A core lesson from 2020: we need to learn how to deal with complex problems and moral dilemmas
Shutting down most of public and social life as well as important parts of the economy is not something that epidemiologists in Western liberal democracies thought they would recommend in case of a severe pandemic before 2020. Just as microregulating when and how far people are allowed to leave their homes and whom they can meet is not something that is foreseen in any pandemic strategy.
In a recent interview the epidemiologist Professor Neil Ferguson was astonishingly open about this when he said: “I think people’s sense of what is possible in terms of control changed quite dramatically between January and March [2020].” And with reference to the authoritarian nature of the Chinese state he states: “It’s a communist one-party state, we said. We couldn’t get away with it in Europe, we thought… and then Italy did it. And we realised we could.”
Lockdowns have become a received wisdom, as if they were a proven and established instrument. In reality, however, lockdowns are a huge new departure in public policy, an unprecedented big global experiment.
The fact that with very few exceptions very quickly during March 2020 something like a global consensus about the lockdown strategy emerged might be interpreted as an indicator that this was the obvious way to pursue and that alternative strategies were obviously worse. However, that a majority believes strongly in something doesn’t mean that history will tell that the majority was right. In fact, history shows many instances where at some point hardly anybody questioned the prevailing worldview of the moment, while in hindsight it becomes clear that almost everyone was wrong and only a few sceptics were right at the time. The moment when in summer 1914 Europe sleepwalked into World War I was such a moment — in a strange dynamic all over sudden the elites all over Europe thought that going to war was a good idea and nobody was there to stop them.
A complex problem
In November 2020 a systems thinking expert who is highly regarded in progressive activist circles stated on Twitter: “Cannot it just be said? — The special Swedish program did not work. It just didn’t.” She referred to the particular way the Swedish health authorities dealt with the Covid-19 pandemic throughout 2020. It is clear that she singled out the Swedish strategy as a particular failure.
But is it reasonable to say that the Swedish strategy has been a failure so far? I would argue that it is too early to make a final judgement as the pandemic is not over yet, but with regard to the past 10 months I will make the case in this essay that Sweden might have made some better choices than many other European countries.
Of course, most media outlets across the Western world have told us again and again that Sweden utterly failed because it allowed too many people to die from Covid-19. The evidence for this verdict was the snapshot of the official Covid-19 related death numbers per million inhabitants in Spring 2020 — Sweden was among the (worst) top 10 globally.
Since then, the Swedish health authorities have acknowledged that many Covid-19 deaths in care homes could have been avoided. An official commission has recently concluded that one of the causes for the bad situation in care homes were the cost cuts imposed on the care sector in recent times. This in turn resulted in low wages and low qualifications of the elderly care workers who have been unable to cope with the challenges during the pandemic. Many other countries have had to cope with similar problems and high death rates in their care homes.
However, this doesn’t answer the question whether the lockdowns have been justified and whether the particular Swedish approach is a failure.
This logic of judging the success or failure of a country in the middle of a pandemic solely on the basis of its current (pandemic disease) death rate is the result of not understanding the nature of complex problems. Complex problems like a pandemic cannot be understood and tackled in a linear fashion and in a one-dimensional way like it has been attempted by most governments so far.
Apart from the fact that changes in a complex system cannot be planned and controlled like in a machine, the focus on trying to optimise a single metric like the daily infection or death rate while largely neglecting all other metrics does likely create undesired trade-offs in other parts of the system, including effects that are often far removed geographically and in time.
Especially in our Western societies, through our education system and the way academia is structured around disciplines, we’re still not used to thinking in complex systems. We usually break down a problem into its parts and attempt to find solutions in largely linear ways. That said, I would expect someone who claims to be a systems thinker and who regularly offers advice on how to deal with complexity to talk about this pandemic and also about the Swedish case in a different way.
The Swedish health authorities and their state epidemiologist Anders Tegnell have been clear throughout that theirs has been a long-term strategy. They found that it was unrealistic to eradicate the virus and believed that the pandemic would not be over any time soon. They were trying to find a strategy and apply a portfolio of measures that would reduce the number of people who would fall ill or die due to Covid-19, but that at the same time would allow society to function reasonably well and without too much collateral damage over a longer period of time.
By contrast, for many international observers it looked like, the Swedes, motivated by selfishness and to keep their personal freedom, didn’t do what was needed to protect the lives of the vulnerable, and therefore many people had to die. However, the journalist Freddie Sayers argued: “It is precisely because the Swedes want to preserve the common good and are proud of their shared way of life that they have been reluctant to infringe it.”
Sweden has kept young children in school throughout the pandemic and has kept shops and restaurants open. It also didn’t make face masks mandatory.
In addition, following the Swedish tradition of mutual trust between the government and its citizens their health authorities didn’t coerce people into following rules and guidelines and issuing fines to those who flouted regulations. The approach has been one that places an emphasis on the people’s personal responsibility and appeals to their sense of civic duty.
So how can one evaluate if this approach has been better or worse than the approach of countries that have applied stricter measures? Well, when dealing with complex problems, this is not a straight-forward exercise.
Firstly, it depends on developing a broader and deeper understanding of what the virus itself and especially the governmental interventions are doing to our societies.
Such an approach is complicated by the fact that it involves many unknown variables: unknowns and unknown unknowns, some of which we will only learn about after time has passed and some of which we might never fully understand. But that’s the nature of complex problems, a world full of uncertainties to navigate.
Navigating through this uncertainty requires cross-disciplinary collaboration as well as a deep understanding of systems thinking. The virologists and epidemiologists that have dominated the public discourse during the pandemic contribute important expertise, but this knowledge is ultimately completely insufficient for dealing with complex problems.
After the Spring wave of the pandemic, it looked like some European countries, among them Germany, Austria and most Eastern European countries had managed relatively well, especially with regard to low death numbers. Partly, so many observers thought, this was due to the effectiveness of their lockdown measures. But now, in the middle of the winter surge of infections, the Eastern European countries, including the Eastern parts of Germany are some of the hardest hit. It is now increasingly unclear how effective many of these lockdown policies actually are in the long run. While some of the strictest lockdown measures, especially stay-at-home orders, might slow down the spread of the virus, over time, especially once lockdowns are relaxed, the spread of the disease seems unstoppable. A pattern that can be observed now in many countries.
Other patterns are more difficult to identify. For example, at this stage, the factors that cause the differences in death rates between countries are still confusing and seem to bear many unknowns.
To make matters more complex, it’s not enough to look at the official Covid-19 death numbers. In some countries, including Sweden, the national excess mortality for 2020 is considerably lower than the official Covid-19 death numbers that have been guiding policy makers for the past year. One of the reasons seems to be that many people who die with the virus, for example residents of care homes, would have died anyway during the same year as a consequence of severe pre-existing conditions.
Dealing with and trying to mitigate the negative impacts of a pandemic means operating in a context that couldn’t be more complex: the global economy and our globally interconnected societies. Complex systems behave according to the logic of emergence. Patterns in complex systems cannot be planned or controlled by any players. They are the result of endless interactions among numerous individuals reacting to multiple and dynamic pressures and opportunities which no one can plan or enforce. A consequence of this is that “leaders who try to impose order in a complex context will fail, but those who set the stage, step back a bit, allow patterns to emerge, and determine which ones are desirable will succeed.” (Dave Snowden)
Unintended consequences
It becomes increasingly clear that many people die as an indirect consequence of the pandemic, and especially as a consequence of the lockdown measures. While no complete data are available yet, suicide rates seem to have gone up considerably in many countries during 2020. These are people who were already psychologically unstable, who might have suffered from extreme loneliness during the lockdown or who have become desperate because of a bleak economic perspective as result of losing all income. We’re also beginning to get a more complete picture of how severely disrupted cancer treatments have been during the pandemic, with the number of treatments gone down dramatically in many countries.
Furthermore, the lockdowns in Europe can have severe consequences far away from home. According to UN estimations, ten thousand children might die additionally each month from starvation in Africa due to the negative consequences lockdowns in Western economies have on trade and tourism in Africa. The WHO recently warned that due to disruptions of anti-malaria programmes during the pandemic, “it’s very likely that excess malaria mortality is larger than the direct COVID mortality” in sub-Saharan Africa.
The lockdown strategies focus on avoiding infections and deaths from Covid-19, but an unintended consequence seems to be that we neglect to take care of our health more holistically. Even the WHO states in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
As part of the lockdown portfolios, governments in many countries have asked people to stay at home whenever possible, in many countries there have been strict curfews in place over many weeks — with likely severe negative consequences on mental and physical wellbeing, including due to low levels of vitamin D. Sports facilities have been closed for many months, leading a to a likely reduction in physical fitness. Apart from a general deterioration of our health that all this will surely bring along, the immune system might also be severely weakened by the lockdowns and lack of vitamin D. There is also research that shows that long periods of stress and fear have very negative impacts on the human immune system. It might well be that many people wouldn’t have fallen ill from Covid-19 had their immune system not been weakened and had governments and media not constantly instilled panic and fear during the past year.
Clearly, not all of these negative consequences were avoided by the distinct approach Sweden has taken in the pandemic, but some of them were probably mitigated or even avoided. The calm approach of communication the Swedish authorities have taken throughout, and the absence of fearmongering (by the authorities) will surely have avoided the high levels of anxiety and fear felt by the population in many countries.
What in the long run might turn out to become an important advantage of the Swedish approach is that children until the age of 13 were able to attend school throughout 2020 without interruptions. By contrast, in many other countries, children have barely or not at all seen their school buildings from the inside over the past year. This will likely have profoundly negative impacts on the children’s development, especially of those children who come from socially and economically weaker families including immigrant families.
This is by far not an exhaustive list of the profound damage caused by the long periods of lockdown restrictions and authoritarian politics during the pandemic. The webpage Collateral Global tries to keep track of the growing body of research of these collateral damages. Many of the consequences will only become clear in the coming years.
A recent study by researchers from Stanford University, co-authored by the influential scientist John Ioannidis, analysed the effects the most restrictive lockdown measures including business closures and stay-at-home orders might have on the spread of SARS-CoV-2. It concluded that the benefits were not significant while at the same time the collateral damages were highly significant.
A moral dilemma
A pandemic is a natural disaster or in case the suspicion is ultimately confirmed that the virus was made in a Chinese laboratory, Covid-19 is still a (man-made) disaster. Once the virus had spread around the world, it was always unlikely that we would ever be able to control and eliminate it entirely. There were no painless choices left.
The more we understand the patterns that emerge, the easier it is to identify which paths are more desirable or less painful and we can attempt to support or disrupt patterns. One possibility that this pandemic has offered from the start was to put much more effort into trying to protect those who were most at risk to die from Covid-19, given that the particular characteristic of this virus is that it disproportionally kills people older than 70. While such a strategy would not have been without challenges, it might have been an opportunity to reduce the collateral damages while at the same time reducing the number of deaths considerably.
Instead, unable or unwilling to deal with complexity, we have focused on a simplistic one-dimensional morality of saving lives at all costs through a strategy focused on avoiding human contacts and increasing physical distance between all citizens as much as possible. Complex problems, however, never have a simple solution but require thorough consideration and deliberation about trade-offs.
In fact, for the whole of 2020 our societies have shied away from discussing the real moral dilemmas that were caused by this pandemic. However painful such discussion might be, we cannot shy away from discussing what we win and what we lose with the alternative responses to the pandemic. We can’t wish the damage away that has already been done by not confronting this question. But the sooner we start talking honestly about this moral dilemma, the further damage we can avoid, especially with regard to the time after the pandemic is over.
We need to urgently discuss how much we are ready to sacrifice for the greatest possible prolongation of our existence. How much do we value freedom compared to safety? How much are we willing to sacrifice of what makes human life dignified and complete?
Humans are profoundly social beings, and it is exactly our sociality that has been deemed problematic over the course of the pandemic. In analogy to the Kantian imperative, the German celebrity virologist, Christian Drosten, formulated what he called the pandemic imperative: “Always act in a pandemic as if you had been tested positive and your counterpart belonged to a risk group.” Instead of seeing one another as fellow human beings, we have become potential hazardous sources to each other. What will this do to us more long-term?
If the current anxious mood continues, it’s likely that much of the new normality of enforced social distancing and social control rules will become permanent. The experience with the powers taken by governments during the so-called fight against terrorism in the last 20 years shows that once these policies are in place, there aren’t many incentives to roll them back. There is always the worst-case scenario of a new virus or a new terrorist attack to justify that protection measures should remain in place.
Surely, efforts to reduce infections and save lives during a severe pandemic like Covid-19 are important, but an approach that is conscious of complexity doesn’t shy away from discussing trade-offs and the moral dilemma involved.
An acknowledgement and open discussion of the moral dilemma might also stop the growing polarisation between the two extremes of lockdown fanatics and lockdown sceptics we’re seeing in many societies as the pandemic drags on.
For this, we also need to understand that not everybody shares the same moral worldview. For some people the highest moral good is to offer empathy and help to those who are suffering. The solidarity with those who are at risk to die from Covid-19 has been the dominant moral code during this pandemic. However, moral psychologist Jonathan Haidt who researched the diversity of moral foundations across cultures, shows that there is more to morality than caring for the weak and vulnerable. The people who are critical of lockdown measures are often caricaturised as morally evil for not caring about the lives of the vulnerable. However, their motivations are often misunderstood. The wellbeing and functioning of our societies are certainly moral values that many people believe being at risk. According to Haidt’s theory, morality itself is complex and not one-dimensional. A more holistic moral code could attempt to find a balance between the wellbeing of society as a whole and the avoidance of harm done to individuals.
We shouldn’t make a final judgement yet about which strategies of dealing with Covid-19 is or has been better. There are still many uncertainties at play, including the role vaccines will play, how safe they are in the long run, how effective they are against new strains and how fast the rollout will finally be. François Balloux, a professor at University College London and who clearly has a complexity mindset, believes that SARS-CoV-2 will be much easier to manage if our societies eventually achieve herd immunity through a mix of natural infections and vaccines. It’s therefore even still too early to tell if New Zealand and Australia will be in a better position than say Sweden in a few years’ time when they might struggle to keep the balance between opening their borders and keeping the virus away from their populations that have no natural immunity.
From a perspective that is conscious about the complex nature of pandemics and the moral dilemmas they pose, at this stage it clearly doesn’t look like Sweden’s strategy has been a failure so far if compared to the majority of Western democracies.
Over the last few years, I have observed that people in the civil society sector who lean highly progressive politically are often very fond of using tools that apply the logic of systems thinking to problems like climate change, inequality or poverty. The aim being to understand the system and the deeper causes of the problems we would like to solve. The problem is that the outcomes of these processes are almost always in line with their pre-existing worldviews and political ideas about what has to change in the world. I have come to the conclusion that these outcomes are often incomplete and sometimes even leading in the wrong direction.
We need to develop more awareness of our innate tendency for motivated reasoning: when we have a moral intuition, we use our intelligence and reasoning to find the most convincing arguments that support the initial intuition.
However, the tools that can help us understand how systems and how complexity operate are only useful if we use them in an ideologically open way and if we allow different perspectives to be part of these processes. It’s probably a good indicator of a successful process if we don’t like some of the outcomes. Navigating complexity in adequate ways requires being open ideologically, allowing different views as legitimate perspectives and accepting that difficult decisions about trade-offs have to be made and moral dilemmas be solved.
Of course, such discussions shouldn’t stop at the level of trade-offs between Covid deaths, children’s development and other illnesses. We should also ask questions about our deeper worldviews and fear of death. Should and can we humans control everything? What are we losing if we continue the path of safety above all and reducing risk whatever the cost? Or should we rather accept our vulnerability and that we’re part of a bigger web of life? How can we increase the chance that life on earth is worth living and that we don’t lose the joy of life and become rather similar to machines?
As societies, we have to learn how to think and act in complex systems, and this means navigating through a whole range of values and trade-offs; otherwise we will be doomed. Humanity will survive Covid-19, but the ecological crisis, and especially climate change, pose a much bigger challenge. If we want to avoid the biggest ecological disasters and indeed the possible collapse of our civilisation, very soon we will have to make important changes to the way we live and the way we run our economies. This will also mean collective decisions that limit the personal freedom of individuals for the sake of the public good and the wellbeing (and survival) of society. But if we want to manage the transition to an ecological society successfully, we should better accept that there are many trade-offs to consider, and we should better become good at navigating these complex trade-offs. Otherwise, bad decisions will be made, and we won’t come anywhere near maximising welfare for humanity, now and for future generations.
