Category Archives: Uncategorized
NEW* installation guide for low-cost #oxygen systems in low-resource settings. Includes #COVID19 isolation ward specs, tips on simple tubing to beds, and DIY flowmeter stand. Free to use and adapt. Please share.
Via Twitter from @GrahamHamish
https://drive.google.com/drive/folders/1m6qf_C1wxSfVi4AyPsm-c19TmG0B8k8C
Lower COVID risk among smokers?… #epitwitter
Some evidence that some smokers may in fact have LESS serious symptoms than non smokers. Interesting! Wonder if this will hold water on further investigation. The researchers are now planning to test nicotine patches.
Report on Weekly Deaths in South Africa 1 Jan – 7 April 2020 #epitwitter
7 min version of COVID on the Breadline
15 fatalities on the 15th in a taxi/minibus crash – maybe South Africans have a reason to fear COVID-19 less than Europeans

On 15 April, 15 occupants of a taxi-minibus (i.e. all of them) died in a head-on collision. Lockdown has reduced road fatalities to a record low, ironically; these people were particularly unlucky. But the event illustrates the kind of hazard that South Africans face daily. Life expectancy here is 59 for men, 65 for women. COVID-19 mortality rises sharply in the 60s, and, while this may not “transport” to African populations, we’re apparently happy to “transport” the exact same measures used elsewhere. Not enough cost-benefit analysis being done. Lockdown might save some from road traffic accidents but it will kill more from malnutrition and diseases endemic in the region, as malnutrition reduces resistance and medical supplies are diverted.
COVID on the Breadline
The Institute for the Future of Knowledge at the University of Johannesburg has partnered with Picturing Health to make a short documentary depicting the impact of severe lockdown measures on those living in poverty in the developing world.
COVID on the Breadline from PICTURING HEALTH on Vimeo.
Predicting Pandemics: Lessons from (and for) COVID-19
This is a live online discussion between Jonathan Fuller and Alex Broadbent, hosted by the Institute for the Future of Knowledge in partnership with the Library of the University of Johannesburg. Comments and discussion are hosted on this page, and you can watch the broadcast here:
We know considerably more about COVID-19 than anyone has previously known about a pandemic of a new disease. Yet we are uncertain about what to do. Even where it appears obvious that strategies have worked or failed, it will take some time to establish that the observed trends are fully or even partly explained by anything we did or didn’t do. And when we take a lesson from one place and try to apply it in another, we have to contend with the huge differences between different places in the world, especially age and wealth. This conversation explores these difficulties, in the hope of improving our response to the uncertainty that always accompanies pandemics, our ability to tell what works, our sensitivity to context, and thus our collective ability to arrive at considered decisions with clearly identified goals and a based on a comprehensive assessment of the relevant costs, benefits, risks, and other factors.
Further reading:
- Thinking rationally about coronavirus (Alex Broadbent)
- Why a one-size-fits-all approach to COVID-19 could have lethal consequences (Alex Broadbent and Benjamin Smart)
- South Africa’s COVID-19 lockdown: cigarettes and exercise could ease the tension (Benjamin Smart and Alex Broadbent)
Professor Alex Broadbent (PhD) is Director of the Institute for the Future of Knowledge at the University of Johannesburg and Professor of Philosophy at the University of Johannesburg. He specialises in prediction, causal inference, and explanation, especially in epidemiology and medicine. He publishes in major journals in philosophy, epidemiology, medicine and law, and his books include the path-breaking Philosophy of Epidemiology (Palgrave 2013) and Philosophy of Medicine (Oxford University Press 2019).
Dr Jonathan Fuller (PhD, MD) is a philosopher working in philosophy of science, especially philosophy of medicine. He is an Assistant Professor in the Department of History and Philosophy of Science (HPS) at the University of Pittsburgh, and a Research Associate with the University of Johannesburg. He is also on the International Philosophy of Medicine Roundtable Scientific Committee. He was previously a postdoctoral research fellow in the Institute for the History and Philosophy of Science at the University of Toronto.
The role of philosophers in the coronavirus pandemic
What is the point of philosophy? That’s a question many philosophers struggle with, not just because it is difficult to answer. That goes for many academic disciplines, including “hard” sciences and applied disciplines like economics. However, unlike physicists and economists, philosophers ought to be able to answer this question, in the perception of many. And many of us can’t, at least to our own satisfaction.
I’ve written some opinion pieces (1,2) and given some interviews during this period, and I know of a handful of other philosophers who have done so (like Benjamin Smart, Arthur Caplan, and Stefano Canali). However, I also know of philosophers who have expressed frustration at the “uselessness” of philosophy in times like these. At the same time, I’ve seen an opinion piece by a computer scientist, whose expert contribution is confined to the nature of exponential growth: something that all of us with a basic mathematical education have studied, and which anyone subject to a compound interest rate, for example through a mortgage, will have directly experienced.
Yet computer science hasn’t covered itself in glory in this epidemic. Machine learning publications claiming to be able to arrive at predictive models in a matter of weeks have been notably lacking in this episode, confirming, for me, the view that machine learning and epidemiology have yet to interact meaningfully. Why do computer scientists (only one, admittedly; most of them are surely more sensible) and philosophers have such different levels of confidence at pronouncing on matters beyond their expertise?
There are no experts on the COVID-19 pandemic
This pandemic is subject to nobody’s expertise. It’s a novel situation, and expertise is remarkably useless when things change, as economists discovered in 2008 and pollsters in 2016.
Of course, parts of the current situation fall within the domains of various experts. Infectious disease epidemiologists can predict its spread. But there is considerably more to this pandemic than predicting its spread. In particular, the prediction of the difference that interventions make requires a grasp of causal inference that is a distinct skill set from that of the prediction of a trend, as proponents of the potential outcomes approach have correctly pointed out. Likewise, the attribution, after the fact, of a certain outcome to an intervention only makes good sense when we know what course of action we are comparing that intervention with; and this may be underspecified, because the “would have died otherwise” trend is so hard to establish.
Non-infectious-disease epidemiologists may understand the conceptual framework, methodology, terminology and pitfalls of the current research on the pandemic, but they do not necessarily have better subject-specific expertise than many in public health, the medical field, or others with a grasp on epidemiological principles. Scientists from other disciplines may be worse than the layperson because, like the computer scientist just mentioned, they wrongly assume that their expertise is relevant, and in doing so either simplify the issue to a childish extent, or make pronouncements that are plain wrong. (Epidemiology is, in my view, widely under-respected by other scientists.)
Turning to economics and politics, economists can predict the outcome of a pandemic or of measures to control it only if they have input from infectious disease epidemiologists on the predictive claims whose impacts they are seeking to assess.
Moreover, the health impact of economic policies are well-studied by epidemiologists, and to some extent by health economists; but these are not typically knowledgeable about the epidemiology of infectious disease outbreaks of this nature.
Jobs for philosophers
In this situation, my opinion is that philosophers can contribute substantially. My own thinking has been around cost-benefit analysis of public health interventions, and especially the neglect of the health impact – especially in very different global locations – of boilerplate measures being recommended to combat the health impact of the virus. This is obviously a lacuna, and especially pressing for me as I sit writing this in my nice study in Johannesburg, where most people do not have a nice study. Africa is always flirting with famine (there are people who will regard this as an insult; it is not). Goldman Sachs is predicting a 24% decline in US GDP next quarter.
If this does not cost lives in Africa, that would be remarkable. It might even cost more lives than the virus would, in a region where only 3% are over 65 (and there’s no evidence that HIV status makes a difference to outcomes of COVID-19). South Africa is weeks into the epidemic and saw its first two deaths just today.
Yet the epidemiological community (at least on my Twitter feed) has entirely ignored either the consequences of interventions on health, merely pointing out that the virus will have its own economic impact even without interventions, which is like justifying the Bay of Pigs by pointing out that Castro would have killed people even without the attempted invasion. And context is nearly totally ignored. The discipline appears mostly to have fallen behind the view that the stronger the measure, the more laudable. Weirdly, those who usually press for more consideration of social angles seem no less in favour, despite the fact that they spend most of the rest of their time arguing that poverty is wrongly neglected as a cause of ill-health.
Do I sound disappointed in the science that I’m usually so enthusiastic about, and that shares with philosophy the critical study of the unknown? Here we have a virus that may well claim a larger death toll in richer countries with older populations, and a set of measures that are designed by and for those countries, and a total lack of consideration of local context. Isn’t this remarkable?
There is more to say, and many objections; I’ll write this up in an academically rigorous way as soon as I can. Meanwhile, I’ll continue to publish opinion pieces, where I think it’s useful. Right now, my point is that there’s a lot for philosophers to dissect here. I don’t mean in this particular problem, but in the pandemic as a whole. And the points don’t have to be rocket science. They can be as simple as recommending that a ban on sale of cigarettes be lifted.
What is required for us to be useful, however, is that we apply our critical thinking skills to the issue at hand. Falling in with common political groupings adds nothing unique and requires the suspension of the same critical faculties that we philosophers pride ourselves on in other contexts. This is a situation where nearly all the information on which decisions are being made is publicly available, where none of it is the exclusive preserve of a single discipline, and where fear clouds rational thought. Expert analyses of specific technical problems are also readily available. These are ideal conditions for someone trained to apply analytic skills in a relatively domain-free manner to contribute usefully.
Off the top of my head, here are a handful topic ideas:
- How to circumscribe the consequences of COVID-19 that we are interested in when devising our measures of intervention (this is an ethical spin on the issue I’m interested in above)
- The nature of good prediction (which I’ve worked on in the public health context – but there is so much more to say)
- The epistemology of testimony, especially concerning expertise, in a context of minimal information (to get us past the “trust the scientists FFS” dogma – that’s an actual quote from Twitter)
- The weighing of the rights of different groups, given the trade off between young and old deaths (COVID-19 kills almost no children, while they will die in droves in a famine)
One’s own expertise will suggest other topics, provided that the effort is to think critically rather than simply identify people with whom one agrees. I very much hope that we will not see a straightforward application of existing topics: inductive risk and coronavirus; definition of health and coronavirus; rights and coronavirus; etc. To be clear, I’m not saying that no treatment of coronavirus can mention inductive risk, definition of health, or rights; just that the treatment must start with Coronavirus. My motto in working on the philosophy of epidemiology is that my work is philosophical in character but epidemiological in subject: it is philosophical work about epidemiology. Where it suggests modifications to existing debates in philosophy, as does happen, that is great, but it’s not the purpose. The idea is to identify new problems, not to cast old ones in a new light. Perhaps there are no such things as new philosophical problems; but then again, perhaps it’s only by trying to identify new problems that we can cast new light on old ones.
Call to arms
The skill of philosophers, and the value in philosophy, does not lie in our knowledge of debates that we have had with each other. It lies in our ability to think fruitfully about the unfamiliar, the disturbing, the challenging, and even the abhorrent. The coronavirus pandemic is all these things. Let’s get stuck in.
Thinking rationally about Coronavirus
I have written an op ed which can be found here:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/country-readiness
There is also a very good (in my opinion) peace in the Lancet which emphasizes the importance of rate of spread and anticipates public health measures as an inevitability, better embraced sooner than later.
https://doi.org/10.1016/ S0140-6736(20)30567-5
Events like this really make me feel that epidemiology must be much more widely understood in the contemporary world. Debates about red meat do the same, but less dramatically. This is such a stark case. Epidemiological expertise must guide us and basic comprehension of epidemiology – even as basic as just knowing that there is such a thing and that there are Experts in it, and that they are not necessarily doctors – would help so much. Politicians aren’t better educated than the rest of the educated public. I’m not critiquing any particular decision – so far, things have mostly been sensible, I think – but the sense of not knowing could be greatly alleviated. How about just a short module on epidemiology as part of high school biology?…