In deciding the best approach to dealing with the challenging spread of a virus, it is often easier to attack the messenger than to try to argue against a message. “You don’t know what you’re talking about, you’re not a doctor”.
In many cases, deferral to expert authority is correct. We should defer to people who are smarter and know more about a topic than us. But we also need to recognise that personal incentives can influence their views.
Consider an emergency room doctor or general practitioner. Media outlets regularly seek views from emergency doctors who are treating COVID-19 patients on the best way to approach the virus. The Australian Medical Association (AMA), which is essentially a union representing the interests of doctors, provided that view a few weeks ago, when AMA boss Tony Bartone demanded Melbourne move to a strict stage four lockdown as cases climbed.
But are doctors, especially those treating COVID-19, the best people to be giving advice on decisions relating to an entire economy? Doctors witness devastation and death first hand, while also having to console the families of victims. It’s impossibly not to be emotionally affected by that.
Even worse, there’s a very high likelihood of health workers being infected by COVID-19. Globally 10% of those infected are health workers (and in Victoria, disturbingly, that number is almost 13%). It would be difficult for even the most rational ER doctor to overcome such cognitive bias and provide truly impartial advice.
Or consider epidemiologists. That is, the statisticians who provide modelling to governments on the reproduction rate and fatality rate of the virus. Governments consult epidemiologists to determine policy responses to the potential virus spread, such as how many ICU beds are required.
But epidemiologists have their own personal incentives and biases. Think of the difference between an epidemiologist who overstates the impacts of a virus and one who understates them. The overstatement is a classic “under-promise”. The epidemiologist who got it wrong on the downside is quickly forgotten, but their ultimate employer, usually the government of the day, is able to claim victory to electors, and remind everyone how many lives they saved by their brave action. (The costs of that response, be it financial or other lives lost, is forgotten in the fog of war and vanquishing of the enemy).
Now think about the epidemiologist who understates the potential impact. This is far less quickly forgotten. That epidemiologist may even be blamed and scapegoated for the deaths, potentially losing their jobs and reputation. (One of the few to take a sceptical approach to COVID-19, Sweden’s chief epidemiologist Anders Tegnell, received death threats.)
Epidemiologists need to make a number of critical subjective assumptions in their modelling. Like with any model, slight changes to key assumptions, like a case fatality rate or reproduction rate, will have a significant impact on the outputs.
In March, one of Australia’s highest profile and experienced epidemiologists, Melbourne University’s Tony Blakely, produced modelling which showed four scenarios. The “best-case” scenario (with “extreme” social distancing in place) suggested a peak of 100,000 infections a day, while the worst-case scenario estimated more than 500,000 daily infections.
During Australia’s peak last week, the infection rate hit 700 per day (albeit only in Victoria). It appears Blakely’s March modelling was off by more than 99%.
Some of Australia’s smartest people working at the Doherty Institute reported in modelling used by the federal government that if only “isolation and quarantine measures [were] in place … 36,000 Victorians could have died” and that “10,000 intensive care beds would have been needed”. As a comparison, Florida, which has more than three times the population of Victoria and took even less measures than the Doherty Institute suggested, has suffered 8770 deaths. There are currently 44 people in Victoria in ICU.
Many in the community turn to doctors for advice about what action we should take to limit the spread of COVID-19. But asking medical doctors about preventative measures is a bit like asking a conscripted soldier whether we should go to war. The decision on what non-pharmaceutical measures to take must be made on the basis of considering all the known externalities, not merely the estimated impact of the virus itself on human life.
Doctors are able to answer a part of the puzzle, but the question of the full impact is best not answered by an emergency room surgeon, or even epidemiologists in isolation. Rather, we need to listen to those experts alongside other key stakeholders, including childhood education experts, economists and psychologists, recognising that everyone has their own biases and incentives.
Harsh lockdowns have benefits and significant costs. And getting the decision wrong is literally a matter of life and death.
Author’s note: Like most, I’m certainly not exempt for having biases, albeit in a different sense. Most of my interests benefit from a quicker, harsher lockdown, like our travel business, which is helped by borders rapidly reopening.
Editor’s note: This piece has been updated to more accurately reflect the modelling from the Doherty Institute.
Biases are normal, our family & friends will often take priority.
Common sense is one common denominator in fight or flight scenario so why don’t we use it when it comes to this virus?
Obey the law, use recommended safety precautions, think of others and hope they’re doing the same. Wear a mouth and nose cover when shopping or in other crowded places. Don’t go out unless it’s an absolute necessity. Use phone or internet to keep in touch. Eat, sleep, breath and move. Get a hobby that requires a bit of activity.
My comment is biased toward those like me who are staying at home & constantly thinking about their loved ones.
Stay safe everybody.
OK. But wasn’t that modelling in March largely based on what was happening elsewhere? And when there was much less known about this virus?
So aren’t the decisions being made now, based on ‘real time’ transmission data and a much better (if still incomplete) understanding of COVID-19?
And, sure, eveyone has their own biases. But it’s fair enough for frontline healthcare workers to expect that they’ll be kept safe while saving lives – something that gets way harder the more people who get this thing? Afterall, martyrdom wasn’t part of their job description.
Better, surely, that we take a cautious approach – with fewer people dying (or therwise experiencing the serious long-term health ramifications that are only really starting to be understood) – than underestimate the required response, and end up like US or Brazil.
As for those who are being harmed by the lockdown in other ways – especially the young, whose eductaion and employment prospects are being impacted – it’s not as if the AUS GOV can’t afford to cushion those blows.
It’s just a question of whether they will. Or not. (I’m betting not…)
This is a strange article, are you reeling from the comments you received on your earlier article?
After reading this I think of two situations:
1) USA
2) NZ
I know what situation I would prefer.
Covid is relentless. If Australia is to be like NZ, we will need to be focussed and relentless.
To be polite as I can be, you seem to be way out of your depth. The article has a bit of a “committee” feel to me.
Have we as a nation got what it takes to focus and prevail.
I for one am listening to the doctors, if we all did what they told us to do we would be like NZ. It’s not that complicated.
One notable public health expert recently suggested that infected patients be removed from their family home because of the (high) risk of transmission in the home environment. (Where they would be taken, I’m not sure.) This was ‘expert’ opinion. In practice, it would lead to under reporting because people – especially those in higher risk categories – would avoid testing for fear of being removed from their home, and therefore be counter-productive. Just because an expert has an opinion does not mean it’s immune to challenge.
A very comprehensive summary. One of the key elements here is the covid calculations based on the modelling and reporting.
There have been many posters here at Cky over the last week who have placed blind faith in the official health department covid modelling and reporting and used that “syndrome” ( blind faith in authority) to attack the “messenger ” who to some degree challenged the accepted view of that covid modelling and reporting and lock-down justification.
All good, but then there was the Fox 35 investigative report in Orlando Florida on the covid testing rate. The Florida state health authority issued a press release stating that it was 98% positive for covid testing. The Fox 35 report revealed it was only 8% positive with the health authorities backing down and blaming the method of testing and calculation – dear me.
I am not suggesting anything near that here in Victoria, but as the author points out, there are other stake-holders who should have equal consideration.
I think this article raises an excellent point that has been ignored for too long. The sort of media tendency to assume that someone – even a professional – working in a particular field has specific expertise is common and is typically wrong.
Let me give a different example. In climate change policy, a field in which I work, there is inevitably a tendency for the media to ask scientists who study the impacts of climate change about the best way to reduce emissions. Some of the answers are smart and insightful, others wildly off-base and politically naive. In most of the cases though the responses are not based on detailed research and experience. Those questions are best asked to the think tanks, public servants and others who study the question in detail (despite their own biases).
The problem with all of this – back to the Covid example – is that it will always sound better in the media to ask a doctor what to do, rather than a hospital administrator or a health department official. While these people would be far better placed to give a sensible answer based on evidence and experience, taking someone’s blood pressure is better TV than shifting papers in an office.
We frequently ask someone who will give the answer we want to hear instead of asking an expert who would give us the answer we don’t want to hear. If we ask how to make trivial reductions, we ask a renewables salesman. But if we want to hear how to eliminate our emissions down to “net zero”, we must ask a power engineer. Similarly, if we want to know how to behave in a pandemic, we must ask the pandemic specialists.