Saturday, April 4, 2020

Risk, Corona and Judging others

Risk Board Game : Target
Facebook is often a place for us to post or notice extremes and this Corona epidemic is no exception. I see hundreds of post claiming it is a hoax made up by the media to scare us and control us. These post focus on statistics that show that Corona isn't much more deadly than many of the common risk of death we deal with everyday, heart failure, flu, smoking or car accidents.

On the other hand, I see the posts that this Corona virus will leave millions in the US dead if we don't do exactly as our leaders demand, avoid large groups (the magic number seems to be 10), avoid leaving our home, stay 6 feet apart, where masks, and under no circumstance visit others. This group is gone to public shaming if you fail to comply, and mocking politicians they feel who don't go far enough or who were too slow to react (our President being their favorite target.)

These groups seem to see the whole Corona pandemic from very different lenses and most of us likely fall somewhere between. But who is right? Before I answer that can I go on a bit of a lecture about risk?

Risk is a major part of my job in Dam Safety. It is my job to ensure that the dams I oversee do not fail and kill people down stream. Can I 100% promise the dams won't fail? No. I have to make an estimate of the risk that dam poses to downstream population. In my job we attempt to keep all risk of losing one life in any given year at or below 1 in 10,000. We call this "tolerable risk". Meaning our industry feels that is the risk that society will tolerate dams to pose.

My study of risk has taught me a few things.
1. We are horrible at estimating low probability events: Partially because we have a hard time wrapping our brain around probability lower than 1 in 100 to 1 in 1000. There is something about very small numbers, 1 in 100,000 or 1 in a million, that we can't grasp. Most of us fall into one of two camps when numbers get this small. Either, this is basically zero so don't worry about it, or there is still a chance so we over worry about it.

Another way of looking at this is would you buy a lottery ticket? It depends, are you of the camp that says the chances are basically zero, so I am throwing my money away. Or are you of the camp that says there is a chance, so why not?

2. Perceptions drives our view of risk more than actual risk: One of the most interesting phenomenons in risk is that we as a society tolerate a lot less risk in mass casualty situations. The most classic example of this is cars vs. planes. We all know commercial planes are far safer than driving vehicles, we are told this over and over. Why? Because we as a society tolerate much less risk in commercial planes and have forced the industry to be much safer, and it comes at a very high cost. Why are we willing to pay it? Because when an airline goes down with 100+ passengers, it is all over the news and we simply demand action. Look at the recent failures of two Boeing 737 max's (October 29, 2018 Lion Air Flight 189 Dead, March 10, 2019 Ethiopian Airlines flight, 157 dead). All the 737 Max's were grounded there was huge public outcry and demand that action be taken. But think about it, this was a total of 346 deaths in the air over about 6 months, and this was world wide. During the same time there was over 600,000 motor vehicle deaths, no outcry or demands that companies who make cars need to be held accountable, or demand cars stay in their garages.

You could say the same thing about guns or many other things. One mass casualty shooting that kills 15 people will have 1000 times more coverage and therefore calls for action, than 15 individual murders committed using  the same style weapon.

Likewise our perception is driven largely by a very small number of interactions. Think of the person whose neighbor gets Corona and dies, versus the person whose neighbor get's Corona and says, it was no big deal and recovers 100%. Now the person's neighbor was one data point among millions, yet because of our interaction with this person it may sway our view of the risk much more than that one data point really should.

3. True Fear magnifies risk immensely: Once we truly fear a situation and I mean really fear it, it doesn't matter if the risk is 1 in 10 or 1 in 10 Million, we will do anything to avoid it. I want to give an example and I hope my wife will forgive me. My wife handles situations very well. I think she does better than most at weighing risk and then making wise decisions based on those risks. As such she has handled the Corona situation in a level headed manner, that is until she read a certain article. The article was about how even though very few infants died, 10% are being hospitalized and it gave an example where because the infant had COVID the Mother had been exposed, so she was told she had to stay at home and be on quarantine and could not be with the baby at the hospital.

Being separated from her 3 month year old son is a true fear of my wife. What is the risk that it would happen? We would have to calculate the risk of the baby coming in contact with the infection, risk he gets the infection, risk he goes to the hospital, risk our hospital has the same policy as this one and won't allow her to stay...Anyway, the risk is likely very, very small. But it doesn't matter, she will do anything to avoid that situation. Shortly after she read this, I woke up at like 2 AM, my mouth had been open, so it was dry. I cleared my throat and coughed. That was it, she was convinced I had Corona. She wouldn't kiss me and debated kicking out of the bed that night. Likewise, she has increased the amount of isolation our family has. Fear of a specific outcome magnifies risk beyond their true value.

4. Every has different tolerable risks: I mentioned earlier that the Dam Safety industry has put a risk tolerance at 1 in 10,000 chance of loosing one life in a year. But that is trying to average what risk society will allow in a given industry. Every individual has different risk tolerances. And risk tolerances are a big part of all risk decisions.

5. Our Risk choices affect others: While our risk tolerance is personal, whatever risk choices we make will affect those around us. When and how we drive will affect others, our decision to engage in risky behaviors such as drug use, or open sexual behavior. All of these choices will have impact on the world around us.

6. Good risk analysis requires data- If you really want to understand the risk of an event happening. You need a lot of data to get an accurate number. Data takes money, time and effort to get, lots of it.

So, what is the point. Who is right when it comes to COVID? Everybody and nobody, or simply put, we really don't know. Let me break down how both sides are right and how both sides are wrong.

The side saying this is all a hoax and politicians and everyone else is over reacting- Clearly COVID-19 is real, people really are dying, it is clearly very contagious. We should not ignore science and we should be anxious for the new data we get as time goes on. I think this side is wrong that the media is purposely just making this up to scare us, or control us or whatever the conspiracy theory of the day is.  I think it is wise to take precautions to avoid getting infected and spreading Corona. Ignoring all the advise, to stay home, watch hands, social distance etc... is unwise.

However, this side is correct that our current judgement of this risk is based more on perception than reality, and magnified by lopsided coverage and fear. What do I mean by that? Because we are all going through this together, we as a society, watching the numbers going up day by day. Getting 24-7 news media about it etc... Our perception of this is more closely related to what would go through our mind in a mass causality situation. We naturally as stated above tolerate much less risk as a society in such situations, weather or not that is logical. Compare to the flu, we don't track every death and wonder how bad it will be every year. We don't hear about every celebrity who gets it, or every quasi-clerity who dies from it. (I have read and heard more news coverage about people who are supposedly famous, who I have never heard of, because they died of Corona than I thought possible.) But the CDC estimates that as much as 60,000 people die a year in the US with the flu. Will COVID-19 exceed that number? We really don't know. It is looking increasing likely with deaths of around 1000 a day. But, if this bug is seasonal that may drop off quickly in the next month and we may not reach that total. I have considerable hope that Nevada for instance, where I live, which has had 43 deaths, will not exceed it annual death toll from the flu (636 in 2017), but I really don't know.

The other thing that changes this is, it is a new disease, therefore it is unknown and we naturally fear the unknown. And there is some logic to this. When we go to calculate the risk we say to ourselves, what is the chances that if I get this I will die. The truth is we have no idea at this point. The world health organization put the chances at 2-3%, which is very high for a disease. Those are big enough risk numbers that we can really wrap our mind around them. But what is clear is that we really don't know how accurate this estimate is. The death rates vary wildly from country to country and state to state. Much of this is from limited testing. There is anecdotal evidence that some people get this disease and have mild to no symptoms. Given that, it is almost impossible to say what the death rate is. Are there twice as many people sick as have been tested? Ten times? 100 times? Nobody at this point really knows. And of course, the death rate varies wildly on age, health condition, past and current health choices etc...

Now for the other-side. The, take pride to stay at home and shame anyone who isn't and let's shame the politicians who aren't as cautions as I am. Maybe my problem with this side is the dirty looks I get when I go outside for a walk with my family. Yes, we are violating the don't congregate in groups of 10 rule, I have 8 kids and a wife and we decided we will still all live together despite Corona and the government suggestion. Almost every decision we make is risked based and when we make the decision we have to weigh the risk to ourselves, to those around us, and the benefits taking that risk will bring.

That is why many of us choose to shop. There is a risk associated with it, but we like food and get a general benefit from it. Some say, we all have to eat. But the truth is, most of us could buy a months worth of oatmeal and survive with no trips to the store, but we like variety in what we eat. We like and benefit from fresh food, so for our personal benefit, we risk society and ourselves and go to Costco to get our milk, bananas and chocolate chip cookies.

But should we visit our neighbors? No, No, No. I hear a group crying out, posting facebook memes to dissuade us of this evil practice. Do you hate them? You ask. Aren't you putting yourself and them at risk for no reason? I am not so sure on this one. Social, face to face interaction has many benefits. People need physical touch. I agree with my wife that separating a new born from their Mother is wrong and in that case, I think the benefits of letting them be together outweigh the risk. I worry that none of us are visiting our most vulnerable part of society because of fear or a disease we don't fully understand, this may have lasting negative consequences. More than the many deaths it would save otherwise? I don't know. I don't think any of us do.

What I do know is this? The risk varies greatly from place to place at this time. If I choose to visit my Grandma when we both live in rural Kansas and have both been socially isolating, is a lot different than if I live in New York city and have been going to work everyday in a hospital.

We also really don't know enough about this disease to accurately say what all our precautions are doing. It is clear to me that the actions we have taken will reduce the amount of lives lost from Corona. But by how much? I don't think we really have an accurate picture of that.

Governors, Mayors and our President all have some very difficult decisions to make. And they are making them will very little data, and with no time to really calculate and weigh it out. I do not envy them. There are risks to everything they do. Everyone who knows me, knows that I have my disagreements with our current President. But I am glad on this, I think he is really weighing what is best. He has had much ridicule for saying, "The cure can't be worse than the problem."  People say, "It's just money versus people lives. We are a rich economy we can afford to take a few months off." I think that is as narrow a viewpoint as the idea we should pretend Corona doesn't exist.

There are negative externalities to doing the shutdowns we have. People not working is bad for individuals and society, and not just because of money. Work makes us better. Taking a few months without working may have significant negative impacts on some, and it is impossible to know how quickly we will or won't bounce back. In addition, we may see a spike in suicides. Unfortunately, many kids are saved from abusive relationships because they go to school and even in the summer the abusive parent goes to work. We will likely see an increase in the amount of child abuse, due to stress and the situation.

Also when the US economy suffers we do get a trickle down effect and not a good one. Charitable giving will drop and many organizations will be unable to help when those in need may need it most. Many of those organizations help the poorest, most vulnerable countries. What happens when the next wave or Corona virus takes off in Africa and the much of the wealthiest countries, US and Europe are all still in the middle of a recession? Who will they turn to for medical aid, the treatments, doctors, vaccines? Our choosing to slow our economy now may save thousands of Americans only to kill millions of Africans. Do I know this? No. It's a risk.

My point in all this. We are all searching for the right thing to do. As politicians, businesses, and individuals. We need to be open to data, figuring out more so we can be better informed and make better decisions. And we need to be a little less judgmental, of our politicians, business owners and individuals. We will look back and realize we made some mistakes. We may look back and say we overreacted, or we may look back and say we under-reacted, as a society and as individuals. But let's spend more time supporting each other, building on what we get right and learning from what we get wrong, than we do tearing each other down, or shaming those who disagree with us. We need each other now more than ever.

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