Decisions on restarting the economy will be science based and data driven.

Our elected officials are all telling us that they will restart the economy in phases to ensure public health and safety.  So why aren’t they giving us the data that is needed to determine if the public can safely return to work and school?  We’re still not being given the right numbers.

By Israel Zwick, April 27, 2020

About the author: Israel Zwick holds advanced degrees in biology, science education, and school psychology. He recently retired from working as a school psychologist for the NYC Department of Education. Before that he taught biology and chemistry for 15 years. Prior to that, he worked in the microbiology laboratories of the NYC Department of Health.

“Our decisions on restarting the economy will be science based and data driven.”

“Science based and data driven.”

“Science based and data driven”

This statement is often repeated by our elected public officials when they discuss relaxing the lockdown and restarting the economy. It appears to be their new mantra for dealing with the public.  They want us, Mr. and Mrs. Citizen, to develop faith, trust, and confidence in the officials that we elected. They want us to know that they will do the right thing for us. They want us to believe that the decisions that they will make on reopening businesses and schools will be in our best interests, and keep us safe, healthy, and prosperous.  Yet, somehow, I can’t seem to garner the trust and confidence that they would like me to have. That’s because over the last six weeks since this lockdown started, there have been numerous articles published by medical experts noting that we do not have the accurate numbers needed for understanding this pandemic and implementing effective policies.  (See: http://cnpublications.net/category/health-sciences/)   Yet, those were the dissenting opinions that caught little attention, and quickly passed from public view. So, I decided to browse through some basic textbooks on epidemiology and find out for myself what this “science based data” is that we need to know to restart the economy and get us back to our normal lives.  What I found was revealing.

The book High-Yield, Biostatistics, Epidemiology, & Public Health, Fourth Edition, by Anthony N. Glaser, MD, Phd, devotes Chapter 8 to “Epidemiology and Public Health.”  The entire chapter is filled with statistics needed for public health studies. On page 91, he discusses the analogy of the Epidemiologist’s Bathtub.

THE “EPIDEMIOLOGIST’S BATHTUB”

“The relationships between incidence, prevalence, and mortality in any disease can be visualized with the aid of the “epidemiologist’s bathtub,” shown in Figure 8-3.

• The flow of water through the faucet into the bathtub is analogous to incidence, representing the occurrence of new cases of the disease in the population at risk.
• The level of water in the tub represents the prevalence, or number of cases of the disease existing at any given point in time.
• The flow of water out through the drain represents mortality.
• The evaporation of water represents recovery, whether spontaneous or through treatment, or the emigration of people with the disease (so they are no longer part of the population in question).”   –Anthony N. Glaser, MD, PhD

The author goes on to discuss absolute risks, relative risks, odds ratios, and outbreak investigations, as well as how these may apply to viral outbreaks.

The basic textbook, Epidemiology 101, by Robert H. Friis, PhD,  also devotes Chapter 8 to the study of “Infectious Diseases and Outbreak Investigations.”  Table 8-7 discusses “Steps in the Investigation of an Infectious Disease Outbreak.”

The popular textbook, Epidemiology, Fifth Editition, by Leon Gordis, MD, MPH, DrPH, gets right to it. The entire Section 1 is devoted to the “Epidemiologic Approach to Disease and Intervention.” Chapter 3 is devoted to “Disease Surveillance and Measures of Morbidity,” while chapters 7 and 8 are devoted to randomized trials.

So, with all this information readily available to all who are interested, why are we still not getting all the ratios that we need to properly understand this pandemic and implement appropriate interventions? All we are being fed are the number of COVID+ cases, number of deaths, number of hospital admissions, number recovered, and other basic numbers that provide little information about how this disease is progressing in the populations affected.  Is it possible that the eminent physicians Anthony Fauci, Deborah Birx, and Robert Redfield, who are advising presidents and prime ministers, don’t know basic epidemiology?  That’s very highly unlikely. Each of these esteemed infectious disease experts have about 40 years of experience working with infectious diseases. They have stellar reputations in their fields of study.  Their curricula vitae have long lists of impressive achievements and accomplishments. Nobody has to teach them epidemiology.  They can write the book.

So why do we still not have the “science based, data driven” answers that we need to start getting us out of this global lockdown and get the economy moving again?  Could it be that “something is rotten in the state of Denmark?”  Interestingly, Denmark was one of the first countries to implement a lockdown, and one of the first to relax it.  Another interesting point: The term “social distancing” cannot be found in the index of any of the books that I reviewed.