The “Wicked Problem” of the Covid-19 Pandemic

The current outbreak of the new coronavirus (SARS-CoV-2) will affect virtually every person on Earth, either directly or indirectly. Many people will die of the infectious disease caused by this coronavirus (Covid-19), and others will lose people close to them. Many more will suffer other extreme hardships – psychological, social and financial – due to the extensive physical distancing measures that are reducing the spread of the virus. While there may be some perceived “silver linings”, such as temporarily reduced air pollution and CO2 emissions, and for some an opportunity to slow down and contemplate their ways of living, in the balance the effects are already tremendously challenging for the world, and are likely to get much worse before the pandemic is over.

The imminent but unfamiliar danger due to the rapid spread of SARS-CoV-2, and the extensive physical distancing measures implemented in response, are leading to many difficult questions. In this article, I’m going to address three of these:

• How does the current coronavirus situation compare to climate change and other great societal challenges?
• Are the extensive physical distancing measures really justified?
• Is there a chance to move “forward to better” rather than “back to normal” (or even worse)?

How does the current coronavirus situation compare to climate change and other great societal challenges?

In some ways, the discussion about the dangers of the Covid-19 pandemic and the countermeasures being taken resembles the discussions around measures to limit climate change. This also applies to many other forms of environmental degradation, such as air, water and soil pollution. One important difference is that for all of these, the effects are unfolding on much longer timescales than the Covid-19 pandemic. Similar, though, is the need for effective communication between a wide range of societal groups (including researchers). For environmental challenges like climate change, extensive experience has been gained with effective (and sometimes not-so-effective) forms of communication, which may help with the urgent discussions needed as we face the Covid-19 pandemic. In turn, what is learned over the next months during this crisis may prove valuable for the ongoing discussions around climate change and other forms of environmental degradation. This is especially the case if low-probability or unexpected rapid changes were to lead to a so-called “climate emergency” situation, such as a future collapse of the West Antarctic ice sheet.

In debating measures to mitigate climate change, valuable information is provided by scenarios of how the climate system would be expected to respond to various measures that could be taken to reduce emissions of climate-forcing gases and particles, especially CO2. These scenarios are used in a wide range of studies and assessments, especially the reports by the Intergovernmental Panel on Climate Change (IPCC). Similarly, for the possible future spread of SARS-CoV-2 and the further development of the Covid-19 pandemic, information is already available based on epidemiological scenario studies for Germany and other countries, conducted for example by the Robert Koch Institute (RKI) and the German Epidemiological Society (Deutsche Gesellschaft für Epidemiologie) for Germany, and for the UK and USA by the Imperial College London. Although put together on very short notice, these are nevertheless high-quality scientific studies which use computer models developed and tested extensively to simulate the spread of influenza and other similar diseases.

But in the case of both the Covid-19 pandemic and climate change, these scenario studies are scientifically complex, and typically full of technical jargon describing the model equations and the various values that are selected for model parameters. As such, they are not very inviting for the broader public to read. In the case of climate change, often even the policymakers and activist groups that are closely involved with the topic are not familiar with the details of these studies, e.g., the extreme assumptions that have been made in the scenarios that would keep global warming below 2°C. This leads to the problem, as we pointed out in Science magazine last year, that ambitious goals are sometimes set without really understanding what would be needed to achieve them, or how realistic it would be to fulfil these conditions. And since achieving these goals would typically mean considerable societal transformations, a successful implementation will often depend on a broad public debate of these assumptions and requirements, in order to garner widespread acceptance.

To support public debate around such issues, it is important to have the most essential information available in forms that are more readily accessible than the original scientific reports, and preferably in a wide variety of formats to fit various audiences, so that the key messages get across to more people in ways that they not only understand, but also can identify with.

However, this should not be misunderstood as suggesting that “science tells us the truth,” or that based on such “truths” it will be clear what we should do. That might work for relatively simple issues, like where to place a weather station or an air quality station in order to obtain representative measurements (although even then, issues like property rights can complicate things). But for really complex challenges, like how to respond to the threats of the Covid-19 pandemic and climate change (and many other similarly complex challenges of the Anthropocene), there is not a single “correct” answer or perspective, rather very many different valid ways of viewing the issue and weighing the different options, which will depend on the values and norms of the individuals and societies that are involved.

Are the extensive physical distancing measures really justified?

With this in mind, I come to the question of whether the current measures against the Covid-19 pandemic are justified. As is the case with climate change – and many other highly complex and interconnected societal challenges, which scientists often call “wicked problems” – there is no universally right or wrong answer to the question of whether countermeasures are really justified, and there is no way to even know what an “optimum solution” is. Instead, it depends on what you value, and how you weigh different risks and benefits against each other. For instance, for you personally: how do you weigh the many additional deaths due to Covid-19 and the extreme strain on the healthcare system (and on our social conscience), which will be partly prevented by various physical distancing measures, against the very large, negative social and economic impacts of these measures? Thinking over this, you can see the great challenge that policymakers are facing, having to debate how many prevented deaths would be “worth” the costs – economic and social – of the physical distancing measures (which may themselves have impacts on health and mortality). Adding to this challenge: these decisions need to be made very quickly, leaving little time for adequate debate. Furthermore, for many people, the related social and health costs often seem to be neglected or only in the background, so that the comparison can be misperceived as only being between economic indicators and lives, which can make posing the question in this form fundamentally problematic. But in politics, comparisons of this nature often need to be made in order to debate and justify various possible measures (including doing nothing). Therefore, in order to be broadly accepted, such comparisons and justifications often need to be framed differently to fit to the worldviews of different groups – adding even more to the complexity.  

A further challenge is the information basis that is available. The factors that need to be weighed against each are numerous and wide-ranging: on the one hand, the number of deaths that would be expected, the potential lasting physical and psychological impacts on survivors of severe cases of Covid-19, the impacts on the physical and mental health of healthcare professionals and on the medical system itself, and the impacts on the overall social fabric due to the large number of deaths; and on the other hand, the impacts of the physical distancing measures on the lifestyles, productivity, jobs, income, savings, and the psychological and social health of millions of people in Germany, and possibly even billions of people worldwide, along with the possible increase in unrelated health problems and unnecessary deaths due to decreased capacity for testing and treatment of other conditions, and the broader impacts on national economies and, here as well, on the overall social fabric. The scientific and medical research communities have already begun developing initial insights into some of these issues.  

For example, the epidemiological studies mentioned above give us valuable initial insights into one of the most critical parameters: how many additional deaths are the physical distancing measures preventing? The model simulations by the RKI and others typically include a “world avoided” scenario, in which nothing at all is done, and the virus is allowed to simply run its course. While only hypothetical, such scenarios are often helpful in judging whether precautionary measures can be justified for wicked problems like the Covid-19 pandemic. In this case, based on what is currently known about how the SARS-CoV-2 spreads and the fraction of cases which are severe and fatal, the RKI study computes that we would expect at least 200,000 to 350,000 deaths in Germany alone due to Covid-19 over the next few months, depending on assumptions such as whether the virus has a strong seasonality, and whether some fraction of the population has an innate immunity (see here[1] for details).

The actual number of deaths would likely be much higher, since the assumed fraction of severe cases and fatalities is noted to be at the lower end of the estimates made in other studies, and also because the number of intensive care beds that the study calculates would be needed would vastly exceed the number available in Germany, so that many patients would not receive the necessary treatment with respirators. As a result, up to 500,000 or perhaps even more deaths could have been expected in Germany due to Covid-19 alone, in just a few months, if nothing had been done to limit the spread of the virus. To put this in perspective: in Germany just under a million people die each year due to all other causes combined. In the “world avoided” scenario, the average rate of deaths would have likely been more than doubled during the pandemic period.

Fortunately, due to the early and extensive response of the German government, the actual number of deaths due to Covid-19 is likely to be much smaller than this. The scenario studies also show that physical distancing measures can significantly reduce the total number of deaths, as well as the number of intensive care beds needed at any one time. However, to accomplish this, some form of physical distancing measures would have to be implemented over a long time, possibly continuing for the next half year to a year (possibly intermittently, especially if there is a strong seasonality and the measures can be relaxed during this summer, then reinstated in the winter, until a vaccine hopefully becomes available). This possibly long physical distancing period emphasizes how severe the social and economic impacts of these preventative measures are likely to be. Unfortunately, we are only scratching the surface of quantifying such social and economic impacts. While epidemiologists have several past cases of epidemics and pandemics on which to base their model simulations, there is no known precedent of comparable, near-global physical distancing measures in the history of humanity to use as a good basis for estimating what the social and economic consequences will be.

Nevertheless, sociologists, psychologists, economists and many other researchers around the world are already working hard on analyzing the situation, using what information and scientific knowledge is available. Unfortunately, in contrast to the short political timescales involved, such scientific studies exploring completely new territory like this usually take months to years to come to results that are anywhere near as reliable as the epidemiological studies by the RKI and others. This scientific uncertainty in the estimates of how large the negative effects of the measures will be is yet another complexity added to weighing the benefits and costs of the physical distancing measures. But here it is important to understand that “scientific uncertainty” doesn’t mean “we don’t know”. Instead, it means that there is a constrainable range of possible results, like the range of 200,000 to 500,000 deaths in the “world avoided” scenarios discussed earlier. While it may be hard to precisely quantify the various effects, however, we do know that the effects on people’s lives and livelihoods, as well as on the social fabric and economies of nations around the world, are already large, will likely become much larger, and so far are clearly overwhelmingly negative for most of the world’s population. As mentioned at the outset: this pandemic will affect virtually every person on Earth, either directly or indirectly.

Is there a chance to move “forward to better” rather than “back to normal”?

This is another part of what makes the Covid-19 pandemic a wicked problem – there is no solution to it that does not involve extreme losses in some form or another. The question is not whether we can win in this situation itself, but rather only how we choose to weigh the losses against each other in deciding how to approach this crisis. There is, however, a glimmer of hope: while the situation will involve losses for the vast majority of the world’s population at present, there is a small but real possibility that over the course of a longer time, the pain and suffering of going through this situation can be more than compensated by the impulse it gives to develop future societal structures that are better for the world’s population as a whole. Instead of going “back to normal” (or even worse for many people), perhaps we can go “forward to better” after this crisis is over.

That would not at all be easy, especially for the many people worldwide whose entire social and financial existence is being threatened or wiped out by this situation. It would require those who are privileged enough to go through this crisis without substantial existential loss to capitalize on the difficult impulse that the pandemic brings to make extensive changes towards sustainable development. It would also require continued development of “transdisciplinary”, “co-creative” and “transformative” research processes, which characterize our work at the IASS. These research methods incorporate perspectives and voices from a wide range of societal groups, including policymakers, activists, industry leaders, worker’s unions, religious leaders, researchers, and representatives of the broader public. These various perspectives and voices are all imperative to include in the extensive negotiation processes towards designing such a world.

It’s admittedly a long-shot. But does it not make sense to at least try to first get through this situation together – as humanely and with as much solidarity as possible – and afterwards to try to develop societal structures that are not only more resilient to other possible future shocks (from climate change, multi-resistant bacteria, and other emerging threats), but which are also built on greater solidarity, and which provide much better living and working conditions for the population of the world as a whole? That’s up to each person to decide for themselves. My answer to this is clearly: “Yes – please join me in figuring out how to make that happen, and providing support to each other to take the hard steps that will be needed!”
 

[1] Supplement: Epidemiological Scenario Study Details

The epidemiological studies discussed in the blog are based on what is currently known about how SARS-CoV-2 spreads and the fraction of cases which are severe and fatal. The Robert Koch Institute (RKI) study computes that at least 350,000 deaths would be expected in Germany alone due to Covid-19 over the next few months, if the virus has a weak seasonality (that is, if it spreads and has the same effects in the summer as in the winter), or at least 250,000 deaths (mostly during the first few months of next winter) if it has a very strong seasonality. The study also considers the possibility that a third of the population has an innate (already existing) immunity to the disease, which would reduce the number of expected deaths to about 250,000 for no seasonality and just under 200,000 for strong seasonality.  However, the actual number of deaths would likely be much higher for all of these cases. First, the model simulations assume a constant fraction of 50% fatality for the cases that need intensive care beds, and that 4.5% of the cases with symptoms will need hospitalization, with a fourth of these (that is, just over 1% of all cases) requiring intensive care beds (based on the knowledge from the COVID-19 progression in other countries, and differences in the demographic age profile in German compared to those countries). This is noted to be at the lower end of the estimates made in other scenario studies, such as that of the German Epidemiological Society (Deutsche Gesellschaft für Epidemiologie, or DGE).  Furthermore, at the peak of infections this would require over 120,000 intensive care beds (and the personnel to attend them) in the case of no seasonality, while with a strong seasonality the peak would be over 80,000 intensive care beds (the values would be correspondingly lower if a fraction of the population is innately immune). This can be compared to the 30,000 intensive care beds currently available in Germany (with possibly 10,000-20,000 more that could be added over the next weeks or months). According to the DGE report, the 30,000 intensive care beds are already mostly in use, and will still be needed for patients with other conditions besides COVID-19, for example, heart attacks, strokes and automobile accidents.  In this case, the number of patients needing intensive care beds would likely exceed those available – as has already been tragically being experienced in Italy and other countries – for up to a few months. And since in this extreme case most patients would not be able to receive intensive care, the fraction that would die would be much higher than the assumed 50%, so that up to 500,000 deaths, or possibly even more, could be expected in Germany due to COVID-19 alone, in just a few months. To put this in perspective: between 2015 and 2018, the number of deaths in Germany each year due to all other causes combined ranged between 910,000 and 955,000 (the data are not yet available for 2019).