Public Health 101 – Or How Not to Manage a Corona Pandemic

When Israel was under attack from Iraqi Scud missiles in 1991, the public did not presume to advise the government on how to handle the affair. The professional military establishment was trusted to deal with this threat as it had with similar threats in the past.

As Israel has been blowing up critical aspects of Iran’s nuclear aspirations over the past few weeks, few Israelis have proffered their opinion on how best to target these installations.

And yet, when the Coronavirus struck in March, the general public in Israel, and all over the world, strongly voiced their opinions on how severe this crisis was and how to tackle it. 

Well, medical data is easy to interpret, isn’t it?

Having recently made aliyah, I was fortunate to be admitted to study a Masters in Public Health at Hebrew University in 2014. I can’t say that I remember every detail of the fascinating course, but I remember one key message that was repeated over and over again and tested for extensively in our final exam. And that was: 

“Never take medical research data literally. Always understand that it comes with multiple biases from those who are reporting it” 

As such, most of the course was taken up by studying these biases in order to understand the data that is so prevalent.

Information is data that has been processed by someone who understands it.

One of the main types of bias for Public Health officials to be aware of is Selection Bias. This means that, when analyzing a clinical study, it is important to know how the group being studied was selected. For example, if you wanted to know how many people were being infected by a particular disease, you wouldn’t select a “random” group from the emergency room of the hospital and then extrapolate from there – so if 50% of the emergency room had the disease, that clearly wouldn’t suggest that 50% of the whole country had the disease.

And yet….

When it comes to Coronavirus, the general public, and worse still the numerically illiterate politicians, presume to understand clinical data. 

So when the first data of the virus came through from China and elsewhere showing that 3% – 10% of those tested for the virus were dying from it, the general masses interpreted this to mean that 3% – 10% of the world population was at sudden risk of death – hence the categorization of this crisis as a “severe” pandemic, perhaps as severe as Spanish Flu that killed 3% of the world’s population in 1918.

The public health establishment failed to communicate that this was clearly a case of Selection Bias. Obviously the people who had been tested for the virus were far more likely (10x or 100x) to have the disease than the public as a whole, as only those with symptoms were being tested.

Clearly a better measure for the potency and prevalence of Corona is the percentage of the whole population that dies from it (closer to 0.05% – 0.1% from currently available data). This places it solidly in the level 2 (out of 5) severity on the US Government’s Pandemic Severity Index. A “mild” pandemic – a level just above seasonal flu.

This lack of general numeracy among the public and politicians might normally be seen as joke. However, in this case, the misunderstanding of Selection Bias did not lead only to amusingly wrong conclusions. It led to an increased risk of death on an unprecedented scale. Not for Corona patients, but for the millions of cancer patients put at high risk from delayed treatments and the hundred million extreme poor who have been put at risk of starvation in the developing world.

Governments have experts in defense and in military intelligence, such that the average man in the street, and the average politician, would not presume to know better in a military emergency. However, the prolific availability of clinical data, but not information, for Coronavirus has led many laymen and women to believe that they are experts in interpreting the severity of an epidemic.

Now is the time for the true experts to return to managing this crisis. Not doctors, not even seasoned Army Generals, but the quiet teams of educated public health experts who have been trusted to manage our medical budgets for decades, but who were sadly and dangerously overruled and ignored during the past few months of Coronoaia.

Let’s welcome them back to their rightful roles and put a solid line under this miscategorized event.