Protests over Stay-at-Home Orders During the Pandemic: Some Reflections

A lot of media are reporting on the protests against stay-at-home orders in the United States. These protests are something I predicted would occur weeks ago when public health officials in democratic countries were pointing to China’s lockdown as an appropriate public health response to the threat of the virus. What might (arguably) work in an authoritarian regime is not easily applied as a viable and effective measure in a free and democratic country. Rather than characterize all such protesters as the actions of selfish or “anti-science” ignorant people, I instead want to paint a more nuanced picture of why such protests were inevitable (at least in the United States) and, to some degree (especially when they do not defy physical distancing recommendations), justified and a healthy aspect of democratic culture.

I realize my saying this during the pandemic will strike many as problematic. I am not saying that stay-at-home orders are not defensible policy decisions, nor am I suggesting that people should not comply with them. What I am saying is that such policy decisions are contentious, and subject to debate and criticism. This means such policy decisions are legitimate targets of public protests. Such protests can actually improve policy decisions because they can increase valuable information (e.g. the expression of people’s opposition to extended stay-at-home orders) and increase the accountability and scrutiny of decisions to extend such orders indefinitely.

Firstly, let us start by recognizing that, for ANY public health measure, there is often a low level of compliance with following the prescribed behaviours. It is very hard to change people’s behaviour, especially people in a free society where we grant them extensive autonomy over making healthy and (more commonly) unhealthy choices.

We know people shouldn’t smoke, and yet in the United States it remains the most preventable cause of death. Each year approximately 480,000 Americans die from smoking. If you can’t persuade Americans to stop smoking, which is arguably far less burdensome for many than self-isolating in home indefinitely, it is not surprising that many will reach a breaking point when staying home and not seeing family and friends, let alone not working, becomes unviable.

Or consider obesity. Eating a balanced diet and exercising regularly is also (arguably) less burdensome than self-isolating at home. And yet nearly half (42%) of the American population is obese, and these behaviours lead to an annual death toll of approximately 300 000 people each year.

So before the outbreak of the COVID-19 epidemic, there was already an obesity and tobacco epidemic that kills approximately 17 times the number of Americans who have died from COVID-19 to date every year. Of course it is more complex than this, as smokers and those with co-morbidities also contribute to the mortality risks for COVID-19, so the problems of smoking and obesity contribute to COVID-19 deaths.

Consider also the reality that the compliance rate for medications, like hypertensive medications, is low. People stop taking their medications because of side-effects, the costs or they simply forget to take it. So given the track record people have with smoking, diet and taking medically beneficial pharmaceuticals, it is not surprising that there is some push back after a month of stay-at-home orders.
Unlike smoking, healthy diets and lifestyle and hypertensive medications, there is no sound empirical evidence for believing stay-of-home orders will prove to be a safe and effective strategy for reducing COVID-19. Their widespread adoption was based instead on a precautionary principle when the data of the virus (e.g. mortality rate) was still an unknown. Thus many policy makers planned for the worst case scenario, swayed by epidemiological models that predicted millions could die from the virus. This is not to suggest that such aggressive public health measures were not justified, only that they are contentious. Citizens are being asked, indeed compelled, to make significant behavioural changes without scientific evidence that such measures would have the desired effect.

These lock down measures are, in effect, an experiment. This is a scientific experiment that has been thrust upon the population without extensive scientific study of their effectiveness, and without the informed consent of the population who are being compelled to comply with the experiment. These measures are not only very costly, but they are known to have significant adverse side-effects (e.g. financial hardship, increases in mental illness, suicide, domestic violence, etc.).

The impact stay-at-home orders have on people can vary significantly. For some people, especially those that can work from home and have comfortable living conditions at home (like myself), the burden might not be significant. But for those who have lost their job, and those living in small spaces with children home from school, the idea of continuing indefinitely in such a state can be overwhelming. The stay-at-home orders will have significant adverse side-effects, this is a certainty. The potential public health benefits from these closures are, at least for now, mostly unknown.

So bringing all the above together my first main point is—MANY PEOPLE DO NOT CONSISTENTLY FOLLOW PUBLIC HEALTH GUIDELINES. This is true of the guidelines that have ample scientific study to show they are cost-effective and safe public health measures, like smoking cessation, healthy diet and lifestyle and BP medications. So it is not surprising that, for public health measures that are experimental, costly and burdensome, many people will resist, indeed even challenge, their soundness and, most importantly, their being enforced on the population under threat of fines, etc.

The second point I want to address concerns the emphasis American society places on liberty. At the time of my this blog post the COVID-19 death toll in the US was roughly equal to the estimated annual death from guns. The United States has done little to try to reduce the high mortality from gun suicides and homicides. The Second Amendment guarantees the right to bear arms, and imposing more stringent regulations on fire arms is a contentious political issue in the United States. If regular mass shootings are not sufficient to persuade politicians and the general public to re-think gun control in the United States, how can we seriously expect these same people to accept stay-at-home orders to (primarily) protect the elderly given such measures infringe upon mobility rights and employment?

While I think the social distancing measures and non-essential work closures invoked to date have been justified, what I think is not justified is the lack of any discussion of reasonable timelines for imposing and lifting such measures from the start. The public should have been informed from the start that such measures would be pursued for a set and reasonable period of time. COVID-19 is not comparable to Ebola or smallpox, so the idea of letting the virus dictate the timelines vs what is feasible to expect people to comply with was, in my opinion, a mistake as uncertainty is a major contributor to the hardship people (especially the young) are experiencing.

Without the ability to test (on a very large scale) who has the virus, and who has the antibodies after having recovered from the virus, policy makers face a really difficult decision concerning how far public health measures can justifiably go in terms of encroaching upon individual liberties, as well as jeopardizing economic and mental well-being. The COVID-19 pandemic is really uncharted territory for liberal democracies. And the principles and regulations invoked now will set a precedent for any future pandemics.

So while it is easy to demonize the protesters opposed to extended stay-at-home orders as stupid and selfish, I think sch measures raise legitimate and pressing societal concerns that must be addressed and given a voice. Stay safe!

Cheers,
Colin