Barend Vlaardingerbroek: Coronavirus –musings from Beirut

Invercargillites would have been delighted to hear Boris Johnson publicly thanking a nurse called Jenny who is from their city for keeping a watchful eye on him while he was in intensive care – indeed at the juncture where, in his words, “things could have gone either way”. 

The nightmare continues, but pressure is mounting on governments to start easing the lockdown restrictions. Austria is allowing some cafés to reopen. France is likely to follow suit in mid-May. The pressures are social and economic but these decisions should be based on robust statistical data.

We see and hear figures daily and try to make sense of what is happening and who may be doing better than others and why, with a view to learning from the comparative experience of all those affected. But this will only work if the figures are reliable and comparable.

We are given mainly simple tallies – X confirmed cases of infection, Y deaths. These are suspect as the death of someone with COVID-19 who had ‘underlying issues’ may be recorded as a coronavirus death but may not be – it may be attributed to those ‘issues’ on the death certificate. If there was a standard approach to this, that everyone was following, fine and well; but there isn’t. As for the ‘confirmed cases’ number, that tells us more about how much testing has been done than anything else.

Far more important than simple tallies are the infection rates and mortality rates. To go back to school for a moment, a rate is calculated by dividing the number of cases of a specific outcome (in this instance, dying of COVID-19) by the number of potential cases of that outcome (the total pool of infected people). Here we run into two huge problems. First, there is the accuracy of the figure being used as the numerator in our rate equation. To use the UK as an example, the policy of reporting only deaths that occur in hospitals means that the numerator used is lower than it should be, so the calculated rate will be too low – the real rate is higher. This is not a trivial issue – the UK health authorities have admitted to coronavirus outbreaks in more than 2,000 nursing homes. Secondly, there is the accuracy of the figure used as the denominator, because we simply don’t know what the total infected population is – there is a large pool of infection out there that is not on our radar screen because of limited testing (relative to the total population size) and because so many carriers are asymptomatic. India provides an extreme example of this uncertainty with doctors whose identity had been disguised telling the BBC that the authorities just haven’t got a clue about the extent of the infection. The good news is that, given a denominator which is definitely too low, the true death rate is actually considerably lower than that calculated using those flawed divisors.

The Swedish experiment is one worth keeping tabs on. Sweden’s policy of minimal restrictions on people’s movements is based on the expectation that ‘herd immunity’ will develop and that this will put the brakes on any further spread of the virus. The danger with the lockdown/stay-at-home approach is that there may be a second wave once the restrictions are eased because there isn’t that ‘herd immunity’ to stop a resurgence – we’ll be back to square one.

Wouldn’t it be useful if we had statistics that were both reliable indicators of the situation on the ground and were directly comparable between different jurisdictions.

Commentators have been saying of late that this pandemic may be a global game-changer: the world won’t simply return to normal once it has passed. That could certainly be true for a lot of restaurateurs and café owners in Italy if the current Minister for Health gets her way – she told the BBC that most of those joints should not be allowed to reopen until there is a vaccine for COVID-19. That would presumably be a whole new generation of establishments as all those now in existence would have long gone bust. We are talking end next year at the earliest even if the testing and approval processes that a new vaccine has to go through are expedited. “It is the end of Italy as we know it,” said one café owner.

Mention of game-changers prompts my thoughts to turn to the developing world. Most working people in the poorer developing countries are employed in the informal economy or are on day rates with formal employers. One recent BBC report included the claim that 90% of workers in Bangladesh are potentially affected. Remittances from family members working overseas are crucially important sources of income for many communities and those have largely dried up too. There are few or no social security safety nets for those neediest of people to fall back on. Relative poverty rapidly degenerates into absolute poverty – the inability to provide the bare necessities of life such as food for oneself and one’s dependents. The possibility of massive social upheavals in such societies is staring us more menacingly in the face than it has done for decades.

Much the same applies here in Lebanon where most workers enjoy very little protection from exploitation and abuse. Add to that a fiscal crisis that has seen the Lira lose two-thirds of its value on the black market and the recent, still simmering political upheavals (see my article “What’s been up in Lebanon?”, Breaking Views 7 January 2020) and you have an explosive mixture that it may be hard to keep the lid on should the situation deteriorate. And that’s not to mention the refugee camps where the virus could well effect a massacre. It’s tough enough for them already with the effects of the disease on employment and on begging, an important source of income for some families. I saw several beggar kids I know on the near-empty streets on Sunday from the taxi I had engaged to take me to the supermarket and some of them are starting to look awfully rough.

Stay safe!

Barend Vlaardingerbroek BA, BSc, BEdSt, PGDipLaws, MAppSc, PhD is an associate professor of education at the American University of Beirut and is a regular commentator on social and political issues. Feedback welcome at bv00@aub.edu.lb