Pages

Monday, March 16, 2020

Social tug of war

There's a perennial tug of war between two types of people: alarmists and procrastinators. For convenience I'm using these as neutral designations, not pejorative terms. 

In many times and places, most folks live on the edge. There is no margin for error. Little mistakes and oversights can get you killed. So you always have to think ahead. Take precautions. To survive, much less having any hope of thriving, you must be an alarmist. 

But there are other times and places where most folks lead insulated lives. The culture has a lot in reserve. Redundant capacity. Many things can go wrong before it burns through the buffer. That fosters procrastinators. 

Both temperamental types are represented in every generation because life lacks a consistent pattern. Sometimes the gamble pays off–big time. Sometimes you lose the bet–big time. Sometimes playing it safe keeps you stuck in a rut. 

Conversely, because there's so much padding, the procrastinator may get away with reckless, shortsighted behavior. Or even prosper. But sometimes it catches up with him. 

When alarmists are wrong too often, they are discounted. They cried wolf one too many times. This means people tune them out even when their warnings are justified. 

Some people are crisis-driven. They ignore warnings until it's too late. But sometimes the crisis never materializes. 

To the alarmists, the voices of reason are dangerous. They lull people into a false sense of security until disaster overtakes them. What was preventable becomes inevitable. Avoidable catastrophes become unavoidable.  

To the voices of reason, the alarmists are dangerous. They create nonexistent problems. They create an artificial crisis in their fanatical efforts to avert a crisis. 

Because life is inconsistent, there is no generally successful or unsuccessful formula. Both strategies have winners and loses. Both sides can say, "If you only listened to me, we wouldn't be in this mess!"

Adages like "better safe than sorry" or "take necessary precautions" are useless in the abstract. They provide no practical guidance without feeding some facts into them. 

4 comments:

  1. The last flu season put 40,000-60,000 people in the hospital per MONTH. Already, though, there are reports of hospitals being over-stretched despite a national incident count of less than 5,000 for the entire nation for the last month and a half. The math just isn't adding up.

    Same thing with Italy. It's a nation of 60,000,000 people, and they've suffered influenza epidemics in the millions where hundreds of thousands were hospitalized. Yet they can't handle 10,000 hospitalizations for the entire country?

    This isn't to say we shouldn't be cautious and fear the potential destruction of this virus. I think we should, and I'm glad states like Ohio are shutting down restaurants and bars to prevent the spread of a highly infectious and deadly disease.

    At the same time .... the numbers just look odd to me. If hospitals are being taxed NOW, then we're cooked. Or someone's lying to us. Or they're incompetent.

    ReplyDelete
    Replies
    1. 1. It's been a public health disaster in Italy. As infectious disease specialist and critical care physician Amesh Adalja pointed out nearly a week ago regarding Italy's lockdowns, etc.:

      "I think this will be the wrong lesson for the world" (source).

      2. However, the good news is we're not Italy. Not yet anyway.

      3. By contrast, some of the Asian nations seem to be doing well. For example, it looks like Singapore is doing really well. Likewise it seems S. Korea, Taiwan, and Hong Kong. I think that's due to several reasons, though I could be mistaken since I haven't closely followed things:

      a. They've had recent experiences with epidemics in their regions. So they've already had structures set up which they could quickly mobilize (e.g. command centers tasked to deal with viral outbreaks).

      b. Also, they've implemented early and extensive testing ("drive through testing") of the general population to isolate pockets of outbreaks and stamp them out before they could spread too widely.

      c. Likewise they've placed temperature monitoring stations at large office buildings and at their borders. If a person had a temperature and other signs and symptoms of sickness, they were asked to return home and rest. A health care worker would follow-up with them.

      d. The early use a drug known as chloroquine on certain patients, though our physicians debate its efficacy with the coronavirus (SARS-CoV-2/COVID-19).

      e. Admittedly some of what these Asian nations have done doesn't entirely sit well with me from the perspective of an American who respects the Constitution and Bill of Rights.

      Delete
  2. Jim--

    During the N1H1 epidemic of 2009-2010, close to 60 million Americans caught the bug (and around 12,000 died). I think the "overwhelmed medical community" meme is based on a repeat of those kinds of contagion numbers. (Thus, a New York Times article predicted anywhere from 200,000 to 1.7 million DEATHS from COVID-19.)

    From everything I've heard, however, this virus has a fairly low contagion rate compared to N1H1. Not only that, but China is on its way down after only 80,000 cases. So I'm with you: the numbers just look odd.

    On the other hand, the coronavirus CFR (case fatality rate) is clearly 5 to 10 times that of the flu. So if millions do catch it, we're in for one dark night of the soul.

    ReplyDelete
    Replies
    1. 1. I think the best current estimates for the transmission rates (R0) of the coronavirus (i.e. SARS-CoV-2/COVID-19) are between approximately 2-4, while the best current estimates for its case fatality rate (CFR) are between approximately 0.5% to 3.4%.

      2. The seasonal flu has an R0 of approximately 1 (depending on how bad the particular flu seaosn is), while it has a CFR of approximately 0.1%.

      3. Both R0 and CFR will have regional variations and that in turn is partly based on how public health services respond to the pandemic. As I mentioned above, Italy has been overwhelmed, so I wouldn't be surprised if their CFR is much higher, whereas the Asian nations I mentioned above might have lower CFRs.

      4. All that said, R0 and CFR are dynamic. That's because we're still in the midst of the pandemic. We won't know its true impact until it's all over.

      In addition, it's worth noting that these calculations are based on epidemiological models. However an issue with statistical models is that they depend on certain assumptions which could be debated as well as depend on what data is fed into these models. What's more, if we change a small variable, it could have a large effect in these models. These are a couple of the limitations in relying on models.

      Delete