Worry, fear, and the Zero Risk Bias #nlpoli

 Accepting that life is all about risk is the first cognitive step.

Mark Kingwell, On Risk (2020)

The reporter just wanted to confirm how many active cases there were in the province. 

The question at last Monday’s news conference was simple enough.

 It’s a figure the Chief Medical Officer’s staff releases every day when they update the government’s COVID 19 page.

Dr. Janice Fitzgerald chuckled. 

She didn’t know.

And what’s more, it’s not a number people in public health pay attention to, according to Fitzgerald. 

People talk about it publicly, Fitzgerald said, but what public health is “worried about” are “the cases we don’t know about.”

She said the same thing a couple of days later at the next news conference that started with her rattling off the total number of cases since March, the number recovered, and the number of active cases.

So if Fitzgerald worries - her word - about unknown cases and things like active cases don’t bother her, then why does she talk about them?

Anyone involved in any planning, including emergency response has to be aware of the possibility that something will happen that no one anticipated.

Former American defence secretary Donald Rumsfeld famously talked to reporters one day about things they knew they didn’t know but also about the unknown unknowns.  People snickered but the idea is pretty simple:  unknown unknowns That’s the stuff that he and other officials weren’t even aware existed.

Here’s a little chart if it helps you see what we are talking about.

To put it another way, what we are talking about here is risk.  Managing risk is a key part of any plan.  You have to give some attention to information you don’t have or events that may occur that will hinder or even stop you from achieving success in your plan.

Any good planner will make allowance for stuff popping up out of nowhere.  Call it a Plan B.  Call it what you want.  It is what you do if one of these unforeseen events pop up.

Now think about the provincial government’s COVID response in light of that.  From the outset of the pandemic, Fitzgerald has had a system in place to identify cases, isolate them, trace their contacts, and – in the process – contain the spread of the disease.  The goal is supposed to be containing the spread of the disease so that:

•               lots of people don’t die, and
•         lots of people sick with COVID don't block off the health care system and make it almost impossible to treat patients with COVID and everyone else besides.

Restrictions are not supposed to interfere with normal life beyond what is needed to contain the spread of the disease.  That’s the premise of the mitigation or containment strategy, as described at the out of the pandemic by scientists at the Imperial College, London.

SRBP has written about it before, particularly to notice how far away from the containment strategy Fitzgerald’s approach has been.  What we’ve actually been doing is piling on restrictions on everyday life beyond what is indicated by the actual state of the disease in Newfoundland and Labrador.

Back in April, government officials saw the same thing that SRBP saw.  They circulated a slide deck that showed a decline in the number of cases. On April 13^th, a post here noted that the number of active cases was declining and would likely hit zero by the end of the month. 

It did.

But when CBC’s Peter Cowan asked about it, health minister John Haggie said something that was striking at the time and remains so.  SRBP described it in a post called “The facts of the case”.   

“Regardless of what the numbers show,” Haggie said, “we cannot relax physical distancing. The only question in my mind is whether we need to be even more strict or even more restrictive.”.

Go back to what Fitzgerald said last week. She is “worried” about the cases she does not know about.

That isn’t about the balanced approach to risk discussed above. Literally every single case is one that public health officials do not know about until someone turns up sick and reports for testing.  She does not know about any of them beforehand.  That’s exactly how this sort of things works. 

Fitzgerald has is a system that handles cases when they turn up.  It works.  The facts of the case are unmistakable.  They are not debatable.  The system works so well that every single case that arrived in the province from outside has been identified and contained.  If, by some bizarre and freakish occurrence there is a pandemic raging undetected, then the cases are so novel and so utterly mild that they are of no consequence.

So, there is nothing to worry about.

And yet Fitzgerald, and presumably other senior officials, *are* worried.

That worry - an abnormal and excessive fear - is reflected in what they do and say.  That worry is why John Haggie said back in April that the facts be damned, he was pondering greater and greater restrictions.

That excessive and abnormal fear is why last week Fitzgerald and her associates also changed their testing rules.  Until now, government has been scrupulous about insisting that only those who are sick need get tested.  They’ve also resisted calls for everyone to be tested.  That simply doesn’t work in identifying people unless they are sick at precisely the time they are tested.  More often than not people aren’t sick when they travel so lots get missed.

Yet, last week, the provincial government asked people who had merely been in Halifax in the previous two weeks to get tested.

Didn’t have to be sick.

That excessive and abnormal fear is why Fitzgerald, Haggie, and Premier Andrew Furey decided to hold three news briefings each week instead of the usual one.  There’s been an increase in the number of active cases but otherwise everything is under control.  Holding the extra news conferences, reinstating the three-party meetings about COVID, and letting parents shut down schools in Deer Lake contradict the message the same three doctors have been giving that everything is okay.

The biggest signal of Fitzgerald’s abnormal and excessive worry is her encouragement for people to stay home and stay away from one another.  She has now taken to telling stores to cut the number of people in their businesses, shut their doors even and go to curbside delivery, and generally to go back to what they were doing in April.  This is nothing like April.

Fitzgerald and Haggie have gone back to the fear-mongering screams about the holidays as well.  Fitzgerald’s warning that Christmas could be a “perfect storm” is reminiscent of Haggie’s hectoring and scolding over Easter and Victoria Day even though nothing came of any of it.

What we are seeing here is called Zero Risk Bias.  It’s a decision-making fallacy that exaggerates the normal human instinct to avoid risk.  People who succumb to Zero Risk Bias will tend to favour the complete elimination of risk in one part (zero cases = zero risk) rather than accept a lower overall risk or indeed even accept any risk at all.

We’ve seen the Zero Risk Bias repeatedly in the way that Haggie and Fitzgerald talk about the number of active cases.  Fitzgerald does pay attention to them.  They are a sign of failure, apparently, since she speaks very happily when the numbers go down.  She and Haggie are happiest when there are no cases.  And when there is one, they tut and fret.  When the number grows, they pile on the restrictions or at least threaten to do so, as they have done this past week.

Dwight Ball is gone but Andrew Furey has now been sucked into the same headspace Ball used to occupy for these COVID shows. Last week, Furey started off Monday’s news conference with a sombre announcement about travelers from Nova Scotia.  He looked at the camera and read a Ballish pile of cliché as if he trained at the feet of Bill Shatner and Lorne Green.  For those who don’t know, Green spent the Second World War as a CBC announcer and earned the nickname “The Voice of Doom” for the way his bass-baritone reverberated with the bad news of the early years of the war.

What he actually announced was modest.  People from the Maritimes just had to hole-up somewhere for a couple of weeks.  But the two-day warning of the newser and Furey’s melodramatic performance made people think something far worse happened.

Furey, Fitzgerald, and Haggie do not use language precisely, except when it suits them. That's another problem.  “We have said all along, “Haggie said last Friday, “that Dr. Fitzgerald's recommendations will be based on evidence, not decisions that are made arbitrarily.”  Said it, yes but, as Haggie himself said in April, he felt things should happen regardless of the numbers.  Numbers are facts and evidence.

So which is it, John?

When CBC’s Peter Cowan asked Furey last week about the science behind the Nova Scotia travel restriction, Furey fluffed.  He just said it was a “balanced” approach. He couldn't point to scientific evidence to justify the added measure. By contrast, Cowan prefaced his question by noticing the similar infection rates across the Atlantic provinces.  He could have added, just as easily, that the available data shows that across Atlantic Canada the positivity rate – the number of tests turning up positive for COVID is – quite literally  - a fraction of that found in Ontario, Quebec, BC, Alberta, Saskatchewan, and Manitoba.

And, as Cowan noted on Twitter Friday, Fitzgerald herself likes to use contradictory reasoning when answering different questions.  “Dr. Janice Fitzgerald has said we need a travel ban because some people don't follow quarantine rules, but today said we don't need point of entry testing, there's no benefit because everyone should just follow quarantine rules.”

There is no travel ban, of course.  Fitzgerald and others call it a travel ban but that only applies to non-residents who have no ties of blood or previous residency to the province.  They are not allowed to come here, full stop. The people who cannot be trusted to obey the rules are not from here, apparently.  The locals can come and go, only having to isolate on return.  They are not barred from travel.  And any of them wanting to come home for Christmas can do so, without a worry from Fitzgerald and her worriers as long as they stay to themselves for a couple of weeks.

And perhaps in one of the most persistently deceptive ways that Fitzgerald speaks, there is her constant references to the fact there has been “no widespread community transmission” of COVID in Newfoundland and Labrador.  This is not a deliberate deceit.  Fitzgerald seems to be reflecting her Zero Risk Bias.  Objectively, as she knows, there has been no community transmission whatsoever.  In the public health world, community transmission cannot be tied back to a known source. It has a very specific meaning. In the current case, it would be travel.  The facts are every single case in this province – except for a few false positives – can be traced to an external source.

There is *no* community transmission.

The deception comes from using the word “widespread” and the phrase community transmission together.  “Widespread” implies there had been community transmission.  The correct phrase, based on evidence, is that there had been none.

Zero community transmission.

That imprecise use of precise words has led people to think community is a synonym for "local".  They think people who got COVID from a traveler is community transmission and so they react appropriately. They get the message of fear and worry that runs through every government utterance and action.  Any case is bad.  Only zero cases is a good state.  The “quiet” days of COVID as Furey called them last week are where we want to be.

That’s why people ostracize anyone suspected of having COVID.  It is why the busybodies call the police on a rotational worker for doing nothing more than being on the wrong side of his threshold.  There have been literally thousands of these busybody reports to police and health authorities.  None of them, as best we know, were anything more than some scumbag peeking out from behind a curtain and ratting out an innocent neighbour.   

It is why people keep their kids home from school as well, despite the lack of a genuine risk.  It is also why the teachers are stressed to an absurd level and their union last week called for every precaution short of insisting everyone wear a hazmat suit in every school across the province.

All this fear and worry is not free.  Janice Fitzgerald admitted her unconstitutional travel order was based on false accusations about tourists.  Rotational workers suffer the stress and harassment of their neighbours. People are getting sicker from non-COVID illness either because they cannot get access to care or are too afraid to go out.  Some have died. 

Others, many more thousands of others, are suffering the effects of living with restrictions based on the unfounded assumption  that “COVID can be anywhere, any time” – to use Fitzgerald’s words – even though it demonstrably isn’t.

-srbp-