← Return to search results
Back to Prindle Institute

COVID-19

Posted on

Pathogenic Research: The Perfect Storm for Moral Blindness?

microscopic image of virus cells

In October, scientists at Boston University announced that they had created a COVID-19 variant as contagious as omicron (very) but significantly more lethal. “In K18-hACE2 mice [engineered mice vulnerable to COVID],” their preprint paper reported, “while Omicron causes mild, non-fatal infection, the Omicron S-carrying virus inflicts severe disease with a mortality rate of 80%.” If this beefed-up Omicron were released somehow, it would have had the potential to cause a much more severe pandemic.

The National Science Advisory Board for Biosecurity has now released new guidelines which seek to strike a significantly more cautious balance between the dangers and rewards of risky research involving PPPs — potential pandemic pathogens. The previous standards, under which the Boston University research was allowed to be conducted without any safety review, were, according to the NSABB, reliant on definitions of a PPP that were “too narrow” and likely to “result in overlooking… pathogens with enhanced potential to cause a pandemic.” (The researchers at Boston University claimed their enhanced COVID-19 variant was marginally less deadly than the original virus, and hence that they were not conducting risky “gain of function” research requiring oversight. But this argument is flawed since the deadliness of a virus with pandemic potential is a function of the combination of infectiousness and deadliness. Since the novel variant combined close-to-original-COVID-19 deadliness with omicron infectiousness, the novel variant is likely significantly more dangerous than the original strain.)

Experiments like these are not merely a question of public policy. Apart from the legal and regulatory issues, we can also ask: is it morally permissible to be personally involved in such research? To fund it, administer it, or conduct it?

On the positive side, research with PPPs, including some forms of the heavily politicized “gain-of-function” research, promises valuable insight into the origins, risks, and potential treatment of dangerous pathogens. We may even prevent or mitigate future natural pandemics. All of this seems to give us strong moral reasons to conduct such research.

However, according to Marc Lipsitch and Alison Galvani, epidemiologists at Harvard and Yale, these benefits are overblown and achievable by safer methods. The risks of such research, on the other hand, are undeniable. Research with dangerous pathogens is restricted to the safest rated labs. But even top safety-rated BS-3 and BS-4 research labs leak viruses with regularity. The COVID-19 lab leak theory remains contentious, but the 1977 Russian flu pandemic was very likely the result of a lab leak. It killed 700,000 people. Anthrax, SARS, smallpox, zika virus, ebola, and COVID-19 (in Taiwan) have all leaked from research labs, often with deadly results. One accident in a lab could cause hundreds of millions of deaths.

Given the scale of risk involved, you might ask why we don’t see mass refusals to conduct such research? Why do the funders of such work not outright reject contributing to such risk-taking? Why does this research not spark strong moral reactions from those involved?

Perhaps part of the reason is that we seem particularly vulnerable to flawed moral reasoning when it comes to subjects this like this. We often struggle to recognize the moral abhorrence of risky research. What might explain our “moral blindness” on this issue?

Stalin supposedly said, “One death is a tragedy. A million deaths is a statistic.” Morally, he was wrong. But psychologically, he was right. Our minds are better suited to the small scale of hunter-gatherer life than to the modern interconnected world where our actions can affect millions. We struggle to scale our moral judgments to the vast numbers involved in a global pandemic. Moral psychologists call this effect “scope neglect” and I discuss it in more detail here.

When a lab worker, research ethics committee member, or research funder thinks about what might go wrong with PPP research, they may fail to “scale up” their moral judgments to the level needed to consider the moral significance of causing a worldwide pandemic. More generally, research ethical principles were (understandably) built to consider the risks that research poses to the particular individuals involved in the research (subjects and experimenters), rather than the billions of innocents that could be affected. But this, in effect, institutionalizes scope neglect.

To compound this clouding effect of scope neglect, we tend to mentally round up tiny probabilities to “maybe” (think: lottery) or round them down to “it will never happen” (think: being hit by a meteorite while sleeping, the unfortunate fate of Ann Hodges of Alabama). Lipsitch and Inglesby’s 2014 study gives a 0.01-0.6% probability of causing a pandemic per lab worker per year to gain-of-function research on virulent flu viruses.

But rounding this probability down to “it won’t happen” would be a grave moral error.

Because a severe pandemic could cause hundreds of millions of deaths, even the lower-bound 0.01% risk of causing a global pandemic each year would mean that a gain-of-function researcher should expect to cause an average of 2,000 deaths per year. If that math is even remotely close to right, working on the most dangerous PPPs could be the most deadly job in the world.

Of course, we don’t act like it. Psychologically, it is incredibly hard to recognize what is “normal” as morally questionable, or even profoundly wrong. If your respected peers are doing the same kind of work, the prestigious scientific journals are publishing your research, and the tenure board are smiling down from above, it’s almost impossible to come to the disturbing and horrifying  conclusion that you’re doing something seriously unethical. But if the risks are as severe as Lipsitch and Co. claim (and the benefits as mediocre) then it is difficult to see how working with PPPs could be ethically defensible. What benefit to the world would your work have to provide to justify causing an expected 2,000 deaths each year?

Even putting the ethical debate to one side, extreme caution seems warranted when debating the morality of lab research on PPPs. It is a topic that could create the “perfect storm” of flawed moral reasoning.

Posted on

Taking Pleasure at the Ultimate Self-Own?

photograph of Herman Cain

Does Reddit.com’s r/HermanCainAward wrongfully celebrate COVID-19 deaths? To some, the subreddit is a brutal, yet necessary look at the toll of vaccine misinformation and the deaths that follow. To others, it is a cesspit of schadenfreude (taking pleasure in the pain of others) that has few, if any, redeeming qualities.

The description of the popular forum reads: “Nominees have made public declaration of their anti-mask, anti-vax, or COVID-hoax views, followed by admission to hospital for COVID. The Award is granted upon the nominee’s release from their Earthly shackles.”

An average post contains multiple screenshots of social media posts made by someone who expresses anti-vax views followed by screenshots of friends or family members reporting on the person’s sickness with COVID and, often, subsequent death. The victim’s social media posts are usually right-wing and often feature conspiracy theories as well as a set of common memes.

Outside of the nominations, one can find community support posts as well as “IPAs” or “Immunized to Prevent Award” posts, in which users report getting vaccinated after witnessing the horror presented in the forum. There are also “Redemption Awards” for those who change their minds about the vaccine, often as they are dying. (Last fall, the subreddit changed its rules to require that all names and faces of non-public figures be redacted.)

The Herman Cain Award is named after Herman Cain, a Black Republican who ran for president in 2012 and co-chaired “Black Voices for Trump” in the recent election cycle. Cain, who had prior health issues, opposed mask mandates and attended a Trump rally in Tulsa on June 20, 2020, where he was photographed not wearing a mask in a crowd of people not wearing masks. Shortly after, Cain tested positive for COVID and was hospitalized. Cain died from COVID six weeks later at 74 years of age.

To gain a better understanding of the rich, ethical dimensions the subreddit presents, there are a few questions we should ask: What is the narrative of HCA posts, and what feelings do these narratives engender? Do HCA posts, taken as a whole, accurately reflect the world around us?

Let’s start with the narratives. Perhaps the most obvious one is a narrative of righteous comeuppance. HCA nominees and winners have endangered not only themselves but also others, and they have reaped the consequences of their actions. This seems to be the primary lens of HCA viewers, who often make posts venting about the harms of anti-vax sentiments and actions.

This narrative tends to produce a sense of righteousness and stability, along with reassurance of one’s experience of the world and the moral responsibility that nominees bear. This sentiment acts as a counter to gaslighting resulting from widespread denial of the reality of the pandemic, perhaps expressed by close friends and family.

The second narrative lens appropriate for HCA content is tragedy. This is not necessarily distinct from the first lens, but it emphasizes more strongly the unnecessary suffering caused by the pandemic and our collective response to it. This lens, perhaps more than the first, encourages us to see HCA nominees as persons whose lives have value.

Pity might be too much to expect, given that the nominees are facing the consequences of their own actions, but the tragic reading does produce genuine horror at the suffering that could have been prevented. At best, this horror keeps us alive to the value of the lives lost. At worst, it devolves into a numbed-out nihilism, as we can no longer bear the burden of moral harms witnessed. It’s very easy to doom-scroll through r/HCA posts and lose hope at the possibility of change.

The third narrative is less noble than the first two. This is the narrative of the self-own — with motives that are tribal, petty, and wishing ill upon those who purport to make the pandemic worse. It is a narrative we might easily slip into from the first. This variant cares less about what is fair or appropriate and more about being right or superior. We might be especially worried about this, as the subreddit feeds off of other polarized dynamics that arise from tribal divides on the left/right spectrum. This, I believe, is the narrative that has primarily concerned those who have written against r/HermanCainAward, contending that it produces schadenfreude.

But what is troubling here is not merely pleasure in the pain of others but something stronger: pleasure in the death of others (and if not death, then extreme physical distress). Is it ever permissible to take pleasure in the death or pain of others? It seems acceptable to take comfort in knowing someone can no longer do any harm, but a preventable death is a bad thing that we should never see as good.

If we take pleasure in the deaths of others, we must either take up some view on which their death is deserved and proportional to their crimes or else discount the value of that person’s life. Neither is an attractive option. Even if nominees have caused the deaths of others by spreading the virus, it is a strong view to claim that their own deaths are deserved because of their actions. And assuming that their deaths were deserved, it still might seem unsavory to take pleasure in their punishment. But the predominant kind of gratification appears to fall into the category of feeling somehow superior to those who are dying. Self-satisfaction at the downfall of others is rather ugly.

These critiques do not rule out righteous anger or the recognition that r/HCA nominees have flouted moral requirements. But they do require that we not reduce them to faceless, nameless monsters that lose their humanity when relegated to a series of memes. The Reddit.com rule changes actively made this aspect worse, even if they helped to prevent doxing.

Does r/HCA currently represent the reality of vaccine denial? The answer seems to be no. The posts that receive attention on r/HCA are for those who are hospitalized and sometimes die from the virus, but there are other unvaccinated individuals who have relatively mundane experiences of the virus. Yes, the unvaccinated are significantly more likely to die, but r/HCA displays the same kind of data skewing as the programming on The Weather Channel — the most extreme cases are given the most attention.

Is there some version of r/HCA that could preserve its prosocial functions and avoid its morally problematic elements? Perhaps, but it would look drastically different from the current subreddit. First, the subreddit would need to include more representative individual stories that capture the variety of experiences of those living through a pandemic. Second, the people featured would need to be more humanized, with more details about their lives included beyond their online, meme-sharing activities. Third, the community should be reworked so it is not constructed in an us-vs.-them dichotomy, where pro-vaxxers are unequivocally the good guys and anti-vaxxers are unequivocally the bad guys.

Would the subreddit be as popular if it were reconstructed in that way? Probably not. But we might start to see each other as human again.

Posted on

The Heartless Matter of Organ Transplantation and COVID Vaccination

photograph of surgery

Boston’s Brigham and Women’s Hospital has removed one of its patients from its transplant list because he refuses to get the COVID-19 vaccination. 31-year-old DJ Ferguson, who suffers from a hereditary heart issue that causes his lungs to fill with blood and fluid, had previously been prioritized for a life-saving heart transplant. However, according to his family, he has been removed from the transplant list due to his vaccine hesitancy. DJ’s father, David Ferguson, said, “[i]t’s kind of against his basic principles; he doesn’t believe in it. It’s a policy they are enforcing and so because he won’t get the shot, they took him off the list [for] a heart transplant.” DJ’s family are currently considering moving him to another facility but are unsure whether he would survive the trip.

The fair distribution of scarce resources has been an issue throughout the pandemic. For example, in its early days, there was considerable discussion about distributing life-saving ventilators when the number of people needing them outstripped hospital reserves. States such as Alabama, Kansas, and Tennessee all produced guidance recommending, suggesting, or explicitly stating that a patient’s disability status could be considered a reason to withhold — or even withdraw — ventilation. In other words, they deprioritized the disabled in favor of the non-disabled. This problem has, to a degree, eased with the development of effective vaccines and the production of more ventilators.

However, unlike ventilators, we cannot simply manufacture more bodily organs, such as hearts (at least, not yet). The supply of hearts is dictated by how many people donate them. Unlike other donatable organs, like kidneys or livers, donating a heart isn’t something one can do as a kind act during their lifetime. If you’re donating your heart, you’re already dead. As such, hearts are incredibly precious resources. They possess value born from the life that the donor no longer lives and the organ’s potential for its recipient – heart transplantation both takes and awards life.

Because someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ. Giving such a vital and scarce resource to someone who would treat it improperly squanders its potential and disrespects the person who donated the organ. Turk, from the sitcom “Scrubs,” summarizes this well when he refuses to perform surgery on another character’s longtime patient when he finds out that the person has continued to drink, saying:

Dr. Cox, I know it’s really hard on you medical guys, because you spend most of your time with your patients and you get emotionally attached. But as a surgeon, the person I’m closest to is the guy who’s giving us the liver, because it’s a gift, and I think it’s important that it goes to the person that’s proven they’re up to the responsibility.

While the phrase ‘responsibility’ clouds the water here somewhat, the general message remains the same: some people are more deserving of organs than others. While we may wish to save everyone, this isn’t possible given the global shortage of organs. Roughly 17 people die each day because of a lack of organs in the U.S. alone. So for each person who receives an organ, there are numerous others deemed less worthy who must miss out.

In “Scrubs,” it comes down to a matter of responsibility and the ability of potential recipients to demonstrate they will treat the organ with the regard it demands. In a sense, they have to earn that organ. In DJ Ferguson’s case, the point of contention is slightly different. As Arthur Caplan, Head of Medical Ethics at NYU Grossman School of Medicine, states, “Organs are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving.” So, the concern here isn’t whether Ferguson’s shown he is responsible enough (although you could make a case that his actions demonstrate he isn’t). Instead, it is simply a matter of maximizing outcomes and minimizing risks. Being vaccinated against COVID-19 means you’re less likely to die from the disease, and a reduction in this risk improves the chances of getting the best ‘value-for-money’.

Pinning so much on the vaccination status of a potential organ receipt might strike some as odd. After all, there are countless ways to act that might jeopardize an organ’s recipient but which would seem unreasonable to use as exclusion criteria (denying a transplant to someone who enjoys extreme sports, for example). However, it is essential to remember that individuals are at substantial risk from infections post-transplantation as their immune systems are compromised. This is because the body’s immune system sees donated organs as a foreign entity that must be destroyed, causing organ rejection. To help prevent this, organ recipients take drugs to suppress their immune systems. While allowing successful organ implantation, it means that the recipient is at greater risk from infections. Even something as innocuous as a cold can be fatal, and the same goes for COVID-19. With this increased risk comes an accompanying increase in the threat posed to the positive outcome of transplantation. Therefore, a vaccinated person is a much less risky investment than a non-vaccinated person. Given our interest in maximizing the benefits someone will receive from a donated organ, it seems reasonable (even prudent) to make vaccination a requirement for anyone to receive an organ.

David Ferguson has said his son “is fighting pretty damn courageously, and he has integrity and principles he really believes in, and that makes me respect him all the more… It’s his body. It’s his choice.” David may be right. His son may indeed be acting bravely by exercising his right to bodily autonomy in a dire situation, which might make him deserving of respect. But this does little to change the fact that, when deciding who should receive a heart transplant, DJ is a risky investment. If we’re concerned with making sure that the consequences of a transplant are as positive as possible — “positive” meaning conferring the most amount of life — a person’s choice to be unvaccinated must be taken into consideration.

Posted on

Boris Johnson and the Hypocrisy of Lawmakers

photograph of Boris Johnson making a face

There is something ridiculous about the idea that Boris Johnson might have to resign for hosting a few parties. You might think that it is his policies, or his saying he’d rather “let the bodies pile high” than institute further lockdowns, that should see him go. But parties?

The problem with these gatherings is that they violated COVID regulations, regulations set by Johnson and his party. And the fact that he violated his own decrees (nobody takes seriously his claim that the parties were, in fact, work events) raises an interesting question: what’s so wrong about lawmakers breaking the law?

The first obvious, but bland, answer is that – in a fair legal system – breaking the law simply is wrong, and it’s wrong for lawmakers to break the law in just the same way that it is wrong for anybody to break the law.

This might be a reasonable explanation for why it is wrong for lawmakers to break some laws. For instance, if a lawmaker breaks the speed limit, that seems bad in the same way as if an ordinary member of the public breaks the speed limit. This isn’t just because it is a minor offense. If a member of parliament went and murdered someone, it would be a grave moral wrong, but I don’t think there would be anything especially wrong about it.

In these cases, the wrongness involved is simply the (appalling or minor) wrongness of breaking the law. But there seems to be something especially bad about Johnson’s behavior.

What I think is key is that there is something more involved when a lawmaker breaks a law they have set. Gideon Yaffe has an interesting argument that could lead to this conclusion. He thinks that, since the law is created by citizens in communities, we are complicit in the creation of these laws. But some people are more complicit than others. For instance, kids aren’t very complicit at all in creating the law (since they can’t vote). Yaffe thinks that the more (or less) complicit one is in creating a law, the stronger (or weaker) that law’s reasons apply to you, and the more strongly (or weakly) you should be punished for violating it. And someone like Johnson was maximally complicit in setting England’s COVID laws.

But I’m not sure I’m persuaded. I simply do not buy Yaffe’s “complicity” argument: I don’t see why we need to suppose that the more say someone has over the law, the more it binds them. And I think there is something to be said for the idea that we are all equal before the law: politicians should be punished, but they shouldn’t face any harsher legal punishment than Joe Bloggs.

It’s also important to note that there isn’t really a push for Johnson to see legal punishment. Although some people want to see that, the real focus is on him facing a political punishment. They want him to resign in disgrace. And I think that what explains this pressure is that Johnson has shown that he cannot take his own laws seriously – and taking the law seriously is the point of being a politician.

We can get to this idea by thinking about hypocrisy. Hypocrisy is problematic in politics because it undermines how seriously we take someone. During the 1990s, John Major’s government had a campaign called “Back to Basics,” which aimed to underscore the importance of traditional values like “neighbourliness, decency, courtesy.” Inevitably, Major’s cabinet was then beset by scandal.

The behavior of Major’s cabinet suggested that they did not take these values very seriously. But this was a moral campaign, the difference that compounds Johnson’s case is that his hypocrisy involves the laws he set.

Johnson was not just a hypocrite, he was a hypocrite about the laws he set, laws which are supposed to protect the public. To return to an earlier example, there might not be anything especially wrong if an ordinary lawmaker speeds, but a lawmaker elected on a platform of making the roads safer might do something especially wrong because they are being a hypocrite. By being a hypocrite, this lawmaker shows that she does not – despite her claims – really take speeding laws seriously, she does not act as though they are important. Likewise, by attending parties, Johnson showed that he did not take these laws seriously, and – if the purpose of the laws is to protect the public – he showed that he did not care about protecting the public.

(Alternatively, he showed that he thinks he is special, different from the rest of us: that he can party whilst his laws stop grieving relatives from saying goodbye to their loved ones. I’ll set aside this possibility.)

Johnson (as well as the hypocritical speedster) demonstrated a lack of care about the underlying issues: protecting the public (or keeping to the speed limit) is not important to him. But it also strikes at the strength of this law. Our system of law is not supposed to be simply a matter of force, where the most powerful get the least powerful to comply with what they want. Rather, the law is supposed to provide us with genuine reasons to act, that are somehow linked to the good of others in our community. Nowhere is this more clear than with attempts to curb the ravages of COVID-19.

Everywhere, there is skepticism about COVID-19 laws. They inherently curb our freedoms. By not taking COVID-19 laws seriously, Johnson suggested that the laws are not to be taken seriously. But it is only by taking good laws seriously that they remain good laws, laws which govern us as rational agents rather than as those merely fearful of greater power.

That is why Johnson is under political pressure to resign: Johnson has shown himself incapable of taking seriously the laws he creates, which is the entire point of being Prime Minister. His behavior undermined the justification of the laws he set.

Posted on

Aaron Rodgers, “Critical Thinking,” and Intellectual Humility

photograph of Aaron Rogers in football uniform with helmet

NFL quarterback Aaron Rodgers made headlines recently when he was sidelined for having contracted COVID-19 and it became public knowledge that he has not been vaccinated. While Rodgers is far from the only unvaccinated NFL player, controversy ensued when it came out that he had misled reporters and the public into thinking that he had, in fact, been vaccinated. Rodgers stated that he has been “immunized,” something which many took to mean that he had been vaccinated, but really meant that Rodgers sought alternative treatments, including the thoroughly-debunked ivermectin, and defied the advice of trusted experts in lieu of that of Joe Rogan.

While there is plenty to be worried about when it comes to Rodgers’ situation – he is actively spreading misinformation about the safety of vaccines and the efficacy of alternative treatments, he is a public figure and role model and thus has a greater responsibility that comes with having greater influence, etc. – something stood out when he was explaining why he had chosen to mislead reporters about his vaccination status. While Rodgers claimed that he was worried about the repercussions of the “woke mob” and “cancel culture,” he also justified his actions by stating that, “I’m not, you know, some sort of anti-vax flat-earther. I am somebody who is a critical thinker.”

In labeling himself a “critical thinker,” Rodgers and those like him are attempting to avoid being targets of criticism, while at the same time presenting themselves as rational inquirers who have happened to have reached conclusions that diverge from the scientific consensus. Given that rational inquiry and independent thinking seem like generally good things, self-proclaimed critical thinkers might then feel persecuted for having their views rejected and mocked.

You’re supposed to think critically! Shouldn’t we encourage critical thinking, and doesn’t the “woke mob’s” refusal to even engage with divergent views from those such as Rodgers represent some kind of failing as rational thinkers and inquirers?

In thinking about these questions, we need to get clearer on what it means to be a “critical thinker.” When we think about being a “critical thinker,” we might also think about being intellectually virtuous: possessing character traits or dispositions that lead someone to effectively pursue the truth, acquire knowledge, and gain understanding. In other words, just as there are traits that are typically representative of morally admirable people – for example, being generous, kind, empathetic, etc. – so, too, are there traits that are representative of being intellectually admirable. These might include traits like being open-minded, curious, and honest, among others. There’s no definitive list of all the virtues out there, but a good place to start when thinking about virtues is to think about smart people we really admire, and to see what kinds of traits they possess.

One such trait that we might associate with our intellectual idols is being a critical thinker. Indeed, some have come out in support of Rodgers, and have expressed admiration of the way he has inquired into issues surrounding COVID-19 vaccines. However, many of those using the term seem to be conflating two senses of “critical thinker,” one which is intellectually virtuous and worthy of guiding our inquiries, and one which is not.

The sense in which Rodgers, and many of those he has associated with, use the term seems to be one in which “critical thinking” means thinking independently: one pursues the truth on one’s own (or else in conjunction with a small group of other “critical thinkers”), often in such a way as to challenge a dominant view. When thinking about which intellectual traits are good ones, these kinds of critical thinkers might look to admirable intellectual figures throughout history, perhaps ones who have made significant scientific progress by rejecting the intellectual authorities of their day. In this sense, “critical thinking” is really a kind of critical thinking, insofar as one looks primarily to criticize consensus views.

The problem with being a critical thinker of this variety, however, is that it can come at the expense of other intellectual virtues. For instance, one important intellectual virtue is that of humility: one needs to be able to recognize what one knows and is capable of finding out, and not try to tackle problems one does not have the training or capacity to meaningfully contribute to. While it is, of course, worthwhile to learn new things, part of being intellectually humble means recognizing when one needs to listen to others.

For example, I have a passing interest in cosmology, but have no formal training in the physics of black holes. It would not, then, be intellectually humble of me to challenge trained scientists on their views just because they don’t align with my pet theories: it wouldn’t help make any progress, and I wouldn’t be any closer to gaining any new knowledge or understanding. What I should do in such a case is listen and learn.

There are certain kinds of critical thinking, then, which may very well be bad for one’s intellectual character. This is not to say that we always need to simply accept what we are told by people who apparently know better. Rather, it means that we need to be able to evaluate the areas in which we could help make a contribution and the ones in which we simply need to listen to what people who know better are saying. It is not always easy to do this. Regardless, while those like Rodgers might want to distance themselves from conspiracy theories and claim that his dissent from the recommendations of doctors, scientists, and the NFL is the result of some rational inquiry, the kind of critical thinking he is engaged in is not the kind of intellectual trait that one should admire.

Posted on

Ethical Considerations in the Lab-Leak Theory

3D image of Covid-19 virus cells

President Biden announced recently that he would be launching an investigation into the origin of the coronavirus. While the standard narrative over much of the course of the pandemic has been that it was initially transmitted to humans via contact with animals in Wuhan, China – thought by many to be bats, although there have also been theories that pangolins could have been involved – a second possibility has also been entertained, namely that the virus originated in a virology lab. Indeed, this was one of the favorite theories of Donald Trump, who, on several occasions, simply stated that the virus originated in a lab, although he failed to provide any evidence for his assertions. The so-called “lab-leak” theory soon took on the status of a conspiracy theory: it was explicitly rejected by numerous scientists, and its association with Trump and other members of the alt-right greatly hindered any credibility that the theory may have had within the scientific community. With Trump out of office, however, questions about the plausibility of the theory have resurfaced, and there has been enough pressure for Biden to open the investigation.

Should Biden have opened his investigation into the lab-leak theory? While it might seem like a question that can be answered by considering the science – i.e., by looking at whether there is good evidence for the theory, whether expert scientific opinion considers it a plausible hypothesis, etc. – there are other ethical factors that we should consider, as well.

Here’s one sense in which it seems that such an investigation is worthwhile: it is always worthwhile to try to learn the truth. Now, there are a lot of truths that we might think really don’t add that much value to our lives – I can spend a lot of time counting the number of blades of grass on my lawn, for example, and at the end of a very long day will possess a shiny new true belief, but hardly anyone would think that I had spent my time wisely. The COVID-19 pandemic, however, is of substantial importance, and so learning about where it came from may seem like an investigation that is worth pursuing for its own sake.

At the same time, there are also potential practical benefits to learning the truth of the matter about the origin of COVID-19. The pandemic has raised many questions about how we should react to the next one, and what we can do to prevent it. Making sure that we have the correct theory of the origin of the virus would then no doubt be useful when thinking about responses to future outbreaks. So here are two points in favor of conducting the investigation: we can learn the truth of something important, and we might be able to become better prepared for similar events in the future.

However, there are also some potential drawbacks. Specifically, there have been concerns that, especially during the previous administration, the impetus for discussing the lab-leak theory was not an attempt to make sure that one’s science was correct, but to find a scapegoat. The theory comes in two different forms. According to one version, the virus was intentionally released from the lab, for whatever reason. If this were to be the case, then there would be a definitive place to direct one’s blame. This version of the theory, however, falls predominantly within the realm of conspiracy theory. The other, more popular version states that while the virus originated in a lab, its transmission into the surrounding population was an accident. Even if this is the case, though, it would seem to represent an act of negligence, and thus the lab, the scientists, and the government would be blameworthy for it.

One of the early criticisms of Trump’s endorsement of the lab-leak theory was that given that it was driven by the search for someone to blame instead of a theory that was best supported by evidence, he was fanning the flames of anti-Asian racism. Indeed, by insisting on the truth of the theory without evidence, as well as consistently referring to the coronavirus as the “China virus,” incidents of anti-Asian racism increased during the course of the pandemic in the U.S.

Here, then, is a concern with Biden’s investigation: opening an official investigation into the lab-leak theory gives legitimacy to a view that has been considered by many to be little more than a conspiracy theory, which may again result in an increase in incidents of anti-Asian racism. Given the potential ethically problematic results of the inquiry, we can then ask: is it worth it?

What is perhaps encouraging is that Biden’s investigation seems to be motivated more by dissent within parts of the scientific community than by the political search for a scapegoat. We might still be concerned, however, that people will not be good at distinguishing versions of the theory under consideration. As noted above, there are two versions of the lab-leak theory, one more distinctly conspiratorial than the other. However, by giving credence to the view that the virus accidentally leaked from the lab, one may instead interpret this as giving more credence to the other.

This is not to say that the investigation is a bad idea. Instead, it should remind us that inquiry is never conducted in a vacuum, and that which questions are worth investigating may depend not solely on the evidence, but on the ethical consequences of doing so.

Posted on

Time to Let Up or Double Down?

photograph of woman with face mask sitting in large, empty street dining area

Rollout of COVID-19 vaccines represents a significant step in combating the pandemic, one that will likely alter people’s behavior to this global health crisis in significant fashion. With a vaccine on the horizon, risk assessment can change in two very different ways:

On the one hand, it can alter the risk associated with individual behaviors. For instance, with a risky behavior, the prospect of safety can reduce the perspective of associated risk. Here we could think of jumping out an airplane, which seems less risky because there is a parachute. With a vaccine in circulation, taking one’s chances with exposure can seem a more reasonable thing to do. Vaccination will (hopefully) mean there will be fewer people contracting it, lowering the impact on the societal concerns overall. This means risk is assessed in short-term frames: if every risk of exposure over 4 months compares to 12 months, one could think that they might as well lighten restrictions.

On the other hand, the prospect of a vaccine can alter the way we assess risk in a long-term context. When fighting a disease with a radical course of treatment, having an indeterminate time frame versus a given length of time to “push through” makes a great deal of difference. When the end point is unclear, it makes sense to consider harsh conditions unrealistic or unreasonable. In less dire cases, say a highly demanding and stressful workload at work, the expected length of time makes a significant difference in deliberation. Altering the long-term structure of your life around such demands can seem less than feasible, and compromises in meeting those demands can make a great deal of sense. It can make less sense, on the other hand, if the heightened demands are only for a short period of time and come with an important payoff.

With a vaccine in sight, much rests on how the adjustments to daily life given the risk of exposure are reassessed. One reason many give for not complying with state restrictions is that the virus is just something we “have to learn to live with,” or that it is a new way of life. Treating the vaccine as a parachute, as a dialing down of the harm associated with individual actions that put others at risk of contracting the virus, increases danger until the vaccine can come into effect. Letting up on the adjustments to behavior continues to do all the harms that have been associated with the spread of the virus: the deaths, the long-term effects of contracting the virus, the impact on our healthcare system, the systemic impact on the most marginalized populations, the destruction of our economy due to essential workers becoming ill, etc. These effects will not stop simply because of the prospect of a vaccine. The goals remain the same as they have been since February.

With the prospect of improving the fight against the pandemic, the reasonable choice could actually be to double down because we lose one reason to avoid the restrictions. The counterargument that pushes that long-term restrictions will harm the economy, will undermine the values in daily lives, etc. has been weakened considerably as we are now facing a short-term sacrifice for a long-term reward. But until inoculation reaches critical mass, we can’t point to our parachute to justify a refusal to exert effort in pursuit of our shared end goal.

Posted on

Should I Stay, or Should I Go: Holidays in the Age of Coronavirus

photograph of "Stay Safe" message among pumpkins and thanksgiving background

Some of the busiest holidays in America — Thanksgiving, Christmas, and New Years — bring floods of people into airports, who are all looking to travel across the country to see family that they might not have seen all year. Normally, the last few months of the year bring plenty of opportunity for those families to meet each other over pounds of food and gift exchanges. The year of 2020, however, is anything but normal. The coronavirus has put a halt to any and all ideas of what was once considered typical. This virus has been ravaging the world for almost a year now, and the country has managed to still celebrate some holidays, such as the Fourth of July, as summer weather allowed for outdoor gatherings where it was easy to social distance, and harder for the virus to spread. Now that winter is coming on, however, these get-togethers will have to be inside the homes of Americans, with far more risk of transmission. As cases climb and hospitals fill, one has to ask what the appropriate course of action is for Americans who want (understandably) to visit family during the holidays, while this pandemic is surging forward with little end in sight.

As scientists have been concerned about since the beginning of this pandemic, the world appears to be entering a second wave of coronavirus cases. After opening up during the summer months, Europe is introducing new restrictions limiting which businesses can open, as well as night curfews for citizens, as they see cases beginning to surge across the continent. Due to far less restrictions than Europe, and the lack of a cohesive federal response to COVID, America never really cleared the first wave of the virus. While the summer months saw a decline in cases, recently the country set a new record of 90,000 cases in a single day, bringing the total cases to nearly 9 million just in the U.S. As cases rise, hospitals are quickly beginning to fill up, which when this virus first hit led to people dying in hallways of hospitals, mass burials, and hospital workers not having proper equipment to protect themselves from the virus. While in the summer it appeared as if the country was past those horrible conditions, the colder months have brought a reminder of the fact that the world is still very much in the midst of this pandemic.

As the temperature grows colder people are coming in contact more often in enclosed spaces, which increases the spread of the virus. But there is also the issue of pandemic fatigue. This virus has taken over every aspect of life, putting extra stress on everyone’s lives. People have had to create new routines and question behaviors that they once thought completely normal, like hugging grandma. People are growing weary of the fact that life is not what it once was, and that there is an ever-present threat that continues to loom over the entire globe. This exhaustion can lead to an increase in cases as people begin to exercise more risky behavior, like dining inside or going to large events, as if we’ve beaten the virus. As we head into the holidays it makes sense that people want to spend time with their loved ones, especially ones that they haven’t seen for months. The winter months already see a combination of seasonal depression with regular depression among people, and COVID certainly led to a decline of mental health among Americans. The rates of both suicides and opioid overdoses have become very concerning for public health experts who warn of an underlying mental health crisis as a result of the stress and anxiety surrounding the coronavirus. People have been isolated from their families and friends for months because of travel restrictions, and now is the time when people most often travel to see their loved ones. It makes perfect sense that people would want to gather for comfort and strength in these very uncertain and stressful times. Many families have lost loved ones — there are over 230,00 deaths in the U.S. currently — and this is the first time that they will have to experience these holidays without those people present. Grief is a powerful emotion, and mixed with pandemic fatigue, this may lead to people willing to take more risks in order to seek comfort in their families.

The winter holidays are most definitely some of the busiest days of the years for travel, either by car, plane, or other transport. This creates a big risk for people who want to visit their families, but need to visit airports to make it home. Just last year over 45 million people traveled on American airlines throughout the globe over this time period. Considering the fact that many countries have restrictions on who can come in, and America is often on the list of those nationalities who are not allowed in, that number will most definitely be lower. Masks are required throughout the airports and during the flight, which would make it seem as if these flights were quite safe. A new study even came out recently which concluded air travel was safer than eating at a restaurant, albeit this study was sponsored by the air industry, which is desperate for flyers due to the loss of revenue from air travel being restricted throughout the entire globe. A recent long distance flight to Ireland, however, questions the validity of this study as 13 passengers tested positive for the coronavirus on the flight, and then passed it on to people in Ireland, for a total of 59 cases all linked to this flight. Throughout the pandemic, the coronavirus has shown how little we actually know about the virus, as even mask wearing was once deemed not important by health officials. But now calls for a national mask mandate have been amplifying, as they have proven to be extremely effective in stopping transmission of the virus. So the question of risk regarding air travel remains up in the air.

This last year has probably been one of the most stressful, if not the most stressful, period of most people’s lives around the world. This virus is something that none of us can ignore because it affects everyone. If it takes the whole world to spread the virus, it seems it is going to take the whole world working together in order to stop it. This end appears to still be quite a ways off, however, and people are still left with a feeling of inevitableness of this eternal feeling of waiting. Understandably, the first instinct for a lot of people might be to reach out to those closest to them. Some might want to continue decades-long traditions that their families have carried on in an attempt to find a sense of normalcy in these strange times. The Centers for Disease Control (CDC) has information on their website to help people make responsible decisions if they decide to have some sort of celebration for the holidays. But, one must remember that these are strange times, and any contact with people outside those you live with carries some level of risks. As with most things during this pandemic, people will have to consider the risks of celebrating the holidays this year with those they hold most dear.

Posted on

Moral Panics about “COVID Parties”

photograph of teenagers at corwded concert on the beach

In recent weeks, a new feature has appeared in the discourse focused on the global pandemic and its related quarantine procedures: reportedly, people have been hosting and attending parties designed to spread the coronavirus. From Alabama to Florida to Texas, the details of these so-called “COVID Parties” differ, but one element is common: attendees do not take the threat of the disease seriously. Some gatherings seem to be patterned after “chickenpox parties” intended to encourage herd immunity, others are allegedly motivated by sport or financial gain (one widely-circulated report claimed that a party in Tuscaloosa offered a cash prize to the first guest to contract COVID-19).

However, to date, the evidence for the phenomenon of “COVID parties” is surprisingly scarce: that is to say, it is not clear that any such parties have actually taken place. Consider the story of the “Texas millennial” who supposedly confessed to attending a COVID party shortly before he died in a San Antonio hospital in mid-July.

The hospital’s health director admits that she heard of the disclosure secondhand and journalists have been unable to locate the nurse who purportedly received the confession in the first place. Similarly, most of the claims about college students in Alabama holding contests to intentionally catch COVID-19 are traceable to a single member of the Tuscaloosa City Council commenting on (and seemingly embellishing) a rumor shared by the city’s fire chief about sick teenagers leaving their homes: at this point, no hard evidence (such as alleged eyewitnesses or posts on social media) have surfaced of these parties and the University of Alabama has been unsuccessful at locating any potential attendees. Nevertheless, both of these small-scale stories have been reported by national news outlets.

This suggests that the trending discussions about “COVID parties” evidence what’s called a “moral panic” concerned with discouraging lackadaisical responses to the coronavirus. Such panics result when false beliefs about a purported threat to a social group spread throughout that group, thereby leading group members to be increasingly hostile towards anyone or anything they suspect of embodying the rumored threat. Consider the overreaction of the Christian Right to the popularity of Dungeons and Dragons in the 1980s, longstanding urban legends about the risks of poisoned Halloween candy, and the relatively recent “Momo Challenge” where a YouTube video supposedly tried to convince viewers to harm themselves: each of these were rooted in false beliefs about over-exaggerated threats to children. More serious examples of moral panics can be found in the abuses suffered by patients with HIV/AIDS or members of LGBTQ communities as ignorance and fear-mongering among more dominant social groups fueled (and still fuels) official policies of abandonment and exclusion. Importantly, Oxford Reference points out that “moral panics are generally fueled by media coverage of social issues” — a feature only exacerbated by the contemporary explosion of social media.

Given the many risks posed by the coronavirus, the perceived threat of a COVID party might be understandable: if such a party were to happen, it could significantly contribute to more people contracting the disease — including, crucially, more people than just those who actually chose to attend the party. But there are at least two broad kinds of problems with moral panics, and the rumors of COVID parties seem to exhibit both.

Firstly, moral panics unavoidably pose epistemic problems insofar as they are, by definition, fueled by false beliefs and, often, mishandled evidence (or evidential requirements). For example, to date, the reports of COVID parties have ranged from hearsay to misattribution to, potentially, straightforward fabrication. Consider the tragic case of Carsyn Leigh Davis, an immunocompromised seventeen-year-old in Florida who died after contracting COVID-19 in mid-June. Shortly before she fell ill, Davis attended a party at her church where neither face masks nor social distancing practices were required; initial reports (now corrected) labeled this church gathering a “COVID party,” despite there being no clear evidence that the event was actually intended to spread the coronavirus (the church has explicitly denied these allegations). By jumping to conclusions about the nature of the church party, at least some reporters (and self-styled reporters who share information on social media sites) seem to have fallen prey to the problem of confirmation bias. In a similar way (and for a variety of additional reasons), failures to thoroughly vet second-(or third or fourth)-hand reports of COVID parties have led to what amounts to conspiracy theories being shared openly and uncritically.

Which leads me to the second — and, arguably, more problematic — issue about moral panics: what they tell us about the social groups doing the panicking. Naturally, in order for biases to be confirmable, they must first exist in the minds of biased observers: someone cannot, for example, reflexively equate homosexuals with pedophiles if they do not already falsely believe that those two groups of people are somehow logically associated. Certainly, it is no secret that plenty of skeptics doubt the severity (and even reality) of the COVID-19 pandemic, but the panic about COVID parties suggests more complicated stereotypes are at work.

Consider the commonalities amongst the COVID party reports I’ve already mentioned: each of them focus on patients (or imagined patients) who were also members of subcultures frequently treated as fair game for jokes by the culture-at-large: millennials, college students, and religious fundamentalists. Perhaps most importantly, all three stories hailed from the Deep South. For these sorts of stories to seem salient to readers in the first place, those readers must already be at least somewhat suspicious of (or, at the very least, pretentious towards) those subgroups in a manner that will be suspiciously unvirtuous.

Let’s imagine that Barry is a person who takes the threat posed by the coronavirus seriously, but has never before heard of a COVID party. When Barry reads allegations that people in Alabama have been intentionally competing to contract COVID-19 and win a pot of money, they will likely be skeptical (because it will strike Barry as a wildly unlikely thing for people to do). If, however, Barry then reads that it was a group of college students throwing this alleged COVID party and Barry thereby takes the premise of the story to be more likely, then we can reasonably infer certain unflattering things that Barry likely believes about college students. Replace “college students” with “millennials, “religious fundamentalists,” or “Southerners” and the story reads no differently.

This kind of condescending attitude is akin to what Aristotle decried as an act of “insult” (sometimes also translated as both “insolence” and “hubris”). In his Rhetoric, Aristotle explains that insult consists in shaming someone simply for the mean-spirited pleasure of doing so; as he says, people prone to such acts “think that, in committing them, they are showing their superiority.” Such behavior, Aristotle continues, is often evidence of a dishonorable character and this seems equally true of biased attitudes that do not provoke overt action (beyond tapping the “share” link). Insofar as rumors about COVID parties activate biased presuppositions about various subgroups that Barry assumes to be inferior, we can thereby reasonably suspect that Barry harbors certain immoral prejudices.

So, in addition to their other features, moral panics can function as a barometer for subgroups that prideful members of the dominant social group reflexively patronize. If real evidence of COVID parties becomes available, then critical reactions to such threats would be warranted, but in the absence of such evidence, moral panics are epistemically unjustified. Moreover, insofar as moral panics are motivated by regionalism or other kinds of snobbish stereotypes, they run the risk of actually being prideful moral hazards.

Posted on

COVID-19 and Systemic Racism

photograph of "No Justice No Peace" sign at protest

As more information about COVID-19 and its effects comes to light, it is clear that the impacts of the disease are not the same everywhere or for everyone. Some communities are hit harder than others. In many cases, COVID-19 hot spots highlight systemic problems that existed before “coronavirus” was a household word. The public action that a society takes when things get rough reflects its values, in this case, its judgments about who and what is really important. Unsurprisingly, the circumstances of marginalized groups are not sufficiently taken into account in the construction of social programs and systems. When these social programs serve as the circulatory system of a nation during a pandemic, marginalized groups are the hardest hit. One lesson that this great tragedy should teach us is that we must recognize and embrace the diversity in our communities. Respect and appreciation for our cultural differences can help us to construct preemptive, life-saving policies.

If we’re willing to collectively put forth the work, the multiple tragedies we’ve recently gone through as a nation could give rise to transformative action. The murder of George Floyd and the subsequent protests to amplify the message that Black Lives Matter have cast the issue of racial justice onto center stage. The disproportionate effect of COVID-19 on communities of color can and should help people to understand what it means for racism to be systemic. One barrier to meaningful dialogue about racism is that some people think that for an action to be racist, it must be done with an explicit, hateful, discriminatory intention. Certainly, there are cases in which these conditions are met—some people are explicit, hateful racists. Systemic racism, however, has the potential to be even more pernicious and impactful. Understanding systemic racism requires us to think more holistically. We need to ask ourselves: How do we design our cities? Where do we put institutions that generate pollution and waste and why do we put them where we do? What social programs do we provide and to whom? What steps are we taking to see to it that upward mobility and human flourishing are attainable for all members of society? When answers to these questions suggest that people of color are consistently more negatively impacted by our practices, we have problems of systemic racism to fix. We find ourselves in just that situation when it comes to our response to COVID-19.

One critical component of emergency response is the transmission of information. Across the country, there have been huge challenges to information dissemination, created by a cluster of assumptions. Chief among these assumptions is the idea that everyone can speak English or is in regular contact with someone who can. For instance, meatpacking plants have been among the hardest hit institutions worldwide. As I have written in a previous article, conditions in slaughterhouses create a perfect storm for the spread of coronavirus. People work shoulder-to-shoulder doing strenuous activities that cause them to sweat and breathe heavily. Many employees at these facilities are immigrants and refugees who don’t speak English. Even if health and safety materials about COVID-19 are being created and widely disseminated, if a person can’t understand that material, they are in a poor position to help themselves or those around them. In crafting public health policy, we need to take into account the diverse nature of our communities. We need to provide information in more than one language. What’s more, we need to find ways of being proactive with these communities. We shouldn’t assume that everyone has access to television or the internet.

Florida governor Ron DeSantis made headlines last week for blaming his state’s spiking COVID-19 cases on migrant farm workers. This is a common move from the emerging coronavirus playbook—blame an outbreak on one event or group of people and imply that the spike is, therefore, somehow not real. Far from being exculpatory, increased cases among migratory farm workers is evidence of failure in governmental strategy. Florida public policy officials are aware that migrant farm workers exist in their state. However, in thinking about public health and the economy, concern for what might be happening on the margins came much too little and too late.

Racial injustice often leads to a snowball effect of harms. Consider the case of Louisiana’s infamous “Cancer Alley,” an 85-mile stretch of land along the Mississippi River that is home both to a majority black population and to roughly 150 petrochemical plants. The pollution in this area causes a range of health issues for those who live there. According to the EPA’s 2014 National Air Toxics Assessment, residents of this area are 95% more likely than most Americans to develop cancer from air pollution. These communities were already disenfranchised; pollution makes it worse. Pollution also causes pre-existing conditions, so, unsurprisingly COVID-19 has ravaged communities in Cancer Alley. At one point in April, a community in the area had the highest per capita COVID-19 death rate in the country.

The Navajo Nation has also been disproportionately affected by COVID-19—at one point it had the unfortunate distinction of having the highest per capita infection rate in the United States. The Navajo community has enacted strict lockdown and prevention measures, which have appeared to flatten the curve, at least for now. Help was slow to arrive. The CARES Act set aside 600 million to assist the Navajo Nation in its fight. To combat such an infectious disease, assistance is needed urgently. However, in order to receive the money to which they were entitled, the Navajo Nation had to sue the U.S. Treasury. By this point, people were already dead. Given the position in which the United States government stands to native people, swift assistance should have been a top priority.

When we say that Black Lives Matter and when we say that the lives of people of color matter, we take on responsibilities. We need to be reflective and active not just about our criminal justice system, but about the broad social and economic systems that give rise to inequity and injustice.

Posted on

The Moral Pitfalls of Color-Coded Coronavirus Warning Systems

Color-coded chart showing the risk of covid-19 in UK

As states around the country ease lockdown restrictions, some are putting into place systems advising people about threat levels. In some states, these are color-coded systems that strongly resemble the Homeland Security Advisory system, put into place by George W. Bush to inform people about the risk of threats from terrorism after the September 11th terrorist attacks. 

Utah, for example, has a four-tiered system: a red designation indicates high risk, an orange designation indicates moderate risk, a yellow designation indicates low risk, and a green designation indicates “new normal.” The color-coded systems of other states and some other countries largely follow this same model.

It’s important to remember that there were lots of serious problems with the Homeland Security Advisory System, and it was eventually abandoned and replaced. Many of the problems had to do with the fact that color-coded systems are vague by their very nature. People have a sense that red means “stop” and green means “go.” Very few people will investigate the situation further. As a result, these systems are easily manipulated for political purposes. Color-coded systems don’t encourage careful, responsible thinking about risk. They encourage behavior motivated by sentiment rather than reason, and sentiment is easily coerced. Politicians tend to be excellent at cultivating certain kinds of common sentiments that drive political behavior and the Homeland Security Advisory System roused both fear and xenophobia. These are powerful forces and invoking them caused people to make voting decisions that they might not otherwise have made, to support wars they might otherwise have found unjustified, and to accept unprecedented privacy violations on the understanding that they were being protected from imminent harm.

Color-coded responses to coronavirus operate according to similar principles. If people want to know the current level of danger posed by coronavirus, they should be paying attention to the relevant data. How many new cases is a state discovering each day? What are the hospitalization rates? How many people are dying? These color-coded systems are not responsive to these important considerations. For example, there was recently a major outbreak of coronavirus at the JBS meatpacking plant in Hyrum, a city in Northern Utah. The outbreak was the biggest hotspot yet discovered in the state. At this point, 287 workers at the plant have tested positive for COVID-19. This meat packing plant refuses to shut down or to give employees meaningful time off to heal. 

Hyrum is in Cache County, and despite the unknown extent of the spread, Cache County remains in the yellow “low risk” zone. In fact, even in light of the outbreak, the Cache County Council voted to request that the county be moved to the green designation. As one councilperson put it, “I’m in the age group that’s most likely to die, but I’ve had a good life and I say let’s get on with it. That may sound like I’m being pretty casual about it, but that’s the way I feel.” If an area like Cache County requests a green designation on the basis of these kinds of considerations, the system is not responsive enough to actual data.

The Cache County example also illustrates the point that these vague, color-coded systems track not a set of facts, but a set of values. Many states have decided that thriving economies are more important than the lives of the vulnerable, but they haven’t exactly made this value judgment explicit so that people can evaluate it and respond accordingly. Instead, the values are obscured by color designations that look for all the world like they are based on public health considerations.

Instead of motivating people with fear, coronavirus color-coding systems encourage a different form of cognitive bias—wishful thinking. People across the country are sick of lockdown. They are exhibiting quarantine fatigue. They are sick of travel restrictions and of being prevented from engaging in their favorite consumer activities, especially during the summer. The fact that coronavirus cases have reduced dramatically in places like New York is causing the national curve to flatten. This doesn’t tell us anything encouraging about what is happening across the rest of the country. People have self-interested reasons to interpret the numbers favorably, even though there is no evidence-based justification for doing so. These warning systems also undercut good critical thinking practices in another way—they encourage people to disregard the advice of experts on infectious disease. The best available evidence we have now suggests that people should wash their hands regularly, maintain social distance from others, and wear a mask in areas where social distancing is difficult. It’s hard to get people to engage in these practices regularly anyway, and it is even more difficult to convince them that they should be doing so when their county is in a yellow or even a green risk designation.

At least in Utah, these systems do track some data, but not the data people might be inclined to believe. They are not tracking information relevant to whether people are actually safe to participate in social and consumer activities again. Instead, decisions are being made on the basis of how many hospital beds are available in a given area. The concern is not about whether people will contract the disease, but about whether health care systems will be overwhelmed if and when they do. This isn’t a metric we would stand for in other cases. Consider the following analogy. City officials are aware that the water at the local beach is infested with dangerous man-eating sharks. They are tasked with making recommendations about the safety of getting in the water. Tourism to the beach generates a lot of revenue every year, so it is in the state’s interest for the water not to be infested with man-eating sharks. Officials determine that the health care system is well equipped enough to treat people for shark bites, so they advise people that it is safe to swim in the water. Presumably, residents would think that this was an unconscionable decision and there would rightly be a degrading of trust in the public officials that were so callous with people’s lives.

The Homeland Security Advisory System was eventually replaced with the National Terror Advisory System, which was designed to “more effectively communicate information about terrorist threats by providing timely, detailed information to the American public.” Both terrorism and public health are high information issues about which it is difficult for the public to be fully informed.  Nevertheless, we should encourage people to be engaging with actual data rather than with colors that lull them into a false sense of security. 

Posted on

Hydroxychloroquine and the Ethical Pitfalls of Private Science

A box of hydroxychloroquine sulphate tablets held by a hand with coronavirus written in background

Last week, news broke that a significant study into the effects of hydroxychloroquine for treating COVID-19 relied on data that has now been called into question. The effects of this study, and other studies that relied on data from the same source, were profound, leading to changes in planned studies and in treatments for COVID-19 being prescribed to patients. The fact that this data comes from an unaudited source highlights the ethical concerns that stem from having an increased corporate role in science.

In late May, a study published in the elite medical journal The Lancet suggested that COVID-19 patients taking chloroquine or hydroxychloroquine were more likely to die. The study included over 96,000 patients, relying on electronic health data from the company Surgisphere run by Dr. Sepan Desai, who was also included as a co-author of the article. It found that at 671 hospitals where COVID-19 patients had been prescribed hydroxychloroquine, the risk of death was over twice as great as patients who were not prescribed the drug. An additional study using data from Surgisphere investigated the uses of blood pressure medication and was published in a paper for The New England Journal of Medicine. A third paper using Surgisphere data was available as a preprint which suggested that ivermectin significantly reduced mortality in COVID-19 patients. All three papers have been retracted.

The retractions occurred after discrepancies were noticed in the data. The reported doses of hydroxychloroquine for American patients was higher than FDA guidelines and the number of Australian deaths were higher than official statistics. There was also a discrepancy between the small number of hospitals included and the vast number of patient records. Following this, independent auditors were asked to review the data provided by Surgisphere; however, the company refused to provide the data, citing confidentiality requirements with the hospitals. Yet investigations found that no hospitals located in the US admitted to participating with Surgisphere. 

Surgisphere itself is also a suspect source. The company was founded in 2007 but has little online presence. Their website does not list partner hospitals or identify its scientific advisory board. It claims that the company has 11 employees. Their enormous database doesn’t seem to have been used by peer reviewed studies until May. Desai himself also has a colorful history, including a record of three outstanding medical malpractice suits against him. 

The studies had significant impact world-wide. Following the report that hydroxychloroquine increased mortality rates in patients, the WHO announced a “temporary” pause into their studies of hydroxychloroquine (they have since resumed their efforts). The studies also played a role in the national conversation about the drug in the United States following President Trump’s announcement that he had been taking it to combat the virus. The preprint on ivermectin was never officially published, but it did lead to changes in treatment protocols in South America. In Bolivia, a local government planned to hand out 350,000 doses of the drug after receiving authorization from the Bolivian Ministry of Health. The drug was also cited as a potential treatment in Chile and Peru. 

This episode highlights several general moral issues. Retraction scandals at a time when the public is looking to, and relying on, medical science are dangerous. The situation is intensified by the fact that these controversies are tied to the political debate over hydroxychloroquine, as it may undermine science along partisan lines. Polls show that Democrats are far more likely than Republicans to have a great deal of confidence in scientists to act in the best interests of the public — yet such scandals further undermine public trust and make science seem more partisan. 

The matter also raises ethical issues within the sciences. According to Ivan Oransky from Retraction Watch, the case represents larger systematic issues within the sciences, noting that even leading journalists rely too heavily on an honor system. For example, the pandemic has led to warning signs about the use of preprints in journals, which have moved away from getting feedback while studies are being finalized to sharing “breaking data” as fast as possible, despite the lack of peer review.  

The Surgisphere episode highlights the ethical pitfalls of science relying on private sector companies for research. Since the twentieth century, the private sector has been an increasing source of scientific funding. In the United States, private funding accounts for 65% of research and development spending in 2013. There are good reasons for private sector investments and corporate-university level partnerships. The public sector has shown less willingness to supply the needed funding. As Ashtosh Jogalekar points out in an article for Scientific American, investments by private interests have allowed for many projects to be funded which might not be funded otherwise. He notes, “For these billionaires a few millions of dollars is not too much, but for a single scientific project hinging on the vicissitudes of government funding it can be a true lifeline.” It has also been noted that private funding can ensure cost-effective replication studies are possible, especially important since efforts to produce reproducibility were only successful in 40% of experiments published in peer-reviewed journals. 

On the other hand, according to Sheldon Krimsky, the author of Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research?, numerous problems can occur when scientists partner with private corporations. Krimsky finds that publication practices have been influenced by commercial interests: the commercialization of science has led to a decline in the notion that scientists should work in the public interest, and sharing data becomes more problematic given the use of paywalls and intellectual property protection. This makes it more difficult to verify the data.

There are many ways corporations can complicate data-sharing. By choosing not to release unflattering findings or claiming data as exclusive intellectual property, companies can make it difficult for others to use research (consider Diamond v Chakrabarty which began the precedent for allowing genetically modified organisms to be patentable). And, of course, the Surgisphere episode is an example of university-level researchers working in collaboration with a private company where the company retains sole control of the data. Such cases allow for fraud and suffer from a lack of oversight. 

One proposed solutions is to move towards “open science,” making publications, data, and other information open and accessible to everyone. Such a move would allow for both increased transparency and accountability as well as more rigorous peer-review. Under such a system, falsified data would be more difficult to provide and more easy to detect. 

While many of these issues have been brewing for years, it is not every day that a single published study can have the kind of global impact that came with investigations into the effectiveness of hydroxychloroquine, even while other independent studies have also demonstrated its ineffectiveness. The ethical fallout from this scandal is thus far more obvious given public interest in the disease. Indeed, there have already been calls to stop private speculation into COVID-19 research; part of this call includes the position that all intellectual property should be made available for free to the international scientific community for fighting the pandemic. The question now is what specific reforms should be implemented to prevent scandals like this from happening again?