Time to embrace uncertainty

How small would the risk of excessive deaths from COVID need to be, before you personally would feel comfortable with lockdown restrictions being reduced? Present discussions have focused on a date to reduce or end restrictions, provoking the understandable answer of ‘it depends.’ There is an equally understandable desire to prevent avoidable risks to the NHS and to public wellbeing, especially with the mass rollout of vaccines giving the impression that we are on the home straight.

Photo by Kyle Glenn on Unsplash: https://unsplash.com/photos/IFLgWYlT2fI

There is an uncomfortable truth however. The risk from COVID in future is never going to be zero, much though we would like it to be. Even before the advent of new strains of the virus, it was clear that eliminating the virus was an impossible target, and a more realistic goal was to nullify its impact. That then means you must answer a much more difficult question: not ‘when will it be safe to unlock?’ but rather ‘how much risk is acceptable?’

So far we have been told that decisions on what sort of restrictions should be in place and for how long have been ‘guided by the science.’ The difficulty with deferring decisions to experts, is that while someone well versed in their field can furnish you with huge amounts of relevant data, insight, and interpretation, they are no better placed than anyone else to tell you if an uncertain outcome is worthwhile. And every possible choice in the pandemic, whether to tighten or loosen restrictions, involves uncertain outcomes.

Suppose for one moment you are one of the very intelligent scientists advising the government throughout the crisis. You can present exact measurements of what has gone on, make reasonable inferences to what you think is happening right now, and present models showing the different potential futures, with an estimate of how likely you think each one is. You may be able to advise ‘if your priority is preventing avoidable deaths (or protecting the NHS, or protecting the most vulnerable, or whatever metric you prioritise), then our models indicate that this course of action is best.’ What a scientist cannot do, is advise you whether the risk and uncertainty associated with that course of action is worthwhile.

Humanity is instinctively loss averse. Suppose for example that you needed a qualification to advance in your career. School A proudly announces that 95% of their candidates succeed, while School B warns that 1 in 20 candidates fail. Which school would you instinctively go for? If you went for A, you are in the company of most of the population who are attracted to what looks like a successful proposition – but would also have failed to spot that the two schools are exactly the same.[i] As School B is presented as a risk rather than an opportunity, we are less likely to accept it.

In British sitcom Yes Minister, this aversion to risk is played out in the episode ‘The Greasy Pole’, a rare episode where the Civil Service are on the right side of the argument and the minister Jim Hacker is in the wrong. Coming under pressure to prevent a new chemical plant opening in Liverpool, Hacker sneakily arranges to meet the academic writing an “independent” report on the safety of the chemical planned to be produced at the plant. By introducing doubt into the academic’s mind, and the fear that his name would be associated with catastrophe if anything goes wrong, he persuades the academic to include a cautionary sentence into his report, providing Hacker with all the excuse he needs to block production of the chemical at the plant.[ii]

While the Yes Minister episode is obviously exaggerated for comedic effect, the point it makes about human nature remains intact; it is contrary to human nature to expect anyone to support an uncertain outcome, where there is no benefit to being right, great personal cost if they are wrong, and no direct penalty choosing what seems a ‘safer’ outcome.

Knowing that this is the way the human mind works, no scientist in their right mind would ever countenance advising the end of lockdown. It is highly unlikely that any scenario in which lockdown restrictions are eased will ever be devoid of risk. No scientist would want the ‘blame’ attached to their name, when the option to say ‘wait a little longer’ remains on the table as a less risky alternative, and they are relatively protected from the worst impacts of lockdown.

You may have heard the expression ‘officials advise, and ministers decide.’ It is exactly this kind of scenario which illustrates why this is so. The minister (or indeed, Prime Minister) is meant to weigh the advice received against the costs of each possible way forward. Scientists cannot advise if a risk of one in a hundred (or one in a thousand, or one in ten thousand) is acceptable. Nor can they advise if choosing the ‘less risky’ option is worth the associated costs to people’s well-being and mental health, to children’s education, or to the economy and health service. Only a minister can use the data provided by scientific approaches to take a political decision.

If we make zero risk a condition of ending COVID restrictions, the virus has won. We face a Waiting for Godot purgatory of interminable length. While there is wisdom in pre-empting possible problems and judging the costs involved in any decision, remaining perpetually risk averse will do greater harm than a complete absence of COVID restrictions. I am not saying that we should end lockdown tomorrow. I do believe we must change our mindset from waiting for an absence of risk, to instead asking what degree of risk and uncertainty we are prepared to live with.

[i] For those who do not like Mathematics – if 95% succeed, that is 95 in 100, which is the same as 19 in 20. That therefore means that 1 in 20 do not succeed.

[ii] Anyone wishing to watch the full episode can watch it through Britbox, or can buy the episode on YouTube

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