The pandemic seems to be gradually winding down. After a spike of cases and hospitalizations in the spring, nearly half of the United States has received at least one vaccine dose. Cases, hospitalizations, and deaths are all declining.
Slowly, things are returning to business-as-usual. It is a good time to reflect on what we have all been through in the form of lockdowns and social distancing. From the beginning, some resisted lockdown and masking orders, mostly on the right, but some lefty libertarian types, too. Some did so violently. Others lampooned the same people while voluntarily withdrawing from public and family life. A few proclaimed their delight that lockdowns upended normal routines, slamming them as oppressive.
How burdensome have these been? What sacrifices can people be justly asked to make, on an ongoing basis, on behalf of public health? What can and must they do to help?
Colleagues and friends of mine with lots of intellectual and financial capital—and I might add, mostly perfect health—have been asking this question since the dawn of the COVID apocalypse. They want to do something with that capital to help make the world better in the middle of this disaster. Many felt powerless given that, according to the prevailing epidemiological wisdom, the main thing most of us could do throughout is shelter in place. That rules out most things that would come natural to this crowd, such as organize a workshop or conference, to say nothing of the things that working people can do, such as church volunteering.
Many things people have been asked to do are mundane and not especially burdensome, though certainly many are annoying: the incessant hand washing, minding one’s hands around one’s face, the sewing or wearing of face masks, avoiding crowded public spaces like restaurants and sporting events and the museum. However, even these involve different burdens for different people, some of them significant. The livelihoods of business owners and their employees and suppliers are at stake when the rest of us stop eating out, appreciating art, or attending sporting matches.
Other things people have been asked to do are hardly mundane. Families and loved ones have been forced apart for over a year at international borders. Children have been forced apart from their friends through the closure of schools, voluntary family social distancing, and cancellation of extra-curriculars. And again, businesses like restaurants have been asked to close their doors altogether for weeks at a time and otherwise significantly reduce their operating capacity.
These things are substantial burdens in themselves. But they have upended the lives of some, at this point, for over a year. Some children of cross-border parents have yet to meet their fathers, and fathers their children. In Australia, the government has refused to permit citizens to travel to India to reunite with family, including more than 170 children, such as one two-year-old—now three—separated from her mother for over a year. Siblings, parents and spouses not suffering from COVID have died for ordinary causes (not COVID) without family. Parents have been asked to convert their homes to schools while continuing to work remotely, or even worse, for some, while still being required to go in to work (for essential workers, from nurses to grocery store clerks). This is an extraordinary ask for all parents, but it has had radically unequal effects for women, working-class parents, and minorities.
The loss of face-to-face instruction for children has obvious serious costs. Meanwhile sports, music, theater and the arts provide essential developmental and social purposes for school-aged children especially. Prolonged restrictions on these activities is a significant burden on these young people.
We all have gained our COVID-15, whether physical or psychological.
Philosophers have thought lots about what can reasonably be asked of individuals in the way of doing their moral duty. Are these more extraordinary burdens of lockdown and social distancing reasonable asks?
In one way of thinking, we are all responsible for doing whatever will result in the highest possible level of social well-being. Let’s assume that if we don’t social distance, many more people will die, or their well-being will be greatly diminished in some other way. This pretty straightforwardly justifies extensive lockdowns—closing schools, sporting matches, small businesses, the border, etc—at least until such a cure becomes worse than the disease.
This way of thinking however is also known to demand that we make many, many more sacrifices. Is Netflix keeping you entertained through quarantine? Too bad. The value to you of watching Tiger King is nil compared to saving a life, which your monthly $12.99 could do—many times over—if given to the right famine relief charity. Better cancel your subscription. And likewise for many of your other enjoyable but utterly inessential pleasures (think Sunday morning donuts and new jeans, which I for one could really use).
In another way of thinking, what can reasonably be asked of us is linked to what we owe one another as fellow human beings. And this involves thinking about how individual people are affected by what we are asking of them, comparing these effects, and asking what we can then justify to them. If we ask shop owners, for example, to close in order to limit the spread of the virus, what is the nature and significance of the burden of this to them as individuals? And what is the nature and good of the benefit this secures for others? We then ask how these things compare, and what set of trade-offs we can justify to one another as morally equal persons.
What this view demands of us requires a certain amount of careful thought. There are cases. And then there are cases.
It also varies quite a bit depending on the context of choice, itself a function of past choices. There is a possible world in which Donald Trump had not foolishly disbanded America’s pandemic response team nor denied the severity of the impending crisis in its earliest phases. There’s also one in which the United States in the 1990s had taken up Hillary Clinton’s proposals for a universal health care system, or adopted a similar system during the Obama years (instead of the half-measure that is the ACA).
These choices would have asked very little of citizens in the way of burdens. In the first case, they ask nothing at all. It is Trump who is at fault here, though a portion of the American electorate is responsible either for having voted that walking disaster into office, or having continued to support his reality-denying policies. In the second case, all that is required is to pay the additional marginal income tax that a national health care system involves (and presumably, returning to a more justly graded tax system, so that the wealthiest shoulder the biggest financial burden).
These choices might have paid big dividends from the standpoint of every individual right now. With a well-funded national healthcare system and a pandemic response team in place, the initial response to the COVID crisis might have been quite a bit different. It might have been both more aggressive, and consequently less long-lasting. It might also have made possible further alternatives to mass undifferentiated lockdown, such as a robust testing and contact tracing regime.
In turn, Americans might have been faced with less demanding asks. In exchange for a more aggressive tax system for the most well off, all of us could enjoy more freedom sooner. It is ironic that conservative working-class Americans opposed to this sort of system have been among the most vocal in opposing the lockdown measures made necessary in part by its absence. Witness the crowd that appeared at the Michigan capitol building in April 2020. On the other hand, it is hard to see the wealthiest Americans reasonably complaining much (though some will unreasonably complain of course). After all, what these folks would have surrendered in money—an inherently valueless good—they would have got back in greater freedom from forced isolation, illness, and death. It’s a no-brainer to pay the tax.
Such as the world is, Americans did not make the political choices that might have mitigated the severity of the pandemic in its earliest phases. As a consequence, they have now faced more prolonged, serious burdens.
If my local donut shop closes, I won’t be able to enjoy Sunday morning donut outings. But if in staying open more people would die from the virus—or even have to suffer two weeks of illness—then the shop should close. The loss of my Sunday morning donut outing just isn’t important enough to justify the risks of illness and death to others.
Things look quite a bit different however from the standpoint of the shop owner and her employees. Their losses are significant, potentially long-lasting, and will ramify through the economic system. They will be unable to pay their bills, and owners may have to declare bankruptcy. Their creditors and suppliers will suffer similarly. All of them have to eat, pay rent, and keep the power on. Paying for such essentials with credit incurs further unfair costs in interest paid. And this is not yet to account for the loss in enjoyment and meaningfulness of life that comes from good work.
These are big asks. They might very well justify allowing donut shops to stay open—and me to go buy some tasty locally made donuts—if the cost is that a few more of the rest of us (and maybe some of them!) will have to suffer being ill for a couple of weeks.
We could, of course, avoid the merely economic aspects of this situation if we chose to provide robust unemployment benefits and financial aid to small business owners. This would only require that the rest of us—or those with sufficient incomes anyway—pay a bit more tax in exchange for the better health of everyone.
But this way of managing things is unfortunately not possible in the conservative America of today. And in any case it does not compensate for the loss of meaning people derive from work.
So: What if the cost is that more of us will die?
It might seem obvious that this risk justifies the hardship to donut shop owners and the like. After all, this is a dreadful risk that they share in common with their patrons.
But in truth, it depends. We do not live for the purpose of sucking oxygen, but in order to do meaningful things with our limited time as humans, to be involved in worthwhile creative projects, and to love and be loved. We frequently risk some—normally small—chance of harm to enjoy these things, e.g. by driving our cars, riding our bicycles, shaking hands, or hugging. We are properly more willing to risk them the more that doing so is necessary to live a meaningful life, which, relative to some people and some activities, is inevitable.
So we must ask: What do we have to give up in order to avoid the additional risk of illness or death from COVID, and for how long must we compromise it? How many more of us will die (or suffer other undesirable long-term effects of COVID)? What is the probability for any given person that they will contract COVID? And of those people, what is the probability that any of them will face the possibility of hospitalization or death? And how different are these risk levels compared to “background risk,” i.e. the similar risks we take every day, such as driving a car, without flinching?
Notably, it is not easy to find clear information on the last question. Instead of providing such information, public health officials and the media have themselves decided what levels of COVID risk are “high”, “very high”, or “extremely high” (I have never seen them dip below “high” where I live), and then simply pronounced upon them.
For any given individual, what it is rational to do depends not merely on some raw calculation of the probability of harm. It depends rather on whether that harm is worth risking given the value of the ends achieved. Illness, hospitalization, or death are not worth a great deal of risk if the end achieved is, say, dinner out once a week. The same is not true if the cost of avoiding those risks is indefinitely forgoing the things that give life meaning—spending time with loved ones, meaningful work, intrinsically valuable social activity.
The risks of COVID-19 exposure to everyone are above 0%. Even very healthy middle-aged fitness trainers have had to fight for their lives. Some have died. As father to the world’s best tween daughter, these facts, together with my having meaningful remote work and a stable income, have made me quite happy to limit most of my social life.
But the risks, it has turned out, have not been the same for all of us, and for relevant groups, not even close. Data on COVID risk have to be handled with care. The average infection rate as indicated by data from the past year, for example, are a partial function of lockdowns which, if effective, will have helped keep rates down. Similar things could be said for rates of hospitalization or death.
However one thing we can glean from the data are differences in risk across different age groups. And we can compare these to other risks people in these groups face. As of March 2021, one of two worst phases of the pandemic, mortality rates among those 17 or younger in the United States was less than .05%. For their somewhat older peers and their parents—people ages 20 to (let’s be inclusive) 65—mortality is quite a bit higher. But here the numbers vary greatly for those under/over age 54. In January of 2021, the very worst phase, people ages 18-54 died from COVID-19 at a rate of 1.83 per 100,000. Those ages 55-64 died at a rate of 5.35. From here the numbers leap dramatically, with deaths at rates of 17 per 100k for ages 65-79 and 67 per 100k for those 80 or older.
What do these numbers mean? Comparing an unfamiliar set of risks to a familiar set is the easiest way to gain perspective on risk information. So we could—and should—compare COVID risk information to similar and dissimilar risks, such as the risk of dying of influenza, on the one hand—a similar communicable disease—and the risk of dying of cancer, on the other, a very lethal but not communicable disease.
However caution must be exercised in handling such comparisons given certain relevant differences. People are yearly vaccinated for influenza, for example, while data indicating COVID risk from the past year mostly indicate risk without access to vaccination.
Above all, these data indicate the severity of the pandemic despite various phases of lockdown or partial closure. Presumably things would be much worse without them.
Still, these comparisons are interesting. There are about 50 million cases of influenza per year and about 55,000 Americans die from it. Most who die from it are 65 and older, at a rate of about 49 per 100,000. This rate is nearly the same as the average between the two hardest hit groups from COVID, those between 55-64 and 80+. Americans also suffer new cases of cancer at a rate of 442.4 per 100,000 (about 1.8 million cases per year) and 158.3 per 100,000 men and women per year die from it. The vast majority of cancer victims are 45 or older and cancer kills about 600,000 people per year.
COVID-19 mortality among unvaccinated people during lockdown measures is, overall, lower than from cancer or influenza for most individuals except for the elderly. And the risk overall is rooted less in lethality and more in infectiousness. While killing older Americans at a much lower rate than cancer, as of this writing COVID-19 has now killed nearly as many per year by infecting almost 32 million.
Individuals at retirement age or above with preexisting chronic conditions are high risk. These individuals have very good reasons to want to be protected from the risks incurred by everyday interaction—that is, from the rest of us. We must do what we can to help them stay safe.
However, arguably we must only do what will help them stay (roughly) as safe as they choose. A reality of COVID-19 is that it is spread largely through the normal activity of healthy young (under 55) people, the vast majority of whom experience either mild or no illness at all. The activities of these people, notably, are what keep the water and power on, as it were. They are also typically centers of social and extended family life, grandchildren’s births, birthdays, graduations, weddings. Unfortunately, without vaccinations, older people can be helped to avoid the risks of COVID by attending such events only in one of two ways: the cancellation of such events, or by not attending.
Our approach through much of the past year has been the first approach: Cancel everything. To those whose life milestones have gone uncelebrated, whose livelihoods have been upended, whose loved ones died alone, whose intimate relationships were ruptured and ended, it is now clear that this is a very, very costly approach, both in economic and human terms.
Setting aside the economic costs, the human costs are substantial, and they include, ironically, costs to individual physical and mental health. Because gyms and outpatient treatment have been shut, for example, healthy younger people have suffered from other maladies from declining fitness, untreated bowel disease, severe depression, and so on. Enduring troubles like these may well still be worthwhile given that the lethality of COVID rises for those with underlying health conditions. Sadly, some people have overcome other diseases, like cancer, only to be killed by COVID acquired during treatment.
However, the human costs of lockdowns accrue not only to the younger (under 55) people whose life milestones go uncelebrated and the like. They accrue also to the older people who are asked to live, and potentially die, in isolation. Does ongoing lockdown buy enough safety for the most vulnerable to justify these costs to the individuals who have been—still are—being asked to pay them?
It is hardly clear. It is easiest to see this by reasoning from the perspective of the most vulnerable, i.e. the people aged 55 and older. From this perspective, lockdowns constitute a policy of forced isolation at a stage of life when family connection and personal projects—also usually social, such as community volunteering—are its focus. Some people in this group have seemed content to accept that situation. But many have not. For them, isolation from children and grandchildren with no end in sight is no way to live. This pattern is exhibited by my own parents, one of whom has generally chosen not to visit during the 15 months of the pandemic, the other who accepted isolation for a time before choosing, with some precautions, to risk regular visits to my daughter and I.
I believe there are principles for ethical, just lockdown policies in all this. They are not new, though I hope to have provided a clearer rationale for them.
Lockdowns should be a last resort. When they are implemented, they should apply to every sector of society to the greatest possible extent for not much longer than the typical gestation period for the disease. Because viral diseases tend not to just disappear, they should be undertaken with the hope of reducing and not eliminating viral spread. Should they fail after a handful of attempts, they should, barring extreme viral lethality, be let to expire, replaced by strong advice to voluntarily make careful, wise choices for the sake of self and others.
Throughout lockdowns, we need a much, much more humane notion of “essential activities”, i.e. those exempt from stricter restrictions. “Essential” economic activities—such as Amazon deliveries and professional sporting matches in empty arenas—should never be permitted while individuals and families are forbidden to make decisions for themselves about their own health risks. This includes risks undertaken, for example, to host extended family events; travel to see loved ones, including crossing international borders; go to church (I say this as an atheist heathen who would never); workout at a gym, or similar.
Such activities are crucial to living a meaningful, happy life. No one should be forced to forgo them for an indefinite length of time, whether paternalistically for the sake of oneself or altruistically for the sake of others. Ensuring that lockdowns and social distancing are rare, sweeping, and short is not a “screw the old and the weak” policy. It is in the best interest of all.
Written by Matt Ferkany
Matt Ferkany is Associate Professor in the departments of Philosophy and Teacher Education and affiliated faculty of the Environmental Science and Policy Program at Michigan State University. Ferkany’s work has been funded by the Spencer Foundation and published in journals such as Pacific Philosophical Quarterly, Environmental Values, Journal of Philosophy of Education, Educational Theory, and Theory and Research in Education.