Price of that Beer? Several Dead Grandparents

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
My fellow Americans- and to be ecumenical about it, my fellow humans- I have two questions for you. Do you have at least half a wit? And, do you have at least half a heart? If the answers are yes- you have at least half of each- then I contend it’s time to come out of opposing corners and meet in the middle of the COVID infodemic. Enough of the polarizing nonsense that passes for COVID policy debate in this country. Seriously: enough.
Three hands raising full glass beer steins and clinking them together to toast.

To the “lock it all down indefinitely” camp- I say enough. Do you truly not care how many people are thrust into poverty and desperation? How many dreams are crushed, educations set back, livelihoods destroyed? Do you truly not care about addictions, suicides, and child abuse– even if these devastations are failing to purchase any fewer COVID deaths, or alleviate hospital demand – because all the wrong people are being “protected”? Do you truly not care if more total people are hurt and killed by the combination of infections and haphazard interdictions? Do you really disagree with the objective of total harm minimization, of saving as many lives from loss and ruin as possible, whatever the specific pandemic-related causes of the toll?

Decency obligates a chorus of “no’s” to such questions, and I believe decency prevails, and that no ideology, party, or inclination owns the monopoly on it.

And you, the “let it all loose” camp- seriously? Do you truly not care if the price of that beer you enjoy in a crowded bar is several dead grandparents? Grandparents- yours, someone else’s, does it really matter? – who get COVID by proxy because you acquired it with your brew, and had no clear plans in place to avoid transmitting it to others.

Again, decency of the most basic variety obligates another chorus of “no’s.”

Well, then- enough.

I suppose it’s possible that membership in the “liberate my state, and join me for a beer” camp is born of genuine belief that COVID19 is no big deal, among people who have not seen a case for themselves. But do you disbelieve in terrorists because you’ve never been on a plane they commandeered? Do you disbelieve the harms of bullet holes through bodies because you haven’t happened to see anyone shot? Do you disbelieve the devastations of colon cancer, ALS, retinoblastoma, or…pick any agent of calamity – simply because they haven’t happened to you?

Let’s state it bluntly: you get no license to doubt the devastation of any given illness or injury just because it hasn’t happened to you…yet. For whatever it’s worth, I’ve been briefly to the front lines of the campaign against this contagion, and can personally attest that when it’s bad, it’s awful.

I suppose it’s possible that ordinarily thoughtful people actually and truly believe that the sky is now falling, and that any alternative to “lock it all down indefinitely” is callous disregard for humanity at best, willful genocide at worst. I suppose it’s possible, but I very much doubt it.

Far more likely is this: we have so far surrendered the inclination to listen and consider, that we disagree before doing either. The reflex- and it does indeed seem to function with the mindless pacing of reflex- is to scan for evidence that an opinion being expressed is the one we already happen to own. If yes, we listen further. If no, we spew opposing vitriol, declare the notion reprehensible, and go temporarily deaf.

My friends, enough of that. We are human, all; more alike than different. We love the people we love, and don’t want them hurt. We are all afraid of losing people we love to one thing or another. We all want to live the best versions of our lives. We all feel the same hurts, seek the same joys, have much the same skin in this game- that is no game.

It’s serious, and so we must be, too. Serious people listen. Serious people reflect. Serious people consider opinions they don’t already own, concede that going to extremes is an easy temptation that seldom serves a nuanced truth.

So again I say, enough. We cannot just “liberate” at random what we have contained, because that will kill people who would otherwise not die. We cannot just live in indefinite “lock down” either, because that will do exactly the same- just to a different set of people, and by other means.

Past reflexive vituperations and opposing disdain, there is a common objective of intrinsic merit: total harm minimization. We might have work to do establishing the operational definition of “harm” that satisfies us all. We would certainly have work to do mapping out the best methods of minimizing that metric. But this would be good work; this is work worth doing.

It will not begin if half of us only ever watch, and read, and hear the tales of COVID’s terrible toll, and in particular, the most alarming and tragic anecdotes, the most dire anomalies: deaths among children, severe disease among the formerly young and healthy, the fall of a front-line professional. These happen; they are tragic. But other kinds of tragedies happen every day, alas, in these same populations. Fixation through an endless sequence of news cycles on only COVID creates a distorted reality all its own, one in which the background noise of perennial human tragedy is denied, the importance of knowing the denominator – dismissed.

It will not begin if the other half of us single out COVID as the one projectile of outrageous misfortune that must fall on us, personally, before we concede it is real and worthy of respect. Chances are good you’ve lost no one you love to malaria; but chances are you accept just the same that malaria can kill. In case you are wondering, as I write this, that disease has taken over 360,000 lives so far this year– more to date, in fact, than COVID19; does so year after year; and among a generally much, much younger population. But that’s a discussion for another time.

Common ground consolidates the fullest measure of human potential. Common cause obviates the diffusion of our effort and will and ingenuity, concentrates these assets instead on a shared objective. That objective, I contend, is and has been all along– total harm minimization. Risk-based interdiction, informed by the best data we can procure, is means to that end. The many implementation details to be sorted out are best met with a strength born of the unity that eludes us, if we let it. Our strength is dissipated fighting one another, rather than the contagion.

We cannot prevent every last case of COVID19, or achieve a guarantee of zero risk of COVID death, without recourse to measures that will kill and ruin many more lives than they save. We cannot allow those at highest risk of severe COVID infection to be exposed when we have the means to protect them. We might hold these truths as self-evident, and hold them so, together.

I hope we do. Find me here, in the middle, under the banners of #TotalHarmMinimization and #VerticalInterdiction. Please fly these banners, too, in your social networks, if willing. Please join me here on the commons, while practicing the right suite of COVID precautions, and…I’ll buy the beer.

-fin   

This article was first published on LinkedIn.

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