Since the start of the year, the West has been in the grip of an unprecedented public health crisis. Hundreds of thousands have died, daily life has changed severely and the economy has been dramatically disrupted. It's plausible to call this the West's biggest crisis since World War II.
COVID-19 originated in China. Despite Asia being the epicenter of the outbreak, the consequences of the virus have been a lot less disastrous there. Taiwan, Vietnam and South Korea respectively suffered 7, 35 and 526 deaths, at the moment of writing.
In contrast, the Netherlands, Germany and the United States suffered 9518, 17177 and 270642 deaths. Why do Western countries have so much more casualties? It's tempting to say we chose 'the economy' over public health, but that couldn't be less true. Letting the virus spread through entire countries for a long time has been highly disruptive to our habits and thus to our businesses. Compared to for example South Korea, we've had way more casualties, harsher measures for a much longer time, and more economic decline. We're doing worse in every metric. What mistakes are we making?
The Public Doesn't Know How The Virus Spreads
At the start of the crisis, we focused on two main modes of transmitting the virus: via 'big droplets', emitted by for example coughing, and via surfaces. To prevent being infected by big droplets, you've got to keep distance from other people: somewhere between 1 and 2 meters, with different countries recommending different distances. To prevent infection via surfaces, you've got to wash your hands and disinfect commonly touched objects.
In many Western countries, these are still the main recommended strategies to avoid being infected by COVID. Yet in highly successful countries like Japan, different recommendations have been made from the start. It seems possible to transmit COVID via aerosols, small particles that can float in the air for a long time, and that can fill a room way beyond the recommended safe distance of 1 or 2 meters. Proper ventilation and things like maintaining the right humidity and temperature can help prevent this, but it's highly plausible to be infected while maintaining a safe distance, disinfecting surfaces and wearing face masks.
I live in the Netherlands, and we've invested a lot in preventing transmission via surfaces. Nearly every shop has a bottle of disinfectant at the entrance. Our Prime Minister recommends us to wash our hands until they're broken. Supermarkets have machines to automatically wash shopping carts, or employees at the entrance who offer to disinfect your shopping cart manually. Too bad transmission via surfaces seems to be highly implausible.
A Total Failure To Calculate Cost/Benefit Ratios
Let's start at 0 COVID. The virus must be 'imported' from somewhere else. It seems most infected people don't infect anybody at all, meaning you need multiple infections to ignite a wider outbreak. Combined with the fact that testing for COVID has been possible from the start, and the fact that we've even got rapid tests now, this makes it relatively easy to keep COVID out of your community, if you can make sure that those who enter the community are tested. This community can be relatively small (see Formula 1) or large (see New Zealand and South Korea).
Of course, it's possible you fail to protect your borders: an infected person ignites an outbreak inside of the "bubble". It's relatively easy to rectify this situation. Every outbreak starts relatively small, affecting only a small group of people in a handful of places. The full resources of the nation can be utilized to fight this outbreak. A nation's full testing capability can be focused on a small area, and an army of contact tracers can figure out exactly how the virus has spread. A large majority of the nation can continue to live on as they always did - going to restaurants and community gatherings, not wearing facemasks, meeting up with friends and family.
When you fail to do this, you leave the "green zone" in the graph and enter the white gap in the middle. The outbreak keeps growing exponentionally. Moment by moment, it becomes harder to contain the outbreak. Contact tracing becomes impossible. But while the engine of the virus is "revving up", the negative consequences are relatively benign. Most infected patients feel quite ill, but they'll survive without needing to go to the hospital. The death toll starts rising, but it's relatively low compared to other causes.
As the death toll keeps growing exponentionally, it reaches astronomical proportions in a couple of weeks or months. Suddenly, the situation looks like Bergamo in Italy, with hospitals totally overwhelmed and morgues unable to cope with the amount of coronavirus deaths. We've reached the red area of the graph.
This is the trauma that Western policymakers are trying to avoid. Hospitals must not get overwhelmed. Harsh measures will be used to get out of the red zone, back into the "white zone". But these harsh measures hurt the economy severely, so they will be scaled back as soon as possible. These actions are as understandable as the actions of a panicked animal, but they lack foresight and a deeper understanding of the crisis.
The optimal policy seems obvious to me: get in the green zone ASAP and do what you can to stay there. The "R number", the average number of people that will be infected by a COVID patient, has to get below one eventually. No Western nation wants to accept a situation where hospitals are completely overwhelmed for many months on end.
Keeping the R number <1 is relatively easy in the green zone, when borders with high-COVID areas can be closed, and loads of testing capacity and contract tracing are available for every infection. Above the green zone, you'll need to severely affect the daily lives of your citizens: enforce face masks and social distancing, limit visits at home, close restaurants, etcetera. This requires a lot of cooperation from a large part of the populace - something that is a limited resource, which will run out over time. In a crisis, people will adjust their habits for a short amount of time, but this isn't sustainable over a long period.
The Information Problem
Sacrifices unprecedented since WWII have been asked from citizens. Many billions have been invested in vaccine development, in testing and in hospital care. Many more billions have been lost in the economy. In terms of money and effort, we've done our best. But these efforts have been misdirected, because the public, the media and the government hold the wrong ideas about COVID. A list of very common misconceptions:
- Transmission via surfaces is a big problem
- Transmission via aerosols is not or barely relevant
- It's fine to hover just below the point where hospitals get overwhelmed - it's not important to bring down the number of active cases as low as possible
- A vaccine is the only possible long term solution. We can't reduce the amount of infections to 0 any other way, even with potential technical developments like quicker, cheaper and less invasive tests
I'm surprised and shocked by this. I'm a rather pessimistic person, and I wasn't surprised by the incompetent way in which government officials initially tried to tackle this problem. But the stakes are extremely high: hundreds of thousands have died in the West, many billions of economic activity have been lost, and the daily well-being of all citizens has been negatively affected. I had expected best practices and the most up-to-date information to spread pretty rapidly. Back in February, many things were still unclear about the virus. But in April/May, most of the information in this post was already pretty obvious.
While many Asian countries were able to contain the virus during their first try, in the first wave, most Western countries failed. Summer bought us some time to prepare for the second wave: many European countries managed to bring the amount of active cases to a very low number. This probably had more to do with the climate, with activities being moved outside, than with the official measures.
But even with all the information necessary to defeat the virus available, with best practices visible all around us, with many months to prepare, we still failed again. Many will die. The economy will be hamstrung. Our lives are on hold. Many countries apply the same strategies and recommendations that already failed in the first wave.
It's pretty obvious which mistakes we've made. But why? Why didn't we learn? Why didn't we apply the new information? Why didn't we choose better strategies?
I find it hard to answer this question with full certainty. The explanation that comes closest in my opinion is this 2019 video about Chernobyl. Some quotes:
What you might not know is that the incident also propelled into in fame the work of German sociologist Ulrich Beck, who, earlier in the same year, finished the first manuscript for a grand social theory called 'Risk Society', that would become a bestseller in the months following Chernobyl.
The theory poses that we have entered a new stage of modernity that is increasingly occupied with debating, preventing and managing risks that we ourselves have produced; that are the direct result of our technological progress.
These risks are unlike any we have faced before, both in scale and in complexity. And because they are inherently connected to many of the essential aspects of modernity, they have infected our society with a fundamental feeling of vulnerability.
Moments after the incident, we immediately see one of the defining characteristics of modern risks; which is that the danger is pretty much impossible to perceive using our own senses. We are therefore dependent on technology, in this case; dosimeters, to measure the amount of danger we’re in.
This reliance on external risk assessors, of course, puts us in a much more vulnerable position as the series repeatedly shows us. In his book World Risk Society, Beck explains how this expropriation of the senses also means the loss of common sense, and writes that; "Human life is thereby jeopardized to its very core and individuals are robbed of their power of judgement."
It seems that COVID-19 is just too complex for most humans in 2020. Finding accurate information about the virus is hard, with official instutions not always being reliable. Analyzing the way the virus spreads through our society, and figuring out effective measures to combat this, is very difficult. We didn't fail completely, we're not in the worst-case scenario. But most Western countries failed to implement a strategy that would've saved both many lives and the economy, by making some silly errors, not updating their information, and not thinking through the long-term effects.
If you believe that the 21st century will look much like the second half of the 20th century, this isn't too worrying. A terrible pandemic happened, a lot of older people died prematurely, but the storm will pass and things will continue much like they did before COVID.
But I think most of us here believe the 21st century will not look like that. New technologies, AI, nanomachines, bioengineering and many other known and unknown innovations threaten to severely disrupt our world. As COVID has taught us, we are not prepared. Our politicians are unable to handle problems of this scale and our media is unable to properly discuss and disperse information about complex topics. In the West, nobody has been able to intervene successfully.
We are not sure exactly what the future will bring, and whether new capabilities will make it easier to meet future challenges. But they'll probably be as difficult as COVID, and they'll require a response that's as complex as the right COVID strategy. That means that we're currently not ready and that we need to do better. Let COVID be a wake-up call, let us transform our institutions and our mindset to be more capable and effective, and let us not repeat our mistakes on a bigger scale in the future.