30 May 2020 COVID19 and OPDs Fundamentally speaking, you do not take decisions based on what is likely to work, but based on the systemic costs of the error. - Nassim Nicholas Taleb Thou shalt not confound the unobserved with the nonexistent. The unknown risk WHEN THE NOVEL CORONAVIRUS emerged out of Wuhan, little was known about the characteristics of it. However, as is with any unknown threat, the size of it can be estimated from the response it took to contain it. China imposed travel restrictions on tens of millions of across several of its major cities. Virus itself doesn’t move on its own. It’s the human activity that moves it: large scale gathering, intercity, inter district, interstate and international travel. The interconnectivity of our society acted as necessary oxygen for the fire to spread. We were unsure of its mortality rate, morbidity in the survivors, the infectivity (R₀, which is not the property of virus only but also the response from the society as a whole), and the most important being the asymmetric uncertainty. 1 30 May 2020 Reactive vs Proactive The pathologies are multiple: our response is largely reactive. We wait for the virus to attack first and then look for the evidence to justify our step, by the time the virus, because of its exponential nature will be many steps ahead of us. It seems prudent to change our policies to proactivity: to act before the virus takes its next step. However, the problem with proactivity is that we have to assume much worse, even before it happens and then act accordingly and thus prevent it from happening ever in the first place. That is the basis of precautionary paradox. The cost of disengaging large scale non-essential OPDs is salient. The benefit of such a monumental decision is hidden, possibly infinite. Pandemic is fractal Each infected person by the virtue of his/her infectivity, acts as a viral particle for the system. However, unlike our society, the human body doesn’t stay to calculate the economic cost of containment. It just goes ahead and tries to contain it, that is the rigour of millions of years of trial and errors: evolution. Separate them in time. Separate them in space. Was it a correct decision to close the large-scale OPDs? Let’s calculate the cost and then conclude independently. Harm due to closing large-scale OPDs: many cases of otherwise non-emergency illnesses were left unattended and had to seek out alternate small-scale OPD appointments. Harm due to NOT closing large-scale OPDs: UNKNOWN. Decide it for yourself. - @dr_neurone 2
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