Risks and harms: consequences of our response to a virus
In his essay The drift from domesticity, G.K. Chesterton pictures ‘a certain modern type of reformer’ who comes across a fence in the middle of a road and says “I don’t see the use of this; let’s clear it away.” To which Chesterton replies: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it”. Many share the habit of Chesterton’s modern reformer: when they find something in their way, their first instinct is to remove it with scarcely a thought for why it is there, what it might be supporting, or what disasters it might be preventing. ‘People do not know what they are doing’, he writes, ‘because they do not know what they are undoing’.
In the year just ended, Britain, along with many other countries around the world, imposed a series of strict ‘lockdowns’ in a purported attempt to slow the spread of a new type of coronavirus. These measures have been imposed not only on the infected, but on the entire population. Businesses have been forced to close, then to invest hundreds or thousands of pounds to comply with ‘safety’ measures so they can reopen, only to be forced to close again. We are now required by law to cover our faces in shops, on trains, and in schools and churches. Schools have spent large portions of the year in forced closure. Public gatherings of varying sizes have been banned. The British state decides who you can have in your home, when you are allowed to leave it, and what limited range of activities you are allowed to do when you leave. And much of this changes from one month to the next.
Our vision has narrowed like a microscope, focusing on one small thing and with no peripheral vision. Our minds are bent to a singular purpose: preventing death from a single cause. This is understandable to a point. A new and unknown threat holds the imagination hostage. The predator grabs the attention of its prey for a reason, and one can reasonably argue that we must deal with an imminent threat above all other dangers. But the dangers in a complex society are not so stark or simple as the perils of the savannah, where you are hunted only by the lion. Even there, the lion in front of you may be a mere diversion while another creeps up on you from behind. It is hard for us to assess which threat is most pressing, because the things most dangerous to us are often not the things we are paying attention to. There is a mass fixation at the moment on the thing we think we see in front of us, and we are tracking what we believe are its movements. But it is to the dangers outside our vision, that are not being tallied and charted in red before our eyes, and to all the things that we are ignoring, weakening, or destroying because we do not really see the use of them, that I find my attention unavoidably drawn.
All the measures we have put in place are primarily intended - in the words of their defenders - to save lives, i.e. to prevent people from dying, which, regardless of whether or not they achieve this, rests on the assumption that keeping people alive for as long as possible is what matters most. But is this right? Is it an end to which all other ends should be subordinated, regardless of the consequences?
It is important to remember a fact that likes to be forgotten: the fact that we die. Death is one of the few certainties common to all living creatures, and it may forever remain the greatest unyielding mystery of life. Any attempts to save life must be seen against this backdrop. A life ‘saved’, whether prolonging life by a day or a decade, is not death averted so much as death postponed, however welcome and miraculous. And always the judgement is made: is this particular attempt to postpone death worthwhile? If you are 75 and diagnosed with a cancer for which the only viable treatment is a gruelling course of chemotherapy that may give you several more months of unpleasant life, you may wish not to be ‘saved’, but to die.
In England and Wales, roughly 540,000 people die on average every year. That is about 1,500 per day (though it is always higher than this in the winter and lower in the summer). Between the beginning of the first lockdown in March and the end of the year, around 470,000 people, according to the ONS, have died, coronavirus or no coronavirus. Many died in hospital with no family by their side, for the family were made to stay away in order to keep everyone ‘safe’. Perhaps some were lucky enough to have held the hand of a kindly nurse, but nevertheless died away from home and from loved ones. Many of the hundreds of thousands of deaths were the old, the frail and the vulnerable, as is always the case, and many spent their last months alone, forbidden from seeing their family, friends, and loved ones, and without all the social events and structures that make life worth living. To even the young and fit, nine months is a long time to be locked away, but they may look forward with hope to the time when this is over. To the very old, nine months is likely all the time they have left on earth. In doing what we’ve done, we have made the sweeping generalisation that nine months is easily recouped down the line, that everyone would want to prolong the amount of time they have left at all costs, and that we would all judge it worthwhile to spend the best part of a year in isolation. But might many of the old (to say nothing of the young), if given the choice, choose the risk of freedom over ‘a little temporary safety’? Might it be that an old lady in her eighties, having lived a long life, rather than enduring an extended period of loneliness before death, wants little more now than to hold the hands and see the faces of her children, her grandchildren, and the friends who have been with her through the decades, and finally at the end to be kissed and embraced and to say goodbye?
These choices, the choice to die with dignity and in a manner of one’s choosing, and the choice of how to spend their last months, we have taken away from nearly half a million people, and from more who are dying by the thousands every day - of which coronavirus deaths are but a fraction. Why not instead let everyone decide for themselves what risks they are willing to take? If one man wants to stay at home and take the precautions he deems necessary, he is free to do so, but if you wish to go out and live as normal, taking a risk, along with all the other risks you ordinarily take by stepping outside your front door, then you are free to do that instead. A common response to this is: ‘what if, in leaving the house, you infect another person: he would have had no choice in the matter’. This could almost appear logical unless you consider that he has also chosen to take the same risk you have. He could have stayed at home but didn’t. Then the retort: ‘what about people who must leave the house for work, but who are scared and want to stay at home?’ Millions of people have to leave the house for work, regardless of what the rest of us do, if we want to keep society functioning. The water in your tap does not run and the electricity in your lights and computers does not flow by magic. It is only the dubious miracle of the internet that enables a significant number of people to work from home. Many jobs remain impossible or impractical to do remotely. Unless you are willing to turn off the electricity grid, let the taps dry up, close the hospitals, and abolish the food delivery network, you must accept that people will need to leave their houses and go to work, come good or bad ‘weather’. And these people have all had to go out to work despite lockdown to keep thousands of systems large and small ticking along so that most of us can forget how looked-after we are.
Another argument might be made: the state already limits our personal freedoms in order to minimise risk to other people, so why not do it in this case? I accept the principle that some limitations on liberty are required for society to work, but a question remains: where should this line be drawn? An ancient problem not easily resolved. And how to balance a liberty against a 'risk’? Vital it is to assess the nature and value of the liberty in question. Not all liberties are equal, and not all constraints on pure freedom are constraints on liberty. To illustrate this, take two examples which I have heard given in support of the argument that we should limit liberty in order to lessen risk: the fact that the law requires us to wear seatbelts, and the fact we impose speed limits on roads. Well, when you are in a car, your movements are constrained already, so the seatbelt does not really restrict you. For most of a car journey I hardly notice I’m wearing one, and I am already wearing clothes, so I don’t feel it against my skin. As for speed limits, the car itself has mechanical limitations on its speed. The legal limit on a particular road may be lower than I wish, but this is a limitation of degree: the range of behaviour available to me is not narrowed or changed in nature. I am already restricted bodily by sitting behind the wheel; a self-imposed limit greater than the seatbelt or the cap on speed. In both cases I am compelled by law to do something that in a technical sense limits my absolute freedom to do whatever I want, but the limits are neither material nor especially meaningful. It really matters what a particular liberty allows, and what the removal of it hinders. Being able to drive faster does not fundamentally change my relation to my fellow man, to the world, or to life itself.
But forcing us to stay at home, forbidding us from visiting or being visited by anyone, controlling how many people we can meet in public, requiring us to give justification for leaving the house, shutting down practically all social spaces where people might meet, effectively closing down public life - these are all meaningful and vital liberties which cannot be cast aside without severe consequence. It is claimed that ‘lockdown’ is a protective measure which minimises risk, but it is not. We have merely turned our attention away from all risks but one, and in so doing created new harms and risks and exacerbated others. There is incalculable danger in depriving an entire population of ordinary social interaction, in stopping grandparents seeing their grandchildren, in closing churches, in shutting restaurants and gyms, in preventing people from travelling and moving as freely as they are used to. Children have had their education irreparably impaired and a vital routine removed from them. We have severely disrupted the precious habits and vital supports of a country of people, and not with gentle adjustment but with the jolt of a slammed door. On top of this, we are seeing widespread depression and stress, along with thousands of avoidable deaths from all sorts of other causes. In March and April 2020 alone there were, according to the ONS, something in the region of 10,000-15,000 excess deaths not related to coronavirus. Millions of doctors appointments, surgeries, cancer screenings, regular treatments, dentist appointments, have been delayed or cancelled over the year. Imagine agonising toothache but no dentist to visit. Or going into hospital six months late after a postponed appointment, only to be told that you have advanced cancer which could have been treated had it been found sooner, but which will now kill you. The extended isolation of tens of millions of people will also shorten lifespans. By the time this is studied, measured or noticed, the damage will have been done.
I doubt it is possible to quantify the ruin we are inflicting on ourselves and our way of life, nor do I expect anyone can assess the long-term consequences. But we must believe that the things we are sacrificing are worth sacrificing, or why would we do this? In order to work out what a man values, you cannot only listen to his words and his speeches, you must observe his deeds, and in particular: what he protects and what he neglects, what he saves and what he discards, what he hallows and what he desecrates. The same goes for a civilisation. Common to all the restrictions seems to be the weakening of the social realm. In curtailing ordinary liberties, a demarcation has been made between the necessary and the unnecessary, or essential and non-essential. Food shopping is deemed ‘essential’, but seeing one’s family not. It goes without saying that people need to buy food, but does anyone really believe that seeing friends and family can be safely dispensed with? We must ask: essential to what? A friend pointed out to me that all the ‘essential’ things facilitate existence primarily on the level of the individual (food shopping, working, going to the bank, getting your nails done), and the non-essential things – seeing family, going to social events, going to restaurants and clubs, playing sports, seeing people’s faces in public, being in school - are all to do with communal life. Considering social life expendable is a perspective arising not from any physical reality of ‘facts’ but from a certain belief - that the individual is properly thought of as an independent being and not as part of a family, part of a web of friends and acquaintances, all of which requires real physical contact to maintain, and which not only sustains and nurtures but also defines and in some sense creates the individual. Individual lives are not all that need protecting. Relations between people, and everything that facilitates physical contact, need protecting too and are no less important - not least because it is only in relationship, to paraphrase Martin Buber, that a mere individual becomes a person.
This puts me in mind of another angle on liberty worth considering. J.S. Mill would say that my liberty ends only where it causes harm to you. This may not be a bad rule of thumb, but it accounts only for the liberty to ‘do what I like’ (as long as it harms no-one), not, for example, the liberty to participate in public and social life, the liberty to help and nourish one another with presence and contact. Much of the freedom that has been taken away from us as individuals does not benefit only us, and its removal is anything but protective of others. My liberty to visit my mother is part of her protection against loneliness and despair. Your liberty to run a business with minimal interference is protection for your family against destitution, illness and poverty. Removal of personal liberties removes not only the liberties, it removes a delicate canopy of care and protection from an entire population.
We have perhaps convinced ourselves that there is no alternative. When I read reports of falling employment and economic downturn, this is rarely blamed on the actions of the state, but on ‘the pandemic’. When there is criticism, it is not of the paradigm but of the government’s failure to ‘do more’, as if it were taken for granted that the thing we ought to be doing more of is good, and that the only problem is that we’re not doing enough of it. Underlying much of this is the apparent absence of morality altogether from the ‘equation’. Our leaders assert frequently that they are (and therefore we all should be) guided by ‘the science’, as if there were no other considerations. The use of the definite article (‘the science’ as opposed to ‘science’) implies a fixed and definite source of truth - a single coherent body of knowledge personalised and made whole, to which we can turn to for answers. Does such a thing exist? Karl Popper argued that for a claim or a theory to be considered scientific rather than metaphysical, it must be falsifiable (capable of being proven wrong), and that the highest standing any scientific knowledge can attain is merely to not yet have been proven wrong - a rather negative conception, if not fragile then at least never certain or safe from revision or outright destruction. There is no such thing as ‘the science’, only a gradual and unending practice of guessing, testing, and discarding. This is what allows science to be continually revised – because nothing, theoretically, is sacred - but also what should keep it humble: science is never settled.
I think we have no idea how deep the ‘well’ goes. Each new piece of knowledge in science comes as if hewing a head from the hydra: the moment new knowledge is acquired, new questions and new unknowns appear. We seem often to believe that once a theory has been ratified by the scientific method, it has taken on the same certainty as the certainty that heavy objects will fall to the earth. Much knowledge rests on layers of metaphor, reference, guesswork, assumption, and the spirit and prejudice of the time. This does not mean that things can’t be known, or that scientific knowledge is relative or subjective, but that even the hard, cold eye of science reveals only a fraction of the full picture of truth, and it remains ultimately a point of view - a model of reality, not reality itself, despite claims that it is the ‘view from nowhere’. Science is a mechanism for expanding a certain domain of knowledge. Powerful, useful, but bounded, imperfect, incomplete, as all knowledge is. Above all it cannot tell us what to do. Yet we are being told that ‘the science’ is giving us unambiguous instructions to be followed as if without will or choice, obviating moral judgement as if that were a mere nuisance, an impediment to action. It seems to me like a wish to obey something greater than ourselves, something complete and absolute. A yearning for God? Perhaps. Or perhaps a yearning to negate ourselves as moral agents, and to abdicate responsibility.
And what sort of science is ‘the science’? In this case it involves predicting the future using statistical models, which should at most be a single angle informing our decisions. There are whole other sciences - microbiology, immunology, virology - whose voices seem strangely quiet amid the deafening chant of the modellers. The practical danger of any model, mathematical or otherwise, is not so much in the model, nor even in the gulf between the model and reality, but in the inability of the modeller to notice this gulf or to accurately estimate its size. However, the fundamental problem not only with models but with all similar appeals to follow and trust ‘the science’ is this: that even if the model - or scientific theory - is accurate enough to be used it cannot alone guide action, because it cannot assign value or meaning to anything.
Consider the mask mandate. I know of no precedent or tradition in this country for compelling by law the covering of the human face. This is a radical reforming of human interaction on mass scale and a never-before-seen intervention by the state in controlling the bodies of its citizens. Aren’t we legally compelled to wear clothes in public? Yes, but that law has arisen out of millennia of tradition and culture: here the law has come as if from nowhere, and overnight. And faces are different from bodies. An exposed face is not a naked face, it is the organ of communication, conveyor of emotion, intention, and mood. It is impossible to read more than a hint of expression through a mask. You can’t lip read. Speech is muffled. Communication is impaired. A certain ambiguity and subtlety is removed from conversation, rendering social interactions more purely functional. In addition we are developing the sense, perhaps unconscious, that the breath is no longer to be understood as a sign and symbol of life, but a potential carrier of disease.
For a certain sort of anxious person who feels smothered or panicked wearing a mask, the mere possibility that someone might confront her could be enough to prevent her ever taking a train or visiting a shop. Technical legal exemptions are little defence against this. Then the practical side. It is one thing for trained personnel to wear masks in a controlled environment, it is quite another for everyone in a country to wear them, whether properly or improperly, clean or dirty, often for hours at a time. Even if masks were proven to work in theory, that may indicate nothing about the efficacy of their use by millions of people with no prior habit. But this is the difference perhaps between the logical calculations of mathematics and the irrational movements of the living world.
These are not primarily factual problems or problems that even the best, most accurate science can answer for us, because they are essentially questions of what sort of world or society we want to live in. Perhaps some people feel safer wearing masks, and that may be a good thing. But it is no argument for universal compulsion. The point is, we do not give the downsides a hearing, nor do we discuss the meaning of what we are doing or the value of what we are messing with. We do not ask: are we confident this is a worthwhile compromise, considering all the problems and side-effects? We simply assert that, even though we cannot prove it, we think it might have some positive effect along a single dimension (that of minimising virus transmission), so we shall force everyone to do it.
It remains unproven whether we can slow the movement of the virus by any means - lockdowns, mask wearing, anything - and the more time passes the more this lack of clear evidence speaks. The virus can supposedly survive on many kinds of material for days. It is so tiny that it is invisible to the human eye, and is easily conveyed and spread by air. What makes us believe we have the power to alter its course so dramatically? I do not say that nothing can or should be done, but why is controlling the spread of an airborne virus thought to be the most effective intervention? The real terrain of the virus - any virus - is not the air, which is merely the transport system, but the human body. We can’t quarantine an entire country, that is to say, keep each person continually isolated from all others. Even less are we able to control the flow of air out in the open. And the strictest lockdown is not a quarantine. The most any lockdown could do, even hypothetically, is delay the spread by some unknown amount. Sooner or later a battle will be fought within a specific human body, and the preparedness, the health, of that body will determine the fate of the person, not whether the virus finds them or not. Would it not make sense to concentrate at least some of our efforts on the inner defences of the vulnerable - metabolic health, the strength of the immune system - especially since it has been clear for some time that, as with other respiratory viruses, the people worst affected are the metabolically sick? I have heard hardly a whisper along these lines from anyone with any power to influence the course of events. Might this be because it would not be considered ‘taking action’? Compared to the current scale and depth of interference in the lives of citizens, would advising people to eat healthy foods, to keep fit, and to get plenty of fresh air and sunshine appear, for all its obvious benefit, like negligence?
It must not be assumed however that ‘doing something’ is the only sensible option. Refraining from action is often the wisest and most difficult course, and one to which we ought always to default in order to avoid the risk of making things worse. But it is neither my place nor my intention to propose specific alternatives to what we have done, nor to prove that lockdowns or mask wearing are ineffective. Firstly, the onus is, and should have been from the beginning, on those in favour of these measures to carefully and diligently prove their effectiveness, and to show that they deeply understand the use and value of all the things they propose to abolish. Only then may we begin the debate as to what, if anything, should be done. This prerequisite so far has not been met. Secondly, criticism of the measures from a pragmatic or purely factual perspective has already been done elsewhere, by people like Carl Heneghan (Director of the Centre for Evidence-Based Medicine in Oxford), Mike Yeadon (former CTO of Pfizer), Sunetra Gupta (Professor of Theoretical Epidemiology at Oxford University), Sucharit Bhakdi (retired microbiologist and former head of the Institute of Medical Microbiology and Hygiene at Mainz University), and many others far more qualified than me to address that side of things. I refer the reader to those experts to judge for him or herself the merit of their conclusions, which are unanimous in their condemnation of lockdowns as ineffective and disproportionate.
My argument here is that even if the measures had proven effective and Imperial College’s predictions had turned out accurate, what we are doing would still be too inhumane and too damaging to be worthwhile or morally justifiable, especially given how long we have now been doing it. And after nearly a year it shows no sign of ending. In March 2020 it began as ‘three weeks to protect the NHS’. This morphed into another few months to ‘flatten the curve’. Then: ‘if we wear masks we’ll be back to normal by Christmas’. Then: ‘just a little longer til the vaccine’. Now, it turns out, the vaccine won’t remove the need for masks or even the need to lock down again next winter. How much longer might this go on, and if enough is not yet enough, I wonder when we will decide it is?
Meanwhile the state draws to itself unprecedented power and reach, unchecked by the courts, by parliament, or by the press. There are a handful of MPs bravely dissenting, but by and large the scrutinising and oppositional tradition of our adversarial system have been cast aside. Police have taken to fining people for going for a walk too far from their home. Neighbours are encouraged to inform on one another, as they did in the Soviet Union. Some will say this is temporary, but that is not the pattern of history. Temporary ‘solutions’ tend to become permanent fixtures, and a state tends to expand, become tyrannical, and to dominate ever more areas of life if not kept in check. Things done cannot as easily be undone, and as time passes drastic change fades until it is invisible, and a former normality and freedom is forgotten. Consider the opening lines of A.J.P. Taylor’s English History 1914-1945, that ‘until August 1914 a sensible, law-abiding Englishman could pass through life and hardly notice the existence of the state, beyond the post office and the policeman.’ All this was changed by the onset of World War I, during which ‘the state established a hold over its citizens which, though relaxed in peacetime, was never to be removed’. I suspect that after what we are going through now is all over, if it ever is, many of the habits we are forming and rules we are imposing now will be here to stay unless they are fought off. The virus may dwindle, or it may be back every winter as is the way with flu. Either way, if we allow things to continue as they have been, an authoritarian state will be here for good. And every day more jobs are lost, more businesses are forced to close, we borrow more money, more people grow lonely, miserable, depressed, suicidal. And people continue to die, as they always do, only this time, some of them are killed by the very policies thought to protect them. My hope, if there is hope to be found, is that we will remember, before it really is too late, the value of our ancient liberties, the same liberties the men and women of the last century believed worth laying down their lives to save.