Acceptable Loss, Collateral Damage, & Freedom Of Choice During Pandemics

Data-Driven Ethical Choices

Photo by Edwin Hooper on Unsplash

I presented the following paper at a closed symposium for Medical & Health professionals, sociologists, and politicians. It is available in PDF format, in an academic format, at ResearchGate. Or contact the author here directly on Medium for a free copy.

The Needs of the ‘Many’ vs. The Needs of the ‘One’

Image Copyright © 2022 by If-What-If All Rights Reserved

In the middle of ‘Star Trek II — The Wrath of Kahn,’¹ Admiral Kirk² has a brief exchange of words with his best friend and fellow officer, Spock,³ which resonates through the next movie in the series. This dialogue would become one of the most oft-quoted lines in Star Trek fandom if not in movie history.

Spock tells Kirk: “Logic clearly dictates that the needs of the many outweigh the needs of the few.” To which Kirk immediately answers, “Or the one.” ⁴

At the end of the movie, Spock enters a radioactive chamber giving up his life to save the crew of their beloved ship, the ‘Enterprise.’ As he is dying, the exact exchange takes place, although the dialogue is reversed between the characters. In the last moment before death, Spock says to Kirk, “Don’t grieve, Admiral. It is logical. The needs of the many outweigh” Kirk finishes the statement for Spock, “The needs of the few.” Spock replies, repeating and affirming Kirk’s earlier statement, “Or the one.” ⁵

Fast forward two years to ‘Star Trek III — The Search for Spock.’⁶ ⁷ Spock’s body is found, and he is reborn. As Spock grows swiftly into adulthood without his memories, Kirk attempts to get Spock to remember his previous life. Spock slowly grasps what happened but is puzzled why an Admiral in Star-Fleet would risk his entire crew to save one person. It simply is not logical. To this question, in a reversal of all that we have heard beforehand, Kirk answers: “The needs of the one outweigh the needs of the many.”

We face a dichotomy on the first order. Either the needs of the ‘many’ come before the needs of the ‘one,’ or the needs of the ‘one’ come before the ‘many.’ You cannot have it both ways. It is, as Spock would say, “illogical.”

This illogical predicament is what humanity faces during the current COVID-19 pandemic. Our ethical and moral principles face a daily challenge, forcing us to reassess the values we seek to emulate as an enlightened society. We find ourselves balancing the needs of the many against the needs of the few, along all fronts.

How far does society need to yield to protect one class of citizens? Should ‘personal choice’ be a factor when one’s decisions may endanger others and even themselves? Is there a point when society can morally declare that ‘acceptable loss’ is valid and ‘collateral damage’ is to be expected, tolerated, and endured without argument — all for an esoteric concept known as the ‘greater good?’ Indeed, is there even such a notion as the ‘greater good’ or do the needs of the one genuinely negate the needs of the many? Perhaps most importantly, who gets to make such decisions during a worldwide pandemic? The individual, politicians, or medical professionals? Should such decisions be determined by predictive analytics, medical data, ethical principles, personal preferences, or political decisions as they converge on the coronavirus battlefield?

So, which one is it? Do ‘the needs of the many outweigh the needs of the few’ or do ‘the needs of the one or few outweigh the needs of the many?’

The Lexicon

What’s In a Name?

“Names, once they are in common use, quickly become mere sounds, their etymology being buried, like so many of the earth’s marvels, beneath the dust of habit.”⁸

The virus that created the current pandemic is often called by differing names. One will usually see in print, ‘Covid-19’ or ‘COVID-19’ or ‘Coronavirus’ or ‘Coronavirus disease’ or ‘Corona.’ None of these are incorrect.⁹ It depends on the style of grammar and print one is using.

What is a ‘virus’ in simple terms?

A virus is a tiny infectious agent that reproduces inside the cells of living hosts. When infected, the host cell is forced to rapidly produce thousands of identical copies of the original virus. Unlike most living things, viruses do not have cells that divide; new viruses assemble in the infected host cell. But unlike simpler infectious agents like prions, they contain genes, which allow them to mutate and evolve.¹⁰

SARS is an acronym for ‘severe acute respiratory syndrome,’ the name of the virus is, in actuality, ‘SARS-CoV-2’ (which is a variant of the original SARS-CoV virus of 2003.) The name of the disease caused by ‘SARS-CoV-2’ is COVID-19. (The 19 referred to 2019 when it was first named.)¹¹ The International Committee on Taxonomy of Viruses (ICTV) names viruses, and the World Health Organization (WHO) adopted this specific name.

The International Committee on Taxonomy of Viruses (ICTV) is concerned with the designation and naming of virus taxa (i.e. species, genus, family, etc.) rather than the designation of virus common names or disease names. For an outbreak of a new viral disease, there are three names to be decided: the disease, the virus and the species. The World Health Organization (WHO) is responsible for the first, expert virologists for the second, the ICTV for the third…

As experts on coronaviruses, the ICTV Coronaviridae Study Group has studied the classification (taxonomy) of the new virus. And given that they are experts on this family of viruses, they have also contributed their expertise to the naming of the virus. The virus name is “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). And the species to which the virus SARS-CoV-2 belongs is Severe acute respiratory syndrome-related coronavirus.

The disease name (which in many cases is different from the virus name) has been designated as COVID-19 by the WHO. The ‘19’ in COVID-19 stands for the year, 2019, that the virus was first seen. The number ‘19’ has nothing whatsoever to do with virus strains, genotypes, or anything else related to the virus’ genetics. The virus name was announced by the World Health Organization on February 11, 2020.¹²

COVID-19 Naming: International Committee on Taxonomy of Viruses-ICTV

The diagram above¹³ depicts the historical progression in naming the virus. Why are all these terms so vital to our discussion? The answer lies in data. Any system attempting to trace the trajectory or predict the future spread of the disease must consider these different names within collected data. During the initial stages of the pandemic, the various names confused the public and researchers.

Recognizing this perplexity over names and variants, the WHO published the process of naming the various strains and variants distinguishing between “Variants Of Interest” (VOI), and “Variants Of Concern” (VOC).

To assist with public discussions of variants, WHO convened a group of scientists from the WHO Virus Evolution Working Group (now called the Technical Advisory Group on Virus Evolution), the WHO COVID-19 reference laboratory network, representatives from GISAID, Nextstrain, Pango and additional experts in virological, microbial nomenclature and communication from several countries and agencies to consider easy-to-pronounce and non-stigmatising labels for VOI and VOC. At the present time, this expert group convened by WHO has recommended using letters of the Greek Alphabet, i.e., Alpha, Beta, Gamma, Delta which will be easier and more practical to be discussed by non-scientific audiences.¹⁴

What is a VOC? It has three elements.

1. Increase in transmissibility or detrimental change in COVID-19 epidemiology; OR
2. Increase in virulence or change in clinical disease presentation; OR
3. Decrease ineffectiveness of public health and social measures or available diagnostics, vaccines, therapeutics.¹⁵

Adding to this turmoil, we currently have several variants (also known as mutations) to the original virus, including Alpha, Beta, Delta, Omicron,¹⁶ and most recently BA.2.¹⁷ ¹⁸

It is an obvious fact that confusion does not lead to decision-making clarity. Indeed, ‘confused clarity’ is an oxymoron, though one which undoubtedly depicts our state of understanding and reaction to the virus.

Endemic, Outbreak, Epidemic, or Pandemic?

Photo by Ben Garratt on Unsplash

To put a bit of order into the various theories, propositions, postulations, and decisions made during an outbreak of any disease, we must first understand “the nature of the beast.” Indeed, politicians will look upon the situation with diverse prerequisites, safeguards, and deterrents in order of preference over the prerequisites medical professionals may apply to the situation. The public-at-large, a conglomeration of billions of people, each with their unique thought process and belief system, will view the situation differently and individually. Indeed, the terminology “public” is questionable, as consensus has proven impossible. Though the data is quantifiable, predictive analytics are not.

There are four categories that concern us:

1. An epidemic is a disease that affects a large number of people within a community, population, or region.

2. A pandemic is an epidemic that’s spread over multiple countries or continents.

3. Endemic is something that belongs to a particular people or country.

4. An outbreak is a greater-than-anticipated increase in the number of endemic cases. It can also be a single case in a new area. If it is not controlled with rapid response, an outbreak can become an epidemic.¹⁹ ²⁰

“A disease outbreak is endemic when it is consistently present but limited to a particular region. This makes the disease spread and rates predictable. Malaria, for example, is considered endemic in certain countries and regions.

The Centers for Disease Control and Prevention (CDC) describes an epidemic as an unexpected increase in the number of disease cases in a specific geographical area. Yellow fever, smallpox, measles, and polio are prime examples of epidemics. An epidemic disease doesn’t necessarily have to be contagious. West Nile fever and the rapid increase in obesity rates are also considered epidemics.

The World Health Organization (WHO) declares a pandemic when a disease’s growth is exponential. This means the growth rate skyrockets, and each day cases grow more than the day prior. In being declared a pandemic, the virus has nothing to do with virology, population immunity, or disease severity. It means a virus covers a wide area, affecting several countries and populations.”²¹

The Pandemic Stage

In history, Covid-19 is not the first pandemic to wreak chaos and destruction upon humanity. The chart below paints the grim statistics.

Top Six Pandemics in Human History²²

The Black Death

During the Middle Ages, the Black Death, the most virulent and deadly plague in history, spread through Europe, Asia, and North Africa. (This is without including its precursor, the “Plague of Justinian,” which also ravaged entire populations.) However, both took place when prevention or medicines were not available or even understood.

The Black Death (also known as the Pestilence, the Great Mortality, or the Plague) was a bubonic plague pandemic occurring in Afro-Eurasia from 1346 to 1353. It is the most fatal pandemic recorded in human history, causing the death of 75–200 million people in Eurasia and North Africa, peaking in Europe from 1347 to 1351…

The Black Death…is estimated to have killed 30 percent to 60 percent of the European population, as well as about one-third of the population of the Middle East. The plague might have reduced the world population from c. 475 million to 350–375 million in the 14th century. There were further outbreaks throughout the Late Middle Ages…Outbreaks of the plague recurred around the world until the early 19th century.²³

For these colossal numbers and statistics to take on meaning, let us compare the worst pandemic with the most catastrophic war — World War II.

World War II was the deadliest military conflict in history. An estimated total of 70–85 million people perished, or about 3% of the 1940 world population (est. 2.3 billion). Deaths directly caused by the war (including military and civilian fatalities) are estimated at 50–56 million, with an additional estimated 19–28 million deaths from war-related disease and famine. Civilian deaths totaled 50–55 million. Military deaths from all causes totaled 21–25 million, including deaths in captivity of about 5 million prisoners of war.²⁴

Bubonic Plague still exists, and as recently as October 2017, it hit Madagascar, killing 170 people and infecting thousands.²⁵ One should also take note that there is no vaccine for the plague as of 2022 and even using antibiotics is not a guaranteed cure.²⁶

Spanish Flu

The Spanish flu began towards the end of World War I. It was particularly virulent in young adults²⁷, a fact which should not go ignored during the current Covid-19 pandemic and its mutations. While there were no antivirals or antibiotics, there was already a semblance of public health systems. Indeed, in some countries, social distancing, facemasks, and closures of public places, including schools, took place. There was also resistance to these measures.

The Spanish flu infected around 500 million people, about one-third of the world’s population. Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the deadliest pandemics in history. An early estimate from 1927 put global mortality at 21.6 million. An estimate from 1991 states that the virus killed between 25 and 39 million people. A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%). However, a 2018 reassessment in the American Journal of Epidemiology estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population…

While systems for alerting public health authorities of infectious spread did exist in 1918, they did not generally include influenza, leading to a delayed response. Nevertheless, actions were taken. Maritime quarantines were declared on islands such as Iceland, Australia, and American Samoa, saving many lives. Social distancing measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings. Wearing face masks became common in some places, such as Japan, though there were debates over their efficacy. There was also some resistance to their use, as exemplified by the Anti-Mask League of San Francisco. Vaccines were also developed, but as these were based on bacteria and not the actual virus, they could only help with secondary infections. The actual enforcement of various restrictions varied. To a large extent, the New York City health commissioner ordered businesses to open and close on staggered shifts to avoid overcrowding on the subways.

A later study found that measures such as banning mass gatherings and requiring the wearing of face masks could cut the death rate up to 50 percent, but this was dependent on their being imposed early in the outbreak and not being lifted prematurely.²⁸

What we should not overlook is that the Spanish flu began on the heels of World War I, catastrophic war in terms of death and wounded. Even if we accept the low figure of 17 million deaths from the Spanish flu, the deaths during World War I pale compared to those caused by the pandemic.

World War I Casualties²⁹

Covid-19

Covid-19 reached the pandemic stage in a few short weeks. While the term “exponential” may not be mathematically precise, it suffices to show the uncontrollable rapid spread of the disease. Our modern world has medicine, antivirals, and vaccines. It has public health and global health awareness. Though there was no vaccine at the beginning of the spread of Covid-19, society certainly had the tools, knowledge, data, and historical experience to understand the implications of not reacting immediately.

Covid Sickness & Death Cases as Of April 4, 2022 ³⁰ ³¹

The numbers above, as in other pandemics, speak for themselves. Over six million deaths globally have already occurred, and the number continues to rise, despite the availability of a vaccine and modern medical science. Just to put the above chart in context, let us look at the casualty rates for the United States for both World Wars as a comparison to avoid any accusation of cross-pollination of statistics.

Data from United States Government-Department of Veterans Affairs ³²

Pandemics and wars are a lethal combination for humanity. The United States alone, during Covid-19, has far surpassed the total death numbers of both wars.

So, how does one measure the spread of disease? How does the scientific and medical community realize that the spread of the virus is beyond specific control measures? This is where the now-famous and controversial “R” comes into play. Politicians further complicated matters by using the “R” factor differently than medical professionals and epidemiologists.

When epidemiologists refer to R (R⁰), this is the first assumption within the virus that states that everyone is susceptible to the virus. The factor then represents exponential growth.

“For example, an R of 3.5 would mean 100 people with the new coronavirus would likely go on to infect 350 people. Those 350 would in turn transmit it to 1225 people. When the R is above 1, the virus will grow exponentially in a population with no immunity. At 1 it stays steady. Below 1, the virus will gradually infect fewer people, until the epidemic dries up.”³³

“If R is two, two infected people will, on average, infect four others, who will infect eight others, and so on. The measure allows modellers to work out the extent of the spread, but not the speed at which the infection grows.”³⁴

Because of many country leaders, the R-number became one of the most discussed attributes during the current pandemic. They began using it as a “predictor” and relying on the fact that if R was at R1 or below, the pandemic had come to a halt or, at the very least, was reduced to a controllable situation. However, this does not consider various mathematical, scientific, and human factors. When there is a delay of at least two weeks between infection and symptoms, there is a massive possibility for miscalculation and mistakes because scientists and statisticians must calculate backward into the past.³⁵

Society must decide how to control the pandemic and stop it in all scenarios. There are many ways to do so. Natural immunity, antivirals, and vaccinations are the first line of defense. We can include within this those who have already been infected and recovered. However, with Covid-19, the multiple variants-mutations of the virus do not make this a sure-fire answer. The second line of defense is to stop the spread of the disease through personal, individual actions.

• Social Distancing — is a term that has taken on new meaning during the Covid-19 era.
• Isolation of the sick & those exposed — to halt communication with others and spread of the virus.
• Facemasks — to stop the spread of the communication of the disease to others, as there is an incubation period of two weeks or more, and one may be infected and communicate the disease without being aware of it.
• Closure of all non-essential public areas to limit the spread of the infection
• Closure of schools — to limit the spread of the infection, halting education and putting further limitations on the workforce as parents with children at home cannot get to work
• Drastic measures of curfews and lockdowns of entire populations

All the above are supposedly aimed at bringing down the “R” and yet another term that has entered our modern lexicon, “Herd Immunity.”³⁶

“Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection from infectious disease that can occur with some diseases when a sufficient percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby reducing the likelihood of infection for individuals who lack immunity. Immune individuals are unlikely to contribute to disease transmission, disrupting chains of infection, which stops or slows the spread of disease. The greater the proportion of immune individuals in a community, the smaller the probability that non-immune individuals will come into contact with an infectious individual.”³⁷

One of the chief proponents of herd immunity is Iceland, where 80% of the population has been vaccinated.

“Iceland will lift all remaining COVID-19 restrictions on Friday, including a 200-person indoor gathering limit and restricted opening hours for bars, the Ministry of Health said on Wednesday.

“Widespread societal resistance to COVID-19 is the main route out of the epidemic,” the ministry said in a statement, citing infectious disease authorities.

“To achieve this, as many people as possible need to be infected with the virus as the vaccines are not enough, even though they provide good protection against serious illness,” it added.

All border restrictions would also be lifted, it said.

Iceland, with a population of some 368,000 people, has registered between 2,100 and 2,800 daily infections recently. More than 115,000 infections have been logged throughout the epidemic and 60 have died due to COVID-19.”³⁸

As we can see, the politicians hope to produce an acceptable R, and many have relied on the controversial “herd immunity” factor. Either a country introduces measures to curb the rate of infection or relies on achieving herd immunity. Undoubtedly, all this is supplemented by introducing vaccinations (and antivirals), coupled with the medical community caring for the sick and dying in overburdened hospitals and care centers. This method may seem logical and even scientific to most, combining varying methodologies and methods to curb the spread of Covid-19. However, almost all the possibilities mentioned above depend upon adherence or purposefully endangering oneself, hoping, if infected, recovery is imminent.

When we view this entire approach to pandemic recovery through a critical lens, we face three major categories. Governments worldwide reacted differently, and they forced medical professionals to bear the consequences. These three categories are as follows:

1. Acceptable Loss
2. Collateral Damage
3. Freedom of Choice

Acceptable Loss (also known as Acceptable Risk)

‘Everyone can master a grief but he that has it.’³⁹

Photo by Mike Labrum on Unsplash

How to Define Acceptable Loss & Who Defines It?

Fundamentally, there are two related yet paradoxically opposing views of ‘acceptable loss’ (AL). The first is based upon a moral-ethical compass. The second is a straightforward, realistic understanding that AL is unavoidable and necessitates employing pragmatic and realistic objectivity concerning a specific situation.

Of the various definitions offered for the word ‘acceptable,’ only the following meet our requirements — ‘capable of being endured; tolerable; bearable, barely adequate.’⁴⁰ ‘Loss’ in our lexicon is ‘death, or the fact of being dead,’⁴¹, and refers to the number of people who will die because of a decision or policy being enacted.

There is no one-definition-fits-all for AL, nor even, surprisingly enough, an official definition. Most dictionaries do not define the term. Wikipedia makes a half-hearted stab at it, quoting from an obscure source that only deals with AL’s ‘military’ aspect.

An acceptable loss, also known as acceptable damage or acceptable casualties, is a military euphemism used to indicate casualties or destruction inflicted by the enemy that is considered minor or tolerable.⁴²

What is considered tolerable? Who or what institution assigns specific numbers or percentages to represent ‘minor or tolerable’ death? Considering AL as being “minor or tolerable” only refers to the perspective of those applying current AL statistics and never to those who have to bear the burden of the actual losses. While some individuals may consider this a picayune linguistics side-point, we should emphasize that the moment we trivialize a loss-of-life event with language such as “minor or tolerable” is the instant we lose perspective.

One point, though, in the above definition is accurate. AL is a euphemism created purposely to shield the actual consequences of its meaning to make the concept palpable to the public. Euphemisms have the prodigious power to conceal actual meanings.

Nor is AL the only terminology used. Depending upon the situation and quandaries society or individuals must confront, we can represent AL as ‘Acceptable Risk’ (AR) in military and non-military situations, such as finances or medicine. ‘Risk’ is a more palpable phrase because it does not explicitly imply loss, i.e., death. Therein lies the danger as we sometimes use AR within the military or medical context to imply, in actuality, loss and death. One takes a risk determined by the available data, and the risk is something that may or may not be realized. In any system, AL or AR is an essential actuarial facet, and one cannot honestly represent data without taking it into account. However, in a pandemic, losses are in terms of a final, no-return-no-going-back inference.

Any intelligent individual who gives thought to AL will find it anathema to moral and ethical standards. Nevertheless, this modern phrase (whose origins remain mysterious) is used repeatedly in modern military and health literature. However, just because the terminology did not exist until a few decades ago does not imply that the thought processes behind the phrasing and terminology were not in existence from the dawn of humankind.

During the current pandemic, scientists, epidemiologists, virologists, journalists, and society gave voice to this specific quandary. An article in the Boston Globe put it:

Would any number be acceptable? What if the COVID-19 deaths occurred only among children and teenagers? Would our acceptance level change? Can death rates that are unequal across income or ethnic groups or states ever be acceptable? And acceptable to whom? Each person killed by COVID-19 is someone’s child, someone’s friend, a mother, a cousin. Acceptable deaths seem unquantifiable…To “accept” deaths from an infectious disease even when we know well how to limit transmission seems not only a failure of determination, but also a failure of imagination as to how we could have done better.⁴³

The above commentary stemmed from a CBS News poll taken in August 2020 based on registered voters in the United States. Ostensibly, it attempts to reveal how political views shape our moral and ethical outlook. At the time of the poll, the overall death toll in the United States from coronavirus had reached approximately 180,000.⁴⁴

Question: Number of U.S. Deaths from Coronavirus Has Been:

Acceptable Loss Poll among United States Registered Voters — Data from CBS News Poll, August 2020⁴⁵

In August 2020:

· Vaccinations were not available

· Social Distancing was not enforced

· Facemasks were voluntary and mostly ignored

· Epidemiologists were still guessing at rates of infection, even as the world faced a fully blown pandemic

· The overall death rate in the USA was at 180,000

Nevertheless, the public had enormously high percentage rates of willingness to assent to ‘acceptable loss.’

The other facet of AL is undeniable. In a pandemic, it is part of nature. In military action, it is part of reality. It is a necessary component of investment in financial markets where it becomes AR. Even in the fundamental laws of nature, one can say there is a built-in AL, which is known as “entropy.”

In short, there will always be a loss. The question before us is, how much of this loss is acceptable? How much of it is categorically unavoidable? At what point will it force society to reevaluate decisions when its self-defined acceptable plateau has been reached?

As Dr. Camara Phyllis Jones, an epidemiologist and past president of the American Public Health Association, said: “The massive number and the loss of those people from our society has not been acknowledged. We cannot think these people are disposable and dispensable and that we can just get along very well without them. It’s those kinds of blinders that sap the strength of the whole society.”⁴⁶

Humanity faces the darker side of AL consistently. It is unquestionably easier to discern in two specific areas: War and Pandemics. For the moment, two examples of AL during War will suffice.

D-Day

On 6th June 1944, Allied forces launched “Operation Overlord” against Nazi Germany to gain a foothold in Europe and put an end to the Nazi regime. D-Day is the archetypical example of AL (and Collateral Damage).

In planning the D-Day attack, Allied military leaders knew that casualties might be staggeringly high, but it was a cost they were willing to pay in order to establish an infantry stronghold in France. Days before the invasion, General Dwight D. Eisenhower was told by a top strategist that paratrooper casualties alone could be as high as 75 percent. Nevertheless, he ordered the attack.⁴⁷

The National D-Day Memorial Foundation is one of those organizations. At its memorial site in Bedford, Virginia, there are 4,414 names enshrined in bronze plaques representing every Allied soldier, sailor, airman and coast guardsman who died on D-Day.⁴⁸ ⁴⁹

The Normandy landings were the largest seaborne invasion in history… Nearly 160,000 troops crossed the English Channel on D-Day… Allied casualties on the first day were at least 10,000, with 4,414 confirmed dead… Civilian casualties on D-Day and D+1 are estimated at 3,000.⁵⁰

As we view D-Day from the perspective of history, the percentage of AL was exceedingly high. Nothing was more important than the destruction of Nazi Germany, and therefore nothing was considered beyond the limits of sacrifice. The allies were willing to accept exceptionally high losses to achieve this goal — even if it meant a 75% loss of paratroopers and 4,414 dead within the first 24-hour period during the invasion. Indeed, expectancies of losses were much higher.

There is another factor that guided the AL percentages. Letting the war and occupation of Europe continue while the Nazi atrocities went on unabated would have undoubtedly in the future caused even more death and destruction.

Ernie Pyle⁵¹, the Pulitzer Prize war correspondent, filed a report about D-Day in which he took part. He witnessed the carnage on the beachheads, yet he told the American people how necessary it was. In our terms, AL had almost no bounds. Excerpts of his journalistic report are below:

NORMANDY BEACHHEAD, June 16, 1944 — I took a walk along the historic coast of Normandy in the country of France. It was a lovely day for strolling along the seashore. Men were sleeping on the sand, some of them sleeping forever. Men were floating in the water, but they didn’t know they were in the water, for they were dead…

The wreckage was vast and startling. The awful waste and destruction of war, even aside from the loss of human life, has always been one of its outstanding features to those who are in it. Anything and everything is expendable. And we did expend on our beachhead in Normandy during those first few hours…

For a mile out from the beach there were scores of tanks and trucks and boats that you could no longer see, for they were at the bottom of the water — swamped by overloading, or hit by shells, or sunk by mines. Most of their crews were lost…

In the water floated empty life rafts and soldiers’ packs and ration boxes, and mysterious oranges…

On the beach lay, expended, sufficient men and mechanism for a small war. They were gone forever now. And yet we could afford it.

We could afford it because we were on, we had our toehold, and behind us there were such enormous replacements for this wreckage on the beach that you could hardly conceive of their sum total. Men and equipment were flowing from England in such a gigantic stream that it made the waste on the beachhead seem like nothing at all, really nothing at all.⁵²

On D-Day, in those 24 hours, there were 4,414 dead among the allies. They considered this to be an acceptable loss. On February 1st, 2022, according to the Center for Disease Control (CDC), there were 4,144 deaths from Covid in the United States alone.⁵³ Should this be considered an acceptable loss as well?

Many factors rule AL. Necessity, ethics, and indeed predictive analytics. Data is essential to most AL decisions. Predictive data is imperative to a decision that will end lives.

Russia & Ukraine

In the current war (as of the writing of this article) between Russia and Ukraine, a different characteristic of AL comes into play. One from the Russian side and one from the Ukrainian side. Russia invaded Ukraine on February 24th, 2022. Putin had to decide what the AL would be for his country?

Still, Vladimir Putin is signaling that he will respond to setbacks with more destruction. He also seems willing to allow Russia to pay a high price, in both economic terms and soldiers’ lives.

During a 90-minute call yesterday with French President Emmanuel Macron, Putin said that Russia would achieve its goal in Ukraine “no matter what.” In a televised address yesterday, Putin told Russians that he was determined to fight the war.⁵⁴

“No matter what” is how Putin stated his position. This tells us that his AL ratio is probably not significant to him. He has an objective for Russia, and he intends to achieve it no matter the cost.

However, there is another side to AL. The Ukrainian position. They are being invaded, and they are being bombed and killed. What is the AL to Ukrainians for resistance? Will they all flee to avoid the consequences of the invasion? Will they fight back to the last man? Will their AL match the will and strength of Russia, which is invading it?

Here, we see AL can be different within the same conflict depending upon one’s perspective and goals. This factor became apparent when the Covid-19 pandemic began. The key here is the data and how one relates to that data. It is, in the modern cliché, “all about perspective.”

Data, Numbers & Putting AL Into Perspective

In order to grasp the meaning of these numbers and statistics, one must place over 6,000,000 deaths into perspective. (And let us not forget that number, 6,000,000, which will forever be associated with the Holocaust and its atrocities, is not trivial.) How many of these Covid deaths were genuinely unavoidable, and how many resulted from the willingness of governments to write these deaths off as AL? The AL statistic depends on numerous factors, many of which are unknown, making it impossible to calculate in any specific data analysis. However, we can observe how long it took for any specific government to react with a plausible defense strategy for their populace to lessen the pandemic’s impact. We can also attempt to delineate specific actions as part of AL, making predictive analytics more accurate.

Any solution to impeding the spread of the virus carries consequences, especially for economies. Stores and workplaces close, causing the loss of jobs. Schools close, and thus parents cannot get to work. Offices transition to remote work, which obligates employees to acclimate to a new, unfamiliar work environment. In contrast, the offices remain empty, though the cost of keeping this real estate remains the same. The list goes on and on, but one thing is clear. The economy suffers, coupled with the toll that the sick, isolated, and deaths take upon the hospitals and the mental health of individuals.

At the beginning of the pandemic, two researchers, Prof. Isaac Ashkenazi and Dr. Carmit Rapaport were acutely aware of AL’s problems on a global level. In what can be called a “prophetic” LinkedIn post, they attempted to summarize the problem of AL and its consequences.

The COVID-19 pandemic takes its toll in terms of human lives and global economic consequences. Social distancing has proven to be the most promising strategy against emerging viruses without borders, but the heavy economic damage which follows, puts in question the possibility of its continuation. In fact, weighting the two elements raises an important debate: what is the acceptable loss which we are willing to ‘pay’ in order to win this battle?

Strategically, another consideration should be on the decision makers table: the acceptable loss. This means the “price” we are willing to “pay” for achieving a balance between the length of the quarantine, economic losses, level of public compliance and healthcare capacity. Evaluating the acceptable loss is a professional, financial, ethical, legal, social, cultural and historical dilemma. Despite this, it is inevitable for choosing the appropriate crisis management strategy, and more important — the condition to end it.

In the military perspective, the ‘acceptable loss’ refers to the assessment of the fatalities and damages that might [be] caused by a specific action or operation. Industries use “acceptable risk” to define the degree of risk to human lives and environmental damage we accept after mitigating the maximum risks.

When managing a pandemic, we should first ask: “loss of what?” and “acceptable by who?” are we talking about the loss of lives? Or economic aspects? Or is it loss of control? While it also has to be accepted, but by who? The public? Decision makers? Politicians? And on the contrary to the acceptable loss — what is the benefit? How much loss are we willing to accept in order to achieve (an acceptable degree of) benefit?

How many fatalities of the COVID-19 are we accepting? How many of them young and healthy? On the other hand, how many unemployed persons “are accepted”? [W]hat is the alternative economic cost of 100 coronavirus deaths? Is it accepted? And 150? It is also known that this pandemic puts at higher risk the elderly. Given this, is the “price of life” of 85 years old lower than a kid’s life? How can we measure the economic cost of the lives that might be lost given mental conditions of those who lost their jobs and committed suicide?⁵⁵

Following this post, the same researchers published a paper on AL and how we may approach it within a pandemic.

Strategic planning at the early stages of a pandemic should consider the “acceptable loss,” which represents the ultimate balance between saving lives and keeping life routines. This includes defining the “price” we are willing to “pay” in order to be able to save the most lives and life-years and to lower the morbidity rate while, at the same time, safeguard the economy and individuals’ workplaces and social existence.

Evaluating the acceptable loss is a professional, financial, ethical, legal, social, cultural, and historical dilemma. It should be the basis for planning before and during a pandemic and should take into consideration current infrastructure and resources. Defining the acceptable loss is critical for scarce resources allocation (such as ventilators, personal protective equipment, and ICU beds) and sets standards for the conditions to reopen businesses and schools. Defining the acceptable loss is also important for gaining public support in extreme circumstances when there is a need to prioritize certain patients over others due to limited resources.

Similar to the triage performed by medical personnel in mass causality events, the acceptable loss should be put forward to a public debate. Discussing the price of life is complicated but inevitable. As in the case of medical triage, acceptable loss is based on two basic principles: beneficence and distributive justice. Strategic planning at [the] early stages of a pandemic should prioritize finding an accepted balance — between saving lives of COVID-19 patients and saving the life of the country.⁵⁶

However, there is still another side to AL that goes beyond a cold statistical analysis. It crosses all social, religious, economic, ethical, and philosophical boundaries. In an article that appeared in “The Atlantic” entitled “How Did This Many Deaths Become Normal? — The U.S. is nearing 1 million recorded COVID-19 deaths without the social reckoning that such a tragedy should provoke. Why?” the author places the consequences of AL in stark clarity. It is no longer a philosophical-economic-numbers debate. Instead, AL has become a clear moral imperative with no solution.

The United States reported more deaths from COVID-19 last Friday than deaths from Hurricane Katrina, more on any two recent weekdays than deaths during the 9/11 terrorist attacks, more last month than deaths from flu in a bad season, and more in two years than deaths from HIV during the four decades of the AIDS epidemic. At least 953,000 Americans have died from COVID, and the true toll is likely even higher because many deaths went uncounted. COVID is now the third leading cause of death in the U.S., after only heart disease and cancer, which are both catchall terms for many distinct diseases. The sheer scale of the tragedy strains the moral imagination.⁵⁷

It should not be surprising that data determine AL, both in raw numbers and dependent upon Predictive Analytics. When dealing with finances, AR comes into play. However, those willing to accept a financial risk will either gain or lose. In War, as we have seen, AL is determined by a purpose and objective. The necessity of the mission will also influence it. However, in a pandemic, endless questions are raised during our modern age, requiring answers.

Acceptable loss is a concept that may be used to understand and measure how far a government will react to protect its citizens. However, the numbers may be so overwhelming within a pandemic that “acceptable” may no longer be validly used. In short, “acceptable loss” becomes “unacceptable” with no consistent policy offered to halt the process as the death and sickness that entails applying a policy of AL have passed all boundaries. As quoted above: “The sheer scale of the tragedy strains the moral imagination.”

Collateral Damage

Photo by Philippa Rose-Tite on Unsplash

For what I feared has overtaken me; What I dreaded has come upon me. I had no repose, no quiet, no rest, and trouble came.⁵⁸

Perhaps the first time one discovers an expression and execution of ‘Collateral Damage’ (CD) within the annals of literature and history comes from the ‘Book of Job’ in the Old Testament. In this strange tale of loss, pain, suffering, and horror, Job’s children and all his possessions become collateral damage in a wager made between God and Satan. In modern terminology, Job’s children were innocent bystanders in the midst of a battle that had nothing to do with them.

Collateral Damage is terminology usually applied to the consequences of waging war.

The phrase “collateral damage” refers to harm done to persons, animals, or things that agents are not morally permitted to target in the conduct of war, as a side effect of attacks on persons, animals, or things that agents are morally permitted to target in the conduct of war. Call the first category that is, those persons, animals, or things that agents are not morally permitted to target — illegitimate targets of war, and the second category legitimate targets of war. Collateral damage, then, refers to harm done to illegitimate targets of war as a side effect of attacks on legitimate targets of war.⁵⁹

As we shall see, the CD also comes into play when dealing with a pandemic, and it is paradoxical as it will largely depend upon the point-of-view of the statistician or politician. Will they view a specific area as part of AL, or will they view it as a result of the CD?

First, let us examine a classic example of AL & CD and their interaction during wars.

Casablanca, Iwo Jima, Okinawa, and the Atom Bomb

Step #1 — The Casablanca Conference was attended by U.S. President Franklin D. Roosevelt and British Prime Minister Winston Churchill between January 14–24, 1943. The result was unambiguous. The allies would accept nothing less than an “unconditional surrender” from Germany and Japan.

On the final day of the Conference, President Roosevelt announced that he and Churchill had decided that the only way to ensure postwar peace was to adopt a policy of unconditional surrender. The President clearly stated, however, that the policy of unconditional surrender did not entail the destruction of the populations of the Axis powers but rather, “the destruction of the philosophies in those countries which are based on conquest and the subjugation of other people.”⁶⁰

Step #2 — Iwo Jima.

Raising the Flag on Iwo Jima, by Joe Rosenthal of the Associated Press

As World War II was ending in Europe and the Nazi Regime was being pushed back into Berlin, the allies turned their attention to the war in the Pacific. Between 19 February — 26 March 1945, the battle for Iwo Jima took place. Two facts about this famous battle and its consequences should not be overlooked.

1. According to the Navy Department Library, “the 36-day assault resulted in more than 26,000 American casualties, including 6,800 dead.”
2. Iwo Jima was also the only U.S. Marine battle where the American casualties exceeded the Japanese.⁶¹

After Iwo Jima, AL was contested, if not publicly, but certainly within the confines of military leadership. It became clear that the Japanese were unwilling to surrender and would fight for every inch of land, making the Allies pay dearly for any conquest.

Step #3 — Okinawa. Following on the heels of Iwo Jima, the 82-day battle for Okinawa began on 1 April and lasted until 22 June 1945. By the end of this battle, the Nazi Regime had already signed its unconditional surrender on 8 May 1945. However, the capture of Okinawa was even more costly than that of Iwo Jima.

The Americans suffered over 75,000–82,000 casualties, including non-battle casualties (psychiatric, injuries, illnesses), of whom over 20,195 were dead (12,500 were killed in action, 7,700 died of wounds or non-combat deaths). Killed in action were 4,907 Navy, 4,675 Army, and 2,938 Marine Corps personnel. The several thousand personnel who died indirectly (from wounds and other causes) at a later date are not included in the total.⁶²

Step #4 — The Atom Bomb. The Allies, especially the United States, realized because of how the Japanese were defending their homeland, along with their refusal to offer an “unconditional surrender,” that the cost of invading Japan would be extremely high.

The Americans were alarmed by the Japanese buildup, which was accurately tracked through Ultra intelligence. Secretary of War Henry L. Stimson was sufficiently concerned about high American estimates of probable casualties to commission his own study by Quincy Wright and William Shockley. Wright and Shockley spoke with Colonels James McCormack and Dean Rusk, and examined casualty forecasts by Michael E. DeBakey and Gilbert Beebe. Wright and Shockley estimated the invading Allies would suffer between 1.7 and 4 million casualties in such a scenario, of whom between 400,000 and 800,000 would be dead, while Japanese fatalities would have been around 5 to 10 million.⁶³

In our terms, the AL did not warrant the invasion of Japan. The normal populace of the United States would not be willing to sacrifice almost a million soldiers to Japan’s conquest. Acceptable losses no longer had the same imperative or force they once comprised on D-Day. Priorities and objectives had shifted. However, there was still the demand for unconditional surrender, and Japan would not comply with that stipulation.

President Harry S. Truman and the allies had the atomic bomb. Though not entirely aware of the devastation it would cause, they were knowledgeable enough to understand its implications. It was the tool the US, Britain, and Canada used, avoiding the predictive analytics of battle losses that no longer would be considered “acceptable.” Dropping the Atom Bomb on Hiroshima and Nagasaki brought World War II to its ultimate end.

When acceptable loss became too great a number to bear or be called “acceptable” for the allies, it became preferable to inflict collateral damage upon the enemy through the Atom Bomb. We may see this as a classic tradeoff between AL and CD. To be sure, elements of fear, revenge, and impatience all swayed the decisions on both sides. However, the fear of such a powerful weapon, the losses it incurred, and the collateral damage it caused created the atmosphere in which Japan’s unconditional surrender occurred.

Modern Warfare — “jus in bello” & “jus ad bellum”⁶⁴

Photo by UX Gun on Unsplash

The purpose of international humanitarian law is to limit the suffering caused by war by protecting and assisting its victims as far as possible. The law therefore addresses the reality of a conflict without considering the reasons for or legality of resorting to force. It regulates only those aspects of the conflict which are of humanitarian concern. It is what is known as jus in bello (law in war). Its provisions apply to the warring parties irrespective of the reasons for the conflict and whether or not the cause upheld by either party is just.⁶⁵

Beginning with the Vietnam War, the “Law of Armed Conflict” (LOAC), based upon the principle of “jus in bello,” was implemented on a system-wide basis. Though the United States did not adhere to the entirety of this law at the time, LOAC guided many military missions and targets. Simply put, civilians and innocents could not be targeted. In our terminology, CD must always be weighed and judged before any military mission. LOAC has since become a mainstay for many countries.

International humanitarian law, jus in bello, regulates the conduct of forces when engaged in war or armed conflict. It is distinct from jus ad bellum which regulates the conduct of engaging in war or armed conflict and includes the crime of aggression. Together the jus in bello and jus ad bellum comprise the two strands of the laws of war governing all aspects of international armed conflicts. The law is mandatory for nations bound by the appropriate treaties.

LOAC now comprises “jus in bello” and “jus ad bellum” within its legal parameters.

The avoidance of collateral damage can even be determinative for nations like the United States (U.S.) who value LOAC. A decision based on avoidance becomes problematic where key objectives cannot be targeted because of an adversary’s invitation or fabrication of collateral damage to discredit operations. Any targeting decision must be premised on LOAC; however, a decision based on avoidance must carefully evaluate the loss of initiative and tactical superiority, the increasing and persistent nature of these events in the context of a well-organized strategy, and the effect on tactical, operational and strategic objectives.⁶⁶

However, let us be clear. There is almost no reality where collateral damage can be avoided in its entirety. The reality of war is often inclusive of CD. The intent of the law is to force nations to comply with a maximal attempt to reduce CD in any given situation.

Reassessing Acceptable Loss & Collateral Damage in Light of a Pandemic

Understanding acceptable loss and comprehending the meaning of collateral damage is critical to how society manages pandemics. As pandemics mimic war in fatalities and casualties, they also contain both AL and CD in their respective measure. However, we often face a paradoxical choice with pandemics. Governments that are careful to adhere to LOAC seem to abandon all the philosophy behind “jus in bello” when dealing with their citizens during a pandemic. As we have read: “The purpose of international humanitarian law is to limit the suffering caused by war by protecting and assisting its victims as far as possible.” Additionally, we must define what the AL consists of and what CD consists of, which can get extremely complicated.

The Enemy During a Pandemic

Who is the enemy during a pandemic? Obviously, the enemy is the pandemic itself, and therefore ostensibly, we should take measures in order to:

· Mitigate the original intensity of the pandemic and its spread

· Create a situation where there is the least amount of loss of life possible

· Find methods to halt the spread of the disease and implement them

· Create antivirals and vaccines to protect the public against infection

· Offer immediate health care to those in need

· Protect vulnerable populaces with extraordinary measures if the need arises

· Assist in the rehabilitation of victims who have been infected

· Assure the continuation of a normalized economy

Nevertheless, many, often conflicting goals are at play even during a pandemic. We have established that AL and CD will always be a factor. The question that global society has still not come to a consensus on what is considered “loss” and what is considered “damage.” Furthermore, it is this very distinction that determines our course of action.

Acceptable Loss vs. Collateral Damage

Suppose a government places the sacredness of human life as its primary goal. In that case, the underlying assumption is that the government’s foremost responsibility is to ensure the continuation of life during the pandemic. All else becomes secondary. The inviolability of life takes precedence over all other factors, therefore slowing the rate of infection, caring for the sick, finding a method to attack the virus, e.g., antivirals and vaccines, disseminating them among the public, and protecting the populace are of paramount concern. There will, of course, remain an AL factor, but assuring that loss of life is held to the minimum is the primary goal.

However, society cannot exist in a vacuum. Many other critical factors are at play. The economy must continue, or lives will also be at risk, albeit not from contracting the virus. For this to happen, jobs and work must continue without interruption. Workers must do their jobs, and companies must continue to produce their products. Schools must educate. Families must function. These cannot be allowed to become CD to the primary goal of saving lives.

So, it forces governments to decide what and where their AL and CD coefficient will be. A government may choose to allow the endangering of lives and spread of a pandemic to keep its citizens from being isolated and locked down. The government may consider the disastrous consequences of a lockdown — economic, mental health, family structure, education, and social interaction — more dangerous than spreading the pandemic. In such a case, the CD flips to the cost of human life, and the AL is kept to a minimum by allowing the economy to continue. The attempt to reach Herd immunity (as we discussed above) is a clear expression of this view.

So, the real question is how we define AL and CD during a pandemic. If something is not AL, it becomes CD. For instance, if a government will allow its citizens complete and unfettered access to public places, without facemasks, and no isolation imposed, and trusts that verified “sick” citizens to stay home, the population becomes Collateral Damage. In contrast, we limit Acceptable Loss as much as possible to the economy. In simple terms, “Loss” is considered in terms of economy, and “Damage” is considered the loss of human life and sick people.

On the other side of this coin, if a government imposes regulations on the population, demanding facemasks, social isolation, quarantine of the sick and infected, closure of public places including schools, and even total lockdowns, a different measure of AL & CD is applied. AL turns to the more traditional approach, where the cost of human lives determines loss. This forces funds to be allocated to hospitals, Covid-19 wards, staff, and other necessities to limit the amount of loss in human life. However, the CD now turns to the economy, results of isolation, psychological health issues, normative growth of children, and a myriad of other problems.

Essentially, it is a pivot table holding data for AL and CD. Then we must add various AI algorithms in order to understand the current data and apply predictive analytics - not for marketing or finance — but to measure the loss of human life.

As one can see, AL & CD are not absolutes. They are determined by the government’s emphasis and by the politicians who are forcing policy implementation. Let us redefine “jus in bello” for our purposes by replacing the term ‘war’ with ‘pandemics.’ “The purpose of international humanitarian law is to limit the suffering caused by pandemics by protecting and assisting its victims as far as possible.” The outcome of this statement is to defend the citizens in terms of AL and not the economy.

As we have seen from the current pandemic, there are significant consequences to such an action. We can attempt to limit the loss of human life to the virus with Draconian measures. However, in doing so, we increase the danger to public mental health, increase the rate of suicides, increase the mental and physical effects of social isolation, and cause many other issues. These too, cause “loss,” and we must calculate such loss either as AL or CD. Alternatively, those in power may decide that such loss cannot be tolerated either.

Then compromise enters the equation. Balancing between AL & CD can be incredibly problematic.

Who determines the nature of the compromise?

• Politicians
• Medical Professionals
• General Public

Each one of these categories can contain a myriad of opinions. We cannot consider them a block in which all involved agree. Politicians will not agree with one another, nor will medical professionals. The general public will have an even greater division and dichotomy of opinion.

1. When and how do we reevaluate the current status?
2. Who imposes the rules?
3. Do these rules take on the same validity as law?
4. Can we legally prosecute one who does not follow these rules?
5. How do the rules get imposed? How does any government guarantee that its citizens will follow the rules which are currently in place?

The Wild Card — Freedom of Choice

“The strongest principle of growth lies in human choice.”⁶⁷

Photo by Vladislav Babienko on Unsplash

One can analyze AL and CD from many objectives and views. However, there is always a ‘wild card’ that must be accounted for in most modern societies. Freedom of choice comes into play in all situations where governments, perhaps with all good intentions, attempt to limit the individual rights of their citizens. This factor has come to the forefront repeatedly in the global reaction to combatting Covid-19.

The lesson of Covid-19 is brutally simple and applies generally to public regulation. Free people make mistakes and willingly take risks. If we hold politicians responsible for everything that goes wrong, they will take away our liberty so that nothing can go wrong. They will do this not for our protection against risk, but for their own protection against criticism.⁶⁸

The first stage of a pandemic is fear. This is natural and understandable. There is fear that people will catch the virus and become sick and death follows. There is fear for one’s livelihood, way of living, family, children, and friends. There is fear for a future where suddenly nothing can be planned or relied upon with confidence — not even a family outing.

Governments, coupled with medical professionals, analyze the pandemic data as much as possible and attempt to produce a balanced AL and CD ratio. Each government will act according to its own requirements, basing its AL and CD on varied factors. On a global level, however, and we are in a globally connected world, the AL is judged on the loss of human life or the extent and degree of the sickness based upon the CDC or the WHO evaluation.

One, nothing matters nearly as much as vaccination. A continued push to persuade skeptics to get shots — and to make sure that people are receiving booster shots — will save lives.

Two, there is a strong argument for continuing to remove other restrictions, and returning to normal life, now that Omicron caseloads have fallen 95 percent from their peak. If those restrictions were costless, then their small benefits might still be worth it. But of course they do have costs.

Masks hamper people’s ability to communicate, verbally and otherwise. Social distancing leads to the isolation and disruption that have fed so many problems over the past two years — mental health troubles, elevated blood pressure, drug overdoses, violent crime, vehicle crashes and more.⁶⁹

This is a slippery slope in terms of individual rights. Many political leaders have opted for a compromise. For instance, the facemask is non-intrusive on the body. It does not demand a traumatic act of putting something ‘into’ the human body. It is also to be worn only in public spaces. Therefore, legislation in such an area may not directly interfere with an inherent human right (even if one views clothing as individual freedom.) Indeed, most countries will not allow one to walk nude in public areas. This, too, is a balance of public desires and requirements against individual rights. However, a possibly infected individual not wearing a facemask will interfere with the rights of an individual wearing a facemask or someone who has already recovered (as Covid can be contracted again with all the various mutations.) So, an individual who refuses the facemask is choosing the good of the one over the good of the many. The AL and CD are not their concern.

Once the first shock wears off and specific measures are taken, our wild card of ‘freedom of choice’ comes into play. Every one of these factors forces questions of freedom of choice, the good of the one vs. the good of the many, and a balance of AL & CD. Every item below carries with it the consequences of limiting freedom of choice. Let us take a few examples of action-reaction regarding just a few of the ‘freedom of choice’ problems facing us during the Covid-19 outbreak.

Vaccines

Photo by Daniel Schludi on Unsplash

In the United States, President Biden decided in September 2021 that it was time to place the good of the many over the good of the few. However, enforcing the policy was a different matter entirely. The only place he could enforce such a policy was in federal institutions, as these were government employees. As the employer, he could enforce vaccination. He could not enforce it on any other employer or employees.

“My job as president is to protect all Americans. So tonight I’m announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees — that together employ over 80 million workers — to ensure their workforces are fully vaccinated or show a negative test at least once a week. Some of the biggest companies are already requiring this: United Airlines, Disney, Tyson Foods and even Fox News. The bottom line — we’re going to protect vaccinated workers from unvaccinated coworkers. Already, I’ve announced we’ll be requiring vaccinations at all nursing home workers who treat patients on Medicare and Medicaid because I have that federal authority. Tonight, I’m using that same authority to expand that to cover those who work in hospitals, home health care facilities or other medical facilities. A total of 17 million health care workers. If you’re seeking care at a health facility, you should be able to know that the people treating you are vaccinated. Simple, straightforward, period. Next, I will sign an executive order that will now require all executive branch federal employees to be vaccinated, all. And I’ve signed another executive order that will require federal contractors to do the same. If you want to work with the federal government and do business with us, get vaccinated.”⁷⁰

• Isolation of the Sick — Can this be regulated and legally enforced?
• Isolation of the Exposed — Can this be regulated and legally enforced?
• Facemasks — Can this be regulated and legally enforced?
• Testing — Can this be regulated and legally enforced?
• Access of the Infected & Exposed to Public Transport and other Public Areas — Can this be regulated and legally enforced?
• Schooling — Can we mandate an end to traditional education?
• Work — Can we force the closure of offices and stores legally and without reimbursing those affected by such closures?
• Limiting Movement Based Upon Age — Can we apply a form of discriminatory practice, with Covid-19, “Ageism,” based upon our knowledge of who is more susceptible to the current mutation?
• Public Lockdowns & Curfews — Can we close areas, neighborhoods, cities, and even entire countries to protect our citizens?

Freedom of choice is a wildcard. While governments and medical professionals all deal with AL & CD, they have no control over the freedom of choice granted to those asked to follow specific mandates and rules unless legislation occurs. Nothing makes this problem more evident than the issue of forced vaccinations or forced facemasks.

F³ — Fate, Fortune, & Foresight

O Fortuna Translated into English⁷¹

“O Fortuna” is a medieval Latin poem written in the 13th century of uncertain authorship, which became famous with a haunting musical composition by Carl Off in his “Carmina Burana.”⁷² It resonates deeply within our collective consciousness when we must deal with pandemics.

Ask any virologist or epidemiologist what keeps them up at night and appears in their worst nightmares. They will answer without hesitation, “a new virus or another mutation of Covid-19 where a method to slow it down or a vaccine proves impossible to find.” In non-academic terms, such a scenario should scare the hell out of anyone.

“Long Covid” has essentially begun to fulfill these dark prophecies. At first, it seemed simply to be a post-Covid series of symptoms. The WHO addressed these symptoms as a “post-Covid-19 condition” as follows:

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.⁷³

The terminology evolved as more cases surfaced. Covid-19 even among the vaccinated, was not being eradicated. Indeed, it seems to insinuate itself in the body, causing many long-term effects.

Long COVID is a condition characterized by long-term consequences persisting or appearing after the typical convalescence period of COVID-19. It is also known as post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS). Long COVID can affect nearly every organ system, with sequelae including respiratory system disorders, nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain, and anemia. A wide range of symptoms are commonly reported, including fatigue, headaches, shortness of breath, anosmia (loss of smell), parosmia (distorted smell), muscle weakness, low fever and cognitive dysfunction.⁷⁴

Though we have known about Long Covid for more than a year, it is now becoming a critical factor in combatting the disease. Needless to say, it must also enter all AL, CD, and Freedom of Choice decisions.

Millions of people continue to suffer from long-term Covid symptoms. Studies estimate that 10 to 30 percent of people infected with the coronavirus may develop such symptoms, including cognitive issues, exhaustion, shortness of breath and many others.

“It involves a very varied constellation of symptoms, and it’s still quite mysterious,” said my colleague Pam Belluck, a health and science reporter. “But a growing number of studies are shedding light on the range of symptoms and what they look like. And we’re getting some scientific clues about what seems to be happening in the body.”⁷⁵

Our nightmare scenario may not end there. We have endured mumps, flu, polio, measles, and many other diseases, which spread at increasing rates and posed great dangers. Maurice Hilleman, the world-renowned microbiologist, was the force behind developing over 40 vaccines for all these main viruses.⁷⁶ What would we do as individuals, as a society, and as globally connected humanity if a mutation appeared that no longer spared infants and children? A Covid-19 variant outbreak or a new pandemic racing through the world, attacking old and young alike, where we are still grappling with isolation, facemasks, gloves, vaccines, and our freedom of choice to apply them or not — brings to the fore a myriad of legal, ethical and moral problems.

We may accept it as fate. “Fate is against me in health and virtue, driven on and weighted down, always enslaved…since Fate strikes down the strong, everyone weep with me!” When we survive, we may view it as fortune — “ever waxing, ever waning.” These are, at best, personal views of any given situation. What we cannot ignore, what society absolutely must ensure — is to exercise the wisdom of foresight. We may never be able to avoid an acceptable loss ratio, nor may we be able to find a method to avoid collateral damage entirely. However, we must demonstrate farsightedness and planning to minimize both while considering the freedom of choice granted to each member of society.

There is essentially no possibility of a ‘non-reaction.’ By choosing to do nothing and not reacting, one essentially chooses a position on this battlefield. Medical data, political decisions, personal preferences & ethical principles have converged upon the coronavirus frontline — and all humankind are potential casualties.

Knowing the consequences of acceptable loss, collateral damage, and our inherent right to freedom of choice, forces the primary question to the fore once again: Do the needs of the many outweigh the needs of the few, or do the needs of the one or few outweigh the needs of the many?

How we respond to this question will formulate humanity’s course over the next century. One factor is undeniable. The next virulent mutation of Covid-19 or an entirely new pandemic awaits us. Data-driven decisions may not necessarily be ethical ones. We may just find that with all the data we do already possess, the answers derived from cold calculations do not suffice.

Society must define for itself how much loss is truly “acceptable”? How much “collateral damage” are we willing to consent to? And how far can we take “Freedom of Choice” when our own choices endanger others?

“In critical moments, men sometimes see exactly what they wish to see.”⁷⁷

Photo by dj_johns1 on Unsplash

References

1. Sowards J.B., Bennett H., ‘Star Trek II: The Wrath Of Khan’ (motion picture). (1984) Meyer M., director. Sallin R., producer. Hollywood, CA. USA: Paramount Television, Cinema Group Venture

2. Wikipedia (n.d.) ‘James T. Kirk’, available at: https://en.wikipedia.org/wiki/James_T._Kirk (accessed 20th March 2022)

3. Wikipedia (n.d.) ‘Spock’, available at: https://en.wikipedia.org/wiki/Spock (accessed 20th March 2022).

4. Quote taken from: Sowards J.B., Bennett H., ‘Star Trek II: The Wrath Of Khan’ (motion picture). (1984) Meyer M., director. Sallin R., producer. Hollywood, CA. USA: Paramount Television, Cinema Group Venture

5. Ibid

6. Quote taken from: Bennett H., ‘Star Trek III: The Search For Spock’ (motion picture). (1982) Nimoy L., director. Bennett H., producer. Hollywood, CA. USA: Paramount Television

7. Wikipedia (n.d.) ‘Star Trek III: The Search for Spock’, available at: https://en.wikipedia.org/wiki/Star_Trek_III:_The_Search_for_Spock (accessed 20th March 2022)

8. Rushdie S. ‘The Satanic Verses’, (1989) The Viking Press, New York, N.Y. 560 p.

9. CMOS Shop Talk, ‘Styling COVID-19 and Related Terms’, (2020) Chicago Manual of Style — CMOS Shop Talk, 21st April, available at: https://cmosshoptalk.com/2020/04/21/styling-covid-19-and-related-terms/ (accessed 20th March 2022)

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11. WHO (n.d.), ‘Naming the coronavirus disease (COVID-19) and the virus that causes it’, available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it (accessed 20th March 2022)

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13. Ibid

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15. Ibid

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