Covid 19 – confronting our fallibility is as crucial as it is hard
These thoughts are my musings about our fallibility, brought on by time on my hands.
We are all deeply affected by the Covid 19 pandemic. New orthodoxies of behaviour and belief inform our daily lives as policies are rolled out. We know that the policy decisions are made with limited data, understanding of the disease and poor global coordination. It seems certain that as our understanding improves and the financial and social costs soar we will confront hard questions about whether this is the right way to respond. While acknowledging and confronting fallibility is great in theory, in practice it is hard. As the stakes pile up it gets harder.
We are afraid and we have all made sacrifices to get on board the lock-down instructions. We follow behavioural guidance to avoid infection. As we do the challenge is to remain open-minded to the real possibility that experts we have listened to and agreed with are fallible and have been wrong or muddled in their thinking.
Confronting our fallibility is crucial. In science, it informs new questions and makes us look for new answers. In politics it enables the weighing up of the relative merits of courses of action against ideologies. Normally these take place at slow pace with more time to assess and reflect. Now we are moving at high speed meaning the margin of error is far greater.
There are two layers of risk to consider. The first is the risk that the experts refused to reconsider, review discuss and adjust deepening our losses further. The second is that fear of a loss of face and backlash against the experts and decision-makers acts as a barrier to full review and reconsideration.
Too much information?
Every day there are new graphs and information showing the scale, spread and death rate, but I cannot honestly say I am informed. The information creates fear but not judgement. For instance, I have no idea how the reported deaths compare with others that effect excess deaths. I know there are 100,000 deaths each year from strokes and 23,200 excess deaths were recorded in UK 2018/19. The age range spread looks very similar to those were seeing from Covid 19. I suspect others are the same as hits on Google for Corona Virus are over 9.5billion while for excess deaths its around 81million.
Obviously, public health messaging needs to be clear, easy-to-follow and un-nuanced for compliance, there can be no rooms for the ifs and buts. So we follow the rules to stay home and save lives. Are there alternatives we should consider? Even posing this question right now seems heretical.
A tale of two responses
Two key policy debates are playing out in response to Covid -19. One is a public health response, the other I call a social health response.
If I have understood it properly, the public health response says because people’s lives are at risk, we must do as much as is possible to curtail movement and interaction to prevent contagion. Our health services will thus be better able to cope and more lives will be saved. Containment reduces infection and keeps the flow of patients at a manageable flow. The value driving this is the value of life itself.
The social health response argues for the need to enable a return to economic and social movement as soon as possible, even if there are still health risks. It argues that the damage to our – already unequal and shaky – economic systems, to our culture and creativity and community support mechanisms, may suffer irreparable damage during a prolonged period of lock-down. This, in turn, may outweigh the benefits of saving lives through containment as poverty, social distress and other untreated problems occur. Notwithstanding what we may feel about the politicians espousing the social health response – more on that below – the value that drives this can also be said to be the value of life itself.
I will eat my hat if I am wrong
Presently our knowledge of the virus, how it spreads and who is most at risk is unfolding. It has been widely reported that the data needed to make decisions from testing before and after is limited. It seems clear that such huge disruption and risk to life, health and well being of populations must rest on excellent knowledge of factors beyond only disease control. Graphs depicting the spread of the disease to inform the management of the response have been widely shared. There is no similarly coherent data or modelling regarding the the impact of widespread disruption and social/physical isolation, beyond analysis of the macro economy.
Meanwhile, politicians and scientists are staking their futures and their reputations on making cases for one or other of the policy positions. At present the Public Health response is winning, supported by some excellent modelling by Imperial College. As it gains traction new social and political taboos are developing backed with legal enforcement mechanisms. It’s hardly surprising that questioning the response meets with hostility and fear. But this is risky.
Dr John Ioannidis of Stanford University in a recent interview argues strongly against blame and the need to win arguments. He points out excellent science is both excellent and flawed. Opening up to peer review and ongoing challenge is central to scientific progress and quality. Scientific models are just that: models.
More than one hat?
The public health risk response of the current magnitude also affects social systems beyond health. A wider range of scientific studies is needed to make judgements so that our current thinking can be supported with studies modelling the varied impact of whole community shut-down on other health and well being, education and skills and productivity for the future, through and beyond Covid -19. Data of these other considerations need to be seen alongside the health models. They could perhaps support better decisions making.
China is presumably well placed to provide the kind of reflective, post infection data evaluating and learning from their response. Several people have pointed to the environmental benefits of the lock downs on air quality. But will a globally depressed economy really be better for tackling environmental sustainability, arguably a threat far greater than Covid -19?
Herd mentality or herd immunity? Keeping an open mind
The paradox for science, in our present scenario, is we depend on it to guide our thinking even as it is bound to be wrong to some degree. For our democratically elected politicians it is worse. Not only are they fallible and frightened individuals like us, the system that elects them is deeply intolerant of prevarication.
It is possible that in coming months we will find that mortality rates are lower than at first thought, or that social isolation is more damaging and even kills more – albeit for different reasons- than continued unfettered movement. We may learn that a disappointed and angry population is less willing to respond to pressing and more deadly issues in future.
Matthew Syed in “Black Box Thinking” demonstrates both how important and how hard it is for powerful figures to admit they have been mistaken. With this global disruption feeding global depression and widespread misery, the stakes have never been higher. The challenge of the coming months, even as we mourn the dead and struggle to remain as productive as possible, is to remain open to the possibility that we are fallible and may have got it wrong. Imagining it is the first step.