by Jessica Weinkle, Department of Public and International Affairs, University of North Carolina Wilmington
In North Carolina, where I live, policy makers have taken to use the analogy of a “dimmer switch” to explain the state’s response to COVID. The analogy likely originated from an “informal collaboration” of epidemiological modelers associated with various North Carolina public and private institutions organized under the auspices of University of North Carolina’s Sheps Center for Health Services Research.
According to North Carolina Governor Cooper, “Experts tell us it would be dangerous to lift our restrictions all at once. Rather than an on/off light switch, we are viewing this as a dimmer switch that can be adjusted incrementally.”
The thing about a dimmer switch is that it implies smooth management and control.
The dimmer switch in my dining room provides me with subtle differences in lighting intensity. I can turn the light up or down. I can even turn it off after having the light on fully. I can manage this closed system quite effectively.
What is not well represented in the “dimmer” switch policy approach to COVID is that society doesn’t dim gently when twiddled. We often move begrudgingly, skeptically, and without deft. It’s an open system of thought, feeling, demands, and interactions. Vulnerabilities are plentiful and not equally shared. Small change can bring to the surface simmering resentments and incite dangerous conflict.
The dimmer switch analogy emerged as policy makers and their scientific advisors came to accept that complete suppression was not possible.
Around the same time NC introduced its dimmer switch approach, the UK as grappling with a similar decision context.
According to commentary in The Lancet, during the first press conference of the independent Scientific Advisory Group for Emergencies (SAGE), Sir David King, asked policymakers the most important questions one can ask for orienting any type of inquiry: What are you trying to do? Or more specifically,
“Is the government's objective to suppress infection or to manage the infection?”
An independent SAGE report came out in early May recommending that:
The government should take all necessary measures to control the virus through suppression and not simply managing its spread. Evidence must show that COVID-19 transmission is controlled before measures are relaxed. We detect ambivalence in the government’s strategic response, with some advisers promoting the idea of simply ‘flattening the curve’ or ensuring the NHS is not overwhelmed. We find this attitude counter-productive and potentially dangerous. Without suppression, we shall inevitably see a more rapid return of local epidemics resulting in more deaths and potentially further partial or national lockdowns, with the economic costs that will incur.
But as the independent SAGE also noted, as early as February the WHO had pointed to the difficulty that many nations would have in implementing strong suppression measures akin to those in China, “Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China.”
The mindset component to effective control of COVID has received a greater bit of discussion more recently. Most notably in commentary identifying public loss of trust in government as a significant problem for pandemic response, of any kind.
By adopting the dimmer switch approach NC policymakers implied at least two things.
First, there is an acceptable level of COVID in the community that is greater than zero and, presumably, lower than the level that will overwhelm the hospital system. As Gov. Cooper noted, “We want to get back to work while at the same time preventing a spike that will overwhelm our hospitals with COVID-19 cases.” So, complete suppression was no longer a goal and control believed possible.
The second implication was that scaling up or scaling back regulations would go smoothly- like a dimmer switch. It implied that policymakers could control the complex, open system that is society-at-large. Even the independent SAGE made this assumption, “Equally important is that we design in flexibility to allow for rapid escalation or de-escalation of measures as new evidence emerges.”
Current messaging from the state reflects this belief all while the state reports record breaking daily COVID case counts.
However, management plans of any kind, are only as good as the compliance (and enforcement) of them. In the US, compliance has been consistently problematic and the inability to ‘dim’ public behavior in response to restrictions is readily apparent.
This is at least in part- and likely in large part- due to a breakdown in public trust in government.
I will have more on this some other time.
For now however, it reasonable to conclude something quite simple, policymakers should have known better than to have framed society (and its economy) as something easily subdued.
Good science advice provides policymakers with information about their alternatives. And while the independent SAGE encouraged virus suppression and NC modelers encouraged a dimmer switch approach to reopening, it was the responsibility of policymakers on both sides of the Atlantic to know that a large, diverse, and polarized public would not respond well to being fine-tuned.