Information and Compliance

A couple of detailed BC COVID reports leaked to the Vancouver Sun last week. They were interesting in themselves – I just moved from 0% positivity rate North Saanich to .1-1% positivity rate Oak Bay – but they bring up the question of how much information should be given to the public and how much, if any, withheld? And for what reasons?

My own view is that it all should be released as soon as it is compiled so I can make informed decisions as to my relative level of risk and my behaviour in the face of such risk. Against that view are a variety of arguments: granular data may compromise privacy, detailed demographic data could lead to racial discrimination, data on co-morbidities might give people a false confidence (“I’m not fat so COVID is not a problem for me.”)

However, underlying the decision not to fully disclose is the public health agenda of compliance. In BC, unlike Ontario and Quebec, we do not have mandatory stay at home orders. Our public health response has been to suggest limiting contacts, eliminating a lot of indoor activities, mandating masks and asking people to limit travel to essential purposes. Whether this has worked better than the more restrictive lockdowns in other provinces is an open question.

For the BC light handed approach to work there has to be a good deal of voluntary compliance with the various measures suggested. Generally there has been, but as the vaccination program gains traction and Spring brings a welcome decline in cases, hospitalizations and deaths, the logic of compliance is beginning to break down.

Having better, more granular, information would, I suspect, actually improve public health outcomes. We are going to open up in any event eventually; have good information will let each person assess his or her relative risk. Vaccinated in Oak Bay? You’re golden. In South Surrey? It would be wise to maintain precautions until a really significant percentage of the population is vaccinated.

In the early stages of the COVID problem there was a great deal of uncertainty. We were given advice in good faith which turned out to be wrong. COVID is almost never transmitted by surface contact so the sanitary theatre and gloves were largely a waste of time. However, COVID is airborne which means that ventilation is critical. Social distancing and masks have turned out to be of limited use in stopping the spread but may have some utility in “hot spots”. There are all sorts of pieces of information like this which are useful to individuals trying to reduce their own risk.

At the beginning the messaging was that “we are all in this together” and that messaging worked. But, in actual fact, we now know that some populations and demographics have much higher risks. Pinpointing those populations and demographics – the poor and the brown – means that vaccination doses can be targetted while shortages persist. (And, frankly, for those vunerable populations, the “two dose right on time” regime makes a lot of sense. Even at the expense of us Oak Baysians having to wait a bit longer.)

Most of all, giving complete information will tend to increase the public’s trust in the public health officials and the politicians who direct them. At this point, with the end of the crisis (but likely not COVID itself) in sight, that public trust is a critical factor in defeating the virus.

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