The missing conversation: How are we going to live with this virus in the long run?

In early March, when broad consensus emerged that Covid-19 was turning into a global pandemic, social media suddenly felt like a math class on exponential growth graphs. #flattenthecurve became a social media campaign and soon, the political goal of most governments. After the footage of collapsing ICUs in Bergamo shocked the world, at least in Europe the consensus was to prevent such chaos and suffering. The goal was to maintain our capacity to treat any patient in need of intensive care.

In one of her early televised statements, on March 12th, chancellor Merkel said that eventually 60 to 70% of the Germany population would be infected by the virus, but it was imperative to prevent it from spreading so rapidly that the health system wouldn’t be able to cope.

The various versions of lockdown implemented by governments in Europe and many other countries at remarkable speed achieved just that. With very few exceptions, like Madrid, at least in Europe, there were no further crises like Northern Italy’s.

Until mid-April, German politicians were constantly warning that the worst was still to come, with the peak of the demand for ICU beds to be expected at around Easter.

But the almost weekly appearances on TV and calls for compliance with physical distancing rules by Merkel were successful. Germany never came anywhere close to maxing out its ICU beds. Other countries didn’t have it nearly as easy, but nevertheless the goal of not overextending the health system was mostly met. In any case, we were past what was supposed to be the peak of the pandemic. Physical distancing had worked and the curve had been flattened, exactly as pushed for by campaigners in early March.

But then suddenly, towards the end of April, with no explanation from political leaders, the goalposts were shifted. The inevitability that 60% of the population would eventually get the virus, and therefore herd immunity as a long-term vision, disappeared from public discourse. The new emerging goal was to reduce the daily number of positive new cases (of Covid-19), initially to below 1000, and later down to a few hundred (in the case of Germany).

My own explanation for this shift is that people in almost all countries were more disciplined than expected. The severe and unprecedented lockdown measures, initially meant to flatten the curve and avoid another Bergamo, received very high approval rates in most countries and were followed by the vast majority of the population. Eventually, they helped to reduce the infection rate so effectively that much more ambitious goals seemed to be within reach. The argument sounded convincing: only a few more weeks of lockdown and we would be able to control the pandemic through track and trace systems, and as a result save thousands or even hundreds of thousands of lives. A German epidemiologist at one point even speculated that Germany would be in the position to eradicate the virus if we could only keep the lockdown going for a few more weeks.

What followed are endless discussions since the end of April between those who want to loosen the lockdown measures and those who warn that the pandemic isn’t over, that we have to be careful. Those who warned that the economic downturn could lead to a long recession were often accused of being willing to risk the life of the elderly and vulnerable for the sake of profit and money. The German finance minister at one point said that considering trade-offs between the economy and Covid-19 deaths was intolerable.

Eventually, a compromise emerged between getting the economy back on track and keeping the risk of infection low. The vision of the moment was given a name: the new normal. The continuous use of disinfectants in shops and almost everywhere else as well as the use of masks are core to this strategy.

In Spain, the government laid out an impressive step-by-step plan for the country’s transition from total lockdown to this new normal in about two months (May and June). I guess that having such a clear timeframe gave hope to a population that was basically locked indoors for about three months, including children who couldn’t even leave their homes for a walk.

The discussion about how long this new normal is supposed to last has mostly been kept very vague. My guess is that most people hope that a vaccine will be available very early in 2021, after which they can finally get back to normal life. In addition, the insistent calls by politicians and epidemiologists to keep the lockdown in place for a few more weeks to fully or nearly eradicate the virus have probably spurred some hope that this nightmare might be over even sooner.

Hope is key to getting through this pandemic without suffering psychological damage. But is this hope realistic? Well, I don’t know! And that’s why I find the whole situation so problematic. The media are still talking about Covid-19 day in and day out, but almost nobody in the public sphere is talking about the most important question of all questions regarding Covid-19: how are we going to live with this virus in the long run?

As far as I understand it, it is completely unrealistic to expect that we can eradicate the virus, which means that the virus, like the four coronaviruses before it, has already become endemic. We will have to find a way to live with it.

Instead of lying to ourselves with the vague hope that this will soon be over, we should center our discussions on this long-term perspective. Doing this will most likely influence what we do now and tomorrow.

The German epidemiologist and health politician Karl Lauterbach has been on German TV almost every day since the pandemic started. He has been the fiercest opponent against any loosening of the lockdown measures and continues to warn against schools opening after summer without strict social distancing measures. He also argues that football stadiums should be vacant of spectators next season. I assume he has greatly influenced what many people think.

One might assume that he defends this extremely cautious path because he believes that it will navigate us safely until, next summer at the latest supposedly, we have an effective vaccine. But no; even he recently acknowledged the very real possibility that we may never have a vaccine, or that we may not have one for years, or that the one we have may not be very effective.

One might conclude that such an outlook should lead to a discussion about what to do in such a case, to the question that we’re not asking: how are we going to live with this virus if the vaccine doesn’t save us next spring?

I have read the optimistic news popping up in the last few weeks about the possibility of a good vaccine early next year. If this happens, maybe the concerns I raise in this article will look exaggerated in hindsight. But even if the most optimistic prospects hold true, it is unclear how effective the vaccines on offer will actually be, and also how many people will want to be vaccinated. For example, the flu vaccine reduces the risk of flu by between 40 and 60% depending on how well matched the vaccine is to the flu viruses circulating that year. We could see similar rates with Covid-19.

What I’m getting at is that we shouldn’t rely on the vaccine to be our saviour and liberator from the new normal. There is a high chance that it won’t liberate us in the way that many people probably hope it will. Covid-19 is now endemic and will cost lives every year, just like the flu virus and previous coronaviruses are already doing.

The vaccine won’t liberate us from the tough conversation that our societies urgently need to have about what and how much we are willing to give up to save lives through social distancing measures. We can certainly choose to reduce lethality from all kinds of infectious diseases, including Covid-19, by maintaining social distancing measures indefinitely. But at what cost? And I don’t mean economic cost. Although the economy is an essential factor for human wellbeing, I’m referring here to a much deeper and broader question: what makes life worth living? What is fundamental to human flourishing, beyond mere survival, beyond avoiding death?

We’re now living in a constant state of alarm, fearing that at any given moment a new outbreak might lead to a new local or regional lockdown. Most notably, the Spanish population, who persevered in their homes for more than three months with stoic resignation and then stayed the course through the de-escalation to the new normal with near-total discipline, now a few weeks later finds itself on the way back into lockdown, after many regions saw a spike in new infection cases (of Covid-19). Apparently, many Spaniards had been completely separated from their wider families and friends for too long. When they could finally reunite, the physical proximity of kissing and hugging, which are so essential to Spanish culture, was unavoidable and increased the risk of infection.

Everywhere in Europe, young people, who had been yearning to meet up and party with friends again, are filling public squares and parks while nightclubs remain closed and many other nightlife activities restricted. While this is very understandable, obviously there is at least some increased risk for infection and city governments are reacting by closing squares and imposing fines or by making it compulsory to wear masks outdoors.

I don’t know what the psychological and of course economic impacts will be for people in regions that are going through or will go through a rollercoaster of lockdowns over the coming months. As I was writing this, infection rates in my beloved Barcelona were rising sharply, and there were talks about putting the Barcelona metropolitan region under full lockdown again. I don’t want to imagine the damage this will do to people.

Are we as society and are our governments doing the right thing? Maybe. But honestly, I don’t know.

In principle, the extraordinary solidarity with the vulnerable and elderly that seems to dominate public discourse and sentiment during this pandemic is the expression of a highly developed moral attitude. I don’t have doubts about the sincerity of this general sentiment, but saving lives should never be an absolute value. Different values are always in conflict with each other. Trade-offs are unavoidable.

In her 2012 novel Corpus Delicti (in English, The Method) German writer Juli Zeh describes a dystopian world in the year 2032 where a health dictatorship (the Method) has replaced the current liberal democracy and health has become the absolute value in this authoritarian system. The state controls all variables that might influence its citizens’ health through a variety of surveillance methods as well as penalties in the event of infringement. This includes controlling for the optimal amount of physical activity, the optimal healthy diet and protection against infectious diseases, including obviously continuous hygiene measures, distance keeping and mask wearing in the presence of other people.

While Juli Zeh obviously believed that we were (and still are) far from living in a health dictatorship, she wrote this novel because she had observed that we were moving in a direction where we progressively subordinate other values to physical health as a goal in life and for societies as a whole. The novel can be interpreted as a critique of a society that equates physical well-being with mental well-being and regards the attainment of this as the highest goal. It leaves little room for dissenters and people who want to prioritise anything other than the greatest possible extension of their earthly existence. Also, this very prolongation of existence requires great sacrifices and limitations on the part of each individual, but can only be successful when done collectively. Thus, such a health dictatorship also forces everyone into a life pattern that comes close to the ideal but leaves no room for personal freedom.

Zeh hasn’t talked much about the parallels between her book and the current situation. But undoubtedly, there is much food for thought in comparing Zeh’s dystopian novel and the Covid-19 reality.

I have listened to countless conversations in the public sphere over the last few weeks where people were basically repeating the same narrative: accepting the current social distancing measures, including the wearing of masks and the starkly reduced cultural and night life, were small sacrifices that we all need to make in order to save the lives of the vulnerable and elderly. People then often close their statements with a strong critique of young people who, so the critique, act as if the pandemic were already over when they infringe the social distancing measures and while socialising and enjoying their night.

Since they began, the unprecedented lockdown measures have received unusually high public support in most if not all European societies, and the current social distancing measures still enjoy majority support. Every time a regional government in Germany has proposed to loosen a lockdown measure, immediately thousands of voices warned that it was too early, that it would put lives at risk. On the extreme end of this dynamic, a few weeks ago when the infection rate in the Barcelona region began to rise once more, the regional government of Catalonia made it compulsory to wear masks outdoors, even in situations where no one else is around. It is summer and regional daytime temperatures regularly exceed 30º Celsius. Despite the lack of scientific evidence for the effectiveness of such a measure, other regions in Spain were quick to copy it. Remarkably, I didn’t see a single article in a Spanish newspaper, nor politician, voice any disagreement. Even worse, a number of journalists complained that the Madrid region had not yet adopted the measure. And when Catalonia recommended that Barcelonans stay at home, instead of immediately locking them back into their apartments, a number of journalists complained in their opinion pieces that such voluntary measures wouldn’t work, that they had to be mandatory.

All this makes it clear to me that people are increasingly happy to give up important chunks of their personal freedom for the sake of public health.

This wouldn’t be a bad thing at all if it were the result of careful societal deliberation about what we gain and what we lose. And after carefully discussing which measures really improve public health and save lives and which are useless intrusions into our personal freedom, such as the mandatory wearing of masks outdoors.

But we seem to be increasingly incapable of doing this. We far too readily trust authorities to take care of things.

An honest conversation about what to do with the Covid-19 situation would have to start with the realisation that we won’t be able to eradicate the virus, and that if we continue with the current approach of dealing with the pandemic, we are resigning ourselves to live in the continuous fear that everywhere at any time a new outbreak might occur. While an important section of our societies happily accepts the social distancing measures, increasingly more people, especially young people, are unwilling to cope with the regime. They rebel against it and start to take less care than they did even a few months ago. Let’s not forget that the risk for young people of dying from the virus is extremely low (for example, only 12 people under the age of 30 have died so far from Covid-19 in Germany).

But this and many other human behavioural patterns — we are not machines! — will lead to many local or regional virus outbreaks across Europe, some of which have already been set in motion during the summer months.

So, we need to discuss whether we are willing to be in this state of continuous stress and panic, over many months and possibly years.

We need to talk about the importance of physical contact and of social life for human wellbeing. Are we willing as a society to sacrifice much of our social life and close contact with other people over many months and possibly years? I know that some people believe that Zoom is becoming a great substitute for physical contact, like Zoom cocktail parties, for example. And of course, many people don’t feel the need for much social life and close physical contact. But I will never be convinced that the screen can be a real substitute, if the overall goal is human wellbeing and flourishing in its fullest sense.

I don’t know how much physical contact we should sacrifice more in general, but I have strong feelings about one of the lockdown measures that I have found to be outrageously wrong from a perspective of what makes human life dignified and complete. Even at the peak of the pandemic, we should have found ways for families to say goodbye to their loved ones who were dying of Covid-19, and arrange a dignified funeral for them. I’m convinced that the wrong priorities were set when this was not made possible. Public health was set as an absolute priority over other values in these situations, and compromises could have been found.

Then we need to talk about the importance of cultural life and filling football stadiums. Much of cultural life, like cinemas, theatres, concerts etc., is nearly dead right now. The social distancing measures make many of these activities unprofitable or unviable, and many people don’t feel safe anyway, sitting in a room with so many others watching theatre.

Football is a sterile spectacle as long as spectators are not allowed in the stadiums.

But how important is cultural life to human flourishing? How long are we willing to live without these cultural activities, and how long can artists survive as they wait to be able to perform again under realistic conditions? How many months or years?

What does it do to the millions of sports fans who now have to follow their teams at home on TV? We know that football plays a bigger role than that in people’s lives and society as a whole. It’s not just a leisure activity for many. How many months or years are we willing to keep fans from sitting in a stadium with each other?

Maybe the most important topic after these summer holidays will be children, schools, kindergarten, and child care centres. Is it at all realistic to impose any physical distancing measures on children in these places, and if it were, how much psychological damage are we doing to a whole generation’s childhood?

What will happen to our associational and democratic life? Many meetings, workshops, gatherings and conferences that are vital for a healthy democratic life are now happening on Zoom or not at all. What impact will all this have on the already fragile health of our democracies and on our already fragile social cohesion? How long are we willing to keep the status quo?

And last but not least, the economy. While since the beginning of May much has been done to get the economy back up and running in most European countries, we don’t yet know the economic damage of the lockdown. Unemployment is still rising, and there is a wide range of economic sectors that are just dead right now, and will be so as long as the ‘new normal’ lasts. The longer that is, the more irreparable damage will be done. We don’t know yet how severe the social consequences from the economic downturn will be and how much damage current government spending can really prevent, taking into account that public moneys have a limit. Serious social and political unrest are realistic possibilities even if no further lockdowns are imposed.

However, in the event that many more local and regional lockdowns or similar drastic measures are imposed, the economic damage will increase even further. This scenario seems very likely if the current regime of the new normal and fixation on the number of new positive cases continue into the coming months. We are already seeing how the recent outbreaks and new measures (like outdoor mask wearing) imposed in Spanish tourist destinations like the Balearic Islands have led to massive hotel and flight cancellations.

Already today, the Spanish economy is one of the worst hit by the Covid-19 crisis. In the event of much further economic downturn, and a then likely deep depression, one has to seriously ask whether a country with a dramatically reduced living standard will be able to maintain anything close to its current standard of healthcare, or whether many people might lose health and years of their life because they can’t get the medical treatment they need.

All this is just a taste of the type of considerations that would have to be part of a serious conversation about how we’re going to live with this virus over the next year or possibly years. It would have to take a long-term perspective, as well as consider a much broader set of values and the trade-offs between them, than what is currently the case.

The current public discourse is obsessed with the total number of new infections and doesn’t seem to provide much space for the type of complexity that needs to be addressed.

A broader discussion would have to address painful questions about trade-offs that exist between the number of lives that social distancing can save as a direct consequence and the many indirect consequences that these measures have in the short and long term. But political decisions are very often about life and death. A mature society has to have the ability to address these difficult questions in a holistic manner. Unfortunately, when on the rare occasion in the last few months someone in the public sphere has raised the question of trade-offs, the twitter mob silenced these voices immediately with references to social Darwinism.

However, such a conversation would most likely be less painful than it might seem in the current mood of moral panic.

Firstly, recent trends seem to make Covid-19 a less deadly disease than only three months ago. Most importantly, the medical treatment of Covid-19 patients has already improved to an important degree and will probably improve further. Mortality is going down. In addition, many more young people and fewer older people are getting infected these days, which reduces the mortality rate further. The daily infection case numbers therefore hold a different meaning than they did three months ago. These are all positive news that should be part of the conversation.

Secondly, the fact that Covid-19 is mostly dangerous for people over 65 or with a serious condition is an important factor that we could make better use of. If our societal efforts focused much more on protecting the elderly as well as the most vulnerable people in our society, we could become more relaxed about infection rates of young people. I know that young people can become seriously ill from Covid-19 and can also suffer long-term physical damage, but it still remains a small health risk compared to that of the elderly.

And finally, we should look at the Swedish case from a different perspective. Yes, the number of deaths in Sweden is among the higher rates per million inhabitants in the country ranking. But the reason for this isn’t so much the much more relaxed approach to social distancing, but rather the lack of protection in retirement homes at the beginning of the pandemic. Sweden relies heavily on voluntary social distancing and has always emphasised that their approach is long term. Children have continued to go to school, and there is no major panic when infections go up a bit here or there. The number of daily deaths from Covid-19 is now mostly in the single digits. The final accounts on all aspects and the final verdict about the Swedish approach can only be made once the pandemic is over and all consequences can be evaluated. But I believe that most discussions about and critiques of the Swedish model have not grasped that most other countries don’t have a sustainable long-term strategy, for the simple reason that it is not even discussed. At least Sweden is trying to navigate a long-term approach.

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.

We have now a chance to learn how to deal with conflicting values and trade-offs. For the coming weeks I hope that more people start asking the question of how we are going to live with this virus in the long run, and that this will lead to a richer conversation about what we should do with the pandemic today and tomorrow.

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