Debating Risk and Value

I spent way too much time building this tool to visualize the concept of how we are trying to balance risk and value in a COVID-19 world. I think it’s important and I hope you agree.

• Risks, Values, and We All Want The Best for Everyone - I set forth a rubric of why we get animated about certain policies

• The Folly of Theory - Theories that happen to match the data are fine, but are they helpful?

• Disney Shorts: The Flying Mouse

Risks, Values, We All Want The Best for Everyone

I had an encouraging epiphany recently. It started as I was thinking theoretically about the impact of protests on the current surge of cases.

There are lots of interesting theories about protests and COVID spread, but the thing I’ve noticed among my most seriously scientific friends and colleagues is that they are very hesitant to justify any behavior or action one way or the other. They are most comfortable saying “this action increases the risk of spread, we should figure out how much” and leaving it there.

As I’ve thought through this, I came to a realization that I haven’t seen elucidated anywhere: In a pandemic, every human interaction carries with it both risk and value. If the risk outweighs the value, we decide to forego the activity. If the value outweighs the risk, we choose to increase our personal danger (and the danger to others) because the behavior is important enough to take the risk.

I tried to elucidate this concept in a chart, but I decided to use a bucket metaphor instead and I spent WAY TOO MUCH TIME making a video because I think the visual helps.

When we are in the midst of a pandemic, we need to reduce the risk as far as we can while maximizing the value. As we open our way back out, we start by picking options that slowly increase the risk while still maximizing the value.

We need food. So we definitely need to tolerate the meat packing risk to justify its high value. We need work, but does it need to be in the office? Is going into the office worth the risk? 42 percent of US workers are now working from home so maybe we can give up the value if we give up the risk.

This is why people get so passionate about masks. To many people, masks are an extremely low-risk solution. It costs very little to wear a mask, so any value it brings is a net positive. With that view it’s a no-brainer, we should obviously add it to the list of things we do gives us flexibility to do other things.

Unfortunately, a lot of people interpret “low risk” as “obviously high value”. I do think people are putting too much weight on masks as THE SOLUTION to this problem. Pro-masks should be viewed with more of a “probably helps, can’t hurt” eye since we are still fairly short of hard evidence on exactly how much of an impact mask-wearing makes. But we can add it to our column of things to implement since it likely gives us space to do other things, like protesting.

I like this rubric because it helps explain why people get so passionate about masks, and also why people very passionate about the nature of the recent protests. Let me be frank: From an epidemiological view, the protests carry risk. More people in a single place at one time means a risk of transmission. From an epidemiological perspective, this is almost tautological; the very nature of transmission means more people in one place at one time equals more risk.

But how much risk? That is the fight people are having. Many people want to say that the risk is minimal while the value is high. We don’t yet have enough evidence to be certain about the scale of the risk, but the determination of high value is purely subjective. My mom doesn’t care much for the protests, community worship in her church is much more important.

You can see in the chart above that worship services are listed as high risk and low value. That too is a subjective assignment. What if we said that protests were unimportant and worship services were more important? If we were determined to make worship possible, what steps could we take to reduce the risk? What if we, as a society, had to choose between the two? Either protests or church. The risk is too high for both, you have to pick one. It’s a juggling act with with severe consequences.

pictured: balancing all the things we want to do that run risks of COVID transmission

I’ve been inundated with arguments that the risk of protesting is, in fact, zero or close enough to zero that the prevalence of other risks overwhelm it. We all want to minimize our societal risk while maximizing our societal value. We don’t agree on what the value scores are. And if we find something valuable (like worship or protesting) then we are incentivized to downplay the risks so that our activity is easier to justify. But others can see us downplaying that risk and they feel this is unfair to their preferred high-value activity.

If someone who values protests chooses to add the protests to their list of acceptable actions, they are *necessarily* removing something else from the list of safe actions we can take. They have made a unilateral decision. The choice is then this: Either they have to tell their fellow citizens “I’ve decided to allow protesting because it is important and, as a result, you may not go to a restaurant” or they have to claim that protesting is a zero-risk proposition (it is not) which then implies that all activities that approximate the dangers of protests are also zero-risk (they are not).

We all want the same thing: to reduce the risk of infection while maximizing the value to our communities and society. The roadblock is that we don’t all value the same things. We need to find some way of striking that compromise, to not insist that my preferred activities are risk-less and high value while your preferred activities are high risk and and valueless. Maybe adopting this rubric can help us understand each other better and work toward a path out of this pandemic.

The Folly of Theory

The case surge in Arizona that I am currently most anxious about began in late May. In early June, we were seeing week-over-week new cases doubling. We weren’t seeing an increase in deaths, but there was a lot of confidence in the concept “deaths are lagging, wait two weeks”.

And then two weeks went by. The cases increases were more pronounced, even startling. But the deaths hadn’t risen. We kept waiting. Still (thankfully) no rise in deaths. Still the claims that we will see the deaths rise, they’re coming next week or the week after that. Most of the data people I follow were expecting a rush of deaths reported today after a slow 3-day weekend. Still nothing.

I don’t know why. None of us do. The levels of uncertainty are high.

pictured: me trying to talk to someone who claims to already know everything about COVID

Why aren’t we seeing what we expected to see? Georgia weekly cases are up over 200% from this time last month. Why on earth are Georgia weekly deaths *down* 60%?

I’ve become convinced that our minds abhor an explanatory vacuum. We must fill the unknown with some reason, ANY REASON, why things are happening. This has given way to a great flourish of theories around all things COVID.

There are theories about why certain states are seeing case surges and other aren’t. Could be some combination of air conditioning, protests, opening up, or increased testing. It could be something else we don’t know about yet.

There are theories about why we haven’t seen the death surge we very much expected. I’ve seen speculation that that we haven’t waited long enough, they’re still coming. I’ve seen people point out that we have better treatments (this is true), that the cases are largely in younger demographics (also true), but also theorize that the virus has evolved to be less dangerous.

There are theories about mask compliance, about protest risk, about regional differences, about racial differences, about European vs American vs Asian case rates and death rates. Name a metric or some hiccup in the data and the theories that explain it away come pouring down like a Florida hurricane.

This is fine if we treat these theories as a sort of speculative game of pattern matching. Maybe if I find a theory or two that seems to have unique explanatory power, I’ll tuck it aside and come back to it in a few weeks to test it against the newest trends and data.

But generally speaking, I simply wish we could all be more comfortable with uncertainty and communicating how much we don’t know. I wish we did know these things, but if we mix statements about what we know for certain with speculative theories that are barely educated guesses, we undermine the truth and give people reasons to doubt us when we’re speaking from confidence. Earned confidence comes from expertise, rigor, study, and a careful examination of evidence that establishes facts about the world on which we can rely. I’ve come to really dislike theories stated with unearned confidence because it does such a disservice to those hard-earned facts.

Disney Shorts: The Flying Mouse

In this short, a little mouse sees the graceful loveliness of the birds and wishes he could be like them. His siblings mock his ambitions, which only drives him to greater determination.

He rescues a helpless butterfly who (naturally) turns out to be a magical fairy who grants him the gift of flight. I love the line “If wings are what you wish, then you shall have a pair”.

Of course his heart’s desire turns quickly sour as the birds reject him, his family rejects him, and the only creatures could possibly accept him are the creepy bats who sing “You’re nothing but a nothing”… a serenade to the idea that nature determines our place.

This is one of those shorts that communicates a worldview, perhaps lost or abandoned in the last 80 years, that reaching outside of our place and position is a foolishness and that joy and contentment are found in the home.

Now that I’ve written about this, I’m going to have to think about it much harder. There is something about the class dynamics that is both comforting and disquieting.