I should start this whole thing by saying I’m not an expert in infectious disease, or an epidemiologist, or a statistician. I am an expert in primary care and on the frontline of medicine and this is my informed take on what’s going on.
The process for decision making in situations like we are in now with Covid -19 can be complicated. We live in a world where information is everywhere; endless information.
We scroll Twitter feeds that are often echo chambers of our own beliefs and Facebook pages that are the same. The data is changing continuously and so should our ability to move our position on it. An entrenched belief in these situations is not helpful.
We tend to surround ourselves with people that think the same way as us. I expect it’s because we are not as good as we think at having conversations with others that have opposing points of view. We feel defensive or annoyed, or we just don’t want to be around people who don’t fit into our world view. Maybe we just feel too exhausted to engage in these dialogues. We dismiss people as not worth engaging with. There are of course people out there that love to stir the pot just for the hell of it. The “just bants” crew. Those people are relatively easy to identify and to be honest I think bring no benefit to anyone other than to further divide a divided society. There will be a direct correlation with this mindset and the number of times the term ‘snowflake’ is used as an insult…
Conversations with people who have opposing views can be incredibly fruitful and provide insight into our own capabilities – to communicate our points of view, actively listen to someone who may give some food for thought if not change our minds. Through this we learn to listen and to hone conflict resolution skills. We can learn how to change someone’s mind by sharing common ground first. We learn from each other, become friends, make a community that is vibrant with debate, engendering critical thought. It’s important to make sure our world isn’t just full of people that agree with us.
So, how do we go about making sure that the information we gather to make decisions about major things is solid and based on truth as it stands on that day?
These days we tend not to defer to the views of experts when we really ought to. We seem to be far too confident about things we really know nothing about!
We make decisions that seem to be agenda based, for example when considering Covid -19. On suggestion that a pandemic was coming, if a decision involved cancelling a trip, a concert or losing money in some way, we are likely to suggest to people that society is overreacting. Deciding to go about life as normal in this situation gives us comfort that we are sensible and the rest of the world is mad, because we don’t want our lives to be disrupted. This is despite what the models are predicting, what experts are saying and potentially even after watching what is unfolding in Italy (I chose Italy because I expect it’s easier for a UK population to relate to).
This obviously isn’t the best way to make these decisions – based on incentives, agendas, small gains or losses, especially because usually the worst case scenario (critical illness), or even moderate case scenario (isolating for 7 days) will totally outweigh a 3 day jaunt to Amsterdam. None of us were that worried until a few weeks ago and then the information started to pile up and without invoking mass hysteria it is worth taking some time to make sure we are invested in obtaining good information and being risk averse. Not letting our drive for undisrupted lives, drive us.
We as humans are epically incapable of understanding risk. Trying to convey to someone with type 2 diabetes about their risk of losing a leg or their eyesight is inconceivably difficult. There aren’t great analogies to turn to. We as a species just can’t seem to grasp the potential for damage until the damage is upon us. But I think we can hone these skills and become more rational and risk aware.
Rational or even metarational people are well in tune with their limitations; they know what they don’t know AND they know where to turn for expert advice. An excellent physician will have this skill honed. Curate a group of experts and in the knowledge that this advice may be right for the moment or just an opinion (but an expert one), cross reference the concept/idea/advice with other experts in the space. Yes, experts can be wrong but curate your specific list of experts well and the odds are with you that your choices are based on strong information.
Twitter is a great tool for this. Searching Covid-19 in the search facility will give you a morass of views, many of which may contradict your own – this is good. But there will always be go to leaders in that field and some quick research will allow you to put together a list of people that you can learn from and quiet the noise.
Covid -19, the illness caused by SARS-CoV-2 has divided the nation with regards to response. Many feel that people are overreacting to the threat, many are overreacting in bizarre ways and overbuying strange things, and some are reacting in a measured, rational way and are still thought of as hyperbolic. I think it’s interesting to understand what causes these differing responses.
So what is the difference with Covid-19 and Flu?
In December 2019 Wuhan City, the Capital of Hubei Province in China found itself in the middle of a spate of pneumonia with an unknown cause. By January, Chinese scientists had isolated ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2) from these patients with viral pneumonia. This virus was then designated as the cause of the Covid-19 disease.
We know Flu. It’s been around forever.
Flu causes an overwhelming immune response. The immune system can be crippled, that’s why vulnerable people can then succumb to overwhelming bacterial infection and are at higher risk of death from the Flu. Their immune system is dealing with the virus and can’t compete with bacterial infections that come in on top.
Covid 19 seems to affect a particular cell in the lungs. These cells make a substance called ‘surfactant’. This assault does not occur in a linear fashion.
Essentially, this means that Covid -19 isn’t that predictable. It doesn’t seem to cause an overwhelming immune assault like the flu. In some people (it’s expected that the majority will have mild illness) the virus specifically attacks the lungs and causes respiratory distress and it seems to be doing it randomly – whomever you are.
Covid -19 regrettably sits somewhere in the middle of the graph of Infective spread v Fatality.
It spreads easily and is potentially very harmful. This is different to something like chicken pox which is easily spread but causes little harm, or Ebola with low spread rates but a high death rate.
Right now we have to limit spread. Some people we know may get mild symptoms, some people may become very unwell. People with mild symptoms can spread illness too. The next person may not be mildly affected though. There is some clinical guidance being developed as to who these higher risk of death people are once in hospital, but this doesn’t help the community. What we need to do now is listen to experts, learn from other countries and not take any risk that isn’t required.
Washing hands with soap is the easy part, considering staying at home if you have a viral illness regardless of where you’ve been , reconsidering mass events, deciding if an airport is a great place to be right now – harder. Is life meant to stop? How long will this go on for? They are all tough questions. There will be more nuanced situations that need further consideration, of course, no doubt…just consider the downside of any decision in both directions.
Source I’m using: Johns Hopkins University http://centerforhealthsecurity.org/