COVID19 and the medical information supply chain

Recently, WHO announced that there is no evidence of acquired COVID19 immunity in people who have recovered from COVID19.    The same organization previously announced that this disease is much more lethal and contagious than what we have experienced in recent history.

Both pronouncements have similar scientific evidence as the time they were announced.  In both cases, the proof requires waiting out the time to gather the data to make the decision.   Both are consistent in that the first demanded urgent action to impose severe economic hardship on most of the planet, and the second demands that that action must continue.

From a scientific perspective, neither have definitive evidence in the form of recent observations.   There is a fundamental inconsistency in the two.   Typically, when given a lack of evidence, the standard policy is to presume that the situation is similar to the past situations.

  • When the disease was first observed, the presumption should have been that its impact would be in the range of a bad flu season.
  • Similarly given the observation that this is caused by a virus, the presumption should have been that recovery from a viral infection infers at least some period of acquired immunity to the patient.

Instead we get information the opposite information.   Unless proven otherwise, this one disease is entirely unlike anything we have seen in over 100 years or even longer, and this one virus acts in such a way that immunity is impossible to acquire naturally.    It is true that future information can decide the truth of either assertion, but typically we presume that this is disease is similar to what we always deal with.    As the medical saying goes: if you hear hoofbeats, think horse instead of zebra.

These are extraordinary claims.   This particular disease is far more dangerous than anything encountered in recent history.   The virus is the rare type that does not result in immunity for recovered patients.   Normally, we demand extraordinary evidence before accepting extraordinary claims.

In the case of COVID19, we demand extraordinary evidence before accepting the normalcy of this pandemic.   This sets a major precedence for all future novel diseases.   From now on, we need to accept that anything new is an existential threat to humanity until evidence conclusively proves otherwise.

This attitude fits with my observations in recent posts that in recent times (last couple decades) our governments have made a fundamental change in attitude about science.   In earlier ages of our enlightenment-inspired governments, we had a preference for present-tense science to be open to admitting novelty to our way of life.   Now, we have a preference for past-tense science that demands that anything new is necessarily damaging to our way of life.   In both perspectives, everything new portends the end of life as we know it, but the earlier attitude is that this could be a good thing unless proven otherwise while the current attitude is that this must be a bad thing unless proven otherwise.

We live in a time that can not tolerate anything new.   The best possible response to a novel virus is it immediate and complete eradication at any cost.   We can’t risk waiting for the evidence that proves that this virus is within normal parameters for contagion and lethality that we always deal with such as with influenza pandemics.

Novelty always bring the risk that this time the virus would find the right combination to be devastating, but we see novelty in viruses every year without experiencing anything extraordinary.    Each new flu season kills a different set of people because the people previously killed are already dead and people age and become more vulnerable each year.

I mentioned in an earlier post that the optimal policy for dealing with a pandemic is to operate hospitals at a continuous rate below the capacity but above zero until the pandemic exhausts itself naturally.   From a medical perspective, this gives medical staff the opportunity to practice an improve their skills so that each new patient gets better treatment and that we have better practices in the future.    From an economic perspective, this optimal level allows supply chains to continue to sustain the healthcare capacity directly in terms of maintaining supplies and giving comfortable lives to the medical staff, and indirectly in terms of keeping up the funding for these operations with both taxes and insurance premium payments.

In my fantasy government of dedomenocracy, the initial assessment of the disease would be to expect it to be at the high end of normal parameters for a virus pandemic.   As a result, there would be no panic shut down of the economy but there would be an immediate preparation to increase capacity as normally would occur for similar events.   Similarly, my fantasy government would expect that the recovered patients will have some acquired immunity to the virus at least for the particular strain they recovered from.

Of course, both might be wrong decisions at some time in the future but this is unlikely in the present.   In any case, this fantasy government of data and urgency is much more flexible to respond to new data and adjust policies quickly when the evidence proves new actions are necessary.   The fantasy government does not commit to being absolutely right its decisions and instead has total freedom to change policies very quickly and even implementing U-turn policies that contradict the first.    I believe this agility is necessary when dealing with novel threats that don’t conform to past science, and I believe we had this agility in the now distant past that distrusted their past-tense science.

I believe we will regret our current trust in past-tense science.

The concerning thing about the WHO announcements is that they are departing from the role we need from that.   We need WHO to be a source of comprehensive and current data to inform our elected policy makers.   Instead, it appears the WHO is manipulating the information to support their desired policy outcome.    The evidence is in the burden of proof of their announcements that this disease is worse than any other without evidence to the contrary, and that this virus does not cause acquired immunity without evidence to the contrary.    Both consistently support their preferred policy that we must socially isolate the population.

Earlier in this blog I described my concept of an information supply chain that follows an analogy to a manufacturing supply change from extraction of raw material to the ultimate delivery of a product to a consumer.    Each stage of the supply chain involved receiving product from the previous step and refines it for delivery in a different form to the next step.   In the context of data, the first step is to collect raw observations from sensors and the last step is to present the information to decision makers.

In the context of information related to a pandemic, the supply chain might be as follows:

  1. Doctors and hospitals record from their daily patients basic vital signs such as body temperature and blood pressure, along with any diagnosis of these measurements.  Included in this raw data would be the new cases and the closed cases (either recovered or dead).
  2. The hospitals summarize this data with quality control steps before sending it on to their territorial departments of health.   The data may be augmented with hospital location and affiliated health organizations.
  3. The departments of health summarize this data and augment this information with regional trends or comparison with thresholds to identify locations where quantities exceed or undercut typical ranges for those values.  These departments of health may identify a local outbreak of some disease and identify the geographic boundaries between various levels of the outbreak.   They provide this information upward to the national health agencies like the CDC and downward to the local hospitals and doctors for their situational awareness.
  4. The national health agencies summarize and augment the data similar to the territorial departments of health but at a national scale.   The provide this information to the international health agency like WHO and downward to the territorial health departments for situational awareness.
  5. The international health organization summarizes and augments this data at an international level and delivers its results to the national health agencies for action.   They also deliver their results to the international body such as the United Nations.
  6. Ultimately the information is provided to the elected government officials to make policy decisions.

In the information supply chain concept, each step in the chain is responsible to assure that the data they provide is up-to-date, accurate, reliable, and complete.   Part of their product is a certification that these qualities are met or an explanation for what data is missing, late, or low in confidence.

Each step preserves the information content of the data but augments it with additional intelligence gained by observing the larger data sets.  Each successive step in the chain expects requires this diligence from its sources.   Each successive step can not tolerate the predecessor withholding product or hiding defects in the product in much the same way that manufacturing supply chains work.   The final consumer of the data is the decision maker just like the final consumer of the manufacturer is the retail customer.   Both have recourse if provided defective product.

The WHO is an information supplier at an international level.   Governments ought to expect that the supplied information is complete and accurate summary of all observations at the patient level all over the globe.    As an information provider, this information must not be contaminated with human agendas or policy preferences.   If the information supplier provides contaminated information product, then the consumer has every right to demand a remedy or to cancel the contract and demand payment for damages.

There needs to be a consistency in the quality of the information that the WHO is providing its consumers, the leaders of national governments.   The information needs to be an accurate summary of the complete data collected all the way back to individual patient observations.

The completeness of the information provided by the WHO must permit the individual government leaders to come to their own conclusions as to what the data implies.   This includes where to assign the burden of proof as to whether the disease is abnormally dangerous or abnormally resistant to acquired immunity.

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