Making Decisions in a COVID-19 World

Baruch Fischoff
JAMA. 2020;324(2):139-140.
doi:10.1001/jama.2020.10178

Here are two excerpts:

Individuals must answer complementary questions. When is it safe enough to visit a physician’s office, get a dental check-up, shop for clothing, ride the bus, visit an aging or incarcerated relative, or go to the gym? What does it mean that some places are open but not others and in one state, but not in a bordering one? How do individuals make sense of conflicting advice about face masks, fomites, and foodstuffs?

Risk analysis translates technical knowledge into terms that people can use. Done to a publication standard, risk analysis requires advanced training and substantial resources. However, even back-of-the-envelope calculations can help individuals make sense of otherwise bewildering choices. Combined with behavioral research, risk analysis can help explain why reasonable people sometimes make different decisions. Why do some people wear face masks and crowd on the beach, while others do not? Do they perceive the risks differently or are they concerned about different risks?

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Second, risk analyses are needed to apply that knowledge. However solid the science on basic physical, biological, and behavioral processes, applying it requires knowledge of specific settings. How do air and people circulate? What objects and surfaces do people and viruses touch? How sustainable are physical barriers and behavioral practices? Risk analysts derive such estimates by consulting with scientists who know the processes and decision makers who know the settings.3 Boundary organizations are needed to bring the relevant parties together in each sector (medicine, sports, schools, movie production, etc) to produce estimates informed by the science and by people who know how that sector works.

The info is here.

Ivanka Trump's love for Goya beans violates ethics rules, say US rights groups

Associated Press
Originally posted 15 July 2020

The White House has defended Ivanka Trump tweeting a photo of herself holding up a can of Goya beans to buck up a Hispanic-owned business that she says has been unfairly treated, arguing she had “every right” to publicly express her support.

Government watchdogs countered that President Donald Trump’s daughter and senior adviser doesn’t have the right to violate ethics rules that bar government officials from using their public office to endorse specific products or groups.

These groups contend Ivanka Trump’s action also highlights broader concerns about how the president and those around him often blur the line between politics and governing. The White House would be responsible for disciplining Ivanka Trump for any ethics violation but chose not to in a similar case involving White House counselor Kellyanne Conway in 2017.

Goya became the target of a consumer boycott after CEO Robert Unanue praised the president at a Hispanic event at the White House on Thursday last week.

Trump tweeted the next day about his “love” for Goya, and his daughter followed up late Tuesday by tweeting a photo of herself holding a can of Goya black beans with a caption that read, “If it’s Goya, it has to be good,” in English and Spanish.

The info is here.

Immunity to Covid-19 could be lost in months, UK study suggests

Ian Sample
The Guardian
Originally posted 12 July 20

People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds.

In the first longitudinal study of its kind, scientists analysed the immune response of more than 90 patients and healthcare workers at Guy’s and St Thomas’ NHS foundation trust and found levels of antibodies that can destroy the virus peaked about three weeks after the onset of symptoms then swiftly declined.

Blood tests revealed that while 60% of people marshalled a “potent” antibody response at the height of their battle with the virus, only 17% retained the same potency three months later. Antibody levels fell as much as 23-fold over the period. In some cases, they became undetectable.

“People are producing a reasonable antibody response to the virus, but it’s waning over a short period of time and depending on how high your peak is, that determines how long the antibodies are staying around,” said Dr Katie Doores, lead author on the study at King’s College London.

The study has implications for the development of a vaccine, and for the pursuit of “herd immunity” in the community over time.

The immune system has multiple ways to fight the coronavirus but if antibodies are the main line of defence, the findings suggested people could become reinfected in seasonal waves and that vaccines may not protect them for long.

The info is here.

At Stake in Reopening Schools: ‘The Future of the Country’

Matt Peterson

barrons.com
Originally posted 10 July 20

Here is an excerpt:

We do have to think about this longer-term. We also have to think about it from an ethics standpoint, acknowledging the following. At least right now, the primary motivation behind closing schools—having children not be educated in school buildings—is because of a belief that keeping schools physically open with children congregating poses a risk to community transmission. Either to teachers directly or back to households and the wider community. Whether it’s bad for kids themselves or how risky it is for kids themselves remains an open question. We’re worried about multisymptom inflammatory syndrome. But at least, right now, the evidence continues to suggest children are not themselves a particularly high risk group for serious Covid disease.

From an ethics point of view, when one group is being burdened primarily to benefit other groups, that puts a very special onus on justifying that it is ethically OK. If we conclude it is the right thing to do ethically because of what’s at stake for the community, we have both to make sure that it’s justified, this disproportionate burden on children, and that we do everything we can to mitigate those burdens.

The info is here.

Cognitive Bias and Public Health Policy During the COVID-19 Pandemic

Halpern SD, Truog RD, and Miller FG.
JAMA. 
Published online June 29, 2020.
doi:10.1001/jama.2020.11623

Here is an excerpt:

These cognitive errors, which distract leaders from optimal policy making and citizens from taking steps to promote their own and others’ interests, cannot merely be ascribed to repudiations of science. Rather, these biases are pervasive and may have been evolutionarily selected. Even at academic medical centers, where a premium is placed on having science guide policy, COVID-19 action plans prioritized expanding critical care capacity at the outset, and many clinicians treated seriously ill patients with drugs with little evidence of effectiveness, often before these institutions and clinicians enacted strategies to prevent spread of disease.

Identifiable Lives and Optimism Bias

The first error that thwarts effective policy making during crises stems from what economists have called the “identifiable victim effect.” Humans respond more aggressively to threats to identifiable lives, ie, those that an individual can easily imagine being their own or belonging to people they care about (such as family members) or care for (such as a clinician’s patients) than to the hidden, “statistical” deaths reported in accounts of the population-level tolls of the crisis. Similarly, psychologists have described efforts to rescue endangered lives as an inviolable goal, such that immediate efforts to save visible lives cannot be abandoned even if more lives would be saved through alternative responses.

Some may view the focus on saving immediately threatened lives as rational because doing so entails less uncertainty than policies designed to save invisible lives that are not yet imminently threatened. Individuals who harbor such instincts may feel vindicated knowing that during the present pandemic, few if any patients in the US who could have benefited from a ventilator were denied one.

Yet such views represent a second reason for the broad endorsement of policies that prioritize saving visible, immediately jeopardized lives: that humans are imbued with a strong and neurally mediated3 tendency to predict outcomes that are systematically more optimistic than observed outcomes. Early pandemic prediction models provided best-case, worst-case, and most-likely estimates, fully depicting the intrinsic uncertainty.4 Sound policy would have attempted to minimize mortality by doing everything possible to prevent the worst case, but human optimism bias led many to act as if the best case was in fact the most likely.

The info is here.

COVID-19 is more than a public health challenge: it's a moral test

Thomas Reese
religionnews.com
Originally published 10 July 20

The time is already past to admit that the coronavirus pandemic in the United States is a moral crisis, not simply a public health and economic crisis.

While a certain amount of confusion back in February at the beginning of the crisis is understandable, today it is unforgivable. Bad leadership has cost thousands of lives and millions of jobs.

A large part of the failure has been in separating the economic crisis from the public health crisis when in fact they are intimately related. Until consumers and workers feel safe, the economy cannot revive. Nor should we take the stock market as the key measure of the country’s health, rather than the lives of ordinary people.

It can be difficult to see this as a moral crisis because what is needed is not heroic action, but simple acts that everyone must do. People simply need to wear masks, keep social distance and wash their hands. Employers need to provide working conditions where that is possible.

These are practices that public health experts have taught for decades. Too many in the United States have ignored them. Warnings about masks, for example, have been ignored.

For its part, government needs to enforce these measures, expand testing on a massive scale, do contact tracing and help people isolate themselves if they test positive. Instead, government, especially at the federal level, has failed. Businesses, especially bars, restaurants and entertainment venues, have remained open or been reopened too soon.

That it is possible to do the right thing and control the virus is obvious from the examples of South Korea, Thailand, New Zealand, China, Vietnam, most of Europe, New York, Massachusetts and Connecticut.

There is also the sin of presumption of those who trust in God to protect them from the virus while doing nothing themselves. Those who left it to the Lord forgot that “God helps those who help themselves.” There is also an arrogance in seeing ourselves as different from other mortals like us. Areas where people insisted they were somehow immune to this “blue” big-city virus have now been hit with comparable or worse infection rates.

The info is here.

Empathy is both a trait and a skill. Here's how to strengthen it.

Kristen Rogers
CNN.com
Originally posted 24 June 20

Here is an excerpt:

Types of empathy

Empathy is more about looking for a common humanity, while sympathy entails feeling pity for someone's pain or suffering, Konrath said.

"Whereas empathy is the ability to perceive accurately what another person is feeling, sympathy is compassion or concern stimulated by the distress of another," Lerner said. "A common example of empathy is accurately detecting when your child is afraid and needs encouragement. A common example of sympathy is feeling sorry for someone who has lost a loved one."

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A "common mistake is to leap into sympathy before empathically understanding what another person is feeling," Lerner said. Two types of empathy can prevent that relationship blunder.

Emotional empathy, sometimes called compassion, is more intuitive and involves care and concern for others.

Cognitive empathy requires effort and more systematic thinking, so it may lead to more empathic accuracy, Lerner said.  It entails considering others' and their perspectives and imagining what it's like to be them, Konrath added.

Some work managers and colleagues, for example, have had to practice empathy for parents juggling remote work with child care and virtual learning duties, said David Anderson, senior director of national programs and outreach at the Child Mind Institute….   But since the outset of the pandemic in March, that empathy has faded — reflecting the notion that cognitive empathy does take effort.

It takes work to interpret what someone is feeling by all of his cues: facial expressions, tones of voice, posture, words and more. Then you have to connect those cues with what you know about him and the situation in order to accurately infer his feelings.

"This kind of inference is a highly complex social-cognitive task" that might involve a variation of mental processes, Lerner said.

The info is here.

The Pandemic Experts Are Not Okay

Ed Yong
The Atlantic
Originally posted 7 July 20

Here is an excerpt:

The field of public health demands a particular way of thinking. Unlike medicine, which is about saving individual patients, public health is about protecting the well-being of entire communities. Its problems, from malnutrition to addiction to epidemics, are broader in scope. Its successes come incrementally, slowly, and through the sustained efforts of large groups of people. As Natalie Dean, a biostatistician at the University of Florida, told me, “The pandemic is a huge problem, but I’m not afraid of huge problems.”

The more successful public health is, however, the more people take it for granted. Funding has dwindled since the 2008 recession. Many jobs have disappeared. Now that the entire country needs public-health advice, there aren’t enough people qualified to offer it. The number of epidemiologists who specialize in pandemic-level infectious threats is small enough that “I think I know them all,” says Caitlin Rivers, who studies outbreaks at the Johns Hopkins Center for Health Security.

The people doing this work have had to recalibrate their lives. From March to May, Colin Carlson, a research professor at Georgetown University who specializes in infectious diseases, spent most of his time traversing the short gap between his bed and his desk. He worked relentlessly and knocked back coffee, even though it exacerbates his severe anxiety: The cost was worth it, he felt, when the United States still seemed to have a chance of controlling COVID-19.

The info is here.

The MAD Model of Moral Contagion: The role of motivation, attention and design in the spread of moralized content online

Brady WJ, Crockett MJ, Van Bavel JJ.
Perspect Psychol Sci. 2020;1745691620917336.

Abstract

With over 3 billion users, online social networks represent an important venue for moral and political discourse and have been used to organize political revolutions, influence elections, and raise awareness of social issues. These examples rely on a common process in order to be effective: the ability to engage users and spread moralized content through online networks. Here, we review evidence that expressions of moral emotion play an important role in the spread of moralized content (a phenomenon we call ‘moral contagion’). Next, we propose a psychological model to explain moral contagion. The ‘MAD’ model of moral contagion argues that people have group identity-based motivations to share moral-emotional content; that such content is especially likely to capture our attention; and that the design of social media platforms amplifies our natural motivational and cognitive tendencies to spread such content. We review each component of the model (as well as interactions between components) and raise several novel, testable hypotheses that can spark progress on the scientific investigation of civic engagement and activism, political polarization, propaganda and disinformation, and other moralized behaviors in the digital age.

A copy of the research can be found here.