It’s Always About Choices


Leonard Zwelling

         There are only choices. Those choices have type one (alpha) or type two (beta) errors. The first is an erroneous rejection of the null hypothesis—accepting significance when none exists. A type two error occurs when the null hypothesis is erroneously retained—missing a significance that is present. When making any decision, especially one where the data informing the decision are inadequate for certainty to rule, you are always prone to these errors. Your decision is based on whether you wish to have your decision favor a type one or a type two error. In the end, it’s about regrets.

         The decision with the coronavirus was a stark one. Should the country, state, county or city over which some leader had authority close down its economy to protect the health of the citizens? If you do it, and the threat turns out to not have been significant you are basically saying the null hypothesis was not in play and that you will favor being wrong that way—a type one error. If you kept everything open, you are basically risking that the null hypothesis (correlating the risk of the virus via open commerce to your constituents) was retained erroneously. You get the idea. There is no way to be certain so you are betting on your being wrong one way or the other. Most of the world bet that the threat from the coronavirus was so great as to necessitate the closing of virtually all commerce, a tanking of the major markets, and the upheaval of the health care systems.

         Most every leader, seeing the devastation in China and Italy elected to reject the null hypothesis (this is not significant or significant enough to close down the economy) and risk a type one error. Was that the right call? I don’t know yet, but I do know it was the safe call. Better many people should lose money than many people lose their lives. If that was the trade off, which it appears to have been. But, it is not the number who died from covid-19 that is the issue. It is the number who died of covid-19 who would not have died of something else (influenza, cancer, etc.) AND comparing that with how many died because of the closure of the economy and life as we knew it? It all has to be considered and can only be considered in retrospect.

         This blog is just a plea to understand that is what happened. I have friends that would have chosen the other alternative. Would that have led to the apocalypse? We shall never know. What we may know when this is all said and done is:

  1. With truly widespread testing of antibody levels, how many Americans contracted the virus? This assumes many of the infected were not ill. What if most of the infected were not ill?
  2. Of those, how many became symptomatic? If this is a small percent of the total infected, herd immunity may already be operational or the virus is not serious in most people.
  3. Of those infected and symptomatic, how many were hospitalized?
  4. Of those, how many died?
  5. Can we explain those who fall into category 3 and 4?

         When the data come in, we will know whether the gamble on the “safe” alternative was the wise one and precisely how much it cost. This is very important because it is unlikely that this will be the last such global medical challenge and we need to learn how soon we could have known what the right decision was. As of now, we do not.

         I have been wrestling with myself, my family and many friends trying to imagine what I would have done had the decision been mine in any of the jurisdictions in which these tough calls had to be made. I know I would not have shut down all research or elective surgery at MD Anderson. I would have found a way to let the most vital of investigations stay alive and given optimal care to cancer patients.

         If it turns out that Governor Cuomo really does need 30,000 ventilators, he will have looked like a genius in predicting the course of the plague and how to get ready for the next one.

         By contrast, if a robust economy falls backward to a significant degree and the number of total deaths from covid-19 are no more than what one might see in a bad flu year, well, we may have made the wrong call.

         This is just a plea to understand that is what has been going on for the past few weeks and months. Yes, had China been more forthcoming, we might all have been more ready. Yes, had Mr. Trump paid more attention to some of his own advisors, he would have been better prepared to weather this storm and he would have stopped saying silly things at his news conferences and let the people who know actually talk. This scourge was all predicted by his own people back in October and by the Obama Administration almost three years ago. Why wasn’t the federal government ready?

         It’s all about choices. Everyone makes them except when the government steps in and makes the choice for you. In the end, the voters ought to hold the leaders responsible for these decisions. Type one and Type two errors are all there are in life. You make the call when you get married, buy a house or pick a college. There are always choices. They can be wrong. You do get to pick which wrong way is the most likely. That’s all you get to pick.

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