Saturday, December 26, 2020

2020: A year of control experiments

Social sciences, including economics, are not considered “real sciences” because control experiments, by and large, can’t be conducted.  Hence, much text-book knowledge is based on assumptions, speculations, hunches, and who has the loudest voice, the most disciples, or, simply, the backing of the ruling classes.  Because of COVID-19, however, the world comes the closest to see and compare how different peoples, societies, countries, and governments handle the same virus, a control experiment as good, as large-scale, as real-time, and as real-life as it will ever get.  And much more can be learned beyond COVID-19. 

This control experiment does have the one and only “blemish” in that the virus didn’t break out in all countries at the same time, which can nevertheless generate important comparisons and insights.  There is also this pandemic paradox: Say there were 5 cases before the government enacted a strict measure; after 2 weeks, the outbreak was no more.  But since there were only 5 or a handful more cases, people took it as a sign the disease was nothing, not an indication the government did it right.  So the next time 5 new cases emerge, people will resist actions, then 5 turn into 50, 500, and the same old measure, applied belatedly, no longer suffices, reinforcing the thinking that it is either needless or useless.  The moral here is certainly not that the initial measure must not change, but that the cause-and-effect relationship can be hard to discern, especially when involving so many lay people.  But the question can be answered in a control experiment with different countries and diverse responses.        

So what can we learn from the ongoing control experiment(s)?  A lot truly, but here, only the obvious and straightforward ones.  As COVID-19 turns societies upside down, the biggest lesson is probably self-reflection and re-evaluation of long-held beliefs.  Because it emerged as a new virus, a learning curve was inevitable, and absorbing new knowledge and changing perceptions and strategies quickly is the key to any success.  Fortunately, much about the disease itself was established by late Feb, and the next 10 months of 2020 has offered little real progress, with the only major breakthrough being the vaccines. 

Countries fared poorly if they didn’t pay attention to the early events and findings in Jan and Feb, like those about tracing, quarantine, isolation, wearing masks, and asymptomatic carriers.  For example, asymptomatic and pre-symptomatic carriers are the norm rather than exception in infectious diseases, and COVID-19 is no different.  This was well-known in China and Germany, which published the first relevant but erroneous paper, by late Jan and early Feb, so testing people even without symptoms, and wearing masks are important to fight COVID-19. 

It was astounding that so many in the West did not know or faked not knowing asymptomatic or pre-symptomatic transmission even in April.  Moreover, most Western societies and the medical establishment hate mask wearing for the public, even though their reasoning is never convincing.  The worst the doctors can think of is that the public don’t know how to wear masks, but does any normal person needs 4 years’ medical school to learn wearing a mask properly?  Even Dr Fauci was revisionist when he said he didn’t recommend masks in Feb because he feared masks were in short supply.  He didn’t simply because it was the consensus at the time in the West and WHO that masks didn’t work!  That availability issue was always the last reason whenever masks were debated, and the more abundant surgical masks have been used in China and other places since Jan.  If they had had recommended masks early on, or at least not actively discouraged it in Feb and Mar, wearing masks likely might have become less a political issue in the US.  I’ve seen nobody arguing that masks offer 100% protection, but not wearing or wearing a mask may be the difference between being infected vs not, being seriously vs mildly sick, dead vs alive.  Fauci, CDC, and WHO have been taught no masking for ages, so that was their long-held belief.  They still deserved credit for reversing courses, better late than never, but the earlier, the better.

Globally, countries with a mask mandate early and consistently have fewer cases than those without.  Of course, the former also do other things as well.  China had a stunning Wuhan lockdown for 2.5 months.  Despite gleefully ridiculing China at the time, the West likely fell for the aforementioned pandemic paradox secretly: China used the totally ancient method of locking down and the totally useless mask wearing, and the result was not bad, so COVID-19 must be no big deal.  If COVID-19 in China was much worse than SARS, well, that just showed China’s sheer incompetence.  Thus, when COVID-19 struck in their own soil, and the West was so powerless, what else could they scapegoat their ineptness except to blame China for a coverup?  But since other countries did well against COVID-19 at the same time, one has to wonder why not everybody was duped by the ubiquitous Chinese coverup.

A separate but also related lesson is that the pandemic runs a scientific cause, and politicization is meaningless if not counterproductive: so much is human nature that race or ideology makes little difference at hospitals.  This is the most apparent when comparing the data and responses in China and subsequent ones from other countries.  In the well-publicized, chaotic days in Jan and early Feb, testing was limited, less reliable, and often available to only the very sick.  China also revised or updated the COVID-19 criteria and figures a couple of times.  As a result, some people knee-jerkingly asserted that China was hiding its cases.  But when the pandemic later broke out in the West, the exact same thing happened in every single country, often to a much greater extent.  Didn’t Italy, Spain, France, UK, and NYC experience the same or worse chaos in March and April?  Is there a country or state in the US that hasn’t revised its COVID-19 case and death numbers, some countless times since March?  Is there a country that can guarantee that its official case number is the real infection number?  Again, more self-reflection by the officials, media, and scientists, looking back at one’s own thinking and remarks in Jan-Mar, is necessary. 

A third lesson is that pandemic fatigue is real.  This makes perfect sense in psychiatry, but it is still revealing to see in real-time it unfolds and the vast, real-life consequences.  Since Sept, European and other countries are experiencing their 2nd , 3rd wave of infections.  One reason is that no country is safe until all are safe.  But a bigger problem is that people got tired and let down their guard, and didn’t do or finish the hard work necessary to drive down their domestic cases low enough to stop a large flareup. 

The control experiments, i.e., realities, also invalidate every single attack against China as 2020 labors on.  On the issue of COVID-19 origin, history, as the only control “experiment” available, is on China’s side.  For analogy, AIDS was first reported in the US, so is the US the origin of AIDS?  No.  Did anybody blame the US for releasing or letting HIV/AIDS “escape” to other countries?  No.  But on all other issues, the ongoing COVID-19 control experiments provide incontrovertible results.  The attacks on China’s incompetence fell apart quickly when those countries fumbled their own responses much worse, despite having at least one month’s advanced warning and head start.  Even more tellingly, remember the last fig leaf assertion that the Chinese coverup led to the West’s unpreparedness?  Here lies a paradoxical farce in the West that portrays China as being so powerful and yet so powerless at the same time.  The West has been mindlessly chanting Chinese coverup since early Jan, so apparently the almighty Chinese coverup didn’t work at all: if you cover up sth, you don't want others to know you do; if they do, then you fail.  Then, the West blamed the coverup for their own failure in March, April, and beyond, as if China was powerful enough to dictate these countries’ own COVID-19 policies, like China can tell the UK or US if, how, or what to lockdown, not to avoid crowds, wear masks, test, etc.  Which was after the great Chinese coverup had been blown away months ago!  Never mind there was no Chinese coverup amounting to anything.  But even if there were, how does one explain the 2nd, 3rd wave/surge in Europe, US, etc?  Was China covering up the first wave in the US and Europe too such that the US and Europe is having an even worse 2nd and 3rd wave/surge?  If they can’t even prevent and contain the 2nd and 3rd wave/surge, having ample experience in the spring already, what confidence should anyone have in them if they had had been the first to face COVID-19?  To top it off, looking back at history: was the 1918 pandemic a resounding success story? 

This winter will be tough, and vaccines are many countries’ only hope, whose effects won’t be apparent months from now.  But vaccines have been the only pleasant surprise in the whole 2020.  Who could have predicted in the spring that all kinds of vaccines, from different countries and with different designs, can achieve the similar efficacies at 80-95%?  This is among the best numbers in all vaccines in history, even though we didn’t even have one against any coVs before.  While no one has asked the question, I think why COVID-19 vaccines are so effective is because the unique feature of the virus.  Unlike most respiratory diseases, COVID-19 affects the respiratory system, circulation system, GI system, the kidney, pancreas, nervous system, etc.  The virus may depend on this pattern of systemic infection to reproduce, leading to a lasting, strong infection and pathology.  Thus, it is a well-known fact that COVID-19 patients don’t die as quickly as in similar diseases, and the virus can stay in one’s body for months even after he is “cured”.  Vaccines, by mounting an immune response all over the body, will be able to shut down widespread infection.  For example, even if a vaccine can only partly reduce infection in the lung, by better controlling infections at other organs because, e.g., those organs are more efficiently perfumed or more open to immune surveillance, virus replication is still sufficiently prevented or suppressed.  In other words, whole body infection is a weapon but also the Achilles heel of COVID-19, luckily exploited by the vaccines.

2020 is the year of COVID-19.  2020 is also the year of social sciences.  If there is a silver lining for 2020, conducting an unprecedented, control social experiment will be it.  So much is laid bare and so much can be learned, which before 2020 no one believed would be possible and had led to ageless and endless arguments to no avail.  Now, just a bit of fact-based reasoning is enough to see a great deal in the present and into the future. 

 

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