It is striking that political leaders today underline how their decisions to contain the COVID-19 outbreak are based on expert recommendations. By experts they of course mean virologists and medical care specialists. They are at the forefront of the battle against the virus and do what they do best: define measures to minimize the spread of the virus, flatten the epidemic curve and predict the effect of the relaxation of covid-measures. However, experts also have their limitations. They are only experts in their own specific field. We cannot expect virologists to scientifically judge the impacts of their recommendations on society as a whole, nor on the economy or even on other medical conditions. In this Corona-crisis what we need is transdisciplinary and trans-sectoral collaboration more than ever. Today, virologists set the rules and other scientific fields - from computer sciences to economics - do their best to either mitigate or absorb the bystander effects. But can insights from other scientific fields be taken up more early in the decision making process, and yield better policies?
Epidemiologists are already well served at this moment. Governments make the daily corona-numbers publicly available. Epidemiologists use them to predict the peak of the outbreak, assess the effect of the measures and to predict if hospital capacity is sufficient. Yet, all these assessments mainly deal with the nominator of the data (i.e. How many cases? How many hospitalisations? How many deaths?). There is far too little attention on the denominator. Such assessments would include the total (estimated) prevalence of infection including the mild cases, looking at total mortality instead of only that caused by COVID-19, and comparing impacts across diseases. Indeed we should tackle the emergency first, but please also monitor the “over-mortality” (mortalities above the average) and don’t forget the other diseases. Public health sciences developed the concept of DALYs (Disability-adjusted life years) to compare the health impact of diseases. DALYs for COVID-19 are not yet available. However, a worst-case scenario with 33 million pre-mature deaths (today we are at 120,000) globally and an average of 10 years of life lost per case yields 330 million lost DALYs in the epidemic situation. This is a little lower than what all other infectious diseases are causing each year and 5 times less than the yearly impact of non-communicable diseases. Admittedly, with COVID-19 we are facing a new and unknown disease with a high death toll. But with growing knowledge, news reports should not just focus on the number of deaths and hospitalisations, but should also give more attention to the denominator data to inform public opinion and put it all in context.
Veterinarians are regularly confronted with viral disease outbreaks in non-immune populations, with mortality rates higher than those observed for COVID-19 (bluetongue, porcine epidemic diarrhoea or African swine fever, just to name 3 recent examples). They have learned that quick and drastic measures are needed to contain such an outbreak. They are also aware that the economic impact of chronic and common diseases, although not so spectacular, is often bigger because they have an long lasting impact every day. Veterinarians are aware that their health interventions have to fit within a farm’s economic framework. Talking human health, it is rightly considered inhumane to think of the value of life in economic terms. Therefore, we are hearing now more than often “First we deal with the health crisis, than we deal with the rest”. However, implicitly we value human life all the time. The Dutch science philosopher Bas Haring showed that our society is prepared to invest about €5 million in safety measures per saved traffic victim. The question is also very relevant in the discussion on how much of the cost of an expensive but necessary medicine social security can refund. Our responses to try to contain the virus are causing an unknown economic impact, have far-reaching societal consequences and put a huge pressure on future generations. More than one (health) economist or sociologist warn that the death toll and societal cost of COVID-19 measures may in the long term outweigh the deaths caused by COVID-19. After all, a good socio-economic status is a condition to be resilient against any threat. Such discussions and related expertise should be taken on board sooner rather than later.
Everything is biology. Of the three great thinkers of the Modern Age (Darwin, Marx, Freud), only Darwin’s ideas have survived the test of time. In fact, they are more alive than ever. In his masterpiece “The Discovery of Heaven”, the Dutch author Harry Mulisch postulated that only biology could explain how Hitler had been able to persuade the masses. From a risk manager point of view, it is logical to act strongly against the small proportion of society that turns its back against the imposed restrictions. From a biology point of view, it would be far from smart if the whole population uses the same survival strategy. The virus has jumped –with an unknown intermediate species - from bats to humans. The pressure of a growing human population on the planet’s ecosystem leads to higher disease transmission risks between humans and animals. An important function of viruses in biology is to regulate overpopulation. On the other hand, improving the human condition has always been an act against forces of nature. Yes, we will have a vaccine against COVID-19 in the not-so-distant future. And yes, there will be other viruses spilling over from animal to humans in unpredictable events. COVID-19 is another example that the health of eco-systems, animals and humans are closely connected, such as recognised in the One Health approach, adopted by leading health organisations such as the OIE and the WHO. It endeavours to support multiple sectors and disciplines and using interdisciplinary sciences to achieve better public health outcomes. It seems we are going to need to implement this approach more than ever.
Putting it all together
Receiving information from so many sciences (including many disciplines not mentioned here) is undoubtedly a huge challenge for politicians. There is a risk of information overload, a tangle of conflicting advice and recommendations, and the impossibility to differentiate cause from consequence. But there are scientific methodologies for multiple criteria decision-making and for whole system thinking. Interdisciplinarity will be needed more than ever to prepare for the next epidemic, but will always reflect that our systems are imperfect and a matter of trade-offs and uncertainties. So let’s also accept vulnerability and uncertainty and let the way we do that mark our human dignity. Strong leadership based on common sense and wise decisions will always be needed. After all, as the Dutch cabaret artist Toon Hermans used to say: “wise is different from learned”.
(First published: 10 April 2020; Last update: 14 April 2020)
Dutch version available on Knack.be
About the author: JC is DISCONTOOLS project manager and founding manager of the research and consulting agency Kreavet. He has a background in veterinary epidemiology and parasitology. He wrote this piece as a personal opinion.