It's been years since I've posted (and looking back, some of my opinions have moderated or changed). But 50, or 60 or something-like-that days into the madness that is the global COVID-19 coronavirus pandemic and associated quarantine, and after countless (by now trite) exhortations to be "data-driven", "follow the science", "listen to the experts" and "we're all in this together", I find myself oscillating between frustration and exasperation. An endless stream of media calculated to shock and scare me now just annoys me. While I'm willing to do my meaningful part, I have growing concerns about the virus-related public policy/restrictions being rolled-out by bureaucrats and their experts. Here are my chief complaints and rationale.
1. The numbers being presented lack a helpful context.
"COVID-19 has killed more Americans than the Vietnam War." That's a sensational headline that ran on multiple new sites last week(ish) when the death toll surpassed 59,000. It is, by design, clickbait. What it is not intended to do is provide helpful context. Quite the opposite, it uses a cherry-picked example to elicit an emotional response, making 59,000 seem like an impossibly huge number (wars are horrible and kill lots of people, right?). But how big is it really?
Here's what I mean by context (the following statistics are from Statista). Shark attacks are horrific and sensational. Every time a shark kills someone, it makes the news. Yet sharks kill just 6 people a year! That's a fraction of a fraction of the 20,000 people snails kill each year. Dogs--man's best friend--kill 35,000 people annually. And mosquitos kill a whopping 750,000 humans every year! So, sharks may be terrifying, but in context they're not very dangerous and only worth a headline if the intent is to make advertising dollars. Which it is. Side note: Humans kill each other at a rate of around 437,000 each year.
Here's a more relevant example of sensation without context: The CDC estimates 30-60 million infections in the U.S. alone in 2020, with up to 370,000 hospitalizations and 34,000 deaths. The WHO predicts global deaths this year could reach 650,000.
Wow! Scary, right? Except that these estimates are for the flu, not COVID-19. Who knew that the seasonal flu kills 30,000-65,000 Americans every year? More than the Vietnam war some years! If like me, you're surprised to hear that many people die of the flu, it's because flu deaths don't generally make the news. We're used to it. 30,000-65,000 flu deaths happen every year. It's background noise. But it's important to know because this disease-to-disease comparison, this context, helps us decide how we respond to 59,000 COVID-19 deaths.
Context matters. So here's more:
59,000 COVID-19 deaths is more than the 38,000 Americans that die in traffic accidents each year, the 16,000 annual homicides, and even the 47,000 annual suicides. But it's lower than the 65,000 annual drug overdose deaths and much lower than the 480,000 smoking-related deaths in America each year.
According to the CDC, around 2.8 million Americans die each year. And 74% of these deaths occur as a result of just 10 causes. Here's the breakdown (numbers from 2017):
- Heart disease: 647,457
- Cancer: 599,108
- Accidents (unintentional injuries): 169,936
- Chronic lower respiratory diseases: 160,201
- Stroke (cerebrovascular diseases): 146,383
- Alzheimer’s disease: 121,404
- Diabetes: 83,564
- Influenza and Pneumonia: 55,672
- Nephritis, nephrotic syndrome and nephrosis: 50,633
- Intentional self-harm (suicide): 47,173
So, in context, COVID-19 has (so far) killed about as many people as die from the flu each year. Granted, the number of COVID-19 deaths will very likely continue rising significantly, but at least this gives us some context to use in assessing our risk.
Ideally, context should also guide the decisions of the bureaucratic COVID-19 masters as they craft and issue executive orders. It seems like that would be a good thing.
9/17/2020 UPDATE: As the number of deaths in the United States nears 200,000, COVID-19 has become the number three killer of Americans, behind only heart disease and cancer. More troubling still is how the Trump administration has downplayed and politicized the virus. Neither Trump nor his base will wear a mask in public. American citizens have now been banned from traveling to most of the world due to the high rate of infection here. The United States rate per million of infections is near the highest in the world. This context is important because it shows that many of these deaths could have been prevented had we responded differently.
You can see they are using the same formula to derive a 6% fatality rate for the United States. Confirmed cases + deaths = N. Then, deaths dived by N x 100 = fatality %.
And these numbers are used by the news media and "experts" many, many times every day. But does anybody really believe that Russia has a 0.9% fatality rate while France has a 15% fatality rate? If so, what's the explanation? Is the average age of population and quality of healthcare so different between these two countries? Wouldn't these numbers make the average 3rd grader suspicious? Are these numbers even accurate?
No, not even close, but they are "confirmed" by medical facilities nationwide. In other words, they're the numbers we have.
Unfortunately, the confirmed numbers are laughably incomplete and very biased towards sick people who have sought medical attention (and thus been counted). Moreover, there's mounting evidence that COVID-19 deaths are being counted creatively in a way that maximizes their number. Illinois State Health Director, Dr. Ngozi Ezike, recently explained something that I had initially rejected as right-wing propaganda too stupid to be true. But here's the quote: "If you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. Even if you died of a clear alternate cause, but you had COVID at the same time, it's still listed as a COVID death. So, everyone who's listed as a COVID death doesn't mean that that was the cause of the death, but they had COVID at the time of the death."
So, if you are shot or drown while you have the COVID virus, that's a COVID death?
6/2 ADUNDUM: On May 25, 2020, George Floyd, a 46-year-old black man suspected of passing a counterfeit $20 bill, died in Minneapolis after a white police officer pressed his knee to Floyd's neck for almost nine minutes while Floyd was handcuffed face down in the street. This outrageous murder has sparked massive protests and riots nation-wide that are still ongoing as of this writing. Not surprisingly, the autopsies found that the cause of death was homicide--Floyd died of heart failure and asphyxia. Oh, and by the way, the autopsies also showed that George Floyd had COVID-19. Uh-oh. Are we still going to count Mr. Floyd's death as a homicide, or is someone from the government going to get in front of the cameras and tell the world that his death is being reclassified? No, I didn't think so. That would be truly asinine.
If this were simply a problem of insufficient data, that could be understood and excused. The experts could (and should) easily say, "Look, these are the best numbers we have today. They're incomplete and we know it. So take them will a grain of salt." Instead, these fantastically fallacious numbers are being taken and presented at face value, used by bureaucrats to craft public policy and monetized by the media (fear drives more traffic than nuance).
Although we may not have all the data, we have enough to be far more accurate in our estimates than we are. The data is growing and the picture becoming clearer daily, as more and more studies are done. Of critical note are a number of recent studies that have, without exception, shown that the virus is far more widespread--and thus far less deadly--than the confirmed numbers show.
Here's part of a New York Times article entitled, "Coronavirus Infections May Not Be Uncommon, Tests Suggest" from April 21. It's representative of many similar articles I've read (though such articles are certainly not front-page news anywhere):
"Antibody studies in other countries have produced similar numbers, noted Dr. John Ioannidis, a professor of medicine at Stanford University and an author of the paper on Santa Clara County. If the numbers prove accurate, he added, the virus may be much less deadly than originally expected, with a fatality rate more closely resembling that of a bad flu strain than a pandemic of profound lethality."
The bottom line: The vast majority of people who have or have had the COVID-19 virus are not being counted in the official numbers, either because they were asymptomatic or they didn't feel sick enough to seek medical attention. In Los Angeles Country, the extrapolated number was up to 55 times higher than the confirmed number. Thus, the actual fatality rate of COVID-19 is likely less than 0.5%, not 6%. How is this not a headline somewhere? Why is such data not being presented as at least a caveat to the confirmed numbers?
2. The numbers being presented are wrong (and/or misleading)
I read an inane article a few weeks ago that said 60,000 Americans have recovered from COVID-19 compared to 37,000 deaths, leaving the credulous reader with a calculator to infer a 38% mortality rate (60K + 37K = 97K and 37K/97K = .38 x 100 = 38%). These are the confirmed numbers. Are politicians and infectious disease experts using these numbers to make policy? Surely not! That would be ridiculous! But maybe they are. Here are the May 8 numbers from Johns Hopkins University, as presented on the Information Is Beautiful website:
You can see they are using the same formula to derive a 6% fatality rate for the United States. Confirmed cases + deaths = N. Then, deaths dived by N x 100 = fatality %.
And these numbers are used by the news media and "experts" many, many times every day. But does anybody really believe that Russia has a 0.9% fatality rate while France has a 15% fatality rate? If so, what's the explanation? Is the average age of population and quality of healthcare so different between these two countries? Wouldn't these numbers make the average 3rd grader suspicious? Are these numbers even accurate?
No, not even close, but they are "confirmed" by medical facilities nationwide. In other words, they're the numbers we have.
Unfortunately, the confirmed numbers are laughably incomplete and very biased towards sick people who have sought medical attention (and thus been counted). Moreover, there's mounting evidence that COVID-19 deaths are being counted creatively in a way that maximizes their number. Illinois State Health Director, Dr. Ngozi Ezike, recently explained something that I had initially rejected as right-wing propaganda too stupid to be true. But here's the quote: "If you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. Even if you died of a clear alternate cause, but you had COVID at the same time, it's still listed as a COVID death. So, everyone who's listed as a COVID death doesn't mean that that was the cause of the death, but they had COVID at the time of the death."
So, if you are shot or drown while you have the COVID virus, that's a COVID death?
6/2 ADUNDUM: On May 25, 2020, George Floyd, a 46-year-old black man suspected of passing a counterfeit $20 bill, died in Minneapolis after a white police officer pressed his knee to Floyd's neck for almost nine minutes while Floyd was handcuffed face down in the street. This outrageous murder has sparked massive protests and riots nation-wide that are still ongoing as of this writing. Not surprisingly, the autopsies found that the cause of death was homicide--Floyd died of heart failure and asphyxia. Oh, and by the way, the autopsies also showed that George Floyd had COVID-19. Uh-oh. Are we still going to count Mr. Floyd's death as a homicide, or is someone from the government going to get in front of the cameras and tell the world that his death is being reclassified? No, I didn't think so. That would be truly asinine.
If this were simply a problem of insufficient data, that could be understood and excused. The experts could (and should) easily say, "Look, these are the best numbers we have today. They're incomplete and we know it. So take them will a grain of salt." Instead, these fantastically fallacious numbers are being taken and presented at face value, used by bureaucrats to craft public policy and monetized by the media (fear drives more traffic than nuance).
Here's part of a New York Times article entitled, "Coronavirus Infections May Not Be Uncommon, Tests Suggest" from April 21. It's representative of many similar articles I've read (though such articles are certainly not front-page news anywhere):
"Two new studies using antibody tests to assess how many people have been infected with the coronavirus have turned up numbers higher than some experts had expected. In both cases, the estimates of the number of people infected in those counties were far higher than the number of confirmed cases.
"The studies, conducted by public health officials and scientists at Stanford University and the University of Southern California.....tested 3,330 volunteers for antibodies indicating exposure to the virus. After adjustments intended to account for differences between the sample and the population of the county as a whole, the researchers estimated that the prevalence of antibodies was between 2.5 percent and a bit more than 4 percent. The county’s population is 1.9 million. That means that 48,000 to 81,000 people were infected with the coronavirus in Santa Clara County by early April, the investigators concluded.
"The studies, conducted by public health officials and scientists at Stanford University and the University of Southern California.....tested 3,330 volunteers for antibodies indicating exposure to the virus. After adjustments intended to account for differences between the sample and the population of the county as a whole, the researchers estimated that the prevalence of antibodies was between 2.5 percent and a bit more than 4 percent. The county’s population is 1.9 million. That means that 48,000 to 81,000 people were infected with the coronavirus in Santa Clara County by early April, the investigators concluded.
"In Los Angeles County, researchers conducted tests at drive-through sites and at participants’ homes and estimated that 2.8 percent to 5.6 percent of the county’s adult population carried antibodies to the coronavirus. There are 10.4 million people in Los Angeles County. If accurate, that would mean that 220,000 to 442,000 residents had been exposed. By comparison, only 8,000 cases had been confirmed in the county by early April, when the testing was done."
And test after test is showing similar results:
The bottom line: The vast majority of people who have or have had the COVID-19 virus are not being counted in the official numbers, either because they were asymptomatic or they didn't feel sick enough to seek medical attention. In Los Angeles Country, the extrapolated number was up to 55 times higher than the confirmed number. Thus, the actual fatality rate of COVID-19 is likely less than 0.5%, not 6%. How is this not a headline somewhere? Why is such data not being presented as at least a caveat to the confirmed numbers?
9/17/2020 UPDATE: Nearly 7 months into the pandemic, it appears that the death rate for COVID in the United States is indeed around 0.5-0.7%. Still, that's 5-7X as deadly as the flu. Worse yet, it's higher than it would have been due to the political response to the pandemic by the Trump administration.
Testing (or the lack thereof) has been a perverse and persistent problem from the outset of this pandemic. The more we test, the better our numbers are and the better our decisions have the potential to be. But testing in the U.S. has been insufficiently available and slow coming up to speed. Fortunately, more tests are being administered every day and the trendline is moving up and to the right.
But while too little testing has clearly caused problems, the increased testing is causing its own less obvious problem. In brief, two months into the quarantine the numbers of COVID-19 infections should be dropping steadily, but they're surprisingly flat. Does this mean that the quarantine isn't working? Or that we need to quarantine harder and longer? These would be unfortunate conclusions. The far more likely explanation is that the more you look, the more you find.
Here's a simple hypothetical (using small, made-up numbers) that illustrates my point:
Last week we administered 100 tests and 10 were positive for COVID-19.
This week 50 tests came back positive! Holy crap! Write the headline! COVID-19 explodes! Call the governor! Shelter in place!
But wait...did I mention that we administered 1,000 tests this week? Yep, which means that the rate of positive test results fell by 50%, from 10% to 5%.
Yes, the quarantine hopefully/likely/logically helped reduce the number of infections. But at the same time, thanks to more testing, a high number of infections are being found among a decreasing population of those infected. Thus, the number of infections line remains flat. The concern is that policymakers and their "experts" will accept the unfortunate conclusion that we need to quarantine harder and longer based solely on the number of confirmed infections, ignoring the favorable trend in positive test %.
9/17/2020 UPDATE: Well crap, Trump used this same argument. But while it's a valid concern, it doesn't explain the full picture. Seven months into the pandemic, the testing is actually going down in the United States but infections are going up. Here are the latest numbers for the United States. Undoubtedly still not accurate, but if they're even in the ballpark, we've got a big problem and--after 7 months--we're doing a piss poor job of fixing it.
Testing (or the lack thereof) has been a perverse and persistent problem from the outset of this pandemic. The more we test, the better our numbers are and the better our decisions have the potential to be. But testing in the U.S. has been insufficiently available and slow coming up to speed. Fortunately, more tests are being administered every day and the trendline is moving up and to the right.
But while too little testing has clearly caused problems, the increased testing is causing its own less obvious problem. In brief, two months into the quarantine the numbers of COVID-19 infections should be dropping steadily, but they're surprisingly flat. Does this mean that the quarantine isn't working? Or that we need to quarantine harder and longer? These would be unfortunate conclusions. The far more likely explanation is that the more you look, the more you find.
Here's a simple hypothetical (using small, made-up numbers) that illustrates my point:
Last week we administered 100 tests and 10 were positive for COVID-19.
This week 50 tests came back positive! Holy crap! Write the headline! COVID-19 explodes! Call the governor! Shelter in place!
But wait...did I mention that we administered 1,000 tests this week? Yep, which means that the rate of positive test results fell by 50%, from 10% to 5%.
Yes, the quarantine hopefully/likely/logically helped reduce the number of infections. But at the same time, thanks to more testing, a high number of infections are being found among a decreasing population of those infected. Thus, the number of infections line remains flat. The concern is that policymakers and their "experts" will accept the unfortunate conclusion that we need to quarantine harder and longer based solely on the number of confirmed infections, ignoring the favorable trend in positive test %.
9/17/2020 UPDATE: Well crap, Trump used this same argument. But while it's a valid concern, it doesn't explain the full picture. Seven months into the pandemic, the testing is actually going down in the United States but infections are going up. Here are the latest numbers for the United States. Undoubtedly still not accurate, but if they're even in the ballpark, we've got a big problem and--after 7 months--we're doing a piss poor job of fixing it.
3. The goalposts keep moving
The original goal for the quarantine was to "flatten the curve" so that hospitals would not be overwhelmed. Everybody got behind that goal. Well, with rare exceptions, hospitals never were overwhelmed--certainly not here in Washington. And the curve has been flat for weeks!So we can lift the quarantine, right?
Nope! That's no longer good enough! Washington state's criteria for exiting lockdown changed to the death rates dropping for two weeks in a row. And then the criteria changed again: Now there's a four-phase plan, and to move into phase 2 (ever so slightly eased restrictions) a county must have less than 10 new cases per 100,000 residents over a 14 day period.
Epilogue: The criteria changed again when the powers that be realized that we were likely never going to get to 10 cases or fewer over a two week period. The number has now moved from 10 to 25 and the authority to move to a new phase has been pushed to ~10 people/committees at the county level. It's too confusing to explain (and will thus be ignored) but the gist of it is the governor is no longer the bad guy and if any single person in the string of people/groups required to approve a phase move decides to hold-out for any reason, the county is not able to move to the next phase.
This all reminds me of the day in grade school when your teacher tells you, "Remember, i before e! i before e!" And you're thinking, "i before e. OK, that's easy enough." And then they say, "Oh, except after c. Then it's e before i. And also except when sounded like a, as in neighbor and weigh. In such cases also put the e before the i rather than the i before the e. And um, also not i before e when the c sounds like sh, as in proficient. Oh, and there are a number of exceptions, like neither, leisure, seizure, foreign and so on and so forth." The rule becomes a joke.
4. Everybody has a bias, if not an agenda.
There are people who have an agenda when it comes to the virus. They're self-interested in influencing an outcome. Maybe you think Trump wants to end the quarantine ASAP and get the economy going again to increase his chances of being reelected. Maybe you think the Democrats want to hand out trillions in bail-out money to so that they literally become the hand that feeds the people.But even without an agenda, you and I and everybody else are biased, even if subconsciously.
Imagine the infectious disease geek toiling away for decades in the basement of some government agency, perpetually ignored, constantly getting their funding clipped, all but invisible. Then suddenly they're being pulled out of their hole, marched in front of the cameras and asked their opinion about the one thing to which they've devoted their entire unappreciated life. What does human nature predict that doctor will do with their 15 minutes of fame? Downplay the crisis? Offer a big picture view that considers multiple socio-economic factors? Provide a nuanced look at the pros and cons of various actions?
Or is it more likely that doctor will ride the media horse for all it's worth, proving to the world--including the highschool bully who gave them a wedgy--exactly how vital and momentous they and their field of study are.
But even if such experts resist the natural urge to toot their horn, the politicians never will. Consider this: Government "essential" businesses allowed to remain open during the lockdown include the state lottery, liquor stores and pot shops.
9/17/2020 UPDATE: The biggest, most harmful and idiotic bias has been introduced and fostered by President Trump. He's politicized the virus to the point where most Republicans won't wear masks and his more devout followers think the virus is a hoax.
Supporters and advocates of extended, rigorous quarantines seem to think that if we, as a nation, just follow the quarantine path, everything will be fine. Or at least vastly better than if we don't. This is their "happy path", and it is naively fictional.
There is no happy path in all of this, only a number of bad options. When COVID-19 arrived, a lot of people were going to die. The question was--and still is--the cause of death. No quarantine means more deaths from the virus. Extended, rigorous quarantines mean fewer people will die from the virus. BUT....it also means more will die from other medical conditions that weren't diagnosed/treated because "non-essential" medical procedures were banned. It means more depression, anxiety and suicides, etc. It means that millions will fall below the poverty line. Among the poor and in the developing world, millions will suffer from malnutrition and starvation, as aid that used to flow from strong first-world economies dries up. It will take a long time to fully assess the impact of the quarantines on the world, but that there will be many deaths, either way, is a certainty. And I strongly suspect that we have a fleeting opportunity now to trade tens of thousands of virus deaths for millions of non-virus deaths. And I just as strongly suspect we won't take the opportunity.
There is no happy path. We must pick our poison. It's not an easy decision, but a balanced approach certainly seems worth discussing. Instead (at least up to this point), anyone who suggests that we ease restrictions is shamed and shouted down by the virtue signalers.
5. We're too afraid to go back to normal.
The media has done such a thorough, effective job of terrorizing the public that even when the quarantines are eased and lifted, many people will be too afraid to return to work, travel, shop, take a vacation, etc. At best I suspect we can expect a 90% economic recovery, which will keep unemployment above 10% for the foreseeable future.6. A happy path is assumed when there is none.
There is no happy path in all of this, only a number of bad options. When COVID-19 arrived, a lot of people were going to die. The question was--and still is--the cause of death. No quarantine means more deaths from the virus. Extended, rigorous quarantines mean fewer people will die from the virus. BUT....it also means more will die from other medical conditions that weren't diagnosed/treated because "non-essential" medical procedures were banned. It means more depression, anxiety and suicides, etc. It means that millions will fall below the poverty line. Among the poor and in the developing world, millions will suffer from malnutrition and starvation, as aid that used to flow from strong first-world economies dries up. It will take a long time to fully assess the impact of the quarantines on the world, but that there will be many deaths, either way, is a certainty. And I strongly suspect that we have a fleeting opportunity now to trade tens of thousands of virus deaths for millions of non-virus deaths. And I just as strongly suspect we won't take the opportunity.
There is no happy path. We must pick our poison. It's not an easy decision, but a balanced approach certainly seems worth discussing. Instead (at least up to this point), anyone who suggests that we ease restrictions is shamed and shouted down by the virtue signalers.
7. Some policies don't make sense.
My pet peeve in all this is the fact that they've shut down national forests. Seriously? Even if the numbers are every bit as bad as CNN wants them to be (and not even close to as good as FoxNews wants them to be), do we really want to keep everybody together instead of inviting them to go outside and hit the trails, where you might run into another human being once every few miles?9/17/2020 UPDATE: This policy was stupid and has been reversed for some time now.
While being touted as frontline heroes, thousands of doctors and nurses have been laid off or furloughed. With rare exceptions, the wave of patients never materialized. And because all non-essential medical procedures were put on hold as part of the quarantine, whole floors of hospitals became ghost towns. Numerous hospitals have been pushed to the brink of closure financially.
While being touted as frontline heroes, thousands of doctors and nurses have been laid off or furloughed. With rare exceptions, the wave of patients never materialized. And because all non-essential medical procedures were put on hold as part of the quarantine, whole floors of hospitals became ghost towns. Numerous hospitals have been pushed to the brink of closure financially.
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