Edinburgh Infectious Diseases
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Pandemic ‘nowcasting’: on the blind spots of covering Covid-19 in real time

A summary of Lukas Engelmann's webinar on 28th April

Dr Engelmann, a historian of medicine and epidemiology, is working to understand what makes this pandemic unique. It is not the first modern pandemic, with no historical comparison; instead, it holds some unfamiliar characteristics in comparison to past epidemics. Past epidemics have been  understood as engines of historical change, as enhancement of our preparedness, and as lessons about our social vulnerabilities and weaknesses. Perhaps the main outcome of COVID-19 will be a renewed focus about health systems. 

The Plague pandemic (1894-1952) was the first to be perceived as a pandemic by a global community, and lies at the heart of early 20th century epidemiology. It was reported through narratives and stories concerning imagined inferior races, Western immunity due to superiority of hygiene, but it also connected the Plague to global trade. The Influenza Pandemic (1918) has been used most comparatively to COVID-19 due to the commonality of facemasks, but at its time it remained largely invisible to the world, perceived instead as localised outbreaks or different diseases. However, it ushered in an era of data standardisation and thereby led to the development of global monitoring of infectious diseases. Furthermore, as influenza emerged from within Western societies, the ‘old style’ of blame, i.e., finger-pointing at an ‘Other’, was disallowed. One last example is HIV/AIDS, a history that began with neglect, ignorance, and marginalisation, and ultimately led to the democratisation of medical expertise, challenging who is supposed to be an ‘expert’. HIV/AIDS also defined the moment when a global health response became paired with the protection and preservation of human rights.

‘Nowcasting’ is originally a meteorological tool used increasingly by public health and epidemiology to predict, estimate and simulate a current status. Nowcasting identifies signals of an epidemic to produce short-range forecasts on the basis of quantifiable data. Nowcasting, with its overt reliance on quantifiable information provides a sense of control, which may in fact be a problematic illusion, as it is in actuality nothing but a simulation, creating three blind spots. Firstly, it overlooks problematic narratives and metaphors that are turned into policy, rather than questioning and engaging with how these shift focus and blame. Secondly, nowcasting assumes data is identical with facts, whereas data is not self-evident. Falsely understood as a tool of surveillance, nowcasting can obscure how data was produced in inconsistent ways bound up inevitably to local differences. Thirdly, nowcasting offers a picture of the pandemic as unconstrained by disagreement among experts. The lessons from HIV/AIDS apply here: rather than close expertise down, we should broaden expertise to a wider range of backgrounds that integrate qualitative and quantitative data. A democratisation of expertise enables better understanding of vulnerabilities and marginalizations, and accounts for the unforeseeable effects of the pandemic and its mitigation. 

Overall, much could be learned from questioning of how we understood in the past what an epidemic is, how we perceived its social, technological and medical effects, and how pandemics have change our way of seeing before we approach the challenges this pandemic poses.