Chris Johns: Obsession with zero Covid not what the doctor ordered

Peter Thiel, co-founder of payments firm Paypal and a beneficiary of an early investment in Facebook, became prominent not just for his billions but his backing for Donald Trump.

He is said to have coined, in 2016, the infamous aphorism that we shouldn’t take Trump literally but should take him seriously.

A variation on this theme is now seen in Ireland’s evolving approach to coronavirus. The Government and its health advisers appear not to take the strategy advocated by the “zero Covid” independent scientific advisory group (ISAG) literally, but does take it seriously.

Rather than a formal adoption of the recommendations of the "zeroids", a term suggested to me by Edgar Morgenroth, an economics professor at DCU, it seems to me that a zero-risk tolerance is now driving policy. It's a subtle but significant difference. And one with potentially profound consequences.

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The strategic plan of ISAG is, I think, well known. It can be summarised in terms of an attempt to emulate the experiences of New Zealand. Critics, including members of the Government, argue that factors like geography, culture and timing mean that New Zealand’s policies, even if replicated by Ireland, wouldn’t produce the same result.

The Border, the arrival of thousands of ferries and the fact that Covid is widely circulating means, for doubters, that the zero-Covid ship has sailed. It’s a laudable but impractical objective.

The vitriol elicited every time anyone takes a position on any side of this debate is a reflection of the times we live in. Expressions of doubt and uncertainty are notable by their absence. Merely to ask questions – without expressing a view – is to invite a social media pile-on, as I have found to my cost.

Certainty

A welcome departure from expressions of certainty was seen this week when Prof Anthony Staines of DCU, a leading member of ISAG, was quoted in the Examiner as saying, "' don't know' is a frequent answer in their [ISAG'S]discussions internally".

Impressions aren’t everything, but that’s not what I would have thought from their public pronouncements. Indeed, that same Examiner article says “senior members of Nphet accused proponents [of zero Covid] of making false promises”. Which is where lack of doubt often leads.

The fact that I write this column with great trepidation speaks volumes. Ad hominem attacks and credentialism are all the rage these days. Let’s try and engage with the arguments rather than having a go at each other.

Zero Covid is, indeed, a laudable aim. The only way we can truly know whether its proponents or critics are right is to run the experiment: drive cases down to zero, seal the border and implement a fit and proper test, trace and isolate (TTI) regime. There are nuances around this simplified version of the recommendations.

“Sealing the Border” is perhaps the biggest bone of contention, with some, again, taking it literally, others seriously. The fact that we have never done TTI properly is, surely, now well established. TT without I is almost useless, as the UK discovered to its great cost – now reckoned to be in excess of £30 billion and counting.

The world of modern finance, when it’s not misbehaving, is obsessed with “risk budgeting”. It’s all about decision-making (in this case investing) in a world of uncertainty. Investing in an unknown future is quintessentially risky. Finance types embrace this uncertainty with sophisticated quantitative tools that get better every day, now enhanced with artificial intelligence.

Qualitative overlays are also ubiquitous because everybody knows that the quantitative answers are, at best, only approximate. Preparations are made for alternative strategies in the almost certain event that the model’s forecasts turn out to be wrong.

Regulators make sure that claims to certainty are not allowed in the marketing literature: financiers are not allowed, by law, to make false promises.

Plausibility

A zero-risk approach to Covid has superficial plausibility. Take no risks with regard to reopening until cases are “low” seems to be the strategy. I have to infer the strategy as it evolves because it is is poorly explained and communicated. The fact that it seems to be focused mostly on cases is a problem.

The point of the vaccine is to break the link between cases and serious illness. Most scientists I am in contact with think our best hope is for Covid to become, via vaccines, endemic and that zero is unachievable.

Locking down until something turns up is one approach. An explicit acknowledgment of risk and its management would be another.

Obsessing about zero means emerging data about indoors versus outdoors, dosing intervals, vaccine efficacy in total or in various age groups and all of the emerging evidence about what works (or doesn’t) is neglected.

Obsessing about zero means our risk and attention budgets are wasted: scientists should be politely reminding policymakers about the science and, in particular, when they are not following it.

Policymakers and health advisers forever deflecting questions about zero Covid can be focused on the wrong things.

Tons of new data about this virus emerges every day. Part of the job of the diligent scientist who aims to influence the public health debate is to help communicate what we are learning.

“We are all doomed unless you do what we say” may or may not turn out to be right, but surely we can do better?