On COVID-19 and pandemics: a Stoic perspective

[The COVID-19 virus, Wikipedia]

[This post has been revised, updated and expanded with respect to the original: latest update on 1 April 2020.]

As I'm sure I don't have to tell you, the long anticipated next pandemic has now arrived, and it has quickly become a new reality for all of us. Welcome to the age of COVID-19. Also predictably, you have already been exposed to a barrage of nonsensical or pseudoscientific notions about the virus, that you have been told by obviously incompetent government officials that there is no reason to panic, and that you are worried about what might happen to you and your loved ones in the near future. For all these reasons, here is a Stoic guide to the COVID-19 epidemic, and -- more generally -- to any future pandemic. Keep it handy.

The way I'm going to tackle the issue is by using a threefold Stoic curriculum as it was taught in ancient schools: we are going to look at the epidemic from the point of view of "physics," logic, and ethics. The word physics, for the Stoics, actually refers to a broad approach to the understanding of the world, which includes what we nowadays call the natural sciences and metaphysics. Logic is also understood in a broader-than-usual sense, to mean anything to do with proper reasoning. Finally, ethics too has an enlarged meaning in Stoicism, as it encompasses not just the study of right and wrong, but our best understanding of how to live a human life that is actually worth living. 

"Philosophic doctrine, say the Stoics, falls into three parts: one physical, another ethical, and the third logical. … Philosophy, they say, is like an animal, Logic corresponding to the bones and sinews, Ethics to the fleshy parts, Physics to the soul. Another simile they use is that of an egg: the shell is Logic, next comes the white, Ethics, and the yolk in the centre is Physics. Or, again, they liken Philosophy to a fertile field: Logic being the encircling fence, Ethics the crop, Physics the soil or the trees. Or, again, to a city strongly walled and governed by reason." (Diogenes Laertius, Lives and Opinions of the Eminent Philosophers, VII.39-40)

That is to say, for the Stoics, a sound ethics is made possible by good physics and logic. Or, to put it differently, we live a good life if we use reason and evidence to navigate it. So let us get started!

The "physics" of COVID-19. The virus in question belongs to a family known as Coronaviridae (which means that to call it "Coronavirus" is a bit inaccurate), the name stemming from the Latin "corona," crown, because of the appearance of the viral particles. Other Coronaviruses include the common cold, as well as the lethal MERS and SARS. The common flu, by contrast, is not a Coronavirus, as it belongs to a different family, known as Orthomyxoviridae. Why does this matter? Because it helps us put COVID-19 in its proper biological context, telling us something about what it is and what it isn't.

Here are the basic facts regarding COVID-19 that we need to keep in mind:

i. There is no vaccine, nor will there be one available likely for at the least a year.

ii. There is no effective medication at the moment, though some are being experimented with.

iii. The most practical things you can do are: (a) wash your hands carefully (at least 20 seconds), especially after you have been outside, and particularly if you have come into contact with other people, for instance while using public transportation; (b) stay at home (i.e., practice "social distancing") unless absolutely necessary, even if you are healthy, but most definitely if you are sick; (c) drink plenty of fluids; (d) call your doctor if you feel sick and follow her instructions. That's pretty much it. Talk about a low-tech response to a 21st century challenge.

iv. Initially, the general medical advice was not to wear masks, unless you were sick or you were a health provider. That's because masks do not filter the virus, since its particles are too small, but they reduce the chances that your mucus -- if you are infected -- will reach other people and infect them. However, new evidence now shows that people who are infected but asymptomatic are capable of transmitting the infection up to two days before showing symptoms, which means they should be wearing masks as well. It also appears, contra to initial reports, that the virus may be airborne, which also makes wearing masks a reasonable precaution. That said, you should NOT wear medical grade masks, because those are in limited supply and are needed by health workers who are on the front line of this fight.

v. COVID-19 is more contagious than seasonal flu, SARS, hepatitis or HIV, but less contagious than measles, chickenpox, and tuberculosis. That is because droplets containing COVID-19 fall within a few feet from infected individuals, while in the latter three diseases the particles have a range of infection of 100 feet. The reason the first four diseases are less contagious than COVID-19 is because seasonal flu is typically slowed down by vaccines, SARS was easier to contain after the initial outbreak, and hepatitis and HIV require direct transmission of bodily fluids.

vi. The incubation period for the virus -- that is, the time from infection to when symptoms are visible, and throughout which a person is capable of transmitting the infection -- has been estimated to be between 5 and 7 days (though estimates range from 2 to 14 days). Compare with the common flu, which has an incubation period of 2-3 days. This means that there is no way for you to know whether you have contracted the virus for several days, until the symptoms show up. Nor is there a way for you to know whether you have already come into contact with someone who is infected within the last several days.

vii. The symptoms of COVID-19 are, unfortunately, pretty generic, hardly distinguishable in many cases from a common cold or mild flu: fever, cough, and difficulty breathing; sometimes they include diarrhea or vomiting.

viii. The estimated fatality rate of COVID-19 is between 2% and 3% (give or take, with a fairly large margins of error, since data is limited). Compare that to the fatality rate of the common flu (0.1%, which still translates to 35,000 annual deaths in the US alone), of SARS (10%), and of MERS (a whopping 33%!). As in general with respiratory viruses, your chances of being killed by an infection vary with age and health status. In the case of COVID-19, children do not seem to be at heightened risk, but elderly people, or people with health conditions, are. Analyses of data so far show a mortality rate of 8% for people in their 70s, and 15% for people in their 80s.

The ancient Stoics did not know any of this, of course. But they did have to deal with infectious diseases. Socrates (the chief inspiration for Stoic philosophy) lived in Athens during a plague that hit the city in the second year of the Peloponnesian War. He survived it, allegedly in part because he had a strong constitution, and because his needs -- in terms of food, drink, and social entertainment -- were few. The emperor Marcus Aurelius, also a Stoic, had to handle the devastating effects of the Antonine plague, probably smallpox brought back from the legions after the war against the Parthians on the eastern frontier of the empire. The plague was the worst in antiquity, causing millions to die.

The (Stoic) logic of COVID-19. Now that we know the basic facts, let's reason about them. In the first place, should we panic? Obviously not. Panic is an emotional overriding of reason, which means it is automatically a no-no for a Stoic practitioner -- or a secular humanist. Moreover, there is no good reason to be too worried, given the above facts.

The likelihood of contracting the virus, even in the countries were it is currently widespread, is still moderate. Even if you do contract the virus, there are very good chances that you will recover, especially if you don't have severe health conditions or are particularly old.

By the same token, however, reason also dictates not to be too casual about the danger. It is still a worrisome virus, and the rational thing to do is to respond in a measured way to the threat. That is, to deploy the Stoic virtue of temperance, which means doing things in the right way, neither overdoing it nor under-doing it.

In the case in question, this means following the recommendations given above, particularly about washing hands thoroughly and limiting exposure to large crowds or public places, if possible. In terms of travel, use what Marcus Aurelius called your "ruling faculty" -- that is, reason -- and don't travel at all unless absolutely necessary. It is useful to keep in mind what the Stoics call the dichotomy of control:

"Some things are within our power, while others are not. Within our power are opinion, motivation, desire, aversion, and, in a word, whatever is of our own doing; not within our power are our body, our property, reputation, office, and, in a word, whatever is not of our own doing." (Epictetus, Enchiridion 1.1)

In modern language, this means that the only things that are really up to you are your considered judgments and your decisions to act or not to act. Everything else, ultimately, depends on external factors, and the only rational attitude toward those is to accept the notion that sometimes things in life go our way, at other times they don't, despite our best efforts.

The (Stoic) ethics of COVID-19. Finally, what does the above mean from an ethical perspective? As Stoics, we are cosmopolitan, which implies that we should be concerned for all members of the human cosmopolis. In practice, this means that, for instance, we shouldn't hoard medical grade masks (or anything else, really) that we don't need, as this may cause a shortage that may affect those who do need them -- mostly health care workers.

It's also incumbent on us not to expose others to the virus. So we have an ethical duty not to go to work, if we are sick. We moreover have an obligation to help others reason, and not panic, about what is going on. And it would be consistent with Stoic virtue, I think, to donate money to organizations that help combating the epidemics (food pantries, for instance), especially in countries that are soon likely to be hit and have insufficient medical resources, like many places in Africa.

What if, after all of this, we are actually struck by the virus? In that case, we of course will follow all recommended medical procedures. But we will also keep in mind the dichotomy of control: our considered judgments and our decisions to act or not to act are up to us, but outcomes are not. That includes, of course, health outcomes.

Even when sick, we should treat others kindly, particularly our caretakers, like doctors, nurses, etc. After all, they are there to help us, and they are doing a very stressful job. More broadly, however, it is precisely when circumstances are dire that we get to exercise our virtue. And a possible pandemic is most definitely a dire circumstance. 

As the the situation progresses, we also have to face the possibility that there will be additional shortages, hardship, and deaths. Including of loved ones. Death, for the Stoics, is a natural and inevitable occurrence, and moreover, there is no such thing as "premature" death: we depart whenever the cosmic web of cause-effect has determined it, not a minute too soon nor one too late. The Stoic literature is rich on this topic. You can read much of Marcus Aurelius' Meditations as a reflection on impermanence and how to best relate to it. Several letters that Seneca wrote to his friend Lucilius tackle the same issue, and he wrote three separate letters of consolation, two of which -- to his friends Marcia and Polybius -- were aimed at comforting for the loss of a loved one.

The Stoic take on death itself is similar to the Epicurean one:

"He who fears death fears either the loss of sensation or a different kind of sensation. But if you shall have no sensation, neither will you feel any harm; and if you will acquire another kind of sensation, you will be a different kind of living being and you will not cease to live." (Marcus Aurelius, Meditations 8.58)

Stoics even deploy a sense of humor to deal with the prospect:

"Death is necessary and cannot be avoided. I mean, where am I going to go to get away from it?" (Epictetus, Discourses 1.17.7)

Yet, precisely because death is the norm, and may arrive at any moment, Stoics focus on the here and now, and particularly on appreciating what they have, and the people they love. It's the most meaningful thing we can do as human beings, and let the rest be as it may. This isn't nihilism or defeatism: it's an attitude that requires the courage to look at things as they are, as well as the wisdom to appreciate and enjoy what we have, while we have it.

COVID-19 will not be a civilization-ending event. Though even at that level the Stoics were somberly realistic. Subscribing to what today is known as process metaphysics, an approach that began with the Pre-Socratic philosopher Heraclitus, they understood that change is the inevitable norm in the universe. The world will look different after the current pandemic. But not unrecognizably so. And our task is going to be to rebuild it and make it better than it was before.

In the end, as Seneca puts it:

"The storm does not interfere with the pilot’s work, but only with his success. ... It is indeed so far from hindering the pilot’s art that it even exhibits the art; for anyone, in the words of the proverb, is a pilot on a calm sea." (Letters to Lucilius, 85.33)
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