The mayor of Moscow just ordered all Muscovites older than 65 to stay at home. This idea of restrictions imposed on just one category of citizens — those most at risk of dying from Covid-19, which mainly means the elderly — will come up a lot more now that the second wave is here. To put it bluntly: Should we lock down the old, or is that like locking them up, and thus unethical?
This isn’t meant to be a “modest proposal” in the tradition of Swiftian satire. We need to discuss our options, because going back into general lockdowns isn’t one. Renewed shutdowns wouldn’t be accepted by the population. They’d crush our traumatized economies and cause so much second-order suffering that an honest accounting against the relative harm from Covid-19 would become elusive.
It makes epidemiological sense, moreover, to distinguish between the young and well and the old and vulnerable. We now know that children and young to middle-aged adults rarely have really bad cases of Covid-19 if they’re otherwise healthy. Hypothetically, if the world’s population were entirely under the age of 60, hospitals in Bergamo, Madrid and New York would never have been overwhelmed this spring. Most countries might never have imposed lockdowns at all.
Instead, they would have followed the controversial and still ambiguous “Swedish model.” Sweden never closed schools, restaurants or factories, and didn’t even tell people to stay home. It posited instead that in time enough people would get asymptomatic or mild cases and recover with active antibodies to gradually give the whole population “herd immunity.” This is how most coronaviruses peter out.
The catch is we don’t live in a young-only scenario. In the real world, asymptomatic spreaders also give the virus to the vulnerable and the old. That’s what happened in Sweden, where Covid-19 took a heavy toll on the elderly population. Something similar is now happening elsewhere. In the U.S., the virus is spreading fastest among young adults, but those outbreaks eventually reach the old.
So it might make sense to put the elderly population behind the epidemiological equivalent of a firewall. The young outside the wall “live with” the virus and gradually achieve herd immunity. The old inside the wall are kept relatively safe for the duration of the pandemic, until vaccines are available.
Unfortunately, good epidemiology isn’t always good politics, ethics or sociology. A selective lockdown would probably be unconstitutional in many liberal democracies, and for good reason. Even if well-intentioned, it would set a precedent that’s unacceptably dangerous.
A fundamental tenet of classical liberalism, on which most Western democracies are based, is that individuals have priority over groups. You can sanction behaviors — such as boozy parties or mask-less public transit. But once you target groups, you’re one step toward potential tyranny.
It doesn’t take much imagination to picture such a precedent leading to dystopian scenarios. Another statistical risk group of Covid-19, for example, is Black people. Would anybody seriously propose a lockdown for this group?
And what would autocrats do with the precedent? An outbreak at a refugee camp, for example, might give the likes of Hungarian Prime Minister Viktor Orban an excuse to lock down all migrants. Or ask yourself — sorry to corroborate Godwin’s law — which groups Germany in the 1930s would have put into lockdown.
Even a policy goal of protecting a certain demographic cohort must never deprive its members, more than others, of their freedom to decide for themselves how much risk they’re willing to bear. Individuals, not the state, must choose how they want to live and even to die. Incidentally, that’s also why more countries should allow “assisted suicide,” the voluntary decision to end life on one’s own terms and with dignity.
The reality at this point in the pandemic, however, is that a great many elderly people actually want to isolate from potentially contagious youngsters. But for all those who wish to stay independent — that is, to keep out of nursing homes — doing so is often difficult, if not impossible. They must still shop for groceries and run errands, visit their doctors for standard medical care, deal with government bureaucracies and so forth. With each contact, they risk infection.
Good policy can make this easier. Let’s hire and train an “army of angels.” They’d be constantly screened and tested for the virus. And if safe, they’d see to the needs of anybody who voluntarily and temporarily wants to eliminate social contacts for health reasons. The offer would be open to anybody old, sick or otherwise immunocompromised.
Policy makers could thereby turn a negative — a coercive lockdown of one group — into a positive: the voluntary use of a public support service. It would be a demonstration that freedom and solidarity can dovetail. And it might even aid, rather than strain, cohesion among the generations. – Bloomberg