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COVID-19 Cytokine Storm Is a Metaphor for How a Society, Fearing the Unknown, Can Destroy Itself

This Aug. 3, 2017 photo provided by Human Rights Watch shows Laurel Cline during a visit to her mother Lenora, who has Alzheimer's disease, in a nursing home in Whittier, Calif. Laurel says her mother, during stays at three different nursing homes in recent years, was sometimes left neglected for hours at a time in her wheelchair after being given antipsychotics. "Instead of seeing what's wrong with her, they just want to drug her up," said Cline. (Ed Kashi/Human Rights Watch via AP)

One of the ways the Coronavirus kills is by stimulating an overreaction of a patient’s own immune system. “Diseases such as covid-19 and influenza can be fatal due to an overreaction of the body’s immune system called a cytokine storm.”

Sometimes the body’s response to infection can go into overdrive. For example, when SARS -CoV-2 – the virus behind the covid-19 pandemic – enters the lungs, it triggers an immune response, attracting immune cells to the region to attack the virus, resulting in localised inflammation. But in some patients, excessive or uncontrolled levels of cytokines are released which then activate more immune cells, resulting in hyperinflammation. This can seriously harm or even kill the patient.

This metaphor can also describe how society can harm itself when measures taken to control a disease do more harm than good. Perhaps the most forceful and controversial reaction to the coronavirus epidemic has been the lockdown which, believe it or not, did not exist in the American context as a bureaucratic concept before 2006. As Jeffrey Tucker writes in the American Institute for Economic Research:

So far as anyone can tell, the intellectual machinery that made this mess was invented 14 years ago, and not by epidemiologists but by computer-simulation modelers. It was adopted not by experienced doctors – they warned ferociously against it – but by politicians. …

Maybe you don’t remember that the avian flu of 2006 didn’t amount to much. It’s true, despite all the extreme warnings about its lethality, H5N1 didn’t turn into much at all. What it did do, however, was send the existing president, George W. Bush, to the library to read about the 1918 flu and its catastrophic results. He asked for some experts to submit some plans to him about what to do when the real thing comes along.

Tucker lets the New York Times take up the story of how lockdown was born.

Fourteen years ago, two federal government doctors, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint in suburban Washington for a final review of a proposal they knew would be treated like a piñata: telling Americans to stay home from work and school the next time the country was hit by a deadly pandemic.

When they presented their plan not long after, it was met with skepticism and a degree of ridicule by senior officials, who like others in the United States had grown accustomed to relying on the pharmaceutical industry, with its ever-growing array of new treatments, to confront evolving health challenges.

Drs. Hatchett and Mecher were proposing instead that Americans in some places might have to turn back to an approach, self-isolation, first widely employed in the Middle Ages.

How that idea — born out of a request by President George W. Bush to ensure the nation was better prepared for the next contagious disease outbreak — became the heart of the national playbook for responding to a pandemic is one of the untold stories of the coronavirus crisis.

Not everyone was convinced this weapon should be added to the government repertoire. “It required the key proponents — Dr. Mecher, a Department of Veterans Affairs physician, and Dr. Hatchett, an oncologist turned White House adviser — to overcome intense initial opposition.” But eventually it happened and the bureaucrats now had a canned response to pandemics that did not exist before. When the coronavirus began to devastate the health systems of northern Italy, the frightened bureaucracy had an instrument ready to use.

No one really knew what the effects of shutting down economic activity would be in early 2020 but neither did anyone know how potentially deadly the disease would be. What really broke the intellectual tie were hair-raising forecasts by epidemiological modelers predicting deaths in millions. Faced with this apocalyptic scenario and perhaps recalling the warnings of Climate Change advocates, the public was admonished to “trust the science.”

But the science, given the lack of data in the early days, was far from certain. When models, in which so much trust had been reposed, failed to pan out, especially those of the prestigious Imperial College, public confidence was shaken.

Imperial College has advised the government on its response to previous epidemics, including SARS, avian flu and swine flu. With ties to the World Health Organization and a team of 50 scientists, led by a prominent epidemiologist, Neil Ferguson, Imperial is treated as a sort of gold standard, its mathematical models feeding directly into government policies.

It was the crash heard round the world. After it was discovered how amateurish the software code was, trust turned to anger and the Daily Telegraph wrote in disgust that “Neil Ferguson’s model could be the most devastating software mistake of all time.” It was certainly an expensive one.

But even the most skillful software authorship could not have saved the Imperial model from the uncertainty surrounding the pathogen’s environmental behavior, which remains mysterious to this writing. Simon Jenkins writing in the Guardian captured his frustration at science’s ability to forecast a socio-medical phenomenon as complex as the weather in a kind of layman’s rant.

There is no correlation between fatalities and lockdown stringency. The most stringent lockdowns – as in China, Italy, Spain, New Zealand and Britain – have yielded both high and low deaths per million. Hi-tech has apparently “worked” in South Korea, but so has no-tech in Sweden. Sweden’s 319 deaths per million is far ahead of locked-down Norway’s 40 and Denmark’s 91, but it’s well behind locked-down UK’s 465 and Spain’s 569. …

The half-Swedish commentator Freddie Sayer has been closely monitoring this debate from the UK. He makes the point that with each passing week the rest of Europe moves steadily closer to imitating Sweden. It is doing so because modern economies – and their peoples – just cannot live with such crushing abnormality as they have seen these past two months.

Some of these crushing abnormalities are actually unintended consequences of government’s response to the virus, of fixes gone wrong. Governments, like New York’s, keen to avoid the forecast (see ‘models’) inundation of hospitals by patients, responded by offloading infected seniors to nursing homes. Distracted by their efforts to lock down whole societies, they caused a massacre of the elderly in a fit of absentmindedness. As the New York Times notes:

At least 28,100 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database. The virus so far has infected more than 153,000 at some 7,700 facilities. …

While just 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities.

If nobody saw it coming, maybe it was because government was fascinated with its shiny new superpowers. Only later did officials waken to this bit of friendly fire. “Gov. Andrew Cuomo has finally admitted — tacitly and partially, anyway — the mistake that was state health chief Howard Zucker’s order that nursing homes must admit coronavirus-positive patients.”

One of the reasons the lockdown debate is so psychologically difficult is it involves getting the public to choose between two risks, one with a tight sigma (economic collapse) versus another with a poorly defined sigma, the virus. Many people are hard pressed to select between a familiar, predictable system run-down and “high-profile, hard-to-predict, and rare event … beyond the realm of normal expectations,” It has divided the public into those who would rather endure a known, but certain economic doom than take their chances with a less predictable yet psychologically more menacing viral hazard — or vice versa.

Unfortunately we now know there is a third source of risk, arising from the chance that governments may initiate  reactions to the pandemic that are catastrophic and unforeseen. Examples include the nursing home massacre and inflicting lasting damage on whole swaths of the economy. Such government reactions, far from having predictable linear effects, can be Black Swans in their own right.

If the lockdown set new standards for the intensity of government response to pandemics, it also increased the risk of bureaucratically induced harm. Like the patients done in by a cytokine storm, countries and states may survive the virus only to succumb to their own countermeasures, felled by their own bureaucratic reaction.

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