By Kevin Roche
I am going to pretend that people have come to their senses and realized that we have to live with CV-19 and stop obsessing over it. And as part of my effort to do that, I am going to write my initial retrospective on the epidemic now. After any great event in human history, we should attempt to step back and evaluate what the dimensions of the problem actually were and how effective our responses were, always mindful of human thinking process biases.
1. All people are human. That tautology is important because if we think that scientists, public health experts, politicians or anyone else is somehow not human, is above human frailties, we are wrong and we will suffer the consequences of giving greater credence to the pronouncements of these particular humans than they deserve.
2. The bigger the “title” or “role” certain humans have, the more likely they are to be unaware of their biases or to engage in constant questioning of their own beliefs and conclusions. And therefore the more likely that they will make mistakes.
3. A corollary to the first two points, and an important check upon these potential sources of policy error, is that all data and information should be completely, immediately and accurately disclosed to the public and any person who seeks further information for the purposes of analyzing and understanding such data should be encouraged and assisted. The role of citizen analysts should be highlighted and encouraged, as these persons often have perspectives that are more accurate than those of officials.
4. Those first three points are what I would call process ones. And they really apply to issues beyond how we responded to this epidemic. They are fundamental to good government. They should be embedded in the very structure of government.
5. With all due respect to the idiot hack Dr. Fauci, no one person is or represents science. Science is an ongoing process of discovering relevant facts and logical relationships between events. It constantly changes as new data and research emerges. It needs constant challenge, constant new ideas, to improve understanding. At no time can anyone claim that “the science tell us to do this” or “the data say we must adopt this policy”. Anyone who makes such statements should be immediately fired from any post in which they can influence policy. Unfortunately but realistically, knowledge and the guidance from knowledge is fluid; this should be acknowledged and accepted and the public should be told that we are taking the steps we take based on our current understanding, but we are constantly seeking new data and research and we will change our policies if that new information suggests it is appropriate to do so.
6. All data, analysis and research should be presented with full caveats that may affect its credibility. Weaknesses of a chosen experimental design and statistical analysis plan should be disclosed and potential alternatives and the results using those alternatives should also be given.
7. The big picture must always be kept in mind. What is the policy which advances the overall general welfare. We cannot be myopically focused on solely the current problem; we must consider what the consequences of policies to address the problem will be and we must weigh all of those consequences against any potential benefits. All potential consequences should be explicitly presented to the public.
8. In regard to a respiratory virus epidemic in particular, and really any epidemic, the following principles should be foremost:
A. Disturb normal life as little as possible–don’t close businesses, don’t close schools, don’t tell people to avoid health care, don’t tell people to stay home. There is little evidence that any of these measures have any meaningful impact on transmission.
B. Protect those who are most vulnerable as we can identify who those groups are. But respect the autonomy of individuals in those groups. Locking away nursing home residents, for example, against their wishes, deprives them of the few social contacts they may have and leads to more deaths from isolation and loneliness.
C. Do not politicize mitigation measures. This can be avoided by not invoking states of emergency and ensuring that any policies to fight the epidemic must have super-majority support among the political representatives making these decisions.
D. Develop and only use tests which are actually capable of determining that someone has an active infection and is infectious. Limit testing to symptomatic persons and limit quarantines to symptomatic persons. Excessive testing and tracing wastes resources and places a burden on healthy persons.d
E. Vaccines are likely to be the most effective measure to limit transmission and morbidity and mortality, so the emphasis should be on rapid vaccine development and deployment. But the public needs to be educated to have realistic expectations about the effectiveness of a respiratory virus vaccine. They cannot stop exposure and they likely cannot stop all infections.
I don’t know if anyone will pay any attention to these, and others may have other lessons learned that are equally valuable. But I also am keenly aware of human limitations and our clear inability to learn from the past when it comes to large-scale problems and issues, so I have no hope that the next epidemic will be handled better. Politicians will make the same stupid mistakes, think they need to assert their power and do something, anything, no matter what the consequences, and will ignore the damage their actions will cause.
I probably won’t be here, so good luck to all of you and all the future humans who have to live not just with our inherent weaknesses, but with our inability to recognize and correct for those known weaknesses.