The societal norm against speaking ill of the dead is definitely a good one. No matter what a person’s shortcomings, their flaws shouldn’t be publicly rehashed the minute that they’re too dead to respond. When I die, I like to imagine that there will be a polite cooling off period before someone utters the phrase “poor man’s Mark Russell but without the musical talent.”
This taboo might be one of the reasons why we seem to be mostly dodging one of the central questions of the pandemic: What steps should we take to protect people who could greatly reduce their risk from Covid by getting vaccinated, but who choose not to? As David Leonhardt notes, we seem to be keeping some restrictions in place at least partly to protect people who make this choice.
There’s a lot of invective being directed against the unvaccinated; I’m not going to take part in that. Unvaccinated people frustrate the hell out of me, but I don’t think that railing against them gets us anywhere. And it should go without saying that I don’t want anyone to die; the only people who I want to die are terrorists and a few singers from ‘90s bands, and I know that the second category isn’t ethical (even though it remains very real). Still, I think that there’s a simple answer to the question: “What steps should we take to protect people who choose not to protect themselves?” I think the answer is “none”.
The freedom to do something stupid is a fundamental human right. From crypto to cave diving, we all have the right to manage our body and possessions in ways that others would consider patently insane. When we celebrate the Fourth of July, we’re celebrating — among other things — the right to get drunk and blow our thumbs off with fireworks and the right to commit slow suicide by consuming pornographic amounts of grilled meat.
One reason why these freedoms exists is because people have different levels of risk tolerance. At the moment, I’m enjoying the Winter Olympics even though every single sport is one that I, personally, think you’d have to be absolutely batshit to pursue. And that feeling isn’t limited to the sports that amount to “jump off a mountain and hope it goes well”; I also think it’s insane to train five hours a day in an ice rink from the age of three. But, hey: It worked for Nathan Chen, so good for him. We all take risks; my hobbies are soccer and home renovation, so the odds of me blowing out a knee or chopping off a finger are well north of zero. And, actually, I’ve done the first and damn near done the second, but it’s my knee and my fingers, so I can do what I want with them.
The limit to this freedom, of course, is that you’re not free to do things that harm other people. This is the classic harm principle laid out by John Stuart Mill 163 years ago. Personally, I find this to be an extremely helpful precept; it’s as good of a guide as the Golden Rule or “beer then liquor, never been sicker.” Much of the anger against the willfully unvaccinated comes from the fact that they’re obviously violating this rule; they’re increasing the risk to people around them and heightening the strain on the hospital system. A frequently used formulation of Mill’s principle is “Your freedom to swing your fist ends where my nose begins”, which in this context could be reformulated as “Your freedom to not get vaccinated ends when you get a job that puts you in close proximity to my grandma, and under no circumstances does your freedom allow you to drive through Ottawa honking a truck horn and closing down roads like a complete fucking asshole.”
But let’s ignore the externalities of the decision to not get vaccinated, because that’s not really the question here. The question is whether we should take action to protect people who could get vaccinated, but don’t. I’ve already answered that question with a “no”. My “no” doesn’t come from a place of callousness or vindictiveness; it comes from respect for a person’s moral agency.
There have, unfortunately, been many cases of frustration with unvaccinated people boiling over into spite. That spite usually takes the form of some dumbass on Twitter spouting off, and one of the great challenges of modern life is learning to ignore some dumbass on Twitter spouting off, but regardless: The “fuck it, let ‘em die” mindset is out there. That’s not my position. I don’t want anyone to die. In fact, one of the reasons why I wish people would get vaccinated is that it’s clear to me that getting the shot greatly reduces your chances of developing severe illness from Covid no matter who you are.
But — noting again that we’re ignoring the ways that refusing the shot affects others — people get to make their own choices about their own health. For me, the question of whether I’d like to get the vaccine was like getting asked if I’d like a free box of money; yes, I do want that, how quickly can I get it? But others made a different assessment. And — in so far as that assessment affects themselves — fair enough. People have a right to manage their own health however they want.
And yet, we often treat all Covid illnesses and deaths as ethically indistinguishable. A lot of the reporting about the Omicron wave has acted as though the impact has been equivalent to pre-vaccine waves. And, of course, the plain fact is that the death rate at the height of Omicron was slightly higher than the death rate at the peak of the first Covid wave (5.29 deaths per 100,000 people in the seven days prior to January 26, 2022 versus 4.84 deaths per 100,000 on April 21, 2020) and almost as high as the peak just before vaccines became widely available (7.22 on January 22, 2021). This is the chart:
But how many deaths in recent waves have been unvaccinated people? We have an approximate answer to that question: When the AP looked at data from May 2021, they found that 0.8 percent of people who died were fully vaccinated. So, if we assume that 0.8 percent of people who died during the Omicron wave were fully vaccinated — which might not be a completely accurate estimate but it’s probably pretty close1 — we get a graph that looks like this:
The orange line looks perfectly flat, but it’s not: It wobbles between nine and 20 deaths per day. And even if you think that the AP’s estimate is too low — which it might be, especially now that there’s a difference between “vaccinated” and “vaccinated and boosted” — we’re still talking about fatalities measured in the dozens. For comparison, about 197 people die every day from the flu during an average flu season.2 For fully vaccinated people, Covid appears to be about as deadly as a mild flu.
But we’re definitely not treating Covid like a disease that’s similar to the flu. We’re still using non-pharmaceutical interventions (NPIs), including ones that are basically useless and ones that appear to have serious negative effects. I’m not saying that because Covid is now a basically-ordinary disease among fully vaccinated people, we should permanently ditch all NPIs; decisions about which precautions to take will always be a cost-benefit analysis that changes with circumstances. But I am saying that we have no ethical obligation to protect people who choose not to protect themselves.
Let me flesh out that belief a bit: Remember Grizzly Man? Timothy Treadwell was a naturalist who lived with grizzly bears in Alaska and became the subject of the 2005 documentary Grizzly Man. I’m not going to make light of any part of his story, because, tragically, it ended exactly the way you’d guess: He was killed by a bear. But, when he was alive, would I have had any right to tell him “You can’t live with bears”? No; that would have been me trying to impose my values and sense of risk onto him. No matter how convinced I might have been that he was making a terrible choice, a person of sound mind and body3 has a right to decide how to live. But it follows that I have no moral obligation to protect him from his decisions; that would transfer responsibility for his decisions onto me. He’s an adult; I’m not his dad. I’m not going to deny his autonomy by taking on a father role that nobody asked me to play.
And yet, a sense that we need to protect adults from the consequences of their own actions is clearly factoring into many people’s thinking about Covid. This tweet directly asks people who are calling for school closures if they’re doing so out of concern for the unvaccinated, and many of the respondents say yes, that’s their concern. Much of the recent writing on Covid fails to acknowledge any difference between the disease we had two years ago — which killed thousands of innocent Americans every day — and the disease we have now, which kills thousands of Americans every day who could have protected themselves but didn’t. It feels unbelievably callous to acknowledge the difference between the two scenarios; as I type this, I’m thinking that my column today probably should have been “The Ten Wackiest Super Bowl Ads”. I don’t like seeming to shrug when a person dies; on a visceral level, that’s honestly not my reaction. But it seems to me to be a simple fact that there is a moral difference between the death of a person who couldn’t protect themselves and the death of a person who could.
What we have — yet again — is a situation in which political extremists are feeding each other. It’s tragic that Covid got politicized; if I could turn back time, I would put some money on the Rams and also do whatever I could to keep Covid from becoming yet another front in our political forever war. But I can’t, and now there’s an obvious political dimension to people’s vaccination decisions. We have disproportionately right-wing ideologues refusing vaccination, going to the hospital in large numbers, and sometimes dying from the disease. This fuels “IT’S NOT OVER!!!” hysteria from the pants-wetting elements of the left who would like Covid to be a prominent chapter in an autobiography they’re writing called How I Became the Most Righteous Person Who Ever Lived Or Will Live. That, in turn, creates support for more restrictions, which outrages anti-vaxxers, so they do things that prolong the pandemic, and, well, long story short: Kids in New York still wear masks during recess and the Ambassador Bridge was blocked for six days.
Governors, including Democrats, are lifting restrictions as Omicron subsides. Some people have noticed that there’s a discrepancy between what most governors are calling for and what the CDC recommends. I think that makes perfect sense. The CDC is a “just the facts” agency; they’re statutorily forbidden from making the kind of ethical distinctions I’m making in this article. That second graph above, the one that more-or-less separates deaths into “avoidable” and “unavoidable”? The CDC’s not allowed to think like that. But I am, and governors are, and there seems to be an implicit understanding in some governors’ decisions that we can’t keep imposing large societal costs to counteract choices that some people have made about their personal health.
Decisions about which NPIs to pursue will continue to be difficult. In my opinion, our focus now should be on reducing risk for vaccinated people who are still vulnerable by using things like rapid tests and N95 masks where appropriate. The goal should be to reduce risk to roughly the same level that we all understood as “normal” before the pandemic. The goal should not be to perpetuate a siege mentality that’s clearly driving us insane in a million different ways in pursuit of a societal risk level so low that it makes the risk tolerance of the typical helicopter parent seem like Evil Knievel. Though that does seem to be what some people are angling for.
My personal risk-reward calculus doesn’t give any weight to protecting people who won’t protect themselves. I feel like a dork saying that — I think I sound a tad like a “life’s a bitch and then you die” wannabe hard-ass, the type of person who would blow the doors off the place at a Libertarian Party debate. That’s honestly not what I’m going for. I’m going for respect; I respect adults’ ability to make decisions for themselves. And with that being true, I think that the “what should we do to protect people who won’t protect themselves” question only has one answer.
***POLL FOR MONDAY***
I'd like Monday's column to be about...
1. How depressing it is when politics is just a reprise of the jocks vs. nerds dynamic from high school. [VOTE FOR THIS]
2. Whether the prevalence of reboots is a sign of artistic stagnation. [VOTE FOR THIS]
3. Whether the left is particularly bad about updating our opinions in light of new information. [VOTE FOR THIS]
More recent data — which is a little fiddly because it gets into the difference between “vaccinated” and “vaccinated with a booster” — found that in October and November of 2021, the death rate was 7.8 per 100,000 people for the unvaccinated and .1 per 100,000 for those who are vaccinated and boosted. That works out to a death rate for boosted folks that’s 1.2 percent of the unvaccinated rate. So, that number is in line with the AP’s 0.8 percent estimate. Also, cardiologist and scientist Eric Topol estimates the vaccinated and boosted death rate at 1 percent of the unvaccinated rate, so there’s another estimate in the same range.
My math: The CDC estimates that about 36,000 people die in an average flu season. A flu season is about six months, so 182.5 days, so 36,000/182.5 = 197.26 deaths per day.
I don’t know for certain that Timothy Treadwell was of sound mind and body, but for the purposes of this thought experiment, let’s assume that he was.
Great post! I like use an analogy to talk about Covid restrictions for everyone to protect the unvaccinated: there are a lot of people out there who refuse to wear helmets when they ride their bikes. We could forbid people to drive cars in order to protect the helmetless, but we don’t. We rightly recognize that there are limits to the suffering we ought to impose on the general population in order to protect a foolish few.
I write this from Switzerland, where (except for the mask requirement in healthcare settings and on public transportation, which they’re keeping for a few more weeks) the government just lifted all Covid restrictions. All! Yippee! The government’s attitude, quite properly imho, is that vaccines are available and accessible to everyone, and an exceptionally effective treatment is about to become widely available. It’s time to be done.
I went grocery shopping this morning, and I can’t begin to convey how happy everyone (including every worker I saw—about 20 people) was not to have to wear masks.
Hey Jeff, one question for you - should the orange line in the second graph (the one that looks ~flat) be labeled "estimated fully vaccinated deaths" instead of "estimated unvaccinated deaths"? My read of the chart now (and, pun intended, I might be wrong) is that it seems to display an optimistic case for the unvaccinated, which I don't think is what you're going for...