If you had to name the most important fact in the world right now, it would be how many people have been infected by the novel coronavirus, including not only those who have become sick but also those with no symptoms.
It is the key to an appropriate public health policy response, one which neither overreacts nor underreacts to the threat.
Yet it is not only unknown, but possibly unknowable — at least in the short term, which is when it matters most.
The director-general of the World Health Organization has noted that the death rate from known cases so far is 3.4 percent. But given the lack of a reliable figure for total infections, in China and elsewhere, that is “certainly an overestimate,” Tom Frieden, a former director of the Centers for Disease Control and Prevention and New York’s health commissioner, recently told Bloomberg News.
Frieden expects a global fatality rate of less than 1 percent. Even if he is right, a great deal hinges on how much below 1 percent the rate winds up.
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There could be a huge difference in total deaths, globally, depending on whether the virus is as deadly as the seasonal flu, with its roughly 0.1 percent mortality rate, or the H1N1 virus of 2009, which killed in just 0.02 percent of infections, according to a peer-reviewed 2013 study.
To complicate matters, that updated fatality rate for H1N1 is much lower than the 1.0 percent to 1.3 percent experts originally calculated amid the 2009 outbreak.
A modern world that has learned to expect information, instantly, for free, must adapt to the realization that the one fact it really needs to know, right now, cannot be had at any price.
And from that flows a great river of uncertainty. We can’t know the true risks of the virus, so we can’t estimate with confidence the costs and benefits of alternative public health responses — much less the potential economic repercussions and the right way to cope with those.
Should we cancel the NCAA men’s basketball tournament? Forbid all outdoor gatherings, including for the 2020 political campaign? How about the rest of the Democratic primaries? How much fiscal stimulus should Congress approve, and in what form? For now, the answer to all of the above is: We don’t know. All we know is that inaction is not an option.
This moment of radical uncertainty is frightening, humbling — and an occasion to reflect on the advantages as well as, yes, the limitations of governing based on facts and data.
Obviously we want leaders who are both open to valid information and expert opinion, and capable of processing it.
President Trump lies all the time about large matters and small; he embraces conspiracy theories and disinformation, much of which comes his way from murky quarters of the Internet.
These character traits make him difficult to trust and ill-suited for this moment, much of which he has wasted tweeting about his political enemies or about other irrelevancies.
The traits were evident long before the coronavirus broke out, and so it was both foreseeable and appropriate that Democratic candidates have been campaigning to replace him by promising to restore truth to its rightful place.
An interesting question, though, is how and why the situation would be any different now if Trump were, by nature, honest and reality-based, or if someone with better temperament and more wisdom were in the Oval Office.
Given the inaccessibility of the most important data, any president would be forced to rely on some combination of hard information, expert advice — and his or her best judgment. Gut instinct.
He or she would also have to operate within the law and the Constitution. The methods of a Xi Jinping in China would not be on the table, even if some experts might consider them advantageous from a public health perspective.
This is what governors and local officials across the country, most of them not burdened with Trump’s defects, are doing right now.
Sometimes considered a hindrance to national unity and action, federalism seems like an advantage of our system right now, to the extent that it promotes locally tailored solutions and dispersed accountability.
Neither a governorship nor a mayoralty — nor the presidency — is essentially a “management job,” as former New York mayor Mike Bloomberg coolly, but inaptly, framed it during his short-lived campaign to replace Trump.
These are leadership jobs. Leadership is what you do when the answer to all your what-if questions is “we don’t know,” but the people are counting on you anyway.
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