What you don’t know . . .

Can make you look foolish.

It’s starting. To be fair, it never ended, but I thought for a few brief moments sanity and restraint might rule, as the world faced a deadly virus. Perhaps people would realize that there is something more important than politics. But no.

Politicians, pundits and the talking-head classes are doing what they always do, taking credit and laying blame in the middle of a global crisis. Sadder still (to me) are the number of Facebook friends who are doing the same. You might think they would know better. But no.

There are two kinds of these instant analyses: those which hedge and identify the uncertainties and still try to make a call about what happened, and ones which grab some little factoid and run to the extreme to make a political point. Hey, pundits got to . . . pundit, right? Isn’t this what they do for a living? Don’t doctors and government officials make such statements? Yes, but no.

Emergency Room doctors have to make snap judgments with the data at hand., and they don’t always have time to explain all the assumptions under which they are working. Government leaders (and doctors speaking to the public) have to make similar policy decisions under great uncertainty, but must also appear to be confident. It is a fine art, and one which is on display (both for good and ill) right now.

Why be a tad humble, a little hesitant, a bit shy about certainty? Let me count the ways, for here is a short list of things we DO NOT KNOW about the coronavirus in particular and the crisis in general:

• How many people have been infected? Because testing is miniscule everywhere, estimates are we may be orders of magnitude (100x) wrong in our number of cases, which puts all our other data under suspicion.
• How many people have died? Seems like this would be a no-brainer, since the dead are pretty countable, but the recent addition of 3700 deaths in NYC (from nursing homes and at-home deaths) is a reminder we’re only catching the reported deaths. Eventually, we will be able to estimate total deaths much like we do for the seasonal flu, driving the total up. Silver lining: increases in deaths are a percentage, not an order of magnitude, so the net effect on the final data is to drive the case fatality rate down.
• Does infection effect immunity? For how long? Nearly every virus confers some immunity between months and years. If this coronavirus provided no immunity, we would expect to see many re-infections, since it is so infectious. We don’t see that, and those cases we do see are more like resurgence (where a person appears recovered but the same infection lingers and then rebuilds). But we still don’t know how much immunity.
• Who was patient zero and how/where/when did the virus originate and cross the species barrier? We know it was Wuhan, but China’s origin story has holes in it. Medical researchers have determined this coronavirus was not developed in a lab, but that doesn’t mean it didn’t come from one. China has two labs near Wuhan. Not everybody who got sick initially was associated with the wet market in Wuhan. Some doctors who would have known more have disappeared. We essentially know almost nothing about the initial outbreak, and that is very suspicious.
• How effective are various prophylactic medicines and treatments? Still under varying trials, so again we don’t know. The President’s confidence in hydroxychloroquine is a case study is needlessly going too far: he may be wrong, he may be right. But there are consequences nonetheless.
• What are the tolerances of the many new viral/antibody tests? People scream for more and faster testing, but all new tests come with a caveat: if you want it done faster, you must accept lower tolerances and accuracy. Every country makes a decision on how “good” is good enough for their tests, with resulting implications. A false positive and someone kills himself; a false negative and somebody visits grandma and kill her. Most oversight organizations are approving tests provisionally, arguing that the data derived from the increased number of tests is more important than the accuracy of those tests. It’s an interesting approach, but understand this is another unknown.
• What policies mitigate the spread: border closures, social-distancing, business closures, stay-at-home, isolating the vulnerable, quarantine, case tracking? All do, but how much? Still unknown. We are engaged in a massive experiment as countries all over the world select from a menu of options. It seems obvious that early adopters gain an advantage in mitigation, but what happens if we have to keep the measures in place for an extended period of time? Eventually, people will cease to comply, and infections will re-ignite (see Singapore).
• What roles do demography and culture play? Undoubtedly huge, but not yet measured. Older populations will suffer more than younger ones. Smaller and more compact states should benefit, as well as places nobody wants to–or can–visit. Urban areas might be more vulnerable, but may facilitate government action and response. Authoritarian states can lock people up or intimidate them into compliance, but then they don’t tell the truth or share information well. Some peoples practice social distancing as good manners; others the reverse. Even per capita comparisons (normally used to compare dissimilar countries) will be challenged as useful data.

All of which is to say, if you see someone saying “look how well Germany is doing” or “why can’t we be like South Korea?” or “here’s what works” be cautious. We are in the first half of the coronavirus game, and we don’t even know how to count the score. When all is said and done, there will be enough good data to make real comparisons and assess performance. And there is a small glimmer of hope we will learn the right lessons, as two of the countries which apparently are doing better this time (South Korea and Taiwan) were ones which suffered under a previous contagion and spent time learning from it.

People love to make heroes and villains. But the coronavirus is serious business, not politics. If you think anything is obvious about this crisis, think again.