Covid-19
Covid: Nation’s Conduct
Do No Harm in the politics of Covid-19
Nations — Pros and Cons:
In recent years, thought influencers have been promoting the concept that nation states are a bad idea, and the cause of all kinds of evil, and maybe it would be better if we could just get rid of borders, and allow any immigrants for any reason to go anywhere, and communities will just have to accommodate them. Countries are archaic, useless, and borders are an impediment to free trade and global economic progress. It sounds like a nice idea, sort of like John Lennon’s ‘Imagine’, but is fraught with hazards for any country trying to actually appease this sentiment.
Anyway, now this past year, people have been complaining that governments didn’t act quickly enough to close off borders, to protect its citizens. I would tend to agree that in most cases, governments were very hesitant to do that, probably more than they would have been in previous eras.
As we look at policies to deal with the Covid-19 pandemic, we have to recognize the great differences in the situation on the ground in various countries. What happens in Sweden, Japan or New Zealand is completely irrelevant to what can work in Canada, Chile or China. Different situations call for different policies. Not only their geography and demographics, but also what is culturally acceptable needs to be taken into account. Even differences between NYC and Ark make different policies reasonable, if not feasible to have different isolation in different regions across the same country, with state borders as open as they are.
Perhaps in this calamity, we may come to realize that there is a useful role for western democracies and the nation state after all — if they don’t over-reach their authority.
Another aspect to all of this — after recessions, there is always an opportunity to grab power. The most dangerous thing to say? “It can’t get any worse, why not try this guy’s idea?” The history of the 20th Century around the globe is littered with examples of just how much worse it could get! I hope we will be able to keep this in mind as the fallout from this pandemic unfolds.
In the previous blog, we have seen how scientific decisions and political ones have overlapped.
We itemized the reasoning behind the protocols that have been implemented and issues that have arisen. We looked into the supposed benefits, and some deviations from the Principle of Effectiveness.
‘Do No Harm’ is the first Medical Principle. How well have our public health departments been keeping this principle? Evidence of harm is mounting. {I want to make clear at this point that I am in no way condemning any of my friends, or strangers for that matter, in the healthcare systems who are doing their best under extremely stressful situations. I am merely suggesting that some political decisions may have made their job way tougher than it should have been.}
Harms of Public Policy
We have all seen happy families on FaceBook or YouTube videos making the best of this situation. But, sadly, this isn’t the case for many families. The UNHCR observed an increase in gender based violence in 2020, attributing it to government closures and lockdowns. States reported a 20–35% increase last year.
While 50% of us were exercising outdoors to cope with this pandemic, 20% of us increased our alcohol consumption. During the Second Wave, 10% of Canadians reported having suicidal thoughts. By comparison, in 2019, the figure was 2.5%, so a 4-fold increase.
The CDC has noticed another troubling trend in 2020 and has connected it to the Covid policies. In a study published by the Center for Disease Control (CDC) in October 2020, there was an increase not only in COVID deaths compared to the previous year but also about 100,000 non-COVID deaths. In the 25–44 year-old group, which has an extremely high chance of recovery of COVID, there was a 26.5 per cent increase in deaths in this group. Many of these deaths can be attributable to “deaths of despair.” So, this group is more affected by the treatment than the actual disease, indicating that we should perhaps think of having different policies for different demographics.
“Measures taken at the national, state, and local level to address the COVID-19 pandemic may have unintended consequences for substance use and overdose.”
AMA has also expressed concern over this epidemic in their report in Dec 2020. In 2020, USA recorded the highest ever number of OD deaths, a 38% increase over previous years. Other areas have been hit worse. British Columbia, Canada, experienced a 74% increase in illicit drug overdoses in 2020, compared to 2019. To put this in perspective, 1,012 died of Covid in BC in 2020, while 1,716 died of ODs. For some reason, a whole lot more time, energy, money and airplay have gone into those 1,012 deaths than the 1,716. I do not expect data will have improved for 2021 during a cold, dark winter of lock-downs with no Christmas.
People with pre-existing conditions have also been greatly affected by these restrictions. Half of cancer patients had their appointments postponed or re-scheduled or their clinical trial put on hold over the spring of 2020 across Canada.
What Some Scientists Have Tried to Tell Us:
Of course, scientists can also have political affiliations, family bonds, a favorite sports team, or a business. And they are free to have opinions about each of these things. But we have to be careful not to just automatically call those opinions ‘science’. Is the person giving an opinion informed by scientific method and derived data? Is it biased by other concerns?
There are all kinds of retrospective observational studies showing that the author’s pet idea helps or hurts. Science, on the other hand, uses reproducible randomized trials following a pre-determined protocol to determine the efficacy of any particular hot topic. Science is coming up with a testable falsifiable hypothesis, and competing ideas battle it out on their merits. Believing in things that cannot be falsified or tested is religion. I worry that we have a lot of religion when it comes to Covid-19, and not enough focus on genuine science.
The Great Barrington Declaration is a proposal signed by approximately 40,000 medical professionals. It expresses their concerns over common Covid-19 government policies, instead proposing Focused Protection. In a nutshell, this means older and higher-risk populations should be protected from community transmission. Open everything up and let everyone else go free (doing hand washing and staying home when symptomatic), building up herd immunity eventually.
In considering this as a viable option, certain questions have to be answered.
1-is it feasible to implement?
2-does it have a reasonable chance to be effective?
3-What negative consequences may ensue?
Can we get people to agree to a very simple (simplistic) protective behavior like wearing a mask?
For those who are unwilling to comply with rules requiring wearing a mask, there is probably a greater chance of compliance, just for Granny, than having to do it everywhere, all day.
The protection of older and higher-risk populations from community transmission seems like a reasonable goal to achieve. They propose policies like having senior’s residences staffed by people with immunity, under minimal rotations, and aiding other old people in getting home deliveries and meeting family only outdoors. I have seen lock-downs in Seniors Residences backfire terribly in my jurisdiction (more on that in another blog) so, trying this could hardly be worse that it was here.
They believe that the negative consequences of a shutdown outweigh the negative consequences that would ensue from following this Focused Protection approach. I say “believe”, because that’s what it is, on both sides of the debate. It is only by using a controlled well-designed experiment comparing both methods that anything scientific can be said about either proposal.
Of course, the USA CDC and WHO are also scientists with their own take on the data they see. I’m sure you’ve heard it.
I’d like to point out that just because one group has been more accepted by governments is not in any way an indicator that their views are more scientifically correct. We also have to keep in mind that these policies involve more than scientific questions.
Political Choices
The Great Barrington Declaration shows that there is disagreement on interpreting the data among scientists. They disagree on the science, and on the applications of it to society. In science, this means more research must be done to discover more truth. In politics, whoever is in power gets to decide the application. And despite the fact that thousands of scientists signed it and many have produced their own scientific studies with different conclusions, you may not have seen any reference to it in mainstream or social media.
However, we need to recognize when one discipline has drifted into the other’s lane.
For instance, politicians can say,“We have this test result, so it is scientifically proven that this strain of virus is more contagious than the previous one.” That is a scientific claim that can either be backed up, or dis-proven.
“Therefore, the situation is worse.” This statement is in the scientific domain, but not necessarily backed by that result. It is possible that like many other viruses, that it has mutated into something that is more contagious but less deadly. This would indicate that the situation is better (more like a cold), not worse. But, the science hasn’t had the opportunity to answer that question yet.
However, to say “that is the reason I have to close the schools or the restaurants” is NOT a scientific claim. Maybe statistics show an increased community spread in these population sectors. That would be a scientific investigation.
Now, politicians may say, “I want to close them anyway, as a precaution.” OK, but don’t tell me it has anything to do with scientific data! “I have no time to wait for the science,” would be a more honest thing to say. I don’t know how many votes that would lose him, or gain him — that’s not my field.
So why don’t politicians resist the media calls for these closures? First of all, I realize that the stakes are high. Nobody wants to be the one who did something different and is responsible for thousands of deaths. So, it’s better to be safe than sorry.
Secondly, they have the religion of ‘experts say ….’ (This currently applies in our society to parenting, Covid, and some other topics.) It’s easier to hide behind the ‘expert’ opinions.
Wisdom and Knowledge
However, what we need now is not more expert information, but wisdom in how to interpret whatever information is available (all of it) and for the leadership to make decisions that the whole country will have to live with.
While we still have limited knowledge of this virus, we need to avoid the current situation where each side is suggesting the other side is the epitome of arrogance. If they followed the science, these decisions would be based in a fair critique of the scientific method used and results obtained.
If you follow the science, how does science evaluate putting grandma at risk of Covid or a teen at risk of suicide? There are no numbers or values I can assign to the importance (or chance) of each factor. So, the politicians and the scientists need to support one another with information, while staying within their own domains.
“But when policy is seen as a negotiation between a number of more or less factual and more or less normative perspectives, we should all want to see how these various perspective and considerations have been weighed against each other. That, ultimately, is what we hope our politicians will do for us, and that ultimately we shall judge them to have done well or badly. They cannot simply decide the goals and let the scientists point the way to achieve them, because the goals and the science constantly change one another.” Nuffield Bioethics
Follow me to see the next Blog: Testing the Test for Covid — The policies and fatality rate of Covid-19
