Tuesday, August 4, 2020

Waves??? Covid-19 and the problem with analogies.

What if we thought of the Covid-19 virus as sparks floating around in the air, some hotter, some in clusters coming off a nearby fire? What if we thought of the guy refusing to wear a mask in the same way we thought of the guy who throws a lighted cigarette out the car window into the grass along the roadside? Only you and your family are the dry grass.

Humans apparently have a desperate need to assign analogies to that which they do not understand. Only a calendar quarter after the Western press started noticing the Covid-19 pandemic, politicians and the press were seriously discussing "waves" of the disease, as in arguing over whether we were in the first wave or second wave. It got so bad that on April 30 Oxford's Centre for Evidence-Based Medicine felt compelled to publish an article that noted in part:

    Waves, as in the sea, are usually preceded by a trough, but this visual analogy is hardly ever mentioned; nor the appropriateness of forecasting waves in a coronavirus pandemic. We reviewed the evidence (Search strategy at the end) underpinning second-wave theory.
    Most of our thinking on second-wave theory arises from the 1918-20 “Spanish Flu” that infected 500 million people worldwide and reportedly killed an estimated 20 million to 50 million. By August of 1918, a deadlier strain of the “Spanish flu” emerged. When reading the “Spanish flu” story we must remember the role of military censorship. The identity of the index case remains a mystery. ...Censorship is also responsible for the sobriquet “Spanish” attached to the pandemic. As Spain was not in the war and had no censorship, all cases appeared to originate from Spain – an example of ascertainment bias.
    For influenza, school vacations are thought to be one of the mechanisms for reduced transmission. Contact reductions in the summer vacation of the 2009 outbreak, led to the summer ‘trough; before the infection picked up again – the ‘wave’ – into the winter.
    Both the 1918 and 2009 outbreaks are similar in that they started in the ‘spring wave’ and went on into the summer. These spring/ summer delays in the initial numbers infected are thought to have little impact on the overall attack rate.
    We do not know for certain whether COVID will recur in phases, or sporadic outbreaks or disappear altogether.
    Making absolute statements of certainty about ‘ second waves’ is unwise, given the current substantial uncertainties and novelty of the evidence. As we cannot see the future and our understanding of this new agent is in its infancy we think preparedness planning should be inspired by robust surveillance, the flexibility of response and rigid separation of suspected or confirmed cases. These measures should stand for all serious outbreaks of respiratory illness.

Focusing both on history and science, that article immediately caught the attention of almost nobody, most particularly among politicians and the press. Thus, most folks are sitting around waiting for some kind of break followed by more infections while the press and politicians are assigning "wave" terminology when local stay-at-home orders resulted in downturns followed by opening up followed by expanding infections.

Three months after the April 30 Oxford's Centre for Evidence-Based Medicine's article, on August 3 The Guardian, also from the UK, published this piece We're thinking about Covid-19 the wrong way. It's not a 'wave' – it's a wildfire written by Director of the Center for Infectious Disease Research and Policy at the University of Minnesota Michael T. Osterholm, PhD, and writer and documentary film-maker Mark Olshaker who were the authors of the 2017 book Deadliest Enemy: Our War Against Killer Germs. You can read the article, but consider this from a review of that book published three years ago:

    For decades, Osterholm has been in the business of telling people what they don't necessarily want to hear: Pandemics are inevitable; outbreaks can be devastating; bioterrorism is a threat. Several real infectious disease threats exist that could stop the world in its tracks, and by and large government officials, industry professionals, and researchers are not acting together to stop them, he warns.
    But his latest book hopes to help in our fight against these epidemics. In Deadliest Enemy, Osterholm lays out a "Battle Plan for Survival" with a nine-point strategy on how we can keep ourselves safer from emerging infectious disease threats. Preventing a global flu pandemic is the top priority of the plan.
    "If we know how to greatly reduce the risk of these public health problems and we don't, then we become an accomplice to the morbidity and mortality they cause," he says. "We need a new generation of public health experts who can effectively address these issues in ways we're not addressing them now."
    "I have the reputation as 'Bad News Mike,'" said Osterholm. "But it's not just bad news [in the book]. I'm also saying, 'Wake up, there's something you can do about it.' I guess I'm at the age where I'm looking at what kind of world I'm leaving for my kids and grandkids, and I want to make sure we do what we can to stop disease."

Unfortunately for "Bad News Mike" not only did no one do anything based on his book but reporters who daily cover such enlightened folks such as politicians like Donald Trump bought right into the "wave" concept. Of course, for the most part those reporters don't read scholarly books about "killer germs" which leaves us with a press corps equally as informed as Trump.

If we must have an analogy, look at each person's uncovered mouth and nose as potentially emitting over a distance of 16 feet fireworks which may or may not explode. You and all people are made of dry grass and brush. The more people around, the more who are potentially emitting fireworks in a field of dry grass and brush.

That's the analogy to use.

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