I am researching and writing this primer to take a big-picture look at the COVID-19 epidemic. What I originally envisioned as a single essay has now developed into an ongoing series of indefinite duration! Now that I have examined the pandemic from biological, medical, epidemiological, and social perspectives, today I consider the upshot: “So … what should we do now?!” How shall we resolve the three-way tug of war involving public health, the economy, and political peace? How should we conduct our lives until the virus is under control?
- I. A Tricky Balance
- II. Suggestions from the Left and Right
- III. My Humble Suggestions
- IV. Conclusions
- V. Citations
I. A Tricky Balance
President Trump tweeted, “We cannot let the cure be worse than the problem itself.” 2
Most people would agree with President Trump’s rationale. The keyword in this sentiment is “worse”, which is frustratingly hard to define. It depends on the costs and benefits of action vs. inaction.
Let’s suppose at its simplest level that cost is measured strictly in terms of human lives lost. One research team estimates that strict public health measures could save about a million American lives this year while causing around 100,000 poverty-related deaths. That is a nightmarish ethical dilemma. On balance, though, playing it safe with public health measures like stay-at-home orders would be justified. 3 The problem is that prevented deaths are invisible. Virtually nobody would celebrate the million lives saved, while the actual recession-related deaths would make headlines daily.
I got curious to look up the countries that had done best at protecting their economies, those that had done best to minimize infections, and those that had struck the best balance. The results surprised me. In the long run, there is no tradeoff. The countries that have done best at keeping their COVID-19 deaths down are actually those with the most successful economies now. 4 Although “lockdown” is a difficult short-term process, it allows for an earlier return to normalcy and therefore greater long-term recovery.
If numbers were the only consideration, the solution would seem “obvious”. With a truly rigorous, highly-enforced social lockdown for 2 – 4 weeks, we could put this pandemic behind us. That scenario alarmed us in March, but by now another 2 – 4 weeks would not feel shocking.
There’s another factor, though: political will. I’d be willing to horde groceries and stay home for a couple more weeks. I know that many of you would too, even some conservatives in small states. But we also know how ferocious the resistance would be. People would refuse to comply; the stricter the order, the harder it would be to enforce. The short-term pain would be undeniable. Some people would feel so angry and oppressed that they would develop permanent vendettas or even go Rambo on us. The emotional costs of such drastic action would simply be too high. Unfortunately, the longer this goes on, the more time the pandemic has to grow exponentially.
If the short-term and long-term solutions are at odds with each other, how else can we find the right balance?
II. Suggestions from the Left and Right
I seem to see two competing visions emerging.
A. The “Experts'” or “Liberal” Solution
- Monitor hotspots
- Locally tailor protocols, including face mask mandates, business closures, and prohibitions of mass gatherings, where and when appropriate
- Increase the number and speed of tests where needed
- Improve contact tracing and quarantine procedures
- Wait for a vaccine
A good example of this model is California’s stay-at-home order, which was one of the first statewide responses in the United States and which is regularly updated. California counties are ranked on a heat spectrum (yellow < orange < red < purple < blue) which is now defined by availability of ICU beds. Business activities and freedom of movement are more strictly restricted in hotter spots. The state also recently launched the CA Notify app. When someone who uses the app tests positive for SARS-CoV-2, she can alert the app. Users who spend extended periods of time in proximity to her will then get notifications on their phones.
B. The “People’s” or “Conservative” Solution
- Preemptively quarantine the vulnerable
- Let everyone else get back to life as usual
- Face masks and social distancing up to personal conscience
- Wait for herd immunity
The conservative model is expressed in the Great Barrington Declaration. The preamble to this declaration indicates that its proponents are more concerned about government orders than the virus. The plan calls itself “Focused Protection” because it would focus on protecting nursing home residents and other vulnerable patients, while keeping children in school because they are much less susceptible. Many experts do not find focused protection to be feasible; flu pandemics illustrate that is not possible to effectively identify or quarantine the vulnerable population. 5 In fact, the apparent mass appeal of the Great Barrington Declaration is that it is extremely simple. The declaration is short and abstract, more a set of goals than a plan of execution.
III. My Humble Suggestions
- A. Principles & Guidelines
- B. Spreading the Liability for Spreading the Disease
- C. Just Compensation and Focused Bailouts
- D. Conservative Messaging for Conservative Communities
- E. Anti-Curfews
A. Principles and Guidelines
In my coronavirus primer, I have discussed benefits and drawbacks to various prongs of the liberal and conservative approaches. Business lockdowns cause their own pain, and mandates lead to political friction. A vaccine could be years away in some parts of the world. With indiscriminate reopenings, we might reach herd immunity before a vaccine is available, but that process would kill tens of millions of people and would overwhelm hospitals to the point of causing millions more non-COVID deaths.
Some compromise will be necessary and optimal. 6 Compromise requires looking at this pandemic as a political problem, not strictly a medical or economic one. The political controversy is the main factor that tends to be left out when people discuss solutions. No single plan will be perfectly acceptable to everyone. But the status quo approach, which has led to violence and deep societal rifts, is outright unacceptable.
Here are some abstract political principles that guide my thoughts.
- “I’ll explain my position and respect yours.”
- In a democracy, we define what is “right” by the people’s choice, even when it’s based on false premises. That is frustrating, but it’s a price we pay.
- The more controversial a decision is, the more locally it should be made.
- Consider externalities
Externalities are a fancy way of saying costs or benefits that one person’s decisions have on society around him. Most economics classes teach that an economy is most efficient when people are charged for the messes they make or rewarded for the messes they clean up. I’m a little surprised that I haven’t heard this topic being discussed widely this year in response to the pandemic.
When I consider these principles in sum, I conclude that each person, family, business, and government should assume the right and the responsibility for its own decisions. Here are some applications that would follow from this existential approach.
The people’s primary freedom is the right to decide how to carry out their lives. Face masks, social gatherings, and business closures should mostly be individual decisions. In fact, this already is true in reality. It’s difficult to enforce mandates on individuals, so people already are acting according to their own judgment.
In order to guide people’s actions, governments have a responsibility to educate: to provide data, science, and recommendations with justifications. Most people will choose to do the right thing and respect sensible recommendations. For instance, governments everywhere have been consistent about their advice to wear face masks. Even without a mandate, 85% of Americans already report that they regularly wear face masks voluntarily, including 76% of Republicans. 7 For conservatives, it’s that last step of the requirement that gets the blood boiling. Thus, the benefits of requiring face masks probably does not greatly outweigh the political ill-will.
There are a few more COVID-specific principles to help us make common sense decisions.
- A higher current level of infections justifies more restricted behavior.
- Stricter regulations are only sustainable over smaller places or shorter times.
- Vulnerable people require greater protection.
States differentiate counties depending on their rates of new cases, rates of positive tests, percentage of ICU capacity available, etc. Personally, I made a 1% rule of thumb for myself. When the pandemic started, I vowed to stay out of areas where more than 1% of the population is actively infected. Today, it so happens that my neighborhood, city, county, state, and country are all 2 – 6% actively infected. These levels tell me that it’s time to stay in as much as possible. While I can commit to locking down at home for a couple of days, it’s unreasonable to expect self-quarantine for months on end. It’s completely unrealistic to expect the whole world to hunker down for a year. I did find it reasonable to stay home for last year’s holidays. It’s a sacrifice I was willing to make because it felt like the right thing to do. I’m sure that you have your own standards to suit your own lifestyle. No matter how young or healthy you are, though, be mindful that this disease can be fatal to the oldest generation in your family.
Below, I detail a few more specific recommendations that follow from my principles.
B. Spreading the Liability for Spreading the Disease
COVID-19 liability is a hot topic this year, and it should play an important part in our response. A pure economist might suggest that people, and especially businesses, should be held liable for medical costs if they cause infections by high-risk behavior. We all know that’s an impractical solution. For starters, it’s almost impossible to trace the origins of each transmission. Furthermore, most germ-spreaders couldn’t afford the medical costs. The ensuing lawsuits would not exactly help lighten up the atmosphere either.
A practical middle-ground would be a “liability spreading” system, where the costs are spread out among the whole risk-sharing population. The closest analogy would be a toll road: those who use it pay for it. A similar cost-reward system with tolls and subsidies could be set up by a city or county that chose to participate. Just to throw an example out there, a city could sell foot traffic permits to businesses. Pricing could be based on population density, with a discount for businesses that require on-site rapid testing. The business could pass the cost on to customers. Perhaps customers could pay a little extra by the minute or the mile to enter stores, ride buses, and the like. The proceeds from these tolls could fund medical treatment, vaccine and face mask giveaways, and rapid tests.
Nobody likes tolls, but they’re better than outright bans. Government directives to “stay at home” have been highly contentious – they are largely to blame for the rise of right-wing militarism in the last year. Worse yet, these bans aren’t even enforceable. Most governments are relying on an honor system with their citizenry. The liability spreading system would
- keep businesses open,
- effectively discourage frivolous outings with an added cost (perhaps movie ticket prices would double)
- still allow citizens freedom of movement according to their own judgment and budget,
- not cost anything for citizens who stay home,
- raise money for COVID-19 treatment,
- and be flexible. It’s easier to adjust tolls than to expect citizens to keep up with an ever-shifting front of regulations.
C. Just Compensation and Focused Bailouts
If a government does force a business to close, it ought to compensate for lost profits. In fact, in the United States, there is a constitutional argument in favor of such compensation. The 5th Amendment states in part:
“nor shall private property be taken for public use, without just compensation.”
This “Takings Clause” applies to state and local governments as well as the federal government.
In this pandemic, closing a business to mitigate the spread of a virus is a “public use”, and forcing an establishment to close is arguably “taking” the property for that use. Under this theory, a government that ordered a business to close for a month would compensate that business for one month’s lost profits or payroll.
This argument is not likely to be legally enforceable. COVID-19 closures fall under a government’s police powers, which are legally exempt from the 5th Amendment. (Such compensation was not made for Spanish Flu closures). At least one legal scholar argues that some compensation would be the morally right thing to do, a responsibility that I argue for here. This must be balanced by cost. It would be prohibitively expensive to cover the widespread closures that have been mandated. In fact, coronavirus bailouts like the PPP program have been the largest stimulus bills in US history.
The liability-spreading system would mitigate such costs by allowing all but the worst super-spreader businesses to remain open. In fact, it would be a mechanism for funding any such compensatory payments. If a government were committed to covering profits for businesses that it forced to shut down, that government would have incentive to become extremely judicious with its closures.
D. Conservative Messaging for Conservative Communities
Aristotle described three forms of persuasion: logos, pathos, and ethos. As someone trained in the sciences, I respond to logos: facts and logic. However, I recognize that most people base their values primarily on ethos (who is delivering the message) supported secondarily by pathos (emotions), then perhaps justified after the fact by heavily filtered evidence. In the United States, for instance, 1/3 to ½ of the nation is conservative. Many people in this constituency have made up their minds that Democrats or even scientists are bad guys. Those folks won’t listen to a word that Dr. Fauci, Governor Whitmer, or President Biden says, no matter how well it is supported by science.
To reach conservative citizens, public health agencies must recruit conservative spokespersons. I can hardly think of a better example than Dolly Parton. This beloved red-state icon donated $1 million to the Moderna vaccine. In fact, federal agents have already suggested enlisting her as a spokesperson to encourage mask wearing in Knox County, TN. 8 If Dolly and other conservative heroes encouraged people to stay at home and avoid gatherings as a patriotic call of duty, conservatives just might take it more seriously. Let’s start comparing the sacrifices that we ordinary citizens make to those of soldiers and policemen, part of a higher cause. These are the arguments that resonate with conservatives.
I don’t understand the rationale behind curfews, and I’m not sure anyone has evidence that they do any good. In fact, I would propose that businesses in high-risk zones should stay open 24 hours. Then customers could spread themselves out throughout the day instead of packing themselves into limited business hours. Hell, stores could even offer graveyard shift discounts.
It would be possible to end this pandemic within a month, but only with a coordinated and strictly enforced worldwide shutdown. If the pandemic were strictly a medical issue, or even a long-term economic issue, this solution would be the sensible one. But we all know it’s draconian and unrealistic. Some people would suffer great loss, some would resent the lockdown for the rest of their lives. Different people are swayed by different emotions or evidence, and some pay no heed to evidence at all. But they are all part of the democratic decision-making machine.
There is room for individualized response. In fact, that may be the only way to keep political tensions under control. We must allow some latitude for people and businesses to make their own choices.
On the flipside, freedom bears responsibility. Charge an extra $10 for a movie ticket or 25% for bus fare, and then let people decide what they’re willing to pay for. Use the proceeds for COVID-related medical expenses and to support businesses that have closed their doors.
As I said, no solution is perfect, and this proposal is no exception. Some people would object to paying extra to congregate. Others would complain about a system that permits gatherings at all. What can I say – life can not be perfect in times of pandemic. That’s the hand we’re dealt right now. The best we can do is respond efficiently and holistically. Let’s seek the greatest medical, economic, and emotional good for the greatest number.
- lumaxart, CC BY-SA 2.0 https://creativecommons.org/licenses/by-sa/2.0, via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Working_Together_Teamwork_Puzzle_Concept.jpg (accessed 12/17/20). ↩
- Donald Trump, Twitter, 3/22/20, 8:50 PM, https://twitter.com/realDonaldTrump/status/1241935285916782593 ↩
- Olga Yakusheva, “The Cure is Not Worse than the Disease – A Humanitarian Perspective”, SSRN (8/07/2020, pre-print awaiting peer review), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3638575 (accessed and saved 10/01/20). ↩
- Joe Hasell, Which countries have protected both health and the economy in the pandemic? – Our World in Data (9/01/2020; accessed, saved, and archived 11/27/20). ↩
- Julian Tang et al., “Expert reaction to Barrington Declaration, an open letter arguing against lockdown policies and for ‘Focused Protection’”, Science Media Centre (10/06/2020), expert reaction to Barrington Declaration, an open letter arguing against lockdown policies and for ‘Focused Protection’ | Science Media Centre (accessed, saved, and archived 12/16/20). ↩
- Dr. Sandro Galea as quoted by Amelia Thomson-DeVeaux, “Republicans And Democrats See COVID-19 Very Differently. Is That Making People Sick?” Five Thirty-Eight (8/27/2020), https://fivethirtyeight.com/features/republicans-and-democrats-see-covid-19-very-differently-is-that-making-people-sick/ (accessed, saved, and archived 10/23/20). ↩
- Stephanie Kramer, “More Americans say they are regularly wearing masks in stores and other businesses”, Pew Research Center (8/27/2020), https://www.pewresearch.org/fact-tank/2020/08/27/more-americans-say-they-are-regularly-wearing-masks-in-stores-and-other-businesses/ (accessed, saved, and archived 10/22/20). ↩
- Cole Sullivan, “Federal report: Tennessee needs mask mandate, should enlist Dolly Parton to help”, WBIR News (7/21/2020), https://www.wbir.com/article/news/health/coronavirus/federal-report-tennessee-needs-mask-mandate-should-enlist-dolly-parton-to-help/51-7a3c938a-6f82-4760-ae91-963e4f0c66d3 (accessed, saved, and archived 12/29/20). ↩