Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
We Have Met the Enemy and He Is Us
This year in the USA we’ve had around 35 million cases of influenza with around 35,000 deaths, for a fatality rate of 0.1%. That’s a pretty typical year, although a couple of years ago we lost 80,000 people one flu season. That was considered to be a bad year, but it barely made the papers. After all, it’s influenza. It happens.
Meanwhile, we’ve had a grand total of 282 deaths from COVID-19 so far and not only has this made the papers, we’ve essentially shut down our society and our economy. This has struck me as odd from the beginning. I’ve had the feeling that I simply must be missing something. So I’ve spent the last few weeks reading all the data I could find on this topic from the World Health Organization, the CDC, and various other data sources. Today I read an outstanding article from Aaron Ginn. I know a lot more about COVID-19 now, but I’m still confused.
Let’s consider three countries and their experiences with COVID-19:
- Italy has 778 cases per million population, with a fatality rate of 8.5%.
- South Korea has 172 cases per million population, with a fatality rate of 0.1%.
- The United States has 67 cases per million population, with a fatality rate of 0.1%.
Italy has essentially locked down its entire country. South Korea has done very little in terms of public policy but has encouraged common-sense personal hygiene practices, like hand washing. The United States is somewhere in between. So suppose you’re a politician and you’re trying to explain the benefit of draconian government actions in response to this virus. How would you present your argument, based on those numbers?
The best controlled study group we have available for this disease is The Diamond Princess. From an infectious disease standpoint, this was close to a worst-case scenario. During its two-week “quarantine,” it turned into essentially a floating petri dish. It had 3,711 people on board, including staff and passengers. It started out with ten COVID-19 cases. Two weeks later, it had 705 cases, and seven of them died. What a fiasco.
But let’s stop and think about that for a moment. First of all, with 705 cases and 7 deaths, that means a fatality rate of 1%. And remember that this is an extremely elderly population, away from their homes, under living conditions that were far from ideal, in a closed environment that was absolutely flooded with the COVID-19 virus. Health care facilities were woefully inadequate. The average age on the Diamond Princess was 58, and 33% of the passengers were over 70. All seven of the deaths were in those over 70.
There were no children on board, to skew the numbers toward the more mild form of COVID-19 that children get. Only old people. Old people who are traveling, tired, away from home, and spending two weeks sitting in their tiny cabins in a floating petri dish being flooded with the COVID-19 virus. And of those 3,711 people, there were 7 deaths.
So of the 3,711 (mostly elderly) people trapped in that worst-case scenario, 0.2% of them died.
Surely we can do much, much better than that 0.2% fatality rate here.
The American population is much younger and healthier than the Diamond Princess passengers, we are not cooped up in a floating petri dish for weeks at a time, we have good health care facilities, and we can respond to problems much more quickly and intelligently than they did.
Plus, huge segments of our population are not seriously threatened by COVID-19. Children, for example.
An article in JAMA from February pointed out that of the 45,000 cases of COVID-19 in China at the time, only 2% were in children, and there were no deaths in children under 10. So far this flu season, we’ve lost 136 children to influenza. But COVID-19 does not seem to threaten kids. On March 8, the Korean Centers for Disease Control and Prevention reported that South Korea had 6,300 cases of COVID-19, but no deaths in anyone under 30.
The World Health Organization has been studying COVID-19 all over the world for months now, and reports: “Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around. And the children tend to have a mild disease.”
So children do not seem to act as a vector to give this disease to older family members. And if older family members give the disease to children in the home, children get only a mild form of the disease.
So why are we closing schools? Not due to data or evidence, that’s for sure. “Just to be safe.” Or “out of an abundance of caution – it’s all about the children.”
Ok, but these actions are not without consequences. Much of the hoarding and other unhelpful behaviors we’re seeing right now are not due to fear of the COVID-19 virus, but rather due to fear of ever-increasing government crack-downs on personal liberties.
As Mr. Ginn states, “Infection isn’t our primary risk at this point.”
I’ve spent an enormous amount of time reading, and trying to figure out why we’re responding this way to this virus. I now know a lot more about COVID-19, but I still don’t understand our response.
As I mentioned in a previous post, I think a big part of the problem is that we, as a society, have lost the ability to consider risk-benefit ratios with any semblance of reason or logic. The herd mentality and panic-mongering on social media don’t help. The conventional media earns a living on advertising dollars, so they endlessly repeat the scariest scenarios they can think of, to attract viewers. Politicians, of course, want to exaggerate every problem so they can portray themselves as our indispensable saviors.
There really is no one who is motivated to present a more reasoned perspective. No one.
Plus, people naturally love bad news and are skeptical of good news. A patient can come to me with a headache, I can do a complete history and physical, complete with labs and X-rays, and then finally tell the patient, “You’re fine. Go home and take some aspirin.” And they’ll respond, “Are you sure? I think something’s really wrong…”
Or I can have the exact same patient come in, with the exact same headache, and I can just walk in the door and holler from across the room, “You’ve got brain cancer. You’re gonna die.” And the patient will respond, “I knew it. I just knew it.” They don’t even question me. Because people love bad news.
So, in summary, I think we have a serious problem here, which has no clear solution. A very, very serious problem.
And it’s not COVID-19.
It’s us.
Note: I thank Aaron Ginn for his outstanding article. Please read the whole thing. Some of my writing above was based on (or in a couple of cases, shamelessly plagiarized from) his work. He covers a lot of topics that I skipped, he does a good job citing his sources, and he explains his logic clearly. It’s very long, and I was afraid that most would not read it, so I compiled the above summary. But please read Mr. Ginn’s article. It’s worth your time.
Published in General
To me, the most striking thing about the Diamond Princess “experiment” isn’t the mortality rate, but the fact that only about 20% of the people aboard even got infected. Given the nearly ideal conditions for the spread of the virus, how can it be that 80% of the people aboard avoided it completely? Could it be that this virus is actually less contagious than we’ve heard?
I believe your figures are off by a factor of 10. From Worldometer:
US: 24,173 cases, 288 deaths = 1.2%
S. Korea: 8,799 cases, 102 deaths = 1.2%
Meanwhile, nobody believes the Italian rate is genuinely that high because they simply can’t test enough people.
Similarly, the article you cite heavily from also makes a few basic errors in math or reading comprehension that are quite howling. It has a few decent points, but there are some high-school level mistakes in there as well.
I’ll repeat my standard take:
I don’t believe the case fatality rates are anywhere near as high as the eye-popping figures that keep showing up in the media or can be derived from the case trackers. And it’s certainly intriguing that a maximum of 20% of passengers on the Diamond Princess were infected, although that sample size is still much too small and non-representative to use to make major public health decisions at a global level.
But here’s the bigger point: the case fatality rate is only one factor of many. Other factors include things like how quickly the virus can spread – 200,000 deaths in the US over two years could be manageable, 200,000 deaths in two months in the US would cause pandemonium.
Now let’s take a look at what the virus has actually done in real life: in Italy, the outbreak has been mainly confined to the Lombardy province. In that province, the virus has killed as many patients in two weeks as the flu kills in an entire year, all while the entire province was in full lockdown.
2,500 deaths in 2 weeks among 10 million people – during the most stringent infection control measures of the last century. If we had 75,000 deaths in two weeks in the US there would be absolute chaos.
I’m not predicting that would actually happen if we did nothing. Large-scale projections of that manner are rarely correct. But the current situation in Lombardy shows quite clearly that this virus is a more unique threat than can be appreciated by simply dividing small numerators by large denominators.
Or that some people have a natural immunity to it? I think the Diamond Princess is evidence that a certain segment of the population is naturally immune to this virus, contrary to prevailing theories. If we could develop some type of quick test to find out who those people are, we could go back to sanely isolating active cases and quarantining at home people who are not immune.
Marci, I don’t mean to hound you about this, but you’re still conflating two very different concepts: being immune to a virus and not being susceptible.
People become immune to the virus either by being infected and then recovering, or by being vaccinated (when a vaccine exists). We will soon have a test that allows us to tell who is immune.
People are born not susceptible to a virus. We cannot even be completely sure yet that anyone like this exists for Covid-19, but the Diamond Princess example suggests they certainly do and may even comprise a majority of the population. However, we probably won’t have a test for this within the next year, if at all.
Please explain. I’m not arguing at all. But I’d appreciate some help here. Thanks!
You are correct with “we, as a society, have lost the ability to consider risk – benefit ratios with any semblance of reason or logic” but it is even more basic than that. Through the magic of The Comprachicos of the Mind, too many have never been trained how to think and have never had the basic human drive to think nurtured beyond phone selfies and typing 50 character “thoughts” with their thumbs.
Once a sufficiently ignorant People have been cultivated there is no check on the rest of the system…the sensationalists in the media and the pols (who are predisposed to not be blamed for under-reacting and who have The People’s check book in their hip pocket.) Unfortunately, the system is now working exactly as it has been (re-)programmed to do.
I essentially feel the same way about this as I do the non-interventionist takes on Iraq. How’s that for a connection?
It’s not very hard–in fact, it’s pretty easy–to criticize action because one can reliably point to tangible detriments to the action. Because of that, the side in the debate that has “Resolved: Inaction (or shades thereof) is better” will usually have the edge.
I guess in a week or so we will know more about what our rates are.
What I personally know is that a young, healthy staff member of my organization has it, and is currently in ICU, very sick, with new cardiac issues as well.
The consistent number for fatality I have seen is 10x that of the flu. It is too early in America to know what the # will be for us. I hope it is less.
According to epidemiologists I have seen, this will keep on, become seasonal, and eventually, we will all get it. The CDC predicted 60% of us by the end of the year. If that is the rate, and it kills at 1%, we are talking 1.5 million killed. I keep hearing the flu kills 80,000 a year and is no big deal. Is 1.5 million no big deal?
Oh, I know, people don’t believe it will be that bad. They have looked at the numbers in the media, while the people at the CDC have looked at far more data. They still know better than the experts, because all those people in government are lying about it for reasons, or maybe they are just stupid experts.
I only skimmed through it until a found a few howlers than closed it. Here’s one example:
Quote from the article:
He apparently neglected to read the large box saying “data in the shaded area should be read with caution…”. The reason this data shows a bell curve is because the data simply wasn’t available yet. The data for that time period now exists and shows all of the rates continuously increasing. Face-palm embarassingly bad.
Same section:
Nowhere does he mention that the very pertinent fact that China and S. Korea had human interventions in these cases and would very possibly have had much, much higher peaks without that.
I think inaction is often much more difficult to defend. You look heartless. WHY DIDN’T YOU DO SOMETHING?!?
So our leaders always ere toward action. “See? I did something. Because I care.”
No, because there are tangible actions to point to if one is looking for things to critique. At this point, the costs of scaling back the response (or of having little to no response) are rather vague. One only need to read the posts here about the looming economic disaster–which may well be true–to know the actions of the government are stationary targets.
Ouch. That’s pretty bad.
That may be true. Hard to be sure.
That’s the tough part. “What would have happened if we had done something else?” Hard to say.
But you may very well be right.
Thanks much for helping me out.
Okay. What label would you attach to someone who was not susceptible to it? That’s not his or her immune system at work?
Webster’s defines “immune” this way:
I would accept my usage of the term “immune” as in the first line above. It’s a “natural resistance” of some kind.
I am sure in the laboratory and journal articles, there’s a more concrete definition.
All I have been trying to get at when I’ve written about this subject is that it is clear from the numbers of “active cases” and “critical cases” and those “asymptomatic cases” that some people are not being made sick from this virus.
But from now on, to avoid driving you nuts, I will say, “those who are not susceptible to the virus for some biochemical reason we need to determine.” Would that work for you? :-)
Fair enough. We can’t say yet for sure how much of the turnaround in those two countries was natural or due to human intervention. Comment changed accordingly.
Nonetheless, Ginn’s failure to mention this highly obvious and relevant point knocks his credibility down a lot in my eyes.
@drbastiat If this epidemic is really no big deal, why are the hospitals in Italy and Spain overloaded? Why are the local folks panicking about the availability of an adequate number of ventilators?
Perfect!
It is definitely complicated:
There are people who get sick, recover, and become immune.
There are people who get the infection but are asymptomatic. They also become immune.
Then there are the people who never get it in the first place. They are not susceptible for non-immunological reasons.
This sounds correct to me and I could probably project this as a very likely outcome of America’s shift from agricultural through industrial to the Information Age where more and more individuals are urbanized and become social democrats if not communists. Risk assessment moves from the individual to the collective and the collective leaders behave as described.
This is the part of the story that never seems to make it to the charts I’ve looked at. Thank you.
The doctors and hospitals have been doing an incredible job. Humanity owes them a great debt of gratitude.
Has there ever before been a case in history in which a major country talked itself into its own destruction?
I just finished watching the Director of the Ohio Department of Health, who is herself a physician, give an impassioned plea — complete with statistics and other local information — to take this contagion seriously. I cannot judge her statistics, but of this I am certain. She is a true believer that the drastic measures under way are absolutely necessary to prevent out hospitals and equipment from becoming overwhelmed.
China’s infection rate is 0.006%. I can’t imagine that ours will end up being 10,000 times that.
Of course, you never know. We’re all speculating here.
But my goodness…
Any time a politician intones “if it saves one life …” he or she needs a dope-slap.
I can imagine what led to China’s death rate. They pretended for the longest time that this wasn’t happening. Those jokers could lie the truth out of a multiplication table.
What, I wonder, was the deal in Italy? They weren’t predisposed to ignore the problem.
The Third Reich comes to mind–there may be others. And when this is over, that number will still be one.
Fair question.
First, I’m trying to express that our response is unhelpful and misguided. Not that this is “no big deal.” Closing schools and beaches makes no sense to me, based on the data we have, for example. But should we have some response? Of course. But I think there are better ways to do this. Which I didn’t mention, so your criticism is extremely fair.
COVID-19 has killed 13,000 people worldwide so far, with more every day. It’s a big deal to those 13,000 people. On a planet of 7.5 billion, though, this is not yet having a big impact. Except in certain locations, as you correctly point out.
COVID-19 appears to be very dependent on weather (like influenza), and is very sensitive to UV radiation. So I find predictions that this will persist on the same trajectory through the summer to be unlikely.
Time will tell. I may be very wrong. It wouldn’t be the first time.
But I think that some of our more dire predictions are way, way off.
I heard something from Dr. Grace, the NY doctor who has been using the H & A therapy, that surprised me. He said the Hydroxychloroquinine is an immune system suppressant and is effective because the virus overstimulates the immune system.
Edited to add: maybe that treatment was limited to otherwise healthy patients or other special circumstances, although I guess it would be possible to overstimulate even a weakened system.
Great Courses lecturer said 1% of descentants from Northern Europe are immune to AIDS virus. I looked it up and there seems to be something to it.
China’s official infection rate is incredibly low – but we’ve had to take their word for that. Bad idea.
Meanwhile, 15 million Chinese have dropped off of their cell phone network, but nobody seems to know why. The prevailing theory is that they shut down those phones to keep people in “bad” areas from telling the truth.
The problem we have here is that almost nobody has a mental handle on how fast “exponential” can be. They look at the numbers, frown, and tell themselves that “it’s just not possible.” Then they look for reasons that it isn’t.
He’s probably not using the term in the most precise way. :-) :-)
But something’s happening. :-)