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In which John considers the differences between individual risk and societal risk, especially as it related to infectious disease pandemics.

NOTE: no secret livestream this week, as e-learning support currently occupies quite a lot of time. sorry/thanks for understanding.

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Good morning, Hank, it's Tuesday.  In the United States, if you're 75 years old and contract COVID-19, you have, on average, well over a 90% chance of surviving.  If you're my age, even if you have a couple pre-existing health conditions like I do, your chances of surviving are over 98%.  That's your personal risk, but there's a big difference between personal risk and societal risk.

Like, one simple way of imagining this is that if 1% of Americans died tomorrow, I would almost certainly not die, but 3.3 million people would, and so my personal risk might be low, but societally, it would still be catastrophic.  Now, the reality of COVID is, of course, less simple.  For one thing, it doesn't only cause death, it can also cause severe illness and long-term health complications, but also the disease does not infect or sicken or kill people at random.  Infectious disease never treats people equally because our social orders don't treat people equally, and so in the United States, we see, for instance, far higher rates of mortality among people of color.

We also have to consider the disease itself.  Like, in the 1918 flu pandemic, middle aged adults were most likely to die.  With this pandemic, older adults are most likely to die, and so it's not random, because of disparities in our socioeconomic order and disparities in our healthcare system and because of the disease itself.  More vulnerable people have more personal risk, which I would argue makes the societal risk higher, but some people seem to be arguing makes the societal risk lower.

Okay, so our responses to the pandemic also come with personal and societal risks, right, like there are risks to disrupted educations and decreased economic activity and increased isolation and so on.  These costs are huge and again, they reflect inequities in our social order and so are not distributed at random, but I would argue their root cause is not government regulation, their root cause is the disease.

Like, government restrictions are not the only factor of affecting human behavior.  Even where bars and theaters are open, people are less likely to patronize them as long as indoor maskless gatherings are known to spread a highly infectious novel disease, and it's not at all clear that keeping everything open actually reduces these costs of the pandemic.  Like, Sweden, for instance, implemented far fewer public health measures than neighboring Norway, and as a result has a COVID death rate that's over 10 times higher but Sweden's economy has actually suffered more than Norway', and then, maybe most critically, there are the societal risks that accompany an overwhelmed healthcare system.

Like, when Sierra Leone had an ebola outbreak in 2014, the healthcare system collapsed and as a result, there was a huge increase in mortality.  More mothers dying in childbirth, more children dying of diarrheal illnesses, and so on, and so as one doctor put it to me, "Most people who died of ebola did not die of ebola.  They died because the healthcare system got overwhelmed."

Now, the COVID-19 pandemic is very different, but uncontrolled spread of COVID will also lead and in some cases, is currently leading, to an overwhelmed healthcare system.  If there are too many patients for doctors and nurses to treat, or not enough hospital beds or inadequate supplies, people will die of health issues that, in normal times, would have been survivable, and so one of the reasons the societal risk of COVID-19 is so high is the stress it places on the healthcare system itself, and one of the reasons to try to slow transmission is to lessen the unconscionable burden currently being placed on healthcare workers.

Not everyone has a choice about whether to be exposed to COVID-19 at work or whether to be exposed while engaging in daily activities, but this week, many Americans will have a choice.  Many of us will have a choice about whether to expose ourselves and those we love to COVID-19 at the Thanksgiving dinner table.  The personal risk to you in that choice may be low, although it's not that low, but the societal risk is very, very high.

We know COVID is real, we know it killed over 10,000 Americans last week, and we know safe and effective vaccines are coming, so please, if you have a choice, choose to stay home.  Hank, I'll see you on Friday, because I love you, and so you can't come to Thanksgiving.  Next year, though.  Next year, there will be feasting and dancing in Jerusalem next year.