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It might be a prudent time to talk about the precautionary principle because it seems to be getting its moment in the sun this week.
https://en.wikipedia.org/wiki/Precautionary_principle
https://en.wikipedia.org/wiki/Precautionary_principle
The wiki article is actually pretty good, and I'd encourage you to read it.
But it's amazing how it gets deployed to support personal opinions without good supporting evidence.
Uncertainty is hard. This isn't new, or surprising, and I've tweeted before about the reasons why pandemics have it in spades, but let's look at some of the challenges around the evidence and the anecdata.
First up, we don't know much about infections in healthcare workers. This is (in part) because of the siloing between public health and infection control.
Public health don't necessarily collect lots of data about the nature of patient care provided by healthcare worker cases in hospital. It would make contact tracing much more complex.
Infection control do try to look back and see if there were any PPE breaches, but this is fraught with recall bias.
Secondly, we don't know at what rate healthcare workers are being tested compared to the rest of the population. As many hospitals are enforcing "get tested if you're unwell and don't come to work until you have results", I suspect it's quite high
Of course, staff need to feel safe and have confidence they're adequately protected at work, but it's crucial to point out that there is no concrete evidence of rampant occupational infection in healthcare workers.
The epidemiology doesn't support significant aerosol transmission.
We don't have good enough data on healthcare infection epidemiology to say if there's definitely a problem.
So "what's the harm" in deploying the precautionary principle then?
We don't have good enough data on healthcare infection epidemiology to say if there's definitely a problem.
So "what's the harm" in deploying the precautionary principle then?
Trivially, there's cost.
N95s cost stacks more than surgical masks. The pandemic is already going to cost a bomb, so tripling the cost of PPE is going to be a significant extra cost we're going to have to pay for.
Sure, no amount of money too much to keep staff safe etc
N95s cost stacks more than surgical masks. The pandemic is already going to cost a bomb, so tripling the cost of PPE is going to be a significant extra cost we're going to have to pay for.
Sure, no amount of money too much to keep staff safe etc
But (here's a precautionary principle) what if we're adding 200% marginal cost for no additional staff benefit?
What other health services could we be funding with the extra money to respond to the demands for N95s?
What other health services could we be funding with the extra money to respond to the demands for N95s?
The second opportunity cost is time.
I've been in three meetings this week where a significant proportion of the time was dedicated to discussing this issue. I've reviewed three documents about it and I've received a heap of emails.
I've been in three meetings this week where a significant proportion of the time was dedicated to discussing this issue. I've reviewed three documents about it and I've received a heap of emails.
I've heard from colleagues interstate that they're getting the same sorts of demands.
How many infectious diseases physician hours are being consumed >in the middle of the largest infectious emergency in my lifetime< on this one question?
How many infectious diseases physician hours are being consumed >in the middle of the largest infectious emergency in my lifetime< on this one question?
What about the opportunity cost of the many, many anxious clinicians who are calling their union rep, writing to their professional societies and lobbying their local infectious diseases physicians about this issue.
Instead of delivering patient care?
Instead of delivering patient care?
What if all this is for nothing?
And that maybe the ICEG advice is correct?
Will anyone feel bad that they've panicked staff, damaged trust in infection control recommendations and wasted time and money?
Or does the precautionary principle only work that way if it suits you?
And that maybe the ICEG advice is correct?
Will anyone feel bad that they've panicked staff, damaged trust in infection control recommendations and wasted time and money?
Or does the precautionary principle only work that way if it suits you?
