Global response to COVID-19 pandemic has been amateurish; complex issues need many thinking hats

The global response to the current pandemic has been amateurish from the beginning. Lockdowns, school closures and physical distancing were all panic reactions based on a school computer project of a 14-year-old daughter of a computer scientist in the US.

Similarly, study of efficacy of masks was first done on hamsters (rodents) under laboratory conditions and overlooked the fact that humans do not behave like hamsters either inside or outside the lab! Subsequent randomized trials, in Denmark and Bangladesh, on the efficacy of masks, thankfully in humans reported negligent to very modest impact.

Covid-19 is not as simple as it looks, or, counter intuitively, a simple problem has been turned into a complex one.

Edward de Bono, a Maltese physician, had proposed that for finding solutions to complex issues, the technique of Six Thinking Hats could help develop a blueprint free from biases of information, optimism, pessimism and emotions, while making way for creative solutions and seeing the big picture.

The “thinking hat” is symbolic of thinking but without falling in love with your idea, as hats can be replaced. Bono proposed attributing a colour to each of the six hats encompassing a range of human thoughts and emotions.

The “White Hat” would signify hard facts and figures on which sound decisions are taken. The “Red Hat” would explore emotions such as fear, hope, beliefs, attitudes and faith which may often be unrealistic; the “Yellow Hat” like sunshine would denote optimism, sometimes based on facts; the “Black Hat” would play the role of the devil’s advocate, proposing caution and to consider the downside of any policy; the “Green Hat” would look for innovative solutions and finally the “Blue Hat” would look at the big picture and ensure that all hats are used.

In the current pandemic, rakish cowboys wearing hats of a single colour hijacked issues and shot down people wearing other hats. The gullible public, the majority in most countries too numbed to think clearly, accepted mostly the red hats thrust on them, the red hat of emotions - fear, panic and anxiety. Cowed into submission people happily fell prey to the greed of politicians, market forces and even career scientists.

Let us address the pandemic using all six hats. First the white hat, the hard data. The latest data available confirm that initial estimates of the lethality of the virus were highly exaggerated. Most people who died in the West were around 80 years old with co-morbidites. Only 6% of the reported Covid-19 deaths were solely due to the virus.

Subsequent research attribute much lower lethality to the virus. The following table shows the age-wise survival rates by researchers from Stanford University:

From these figures it is evident that risk of dying from Covid-19 for children and young people is negligible. This is important for framing policy since a recent paper in Toxicology Reports titled, “Why are we vaccinating children against Covid-19,” concludes that deaths from Covid-19 in children are negligible, but post-vaccination deaths in children are not.

Particular concerns have been raised in the paper about the spike protein of the vaccine, which have been found in different organs, and the uncertain long-term effects, - “black hat” thinking. These concerns are serious as data for England and Wales from 01 May 2021 until 17 September show excess deaths ranging from 16% to 47% above expected levels in 15-19-year old males, coinciding with the roll out of the vaccine in this age group.

The red hat on people evoked fear and panic, besides concerns that their children would fall prey to the virus. The red hat promoted fear, exploitation and greed,and pushed for mass vaccination of children. Both these red hats, the panic and the greed, should have been checked by the white and black hats.

What about the yellow hat? Yellow hat thinking is influenced by perceptions. For those who use the white hat,those who use data extensively to assess risks and benefits, low mortality is a cause for optimism. For those who succumb to propaganda without looking at the data, blind faith in the vaccine brings optimism.

“Expert” narratives fuelled this faith in vaccines as the saviour of humankind. Waiting for the vaccine justified prolonged lockdowns and associated misery. The inflated estimates of lethality of the virus were not corrected in people’s mind, leading to a sort of “medical stampede” during the second wave in India when a majority of people who had Rt-PCR positive results, but who had mild to no symptoms, rushed to hospitals overwhelming the system and depriving more serious patients of beds and oxygen. If the white hat been used judiciously from the beginning this “stampede” could have been avoided saving many lives.

After the vaccine roll out in many countries, we have more data for “white hat thinking” which should guide policy. A paper in the European Journal of Epidemiology is sobering. The study published online on 30 September 2021, titled, “Increases in Covid-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States,” concludes that vaccines should be offered with humility and respect without stigmatizing (excessive use of the red hat), as mass vaccination does not seem to check transmission. A bit of black hat there.

Studies from Israel among others have established that recovery from natural infections gives 13 times more robust immunity compared to vaccines. Solid white hat data.

The serosurvey in June 2021 by ICMR had brought out that almost 70% Indians and a considerable number of children had recovered from the infection and have acquired natural immunity. By any standard this amounts to herd immunity of the population. So even without the mass vaccination rollout, there was no chance of the dreaded third wave.

What role did the creative green hat driving innovation, play in this pandemic? A laudable one. It brought new technology in vaccine development, paving the way for vaccine development for other diseases. However, like a strong force, it should be tempered with the remaining five hats. Just because a technology has been developed it should not be used indiscriminately. It can harm as emerging signals from the data indicate.

And lastly the big picture. The green hat should balance all the hats equitably and change hats according to the situation and region. No one hat, should get stuck indefinitely. Presently its role is to distribute a lot of white hats (data) and yellow hats (optimism based on data), and some black hat too (regarding the efficacy/harm of vaccines, based on white hat driven data).

And of course, the major role is to remove the red hats among the population who are still in panic mode and the red hat of “greed” among the exploiters which include politicians, career scientists and market forces.

Edward de Bono quotes

• You can analyse the past but you have to design the future.

• If you never change your mind, why have one?

• Everyone has the right to doubt everything as often as he pleases and the duty to do it at least once.

• You cannot have a beautiful mind, if you do not know how to listen.

• Many highly intelligent people are poor thinkers. Many people of average intelligence are skilled thinkers. The power of a car is separate from the way the car is driven.

• Creativity involves breaking out of established patterns in order to look at things in a different way.

(The writer, Dr. Amitav Banerjee, is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)