Friday, March 13, 2020

Containing the Coronavirus

Another crisis, another chance for David Brooks to pretend that he is a moral philosopher. Nevertheless, Brooks does provide us with some interesting literary texts, mostly from the time of the bubonic plague. 

Dare we say, for those who care to keep things in proportion, that the plague, which began in Italy in 1348 continued on and off until the seventeenth century. In the end it killed approximately half the population of Europe. Keep in mind, this was before antibiotics and before scientific knowledge.

No one really knew what was causing the plague. People did understand that once one person in a group got it, the chances were very good that everyone would get it. Monasteries and convents and universities were especially vulnerable. There, people lived in close quarters, and the poor hygiene caused a proliferation of rats and fleas. This made transmission frightfully easy.

During the bubonic plague people tended to avoid other people. Community ties frayed, because those who kept in close touch with neighbors were the first to die. One might suggest that the plague initiated a new form of radical individualism.

When Martin Luther attacked the Church in the early sixteenth century he proposed that individuals read the Bible themselves, without priestly intermediaries. Was this counsel a reaction to the fact that congregating in a Church made transmission more likely?

Among the great literary works of the early plague period was Boccacio’s Decameron. It belonged to the genre of pilgrimage literature-- see Chaucer’s Canterbury Tales-- where a group of Florentine plague survivors recounted tales of erotic lust. Yes, indeed, The Decameron, counts as one of the great works of erotic literature. In the absence of community ties people found other ways to connect.

Despite the fact that community ties killed people, Brooks bemoans their fraying:

In “The Decameron,” Giovanni Boccaccio writes about what happened during the plague that hit Florence in 1348: “Tedious were it to recount how citizen avoided citizen, how among neighbors was scarce found any that shewed fellow-feeling for another, how kinfolk held aloof, and never met … nay, what is more, and scarcely to be believed, fathers and mothers were found to abandon their own children, untended, unvisited, to their fate.”

Apparently, we are meant to compare the Italian plague to the current state of Italy, where an undermanned and underfunded public health system-- two cheers for socialized medicine-- has been allowing the elderly ill to go untreated. One remarks that during the plague years, there were no elderly people… given that life expectancy was probably in the forties.

Brooks continues to quote Daniel Defoe:

In his book on the 1665 London epidemic, “A Journal of the Plague Year,” Daniel Defoe reports, “This was a time when every one’s private safety lay so near them they had no room to pity the distresses of others. … The danger of immediate death to ourselves, took away all bonds of love, all concern for one another.”

One appreciates the moral philosophizing here, but those who expressed love and concern for others were more likely to die. It was a survival issue, not so much a moral issue. Obviously, there were exceptions, but we should not make too much of the moral philosophizing here.

Of course, we would also note that compassion, which Brooks favors, is not quite the same thing as community ties, a sense of proudly belonging to a community.

As for more salient lessons, Brooks quotes a Yale historian:

Frank Snowden, the Yale historian who wrote “Epidemics and Society,” argues that pandemics hold up a mirror to society and force us to ask basic questions: What is possible imminent death trying to tell us? Where is God in all this? What’s our responsibility to one another?

Surely, people asked those questions. Just as surely they seemed to conclude that prayer was not a very good treatment. And they also understood that the plague did not discriminate. It killed the pious and the impious equally. In truth, since the plague ravaged religious communities, it is fair to say that the bacterium seemed to prefer those who were religious.

Now, Brooks is puzzled about the fact that the 1918 Spanish flu pandemic has largely been erased from memory. Perhaps Brooks overdosed on therapy and believes that we can solve medical problems by talking about them and making ourselves depressed. Otherwise one does not understand why he seems to bemoan the fact that we did not have a national conversation about the Spanish flu:

This explains one of the puzzling features of the 1918 pandemic. When it was over, people didn’t talk about it. There were very few books or plays written about it. Roughly 675,000 Americans lost their lives to the flu, compared with 53,000 in battle in World War I, and yet it left almost no conscious cultural mark.

To keep the current pandemic in perspective Richard Baehr offers some statistical comparisons in The American Thinker. He explains that we are certainly not in the zone of the bubonic plague or the Spanish flu. One might argue that it is good to panic, because hunkering down and reducing our social contacts will help contain the plague, but that would contradict Brooks, and we can’t have that.

Anyway, Baehr looks at the numbers:

 This virus began in China and grew rapidly there, particularly in one area of the country, but case volume now has leveled off with very small growth in the caseload, and well over half recovered.  This is encouraging, or should be; it suggests that containment is possible.

Now, an authoritarian country has tools at its disposal that democracies do not.  In any case, China has a total caseload of 80,000 that has been quite steady for a few weeks.  China has a population of 1.4 billion. In other words, 1 in every 17,000 Chinese has come down with the disease.  Obviously, the incidence rate in the Wuhan area is higher than the national incidence rate in China — maybe more than 25 times higher.  This is also the area where the disease spread rapidly, since almost nobody early on knew what the population was dealing with.

Yesterday, Germany's Angela Merkel predicted that 60–70% of that country's population of roughly 85 million would come down with the virus.  Really? Based on what? One in 17,000 in China but 7 in 10 in Germany?

So, containment is possible. Controlling Angela Merkel’s mini-mind, not so possible.

How are we doing in the United States:

We now have just over 1,000 identified cases (the number infected is undoubtedly considerably higher, since few people have been tested).  The U.S. population is close to 330 million, meaning our incidence rate so far is 1 in 330,000, about 1/20 of China's rate. In other words, if our incidence rate grew to match China's before leveling off, we would get to about 20,000 cases.  If our rate grew to match that of the Wuhan area, it might be 500,000 cases. Why the U.S. incidence rate should grow to match the Wuhan area rate is not at all clear to me. Some of the data in the country tables seems suspect. Why would Russia have only 15 cases?  The world's highest incidence rate could be in Iran, if the official numbers represent just a small fraction of the actual caseload as some non-government sources in the country suggest.  Iranian leadership has been decimated by the virus, which has not occurred anywhere else.

Baehr concludes by mentioning the gorilla in the room. That would be, the health of your stock portfolio:

In short, the world is not showing signs that the end is near (though it may be for some of us). The virus is a scary thing for many people for good reasons, and precaution is a good thing, as are active measures to deal with the economic fallout as well as testing, and treatment and speedier than normal adoption of any vaccines which prove effective. I do not have the scientific background to know whether warmer months will slow the growth of the virus, as some have argued.

You might not be sick, but the chances are good that your portfolio is. It’s one thing to ask whether you should panic about the coronavirus. It’s quite another to ask whether you should panic about the stock market. 

In the meantime Fortune magazine reports on how Singapore has succeeded in containing the virus. We note this article with special interest, because we have been told that Chinese efforts at containment failed because China is an authoritarian state.

If only China had touted the virtues of free expression, it would not have let the virus get out of control. By this reasoning, the Chinese approach is an argument for liberal democracy.

And yet, Singapore is not what we would call a liberal democracy. It does not grant you a constitutional right to use the streets as a public toilet. And their authoritarian methods seem to have succeeded in containing the virus. It seems to have less to do with compassion and more to do with discipline and pride in country.

Fortune explains:

With no reported virus-related deaths despite 96 cases, and a slowing rate of infection that’s been outpaced by recoveries, the Asian city-state is emerging as a litmus test of whether the deadly pathogen can be, if not contained, then neutralized.

The answer is maybe, and perhaps only with the unique combination of factors that Singapore brings: a top-notch health system, draconian tracing and containment measures, and a small population that’s largely accepting of government’s expansive orders. Few other countries battling an outbreak that’s now infected more than 83,000 globally and killed over 2,800, can replicate these circumstances.

Singapore has succeeded because it has placed society’s needs over individual liberty. Thus, the culture as it was promoted community ties. In our case, community ties had already frayed. The virus made it more manifest.

It’s worth considering:

“There seems to be more of a willingness to place the community and society needs over individual liberty and that helps in a public health crisis,” said Kent Sepkowitz, an infectious disease control specialist at Memorial Sloan Kettering Cancer Center in New York.


trigger warning said...

Pity the perfectly creased pant legs are gone from the White House. In his "Report to the President on US Preparations for 2009 H1N1 Influenza", John Holdren and his Dancing Science Guys estimated that H1N1 would cause 30,000 to 90,000 deaths and result in 1,800,000 hospitalizations. As a result, hospitals were setting up tent clinics in parking lots to accommodate throngs of panicked parents and children with sniffles.

In fact, about 12,000 people died with 275,000 hospitalizations (CDC 2011)

It's worth noting that 2009-10 time frame was coincident with "Affordable Care" Act debate and enactment.

Anonymous said...

2009 deaths were not caused by H1N1 but rather by bacteria tainted OTC NSAID products. The CDC claimed it was due to tainted water in gelcap products.

Anonymous said...

Normally B. cepacia complex is relatively benign and kills only cystic fibrosis patients. The strain that contaminated many liquid medicine products caused necrotic pneumonia (holes in lungs) in people even without cystic fibrosis, perhaps due to immune systems weakened by seasonal viral influenza, perhaps. The contamination of sterile lab water is cited as the culprit.

UbuMaccabee said...

I was having lunch with Giovanni last week. He said that under no circumstances was David Brooks permitted onto the property of the Villa Palmieri. Giovanni explained that Prince Galehaut hates David for a variety of reasons, both personal and professional.

But Giovanni noted that Anne Brooks was a regular at Villa Palmieri, and that she was always welcome to attend.