The fear of the LORD is the beginning of knowledge; fools despise wisdom and instruction. (Prov 1:7 ESV)
By Stephen W. Hiemstra
In small group discussions this week, we talked about the nature of wisdom.
One interpretation of wisdom arises through distinguishing different types of knowledge. In my book, Simple Faith (2019), I distinguish three types of knowledge: knowledge about what is (positivistic knowledge), knowledge about values (normative knowledge), and knowledge about what to do (prescriptive knowledge). Prescriptive knowledge is necessarily contextual and often referred to colloquially as wisdom.
In the context of the current corona virus pandemic, we face large and uncertain threats, but also large uncertainty about all three of these types of knowledge. High levels of uncertainty have pushed decisions up the chain of the command in cities, states, and countries, which is the natural response when the delegated authorities of other leaders have been exceeded.
This is clearly a Gethsemane moment, when we have the choice between turning into our pain or turning to God. But, what does turning to God look like? In a similar crisis—the U.S. Civil War—President Lincoln declared a national day of prayer—Thanksgiving. This is an important precedent for the current crisis because in turning to God we admit our inadequacy and turn away from various traps, like political division. Being open to God’s will for our lives is an obvious plea for wisdom, which we sorely lack.
In the secular realm, our current dilemma appears like the classic venture capital problem. Venture capitalists normally operate in an investment context of high uncertainty and, potentially, high rates of return. How does a venture capitalist respond? Set goals and work on figure out what you need to know to achieve them, much like the moon landing in the 1960s using techniques like decision trees and project management approaches.
When President Kennedy announced the objective of putting a man on the moon and returning him safely home again, no one knew how to do it because it had never been done before. I suspect that white boards were brought out, a list of things unknown was identified, and project managers were assigned the task of exploring the unknowns with deadlines for completion.
The Swedish Experiment
In the midst of the corona virus pandemic, the Swedish have apparently decided to continue with business as usual rather than having people shelter in place. This decision was not made out of ignorance, but out of recognition that we do not know the costs involved in alternative strategies.
Social distancing is a policy that evolved out of experience of the Spanish flu in 1918. U.S. cities that practiced social distancing had lower mortality rates than those that did not. In the current crisis, the argument is that by slowing down the transmission of the corona virus, hospitals will be able to treat the victims more adequately because resource constraints on staff and things like ventilators will not be exceeded. Hence, fewer people will die for lack of medical attention.
The Swedish response is to ask whether hospitals are actually able to save more patients than simply having them remain at home.If hospital care does not change actual mortality experience or changes mortality rates only modestly (about two-thirds of patients on ventilators have been reported to die anyway), then the social cost of shutting down the economy may seem to be a drastic measure.
In any case, we really do not know the actual cost of these trade-offs. Is the effect of hospital care simply an example of the placebo effect, where doing anything seems offer improvement that is, in fact, illusionary? We hope that hospital care is a real benefit because in shutting down the U.S. economy we have bet a significant sum to gain this benefit.
We really do not know what the mortality rates are from corona virus. Mortality rates currently mask actual mortality rates because deaths are divided into the more difficult cases where tests are administrated. If we tested everyone, we might learn that the mortality rates are actually much lower than reported.
The variance in reported cases suggests extreme uncertainty about mortality rates. In Europe where everyone has social medicine, mortality rates average 10.5 percent. Sweden has a rate of 10.7 percent; in France it is 17.5 percent. In the United States, the mortality rate 5.3 percent on April 18, 2020, exceeding the mortality rate for U.S. Marines (5.2 percent) during World War 2.
A meaningful strategy for dealing with the corona virus requires knowledge about three public policy strategies and their cost:
1. Develop herd immunity (the Swedish alternative) without sheltering in place (likely costs the most lives; likely least expensive).
2. Shelter in place until a vaccine becomes available (saves most lives; likely the most expensive).
3. Shelter in place until antibody tests give a green light to come out (unclear how effective in saving lives).
These strategies can be used together. We could, for example, shelter the most vulnerable people while opening the economy, but unfortunately we do not know whether sheltering some is even possible as a practical matter.
The hand-wringing and finger pointing that surrounds conversation about these strategies arises because the Coronavirus Aid, Relief and Economic Security Act (CARES Act) signed on March 27, 2020 and related announcements by the Federal Reserve implicitly assume the corona crisis will end in weeks not months or years. Because a vaccine is likely not going to be available until 2021, and the Spanish flu pandemic in 1918 went on for roughly four years, these alternatives meed to be seriously researched and discussed. Additional public bailouts are simply not financially possible.
The question is: Which strategy is most cost effective in terms of lives and financial resources spared?
Life at Sea
The infection of people on cruise ships and naval vessels gives us a peek at actual mortality rates when everyone is infected.
Aboard the USS Theodore Roosevelt, the U.S. Navy tested 94 percent of the crew, finding 600 sailors (out of 4,800 sailors) infected. Accordingly to Secretary of Defense Mark Esper, 350 of those 600 infected were asymptomatic. As of this writing, the Washington Post reports that only one sailor has died. That yields a mortality rate of less than one percent (0.166 percent = 1/600). Sailors tend to be young and healthy, not a high risk group.
One of the early examples of cruise ship outbreaks in February 2020 resulted in 1,500 infections and 39 deaths (mortality rate of 2.6 percent) in one cruise line, more than any nation other than China at the time. More than two-thirds of the passengers on one such cruise ship were over the age of 65, a healthy strata of high risk group. This compares with media reports of up to half of the corona virus death in the United States being among nursing home residents, a high risk group with pre-existing conditions where mortality rates of around 20 percent have been reported. Still, most corona virus deaths have been of patients who were otherwise living without extraordinary medical intervention.
We all will die. The mortality rate of human beings taken over 120 years is one hundred percent. The question is whether we can live a faithful life between now and then, pointing those around us to God and his salvation in Jesus Christ.
I published my new book, Living in Christ, this week in Kindle on Amazon.com. Once a paperback edition is released within the next couple weeks, I will begin advertising more actively.