Assessing Covid 19 response - when experts got it wrong, again!

Siddharth Mukherjee has a great long form in New Yorker examining the epidemiological mystery around Covid 19,

The usual trend of death from infectious diseases—malaria, typhoid, diphtheria, H.I.V.—follows a dismal pattern. Lower-income countries are hardest hit, with high-income countries the least affected. But if you look at the pattern of covid-19 deaths reported per capita—deaths, not infections—Belgium, Italy, Spain, the United States, and the United Kingdom are among the worst off. The reported death rate in India, which has 1.3 billion people and a rickety, ad-hoc public-health infrastructure, is roughly a tenth of what it is in the United States. In Nigeria, with a population of some two hundred million, the reported death rate is less than a hundredth of the U.S. rate. Rich countries, with sophisticated health-care systems, seem to have suffered the worst ravages of the infection. Death rates in poorer countries—particularly in South Asia and large swaths of sub-Saharan Africa—appear curiously low. (South Africa, which accounts for most of sub-Saharan Africa’s reported covid-19 deaths, is an important exception.)

This on the so-called Models,

... for rich countries, deaths predicted by the model weren’t far from what we’ve seen, or, anyway, what we can now reasonably extrapolate. The surprise emerged when looking at South Asia and most of sub-Saharan Africa. The model—which, it should be emphasized, took age differences into account—appeared to be off, in most cases, by a staggering margin. Pakistan, with a population of two hundred and twenty million, was predicted to have as many as six hundred and fifty thousand deaths; it has so far reported twelve thousand. Côte d’Ivoire was predicted to have as many as fifty-two thousand deaths; by mid-February, a year after the pandemic reached the continent, it had reported under two hundred... Nigeria was predicted to have between two hundred thousand and four hundred and eighteen thousand covid-19 deaths; the number reported in 2020 was under thirteen hundred. Ghana, with some thirty million residents, was predicted to see as many as seventy-five thousand deaths; the number reported in 2020 was a little more than three hundred. These numbers will grow as the pandemic continues. As was the case throughout much of sub-Saharan Africa, however, the statistical discrepancy was of two orders of magnitude: even amid the recent surge, the anticipated devastation still hasn’t quite arrived.

In the days and years ahead, there will be volumes written on the Covid 19 response by governments. This post is a very brief early assessment, based on some emerging data.

This blog has written on multiple occasions from the very beginning of the pandemic arguing that for some unknown reason the pandemic mortality was lower in developing countries than in developed countries. The emergent evidence was unambiguous enough to make this as a simple affirmation. This and this, and this and this, are two very early posts each urging less aggressive lockdowns and proposing a plan of action for opening respectively which are worth revisiting (in case people think this is hindsight analysis). 

This demanded a different and less aggressive response in terms of lockdowns and restrictions on economic and other activities in most developing countries. And this case was based on available real-world evidence and judgement on the likely costs and benefits. It stood in contrast to the panic reaction among experts arising from purely theoretical models-driven assessments, with little consideration for the emergent reality in developing countries. Epidemiologists, public health specialists and even economists assumed the stage of expertise and scared politicians and bureaucrats everywhere into persisting with the aggressive overkill on lockdowns. 

In recent weeks there have been numerous serological studies from across India which point to very high levels of Covid 19 infection rates, almost reaching herd immunity levels. So much so that the demand for even the AstraZenca/Oxford vaccine has been lukewarm. State governments are facing resistance among significant numbers of people in accepting the vaccine. Dose completion rates are disturbingly low. This, in a country where, unlike in the US, vaccines are commonly and widely accepted and administered.

Another argument that has commonly been used in the western media is that systematic large under-reporting was responsible for the low mortality rates in developing countries. Dispelling this, if it needed any at all, comes data on all-cause deaths from Kerala. It dipped from 2.64 lakh to 2.35 lakh, a decline of 11.1%. As this report points out, given the low levels of deaths due to road accidents and communicable diseases, there is a case that Covid 19 deaths in 2020 were no more than would be expected of any normal disease. 

This raises the question that will be asked in the days ahead.

After the initial month or two of hard lockdown, should India and other developing countries not have opened up more (allowing economic activities, schools etc with mandatory mask wearing and practical social distancing) while accepting slightly higher deaths than has been the case, but thereby limiting the economic damage and human suffering?

The experts (with their western orientations and biases) won the day with the Covid 19 response. But at what cost?

It also raises the question on how much should public policy be determined purely by technical experts, overlooking other equally important considerations. This post explains how the pre-pandemic economic weakness in India may have been the doing of excessive reliance on the opinions of experts.

We over-estimate the importance of pure technical expertise in the management of complex public policy choices. For sure they are important as critical inputs into decision-making. But they have to be considered along with other equally important contextual factors and judgement exercised.