Only The Sangfroid

Mark is of fair average intelligence, who is neither perverse, nor morbid or suspicious of mind, nor avid for scandal. He does live in an ivory tower.

These are his draft thoughts…

Frauen liebten seinen Punk… Expertise in the time of disease: the @ProfMikeToole and @CrabbBrendan article #MakeMasksMandatory

There is an ongoing debate about the role of expertise in public debate, and it is a debate that is unlikely to be resolved any time soon.  What even is expertise?  How do you recognise it?  How should mainstream media outlets utilise it?

A recent article in the Sydney Morning Herald written by Profs Mike Toole and Brendan Crabb (Burnet Institute) referenced a study co-authored by Toole and Crabb in order to make a number of claims about how NSW should respond to the recent outbreak.

The magnificent efforts of NSW contact tracers and the outstanding response of the NSW community have averted the worst so far. But there is more that can be done to douse the Sydney spot fires and minimise the risk to health and economic disruption. Starting with an immediate mask mandate.

As part of me developing some skills in research communication, I made a video about the mask mandate and the legal puzzles that are associated it (especially why human rights lawyers were so opposed to making masks mandatory).  TL;DW: there are a bunch of policy questions that don’t get asked by STEM commentators.  There is always more that you can do, but the serious question is how draconian is the State permitted to be in doing more?

But the SMH article raises some questions.  First among these is why a person should accept Profs Toole and Crabb’s opinion over that of NSW Health.  NSW Health has vastly more data than the Burnet Institute and, unlike the Burnet Institute, has to develop policy that is lawful.  And it’s one thing that we’ve seen with the Victorian response: the go-hard approach might not be lawful, and the consequences of this unlawfulness is that vulnerable populations suffer real harm.

The second of these is what study, precisely, are they referencing?  The SMH article makes two references:

A study published in the Medical Journal of Australia by Burnet Institute researchers demonstrated that the introduction of Stage 3 restrictions (similar to those now in place in the northern beaches) on July 8 in metropolitan Melbourne reduced the effective reproductive rate from 1.75 to 1.16 just prior to the introduction of stricter measures in late July.

and

A Burnet Institute study found that mandating masks in Melbourne led to mask usage increasing from 43 per cent (when recommended but not mandated) to 97 per cent. This was associated with a decrease in the rate of infections by between 22 and 33 per cent.

The research referenced here is not linked, so the interested reader who wants to verify the claims of the researchers has to go on an adventure.

Which Twitter has.

A journalist from the ABC has referenced a paper on the Social Science Research Network, but it’s not clear that this paper matches the description above of one of the papers (published in the Medical Journal of Australia).  The journalist notes that the SSRN paper ‘is a pre-print that has not been peer-reviewed’ and comes with a caveat that the ‘findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed’.

In the game of ‘Whom do you believe about medical research, a journo or two professors of medical research?’ you shouldn’t need to wait for the thinking music before rejecting the views of the journo.  After all–and I really must stress this point–the SSRN paper does not match the description given in the text.

Instead, the article ‘Impact of Victoria’s Stage 3 lockdown on COVID-19 case numbers‘, a peer-reviewed article published in the Medical Journal of Australia actually does match the description of one of the papers discussed in the SMH article.  This paper argued precisely what is stated in the SMH article: that Stage 3 lockdowns in Victoria helped to stunt the outbreak prior to the introduction of the mask mandate on 22 July.  The paper then says:

In conclusion, the control measures introduced in Victoria from 1 July reduced the transmission of COVID‐19, averting 9000–37 000 infections between 2 and 30 July. Importantly, there remained small but significant ongoing growth. Subsequent to the analysis in this report, further controls, including compulsory masks, were imposed, Stage 3 lockdown was extended to regional Victoria, and Stage 4 lockdown commenced in metropolitan Melbourne. The sustained decline in daily COVID‐19 case numbers to zero by 1 November suggests that these control measures were successful in controlling the epidemic.

All well and good.  But this paper does not include anything about mask usage.

For that second study, we simply don’t know where (or if) it was published.  The SSRN paper at least has the advantage of reflecting the supposed content: mandating masks (unsurprisingly) increased mask usage.  But what is surprising is that the SSRN paper does not match the argument made in the SMH article:

Care should be taken in ascribing causality; we did not assess the direct effectiveness of masks in preventing COVID-19 transmission. We cannot determine whether masks had a direct effect or whether near-universal adoption of masks reminded wearers to engage in other behaviours recommended to reduce COVID-19 transmission, including regular hand hygiene and physical distancing. Interestingly, introduction of masks in the metropolitan area coincided with a decrease in the growth rate in rural areas, where masks were not introduced, which is consistent with an indirect effect, a decrease in seeding of rural areas from the metropolitan area, or both.

The ABC journalist criticised the method used in the SSRN paper but, I suspect, a lot of that criticism is based on a misreading of the paper.

But let’s get back to the start: should this article have been published in the SMH?  It presents an argument asserting facts that are hard, if not impossible, for the average reader to verify for themselves.  And it makes claims that look like opinion rather than being derived from the data.

There’s nothing strictly wrong with that, except the influence on public debate (as imperfectly represented on Twitter) was profoundly negative.  We even had the ABC’s Norman ‘Don’t trust your GP‘ Swan claiming that NSW’s ‘public health measures are ordinary‘ when linking to the SMH paper, which said that NSW ‘justifiably has great confidence in its capacity’.  Swan also claimed that the ‘problem in NSW is that they’re relying on contact tracing’, where the SMH article says ‘no jurisdiction, including NSW […] relies totally on this approach’.  One wonders if Swan can read.

How do we use expertise effectively, especially in contentious situations?  Ultimately, the SMH article was ‘Here is what Profs Toole and Crabb would recommend if they were Chief Health Officer, which they’re not.’  And that’s fine, but it’s not clear why anybody would believe them based on the content of the SMH article.

There has to be a better way of showing where the reasonable differences of opinion are, and why this is an interdisciplinary problem that goes beyond encouraging increasingly draconian approaches to the use of emergency powers.  The current approach does not result in an informed electorate.


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