TL;DR – All 3 events carry very low or low likelihoods. The key insight here is that risk is an inevitable part of life.
First things first, does anyone know what an actuary is? Well, an actuary is a professional who deals with the measurement and management of risk and uncertainty, and you can find them mostly in the finance and insurance sector.
Now next, Mr Tan Suee Chieh is the President Elect of the Institute and Faculty of Actuaries and a member of the Presidential Team (June 2019 to June 2022). He also sits on the boards of Singapore University of Social Sciences, Sim Kee Boon Institute of Financial Economics (SMU), LSE Trust (Singapore), Singapore School of the Arts and various boards of the Institute and Faculty of Actuaries (UK).
You can read more about his credentials and experience on his Facebook page.
So why am I talking about an actuary by the name of Tan Suee Chieh?
You see, I’ve seen someone share one of his Facebook posts in a COVID-19 groupchats. Intrigued, I went to check out his other posts and saw that he has put up two interesting ones that are worth sharing. He has kindly given us permission to republish his posts here. Thanks much!
The first post looks at COVID-19 from a psychological and actuarial approach. Tan looks at how our fear of the unknown traps us and how once we have more information and statistics, we can dispel the fear.
The second post takes on an actuarial and risk-based approach, and how three events need to happen before COVID-19 causes fatality.
#1 COVID-19 – A psychological and an actuarial approach
There is a lot of fear of COVID-19 coronavirus. Largely, it is the fear of unknown, as this virus is new.
As Gandhi said, “The enemy is fear. We think it is hate; but, it is fear.”
As a trained psychologist and an actuary, and a student of crowd dynamics, I would like to bring a sense of perspective, different contexts and rationality into the discussion on COVID-19 to dispel fear.
As of 15 February, we have 1527 number of deaths in the last three months arising from 67,000 infections (99% from China).
These numbers are likely to rise to tens and maybe hundreds of thousands of deaths and millions of infections. So when you hear about more deaths, you should not be alarmed. This is how pandemics work.
For me, the increase in numbers were not particularly alarming, as they are decelerating since late January because of everyone’s efforts of containment. The only hike was on 12 February, when China included clinal cases to laboratory cases. This is in contrast to Swine flu H1N1 in 2009 originating from USA – see item 1.0 below.
So we do not have to be paralysed by fear of these statistics. We can be rational, objective and calm in our our response because
- In 2009, the H1N1 swine flu which emanated in USA caused 360,000 deaths (range 150,000 -575,000) in the first year – CDC/Lancet. And 762 million infections in the first year. As in COVID-19, this virus was unknown and there was no vaccine. The fatality rate eventually settled down to 0.02 %. Were you panicking then?
Do you know according CDC (Center of Disease Control – USA) about 40,000 people die from seasonal flu worldwide monthly? Do you worry about dying from seasonal flu?
Do you know that according to WHO (World Health Organisation, a United Nations organisation) on a worldwide basis,
• 65,000 die from HIV monthly
• 112,000 die from car accidents monthly
• 130,000 die from diabetes monthly, and an additional 185,000 die from high blood glucose monthly
• 250,000 die from alcoholism monthly
• 600,000 die from smoking monthly
• 1.5 m from heart disease monthly
Also, according to John Hopkins University, 20,000 die monthly from from Iatrogenic causes (medical errors) in USA alone!
Don’t you think you should worry more about the above causes of death, which are more threatening to you than COVID-19 and which you have a better control of?
Don’t you think it’s better and more productive to lose weight, have a balanced diet, exercise, drive safely, sleep well and do not imbibe too much alcohol than to worry about COVID-19 inappropriately?
But of course, I am not asking you to be reckless. I ask you to be responsible and do your part! See the MOH website.
- Current estimates of fatality rate of CPVID-19 is 1.0% to 2.0% (Lancet) but some scientists believe that eventually this rate will come closer to the swine flu of 0.1%. And PM Lee Hsien Loong and Minister Lawrence Wong implied that as well. Discovery of vaccines will of course reduce the rate to close to zero. And preliminary data suggest those who die are of vulnerable groups – those who are older and those who are already sick.
For comparison, mortality rates of Singaporean males are:
- Age 60 0.686%
- Age 65 1.076%
- Age 70 1.842%
(Department of Statistics 2018 preliminary analysis)
This mean if you are infected with nCOV-19, your chance of dying from it is quite close to a Singaporean male in the above age groups dying of all causes. Does a 65-year-old man go around worrying he will die that year?
Please understand this. You have to get infected first. Your probability to get infected is very very low, and you can reduce this further. I will write in a separate posting on how you can reduce the rate of infection.
Lastly, if you do get infected, I can recommend things you can do to strengthen your immune system. Sleep and intermittent fasting. And, l will write on this separately later as well!
One of the philosophers I admire is Bertrand Russell. He said,
#2 COVID-19 An Actuarial and Risk Based Approach
Three events need to happen before COVID-19 causes fatality, all of which carry very low or low likelihoods.
1. You need to meet a carrier – the odds are very low. 1-2 per 100,000 in Singapore. Even if we allow for delayed reporting, it will be 7-8 per 100,000 at most.
As an analogy, actuaries, chief risk officers, Monetary Authority of Singapore and Bank of England set capital/ solvency requirements typically at 1 in 200 (2.58σ) or 1 per 2000 (3σ). To set at 1 per 10,000 would render our financial institutions unsustainable and destroy the value creation of our economy, let alone 1 in 100,000!
The key insight here is that risk is an inevitable part of life. We need to calibrate our actions with our risk appetite. You cannot eliminate risk all together (say ban all travel and all meetings) because this is often is an over-reaction and is not sustainable in the long run.
2. You need to get transmission from the carrier. Current epidemiological assumptions is that the transmission rate ρ is between 1.5 to 2.5. That is an carrier will infect 1.5 to 2.5 persons. Whether you are the person getting the infection will be a function of your personal hygiene – washing of hands, not touching your face, observing social distances et al.
From what I read and understand there is very low risk of droplets reaching you from the infected person, if you observe personal hygiene
3. Once you are infected. The vast majority of fatal cases are people with pre-existing conditions or people who are old. If you are healthy, your chances of a full recovery look good. Current estimated mortality rate is 1.0% to 2.0%
The intent of my note is not to devalue the huge amount of concern and worry people have. Nor to reduce human life to just numbers. My intent is to provide perspectives and appeal for measured and rational responses so that we can overcome this challenge in a disciplined and strategic manner.
“Fear is the main source of superstition… To conquer fear is the beginning of wisdom.”
– Bertrand Russell
Will DORSCON level move to red?
Now that we understand better COVID-19 from the actuarial aspect from the above two posts, let’s now have a look at the current situation.
Singapore adopts the Disease Outbreak Response System Condition (DORSCON), a colour-coded framework that provides us with general guidelines on what needs to be done to prevent and reduce the impact of infections.
It takes into account:
- The current disease situation overseas
- How transmissible the disease is
- How likely it is to arrive in Singapore
- What impact it may have on Singapore’s community
We’re at Orange now, and some people are speculating we might go Red soon.
Even if in the unfortunate event of our first fatality (choi, choi, touch wood), it does not necessarily mean we will move straight to Red. For us to escalate to Red, the situation, i.e. the disease needs to be very serious and we probably need to see wide community spread with multiple deaths.
As the situation drags on, we need to brace ourselves for deaths among those in critical conditions. Of course, it is not something we hope to see. But if in the event it unfortunately happens, we should all remain rational and calm. For mass panicking and runs on the supermarkets will only hurt us all. Or maybe make idiots out of us.
Meanwhile stay safe, wash your hands often! Please send prayers for all the COVID-19 patients for their recovery.
(Featured image via)