With COVID, ‘normal’ is a relative term
On Nov. 12, the Journal reported that Presbyterian and UNM Hospitals had activated the state’s crisis standards of care plan, which, among other things, establishes a legal mechanism for allocating medical resources away from patients least likely to benefit.
On the same day, David Leonhardt’s morning newsletter for The New York Times recounted a conversation with Dr. Robert Wachter of the University of California, San Francisco.
Wachter, introduced as a COVID expert, “has begun to think about when most of life’s rhythms should start returning to normal. Increasingly, he believes the answer is: Now.”
Which, I guess, makes perfect sense if your definition of “normal” includes the potential denial of medical care.
In recent weeks, Idaho, Alaska and Colorado have also activated crisis standards of care. Would Leonhardt’s and Wachter’s feelings change if hospitals in San Francisco and New York followed suit?
Comparing the toll from COVID and flu, Leonhardt writes: “The bottom line is that COVID now presents the sort of risk to most vaccinated people that we unthinkingly accept in other parts of life.”
But, if COVID is only as dangerous as the flu, its endemicity represents a doubling of the risk posed to Americans by infectious respiratory diseases.
And to speak of the risk as if it’s the same for all vaccinated Americans is misleading. David Wallace-Wells writes in New York Magazine that “a vaccinated 80-year-old has about the same mortality risk as an unvaccinated 50-year-old, and an unvaccinated 30-yearold has a lower risk than a vaccinated 45-year-old.”
COVID’s drastic age skew, and the way it selects for people with preexisting health issues, forces citizens who consider themselves safe to decide what, if anything, they owe to their
more vulnerable fellow citizens.
Leonhardt suggests that “greater precautions make sense for vulnerable people.” That sounds modest and sensible until you think through what he’s actually proposing: a lockdown of indefinite duration, limited to the elderly and medically vulnerable.
He’s proposing to shift the burden of disease control away from the government and place it on the isolated individual.
And I do mean “isolated.” If COVID remains prevalent in a region, the only truly effective way for the medically vulnerable to shield themselves long term is by adopting isolation as a lifestyle.
There’s a precedent for that approach.
The single most illuminating book I’ve ever read about crime in America deals with the subject only indirectly. The book is “Heat Wave: A Social Autopsy of Disaster in Chicago” by Eric Klinenberg.
In July 1995, Chicago was blasted by a weeklong heat wave, with temperatures reaching 106 degrees. The urban heat sink effect meant nights provided little relief. Many apartments, in a city better known for frigid winters, lacked air conditioning.
By the time the heat finally broke, the city had recorded more than 700 excess deaths. But to label them heat deaths is a bit misleading. Temperatures were the same across the metropolitan area, but the deaths were heavily concentrated in just a few neighborhoods.
Those neighborhoods were poor and crime-ridden. Elderly residents, living alone, knew only too well how to protect themselves from crime. They kept their doors shut and carefully locked their windows at night.
They were victims not just of heat, but of their entirely rational fear of victimization.
You will always find someone ready to point out that, statistically, the elderly are the age group least likely to become victims of violent crime. That’s not because criminals are solicitous of age. It’s because old people, conscious of their frailty, take steps to protect themselves. Sometimes drastic steps.
Klinenberg met one woman who told him, “I go out of my apartment about six times a year.” She explained, “Chicago is just a shooting gallery and I am a moving target because I walk so slowly.”
She and many others like her protect themselves from crime by locking themselves away. It’s not too hard to imagine a similar future for people at the highest risk of COVID in the absence of effective public health measures.
When such politicians as Texas Gov. Greg Abbott and Florida Gov. Ron DeSantis battle against such measures, thundering against government overreach and the trampling of constitutional rights (that aren’t actually enumerated in the Constitution), they sound exactly like defense lawyers arguing for the suppression of evidence.
That’s not a coincidence. The belief that an intrusive government is the greater danger lies at the core of our legal system’s response to the social problem of violence.
Whenever someone says “we need to learn to live with COVID,” I think of all the other things we’ve learned to live with, such as the threat of criminal violence. Yes, it can be done. We can live with it. Well, a percentage of us can.