COVID-19: The Endurance of Empathy

Self-isolation makes it feel like winter has come early to the Southern Hemisphere. I find myself hankering for stew and cornbread, rich, hearty things that fill me up and fortify me. The illusion has seeded itself so deeply in my mind that I put on too many layers before leaving to walk along the nearly empty tracks that weave through the reserve near my home. I return to the house sweaty, weighed down by the jackets and pullovers tied around my waist.

Winter is my favorite season. I like the sharpness of the air. I like burrowing down in the warm den of my bed in the brisk morning chill. But as with any season, part of winter’s charm is that it ends all too quickly. Self-isolation and social distancing make no such promise. With a vaccine more than a year away by the best estimates, it is likely that the global community will need to practice social distancing for months at a minimum. So I find myself asking, like any good Game of Thrones character might, what do I do now that the long winter is here?

Social distancing and self-isolation have been described as acts of empathy, because the majority of those who take part (which should be more or less everyone) are not at the highest risk of severe disease. But empathy, which Paul Bloom defines as “the act of coming to experience the world as you think someone else does” [1], and which I take to be a composite of compassion and understanding, is a challenge even in the best of times. It’s hard to bridge the gap between ourselves and other people, even those we love. It’s harder still to act on that empathy every day for weeks on end.

That’s why we see people, often young, healthy people, filling beaches and bars, taking a sledgehammer to social distancing [2,3]. As a group, their risk is much lower than for the elderly or the immunocompromised, and empathy—seeing the world as someone else does—is hard. That’s not because they’re selfish or immature (though of course, they may be those things as well), it’s because they’re human. And they don’t understand risk.

Risk a tricky thing. It’s hard to wrap your mind around because it relies on statistics, and humans—even statisticians, who despite their reputation are also humans—are terrible at statistics. As Michael Lewis explains in The Undoing Project, “Whatever human beings did when presented with a problem that had a statistically correct answer, it wasn’t statistics” [4]. Instead, we use our intuition, and our intuition often fails us.

Sometimes this is just a matter of not seeing the forest for the trees. When we hear that there is a 5% chance of something, it doesn’t immediately sink in that 5% is equal to 1 in 20. But on other occasions it’s a bit more complicated than that. When a public health official presents a risk—for instance, that there is a 13% chance of treading on bubblegum (in case it’s not clear, I have made this whimsical statistic up)—it is what we epidemiologists would call a population risk, a kind of average risk across a whole group. But population risk is only an estimate of our individual risk. Let me explain.

Imagine you go to your doctor and they tell you that you have a 13% chance of treading on bubblegum today. If they were being statistically honest with you, which is like regular honesty only more boring, they would say that you belong to a group of people whose overall risk is 13%. But, your doctor would go on to say, no one can measure your individual risk, the risk to you personally. So while your risk is likely to be around 13%, it might be 2% (1 in 50) or it might be 20% (1 in 5).

The same is true of COVID-19. That’s because there are too many factors at play in individual risk and not all of them are obvious or possible to measure. There are genetic factors, the predisposition you’ve inherited from your parents, unique to you. There are environmental factors, the things you’ve been exposed to over the course of your life, everything from sunshine to smog. There are lifestyle factors, like smoking or exercise. And there are health factors, like pre-existing conditions, some of which may be unknown to both you and your doctor.

The disconnect between individual risk and population risk is why some young, healthy people have become seriously ill from COVID-19. These people are unlucky, certainly. But they aren’t unlucky in a cursed-by-God kind of way. They are unlucky in a we-are-products-of-our-genetics-and-environment-and-we-don’t-have-much-control-over-either kind of way. This kind of bad luck isn’t a thunderbolt from on high, it’s a losing hand of cards; it isn’t randomness, it’s unmeasured risk.

Your risk of developing COVID-19 might not be equal to the risk for your age group. That is the population risk; it doesn’t belong to you. Your individual risk cannot be measured. It might be much lower or much higher than population risk, and there is no way to know for sure. Banking on the population risk to protect you is “gambling on chance and chance is on nobody’s side” [5].

That uncertainty—the fact that there is a non-zero chance that you are less like your peers and more like an 80-year-old asthmatic—narrows the gap between us. It makes it easier for us to imagine the world as other people see it, because there’s a real chance that we’re more alike than we know. The message is simple: we are all at risk and when we take action to save others, we are saving ourselves.

So long as our empathy endures, so do we.

References

  1. Bloom, Paul. Against Empathy: The Case for Rational Compassion. Penguin Random House, London, p.16
  2. Smee, Ben. Bondi beach closed after crowds defy ban on gatherings of 500-plus. The Guardian 21 March 2020. Accessed 22 March 2020. Available at: https://www.theguardian.com/australia-news/2020/mar/21/bondi-beach-closed-down-after-crowds-defy-ban-on-gatherings-of-more-than-500-people
  3. Chan, Tiffany. South Boston bars crowded Saturday despite calls for social distancing. CBS Boston 14 March 2020. Accessed 22 March 2020. Available at: https://boston.cbslocal.com/2020/03/14/coronavirus-south-boston-bars-crowded-social-distancing/
  4. Lewis, Michael. The Undoing Project. W.W. Norton & Company, New York City, p.157
  5. Camus, Albert. The Plague. Penguin Classics, London, p. 151

COVID-19: Lest We Forget That We Always Forget

New Zealand closed its borders yesterday. The Land of the Long White Cloud called its sons and daughters home, latching its door shut behind them like a parent ushering their children across the threshold as the day darkens. In a world of porous borders, it’s strange to be reminded that each of us belongs in a place.

There’s some comfort in it, some security in laying down roots and staking a claim to a piece of land. It gives you a kind of assurance—or is it insurance? As if, when everything goes to hell, you can sink yourself in your own sweet mud, a frog seeing out the winter. But there is a flipside to the bargain. A country quite literally is its people; it cannot live unless its people survive. That connection is what makes public health a matter of national security.

And so, the nations of the world debate what can be done and what should be done to curtail the spread of COVID-19. The world has broken apart into its constituent pieces, each one coming to its own conclusion. As of now, it’s unclear which countries have been bold enough to walk the tightrope successfully and which have made missteps. What is beyond doubt is that when you put all those puzzle pieces together, we as a global community are not prepared for pandemics. And if past performance is the best predictor of future behaviour, I’m afraid that there is no reason to expect that to change.

In his seminal work, The Plague, Albert Camus wrote:

The people of the town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate? They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine [1].

Camus lays out the problem clearly: part of living is ignoring the fact that we will die. That’s natural, even essential. It does not merit blame, only acknowledgement. But a side effect of this defence strategy, which protects us so well from distress, is that we lower our guard and leave ourselves vulnerable to attacks from other quarters.

The result, as it relates to pandemics, is a cycle of increased funding followed by relative neglect [2]. A disease emerges and spreads and we are afraid, and where our fear is, so goes funding. Then time passes and we forget, because forgetting lets us go on with our lives. Less fear, less funding.

This is not new. Following the Ebola epidemic of 2013-2016 (remember that?), there were calls for increased, sustained funding for pandemic preparedness [3], as professionals felt that the crisis highlighted gaps in our defences. But it is hard to stay focused on what seems like a possible threat when there are so many real and present dangers and only so many dollars to go around.

It’s true that over the short-term (1-4 years or so, the length of an elected official’s term in office), the threat of disease is merely possible. But over longer periods, say, a decade, an outbreak becomes a near certainty. I was born in 1987. In my lifetime, there have been at least 3 pandemics (AIDS (ongoing); H1N1influenza (2009-2010); and COVID-19), as well as several serious epidemics, including SARS and Zika virus. And yet, even with all this warning, the world wasn’t ready. All around us, governments, schools and businesses are developing plans on the fly. Lessons have not been learned because the fear doesn’t last. As recently as 2018 (just two years after an Ebola epidemic), President Trump dissolved the White House National Security Council Directorate for Global Health Security and Biodefense, one of the bodies in charge of pandemic preparedness at the federal level [4].

Rahm Emanuel famously said that we should “never let a serious crisis go to waste” [5], urging action when fear is the freshest in our minds. Abiding by that advice means taking definitive, long-term steps now to stave off the next pandemic. But how can we break the cycle and ensure that a boost in funding now doesn’t fall prey to later cuts? The only way is to place humans one step removed from the equation. Nations need to set aside a generous fund for pandemic preparedness in perpetuity with the appropriate checks and balances, eliminating annual budget debates. Spending should be scrutinized, but the allocation should be accepted as a given. That is the only way to insulate pandemic preparedness from the whims of lawmakers in less troubled times.

We need to establish a system that will shoulder the burden of remembering our fear. And we need to do it when we are most afraid. Because, lest we forget, we always forget.

References
1. Camus, Albert. The Plague. Penguin Modern Classics, London, England, p.30-31.

2. Yong E. The deadly panic-neglect cycle in pandemic funding. The Atlantic 24 October 2017. Accessed on 15 March 2020. Available at: https://www.theatlantic.com/science/archive/2017/10/panic-neglect-pandemic-funding/543696/

3. Burkle FM. Global health security demands a strong international health regulations treaty and leadership from a highly resourced World Health Organization. Disaster Medicine and Public Health Preparedness 9(5):568-580.

4. Cameron B. I ran the White House pandemic office. Trump closed it. The Washington Post 14 March 2020. Accessed 15 March 2020. Available at: https://www.washingtonpost.com/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html?fbclid=IwAR0TFwUNNFGx6U9zyQiK0MHwGKmj8abG-BusDcQbH-Wp5IHYuW82yA7U5ZU

5. Wikiquote. Rahm Emanuel. Wikipedia. Accessed on 15 March 2020. Available at: https://en.wikiquote.org/wiki/Rahm_Emanuel