I say on Twitter that it is much too early to judge which countries have responded well to coronavirus, and that the picture of ‘good and bad responders’ that we have today might look very different 12 months from now. I meant the comment partly as reference to the fact that we can’t see how the pandemic will develop in future (countries that have succeeded in suppressing outbreaks so far might struggle to keep it up), but also that our focus on the daily graphs of cases and deaths is giving us a very narrow view of what ‘success’ and ‘failure’ looks like. This is natural in the middle of a crisis, but hindsight usually allows us to reassess.
A Twitterer asks, reasonably enough, what metric I would use in 12 months’ time to judge the success/failure of national responses. This sets me thinking.
I’m not a metrics person, being generally much more interested in people’s stories and experiences than quantitative measures. But the question is definitely one worth engaging with. So here is my imperfect first attempt at an answer to the question.
To start with, it is clear to me that there should not be one single metric for judging whether a national response has been ‘good’ or ‘bad’. In the hundreds of ‘lessons learned’ processes that will inevitably follow this pandemic, we are almost certainly going to hear most about:
- Number of infections (as a proportion of national population).
- Number of deaths (as a proportion of national population).
They are important of course because they tell us about the direct human costs. But in many ways they are extremely limited metrics. Responding well to a pandemic should be about much more than the crude statistics of infections and deaths.
I would want to add many more metrics to the list, to ensure that judging national responses also addresses how well/badly countries have done against other things of value, including equalities, social and economic impacts, human rights, and other health issues. This doesn’t mean that they should all be weighted equally, but they should all be part of our analysis.
So, here comes my incomplete and very provisional list of potential metrics. I’m sure every reader will think of their own metrics to add, or some of mine to amend (as I said, I’m not a metrics guy…):
1. Coronavirus and the public health/medical response
- Number of deaths (as a percentage of national population).
- Number of infections (as a percentage of national population).
- Recovery rate of patients admitted to ICU
- Number of patients who died following a shortage of essential medical equipment (e.g. ventilators)
- Number of infections/deaths amongst health workers
- Proportion of infections/deaths amongst ethnic minorities
- Proportion of infections/deaths amongst immigrant communities
- Proportion of infections/deaths amongst women
- Proportion of infections/deaths by income decile
- Regional and urban/rural splits of infections/deaths
- Number of infections/deaths amongst prisoners and those in state care/custody
3. Social and economic consequences
- Number of new redundancies/unemployment benefit claimants
- Number of businesses declaring bankruptcy
- Direct costs of response per head of population
- Number of people who fall below the poverty line
- Average household debt
- Increase/decrease in domestic violence incidents
- Number of days of education lost
4. Human rights/civil liberties
- Number of prosecutions under emergency legislation (where applicable)
- Number of incidents of police/security forces use of violence in enforcement of emergency legislation
- Number of appeals upheld against enforcement of emergency legislation
- Number of forced quarantines
5. Knock-on impacts on other health issues
- Increase/decrease in suicides
- Increase/decrease in deaths from stroke, heart disease, cancer and other non-COVID related conditions
- Increase/decrease in patients presenting at Emergency Rooms
As always, using metrics to reach a judgement doesn’t allow us to escape the politics of judging the response. The metrics are the politics. Which ones are chosen - and how they are weighted - by the various groups who will be handing out garlands and brickbats once the COVID-19 crisis is over will be extremely revealing.