I have been asked several times if I would do a blog on the novel corona virus, co-vid19, hereafter referred to as CV19. I have declined, partly because facts were coming in so rapidly but mainly because I was so angry and upset that I could not write coherently. A friend even recommended my blog as a corona virus-free zone. I am calmer now, and must disappoint him by finally writing about CV19.
Of course CV19 is being treated like a devastating, life-threatening illness. I'll give away the conclusion- I don't think it is. For my heresy I have been called all manner of names. I have been preached to about the importance of quarantine, about selfishness, risk to the elderly, the devastating infection risk. I've been called a virus denier, told several times in forceful tones that Fauci knows more than I do. One person on Facebook asked me 'are you an immunologist? Because if you're not I'll put my faith in the experts.'
One of my teachers was a famous fetal physiologist, Karlis Adamsons. He taught us journal club, and would always ask the students their opinion. He would say 'you are not more stupid than your teachers. You've just read the book fewer times.' I took statistics twice, and have taught it a couple of times as well. In running journal clubs for years I have told students and residents to read the methods and data and form your own conclusions before you read the paper's. If you reach a different conclusion, ask yourself whether your knowledge and understanding is lacking, or if the authors are simply confirming their biases through circular reasoning disguised as 'research', a surprisingly common problem, particularly for narrow focus experts.
A bit of corona virus background. CV is hardly new. CV is, along with paramyxovirus and adenovirus, a major cause of flu-like illness, patients who present with cough and fever but have a negative flu swab. Since the vast majority of these patients recover uneventfully there is no further testing done in most cases. There are a couple hundred serotypes of CV, most in bats. Every once in a while there is crossover into the human population. The most common vector, as it is for ebola, is the handling of carcasses or meat of infected animals. There have been a couple of new CV outbreaks in the last 15 years, all from China- MERS, SARS, and now CV19.
There has been a persistent problem in the reporting of data on the illness. First cases were diagnosed only among hospitalized patients. Of these, 5-9% were dying. As the outbreak spread diagnostic criteria were loosened to include outpatient cases, and total cases soared in part because of definitional changes. The death rate of the sickest, hospitalized patients, however, was applied to the larger denominator of outpatient cases. It was then rapidly discovered that most cases were mild, but the mortality rate of the hospitalized was still applied to them. Now we know that over half of cases are asymptomatic, but still the higher mortality rate is applied.
This is a classic statistical error- applying results outside of the subset in which they were generated. There are many examples of this mistake being made. The Denver growth curves for infants and children were used for years, until it was realized that growth was going to be different at 5000 feet of altitude than at sea level. Cardiac data for men was applied to women, despite their being marked differences in cardiovascular physiology.
Every year, thousands of elderly people die of pneumonia. It is one of the leading killers of the elderly, for many reasons. Nearly 90% of all pneumonia deaths in the US occur in those 65 and older. The death rate for gram negative pneumonias in the elderly exceeds 20%. We know this number does not apply to young people getting pneumococcal or atypical pneumonias in an outpatient setting. Everybody knows that. Except that is precisely the analytical error being made.
This mistake produced the wild claims of millions of dead. The US population is 330,000,000. If 50% became infected, and 20% of infections needed hospitalization with 5% dying, we get 165,000,000 infections, 32,000,000 hospitalizations and 8 million dead. Our media promptly promulgated such numbers, somehow finding talking heads that would corroborate the calculations.
Except they are obviously, instantly provably, wrong. The simplest look at the data showed mortality was 1% when calculated across all the then-symptomatic cases (meaning mild symptoms and asymptomatic persons were not included). Fauci, the director of the National Institute for Allergy and Infectious Disease (NIAID), a part of NIH, has made explicitly clear in writing that mortality is likely to be far lower than this, as early as late February. Despite this, the media persisted with lurid stories of a viral apocalypse, and added political fuel by saying Fauci was being muzzled by Trump. Fauci has repeatedly denied this, but clearly by this time facts were not being allowed to interfere with a good story.
Fauci noted mortality was likely to be much lower, and epidemiological studies, looking at mortality rates throughout China and talking into account the likely number of asymptomatic patients, found mortality not of 5% or 1% but 0.04%.
There are ongoing problems in ascertaining the extent of infection, since so many are asymptomatic. The US has a crude reported mortality rate of 4.2 per million population and 1.48% of confirmed cases. In many areas only the sickest get tested at all, and in all cases the asymptomatic are omitted. The death rate is almost certainly 1/3 to 1/10 of the current reported number; ie, 0.5 to 0.1%, and testing is grossly incomplete.
There are areas of much higher mortality. Wuhan was one, and New York City is another. We don't know why, although various factors are likely at work.
Various other 'facts' are being used to stoke continued panic. We are told in breathless terms this is likely to be cyclical and seasonal, implying we are going to have to shut down our nation every year. Infectivity is 10 time worse than flu, which is impossible since when exposed to flu virus 100% become seropositive for antibodies, even though half show no symptoms. You can't have 1000% infectivity.
In fact, all the data suggest this illness is startlingly similar to flu. Crude mortality from CV19- 4.2 per million. Flu- 100 per million last year, 50 per million this year. Range of illness is similar, as is distribution- a large number asymptomatic, a large number mild, few severe, and some dead. Deaths from both are concentrated overwhelmingly among those over 65 and with cardiopulmonary comorbidity. Only in NYC are hospitals being swamped. I have two friends in Delaware, one a pediatrician. He reports his practice is swamped (I believe him) but data show otherwise- 143 total cases (91 New Castle, 19 Kent, 33 Sussex); 1 death, 13 hospitalized (there are 400 ICU beds in Delaware).
So what is going on here? Our social media and news media are acting like a laser box. They take inchoate signal and by bouncing it between mirrors of anxiety produce a focused, destructive beam of panic.
Government is trapped in a paradigm of having to 'do' something, and over-reacts after being under-prepared. This is sadly typical. Californians, in response to their drought, stopped serving water at restaurant tables, watering their lawns or washing their cars. These measures had absolutely no impact, as any engineer would tell you, since 90% of water use in California is for irrigation or industry, and most personal use is for showers or cooking. Nonetheless, despite the obvious inutility of its actions, government is looked to for 'help', for 'salvation', and so must act.
Plain reason suggests selective quarantine of the most affected areas and vulnerable populations- elderly, immunosuppressed, cardiopulmonary disease- rather than mass quarantine that shuts down our entire nation. The idea we can best protect the elderly by keeping children out of school and basketball players from playing is prima facie ludicrous, but that is what we have done. We have hobbled the very populations not at risk to protect those who could have self-isolated or had visitation restricted. No one will address the question of why we are losing our minds for a disease with a crude mortality of 4.2/millions when we ignore a disease with a crude mortality of 100/million every year.
I think the real driver of our panic is we realize our enemy, and we can't stand it. America has had the convenience of an external enemy for 50 years- 1940-90. Without one, we have become focused on our lifestyles rather than our productivity, happily outsourcing everything dirty and difficult, making less and less of what we consume every year. We are fat, lazy, whiny, and consumptive. And we know it, and we hate ourselves. We direct that self-hatred into rage at the opposing political party, or China, or something. Anything and everything except ourselves. The response to this non-crisis has revealed much about America' current character. There is no viral apocalypse, only an ongoing crisis of zeitgeist in the American soul.
Ted
Of course CV19 is being treated like a devastating, life-threatening illness. I'll give away the conclusion- I don't think it is. For my heresy I have been called all manner of names. I have been preached to about the importance of quarantine, about selfishness, risk to the elderly, the devastating infection risk. I've been called a virus denier, told several times in forceful tones that Fauci knows more than I do. One person on Facebook asked me 'are you an immunologist? Because if you're not I'll put my faith in the experts.'
One of my teachers was a famous fetal physiologist, Karlis Adamsons. He taught us journal club, and would always ask the students their opinion. He would say 'you are not more stupid than your teachers. You've just read the book fewer times.' I took statistics twice, and have taught it a couple of times as well. In running journal clubs for years I have told students and residents to read the methods and data and form your own conclusions before you read the paper's. If you reach a different conclusion, ask yourself whether your knowledge and understanding is lacking, or if the authors are simply confirming their biases through circular reasoning disguised as 'research', a surprisingly common problem, particularly for narrow focus experts.
A bit of corona virus background. CV is hardly new. CV is, along with paramyxovirus and adenovirus, a major cause of flu-like illness, patients who present with cough and fever but have a negative flu swab. Since the vast majority of these patients recover uneventfully there is no further testing done in most cases. There are a couple hundred serotypes of CV, most in bats. Every once in a while there is crossover into the human population. The most common vector, as it is for ebola, is the handling of carcasses or meat of infected animals. There have been a couple of new CV outbreaks in the last 15 years, all from China- MERS, SARS, and now CV19.
There has been a persistent problem in the reporting of data on the illness. First cases were diagnosed only among hospitalized patients. Of these, 5-9% were dying. As the outbreak spread diagnostic criteria were loosened to include outpatient cases, and total cases soared in part because of definitional changes. The death rate of the sickest, hospitalized patients, however, was applied to the larger denominator of outpatient cases. It was then rapidly discovered that most cases were mild, but the mortality rate of the hospitalized was still applied to them. Now we know that over half of cases are asymptomatic, but still the higher mortality rate is applied.
This is a classic statistical error- applying results outside of the subset in which they were generated. There are many examples of this mistake being made. The Denver growth curves for infants and children were used for years, until it was realized that growth was going to be different at 5000 feet of altitude than at sea level. Cardiac data for men was applied to women, despite their being marked differences in cardiovascular physiology.
Every year, thousands of elderly people die of pneumonia. It is one of the leading killers of the elderly, for many reasons. Nearly 90% of all pneumonia deaths in the US occur in those 65 and older. The death rate for gram negative pneumonias in the elderly exceeds 20%. We know this number does not apply to young people getting pneumococcal or atypical pneumonias in an outpatient setting. Everybody knows that. Except that is precisely the analytical error being made.
This mistake produced the wild claims of millions of dead. The US population is 330,000,000. If 50% became infected, and 20% of infections needed hospitalization with 5% dying, we get 165,000,000 infections, 32,000,000 hospitalizations and 8 million dead. Our media promptly promulgated such numbers, somehow finding talking heads that would corroborate the calculations.
Except they are obviously, instantly provably, wrong. The simplest look at the data showed mortality was 1% when calculated across all the then-symptomatic cases (meaning mild symptoms and asymptomatic persons were not included). Fauci, the director of the National Institute for Allergy and Infectious Disease (NIAID), a part of NIH, has made explicitly clear in writing that mortality is likely to be far lower than this, as early as late February. Despite this, the media persisted with lurid stories of a viral apocalypse, and added political fuel by saying Fauci was being muzzled by Trump. Fauci has repeatedly denied this, but clearly by this time facts were not being allowed to interfere with a good story.
Fauci noted mortality was likely to be much lower, and epidemiological studies, looking at mortality rates throughout China and talking into account the likely number of asymptomatic patients, found mortality not of 5% or 1% but 0.04%.
There are ongoing problems in ascertaining the extent of infection, since so many are asymptomatic. The US has a crude reported mortality rate of 4.2 per million population and 1.48% of confirmed cases. In many areas only the sickest get tested at all, and in all cases the asymptomatic are omitted. The death rate is almost certainly 1/3 to 1/10 of the current reported number; ie, 0.5 to 0.1%, and testing is grossly incomplete.
There are areas of much higher mortality. Wuhan was one, and New York City is another. We don't know why, although various factors are likely at work.
Various other 'facts' are being used to stoke continued panic. We are told in breathless terms this is likely to be cyclical and seasonal, implying we are going to have to shut down our nation every year. Infectivity is 10 time worse than flu, which is impossible since when exposed to flu virus 100% become seropositive for antibodies, even though half show no symptoms. You can't have 1000% infectivity.
In fact, all the data suggest this illness is startlingly similar to flu. Crude mortality from CV19- 4.2 per million. Flu- 100 per million last year, 50 per million this year. Range of illness is similar, as is distribution- a large number asymptomatic, a large number mild, few severe, and some dead. Deaths from both are concentrated overwhelmingly among those over 65 and with cardiopulmonary comorbidity. Only in NYC are hospitals being swamped. I have two friends in Delaware, one a pediatrician. He reports his practice is swamped (I believe him) but data show otherwise- 143 total cases (91 New Castle, 19 Kent, 33 Sussex); 1 death, 13 hospitalized (there are 400 ICU beds in Delaware).
So what is going on here? Our social media and news media are acting like a laser box. They take inchoate signal and by bouncing it between mirrors of anxiety produce a focused, destructive beam of panic.
Government is trapped in a paradigm of having to 'do' something, and over-reacts after being under-prepared. This is sadly typical. Californians, in response to their drought, stopped serving water at restaurant tables, watering their lawns or washing their cars. These measures had absolutely no impact, as any engineer would tell you, since 90% of water use in California is for irrigation or industry, and most personal use is for showers or cooking. Nonetheless, despite the obvious inutility of its actions, government is looked to for 'help', for 'salvation', and so must act.
Plain reason suggests selective quarantine of the most affected areas and vulnerable populations- elderly, immunosuppressed, cardiopulmonary disease- rather than mass quarantine that shuts down our entire nation. The idea we can best protect the elderly by keeping children out of school and basketball players from playing is prima facie ludicrous, but that is what we have done. We have hobbled the very populations not at risk to protect those who could have self-isolated or had visitation restricted. No one will address the question of why we are losing our minds for a disease with a crude mortality of 4.2/millions when we ignore a disease with a crude mortality of 100/million every year.
I think the real driver of our panic is we realize our enemy, and we can't stand it. America has had the convenience of an external enemy for 50 years- 1940-90. Without one, we have become focused on our lifestyles rather than our productivity, happily outsourcing everything dirty and difficult, making less and less of what we consume every year. We are fat, lazy, whiny, and consumptive. And we know it, and we hate ourselves. We direct that self-hatred into rage at the opposing political party, or China, or something. Anything and everything except ourselves. The response to this non-crisis has revealed much about America' current character. There is no viral apocalypse, only an ongoing crisis of zeitgeist in the American soul.
Ted
As Walt Kelly's star character, Pogo, stated, "We have met the enemy and he is us."
ReplyDeleteI totally agree with everything except the last paragraph. It's obvious that this is not an actual, serious pandemic. Take measure precautions and stay healthy. The same things we do every year for the flu.
ReplyDeleteI agree that America has become its own enemy in many respects, but I don't think it's because of the fall of the Soviet Union. This delves deep into a conversation that I think is best saved for another time, but America's self-cannabalizing behavior isn't strictly tied to lack of external enemies, or change in values. However, I do agree that our response to the disease represents many problems in our country and many other western countries.