Probably for the shock value, news outlets are quoting this odd doctor, Ezekiel Emanuel, who, the title promises us, says “U.S. Must Stay Locked Down For 12-18 Months Until There’s A Vaccine.”
“Realistically, COVID-19 will be here for the next 18 months or more. We will not be able to return to normalcy until we find a vaccine or effective medications,” e [sic] said. “I know that’s dreadful news to hear. How are people supposed to find work if this goes on in some form for a year and a half? Is all that economic pain worth trying to stop COVID-19? The truth is we have no choice.”
EZEKIEL EMANUEL: No one is immune to the COVID-19 virus. It threatens all of us.
That last statement is not so. Those who have had it and have developed antibodies are immune—but that’s a pedantic point. There may be many more who are naturally immune, or who possess characteristics that forestall infection.
Let that pass. Let’s discuss the return to normalcy instead.
The H1N1 virus responsible for many deaths is still with us. for this year, the CDC says, “Nationally, influenza A(H1N1)pdm09 viruses are now the most commonly reported influenza viruses this season.”
Given the ease with which it spreads, it’s reasonable to suppose variants of COVID-19 will be with us in years to come, too.
Accepting its permanence, should we shut down everything forever? We’d have to, and it would be worth it if, as Governor Cuomo said early on in this crisis, it “saves at least one life.” A permanent lock down will take a lot more lives than it saves once starvation, and the other associated diseases with it, set in. This Emanuel says “we have no choice.”
There is always a choice. We could return to normal in the same we did after Swine Flu, Asian flu, Hong Kong flu, and on and on, by realizing everybody dies and you have to die of something, and that it’s better to die standing rather than crouching under the bed hoping to avoid only one disease out of all of them.
Why can’t Emanuel see this? The same reason his colleague Anthony Fauci says “I don’t think we should ever shake hands ever again, to be honest with you. Not only would it be good to prevent coronavirus disease; it probably would decrease instances of influenza dramatically in this country.”
He’s right. Foregoing handshakes would decrease all manner of disease. Just as locking people in their homes would block transmission of sickness. Both would radically change our culture and manner of living. Yet if our only goal in life is to save lives, we should do both!
Why do doctors like Emanuel and Fauci sound as clueless as they do? Because doctors don’t think like ordinary people: their goals are largely different. Here’s a brief explanation why.
Most medical tests are imperfect. (Some tests are great. Doctors usually nail it when they say “That guy’s dead.”) The expected error means you can’t trust at face value the results of the tests. Because a test says you have a disease doesn’t mean you have it with certainty, and vice versa. You can formalize this, which we did for coronavirus. The always surprising result is that for most diseases, coronavirus included, you still do not have a large chance of having the disease even when you test positive.
Still, just because the chance of having a disease isn’t high, doesn’t mean you shouldn’t take some action regarding it. And vice versa: just because the test says you don’t have it don’t necessarily mean you wouldn’t act.
How to act depends on how you view the costs and losses associated with the possible outcomes.
Tests usually come in batteries, from simple error-prone first tests to complex, expensive, and accurate secondary tests. Suppose a first cheap test comes back positive. You might opt to go in for a more expensive test “to be sure”. Or you might notice that even thought the cheap test gives a positive, you still only have a small chance of actually having the disease. Anyway, you’d rather not take your chances in a hospital for the second test, which are full of sick people. And even if you do have the disease, you’re not too worried about overcoming it. You blow the second test off.
On the other hand, the cheap test might come back negative, implying you’re disease free. Most would celebrate and get on with things. But a few are so nervous about the possible consequences of a dread disease, that they still go for more tests.
Whatever the case is, you make your decision by weighing the probabilities and the costs and loses relevant to you. All this can be formalized, and your decisions made optimal—for you. I’ve done so in a series of papers (gory details here).
Doctors are different the ordinary people. They do not have the same cost-loss values you do. The decisions they make—decisions optimal to them—are therefore almost always different than decisions optimal for you.
You might like most people be satisfied with a negative test on a cheap metric, say a drive-in nose swab. The disease wasn’t too likely in the first place (according to background rates). And even if you get it, you likely won’t suffer much. Odds of dying from it, given your (we assume) good physical condition are tiny. A negative on a cheap test is good enough.
But a doctor might order more tests. He’d do so for all kind of reasons: he’s not paying for them, ordering second tests are mandatory protocol, he suffers no angst waiting for the tests to come in, finding something wrong with people is his job, and not finding something wrong when it really is scares the Hell out of him. He suffers professionally, his insurance rates rise. Doctors are much more concerned with quantity of life over quality of living.
And so on. You have the idea.
Magnify all this at a national scale and, even though I’ve given the barest sketch, you can see why putting doctors in charge of political decisions leads to overly cautious, even painfully frightened, decisions. Doctors become too narrowly focused on the single malady in front of them, to the exclusion of all else.
Not for the first time I leave us with these wise words from Mark Twain:
There are people who strictly deprive themselves of each and every eatable, drinkable and smokable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get for it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.
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