I am just off a very interesting call with @markomanka. He and @simonaferlini are thinking of a new bottom-up initiative. Through me, they are asking Edgeryders for help. Marco – a doctor – and Simona – a public health manager – both in Italy, are on the frontlines, so I am going to do the writing here.
It turns out that the health care system, in many countries (but not in all), got overoptimized over the years. It was honed to be efficient in the context of a predictable environment, with a known mix of pathologies. Over time, it discarded redundancies and second lines. It is now badly equipped to deal with unknown unknowns and black swan events.
Overoptimization also happened in agent space. Not only hospital wards not running at full capacity were closed: the people who got promoted to leadership positions in public health tended to be narrow specialists, who build their career on, say, hepatitis B. Their epistemic horizon is also made for stable environments. They do not know how to move in an epistemic space where evidence is absent, or ambiguous; they are not used to questioning evidence, and dislike doing so.
The result was a situation where evidence from China was not sifted and interrogated, but mistrusted. As a result, many countries in Europe underestimated SARS-CoV-2 (“mortality is like a flu’s”, which is of course true if you have the resources to treat every affected person to high standards). At this point, in Marco’s reconstruction, the whole system went into emergency mode. The emergency, plus the epistemic rigidity, mean that the protocols that are being communicated to doctors on the frontline are shaky at best, and “magical thinking” at worst. Ward directors and even government guidelines (Italy) will tell doctors to “keep working on patients even if you test positive, as long as you asymptomatic” (!!!), or to wear makeshift masks if you do not have any proper ones “because they are better than nothing”. Intensive care wards are being erected in a few days, by reconverting space from, say, psychiatric ones. Additionally – and this is very, very serious – there are strong suspicion that actual data are being hidden or misrepresented. Hidden: I have some personal evidence, as the open data community in Italy (@napo, @piersoft) is desperately asking regional authorities to release the data with open licenses and proper documentation. Misrepresented: it turns out that, in places like Bergamo, only 10-25% of the extra mortality with respect to seasonally adjusted average is explained by the official deaths by COVID-19. It’s hard to really figure out what is going on, also because shifting criteria of access to testing (Italian) mean that there is no way to even observe the statistical trends.
Epistemic resilience means, instead, being critical of evidence, and disobeying if that saves lives or unnecessary suffering. In the case of masks, we do have evidence: a makeshift mask is to a mask what a blanket it to a parachute. It is not “better than nothing”, it is exactly the same as nothing. A makeshift hospital ward might have intensive care machines, but it risks infecting patients in nearby wards unless air circulation is addressed seriously, with proper ventilation and filters, which is a feature distinguishing makeshift wards from proper ones. Plus, these things might create a false sense of security – again, we have a literature on this, more from finance and from war medicine – and distract us from taking measures that, while far from optimal, are indeed “better than nothing”. Example: isolate people at home, and send them cheap DIY ventilators or some such.
Marco and Simona think that epistemic resilience for the medical community means three things.
- Build a trusted knowledge base on practices to deploy in the face of the evidence we have, and that we do not. Right now, doctors are getting advice off YouTube channels, and randos on WhatsApp. Some solid stuff is there, but also people who say the government has created SARS-CoV-2 to kill all the NoVax. I think of this knowledge base as the kind of document that @matthias and @lucasg are good at maintaining. This is necessary, because in the face of bad instructions doctors and nurses need some evidence-based good knowledge to push back. This need is why they are all on WhatsApp. Marco thinks this would consist both of articles and of stories from the frontlines. Important: this needs to be multilingual, because “the doctor on the field in Heidelberg is going to look for evidence in German”.
- A lobbying effort, informed by this knowledge, to try to get the health care system to get unstuck.
- A way for these doctors, nurses, etc. to stage a symbolic protest. “We cannot strike during an emergency, but maybe we could carry a symbol, or something.”
So, they asked me if Edgeryders could help, mostly with 1. A community is assembling around them; translation efforts could be asked to Translators Without Frontiers or something. But we could host the community, and put in some editorial/community management work, maybe? Collect stories? Anybody has any thoughts, especially @matthias, @nadia, @noemi, @hugi and @johncoate?