A Tale Of Two Maladies: How to Think About communicable disease risks

Introducing the Contrast Method

One strategy I use often when analyzing an issue is to apply sharp contrasts to the matter. That is, if I was exploring whether or not air travel is safe, I would look at it from two very different perspectives. One perspective would be to consider what extremely unsafe air travel would look like, compared with what overwhelmingly safe air travel would look like. For example, no flights would ever arrive at their destination safely if air travel were completely unsafe. On the other side of the spectrum, perfectly safe air travel would see absolutely every single flight arrive at its destination, without incident. Stepping back, we can then consider where we might place the current state of air travel along the continuum between grossly unsafe and totally safe. (And I think it’s pretty safe, all things considered. Wouldn’t you agree?)

Subtle distinctions can make it very difficult to analyze something effectively. For example, it would be very challenging to guess if a rock weighs closer to 5 or 6 pounds—but ridiculously easy to guess if that rock weighs closer to 1 pound or 100 pounds!

The “Contrast Method” makes it easier to think about challenging issues by carving a path through subtle distinctions by exaggerating them—giving you a window into the deeper issues at play that allows you to view the entire situation with more clarity. You are then in a better position to return from those exaggerations and consider those subtle distinctions from a position of new wisdom.

Applying contrasts is a fairly straightforward process. First, you define the main question. Then, you look at the contributing factors involved. You then adjust those factors to be exaggerated, sharply-contrasting versions of themselves. And finally, you review how those contrasts apply to the main question at hand. So, what does this look like in practice? Let’s find out!

To Fear Or Not To Fear

Given the current political and social climate, what better issue to consider than this: how concerned should we be about not just COVID-19, but any communicable disease? How do we reason about communicable diseases and the risks they pose to us and to others?

Worst-Case Scenarios

Let’s take a look at 2 radically different diseases. To avoid bumping into any secret biases we might have which could potentially spoil our exploration, we’ll consider two sharply contrasting fictional diseases. Let’s meet the contenders by building our first contrast around the “worst-case scenario”…

The Tallahassee Tickle: This charming little disease was first recognized in Tallahassee, FL. It gets its name from its signature symptom, which is a nettlesome tickling sensation on your earlobe. It lasts for about 15 minutes and it’s gone. 

The Rhody Horror: This ghastly spectacle was first discovered in Providence, Rhode Island. Its horrific, tell-tale symptom reaches its climax when your eyes liquefy, leaving you writhing in agony over a period of 12-14 hours until you finally die from sheer exhaustion (and extensive internal bleeding).

I trust you would agree that of the two, The Horror is by far the more distressing of the two maladies. It would certainly be understandable if you were to fear it! But would it be rational? That depends on a number of other factors. Like how contagious it is, for example. So let’s take a look at that next.

Infectiousness

For this contrast, let’s look at the difference between a disease that’s nearly impossible to get and one that’s nearly impossible to avoid. On the one hand, imagine you could catch these diseases only if you were continuously within 3 feet of an infected person for 12 hours or more. And on the other hand, imagine that you could catch these diseases merely be being in an infected person’s field of vision! As in, if they see you, then you’re infected. How does this affect the rationality of our fear of these diseases?

For The Tickle, this doesn’t really move the needle at all, does it? Whether it’s impossible to catch or impossible to avoid, in the end The Tickle is merely an inconvenience.  Whether it’s contagious or not is almost irrelevant.

But The Horror is a very different matter, isn’t it? When it’s nearly impossible to catch, that provides a lot of hope, doesn’t it? Suddenly, it doesn’t look as scary as when we were considering only the worst-case scenario, wouldn’t you agree? Even though The Horror is out there, the fact that it’s nearly impossible to get actually makes it appear less horrific than before. But when it’s nearly impossible to avoid, its infectiousness seems to act as a fear multiplier. While the notion of possibly contracting this dreaded disease was already pretty disturbing, being nearly certain of contracting it makes it sound many times worse, and far more terrifying!

Here we see that the infectiousness of a disease matters in direct relation to the seriousness of the disease. By itself, that a disease is contagious is almost irrelevant. But when paired with a dangerous disease, suddenly the stakes are raised—by orders of magnitude if the disease is serious enough. But let’s not abandon all hope yet. Let’s take a look at how the treatability of a disease impacts our rational concern about it.

Treatability

Here, a natural contrast springs up. On one side, we look at what would happen if the disease was easily treatable (and since we’re dealing with fiction here, let’s say all you had to do was drink a tall glass of water to be fully cured). On the other side, we look at what happens when it is absolutely not treatable.

Once again, we find that when it comes to The Tickle, whether or not it’s treatable is essentially irrelevant. Once that tickle sets in, it’ll be over in 15 minutes anyway. 

And once again, we find the same scenario play out for The Horror with regard to treatability as we saw with infectiousness. When it’s eminently treatable, it loses all of its power. Now, even if you were to catch it—even if it was certain that you would—you have essentially zero reason to fear the virus if there’s an exceedingly effective treatment for it.

Interestingly, if The Horror is not treatable at all, that doesn’t appear to have the same multiplying factor as with infectiousness, because we were already basically assuming it wasn’t treatable when we were looking at the other factors.

So it seems that the treatability of a disease has the potential to make it better—far better, if it’s completely treatable—yet does not have the power to make it “worse” in the event it’s not treatable.

Now, so far we’ve been looking at these diseases from the standpoint of the worse-case scenario. But how do these look when we look at the most likely scenarios instead?

Typical Prognosis

So the tickle of The Tickle and the horrific liquefied eyeballs of The Horror are the things that get the headlines. But how would these illnesses look if those were not the most likely outcomes?

Even without getting into the weeds here, can we just agree that The Tickle is going to fare pretty much the same as with all the previous contrasts? If the worst-case scenario (getting a tickling sensation on your ear lobe for a short time) isn’t the most common symptom, what was already a trifling disease now becomes even less concerning…but not by any meaningful degree.

Moving on to The Horror, we find an interesting thing. If the horror of The Horror is not the most common scenario, now what? Let’s imagine that only 1 in a billion cases end in the horror, and all other cases result in a minor runny nose. As in, most people will think they simply had seasonal allergies or something. Now, suddenly, The Horror is starting to look a lot like the Tickle, isn’t it? By contrast, if instead 1 in a billion cases presented the runny nose, and all other cases brought the full-strength Horror, well, now it’s terrifying again. So as we slide that needle along the spectrum, at what point does The Horror make the leap from “relatively harmless” to “relatively terrifying”? When 1 in a billion cases present the full-strength Horror? At 1 in a million? 1 in 100,000? If we were to chart how frightening The Horror was as the likely outcome changed across that spectrum, how would that graph look?

It seems, then, that the likely outcome of a disease is a far more meaningful driver of rational concern than the worst-case outcome. Essentially, the worst case is meaningful only in relation to how likely it is to occur.

The Cure For Fear

Fear is often the result of a lack of information, or facts without context. The Contrast Method helps encourage us to dig deeper into an issue, to view it from many angles and to come face to face with worst-case scenarios. This gives us courage and confidence when we return to the original issue with new perspectives. It frees us from being driven by emotions (which in this example would leave us in crippling fear of catching the Rhody Horror, no matter what the reality of the situation is), and nudges us closer to thinking objectively about the issues.

I hope you will find, as I have, that the Contrast Method is an invaluable tool, and that it serves you well. 

Before you go, I invite you take a moment right now and apply the Contrast Method to the COVID-19 pandemic. Mentally adjust the settings on each of those factors as if you were adjusting the equalizer dials on a stereo, and watch how those changes impact the reasonable concern for this disease. For added perspective, I invite you to contrast those findings with the common cold, the seasonal flu, and bubonic plague. Good luck!

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