The onset of the Covid-19 pandemic early in 2020 panicked many people, but Gabrielle Bauer was not among them. Bauer, a prize-winning Canadian author who has specialized in medical journalism, tells us that two stories emerged about Covid. One was that a virus threatened to kill millions of people and required drastic measures, such as lockdowns, to cope with it, disrupting the economy and radically restricting social life, if not doing away with it altogether. This story prevailed over the other one, which was that the virus posed a much more severe risk to some people, such as the elderly, than others, and that the value of the countermeasures needed to be weighed against competing goods. Bauer is a firm adherent of the latter story, and in Blindsight, she presents accounts of 46 people who all took issue with the worlds single-minded focus on stamping out a virus and the hastily conceived means to that end. These people include epidemiologists, public health experts, doctors, psychologists, cognitive scientists, historians, novelists, mathematicians, lawyers, comedians, and musicians (p. 8).
Those of us who did not want to follow the restrictions were often told that we had no choice: we must follow the science. As several of the people featured in the book remind us, this slogan embodies a category mistake: science is a descriptive enterprise and from it, no directions follow. The hematologist-oncologist and epidemiologist Vinay Prasad argues that even assuming a perfect pandemic science, a science that can predict with 100% accuracy which measures slow the spread and which measures dont, theres no such thing as following the science because policy is a human endeavor that combines science with values and priorities (p. 56, quoting Prasad).
One might object that this is true in an academic sensean ought does not follow from an is, at least in the opinion of most philosophersbut isnt the point trivial in the context of the pandemic? It doesnt follow from the chemical analysis of a substance as poison that one shouldnt imbibe it, but the case against doing so is in ordinary circumstances overwhelmingly strong. In like fashion, isnt it obvious that taking preventive measures against the Covid-19 virus, based on the available scientific evidence, was the correct policy?
The objection fails, and the reason it does is probably the most important lesson readers can draw from the book. And it is a lesson familiar to all economists: all choices involve trade-offs that call for balancing the relevant values against one another. These values are often intangibles, but the monetary costs of a measure need to be considered, along with its supposed benefits. The Indian economist Sanjeev Sabhlok, who now lives in Australia, wrote in March 2020 that the virus required a serious response but strongly advised against shutting down entire societies. Instead, we need a risk-based, data-driven approach that will minimise the spread of disease while facilitating economic activity.... Quoting Nobel laureate Vernon Smith, he pointed out that there is no such thing as a minimum risk policy defined only in terms of unweighted outcomes. Take away one risk and another one pops up, and we have to consider them all (pp.174175).
The costs of the lockdowns were very substantial indeed. There is more to human life than bare survival, as the Italian philosopher Gorgio Agamben reminds us, but governments throughout the world acted otherwise. People for long periods of time were not even permitted to bury their dead, though this rite of passage is basic to human society. The suspension of this and other civil liberties in a state of emergency is characteristic of dictatorial regimes. Though Bauer does not point this out, Agambens stress on the importance of the state of emergency in understanding the states grasp for power stems from the famous German jurist Carl Schmitt, whom he has studied extensively.
In some instances, people in their ordinary lives were treated in horrendous ways, and not only in the one-party dictatorship of China, where a vast country was subjected to a draconian shutdown. The distinguished journalist Glenn Greenwald recoils against the authoritarianism that comes with the territory of crushing a virus at all costs. Australia has gone insane on COVIDso far to extensive authoritarian impulses, that its hard to put into words at this point, he wrote in reaction to an Australian news clip showing police handcuffing young beachgoers (p. 201). Unfortunately, Greenwald points out, there are those who do not regard authoritarianism as a cost. But for some sectors of the liberal Left, this form of authoritarianismthe State controls your actions in the name of protecting youis appealing. (p. 201, emphasis in original).
One of the costs of a rigorous lockdown policy especially troubles Bauer. Children isolated from their friends have an increased risk of developing psychiatric disorders such as depression, and the closure of schools impedes their education. Though Covid cases among children have occurred, they are for the most part not seriously disabling. Why then are they isolated? It is claimed that doing so offers marginal benefits to the more vulnerable parts of the population; but this is to use the young as a means to aid the old, hardly what most people would regard as ethically mandated, to say the least.
As we have so far presented matters, the situation is this: Covid policymakers faced a choice between trying to control the virus though drastic measures and attending to competing values; and for the most part they chose the former course, unduly discounting the costs. But we must now add another consideration. It is by no means evident that the lockdown measures succeeded in having a substantial effect in preventing large numbers of deaths. Sweden adopted a much less restrictive policy than her Scandinavian neighbors but did not fare worse. In the words of the states epidemiologist Anders Tegnell, We have to find long-term distributions that keep the distribution of infections at a decent level (p. 152). According to Bauer, this policy has proved a success. The more time passes, the saner Swedens Covid policy starts to look. We can quibble about the fine points, but the tsunami of death predicted by the simulations never materialized. Within a year, Swedens all-cause excess deaths were back at zero (p. 155).
Mention of simulations leads to another vital issue covered in the book. Advocates of lockdowns often appealed to the precautionary principle, according to which Covid policy should be guided by the worst-case projections rather than the most likely ones. Without this principle, the case for drastic action is weakened. And there is a further point. According to Zeb Jamrozik, an infectious disease ethicist, lockdown advocates failed correctly to apply the precautionary principle to which they appealed. They considered only the worst case scenario for the spread of the Covid virus but ignored the worst-case effects of the restrictions they supported. What happened was an abuse of the precautionary principle, he [Jamrozik] told me when we chatted on Zoom. Our leaders used the principle to justify shutting down the world, without fully considering the dangers of doing that. They looked at the worst-case scenario for the virus, but not for the shutdowns. It is an irony of sorts (p. 66, emphasis in original).
Should one apply the precautionary principle when dealing with a pandemic, rely on more likely outcomes, or use some mix of projections, and if so what mix? That is a difficult question the book does not attempt to resolve, but if one does choose to use the precautionary principle, the case against the lockdowns seems even stronger than Bauer has set forward. She has described the actual damage resulting from the lockdowns, and this has been severe. But it is prima facie rational to apply a symmetry rule when assessing the risks of the Covid viruss spread against the costs of lockdowns: if the precautionary principle is to be applied to the first, it should also be applied to the second. In that case, we would have to use not the actual damage the lockdowns in fact caused, but the worst-case projections for this damage. Unless these worst-case projections turned out to be true, these estimates would be higher than the actual damage, and the weight accorded them by the precautionary principle would indeed have been crushing.
In this review, I have concentrated on what Bauer says about lockdowns, but she does not neglect ethical issues raised by vaccines, though these are not her primary concern. Unlike the medical paternalists anxious to suppress dissent from their policies, she is committed to the value of individual freedom in coping with medical emergencies. Pandemics should not cause us to lose sight of our rights.