Tag: coronavirus

Time and the pandemic

There is this idea in physics that the fundamental laws of nature apply the same way for processes moving both forwards and backwards in time. So you can’t actually measure the passage of time by studying these processes. Where does our sense of time, rather the passage of time, come from then? How do we get to tell that the past and future are two different things, and that time flows from the former to the latter?

We sense time because things change. Clock time is commonly understood to be a way to keep track of when and how often things change but in physics, time is not the master: change doesn’t arise because of time but time arises because of change. So time manifests in the laws of nature through things that change in time. One of the simplest such things is entropy. Specifically, the second law of thermodynamics states that as time moves forward, the entropy of an isolated system cannot decrease. Entropy thus describes an arrow of time.

This is precisely what the pandemic is refusing to do, at least as seen through windows set at the very back of a newsroom. Many reporters writing about the coronavirus may have the luxury of discovering change, and therefore the forward march of time itself, but for someone who is somewhat zoomed out – watching the proceedings from a distance, as it were – the pandemic has only suffused the news cycle with more and more copies of itself, like the causative virus itself.

It seems to me as if time has stilled. I have become numb to news about the virus, which I suspect is a coping mechanism, like a layer of armour inserted between a world relentlessly pelting me with bad news and my psyche itself. But the flip side of this protection is an inability to sense the passage of time as well as I was able before.

My senses are alert to mistakes of fact, as well as mostly of argument, that reporters make when reporting on the coronavirus, and of course to opportunities to improve sentence construction, structure, flow, etc. But otherwise, and thanks in fact to my limited engagement with this topic, it feels as if I wake up every morning, my fingers groaning at the prospect of typing the words “lockdown”, “coronavirus”, “COVID-19”, “herd immunity” and whatever else1. And since this is what I feel every morning, there is no sense of change. And without change, there is no time.

1. I mean no offence to those suffering the pandemic’s, and the lockdown’s, brutal health, economic, social, cultural and political consequences.

I would desperately like to lose my armour. The bad news will never stop coming but I would still like to get back to bad news that I got into journalism to cover, the bad news that I know what to do about… to how things were before, I suppose.

Oh, I’m aware of how illogical this line of introspection is, yet it persists! I believe one reason is that the pandemic is a passing cloud. It leapt out of the horizon and loomed suddenly over all of us, over the whole world; its pall is bleak but none of us doubts that it will also pass. The pandemic will end – everybody knows this, and this is perhaps also why the growing desperation for it to dissipate doesn’t feel misplaced, or unjustified. It is a cloud, and like all clouds, it must go away, and therefrom arises the frustration as well: if it can go away, why won’t it?

Is it true that everything that will last for a long time also build up over a long time? Climate change, for example, doesn’t – almost can’t – have a single onset event. It builds and builds all around us, its effects creeping up on us. With each passing day of inaction, there is even less that we can do than before to stop it; in fact, so many opportunities have been squandered or stolen by bad actors that all we have left to do is reduce consumption and lower carbon emissions. So with each passing day, the planet visits us with more reminders of how we have changed it, and in fact may never have it back to the way it once was.

Almost as if climate change happened so slowly, on the human scale at least, that it managed to weave itself into our sense of time, not casting a shadow on the clock as much as becoming a part of the clock itself. As humankind’s grandest challenge as yet, one that we may never fully surmount, climate change doesn’t arise because of time but time arises because of climate change. Perhaps speed and surprise is the sacrifice that time demands of that which aspires to longevity.

The pandemic, on the other hand, likely had a single onset… right? At least it seems so until you realise the pandemic is in fact the tip of the proverbial iceberg – the thing jutting above the waterline, better yet the tip of the volcano. There is a complicated mess brewing underground, and out of sight, to which we have all contributed. One day the volcano shoots up, plastering its surroundings with lava and shooting smoke and soot kilometres into the air. For a time, the skies are a nuclear-winter grey and the Sun is blotted out. To consider at this time that we could stave off all future eruptions by pouring tonnes of concrete into the smouldering caldera would be folly. The pandemic, like magma, like the truth itself, will out. So while the nimbuses of each pandemic may pass, all the storm’s ingredients will persist.

I really hope the world, and I do mean the world, will heed this lesson as the novel coronavirus’s most important, if only because our sense of time and our expectations of what the passage of time could bring need to encompass the things that cause pandemics as much as they have come to encompass the things that cause Earth’s climate to change. We’ve become used to thinking about this outbreak, and likely the ones before it, as transitory events that begin and end – but really, wrapped up in our unrelenting yearning for the pandemic to pass is a conviction that the virus is a short-lived, sublunary creature. But the virus is eternal, and so our response to it must also transform from the mortal to the immortal.

Then again, how I wish my mind submitted, that too just this once, to logic’s will sans resistance. No; it yearns still for the pandemic to end and for ‘normal’ to recommence, for time to flow as it once did, with the promise of bringing something new to the threshold of my consciousness every morning. I sense there is a line here between the long- and the short-term, between the individual and the collective, and ultimately between the decision to change myself and the decision to wait for others before I do.

I think, as usual, time will tell. Heh.

Science journalism, expertise and common sense

On March 27, the Johns Hopkins University said an article published on the website of the Centre For Disease Dynamics, Economics and Policy (CDDEP), a Washington-based think tank, had used its logo without permission and distanced itself from the study, which had concluded that the number of people in India who could test positive for the new coronavirus could swell into the millions by May 2020. Soon after, a basement of trolls latched onto CDDEP founder-director Ramanan Laxminarayan’s credentials as an economist to dismiss his work as a public-health researcher, including denying the study’s conclusions without discussing its scientific merits and demerits.

A lot of issues are wound up in this little controversy. One of them is our seemingly naïve relationship with expertise.

Expertise is supposed to be a straightforward thing: you either have it or you don’t. But just as specialised knowledge is complicated, so too is expertise.

Many of us have heard stories of someone who’s great at something “even though he didn’t go to college” and another someone who’s a bit of a tubelight “despite having been to Oxbridge”. Irrespective of whether they’re exceptions or the rule, there’s a lot of expertise in the world that a deference to degrees would miss.

More importantly, by conflating academic qualifications with expertise, we risk flattening a three-dimensional picture to one. For example, there are more scientists who can speak confidently about statistical regression and the features of exponential growth than there are who can comment on the false vacua of string theory or discuss why protein folding is such a hard problem to solve. These hierarchies arise because of differences in complexity. We don’t have to insist only a virologist or an epidemiologist is allowed to answer questions about whether a clinical trial was done right.

But when we insist someone is not good enough because they have a degree in a different subject, we could be embellishing the implicit assumption that we don’t want to look beyond expertise, and are content with being told the answers. Granted, this argument is better directed at individuals privileged enough to learn something new every day, but maintaining this chasm – between who in the public consciousness is allowed to provide answers and who isn’t – also continues to keep power in fewer hands.

Of course, many questions that have arisen during the coronavirus pandemic have often stood between life and death, and it is important to stay safe. However, there is a penalty to think the closer we drift towards expertise, the safer we become — because then we may be drifting away from common sense and accruing a different kind of burden, especially when we insist only specialised experts can comment on a far less specialist topic. Such convictions have already created a class of people that believes ad hominem is a legitimate argumentative ploy, and won’t back down from an increasingly acrimonious quarrel until they find the cherry-picked data they have been looking for.

Most people occupy a less radical but still problematic position: even when neither life nor fortune is at stake, they claim to wait for expertise to change one’s behaviour and/or beliefs. Most of them are really waiting for something that arrived long ago and are only trying to find new ways to persist with the status quo. The all-or-nothing attitude of the rest – assuming they exist – is, simply put, epistemologically inefficient.

Our deference to the views of experts should be a function of how complex it really is and therefore the extent to which it can be interrogated. So when the topic at hand is whether a clinical trial was done right or whether the Indian Council of Medical Research is testing enough, the net we cast to find independent scientists to speak to can include those who aren’t medical researchers but whose academic or vocational trajectories familiarised them to some parts of these issues as well as who are transparent about their reasoning, methods and opinions. (The CDDEP study is yet to reveal its methods, so I don’t want to comment specifically on it.)

If we can’t be sure if the scientist we’re speaking to is making sense, obviously it would be better to go with someone whose words we can just trust. And if we’re not comfortable having such a negotiated relationship with an expert – sadly, it’s always going to be this way. The only way to make matters simpler is by choosing to deliberately shut ourselves off, to take what we’re hearing and, instead of questioning it further, running with it.

This said, we all shut ourselves off at one time or another. It’s only important that we do it knowing we do it, instead of harbouring pretensions of superiority. At no point does it become reasonable to dismiss anyone based on their academic qualifications alone the way, say, Times of India and OpIndia have done (see below).

What’s more, Dr Giridhar Gyani is neither a medical practitioner nor epidemiologist. He is academically an electrical engineer, who later did a PhD in quality management. He is currently director general at Association of Healthcare Providers (India).

Times of India, March 28

Ramanan Laxminarayanan, who was pitched up as an expert on diseases and epidemics by the media outlets of the country, however, in reality, is not an epidemiologist. Dr Ramanan Laxminarayanan is not even a doctor but has a PhD in economics.

OpIndia, March 22

Expertise has been humankind’s way to quickly make sense of a world that has only been becoming more confusing. But historically, expertise has also been a reason of state, used to suppress dissenting voices and concentrate political, industrial and military power in the hands of a few. The former is in many ways a useful feature of society for its liberating potential while the latter is undesirable because it enslaves. People frequently straddle both tendencies together – especially now, with the government in charge of the national anti-coronavirus response.

An immediately viable way to break this tension is to negotiate our relationship with experts themselves.

For coronavirus claims, there is a world between true and false

In high school, you must have learnt about Boolean algebra, possibly the most fascinating kind of algebra for its deceptive ease and simplicity. But thanks to its foundations in computer science, Boolean algebra – at least as we it learnt in school – is fixated with ‘true’ and ‘false’ states but not with the state of ‘don’t know’ that falls in between. This state may not have many applications as regards the functioning of logic gates but in the real world, it is quite important, especially when the truth threatens to be spun out of control.

Amitabh Bachchan recently published a video in which he delivered a monologue claiming that when a fly alights on human faeces containing traces of the new coronavirus, flies off and then alights on some food, the food could also be contaminated by the same virus. The Wire Science commissioned a fact-check from Dr Deepak Natarajan, a reputed (and thankfully opinionated) cardiologist in New Delhi. In his straightforward article, Dr Natarajan presents evidence from peer-reviewed papers to argue that while we know the new coronavirus does enter the faeces of an infected person, we don’t know anything about whether the virus remains viable, or capable of precipitating an infection. Second, we know nothing of the participation of flies either.

The thing to remember here is that, during a panic – or in a pre-panic situation that constantly threatens to devolve into a panic – society as such has an unusually higher uptake capacity for information that confirms their biases irrespective of whether it is true. This property, so to speak, amplifies the importance of ‘not knowing’.

Thanks to scientism, there is a common impression among many experts and most non-experts that science has, or could have, the answers to all questions that could ever be asked. So when a scientist says she does not know something, there is a pronounced tendency among some groups of people – particularly, if not entirely, those who may not be scientistic themselves but believe science itself is scientistic – to assume the lack of an answer means the absence of an answer. That is, to think “If the scientist does not have an answer, then the science does not have an answer”, rather than “If the scientist does not have an answer, then the science does not have an answer yet” or even “If the scientist does not have an answer yet, she could have an answer later“.

This response at a time of panic or pre-panic forces almost all information to be classified as either ‘true’ or ‘false’, precluding the agency science still retains to move towards a ‘true’ or ‘false’ conclusion and rendering their truth-value to be a foregone conclusion. That is, we need evidence to say if something is true – but we also need to understand that saying something is ‘not true’ without outright saying it is ‘false’ is an important state of the truth itself.

It also forces the claimant to be more accountable. Here is one oversimplified but nonetheless illustrative example: When only ‘true’ and ‘false’ exist, any new bit of information has a 50% chance of being in one bin or the other. But when ‘not true/false’ or ‘don’t know’ is in the picture, new information has only a 33% chance of assuming one of the truth values. Further, the only truth value based on which people should be allowed to claim something is true is ‘true’. ‘False’ has never been good enough but ‘don’t know’ is not good enough either, which means that before we subject a claim to a test, it has a 66% chance of being ‘not true’.

Amitabh Bachchan’s mistake was to conflate ‘don’t know’ and ‘true’ without considering the possibility of ‘not true’, and has thus ended up exposing his millions of followers on Twitter to claims that are decidedly not true. As Dr Natarajan said, silence has never been more golden.

On India’s path to community transmission

There’s a virus out there among many, many viruses that’s caught the world’s attention. This virus came into existence somewhere else, it doesn’t matter where, and developed a mutation at some point that allowed it to do what it needs to do inside the body of one specific kind of animal: Homo sapiens. And once it enters one Homo sapiens, it takes advantage of its new surroundings to produce more copies of itself. Then, its offspring wait for the animal to cough or sneeze – acts originally designed to expel irritating substances – to exit their current home and hopefully enter a new one. There, these viruses go through the same cycle of reproduction and expulsion, and so forth.

This way, the virus has infected over 210,000 people in the last hundred days or so. Some people’s bodies have been so invaded by the virus that their immune systems weren’t able to fight it off, and they – nearly 9,000 of them – succumbed to it.

Thus far, the virus has reportedly invaded the bodies of at least 282 people in India. There’s no telling how the virus will dissipate through the rest of the population – if it needs to – except by catching people who have the virus early, separating them from the rest of the population for long enough to ensure they don’t have and/or transmit the virus or, if they do, providing additional treatment, and finally reintegrating them with the general population.

But as the virus spreads among more and more people, it’s going to become harder and harder to tell how every single new patient got their particular infection. Ultimately, a situation is going to arise wherein too many people have the virus for public-health officials to be able to say how exactly the virus got to them. The WHO calls this phase ‘community transmission’.

India is a country of over 1.3 billion people, and is currently on the cusp of what the Indian Council of Medical Research (ICMR) has called ‘stage 3’ – the advent of community transmission. It’s impossible to expect a developing country as big and as densely populated as India to begin testing all 1.3 billion Indians for the virus as soon as there is news of the virus having entered the national border because the resource cost required to undertake such an exercise is extremely high, well beyond what India can generally afford. However, this doesn’t mean Indians are screwed.

Instead of testing every Indian, ICMR took a different route. Consider the following example: there’s a population of red flecks randomly interspersed with yellow flecks. You need to choose a small subset of flecks from this grid (shown below) such that checking for the number of yellow flecks in the subset gives you a reliable idea of the number of yellow flecks overall.

The ideal subset would be the whole set, of course, so there is one more catch: you have a fixed amount of money to figure out the correct answer (as well as for a bunch of other activities), so it’s in your best interests to keep the subset as small as possible. In effect, you need to balance the tension between two important demands: getting to a more accurate answer while spending less.

Similarly, ICMR assumed that the virus is randomly distributed in the Indian population, and decided to divide the population into different groups, for example by their relative proximity to a testing centre. That is, each testing centre would correspond to the group of all people who live closer to that testing centre than any other. Then, ICMR would pick a certain number of people from each group, collect their nasal and throat samples and send it to the corresponding labs for tests.

Say group size equals 100. For a Bernoulli random variable with unknown probability p, if no events occur in n independent trials, the maximum value of p (at 95% confidence) is approximately 3/n. In our case, n = 100 and p at 95% confidence is 3/100, which is 3%. Since this is the upper bound, it means less than 3% of the population has the ‘event’ which didn’t occur in n trials – which in our case is the event of ‘testing positive’. Do note, this is what is safe to say; it’s not what may actually be happening on the ground. So by increasing the sample size n as much as possible, ICMR can ascertain with higher and higher confidence as to whether the corresponding group has community transmission or not.

Thus far, ICMR has said there is no community transmission in India based on these calculations. Independent experts have been reluctant to take its word, however, because while ICMR has publicised what the sample size and the number of positives are, there is very little information about two other things.

First: we don’t know how ICMR selected the samples that it did for testing. While the virus’s distribution in the population can be considered to be random, especially if community transmission is said to have commenced, the selection of samples needs to have an underlying logic. What is that logic?

Second: we don’t know the group sizes. It’s important for the sample size to be proportionate to the group size. So without knowing what the group size underlying each sample is, it becomes impossible to tell if ICMR is doing its job right.

On March 17, one ICMR scientist said that some testing centres had admitted fewer people with COVID-19-like symptoms and the source of whose infections was unknown (i.e. community transmission) than the size of the sample chosen from their corresponding group. She was suggesting that ICMR’s choice of samples from each group was large enough to not overlook community transmission. To translate in terms of the example above: she was saying ICMR’s subset size was big enough to catch at least one yellow fleck – and didn’t.

As it happens, on March 20, ICMR announced that it would begin testing for a potential type of community-transmission cases even though its sampling exercise had produced 1,020 negative results in 1,020 samples (distributed across 51 testing centres).

The reasons for this are yet unclear but suggests that ICMR suspects there is community transmission of the virus in the country even though its methods – which ICMR has always stood by – haven’t found evidence of such transmission. This in turn prompts the following question: why not test for all types of community transmission? The answer is the same as before: ICMR has limited resources but at the same time has been tasked with discovering how many yellow flecks are there in the total population.

The virus is not an intelligent creature. In fact, it’s extremely primitive. Each virus is in its essence a packet of chemical reactions, and when each reaction happens depends on a combination of internal and external conditions. Other than this, the virus does not harbour any intentions or aspirations. It simply responds to stimuli that it cannot manipulate or affect in any way.

The overarching implication is that beyond how good the virus is at spreading from person to person, a pandemic is what it is because of human interactions, and because of human adaptation and mitigation systems. And as more and more people get infected, and their groups verge towards the WHO’s definition of ‘community transmission’, the virus’s path through the population becomes less and less obvious, but at the same time a greater depth of transmission opens the path to better epidemiological modelling.

When such transmission happens in a country like India, the body responsible for keeping the people safe – whether the Union health ministry, ICMR or any other entity – faces the same challenge that ICMR did. This is also why direct comparisons of India’s and South Korea’s testing strategies are difficult to justify, especially of the number of people tested per million: India has nearly 26-times as many people but spends 11.5-times less on healthcare per capita.

At the same time, ICMR isn’t making it easy for anyone – least of all itself – when it doesn’t communicate properly, and leaves itself open to criticism, which in turn chips away at its authority and trustworthiness in a time as testing as this. Demonetisation taught us very well that a strategy is only as good as its implementation.

But on the flip side, it wouldn’t be amiss to make a distinction here: between testing enough to get a sense of the virus’s prevalence in the population – in order to guide further action and policy – and the fact that the low expenditure on public healthcare is always going to incentivise India to skew towards a sampling strategy instead of an alternative that requires mass-testing. ICMR and the Union health ministry haven’t inspired confidence on the first count but it’s important to ensure criticism of the former doesn’t spillover into criticism of the latter as well.

Anyway, the corresponding sampling strategy is going to have to be based on a logic. Why? Because while the resources for the virus to spread exist abundantly in nature (in the form of humans), the human response to containing the spread requires resources that humans find hard to get. Against the background of this disparity, sampling, testing and treatment logics – such as Italy’s brutal triaging policy – help us choose better sampling strategies; predict approximately how many people will need to be quarantined in the near future; prepare our medical supplies; recruit the requisite number of health workers; stockpile important drugs; prepare for economic losses; issue rules of social conduct for the people; and so forth.

A logic could even help anticipate (or perpetuate, depending on your appetite for cynicism) ‘leakages’ arising due to, say, caste or class issues. Think of it like trying to draw a circle with only straight lines of a fixed length: with 200 strokes, you could technically draw a polygon with 200 sides that looks approximately like a circle – but it will still have some discernible edges and vertices that won’t exactly map on a circle, leaving a small part of the latter out. Similarly, using a properly designed technique that can predict which person might get infected and who might not can still catch a large number of people – but the technique won’t catch all of them.

One obvious way to significantly improve the technique’s efficacy as it stands is to account for the fact that more than half of all Indians are treated at private hospitals whereas you can be tested for COVID-19 only at a government facility, and not all VRDLs receive samples from all private hospitals in their respective areas.

Ultimately, the officials who devise the logics must be expected to justify how the combination of all logics can – even if only on paper – uncover most, if not all, cases of the virus’s infection in India.