Monitoring and Evaluation in the time of coronavirus: Unprecedented real-time tracking of a pandemic

Life was simple. I had planned to devote this blog to helping organizations set up monitoring and evaluation (M&E) systems.

Then global events overtook me. And all of us.

With the coronavirus, the invisible Covid-19, we have woken up to find ourselves in a not-so-brave new world. Socializing is over — social distancing is in. As our economic, social, and cultural lives are shut down by the health scare and accompanying protocols, it seems almost impossible to have a conversation in which the virus doesn’t intrude. It is equally rare to read news, or any article, that isn’t about the topic in one way or another. And I find it impossible to go back to my rough draft on M&E systems. The new coronavirus reality has occupied our minds.

Unlike anything in living memory, this invisible, odorless and often symptom-free virus has abruptly changed our world, affecting nearly everyone. Perhaps remote Amazon communities and young infants are the only humans on the planet still unaware, as country after country shuts down all public life and economies are pushed to the brink of collapse.   

We now live in a world of isolation and uncertainty — over our personal health and economic well-being. This uncertainty is fueled by the fact that for the first time in over a century we are experiencing a pandemic of this scope. Many of us have gone, in a matter of weeks, from fixating over the costs to humanity of climate change, (a medium-to-long-term civilizational threat) to the costs of coronavirus, which are immediate and life threatening in a very personal way. (Ironically, the global coronavirus shutdown seems to be the best thing that has happened for emissions reductions in decades, although don’t count on the effect lasting after the social distancing era ends.)

Covid-19, this shrouded, faceless phantom with a scythe, silently stalking the globe, has triggered massive, rapid policy changes and behavioral changes, each with economic consequences. Last week, 3.3 million Americans filed unemployment claims. Whole sectors — travel, hospitality, dining, entertaining — are on their knees and it is far from clear how many will rise again from the rubble.

Who knows how bad it will be, or what world we will re-emerge into? After countless deaths, will humanity emerge healthier, having survived, and become inoculated against the virus, or will it be more vulnerable? Will we socialize less, now that we have grown accustomed to virtual meetings, or socialize more, because we’ll have been starved of real human contact? Whoever reads this blog years from now will know the answer. I don’t.

Notable from an M&E perspective is our ability to track the number of cases — infected, recovered, deceased —in real time across the globe, as illustrated by this Johns Hopkins University  dashboard. I will venture to say there has been nothing else like it in the history of monitoring, where everyone with access to the internet (several billion people, now) can follow a global phenomenon as it unfolds, with almost hourly updates. This not the Olympics (now postponed), but a deadly kind of score-keeping, nonetheless.

Of course, the numbers we see in many countries must be taken with a grain of salt — would anyone like to hazard a guess about why Russia (population 146 million) is reporting fewer cases than Luxembourg (population 602,000)?

Aside from nature of a country’s political regime, the amount of testing seems to be correlated with the number of cases — the more tests that are carried out, the more that infections are found. Much more accurate data on infections and mortality rates would require testing a large, randomly selected sample of the population in each country.

At present, those who get tested are only those who think they have symptoms, or who are able to get tested. Many are infected and don’t know it. And there are some who would like to get tested but cannot, for reasons of access or lack of test kits or hospital resources.

So, the tracking is not a reflection of reality, but it is a near approximation, and we must use our own powers of reasoning to analyze their accuracy, what they numbers mean, and why they differ. Nonetheless, this sharing and publicizing of data is a remarkable phenomenon, with political implications.

Governments, when they finally decided to react, are passing policies and stimulus measures remarkably swiftly, with massive interventions in public life and in the economy, pumping in trillions of dollars to cushion the blow. This is not to say that the measures are always well designed, and the lack of coordination between countries is lamentable. But, from a policy perspective, it is quite astounding to see how quickly evidence and evaluation of an issue — chiefly by epidemiologists such as Neil Ferguson and colleagues at Imperial College, London — is taken seriously on board and turned into policy.

As a thought experiment, imagine if the world were tracking, on a daily basis, every death from malaria, every case of child mortality, every woman killed by her partner, every rise in greenhouse gas emissions, every time another person slips into poverty. Armed with this real time information, citizens would be busy educating themselves on the issues, how to prevent them, following the rise and fall of deaths, or emissions, in each country. Imagine if governments were spending billions and trillions of dollars to mitigate these problems and find solutions.

Of course, it is quite difficult to imagine such a thing. Why? Because the people affected are too few, relatively speaking, and they are too poor. The problems are too distant, geographically or temporally speaking, from those in power.

But we now have a pretty good idea of where the tipping point is. That is, the point at which society and government suddenly become willing to act. It occurs when the threat to people in middle and high-income countries is immediate and potentially fatal. It is too early to know the mortality rate for this pandemic, but it might lie between 1 and 2 percent, although using the Johns Hopkins the range, is remarkably wide right now. At the time of writing (March 27, 2020) among countries with at least 5,000 cases, mortality is just 0.6 percent in Germany and 0.8 percent in Switzerland, but 7.6 percent in Spain and an alarming 10.2 percent in Italy.

Coronavirus cases (countries with at least 5,00 cases)

Source: Own calculations, using data from Johns Hopkins University Coronavirus Covid-19 Global Cases by the Center for Systems Science and Engineering

No one is quite sure as to why, although various theories have been advanced, including access to and prevalence of testing (Germany is doing better), demographic factors (South Korea has a younger population) and, of course, government policy on social distancing.

For the historical record, at the time this blog is posted, there have been 585,040 confirmed Covid-19 infections and 26,455 deaths worldwide.  (Between the time I drafted this post in the morning and publishing it this afternoon, the number of cases jumped by more than 35,000, and the number of deaths by over 1,500. That is how bad things are.) For those who are reading this in the future, however, the tally will be many millions of cases, and hundreds of thousands, maybe even millions, of deaths.  

This is not a joyful post to write. Hopefully, in the weeks and months to come there will, again, eventually, be positive news and issues to write about. For now, one can take some small comfort in knowing that M&E systems, if properly deployed, can be used to inform decisions for the common good. In the meantime, stay safe and keep well.

*Image by FunkyFocus from Pixabay