2020-03-29

Superspreading the News [Net]

It is undeniable that we live in an area where everybody gets to choose their own reality and live according to their own convictions. On the surface, this is a good thing. It means freedom of thought and a plurality of opinions. However, there are clear dangers in picking your own facts selectively only to support a certain kind of argument. It is what political circles call "having an agenda". Of course, everyone has an agenda. Sometimes that agenda is making an informed decision based on the evidence at hand. Other times, it's starting from a conclusion and assembling the supporting evidence at the cost of ignoring inconvenient data.

The truth is we all do this. Weighting data for its perceived credibility is an important part of making informed decisions. In truth, we all bias these weights according to our expectations. As a society we are very susceptible to taking this weighted data output from one person and then amplifying these values through a chain of more people, without paying attention to the processes that happened along this chain.

Our collective machinery is first and foremost built on a marketplace of attention to urgency and conviction. We amplify signals that are crass and outrageous, and when in doubt, we amplify signals that are either strictly aligned with our personal ideals or we showcase those that are diametrically opposed to our values. Very few people seem to care for information that cannot be used as ammunition for this process. "It's complicated" does not generate public interest, and keeping more than one factor in view at the same time seems to be huge turn-off for us as a society.

There is money in telling people what they want to hear most. People tend to leave their guard down in the presence of material that tells them what they want to hear. Being critical of such material seems counterproductive. Afterall, you're in search of facts supportive to your position, right? Collecting data and arguments as ammunition to use later feels rewarding. Again, we're all guilty of this. But we lose sight of the fact that this process is a pathology. This war is paralyzing us in places where we would have needed to work together.

When someone makes a point of catering to you, of telling you exactly what you want to hear, that is the time to pay extra attention.

Are the hospitals the real super-spreaders?

I want to highlight an article on LinkedIn written by an investment executive. It's not the worst-possible article, it's not the crassest piece of fake news. It's just an opinion piece. It has a simple message: we are overreacting to SARS-CoV-2 / COVID 19. The numbers are inflated. Incompetence at hospitals is the real reason why there are so many deaths.

The agenda behind this is simple to guess: everybody should get back to work, we need to save the economy. This article targets reasonable business people who are looking for ammunition that could save the economy, and failing that, point a finger at the persons responsible for the recession. Having a human enemy is much easier than judging an invisible, delayed-response, exponential process.

Insidiously, the premise of the article is correct: the mass spread of Covid-19 is indeed happening in places such as hospitals (and care homes, which the article doesn't mention) right now. This is a truism: infections have always been spreading in hospitals. Hospitals are care facilities, not containment facilities. They are doing the best they can on the containment front, but care remains the main priority, and other priorities fall down first in times of crisis and resource shortage. It's not a question of attitude or competence either, as the article alleges, although health staff are still human and mistakes do happen. It's a question of what happens to a system that is being overwhelmed.

What the article fails to mention is that this disease did not originate in hospitals, and our current level of community spread was not initiated by hospitals. The epidemic was spread by travelers, participants in mass gatherings, it was spread in places of mass transit, places of work (!), and inside homes.

The article raises a valid point when it calls into question how different countries are tagging COVID 19-related deaths: is every person who dies with SARS-CoV-2 in their lungs a COVID 19 death? Conversely, one might ask the question if a person who has unrelated health problems dies because they cannot get medical care due to the hospital being overwhelmed, is that a COVID 19 death even though they never had the infection? What about people who would not have died had they never gone to the hospital? The issue here is that our biases and agendas can be actively used to skew statistics, and getting 'clean' numbers was an impossibility to begin with. The real information about the COVID 19 impact will probably only become apparent in many months, when we can compare overall 2020 death rates to previous years.

"A vicious cycle"

On to the core thesis of the article:

The problem now is that EVERY other Western country is looking at Italy as a typical case and drawing exactly the WRONG conclusions. And it’s a vicious circle. Hospitals fill up, so guess what – they call in more doctors, nurses, orderlies and others. In hard-hit places they're getting volunteers. Every one of those new workers is also a new vector to the rest of the community. The media shows us pictures of hospitals collapsing, which frightens people who might just have the cold or the normal flu, and so they go …. to the hospital.

People who have non-threatening health problems, including mild COVID 19 symptoms, should not go to the hospital. No media that I have consumed claimed they should, in fact many journalists and politicians have pointed this out to the public. Even uncontrollable hypochondriacs don't get admitted to the ICU for no reason. Where we are currently calling for more doctors and nurses is mainly in intensive care, which is where critically ill patients need actual help, right now. To implicitly argue that we should dial down critical care is probably an argument the author would not be making if he was a patient gasping for air.

And the sickening conclusion:

By the way, as said before, thanks to excellent GPs, most German hospitals are quite empty. And I am confident the German system will continue to avoid being overwhelmed, NOT because of the partial lockdown, but because of a far better primary care process compared to most other countries.

It's always nice to claim that a countermeasure was not needed after the storm has calmed down, and that it was not needed because of pure national awesomeness is an added bonus.

However, the storm has not yet calmed down. That a partical lockdown is unnecessary is a straight-up lie sprinkled in with the selective truths and opinions here. It is without a question true that spacial isolation stops the spread in its tracks. It may well be true that the German health system is better equipped to handle the pandemic. But to claim premature victory just to coax Germans back into the workforce is irresponsible.

Pundits in the US have argued that workers should be sacrificing their lives and - more importantly - the lives of other people they might infect, to rescue the economy. This is a straight-forward and honest argument. It's unethical, but at least it doesn't attempt to hide the consequences of the proposed action. In Germany, things are more indirect, hiding behind a superficially "reasonable" justification, and playing on the inherent fear of the German managerial class that working from home equates to slacking off.

If heeded, this will kill people.