Within the mirror of COVID-19: a vision of a better society.

Many years ago, during my PhD research, I audited a lively political theory seminar. As you’d expect, at some point, we discussed the ethics of health care.

From the outset, the conversation was framed by the assumption that health care resources are necessarily scarce. Society, it was assumed, would be crippled by the costs of health care, unless they were carefully rationed. The notion that we might organize society to make health care a top priority was characterized as absurd. Society, it was declared with table-thumping authority, must be organized around higher ideals than the good health of all. What are we, animals?

In the years since that seminar, it has seemed to me that most policy discussions about health care begin and end with very similar table-thumping assumptions about the nature of society, its highest aims, and the presumed scarcity of health care resources. Time and again, health care discussions begin with the assumption that we must do more with less, instead of discussing how we might do much more, if only we realigned our priorities. 

Fortunately, during a crisis like the COVID-19 pandemic, most everyone seems to understand that we have a duty to do everything we can to keep as many people as possible as healthy as possible. At a time like this, it is easy for most people to understand that society can’t function if everyone is ill, dying or dead. Moreover, people also seem much more willing to do much more to prevent all ill-health, suffering and death — perhaps, because the consequences are top-of-mind. Unfortunately, once the crisis passes, if past experience is any measure to go by, it seems likely that people will very quickly forget their present concern for the good health of all.  

It is important to remember, I think, that the costs of preventable ill-health, suffering and death are as real when they happen over time as they are when they happen in a wave. Admittedly, the high volume of health care needed during a pandemic is a unique challenge in its own right, but the actual suffering caused by preventable ill-health, suffering and death doesn’t disappear when it is spread over time. It may be less dramatic, more easily managed, and more easily hidden from view, but all of the costs remain: human, social, and economic.  

So, if it is true during a pandemic that we should do everything in our power to keep as many people as healthy as possible, I think, it should also be true when there is no pandemic to focus our attention. Our good health is the very foundation for everything else we value — whatever we might value.

I don’t care if you are financier, a poet or a small business owner, your pursuit of the good life is not possible without your good health and the good health of everyone else.

This pandemic, I hope, has reminded us of that fundamental fact. 

The good news is that this pandemic will eventually end. It will end precisely because we are making its speedy resolution our top social, political and economic priority. The bad news is that, once the crisis is over, we will likely fall back into that old habit of thinking that the good health of all is a priority easily trumped by other considerations, like the marginal tax rate of our wealthiest citizens. It is my hope, however fleeting, that our response to the COVID-19 pandemic will remind us that we can accomplish much, when we align our social, political and economic priorities to serve the good health of all.  In recent history, we have organized society for the sake of the power and privilege of a few “royal” families, to wage total war, and to maximize shareholder wealth. Perhaps, now is the time to organize society for the sake of the good health of as many people as possible.

I have no symptoms. I have locked myself down. You should consider it too.

I have no symptoms. I have not travelled recently. As far as I know, I have not been in direct contact with anyone who has travelled recently. The risk that I have COVID-19 is very low — almost nil. I have, nevertheless, by my own choice, locked myself down. I have not left my apartment since Monday evening. 

Why is that? 

The short answer: I want to be certain that I am not spreading the disease now and that I won’t spread the disease in the future. 

The key statement in the opening paragraph is “as far as I know.” Yes, I am probably not a risk to others, but the evidence seems pretty clear that people without symptoms or people with only mild symptoms are spreading the disease. When it comes time for me to leave my apartment — when it is essential for me to do so — the only way to minimize the chance that I am not a carrier is to self-isolate now. 

While this may seem a bit over-the-top, I need to take this step precisely because so many people who are at risk aren’t taking the pandemic seriously. People who appear to be healthy right now are out and about spreading the disease to other people who will also appear healthy long enough to spread the disease to others who will also appear healthy and so on. One of those people could be me for all I know. I am pretty sure I’m not infected, but, because those who are genuinely a risk aren’t playing their part, I can’t be sure. 

Fortunately, if I can go ten or twelve days without leaving my apartment, I will be pretty confident that I don’t have the virus and I won’t spread it. If I make it to fourteen days of self-isolation (the incubation period probably isn’t longer than fourteen days), I will be almost certain that I won’t put others at risk. For me, at this point in time, when most of my normal activities are already on hold, a couple of weeks in my apartment seems like a pretty small cost to pay for the certainty that I will be part of the solution and not part of the problem — a problem, I don’t hesitate to remind you, that will kill people. 

Practically speaking, I also suspect we are currently in a period of relative calm when the risk of infection is very high precisely because so many people aren’t taking the pandemic seriously. Once lots of people are sick and the hospitals are filling up to the breaking point, I am guessing that the risk of catching the virus in the community will be much lower because the sick will have no choice but to stay at home in their misery; healthy people who are a risk will hopefully recognize the tangible consequences of their actions and adjust their behaviour. 

Looking further down the road, I also want to be healthy when the storm finally hits — and it seems pretty clear that things will get very rough sooner or later. The only way to ensure that I am healthy enough to help others and to continue working is to self-isolate now. And again, to hammer the point home, if it is essential for me to leave my apartment to help others or for work after this period of self-isolation, I probably won’t be putting others at risk. That’s peace of mind that I’m willing to eat leftovers for.

I should also acknowledge that I am both lucky and privileged enough to be able to make this decision for myself. I can easily work from home, my employer officially encouraged all of its employees who could work from home to do so, and my job is about as secure as a job can be in these difficult times. If I am laid off, I also have enough savings that I should be able to weather the economic storm if I am careful. For the time being, I don’t know anyone who needs help or assistance on a regular basis. I have no prescriptions to fill. I have plenty of natural light in my flat, plenty of friends I can reach electronically, and I can workout easily in my apartment. By blind luck, in recent weeks, I even accidentally stockpiled some tasty cooking in my freezer. On Monday, to prepare for my solitary confinement, I only had to buy a couple extra bags of coffee (i.e. no hoarding required). Barring the unexpected, I should be able to stay isolated for another ten days easily or, at least, until it is essential for me to leave my apartment.  

And this is the key consideration: if it is essential that you go out, you absolutely should. No argument here. There are many legitimate reasons to break isolation both now and in the future. However, before you go out, ask yourself, “Is it essential that I go out today? Can I accomplish this task by some other means? Can I put it off until later?” If you can, please do. Additionally, please take whatever steps you need to take right now to minimize your reasons to leave your home in the future. Because the storm is coming, the time to prepare is now — not when it arrives. Now is the time to identify and solve the challenges of isolation while you are in good health and better spirits. Because sooner or later, either the government or the disease will make the decision to isolate for you. 

If you’ve made it this far but you are not entirely convinced that the time to self-isolate is now, please take a few minutes to read an article André Picard published today. Here, I think, is the key message:

As the number of infections rise, we need to behave as if we could all be infected, as if everyone around us could be infected. […] As the risks grow, our actions must accelerate. 

Ultimately, this isn’t about you or me. It’s about some of the most vulnerable members of our community, the front line workers who are going to do everything in their power to contain this storm when it hits, and the very real hope that we can get this pandemic under control. Taking action — even drastic action — is driven by the hope that our actions and choices can make a difference. To carry on as if nothing has changed is the stuff of despair — not hope. If, like me, you are lucky enough to be able to decide for yourself to self-isolate now or, at least, to minimize the time you spend out of your home, please do it now. There is very good reason to believe that this simple choice will help reduce the spread of the disease and make the time ahead easier for all of us.