(updated 01/27/21)…thousands needlessly died because of the "VS" thinking: How fix it? Start a "Mask It or Casket, and Save Grandma" campaign, and put in place an Opt-out Mask Mandate (and, keep vaccinating!), and, think Market&Government, use the "&" meaning joint, needing each other, more productive when both engaged, not "VS" which is guaranteed to lead to failure
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The Essence of the Story (updated January 27, 2021)
To set the stage, we use a quote from Mervosh et al (2021), wherein Dr. M. J. Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida, who was pointing to a massive failure of leadership from the White House, and later the states, noting that the empirical measure is the huge death toll which "...points to colossal failure at every level of government (for one such failure, see the video about the South Dakota case in Dosani and Westbrook, 2021)."
The Rest of the Story in this Blog also notes the massive failure of the market, because of the extent to which it was guided by the kind of thinking in the Great Barrington Declaration (details below, but basically herd immunity, just get out of the way, let it happen!). The Declaration basically parroted, and as a result gave implicit support to operating only on the arrogance of self-love. It supports the Give Me Liberty to Give You Death frame of reference, as if there would be automatic expression of self-responsibility (even though being fed by misinformation). Not. It did not happen, with over 500,000 deaths predicated by February, 2021, with perhaps as many as a half or more of which could have been avoided. Masks work. Social distancing works. Liberty to Give You Death works? Seriously?
The debate, the discourse turned into a market VS government. Unfortunatly, nothing much coherent can be done under a "VS" frame of reference. In fact, little that was coherent did get done, except for the vaccine. And, why did that work? Well, because the vaccine was a market&government effort, an "&" not a "VS" approach. They worked together as in "&" ... it works! Each is essential to the other!
As Metaconomics makes clear, it is in the shared - interest to deal with a public health issue, together. There is a "We" to a Pandemic that an approach focused only on the "I" cannot fix. It is an "I&We" , a market&government matter. The Great Barrington Declaration (herd immunity) is an "I" approach. The Administrative Branch of the Federal Government took an "I" approach starting early in 2020, and it got only worse as it went along. Congress, who is supposed to be a "We" organization did essentially nothing other than borrow and print money and write checks, and fight across partisan lines, over liberty vs government management. In fact most of the people in government in effect ended up supporting a kind of free-for-all market, everyone for themselves approach, and downplayed --- even claiming with distortion there was some evil "deep state" (totally unfounded) involved, even in producing the virus itself --- government. The overall result: Massive failure in both the market and the government.
What would have worked? Market&Government, seeing the key role of each, as Metaeconomics makes clear. An opt-out mask mandate --- and the mandate needed to be for high quality N95 or equivalent masks --- would have alleviated most of the problems, and greatly reduced the overall number of deaths. The N95 masks would have been produced, enough for everyone, in that the mandate would have made it profitable. Wearing N95 masks could have kept factory lines moving and people going to school, the entire economy opened (except the places where one cannot wear a mask and do things like eat and drink alcohol, but, then, again, with mandates in place, creative N95 masks with straws or "barn-doors" to open to eat, might have been produced!). Massive "Mask It or Casket, and Save Grandma" campaigns should also have been run, to help supplement the Trade&Cap system for the masks (i.e. government sets the "cap" and the market figures out how to achieve it through "trade").
And, perhaps most importantly in a free society, the opt-out option would have given the freedom to not wear a mask, which would have shifted the responsibility to the person opting out to make their case. Everyone else, including their private health insurance companies when they came down with Covid, would have the legitimate right to ask for the story. Make your case, opt-outer: Let's hear your justification for killing grandma! And, even some of them might have come around to wearing an N95 once they realized their story did not hold-up under scrutiny? Just asking.
The only part of the story that did work: The market&government produced the vaccine. That is it. The rest is pretty much massive failure that could have been greatly dampened with Metaeconomic framing, which sees the legitimate and essential role of both market&government.
The Rest of the Story
The Great Barrington Declaration ( https://gbdeclaration.org/ ) claimed, as regards the way the US in particular, and many other countries on the Spaceship in general, have addressed the Coronavirus and COVID disease:
Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. …Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
Bhattacharya (2020), representing the Great Barrington Declaration, which supposedly has over 40,000 signatures in support, points to the need to stop all lockdowns, and thus move to herd immunity for the Coronavirus, and in effect greatly reduce if not stop the COVID 19 disease. It is claimed the Declaration has a scientific basis in fact, which is true on one front: The scientific consensus is that herd immunity is achieved at the point when 70% of the population has either lived through the infection, or, which is left out of the declaration, has been vaccinated.
The claim is also that there are adequate scientific facts about death rates:
---the World Health Organization said back in early March that three percent of people who get COVID die from it, they were wrong by at least one order of magnitude. The COVID fatality rate is much closer to 0.2 or 0.3 percent. The reason for the highly inaccurate early estimates is simple: in early March, we were not identifying most of the people who had been infected by COVID.
It is a scientific fact that the denominator is a crucial number, describing how many have actually been infected with the virus. The actual number in the denominator, however, is unknown, so a substantive amount of conjecture enters into what becomes a key part of the contention to stop lockdowns. In particular, using one study, the Santa Clara, CA study, Bhattacharya (2020) cites it, and quickly moves on, claiming the death rate is off by “at least one order of magnitude:”
--- the fatality rate was not three percent, but closer to 0.2 percent; not three in 100, but two in 1,000.
Maybe. We actually do not know, and, to help our less than capable minds with respect to handling probabilities, it would also be better to use the same base, and use numerals, like in 30-in-1000 as compared to 2-in-1000. Now, that simple thing about how the numbers are presented does not matter much for the overall fatality rate, but understanding the 70 and older death rate, well, it goes like this, another part of the solution:
If you look at studies worldwide, the COVID fatality rate for people 70 and up is about four percent—four in 100 among those 70 and older, as opposed to two in 1,000 in the overall population.
So, so let us again look at the situation with numbers people can perhaps better compare, as in “40-in-1000 among those 70 or older, as opposed to 2-in-1000 in the overall population.” Making progress here. And, 40 as compared to 2, well, now that gives something to look at. Bhattacharya (2020) goes on:
Again, this huge difference between the danger of COVID to the young and the danger of COVID to the old is the most important fact about the virus. Yet it has not been sufficiently emphasized in public health messaging or taken into account by most policymakers.
Well, using the framework and theory of Microeconomics, as Bhattachuryan (2020) is doing, sure, makes complete sense. It is strictly about the odds facing the person, the “I” and, not about the people we share things with as an “I” having a shared interest with a “We.” Yet, public health messaging and policymakers need to be primarily concerned about the “We” which is missing in Microeconomics. The community is left out, which means that which everyone in the community can go along with, the ethic, is also left out.
As McCloskey (2019, p. 93) points out, said kind of economic framing is in effect “opposed to any ethical reflection whatever.” And, while we can only speculate on the degree to which ethical reflection played in the Declaration, it is clear the application of it by Dr. Scott Atlas --- who drew on the Great Barrington Declaration --- and who became the source for the approach touted by the POTUS and the Administration, was of said nature. Dr. Atlas is associated with the Hoover Institution, also at Stanford, which mainly uses the Chicago School of Economics, Libertarian Branch style economic framing that McCloskey (2020) is specifically pointing toward: It is an economics practiced by the NeoClassEconL. There is some overlap of the Hoover Institution and the Stanford Department of Economics (some Department faculty involved in both), where Dr. Bhattacharya received his PhD: So, perhaps ethical reflection is being downplayed a bit too much, in that it is not part of that kind of economics. Also, Microeconomics Without Ethical Reflection (NeoClassEconL) is in general also short on empirical science and long on ideology, as is well documented in Behavioral Economic (Empirical) Science (see Altman, 2012; Tomer, 2017; Lynne, 2020).
So, the issue here is, relating to both Science&Ethics: Even if the very low 0.2% to 0.3% death rate numbers are eventually confirmed, how difficult will it be to keep the virus away from the vulnerable population if it is spread throughout the entire population, in order to achieve the 70% needed for herd immunity? And, just what are the Ethical considerations, just what is it that “We” can all go along with in terms of how many people, and who, would die? Ethical considerations --- as Adam Smith tried to teach in The Theory of Moral Sentiments --- are always needed in order to trump the arrogance of self-love (the self-interest only). Such arrogance is well-served by going toward herd immunity with minimal nudging and no mandates, which is the solution offered in the Declaration.
Neither Bhattacharya (2020) nor the Declaration puts the most important number into view, for our Ethical Reflection. The number is never mentioned, but even only 0.2 to 0.3 % death rates give 330,000,000 (roughly the current US population) X (range of 0.2% to 0.3%) = 660,000 to 990,000 funerals. Good business, full employment for the funeral homes, serving the arrogance of self-love, the self-interest of funeral home managers and investors. The US is approaching 300,000 deaths or so right now: Ethical reflection about doubling or tripling that number, anyone? And, there is no guarantee that we can protect the vulnerable 70 years or older group, who would be extremely isolated and set aside by the rest of the population under the Declaration. I guess just, without Ethical Reflection, in effect treat them like isolated animals in a cage? Not.
Also, how about some Ethical Reflection regarding the proportion of said funerals that will be for lower income people: Well, most of them, actually, so, it is not even necessarily a real profitable enterprise as compared to if it were 990,000 funerals for wealthy people. So, maybe the complete arrogance of self-love is not even being served? It seems we would want to encourage more of the wealthy to become infected, in order to maximize the profit of the funeral homes? A NeoClassEconL would have to be thinking as such, because it is economics without ethical reflection. So, do we really want to go there? And, will Grandma and Grandpa --- and the “We” connection with same --- survive? Well, I don’t know.
Bhatthachara (2020) works to convince, based on a variety of “I” considerations, including the economics of hospitals with empty rooms:
The initial rationale for lockdowns was that slowing the spread of the disease would prevent hospitals from being overwhelmed. It became clear before long that this was not a worry: in the U.S. and in most of the world, hospitals were never at risk of being overwhelmed. Yet the lockdowns were kept in place, and this is turning out to have deadly effects.
So, the claim is over-capacity, even in the face of potentially millions of diseased patients, with large numbers needing hospitalization on the way to 990,000 deaths. Plentiful space for more diseased people, he says. No worries, he says. In fact, operating closer to capacity maximizes profits, right, so it must be good? Now, there is the issue of staff, nurses, and doctors also becoming infected, which is not mentioned. And, some are retiring, otherwise moving- on, in part from not even having enough PPE. All are being overworked and their own immune systems are under stress: Any Empathy --- walking-in-their-shoes on the way to at least a bit of Ethical Reflection -- here? Also, there is the matter of medical, frontline people having to deal with upwards of 990,000 deaths in the emotional sense, often holding the hands of dying people who cannot even be visited by friends and relatives, who could help ease their transition out of life? Said people are not “I” robots, without a sense of identity- with, empathy-with, the “We-with” the patient. Medical, frontline people are perhaps the most Human of all people, and most certainly are not Econs: Said people likely have healthy balance in both Ego&Empathy and not just Ego (as the Econs have in huge proportion, way too much) at play. Again, Ethical Reflection, anyone? Also, as I am writing the Blog here in early December, 2020, the empirical realities are being revealed from all over the US. Many areas have less than 5% remaining capacity for ICU beds, COVID infected and exhausted (both physically and mentally) medical personnel, and, yes, 300,000 deaths is just around the corner. and, this is ongoing with at least some masking, some effort at social distancing, and even a bit of lockdown. So, stop all lockdowns, which will also ensure, we might reasonably expect, even more people not wearing masks (and, also, then, keep selling less than fully protective masks to those who want one), stop influencing activity especially in places likes bars and restaurants, and go to herd immunity as quickly as possible? It is doubtful most medical people would agree, although there are some that do, as several have signed the Great Declaration. Seriously?
More “I” framing then appears about starving people:
In the last 20 years we’ve lifted one billion people worldwide out of poverty. This year we are reversing that progress to the extent—it bears repeating—that an estimated 130 million more people will starve.
Well, sure, there can be disruptions in the food supply, and, other medical conditions need attention, too, especially if the supplies of both are “I-only” oriented. If suppliers are only maximizing their self-interest, well, sure, it makes sense. Metaeconomics suggests this is as much as about adequate attention to the “We” of ensuring people are fed, and that attention to other medical conditions is also provided, as it is about the “I” of supply and demand. The matter of dealing with other medical conditions are especially challenging in a situation where medical frontline workers are at near full capacity in terms of the workload, even if the hospitals are not at full capacity in a space sense. It seems the solution of the Declaration actually exacerbates the problem identified in the declaration. Just how is over-loading the medical system with COVID patients going to fix the problem of dealing with other medical issues? Just asking.
So, while a few other “I” frames are also highlighted, none of them any more convincing than the ones summarized above, Bhattaharya (2020) and the Declaration lands here: Remove all the lockdowns. Return to normal. Little to no “We” here, even though the title of the Bhattachayuran (2020) piece speaks about the need for compassion, which can only evolve out of the sequence of empathy-sympathy-compassion, with Ethical Reflection --- widely shared ethics need to be evolved and applied --- a big part of it.
Also, intriguingly, the word “mask” is never mentioned. The possibility for reaching herd immunity using vaccines is mentioned only in passing. The solution is one-dimensional: Remove all lockdowns. Go back to normal.
A MetaEcon (those who practice the I&We, Self&Other, Science&Ethics version of economics, as presented in Lynne, 2020) would suggest something quite different. And, I realize the following could be criticized as "Monday morning quarter backing", but that is not completely fair, as the need to think in terms of the shared other-interest in outcomes was addressed in Lynne (2020, Chapter 11), with that Chapter written about the time the Pandemic was really taking off, early in 2020. Also, Bhattacharya (2020) is doing Monday morning quarter backing in writing his piece in October, 2020,
So, keeping mind the Monday morning quarter backing issue, it is still possible to claim, with a solid Metaconomic analysis to back it up, that in fact, the public health mistake is not the lockdown policy. Granted, there has been some excessive use of it, lacking in common and scientific sense, as well as lacking in ethical reflection because of inadequate empathy. The public health mistake included, and is still ongoing:
1. Treating the Coronavirus and Covid as a hoax, so all the scientists and modelers, and other legitimate sources, were discounted. As a result, conspiracy theories (including encouraging bizarre treatments like ingesting bleach) were given credence, and encouraged to be spread around social networks, not tempered or bounded by any sort of rational consideration. Facts essential to Factualand were destroyed by distortions, lies, and propaganda as the system moved into a COVID Fantasyland. The Fantasyland shared other (shared among those living in Fantasyland, Conspiracyland) -interest is counterproductive for everyone.
2. Blaming outsiders for it, and not taking any responsibility, both on the part of Business for having shipped all the manufacturing of PPE overseas while not stepping up to produce what was needed without “incentives,” and the Government in charge who should have used Ethical Reflection (a main charge of Government if it is a Good Government) to temper not only the arrogance of self-love of political leaders but also nudging Business leaders to do said reflection, too.
3. Not mandating masks. Masks should have been mandated from the outset, and still could be. And, the mandate should have been based in Science, in particular:
3a. The "Click or Ticket" approach is a mandate with a fine to help enforce it, which works well for seat-belts. Such a mandate will not likely work for masks, in part because the situation in which the mask must be worn is not as clearly defined as it is with a seat belt: When the car is moving, a seat belt must be fastened: Very clear. For mask wearing, not so clear. So, using Behavioral Economic Science, an opt-out mask mandate will likely be a better option. Why? Well, an opt-out option gives the freedom to choose, and each situation may require a somewhat different choice. Yet, each person is now responsible to have a good reason for the choice. It cannot just be a blanket rejection, or some kind of outlandish protest against government rule in light the reality that the rule is with respect to a shared public-health problem. The decision to opt-out also cannot be based in unfounded conspiracy or medical quackery: A person can opt-out, but, only with good, reasoned, fact-based cause. Convince us. As a result, the responsibility is shifted to the person not wearing the mask, and, it gives the person wearing the mask the context for asking the simple question, to engage the person in a reasonable, adult way: Why are you choosing to opt-out? And, perhaps there are good reasons that everyone could go along with, but claiming a hoax and using unsubstantiated conspiracy is not part of it, and otherwise running on belief systems that have no reasonable basis. Also, the “Give Me Liberty to Give You Death” argument needs to be convincing to everyone affected by it, including the ghosts of people killed by it! An opt-out provision in effect ensures that everyone takes personal responsibility for the choice, including not only taking care of own-self but also choosing to not kill grandma and grandpa.
Also, campaigns need to be started, like a Mask It or Casket, and, Save Grandma, Too (everyone wants to save both Own-self and Grandma) or some such frame. Such nudges still give the freedom to choose, but it now is more reasoned. I recall the "Don't Mess With Texas" frame used to encourage young Texas men to stop littering the countryside with beer cans and other things: It worked! And, mask wearing is largely about the same thing: Dealing with the bravado, the dare, of facing COVID. Protestors are often young men with AR-15s on their hip, with this kind of mindset a hallmark of it.
3b. Mandating N95 or equivalent masks: Mandate a mask that actually makes a difference, which would build confidence in wearing a mask. Many of the masks people are wearing are not likely to do much good. Also, by mandating high quality masks, manufacturers will find it feasible to produce enough of said masks for everybody, as few would actually opt-out (taking responsibility does amazing things). As a result, it would also be far easier to produce the masks for the medical community and other front liners, because there would be more money in it, with it easier to justify more manufacturing capacity. An opt-out mandate would increase the profit from supplying high quality masks that actually work, as in Market&Mandate, Market&Government --- each entity needing the other in order to achieve the best outcome, in this case Profit&PublicHealth.
3c. Keep the opt-out mandate on the N95 quality masks until the 70% immunity is achieved. And, help the pace to the 70% immunity level by also using an opt-out mandate for vaccinations. That is, just like with masks, use the opt-out approach on the vaccine, which puts the responsibility on those who opt-out to give good cause, good reason for not taking it. Also, a person who opts-out is now responsible for all outcomes, having to take responsibility for same, rather than “blaming the government” or anyone else for their choices and situation. We might reasonably expect that private insurance companies, too, might be asking for the rationale behind opting-out of both masks and/or vaccination, turning it into the matter of “I-only” influencing insurance premiums paid by same.
4. And, last, but not in any sense the least, with lessons for going forward in how we deal with future Pandemics and the politicians as well as business leaders who may again ignore same: Listening to and in effect given credence, from the very beginning, to the arrogance of self-love in the political and business leadership, who needed to be held to account. The mistake was not hitting harder on the lack of empathy-sympathy-compassion, the lack of ethical reflection, from the very start. Metaeconomics makes it clear that such arrogance needs to be tempered with ethics in order for an economy to achieve economic efficiency, as Adam Smith tried to teach us in the 1700s, and few learned the lesson!
Bhattacharya (2020), reflecting the overall solution of the Declaration argues:
Our goal should therefore be to minimize mortality and social harm until we reach herd immunity… Together, I think we can get on the other side of this pandemic. But we have to fight back. We’re at a place where our civilization is at risk, where the bonds that unite us are at risk of being torn.
Good goal. Do it the best way, using Metaeconomic framing, rather than Microeconomics framing. The overall goal can be realized with good balance in the joint I&We that achieves economic efficiency, peace (less chaos), and happiness (minimize the unhappiness, at least). The move to an outcome that is both sensible and compassionate is possible. And, sure fight back, and work at convincing people it is something everyone can go along with, the Declaration taking the system back to a "normal" which includes 990,000 funerals? Really.
Problem is: The bonds involve a lot more “We” than admitted in the Declaration. And, the plan also ignores the fundamental findings in Behavioral Economics --- the empirical science underlying and giving scientific substance to Metaeconomics --- that a Mandate With Opt-Out (Science) would greatly facilitate keeping everything running. If people could actually feel safer, and, in reality, be safer under the mandate to wear a mask that actually works, there would be no need for such extremes in lock-down. Wearing an N95 mask or equivalent into a doctor’s office for a non-covid related matter is now workable. All the students and teachers in a classroom with everyone wearing a N95 quality mask, well, that works. Perhaps even innovative N95 masks with holes for straws sucking beer out of a beer glass!!... could open up the bars again. How about designing an N95 mask that fits over the nose, only, so one could eat at a restaurant, while still keeping the virus out (main place of entry and exit is the nose, and even after the vaccine arrives, we may still need to be protected: A nose mask may be enough). Be creative.
Bottomline: Use common sense and science, and, most importantly, use SensibleScience&Ethics, in good balance. The Great Barrington Declaration could actually approach being Great with more Ethical Reflection, and, a better balance in Science&Ethics,which is both Sensible&Compassionate.
And, for more on the "Rest of the Story" see the other Blog on the Corona virus at https://tinyurl.com/y32oxkro
References
Altman, M. Behavioral Economics for Dummies. Mississauga, ON: John Wiley and Sons Canada, Ltd., Kindle, 2012.
Bhattachurya, J. A Sensible and Compassionate Anti-COVID Strategy. Imprimis, 49, 10 (Octobrer, 2020): Digital access at https://imprimis.hillsdale.edu/sensible-compassionate-anti-covid-strategy/
Dosani, S. and Westbrook, A. How Governor Kristi Noem Rebranded Her Failures as
Freedom." New York Times, January 27, 2021. https://www.nytimes.com/2021/01/27/opinion/kristi-noem-south-dakota-coronavirus.html
Lynne, G. D. Metaeconomics: Tempering Excessive Greed. New York: Palgrave Macmillan, 2020.
Mervosh, S., Baker, M., Mazzei, P., and Walker, M. “One Year, 400,000 Coronavirus Deaths: How the U.S. Guaranteed Its Own Failure.” New York Times, Digital Ed., January 17, updated January 21, 2021. https://www.nytimes.com/2021/01/17/us/covid-deaths-2020.html?searchResultPosition=3
McCloskey, D. N. Why Liberalism Works: How True Liberal Values Produce a Freer, More Equal, Prosperous World for All. Kindle ed. New York: Yale University Press, 2019.
Tomer, John F. Advanced Introduction to Behavioral Economics. North Hampton, MA: Elgar, 2017