Monday, 13 April 2020

The Loyal Opposition

Your capacity for tolerance, inclusivity and compassion is only interesting when you can listen to the other side. It's worth very little indeed unless you hear the other side, maybe even to the extent of changing your own position. Only the greatest among us really mean it when they quote Not VoltaireI disapprove of what you say, but I will defend to the death your right to say it. Because it is only human nature to want to bury the opposition and be right. We live in times more deeply polarised than any in which I have lived, with the possible exception of the miners strike in 1980s UK. Some countries are turning hard right and, believing myself to have leftist tendencies, I feel this more than some other members of the patriarchy. And Covid-19, with all its anxiety-inducing changes, is not dialling up the deep-listening meter.

Across the short water in the UK, one of the most polarising figures in politics is Jacob Rees-Mogg. There is much to loath about the chap - he's parleyed a well-heeled upbringing into a fortune by shuffling money from one off-shore account to another on behalf of his wealthy pals. He is caricatured as "The Honorable Member for the 18th Century" and is consciously out-there with his anachronistic patrician manner. I don't hold with him subverting evidence-based medical decisions [Simon "Orkambi" Harris I'm looking at you too, yeh bowsie] on behalf of his constituents / voters. But patricians can have really good manners and I was impressed at the kind and respectful valedictory remarks JR-M made to retiring Speaker of the Commons John "Brexit-thorn" Bercow. Two weeks ago The Mogg was giving a gracious hat-tip to Labour leader Jeremy "Red-as-Mao" Corbyn on the latter's retirement. I don't think the phrase is used but the tenor of that speech was that Corbyn's sincerity was not in doubt in his role as leader of HM's Loyal Opposition. The two men couldn't really be further from each other on the L-R spectrum and still expect to get elected in Britain: where the electoral system is notoriously unforgiving of extremes. The rest of the Conservative government have been spiteful and mean-spirited about, for example, not giving John Bercow a sinecure for his 10 years of loyal service to parliamentary democracy in the UK.

We could, with advantage, take a leaf out of the Rees-Mogg portfolio in our discussions about Corona Virus and the best way to mitigate its impact. The least dissent or questioning of the lock-down way-of-life brings out howls of indignation which might be caricatured as you're going to kill my grannie if you go jogging ye sonsie git: stay home . . . in your B&B hotel room. Christie Moore, avuncular singer, got all judgmental about middle-class people travelling to their dachas for the Easter weekend - they are spitting at the nation, he said. It's an easy moving target to catch people as they leave the Capital to isolate themselves in their second home. Much easier than sorting out communal feeding and shared bathrooms in DP centres or prisons or homeless hostels. Later in the same interview Christie Moore said he was just grand in his cocooning because the grandchildren travelled [more than 2km, I bet, but tell me I'm wrong] once a week to talk to him through the son's car window. What's sauce for the dacha-owning goose is not apparently sauce for the me-exceptional gander.

But really is lock-down of everyone the only solution to the problem? John Ioannidis is skeptical for an hour . . . too long? John Ioannidis is skeptical for 10 minutes. Ioannidis is not a crank or a yahoo, he's a professor at Stanford . . . who has been hugely critical of the scientific process. I've shown that he's not afraid of big data [and making it publicly available] and also tribbed his study Why most published research findings are false. Ioannidis doesn't get all shouty about the mistakes that The Man is making. He just suggests that a) he also wants to minimise the number of excess deaths this year b) almost every government which can is going for shelter-in-place / cocooning / physical distancing / isolation by household c) this is better than doing nothing but d) there is very little reliable data on why this is a reasonable response to this pandemic.

Charles Eisenstein US public intellectual has some similar questions; which balloon out into in a 9,000 word essay about wot are we like: The Coronation [hat-tip to sister].

For example: everybody knows that the case fatality rate is 3.4%. This is now referred to as The Global Average rate, when compared to Italy where the rate is 10%. But 3.4% is a sum from an early epidemiological tally in Wuhan where the deaths are those recorded in hospital associated with tests flagged as covid-19 positive. He is skeptical about three aspects of the sum:
 % = (covid-19 deaths) ÷ (people who are covid-19+)
  1. some people died at home without being recorded or tested
  2. some [more] people in hospital died with covid-19 rather than of covid-19
    • in Ireland we've heard a lot about this cohort - they have "an underlying condition"
  3. some [uncountable numbers of?] people were never recorded as being covid-19+ because they were part of the 80% [if you haven't heard that number every day for the last month, you have been dozing] who had mild symptoms or none.
When killed by Covid-19, Tim Robinson was 84. My dad was 83 in 2001 when he fell down the stairs and died a few days later. Those are anecdotes. What Ioannidis wants, what decision-makers need, are data to establish what is the likely death /disability rate from covid-19 in <insert country here>. That 3.4% is probably too high [because of the 80%ers] but is it 10% too high or 100% too high? - nobody knows. Without numbers, The Man has no evidence-based idea about whether the plan-of-action is proportionate. Somebody [Gallup or red-C have the infrastructure] needs to go out on the street and test 5,000 random people to see what the infection rate is; and then sample another 5,000 a week later.

I won't here do a co$t based analysis of 'proportionate'. Actuaries do that - they have a figure for what your life is worth, especially if you want to insure it; brutal and utilitarian [=meeee!] as that is. And there are worse things than dying as I've tried to suggest in my posts about road-injuries or QALYs. Let us just reflect ever so briefly on those who are like to die because of being banged up at home for another 4 weeks on top of the 3 weeks we've already enjoyed / endured. Even if you think that the probability of any of these adverse outcomes is small %-wise, remember that there are 4.7 million people dicing with those odds; so that might be a helluva lot of people - the equivalent of everyone in Clonmel or Sligo, say.
  • 100s & 1000s of asymptomatic younger-than-70 people are out of work and banged up at home
  • 960,000 least-at-risk children are being deprived of their schooling 
  • their parents, including health-care workers, are being deprived of state-funded child-care
  • this will be super stressful for all those people
    • stress will lead to an up-tick of depression, heart attacks, suicide
    • with nothing to do but facebook & jig-saws, isolationeers are going to be eating too much so there will be an uptick in obesity and its sequelae: diabetes, depression, cancer, heart-attacks
There are, of course, other adverse outcomes from reactions to covid-19. Saturday lunchtime, I was listening to the wireless. GP from Limerick was talking about the state of his practice in these troubled times . . . and A&E: the local hospital would normally get 1-2 heart attacks a day presenting through A&E, now they are getting 1-2 a week. Which means that sick people, who would benefit from prompt treatment [heart attacks are not necessarily fatal], are not getting it. Either because they soldier on not wanting to be a burden on a stretched health-care system and/or are scared shitless about catching a dose of Corona and getting intubated, and then dying to the shriek of a vital-signs monitor without the solace of family.
But don't listen to me, I have no skin in the game and no special knowledge. But do listen to John Ioannidis unless you're certain sure that your government is doing the very best that can be done.

<Loyal Opposition Alert> what about this alternative action plan [not my idea]: just cotton wool the vulnerable and let everyone else go about their business. Call it a controlled experiment, so we will know next time whether that's better or worse - it will be hella cheaper, that's for sure. Otherwise, next time [bioterrorism anyone?] we'll have even less informed choice

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