In defence of amateur epidemiology

Former deputy chief medical officer Nick Coatsworth, in a piece for Friday's Sydney Morning Herald, made a spirited defence of The Experts in the face of an apparent onslaught of pop epidemiology from media-savvy, medicine-adjacent commentators.

His screed, full of righteous anger, was founded in years of experience - and made a completely wrongheaded case for an anti-democratic and ineffective approach that would put us more at risk.

The most fundamental missteps of this and earlier medical crises haven't been made by, as Dr Coatsworth might claim, an "unqualified and dishonest" chorus of overly risk-averse, lockdown-addicted anti-AstraZenecisists. They have been, and continue to be, made by the bosses.

The worst, most irresponsible step we could take would be to outsource our critical thinking, to take refuge in uncritical faith in government institutions, which have on a number of issues shown themselves to be inefficient, self-interested and often fatally incompetent.

Dr Coatsworth himself obliquely acknowledges this truth in his own piece, in fact.

He calls coronavirus "a disease that is spread indoors", which it is. In another section he mentions in passing the great PPE debate of 2020.

But it wasn't the cynical attention chasers who mucked up those two critical issues, it was Australia's Infectious Control Expert Group - i.e. the experts.

ICEG still does not openly acknowledge the bug is predominantly airborne, and is flat out not spread on surfaces ("fomites"), despite extraordinarily overwhelming evidence.

[To quickly explain why this is an important point: because it's airborne, coronavirus isn't really very dangerous outside, or likely to be spread by people wearing masks, or in well-ventilated areas.]

In terms of PPE, for a year ICEG did not recommend Australians wear masks - again, on the basis of no evidence. Nor did they recommend governments provide the highest-quality PPE to staff required to work at the coalface, most exposed to the risk of the bug. This saved a few bucks here and there at a cost of repeated multibillion-dollar lockdowns.

Even our AstraZeneca hesitancy is based on the advice of experts. The Australian Technical Advisory Group on Immunisation has effectively told people like me to get Pfizer, not AstraZeneca (full disclosure: I have followed their advice).

Contra Dr Coatsworth, we cannot expect non-official, extra-government medical professionals to behave more responsibly than ATAGI.

When proven wrong, our experts have often responded by throwing tantrums, by putting their own ego ahead of public safety. Probably the most disgraceful effort was by the World Health Organization. When the WHO finally, after a year, admitted COVID-19 is spread through the air, it released this crucial health information like an adverse finding from an ICAC inquiry - with minimum fanfare, public health be damned.

After nearly 18 months, our experts have failed to develop any tactic against the virus short of the epidemiological equivalent of nuking it from orbit - the lockdown. Australia still does not have a program for updating our national ventilation standards, does not have an effective quarantine system, cannot produce our own mRNA vaccines, and does not have a strategy for a targeted vaccination program during an outbreak.

Last week cleaning staff at Westmead Hospital were forced to strike because our experts failed to develop a system that would guarantee them PPE - despite the enormous risk of an infected person causing an outbreak. Nobody was sacked for this Chernobyl-level incompetence.

This is not the first time healthcare experts have failed Australians. Ask an older gay man how they performed during the HIV crisis. In the US, the same person is in charge.

All of this failure is because our health institutions are peacetime experts. This is how institutions work when the stakes are low.

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To be fair to Dr Coatsworth, I am sympathetic to his criticism of often hysterical or just silly COVID-19 commentary from the sidelines. The dynamics of our opinion media system encourage quick, half-arsed, inflammatory hot takes, not the genuine search for truth - and it's not just a problem for healthcare. It'd be great to fix that, but it's a long, long road.

In the meantime, the least safe thing we could do is throw uncritical faith in a peacetime health sector when the war drums are beating.

Nor should our institutions be completely filled with experts. No war has ever been won by an army led only by the experts. World War II American commander Dwight Eisenhower invaded Europe with an army led by bureaucrats, engineers, journalists, and even headline chasers. The army that landed at Normandy wasn't led by an amphibious warfare expert, it was led by a general's staff of trained inexperts. The army was surprisingly diverse, open and transparent, and ruthlessly obsessed with winning at all costs. Australia needs a healthcare system like that.

The healthcare system we need should have room for economists and rank-and file nurses, young people and old ones. At the moment you'd be lucky to get a seat at the table if all you had was a degree in public health, if you hadn't first got one in medicine. If you're not a doctor you must be a dummy, I suppose.

If we want our system to work better, we need to be uncompromising. To use just one example - the US army relieved one-third of its officer corps in the first years of World War II, often for minor acts of incompetence. They probably could have learned to fight better, but the mass layoffs created the correct atmosphere of tension needed to build a force capable of winning the war.

Australia needs to sack people.

But above all, Australia needs an old-fashioned royal commission after this crisis is over and done. Our media opinion system isn't going to apply the blowtorch required to get the change we need. A royal commission into epidemiology would.