Living With Uncertainty

A sign asking people to stay at home stands on the sea front in Southend, England on Jan. 08, 2021. (Dan Kitwood/Getty Images)

Commentary

Faced with a war, a pandemic, or a spiritual crisis, it’s easy to fall either into a kind of complacency or into despair and despondency. Or first one and then the other, as with a war that elicits initial enthusiasm—cheering on the troops as they march off to war—and, a few years or military reverses later, falling into despair and defeatism.

In both our complacency and our despair, we presume to know more than we do. In both responses, we tend to be passive when we need to act. Both avoid the reality that life requires us to make decisions in conditions of incomplete and imperfect knowledge. A panic in which we insist on a number of ill-supported measures as if they were the “settled science” of the matter is also a denial of reality. We fall then into a level of certitude and assertion that the evidence doesn’t warrant.

Working With What We Know

What made me think of this was an article in MedPage Today, an online medical news publication, in which the author, Dr. Vinay Prasad, addresses the question, “Do Lockdowns Work?”

Past plagues and epidemics, many far more deadly and infectious than the present one, have led governing authorities to adopt measures that have become familiar to us in the 21st century. They instituted strict border controls or blockades with quarantines for those arriving from infected regions. They used masks and social distancing. They confined the sick in their homes or moved them to hostels to protect the healthy. The big innovation of the present pandemic is the use across large areas or whole countries of “lockdowns,” a term taken from prison management, that both mandated business closures and issued stay-at-home orders for the healthy.

Since these lockdowns and related restrictions are causing immense damage to the livelihoods and mental health of those subjected to them, and since such measures will certainly be urged on governments when new pandemics strike, it’s natural that researchers and politicians want to know whether they work, how much, and at what cost.

Researchers, unless they are caught up in the exigencies of policymaking, seek to take the time and resources needed to gain assurance that their findings are as sound as they can make them. Even then, they report them with caveats about the limitations of the research and need for more of it.

Politicians don’t have that luxury. Like commanders in the field, they have to make decisions on the spot, on the basis of limited and often misleading evidence and guesswork. They often throw a bunch of “solutions” at the problem all at once, hoping that one will work. They have neither time nor patience for employing scientific principles of changing one variable at a time and comparing one group with another as a researcher would. As a result, we may never learn what, if anything, made a difference. And they have to, or certainly ought to, consider trade-offs and costs of getting it wrong altogether. If they’re in government, they’re under immense pressure from media and the public to do something. Even closing playgrounds or dog parks, or removing the rim from a basketball hoop may seem like it might help, though we likely will never know.

Do Lockdowns Work? How Will We Know?

In the case of lockdowns, defined as mandatory business closures and stay-at-home orders for the healthy, a scientific consensus may be reached, suggests Prasad. But we don’t have one yet (see one analysis by Eran Bendavid and colleagues in the European Journal of Clinical Investigation that finds no association of lockdowns with a reduction of infections and another by Jan Brauner and colleagues in Science (pdf) that does) and it will likely take years. The challenges to reaching such a consensus are enormous. Here are a few.

There’s bound to be a lag between instituting a measure and seeing a result, Prasad says. As with a vaccine, if we look too soon for an effect while infections or deaths are rising, we may miss the effect of the vaccine itself and see the surging infection that was already happening. If we look too late, we may be seeing the effect of other measures or of the natural waning of the pandemic.

As the New York Times reports, several prestigious universities, such as the University of California–Berkeley and the University of Massachusetts Amherst, have adopted extreme measures, not just to require mask-wearing outdoors when exercising, but to ban outdoor exercise altogether. The New York City subway system closes every night so that workers can perform a deep cleaning.

Such measures seem to have little or no scientific basis, but if they did how would we disentangle their effects from larger-scale lockdown measures in force at the same time? How would we tell whether it was the restrictions that made the difference we see, rather than the scaremongering of university administrators or the relentless alarmism of news media or politicians or their expert advisers?

Lockdowns, more extreme than wartime measures in their restrictions on civilian activity, depend like them on the buy-in of the populace and the culture, political climate, bordering states and border controls, as well as demographic factors such as household density, Prasad notes. That a nationwide lockdown works in New Zealand doesn’t mean it could succeed, or even be implemented, in the United States.

Support for drastic measures that run counter to the social, relational nature of our species may be strong in a moment of perceived crisis, but inevitably wanes over time, Prasad says. That a lockdown is accepted and complied with in April doesn’t mean it will work in December, especially if no end is in sight, the purpose is unclear, and the goal posts keep moving.

Facing Reality

I don’t follow Twitter, but Prasad, who does, observes that each day he sees “doctors, epidemiologists, or policy experts definitively proclaim what we ought to do.” There’s good reason for humility and tentativeness but little evidence of it in such pronouncements, he says. We have seen manifold failures to deal realistically with the pandemic, along with some important successes. There’s much to learn and apply to strengthen our preparedness for future pandemics.

There’s also a dismal record of bureaucratic failure and mission creep of agencies whose core purpose and reason for being is to prepare for a pandemic. That is, when a pandemic fails to materialize the agency shifts its attention to other issues to justify its existence, such as bullying and inequality in the case of the Centers for Disease Control and Prevention. Administrations lose interest, shift priorities, and shelve the planning efforts of their predecessors. Lessons have to be relearned each time.

Policymakers are damned if they take strong measures and damned if they don’t, and millions die. Mike Leavitt, Health and Human Services Secretary under George W. Bush, who was a leader in pandemic preparation in the first decade of the century, was mocked for urging preparation for a “pandemic” that petered out. He mused in April 2020, “In advance of a pandemic, anything you say sounds alarmist. After a pandemic starts, everything you’ve done is inadequate.”

Let us be humble, courageous, and charitable in the coming months and years as we prepare for the next pandemic, avoiding both complacency and hopelessness, both of which lead to passivity and inaction. But let us also be diligent in learning the lessons of the past. Among them are the responses that make it harder to learn anything—the panic and scattershot measures driven by the political need to be seen to be doing something, effective or not.

Paul Adams writes on ethics, marriage and family, and social policy. He is professor emeritus of social work at the University of Hawaii. He has also taught at Case Western University and the University of Texas.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.