Establishing a score for who lives and who dies

by on July 2, 2020

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The tragic yet surreal next stage of this pandemic

The pandemic is now fully into the second wave and the tragedy of it all can be overwhelming. There’s a frustration that comes from both knowing that we’d arrive here, while also knowing we could have and should have avoided it.

The difference between the first and second waves is we have a greater sense now of how this may play out. In particular that has pushed health care administrators to anticipate the difficult decisions that will arise when resources become scarce and the need for help overwhelms health care institutions.

The exchange captured above is worth watching. The reporter does her best to hold the Governor of Arizona accountable. Tragically he does as most elected officials and slipped out of the question with spin.

I continue to believe that scoring will be a legacy of this pandemic, in part because the logic and infrastructure was already in place, but also because scoring systems are a symbolic means of making complex systems more accessible and understandable to people who depend upon them.

The tragedy will come from the inevitable inaccuracy of such applications. The problem with complexity is that it cannot be converted into simplicity. Metaphors and analogies are great for conversation, but translating (subjective) human values into scores is never going to work out the way we want it to. Case in point, the impact social media metrics have had on our notions of popularity and newsworthiness.

One of the consequences of this second wave is that masks are finally being taken seriously, and various jurisdictions are now either mandating or strongly recommending their use. This is long overdue, and it will be interesting but also frustrating to see how long it takes for this messaging to filter its way through the population.

Hopefully this means that employers will have to provide masks to their workers, while also empowering businesses to refuse service or entry to people without them.

Yet will it mean that they stop obsessively sterilizing surfaces? Probably not. While there is growing evidence that the virus very rarely spreads via surfaces, this kind of pandemic theatre makes people feel better.

However the larger issue remains complexity, and that’s something we simultaneously indulge in yet fail to fully understand.

Enter the superspreading paradox:

Now researchers are trying to figure out why so few people spread the virus to so many. They’re trying to answer three questions: Who are the superspreaders? When does superspreading take place? And where?

We still fundamentally do not understand this virus. Which isn’t saying much, as we arguably don’t understand influenza either, we’re just better at managing it.

It is however worth recalling that this is the largest scientific collaboration and experiment in human history. The insights and lessons we’re learning are potentially incredibly valuable, providing we’re willing to pay attention and learn.

In the context of superspreaders, there where and when seem to be particularly relevant:

Dr. Nelson suspects the biological differences between people are less significant. “I think the circumstances are a lot more important,” she said. Dr. Lloyd-Smith agreed. “I think it’s more centered on the events.”

A lot of transmission seems to happen in a narrow window of time starting a couple days after infection, even before symptoms emerge. If people aren’t around a lot of people during that window, they can’t pass it along.

And certain places seem to lend themselves to superspreading. A busy bar, for example, is full of people talking loudly. Any one of them could spew out viruses without ever coughing. And without good ventilation, the viruses can linger in the air for hours.

This reinforces my hypothesis that the volume of exposure to virus molecules is what matters. Mild exposure results in mild symptoms. However when stuck in an environment in which there is a high volume of exposure, that is what enables these superspreader events.

The moral being, avoid locations and situations in which that may take place. Wear a mask when indoors and near other people. However it’s not clear that a mask can provide full protection when in a potential superspreader location.

Which brings us back to scoring. Rather than scores to determine who to save, how about scores that help people manage risk? Scores that designate the likelihood of a location or event become a superspreader episode?

Preventing people from getting infected in the first place seems far more effective than having to deal with the damage or consequences of not doing so.

Similarly instead of investing effort into (flawed) automated contact tracing, why not automate the prevention of superspreader events? Use surveillance and technology to anticipate when and where these superspreader events happen? This might have benefited the yobs in Toronto at King and Portland?

As we move deeper into this second wave, different jurisdictions will manage their response according to their conditions and needs. While this is a natural way of introducing nuance, we can’t lose sight of the broader message that we’re all in this together.

One of the things I like indulging in, as a futurist, is to think about preparing for the future, and preventing possible worst case scenarios. What frustrates me in our current relationship with this pandemic, is that we’re neither preparing, nor mitigating future risk.

The concept of the superspreader events is interesting, and may provide us with a means of managing and anticipating risk moving forward. I hope to elaborate on this in future issues.

In the meantime, check out this insightful french video about the potential for futurism and why science fiction should inform our understanding of the present and future.

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