The COVID-Risk Social Contract Is Under Negotiation
Is it okay to walk into a bar if you might sicken someone who might need hospital care?
“Three people walk into a bar …” What once launched a thousand jokes now sends a frisson of anxiety. What’s their vaccination status? Are they masked? Did they test before going out?
Nothing in life is risk free. I live in the United Kingdom, where every year several people die, according to the official statistics, by falling from a lower surface to a higher one. I’m still puzzling that one out. But if we’re always ambiently aware of risk, the coronavirus crisis has made us acutely sensitive to it, and pushed us to think beyond questions of personal risk to something much more ethically tangled: When is it morally acceptable for one person to subject another to risk? Is it okay to walk into a bar if you might sicken someone who might need hospital care? Each society settles the risk contract its own way, and that contract evolves over time. Right now, it’s evolving about as fast as the virus.
The argument that one should never subject another to risk, at least without that person’s consent, is a nonstarter. In driving to work, I’m spreading risk far and wide, even if I complete my journey safely. Not even walking exempts me. I might slip and fall and push a stranger into the path of a passing car. And on it goes.
Rather than assuming a right not to be subjected by others to risk, societies have typically come to an agreement that it’s acceptable to impose some risks, provided certain conditions are met. You can drive, but not at 100 mph past a school. You must have passed a driving test, and you must maintain your car to a safety standard. As a society we put physical, social, and legal mechanisms in place to keep risk within bounds. And in the case of driving, if you do harm someone, normally you pay, though in other cases, such as infectious disease, we’ve historically let the loss lie where it falls. If I go to the bar with flu symptoms and infect you, we do not allow you to sue me for a fortnight’s lost wages. Not yet, anyway.
What we consider to be acceptable changes. Once, we allowed smoking in restaurants, shrugging off the dangers of secondhand smoke. In the recent past, we encouraged people to show up for work even when coughing and sneezing. We settled into this pattern because it was a real nuisance for employers to be short of staff, and for the great majority of co-workers, catching a cough or cold was hardly a disaster. The pandemic, though, created a new situation. Infecting others with the coronavirus can lead them into serious difficulties. In the worst case they will die, and even in the best case, their life will be disrupted for the isolation period. In the middle are those who acquire long COVID or need hospital treatment, using up resources and contributing to a situation in which hospitals may be overwhelmed and others may be denied urgent, perhaps lifesaving treatment.
Under negotiation right now is the boundary between reasonable and unreasonable COVID-risk mitigations. Just as you can drive carefully, you can live carefully during a pandemic wave. If the price of safety is never to go to a bar, restaurant, sports event, or performance again, most will agree that we’ve got the balance disastrously wrong. We need to trade off survival against boredom; we can’t expect people to indefinitely forgo life’s pleasures because a domino effect will lead to another sick person in the hospital. But some reject even basic measures, including vaccination and mask wearing.
Some who won’t accept the vaccines or wear masks say they are simply asserting their rights over their own body. Morally, it’s more like choosing not to have routine safety maintenance done on your car. Refusing to wear a mask is less a matter of exercising a personal liberty than comparable to driving at 60 mph in a 40 mph zone. The point is that though it may be up to you what risks you run for yourself, it is not purely up to you what risks you impose on others. That has to be a matter of the social contract. We can no more accept personal choice about infectious-disease control than we can over speeding limits.
The situation is trickier if the anti-vaccine mask refusers contest the received wisdom that vaccines and masks are effective mitigations. Vaccinated people, they point out, can still catch and pass on the virus. And vaccines have side effects. Cloth masks, it is now commonly thought, barely make a difference, and few studies conclusively demonstrate the effectiveness of other, more professional-looking face coverings in the real world. Those advancing these arguments may even accept the need to limit individual rights. Their claim is that scientific research shows we have the wrong limits.
Ultimately, few have the training and understanding to know what counts as a serious examination of evidence under conditions of patchy knowledge. The rest of us engage in confirmation bias, seeking out what we regard as the most credible voices that have defended what we are already disposed to believe. And remember that this behavior is not happening in a vacuum. In countries where citizens feel that they have been lied to by governments, exploited by a rapacious medical and pharmacology industry, condescended to by academics, and treated as fools by media elites, trust of authorities long ago evaporated. Low-trust countries and regions have low vaccination rates.
I’ll show my cards: I’m a vaccinated and boosted FFP2-mask wearer who drives very conservatively when I drive at all. With that said, I’ll surprise no one in stating that vaccines are highly effective against serious illness and as safe as the great majority of medications. Public-health authorities are quite united in recommending mask wearing as a technique for slowing, if not stopping, transmission of the coronavirus. That’s good enough for me.
In this pandemic we’ve been making it up as we go: new public-health measures, new vaccines, new medicines. Lagging a bit behind is the new ethics for this new world, by which I mean a revised moral social contract dealing with risk for infectious disease. Those who share my point of view on mitigation measures may be tempted to say enough already, and that bare-faced vaccine refusers who recklessly infect others should have to compensate their victims and overwhelmed health professionals. Whatever one thinks about this approach from the point of view of abstract morality, it’s a poisonous public policy. Even if we could identify who caused harm, just think of the effect of punishing people who already distrust the system. We need to devise ways of drawing more people voluntarily into the risk social contract, rather than pushing them ever further away.