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| Figure1 A local medical staff member, left, hugs a member of a medical assistance team from Chongqing on March 23, before the team departed after helping with the COVID-19 recovery effort at Yunmeng county in Xiaogan city in China's central Hubei province. AFP |
By Amanda Price
I am an information junkie. I admit it.
Turning down an offering of freshly picked information is hard for me. Stopping myself from indulging my obsession is even harder.
Information fills a void. It feels gratifying, except that the more you indulge, the more addicted you become.
There is sorely little help for this psychological disorder.
Sadly, as the coronavirus crisis has filled the media, in both the social and professional spheres, many have begun to rely on their daily doses of facts and figures. And the media has been keen to keep up the supply.
Without those figures, many fear they will be more vulnerable.
In the midst of the unknown, numbers are the known ― the only way available for us to measure the need for calm or to justify us when we turn to panic.
When the coronavirus outbreak began in Wuhan, I checked the figures on Worldometer.com every day. When it spread outside China, I checked the figures several times a day. I read articles from reliable sources, but in copious amounts that kept me suspended in a haze of over-information.
In between the rushes, data fatigue would sink it and I would promise myself I'd be better … until another surge of coronavirus figures hit the streets.
Then one morning, in what can only be described as a moment of revelation, my rational brain punched through the haze and made me look at what I'd become.
I had elevated numbers and statistics to a position of power and influence. But worse, I had awarded them a legitimacy that they neither earned, nor deserved.
Numbers and statistics had become my master and I their slave. I had begun to follow them as if they were worthy of my trust and deserving of my full attention.
John Allen Paulos, professor of mathematics and author of "A Numerate Life," explained in The New York Times: "Numbers have a certain mystique: They seem precise, exact, sometimes even beyond doubt. But outside of the field of pure mathematics, this reputation is rarely deserved. And when it comes to the coronavirus pandemic, buying into that can be downright dangerous."
Part of ensuring that the public is kept safe, according to biological anthropologist Dr. Jennifer Cole, falls on officials who need to ensure that the media and the public understand that figures are never concrete. They are based on what we know, and do not include what we do not know, until we do, at which time they change again. She added: "Estimates and projections should always be put in context. If figures and estimates change, it's important to clearly explain why this has happened."
Of course, the two figures of most importance in the midst of the coronavirus crisis are the number of cases, and the number of deaths. From the equation that relies on these figures we arrive at the case fatality rate, that is, the percentage of confirmed infected patients who are dying.
One would need to be either ignorant or a fool not to care about these statistics. They are, understandably, the statistics that impact and overwhelm us the most.
We use them to rate the chances of survival for ourselves, and for those we love.
We are lifted when they go down, and depressed when they go up.
Ultimately, we expect them, and expect them in terms that we understand.
And so healthcare authorities take mountains of data, endless equations and countless variables and shove them into bite-sized pieces of information that we can consume.
But working out case fatality rates is like having to summarize "War and Peace" in a paragraph. You have to leave a lot out to make what you do know fit in.
John Edmunds, a professor of infectious diseases at the London School of Hygiene and Tropical Medicine, explains: "It is surprisingly difficult to calculate the 'case fatality ratio,' or death rate during an epidemic.
"The statistics that we see in print or online depend entirely on the number of confirmed cases, but as every international expert agrees, in most countries the number of undocumented cases of infection far exceeds the number of 'confirmed cases.'
"We do not report all the cases. In fact, we only usually report a small proportion of them. If it were possible to identify every case of infection, only then would we be able to arrive at an accurate rate of case fatality".
Consultant in infectious diseases at the University of Glasgow Centre for Virus Research, Dr. Toni Ho, supports Professor Edmunds' explanation.
"The quote case fatality rate of 3.4 percent is taken from 'confirmed' deaths over totally 'reported' cases. This (case fatality rate) is likely an overestimate, as a number of countries, such as the U.S. and Iran, have undertaken limited testing. Hence, few of the mild cases have been picked up and the total number of cases we are observing are the tip of the iceberg."
Summing up his findings, Edmunds explained that the only thing we can safely say "is that if you divide the number of reported deaths by the number of reported cases (in order to get the case fatality ratio), you will almost certainly get the wrong answer."
Of course, in countries like South Korea, which were able to fast-track the production of test kits and undertake community-wide tests on both symptomatic and asymptomatic citizens, the discrepancy in figures will be much smaller.
Epidemiologist Jeffrey Shaman, from the School of Public Health at Columbia University, led a team of international researchers from London and Beijing in an in-depth study of undocumented Covid-19 infections. Their research was based on data taken from Chinese hospitals from January 10-25. Their paper can be found in the journal "Science."
"As physicians and researchers have seen since the start of the outbreak, many infected people never become sick," they say. "As few as 14 percent of people in Wuhan with 'early' coronavirus infections were being detected."
If we are to assume this research is correct, 86 percent of early infections in Wuhan went undetected.
Adding to the number of undocumented cases is the number of mildly symptomatic people with no travel history, choosing protective measures over confirmation. Thousands of people are assuming the worst and strictly self-isolating rather than venturing out onto streets or to hospitals, where, if they are infected, they may pass the virus on.
And healthcare workers are encouraging these decisions.
"If you're feeling a bit under the weather but you can walk, eat and breathe without difficulty, and are not in a high-risk category, stay home in strict isolation for four weeks, not two. Increase your fluids and salts, disinfect everything and don't even go out for a walk. Don't have visitors. Only go to seek medical help if your symptoms get worse or you have been in contact with a confirmed case. The odds are on your side, and you are freeing up resources for those in real need of medical care."
Dr. Mark Morocco, of the Ronald Reagan UCLA Medical Centre, explained that the average healthy person with a mild cough should not be racing into already crowded hospitals, unless they have been in contact with someone who is infected or have traveled overseas.
We don't know how much worse things will get, he said, "but it's critical to limit the spread of the virus through isolation and social distancing, and by not rushing to the hospital if all we feel is a bit under the weather."
There are hundreds of thousands, perhaps millions (apart from the rightly termed "Covidiots") who will ride this storm out at home, drinking Grandma's chicken soup, FaceTiming friends, playing Sudoku and binging on Netflix.
When the virus has been contained, experts estimate that millions of people will have been infected with either no idea they were carrying the virus, or at most a vague suspicion.
What all this adds up to is a statistic that we may well be able to reduce.
Professor Mark Woodhouse, an infectious disease epidemiologist at the University of Edinburgh, is quoted in "Medical News Today" as saying: "Though there is a disagreement about this, some studies have suggested that (the case fatality rate) is approximately 10 times too high."
The number of undocumented cases may well decrease the case fatality percentage, but it also has a darker and much more nefarious side.
Undocumented cases of the coronavirus are now thought to have been the most significant reason for the spread of the virus. Asymptomatic carriers, or those with only very mild symptoms, escape detection and have moved among communities and populations ― from city to city and country to country ― as if they did not present an immediate risk.
This is why lockdowns are necessary, not because most people are doomed to die, but because we simply cannot be sure who is carrying the virus. This virus is not bullet proof and some people's immune systems have a better ability to keep the virus from compromising their health.
Some do not.
This is the human side of the crisis, in fact the only side that really counts. It is not about numbers and statistics, but about our commitment to each other and to the welfare of people that we've never met and probably never will.
Too often we cannot see these people for the numbers.
If instead of checking the latest numbers, we use the time to contact a friend, check up on a neighbor or send some fruit to an elderly relative, we would be actively taking a stand against the virus.
We can all read, and most of us can even count, but that doesn't mean that numbers and statistics should take places of priority in our lives. Those places are reserved for human beings.
The virus will spread and the numbers will increase ― that we can be sure of. We no longer need statistics to motivate us to do what we all know we must.
Less thinking about numbers and more time thinking about each other might strike the balance we so desperately need.
Think about it … but not for too long.
