What would a rational harm reduction strategy for coronavirus look like?
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Harm reduction is a key concept in public health. Every public health intervention has both upsides and downsides. (The tl;dr version of my book The Obesity Myth is NOT that “obesity” isn’t a public health problem, but rather that on balance a public health policy of trying to make the population of a developed country thinner does more harm than good).
Right now, there are a bunch of critical unanswered questions when it comes to COVID-19.
(1) What is the current prevalence? I can’t emphasize enough that the answer to this question in the USA is that we have no idea at all. 50,000 people could be infected at this point, or 500,000 could be. (The NBA tested all its players and found an infection rate that would equal six million infections if applied to the general US population. Obviously NBA players were especially likely to test positive for a number of reasons, but it should still be sobering that this is pretty much the only comprehensive testing of any cohort in this country to this point).
(2) Since we don’t know the current population-wide prevalence — again, at all: the quoted numbers of recorded cases are obviously meaningless, since essentially no one has been tested yet — it’s very difficult to say what sort of mitigation and suppression measures are best, given the very high costs of such measures.
(3) Another things we have no good grasp of is the likely long term mortality rate. You can’t do a division problem if you don’t know the denominator, and we don’t. Information from other countries can help here, given the total failure of our own federal government to undertake any testing, but that information is also fraught with problems. In Italy, for example, it appears that pretty much the only people who are being tested are people who are already very ill. This naturally produces a much higher nominal mortality rate than the true mortality rate for the population. South Korea, which seems to be pretty much the only country that at this point has tested large numbers of asymptomatic people, has vastly better mortality stats. (China’s statistics are unreliable for the reasons that all statistics coming out of an authoritarian regime should be treated with great suspicion. Etc.)
(4) In terms of harm reduction, that question of what would be best to do in theory always has to be considered in the context of what it’s actually possible to do in practice. It could be that it would make more sense right now to dump massive resources into trying to improve ICU capacity, with field hospitals, ventilator and respirator crash production on a wartime footing, and so forth, rather than putting so much emphasis on social distancing measures that may well be of very limited efficacy, given both human nature in general, and the structure of our economy, which as you’ll recall is largely built around a general social policy that could be summarized as fuck the poor. (Americans in particular are very prone to turn to solutions that require individual decision making rather than structural interventions. In a pandemic, that ideology is generally deadly).
(5) I think it’s especially important to keep in mind that knowledge class decision makers are likely to have wildly unrealistic notions about how sustainable quarantine measure are, in a country with essentially no social safety net, where huge numbers of people can’t do their jobs by logging onto the Internet from the relative safety and comfort of their well-provisioned homes.
These are just some thoughts intended to spark further discussion.