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Dr. Jay Bhattacharya: His new MLB COVID-19 Study and the Dilemma of the Lockdown
Dr. Jay Bhattacharaya from Stanford Medicine makes his third appearance on Uncommon Knowledge in eight weeks, this time to discuss a new COVID-19 survey of Major League Baseball employees he co-authored. The survey tested more than 5,600 employees across all 26 Major League Baseball clubs across the country. The results are yet another data set showing how COVID-19 spreads across geographical and economic lines. Dr. Bhattacharya also discusses the very real health risks associated with a prolonged lockdown and answers some of the questions raised by his last survey of Santa Clara County.
Recorded on May 8, 2020
Published in General
The doctor’s comments about observed transmission — rather, the lack of observed transmission — from children to parents was interesting. I wasn’t clear if that was specifically as regards the Wuhan virus, or if it was about other viruses being tested in the country in question. I’d also like to know the prevalence of the disease among children, given their tendency to be high contact and incautious. (This would only be relevant, I suppose, in countries that did not close schools in the earliest days of the contagion.)
I continue to think that ending the shutdown and focusing on control within the highest risk communities remains the best compromise. Everything Dr. Bhattacharaya said reinforces that opinion.
Thanks for another good interview. I’ll look forward to his next visit.
It seemed obvious that the Dr. is now keenly aware of the publicity from his comments, and was very careful with his words.
That said, I’m still confused by this thing. Serology results pretty clearly indicate that, while this is not the flu, nor is it 10X, and certainly not 20X more deadly. Statistically, it is likely on par.
Yet… That is without a vaccine, without proven treatments (like tamiflu) and known protocols. So why are we reacting the way we are? I suppose it may be wise for the Dr. to say “when it is safe to do so,” but it is never safe. Life is not safe. We don’t expect that it should be. I still see no legitimate reason for us to treat this thing any different than we treat the flu.
If we are not close to herd immunity, we are not likely to see a vaccine, contact tracing is impossible, and treatments as well as our knowledge of vulnerability are increasing… How can we justify anything other than a policy of mitigation of harm, exactly as we do with the flu?
Also, Peter, he never addressed your question about viruses burning out. I would not write that off (particularly the possibility of the virus mutating to be less deadly/more contagious).
The most important conclusion that no one on either side of the debate wants to hear: We don’t yet know.
We don’t know how much, if at all, COVID-19 / SARS-COVID-2 will wane in summer months. If it does wane, we don’t know how quickly it would come back or where. We don’t know what therapies or drugs will prove reliable before the winter. We don’t know how long current precautions and habits can be sustained as economics, politics, and other dynamic forces in life shift.
We don’t know how much patient genetics affect vulnerability. Are blacks genetically more susceptible, only more likely to live in dense populations (like apartments), more likely to work in ideal conditions for infection, culturally less likely to take necessary precautions, etc; all or none of the above?
We don’t know how prevalent the virus is in many areas. So we also don’t know from what starting populations of infected citizens the spread will quicken as lockdown restrictions are loosened. We don’t know how much post-lockdown society will look like pre-virus society due to various fears, concerns, expectations, and non-legal incentives.
Restrictions and culture vary significantly by city, county, and state, so we don’t know when to expect post-lockdown infections to spike or how severely. We don’t know how hospitals (and various other businesses affecting health, like food markets) will adapt or falter in the coming months. So we don’t know how the availability of medical services will manage the ebb and flow of COVID emergencies. Current rates are not indicative of various post-lockdown scenarios.
Dr Bhuttacharya’s analysis is a breath of fresh air for simply admittting what so few will. Whether any kind of lockdown was advisable or not, whether Americans should basically return to their previous habits or not, we just don’t have sufficient information to predict how this COVID-19 saga can or will play out.
Sometimes it is necessary to make decisions without reliable information.
Peoples always and everywhere have considered it morally permissible to defend one’s country from conquest by warring against the aggressor. That is a universal belief because it is universally known that some values are more important than survival. Life serves some greater purpose than itself, so death and injury must be risked by degrees in justifiable pursuits.
Thus, it is not necessary to justify the risking of one life by the risking of another. We must consider more than survival statistics with or without lockdowns and restrictions. We have to consider who we want to be.
In the unavoidable tension between liberties and securities, Americans have traditionally preferred an exceptional emphasis on freedom. Our responses to the virus can and should be different than those of Swedes, Chinese, Koreans, Germans, or whomever else.
Governments and companies at many levels should be playing war games right now. That is, they need to plan for various contingencies and not be caught impulsively reacting if the virus or economy don’t follow the patterns they expect.
For example, because of COVID-19’s infection rapidity (in some conditions, not yet well defined), we can reasonably expect some degree of resurgence when restrictions are lifted in some areas. If the virus resurges more quickly than expected in a particular city or county, those politicians should not reimpose full restrictions in a panic. They should have different plans for different degrees of epidemic. Or they should have decided beforehand to let the virus run its course amid normal economic and social activity… and prepare public expectations for that scenario.
Uncertainty depresses markets more than anything else. Political and economic leaders need to minimize uncertainty by saying now what they will and won’t do months from now.
In Minnesota they keep going round and round about their dumb model. I don’t have the patience to follow it, but it sounds like the state is being very disingenuous.
I don’t see why they can’t say “we have smashed the curve, and now we have to open up to take advantage of the likely attenuation of humidity and UV light”. They are being so stupid about the costs of the lockdown.
If you have enough tests and PPE for the medical system, supply chains, nursing homes etc. you need to open up.
I don’t understand why anyone ever got the message that we should stay locked down until the virus is no longer catchable. Even if this was the black plague, that would not be possible. I don’t know why people have such a hard time coming to terms with the idea that people will die from this virus, and we can’t really stop that from happening.
It makes me crazy that there are Republicans that don’t understand that after you have saved the medical system, you don’t change the number of casualties under the curve. These people are so stupid.
I can’t follow it, but there is a really smart Republican, Phil Kerpin, that says we haven’t even smashed the curve.
I loved his answer to Biden. He didn’t accept the premise of the statement and made the point there are casualties on both sides. He’s not the only one to have said this, but I love the way he framed his answer. Thanks for another great interview Mr. Robinson.
We in the Western World have a very hard time accepting our own mortality. Firstly, death is scary. Secondly, without G-d death becomes a ‘guaranteed’ void. Thirdly, death reminds me us that we are not G-ds controlling everything and it is therefore in it’s own way, a refutation of leftwing utopia.
The third one is the biggest difference between the left and the right in response to Corona. According to some recent studies, we could have gone with the Swedish model and about the same number of people would have died. The left cannot accept. The right sighs wearily and goes back to work.
Thanks, Peter. This interview filled in the picture for me in several areas.
Thanks to both Peter and Dr. B for the interview.
This is not good news. The MLB employees are not a representative sample of Americans, but I don’t think that the people subject to the other antibody tests were representative samples, either (they were not in the SF bay and NY studies, but I’m not sure about the others).
With that caveat, I think that the top-line result was an infection rate of 0.7%. Applied to the US population, this is about 2.31 million infections. Worldometer reports 83,315 deaths. This implies an IFR of 3.6%. This figure is about 10 times higher than what has been suggested by other studies.
If we assume that 60% of the population will eventually be infected, this implies over 7 million deaths in the US.
Dr. B said something interesting — something like the existence of “a steep socioeconomic status gradient.” Which means that this disease seems to be hitting the poor much harder than the non-poor. I didn’t get the impression that it’s a question of “the rich” having a low infection rate, but it seemed from the discussion that this extends to the middle class. I’d like to see a good analysis on this.
I’m uncomfortable with small samples taken over wide areas. As the good doctor said, the MLB group was relatively affluent; the institutions for which they worked made significant efforts to limit the spread of the virus; and there were no fatalities in the sample population. It seems likely to me that infection clusters in much the same way death clusters (excluding nursing home concentrations), and so I would be interested in knowing how many fatalities occurred in communities from which these samples were taken, and how that compares to the national distribution of fatalities.
Actually not so. It matters greatly which 60% are infected. Not everyone is equally likely to die, if infected. Some are at much higher risk than others.
We should indeed reject the false dilemma of choosing between two bad options: everyone exposed like normal or else everyone trying to shelter forever.
All viruses are unable to reproduce unless they can reach some susceptible host cell and hijack its machinery sometime before the virus degrades into oblivion.
Think of it like the virus is trying to cross a stream by hoping from one exposed rock to the next. If it cannot find a next rock, it’s stuck.
The ways to prevent transmission are either through quarantining / social distancing (the rocks are too far apart to jump) or by filling the space in between with people who are immune, whether due to a vaccine or having had the virus. Immune people are like submerged rocks that cannot be used for crossing. Enough of them gives herd immunity — the virus cannot cross the stream.
I quite agree that the most sensible near term course is keeping households with those at greater risk safely apart while proactively promoting immunity among those who have the least risk from the virus. If they can acquire immunity, then the others who are at greater risk become safer too.
This would be far better than leaving it to random chance who eventually gets the virus. Smart herd immunity is something we should intentionally aim for while minimizing risk to those who are most vulnerable.
Even though Dr. Bhattacharaya correctly says “There are no safe options”, still there can be options that are much safer than others.
A recent exhaustive study tested all of the passengers and crew that had been on an isolated cruise ship with an outbreak of Covid-19. Out of all those who became infected, 81% had no symptoms at all.
COVID-19: in the footsteps of Ernest Shackleton
Alvin J Ing, Christine Cocks, Jeffery Peter Green
One clear caveat is that we don’t know to what extent this result for the crew and passengers of this ship would be representative of the general population. But this result is generally consistent with Dr. Bhattacharaya’s earlier result that the number of people who have had it in Santa Clara county was 50 to 85 times the number of identified cases.
Even if only 70% of the population get either no symptoms or very mild symptoms, that would mean that it might be possible to approach herd immunity with very low consequences — provided that we identify and protect those at heightened risk for more serious consequences, while those at low risk are exposed and developing antibodies.
It might even be worth considering letting low risk people have controlled low does of the virus under controlled conditions, instead of leaving transmission to chance encounters.
If the seriousness of the symptoms depends at all on the quantity of virus one is exposed to (due to large quantities being more difficult for the body to defend against), then it might be quite prudent to be intentional about getting exposure to a controlled dose of the virus.
Thank you!
Most positive cases are asymptomatic which means they are also less infectious.
According to Worldometers, 3 to 5 percent of positive cases are ‘serious/critical’.
On the Diamond Princess ship, the rate of infection was 20%. 80% of the crew and passengers tested negative despite exposure. This is why I think 60% infection rate is impossible – a cruise ship was 20%!
Most people will not be infected if exposed.
If infected, most people will display zero or mild symptoms.
I think schools and bars should open because these are young people, age 3 – 39.
What’s wrong with large sporting events? If everyone who attends is under age 70, the risk is low… what am I not seeing?
For the exhaustive study I linked to of an isolated cruise ship, they had a different result.
So it can actually happen on a cruise ship that even after a short time one can reach about 60%.
Since herd immunity isn’t an all or nothing flip switch, the higher the percentage of people who have gained immunity, the more difficulty it is for copies of the virus to spread from an infected person to a reachable susceptible person before they naturally degrade.
As we open up (while maintaining heightened safety for those people at heightened risk), the more that low risk people gain immunity, the safer it will be for those at higher risk.
Diamond Princess had over 3700 passengers and crew on board