Were global Health Institutions unprepared for COVID-19?

As the coronavirus disease 2019 (COVID-19) has begun spreading in the city of Wuhan, Hubei Province, China in December 2019, international correspondence from leading health institutions has seen a critical shift. Early responses from the World Health Organisation (WHO), the Center for Disease Control Prevention (CDC) or the U.S. Office of the Surgeon General (OSG) included official statements underestimating the possible impact of COVID-19. Amongst these were advice given to stop the purchase of masks by the OSG, the reported claim that “[…] authorities have found no clear evidence of human-to-human transmission” of the novel virus by the WHO, and multiple shortcomings of the CDC with regards to testing. In late March 2020, the U.S. Surgeon General stated on twitter that “@WHO & @CDCgov& my office have consistently recommended against the general public wearing masks as there is scant or conflicting evidence they benefit individual wearers in a meaningful way, but real concerns about pulling from the healthcare worker supply”.

Robert Redfield, CDC’s Director, explained during a congressional hearing in early March that “[t]he truth is [the U.S. have been] underinvested in the public health labs”, admitting that budget cuts did leave public institutions unprepared for, what is called, a ‘tail event’ in statistics. ‘Tail events’ are events with a lower-than-average probability of happening because, when looking at their distribution, they are outside the median, in what is referred to as the “tails” of the distribution. This means that the CDC was only prepared for normal conduct, however not for rare events of potentially significant impact. The issue with this is, however, this had not been communicated, and the CDC’s stance on using non-homemade masks as protection while performing essential household tasks remains the same:

“The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance”.

What is baffling, is the apparent misunderstanding of the risks individuals are exposed to and the thread individuals can be for others. If individuals protected others and themselves more effectively by wearing masks of higher quality, such as surgical masks or N95 (FFP2 in Europe) masks. The argument does not take the feedback mechanism into consideration which will relieve health workers. Fewer masks for medical workers are needed if the spreading rate in a population drops. While the mask-worker ratio remains the same, COVID-19 has been found to spread exponentially, owing to the fact that individuals can contaminate multiple people – these are also called “multiplicative dynamics”, an effect not seen in car- or ladder-accident statistics. Here, the dynamics are only additive, meaning that these numbers won’t drastically change as those of the COVID-19 contagions.

WHO attracted particular criticism from NYU-Statistics Professor Nassim Taleb who vocally pointed out that, in cases when we do not know the dangers stemming from novel circumstances, our response should be particularly careful: “You don't wear a mask jus[t] because you have evidence that transmission is airborne. You wear a mask because YOU DON'T KNOW whether transmission is airborne”.

WHO’s argument that masks may give a false sense of security fails immediately when applied to comparable cases, such as seat belts, airbags, helmets, door locks, circuit breakers, etc., Taleb stresses. In his ‘Incerto’ series, he focusses on aforementioned tail-risks in real-life scenarios, leveraging a 21-year career as an option trader specialising in the probability of rare events. On January 26th 2020, him, Yaneer Bar-Yam and Joseph Norman had already published a risk-centred perspective of how to react to pandemics, pointing out the multiplicative dynamics of COVID-19.

Edited by: Patrick Lehner