We are already seeing lots of differences in expert opinion. Some say we should wear facemasks, others not. Considerations may not be purely health related, that is how much various masks reduce the likelihood of transmission. There are cultural factors which experts might consider: mask wearing is seen as ‘normal’ in some countries but not others. There are shortage factors: promoting mask use may make it more difficult for health professionals to obtain them. There are psychological factors: wearing a mask may enhance the sense of security the wearer has, which in turn may improve a feeling of well-being, or conversely may encourage risk-taking.
Are the experts behind the Swedish strategy of limited social and economic restrictions, less expert than those behind the UK strategy or the Taiwanese one? The differences of approach can’t simply be attributed to experts taking different national circumstances into account, although that may be part of the explanation.
Some experts support closing schools, others not. Experts in different countries have reached different conclusions about the number of intensive care beds that will be needed. Countries which have adopted broadly similar lockdown regimes, as advised by experts, have produced very different infection and mortality outcomes. There has been extensive modelling of the likely progression of the pandemic, but the numbers of those predicted to die vary widely. And there are different expectations around when the pandemic will ‘peak’. If experts are such experts, it is asked, why do they so often differ?
There are good and less good reasons for such differences. Differences may arise from being alert to local conditions, surely admirable. Ignorance is another good reason. There are many, many things which are not well understood about the COVID-19 pandemic. These include the infection rate, the infection-fatality rate, the role and numbers of asymptomatic carriers of coronavirus, what level and duration of immunity those who have recovered from infection might have, whether the numbers dying are being fully captured (in old age homes for example), and so on.
Strategies seem to have been heavily influenced by epidemiological modelling. All modelling rests on deciding which data can be relied upon, which variables to include in the model, and on assumptions about the relationship between variables. These models will improve as knowledge about these variables and their relationship increases. Is there, for example, and as some have suggested, a warm weather effect or an air quality effect? And modellers must also make assumptions about what the efficacy of measures taken will be on infection and mortality rates. We can be confident that knowledge about such things will improve over time. Public health experts have generally been frank, so far, in conveying where they are ignorant and uncertain.
In the USA, a recent survey of experts (conducted 13-14 April) resulted in an ‘expert consensus’ that the death toll in the USA would reach about 50,000 by 1st May. But this was not exactly a consensus. More accurately, it was the most common answer given by the experts surveyed and the range of answers was striking given they were predicting a situation only 3 weeks away. High-end estimates reached as much as 200,000. Low end estimates were around 20-30,000 deaths. At the time of writing, 25th April, deaths in the USA had already surpassed 50,000 and were rising around 2,000 per day, although even this probably excludes thousands of deaths not (yet) attributed to COVID. 50,000 deaths by 1st May therefore looks likely to be an underestimate, although not wildly so.
A more complex reason for differences arises from the effects of pre-emptive action and lockdowns in one form or another. Estimates need to be made as to the effect of, say, closing (or re-opening) cafes, on the spread of the pandemic. Some countries, where housing conditions are cramped, may find it practically impossible to physically isolate whatever the lockdown regulations say. Estimates of the actual compliance with regulations are also important. These may differ markedly from place to place. They will be significantly affected by levels of trust in the authorities, and the extent and effectiveness of state coercion. Other social circumstances will be critical, from traditions of compliance (or not), to practices of social greeting and gathering, to family structures (such as whether extended families live together and co-habit across generations).
In short, some of the expert differences may result from ignorance and things still unknown or unclear, and some from different local or national conditions. Only some of these differences will be reduced in time through further study and peer review.
Importantly, there will also be differences which arise from competing perspectives on what counts as important. There are legitimate grounds to reach different conclusions and prescribe different answers to the question: what is to be done? ‘Ensuring public health’ or ‘getting the economy moving again’ is one common public form that such competing perspectives take in the current crisis, and neither view is only about facts.
An Australian example relates to shutting down schools. The federal government and Chief Medical Officer argued, and still argue, that expert medical opinion held that schools were not a major vector of transmission. There was therefore no need to close schools. But parents started withdrawing their children from schools unilaterally. Further, teachers’ unions complained that their members, some of whom were health vulnerable, were being exposed and were unable to effectively keep children physically distant from them and from each other, or ensure good handwashing practices. State Premiers then stepped in, also claiming to have received expert advice, and shut the schools. What expertise was drawn upon in deciding this? Clearly expert advice is as much dependent on its reception as on its veracity. Premiers may have decided that to retain their own authority they needed to be receptive to public opinion. Better to shut the schools in a fairly orderly way than to allow attendance to dissipate, may have been their thinking. Perhaps the best science was that which also engaged with public opinion!
A South African example has important implications for the very decision to lockdown. The lockdown order came into force in late March (27th). It was clearly communicated, decisive, very far-reaching and widely lauded by the population (or at least the elites). It required all citizens to stay at home. It was enforced, often with violence, by the security forces. In practice, the majority of the population live in crowded accommodation, often with limited access to soap and running water, making physical distancing extremely difficult. The capacity for the state to provide food is limited, there have been calls to simply hand out cash, and some steps, belatedly, to increase social transfers. The result has been real hunger, looting of shops, and the beginnings of civil unrest. As one commentator has noted ‘while the lockdown has been an inconvenience for the middle class, it has been a double whammy for millions of poor South Africans who have lost jobs and livelihoods and thus the ability to have food on the table’. Not surprisingly, expert advice to the effect that a lockdown was needed, is being contested by others, equally but differently expert. Calls are growing ‘to manage all the risks associated with the epidemic, and not only the disease itself’ and avoid lockdown dependent strategies. As leading thinker on science and technology, Harvard’s Professor Sheila Jasanoff, has noted: ‘We’ve modeled the progression of the disease, but not the social consequences of the preventative measures that we’re taking.’
Expert differences are not something to be scared of. They are certainly not a reflection of ‘truth’ versus ‘error’. Expert differences can even be welcomed. They can both reveal the limits of ‘expert’ knowledge and the value of experts critically engaging with the publics and societies within which they are located. Indeed, as the COVID-19 crisis affirms, Knowledge is never simply about unveiling the ‘true facts’. It is also shaped by the Values of the expert (hence the common charge that elite values are different to those of ordinary folk), by the relations of Power that exist within society, and the Political objectives our rulers wish to pursue. Expert knowledge exists within this messy confluence, not hovering above it. Remember this next time you hear a politician tell you they are 'being guided by' or 'following' the science.
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