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Recalibrating Our COVID-19 Response

By Peter A. York
Peter A. York is a Ph.D. student in the Graduate School of Arts and Sciences.

For every “Joe Homebody” there is an Evel Knievel. Lost in current public discourse over how and when to end emergency stay-at-home and business closure measures are important human realities — our different internal orientations to risk and security. It is important and healthy to examine how one’s internal orientation toward risk informs one’s thoughts and actions. Similarly, it is essential to understand and acknowledge others’ preferences toward risk — especially when they have different default tendencies.

Balancing different preferences toward risk and security is one of the challenges of civil society. Speed limits, airport security, food safety laws, and licensing requirements all contain some internal compromise of risk and safety. That balance is achieved through a diffuse process that plays out over time through our laws, elections, culture, and watershed events.

The challenge of the present moment is that the ethical dimensions are not diffuse, but seemingly concentrated in the hands of civic leaders: If they release emergency stay-in-place orders and allow businesses to reopen, will they be complicit in the deaths that follow? There is a tempting logic in this proposition, but it denies the complexity of the current moment and the difficulty of balancing risk and security in more normal times.

Consider our tax dollars that finance the roads on which tens of thousands of Americans die each year. We clamor for improved infrastructure, but under the logic of complicity we should be advocating for its destruction! Highway deaths are an undesirable consequence of an otherwise excellent arrangement — the rapid, inexpensive transportation of goods and people throughout the country. Thus we make rules to minimize the risk: speed limits, licensing requirements, stiff penalties for driving under the influence, and the like. We could reduce highway deaths to zero by plowing the roads under, and yet we do not, instead choosing a mélange of policies to balance risk, safety, and public benefit.

This calculus is proving difficult in the present moment. In mid-March, there was broad consensus to act with “abundance of caution” and “flatten the curve” in light of the grim projections from Imperial College and others. Now that consensus is splintering, with our different orientations toward risk and security informing our preferred balance.

It is my hope that we can find a new consensus about how to move forward. The data unmistakably show who is most at risk (the elderly) and who is least at risk (the young and healthy). The difference is stark. The latest Massachusetts state data shows that the rate of death is 1,070 per 100,000 people within the 80+ age cohort and 236 per 100,000 people for the 70-79 year-old cohort, falling to two per 100,000 people for the 30-39 cohort and zero for the younger cohorts. As a reference, the level of risk to the middle-aged cohort of 50-59 year-olds, 18 deaths per 100,000 people, is comparable to that of dying in a motor vehicle accident (around 12 deaths per 100,000 people in 2019).

It is also worth understanding that the Imperial model that catalyzed stay-at-home orders and business closure in mid-March was based on much more pessimistic death rates than have actually transpired. The Imperial model predicted the death of 2.2 million Americans by the end of July, but the current total stands at around 79,500 deaths, nowhere near on track to meet that projection.

Given the data, it is not surprising that a majority (nearly 60 percent) of Massachusetts residents who have died from the virus have been in long-term care facilities. Clearly we need more aggressive containment and screening procedures to keep the virus out of these facilities. At the same time, we should move quickly to relax restrictions on the movement of the low-risk young and healthy, allowing them to return to work and school while minimizing transmission to vulnerable populations. For those in the middle, we should continue accommodation strategies such as remote work and meetings.

These preferences, of course, are imbued with my personal balance of risk and security, which tilts toward accepting risk. The important thing is building a new consensus; a good place to start is by acknowledging our own tendencies and being understanding of them in others.

Peter A. York is a Ph.D. student in the Graduate School of Arts and Sciences.

Correction: May 11, 2020

A previous version of this article incorrectly stated that the death rates in confirmed cases of COVID-19 were measured per 100,000 cases. In fact, the death rates in confirmed cases of COVID-19 were measured in rates per 100,000 people.

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