In light of corona, I don’t know whether it’s morally responsible to visit my family (my parents, brother, and 93-year old grandmother) this Christmas. I have a master’s degree in ethics and a long-standing interest in risk communication and risk analysis, so I think a lot about stuff like this: it’s not easy. And the more I think about this issue, the more I realise that the current framing of corona is overly simplistic and ineffective in getting people to behave morally.
Corona has been framed as if it is only about deaths, and only those directly caused by corona. The argument has been: it is risky to meet people, because 1) you are putting yourself at risk, and 2) you are putting the people you meet at risk. There is some mention of secondary contagion, but not so much. When corona is framed like this, it makes sense for low-vulnerability people to still meet plenty of other low-vulnerability people. However, a number of complexities are missing from this framing.
Long covid is a thing, and you don’t want it
First, there is long covid: long-term effects such as brain fog and fatigue. Little is known about it. However, it seems to affect young people as much as older people. It is unclear how long it lasts: some people have symptoms for more than 6 months already. In the earlier SARS epidemic, 40% (!) of patients were found to have chronic fatigue symptoms 3 years later. That’s a long time, and chronic fatigue is associated with a large drop in quality of life. You’re not dead, but you can’t live your life. The big question is how many people get long covid. My estimate is that it’s somewhere between 0.1% and 10%. We simply don’t know enough yet (although see this patient-led study). In other words, young people do have something to worry about.
Secondary infection is also your responsibility
Above, I noted that people seem to consider two categories of people they are putting at risk: themselves, and the people they meet. They have control over who is in this group, and oftentimes, both parties can consent. However, there is a third party: those infected by the people we infect. Low-risk clusters are not fully isolated from high-risk clusters. There is contact between them, maybe via intermediate ‘bridges’. These can be parents or healthcare workers. The higher the prevalence in a low-risk cluster, the higher the probability that it will jump to a high-risk cluster.
The R-naught number indicates how many people the average patient infects during that phase of the pandemic. When it’s above 1, the virus’ spread is increasing exponentially. Below 1 it decreases exponentially. From this, people may draw the mistaken conclusion that, even if you get infected, at worst you’re responsible for about 3-4 infections. And when you only meet young and healthy people, a 1-5% probability of infecting 3-4 people doesn’t sound bad. However, those people will also infect more people, and those people again will infect more people. You are responsible for long chains of infections, that can amount to hundreds of people!
Healthcare displacement/secondary effects
Currently, a lot of normal care is postponed or prevented by corona. Sometimes this is determined by a doctor, but many people are avoiding going to the doctor in the first place. These effects are not immediately visible, but they are visible in excess mortality statistics (as well as positive effects of corona on mortality).
Healthcare displacement is part of a larger category: secondary effects of corona. There are costs to society the higher its infection rate is. The higher the infection rate, the more stringent measures become. And with stringent measures, people with mental health issues or weaker social networks suffer disproportionately. Moreover, other values of society, such as climate change and economic prosperity, become deprioritized as the urgency of the current crises demands our resources and attention.
A new framing: society’s risk budget
The problem with the current framing is that people take risk and that is harmful to them and other people they put at risk. However, most people are frustrated by and tired of Zoom calls and physical distancing. Taking risk is becoming more and more appealing, as it promises more social contact. Risk, therefore, is a scarce and consumable product in high demand. It is also rapidly running out.
A limited amount of risk can be created before a healthcare system reaches an unacceptable amount of societal burden. Where exactly it becomes unacceptable is up for discussion, but (almost) everyone seems to agree that the upper bound should be a healthcare’s peak capacity (which we are approaching even in Germany). So let’s assume that for now.
Because there is a limited amount of risk that can be created, this is a common resource problem. Just like CO2 emissions, or the cake at a birthday, when some people take more, other people can take less. It is well-known that common resource problems are tricky, because people are incentivised to behave in a way that quickly leads to the whole commons being consumed. When everyone is grabbing cake, you better be quick if you want some cake as well. And when most people think like this, the cake is soon gone – now society needs to go on full lockdown until some cake has reappeared, reducing everyone’s freedom.
The problem is worse though, because not every activity is equally risky. Indoor meetings have been demonstrated to be ~20x more risky than outdoor events, because corona spreads easily through air in confined spaces. And meeting 5 people at the same time is more than 5 times worse than meeting 5 people consecutively. Taking higher-risk activities is like a small group eating 80% of the cake, and the rest of the population has to carefully consume less than 20% or otherwise cause a healthcare system collapse. And this is probably what has been happening: a minority of the activities (esp. by young people) has been driving the expansion of the second wave and spending all our collective risk budget. The question of how to behave during a pandemic is a question of how to allocate the risk budget.
The takeaway is this: taking risk does not only mean that you are putting people at risk of death or chronic fatigue, it also means you are limiting the behavior of others. And not everyone is flexible in the amount of risk they are taking. We can distinguish between passive risk and active risk. Passive risk is the risk that is hard to avoid: the risk involved in living in a shared household, the risk that comes with executing a critical job like healthcare workers. Active risk, on the other hand, is the risk created by actions that are easier to avoid: meeting up with friends.
Because passive risk is hard to avoid, we can subtract it from the total risk budget. What is left is a budget for active risk. How do we distribute this budget? I do not have final answers for this, but here are some considerations:
- There is not enough budget to meet everyone’s needs at the same level pre-pandemic. As harsh as this sounds, expect to have fewer of your needs met. If you try to meet all your needs (in the standard way of meeting friends), other people’s needs will be met even less.
- Some people already benefit from their passive risk-taking: those living in (welcoming) households and with (healthy) romantic relationships. It is reasonable that they get a lower amount of active risk to spend. In contrast, people living alone and being isolated have a much lower risk profile, so they should be allocated more of the budget.
- Some people will not conform and will strongly overspend their budget by doing exponentially more risky activities. This means that reasonable people need to spend less than average.
Government policy provides a focal point
However, common resource problems can be overcome. The common resource can be protected when groups are small, can communicate, can see their impact on others, and punish undesirable behavior. But this isn’t happening.
This brings us to the second strategy: intervention by a higher authority, the government. Governments, ideally, exist exactly and only to overcome coordination problems like this. They can provide a norm that everyone has to conform to, and they can punish rule-breakers. It also allows different people to coordinate on the ‘neutral’ prescribed behavior, like a focal point.
But governments can be incompetent, uncaring, or lacking the power to restrict freedoms to a desirable extent (in terms of reducing corona cases). Because democratic governments have trouble restricting people’s behavior by a lot, the rules and guidelines are often weaker than desired by health authorities. Therefore, one should not see government regulations as the final decision on what is right to do. Better, government regulations should be perceived as a minimum for moral behavior.
The framing of ‘corona is about limiting the risk of death of yourself and the people you meet’ is very incomplete. Instead, I propose that you ask yourself: ‘how much of the active risk budget is it responsible for me to take?’ And if you actually want to see numbers, go play around with the magnificent microcovid tool.
This may come as a surprise, but I have ended up deciding to visit my family even if it feels uncomfortable. We will have guests at my flatshare and that would have a similar amount of risk. At least I have more clarity now with the societal risk budget in mind. If I take risk, I risk not only other people from getting covid, I also take up some risk budget from society.