DISCLAIMER #1: As a front-line health care provider, I stand a significantly increased risk of illness and death from COVID-19.
DISCLAIMER #2: My wife, also a health care provider, has an immunodeficiency. She faces an even higher risk of illness and death from COVID-19, which she would most likely contract from me.
 
I read with interest Woody White’s Op-Ed on Monday. I had just returned home to Wilmington from a 48-hour shift as a pediatric hospital physician, and I found his perspective profoundly at odds with my experience. Woody and I share a passion for the work of Duke University’s Daniel Kahneman, who, along with his late research partner Amos Tversky, defined much of what we know about how natural human biases cause us to make decisions in the short term that can lead to disastrous consequences down the road. Everything I know as a physician tells me that we are already making such decisions, and we risk making more of them without swift and concerted action.
 
Mr. White opens with two disclaimers that students of debate will instantly recognize as an “appeal to ignorance”: Since we can’t know everything about X, can we really know anything about it? Indeed we do not know exactly what the future holds, but we do know what the present holds, and we have the power now to change that future.
 
Right now we face a virus that, left unchecked, infects two to three people for every one person who carries it. On average, people spread that virus to others for five days before the first symptoms emerge, and those symptoms can be subtle enough to go undetected. (The most obvious symptom, fever, is present in fewer than half of patients at admission.) The United States is following the typical infectious curve, with the number of infections doubling every two to three days. Now, while we have enough health care workers and ICU beds, around one in every 100 infected people dies. When those workers start falling ill and the ICU’s fill up, that number grows to 1 in 50, 1 in 33 or higher.
 
We now know that those who get sick are not just the elderly or those with underlying conditions like my wife. They include healthy young people as well, even the infants and children that I treat. This is not someone else’s problem; it belongs to us all.
 
We face the sort of calculus that Daniel Kahneman studies. Every time you come within 6 feet of a new person, every time you touch a new doorknob, you increase the risk that you, your loved ones, your friends, and your neighbors will die. Students of ethics and fans of The Good Place know this conundrum as the Trolley Problem.
 
In the classic thought experiment, you must decide whether to save five passengers on a runaway trolley car by diverting it, mowing down one track worker. Here, now, in real life we are choosing how many people have to sacrifice convenience, well-being and financial security in order to save others and themselves. The calculus is not simple: In the United States our weak social safety net means that financial hardship itself has direct, measurable effects on lifespan, increasing the risk of illness and death. Neither I nor Mr. White is a professional health care economist, but I do know that the virus is here now, and lawmakers are currently debating strategies to blunt the economic impact of this disaster.
 
Kahneman also tells us what will happen if we leave people to their own devices – i.e. failing to close schools, shutter stores and restrict beach access. Kahneman won the Nobel Prize for quantifying how people value immediate gratification over future gains and losses. This natural human tendency is why so many of us don’t save enough for retirement or smoke or drink or gamble. What might happen in a week or a month or a decade pales when confronted with what we want right now. We don’t imagine that one day will also be “right now.”
 
If allowed, throngs of young people will return to crowd our beaches, first because the idea of becoming ill five-13 days later seems distant, and second because each of us feels like we’ll be the exception, not the rule, even more so when we are young. If allowed, a certain percentage of the population will crowd stores and restaurants, sit cheek by jowl at bars and breathe on each other at concert venues and houses of worship. What makes us human, what builds and sustains our society, is our instinct to gather and bond. Without external measures in place, many of us will value short term gain over long term loss.
 
What we need is time. My kids are out of their jobs serving coffee and sushi. We are cut off from our friends, our family, even basic supplies. We, too, have retirement accounts that look dismal right now. Hope is on the horizon: Scientists, including one of my own family members, are working around the clock to develop vaccines, medications and improved testing that will help us bend this curve and return to the lives we all miss. But tomorrow morning at 5 a.m. I will put my scrubs back on and walk through a screening station and back into the hospital, hoping that I have enough respirators, face shields and gowns to make it through the shift, praying that I don’t bring home a particle on my hands, my clothes or my breath that leaves me a widower. We all pulled together for 9/11. We all buckle down for hurricanes. We can do this, and we must. If not for me and my wife, then for the 86-year-old Daniel Kahneman.
 
David L. Hill, MD, FAAP lives in Wilmington with his wife, Christy Scott Hill, PA-C and five children. He works as a pediatric hospitalist in Goldsboro and in Wilmington.

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