Most people are no longer interested in talking—or even thinking —about the pandemic. Understandably, they prefer to focus on the media cycle’s most recent turn or on the ordeals of everyday life, than on the bewildering two or so years that we spent being lied to, cajoled, muzzled, and spun. Amongst those of us few obsessives still left in the trench, however, the question of the pandemic’s origin remains an open and controversial one.
There are, roughly speaking, two camps here. In one (usually aligned with the “mainstream”, i.e., pro-lockdown-till-vaccine strategy) are proponents of the “zoonotic spillover” theory, who argue that the pandemic began when a novel coronavirus crossed to human beings from a bat/civet/pangolin/insert other critter here. In the other (usually aligned with scepticism of the lockdowns and/or mass vaccination), are proponents of the so-called “lab leak hypothesis”, who point to the surprising presence of a virological research institute, reengineering coronaviruses to make them more contagious, in the pandemic’s ostensible city of origin. But while the two camps disagree—often viciously so—on answers, both sides agree that the question of the pandemic’s origin is crucial to learning lessons for next time.
Prima facie, there isn’t much to disagree with here. Learning lessons from the pandemic is a worthwhile ambition (why else would I be thinking and writing about it?), and understanding where it sprang from is an important part of fulfilling that ambition. But beyond this laudable goal, the two sides also share a common premise that “the pandemic” is essentially a biological phenomenon, whose origins must therefore be understood in biological terms. Both sides thus assume that getting to grips with the pandemic’s origins means identifying where the novel coronavirus, SARS-CoV-2, emerged from. And it is here that I disagree. “The pandemic”, it seems to me, is not primarily a biological phenomenon but a social one, not primarily born of lab mismanagement or a snotty pangolin’s glands, but of a series of value-judgements and pragmatic decisions. It follows that the pandemic’s lessons can only properly be learned once this fact is recognized and placed at the heart of our post-pandemic debates. In obscuring this, the existing debate over the pandemic’s origins risks distracting us from some of the most important things the Covid episode has to teach us.
“The pandemic” is not primarily a biological phenomenon but a social one, not primarily born of lab mismanagement or a snotty pangolin’s glands but of a series of value-judgements and pragmatic decisions.
To see why, let’s get clear on what it means to see the pandemic as primarily a “social” phenomenon. If you open A Dictionary of Epidemiology (Oxford University Press), you will find “pandemic” defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people”, and “epidemic” as “the occurrence in a community or region of cases of an illness […] clearly in excess of normal expectancy”. By such definitions, accurately declaring a “pandemic” involves identifying an unusual preponderance of cases of and deaths from a particular illness, spread over multiple countries. Seems simple and objective enough, no? Not so. The problem is that neither “cases of” or “cases/death from” a particular disease are self-evident (or, in philosopher’s jargon, “given”). Identifying both depends on a series of pragmatic value-judgements—judgements that may differ wildly between groups of people.
First, consider the question of a “case” of a disease. During Covid times, we all got quite used to thinking of “a case of COVID-19” as “a single positive PCR-test result”. Governments used this definition to collect data, which they then used to make policy and to narrate our experience of the pandemic in the form of widely televized and otherwise mediatized graphs. This, however, is only one way of interpreting a positive result. PCR works by identifying little bits of viral RNA in a saliva sample, translating them into DNA, and then repeatedly copying that DNA to the point of detection. The number of times that a lab technician has to repeat the copying process is known as the “cycle threshold”—and tests run at higher cycle thresholds, while increasing your chances of identifying an infected, infectious person (“true positives”), also increase your chances of mistakenly identifying a non-infected person (“false positives”) or identifying a person technically infected, but not in a clinically or epidemiologically relevant way, (“true-false positives”, e.g., people with a very low viral load or once-infected people still carrying viral remnants).
Governments used to make policy and to narrate our experience of the pandemic in the form of widely televized and otherwise mediatized graphs.
During the pandemic, there was no standardization of cycle thresholds across laboratories, and asymptomatic people regularly tested positive. But a decision was made that neither standardization nor symptoms of illness were important to identifying a “case” of COVID-19. The net was thus cast very wide, reflecting a distinctly epidemiological focus on the big picture and a cautious disposition. It doesn’t matter too much to an epidemiologist (or to someone thinking epidemiologically) if a certain number of “cases” are in fact false or true false positives, as long as (1) the epidemiologists get a general sense of the disease’s prevalence within a population, and (2) they don’t endanger their community by underestimating said prevalence. But crucially, non-epidemiologists might have defined a case otherwise. For example, a clinician interested in treating a particular patient, or an individual peering down the barrel of a purgatorial ten-day “self-isolation”, may give much greater weight to the cycle threshold or the absence/presence of symptoms when interpreting a positive PCR result. Such interpretations are not less valid or true than an epidemiologist’s. They just reflect different priorities.
“Death from COVID-19” is similarly riddled with interpretive ambiguity. Absent something like a bullet-wound between the eyes or a fresh stump where a head used to be, it is surprisingly difficult to establish a person’s cause of death. Often people die afflicted by a number of comorbidities, including but not limited to advanced age, chronic illness, or an infection like COVID-19, making it meaningless to attempt to establish a single cause of death. Nevertheless, medical institutions like hospitals and morgues design rubrics for establishing a deceased person’s cause of death—and the use of these rubrics, much like the interpretation of a positive PCR result, will be shaped by value-judgements about what matters most, in a given situation.
During COVID-19, the definitional net was, again, cast pretty wide—probably reflecting the epidemiologists’ aforementioned focus on the macro-level and better-safe-than-sorry attitude. For example, numerous medical institutions, including Belgium’s Sciensano, a couple of jurisdictions in the US, and our most esteemed World Health Organisation, adopted a version of a rubric that defined a “death from COVID-19” as “a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case”. In effect, this meant that in these instances, a positive PCR-test result was not needed to identify a particular death as a “death from COVID-19”, and an attendant doctor or care home worker’s medical judgement could be relied upon instead. But COVID-19’s symptoms are generic, so that these judgments, made within societies gripped by a monomaniacal focus on this one disease, would inevitably tend to find Covid everywhere. Some medical jurisdictions also allowed for any person who had died within a certain number of days of a positive test result to be recorded as a “death from COVID-19”, leading to a few cases of gunshot or motorcycle crash victims being included in the death count. The crucial point here is that absurdities like this were not merely accidental or incidental, but rather a consequence of the widespread decision to adopt an expansive definition of “death from COVID-19”—a narrower definition would have avoided such errors.
Now, I am pointedly not claiming that the epidemiological definitions of case and death were wrong per se (note that, snark aside, everything that I have so far said is compatible with the belief that these definitions were, and perhaps remain, the most appropriate ones given the circumstances). Instead I aim to illustrate how these definitions, on which were based the main numerical indicators of pandemicity, were not self-evident or “given”, but rather hinged on a series of value-judgements made by particular people with particular disciplinary and political priorities. On these terms, then, insofar as its existence depends on these local value-judgements, a “pandemic” cannot truly be wholly described as a natural phenomenon—indeed, had sober clinicians, medical anthropologists, or certain lockdown-hating youths been allowed to influence the relevant definitions, the “pandemic” would have had a very different shape.
Indeed, had sober clinicians, medical anthropologists, or certain lockdown-hating youths been allowed to influence the relevant definitions, the “pandemic” would have had a very different shape.
Given the levels of spending, coercion, and general terror that pandemics are taken to justify, it is critical that—alongside asking whether they should justify all of these things—we ask who gets to make the value-judgements that bring into being a pandemic event. Who, in other words, gets to set the cycle threshold, or choose the death-attribution rubric, or even determine what the “unusual” in “unusual preponderance of cases of and deaths” means? In as much as it obscures these crucial questions and reifies a biological understanding of pandemics, the debate over COVID-19’s origin is a distraction and presents no real challenge to the international gaggle of pandemic preparedness professionals currently dominating the post-Covid lesson-learning process and taking the primacy of their own value-judgements for granted.
