The Social Health Costs of COVID-19 Prevention Measures

What does not kill me makes me stronger.

This is a famous line left by Nietzsche in the late 19th century, but from the traditional medical perspective it is also a basic principle of immunity. In fact, the same holds true in modern immunology. Exposure and immunity are proportional.

The problems with COVID-19 prevention measures can largely be grouped into two points. One is whether the coronavirus is truly so fatal that every member of society must suffer enormous disruption to their livelihood and wear masks every day, every hour—in other words, whether it lies beyond the scope of human immune capacity. The other is whether the prevention measures now being implemented are actually effective, especially in the long term.

These two points ultimately converge into a single question: is the prevention system that has been imposed on individuals until now, and is still being imposed, really worth the price society is being made to bear? Due to space constraints, I will leave aside the economic aftereffects of the COVID crisis on other industries and limit my discussion strictly to the medical realm, focusing in particular on the virulence of the coronavirus itself from the perspective of immunity, the biases of medical statistics, the nature of infection, and the limits of fragmented and shortsighted public health approaches.

From the perspective of a researcher in the history of medicine with an Austrian School outlook, my direct and logical conclusion based on reason is this: the current prevention system is, in the long run, a set of measures that actually harms health. The main reason is the lack of a balanced perspective that comprehensively grasps risks and costs in the basic philosophy of prevention and health. This is my quiet expression of dissent against the propaganda carried out by the mainstream media and the government over the past year. Of course, the true driving force behind this propaganda was not the media or the government themselves. They merely acted as mouthpieces based on their own social beliefs. The fundamental driving force—the essence—of this mass agitation that may be called a COVID-19 panic is the peculiar combination of immature democracy and a biased expert perspective.

Socially as well, while mutual distrust between the political left and right has only deepened over COVID-19 prevention—some saying the government is doing well, others calling it politically motivated prevention—there has been no essential reflection on the value of COVID-19 prevention itself. In other words, discussion of the effectiveness of the measures is absent.

The world is full of diseases more dangerous and more fatal than COVID. Even apart from disease, cars driving on the road are several times more dangerous than COVID. This is no joke; one need only look at the annual statistics on pedestrian deaths caused by automobiles. Yet no one argues that automobile traffic should be halted. In fact, no one even argues for raising fuel taxes. That is because most people own cars, and policies that prevent them from driving would inconvenience this majority of “the people.” But people do not feel discomfort about wearing masks every day. Presumably that is because they are insensitive to the possibility that living with a mask on, unable to breathe naturally, may entail a serious long-term cost to personal health. Conversely, it is also because fear of the coronavirus has irrationally deepened and spread.

People who live by the creed, “If I get sick, I can just go to the hospital and take medicine,” naturally tend to demand stronger prevention measures from the government. By contrast, people who think in more individualistic terms—“I take care of my own body and health”—naturally feel resistance toward government prevention measures that intrude heavily into the private sphere. Of course, in Korean society, perhaps because the proportion of the latter, individualists, is absolutely lower than in Anglo-American societies, there is little visible dissatisfaction even with intense prevention measures.

But if one gets sick, must one necessarily go to the hospital and take medicine? The answer is: maybe, maybe not. In other words, is the coronavirus really such a deadly disease as to justify the suffering being imposed now? Opinion within the medical community is divided. Clearly, medical scholars with strong interest in immunity and homeostasis have tended, from the early stages of the pandemic, not to see a great difference between COVID and influenza viruses. By contrast, scholars in infectious disease or public health tend to focus all their attention on socially blocking the coronavirus.

Of course, this distinction too is merely a schematic generalization. Once one looks in detail, medical scholars all differ in their views, and quite contradictory perspectives exist within the expert community. Nevertheless, both domestically and abroad, papers accepted by mainstream medical journals generally take the latter position: namely, that the coronavirus has a far higher fatality rate than the influenza virus. This is probably because the editors of mainstream journals and the dominant view in academia stand in that camp.

But a scientific theory supported by a majority at a given moment does not mean it is true. Personally, while reading papers in overseas medical journals last year, I sometimes wondered whether the difference between Westerners and East Asians in bodily responses to the coronavirus might be more significant than the difference between influenza and COVID.

But are those authorities in the medical world and the mainstream medical establishment really politically neutral? In particular, during the past year, mainstream doctors in the American medical establishment who shared an anti-Trump political outlook appeared to mobilize all their authority and knowledge around statistics on COVID cases and deaths that could demonstrate the incompetence of the Trump administration.

Statisticians understand the dangers of statistics. Are medical and public health statistics any different? In reality, throughout last year, even the fatality rate of COVID-19 could not be properly determined. When the infected population itself cannot be accurately identified, it is statistically impossible to calculate an accurate fatality rate from the number of deaths alone. Yet in this situation, where the fatality rate remains unclear, people have lived in fear, shrinking back and guarding against one another based on the constantly updated case numbers announced by the government.

Even so, is the coronavirus, somehow, still more dangerous than influenza? To begin with, can we really boast that we possess a clear conceptual standard for infection? This too is an essential problem of modern medicine, which is biased toward a reductionist approach.

Infection is the process by which a pathogen enters the body and proliferates, and in that process it is usually accompanied by inflammatory symptoms—swelling, fever, pain—as part of the body’s immune response for healing. But can we say one is infected simply because a virus has entered the body? And if someone recovers through treatment, has that virus really disappeared entirely from the body? If one comes into contact with a COVID patient and the coronavirus enters one’s body, must we necessarily assume that it has spread throughout the entire body?

Moreover, in respiratory infections such as influenza, pneumonia, and COVID, it is often difficult in practice to distinguish whether the infection was the primary cause of death or only a secondary cause associated with a primary cause such as an underlying disease. For example, I recently saw a paper in last month’s issue of The Lancet claiming, on the basis of a large epidemiological survey, that the coronavirus has a fatality rate several times higher than influenza. But such studies often reveal problems of statistical inconsistency between the type of virus and the cause of death.

For instance, the coronavirus may be diagnosed as a single cause affecting everything from the upper respiratory tract to the lungs—or indeed the body’s entire tissues—whereas in the case of influenza, if the influenza virus merely moves from the upper respiratory tract into the lungs, the cause of death may be attributed to pneumonia. This too creates a statistical illusion that lowers the number of influenza deaths. In this way, it is difficult for us to be free from epidemiological distortions that can only make the danger of the coronavirus appear far more artificially elevated than that of other respiratory viruses. For example, where did all the viruses that caused influenza and pneumonia in Korea disappear to during the past year?

Of course, it is better not to get COVID-19 than to get it. Getting sick is, to begin with, inconvenient. But getting it does not mean dying, just as getting the flu does not mean dying. It is simply that both COVID and influenza viruses can, in the bodies of high-risk people with weakened immune systems, underlying diseases, or old age, easily and rapidly destroy tissues and organs from the respiratory tract to the lungs and, through the bloodstream, the whole body. But unless one belongs to such a high-risk group, most people recover completely without any special treatment. That too is the most essential similarity shared by COVID and influenza viruses.

The most fundamental problem with prevention measures against the coronavirus, around whose virulence there is so much debate, is that society is far too indifferent to the costs of those policies. When people hear the word “cost,” they tend to think only of economic aspects. To be sure, some doctors mention worsening depression, talking about “corona blue,” but there is another, greater cost brought about by the coronavirus—or, more precisely, by COVID prevention measures. It is the cost our bodies have borne over nearly a year in enduring mask-wearing—in other words, the price of sacrificing health for that length of time.

Of course, this is not visible. Unlike the increase in the number of patients visiting psychiatric clinics, it cannot be easily quantified statistically. Unless some researcher undertakes a longitudinal comparative study over ten years or more with a sufficiently large sample group on the correlation between wearing masks for one or two years and the later incidence of cancer or stroke, it would be difficult to prove numerically. If it does not appear in statistics, public health researchers pay no attention. Paradoxically, the weakest part of modern medicine—with its many specialized fields and such strength regarding specific diseases—is precisely “health.” For example, the indirect and long-term effects that a particular measure has on overall health are difficult for reductionist and fragmented modern public health research to reveal numerically. When people hear the word health and think first of multivitamins rather than a walk in fresh air, that too is a self-portrait of a society dominated by modern public health medicine.

Can one really claim to be living healthily—taking in truly fresh air properly and smoothly expelling stale air from the body—while wearing a mask all day long, 365 days a year, compared with not doing so? The most basic principle of health that humanity has traditionally valued above all else, from a fundamental and long-term perspective, is proper breathing. From an evolutionary standpoint as well, the mucous membrane of the respiratory tract is, along with the intestinal mucosa, one of the most immunologically active parts of the body. As symbolized by the selectively permeable cell membrane, the human body is physiologically an open system that instinctively strives to maintain homeostasis, and it essentially requires smooth and free circulation of air in and out.

Can people who spent the entire past year living with masks covering their noses really say that their health suffered no infringement at all? And yet we are simply supposed to obey prevention guidelines mandating mask-wearing, no questions asked? Then why can we not get rid of private cars? Since we are at it, let us eliminate everything dangerous. On what grounds can we say that the coronavirus—still not free from dispute over whether it is more dangerous than influenza or not—is less dangerous than automobiles, which spew harmful exhaust and send countless pedestrians to their deaths every year? Social cost? Can we really state with confidence that the social health cost of wearing masks year-round is less than the economic cost of not being able to drive cars for a year? Of course, this too is a matter of individual choice and values. In a sense, collectivist hypocrisy is plainly revealed through COVID-19 as well.

For the past year we have heard ad nauseam the gentle public announcement repeatedly broadcast from speakers: “Wearing a mask is the manners and etiquette of mature citizens who voluntarily participate in overcoming the crisis.” The frightening propaganda contained in that message is clear: “The state is responsible for your health. If you wish to survive this terrifying coronavirus, then even if you must wear a mask, keep your mouth shut, and cannot breathe properly, please obediently check the real-time updates on case numbers and the movements of confirmed patients that we announce, and cooperate without complaint with the prevention guidelines we decide.” The illogic and irrationality of ignoring the social health costs of mask-wearing, and the collectivist mindset underlying it, are unsettling whenever one hears them. I hope we may become a society that overcomes problems calmly, logically, and rationally through fundamental philosophical reflection.

Baemin Bae, history teacher at Soongeui Girls’ High School

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Original title: 코로나 방역의 사회적 건강 비용

Author: Bae Min

Date: 2021-02-09

Source: https://www.cfe.org/bbs/bbsDetail.php?cid=free_opinion&pn=12&idx=23497