​Covid-19: the conflict of Data and Public Policy and Politics

The world continues to adjust to new and different times, many in shock, many experiencing the distress that always comes with such a crisis, many inflamed by what they hear or read either on social media or television or wherever is their source of information.

That the disease is dreadfully serious is well beyond question.  It is taxing the energy of the wonderful health care professionals who provide care to those stricken with the virus.  That health care facilities are distressed is beyond question, many having been at a point of crisis long before Covid-19! 

Covid, and each of the viruses and infectious diseases that have preceded it, follows a familiar cycle:  discovery in the country of origin, early management in that country, notification to the World Health Organization, alerts to other countries, and the international war on the disease commences.  The war is always complicated because in the early days, little is known about the virus, how it behaves, how it is transmitted, what drugs and treatments are effective, if any, what the incubation periods are and much, much more that engaged thousands of brilliant people around the globe in research laboratories and regulatory centres.

Any delays in any stage of any process can, and will, increase the risk of harm brought to people and countries.  If the country of origin, for instance, is slow to notify WHO, the virus can spread very quickly given the propensity of humans to travel internationally.  The danger of slow initial response is that each new bug has to be studied carefully in order to develop a profile, treatment plans, prevention plans, and more.

Any delay in engaging leaders in each country can, as well, increase the level of severity of impact.
There are many things that have been complicating the response to this dreadful Covid-19 virus.  To begin with, very little was known about it until just a few weeks ago.  It obviously became evident to the Chinese health authorities that the virus spreads with voracity.  There was a significant impact late in the fall of 2019 with some apparent delay in getting the probable severity to the rest of the world.  Once there was an acknowledgement of the severity of the virus, which seems to have been not until early February, the messages of hygiene and caution got out.

Then came the mathematical modeling that is always done with any outbreak.  International officials produced models that suggested that with the high rate of contagion  there would be a huge death rate.  But those models are always based on imperfect data gathered in a very short period of time.  Dr. Deborah Birx, in explaining some of this in a YouTube interview, said that the whole approach to managing the impact of infectious diseases is based on statistical modeling.

Apparently in the initial modeling, public attention is focused based on worst-case scenarios.  And such seemed to be the case with this virus.  Messages of panic were sent world-wide in early February based on the original modeling which suggested an unusually high rate of contagion associated with a huge death rate.  Soon people were talking about “millions of Americans will die…”
The same media that a month earlier was down-playing the impact of this virus now did a flip and commenced communicating messages of great urgency that converted into panic by many people.  That is why the store shelves emptied of food, canned goods, and toilet paper.  Major retailers said the buying habits of North Americans suddenly were greater than the annual Christmas rush!

Since that time social media, print media, and audio/video media have carried stories, observations, remarks that must leave the public somewhat confused.  Complicating it all is the apparent engagement by persons “on the right and on the left” in what can only be described as opportunism and it cuts both ways.  Thankfully not that way in New Brunswick.

There are many, many “armchair quarterbacks” who find  alluring headlines and stories in the medium of their choice then put them on social media, often coupled with their love or hate they may have for a certain public figure, then a ton of people jump on and create a thread that displays opinions, biases, but seldom hard facts.

This stuff is heart-attack serious; the public is genuinely concerned as we must be.  There is ample good counsel coming from daily briefings of our provincial leaders with much more to be found on government websites.  What we do not need is the level of concern that we all have being fuelled higher than it needs to be with people expressing what they do not actually know to be true.

So what do we know?  The virus is deadly serious and spreads easily.  We know that protecting moisture coming from the mouth through coughing is a major way to reduce risk of transmission.  We also know that washing hands many times per day, which we should be, doing anyway, also reduces risk and removes contaminants from our hands.  We know that a virus is a strange substance that is eliminated with washing with hot water and soap.

We also know that the original projections of “millions of Americans dying” was probably overstated.  Dr. Deborah Birx, described by CNN as a legend in Infectious Diseases, has confirmed the seriousness of transmissibility while noting that the mortality rate even now being experienced is in the vicinity of other viruses.  She noted that most people who receive proper treatment will survive and that seems now to be the pattern.  But she also was quick to point out that people over 65 who have one or more underlying, pre-existing medical conditions represent the group at high risk for mortality.

Of all the deaths recorded in Italy, according to the Italy National Health Institute, only 0.8% had no other co-morbidity; 48% had three or more co-morbidities, 25.6% had two other illnesses, and 25.1% had one other illness. 

In New Brunswick, the Health Council website tells us that 39% of New Brunswick residents over 65 years of age have 3 or more co-morbid conditions; in other words, the over 65 group is typically at high risk for serious illness or death from any serious flu or other virus passing through the province.  In long term care, this is a serious issue and explains why, in each annual flu season, nursing homes periodically have to impose restrictions on visiting.

Each year many people die with the flu as the precipitating factor.   From the week 3 stats in the New Brunswick government influenza report for 2018/19 we see:

• There have been 180 positive influenza cases in week 3. To date this season, 1262 cases have been reported, 103 influenza A (H1N1)pdm09, 1155 influenza A , 2 influenza A (H3) and 2 influenza B.
• There have been 20 influenza associated hospitalizations during week 3. So far this season, 233 influenza associated hospitalizations have been reported and 6 deaths.

• The ILI consultation rate was 19.6 consultations per 1,000 patient’s visits in week 3. The ILI rate was within the expected levels for this time of year.

• Three new influenza outbreaks (Nursing Homes) and two ILI outbreaks in schools were reported in week 3. So far this season, 9 influenza outbreaks have been reported in nursing homes, 1 in a Hospital and 8 ILI outbreaks have been reported in schools

Amidst all the conflicting information swirling about, it is helpful to find one or two proven reliable sources of information and blot out all the other noise; the “other noise” will make you anxious, cause you stress, and leave you confused.  Listen to the official government spokespersons and find another trusted source if you want broader understanding of pandemics.  As Premier Higgs says, we need to be calm but diligent.

Ken McGeorge is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is [email protected].