Thursday, May 28, 2020

Does the Evolution of SARS-CoV-2 by Natural Selection Depend on Intelligent Design?

A Colorized Electron Microscopic Image of the SARS-CoV-2 Virus (in Red) Attacking a Human Cell (in Green)

Was the SARS-CoV-2 virus responsible for the COVID-19 pandemic intelligently designed--by either a human or a divine genetic engineer?  Or did it evolve by natural selection working on chance variation without any intelligent design?  Or should it rather be understood as a virus that evolved by natural selection but parasitically dependent upon the divine intelligent design of its animal hosts--bats and humans?  

And how does this influence our moral judgment?  If this pathogenic virus was created by an intelligent designer, can we rightly blame its designer--either human or divine--for the suffering of its human victims?  If it was created not by design but only by natural evolution, blaming a dumb virus for harming us makes no sense, but can we still judge it to be a bad virus that is very good at infecting us to achieve its parasitic reproduction of its progeny though our cells?  

Or should we blame ourselves for this bad virus because the Bible teaches us that it is a consequence of the Fall of Adam and Eve, whose sin in disobeying their Creator provoked his Curse on them and their world so that all of humanity would have to suffer and die until their redemption by Christ and resurrection in the afterlife to eternal life in Heaven?  If this is so, can we still rightly use any natural means available to us to understand and fight against this virus, while also praying to God for consolation in our suffering and perhaps even relief from the pandemic?  In doing this, is our scientific understanding of the pandemic contradictory to or compatible with our religious understanding of ourselves as sinful creatures longing for redemption by our Creator?  Should this pandemic remind us of our mortality and of our desire for immortality that can only be fulfilled through religious faith in resurrection to eternal life?  Or should this reminder of our mortality enhance our appreciation for our mortal earthly lives, as the only lives we will ever live, in which "death is the mother of beauty"?

Oh, I know what you're thinking--too many questions that I cannot possibly answer in any fully satisfactory way.  Of course, you're right.  But knucklehead that I am, I'm plunging ahead anyway.


The virus that has caused the COVID-19 pandemic has been identified by virologists as SARS-CoV-2--a strain or variety of the species severe acute respiratory syndrome (SARS) coronavirus, belonging to the genus Betacoronavirus and the family Coronaviridae (Gorbalenya et al. 2020).  The term coronavirus was originally coined because there are spike proteins protruding out of the surface of the virus so that as pictured through an electron microscope, the virus seems to have a "corona" like the Sun.

SARS-CoV-2 is the seventh coronavirus known to infect humans.  A previously identified strain of this same species is SARS-CoV, which is the virus that caused the SARS pandemic in 2003.  A closely related virus is MERS-CoV, the strain of the Middle East respiratory syndrome (MERS)-related coronavirus species that caused the MERS epidemic in 2012.  These three coronaviruses that cause severe disease all came from bats.  Of the four coronaviruses that cause common colds, two (OC43 and HKU1) come from rodents, and the other two (229E and NL63) come from bats.

One of the most popular conspiracy theories about the SARS-CoV-2 virus is that it originated not through natural evolution but through the human intelligent design of genetic engineers in a lab near Wuhan, China, who wanted it to be released in the United States so that it would cause a pandemic that would destroy Donald Trump's presidency and lead to his defeat by Joe Biden.  Other variations of this theory that the virus was genetically engineered come up with different sinister motivations for the conspirators--such as pharmaceutical companies that want to profit from selling vaccines and Bill Gates who wants to impose a global mandatory vaccination program on all of humanity.

Arguing against this assumption that this virus is the product of purposeful design, some virologists have compared the SARS-CoV-2 genome with the genomes of other closely related viruses, and they have concluded that the most plausible inference is that SARS-CoV-2 emerged through evolution by natural selection (Andersen et al. 2020).  Coronaviruses have single strands of RNA that carry their genetic information, and they can evolve quickly because not only do they mutate, they also recombine--when two distant coronavirus relatives are in the same cell, they can swap chunks of their RNA; and sometimes this recombination can create new versions of the RNA strand that can infect new cell types and jump to new species.

Recombination happens often in bats that carry many viruses known to infect humans.  The SARS-CoV-2 virus shares 96% of its RNA genetic material with a virus found in a bat in a cave in Yunnan, China, which suggests--although it does not prove--that this virus or some immediately ancestral virus came from bats.  The SARS-CoV-2 virus differs in one critical respect from this similar virus found in the rat.  The spike proteins of coronaviruses have a receptor-binding domain (RBD) that connects to the membrane of the host cell and allows the virus to enter the cell.  This is the key that unlocks the cell so that the virus can invade the cell and then hijack its metabolic machinery for reproducing new viruses that then break out of the cell for transmission to other host cells.  The SARS-CoV-2 virus has a particularly efficient binding domain adapted for entering human cells.  This binding domain differs in important ways from the binding domain of the Yunnan bat virus, which seems to be unable to infect humans.

A scaly anteater called the pangolin carries a coronavirus that has a receptor-binding domain almost identical to the RBD of the SARS-CoV-2 virus.  But the rest of this coronavirus in the pangolin is only 90% genetically similar to SARS-CoV-2.  So there is debate among virologists over whether the pangolin could have been the intermediary animal between bats and humans for the evolution of SARS-CoV-2.

So the SARS-CoV-2 virus might have evolved by natural selection in an animal host (a bat or a pangolin) before it jumped into a human.  Or an ancestor of this virus might have jumped into humans, and then it might have evolved into SARS-CoV-2 through adaptation to its human host cells.

It is unlikely that SARS-CoV-2 was designed in a lab by genetic engineering because its genome does not show any of the standard genetic tools used by genetic engineering scientists (Andersen et al. 2020).

Although it cannot be proven one way or the other, one can infer from this that the most plausible explanation for the SARS-CoV-2 virus is that it emerged not by human genetic engineering but by evolution through natural selection.

On his popular blog, P. Z. Myers--a self-described "godless liberal" who fervently defends Darwinian evolution against creationists and intelligent design proponents--has concluded:  "Sorry, conspiracy theorists.  The best explanation is evolution and natural selection, not Evil Intelligent Design."

Michael Egnor, an advocate of intelligent design theory affiliated with the Discovery Institute, responded to Myers' blog post by agreeing with him that evolution by natural selection can explain the origin of SARS-CoV-2.  But he also insisted that this shows the failure of Darwinian evolution as an explanation for the origin of living species.  He wrote:  "There is another lesson about design and evolution to be learned from scientific research on this virus.  Natural selection, if understood as undirected variation and differential reproductive success, is a destructive process.  Natural selection destroys biological functional complexity--it produces diseases, cancer, and pandemics.  It weakens and kills.  Natural selection does to living organisms what rust does to a machine.  Natural selection corrodes and destroys life, and plays no role in creating it."

Myers responded by claiming that Egnor was wrong about this: "Not for the virus, it wasn't a destructive process.  What was undergoing natural selection here was the virus, not us, and it has acquired attributes that make it wildly successful--it is now colonizing vast fields of billions of human beings, producing uncountable numbers of progeny, infecting more people at an accelerating rate.  The virus is stronger and thriving thanks to those features, and doing very well thank you very much."  It is also possible, he observed, that natural selection could be working through the viral pandemic attack on human beings to make the human species more resistant to SARS-CoV-19, which would be a constructive process in improving the functional complexity of the human immune system.

Egnor responded by claiming that Myers fails to see how the evolution of SARS-CoV-2 by natural selection of chance variation presupposes the intelligent design of those animal species (bats and humans) that serve as hosts for this parasitic virus, which cannot be explained by undirected evolution.  It is not even clear that viruses are living beings, because unlike living species, viruses cannot reproduce themselves on their own.  They reproduce only by parasitically using the metabolic machinery of the living cells that they invade.  And if viruses are not alive, then the evolution of viruses through random mutation and differential reproduction does not show the evolution of life.  "The coronavirus's evolution--the pandemic--depends on the living specified complexity of humans and bats.  Intelligent design in nature is the prerequisite for all natural selection--nature without teleology would be chaos, and no evolution at all."

Egnor claimed that his point here was recognized by Aristotle.  "Aristotle saw this in his definition of chance in nature--chance is the accidental conjunction of purposeful events.  Without purpose there can e no chance.  His example is instructive: he considered a farmer who ploughs his field and by chance discovers a treasure buried by someone else.  The treasure is discovered by chance, but everything else--the farmer's ownership of the field, his decision to plough it, the accumulation and burial of the treasure by the other man--is purposeful, and in fact the only reason the accident of discovery happened is because it is embedded in a world of purpose.  Chance can't happen--the word has no meaning--in an entirely accident world.  Chance presupposes design."

Notice what Egnor does here: he jumps from claiming "intelligent design in nature" to Aristotle's account of human intelligent design.  Here he employs the sophistical technique that runs through the intelligent design rhetoric of the Discovery Institute--the fallacy of equivocation in conflating human intelligent design, which we know by ordinary experience, and divine intelligent design, which we do not know by ordinary experience.  I have written about this here and here.

Notice also that in saying that viruses show how "natural selection corrodes and destroys life and plays no role in creating it," Egnor ignores that fact that most viruses support life in mutualistic relationships with plants and animals.  So, for example, we know that viruses are part of the human microbiome in the human gut, and that some parts of the human genome originated from viruses.

Egnor also ignores the fact that even if viruses are not living, other infectious pathogens--such as bacteria, fungi, protozoa, and helminths (worms)--clearly are living things; and they evolve by natural selection just as viruses do.

Contrary to Egnor's argument, our explanation of the evolution of SARS-CoV-2 and other parasitic pathogens by natural selection does not depend upon any assumption of divine intelligent design.


Any scientific account of the COVID-19 pandemic must explain why the SARS-CoV-2 virus is so good at being a bad virus.

In the scientific writing, it is common to see it said that the SARS-CoV-2 virus is better than the SARS-CoV virus, because SARS-CoV-2 is much more effective than SARS-CoV in successfully infecting host cells (Cyranoski 2020).  SARS-CoV-2 is good at forcing entry into human cells because this virus has a receptor-binding domain that has evolved for a particularly snug fit with the membrane of human cells in the upper respiratory tract and the lungs.

But this good functional complexity of SARS-CoV-2 makes it a bad virus for us.  What's good for this parasitic virus is bad for its human hosts.

This manifests the general character of Darwinian ethics.  There is no cosmic good for all living beings, because what is good is relative to each species, and what is good for one species can be bad for other species.

It is possible, however, for different species to enter relationships of symbiotic accommodation in which one species cooperates with another for mutual benefit.  And so, for example, the viruses and bacteria in the human gut benefit themselves even as they benefit their human host.  In fact, the number of these viruses and bacteria in the human body exceed the number of human cells.  Walt Whitman was right: "I am large, I contain multitudes" (Yong 2016).

To see why SARS-CoV-2 is so good in causing a bad pandemic, one needs to follow the virus through the five steps in his invasion of human cells (Cyranoski 2020).

   An Electron Microscopic Image of  SARS-CoV-2 Viruses Showing the "Corona" of Spike Proteins

First, one of the virus's spike proteins has a special receptor binding domain that binds to a receptor enzyme on the surface of human cells, which is called angiotensin converting enzyme (ACE2).  This enzyme helps to regulate blood pressure, which is good for us, but it's bad for us when this enzyme is used by the virus as the first step in its invasion of our cells.

Second, furin or another enzyme on the surface of the human cell breaks the spike protein at one of its cleavage sites.

Third, this releases small chains of amino acids that fuse the viral membrane with the membrane of the human cell.

Fourth, the fusion of the membranes allows the virus's RNA to enter the human cell, where it hijacks cellular machinery to produce more viral RNA and proteins that are assembled into new viral particles.

Fifth, the new viral particles break out of the human cell, and these new particles can then either attack other cells or leave the body and infect other people.

While the four coronaviruses that cause common colds are most successful in attacking the upper respiratory tract, and the MERS-CoV and SARS-CoV viruses are most successful in attacking cells in the lungs, the SARS-CoV-2 viruses are good at doing both, which makes them more effectively infectious.  This might explain the differences in symptoms.  If the virus starts in our nose or throat, and does not go into the lungs, this might produce a cough and fever, but not much more.  If the virus gets into our lungs, the attack on our respiratory system might become more severe, and even kill some of us.

So, for these and other reasons, SARS-CoV-2 is good at being a bad virus.


Some of the scientists who are studying SARS-CoV-2 and looking for a way to fight it are Christians, who are also trying to understand how the Bible might explain the spiritual meaning of this virus and the pandemic that it has caused.  Perhaps the most prominent of these Christian scientists is Francis Collins.  As the Director of the U.S. National Institutes of Health, Collins is supervising most of the research studying the COVID-19 pandemic and looking for a vaccine.  He is famous as the former leader of the Human Genome Project.  He is also famous for arguing that natural science and religious faith are not in conflict, because science and faith can actually reinforce one another.  A critical part of his argument is that religious believers who reject Darwinian evolution as atheistic are mistaken, because Christians can accept the scientific truth of evolution while seeing natural evolution as God's way of carrying out His creative plan.  To promote this kind of thinking, he founded BioLogos as an organization defending the idea of "evolutionary creation."  Last week, Collins was honored as the 2020 Templeton Prize Laureate for promoting progress in religious thought through science.  (The Templeton Prize website has a lot of material on this.)

I have written a series of posts on Collins as a theistic evolutionist hereherehereherehereherehere, and here.

At BioLogos, there is a podcast with Collins on "Where Is God in a Pandemic?"  He says that he has been troubled by the old question as to why God permits evil and suffering--such as a pandemic.  He says he finds consolation in two Biblical verses.  Psalm 46:1-2 promises "God is our refuge and strength, a very present help in trouble.  Therefore will not we fear."  Joshua 1:9 commands: "Be strong and of good courage; be not afraid, neither be thou dismayed; for the Lord thy God is with thee."

Collins does not hold God responsible for the pandemic.  He does not suggest that God is using the pandemic to punish us.  Collins probably agrees with Jim Stump, Vice President at Biologos, on this point.  As I have indicated in a previous post, Stump argues that God does not intentionally design natural evils like viral pandemics, which actually arise as unavoidable side effects of the naturally good world that God has created.  Human life as we know it would be impossible without viruses.  Most viruses on Earth are infecting bacteria and thus slowing down their reproduction, so that rapidly reproducing bacteria do not overwhelm us.  But for viruses to do that, they must mutate rapidly, and that rapid mutation can sometimes create viruses--like SARS-CoV-2--that are dangerous to human beings.  Evolution creates trade-offs in which we have to take the bad with the good.

Collins and Stump reject the traditional way in which some Christians have solved the problem of natural evil by saying that it's a consequence of the Fall.  Adam and Eve were created by God to live in a naturally good world, free from death and suffering, but when they yielded to the temptation of the serpent in the Garden of Eden, they sinned, and God's curse on them for their sin included a curse on nature, so that human beings would henceforth suffer and die from natural threats to life, including deadly viruses.  In this way, the COVID-19 pandemic is God's punishment for our Original Sin inherited from Adam and Eve.

In this podcast, Gary Bates of Creation Ministries International asserts the literal truth of the Fall in Genesis 2 as the explanation of the COVID-19 pandemic.  Most viruses are beneficial for human beings, but some become bad, and this arises as a consequence of God's curse on Adam and Eve.

Although a scientific creationist like Bates (or Ken Ham) would disagree with theistic evolutionists like Collins and Stump on this point, they all agree that as Christians they can take consolation in their faith that they will be redeemed for eternal life after death, and therefore they need not be thrown into despair by the pandemic's reminder of human mortality.

They also agree that in responding to the pandemic, Christians should follow the guidance of the natural scientists--the virologists and epidemiologists--studying the pandemic.

They also agree that since Christians believe that all human beings are "created in the image of God," this gives ultimate value to every human life, and therefore the governmental orders for lockdowns for minimizing COVID-19 deaths must be obeyed, regardless of the catastrophic economic costs.  To engage in a cost-benefit moral analysis to see if the economic costs of the shutdown outweigh the health benefits would violate Christian morality.

But is that really true?  Shouldn't Christians be morally concerned about the devastating human costs of lockdowns--including the human lives that will be lost or ruined as a consequence of the global Great Depression caused by the lockdowns?


Andersen, Kristian, et al. 2020. "The Proximal Origin of SARS-CoV-2." Nature Medicine 26:450-52.

Cyranoski, David. 2020. "Profile of a Killer Virus: The Complex Biology Powering the Coronavirus Pandemic." Nature 581:22-26.

Gorbalenya, Alexander, et al. 2020. "The Species Severe acute respiratory syndrom-related coronavirus: Classifying 2019-nCoV and Naming It SARS-CoV-2."  Nature Microbiology 5:536-544.

Yong, Ed. 2016. I Contain Multitudes: The Microbes Within Us and a Grander View of Life. New York: HarperCollins Publishers.

Monday, May 25, 2020

The CDC Lowers Its Estimate of the COVID-19 Infection Fatality Rate

Two months ago--in the third week of March--Trump and many of the state governors ordered a mandatory lockdown of the U.S. economy, while Prime Minister Johnson did the same in the U.K.  They did this because they were persuaded by some epidemiological models that without such a lockdown there would be up to 2.2 million deaths from COVID-19 in the U.S. and 510,000 deaths in the U.K.  These estimated death rates were based on the assumption that COVID-19 would be at least as lethal as the 1918 flu pandemic.

In my posts in March and April, I argued that there were at least three problems with the reasoning for these lockdown policies.  First, the estimates of the infection fatality rate for COVID-19 were unreasonably high.  Second, the assumption that without a mandatory lockdown people would not voluntarily change their behavior to mitigate the pandemic was implausible.  Third, the people advocating the lockdown had not engaged in any ethical analysis that would weigh the likely human benefits of a lockdown against its likely human costs, and so they never considered the possibility that the costs of a lockdown might exceed its benefits.

Now, a few days ago, the CDC has issued a new statement of its "COVID-19 Pandemic Planning Scenarios."  This statement is silent about the second and third problems.  But it implicitly recognizes the first problem.  In March, Dr. Anthony Fauci testified to Congress that about 1% of the people infected with the SARS-CoV-2 virus could die.  At the same time, the Imperial College model in the U.K. estimated that 0.9% of those infected would die.  In the new statement from the CDC, however, the "best estimate" scenario assumes a symptomatic case fatality rate of 0.4%; and since it also assumes that over 35% of the people infected show no symptoms, the total number of infections must be more than 50% higher than the symptomatic cases, which implies an infected fatality rate of around 0.3%.

This 0.3% is an overall fatality rate.  The rate is much lower for younger people and much higher for older people.  The CDC estimates a symptomatic case fatality rate of 0.05 for people younger than 50, 0.2% for people between 50 and 64, and 1.3% for people over 65.  Most of the deaths have been among older people in poor health, particularly those in nursing homes.  This supports a policy of protecting older people with prior medical conditions while leaving all others more free to move around.

The higher estimates of the fatality rate in March predicted millions of Americans would die without a shutdown, the lower estimates today would say that hundreds of thousands might have died without a shutdown.

We also have evidence now confirming the second problem with the lockdown policy.  Studies using various kinds of "big data" show that people in the U.S. started to restrict their travel dramatically in early March to mitigate the pandemic, which began before the mandatory orders were in place.  Now, we have similar evidence that beginning in late April, people have been travelling more even before the state governors began loosening their lockdowns.

We can also see now that people are confronting the third problem--the failure to weigh the costs and benefits of mandatory lockdowns--because the move to lift the lockdowns implicitly recognizes that these lockdowns are unsustainable because their costs exceed their benefits.

The general lesson from all of this is that when people understand what kind of pandemic they are facing, their behavioral immune system will motivate them to spontaneously change their behavior in adaptive ways to mitigate the health costs of the pandemic through social distancing, while also securing the social benefits of freedom of movement.

Wednesday, May 20, 2020

COVID-19: How Bad Is It Today?

Many of us begin each day now by checking the latest numbers for the COVID-19 pandemic.  Today, it's reported that the total number of deaths worldwide is 322,483 and for the United States 91,921.  Some epidemiological models are predicting over 110,000 deaths for the U.S. by early June.  Dr. Fauci has predicted the final number of deaths for the U.S. could approach 200,000.

Those are disturbing numbers.  But the obvious question is: Compared with what?

In 2017, 50 million people died around the world.  The leading causes of death were cardiovascular diseases (17.80 million) and cancers (9.56 million).  Other causes included road injuries (1.24 million), suicide (800,000), homicide (400,000), and drowning (295,000).  Compared with these numbers, the numbers of deaths from COVID-19 don't seem so shocking.  Instead of worrying about the SARS-CoV-2 virus, I should be worried about dying in a car accident every time I drive to the grocery store.

But then maybe the appropriate comparison is with death rates for infectious diseases.  For most of human history, infectious disease was the leading cause of death.  Only in the last 100 years, have the degenerative diseases taken the lead, as the death rate for infectious disease has fallen dramatically (at least for the developed countries).  Nevertheless, even when infectious diseases are not the leading cause of death, they can still be shockingly deadly when their outbreaks become severe.

So how does COVID-19 compare with other pandemics and epidemics over the past 100 years?

The yearly death rate worldwide for a typical seasonal flu ranges from 290,000 to 650,000.  In 2017-2018, the U.S. had a high severity season in which over 80,000 people died from the flu.  So, clearly, COVID-19 is going to be worse than a typical seasonal flu.

The worst flu pandemic was the H1NI flu outbreak in 1918-1920, which killed 20-50 million people around the world and about 675,000 in the U.S.  The equivalent death toll today for the U.S. as a proportion of the population would be 2,145,000.  There is no reason to believe that the deaths from COVID-19 will be anywhere close to that.

In 1957-1958, the Asian Flu pandemic killed 1.5 million people worldwide and 116,000 in the U.S.  The equivalent numbers as a proportion of the population today would be 3.9 million deaths worldwide and 220,430 deaths in the U.S.  It seems unlikely that COVID-19 will surpass those numbers.

In 1968-1969, the Hong Kong Flu pandemic killed over 1 million people worldwide and over 100,000 in the U.S.  The equivalent numbers today would be 2.2 million worldwide and 164,500 in the U.S.  It seems possible that the death toll for COVID-19 could surpass that number for the U.S.

In 2009-2010, the Swine Flu pandemic (caused by a new strain of the H1N1 flu virus) killed about 280,000 people worldwide and about 13,000 in the U.S.  COVID-19 is much deadlier than that.

Although COVID-19 is often said to be "unprecedented," these numbers show that previous pandemics of infectious disease have been at least as deadly and in some cases much more deadly than COVID-19.  It is surely "unprecedented," however, in one respect--in that the shutdown of all "non-essential" social and economic activity has never been done before.  In these other pandemics, some schools, factories, and workplaces were shut down temporarily, and sick people were expected to quarantine themselves in their homes, but there was no general governmentally mandated shutdown like that initiated in March and April.

Previously, it had always been assumed that the human costs of such a shutdown would far exceed the human benefits for controlling a pandemic.  Do we have any reason to believe that this assumption was mistaken?  Has anyone proven that the likely benefits of such a shutdown to mitigate the COVID-19 pandemic are much greater than the likely costs?

As I have indicated in a previous post, I can't find any evidence that anyone has actually tried to perform such a cost-benefit analysis in any rigorous way.

Isn't it incomprehensible that we have decided to intentionally create a global Great Depression that will devastate human life without weighing the likely human suffering this will bring?


In his comment on this post, Roger Sweeny has made a good point--that the COVID-19 death numbers in the United States are probably more reliable than the flu death numbers, because the flu death numbers are only statistical estimates by the CDC, and the experience of doctors suggests that far fewer people die from seasonal flu than is reported by the CDC.  If this is true, then there is no comparison between flu deaths and COVID-19 deaths, because COVID-19 is much more deadlier.

The CDC's guidelines for certifying deaths due to COVID-19 look rigorous to me.  In filling out death certificates, doctors and coroners must distinguish between the "cause of death" (Part 1) and "significant conditions contributing to death" (Part 2).  And under Part 1, they must begin with the "immediate cause" and then move back through the list of conditions leading to that cause ending with the "underlying cause"--the disease or injury that initiated the events resulting in death.  So, to certify a death due to COVID-19, this must be identified as the underlying cause.

Here is one of the hypothetical scenarios presented in the CDC guidelines:
"A 77-year-old male with a 10-year history of hypertension and chronic obstructive pulmonary disease (COPD) presented to a local emergency department complaining of 4 days of fever, cough, and increasing shortness of breath.  He reported recent exposure to a neighbor with flu-like symptoms.  He stated that his wheezing was not improving with his usual bronchodilator therapy.  Upon examination, he was febrile, hypoxic, and in moderate respiratory distress.  His chest x-ray demonstrated hyperinflation and his arterial blood gas was consistent with severe respiratory acidosis.  Testing of respoiratory specimens indicated COVID-19.  He was admitted to the ICU and despite aggressive treatment, he developed worsening respiratory acidosis and sustained cardiac arrest on day 3 of admission."
"In this case, the acute respiratory acidosis was the immediate cause of death, so it was reported on line a.  Acute respiratory acidosis was precipitated by the COVID-19 infection, which was reported below it on line b, in Part 1.  The COPD and hypertension were contributing causes but were not a part of the causal sequence in Part 1, so those conditions were reported in Part 2."
In some cases, COVID-19 can only be identified as the "probable" underlying cause:
"In cases where a definite diagnosis of COVID-19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report a COVID-19 on a death certificate as 'probable' or 'presumed.' In these instances, certifiers should use their best clinical judgment in determining if a COVID-19 infection was likely.  However, please note that testing for COVID-19 should be conducted whenever possible."
There have been reports--broadcast by Fox News--that hospitals and doctors are fraudulently inflating the numbers of COVID-19 cases and deaths because of the financial incentives from Medicare--$13,000 for every COVID-19 patient and $39,000 for every COVID-19 patient on a ventilator.  Although there might be some cases of such fraud, it's unlikely to be widespread because there are severe penalties for deceptively "upcoding" patients to increase Medicare payments.

Sunday, May 10, 2020

The Darwinian Moral Dilemmas of Infection-Avoidance Behavior in Humans and Other Animals

Shelley Luther was fined and sentenced to seven days in jail when she opened her hair salon in Dallas, which violated Governor Greg Abbott's COVID-19 lockdown orders.  The judge who sentenced her told her that she was selfish for putting her self-interest ahead of the public good.  She responded that she was not being selfish in opening her salon so that she could feed her children, and that her employees also needed to work to be able to afford food for their children.  In response to the public outrage over her punishment, Governor Abbott revised his orders, so that incarceration would not be a punishment for violating his orders.  Recently, he has loosened the lockdown so that hair salons can open.

This illustrates the Darwinian moral dilemmas that arise when animals fighting against infectious diseases face a trade-off between their need for social distancing and their need for social interaction.

As shaped by Darwinian evolution, animals have two distinct systems for defending themselves against infectious diseases.  One is the physiological immune system of the body that detects pathogenic organisms (bacteria, viruses, fungi, and protozoa) that have invaded the body and then targets them for destruction or mitigation.

The other is the behavioral immune system that includes those behavioral strategies by which animals attempt to prevent infectious pathogens from invading their bodies (Schaller 2016).  One of those behavioral strategies is social distancing: social animals who can be infected by social contact with infected individuals can protect themselves by avoiding contact with those individuals who appear to be infected.  But as social animals who naturally benefit from social interaction, social distancing creates a dilemma in which the animal must weigh the health benefits of avoiding infection against the social costs of being isolated from others.  That's the Darwinian evolutionary explanation for the moral debate we are now having over the COVID-19 lockdown.

Humans are not the only animals who engage in social distancing to avoid infectious diseases (Curtis 2014; Hawley and Buck 2020).  Since social insects are densely packed into large colonies, it is easy for contagious diseases to spread through a colony.  When this happens, ants change their behavior to slow the transmission of the disease.  Among some ant colonies, the older ants are assigned to risky jobs foraging outside the nest, while the younger ants stay inside the nest to care for the queen who lays all the eggs and for the developing brood.  If foraging individuals become sick from a fungal infection, they spend more time outside the nest, thus self-isolating themselves, and the indoor workers move the brood farther inside the nest so that they are far away from the foragers (Stroeymeyt et al. 2018).

Bullfrog tadpoles do not swim with other tadpoles that have been parasitized (Kiesecker et al. 1999).  Social lobsters do not share their dens with lobsters infected with a deadly virus (Behringer et al. 2006).  And olive baboons refuse to mate with partners infected by a sexually transmitted virus (Pacienca et al. 2019).

Sometimes animals must balance the need for social distancing against the need for social interaction.  Healthy vampire bats will not groom sick bats, but they will continue to share their food with the sick bats.  It's as though food-sharing is an essential service that must be maintained even when there's a risk of spreading infectious disease.  Moreover, bat mothers are inclined to care for their sick offspring, so that parental care outweighs social distancing (Stockmaier et al. 2020).  Similarly, among mandrills (a kind of monkey found in the African rainforest), healthy individuals will care for their sick family members, but they will avoid sick individuals unrelated to them (Poirotte et al. 2020).

Some animals are so tightly bound to one another in their social lives that they find social distancing too costly, even when it might protect them from infectious diseases.  So, for instance, among the highly social banded mongooses, there is no avoidance of diseased individuals (Fairbanks, Hawley, and Alexander 2015).

We too are such intensely social animals that we cannot flourish--we cannot satisfy our deepest natural desires--without social interaction with our families, our friends, and our larger community of associates.  For that reason, the COVID-19 lockdowns around the world will provoke a natural resistance from people claiming their natural rights to life and liberty.


Behringer, D.C., M.J. Butler, and J.D. Shields. 2006. "Avoidance of Disease by Social Lobsters." Nature 441: 421.

Curtis, Valerie A. 2014. "Infection-Avoidance Behaviour in Humans and Other Animals."  Trends in Immunology 35: 457-464.

Fairbanks, Bonnie, Dana Hawley, and Kathleen Alexander. 2015. "No Evidence for Avoidance of Visibly Diseased Conspecifics in the Highly Social Banded Mongoose (Mungos mungo)." Behavioral Ecology and Sociobiology 69: 371-381.

Hawley, Dana, and Julia Buck. 2020. "Social Distancing Works--Just Ask Lobsters, Ants, and Vampire Bats." The Conversation, April 3.

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Tuesday, May 05, 2020

COVID-19 Shutdowns By Consent of the Governed? David Hume's Maxim

How do we explain the amazing events of the past eight weeks?  Billions of human beings on planet Earth have been locked in their homes, as much of their social and economic life has been shut down, by orders from their rulers, in response to the COVID-19 pandemic.  Now many people in some parts of the world are beginning to show some freedom of movement, trying to return to a more normal life, but with warnings from governmental experts that such free movement will spread viral infections and elevate the death toll.

David Hume offered one way to explain this, in the first paragraph of his essay "Of the First Principles of Government":
"Nothing appears more surprising to those, who consider human affairs with a philosophical eye, than the easiness with which the many are governed by the few; and the implicit submission, with which men resign their own sentiments and passions to those of their rulers.  When we enquire by what means this wonder is effected, we shall find, that, as FORCE is always on the side of the governed, the governors have nothing to support them but opinion.  It is therefore, on opinion only that government is founded; and this maxim extends to the most despotic and most military governments, as well as to the most free and popular.  The sultan of EGYPT, or the emperor of ROME, might drive his harmless subjects, like brute beasts, against their sentiments and inclination: But he must, at least, have led his mamalukes, or praetorian bands, like men, by their opinion."
Hume's maxim that "the governors have nothing to support them but opinion" sounds like John Locke's claim that governmental authority arises from the consent of the governed, or the argument of Michael Tomasello and John Searle that the social reality of institutions depends on our subjective belief that institutions are authoritative.  (I have written about that here.)

Political rulers cannot govern their people by force alone, because they depend upon the voluntary obedience of the people or at least acquiescence to their orders.  "Force is always on the side of the governed," in the sense that if most of the people in a political order resisted the commands of their rulers, the political order would collapse.  Even despots or military dictators cannot rule by brute force if they do not have the support of some crucial social groups, or "minimum winning coalitions," which I have written about here.

We can see Hume's maxim confirmed by what has happened with the COVID-19 shutdowns.  Governments have commanded shutdowns by executive orders.  In the United States, these orders have come mostly from state governors, following guidelines from Trump's White House and federal agencies (like the CDC).  But all of this depends on the voluntary obedience of the people; and as I have argued in earlier posts, the shutdowns will end when people refuse to obey them.

We now have the big data about the patterns of human movement--from Foursquare and Apple--that show this.  Requests for directions in Apple Maps began to decline dramatically in early March, even before the governmental lockdown orders, because once people heard about the COVID-19 pandemic, they decided voluntarily that staying at home and social distancing were prudent behaviors to minimize the spread of infections.  But then, beginning in early or mid-April, people in some countries (particularly, the United States and Germany) have decided to travel more, even if  this meant disregarding the governmental orders.

For example, in my home state of Michigan, Governor Gretchen Whitmer imposed some of the most severe restrictions on travel--even prohibiting people from travelling to visit family and friends.  But if you go to the data for Michigan provided by Apple, you will see the Michiganders began increasing their travel in April, disobeying the Governor's orders.  Last Sunday, I saw over 40 of my neighbors gathering for a church service in violation of the Governor's order that in-person church services are illegal.  She cannot enforce her orders.

The data collected by Foursquare shows the same pattern in shopping and social movement.  In early March, there was a steep drop in trips to casual dining chains, bars, movie theatres, and gyms, and there hasn't been much movement yet to return to pre-COVID-19 levels.   But travel to gas stations, auto shops, big box stores, and discount stores is back up to normal levels.  During this same time--March and April--there was an increase in visits to hardware stores to buy paint, lawn, and gardening supplies, because people have decided to spend their time working around the house and gardening.

The Foursquare data show regional differences in these patterns of movement--people in rural areas and in the Midwest are moving more quickly out of the lockdowns than are those in urban areas and in the West and Northeast.  Here we see what Friedrich Hayek identified as local knowledge--in deciding how to adapt their social interactions to the contingencies of time and circumstance, people spontaneously generate patterns of behavior that are best for them, without any central planning from government, which lacks the knowledge that is dispersed among millions of people facing their unique and variable circumstances of action.

So in this way, deciding how best to adapt our behavior to the challenges of a viral pandemic arises more from the bottom-up interactions of individuals acting for their interests than from the top-down dictates of central planners in government.  The influence of central planners in this evolutionary process of adaptive behavior comes more from persuasion than from coercion.  In this case, the public health bureaucrats can tell us what they think they know about the SARS-Cov-2 virus--how it spreads, its virulence, and which groups are most at risk of being killed by it--and they can make recommendations about how best to fight the virus.  But their influence will depend on how successful they are in persuading us to voluntarily comply with their advice.

Because these governmental experts--even when they are backed up with mandatory orders from political executives--cannot succeed unless they win our voluntary consent.

"The governors have nothing to support them but opinion."