COVID-19, South Africa, and humility regarding scientific reasoning

COVID-19, South Africa, and humility regarding scientific reasoning

Eusebius McKaiser (host of a show on South Africa’s Radio 702) and I were meant to be part of a public discussion at WiSER (based at Wits University) on COVID-19 and its social implications later this week. The conversation was in the end postponed – not because of health risks (although that is now an utterly sensible reason for postponing) – but because some people thought that a philosophical conversation was inappropriate and that WiSER should include epidemiologists, virologists and the like on any panel related to this coronavirus.

We instead arranged to discuss some of the issues on his show this morning (here’s the podcast), and he followed that up with a conversation with HIV and public health specialist Professor Francois Venter (podcast link), on social distancing and other more scientific aspects of South Africa’s response to COVID-19.

Both segments are – in my unbiased view! – valuable with regard to their content, but they are also valuable in offering a demonstration of the point that there can be more than one aspect of a public health crisis worth talking about, and that we can talk about more than one aspect at the same time.

We only had a half-hour, so I’ll reiterate and expand on some of the points made in the text below. First, to describe COVID-19 as a possible example of a moral panic does not mean that it isn’t a genuine threat that people should be concerned about, nor that some people could rightly be panicking, for example, those who live in very crowded communities, have poor access to water and sanitation, and whose communities have a high proportion of immunocompromised people.

Those of us who are fortunate enough to be in lower-risk groups and environments can – and should – be concerned. But, if we start treating other people as competition for those rolls of toilet paper we want to hoard, or as impediments to stocking our trolleys with food that will probably perish in-home storage, when it could have been bought and donated to more needy people, we are allowing panic to dehumanize us.

The perceived existential threat is the moral panic, when it causes us to overstate risk (to ourselves, particularly), and thereby to forget that this is above all else a collective action problem, in which what we each do affects everyone else, and where we need to cooperate and not compete.

You don’t practice social distancing (only) for yourself – most of us do it because it helps other people, and by helping them you of course help yourself too in the long run, because the virus is hopefully brought under control far sooner, meaning that more of the usual resources for the usual health conditions become available again.

Worse still, the moral panic can result in mistrust and fear of particular others, such as the xenophobia evident in Chinese restaurants and communities in South Africa reportedly bearing an initial brunt of consumer flight, not to mention callous stereotyping or commentary, which can find expression in anti-poor prejudice, as McKaiser observes in a column published today.

A point I made regarding what laypeople could do with regard to understanding and engaging with the science contained a positive and a negative recommendation. The positive one was – again – that we need to trust the expert consensus, rather than advice from WhatsApp groups.

It does not matter whether the experts don’t agree on the precise mortality rate, or that they are not yet 100% sure that you can’t be reinfected (they seem pretty sure, though). It doesn’t matter because they do agree that you should avoid crowds, wash your hands, and not travel unless absolutely necessary.

You really don’t need to go to gym for a few weeks. Even if your chances of being exposed are minimal, there’s little sense in taking the risk. By contrast, there might be a meeting that you absolutely need to go to – and in that case, you keep your distance, don’t share food, don’t shake hands, and so forth.

The negative recommendation: do not join the ranks of armchair epidemiologists, adding your opinion to estimates of mortality rates and the like. You don’t have a clue, otherwise you’d be an epidemiologist. Furthermore, they don’t have a full grasp on it yet, because so few people have been tested (in most jurisdictions – South Korea being a notable exception).

Oh, and ignore the quacks, whether they are offering homeopathy, or whether they are offering prayer or the reading of verses from Psalm 91. If the latter gives you comfort, go ahead, but again – don’t do it in a crowd, and don’t think it gets you off the hook in terms of washing your damn hands, etc.

Another negative recommendation would be to lay off with the comparisons between hypothetical mortality rates and how many people die of TB, malaria, car accidents, angry kittens or whatever. That also does not matter. The other causes of death are known and are by and large already accommodated in how we allocate medical resources.

This is a new threat, and demands particular attention, because one of the exact problems the medical system is grappling with is trying to minimize mortality from this while simultaneously keeping those other things under control.

Yes, they probably won’t find the theoretically optimum balance, partly because that can really only be known in retrospect. But you and I certainly couldn’t do better, and it’s an insult to their skill and commitment to give them our uninformed “reckons” (reference: a hilarious, but accurate, Mitchell and Webb skit) while they try to save as many lives as possible.

Our country cannot afford to suspend corporate taxes, bond repayments and the like, so those solutions aren’t an option for the people who are already or will soon be, out of work. If you haven’t spent time thinking about who they are (on top of the huge percentage who were already out of work), they would include the people who cook and serve your meals or the Uber drivers who get you from A to B, or the person who stands on a stage to sing or tell you jokes.

Perhaps most worrying is when people who are typically not on Twitter start getting affected. We’ve already seen a case in a South African township (Mfuleni), where instead of having the opportunity to grumble about someone having just taken the last jar of hummus off the shelf right in front of you, we’re talking about people who are in many cases already struggling, and their struggles are only going to get worse.

If you can help someone in need, financially or via donations of food, soap and so forth, please do so. But my main point is that we can all help, and it’s pretty darn easy to do. South Africa’s President, the National Institute for Communicable Diseases, and other health advisory bodies have come up with proactive and seemingly sensible strategies.

Do what the NICD say. And, stay away from each other as much as possible – at least for a while – for the good of everyone – including yourself.

P.S. There is now millions of column-inches on the scientific aspects of this coronavirus, but Dr. David Gorski’s piece on Science-based Medicine has so far been the one that I’ve found most useful.

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Shawn

So you people that have been eating that distributed food Mbu it’s from Malawi. Me: You are eating food from abroad. 😁