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A Worthy Counterpoint by Emergency Room Doctors
One of my sisters is seeing a drastic slowdown in medical laboratory employment in Washington state. This is a predictable side effect of Dr. Fauci’s “public health” fraud, in which he has consistently misrepresented his unconstrained opinion from a mere slice of the whole field of public health as a fully informed recommendation.* This was simply not the case from Day One, with real public health including suicide prevention, substance abuse treatment and prevention, domestic abuse of every flavor, and prevention and early treatment of lethal diseases, including cancer, diabetes, heart diseases, and stroke. All of these are being predictably aggravated as known side effects of Fauci’s flawed prescription for treatment of the Chinese coronavirus.
We will, indeed, face a public health crisis as the country re-opens, as the healthcare system gets slammed by patients with delayed, worsened conditions at the same that everything from the local lab to the largest hospital scrambles to get staff back to work. Hear it from two ER doctors from California [hat tip to John Hinderaker at Power Line]:
President Trump did not hold a press briefing on Saturday or Sunday. I very much hope he was sent these very popular videos as a needed counterpoint to the “public health” bubble in which Dr. Fauci has wrapped him and the nation. President Trump has been the only one in the White House briefings actually acknowledging real public health includes suicides and substance abuse deaths. He needs credentialed experts to stand up to Fauci, forcing the good doctor to acknowledge that which every medical professional already knows on some level.
* I will back up this very provocative claim in a further post, and will refer to it in the comments here.
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Nothing bizarre about doubting the expertise of two thinly credentialed ER docs pontificating out of their field (really ER docs expertise in immunology & epidemiology-LOL). Notice I said you can argue the merits of the lockdowns-but not the seriousness of COVID-19. With the benefit of hindsight, it is becoming clear that places like NYC need different policies than much of the US-but that is only AFTER we have had time& experience -which the lockdowns bought for us. Reopening isn’t going to be easy, b/c if we do it wrong we might need a 2nd lockdown-which would be much, much more painful than the 1st. Foolishly acting like COVID is nothing but the flu will likely lead to poor policy. How we “reopen” bars, restaurants, churches and sporting events is very dicey-in truth opening many business is much easier (if we take reasonable steps to limit liability for catching COVID). Until a vaccine is available we will still need to limit certain gatherings & dense urban areas dependent on mass transit will take some serious consideration. Going forward we need avoid the Scylla of carelessness and the Charybdis of petty tyrants like Whitmer.
It sounded to me that one reporter was more hostile. The other 2, were more interested in probing the doctors’ facts and assessments to deepen their understanding. The doctors did say that the lock down at first was the correct course of action. But now we have the data, not models based on theory, and continuing the lock down does not make sense. The doctors are challenging the accepted practice that the media has been presenting to the public.
It is not irresponsible for the reporters to challenge these doctors just as it is not irresponsible for reporters or us to challenge Dr. Fauci, etc. These reporters may be hearing something they’ve not heard before. I teach & it takes time for my students to process new information.
The message I heard from the doctors is that we now have data instead of computer models. The data reveal rates of infection, mortality, etc. Locking down has suppressed our immune systems so the public is now more at risk of contracting additional diseases. Regions with the US are seeing different rates of Covid. It’s time to begin opening the economy & schools.
I’m a Ricochet member & have been reading critiques of stay safe at home, listening to accounts of problems that are occurring while Covid 19 is happening (suicide, addiction, abuse, etc), so I intellectually I am more open to reopening.
I’d love to see our schools reopen. My students are tired of staying home and learning via Zoom or Meet just isn’t the same as being in a classroom. My school-age daughter is not thriving with remote learning. She wants to go back to school. She needs that interaction with her teachers, friends, and classmates.
The reason they did that was that they could see what was happening in Italy, where the hospitals were overwhelmed. They could hear what the experts were saying, that COVID-19 would be many times worse than the flu if nothing was done.
That we dodged that bullet is testimony to the effectiveness of the effort to suppress the virus here in most of the US. That’s not to say that the policies are without flaws
Maybe. Or maybe the situation was different enough here in the States that most hospitals were never going to be threatened with being overwhelmed.
Roderic, no, the absence of an even worse catastrophe is not evidence of the effectiveness of mitigation efforts. Saying it over and over is not going to make it so. We do not know whether various policies have been effective. I expect that many of them have been effective, to some degree.
You’re mixing up case fatality rates with infection fatality rates. They are very different things.
I agree with Mendel. I only watched the first 6 minutes of the first video. It suggested that the doctor was completely clueless.
At 4:05, he said that they had tested 5,213 people, 340 of whom were positive, so he said this was “6.5% of the population.” It’s not clear whether he meant that these were the results at his hospital, or in his county, which is Kern County (population about 900,000).
You cannot assume that the people tested for COVID-19 were representative of the general population. He seems to make this assumption, which is completely wrong. I mean, shockingly wrong. It’s like an ER doc saying we had 100 patients yesterday, and 3 had gunshot wounds, so that means 3% of people in the county were shot yesterday.
At 4:40, he cites figures for the state of CA, 33,865 cases, 280,900 tested, so he concludes that 12% of Californians are positive. At 5:20, he applies this percentage to the population of CA to conclude that this “equates to 4.7 million cases” in the state. This is nonsense, because once again, he assumes that the people tested are representative of the population.
At 5:30, he says that there have been 1,227 deaths in CA, and with a possible prevalence of 4.7 million, this means you have a 0.03 chance of dying. He didn’t even say 0.03% — he left out the “percent” — though I assume that this is what he meant, because a “0.03 chance of dying” is actually 3%. Using his flawed figures, I calculate a 0.0261% proportion, so he must have meant 0.03%.
But this, too, is nonsense, because it relies on his hugely inflated prevalence figure.
This is what Mendel is getting at. I’m not going to watch an hour-long video that has such glaring errors in the first 6 minutes. Frankly, this does not give me much faith in our medical system, if these guys really are ER docs, but perhaps numbers simply aren’t their thing.
Mendel’s big point — and I totally agree — is that this video is worse than useless. The doc makes a good point at the beginning, that hospitals in most places are empty and people are being harmed because they are not seeking medical care, out of misplaced fear of COVID-19. But making this point with obviously flawed and meaningless numbers undermines his credibility, which is a shame, because the correct numbers make the point.
It’s a valid point. Medical practitioners face this dilemma almost every day. You treat one illness and it causes another.
In Massachusetts could this internal problem have been caused by decades of over-regulation of the practice and licencing of medical professionals?
Are hospitals over reliant on Medicare and Medicaid reimbursements which have jeopardized their financial health?
In Los Angeles, one of the oldest hospitals is Good Samaritan (famous patients include John Wayne and Robert Kennedy). The hospital still has coin operated pay phones on each floor.
Killing them without actually killing them
Holman Jenkins column in WSJ : “The Lockdowns were the Black Swan”:
Combined with Andy Kesslers : “What Shape will the Rebound Take?”
The death figures you cite are for the world not for the US. For the US, the death figures for both 1958 and 1968 are closer to 100,000.
From that same Andy Kessler column:
I think they can view the url and see the comments
South Korea CFR is under 2%.
2.2% is too high.
The covid-19 situation in Italy says more about Italy than covid-19. Italy’s hospitals could not handle the flu ‘epidemic’ in 2017-18.
Roderic, I agree with much of your #27, but I think you’re incorrect about the following.
I don’t think that your math is correct here. You have a valid point, but your numbers do not make the point. A test with 99% specificity would have a hard time picking up low levels — say around 1% — but I don’t think this would present a problem at 5%. It would depend on the number of people tested, and would depend on the sensitivity of the test, too.
I’d like you to point out the page and line in the ICL report in which they said that their measures would result in just 60,000 deaths. I have not found it. The prediction was 2.2 million, or maybe 1.1-1.2 million with mitigation. I just haven’t seen a 60,000 figure.
I think that the ICL report was the thing that was ignorant and irresponsible. They had no idea — and still have no idea — how effective various mitigation strategies would be. I think they made a complete WAG on this point. I don’t know why you continue to like their model so much.
There was a world of difference in the two countries’ medical logistics and infrastructure, which is why Fauci knew up front that Italy was less prepared than Mexico for a pandemic. He knew from the beginning that we had base and surge capacity far beyond any other country, which is why those inconvenient numbers were not applied to quantify the cocktail napkin model turned into a live experiment on our public health.
I had “Asian Flu” in 1957. I was in college and we did our rushing in the fraternity house while in bed.
And Jean Harlow. I spent a few years there, but in the old hospital.
I checked my mother’s diary. Apparently none of us kids got the flu that fall, but the teacher of our school did, so there was no school for a few days. Back during February 1957 my mother had a long bout with what she called the flu, and my brother was down with it for a few days. I may have had a quick bout of something, but hardly anything to mention. But the reason I do mention it is that when my brother was sick and Mom was home with him, my sister (age 5) and I (age 8) went to evening service at church (we lived in the parsonage next door) and came home telling about a bat that had been flying around in the church during the service. I do have a vague recollection of something like that. “After church some boys went after it & caught it. John [that’s me] said they wanted to put it in a jar. I asked if they didn’t want to kill it and Carol [my sister] remarks, “We have enough meat anyway.”
Already back then she was thinking about the Wuhan wet markets, maybe.
A year after the fall epidemic the Fremont (NE) Tribune had an article recapping the previous year’s flu. Here are some quotes:
The article goes on to talk about the efficacy of vaccines and the recommendations of the WHO. It doesn’t say anything about the new normal and whether life will ever be the same again.
Jerry covered it very well in his comment above. In a nutshell, to estimate the total rate of infections in a county (or city, state, country, whatever), you need a representative population. That’s difficult to come by in the best of cases, but it usually involves testing a random selection of the population.
The people who come to an urgent care clinic are anything but random. Almost by definition, healthy people don’t seek medical care, so we can expect that the people they tested are highly enriched for coronavirus infections.
Another reason I’m skeptical is because their results aren’t in line with other findings. Even the two studies by Jay Bhattacharya, which have been strongly (and in some cases justifiably IMO) criticized for overstating the prevalence of Covid-19 in California, came up with prevalence figures that were much lower (and fatality rates correspondingly higher) than these ER doctors.
There’s also the fact that at least 0.1% of the total population of NYC and Detroit has died of Covid-19 (the reported figures are higher, I’m intentionally being very conservative). Since this virus almost certainly can’t infect 100% of the population, that would place the infection fatality rate somewhere above 0.1%, or more than 3x higher than 0.03%. Even factoring in different demographics, health levels, and health care levels, a gap that huge doesn’t pass the smell test.
Yes, since we don’t know exactly what their testing policy was and who they actually tested, we can only make well-reasoned assumptions.
And one of those, as I said, is that most people probably wouldn’t make the effort to get tested unless they had some reason to suspect they had been infected.
Also, because California has such limited testing, most guidelines specify that people with no plausible reason for being infected (i.e. no symptoms and no known contact with an infected person) should be denied testing. Don’t know what guidelines this facility used (as I mentioned before, I didn’t watch the whole thing). Maybe they clarify this.
Well I watched most of the first video before YouTube took it down for “violation of terms of service:. That part contained the docs talking about local stats and math. This is insane.
There’s been a study launched this week by Massachusetts General Hospital to test a broad sample of a thousand people for antibodies:
I’m excited about this because it is the most important piece of the information puzzle at this point. It will gather some information–not yet definitive but very helpful–on whether the asymptomatic people have produced antibodies or if they are walking around during the quiet-phase, warmer months infecting people so that when the weather turns gray and cold in November, the virus will reemerge a millionfold.
If people are actually developing antibodies from low-viral-load exposure, then we may see effective “herd” immunity in a year or two. (The herd immunity effect will not take off during the first phase, that is, the first wave, of this contagion. I wish people would stop saying that by opening up the country completely, we’ll reach herd immunity quickly. That will not happen as much as I and others wish it could.)
So did the doctor in your next comment. That was my point. Why did he test them? because they were cases in his ER.
From what the government of South Korea calls “cases”, it is accurate.
244 deaths in 10,752 cases. Actually, rounding up, the CFR is 2.3%. The result surprised me, too.
The SK population is about 51,260,000. Let’s pretend I know what I’m doing:
Assumption 1: The people testing positive were tested 10 times before they were cleared, and ~500,000 were cleared the first time and not retested*; that would mean they’ve tested about 1% of their population.
Assumption 2: That 1% is representative of the population.
With those assumptions, ~922,000 individuals in the country would have had a positive test; the IFR would be about 0.03%
* SK tried to keep R0<1 by quarantining everybody who tested positive and tracing their contacts and testing them. When you only have to do that to .02% of your population, that’s doable.
Hopefully we’ll never see you proved wrong.
You can say that again.
Saying it over and over is not going to make it so.
From the standpoint of diagnosing a single case the high rate of false positives with low prevalence is a problem because it means that without other evidence of illness you can’t make the diagnosis with an antibody test. If you separate out a group of patients that have typical symptoms then you have a group in which people are likely to be positive 20% of the time, and the antibody test is meaningful in that case.
As I’ve already posted, the specificity of the test the Stanford group used does not allow them to conclude that the true prevalence of asymptomatic COVID-19 is non-zero. They make that claim, but they are wrong, and professional statisticians back me up on that. If the false positive rate is 1.5 % and your results are 1.5% positive you can’t claim that the incidence is 2-4%. That’s just common sense.
That was in a digital appendix to the report that was linked here in Ricochet early on. I know you saw it because you commented on it.
Of course they have a good idea from studies of previous epidemics about what will work. These ideas have been tested many times.
I like their model because it turned out to be so accurate. Good predictive power in the face of myriad possible outcomes is the sine qua non of good theory.