Thinking Aloud: COVID Amnesty

Dr. Oster makes several key points.

• “We have to put these fights aside and declare a pandemic amnesty. We can leave out the willful purveyors of actual misinformation while forgiving the hard calls that people had no choice but to make with imperfect knowledge.”
• “All of this gloating and defensiveness continues to gobble up a lot of social energy and to drive the culture wars, especially on the internet. These discussions are heated, unpleasant and, ultimately, unproductive. In the face of so much uncertainty, getting something right had a hefty element of luck. And, similarly, getting something wrong wasn’t a moral failing.”

Let me share some of the arguments made against the concept of amnesty. The authors include a self-described feminist mother, many journalists, a happy wife, and a mother of six. (You can find a list of all seven articles in response to Dr. Oster listed under sources at the end of this article.)

My sensibility

Reflecting upon the outcomes of surgical decisions is an integral part of surgical training and subsequent care. It is an act performed before one’s peers, weekly or monthly, throughout our careers. As with all human endeavors, it is plagued with human foibles – acrimony among competitive surgeons, shifting blame onto patients, or a constellation of improbable events. But all surgeons must stand up and be judged. It is one of our oldest rituals, and despite its flaws, it has served surgeons and their patients well. Dr. Charles Bosk was the first to dissect the sociological components of our ritual reflection, the morbidity and mortality conference (M&M). The title of his book captures the essence of my sensibility for judging the decisions made during the COVID pandemic; it is called Forgive and Remember.

Reviewing the articles, I identified several general arguments, which included

• The intent of policymakers
• The meaning of amnesty and accountability

I  will quote from the articles and respond in sequence.

The intent of policymakers

• “First… those who drove COVID policy presented themselves not just as people doing their best, but as the sole bearers of rational truth and life-saving moral authority. Doubtless the laptop class would prefer that we judge COVID policy by intention, not results, lest too close an evaluation result in their fingers being prised from the baton of public righteousness.”
• “None of this deliberately inflicted mass suffering was necessary, and that was all known early on. It wasn’t, as Oster claims, a matter of “deep uncertainty.”
• “We need to understand what role conscious deception (noble lying) plays in public-health messaging. We should investigate it precisely because, while it didn’t accomplish its ends, it did inspire backlash.”
• “But as research results and experience accumulated, it became obvious that scientists, doctors, politicians and the media at every step along the way had overstated the strength of the evidence on which they were making life-changing policy decisions. More seriously, in some cases, this distortion was not made in good faith, but was calculated and deliberate.
• These elisions, exaggerations and downright lies — as well as the suppression of contradictory information — were being done supposedly with the best of intentions. It has transpired that rather than serving the greater good, their actions often visited substantial harm on those whose best interests they were ostensibly serving.”

This is the best place to begin. At the M&M conference, there was no concern about intent; no surgeon willfully set out to injure, let alone have a hand in prematurely ending their patient's life. (Every time I was tempted to stray outside the sharp edges of surgical care, I would hear the voice of my surgical mentor, “Dr. Dinerstein, this is not a gambling casino.”). One can never truly know the intent of another; we can and do make our best guess. But that guess is colored by our view of humanity as innately good or bad, and even more specifically by whether the individual is part of our tribe. No matter what a surgeon had done, there was often a competitor, looking for a moment to make the other look bad and, perhaps, raising their status in the bargain.

I assume that all the COVID players, from Dr. Fauci to Dr. Bhattacharya, had good intentions. But I agree with this thought,

“Determining the “why” is also a critical distinction between those who advocated for excessive mitigation out of a misguided sense of caution, and those who did so driven by politics and the desire for fame.”

Of course, that applies equally well to those who ignored and still ignore to this day basic safety measures we can use in slowing and stopping the spread of infectious disease. There is a subset of individuals who, like the Shadow, “know” what lies in the heart of others that see everything through political lenses.

COVID policy as a class struggle

• “[COVID policy] was, in fact, a class war writ [encompassing] minute micromanagement of nearly every facet of everyday life, … and doled out material consequences for dissenters.”
• “And these are all downstream of a pandemic-era public discourse [that felt like] a battle for class dominance, in which one side used its stranglehold on public institutions to frame censorship as “fact-checking,” and all dissenters as stupid, unscientific, or actively hateful.”
• “Covid wasn’t that “complicated.” The global left simply believed Covid chaos would benefit their forever goal of consolidating power. So they simply suspended our constitutional and natural human rights ...”

At the surgical M&M conference, we all stood as peers, even as our experience and training gave us differing points of view. What I find disturbing in these quotations is how they reduce intentions, which we can never really know, to one specific focus, a political agenda for control. There are many reasons beyond a “class war” that accounts for our COVID behavior. And is class war indeed the correct term? Some of the “class,” (which one author described as the “Physicals” whose work is more rooted in the material world”) were devastated by COVID, while others were not. Transit and factory workers suffered illness and its sequelae out of proportion to others of their “class,” like construction workers. The other behavior that has no place in an honest discussion of COVID accountability is the reduction of individuals using labels and names. This quote regarding the Atlantic is a case in point.

“… the Atlantic remains the mass middle-class, middlebrow magazine of choice in America; as a status symbol, it signals possession of a college degree, even suggesting a graduate school stint on top of it. It is Reader's Digest for good liberals embarrassed by Reader’s Digest, a West Wing script on glossy paper. The people who do not deserve a pandemic amnesty read it.” 

The moral component of COVID policy

• “Sure, there were unknowns about the propagandized Wuhan-flu, but that isn’t the point. There are unknowns about a lot of things in life, but none … give you the right to act like a crazy person who advocates for vaccine segregation, unemployment for the refuseniks, or locking the elderly in cages like rabid beasts so they can die on Zoom calls while a masked attendant presses “end call” as family members watch grandma give up the ghost.”
• “Getting the facts wrong may not be a moral failing, but smashing and grabbing fellow citizens’ natural rights because you were scared is indeed a major moral failing.”
• “Herein lies the fundamental problem: these people don’t understand that it is not about facts. It is about morality. It is simply wrong
• … for people to publicly advocate for segregation and unemployment of a group of people because they don’t want a medicine that is fifteen minutes old. 
• … to whip your children up into a frenzy about something you have only heard about on the mainstream news to the point where they are yelling at strangers less than two meters away.
• … to uninvite family members from Christmas because they didn’t take the same medicine you did.
• … to close churches—you know, those places you go to when death is near—because you think death is near!
• … to demonize every dissenting opinion in the pursuit of scientific and medical answers. Something about the scientific method requiring dissenting opinions and contrary evidence to buttress claims comes to mind… “

This call to morality asserts that the actions of others were not only wrong but immoral and immediately places you on a higher plane. At the surgical morbidity and mortality conference, we stood as peers. The Chair of the Department was open to the same criticism as the youngest newly autonomous surgeon. Further, moral arguments may make judgments more fuzzy than sharply defined; after all, an ethical dilemma, by definition, has good arguments on either side of the issue.

The strongest argument made by those criticizing Dr. Oster revolves around the role of accountability in amnesty.

Amnesty and Accountability

• “Of course, we should all forgive in a Christian sense; but amnesty is another thing.
• “Men and institutions are fallible. But what we need is more forensic accountability for our institutions.”
• “Accountability is essential to social order and advancement. A good society does not ignore gross harms people commit against others. It seeks to rectify them to the extent reasonably possible, for the sake of justice and to discourage future wrongs.”
• “In democracies, we hold politicians and institutions accountable for their decisions. When those decisions cause harm, we learn from them.” 
• “Amnesty requires a specific admission of guilt and a commitment to repairing the wrongs done. Instead, Oster is pretending to advocate for reconciliation in a way that insists no reconciliation is actually needed.”
• “Other people are “the experts” and, more importantly, “the authorities.” And when they are wrong they must admit it, and be held accountable. That is what makes them, in our modern democratic and scientific society, authoritative: accountability to the public record.”
• “Forgive your family. Even forgive authorities who say they are sorry and seek to make amends. But fire them, too. Throw them all out. “Getting something wrong” might not always be a moral failing, but it is a professional failing, in an expert or public official. They failed at their job. They should not be allowed to keep it. So, no pandemic amnesty. The reckoning has not yet begun.” 

Accountability is part of Dr. Bosk’s “remember.” At the surgical M&M, no one was fired or stripped of their privileges. I am not sure, but I would suggest that massive firings are not the answer. When you remove leadership and “drain the swamp,” you also drain implicit knowledge- the hard-won knowledge gained from experience. We see this already in the less politically charged problem we are having finding qualified pilots to fly our planes and which we will see over the coming years as an entire generation of older, wiser physicians take early retirement and leave the younger generation to learn their lessons on their own, well actually on us, the patients. 

We desperately need a dispassionate consideration of what we got right and wrong during the COVID pandemic. That is not easily done. For one thing, the data we seek is not to be found. Several authors cited the COVID decision for remote education, which by test scores, has shown itself to be an educational disaster. But we have no data on how education would have gone if we had remained in the classroom. If we have learned nothing else, we should be humble in the presence of what we do not know.

The other great difficulty lies in all of those quotes about intent. And let me hasten to add that one can find equally disturbing quotes from the other side of the aisle. Those concerns about purpose create acrimony, as we have seen around the January 6^th hearings or the anticipated Congressional hearings of the next session.

We need a version of the Surgical Morbidity and Mortality Conference; its name will grate on some of us, Truth and Reconciliation.

“Reconciliation requires political will, joint leadership, trust-building, accountability, and transparency, as well as a substantial investment of resources.”

I fear this will not occur and will be to our detriment. We will stumble on the same problem we have had for more than a decade, joint leadership and political will.

Sources: Let’s Declare A Pandemic Amnesty The Atlantic

The tyranny of a Covid amnesty Unherd

There Can Be No ‘Amnesty’ On Lockdowns Without A Reckoning The Federalist

No Amnesty for Pandemic Tyranny The American Conservative

A ‘Pandemic Amnesty’? Hell, No National Review

Pandemic Amnesty? Not So Fast Crisis Magazine

After Covid: Amnesty or accountability? Politics Web

Perspective: The case against pandemic amnesty Deseret News