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.
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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.