Systemic Risk of Pandemic Via Novel Pathogens: Commentary, Part 5 of 6
This part indicts governments and naive policymakers:
One major problem in the control of infections is the lack of testing. Initial policies only warrant testing among symptomatic cases. However, asymptomatic transmission is the “Achilles’ heel” of COVID-19 control, as an article [2] from the New England Journal of Medicine says. We also see this demonstrated in mathematical models [3] which estimate the true proportion of asymptomatic transmissions to be 45%. Later, a systematic review [4] of 50155 patients from 41 studies has found that the pooled prevalence of presymptomatic infection 48.9%.
The problem is twofold; RT-PCR tests are not that sensitive as well in detecting asymptomatic or presymptomatic patients, and this compounds the asymmetric uncertainty.
Likewise, a fatalistic stance has been seen also more in Western countries, on whether to wear a mask or not. It was also intensely debated among intellectuals, when even the average person, by virtue of common sense, understands what is needed to protect himself or herself.
Taiwan and New Zealand are examples of countries who understood this problem and approached it the right way.
New Zealand, recently ordering a lockdown with just three (3) cases, shows what a goal of elimination should be like. They don’t dare to claim “no evidence of community transmission”. They understand that the absence of evidence is not evidence of absence. They understand the nonlinearity of complex systems, the systemic risk of novel pathogens. They don’t wait for sufficient evidence of transmission before acting. They don’t make any foolish and naive trade-offs between health and economy, nor do they do any trade-off modeling. They hunt down COVID at the very start. They prepare their economy beforehand. They use Antifragile methods. To paraphrase what Dr. Yaneer Bar-Yam of the New England Complex Systems Institute and founder of the EndCoronavirus.org said:
“Lazy fools look at Sweden. Industrious sages look at Taiwan and New Zealand.”
References
[1] Joseph Norman, Yaneer Bar-Yam, and Nassim Nicholas Taleb, Systemic risk of pandemic via novel pathogens — Coronavirus: A note, New England Complex Systems Institute (January 26, 2020).
[2] Gandhi M, Yokoe D, Havlir D. Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19. New England Journal of Medicine. 2020;382(22):2158–2160. doi:10.1056/nejme2009758
[3] Ferretti L, Wymant C, Kendall M et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science (1979). 2020;368(6491):eabb6936. doi:10.1126/science.abb6936
[4] He J, Guo Y, Mao R, Zhang J. Proportion of asymptomatic coronavirus disease 2019: A systematic review and meta‐analysis. J Med Virol. 2020;93(2):820–830. doi:10.1002/jmv.26326
