Magazine April 20, 2020, Issue

Coronavirus: The View from Paris

Paris, March 17 (Veronique de Viguerie/Getty Images)
A doctor, stuck in his flat, considers our situation

Like an inveterate gambler who obsessively notes the successive numbers that come up on a roulette wheel, hoping to discover a pattern of which he might take advantage, or an investor who follows the fluctuations of the stock market minute by minute, I study the latest statistics of the coronavirus pandemic throughout the day in an attempt to understand what is going on.

I have the time to do so because I am under virtual house arrest in my small flat in Paris, and if I venture out for a short walk round the block or to the nearest shops (no longer peregrinations are permitted) I must have a self-certified laissez-passer with me stating on my honor that my little excursion is really necessary.

It is a bit like the Occupation. A policeman can ask for your papers, albeit in French rather than German. My wife has been asked twice for hers. If you don’t have your laissez-passer in good order, you are fined the equivalent of $150. We had a conversation with a young man (at a distance of more than a meter, of course) who had received such a fine because he had put the wrong date on his laissez-passer.

There is both fear and insouciance in public reactions to the epidemic, the fear not usually being proportional to the statistical threat, or at any rate the statistical threat so far. The enemy is invisible and therefore both everywhere and nowhere. It is Camus’s great allegorical novel, The Plague, come literally true.

Pascal said that our problems arise from our inability to sit quietly in a room alone: but what about sitting quietly with others? When this is all over, will there be a baby boom, or more divorces? And will the murder rate have risen? My next-door neighbor in England, a mortgage broker, tells me that he is always busiest just after Christmas, when couples break up and have to sell their house to buy two others. This lockdown is far more testing than Christmas, and may last three months or more.

At eight o’clock each evening here, people open their windows or go out on their balconies and start applauding. What is this all about? They are applauding the staff of medical facilities who are devotedly battling the effects of the epidemic. I find this mildly irritating; I can’t quite say why. Is it a manifestation of the irrationalism that can so quickly become epidemic in an epidemic, and is as dangerous as the epidemic?

My sifting of the statistics leaves me not much the wiser, for information is not wisdom, or at least it is not a sufficient condition for wisdom. I still can’t work out whether this pandemic is unprecedentedly deadly or rather ordinary as these things go. What is the death rate from the infection? We still don’t know. The numerator (the number of deaths) is known, more or less, but the denominator (how many people have had the virus) is not, and will not be known for some time, if ever. I say the numerator is known more or less because there is a difference between dying with an infection and dying of it (many more old men die with cancer of the prostate than of it), and because we know the number who have died but not the number who will die. Since emergency departments have never experienced such an influx of patients with acute respiratory distress before, it is fair to assume that most deaths attributed to the virus were actually caused by it.

As for the denominator, it is important because we need to know the true rate of mortality from the infection, without which both irresponsibility and panic will flourish. As I write this, the death rate from ascertained cases in France is 4.2 percent (according to my calculations based on the available data), but if there were ten cases of infection for each ascertained case, the death rate would be 0.42 percent, which (depending on the proportion of the population infected) would mean a lot of deaths, but not in numbers that are orders of magnitude greater than in a “normal” flu epidemic.

Of course, exponential growth is a fearsome thing: If Italian deaths were to double every six days, the entire population of Italy would be wiped out in just over three months. This is not going to happen, of course, and what can rise exponentially can also fall exponentially. As I look at the figures this very morning (I think I woke early specifically to examine them), it seems possible — no more than possible — that a decline is beginning, at least in several countries. In any case I have difficulty in putting the statistics in perspective, because I don’t know what perspective to put them in. There are so many perspectives.

From the point of view of world mortality, deaths from COVID-19 so far represent scarcely more than a blip or faint statistical noise. Deaths from COVID-19 in the United States would have to double six times (from when I write this) to represent more than 1 percent of all annual deaths in the United States. This is not the Black Death or even the Spanish flu.

And from yet another point of view, that of years of human life lost, the epidemic is likely to be of limited importance, because deaths are overwhelmingly among the aged. This is horrible to think about because when we think of death we think of our own or that of the individuals close to us; to say that the death of one 20-year-old (who might have lived to his early 80s) represents as many years of human life lost as the deaths of, say, 15 80-year-olds (who might each have lived a few more years) could easily be taken to mean that one 20-year-old is in some sense “worth” 15 80-year-olds. That is not how we think, or ought to think, of the value of human life, and the murder of an 80-year-old is as much murder as that of a 20-year-old. But I cannot disguise from myself the fact that death at my age would not be as tragic as death at my nieces’ and nephews’ ages, albeit I do not want to die. Alas, both epidemiologists and health economists are obliged to think like this.

There are, of course, anomalies in the figures that cry out for explanation. The death rate in ascertained cases in Israel, for example, is 0.08 percent (again, by my own calculations at the time of writing), that is to say one-fiftieth of that in France. The death rate in Ireland is 0.44, as it is in Austria, that is to say one-tenth of that in France. What explains these differences?

It cannot be treatment, because treatment of the predominantly old victims of serious disease is not very successful. No one would suppose in any case that the Irish medical system is ten times better or more efficient than the French. Could the nature of the virus be different in different countries? Certainly the proportion of serious cases differs very greatly among countries. Is it that the criteria for testing people varies among countries, so that what appear to be low-fatality countries are merely laggards as far as the exponential increase in serious cases is concerned and that Austria, say, will soon catch up with Italy? (The age structure of Austria is not so different from Italy’s that it could possibly explain the vast gulf between the countries’ infection rates.) Is it that the certifications of cause of death differ? Or the technique of testing? Unlikely.

I cannot answer the questions, only ask them, but at least they are both important and susceptible of a reasonably definite answer. Soon, however, questions that are perfectly sensible and important in themselves but capable of an infinitude of answers will begin to torment us and cause discussion that, given the present state of our souls, so ready for acrimonious ideological dispute, will indeed turn acrimonious.

The economic effects of the epidemic are likely to be severe (though economic forecasting makes epidemiology look as certain as a tautology), but will they have been inherent in the epidemic or caused by our response to it? Did or does the epidemic justify more intervention by the state and more state control of the population? Did or does the epidemic spell the end of international supply chains, and if so will we be the richer or poorer, or rather have a higher or lower standard of living, as a result?

Will our conduct as people have changed because of the epidemic? Will we be more selfish or more altruistic than we were? During the epidemic, people have been helping their elderly neighbors as never before (at least in my lifetime), but on the other hand they have fought over toilet paper in supermarkets — and the latter merely in anticipation of shortages.

Amnesia is a powerful force (thank goodness), and crises once over are often crises soon forgotten. Amnesia leads to unpreparedness, however. Moreover, recrimination — always good fun — is likely to occupy the minds of the intelligentsia for some time. Who was or is to blame? Why was something not done before? Why was the wrong thing done?

For the moment, South Korea is held up as the exemplar. It is said to have done almost everything right, an indication that the Mandate of Heaven has moved back from West to East. But South Korea’s results are worse than Austria’s (at least as they stand at the moment). Could it be that we are applying to South Korea the fallacious reasoning of post hoc ergo propter hoc?

Whatever the answer, everyone agrees that the South Koreans were much more efficient than the Europeans or the Americans. Is it a coincidence that in 2019 public expenditure as a share of GDP was about a third in South Korea of what it was in France, which lagged in testing and lacked even masks? One recalls with amazement that in the early 1950s, South Korea was poorer than the Gold Coast (soon to be Ghana).

My wife, a retired doctor, made a very important medical discovery while cooped up in our flat in Paris. Homemade masks being better than none, and material to make them being in short supply owing to the closure of shops, she discovered that a padded bra cut in two and adapted slightly makes two splendid masks. There is no excuse for going out unprotected.

This article appears as “The View from Paris” in the April 20, 2020, print edition of National Review.

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Anthony Daniels — Mr. Daniels, a retired doctor who worked in several parts of the world, is the author of Mass Listeria, a book about health scares.

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