Everybody’s Talking About Bioethics Now #COVID19

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Since this pandemic got rolling, it seems everyone wants to talk about bioethics “trolley problem” quandaries like how to decide which of three dying patients gets the one ventilator on hand or whether it is okay to lock up healthy people to prevent the spread of a deadly virus. All the boring stuff suddenly got real and real fast, but maybe it’s not that interesting.

You should give the ventilators to the people with the best chance of surviving, right? I think that is how triage works. And, oh, was it all right to tell people to turn off their lights when bombers were flying overhead in the middle of the night? Sometimes even the rugged individualists have to work as a group. The problem is that some of our rugged individualists have never really been put in a position to make tough decisions, so they aren’t prepared.

And that gets us to the real ethical issues here. It is really unethical to be unprepared for emergencies. Experts in many fields have been warning of coming pandemics for at least 15 years. Even George. W. Bush, bless his tiny heart, knew he had to prepare for pandemics, and he at least took at stab at it. And the ever financially minded Barack Obama prepared for pandemics and even dealt with one on his watch. His didn’t get quite so out of hand, of course, and no one should have to tell you why.

So, the important ethical decisions were made years ago, and many of them had to do with the most attention-starved principle of bioethics, justice. The failure to prepare for a public health emergency affects everyone, as we now see, but too many people have always seen efforts to protect public health as efforts to protect “people not like me.” This isn’t always a sign of racism; sometimes it is just pure classism. Some people just don’t hate based on skin color, religion, sexuality, or any of that stuff. They hate poor people of all types.

This is also not a matter of choosing between the “economy” and the needs of working people. Preparing for a pandemic would have meant having mechanisms in place for extensive testing, tracing, and isolation that would have prevented the need to shut down almost all business activities. With proper preparation, the world would have suffered but could continue functioning.

And I guess a lot of Americans really were satisfied with their employer-provided health insurance that they are now losing, because it turns out their employers really never valued them as much as they assumed. It would seem that intelligent and hard working people should always be able to get healthcare, and that’s what we’ve been trying to tell you. You can be hardworking and intelligent and also poor, and maybe it is good that more people are learning this rather difficult lesson right now. Maybe it will help in the future.

But public health isn’t all about health insurance, though turning infected people away from a hospital because they can’t pay is certainly not a good way to protect the public from a pandemic. No, protecting the public health, which is really protecting national security (and global security) is about being able to deal with emergencies, which would require not selling off all the equipment you might need. Most homeowners have never used a fire extinguisher, but the ones who used them successfully were pretty happy they had invested in buying one and taken the time to learn how to use it.

So, yes, more than a decade ago, epidemiologists, virologists, climate scientists, public health experts, public health ethicists, and environmentalists were warning that the world was becoming much more hostile. How do we prepare to ensure our own long-term survival isn’t really as much fun as debating who gets the last ventilator, maybe, but it can save many more lives.

And maybe you’re saying there’s no point in going on about this now as it’s too late. What’s done is done, you’re saying, but this ain’t over, folks. One way or the other, COVID19 will be resolved, but other pandemics will follow along with drought, flooding, mass migrations, and a host of other public health crises that aren’t that hard to imagine if you only try. You may think I’m crazy, but I’m not the only one. Plenty of experts in relevant fields are already imagining the worst and best case scenarios. Maybe it’s time to listen to them.

Pandemics, Climate Change and the Threat of Innumeracy

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Among other things, this pandemic has shown the danger of innumeracy. Over the past few weeks, many have tried to minimise the effects of the pandemic by posting blogs and memes listing absolutely accurate statistics that are also terrifying to the specialists tracking the number of infections. Just for example, many people said a fatality rate of 2.0 (or even 1.0) was about the same as that for influenza. Of course, a fatality rate of 2.0, would be 20 times as bad as the seasonal flu, and even 1.0 would be tens times as bad.

Among those posting information to minimise the effect of the pandemic were healthcare providers, including doctors who work with infectious diseases. Doctors trained in medicine and not risk assessment are not better at assessing risk and probabilities than the general population. The 1982 book, Judgment Under Uncertainty: Heuristics and Biases, edited by Daniel Kahneman, Amos Tversky, and Paul Slovic, examined the ability of people, with several chapters devoted to medical professionals including doctors, to assess risk based on probabilities. People in general, including doctors, just aren’t that good at it.

Subsequent research in medicine has shown similar results. Without specific training in assessing risk based on statistics and probabilities, doctors are no better than the general public at making decisions. We all need a more robust understanding of statistics, probabilities, and risk assessment.

It would help us better understand the risk of pandemics, and it may help us better understand the risk posed by climate change. Many people still think it isn’t a big deal to have the average global temperature increase by 1 degree.

Assessing Pandemics

As pandemics go, a virus that produces a lower average mortality rate can have greater overall lethality than a much deadlier virus because of its ability to spread. As Nathan Wolfe puts it in The Viral Storm, “A very deadly epidemic that doesn’t seem to be spreading is less worrying than a nominally deadly pandemic that’s moving at a fast clip.” The fatality rate for Covid-19 is estimated anywhere between 1 and 3.4 percent. For a comparison, Wolfe says the mortality rate for the 1918 epidemic (called the “Spanish” flu), “may be even lower than 2.5 percent, as many deaths were probably caused by secondary bacterial infections.”

Wolfe’s book was published in 2011. Virologists have been warning of the near certainty of future pandemics for many years now. Increased travel, industrial farming methods, loss of habitat for wildlife, and climate change all increase the risk of pandemic in various ways.

Covid-19 may quietly fade away as new cases decrease, or it may become much less deadly to the point that it causes few symptoms, or it may continue to spread rapidly and kill many people. I don’t know what the outcome will be, but I do know we (meaning the human race) must prepare for ongoing pandemics, because they are not going away.

Pandemic, Panic, and Complacency

Crudely, generally, and absolutely not universally, deadlier viruses are easier to contain geographically than milder viruses. Ebola, MERS, and SARS all have much higher mortality rates than Covid-19 and were limited to smaller regions. The obvious reason for this is that sicker people are too sick to spread a virus to the community and the world at large. Covid-19 spreads easily because it appears to be spread in the absence of symptoms and for an extended period of time. People who are infected travel, go to work, go shopping, visit hospitals, and so on.

Quite a few people point out that the mortality rate for Covid-19 may be overstated because an unknown number of people probably contract the virus without ever showing symptoms, so these survivors are not a part of official counts. That’s true, but it is also true that people who have died of pneumonia and other infections may also have had undiagnosed Covid-19. No one knows which group of people is larger, so estimating the mortality rate is still just a guess.

Given that the mortality rate is only a guess, experts have made their best guesses at somewhere between 1.0 and 2.7 percent. The mortality rate for seasonal flu is 0.1 percent. Based on this, Covid-19 will cause from 10 to 27 times more deaths than the flu. 646,000 people die from influenza annually. If Covid-19 reaches a similar saturation, that will mean deaths from 6.5 million to 17.5 million people.

Each year, hospitals and surgeries strain under the burden of treating complications related to seasonal flu. Add a few million cases of pneumonia to the mix, and you have the potential for a fairly daunting problem. Panic doesn’t help anyone, but this is a serious global health event.

Don’t bother saving the world

In the grand scheme of things, worlds, suns, and other fabulous celestial bodies come and go all the time, so the loss of one more wouldn’t really make any difference at all, so you can relax. And, the Earth isn’t really under any serious existential threat at the moment, anyway. I mean, it’s getting warmer, but planets do that from time to time. It quite literally is not the end of the world. Hear George Carlin explain here.

[youtube https://www.youtube.com/watch?v=VNxNgfVzAvo&w=560&h=315]The world will go on for some time, I would imagine, unless it collides with something or some other heretofore unimagined accident occurs. I mean, I guess it is possible the Earth will spontaneously break up into tiny particles and become another ring around Saturn, but the chances of that seem infinitesimally small.

But you’re still worried about the state of the world (aren’t you?) because you’re selfish. Only you don’t think you’re being selfish. You’re just worried about all the pretty flowers, the coral reefs, the poor people in other countries, and the cute animals that will disappear, severely affecting your enjoyment of travel documentaries. To be fair, if the plants and animals on the Earth are capable of wishing anything about you at all, I’m sure they do wish you would either go away or at least clean up your mess, so the anti-litter campaign is probably well received by the non-human inhabitants of the planet.

Somewhere deep down, you must fear that if the world ends, or even just changes slightly, you might also end and leave the world to fight for itself, which it could certainly do better without you, anyway. So, let’s face it, you’re really just fighting for your own survival. Don’t worry, you’ve got this. Humans always seem to find a solution to every problem.

Most inhabitants of the Earth are congregated near large bodies of water such as oceans. If the sea levels rise, you’re thinking you may have to move further inland. It might help a little. The folks who already live inland will most likely welcome you with open arms and give you plenty of food and fresh water as most people have already proven to be extremely concerned about the plight of immigrants and refugees.

Your arrival in the new place isn’t likely to cause too much disruption. They may have to expand the hospital a little, but it shouldn’t take too long. Tax revenue is sure to be increasing, so building more roads, schools, power plants, water processing centers, and so on will be easy enough.

As people like yourself travel around, you will carry germs with you. Things you may have become accustomed to may or may not cause problems for your new neighbors. It’s possible everyone will stay healthy. Of course, animals will also be moving and changing their migration patterns, but that should be all right. It’s not like anyone has ever gotten a serious disease from animals. I mean, whoever heard of bird flu or pig flu or anything like that? It’s absurd.

And no one worries about plagues, anymore, because they haven’t happened in a long time. The viruses that caused great epidemics in the past are long dormant. Who could imagine them being reintroduced into human society as a result of thawing ice or something? Preposterous. New bacteria aren’t likely to emerge, either, as we’ve already dealt with them. Scientists these days develop vaccines and new antibiotics at the drop of a hat. Infectious diseases are simply no longer a matter of concern. It’s hard to imagine a pandemic wiping out billions of people, certainly. That kind of thing doesn’t happen where you’ll be living.

As you travel, you may meet fellow travelers moving away from wildfires, drought, inland flooding, failed crops, and so on. Everyone will be understanding and work together to divide the available food as equitably as possible. The police and military might be called in to help smooth over any disagreements. You may see a few skirmishes crossing borders and so forth, but new drones and fortified structures will offer substantial protection to the good immigrants, like yourself. The people who die in conflict should have been more careful.

It’s possible extreme conditions could lead to occasional power failures, which might impact travel and communication. Some flights may be grounded. Some traffic signals might not work as expected. I guess there is a slight chance it will affect rail transportation. Navigation might be a little difficult. If you have a good signal, you can upload a funny meme about it. I mean, really, global warming shouldn’t affect satellite communication, should it? It’s not like airport runways could get too hot for planes to land, rail could warp under extreme heat, or roads could become impassable from melting or buckling. That kind of thing only happens in movies.

So don’t worry about the old Earth. She’ll keep spinning as long as she is destined to, with or without you. And don’t be too concerned about yourself, either. You’ve survived this far. Surely your good luck will continue. It’s a shame about the animals going extinct, though, and the poor people who have lost their homes. And you’ll always have your memories of how things were.


Climate Catastrophe: Pandemic and Pestilence (#poem)

skull-208586_1920Epidemiologists and public health ethicists have been grappling for some time with the near certainly of widespread disease pandemics resulting from climate change. Changes in non-human animal migration and human migration will bring extant pathogens to new populations as warming releases long dormant pathogens on the world once again. Large swaths of the population could be wiped out in an incredibly short amount of time. Addressing climate change isn’t a matter of preserving the beauty of the plant. Rather, it is a matter of promoting human survival.

A dying planet is a
Planet that kills.
Rising temperatures raise
The spectre of pestilence
In the form of pathogens
Newly released on
Unsuspecting vectors
As other pests breed
Vociferously and march
Into new territories
In a murderous stampede.

The migration of
Pests and pestilence brings
Pandemic and pandemonium.
Rising waters drive life from
Coasts as rising temperatures
Dry the plains; bake the deserts.
Human refuse scatters into
Constant conflict, seeking refuge
Away from the water or away
From the drought, the ice, the disease.

The oceans killed the fish,
And the sun killed the crops.
Infrastructure fails,
Transportation halts,
Medical care is a memory,
And society is preserved
Only in bits and bytes
Scattered to the sands.

The few who remain
May be resilient enough
To restart the madness.