The Wuhan coronavirus and the case for a free society
The Covid-19 coronavirus that emerged in the central Chinese city of Wuhan last December has caused what is probably the largest recent dangerous global epidemic since AIDS. It is a respiratory disease with a relatively long incubation period that causes some percentage of patients to develop a severe lung pathology, exacerbated by an aberrant immune response. With no treatment specifically developed or adapted to target the disease, around 2% of those diagnosed succumb to it.
The crisis brought about by the disease has also led to the discussions of what the best responses to such outbreaks are. While libertarians should not necessarily agree that the merits of our political philosophy stand or fall on such edge cases, it may be important and instructive to consider whether cases like the Covid-19 epidemic actually constitute exceptions from the general libertarian principles of justice and require massive coordinated responses.
But in order to answer these questions, there are a lot of prerequisites to be covered, first. Let us start with the current situation with the disease spread.
The state of the epidemic and important facts to consider
As of the time of publication, there are around 75,000 confirmed cases of Covid-19 infection. The vast majority of those cases have so far been confined to China (all but around a thousand), especially the ground-zero province of Hubei and the city of Wuhan. Out of the 75,000 confirmed patients, around 2,000 have succumbed to the virus. This makes it much less fatal per case than its relatives SARS and MERS but much more contagious. According to the latest major Chinese study, the vast majority of the infections (around 80%) are mild, and mortality rises steeply with age and complicating conditions such as heart disease and diabetes. It has an average incubation period of around two weeks but seemingly with some major outliers.
Beside this big picture, however, there are details that need to be considered which will be important for the discussion below. First, the confirmed international transmission of the virus has so far been low. The majority of the outside-of-China cases (542) have so far been among the passengers of the cruise ship The Diamond Princess (it had been on quarantine in Yokohama since February 3), although the number of infections has been growing outside of it. The territories with the most confirmed infections are, unsurprisingly, the neighboring Hong Kong, Singapore, Japan and South Korea.
One of the most important charts for understanding where the epidemic is at is the one that shows the daily cases by region.
It shows that in China, until some point the number of infections had been growing at the same speed in the Hubei province as outside of it but then the rates diverged. While the situation in Hubei has remained dire for the period concerned, the official data indicate a certain degree of outbreak slowing outside of it. The vast majority of registered fatalities have also taken place in Hubei. For instance, of the 136 new Chinese victims reported on the day of publication, 132 were from Hubei. Of the victims outside of China at the time of publication, all but two got infected in Wuhan.
More interestingly, the international cases (even with the unfortunate cruise ship included) do not show the same pattern of growth. If the cruise ship cases are set aside, the number of confirmed infections outside China had been growing even slower, at least until February 16.
Confined spaces with a lot of people seem to have been hit especially hard. More than 1/7 of the Diamond Princess passengers have already tested positive for the coronavirus (542 out of 3700 total passengers and of 2404 tested). Furthermore, according to the aforementioned major Chinese study, the virus had spread to 3,019 Chinese health workers by February 11. Of the cases among medical workers, many have been severe, and 5 of them died, including the whistleblower hero ophthalmologist Li Wenliang and even the head of one of the Wuhan hospitals.
The evidence summarized above is subject to some important caveats, however. First, many experts seem to believe that the detected cases of infection are only the tip of the iceberg, with the vast majority of virus carriers either asymptomatic or having very mild symptoms not prompting Covid-19-related checks or hospitalization. However, interestingly, the accidental cruise ship laboratory seems to contradict this theory because only a minority of passengers with confirmed infection have so far shown no symptoms (189 out of 454 as of February 17). This, in turn, however, may be the evidence of a higher infection burden in confined spaces and areas with concentrated infection.
Secondly (and related to the first caveat), the detection and quarantine efforts in China and the world outside Wuhan and Hubei may be insufficient to catch the majority of infected people, which may mean that the data on the virus spread outside Hubei may significantly understate the epidemic. The reason for this is the possibility of widespread asymptomatic or very mild infections and the lack of concentrated resources of the kind deployed in Hubei. Some countries with close ties to China (like Indonesia and North Korea) suspiciously report no cases, even though this is unlikely to be true.
Then, almost any Chinese data must be treated with utmost caution. As we shall see, from the very start of the outbreak, the Chinese government has shown wanton interference with the reporting of it, and, generally, the incentives for underreporting negative information are very high in highly authoritarian regimes like China. The situation has probably been even more exacerbated with the recent tightening of restrictions and repression in all kinds of areas due to the rise of Xi-Jinping’s one-man rule. Also, given the initial widely-publicized and outrage-inducing mismanagement of the epidemic and the economic pressure that the massive quarantine has been putting on the country the central and provincial authorities probably have strong incentives to try to paint the most rosy picture possible.
Finally, some experts fear that the features of Covid-19 may, taken together, make it impossible to contain it in the modern world. It may be bound to become endemic in the human populations like other, less dangerous coronaviruses, unless the humanity immediately switches to living in autarchic communities for lengthy periods of time. In the process, the virus may become far less severe and fatal as it will likely need to to spread even more successfully. In this scenario, the initial spread dynamics are almost irrelevant but this possibility itself matters for the larger focus of this article.
Governmental responses to the epidemic
What have the governmental responses to the Covid-19 epidemic been so far? Here, I will, first, consider the Chinese response, which has been crucial so far, and then make a short overview of other governments’ measures.
The Chinese government’s reaction to the Wuhan coronavirus’s outbreak can be roughly divided into two stages. At the first stage that lasted between the first reports of infections in Wuhan to January 23, the regional government of the Hubei province (probably, at the instigation from the highest national level, as it is becoming increasingly clear) has done everything it could to downgrade the severity of the crisis. For weeks, it lied to the whole world that there is no evidence of human-to-human transmission, failed to quarantine the early sick people and censored everyone who tried to publicly speak out about the unfolding outbreak or even warn people in their professional circles (like Li Wenliang). To top it all, the Wuhan government organized a mass banquet involving 40,000 families on January 18 to mark the Lunar New Year and possibly set a record. In the middle of an unfolding epidemic. The initial cover-up could, and perhaps should, be discounted as something peculiar to China and potential other highly authoritarian regimes, especially for the purpose of discussing whether a massive government response could be needed to curb epidemics like that of Covid-19. Let us, hence, turn to the second stage of the Chinese government’s response.
On January 23, after a speech by Xi Jinping, the massive response started with the virtual lockdown of the city of Wuhan and the Hubei province afterwards.
Currently, according to the New York Times coverage, about half of the Chinese population is placed under various forms of lockdown, including the prolongation of the Lunar New Year holidays and the mandatory quarantine of those returning from them. In some cities, people are monitored as they enter and exit their apartment buildings and are only allowed rare exits. It also appears that in many cities, industrial entreprises have had to obtain special administrative permits in order to reopen their activities. There were also multiple reports of people suspected of being sick being forced to undergo medical checks and those showing signs of respiratory illness being put into hospitals.
The crackdown already seems to be having significant economic impacts, including on the supply chains of important global companies like Apple. As another data point, Adidas’s sales in China have fallen by 85% compared to the same period a year ago.
Perhaps, the most important negative impact of this all-out quarantine, however, have been medical. The effective shutdown of the city of Wuhan at the epicenter of the outbreak has forced all the rapidly multiplying victims of the infection in it to be treated within the confines of the city, with its healthcare facilities clearly completely unprepared for such an influx of patients. There have been multiple reports of massive overcrowding, uncontrolled mixing of confirmed cases with other patients, shortages of basic medical supplies, doctors begging for masks online and so on. The medical supply shortages have probably been exacerbated by the travel and transportation blockade.
True, the government has completed the construction of several massive makeshift hospitals in Wuhan in a matter of days but merely constructing some sort of massive premises is not remotely enough. It appears that the conditions within at least one such hospital are just as chaotic as in other hospitals in the city.
It is also possible that the crackdown on the epidemic has affected people with other serious medical conditions. Here is a telling illustration from the New York Times:
Li Jing, 40, an associate professor of sociology at Zhejiang University in the eastern city of Hangzhou, was almost barred from taking her husband to a hospital recently after he choked on a fish bone during dinner. The reason? Her neighborhood allows only one person per family to leave the house, every other day.
Other countries’ and territories’ responses have thus far been far less severe than that of China.
Libertarianism and counter-epidemic measures
Let us now turn to the central issue of this essay. Does the Wuhan coronavirus epidemic imply anything about the soundness of libertarianism? Does it suggest that at least as far as epidemics like this are concerned, other ethical frameworks should take precedence over it?
In this regard, what is apparent in those who wonder about the applicability of libertarianism (or pollution or climate change, for that matter) to epidemics are two ideas. First, some of those who oppose libertarianism believe that it by definition precludes any responses to epidemics that involve the use of physical force, especially measures like forced quarantine. Others contend that libertarianism can hardly justify the sort of massive quarantine and isolation measures that may be required, and have, as we have seen, already been undertaken by some governments.
I will not attempt to discuss all or even most of the potential versions of libertarianism here. It will probably suffice to say that it is an ethics related to the use of physical force in society. The main idea (whether it is a starting point of deduction or a sort of generalization of many ethical intuitions) is that it is only permissible to anyone (including even government agents) to initiate physical force against other people in proportion to their present or imminent use of force against others.
There are several things to quickly unpack here. First, physical force is not limited to the most obvious things like killing, kidnapping or beating someone or stealing what they owe. It potentially includes any physical impact that one person can inflict on another, whether wilfully or not. At the same time, one may not target in self-defense people who do not pose a clear, imminent threat to herself or others. Finally, the self-defense in question must involve the least violence/freedom restriction necessary in order to preclude or minimize the physical impact defended against. If the defense is necessarily or even highly likely worse than the probable potential impact, it becomes unethical from the libertarian perspective.
This unpacking has two implications for libertarianism and the epidemics like that of Covid-19. First, as dangerous viruses like Covid-19 affect the organism in a perfectly physical way, there is, in principle, no reason to conclude that libertarianism precludes measures against spread of viruses, provided, of course that they are proportional to the threat posed by it. Thus, we can already dismiss obvious strawman attacks on libertarianism that charge it with being inapplicable to epidemics at all.
However, libertarianism probably does condemn at least the sort of all-out responses that the government of China has launched against Covid-19 starting from January 23. The vast majority of people this response has targeted have (at least) initially, and probably still are not, contagious. The lockdown of cities with hundreds of millions has probably put the lives and health of many people at risk in various ways (access of people with other serious conditions to hospitals and medical supplies).
Do diseases like COVID-19 actually require mass quarantine to contain?
Now, we have everything we need to answer the question whether what we know about the Covid-19 outbreak and response to it thus far gives credence to the idea that a society without a government or only with a minimal one.
The Chinese response to the crisis, as well as the quarantining of the Diamond Princess cruise ship have taken the quarantine logic to the limit. It is for such scale of quarantines that a high state capacity probably inconsistent with libertarianism is required. In the face of a potentially very dangerous outbreak, they targeted whole populations (whether on territory or ship-wide scale) in order to prevent some sick people within those populations from spreading the virus elsewhere. At the same time, other countries have not gone so far, despite some local transmission. How can we assess the preliminary results?
Let us recall that even today, the vast majority of confirmed cases and deaths are still concentrated in Wuhan and Hubei (and to a lesser extent, China) and the Diamond Princess, despite the disease’s multiple introductions elsewhere. This raises at least five potentially partly interrelated possibilities:
- The other places to which the disease was introduced are just at the relatively early stages of transmission compared to Hubei, with a lot of cases probably just still asymptomatic but on the way to becoming severe
- There is something in particular about Wuhan and much of China
- The confinement efforts against early-stage transmission elsewhere are successful
- There is something about how the disease itself spreads that limits its transmission outside
- There is something particular to the response to the disease in Hubei and on the Diamond Princess
Let us briefly consider each of those one by one. The idea that other areas of transmission are just not showing even remotely the full scale of the epidemic and will soon turn into Wuhans is unconvincing. The transmission to them mostly did not take place later than on Diamond Princess but there are still more confirmed cases from it than everywhere outside of China combined.
The potential important factor about much of China that may explain higher susceptibility to infection is the high rate of smoking and poor air quality that may predispose people’s lungs to infection, especially its severe course. However, most of the infected passengers on the Diamond Princess probably mostly probably are not chain smokers, and have not lived in heavily polluted cities. That said, we do not yet have the information about the severe disease prevalence among the infected passengers, which may be lower than in Hubei.
The confinement efforts outside Hubei may have been successful but it is unlikely that the majority of those infected have been identified and taken care of. For instance, in Japan, the provenance of some of the infections remains unclear.
This brings us to the last two possibilities. While most people have a naive idea of how viruses spread from person to person that may be bolstered by mass-reported averages like R(0), in reality, viruses such as Covid-19 may well be disproportionally spread by just a small percentage of those infected. In the epidemiological jargon, such people are called “superspreaders”. The outbreak of the SARS virus clearly featured such cases, especially in hospitals. With regard to Covid-19, Justin Lessler used statistical modeling to estimate that the current geographical distribution of confirmed cases may be explicable if 10% of cases are responsible for 80% of transmission.
And this ties up neatly with the potential problems with the massive quarantines in Hubei and on Diamond Princess. First, the numbers of at least patients with detectable and severe disease may be so high there not despite the lockdowns but mostly because of them. It may well be that these lockdowns increase viral loads, make healthy people catch disease in confined spaces and complicate the treatment of concentrated masses of the sick. But they can also heavily concentrate the superspreaders together with other cases and make it difficult to target the former.
All in all, the available evidence seems to suggest that it may well have been the lockdown in Hubei that actually led to the massive scale of the epidemic and the subsequent panicky measures elsewhere in China. Even if the Chinese outbreak is ultimately contained, this will not prove that the measures taken in Hubei were reasonable or ethical. Unless, perhaps, there is uncontrolled transmission in places without the current-China-style lockdowns.
Also, if the viral transmission proves uncontrollable everywhere, this will also show that the post-January 23 response was wildly excessive.
The irony of the Covid-19 epidemic is that, despite the perception that libertarianism condemns any sort of quarantine, in late December, a quarantine of a few detected cases and their close contacts in Wuhan would have been justified from the libertarian perspective and could have prevented the whole calamity. The subsequent dramatic reversal of course, that is consistent with the interventionist narrative of state capacity for quarantines, seems to have been extremely excessive and possibly largely counterproductive in light of the current evidence.