‘Evidence based’ does not mean there is no politics

Decisions about acceptable risks are inherently political decisions, write contributors Jay Foster and Jenifer Barton. ‘In the case of SARS-CoV2, there must be many political decisions because the science is not yet all that clear.’L-R: Health and Community Services Minister John Haggie, Premier Dwight Ball and Chief Medical Officer of Health Janice Fitzgerald. (Government of Newfoundland and Labrador/YouTube) Early this month, Newfoundland and Labrador moved to Alert Level 4, the first step in the government’s reopening of the economy. Though slowly reopening, sweeping new powers have been granted to police and health inspectors to enforce public health orders, notably domestic travel restrictions.  This gives force to health minister John Haggie’s one-liner, “If you come from away, you best stay away.” Premier Dwight Ball and Minister Haggie insist that there is “nothing political” in their decisions because they are just following the advice of Dr. Janice Fitzgerald, Newfoundland and Labrador’s chief medical officer of health. That kind of claim is a sidestep that tries to hide political choices behind scientific expertise. Given the political risks of a bad reopening, a temptation is to turtle. As we begin to peak out of our self-isolation, it’s important to remember that different provinces and different countries are all handling SARS-CoV2 (the virus that causes the disease COVID-19) differently. At present there is a lack of consensus across scientific disciplines — like clinical medicine, epidemiology and virology — about what is required to mitigate risks for public safety. This scientific disagreement is to be expected, given that the coronavirus is “novel.” But, it also leads to very different policy recommendations, all of which can make some claim to being “science based” or “evidence based.” Sweden’s response to the coronavirus was arguably the most radical. Under epidemiologist Dr. Anders Tegnell’s guidance, Sweden imposed almost no lockdown. Some might worry about Sweden’s higher than expected mortality rate, but as yet, there is no evidence that this was because of the plan or some other complicating factor. Testing for COVID-19 in Montreal. (Ivanoh Demers/Radio-Canada) Just 50 cases per 100K Quebec began reopening on May 4 under the guidance of Dr. Horacio Arruda. Outside of Montreal and Joliette, children returned to school on May 11 despite the province having 453 cases per 100,000 people, the highest in Canada. Quebec, like Alberta, continues to manage higher-case areas carefully. Here in Newfoundland and Labrador there have been just 50 cases per 100,000. Yet, Minister Haggie warns that we will return to Alert Level 5 if there is an increase in cases. With few cases overall and so few new cases, the incidence of COVID-19 in this province can hardly do anything but increase. This suggests that Newfoundland and Labrador’s leadership may be working with expectations out of step with realities. Confronted with the possibility of electoral defeat if COVID-19 resurges, science becomes a political tool. The purpose of the lockdown was to flatten the curve and protect the hospital system from being swamped, not rid us of COVID-19. We were never going to win a “war” against the coronavirus. As we go about reopening, the critical tools are laboratory capacity, test-kit supply-chains and contact-tracing infrastructure. The aim now is to dampen down COVID-19 cases and keep ICU capacity balanced with need. Yet, in this province and elsewhere, political leaders do not spend much time discussing the details of testing and contact tracing. Instead, their main response has been to impose ongoing travel restrictions which must now withstand the scrutiny of a charter challenge. All this despite the fact that the best available epidemiological evidence suggests that border policing has limited effectiveness.  Quebec Premier Francois Legault speaks to the media at the daily COVID-19 press briefing, Thursday, May 21, 2020 in Montreal. (Ryan Remiorz/The Canadian Press) ‘Science becomes a political tool’ It is noteworthy that the premier with the highest popularity, Françios Legault, is pursuing the most aggressive reopening strategy despite the prevalence of COVID-19 in Quebec. Elsewhere political prudence suggests different courses of action. In Newfoundland and Labrador, the Liberal leadership, and soon the premiership, is up for grabs. There is no savvy politician who is not aware that much depends on the reopening.  Confronted with the possibility of electoral defeat if COVID-19 resurges, science becomes a political tool. The tool works like this. On the one hand, if reopening goes badly, the response will be, “we were following the best science in an unprecedented situation, so we’re not to blame.” On the other hand, if the reopening goes well, the response will be, “our unique and amazing leadership resulted in a great outcome.” Given the political risks of a bad reopening, a temptation is to turtle. Keep the public fearful, borders locked and schools, universities and business shuttered as long as possible. Just hunker down and wait for the white-coats to come to the rescue with a vaccine! That’s little more than an optimistic political gamble, however.  A staff member tests samples of the COVID-19 inactivated vaccine at a vaccine production plant of China National Pharmaceutical Group in Beijing, capital of China, April 11, 2020. (Zhang Yuwei/Xinhua/Getty) ‘Herd immunity’ There are reportedly at least 100 vaccine candidates with a handful fast-tracked to preliminary clinical trials. But there are many hurdles to overcome. A vaccine may turn out to be ineffective because it does not generate a strong enough immune response. It may have unforeseen and unintended consequences. Worst of all, a vaccine might not be effective against an emergent mutation of SARS-CoV2. Even if a vaccine becomes available, it likely will not be available for a year or much longer. For many of the same reasons, we also should not expect “herd immunity” to be achievable. There is a distinct possibility that this virus does not conveniently go away. It is both scientifically and politically naive to hint otherwise. Going forward, it should be fully expected that Newfoundland and Labrador will experience more COVID-19 cases and higher rates of hospitalization.  Decisions about acceptable risks are inherently political decisions. It is more reasonable to expect that the coronavirus becomes part of a new normal. There is the unhappy but real prospect that annual COVID-19 deaths will become another unpleasant fact, like the 24 people who died in highway accidents in the province last year. We could all stop driving, but we don’t, because we have come to accept this risk and the deaths. As we collectively come to terms with the risks of the coronavirus, we will need to be attentive to the ways in which those who are vulnerable are disproportionately affected by the virus. Decisions about acceptable risks are inherently political decisions. In the case of SARS-CoV2, there must be many political decisions because the science is not yet all that clear. There are many ways to approach reopening compatible with the best available science. In the absence of a single right way to go forward, political judgements must be made about what is to be done. These judgments must be a matter of extensive and ongoing political debate as well as public consultation. Leaders here and elsewhere should not be allowed to pretend that they are somehow just following “science.” Read more from CBC Newfoundland and Labrador
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