demographic calculations. . . Allow us to compare the financial benefits of saving lives with the financial costs of closing the American economy while in use [nonpharmaceutical interventions]. By using a standard benchmark of five hundred thousand dollars as the economic value of a year of life (or ten million per lifetime, regardless of age), we can estimate one million coronavirus deaths. . . would be worth about six trillion dollars. Even at the highest end of a series of estimates of the impact on our economy, including our government’s spending, we don’t hit that figure. From an economic point of view, our response was consistent with the threat posed by the pathogen.
Here it would have been useful to think seriously about the unknowns that Christakis himself noted in the foreword – unknowns who mysteriously transform into acquaintances in the course of the book.
An absence of alternatives
Even if he overlooks his somewhat high assessment of the value of life, he overlooks critical aspects of the cost-benefit argument. First, we should think about possible interventions on a continuum from less costly to more expensive policies rather than viewing them as all-or-nothing. Think of his methodology in another area: being willing to pay $ 1,000 for a TV of a certain quality if I can choose between that particular TV or no TV at all doesn’t mean I wouldn’t prefer it Buying a $ 700 TV that still meets my desired quality threshold but gives me an additional $ 300 for something else.
That is, while shutting down the economy may cost less than the economic value of lives saved, it does not take into account the possibility of less draconian policies approaching similar health outcomes, but much lower costs. This doubles as we understand that the cost of closings was far more damaging to poor people compared to wealthier people.
In view of the radical uncertainty of the pandemic, we see advantages for the US system of federalism that will go virtually unnoticed during the pandemic.
The question is what would have happened if policymakers had only emphasized (and enforced) lower-cost interventions and foregone most of the much more costly closings. What if the interventions are limited to face masks, distancing requirements and hand washing, for example? It is not yet clear that these interventions, coupled with the casual decision of high-risk individuals (such as the elderly) to isolate themselves from contact with others, would not have saved many of the same lives, but they would have saved far fewer ones Cost than the costly shutdown of “nonessential” businesses.
Or consider the evidence mentioned above that schools are actually not a significant place for the transmission of COVID-19. This suggests that the spring shutdown, especially for younger children, was indeed a policy response. Not only do school closings reduce children’s learning outcomes (let alone the consequences of their shrunken social circle), but parents – usually younger adults – have to stay at home with their children and cannot work. It was and is an extremely costly political reaction.
The response of the interventionists to this line of reasoning is of course: “We didn’t know then how contagious COVID would be.” But exactly. We didn’t know. The thing is, it’s hubris to assume, like so many proponents of pandemic intervention, that overreaction is superior to underreaction in the face of real uncertainty. Despite the ongoing rationalization of “better safe than sorry,” when “safe” imposes draconian costs on both individuals and society, it is not evident that the costs of “safe” paid with certainty are actually better than a probability “We’re sorry.” Entire books have been devoted to the very dubious subject of making decisions in an environment of “radical uncertainty”. And while it is not always clear how to deal with policy-making in such conditions, these experts do not advise that the extreme and costly risk aversion of “better safe than sorry” is in fact always the optimal policy path.
In view of the radical uncertainty of the pandemic, we see advantages for the US system of federalism that will go virtually unnoticed during the pandemic. Despite all the criticism of President Trump for failing to provide centralized leadership at the national level in response to the pandemic in the face of “radical uncertainty,” it is actually better to let 50 different state governments experiment with different political approaches. The US states are large enough and diverse enough that there is no reason why, given the grave unknowns of this pandemic, Americans should absolutely expect a unified national pandemic policy to be optimal. We see different experiences between urban and rural states, between colder and warmer states, and between states where citizens have different preferences for simply being left alone to judge their own best courses in the face of the threat of the pandemic. In addition to these differences, states that share common demographic characteristics will also be governed by different people and will of course introduce uncorrelated policies.
As time progresses and uncertainties resolve themselves, this heterogeneity between states and their political responses makes it clearer which guidelines are optimal and which are not optimal. There is more information about a sample of policies from 50 different state governments than from the experience of a single, unified policy from one centralized national government.
Christakis rightly nodded to the significant and persistent unknowns of the current pandemic at the beginning of his book. The problem is, you can’t write a retrospective of a pandemic when the unknowns are still unknown. And this pandemic still has a lot to offer. As a result, this hasty book sheds little new light on the epidemic, and ends up doing little more than repeating the shibboleths of intervention when the lingering uncertainties of the matter advise humility and open-mindedness instead.