[CN: Death and suffering. Crossposted from Facebook.]
As the flow of coronavirus death stories in the UK has gradually increased over the past month, I've been trying to make some positive use of the identifiable victim effect: looking at the faces, feeling how sorry I am for those people and their families, and trying to generalise that empathy to the rest of the world.
So many people are already suffering and dying because of this virus. So many more will suffer and die around the world before this is over. The burden of this disease will be vast. The burden of all the things we're doing to reduce that first burden may be vaster still.
I will never know or even vaguely imagine most of the people this crisis will touch. Most of them will be far away from me, in developing countries with fragile healthcare systems and poor reporting. Most will be old, or sick, but even among the young and healthy the number of the dead and (possibly) disabled will be large. And they won't be gentle deaths, either, especially in the absence of modern medical care; there are worse ways to die, but there are also far better ones.
To all the victims of this disaster that I will never meet: I am so, so sorry this happened to you. I am so sorry we, collectively, were too late when you needed us, that we are still so exposed to the boundless viciousness of nature.
I am planning to spend most of my time over the next few months working on things other than the current emergency, because there are other, worse, future emergencies I want to help avert. And even now, in the midst of this crisis, there are still things in the world I suspect cause even more death and suffering than the coronavirus will. But that doesn't make what's happening now any less monstrous.
[Epistemic status: fairly speculative. Practicing throwing out less-polished ideas as shortform. Might tidy up and promote this to a frontpage post in the future.]
I'm hardly the first to note that COVID-19 is a disease of ageing: from the beginning of the outbreak it's been clear that older people were dramatically more likely to experience severe illness or die as a result of infection, while death rates among under-30s have been extremely low. In an important sense, COVID-19 falls into the same category as cancer, heart disease, and dementia: a symptom of ageing, which is currently treated independently, but which in the longer term could be much more efficiently treated by tackling ageing itself.
The same observation can be generalised to respiratory diseases more generally, and (less strongly) to infectious diseases as a whole. Seasonal influenza is overwhelmingly an affliction of older people, with >90% of fatalities occurring in individuals over 65. The original SARS outbreak showed a similar age-skewing to the current pandemic (though with higher CFRs across the board), with <1% mortality among cases under 24 years old and >55% mortality in over-65s. Case fatality rates in adults increase with age for ebola, tuberculosis, and most other disease you might want to check. As a general rule, if a disease is novel (i.e. there is no acquired immunity in the population), older adults who catch it will fare much worse. This isn't surprising: older people have weaker and less adaptable immune systems than young adults and show much higher general frailty.
I'm interested in whether this phenomenon provides a good additional argument for anti-ageing research as a long-termist cause area. In general, the healthier and more robust the population is, the less we have to fear from catastrophic pandemics. Of course, a truly existential pandemic would kill the young as well as the old: trivially, for a pandemic to kill everyone, it must kill young people. But I'd expect that many sub-extinction catastrophic pandemics would kill a much higher proportion of older adults than younger ones. Since our population is ageing, this will only become a bigger and bigger problem with time.
The worse a pandemic is, the bigger we can expect its effects to be on society. COVID-19, a much milder disease than a hypothetical GCBR, has already caused huge changes and is widely expected to leave long-lasting effects on politics and policy; effects that would almost certainly never have happened in the absence of ageing. The dislocation caused by a worse pandemic could be far more drastic. If anti-ageing reduced a future biological catastrophe to "only" COVID-19 levels that would be a big win. Generalising from this, ending ageing could act as an important "anti-risk factor", turning borderline existential biological risks into non-existential GCBRs and borderline GCBRs into "mere catastrophes".
Similar (but shakier) arguments can be made about some other kinds of catastrophe: if any sort of physical health and endurance is required at a population level to survive them and avoid large negative trajectory changes, ending ageing could be very helpful.
I'm not claiming this in itself would be sufficient to justify the huge research expense required to defeat ageing; many pandemics would probably not be as age-skewed as COVID-19, and if our only goal were to defeat pandemics then broad-spectrum antivirals etc. would be more obvious low-hanging fruit to pick. But I think it might militate towards being substantially more favourable to anti-ageing research, from a long-termist perspective, than one otherwise would be.
Obviously, in another important sense COVID-19 is very different: unlike, say, heart disease, COVID-19 has a single, clear, exogenous cause which can be effectively fought with a variety of short-term measures like social distancing. It would be silly to suggest we attack COVID-19 with anti-ageing research in the short term; my claim is that, over the span of decades required to do so, solving ageing would dramatically cut the death toll from both endemic and emerging respiratory diseases. ↩︎
More generally, the reference class of "pandemics similar to COVID-19" falls into this category. ↩︎
The stand-out exception to this trend is the 1918 flu pandemic, which showed three peaks of mortality: early childhood, very old age, and young adulthood. In this pandemic the death rate of 25-year-olds was higher than that of 65-year-olds. There seem to be several competing explanations for this, some of which suggest a biological vulnerability of younger adults and others of which are more circumstantial; I'm not going to dig into it here except to say that this is a very important exception to the general rule I'm discussing here. The 2009 flu pandemic, also H1N1, also killed unusually large numbers of younger adults. ↩︎
Of course, young children, who have both weaker immune systems and minimal acquired immunity, often fare worst of all. ↩︎
This is not always obvious from the raw mortality breakdown, if older people are much rarer than young adults in a society, or if the spread of the disease is concentrated among particular groups that are age-skewed. ↩︎
This is a really interesting point. An additional consideration is that global leaders tend to be older, and hence more at risk (cf. Boris Johnson). You could imagine that their deaths are especially destabilizing. If the longtermist argument for preventing pandemics is that they trigger destabilization which leads to, say, nuclear war, the age impacts could be an important factor.