Ben Bramble, Pandemic Ethics - 8 Big Questions of COVID-19, (Bartleby Books), 2020

To Ben Bramble, the issue of how best to deal with COVID-19 is not very complex. In his new book, he endeavours to deliver clear-cut answers to 8 big COVID-19 questions. The sheer number leaves limited room for in-depth discussions of each one, but the first question: “How long should we stay locked down?” is the fundamental one. Perhaps the book would have benefited if the author would have concentrated on delivering a more nuanced discussion of the dilemmas involved in this question. Instead, he only presents a brief discussion that leads to the sweeping conclusion that:“The right answer is that we should stay in a hard lockdown until we have brought the number of cases very close to zero—i.e., until the virus is almost eradicated.” (p 20).

To bolster his argument, he points to the suffering that is caused when people – mostly older people – die from COVID-19 if the virus is allowed to spread. No one would of course disagree that, all things being equal, these deaths should be prevented. But clearly there is a dilemma here: you have to ask whether they should be prevented regardless of the loss of lives and livelihoods that the preventive measures cause, due to their adverse effects on the economy and on social, educational and health-related sectors. And this dilemma is never given the weight that it ought to have.

Bramble mentions that “When businesses close, people lose their salaries and livelihoods. Unemployment, especially combined with social isolation, can lead to mental health problems and domestic violence.” (p 9–10), but he seems to think that these problems can be fixed if governments provide financial assistance to people who have lost their jobs, subsidize wages to reduce job losses, freeze rents, etc. (p 14). Yet, he has no serious considerations on how long governments will be able to finance these measures without implications for their longtime ability to provide other services, such as social-, educational- and health-related services.

You could expect a more comprehensive deliberation on the hard dilemmas of prioritization of societal resources that the lock-down policies involve. We ought to acknowledge that there are no good choices available for politicians; whichever policy they choose to adopt, people will suffer and die in the short and in the long term because of it. Sadly, all we can do is try to analyze which policies will lead to the least suffering. So, do we have the necessary evidence to say that a policy of hard lock-down adequately includes all relevant concerns - economic, human, and environmental¹ – to justify a claim that a hard lockdown is the right policy? If you think the answer is no, you will still not be convinced after reading Brambles book.

Overall, Bramble unfortunately does not provide much data to support his conclusions. This can, of course, be seen as inevitable since we are still in the midst of the pandemic and therefore do not have sufficient data and analysis of the long term development of the disease or on the consequences of adopting different containment policies. But this is an argument in favor of exercising greater humility in judgements of which policy is right. And this seems not to be the path that Bramble is taking.

For instance, he enrolls in the chorus which has shamed the Swedish government for listening to their health officials and adopting a less restrictive lockdown policy than most other countries. He boldly claims that “these experts chose the wrong course—a version of Open Up—which has resulted in much higher death rates with almost no benefits” (p 37). This is, however, yet another area where the jury is still out, because the latest figures could indicate that Sweden is on the right track to avoid the comprehensive second round of infections that many other countries are heading for, and therefore might, in the long run, have chosen the better policy. Whether this will be the case is still too early to say, but the foundations for Bramble’s conclusion seems to be wanting.

Far from being cautious he goes on to make even more sweeping verdicts about the Swedes: “Many of us find their statements deeply concerning. This, I suspect, is because there is something cold—or coldly rational—about them and what they are saying.” (p 19). His example of the cold rationality is Johan Giesecke, epidemiologist and chief advisor to the Swedish government, stating that “People who will die a few months later are dying now. And that’s taking months from their lives, so that’s maybe not nice. But [compare] that to the effects of the lockdown.”

Instead of engaging in a (rational) discussion of prioritization and which policy will overall benefit more people, or a discussion of whether, in an emergency situation, the lives of the young can be prioritized over that of the old (which is what the Swedish policy amounts to), Bramble not only dismisses the Swedish policy as obviously morally wrong, he also goes on to claim that: “these words and policies shape Swedish culture. They have a huge effect on what Swedes will be like in the future. Some Swedes will be somewhat colder, and so (if I’m right) less able to flourish, because of these significant decisions” (p 19).

This is certainly a sweeping conclusion about the future, and he offers no evidence in support of it. It seems that you would be equally justified in arguing that future citizens in countries who imposed strict lockdowns would be less able to flourish because of this policy that leads to so many casualties. You could argue that this points to a more general problem: that Bramble’s conclusions should be based more on cold rationality and less on gut feelings and assumptions.

For instance, Bramble claims, that the socio-economically disadvantaged will suffer the most if lockdowns are not enforced, because “it is they who would be most financially pressured to go back to work” and therefore get ill (p 14). But this seems to be a very superficial way of addressing a complex issue. Indeed, evidence is coming in that points in the direction that it is actually the lockdowns which affect the disadvantaged groups the hardest all over the world. That the cure affects these groups worse than the virus. For example, the OECD recently reported that school closures worsen the existing learning gap since children from wealthier families continue schooling with digital tools, whereas poorer children fall further behind. Worldwide, COVID-19 containment measures have forced school closures in 188 countries, heavily disrupting the learning process of more than 1.7 billion children.² The consequences are long-lasting, especially for the most exposed children who may never return to school.

Bramble’s claim that governments could easily solve this problem by “doing much more to try to ensure that all children have access to adequate online education in this time” (p 69) also seems too reductionist. Computer and online access will not solve social problems such as parents lacking educational resources or families where abuse or violence prevent children from learning. Not to mention the fact that millions of children the world over rely on school meals that are now not available to them. We need to take seriously that this and other complex social problems are being exacerbated by lockdowns.

Another area where lockdowns have disastrous effects on the weakest is shown in a comment posted by The WHO–UNICEF–Lancet Commissioners in July in The Lancet. The authors draw attention to the fact that children will be the prime casualties of the global economic crisis, that is expected to be caused by the containment policies, especially lockdowns.³

They point to projections suggesting that if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in response to the pandemic), the increase in child deaths could surpass one million in low-income and middle-income countries over 6 months, and tens of millions of children worldwide could face extreme poverty.⁴

In comparison, the total worldwide number of reported deaths from COVID-19 was 971.360 persons on 23 September 2020.⁵

In not including this kind of considerations in the discussion, it is as if Bramble does not really seriously consider the suffering that results from lockdowns rather than from the virus itself. And thereby does not take seriously the complexity of the dilemmas involved in determining the best policies in this situation.

At the moment, we still have too limited data on the long term developments of the virus, and on the consequences of the containment policies on the economy and on people’s lives and livelihoods, to justify the moral conclusions Bramble arrives at.