A little over a year ago, Rochelle Walensky—then a professor of medicine at Harvard Medical School, now the director of the Centers for Disease Control and Prevention (CDC)—gave an interview to WBUR in which she noted the purported successes of lockdown policies in authoritarian countries.
"To give you a sense of what lockdowns were able to do in other countries—and, I mean, really strict lockdowns—in China, their death rate is three per million," she said, lamenting that the death rates in comparatively lax Sweden and the U.S. were much higher.
Whether China's "really strict" lockdowns can truly be deemed a success largely depends on whether that government's reported COVID-19 cases and death totals are accurate—an important question, given how much the Chinese Communist Party has already lied about the pandemic—and whether it will ever be possible to relax them. More than a year after Walensky sounded an admiring note, China's pandemic authoritarianism is still in full-swing; despite sporadic shutdowns of entire cities, the country has not completely stamped out of the coronavirus. Dozens of new cases are reported everyday, and again, it's difficult to say if those numbers represent undercounts. At every stage of the pandemic, Chinese government officials have misled their own citizens, and indeed, the rest of the planet, about the virus.
But even if China does have COVID-19 under control, harsh pandemic mitigation measures exact a steep price in return. One Chinese town bordering Myanmar was recently locked down by the government, and what followed was brutally repressive:
Residents left starving inside makeshift quarantine centers fashioned out of shipping containers. Businesses forbidden from selling goods – even online. A baby reportedly tested for COVID 74 times.
Earlier this year, his wife went to work one morning, only to be forced to find somewhere else to stay for a 45-day quarantine after the city district was sealed off because of a handful of cases discovered nearby. She was rounded up and told to shelter in place, with no date of release and no regular supply of food. Wang says he was finally able to get her out by asking a well-connected friend to bring her to a hospital on medical grounds, after which she did another two week hotel quarantine before being allowed to return home.
Yet despite the anger in Ruili, most people in China support the country's strict pandemic prevention policies, despite their huge economic cost and the risk of being suddenly quarantined or tested during frequent contact-tracing investigations. Local governments are under enormous pressure to ensure no infections crop up; officials who fail are often publicly shamed and fired.
People unlucky enough to test positive or — more commonly — cross paths with a close contact can find themselves ensnared in successive and expensive quarantines. Others have found themselves stuck in limbo, unable to leave cities under lockdown, including Ruili, and also banned from returning to their hometowns.
As Reason's Eric Boehm noted, China is hardly an exception in this regard: The quest for covid zero has steered many countries down the path of illiberalism and oppression. "More than 20 percent of countries have used their militaries to enforce COVID controls," wrote Boehm, citing a new report from the International Institute for Democracy and Electoral Assistance. "According to the report, 69 countries have made violating COVID restrictions an imprisonable offense, with two-thirds of those countries being ones the group considers to be democracies. Albania and Mexico have the most punitive laws on the books, allowing prison sentences of 15 years and 12 years, respectively, for violating pandemic-related protocols."
When health officials like Walensky fantasize about what they could do if the U.S. government was just a bit less constrained by civil liberties protections and human rights law, it is these repressive regimes that they seek to emulate.
But tellingly, this kind fantasizing only ever seems to run in one direction—toward bigger and more powerful government. Here's a question: Does Walensky ever fantasize about how the U.S. coronavirus response have been improved by a government that was smaller and more constrained? Because there's a good argument to be made that less authoritarianism and central control would mean fewer Americans dying of COVID-19.
Nothing illustrates this point better than the Food and Drug Administration's failure to immediately approve Paxlovid, Pfizer's pill-form COVID-19 therapeutic, which may reduce the risk of death by a whopping 89 percent. Substack writer Scott Alexander notes that prediction markets believe the FDA will approve the drug somewhere between January and March. For the FDA, this is remarkably fast—but it still means that thousands of people will die needlessly between now and the date that the drug is approved. If the FDA would get out of the way, people could take the drug much sooner, and lives would be saved.
"It's pretty weird that the FDA agrees Paxlovid is so great that it's unethical to study it further because it would be unconscionable to design a study with a no-Paxlovid control group—but also, the FDA has not approved Paxlovid, it remains illegal, and nobody is allowed to use it," wrote Alexander. "One would hope this is because the FDA plans to approve Paxlovid immediately. But the prediction market expects it to take six weeks— during which time we expect about 50,000 more Americans to die of COVID."
These delays are costly but hardly surprising; after all, the FDA has repeatedly failed to approve COVID-19 tests that would doubtlessly save lives if the government would make it legal for Americans to purchase them.
"Companies trying to get the Food and Drug Administration's approval for rapid COVID-19 tests describe an arbitrary, opaque process that meanders on, sometimes long after their products have been approved in other countries that prioritize accessibility and affordability over perfect accuracy," wrote Lydia DePillis and Eric Umansky in ProPublica.
It gets worse:
The FDA reviewer who quit this May described what the delays looked like from the inside. With a background in virology, he could evaluate the hundreds of pages in an application within a few days. But then, something strange happened: The applications would go nowhere for months as higher-up officials seemed paralyzed by indecision.
"I could easily process dozens of them, but I ended up with one or two in my queue constantly. They would stay there forever," he said. "I had a lot of free time."
His experience is reflected in an outside review of the EUA process conducted by the consulting firm Booz Allen Hamilton, which found that the median number of days it took the FDA to issue a decision on original applications rose to 99 in November 2020 from 29 the previous April, with denials taking substantially longer than authorizations. The assessment also found "limited understanding in the test developer community on how to appropriately validate a diagnostic test."
Instead of waxing philosophical about what might have been possible if the U.S. government were less constrained, it would be nice if federal health bureaucrats conceded that the most ideal, pie-in-the-sky scenario is one in which their authority was more limited rather than less. If Walensky and her ilk care about saving lives, they should daydream about smaller government, not stricter lockdowns.