On 16 March 2020, I posted on the socials:
Someday, if I’m still alive then, we’re going to talk about pre-corona and post-corona. Now it’s ‘just’ corona. Temporality.
It is a fact that the post-corona era is far from dawn. People all over the world are at the beginning or in the midst of this crisis. An end is not in sight for the time being. There are many known unknowns and perhaps even more unknown unknowns. These are terms that I apply in all these years that I am ‘earning’ my life as a project manager, specifically when it comes to risk management.
Risk management: the foundation of strategy and policy
Risks are uncertain events that lie in the future and have consequences. Anything that is yet to come is, by definition, a possibility. Whether or not some possibility will one day become a substantial reality is contingent and hence uncertain: risks may occur … or not. It is, therefore, essential to assess and monitor all risks and to devise and implement countermeasures in advance. To be able to do this as best as possible, the identified risks are classified according to their context. Here the factor time plays a vital role because, as time goes by, progressive insights will emerge, which can change the status of an identified risk.
The known knowns are risks within a clear context: you know what situation you could be dealing with and what countermeasures you can already employ. Thus, there is a clearly defined strategy and a clear policy to be implemented.
A good and current example of this is the countermeasure that the University Medical Center Groningen (UMCG) took long before the coronavirus caused a pandemic. During the Ebola outbreak, their medical microbiologist Bert Niesters ensured that a “pandemic stock” of pipette tips was not only built up but also maintained – materials that are now scarce due to the increasing demand for corona testing. Moreover, UMC Groningen has made itself independent of a single large supplier of test equipment and chemicals by spreading the risk of shortages over several manufacturers. For UMC Groningen, in other words, the risk of a pandemic outbreak was a known known, with the only uncertainty being the when of the outbreak.
An example of how not to manage risks is how the Dutch government has dealt with the risk of pandemics. Despite the fact that in recent years experts have repeatedly warned that a pandemic could break out at any time, and even though this situation was classified among the highest risks in the latest safety analysis of 2019, the central government chose to disconnect the national risk analyses that predicted a pandemic from policy. “This way, it was prevented that the departments had to undertake anything with the results of those analyses.” It was thus decided to ignore this risk entirely and to neglect the implementation of any countermeasures. Such a hollow and empty risk management can never result in any adequate strategy. The chosen policy is therefore wholly neoliberal, careless, and negligent, because it only focuses on the idea of cost savings in terms of money, regardless of the costs in terms of human lives.
The known unknowns are risks within a complicated context: they are situations that are still unknown. Yet, you know you need to know them because you know of their existence, but you do not have all the information.
An example of such a situation is that we now know that the virus is spreading exponentially; only we don’t yet know how that precisely works. Are children potential spreaders or not? Does an infected person become immune or not? And if someone becomes immune, is the immunity lasting or ephemeral? Is it a definite fact that only the elderly belong to the risk group? How many young people are there who also have an underlying disease, such as lung disease, cancer, or some immune disease? Is the corona mortality rate correct, given the insufficient testing? Do we have enough reliable data to draw the right conclusions? How can we ensure that all data directly or indirectly related to COVID-19 are adequately registered?
Consequently, the countermeasure to be taken is to collect the missing information as quickly as possible and not only at a national level but at the level of international collaboration, transparency, and exchange of data and insights. After all, this strategy saves time and capacity and also provides the most extensive possible information in the fastest possible way. However, this requires abandoning a nationally oriented and arrogant superiority mindset. Yet, such modesty proved impossible in the crisis management process that was on display since the appearance of the first infected person in the Netherlands.
The unknown unknowns are risks within a complex context: they are situations that you don’t even know you need to know. As such, they are entirely unidentified. You simply know too little to be able to ask the right questions at all in order to identify the gaps in your knowledge. The main reason for this is our inability to recognize cause and effect directly. As human beings, we are in fact too limited to observe causality. At most, we can only presuppose it.
It is not easy to present a good example of the complex situation of unknown unknowns, given that they are unknown unknowns. Nevertheless, it is reasonable to consider that our knowledge of the coronavirus involves unknown unknowns. A situation, that is comparable to the possible feedback loops in the context of climate urgency, with the difference that there is already much more data and scientific consensus about the consequences of the climate crisis, which incidentally has not suddenly disappeared and for which no substantially effective countermeasure has been put in place as yet.
Finally, there are the unknown knowns: these are situations in which you make decisions purely based on experience and the idea that a particular measure is the most correct and morally just to take.
An example is the experience of South Korea and other Asian countries with SARS, MERS, and COVID-19 and the measures that have worked well in those countries to suppress the exponential spread of the virus with the aim of creating time. Time to develop a vaccine. There are more current examples, however, of unknown knowns that are worthwhile to be taken into consideration, more on this below.
What has become increasingly apparent in recent weeks is the emergence of two opposing camps regarding the assessment of the government’s risk management, strategy, and policy concerning the corona crisis. On the one hand, there are those who are critical. On the other hand, there are those who condemn every criticism. Previously highly critical people suddenly warn that you shouldn’t be skeptical and shouldn’t question the authority and policy of Mark Rutte and the RIVM (the Dutch National Institute for Public Health and the Environment). An authority that would now be indispensable and should thus be followed unquestioningly.
The big question presenting itself here is: what is authority? As so often in my life as a philosopher, I consult the work of Hannah Arendt for guidance. In her essay Was is Autorität, she analyzes the nature of this phenomenon, yet not by wanting to define authority in general. What she is specifically concerned with is what she calls the modern loss of authority: the fact that in the modern world, we hardly have the opportunity anymore to experience authority in its true sense.
Arendt begins with what authority is not. The phenomenon of authority always appears with a requirement of, or a right to obedience. Therefore, authority is commonly mistaken as a form of power, as a special kind of coercion. However, authority precludes any form of violence:
Where violence is used to enforce obedience, authority itself already has failed!
Furthermore, authority has nothing to do with persuasion, because persuasion presupposes both equality between people – i.e., no hierarchical relationship – and working with arguments, which disables any form of authority. In other words, the egalitarian order of persuasion stands opposed to the authoritarian order, which is inherently hierarchical. In the authoritarian relation, the only thing that the one who commands and the one who obeys have in common is the hierarchy itself, which — legitimized by both parties — designates each of them their predetermined and immutable place.
What is important here is the legitimization of the hierarchy by both parties. It means that I voluntarily and in freedom, recognize and respect someone else’s authority. Not because I am convinced with arguments, nor because I am forced to do so. However, this also does not mean that authority is a pedagogical phenomenon. It rather is a political virtue that Arendt considers necessary for a democracy. Unfortunately, she notes, authority in its true sense has become non-existent in the political playing field. Professional politicians hardly allow themselves any longer to be advised by people who have a real understanding, and hence authority, of specific matters, which results in the phenomenon of the loss of authority. This loss creates the problem of power-as-coercion, which always goes hand in hand with arbitrariness. For Arendt, this is the moment when power in a moral sense is given a bad name, which is unjustified because only when people act together, legitimate power can arise.
The big question for me personally is therefore: how can I legitimize in freedom the so-called authority and hierarchical place of a central government that repeatedly and demonstrably fails in its risk management, strategy, and policy? A government that is not transparent about its decision-making process and the criteria used, and above all continually contradicts itself in its communication to the people? A government that is not even able to legitimize the authority of people like Alex Friedrich, head of microbiology at Groningen University Hospital, but instead ‘denounces’ their appropriate action in the face of the risk of a pandemic?
The sovereign individual
Critical people are accused of causing unrest and disrupting the necessary ‘unity.’ I, too, was called stupid and ignorant when I retweeted the WHO’s test-test-test advice on Twitter. Another reproach that is recurring ad nauseam is: “You are not a virologist or epidemiologist, and accordingly, you cannot judge whether the government’s policy based on the advice from the RIVM is good or bad.” No, indeed neither am I a virologist nor an epidemiologist. In that sense, I’m a layperson. But as this layperson, this whole situation does concern me, and it does so existentially. Yet, I’m not merely a layperson.
As a project manager, I am knowledgeable about risk management, and as a philosopher the core of my thought is morality and the criterion to which I orient myself time and again is justice. Moreover, I am schooled in logical thinking and the ability to distinguish between fallacies and valid arguments. In my view, the only logical thing that should have been done immediately after WHO’s first warning was a committed effort to increase testing capacity instantly on a large scale and to start collecting the necessary but still missing data. Only by knowing reality can you take adequate measures, especially when it has long been clear that the virus is spreading exponentially. And to know and progressively learn reality, you must have data based on which you can gain insights. And to have data, you have to test.
Everyone has an individual coping mechanism. Mine is reading, reading, reading, informing myself by looking for the information there is, and unearthing the reliable information by thinking critically. To me this is acting sovereignly, and the sovereign individual is a figure who is autonomous in her thinking and, as such, will never uncritically conform to what is currently called ‘normal.’ Precisely this is what a liberal democracy needs, which brings me back to the previously discussed unknown knowns. Many people are laypersons in the fields of virology and epidemiology, yet they are an authority in their fields and experiences. Experiences that are extremely meaningful in dealing with this crisis. Experiences that were, at least for me, valuable for my comprehension of the situation and my judgment of current policy.
For example, related to the coronavirus, it is an unknown known that people have a cognitive bias and tend to think in first-order effects and not in second- or third-order effects. Another unknown known is that the concept of group immunity is entirely hypothetical with regards to COVID-19. One more unknown known is that the best strategy so far is to suppress the spread of the virus until a vaccine is developed and distributed on a large scale. And there are many more unknown knowns, which possibly may not provide definitive insights and knowledge — as the known knowns do — but which do help to arrive at the best and morally just decisions within the fluidity of the situation.
Regarding the urgently needed morality, I still see many gaps, and this, while Project Corona is a moral project. Consequently, policy and political action must be oriented to, and inspired by the moral criterion of Justice with a capital J — and not by economic criteria. The fact that the latter is, unfortunately, the case is evident from the reality that a company focused on infinite economic growth such as Roche is part of the Outbreak Management Team (OMT). And that’s not all.
By now, a lot of valuable time has been lost. In an effort not to exceed the IC capacity, general practitioners, geriatric specialists, and medical specialists have published a guideline with which doctors can determine whether it is meaningful to hospitalize seriously ill elderly corona patients. Meaningful? Who decides whether a person’s life is meaningful enough to be saved or not? It is shocking how people think about the older and the more vulnerable life. The next step has been taken already as the end of the IC capacity is quickly coming into sight. Thus, triage to intensive care is being considered. Once again, the most vulnerable have to suffer by being classified in the lethal phase 3. At the same time, the lives of non-corona patients are also increasingly endangered.
In such a situation, it doesn’t help — and in my view, it even is immoral — to come up with platitudes such as: “We will have to accept that risk is part of life, and — sad though it may be — also the risk of death.” And: “We’re gonna have to accept that people are dying.” What’s at stake is not the wish of immortality. What’s at stake is that dying in dignity is part of living in dignity. What’s at stake is that no one should decide who is allowed to roam the earth and who is not.
This article is a translation from my Dutch essay published on 27 March 2020. Therefore, it reflects the state of affairs of that day.