« Medical apartheid | Main | Frenemies »

Which science?

covid-stringency-index-2021.pngThe spring of 2021 is all about "last year at this time..."

Last year at this time I was frantically helping Privacy International track covid responses as every country passed laws, mandated curfews and other restrictions, and awarded police enforcement powers. It transpires that lots of others were thinking similarly about the need to track the different policies countries were pursuing to contain the pandemic. Tracking surveillance is important, if only to ensure that we can identify new intrusions inwhatever "new normal" emerges post-pandemic, but there are many other lessons to learn from comparisons across the world in this global, uncontrolled experiment in public health we call a pandemic.

One group doing this sort of study recently reported initial findings based on collected contributions from 600 data collectors in 186 countries comparing policies, vaccine rollouts, and so on. Most of it is negative, listing what *didn't* make a difference: the wealth of nations hasn't counted for much, nor did a nation's scientific and health care capacity by itself, and neither did the democratic or autocratic nature of a country's government.

The instinctive answer to this sort of question is that the countries that had recent experience of epidemics - HN1, SARS, MERS - understood the seriousness of the danger and how quickly exponential - viral! - growth can get out of hand and responded quickly and decisively. In some cases, such as New Zealand (26 deaths in total to April 8, 2021 for a rate of five per million population), Taiwan (10. 0.4), Vietnam (35, 0.4), China (4,636, 3), and Mongolia (18) that response has been effective over the last year (all figures from Worldometers. Other countries, such as the Czech Republic, Hungary, and Bulgaria, responded quickly to the initial threat, but then failed to use that experience to reimpose the measures that had worked for them when new waves of the pandemic arose. Some of the countries that were slow and/or chaotic about imposing lockdowns and other restrictions are at the front of vaccine rollouts. Mongolia, which has done fantastically well at curbing both case numbers and deaths, especially given its limited resources, by starting as early as January 2020 to implement low-tech public health measures, has abruptly seen its daily case load spike from 65 cases a day to 500 in the last month. The prime minister has announced a lockdown.

Eventually those doing this kind of work will be able to look across the entire experience of the pandemic to assess what worked and what didn't and make recommendations for more effective responses in future. That won't, however, be possible for at least another two years. In the meantime, some thoughts.

Even with this many countries to compare, the number of variables is staggering. Are you aiming to minimize deaths, contain costs, ensure your health care system doesn't collapse, or minimize spread? In one sense those are all the same: limit infection and the rest follows. But take vaccines, still patchily available, which goal you prioritize changes who gets protected first: minimizing deaths and hospital admissions means starting with the oldest, as in the US and UK, while minimizing spread might mean first targeting the most mobile, 20- and 30-somethings. If you're a scientist you develop models you hope resemble reality that let you see the results of different strategies. If you're a politician in the US or UK, you might be tempted to remember that old people vote.

One thing I think will become (even more) clear in hindsight is the tension in many countries between the magnetic attraction of new information technology approaches such as AI and risk modeling and the plodding effectiveness of low-tech public health approaches. It's very tempting to view this as the difference between "male" and "female" approaches, particularly because washing your hands, avoiding people when you're sick, and opening a window are the kinds of things your mother might have told you to do, and you're a grown-up now. It's more likely, though, that the last 50 years of high-speed computer industry developments have left us too inclined to think newer must be better.

In some cases this is true; certainly, the new mRNA vaccines seem set to achieve numerous breakthroughs against diseases that have proved recalcitrant until now, and without the Internet we would have been far more isolated and scientists could never have responded so quickly and so collaboratively. But in others our modern gizmos have been largely a distraction. Remember last year's mad rush to develop contact tracing apps? That whole controversial effort appears to have been largely pointless. The UK's app has been downloaded 21 million times...and so what? The country still has one of the highest covid death rates in the world (fifth in number of deaths, 13th in deaths per million population). As Jonny Ball and Michael Goodier write at New Statesman, contact tracing apps help provide manual contact tracers with leads to work with; they are no substitute for robust local laborious effort.

So my guess is that when the dust settles key advice will be that you can't automate your way out of a pandemic. Last year around this time, US Speaker of the House Nancy Pelosi said, "...And for those who choose prayer over science, I say that science is the answer to our prayers." Science, yes, but not just *new* science.

Illustrations: A visualization of the Stringency Index from the Covid-19 Government Response Tracker project.

Wendy M. Grossman is the 2013 winner of the Enigma Award. Her Web site has an extensive archive of her books, articles, and music, and an archive of earlier columns in this series. Stories about the border wars between cyberspace and real life are posted occasionally during the week at the net.wars Pinboard - or follow on Twitter.


TrackBack URL for this entry:

Post a comment

(If you haven't left a comment here before, you may need to be approved by the site owner before your comment will appear. Until then, it won't appear on the entry. Thanks for waiting.)