Category: Health

During the last pandemic, I contracted COVID and it was the sickest I have been in my life. Not being a member of the ruling class, I had to rely solely on my immune system to get through it. I did not die but have had some lasting effects: persistent fatigue and breathing issues. These make running challenging and I struggle to get in over 40 miles a week, but it is likely that my years of running contributed to my ability to get through COVID.

When the vaccines became available to older Americans, I waited my turn. Florida eventually made them available to educators, but Governor DeSantis pointedly excluded higher education faculty and staff. Like most faculty at public colleges, I was required to return to the classroom. I was not overly concerned; surviving COVID is supposed to grant long-lasting immunity and being fired would be far more dangerous than getting COVID again.

Like everyone else on campus, I had to get bi-weekly COVID tests. Eventually the governor allowed everyone over 50 to get the vaccine, and I was able to get my first shot of Moderna at the community vaccination site on campus. I felt a bit rough after that shot. While waiting for my second shot, the possible issues with the Johnson & Johnson vaccine made the news and there were worries about vaccine availability. Fortunately, I was able to get my second shot.

While I got my vaccinations as soon as I could, some were hesitant. In some cases, this hesitation was rational: the vaccines were rolled out quickly by for-profit corporations and emergency use authorization were issued to allow their deployment. While testing was conducted, the timescale of the tests was limited, and possible long-term side effects were obviously a mystery at that time. Medical experts made educated estimates that the short-term benefits (not dying of COVID) outweigh any likely long-term effects. But these estimates were made based on many unknowns and it was (and is) rational to consider possible long-term consequences. That said, vaccines are well understood, and these vaccines were not crazy radical departures from established science. Given what we knew then, the rational bet favored getting the vaccine. Given what we know now, people should get the vaccine. Unfortunately, the current regime is appallingly anti-health and anti-science.

People also opposed getting vaccinated because of ideological reasons and this has only strengthened. Parents have, perhaps from the very best intentions, have condemned their children to illness and even death from preventable illnesses, like measles.

 Trump and some of his fellow Republicans politicized the pandemic for short term political gain at the expense of the well-being of citizens. While it is certain that some would resist vaccination on ideological grounds no matter what politicians say, Trump and his fellows fed this view and increased the size and intensity of the resistance to vaccination. Vaccination, like mask wearing, also became a macho issue: manly men might think that they do not need to be vaccinated.

At this point, the ideological battle is largely lost, and disease is emerging victorious across the United States. Biden did not try to compel people to get vaccinated, understanding that this would have caused people to double down on their opposition and give credence to the tyranny narrative. Instead, medical experts tried and are still trying to get employers, local doctors, and local leaders to encourage people to get vaccinated. Appeals to the public good have been weakened and the right seems to have completely abandoned this notion in so far as it involves people contributing to the public good. But there are those who will, correctly, point out that vaccination is not without risk.

When I first wrote about vaccination,  about 7 million people were vaccinated with the J&J vaccine. Six women between the ages of 18 and 48 developed cerebral venous sinus thrombosis (CVST) 6-13 days after getting their shot and one woman died. In response, the vaccine was suspended. Addressing this sort of situation is challenging. If you approach it with cold rationality and focus on the statistics, then you seem an uncaring monster, even when your objective is the safety and well-being of people. If you approach it emotionally and focus on the individuals impacted, then you seem caring and concerned. But making broad policy decisions based on such feelings can lead to large scale suffering and death. The solution is to follow our good dead friends Confucius and Aristotle: to hit the mean between the two extremes. If we are too coldly rational, then we will be seen as monsters and our efforts to do good will face opposition. If we are too emotional, then we can make bad decisions that hurt the many from a desire to protect the very few.

In terms of the cold facts, even if we assume that the vaccine caused the clots, then the odds of dying are (based on the available data) were about 1 in 7 million (for women 18-48). The odds of getting CVST are about 1 in 1 million (for women aged 18-48). These are objectively very good odds compared to other things that can kill you. The most sensible comparison is to the risk of death from COVID. While there are many factors that figure into your chances of dying from COVID, a person’s chances of dying from COVID are 36 to 78,571 times greater than dying from CVST from getting the J&J shot. There is also to cold fact that so far only women 18-48 have suffered from clotting, so people in other demographics might have no chance of dying from the vaccine. As such, if the choice is between the J&J vaccine or nothing, then the rational choice would have been the J&J vaccine. Likewise for other vaccinations, if we follow the cold calculations of survival.

As others have done, it is also instructive to re-consider the J&J vaccine in the context of other medications. While the types of clots caused are not identical, the odds of getting a blood clot from oral contraceptives is 3-9 in 10,000. The odds of getting a clot when not on oral contraceptive is 1-5 in 10,000 women and the odds of a women getting one while pregnant is 5-20 in 10,000. Like all analogies, this comparison is imperfect, but it does illustrate that even common medications are not without significant risk. Even the ubiquitous NSAIDs can have very serious side effects including death. While it might be thought that all these risks are the fault of irresponsible and greedy corporations, risks can be due simply to the interaction between chemicals and human bodies. After all, people can die from reactions to naturally occurring foods such as peanuts and shellfish.  Because of the complexity of human biochemistry and the variations between people, there is almost always the risk that a small percentage of the population will have an adverse or even fatal reaction to a pharmaceutical product, even when due care is taken. This is not to say that we should simply tolerate dangerous medicines, just that we need to be aware of what are likely to be unavoidable risks. 

As a final consideration, there are those who still argue that vaccination is a personal choice and they should be free to decide. On the one hand, they are right: a person has a general moral right to refuse medical treatment and vaccination. However, this does not entail that they have a right to freedom from all consequences of making this choice. To use an obvious analogy, a person can refuse to get the vaccinations that are required to travel to certain places, but this comes at the cost of not being able to travel. To use another analogy, a person has the right to own a car without brakes, but they do not have the right to take it out on the road.

On the other hand, the principle of harm would morally warrant requiring people to get vaccinated: the unvaccinated are reservoirs of the disease and “breeding grounds” for disease mutations. They could thus extend future pandemics significantly and thus endanger others and the economy. To the degree that they incubate new strains, they would also make it so that people would need to keep getting vaccinations against these strains. In short, this “freedom” would do considerable damage to society, which is good grounds for limiting a freedom. But as vaccines are part of the culture war, requiring them is becoming increasingly difficult, though doing so is as morally warranted as requiring people to have working brakes before getting on the road.

In closing, while vaccines are not without risk, vaccination is a safe and effective method of reducing the risk of getting sick or dying of a preventable disease. This is not to say that people should accept all vaccines uncritically, that would be a straw man of my position.

The United States recently saw another outbreak of the measles with most victims being unvaccinated. Critics of the anti-vaccination movement present incidents like these as proof the movement is not just misinformed but dangerous.  Not surprisingly, anti-vaccination folks are often derided as stupid. After all, the anti-vaccination arguments usually rest on untrue and often debunked claims. For example, the claim that vaccines cause autism is clearly untrue. Vaccination, in general,  has been conclusively shown to safely prevent diseases, although there are some risks.

It is tempting for those who disagree with the anti-vaccination people to dismiss them as to stupid to understand science. This, however, is a mistake.  One reason is purely pragmatic: those who are pro-vaccination want the anti-vaccination people to change their minds and calling them stupid, mocking and insulting them will only cause them to entrench. Another reason is that the anti-vaccination people are not, in general, stupid. There are good grounds for people to be skeptical towards claims about health and science. To show this, I will briefly present some points of concern.

One rational concern is the fact that scientific research has been plagued with a disturbing amount of corruption, fraud and errors. For example, the percentage of scientific articles retracted for fraud is ten times what it was in 1975. Once lauded studies and theories, such as those behind the pushing of antioxidants and omega-3, have proven riddled with inaccuracies. As such, it is not stupid to worry that scientific research might not be accurate. Somewhat ironically, the study that started the belief that vaccines cause autism is a paradigm example of bad science. However, it is not stupid to consider that the studies that show vaccines are safe might have flaws as well.

Another matter of concern is the influence of corporate lobbyists. For example, the dietary guidelines and recommendations set forth by the United States Government should be set based on the best science. However, guidelines are influenced by industry lobbyists, such as the dairy industry. Given the influence of corporate lobbyists, it is not foolish to think the recommendations and guidelines given by the state might not be correct.

A third point of concern is that dietary and health guidelines and recommendations undergo what often seem to be relentless and unwarranted change. For example, the government warned us of the dangers of cholesterol for decades, but this recommendation is being changed. It would, of course, be one thing if the changes were the result of steady improvements in knowledge. However, the recommendations often seem to lack a proper foundation. John P.A. Ioannidis, a professor of medicine and statistics at Stanford, has noted “Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome. In this literature of epidemic proportions, how many results are correct?” Given such criticism from experts in the field, it hardly seems stupid of people to have doubts and concerns.

There is also the fact that people do suffer adverse drug reactions that can lead to serious medical issues and even death. While the reported numbers vary (one FDA page puts the number of deaths at 100,000 per year) this is a matter of rational concern.  In an interesting coincidence, I was thinking about this essay while watching the Daily Show and one of my “ad experiences” was for Januvia, a diabetes drug. As required by law, the ad mentioned all the side effects of the drug and these include serious things, including death. Given that the FDA has approved drugs with dangerous side effects, it is hardly stupid to be concerned about possible side effects from any medicine or vaccine.

Given the above, it is not stupid to be concerned about vaccines. At this point, the reader might suspect that I am about to defend an anti-vaccine position. I will not. In fact, I am a pro-vaccination person. This might seem surprising given the points I just made. However, I can rationally reconcile these points with my position on vaccines.

The above points do show that there are rational grounds for taking a general critical and skeptical approach to health, medicine and science. However, this general skepticism needs to be rational and consistent. That is, it should not be a rejection of science but rather the adoption of a critical approach in which one considers the best available evidence, assesses experts by the proper standards (those of a good argument from authority), and so on. Also, it is important to note that general skepticism does not automatically justify accepting or rejecting specific claims. For example, the fact that there have been flawed studies does not prove any specific study about a vaccine is flawed. As another example, the fact that lobbyists influence the dietary recommendations does not prove that vaccines are harmful drugs being pushed on Americans by greedy corporations. As a final example, the fact that some medicines have serious and dangerous side effects does not prove that the measles vaccine is dangerous or causes autism. Just as one should be rationally skeptical about pro-vaccination claims one should also be rationally skeptical about ant-vaccination claims.

To use an obvious analogy, it is rational to have a general skepticism about the honesty and goodness of people. After all, people do lie and there are bad people. However, this general skepticism does not automatically prove that a specific person is dishonest or evil. That is a matter that must be addressed on the individual level.

To use another analogy, it is rational to have a general concern about engineering. After all, there have been many engineering disasters. However, this general concern does not warrant believing that a specific engineering project is defective or that engineering itself is defective. The specific project would need to be examined, and engineering is, in general, the most rational approach to building stuff.

So, the people who are anti-vaccine are not, in general, stupid. However, they seem to be making the mistake of not rationally considering specific vaccines and the evidence for their safety and efficacy. It is rational to be concerned about medicine in general, just as it is rational to be concerned about the honesty of people in general. However, just as one should not infer that a friend is a liar because there are people who lie, one should not infer that a vaccine must be bad because there is bad science and bad medicine.

Convincing anti-vaccination people to accept vaccination is challenging. One reason is that the issue has become politicized into a battle of values and identity. This is partially due to the fact that the anti-vaccine people have been mocked and attacked, thus leading them to entrench and double down. Another reason is that, as argued above, they do have well-founded concerns about the trustworthiness of the state, the accuracy of scientific studies, and the goodness of corporations. A third reason is that people tend to give more weight to the negative and tend to weigh potential loss more than potential gain. As such, people would tend to give more weight to negative reasons against vaccines and fear the alleged dangers of vaccines more than they would value their benefits.

Given the importance of vaccinations, it is critical that the anti-vaccination movement be addressed in a way that respects their legitimate worries and concerns. Calling people stupid, mocking them and attacking them are not effective ways of convincing people that vaccines are generally safe and effective. A more rational and hopefully more effective approach is to address their legitimate concerns and consider their fears. After all, the goal should be the health of people and not scoring political points or feeling smug superiority.

While the wealthy did very well in the pandemic, businesses and employees were eager to get back to normal economic activity. While the vaccines were not perfect, they helped re-open the economy. As another pandemic is certainly on the way, it is worth considering the issue of vaccine mandates again.

While there are various moral issues involving vaccines, one is whether employers have the right to require employees to get vaccinated. While this situation is somewhat unusual, it falls under the broader issue of employee rights.

In the United States employers hold vast power over their employees. This power stems from the doctrine of employment at will: an employer can fire an employee for almost any reason or no reason at all. Employees can, of course, quit for almost any reason at all or no reason at all. But employers generally hold an advantage: it is usually much easier for an employer to replace an employee than for an employee to find an equal or better job.

This doctrine allows employers to exert broad control over the lives of their employees within and beyond the workplace. For example, an employer can fire an employee for holding political views they dislike and even for social drinking or smoking outside of work. Employers also have a very broad right to surveil their employees at work or when using work equipment. While the government would need a warrant to read your work email or listen to your calls made at work, your employer can do that at will. In some cases, they can legally put cameras in bathrooms to monitor employees.

While some see this degree of employer power as wrong and even on par with tyranny, it is the default moral view in practice. That is, employers have the moral right to fire their employees at will with only very few exceptions. Under this doctrine, an employer would be within their rights to offer an employee the choice between being vaccinated and being fired just as they can do the same thing with almost anything else. Obviously, if this doctrine is rejected, then the ethics must be addressed in a different manner.

One reasonable approach is utilitarianism. This is the view that the morality of an action is determined by its positive and negative consequences for those who count morally. Actions whose negative consequences are greater than their positive consequences are wrong. Good actions are those whose positive consequences outweigh the negative. I, like many others, use this approach when addressing large-scale ethical matters such as public policy.

Assuming mandated vaccines are safe and effective, they would present little risk (though there are always risks). They also provide benefits during this next pandemic. Because of this, an employer could make the moral argument that employees must be vaccinated based on the positive consequences of reducing the likelihood and severity of their illness (which would impact the employer). There is also the fact that vaccination of employees would help protect co-workers and customers. An unvaccinated employee would be a health risk to themselves and others and thus it would be right for employers to mandate vaccination in most cases. Employees who would be harmed by the vaccine or who do not interact with other workers or customers could, of course, opt out.

One could make a broad moral argument against employer power and use this to argue that employers should not have the power to force employees to vaccinate (naturally, employees always have the right to quit to avoid doing anything they do not want to do). I do find this appealing because I think employers have too much power and workers too few rights in terms of how employers can coerce employees. That said, vaccination seems morally on par with safety mandates of other kinds that are aimed at protecting workers and customers from harms and these seem warranted on utilitarian grounds. A business could be morally responsible for not requiring vaccines if employees infect each other or customers.

One way to counter this argument is to argue that requiring vaccination is different from other safety requirements. To illustrate, an employee who is required to wear a hair net while preparing food can take that off at the end of their shift and it has no lasting impact. A vaccination is different as it is not something that could be removed at the end of the workday. Even safe vaccines come with risks that make them different from hair nets and gloves (though a person could be allergic to latex gloves). As such, these might be relevant differences that break the analogy.

This can, of course, be countered by the fact that vaccination is usually required to attend K-12 schools and college so there is a moral precedent to requiring vaccination. One could argue that school and work are different; the challenge would be showing how the differences break the analogy. Or one could also argue that schools should not require vaccination either, but the challenge is proving this rather than just assuming it. But it is worth considering that an employer could be morally responsible if an employee were harmed because they were required to get vaccinated to keep their job.

One can also make an appeal to rights, that people have the right to refuse medical procedures. I do agree that people have this right; but it is distinct from the right to be allowed to be unvaccinated if one is around people at work or school. By analogy, I agree that people have the right to use drugs, but this is distinct from the right to use drugs at work, such as while flying a plane.

Epistemology is a branch of philosophy concerned with theories of knowledge. The name is derived from the Greek terms for episteme (knowledge) and logos (explanation). Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations. While the names of the two fields sound alike, they are obviously different. But I propose a subbranch of epistemology that could be called “epistemic epidemiology” or perhaps given a silly name like “epistidemology.” This subbranch would not be focused on the epistemic features of epidemiology (which would also be interesting). It would not be about knowledge of diseases but about diseases of knowledge.

These diseases of knowledge can include corruption or infection of normally healthy epistemic systems as well as epistemic systems that are fundamentally pathological in nature. One goal of this subbranch would be to work out descriptive accounts of various epistemic diseases as well as theories of how such diseases arise, spread, and do damage. There would also be descriptive accounts of epistemic systems that are inherently pathological. Of special interest would be the nature and causes of epistemepidemics which are widespread epistemic pathologies in populations.

This subbranch, I propose, should be more than descriptive. Like ethics (and medicine) it should also be prescriptive: epistemic pathologies should be analyzed with the aim of curing (or replacing) them, so that people can have healthy belief forming systems. As would be expected, doing prescriptive epistemology will involve disputes and controversies like those in ethics and arguments will be needed to defend claims about which epistemic systems are pathological and how they might be treated. Fortunately, there are already two established areas of thought that will be useful here.

One area is what epistemologists call the ethics of belief (thanks to William Clifford). This area deals with such matters as the moral obligations we might have when forming beliefs. In fact, it could be argued that there is no need for epistemic epidemiology since the ethics of belief already covers the normative aspects of epistemology. While this view is reasonable, while epistemic epidemiology includes normative components it also covers non-normative areas that are not covered by the ethics of belief. An obvious example is that the ethics of belief does not address questions of why pathological epistemologies can be so widespread. So, just as medical ethics and medical epidemiology are distinct, the same holds for the ethics of belief and epistemic epidemiology.

A second area is the realm of logic, with special attention on critical thinking methods. While people can engage in endless debates about epistemic theories, what counts as defective (even pathological) reasoning is well established. Someone who insists on forming beliefs based solely on rhetoric would be in error; someone who insists on forming beliefs based on fallacies would seem to be pathological (pun intended). As such, logic provides an excellent toolkit, much like medical techniques provide an excellent tool kit for medical epidemiologists.

There would certainly seem to be important roles in this field for findings from neuroscience, psychiatry, and psychology. For example, delusional disorder is a serious mental illness that has a profound impact on a person’s epistemic systems: they claim to have knowledge of something that is not true and will persist even in the face of evidence that should logically undermine their false belief. This is not to claim that all or even most false beliefs or epistemic flaws arise from mental illness but that the science of how such epistemically connected illnesses (might) work would be especially useful to addressing epistemic issues in general. Naturally, this matter must be addressed with due sensitivity and there is the obvious worry that the unscrupulous might weaponize claims about mental illness. Example of this sort of thing include when critics of President Trump are accused of having Trump Derangement Syndrome or when Trump supporters are accused of being mentally ill because of their support for Trump. This is, of course, analogous to how people use claims of disease to demonize migrants.

While it is essential to guard against weaponizing epistemic epidemiology, it is also important to be willing to apply it to outbreaks of epistemic pathologies. To use a terrifying analogy, can you imagine what would happen if the response to a medical pandemic were hijacked by political ideology and the scientific response was derailed?  As with disease outbreaks, the appropriate approach is to not engage in demonizing those impacted but by taking an objective approach aimed at analyzing and (if possible) recommending treatments. While there have long been widespread epistemic pathologies, the rise of mass media and social media have enabled these pathologies to become pandemics, and some are global in nature. National and global conspiracy theories provide excellent examples of the likely presence of pathological epistemic systems, though it is worth considering that even healthy epistemic systems can generate many false beliefs.

As with addressing medical pandemics, addressing epistemic pandemics is essential for the health, safety, and well-being of humanity. While philosophers have long struggled to help inoculate people with good logic, we must accept that a global effort is needed to address what is now a global problem. The first step is the easiest, which is the creation of this subbranch of epistemology. 

Back in the last pandemic, lawsuits were filed by some religious groups because of  restrictions imposed in response to COVID-19. If the government imposes similar restrictions during a future pandemic, this will happen again. One  concern about such lawsuits is that churches were super spreaders of COVID-19. An interesting consideration is that while politicians have made a religious freedom issue out of the COVID restrictions, most Americans (including religious Americans) did not see these restrictions as a threat to religious freedom.  The issue is whether these sorts of pandemic restrictions violate religious freedom. I will focus on the moral issue and leave the legal issue to the lawyers.

As a starting point, religious freedom is not absolute and can be justly restricted in at least some cases. As a general argument, unrestricted freedom would restrict (or destroy) itself. To use a silly example, if religious freedom was absolute, then the religious freedom of a religion that wanted to restrict all other religions on religious grounds must also be respected. This is a reductio on the idea of absolute freedom (and one I stole from Thomas Hobbes). As such, religious freedom requires some restrictions on religious freedom. If so, then what we need to settle is the limit (or the extent) of religious freedom and see where pandemic restrictions fall.

Intuitively, we all probably agree that religious freedom should not allow people to engage in such things as murder, theft, rape, and genocide. So, if the Church of Murder, Rape and Robbery insisted they had the moral right to rob, rape and murder you on the grounds of religious liberty you would, I assume, disagree. And rightfully so. Sticking within a rights theory of ethics, your right to life and property would override their right to religious liberty. This rests on the notion that there is a hierarchy of rights, with some rights having more moral weight than others (among other factors). One could also use a utilitarian approach of the sort developed by Mill: if restricting religious liberty would create more positive value than negative value, then doing so would be morally right. While the members of the Church of Murder, Rape and Robbery would be unhappy about not being able to practice their faith on other people, the harm this would inflict outweighs their unhappiness.

I am not claiming that wanting a religious freedom exemption from pandemic restrictions is analogous to wanting the freedom to murder, rape and rob. My point is to establish that limiting religious freedom to protect other rights and to prevent harm can be morally acceptable. But this does not settle the specific issue of whether pandemic restrictions would violate religious freedom. Obviously, this will depend on the specific restrictions and the context.

One relevant factor is the intent of restrictions. If restrictions were created and applied intending to infringe on religious liberty, then that would be wrong. But even if the restrictions were created and applied with only benign intent, they could still violate religious liberty. To use an analogy, one might impose restrictions on high calorie drinks from a benign intent (to reduce obesity) and yet still be wrongly limiting freedom.  But there is no evidence that the past restrictions were created to harm religious liberty. As far as future restrictions go, they would need to be assessed.

Another relevant factor is consistency in restrictions. To illustrate, if religious gatherings were restricted because of the risk of people gathering, then fairness requires that standard be applied consistently. For example, if bars, restaurants, and movie theaters were allowed to operate normally while churches were limited, then there would a moral case that churches were being treated unfairly. The conclusion of such moral reasoning might, however, be that the bars, restaurants, and movie theaters should also be restricted rather than that the churches should not be restricted.

One can also make the essential service argument for churches. Grocery stores, car rental businesses and many government offices remained open because they were considered essential. The justification here is on utilitarian grounds: there would be more harm in closing them than keeping them open. To use the most obvious illustration, closing grocery stores and food delivery would result in starvation, so keeping these operating is morally acceptable. One cannot Zoom salad or download pizza.  But are large, in-person gatherings at churches essential during a pandemic?

Religious is obviously important, even essential to some people. That is not in dispute. What is in dispute is whether large, in person gatherings are essential to religion. That is, can people practice their religion without being able to gather closely in large numbers. To use an analogy, running is essential to me, but large road races were restricted during the pandemic. Could I practice my running without the large gatherings of races?

On the face of it, the answer is yes. Religious people could gather online, they could gather outside and space themselves, they could gather inside in small groups wearing masks, and so on. In the case of running, I can still run by myself, I can run with others by maintaining distance, and I can do virtual races. These do involve costs and inconveniences, but they all allow people to continue to practice the group aspects of religion (and running). The fact that most religious people did these things provides evidence that religion (and running) can be practiced while restrictions are in effect. This can, of course, be disputed on theological grounds—something I will leave to the theologians. But on the face of it these restrictions did not interfere with religious liberty in a way that is unfair, inconsistent, or unwarranted relative to other freedoms, like the freedom of running.  

If restrictions are applied consistently based on relevant factors such as gathering size, risk, being essential, and proximity, then the issue would become whether there should be a special religious freedom exemption from restrictions. The issue is thus whether religious freedom would allow a special exemption because religious people want to gather in ways that violate pandemic restrictions. If so, this means that there should be religious exemption in the case of public health. After all, they would not just be putting themselves at risk, they be putting everyone they contact at risk as well.

Imagine, if you will, that a person infected with Ebola insists on their religious freedom and demands they be allowed to go to church without restriction. This would be wrong: such a deadly disease could kill the others and then spread out into the community. While COVID-19 was not as lethal as Ebola, it is meaningfully dangerous. Other pandemics will come in varying degrees of lethality as well. If the next pandemic is more like COVID-19 than Ebola, perhaps it could be argued that churches should be allowed an exemption to operate normally.  Churches have the right to stay open in flu season, although this does put people at risk. But we would probably all agree that people infected with Ebola should not be allowed to freely go to church because they have religious freedom. So, it is a matter of how much risk is acceptable.

To use an analogy, we all probably agree that military grade flamethrowers should not be allowed for in-church use even if a church considers fire an important part of their services. This is because flame throwers would present a danger to the people in the church and could create a fire that would spread. But imagine a church that wants something less than flamethrowers: they just want their church to be exempt from the fire safety laws and regulations that other people must follow. They argue that their religion values fire, so being forced to have things like smoke alarms, working fire extinguishers and fire exits would violate their religious freedom to practice their faith. They also want to be able to use lots of fire in their services and want to a stock of flammable material on hand, stored in loose piles around the church, as their faith demands. They would argue that there is some risk, but it is relatively low compared to flame throwers. But, of course, they could easily set their church on fire and have it spread to all the nearby structures and burn them down (and hurt the people in them). While they could be argued to have a right to burn themselves and their church, their religious freedom would not seem to give them a right to put the nearby buildings (including other churches) and the people in them at such needless risk. They can, of course, have the fire needed for their faith, but it must be kept in a way that does not needlessly risk hurting other people. The same would seem to apply to pandemic restrictions and churches: they have the right to practice their faith, but they do not have the right to put others at risk while doing so.  

As the death toll from COVID-19 rose, people on social media started asking if anyone personally knew someone who had gotten COVID or died from it. I first thought they were curious or concerned but then I noticed a correlation: people who asked this question tended to be COVID doubters. For them, the question was not a sincere inquiry but a rhetorical tactic and an attempt to lure people into fallacious reasoning. In this essay I will look at this sort of question as a rhetorical tool.

This question can be raised about things other than COVID, so the generic question is “do you personally know anyone who X?” Used as rhetoric, the purpose is to garner either a “no” responses or no response at all. If this succeeds, it can create the impression that X is rare or does not occur. It can also create the impression that X is not serious. In the case of COVID, one goal was to create the impression that COVID is rare. Another goal was to create the impression that it is not that bad. Future pandemics will see the tactic used again.

Rhetoric is logically neutral in that it neither counts for nor against the truth of a claim. Its purpose is to influence feelings, and this is often aimed at making it easier to get people to accept or reject a claim. To use an analogy, rhetoric is like the flavoring or presentation of food: it makes it more (or less) appealing but has no effect on nutritional value. As flavoring and presentation is compatible with serving nutritional food, rhetoric is compatible with serving plausible claims and good arguments. Rhetoric can be used to influence an audience to accept a true claim. For example, a person who wants to protect sharks might address worries about shark attacks by asking the audience if anyone has been attacked by a shark. They are hoping that no one will say “yes” and plan on using that to make the audience receptive to their boring statistics showing that shark attacks are incredibly rare. 

There is an obvious risk in using this rhetorical device: it can backfire if someone says “yes”, especially if they tell a vivid story. Psychologically, people are influenced more by anecdotes (especially vivid ones) than by dull statistics. This underlies the fallacies of anecdotal evidence (rejecting statistical data in favor of a story) and misleading vividness (estimating likelihood based on how vivid an event is rather than based on how often it occurs). In the case of the shark example, if someone stands up and says a shark bit their arm off, then this will probably outweigh the statistical data about shark attacks in the minds of the audience. As such, this method can be risky to use.

If this tactic backfires and you are making a true claim, you can try to get the audience to accept the statistical data while honestly acknowledging that rare events can occur. If this tactic backfires and you are trying to deceive the audience, then there are various rhetorical tactics and fallacies that can be used. One tactic is to launch an ad hominem attack on the person who says “yes” and the usual approach is to accuse them of lying. If the attack is successful, this can make the rhetoric even more effective as those who fall for it will tend to reject anyone else who says “yes.” This is, of course, unethical.

It must also be noted that this sort of rhetoric can also be aimed at getting a “yes” response, though this is less common than the one aimed at getting “no.” The same general principles apply to this version.

If you want to be a critical thinker, you should recognize the rhetorical device that proves nothing. It must also be noted that its use disproves nothing because it would be an error to reject a person’s claim because they use this (or any) rhetoric. While rhetoric is neutral, fallacies are always bad, and this sort of question can be seen as being fallacy bait. That is, it is aimed at getting people to use or fall for fallacious reasoning.

One possibility is that the question is aimed at getting the audience to engage in the fallacy of anecdotal evidence. This fallacy is committed when a person draws a conclusion about a population based on an anecdote (a story) about one or a very small number of cases. The fallacy is also committed when someone rejects reasonable statistical data supporting a claim in favor of a single example or small number of examples that go against the claim. It has the following forms:

 

Form One

Premise 1: Anecdote A is told about a member (or small number of members) of Population P.

Conclusion: Claim C is inferred about Population P based on Anecdote A.

 

Form Two

Premise 1: Reasonable statistical evidence S exists for general claim C.

Premise 2: Anecdote A is presented that is an exception to or goes against general claim C.

Conclusion: General claim C is rejected.

 

It can also be used to lure people into accepting or making the hasty generalization fallacy. This fallacy is committed when a person draws a conclusion about a population based on a sample that is not large enough. It has the following form:

 

Premise 1: Sample S, which is too small, is taken from population P.

Conclusion: Claim C is drawn about Population P based on S.

 

The person committing the fallacy is misusing the following type of reasoning, which is known variously as Inductive Generalization, Generalization, and Statistical Generalization:

 

Premise 1: X% of all observed A’s are B’s.

Conclusion: Therefore X% of all A’s are B’s.

 

The fallacy is committed when not enough A’s are observed to warrant the conclusion. If enough A’s are observed, then the reasoning would not commit the hasty generalization fallacy. As you might have noticed, anecdotal evidence and hasty generalization are similar: both involve drawing a general conclusion based on a sample that is too small.

The “do you personally know anyone who X?” question can be used to lure people into making or accepting these fallacies in the following ways. If a few people respond “no”, then these can be taken as anecdotes that “prove” that X does not happen often (or is not serious). These “no” responses could also be taken as “disproving” a claim that is based on good statistical evidence. They could also be used as the basis of hasty generalization. For example,  to infer that because a few people said “no” to a question on Twitter, then the same holds true for the general population. A lack of responses could also be used as “evidence” in a hasty generalization. For example, someone might reason like this: no one responded “yes” to a question on Facebook, so the answer must be “no” for the general population.

While I have been focused on people raising the question in contexts in which they can get an answer, the tactic can be used in one-way communication as well (such as a YouTube video or televised speech). A person can ask this sort of question in the hope that their target audience will be influenced. For example, a politician might ask “do you personally know anyone who has died of COVID?” in the hopes of getting the audience to believe that the COVID death toll presented by credible media sources is exaggerated.

It must be noted that the same fallacies can be committed with “yes” answers. To illustrate, if a few people respond with “yes” to a Twitter question, it would also be an error to generalize to the entire population. It must also be noted that if the question is being asked in a properly conducted survey that has a large and unbiased sample, then this would probably not be intended to lure people into a fallacy. The conclusion of such a strong generalization would be reasonable to believe. Of course, the conclusion might be that many people believe something that is untrue, but it would be reasonable to believe that many people (mistakenly) believe that untrue claim.

The tactic of using this rhetorical question to bait people into fallacies is most effective when the X is something that is statistically uncommon so there is a good chance that an individual would not personally know someone who X. If X is common or the truth about X is well accepted, then this tactic will usually fail. For example, asking “do you personally know anyone who has heart disease?” would not be an effective way to get people to engage in fallacious reasoning about heart disease. This is because many people know people who have heart disease, and it is well known that it is common. As such, this tactic usually requires an X that is not too common, and which is not well known. But it is possible to undermine belief and make this tactic work.

This tactic can be effective in situations in which an occurrence is significant or serious, yet it is uncommon enough that many people will not personally know someone who has been affected. Take, for example, COVID-19. Back during the early days of the pandemic, I had 826 friends on Facebook. At that time, I personally knew two people who had been infected and did not (yet) personally know anyone who had died. As such, it would have seemed almost reasonable to infer that COVID-19 was not a big deal. However, I also do not know anyone personally who was killed on 9/11. Although I personally know several people who are active duty or veterans, I do not know anyone personally who was killed in action. I could go through lists of causes of death or serious injuries/illness and note that I do not personally know anyone who died or was other harmed. But it should be obvious that it would be an error to infer that such things do not happen or that they are not serious. In the case of COVID, it is not surprising that I did not personally know someone who died in the early days of the pandemic. Given the scope of who I personally know, it was statistically unlikely that a person who died of COVID would be within that small group. But it does not follow that the death toll from COVID presented by reputable media sources was untrue nor does it follow that COVID was not serious. After all, few would question that 9/11 occurred or was not serious because they did not personally know someone who died that day.

In closing, my main point is to be on guard against being misled by questions like “do you personally know anyone who died of COVID?” While they might be asked sincerely, they can be a rhetorical tactic aimed at baiting you into a fallacy. As the next pandemic is fast approaching, we can expect to see this tactic deployed again.

During the last pandemic the ideological battle over masks only slightly surprised me. On the one hand, getting into a fight over wearing masks during a pandemic is like getting over a fight over having brakes on cars. On the other hand, people can fight over what is stupid to fight over and the right has been working hard to undermine trust in reality, facts and science. So, we ended up in a situation in which people in positions of authority embraced the anti-mask position. Or the “pro-choice” position for some. As is usually the case with culture war fights, the fight was not grounded in any consistently held and applied principles.

But to be fair, there are legitimate concerns about masks during the last pandemic. To illustrate, there were concerns about having enough of them, about their impact on the ability of students to learn and teachers to teach, as well as on the development of critical language and social skills that require being able to see faces. These are all matters that are worthy of serious consideration and can provide reasons to forgo masks provided proper precautions are taken. My concern is directed at the reasons given that were ill-founded and inconsistent. Yes, I’m planning ahead for the next pandemic.

Ironically, some people borrowed from the abortion debate and took the position of Jed Davis, the president of Parkview Christian’s school board. As Jed said, “We’re not trying to politicize masks by any means. Again, we’re not anti-mask, we’re pro-choice.” Along this vein, some people also made arguments based on liberty and Constitutional rights. In general terms, these arguments seem to be:

 

Premise 1: People have the right to choose what they wear.

Premise 2: Some people choose not to wear a mask.

Conclusion: These people have the right to not wear masks.

 

While an appeal to rights is appealing, there is the matter of consistent application. This can be used to test if the proponents of allowing people to forgo masks believe in their professed principle. It is also a moral requirement if they believe their professed principle, they must apply it consistently in relevantly similar cases. So, let us engage in a thought experiment and use the same reasoning with a slight change.

 

Premise 1: People have the right to choose what they wear.

Premise 2: Some people choose to wear shirts that say “Fuck.”

Conclusion: These people have the right to wear shirts that say “Fuck.”

 

I suspect that Jed Davis other school officials would not follow their professed “pro-choice” principle consistently and allow students to wear such shirts; but I could be wrong. Give it a try, kids.

It could be argued that there is a relevant difference: students are not supposed to wear shirts with “fuck” on them because the word is vulgar and could offend people. People are supposed to wear masks to protect themselves and others from pathogens. So, students should be able to forgo masks but must be prevented from wearing “fuck” shirts.

While there is a difference between masks and “fuck” shirts, this difference would seem to favor requiring masks. After all, if schools ban clothing like “fuck” shirts because they might offend, they should require masks because forgoing them can result in serious illness or even death. To be consistent, Jed Davis and his fellows would need to allow students to dress as they wish, including “fuck” shirts. Or he would need to maintain dress codes and require masks to protect people from harm.

It could be objected that the “fuck” shirt is not analogous. After all, the choice is to wear a “fuck” shirt versus a choice to not wear a mask. So, the right being advocated is not the freedom to wear what you want, but a freedom to not wear what you do not want to wear. So, I will modify the argument again:

 

Premise 1: People have the right to not wear what they do not want to wear.

Premise 2: Some people do not want to wear clothing.

Conclusion: These people have the right not to wear clothing they do not want to wear.

 

One could object, again, that clothes are not analogous to masks. This is true, clothes are not important tools in preventing the spread of the virus. As such, any argument that would support the right to choose to not wear a mask would serve to support the far less impactful right to choose to go shirtless in school. I suspect that Jed and his fellows would not allow the students to come to school without being fully dressed. But if they are pro-choice when it comes to masks, consistency requires they allow the same freedom across the board. Obviously enough, allowing students to dress as they wish would present no meaningful danger to others, forgoing a mask would.

If the freedom argument has any merit, then the maskless students must be allowed to wear “fuck” shirts and otherwise dress as they wish. Just to be clear, while I favor freedom of expression and oppose the tyranny of pants (in favor of wearing running shorts) what I am advocating is that students be compelled to wear masks if doing so would protect them and others from a pandemic.

While most Americans initially supported the lockdown, a fraction of the population  engaged in (often armed) protests. While the topic of protests is primarily a matter for political philosophy and ethics, critical thinking applies here as well. Given the political success of the anti-health movement in America, we can expect protests against efforts to mitigate the next pandemic. Assuming that any efforts are made.

While the protests were miniscule in size relative to the population of the country, they attracted media attention—they made the national news regularly and the story was repeated and amplified. On the one hand, this makes sense: armed protests against efforts to protect Americans from the virus was news. On the other hand, media coverage is  disproportional to the size and importance of the protests.  The “mainstream” media is often attacked as having a liberal bias and while that can be debated, it the media does have a bias for stories that attract attention. Public and private news services need stories that draw an audience. Protests, especially by people who are armed, draw an audience.  It can also be argued that some news services have a political agenda that was served by covering such stories.

While it can be argued that such stories are worth covering in the news, disproportional coverage can lead people to commit the Spotlight Fallacy. This fallacy is committed when a person uncritically assumes that the degree of media coverage given to something is proportional to how often it occurs or its importance. It is also committed when it is uncritically assumed that the media coverage of a group is representative of the size or importance of the group.

 

Form 1

Premise 1: X receives extensive coverage in the media.

Conclusion: X occurs in a frequency or is important proportional to its coverage.

 

Form 2

Premise 1: People of type P or Group G receive extensive coverage in the media.

Conclusion: The coverage of P or G is proportional to how P and G represent the general population.

 

This line of reasoning is fallacious since the fact that someone or something attracts the most attention or coverage in the media does not mean that it is representative or that it is frequent or important.

It is like the fallacies Hasty Generalization, Biased Sample and Misleading Vividness because the error being made involves generalizing about a population based on an inadequate or flawed sample.

In the case of the lockdown protests, the protests were limited in occurrence and size, but the extent of media coverage conveyed the opposite. The defense against the Spotlight Fallacy is to look at the relevant statistics. As noted above, while the lockdown protests got a great deal of coverage, they were small events that were not widespread. This is not to say that they have no importance. As such we should look at such protests not through the magnifying glass of the media but through the corrective lenses of statistics. I now turn to an ad hominem attack on the protesters.

Some critics of the protesters pointed out that the protesters were also being manipulated by an astroturfing campaign. Astroturfing is a technique in which the true sponsors of a message or organization create the appearance that the message or organization is the result of grassroots activism. In the case of the lockdown protests, support and organization was being provided by individuals and groups supporting Trump’s re-election and who were more concerned with a return to making money than the safety of the American people.  While such astroturfing is a matter of concern, to reject the claims of the protesters because they are “protesting on AstroTurf” rather than standing on true grassroots would be to commit either an ad hominem or genetic fallacy.

An ad hominem fallacy occurs when a person’s claim is rejected because of some alleged irrelevant defect about the person. In very general terms, the fallacy has this form:

 

Premise 1: Person A makes claim C.

Premise 2: An irrelevant attack is made on A.

Conclusion: C is false.

 

This is a fallacy because attacking a person does not disprove the claim they have made. In the case of a lockdown protester, rejecting their claims because they might be manipulated by astroturfing would be a fallacy. As would rejecting their claims because of something one does not like about them.

If the claims made by the protesters as a group were rejected because of the astroturfing (or other irrelevant reasons) then the genetic fallacy would have been committed. A Genetic Fallacy is bad “reasoning” in which a perceived defect in the origin of a claim or thing is taken to be evidence that discredits the claim or thing itself. Whereas the ad hominem fallacy is literally against the person, the genetic fallacy applies to groups. The group form looks like this:

 

Premise 1: Group A makes claim C.

Premise 2: Group A has some alleged defect.

Conclusion: C is false.

 

While it is important to avoid committing fallacies against the protesters, it is also important to avoid committing fallacies in their favor. Both the ad hominem and genetic fallacy can obviously be committed against those who are critical of the protesters. For example, if someone dismisses the claim that the protesters are putting themselves and others at needless risk by asserting that the critic “hates Trump and freedom”, then they would be committing an ad hominem. The same will apply to future protests about responses to pandemics. Again, assuming there will be a response.

To many Americans the protests seemed not only odd, but dangerously crazy. This leads to the obvious question of why they occurred. While some might be tempted to insult and attack the protesters under the guise of analysis, I will focus on a neutral explanation that is relevant to critical thinking. This analysis should also be useful for thinking about the next pandemic.

One obvious reason for the protests is that the lockdown came with an extremely high price—people had good reason to dislike it and this could have motivated them to protest. But there is more to it than that. The protests were more than people expressing their concerns and worries about the lockdown. They were political statements and thoroughly entangled with other factors that included supporting Trump, anti-vaccination views, anti-abortion views, second-amendment rights and even some white nationalism. This is not to claim that every protester endorsed all the views expressed at the protests. Attending a protest about one thing does not entail that a person supports whatever is said by other protesters. Because people try to exploit protests for their own purpose it is important to distinguish the views held by various protestors to avoid falling into assigning guilt by association. That said, the protests were an expression of a polarized political view and it struck many as odd that people would be protesting basic pandemic precautions.

One driving force behind this was what I have been calling the Two Sides Problem. While there are many manifestations of this problem, the idea is that when there are two polarized sides, this provides fuel and accelerant to rhetoric and fallacies—thus making them more likely to occur. Another aspect of having two sides is that it is much easier to exploit and manipulate people by appealing to their membership in one group and their opposition to another.

In the case of the protests, there was a weaponization of public health. Those who recommend the lockdown are expert and there is a anti-expert bias in the United States. The weaponization of the crisis to help the political right followed the usual tactics: disinformation about the crisis, claims of hoaxes, scapegoating, anti-expert rhetoric, conspiracy theories and such. Part of what drove this was in-group bias: the cognitive bias that inclines people to assign positive qualities to their own group while assigning negative qualities to others. This also applies to accepting or rejecting claims.

This weaponization was not new or unique to the COVID-19 pandemic. American politics has been marked by politicizing and weaponizing so that one side can claim a short-term advantage at the cost of long-term harm. Critical thinking requires us to be aware of this and to be honest about the cost of allowing this to be a standard tool of politics.

While there were many aspects to the lockdown protests, one of the core justifications was that the lockdown was a violation of Constitutional rights. The constitutional aspect is a matter of law, and I leave that to experts in law to debate. There is also the ethical aspect—whether the lockdown is morally acceptable, and this issue can be cast in terms of moral rights.  This discussion would take us far afield into the realm of moral philosophy, but I will close with an analogy that might be worth considering.

While the protesters were against the lockdown in general, opposition to wearing masks was the focus of the complaints. While there was rational debate about the efficacy of masks, the moral argument advanced was that the state does not have the right to compel people to wear masks. It can also be presented in terms of people having rights that the state must respect. One possibility is that people have the right to decide what parts of the body they wish to cover. If so, the obvious analogical argument is that if this right entitles people to go without masks, it also entitles people to go without any clothes they choose not to wear. If imposing masks is an act of oppression, then so is imposing clothing in general.

Another possible right is the right to endanger others or at least freely expose other people to bodily “ejections” they do not wish to encounter. If there is such a right, then it could be argued that people have a right to fire their guns and drive as they wish, even if doing so is likely to harm or kill others. If there is a right to expose other people to physical bodily ejections that they do not want to be exposed to, then this would entail that people have the right to spit and urinate on other people. This all seems absurd.

As a practical matter, people are incredibly inconsistent when it comes to rights and restrictions, so I would expect some people to simply dismiss these analogies because they did not want to wear masks but probably do not want people running around naked. But if masks were an act of oppression, so are clothes.

When the next pandemic arrives, we can expect similar protests against efforts to combat it. But this assumes that efforts will be taken, which will depend on who is running America during the next pandemic.

One stock argument against social distancing and other restricted responses to the COVID-19  pandemic was to conclude  these measures should not have been taken because we do not take similar approaches to comparable causes of death. In the next pandemic, we can expect the same reasoning which can be formalized as follows:

 

Premise 1: Another cause of death kills as many or more people.

Premise 2: We do not impose X measures to address this cause of death.

Conclusion: We should not impose X measures to address the pandemic.

 

Those making the argument often used the flu as an analogous cause of death, but there were also comparisons to automobile accidents, suicides, heart disease, drowning in pools and so on. While the specific arguments were presented in various ways, they were all arguments from analogy. Or at least attempts.

Informally, an argument by analogy is an argument in which it is concluded that because two things are alike in certain ways, they are alike in some other way. More formally, the argument looks like this:

 

            Premise 1: X and Y have properties P, Q, R.

            Premise 2: X has property Z.

            Conclusion: Y has property Z.

 

X and Y are variables that stand for whatever is being compared, such as causes of death. P, Q, R, and are also variables, but they stand for properties or features that X and Y are known to possess, such as killing people. Z is also a variable, and it stands for the property or feature that X is known to possess, such as not being addressed with social distancing. The use of P, Q, and R is just for the sake of the illustration—the things being compared might have many more properties in common.

An argument by analogy is an inductive argument. This means that it is supposed to be such that if all the premises are true, then the conclusion is probably true. Like other inductive arguments, the argument by analogy is assessed by applying standards to determine the quality of the logic. Like all arguments, there is also the question of whether the premises are true. The strength of an analogical argument depends on three factors. To the extent that an analogical argument meets these standards it is a strong argument.

First, the more properties X and Y have in common, the better the argument. This standard is based on the commonsense notion that the more two things are alike in other ways, the more likely it is that they will be alike in some other way. It should be noted that even if the two things are alike in many respects, they might not be alike in terms of property Z. This is one reason why analogical arguments are inductive.

Second, the more relevant the shared properties are to property Z, the stronger the argument. A specific property, for example P, is relevant to property Z if the presence or absence of P affects the likelihood that Z will be present. It should be kept in mind that it is possible for X and Y to share relevant properties while Y does not actually have property Z. Again, this is part of the reason why analogical arguments are inductive.

Third, it must be determined whether X and Y have relevant dissimilarities. The more dissimilarities and the more relevant they are, the weaker the argument.

These can be simplified to a basic standard: the more like the two things are in relevant ways, the stronger the argument. And the more the two things are different in relevant ways, the weaker the argument. So, using these standards let us consider the cause of death analogy.

One thing that all causes of death do have in common is that they are causes of death. This is true of everything from swimming pools to the flu to COVID-19. Obviously, different causes of death will be more or less like COVID-19 or other pandemic caused deaths and a full consideration would require grinding through each argument to see if it holds up. In the interest of time, I will consider two main categories of causes of death that should encompass most (if not all) causes.

One category of causes of death consists of those that cannot be addressed by social distancing and the other science-based approaches to COVID-19 and other likely pandemic pathogens. These include such things as suicide, traffic fatalities and swimming pool deaths.  We obviously do not use social distancing to address these causes of death because they would not work. As such, arguing that because we do not use social distancing to combat traffic deaths so we should not use it to combat COVID-19 (or another pathogen) would be a terrible analogy. To use an analogy, this would be like arguing that since we do not use air bags and seat belts to address pandemics, we should not use them to reduce traffic fatalities. This would be bad reasoning. 

To be fair, someone could argue that what matters is not the specific responses but the degree of the response. That is, since we do not have a massive and restrictive response to traffic fatalities, we should not have had a massive response to COVID-19 or have a similar response to the next pandemic. While it is rational to make a response proportional to the threat, the obvious reply to this argument is that we do have a massive and restrictive response to traffic fatalities. Vehicles must meet safety standards, drivers must be licensed, there are books of traffic laws, traffic is strictly regulated with signs, lights and road markings, and the police patrol the roads regularly. Even swimming pools are heavily regulated in the United States. For example, fences and self-locking gates are mandatory in most places. Somewhat ironically, drawing an analogy to things like traffic fatalities supports massive and restrictive means of addressing a pandemic.

Horribly, the best (worst) way to argue against a strong response to a pandemic would be to find a cause of death on the scale of the pandemic that we as a nation do little about and then argue that the same neglect should be applied to the pandemic. Poverty and lack of health care are two examples.  This analogy would certainly appeal to evil people.

The second category of deaths consists of causes that could be addressed using the same methods used to address a pandemic. The common flu serves as an excellent example here. The same methods that work against COVID-19 and many other pathogens also work against the flu. As many argued, even in a bad flu year life remains normal: no social distancing, no closing of businesses, no mandatory masks. While this analogy seems appealing, it falls apart quickly because of the relevant differences between COVID-19 and the common flu. The same would also apply to the next dangerous pandemic.

When people started advancing death analogies against pandemic responses, the best available estimate about COVID-19 was that it killed 3-4% of those infected—though there was considerable variation based on such factors as age, access to health care, and underlying health conditions.  In contrast, the flu has a mortality rate well below .1%. It kills too many people but was less dangerous than COVID-19. So, it makes sense to have a more restrictive and extensive response to something that is more dangerous. We also have(or had) measures in place against the flu: people are urged to take precautions and flu shots are recommended. As this is being written, people feel that the threat of COVID is like that of the seasonal flu and acting accordingly. Likewise, if a dangerous strain of flu emerges again, then it would make sense to step up our restrictions.

In closing, this discussion does lead to a matter of ethics and public policy. As those who make the death analogies note, we collectively tolerate a certain number of preventable deaths. We must seriously address the issue of determining the acceptable number of deaths from the next pandemic and match our response to that judgment. And we should not forget that we might be among those tolerated deaths. We should also consider why we do tolerate so many other deaths.

Stay safe and I will see you in the future.

During the COVID-19 pandemic some public figures and social media users attempted to downplay the danger of COVID-19 by comparing the number of deaths caused by the virus to other causes of deaths.  For example, a common example noted that 21,297 people died from 1/2/202 to 3/25/200 from COVID-19 but that 113,000 people died from the flu during the same period.

Downplaying is a rhetorical technique used to make something seem less important or serious. These comparisons seemed aimed at dismissing claims made by experts that the virus was a serious threat. The comparisons were also often used to persuade people that the response was excessive and unnecessary. While comparing causes of death is useful when judging how to use resources and accurately assess threats, the death comparisons must be done with a critical eye. That was true in the last pandemic, and it will be true in the next one.

Before even considering the comparison between pandemic deaths and other causes of death, it is important to determine the accuracy of the numbers. If the numbers are exaggerated, downplayed or otherwise inaccurate, then this undermines the comparison. Even if the numbers are accurate, the comparison must be critically assessed. The methods I will discuss are those I use in my Critical Inquiry class and are drawn from Moore and Parker’s Critical Thinking text. When an important comparison is made, you should ask four questions:

 

  1. Is important information missing?
  2. Is the same standard of comparison being used? Are the same reporting and recording practices being used?
  3. Are the items comparable?
  4. Is the comparison expressed as an average?

 

While question 4 does not apply, the other three do. One important piece of missing information in such comparisons is that while the other causes of death tend to be stable over time, the deaths caused by COVID-19 grew exponentially. On March 1 the WHO reported 53 deaths that day. 862 deaths were reported on March 16. On March 30 there were 3215 new deaths. On April 8 the United States alone  had 1,997 deaths and 14.390 people are believed to have died in the United States since the start of the pandemic. The death toll kept rising. In contrast, while seasonal flu deaths fluctuate, they do not grow in this exponential manner. As such, the comparison is flawed. We can expect similar comparisons to be made in the next pandemic and should be on guard against erroneous comparisons of this sort.

Another flaw in the comparison is that the flu and many other causes of death are well established. The COVID-19 virus was still spreading when the comparison was made. It would be like comparing a fire that just started with a fire that has been steadily burning and confidently claiming that the new fire would not be as bad as the old fire.

Death numbers are also most likely an estimate from past yearly death tolls. What the numbers reflect is the number of people who probably died of those causes during a few months based on data from previous years. 

While the death toll from COVID-19 was high, COVID-19 deaths were also likely to be underreported. Since testing was limited for quite some time, some people who died from the virus did not have their cause of death properly reported. Even in the early days of the death comparison, the deaths caused by COVID-19 were most likely higher than reported. This leads to two problems with the comparison. One is that if the other causes of death are accurately reported and COVID-19 deaths were not, then the comparison is flawed. The second is that COVID-19 deaths might have been recorded as being caused by something else (such as the flu/pneumonia) and this would also make the comparison less accurate by “increasing” the number of deaths by other causes. 

While the comparison to other causes of death might have seemed persuasive early in the pandemic, the exponential increase in deaths is like to have robbed the comparison of its persuasive power. In mid-April, COVID-19 was killing more Americans per week than automobile accidents, cancer, heart disease and the flu/pneumonia did in 2018.  Somewhat ironically, a comparison of COVID-19 deaths ended up showing the reverse of what the comparison was originally intended to do.

We can expect similar death comparisons in the early days of the next pandemic. While these comparisons can have merit, they are often used as rhetorical devices to downplay the seriousness of a pandemic. As such, we should be on guard against this tactic during the next pandemic.