Prevention paradox and dilemma denialism

Bravo, Boris. His statement this morning, on return from convalescing from his near-fatal encounter with Covid-19, took real courage. Under enormous pressure to lift the lockdown, he refused. His priority, he said, was to avoid a second surge in cases. He asked the public to be patient and not to undo the progress that had been made by social isolation.

No-one can doubt the pressure he was under from his own party, including a number of big donors, who have been warning of the ever-more terrible damage to the economy if the lockdown continues.

There’s no doubt that this is true. And Boris Johnson hardly needs to be told it. His dilemma, however, and it is a hideous one, is that he believes that exit from lockdown risks precisely the kind of surge in Covid-19 cases that the lockdown was intended to avoid. Emerging from it is therefore extraordinarily difficult. As he says, this is the moment of maximum risk to people’s lives. But keeping the country locked down risks destroying the economy. Hence the dilemma.

Although he hinted at announcing the relaxation of some lockdown measures over the next few days, and although the number of new cases seems to have peaked, they are still at far too high a level to be able safely to allow much of an exit from lockdown without cases spiralling up again to dangerously overloaded levels and a further rise in the number of deaths.

There is much on which the government can and should be criticised over its management of this crisis. The appallingly large number of deaths and hospital cases is due in large measure to its slowness to lock down from the start, the chaos of its inadequate testing and PPE provision, and its refusal to acknowledge the need to stop incoming flights and quarantine all new arrivals (the latter is only now even being considered).

Among the prime minister’s critics, however, there’s a mindset which denies there’s a dilemma, denies there was ever any need for the lockdown, and denies that Covid-19 is a dangerous as it is.

I wrote about this here, and called such people “economy-firsters” because they think the need to protect the economy should take precedence over protecting lives.

They maintain they do indeed want to protect lives which they claim, on the basis of no evidence whatever, would be lost in greater number if the economy tanks. But if the numbers of very sick people surge out of control, the economy will be badly hit – along with the unconscionable numbers who will die, but who the economy-firsters inescapably assume constitute a price worth paying.

No-one would deny the distress, hardship, illness and even loss of life that are also inevitable as a result of profound economic harm. But what’s so shocking about these critics is that they dismiss the dilemma by pretending that information exists to show the virus isn’t as dangerous as it is and so the lockdown, and the damage to the economy, was unnecessary from the start.

With the help of scientists who are themselves divided, they argue that health provision has not been swamped as feared and that studies show many more people are infected than has been thought, thus purportedly showing that the death rate from the virus is no worse than from the flu.

But as Germany’s leading coronavirus expert, Christian Drosten, has observed, this is the “prevention paradox” in which the reduction in cases and deaths resulting from lockdown is being claimed as evidence there wasn’t a problem in the first place.

“In Germany, people see that the hospitals are not overwhelmed, and they don’t understand why their shops have to shut. They only look at what’s happening here, not at the situation in, say, New York or Spain. This is the prevention paradox, and for many Germans I’m the evil guy who is crippling the economy.”

It’s a common phenomenon that, when some people don’t want to face up to the unpleasant consequences of a situation, they filter the evidence about it in order to pretend to themselves that it is other than it actually is. This is what some economy-firsters are doing with Covid-19. Unable to admit that prioritising the economy inevitably means sacrificing lives, they proclaim that the latter is not a serious problem and has been hugely exaggerated because a) the public have been panicked (ie they’re stupid); b) the media have cynically panicked them; or c) Boris Johnson is a closet fascist/communist dictator who wants to seize control of people’s lives.

They’re claiming that the numbers infected with the virus are far greater than have been thought and so the death rate is far lower; or that the virus runs its course after a certain period in every country and so all we need to do is come out of lockdown and sit it out; or that the disease is following the same curve on the graph regardless of what different countries are doing to tackle it.

But there’s still a huge amount we just don’t know about this virus. We still don’t have accurate information about the numbers who are infected, about the numbers who are dying from it, whether or not those who have been infected are then immune to it, whether the virus is mutating, exactly how it attacks us and kills us.

This deeply alarming report, for example, based on actual front-line observation, suggests the virus is unlike anything doctors and scientists have ever seen before:

“Early in the epidemic, the coronavirus was seen as a variant of a familiar family of disease, not a mysterious ailment, however infectious and concerning. But while uncertainties at the population level confuse and frustrate public-health officials, unsure when and in what form to shift gears out of lockdowns, the disease has proved just as mercurial at the clinical level, with doctors revising their understanding of Covid-19’s basic pattern and weaponry — indeed often revising that understanding in different directions at once. The clinical shape of the disease, long presumed to be a relatively predictable respiratory infection, is getting less clear by the week.

“…’Despite the more than 1,000 papers now spilling into journals and onto preprint servers every week,’ Science concluded, ‘a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.’ In a single illuminating chart, Science lists the following organs as being vulnerable to Covid-19: brain, eyes, nose, lungs, heart, blood vessels, livers, kidneys, intestines. That is to say, nearly every organ.”

All studies which purport to tell us how Covid-19 is behaving in the general population need to be treated with scepticism because the necessary information for such claims does not yet exist. What we do know, because we can see it, is that the virus is both extraordinarily infectious with exponential growth if left unchecked; and that it causes very rapid spikes not just of death but serious disease, including organ failure, among an as yet unknown proportion of its victims. The inescapable implications of that lethal combination is why governments are facing such a dreadful dilemma.

Even those scientists arguing against lockdown accept that social distancing will still be necessary. Lockdown is just a more effective form of social distancing. In the absence of mass testing and tracing, any increase in social contact will inevitably raise the virus infection rate with all that follows. That’s why emerging from it presents such a dilemma.

To insist that lockdown was unnecessary from the start and is causing needless harm is not only to pressure the government recklessly to put lives at risk. It is also to to incite a breakdown in communal self-control, which threatens to produce more group activity and more infection. It is beyond irresponsible.