The algebra of life and death
As the Covid-19 pandemic rages on well beyond initial expectations, and as billions of people around the world suffer from the economic and other ill consequences of forced restrictions on business and social activities (i.e. so-called “lockdowns”), it is of course natural to have discussions about when and how to lift such restrictions.
Unfortunately, these discussions have been largely political and unproductive, pitting already highly divided political camps against each other, each side utilizing a litany of misinformation in an attempt to bolster their arguments. For a more productive (or at least more realistic) discussion, it is important to parse out the different components at play, and to make an assessment of our values as a society. Fundamentally, the balance of the equation is a ratio between the risk of the disease versus the risks associated with the disease mitigation measures (e.g. lockdowns):
Experts from multiple disciplines have amassed an enormous amount of data for both elements of this equation. With emotions running high and political stakes even higher, however, expert voices are being drowned out by angry masses of non-experts. I am a doctor. It is not only my social responsibility, it is also literally my job to tell you what is healthy and unhealthy. In the case of government lockdowns, doctors are not making the rules. Referring to “the Fauci lockdowns” is as ridiculous as referring to “the Weingarten cookie ban” after I tell you that you need to lose weight. Dr. Fauci is an advisor, not a policy-maker. It is simply tragic that the public discussion has focused almost solely on one side of the equation. Instead of focusing on things that most people can genuinely understand, such as unemployment rates, homelessness and other consequences of economic distress, the debate has centered around an incredibly complex area of science.
I challenge you to try to read this paragraph from a recent article about Covid-19 related coagulopathy:
“…complement factors are able to increase tissue factor activity, form activated thrombin from prothrombin, increase platelet activity and aggregation, increase prothrombinase activity and the release of platelet-derived procoagulant granules, as well as stimulate endothelial cells to release von Willebrand factor and express P-selectin. Complement also regulates fibrinolysis, with complement cascade inhibitors demonstrating the ability to inhibit plasmin, and complement factors able to activate the fibrinolysis inhibitors PAI-1 and TAFI.” doi: 10.1016/j.thromres.2020.06.027
I am a brain surgeon. None of these terms are completely foreign to me, but without looking it all up and reminding myself of things I learned over a decade ago, I understand it mostly conceptually, in probably the same way that an auto mechanic might understand a detailed description of the space shuttle. Why on earth, then, does the general public seem to feel empowered to challenge the expertise of hundreds of thousands of scientists and medical experts worldwide? For those of us in the medical sciences, it is incredibly frustrating trying to constantly combat the steady flow of misinformation coming from certain politically-motivated sources. There are two elements to this equation, but instead of focusing on the part that most people can understand, we appear to have spawned an entire nation of armchair space shuttle engineers, arrogantly telling NASA that they’ve got it all wrong. For a more productive public discussion, focus on the denominator in the equation. That’s where the money is, quite literally. Despite the political tinderbox in which this debate is occurring, everybody recognizes that there are dire consequences to the lockdowns. I’m not going to discuss the ways in which lockdowns are harmful, because – get this – I’m not qualified to determine their significance. Believe it or not, it is possible to admit when you’re not qualified as an expert. When it comes to public education, psychology and economics, I am not an expert. Neither is Dr. Fauci, as he has very publicly acknowledged. Doctors don’t determine the denominator in the equation. The denominator is determined by other experts like education professionals, economists, psychologists and sociologists. Additionally, the value of something like human morbidity and mortality is not an absolute, and is subject to individual weighted value. Thus, the equation looks something more like this:
If you think that your grandmother’s life is worth flushing everybody else’s economic livelihood down the toilet, then your own personal “A” value is probably quite high. If you think that anybody over the age of 65 is a waste of good oxygen and your 401K is more important, than your “B” value is probably quite high. Finally, there is one other critical element that goes into this calculus: lockdowns serve a purpose, and that purpose is not (contrary to popular opinion) to somehow end the pandemic. They are supposed to slow the spread of disease long enough for the healthcare system to prepare for what is believed to be the nearly inevitable invasion of the disease into human civilization. Thus, it is critical for us to ask this question: have we made good use of the time that we have “bought” with the lockdowns?
In some ways, the answer is clearly “yes,” but in other ways, the answer is a rather pathetic “no,” as hospitals across the nation remain woefully underprepared for the surge in infections which will naturally occur as the public grows understandably weary of the disease mitigation measures.
When it comes to weighted social values, the people who decide such matters are politicians. Politicians are the people who actually make the policies that determine things like lockdowns, and politicians are elected based on your vote. You are certainly well within your right to attempt to lean your weight on the scale, and voting is your most powerful tool to influence weighted social values.
In the meantime, please stop blaming doctors and scientists for the lockdowns. We don’t make decisions for the government, but we understand our part of the equation. You literally pay us for that understanding.