The Problems of Abstraction and Cost-Benefit Analysis
COVID as social disease
This essay comes in the wake of the stepping down of Jeff Zients, and the ascension of Ashish Jha to White House Coronavirus Response Coordinator (COVID Czar), both of whom simply echo the White House’s declaration that everything’s fine, as well as a string of tweets and articles from Dr. Leana Wen downplaying the severity of the outbreak of cases at the Gridiron dinner and suggesting that constant risk of infection is the new normal. All of these figures, but Wen especially, have rhetorical styles that operate as, as Beatrice Adler-Bolton puts it, “a perfect blend of what Wolf Wolfensberger called ‘universal forms of deathmaking detoxification’ which has four modes—deathmaking as: life-enhancing, the divine will, hidden or obscured, and nullified commons.” A disability scholar, Adler-Bolton goes into more depth in this twitter thread from which this quote comes. We are seeing a wide-ranging push towards an acceptance of death on an unethical scale; not the death that’s a fact of life, but mass death that can and should be avoided through a turn towards the vulnerable and the implementation of wide-ranging NPI’s (non-pharmaceutical interventions). In this essay I attempt to bring together a wide range of voices in order to centralize data and knowledge on what a refusal of this deathmaking would look like and to discuss the problematics of the individual responsibility that is being forced on the population while simultaneously being lauded as a freedom of choice and “dignity of risk.”
In lieu of citation footnotes for this essay I will be directly linking to articles. Footnotes will operate as a space of greater explanation where merited. Twitter has been utilized as a source for direct thoughts from those who have been participants in this discourse for quite sometime as disability scholars, doctors, public health experts, etc., it should be understood that direct sources are sought when possible, but for certain ideas are the twitter threads themselves as a kind of self-publishing.
The specter of cost-benefit analysis looms large in the culture’s COVID imaginary. Individual risk and “dignity of risk”1 based decisions2 take precedence over the public realities of health that characterize our globalized world. In other words, as Justin Feldman, Sc.D, MPH and Abigail Cartus, Ph.D, MPH put it in their write up on the work of Emily Oster for Protean Mag,
Oster’s books all utilize a type of cost-benefit analysis that rejects the precautionary principle.3 Long embraced by environmentalists, trade unionists, and public health experts, the precautionary principle comes into play in scenarios of scientific uncertainty about risks of harm; it holds that decisionmakers should err on the side of minimizing or eliminating a potential hazard, even if this might prove to have been an overreaction once more research becomes available. Business interest groups, in seeking to expand corporate freedoms, use and promote the exact opposite interpretation of uncertainty. For example, industry groups might argue for permitting a novel pesticide to enter the market while evidence of its carcinogenic potential is still being collected. There is a bias towards interpreting uncertain and inconclusive research findings about health risks as evidence of no risk—a glaring fallacy that serves the needs of profit. [links found in original, emphasis mine]
Oster who, as Feldman and Cartus point out, has been an invaluable voice to many who wish to loosen restrictions during the course of the pandemic (such as CDC director Rochelle Walensky and Florida Governor Ron Desantis [both links are here found in F & C’s article and elucidate these two’s relationship to Oster]) due to her emphasis on the cost-benefit analysis framework as something which gives agency to those who utilize it. To argue instead then, for the precautionary principle as a framework, is to look again at the data we have and what it tells us about the realities of risk of death, long COVID, serious illness and hospitalizations, isolation for those most at risk, and what we can do as a public through N0n-Pharmaceutical Interventions, not just as individuals. Turning away from economic prioritization and towards precaution, not just as a principle, but as an ethic.
While I write this to not only centralize quite a fair amount of data on COVID, and to bring together a myriad of voices who have championed NPI’s and prioritized the vulnerable during this pandemic, as well as contextualize the realities of this pandemic as one that cannot end just because we want it to4, I want to note that it’s aim is to combat what I would call the bureaucratic misinformation of policy and data. That is, while the information itself is not incorrect as far as numbers go5, the impenetrability of that information results in misunderstandings of what it means at best, and manipulations through a different set of (economic) priorities at worst. That is, numbers and data require interpretation that overworked and governmentally under protected individuals don’t have the time or energy to properly parse. And to assume that it is even the personal responsibility of each person to calculate what is worth it to them in terms of risk only serves to entrench the personal responsibility line. I bring this up however to say that a lack in reporting serves to sequester the death and illness still generated by this disease to the margins in a way that leads to a situation where people truly just don’t know the severity of what’s going on, especially when living in pockets that have otherwise been able to avoid the realities of mass death. As the podcast Death Panel hosted by Beatrice Adler-Bolton, Artie Vierkant, and Phil Rocco have argued, government messaging throughout the pandemic has worked to acclimate the country to a “reality” of acceptable and inevitable death and COVID endemicity.
What follows is a collection of data and information and what it means for all of us in the face of COVID funding disappearing, concerted efforts to return to normal, and what will be seen and can already be seen as a “mass disabling event.”6
Let’s begin with numbers alone7:
As of March 17th, we had deaths at over 1000 a day for all but 5 of the previous 209 days according to the New York Times tracker.8 The New York Times states that as of March 31st we are still reporting around 700 deaths a day.
As of April 5th, we have had a total of 60,884 total breakthrough covid deaths with no data found for FL, IA, or KS and incomplete or outdated data available for AL, AR, CO, HI, LA, NH, NV, NY, SD, TX, WI. (direct links to data sources in the linked thread)
As of this writing, according to the NY Times tracker, we are at 981,112 total recorded deaths and 80,128,432 total recorded cases. This is with the understanding that these numbers are likely lower than the true numbers of infection and death due to COVID.
While the booster does provide increased protections, just between December 19th and January 29th over 4400 people died from breakthrough infections. (Update clarification 4/15: this is not indicative of vaccine efficacy one way or the other, as count data cannot be used to ascertain efficacy, but should be read in response to the idea that serious death and illness simply doesn’t come to the vaccinated)
So many Americans died in 2021 that Life Expectancy dropped to 76.6 years. Crucially this was not equal along lines of race. While Black and Hispanic life expectancy did not go down as much in 2021, they were hit so hard in 2020 that they have lost more ground overall, even if the major changes we saw in 2021 life expectancy occurred due to deaths in the white population.
If we momentarily zoom out for a moment, we see that 3.39 billion individuals have been infected with SARS-CoV-2 one or more times, before accounting for the Omicron Wave.
The questions immediately begin to flow. Are deaths going down? Is the amount deaths are dropping promising? Is it indicative of a general and continuing trend downward for illness, hospitalization, and death? Is that a good enough metric for the loosening of restrictions? Who are the people dying? What are the chances of getting long covid? Do those chances stack? What amount of death and disease is acceptable? But what about the flu? What are accurate comparisons between the flu and COVID? What are the levels of efficacy we’re operating with when it comes to the vaccine? What has the vaccine done for us? What about “focused protections,” why do we all have to participate in broader health initiatives? Why are we currently seeing cutbacks on free testing and vaccination for the uninsured?
What I want to arrive at is a recognition of the precautionary principle’s public good as a framework as we continue to move through a pandemic situation which doesn’t seem to be going away anytime soon and while we are still learning about the effects of this disease and its evolution. This would mean a turn towards those who are most vulnerable in all aspects of our society as who we look to in order to understand how we can shift our perspectives on something which does, in fact, effect us all. In an opinion piece for the New York Times, writer Sarah Wildman speaks with Dr. Boghuma Kabisen Titanji (an infectious disease specialist at Emory University), Alan Brown (the managing principle for Wolfbrown a research and consulting firm working with orchestra companies), Dr. Dorry Segev (director of the Center for Surgical and Transplant Applied Research at New York University), the philosopher Martha Nussbaum, Alice MacLachlan (a professor of philosophy at York University in Toronto), and Steven Thrasher (an assistant professor at Northwestern University) all of whom echo these sentiments in various ways. In her discussion of what it means to find oneself on the vulnerable side of this equation (her daughter received a liver transplant for her cancer treatment and takes daily immunosuppressants) she writes out succinctly the fears I often have when thinking about what I hope my communities will do, "I know everyone is fed up. I wonder whether it is unfair for me to insist others care. I am a special request. I am a problem. I like the rules. The more the world opens up, the more cornered I feel. I do not want us to return to isolation.”
I myself am not immunocompromised (although I have sleep disorders, possible undiagnosed mental health concerns, as well as possible chronic illnesses I am unaware of due to a lack of health insurance and time spent with pains and problems), but find myself in a precarious position where I cannot afford to lose the money associated with a COVID quarantine, and am consistently in community with students who I do not want to spread this disease to. Add on top of this the possibility of Long COVID, and I simply cannot participate in the same risk assessments others do when making their decisions. That is not to mention the concern I have for those who are most vulnerable that I do not wish to see take on the brunt of isolation that no one wishes to participate in.
COVID gave us an opportunity to rework the ways we approach the body politic we all participate in. The pandemic did not create the vulnerable population (although as pointed out it is contributing) and these are concerns that have been in the air for quite some time. We did and still do have the opportunity to reorient our perspectives on health and wellness, vulnerability, and questions of what it is that we owe each other. These are perspectives that branch out into health justice more generally especially as it relates to pushes for Medicare for All and beyond, labor organizing and labor equity, criminal justice reform and abolition, community care and social safety nets. The list goes on.
The questions of vulnerability and impact of the virus fall unequally along lines of race, class, and health. This survey by KFF reports that Black and Hispanic adults, those in lower income jobs, and those with chronic health conditions support the continued use of masking as a public health response to the pandemic. And while highlighting this study from Science Direct on the ways highlighting racial disparities results in White Americans being more likely to have reduced fear of COVID, reduced empathy for those who are vulnerable, and show reduced support in COVID precautions, may simply continue to inspire what the study states in my white readers, I highlight it for the simple fact that this White Supremacist reality is glaring. All the while continued American ideals of individualism9 work against notions of public health that could help to mitigate the spread of this respiratory virus as noted in this paper Where is the “Public” in American Public Health? Moving from individual responsibility to collective action.
Questions of possible COVID endemicity have become common as we continue to see efforts by the United States government to “return us to normal” before the upcoming midterms.10 And support of this notion that we could see COVID endemicity sometime soon has people pointing to the flu as a comparable endemic respiratory virus, even though we saw during the course of the pandemic cases of the flu went down, and one flu strain is even believed to have gone extinct thanks to our mitigation measures. And while many will point out that COVID-19 and the Flu are incredibly similar, two important notes must be made: COVID-19 has more superspreading events than the flu, and it is currently believed that COVID’s mortality rate is 10 or more times higher than the flu. And even if, say, COVID became endemic similar to the flu with the same amount of death and illness, that would mean we’d double yearly excess viral death tolls even though the opportunity was there through NPI’s (including paid lockdowns, free vaccines and testing, mask mandates, etc.) to quell the virus in a way that actually led to its elimination or drastic reduction below endemic levels. And, importantly, when we think of the yearly flu season, this is actually not when it is endemic, but rather becomes epidemic.11 As Lukas Engelmann (a historian of medicine and epidemiology at the University of Edinburgh) states, “There’s been a political reframing of the idea of endemic as something that is harmless or normal.” And the article goes on to state, “epidemiologists use endemic to mean something we should watch carefully, he said, because an endemic disease can become epidemic again.”
So why am I talking about frameworks, working through comparisons, and highlighting numbers that we’re seeing? While nothing here is comprehensive, it’s important to discuss the abstract reality of numbers that are beholden to the frameworks we choose to use to look at them in. Now what do I mean when I say they are abstractions? My background, which is primarily art based, historically and theoretically, may be useful to dig into, at least as it pertains to questions of figuration and abstraction. While there is an idea that these are a binaristic system akin to the differences between the real and imaginary, they actually shift in and out of each other as possibility and require one another to strengthen what it is that each can do. And while I use real and imaginary here as an example of another seemingly disparate binary, I want to question them as well to understand how our situations materialize through “public opinion.” Abstraction and figuration can be understood as two nodes along a spectrum of how loosely or strictly interpretable something is. If one looks at the abstract paintings of Marc Rothko for example, they are color spaces reverberating emotion and depth, and have different affects on each individual. But if one looks at say the work of a realist figural painter like Thomas Eakins, the works begin to operate more like strictly conventional narrative depictions of a space we’ll all generally understand similarly. This of course breaks down the instant one looks at the figural work say of someone like Van Gogh or Kehinde Wiley, or the incredibly pared down abstract paintings of say Elsworth Kelly or Jennie C. Jones. The distinctions break down. And while the numbers and data we engage with exist as abstractions this doesn’t make the realities they represent any less real, just more open to one’s interpretation based on ethical values and understanding. 80 million deaths move beyond our ability to comprehend in terms of numbers or even lives lived, and therefore become figurations of a past that move into a level of abstraction that our brains refuse. But to reorient what that number represents, not a past figure, or inevitable deaths, but as the realities of our lacking12 efforts thus far to combat the COVID pandemic, what we could call the “imaginary of normalcy” begins to falter and we can see it as something which constructs (and has constructed) our reality. For an imaginary, when held by enough people, is powerful enough to shape realities.13 And while this notion may seem to exist in the abstract, we need only look to recent changes in medical procedure and CDC guidelines to understand how reality and its definitions can be shifted to accommodate economic imaginaries which require an acceptance of mass death and disease to continue to function. That economics as they exist currently require death to grease the wheels is nothing new, it’s just now it’s happening in the American public realm as well, even if we do a lot of work to continue to keep it out (as we always have).
(This notion of abstraction here—while taken up in regard to the functions of numbers that we must reconcile and discussed in regard to painting primarily—cannot be divorced from the abstraction of the victims of eugenic and governmentally sanctioned death. Those who are allowed to die for the health of the greater body politic are turned into fantastical abstractions of themselves, figured in such a way so as to inhabit the stereotype made to justify what happens. The criminal in police shootings. The unwell patient who would have died anyway. The sex worker who knew what they were doing. The addict, the madman, the vulnerable, the marginal. Abstraction as it exists in art discourses is a powerful tool in working against essentializing representation and tokenizing multiculturalism, but when placed in the hands of news outlets and policy makers it becomes a tool to refigure the dead as stereotypical victims of their own mortality. I put this reality in parenthetical asides here to make this note in response to the last paragraph, but also to recognize that it permeates the very means by which this essay functions. That is, in order for me to argue for a recognition of the vulnerable here, I must engage in certain levels of abstraction due to the size and breadth of this global health emergency. And while there must be a push against policy makers and health influencers to cease normalizing death and begin following the guidance of those most at risk [there I go again] in implementing NPI’s that can save lives while helping us construct a new normal that recognizes all of the excess death we allow, it is also important to turn in to our communities and see what we can do in our immediate spaces as well. As someone on twitter quoted Fred Moten saying [not sure where it’s from but it seems to have been reiterated by him slightly differently in a conversation he took part in with Robin D.G. Kelly, Rinaldo Walcott, and Afua Cooper], “I don’t think that scale is our friend, it’s our enemy. How to get together on small scale with patience, ethical regard for one another… maybe this renewal of our habits of assembly happens on a small scale.”)
As Adler-Bolton puts it in her brief abstract of her overview on the new CDC guidelines changes to Community Transmission Levels, “There's nothing that we can do or say to truly make the pandemic be over if we're going to continue to undermine the public health response by pretending that cases aren't happening or no longer matter. The medically vulnerable are already paying the price of this non-plan and we need your support.” And again to quote Adler-Bolton—who does a fantastic job of articulating how the change in guidelines is really just a shifting around of numbers—here she gives an example of what the old vs. the new guidelines for risk levels looks like,
So, to give an example of how this would work. Previously, under the old system, a seven-day average test positivity rate of 100 cases per 100,000 people would have qualified a county to be considered high risk. Now, with the new metric, counties with up to 200 cases per 100,000 people are still considered in the low category, unless their hospital capacity is being overwhelmed. So, the new CDC guidance allows 20 times the previous low threshold which was 10 cases per 100,000 people. It allows double the old high threshold. And in terms of when the masking recommendations would actually come into place, it's not until you hit the high level of risk under the new system—where cases are above 200 cases per 100,000 people and hospital capacity is over 15%. And so now with the new metric counties with up to 200 cases per 100,000 People are still considered in the low category. And in terms of what that means for scale. It's that at a national scale, right? If every, let's say every single county all 3000 or so counties in the United States, were butting right up against that 200 cases per 100,000 [people] metric. That would mean that we'd be having up to 95,000 new positive cases a day and the CDC would still not be recommending masking for the majority of the American public. Under the old system, only 47 of over 3000 US counties were rated low risk. Under the new system, that figure immediately jumped to 742. For counties that are rated high, the number was reduced from 2,648 under the previous system to just over 1000 under the new system.
This on its own is the perfect example of what interpretation does to the numbers. But you may argue that perhaps because Omicron is seen as mild, this change is merited because it loosens restrictions based on the data, and this new wave, BA.2, is simply a variant on Omicron. But what do we mean by “mild”? To quote Adler-Bolton again from the same article, "And ‘BA.2’ is not a new variant. It is an evolutionary branch of Omicron, which many have said was ‘mild', but Omicron was not mild. Omicron took over 150,000 American lives in a manner of weeks, and hundreds of those were children. I don't think that we should be waiting to see what BA.2 does, before we act.” She goes on to articulate that the CDC says it is only those who are immunocompromised who should be masking and taking the precautions, because we know they still work, but they also only work when the whole community is engaged with them. But that last line gets us back to what it is that our framework should be. The way our current use of cost-benefit analysis is argued, a figuring of personal risk must be done by the individual based on the data they have. But what Adler-Bolton rightly points out in echo of the precautionary principle is that we shouldn't wait to see if BA.2 isn’t bad, but rather approach the possibility of risk as risk, not as no risk at all.
Another example: Following an announcement from the Department of Health and Human Services changing what is defined as a COVID-19 hospitalization we saw a drop in New Hampshire reported COVID cases. The new definition states that “only patients being treated with remdesivir or dexamethasone, drugs used for hospitalized patients with moderate to severe illness” are considered cases, even when people are still in the hospital with cases not being treated by those drugs.
To even get to a place where you recognize how many more NPI’s we should have in place is difficult though. A lot of this is owed to the fact that the information coming from the CDC is consistently garbled in a way that makes it more difficult to parse the information to even begin to make better informed choices on risk when that is made the necessary move. Perhaps the most notoriously celebrated example of this is when Biden rolled back mask mandates for those who had been vaccinated,
These errors in communication can have massive policy implications. “I will literally never forget the day in May of 2021 when President Biden said if you’re vaccinated you can take your mask off,” said Jessica Malaty Rivera, the former science communication lead of the Covid Tracking Project and senior adviser for the Rockefeller Foundation’s Pandemic Prevention Institute. “I wanted to throw my laptop and my phone, everything, out of the window, because I couldn’t believe we had gotten to a place where people were looking at mitigation as one effort canceling out another.” (Link)
In our evaluation of outspoken individuals it also becomes easy to fall into the trap of the cult of “expertise" which leads to those like Leana Wen (public health professor), Ashish Jha (Dean of Brown University School of Public Health), David Leonhardt (senior journalist at New York Times)14, and Oster (professor of economics at Brown University) (to name a few) who while they may be experts in various fields, do not necessarily have the necessary knowledges to engage properly with COVID realities, yet still have outsized effects on policy. And importantly, one can be an expert in a field, but depending on where one’s ethics and values (as well as focus, for example, Jha is not an expert in virology, immunology, or vaccines and, of course to his credit, never claimed to be, but he got where he is because he can speak well about complex issues, even if his takes are not always the best ones)—or the weights they apply to their analyses—lay can drastically change the recommendations one makes. Hence, why I’ve made an effort to include everyone’s qualifications along with their opinions along the way, and I would encourage that their track record is looked at as well.
If we want to really engage with what Public Health can do, it becomes necessary to shift not only how we see the role of ourselves in our communities, but to create a situation wherein those who have the power no longer have the choice of sacrificing us for the preservation of the economy. To work against the necropolitical tendencies of our governments we must recognize the value of those deemed most invaluable by austere and eugenic15 policy proposals. I want to end by referring you to this twitter thread by Arrianna Marie Planey, MA Phd, who does a great job of laying out the realities of why medical expertise isn’t public health expertise, and what it means to really engage with the “public” aspects of health.
What we’ve seen so far is a clear indictment of a vaccine-only approach to “public health.” What we require are layered protections, local outreach to communities who are at risk for vaccine hesitancy and/or low levels of access especially as we move to a situation where the uninsured are no longer covered for COVID vaccines, we need to do the work necessary this summer to improve ventilation systems in schools, workplaces, and public indoor gathering spaces, and we need to implement monetary structures that don’t penalize people for contracting the virus. To be more specific, there should be paid sick leave, payments to enable staying at home in general, child tax credits, frees masks, tests, and vaccines, quarantine housing, continued capacity limits (and no strings attached grants to help smaller businesses that this would negatively effect), mask mandates, and a paid shutdown, not a policed shutdown (this language is repurposed from a twitter thread put together by writer Abdullah Shihipar who has a Masters in Public Health and a B.Sc in Cell and Molecular Biology). This last is important, because currently even when someone is no longer contagious after five days and can return to work it doesn’t mean that they are fully recovered in a way where they’re not doing damage to their bodies, rest is an intrinsic part of recovery. To push towards a structure in which those who get sick are not penalized, access is given to those who need it (in a way not coated in bureaucracy), and the ways in which the virus continues to mutate and change and infect are not ignored but taken as evidence of a more serious and precautionary approach could perhaps begin to get us towards that “return to normalcy” everyone is talking about, but as long as we prioritize the health of the economy over the health of the people, I’m not sure we will see the end in a meaningful way anytime soon.
With that, in a small rework of how Death Panel signs off their podcast each time: Medicare for All Now, Solidarity Forever, Help Each Other Stay Alive Another Week.
To understand why I put dignity of risk here in quotes it’s important to understand that before it was taken up in the public consciousness during the COVID pandemic, it was first put forward by Robert Perske who advocated for intellectually disabled people wrongly convicted of crimes. In his 1972 article The dignity of risk and the mentally retarded (its important to note that this was the language at the time for referring to intellectual disability, and should not be reproduced in our contemporary writing) he puts forward the concept of dignity of risk writing, “It is hoped that this paper has helped to illustrate that there can be such a thing as human dignity in risk, and there can be a dehumanizing indignity in safety!” And while there is still a certain amount of paternalism in his language, it is later taken up by Julian Wolpert and would later be incorporated in so many words into the United Nations Convention on the Rights of Persons with Disabilities.
However as Andrew Pulrang writes in an article for Forbes, “Some degree of risk-taking in life is essential, especially for people with disabilities. The freedom to do so for ourselves is likewise essential. However, there is a crucial difference between disabled people taking risks for ourselves, and other people taking risks that we end up paying for.
Here is where the ‘open America’ protesters, and government officials hurrying to put the pandemic behind us, are not the same as disabled people fighting for the right to take risks in our everyday lives. Disabled people have always fought for the right to risk ourselves. Those who want a quick end to pandemic precautions do so partly in the name of their own ‘dignity of risk.’ The problem is that they are actually pushing for the right to risk others far more than themselves. And lots of those ‘others’ are disabled people.” Its this right to risk others that gets at the heart of my criticality towards this phrase as it’s currently used.
Information around which is constantly changing, as I’ll return to later.
In order to better understand these two frameworks here’s Feldman’s overview of three types of cost-benefit analysis followed by what he calls a simplified overview of the precautionary principle, with an ethical note at the end from Cartus and Phil Rocco in the Death Panel episode Tradeoffs:
1. “Value neutral technical exercise that in theory can incorporate all sorts of assumptions, can weigh uncertainty in different ways ,which allows it to incorporate the precautionary principle… That kind only exists in academic journals, let’s say.”
2. “The cost-benefit analysis as it exists under US policy making and regulation making regimes (or in other countries) and those take very specific forms and assume certain costs and they discount others and they don’t necessarily engage with any kinds of notions of collective good or social justice.” [refer to Death Panel episode with Frank Pasquale or the symposium he put on which is referenced above] This kind, Feldman points out, has been very deregulatory.
3. “Cost-benefit analysis as most of these pundits are actually using it, which is as a metonym… [sic] Cost-benefit analysis is part of the economic style of reasoning. They are invoking cost-benefit analysis when they actual mean economic style of reasoning… Exactly as Abby was saying before, invoking the rational way and quantitative weighing of decisions as a way to justify their particular values and their particular policy preferences.”
“It’s about how you act in situations of uncertainty, so whereas someone like Emily Oster will see some new hazard or potential hazard with unknown consequences, like ok, there’s this completely new respiratory virus, we don’t really know what its effects are going to be do we take that uncertainty to mean there’s no risk or do we take it to mean there is potential for great harm and we should treat it as such. Precautionary principle doesn’t tell you where to go from there, you need other sorts of both principles, values, and assumptions and data to make decisions.”
“Cost-benefit analysis can’t tell you what you want to do, at some point it comes down to what your values are. [this last quote is the only one not from Feldman, but from Cartus]”
As Rocco goes on to say, you have to apply the weights. This note on weights will return later in thinking through why it is the precautionary principle is necessary in the prevention, as opposed to an acceptance of, suffering and death.
To even consider the word pandemic definitionally we can see that focusing on declaring the pandemic over in the US alone cannot end the pandemic, “A pandemic is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals.” Wikipedia To even declare it over in one country is to forget that globalization doesn’t just link us in trade, commerce, travel, and communication, but also brings us all into an ethical relationship with each other as countries and communities, comprising a global body politic. For what I mean here one only need turn to discussions around the Trips waiver, the recent denial of Paxlovid necessary for a pivotal clinical African trial, and the chaos that erupted at Heathrow Airport on April 4th when at least 90 flights were cancelled because of staff absences due to COVID, all the while discussions were happening around the allowance of the lowering of mask mandates for travel and a push by a bipartisan group of senators to continue to limit immigration was brought against a possible loosening of our borders by the Biden administration.
Although, it’s necessary to remember that numbers lag, and accurate numbers require robust data collection mechanisms which we do not have in the United States. Because it requires that all who are getting sick and dying do the proper tests necessary to discover whether one has COVID or not, numbers of illness, hospitalization, and death due to COVID are lower (and perhaps even far lower) than the actual reality of how much disease is out there. This understanding is in contrast to what has often been a declaration that the numbers are inflated, which has itself never been true.
What is estimated in some studies as a 10% chance of getting what is being referred to as Long Covid, the lack of a larger discussion around what this will mean, at best, is an oversight on discussions of what returning to normalcy will mean, and, at worst, is a eugenic undercurrent which has permeated much of how we understand COVID’s serious effects and acceptable deaths otherwise referred to as “deaths pulled from the future.”
I will be limiting my analysis to United States numbers here, with recognition that this is only part of the larger picture. For example, we know that there is often a lag between an increase in cases in the United Kingdom and Europe and an increase in cases in the United States.
The work to account for and report this data is thanks to twitter account @wsbgnl who collects and reports the data as well as does some data parsing. This essay could not happen without their work.
I took up this question of individualism in my essay “AN ARMY OF THE SICK CANNOT BE DEFEATED”: Health Justice and the Dangers of American Solipsism from 2020 as well as in my essay Devotions for Exhaustion and Support from 2021 written during my COVID quarantine. And it should be noted that this emphasis on individualism goes all the way up to CDC director Rochelle Walensky, who stated, “Your health is in your hands.” And was reiterated by the (now former) White House COVID Coordinator Jeff Zients this past winter when he stated, “For the unvaccinated, you're looking at a winter of severe illness and death for yourselves, your families and the hospitals you may soon overwhelm.” This statement does not take into account the vulnerable who are unable to get the vaccine, or those who, if they do receive it, have lower levels of protection, as well as the health disparities in this country which make it difficult for low-income (which is also cut along racial lines), rural, and undocumented communities to gain access to the vaccine.
The recent Gridiron dinner resulting in at least 53 COVID infections among members of government, was an attempt to show that this was possible all the while showing that this is clearly not the case with the BA.2 variant. Yet even still Dr. Leana Wen posted this article arguing that just because it was a superspreader event doesn’t mean we should stop these events, rather it’s just what future events will look like. A horrifying prospect when 2 years into the pandemic we are still learning about what effects COVID has on us, all the while continued masking could have made the event possible, and those who had to work the event are ignored in the analysis.
“Covid is much, much more transmissible than the flu,” said Jeffrey Shaman, an infectious-disease modeler at Columbia University. “Only a small portion of the population needs to be susceptible for an outbreak to foment, and that can happen at any time of year.” Article can be found here.
And while noting that our efforts are lacking here may feel demoralizing, this is simply another effect of the individual responsibility and risk narrative. To point out that the pandemic response has been lacking isn’t to place blame on individuals, but rather to acknowledge all of the deaths we could have prevented, and to allow for the possibility that more must be done in the future.
This understanding of the imaginary is indebted to the work of Frantz Fanon who’s book Black Skin, White Masks takes up this understanding in the evaluation of the white imaginary’s effect on the lived experiences of black people.
Each of these links to a Death Panel episode in which these figures are discussed. Death Panel is able to do a much better job of discussing the issues with each of their positions than I can do in the small space I have.