Recently, I was listening to an old episode of The Skeptics Guide to the Universe, (actually, episode 803, dated 28-Nov-2020), in which Dr. Steven Novella was talking about understanding the risk calculations associated with the COVID-19 vaccines which were starting to come out at that time. He was pointing out that most people were only taking into account the risk of the vaccine itself (we now know that the risk of life-threatening adverse reaction to the vaccine is extremely low, after several billion doses), but not the risks associated with NOT taking the vaccine. At other times, Dr Novella has commented on the need to balance the risk of COVID-19 with the risk of economic impact due to lockdowns, which also has an impact on public health.
While listening, though, I experienced a bit of an epiphany in my understanding of the concept of risk, and realized the degree to which risk is a lingua franca across many areas of life.
A lingua franca is a language or dialect used as a bridge between groups who do not share a native language.
I’ll take a moment to go down this linguistic rabbit-hole a level or two... It’s actually a fascinating topic, and ties into the history of many regions.
In some cases, a lingua franca is the language of a colonial or trading power which is then used by diverse groups as a common language. One example of this is the use of Latin as a lingua franca across the Roman Empire, where many non-Latin communities learned Latin as a second language.
Another case is where a distinct language develops, such as the so-called “Mediterranean Lingua Franca” or “Sabir” from the 11th to 19th centuries. This was based on northern Italian languages such as Venetian and Genoese, with elements from Catalan and Occitan, and borrowings from multiple other languages such as Spanish, Portuguese, Berber, Turkish, and others.
While Sabir is “officially” classed as a pidgin (ie, a “grammatically simplified” means of communication between groups that do not have a language in common), there is debate as to whether it should more accurately be described as dialect of Italian. (I will refrain from diverting down a separate rabbit-hole regarding the likely relationship between pidgin and creole languages, and the hypothesis that this demonstrates that humans are “hard-wired” for language. Perhaps another time...)
Getting back to risk, I noted previously that it’s important to use language that your audience understands so that you can engage with them, but I came to realize the degree to which “risk” is a common element across many fields. A finance person will understand the concept in the context of a broad range of financial risk calculations, such as market or credit risk, while an insurance person might look at the investments needed to support a payout for a particular type of event, such as a car-crash. Project managers will understand from the perspective of the likelihood of an event affecting the objectives or schedule of a project, while InfoSec people may look at the risk of a vulnerability being exploited.
What I see as a challenge, though, is that many people do not give enough consideration to understanding and balancing risk outside their particular area. And, even those that do will sometimes not look at a situation holistically, unless their attention is drawn to it.
In our current example, the COVID-19 vaccination, there are a number of factors which need to be baked into a realistic assessment of risk. Most will think about the risk of catching COVID-19, or the risk of serious symptoms, or the risk associated with getting the vaccine, but very few will attempt to combine these into an assessment of the overall risk.
To start, there are a number of risk factors associated with contracting COVID-19, such as:
Infectivity rates, which vary by the strain of COVID-19, population density, climate, time of year, and various other factors
Economic factors, such as working in essential services, having access to PPE (Personal Protective Equipment), ability to work remotely
Government actions (lockdowns, vaccine mandates, mask mandates, etc)
Compliance with protection protocols (mask-wearing, vaccination, social distancing)
Effectiveness of any given protection protocol against specific strains (eg, cloth masks were reasonably effective against the Alpha variant, but less effective against the Omicron variant)
General level of health (age, pre-existing conditions - also affected by economic factors)
It’s important to understand that all of these risk factors contribute to an overall likelihood of contracting COVID-19. There are no guarantees, but you can dramatically reduce your risk by taking the basic steps of getting the vaccination, wearing a mask, social distancing, and washing your hands frequently. You can also ignore the simplistic notion that something that is not 100% effective is not worth doing – we all need to live in the real world.
While rates vary dramatically by country, and there are data gaps in many countries, the current mortality rate of COVID-19 is estimated to be between 0.5% and 2%, with a dramatic variation between the very young (0.004% for 0-34 years) and the very old (28.3% for 85+). To be reasonably conservative, let’s assume 1%.
Even after taking all reasonable precautions, people will still contract COVID-19. What then? The severity varies from asymptomatic to extremely severe. Some risk factors associated with severe illness or complications from COVID-19 include:
Age
Race/ethnicity
Gender
Some medical conditions
Use of certain medications
Poverty and crowding
Certain occupations
Pregnancy
Diet
Availability of healthcare resources / facilities
One important factor here, though, is that you can transmit the disease to others, even if you are asymptomatic. And these other people may be at dramatically higher risk of severe symptoms. Also, each of the items above can be broken down as well – eg, the cost of a lockdown (economic impact, mental health of vulnerable people, etc), as measured against the economic cost of failing to lock down when it’s necessary (increased infection rates, longer duration of the pandemic, economic impact of infected people, etc).
Now, we can talk about the vaccines. It’s probably easiest to break things out into two main parts. First, how effective is the vaccine? Second, what is the risk of serious adverse effect? For both of these, it’s important to understand that we have now administered more than 10 billion doses globally, so we have a LOT of data available. It’s also important to note that mass vaccination is among the most cost-effective medical interventions we have.
There are a number of different vaccines available globally, but most appear to be very effective at both preventing the disease, and in dramatically reducing the likelihood of severe illness. As an example, the US reported that unvaccinated people were 5 times more likely to be infected, 10 times more likely to be hospitalized, and 11 times more likely to die. In all cases, booster doses caused a significant reduction in risk, and increased the effectiveness against the Omicron variant. So... vaccines work very well.
But how risky is it? Well, like most vaccinations, there are minor side-effects, such as soreness, redness, and rash. Others will experience fatigue, headache, and muscle pain for a few days. Another less frequent side-effect is an allergic reaction that about 1 out of 1000 people experience. As for serious or life-threatening effects, it’s estimated that between 2 to 5 people per million experience anaphylaxis, which is very serious and potentially life-threatening, while other serious side-effects are experienced by about 1 out of 100,000 people.
As noted, a full accounting of all of the factors involved is extremely complicated and the sort of thing people spend entire careers studying and trying to understand better, but we can make it simpler by putting some of the main points into context.
To summarize, we’re looking at a highly-infectious disease, whose impact (both infectivity and severity) we can dramatically reduce through masks, social distancing, and a vaccine which is safe (ie, no severe side-effects) in roughly 99.999% of cases. Balancing that against a disease with an overall death rate of 1% and a list of short- and long-term complications we are still learning more about, it definitely seems cut-and-dried, even without other factors, such as how many people you might infect if you get infected, particularly if you are not wearing a mask or isolating yourself while ill.
All of that said, there’s one more risk I’d like to comment on. We also have to contend with large, overlapping misinformation and disinformation campaigns, which draw people into echo chambers full of misleading and false “information” about almost everything associated with COVID-19. It’s a big problem, but it’s one to which I think there is an answer – probably a number of them.
Cheers!
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