When I was a medical student, a surgeon whose case I was assisting on asked me if I knew our patient’s mortality rate for the operation. Having read up on the procedure the night before, I confidently replied, “4 percent.” No, he corrected me, the mortality rate for our patient was either 100 percent or zero percent; either the patient would die or would not die.
The surgeon was trying to draw a distinction between science and individual psychology that is relevant to today’s pandemic. From science’s perspective the chance of a person dying from COVID-19 is less than 1 percent for a young adult, or greater than 2 percent for an elderly adult, but from the perspective of any single individual, the chance of dying is either 100 percent or zero percent. Either the person will die or will not die. How a person reacts to this knowledge varies; each person has different feelings and different joys; the view of the world is not the same for everyone.
The difference between the two perspectives is really the difference between the two cultures: science and the humanities. For the science of epidemiology, medical events are spread over an entire population, and no particular person suffers. To use an analogy, 100 tons of snow, divided into flakes, merely scatter over the ground without hurting a single blade of grass. Only when crammed into an avalanche does the snow kill a particular person. The humanities are the story of that avalanche and that person.
Science and the humanities have been divided in the public mind ever since the English chemist C. P. Snow gave his famous lecture on the subject in 1959. Although the lecture broke with the style of education passed down from the Victorian era, it was mostly a call to give humanities students more exposure to science in their curriculum. Today’s pandemic calls for influence to move in the opposite direction. Right now, the scientists and public health authorities are running the show, as they should. Yet the humanities can reveal to them some traps they might do well to avoid.
The Power of Explanation
People love hope, and they dread uncertain days. The notion that anyone can die of COVID-19, at any time, without any explanation, demoralizes them. Thomas Hardy captures the feeling in his poem “Hap,” when he says he would rather be the target of a vengeful God than a victim of chance.
In fact, there is logic to COVID-19 mortality, yet it often gets drowned out in the news cycle. Science quietly says older and sicker people are most at risk, but the press loudly plays up the rare cases of the young, healthy person who dies of COVID-19. Confused, the public takes the average of the two voices and decides everyone must be at risk.
This psychology makes life difficult for government officials trying to re-open the economy. Ideally, people will leave their cocoons and start buying again, while also maintaining good social distancing. Yet if people feel themselves to be at risk for random death, many of them will deviate from this ideal.
Some people have a passion for gambling in life. They deliberately search out games of chance. When the economy re-opens they will purposely ignore social distancing to test their luck. We already see this kind of perverse behavior in California, where people violated social distancing on purpose and happily crowded onto the sand during the first warm day, causing Governor Gavin Newsom to close the beaches. In New York, hundreds of people drew close to watch the Blue Angels fly over. Like gamblers, these people like to win through good luck. If dying from coronavirus is a matter of chance, they will gladly try their hand at the roulette wheel.
Other people know there is a free insurance plan against gambling losses, which consists of not gambling at all. At the very least, they prefer to win games by playing well rather than by relying on chance. Yet if a game lacks rules, they cannot hope to play well, and if the outcome turns on chance they won’t play at all. When the economy re-opens, these people will hunker down and refuse to go outside and spend, or even to work in some cases.
To change the paradigm, people must believe that dying of coronavirus involves more than just a roll of the dice. For this to happen science must speak louder.
In Maryland, where I live, officials made an error along these lines. The earliest COVID-19 statistics in the state published a list of the dead, minus names, that included age and whether the person had any co-existing disease. Then the authorities stopped doing this. At the very least, they stopped listing whether the person who died had a co-existing disease. In the third week of April, the authorities cracked down further and told local county health departments that releasing COVID-19 data linked to nursing homes “served no public health purpose.” Other than age, race, and gender characteristics, Maryland residents no longer knew anything about the dead. Death seemed to be little more than a matter of chance.
Eventually, under pressure, Maryland officials began publishing data that showed more than half the coronavirus deaths in the state, and over one-fifth of the infections, involved nursing home patients. Similar results have been reported in other states, such as California. The nursing home deaths are tragic, but the mortality patterns there at least make some sense to the broader public, and they can use that knowledge to make reasonable risk-benefit calculations in their own lives. Maryland and other states should do more, and return to publishing patient deaths (stripped of names) with a list of their relevant co-existing diseases. Although such data may serve no public health purpose, they do serve a vital psychological purpose.
Lack of knowledge kills hope. There is the kind of knowledge-less hope that comes with trying to win the lottery, but that is unreasonable hope. It is a passive hope that makes no demand on people. It is more akin to hopelessness, as it does not require someone to have resources or a plan for moving forward; it does not require confidence; it does not require knowledge. People who believe there is nothing they can do often end up doing nothing, or wait impatiently for the dice to roll. In contrast, reasonable hope is sustained by people’s own confidence, as it is based on what they can accomplish if they, as individuals, so will it. Such confidence requires knowledge.
The CDC has missed this point. To this day, doctors (let alone the public) have no centralized source of information for COVID-19 therapies. In the medical community many of the therapies and protocols for the disease pass by word of mouth, much as they did for treatments in the 19th century. I learned, for example, through a social call that North Shore hospital on Long Island was using the blood-thinner heparin to treat COVID-19, as some of these patients were dying of strokes rather than respiratory failure. While talking to a neighbor next door, I learned that at Johns Hopkins Hospital they were aggressively treating COVID-19 patients with zinc. As a doctor and a citizen, I should not have to learn about COVID-19 in this way.
The CDC is the nation’s premier scientific institution on infectious disease matters. It should post the latest protocols and therapies, even if their benefit is only conjecture and anecdotal, and not yet confirmed through rigorous trials. For the CDC to restrict itself to discussing proven treatments is to forget the humanities’ wise counsel: The only way for people to stop believing in something is for them to stop living. Give people medical explanations to believe in, or at least to hope in, thereby forestalling other, non-scientific explanations from taking their place. Do not let people’s psyches wither and droop. Sometimes pure science is too cold, too socially blunt, to understand this.
Protests against the lockdowns have erupted around the country. Some aspects of the lockdowns may be unconstitutional, yet the authorities were foolish to let people’s anger get out of hand. Again, part of the problem was the lack of explanation. In Michigan, for example, people did not understand why Governor Gretchen Whitmer let them take their rowboats out but not their motorboats, or why she barred the sale of paint or seeds by large retailers, while still allowing the sale of lottery tickets. No explanation was forthcoming, which people resented, for they know that no one bothers to make a slave believe anything, since what a slave believes doesn’t matter. Yet slaves tend to revolt.
Science’s error in language added fuel to the protests. Public health authorities across the country encouraged Governors to implement “stay-at-home” and “shelter-in-place” orders. But what exactly do these phrases mean during a pandemic? Shelter-in-place, for example, was designed for short-term events such as hurricanes, and not for pandemics. The authorities reached for these phrases because they were there, and because they generally summed up what they were trying to accomplish in terms of preventing human viral transmission. Yet as the humanities know well, since words are their business, an arrangement of words, however perfect, in no way speaks for an arrangement of things. The authorities tried to produce a concrete reality by assembling in one or two phrases something that would perfectly address all social distancing needs. Yet “stay-at-home” and “shelter-in-place” are rhetoric in their pure state. When the phrases hit reality, and Governors needed to pick and choose what to allow and what to forbid, they had nothing to guide them, other than the extreme situations for which the phrases were originally designed. This led to arbitrary and sometimes incoherent applications of these phrases, along with overly aggressive lockdowns. The public sensed this, and resented it. Many small business owners believe they went bankrupt not because of the virus but because of grammar.
Public health authorities have also overlooked the various shades of the human will. The humanities know that many people will put up with confinement in dire situations, as they know that true pleasure often demands hardship at the outset. At the same time, the humanities know that people prefer action to pleasure, action that is regulated and disciplined most of all, and especially action in the name of justice. The behavior of Jean Valjean in Les Misérables is just one example from literature. Rather than lock everyone down, thereby inciting a feeling of life-emptiness and humiliation in all, and restlessness and protest in some, better to give young and middle-aged adults the opportunity to serve seniors confined to their homes—for example, bringing seniors groceries and packages, mowing their lawns, making them masks, and so on. The great novels tell us that people who devote their full attention to a difficult enterprise are often happier than those who sit at home and think about their past and their future. When people carry the weight of things for others, they feel better; as soon as they carry the weight of the self, they grow unhappy—and attend protests. Robinson Crusoe did not begin to miss his homeland until after he had built his house and sat in it.
The humanities understand the feeling of vulnerability that fuels the protests. For decades, Americans have imagined themselves to be individualists of a sort. With the pandemic and the interruption of various food and manufacturing chains, they suddenly realize they are not, that their existence is only rendered possible through the high organization of civilized crowds. Their life, their capabilities, and their confidence were all this time only the expression of their belief in the certainty of their surroundings. Even boldness belonged not to any single individual but to the crowd—to the crowd that believed blindly in the power of its institutions to weather all storms, and that enabled the machinery of society to function. Proud people suddenly felt insignificant and incapable, which was humiliating. For many protestors rebellion became a form of self-assertion, a way to regain their lost pride.
Then there are protesters who feel betrayed. For decades, Americans have made a bargain with government in which they yield their influence on public policy in exchange for greater freedom in private life. Unfortunately, life has chipped away at the bargain. Business, for example, increasingly follows people from work to home, thereby shrinking the domain of private life. Social media threatens privacy. The plea for “safe spaces” represents a kind of perverse demand for a bit of terrain that people can call their own. During the pandemic, government has reneged on the contract altogether. By restricting economic activity, it denies people the myriad of activities that they once filled their lives with in exchange for ceding political power. Some states even police family play, or ask people to snitch on their neighbors, in the name of social distancing. For many people the protests against the lockdowns are really a protest against a broken promise.
Then there are the lonely. Sociologists estimate that more than half of Americans are lonely, in that they have no one to talk to about their personal problems, or at most one person. The lonely cleave to what little social contact they have, yet strict social distancing, including the ban in some places on visiting a friend, have made that loneliness worse. Millions of Americans now sit at home in absolute and dumb solitude, then occasionally go outside, see the empty streets, and imagine the world has become bigger and emptier. When they reach their breaking point, they protest.
Class resentment also drives protest. The American economy is increasingly divided between creative types who can write and manipulate images from anywhere, and those who must toil in the object world at specific locations. The ban on economic activity in much of the object world has intensified this resentment and cemented stereotypes in people’s minds. The creative types are the butterflies of mankind, prettily covered, flitting over the surface of life with their ideas and concepts, and feeding on nectar. The toilers in the object world, known as labor, are the worms who churn the earth and make it ready for sowing. This is how many laborers in the object world view knowledge workers, after having lost their jobs or been forced to work in unsafe conditions to make their living. Light and space exist for the butterflies, while they, the worms, are carelessly stepped on.
People vary—and they have imaginations. They do not all react in the same, machine-like way when they face hardship, as the philosopher Edmund Burke once said. Public health authorities would be wise to remember the particular variants of popular psychology in the United States.
More From the Humanities
The humanities have more wise advice for science: Some of what is called “religion” is just the superstition of the past, but some of what is called “science” is no more than the superstition of the present. Prediction models continue to guide coronavirus policy, although some of these models have proved useless because of their faulty assumptions. The Imperial College study that predicted millions of coronavirus deaths in the United States is the most famous example. Two more studies with dire predictions have recently been published, including one from the Wharton school, which predicts 250,000 deaths if the economy is re-opened, and another from the Federal Emergency Management Agency, which forecasts 3,000 additional deaths per day under the same conditions.
These numbers scare officials. Yet in many cases they are merely the products of thought that involve working with the conceptions of the mind alone. In the case of the Imperial College study, a closed loop was created by questionable outputs, which then became inputs, and which then generated more outputs. Believing in the predictive power of these studies borders on superstition, like believing in curses in ancient times. Officials grow helpless and feel themselves incapable of altering the course of events, even of events within their reach, in the face of numbers printed on a piece of paper.
I recognize the power of numbers, yet we must keep a healthy suspicion of the mindset behind them. The creators of the numbers in these models know that disbelief is difficult when the numbers have the air of science about them. Like fortunetellers, they say, “If you don’t believe in them, then what are you afraid of?” And thus the trap is set. Government officials fear any deviation from what the numbers tell them to do. The humanities provide a valuable service when they remind government officials to think twice about a number’s predictive power, especially when human behavior is a major variable. After all, in Tolstoy’s War and Peace, the Prussian general Pfuel, whose battle strategy relied solely on numbers, soon found himself outwitted by Napoleon.
Then there are ideologues who demand that only science guide us during the pandemic. Dr. Ezekiel Emanuel, professor at the University of Pennsylvania, exemplifies this type, when he says we cannot return to normal for 18 months, until a vaccine for the coronavirus comes along. No dinners in restaurants, no religious services, nothing, he says. The humanities have seen people like this before: people who truly believe in something, and who, for the sake of the sublime idea, will sacrifice everything and everyone. Usually one finds this way of thinking in politics, but while science is not by nature political, this very fact lends itself to ideological fervor, for the compelling spell of science is hard to resist. That is science’s strength: It has the power to sap the will of its adversaries. To question science, to doubt the moral rectitude and incorruptibility of scientists, is to cast suspicion on oneself, and prompts an irate refutation from those who believe science to be the only rational discipline.
It is hard, in our science-obsessed culture, for people to come up with any standards of comparison. But the humanities can. There are the French revolutionaries, and the Russian revolutionaries, and all the other believers in history who refused to compromise in the service of their beloved idea. They, too, had pieties, although theirs did not come in tabular form. There stands fanaticism, drunk with its own proofs.
As someone with a science background, I find it curious that so many scientists speak on COVID-19 with such certitude, especially the modelers. So little is for sure in science. Even the Schrödinger wave equation predicts that when a pot of water is put over a flame, there is a small chance the water, instead of boiling, will rush into the corner of the pot and freeze. The only exact and certain truths in science are in geometry—the ideals of the straight line and the perfect circle—and they have never existed in reality.
The humanities know this. They are valuable because they have an eye for the small weaknesses of humanity, include the gaps in science and the pretensions of scientists. It is not a mean eye; just an honest eye. As Socrates warned, we can conquer ourselves but we can also be conquered by ourselves. Science and the humanities—to do right in today’s pandemic a person must listen to both.