A Framework for Decisions in a Post-COVID World: an aid to policy-makers in South Africa. A report of the Institute for the Future of Knowledge at the University of Johannesburg

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A Framework for Decisions in a Post-COVID World – South Africa – Report 1.2

Decision Tool SA 1.0

Executive Summary

The document identifies six fundamental policy priorities which, together, constitute a framework for making all-things-considered policy decisions. These decisions must respond to immediate needs for action, but must also be taken with a view to the future (the post-COVID world). The policy decisions that frame them are not created by this pandemic: they existed before it, will persist beyond it, and constitute the reason that we care about COVID-19 and its consequences.

Available evidence suggests that South Africa’s lockdown lacks a strong evidence base, especially when compared to moderate scenarios rather than complete inaction. A one-page analysis (two-pages in the case of health) is provided for each of the following priorities.

  1. Health
  2. Food security and nutrition
  3. Education
  4. Economy and unemployment
  5. Vulnerable groups
  6. Governance and enforcement

A decision tool is offered for scoring these components to represent the impact of lockdown or other measure on that policy priority, and weighting them to represent the relative accordance afforded to e.g. health, the economy, and so on. This approach is customizable: items may be altered, added and subtracted from the list of policy priorities.

While the report writers offer their own recommendations based on the rationale encapsulated in their one-page summaries, in the end these are of secondary importance. This document is meant to support rather than prescribe to policy-makers, by enabling a decision process that makes implicit assumptions and value-judgements clear.

Our primary recommendation is that this framework be adopted, adapted and used by policy-makers for both making decisions and communicating the rationale for decisions, especially (i) decisions to allow and prohibit particular behaviours at different lockdown levels and (ii) decisions to move from one level to another.

Read the report | Access the decision tool

Note on versions: 1.0, 1.1, 1.2 etc denote minor corrections and updates, e.g. spelling, references, etc. Versions can be used interchangeably for all intents and purposes. Substantive new editions are marked by an increment from 1.1, 1.2 etc to 2.0, 2.1, etc.

A reminder of what Imperial said: with a world on max lockdown, we would still expect about 900,000 deaths around now. Give or take. More or less. Etc. #epitwitter I fear this may be epidemiology’s version of the 2008 financial crisis…

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The table below shows 250 days after first infection. Yes yes infection didn’t all start on 1 Jan but this model would only be ballpark correct if the infection started globally 6 weeks ago.

It’s easy to be wise in hindsight – except that quite a few people were saying this sort of thing, at every step of the way. I predict that in future this – the model, the politics, all of it – will become a classic study in how science policy should not be made. In the meantime, as we climb down from the heights of our panic, it’s just so fascinating to witness ideas that start off as dangerous – like “maybe we shouldn’t be locking down” – gradually become more common, and to feel the tug in oneself of trying to decide who to trust.

The usual disclaimer: I’m not saying the virus isn’t dangerous, that lives don’t matter, that we should do nothing… just that we haven’t reacted well.

page 11 of imperial report

Great piece from @JonathanJFuller ‘What’s Missing in Pandemic Models: Philosophy is needed to put the science of COVID-19 in perspective.’ In @NautilusMag #epitwitter

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http://nautil.us/issue/84/outbreak/whats-missing-in-pandemic-models

Jonathan Fuller writes: “In the COVID-19 pandemic, numerous models are being used to predict the future. But as helpful as they are, they cannot make sense of themselves. They rely on epidemiologists and other modelers to interpret them. Trouble is, making predictions in a pandemic is also a philosophical exercise. We need to think about hypothetical worlds, causation, evidence, and the relationship between models and reality.”

Read more…

At 17:00 today South Africa time I’m part of a panel, “Pandemic and Policy”, organised by the Cambridge Dept of History and Philosophy of Science #epitwitter @ujphilosophy @ujmedia

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17:00 South Africa, Europe | 16:00 UK | 11:00 US East

https://zoom.us/j/93201666974?pwd=cWhoWkhhVjNSazBjRHpzaGlKN1pPdz09

Meeting ID: 932 0166 6974 | Password: 756567

From the organisers: “The threats of the SARS-CoV-2 pandemic, and the effectiveness and harms of the social policies meant to mitigate these threats, rapidly became the most important scientific issues in many years. This session will analyse the pandemic and policy response from a variety of angles. Topics will include the nature and empirical basis for the relevant epidemiological models, the difficulties with exporting policies out of European contexts, and the challenges of democratic citizen science in a context of lay conspiratorial skepticism of science.”

Panel

Elizabeth Anderson, John Dewey, Distinguished University Professor of Philosophy and Women’s Studies
University of Michigan, Ann Arbor

Alexander Broadbent, Director of the Institute for the Future of Knowledge, University of Johannesburg

Eric Winsberg, Professor of Philosophy, University of South Florida

Chair

Jacob Stegenga, Reader in Philosophy of Science, University of Cambridge

To join:

Please join us on Zoom:

https://zoom.us/j/93201666974?pwd=cWhoWkhhVjNSazBjRHpzaGlKN1pPdz09

Meeting ID: 932 0166 6974 | Password: 756567

While it’s not my go-to source of health news, the Daily Mail is reporting that 322 Brits under 45 have died of COVID-19 #epitwitter

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https://www.dailymail.co.uk/debate/article-8290353/ALEX-BRUMMER-Madness-45s-work-economy-burns.html – ALEX BRUMMER: ‘Just 332 under-45s have died in UK from Corona. It’s madness to keep them from work while our economy burns’

Here is the graph they present:

ONS figures released this week show that as of April 24, only 322 people under the age of 45 had died from coronavirus in the UK

Read more…

 

At 18:30 South Africa time I’m part of a panel: “Ethics and Applicability of the Social Distancing Model in the Global South” organised by the Center for Human Rights and Global Justice at New York University School of Law #epitwitter @ujphilosophy @ujmedia

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South Africa, W Europe 18:30 | UK 17:30 | USA East 12:30

To join the event, RSVP here

From the organisers:

“Having first emerged in high and upper-middle income countries (China, Europe, USA), the dominant response to the Covid-19 pandemic has been to try to ‘flatten the curve’ through social distancing, while buying time to develop vaccines and cures. Almost all affected countries in the global north have pursued this strategy, with only a few exceptions such as Sweden, which has refused to order social distancing. It is too early to tell if Sweden will pay a heavy price for its heterodox approach, just as it is too early to know the social and economic costs of social distancing edicts in the north. However, at a moment when the pandemic has begun to shift to the global south, it is appropriate to reflect on the trade-offs of the social distance-dominated mitigation model, as well as its applicability across all environments.”

Read more… | RSVP here to join the event

Panelists

Professor Alex Broadbent, Director of the Institute for the Future of Knowledge; and Professor of Philosophy, University of Johannesburg (South Africa)

Professor Margaret Gyapong (BSc, MSc, PhD), Director, Institute of Health Research, University of Health and Allied Sciences (Ghana)

Dr. Catherine Kyobutungi (MBChB, MSc, PhD), Executive Director at the African Population and Health Research Center (Kenya)

Professor Alicia Yamin, Senior Advisor on Human Rights at Partners in Health; Senior Fellow at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School; and Advisor at the Centre on Law and Social Transformation and the Bergen Center on Ethics and Priority Setting (United States)

Moderator

Professor Jackie Dugard, Scholar in Residence at the Center for Human Rights and Global Justice, NYU School of Law; Associate Professor at the School of Law, University of the Witwatersrand (South Africa)

Read more… | RSVP here to join the event

‘Exclusive: Government scientist Neil Ferguson resigns after breaking lockdown rules to meet his married lover’ reports @Telegraph

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‪https://www.telegraph.co.uk/news/2020/05/05/exclusive-government-scientist-neil-ferguson-resigns-breaking/‬

What is fascinating for me is the regularity with which senior people are demonstrating how hard it is to keep lockdown. This instance is of course particularly satisfying because Ferguson is the global proponent of lockdown and because this particular embarrassment demonstrates how invasive these restrictions are.

Also it has a wonderfully British flavour about it… both the outrage and the immediate resignation

Boston Review: ‘COVID-19 has revealed a contest between two competing philosophies of scientific knowledge. To manage the crisis, we must draw on both’ says @JonathanJFuller #epitwitter

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http://bostonreview.net/science-nature/jonathan-fuller-models-v-evidence

‘How do the coronavirus models generating these hypothetical curves square with the evidence? What roles do models and evidence play in a pandemic? Answering these questions requires reconciling two competing philosophies in the science of COVID-19.’ Great piece which will still be interesting a week, month, year and decade from now, unusually at present.

Lockdown will lead to 29 times more lives lost than the harm it seeks to prevent from Covid-19 in SA, say SA actuaries in @FinancialMail – and that’s a conservative estimate

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‘EXCLUSIVE: Lockdown disaster dwarfs Covid-19, say SA actuaries’ https://www.businesslive.co.za/fm/features/2020-05-05-lockdown-disaster-dwarfs-covid-19-say-sa-actuaries/

It’s becoming hard to keep up with this stuff – there seem to be more and more voices suggesting that the costs of lockdown may exceed the costs of COVID-19, by some measure.

A lot depends what we compare lockdown to, and one bugbear of mine is the tendency to dichotomise the question: lockdown or bust. But the real comparison is between lockdown and some other measures, short of lockdown, but nonetheless somewhat effective. The cost/benefit ratio of these intermediate measures may be more favourable then lockdown for Low/Middle Income Countries, even if they are not in High Income Countries.