The price of freedom in the time of COVID-19
I read the news today.. oh boy!
COVID-19 has been ravaging various communities in so many ways. Other than the obvious risk factors (gender, age, co-morbidities), the cable news talking heads are hypothesizing about the higher incidence rates for certain groups; referring to ‘returning skiers` (lots of patient zeros have been linked to European Ski resorts), race (African Americans and Latinos) and even certain religious groups (e.g. ultra-orthodox Judaism).
I would like to suggest another factor, which is the value that different cultures place on freedom. Some examples;
· The Chinese people are either fearful and/or naturally obedient of their dictatorial government. So when they received the order to stay at home.. they did.
· Brazilians too are a fearful lot but for a different reason than the Chinese. Brazilians fear their precarious national health system, overzealous police and populous no-go crime areas which makes Brazil the world`s largest market for bullet-proofed cars .. the rich and middle classes read the writing on the wall regarding the effect of COVID-19 in Europe and are generally staying `at home` even without a mandatory lock down order.
· In contrast, Americans really value their freedom, their right to bear arms, their right to guzzle cups of fizzy drinks in excess of 16 ounces (Mayor Bloomberg tried and failed to take that right away), etc.. So just the notion of being ordered to stay at home is anathema to the rights embedded in the Constitution. I fear that this embedded right to life, liberty and the pursuit of happiness might prove costly in terms of body-bags. Hope I`m wrong.
Lies, damned lies and statistics
Where did this virus come from? Where is it going? No one really has a clue and to borrow from a Turkish idiom; those who speak, do not know and those who know, do not speak.
Case fatality rates versus mortality rates: It`s incorrect to refer to mortality rates in the context of COVID-19. Mortality rates use the `general population` as the denominator to calculate the percentage. Whenever we refer to the lethality of COVID-19, the denominator is the number of COVID-19 cases and the resulting index is the case fatality rate. Therefore the use of the term mortality rate in reference to COVID-19 is a foolproof circuit breaker to stop reading the article!
I have no doubt that all of world leaders are trying their best, but the present numbers from each country cannot either be readily compared between countries or cannot be trusted. To summarize:
· Number of confirmed COVID-19 cases . Woefully understated owing to the lack of reliable tests
· Number of deaths relating to COVID-19.
The World health organization recommends an emergency ICD-10 code to identify COVID-19 deaths. But many countries (including Brazil) are not using this updated standard of the ICD; International Statistical Classification of Diseases and Related Health Problems.
o In Brazil, health officials have sanctioned the cause of COVID-19 death classifications that include the inconclusive `COVID-19 — probable cause of death` and `COVID-19 — suspected cause of death`
o Lots of deaths are not going to be `tested` for COVID-19 before burial.
The poor quality of the input data confirms the adage `garbage in, garbage out` which is applicable to the vast majority of COVID-19 model projections. So far the most respectable model I`ve seen is https://covid19.healthdata.org/united-states-of-america from the IHME. The IHME is a recipient of funding from the Bill & Melinda Gates Foundation. Their modeled projections do show an extremely wide range of results; which is only realistic given the short comings of the underlying data.
Why aren`t more people adhering to social distancing?
After a lifetime of selling the notion that global travel, bars, restaurants, cruise-liners, stadium concerts, carnival festivities (that ended late Feb 2020), mega marathons and other pleasure domes etc.. are the reward for your hard work and by the way, make excellent backdrops to maximize instagram likes; now the `turn on a dime` notion is stay at home, far away from the madding crowd is just so confusing… mixed signals.
At the moment in this time of uncertainty, we all agree that the best advice is to practice social distancing by limiting face-to-face contact with others to reduce the spread of COVID-19. So why are some people who have the financial & economic means to do so, ignoring this guidance? I would like to suggest some factors that are not making the headlines;
· Most people are not naturally numerate. We are now being treated to a proliferation of graphs on social media, containing all kinds of data, predicting deaths & projecting infection rates. Our TV screens scream the daily number of deaths attributed to COVID-19, but no one benchmarks to the average number of expected daily deaths in general population (around 7,500 in the USA) or annual deaths for a really bad influenza season (65,000 in the USA). The exponential nature of the reported cases and case fatality rate are the real causes of global disruption. When the overall numbers on a lognormal graph are still increasing, this is not a good sign! Why should you rearrange your daily routine when the reports are difficult to interpret? Also known as… when you don`t get the math!
· Basic education. People litter, tip frugally, drive discourteously, text & drive, don`t recycle, waste water and show their complete lack of civility on social media …due to a lack of education. The current recommendation to effect a drastic and quite specific behavioral change for the common good of mankind is not going to be a quick fix. I would like to suggest that instead of the media constantly pointing fingers at who did not do what at the right time, the public would be better served by frequent reminders of a wide range of social niceties that will nudge people to be more mindful of community courtesies that will of course include social distancing.
· The replacement of pleasurable activities. I`m a bit of a sports and nutrition nut so lots of people ask me about creating a diet plan. In addition to the recommendation of an authoritarian dietician and sensible nutritional advice, I always add that a successful weight loss plan must include the inclusion of new pleasures in your life that don`t include the intake of calories. Comfort food provides pleasure, fact! In order to reduce eating junk food, one must find an enjoyable pleasurable substitute. And for each of us pleasure is different! If you stick with your old routine and don`t adopt any new pleasurable habits, then you will be more likely to start inventing all sorts of creative excuses to slip back into the comfort food zone. Same goes for social distancing… it`s going to be impossible to forgo your gregarious habits unless solid substitutes are adopted.
· Please note introvert and extroverted personalities will require completely different new habits. Try and try again until you find something you like.. maybe it`s meditation, yoga, taking an on-line university course, listening to audio books, video games or even/maybe running on the treadmill.
Conclusion
There is a saying in long distance running: Don`t make decisions when running up a hill, you need to stick to the plan. Reason being that running uphill takes a lot of effort, you are stressed, thinking of walking or giving up entirely. The hills we encounter in life come in many forms and COVID-19 is the Mount Everest of our generation. I would therefore suggest that everyone considers adopting the simple plan that the British government apprises: Stay indoors, protect the National Health Service, Save Lives.
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