Epidemiology is a science of possibilities and persuasion, not of certainties or hard proof. “Being approximately right most of the time is better than being precisely right occasionally,” the Scottish epidemiologist John Cowden wrote, in 2010. “You can only be sure when to act in retrospect.”
Epidemiologists must persuade people to upend their lives – to forgo travel and socializing, to submit themselves to blood draws and immunization shots – even when there’s scant evidence that they’re [personally] directly at risk.
Epidemiologists also must learn how to maintain their persuasiveness even as their advice shifts.
These first three paragraphs above are quoted from an article by someone called Charles Duhigg published in the New Yorker two weeks ago:
It’s a long read, but interesting, comparing the reaction of two different states in the US, Washington State and NY State – where the delay of one week in acting to control the epidemic caused two different outcomes.
What we need to get our heads around, when getting to grips with what epidemiology is, is this:
(i) the hard science of statistical possibilities, coupled with
(ii) the art of persuading or convincing people about new ways to act – and
(iii) how both of these (statistics and argumentation) are operating in a social and medical reality that is changing, often fast, over time. What you advise in Week One will need to change in Week Two, as circumstances change.
A tall order to keep all that in mind. But there you go. That is the demand of epidemiology. And most people can and do get their heads around it. Dr. Gujadhur explained it to us, and people listened. Even if he did have to ask, when too many of us acted without the crucial discipline to control the epidemic, if some of us have “koko vid”? He knew what the danger was and that explains his impatience.
Anyway, contact-tracing, which Mauritius has 70 years of experience in, is another important science and art in responding to epidemics, involving important qualities in those that practice it:
i) The ability to get people’s confidence that you are working in their interests (which you are), and immediately
ii) To have the ability to, like a social worker, help them actually get the tests and medical care that they need, while also having
iii) The capacity of a counselor to convince them, in medical confidence, to share details of their contacts, from the ordinary family contacts, to the routine shopping and eating out contacts, and to jolt their memories about a trip to the post office or the dentist, and then into the more difficult domain of socially, even legally, illicit contacts (visits to someone they have a secret liaison with, or to a bar known for prostitution, or an illegal gambling den or drug-related demars). This all means an ability to probe, to guess, to convince the person of the social good of giving all possible contacts in absolute confidence,
iv) And then to follow up these new contacts, in a tactful, respectful way, while
v) Understanding what constitutes likely “contact” – how long, what distance apart, and so on.
All this is to share with you today what it means to control an epidemic.
Controlling an epidemic is not done by passing draconian laws that ban strikes in the port, or that cede to a policeman the power to arrest you if you are out shopping on a day when your surname begins with the wrong letter. No. It is achieved by many of us understanding how epidemiology works as a science.
It is a strict science but with a broad social brush. “Being approximately right most of the time is better than being precisely right occasionally” to use part of the above quotation again. Epidemiology is a science that goes right against the Manichean or “good” or “evil”, only-two-positions-thinking that is so common under capitalism. It goes against the selfish personality traits that capitalism nurtures. If you think only of yourself in an epidemic, you will, even yourself, not get good health care let alone be protected from the epidemic. Remember, when we stay at home and keep physical distance from each other, we are slowing the spread of the epidemic enough to make less people sick. We are also thus sparing the health workers being overpowered and sparing funeral arrangements from collapsing under the sheer numbers. The social distancing is no absolute individual guarantee. It just makes life difficult, quite literally, for the virus.
And remember that, when I wear a mask, you all benefit. And when you wear a mask, we all benefit.
There again, if one idiot fails to understand and does not wear a mask, we should tell him or her to wear one, but if they persist, we should say, jayde. So long as it is only one or two, in epidemiology this makes no difference. If it is a leader who encourages everyone to be selfish like this one or two people, then we should work to get him kicked out because this behavior is dangerous.
As the epidemic recedes after its first wave, it is worth working to understand these two crafts (epidemiology and contact-tracing) because there could be new waves of Covid-19, for a start, but more seriously, there could be much worse epidemics in the future. Humans are rather too densely populated, for our size as “big mammals”, for one. And we are putting too much pressure on the hosts of viruses (bats, other creatures) by destroying big, wide-open spaces where they live. Viruses under pressure, hop species.
As the epidemic recedes from its first wave, it is also worth learning to think in a dynamic way, and to abandon the Manichean, Trump-like, way of thinking. Look where it gets him:
Trumps says two kinds of things:
1. The Coronavirus illness is “just like flu”, “it will go away by itself”, “it will disappear in a few days”, “there is nothing to worry about” and America has handled this “perfectly”. Basically the Coronavirus is, according to Trump, benign.
2. However, China is “evil” because it failed to warn in time of this mortal illness. Basically the Coronavirus is mortal.
So, we have to learn to think dialectically, and dynamically, and Trump is a good anti-model.
Epidemiology, contact-tracing, and the way we think about these, are all also political questions.
for LALIT, a personal viewpoint.