Most countries have faithfully followed the WHO playbook to deal with the COVID-19 pandemic. But has the immense social and economic damage wrought by this response been greater than the true medical impact of the pandemic? And what lessons must we learn to inform our future pandemic response strategy?
In this debate, ‘For’ will argue that the approach deployed at the direction of the WHO has been disproportionate, when a more targeted, evidence-based response would have paid similar dividends.
‘Against’ will say that while hindsight always delivers apparent wisdom, the WHO-led response has been proportionate, given its mandate, and will prove effective, given the circumstances—apparent or otherwise.
YES. The ‘Mass Lockdown’ approach is a Sledgehammer to Crack a Nut.
It Makes the Cure Worse than the Disease.
Please Note: Nothing in the essay that follows is meant to deny the integrity of national health authorities worldwide, or in particular to diminish the heroic efforts of frontline workers in dealing with the COVID-19 pandemic. I acknowledge the possibility of hindsight bias in this analysis, and I have done my best to avoid it.
“The only means to fight the plague is honesty.”albert camus, The plague (1947)
Faced with a novel, life-threatening COVID-19 viral pandemic in early 2020, perhaps the safe and responsible thing for national governments to do was to close down the operation of large parts of civil society and the economy for as long a period as was necessary to halt the progress of the virus in its tracks.
This has indeed been done in most affected countries, albeit at extraordinary cost, both to Nation-States and citizens alike. Yet, if anything has become clear in the past 10 weeks, it is that, in the context of a rampant pandemic like COVID-19, epidemiology is not as exact a physical science as many of its counterparts. It can’t be— because novel viruses have a life of their own. They are simultaneously beautiful and sinister in their ability to evolve and survive from day to day, week to week.
In the absence of mass testing data in most countries, and in the face of a potentially rampant and deadly enemy, Chief Medical Officers have been largely flying blind, whether they wish to admit it or not. There is an impressive apparent precision behind the daily press briefings provided by politicians and their health advisors around the globe. I sense this is designed to bolster public confidence and encourage compliance. It is, unfortunately, a prime example of the ‘tyranny of numbers’ and of their ability to give a false impression of control on the part of those deploying them.
In many countries, much of the data presented around COVID-19, while apparently precise, is not fully representative. Cillian de Gascun, Director of the National Virus Reference Laboratory in Dublin, Ireland said on 3rd April, 10 weeks into the emergency: “We don’t yet have a great handle on how much virus is in the community … we’re targeting about six months (of 100,000 tests a week) and that’s sort of our starting point. That’s 50% of the population, or something.”
Meanwhile, UK COVID-19 fatality data was based, until recently, just on deaths in hospitals, ignoring deaths in Care Homes completely—the single most important site affected by COVID-19. This was an almost unbelievable oversight (but perhaps not an altogether surprising one given that Dominic Rabb was apparently unaware of the strategic commercial importance of the Dover-Calais sea route while fronting the Brexit negotiations last year).
We have no idea what proportion of the general population either currently have the virus, or have had it. Nor do we know what proportion of those who have had it are now immune, if they are in fact immune from its deadly effects. When it comes to the reality of COVID-19, we are simply in the dark.
The mortality rate from the virus is typically quoted as being in the 0.8% to 1% range of those confirmed to be affected. The real mortality rate, based on a much greater proportion of the population having been exposed to COVID-19, could be as low as 0.03% to 0.05%, according to dissenting medical sources. In a CNN interview on March 29th, Dr. Anthony Fauci said ‘I just don’t think that we really need to make a projection (of death rate from COVID-19) when it’s such a moving target, that you could so easily get it wrong’ (my emphasis).
So, in most countries, in the absence of reliable, real-time data, a shotgun is being used to tackle this pandemic when what is needed is a rifle. The overwhelming majority of those severely affected are either aged over 70 (especially those living in Care Homes) or suffer from pre-existing medical conditions. Yet, everyone is expected to follow identical ‘lockdown advice’ to the letter, whether they are aged 16 or 76, whether they live in a densely populated urban area or not, whether they (may) have had the virus or not, whether they (may) have developed immunity to its effects or not. If the response had been targeted to protect these vulnerable groups, based on reliable, real-time evidence, could the broader impact on daily life have been made less severe for the majority of the population?
As Dr. Darren Schulte, CEO of Apixio, a medical analytics company based in San Mateo, California, argues:
“I believe we should counsel individuals to continue going about their daily lives while taking proper and prudent precautions until we learn more about the long-term public health risks of this disease.”
Sweden stands alone in Europe in adopting a different way of dealing with COVID-19. It kept its borders open, while Swedish social life was uninterrupted to a large degree as small-scale social gatherings continued and hairdressers, restaurants and bars remained open. The Swedish ‘confirmed death rate’ from COVID-19 is in line with that of most developed countries, albeit with a particular prevalence in Care Home settings.
Contrary to some opinion, Sweden did not recklessly allow the virus to spread unchecked. Explicitly, it did not rely solely on a ‘herd immunity’ strategy. Rather, it relied on a comprehensive testing regime, along with a degree of trust in the maturity of its citizens to adapt their behaviour to mitigate the spread of the virus; wearing protective face-masks in confined spaces, working remotely where possible and obeying sensible social distancing practices.
Again, none of this is to diminish in any way the scale and difficulty of the task that faced policy-makers around the world, and especially those working on the frontline, just 10 weeks ago in coming to terms with the novel coronavirus. But it is vital, as we face the reality that more mass pandemics will occur in future, that there is an open-minded and honest debate as to how we should deal with such outbreaks,
A highly targeted approach, based on real-time, mass testing is the only way to marry the immediate medical needs of the few with the economic, longer-term needs of the many when the next pandemic strikes.
We should begin to resource such an approach right now, country by country.
It is the least the front-line heroines and heroes of COVID-19 deserve.
Please now scroll down to read the opposing viewpoint.
NO. The WHO’s Response has been Proportionate, Given its Mandate & Will Prove Effective, Given the Circumstances
Hindsight is always 20/20, yes? As human beings, we are vulnerable to revisionism, especially when it means appearing to be on ‘the right side of history.’ We lack immunity to the politics of influence. We prefer to bet on known entities. We protect our reputations with popular opinions. But we are also entitled to change our mind as new evidence presents and old arguments are cast in new light. Proportionality is of course relative to available proportions.
As a group of human beings dealing with a rapidly evolving situation in real time, the WHO is no different. Its response has been, if not predictable, at least in keeping with its mandate and the tools at its disposal.
As an advisory body, the WHO exists to promote health, inspire behavioural change and serve the vulnerable. As Director General Tedros repeatedly pointed out in the WHO press briefing on April 27, its remit is not to set policy. It can and has repeatedly made recommendations on pandemic preparedness, but whether countries heed that advice is a matter for their own wonks.
In effect, the WHO is a communications agency: responsible for gathering, collating, interpreting and transmitting information—which is occasionally encoded in the form of vaccines.
Given the limitations of its mandate, the Agency has done as good a job as could be expected, acting upon incomplete and inconsistently reported data, a large side of assumption, and a long list of known unknowns:
We don’t know what the prevalence of SARS-Co-V2 is.
We don’t know how contagious it is.
We don’t know what its mortality rate is.
We don’t know how reliable the tests are.
We don’t know how accurate the models will prove to be.
We don’t know what long term health effects it may cause.
We don’t know if reinfection is possible, or how long immunity lasts.
We don’t know how many strains are out there.
We don’t know if a vaccine will be viable.
Like any good consultant trying to cook a strategy in the absence of facts, the WHO issued a mantra: Test. Test. Test. (Anything repeated thrice has the magical effect of making the obvious, if not profound, at least memorable.) And, it recommended lock-downs of indeterminate length, based on known knowns:
Asymptomatic carriers can transmit the virus.
Symptoms and their severity differ between infected persons.
Social distancing and proper hygiene slow the spread.
Age, poverty and pre-existing conditions make people more vulnerable. (So, in the event Covid-19 turns out not to be a five-alarm fire, it is most certainly an accelerant.)
And we also know that the fallout from overwhelmed health care systems would lead to dramatic spikes in death, further erode trust in governments, and very likely lead to civil unrest.
Therefore, the WHO knows that social cohesion is essential to preventing the spread, and by extension, societal collapse. See Tedros’ second mantra: Solidarity. Solidarity. Solidarity.
Most people, faced with the threat of potential annihilation, will defer to the authority of power. Whether that power is wielded by a kidnapper, an oncologist, or a blue checkmark on Twitter, human beings will alter their behaviour to save their skin, their kin, or simply face. We put our hands up. We don’t scream. We take the pills. We retract our statements.
But even in high stakes situations, some will question the authority of power. Dissent is a healthy and necessary part of democracy, but dangerous when unity is required to put down a threat. Just look what happened to poor wee Beau in A Quiet Place.
To get entire populations to engage in a behaviour that doesn’t jive with their beliefs or usual way of life, a means of managing cognitive dissonance and reducing the potential for dissent must be introduced.
Here, with limited powers, the WHO played a blinder. Its campaign efforts (Stay at Home. Save a Life, etc.) give people an active role to play, thereby encouraging buy-in. But where memorable slogans and personal heroics are not enough, other soft (and not so soft) solutions may have helped the WHO achieve their aims in ways that are not immediately self-evident.
On the surface, Mozart and Macbeth have nothing to do with putting down a pandemic. However, behavioural economists have derived lessons from both that prove helpful in reducing cognitive dissonance just enough to induce compliance.
Generations of pregnant women have serenaded their bumps with classical music in hopes of birthing smarter babies. But music can be used to similar effect on hardened humans as well. While some of the $128 million raised during the WHO’s ‘One World Together at Home’ fundraiser may certainly be attributed to star power, the Mozart Effect demonstrates how music can be used to coax consonant thinking and elicit socially favourable outcomes. Music it seems, not only soothes savage beasts, but may also help shush dissent.
Shakespeare may have also noticed something new in the familiar, when he wrote of Lady Macbeth’s efforts to wash away the stain of regicide. Perhaps the bard knew then what scientists would later discover: that the physical act of hand-washing can alleviate the mental distress of betraying beliefs and behaviours held integral to one’s person.
Directly or otherwise, the WHO have used the tools at their disposal to the best of their mandate. Protecting the status quo may not fall within that mandate, however it’s interesting to note that the economic deep freeze may end up having some Wim Hof-type effect on the health of the whole. Which is most certainly a goal of the WHO.
But even if consumption doesn’t fall in the longer term; even if conservation fails to increase; even if the surviving population is neither physically nor mentally stronger; even if a return to ‘Normal’ proves possible, the WHO-lead lockdown will have served another valuable purpose: Obedience training for future shocks.
As Leon Festinger’s Theory of Communication points out: there can be no persuasion without cognitive dissonance, no change without discomfort.
If in doubt: Test. Test. Test.