As South Africa moves into finding ways to manage COVID-19 anxiety, a new insights, published in Daily Nous, looks at thinking rationally about the new virus.
The exploration, led by Professor Alex Broadbent, Director of the Institute for the Future of Knowledge and Professor of Philosophy at the University of Johannesburg (UJ), clarifies the panic in terms of understanding the importance of various rates, which is not always understood. Professor Broadbent maintains that, ‘A rate is a measure of a change in one quantity in units of another, and rates are essential to understanding both rational and intuitive reactions to disease.’
He sets out some considerations that would structure a rational cost-benefit analysis of contemplated public health interventions.
Professor Broadbent argues that since we all die eventually, the threat posed by disease to human life does not just depend on how certain it is that a sick person will die. It also depends on the rate at which a disease kills people, which in turn depends on how infectious it is and how long non-survivors last.
Vaccine development is already underway, but it is likely to be at least a year before a vaccine can be mass-produced, even assuming all trials are successful. Social distancing is therefore the most important measure, with an individual’s behavior key. This includes early self-isolation and quarantine, seeking remote medical advice and not attending large gatherings or going to crowded places. The virus seems to largely affect older people and those with existing medical conditions, so targeted social distancing may be most effective.
Behind the scenes, governments will need to undertake cost-benefit analyses of public health measures. The researcher warns that a week-long global curfew might prevent spread but would also have significant economic costs. The scholar says contemplated public health measures that may be assessed, in order to arrive at a rational decision include: Effectiveness, Speed of response, Economic impact on human welfare, including health, Upside of economic downturn, both human and non-human, Identification of losers and winners, and weighing of their rights, Assessment of quantity of life and Egalitarian considerations.
“Masks, latex gloves, and other useful items are being purchased by anxious individuals and institutions. This is leading to global shortages of medical supplies that are needed for many medical purposes. Many public health measures require individual cooperation, and many of these share a feature that makes them difficult to implement: the average individual stands to lose more from participating than not.”
Geoffrey Rose called this the prevention paradox: “a preventive measure that brings large benefits to the community offers little to each participating individual”. In the 1940s, 600 children needed to be vaccinated against diphtheria to save one life. But it was worth it; diptheria was eradicated; but motivating individuals to vaccinate was (and remains) a challenge.
A similar problem also applies to panic buying, in reverse. Refraining from purchasing supplies offers you little as an individual; in fact, it may even cost you, especially if others do not follow suit. But the global benefits are huge.
The researcher says we put ourselves, and notably children, before the mass of humanity on a daily basis. It is hard to condemn all such behaviour; people have tried to imagine living otherwise, but none have succeeded. Still, public health, like democratic process and war, sometimes requires unwinding this behaviour just a little.
“The messaging must not be simply that the masks don’t work; this is not credible, when so many doctors pictured in the media sport one. Nor must the message be moralising: we all behave selfishly, all the time. The message must directly appeal to a sense public good: “wartime spirit”, or something of the sort. Propaganda machines are capable of promoting compassion and cooperation, just as they can promote competition. Maybe the cultivation of such attitudes, not currently very prominent, would be a positive outcome of the outbreak of COVID-19.”
Prof Broadbent is the author of many works, including Philosophy of Medicine and Philosophy of Epidemiology, and co-editor of a forthcoming volume on the philosophy of public health.
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