Why is reopening Turkey wrong now?

Vural Özdemir/ Toronto

Turkey has reopened to a new normal on June 1, following the COVID-19 patient zero reported by health authorities on March 11. Turkey is not alone, and has followed suit with other populist neoliberal economies that are currently pushing for reopening blindly without knowledge of the current immunity levels in society. There is also the collective psychology of the pandemic. After weeks of uncertainty, lockdowns, self-isolation and tragic COVID-19 deaths, hearing the word ‘normal’ from populist governments serves to calm a fearsome and anxious public. 

Before we think together on what is on the menu for our new normal lives, let’s first consider a fictional “parachute experiment”. 

The parachute experiment (don’t ever attempt this)

Imagine a research study testing (1) whether the gravity exists on planet Earth, and (2) the effectiveness of a parachute to prevent free fall related adverse health consequences, for example, deaths. Accordingly, the study asks research participants to jump from a plane at 10,000 feet altitude, with 50% of the study participants scheduled to jump without a parachute, while the other half with a parachute.  The parachute company and its science advisory committee in charge of this fictional study assure the study participants that the study design has the backing of extensive mathematical modeling, and all is, and will be well, as long as the participants take care of themselves. The study investigators say (unconscionably) they will not be responsible, however, for any personal damages to research participants during the “free fall experiment”. 

Pandemic policy for reopening

The parachute experiment tells us that one does not always have to be a scientist or math wizard to anticipate the consequences of certain decisions, be they in daily life or pandemic public policy. Also, there are already available decision tools to govern scientific uncertainty in a pandemic situation, instead of a free fall experiment and sending people to harm’s way to test pandemic policy effectiveness.

Let’s dig deeper on this last point. 

Precautionary principle is a decision instrument used by science and innovation policy makers around the world, particularly in the European Union, to govern scientific uncertainty when:

• The stakes are high, 
• The decisions are urgent, 
• There are unprecedentedly wide range of scientific unknowns, and 
• There is potential for large-scale irreversible damages. 

The precautionary principle has its origins in the 1970s, and was developed in response to air pollution, forest degradation and hazardous environmental changes at that time. The principle has since found wide applications in uncertainty governance in ecology, food safety, critical policy studies, and climate change, amongst other fields. 

In the face of the COVID-19 pandemic, the precautionary principle would advise against reopening at this time, and precisely because:

1. COVID-19 is an existential threat for the entire planetary society with irreversible consequences such as massive loss of human lives.

1. Policy decisions to reopen are made even though we do not know the current immunity levels in the general population; studies with antibody tests so far suggest the world is nowhere near herd immunity or a 70% immunity prevalence rate, even in the most heavily affected areas.

1. We do not have adequate capacity to test-trace-isolate the new cases in the entire population, including the asymptomatic cases that represent 50% or more of the infections, thus acting as silent carriers transmitting the virus to others.

1. A vaccine or drug that prevents COVID-19 deaths is not presently available.

1. We know so little about this novel virus that causes a systemic disease, with a potential to damage the lungs but also the heart, the kidney, blood vessels and possibly many other yet unknown tissue targets. 

1. We have no knowledge of the long-term consequences of COVID-19 in a time scale of years/decades, or in pregnancy. 

1. There is no firm evidence at this time that the virus’ functional biology and genetics have changed to an extent to diminish its infectivity and/or capacity for cellular and organ damage in its human host.

These seven points should already be ample evidence that reopening society and business under these conditions is wrong or premature to put it mildly. Without addressing the above seven caveats, reopening would be akin to the free fall experiment in the parachute research noted above.

If you are somehow not happy with the precautionary principle or find it “too protective of public health”, there is an alternative approach to uncertainty governance: quantitative risk assessment. This alternative to pandemic policy works well, however, when the scientific risks are precisely measurable or foreseeable, which is not the case with the COVID-19 pandemic at the moment. 

And by the way, there is nothing wrong with considering public and planetary health as priority in pandemic policy by deploying the precautionary principle. After all, health is “part of the right to an adequate standard of living,” as recognized by the 1948 Universal Declaration of Human Rights.

What about economic impacts?

Sure thing. Economics is important but not in ways that relentlessly extract the finite natural resources for an untenable, infinite growth in gross domestic product (GDP). We also need to consider the types of economic impacts and metrics that create equitable outcomes for everyone in planetary society.

More is not always better, and is the very mindset that got us into trouble and the eye of the pandemic storm in the first place. 

To be sure, feeding the dubious GDP metric mindlessly, at all costs to the society and the nature, does not suffice as a compelling reason to reopen, let alone in a laissez faire manner leaving the responsibility of public health to citizens. I would think those who have sadly lost friends and family to COVID-19 would certainly agree with this point. 

Moreover, even for those who prefer to put unchecked profits and wealth over health, the feminist economist Marilyn Waring astutely notes that the GDP “doesn't measure the single biggest contributor to almost every nation's economy—the unpaid labour performed every day in homes, in families, and by volunteers—and it doesn't account for the cost of externalities like the environment.” (https://www.youtube.com/watch?v=zIVqhxFEHZw).

In the post-COVID-19 world, we surely need more economists who spend time thinking about not only the GDP related impacts of health crises but also the politics and equity dimensions, power-laden frames and framings of the metrics used in the field of economics. It is time to think beyond the narrow confines of the GDP.

Populist leaders’ toolbox to manufacture consent for reopening

If reopening the society is wrong at this time, how is it that the neoliberal governments and authoritarian populist leaders are so able to manufacture consent to reopen society? 

If you look at the arguments made in favor of reopening around the world, they share one cardinal point: a consistent trend for a decrease in COVID-19 deaths or achieving a zero COVID-19 death count over a given time frame. 

But is it scientifically sound to propose that a low death count is sufficient reason to reopen society?

No, this popularized metric, the COVID-19 death counts, is often cited to reopen society by populist governments, authoritarian leaders and some of the appointed science and technology advisors but the metric has a serious flaw and lapse of reason.

COVID-19 death counts can decrease for multiple reasons. Chief among these are:

1. Effectiveness of social distancing and lockdowns
2. Virus evolving and losing its infectivity and/or lethality
3. Vaccine based immunity and/or herd immunity
4. Passive immunity by transfer of antibodies from survivors who are immune or administration of COVID-19 antibody preparations 
5. Safe and effective pharmaceuticals and similar therapeutic or preventive interventions against COVID-19

In the absence of evidence for (2), (3), (4) or (5), a decrease in COVID-19 deaths in a given geography would most likely attest to the effectiveness of social distancing and related measures, i.e., the explanation (1) prevails – assuming, of course, the reported numbers on death counts are accurate and not politically suppressed. 

Interestingly, this multi-dimensional approach to the analysis of decrease in COVID-19 death counts is rarely explained to the public, including in North America. Instead, when there is a decrease or zero death count, the pandemic is occasionally presented as though the virus is gone or that the pandemic is contained and will not return and hence, it is allegedly safe to reopen society and business. 

No, it would not be safe to reopen under these conditions at this time. 

Moreover, the alleged trade off between planetary health versus the GDP is dubious at best and should be questioned on the grounds that health is a human right over and above the mindless extraction of the nature for GDP boost. Taking into account the astute economists who offer a broader and critically informed deeper view on the metrics for economic growth makes these points clearer.

Given what we know now, the virus is not gone, and has not lost its infectivity or lethality as things stand. It is we, human societies, who left, by lockdowns and staying at home, the spaces where the virus is abundantly present (e.g., crowded offices, etc.). In this sense, it is wrong to say the virus is “coming back”, rather it is we as a society who are “going to the virus” by reopening. Let’s make this point very clear. 

Unfortunately, to the publics around the world who are already traumatized and confused by a devastating pandemic, a decrease in COVID-19 death count is falsely presented by populist governments, as a rationale to reopen society.

Quo vadis?

Let’s cut to the chase. The new normal is a red herring; a smoke screen to manufacture consent to put unchecked political power, profits and wealth over health. Reopening is paving the way for preventable new deaths, and new waves of the pandemic to satisfy a dubious GDP metric at all costs. There will be a greater risk for conflict in the next 12 months in societies divided into haves and have-nots with the pandemic. 

This is the case pretty much anywhere on the planet at the moment while each country and region have varying degrees of resilience and collective agency to cope with these future shocks in the making which will determine the social, political and material landscapes in the post-COVID-19 planet. 

Pandemic might appear as being contained based on low death counts but the reality is that upon reopening and less stringent social distancing in crowded office and business spaces, the second and subsequent waves of the pandemic are very likely. 

I am not suggesting that we should stay at home forever, which itself has adverse effects, including difficulties in access to health care for non-COVID-19 diseases, physical inactivity, and worsening of public mental health, amongst others. 

Instead, we should invest in solutions to address the concrete deficits described above to plan for a rational, robust and actionable exit strategy. 

For example, we need to urgently invest in antibody diagnostics with robust sensitivity and specificity to find out where we stand in immunity levels in the community. This will require broad testing in the general population and not only the symptomatic cases. 

We should also invest in passive immunity through convalescent plasma or antibody preparations. The convalescent plasma dose required for prevention of COVID-19 in healthy persons is likely much smaller than the doses necessary to treat patients in critical condition. 

I would argue that not only the health care workers but also the independent journalists and members of the free press who are crucial for democratic pandemic governance and access to trustworthy knowledge might want to consider passive immunity as a preventive medicine and stopgap solution until a vaccine is found. Convalescent plasma option might be one way to empower the free press in a time of pandemic. We should however continue to be mindful for social distancing until we know more on how long passive or natural immunity lasts.

Real-time pandemic research on how the virus genetics and function (infectivity and lethality) are changing is necessary so we can better interpret the new cases and the changes in death counts. 

COVID-19 is an opportunity to build scale and surge capacity in planetary health beyond the nation state borders. We are shifting from public to planetary health with the COVID-19 pandemic. That will bode well against infectious disease outbreaks and other ecological crises in the 21^st century. 

A plea for a “long now” moment

Now is a time of social tumult and change. Which values one stands for in such times matter greatly. Let’s have a “long now” moment to think deeply and broadly as we devise new pandemic policies for reopening because what we do now will critically affect what happens in the next 12 months of the pandemic, not to mention the next generations in the 21^st century. 

Author:

Vural Özdemir is Diplomat of the American Board of Clinical Pharmacology and editor-in-chief of the New York-based OMICS: A Journal of Integrative Biology. Trained in İzmir, Ankara and Toronto. Qualified as full professor in communication, associate professor in medicine. Works published in British Medical Journal, Nature Biotechnology, Project Syndicate, Agos weekly, amongst others. He was an invited speaker at the New England Journal of Medicine Panel on Personalized Medicine at the 50^th Annual Meeting of the World Economic Forum in Davos, Switzerland in January 2020. Member, World Association of Medical Editors and the Toronto International Film Festival.