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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
Weren’t they different interventions? One was a lock down, the other increased testing and tracking?
One note on school closures. It isn’t just about the children, it is the staff and faculty as well.
This is the current CDC map for today. New York is in bad shape.
The one thing I keep looking for is whether someone has done full, detailed genetic sequencing and comparison between the strain found in Italy and the strain that’s being seen in the US.
What if there’s some slight difference that makes one much more lethal than the other? Not enough to be picked up by the standard tests, but enough to make one relatively mild? That sure would explain some of the confusing aspects of this.
I couldn’t find a mainstream source (or one I knew was reliable) for this. Do you have one?
Perhaps a much older group of people are infected?
Good point.
And about the parents and grandparents. Children are notorious innocent spreaders of disease.
Looks like the CDC takes the emergency off for weekends. And the Michigan numbers are lagging by a couple of days, in comparison to the Johns Hopkins numbers.
National infection and death rates are meaningless, as not all regions are affected. We have clusters around NYC, California and Washington state.
In Italy, the disease is concentrated north, in Lombardy, devastating my beautiful Bergamo.
So what are the population infection and death rates in Lombardy, in Milano, in Bergamo? These might tell us what to expect in Queens and Brooklyn, and any other major city that becomes a nidus.
I think what we are witnessing is the Precautionary Principle. Nassim Taleb is a big fan, William Briggs not. Both statisticians, both convincing.
From Briggs regarding Taleb: “The PP says that if a devastating thing could happen, then that thing ought to be protected against, and that the level of protection should be proportional to the potential devastation.”
But WIKI says measures should be re evaluated as information comes in and proceed with caution.
I think we are operating under the BAG method myself. Big A Guess.
Exactly. Do you remember months ago, when people were demanding we “do something” about the Kurds in Syria, because there was going to be a genocide. Did that silently happen? Or, did it not happen? I am skeptical of anyone who says says “we have to do something” and doubly so for anyone that says “for the children”.
Not really – but so far, everyone who’s looked at the numbers seems to agree that they’re accurate (they reflect the numbers on the sites of the Chinese telecom companies) and that nobody has a solid explanation for the problem.
The people who are most adamant about it not being a problem seem to be following the same script, too. “Fifteen million people just turned off their phones because they were out of work for a few weeks.”
Which makes zero sense. When you’re out of work, and your only communication channel is your phone, that’s the last thing you turn off.
Weren’t all of them sent to their cabins to self-isolate for two weeks?
Yes. But several of the staff was infected – they served the meals. The air circulation system was not designed for isolation. They were kept in their cabins, away from UV radiation and fresh air. A Petri dish.
There are 8 now dead on the Diamond Princess, and I beleive 10 others are still in critical condition. That said, its an interesting example. I’d not realized the average age was so high. 58 is even high for cruises. The one caveat I can think of is that people on cruises presumably are free of conditions like COPD or serious heart ailments…..which is where WuFlu does most its damage. So,its hard to extrapolate from a self selected group, even an old one.
Maybe the average age includes the crew? They are much younger.
Makes passengers even older, huh, I think we can conclude that cruise lines lie in their marketing literature about all the young hipsters they have, when cruises are really an old folks home on the ocean, just as expected. But, are they very healthy old folks? IDK.
Just a couple of data points from Spain to bring perspective:
On the flu vs Coronavirus argument. Spain had about 3525 deaths due to flu in 2017 (with 2232 in January, by far the worst month). So far this month (21 days) Spain has had 1381 fatalities from coronavirus with the worst predicted to come next week. So, probably, March will see a larger number of deaths by coronavirus than they will have due to the flu in the whole year. Even if you point out that there may have been years with larger numbers of flue deaths, still pale in comparison, to what this virus may be able to do.
Last year, approximately 435000 people died in Spain. That comes to an average of 1192 per day, 8342 per week. Last week, around 300 people died from Coronavirus in Spain, which is about 3.6% of the expected weekly rate (assuming similar numbers of fatalities this year). This week is probably going to be about 1400 fatalities from coronavirus (more that 1000 so far in 6 days), that’s 16.8% of the weekly rate. Yes, nobody knows how long this is going to last, but consider that Spanish people have had to stay at home for 7 days now and the number of cases and fatalities continue to go up and up every day. Also consider that Spain has one of the healthiest populations in the world (2nd on life expectancy) and one of the best healthcare systems in the world. We shall see in the next two-three weeks.
Regarding China and South Korea, they had massive State-sanctioned interventions as has been pointed out. Also, I would not believe Chinese numbers. Finally, in their case, the source was a single city, not several places at the same time, like in Europe and the US. I still think that Korean numbers are a good indication of the cases/fatalities rate (because of their high number of tests), but bear in mind that a lot of people there are listed as not-recovered, so wait an see a few more days to get a better appreciation on that (right now 0.9%).
I don’t think that this is correct. New York has 11,729 reported cases, with a population of roughly 20 million. That’s about 0.06%.
Also, those are reported cases, not serious or critical cases. I don’t know if the Worldometer information is correct, but it reports only 64 serious or critical cases in the entire country.
My data source is Worldometer (here).
Beware of scary charts and maps.
Good post, Doc B.
I have a hypothesis about the hysteria. I suspect that many medical doctors are not very good at probability, statistics, and mathematical data analysis. There is no reason that they should be, as this is not their area of expertise. It is pretty weird for a lawyer like me to be knowledgeable in this area.
Also, the news reporting on the actual figures seems to be quite atrocious. Most of the publicly available graphs are sensationalist and misleading. I’ve been trying to address this with my periodic posts on the subject.
Most medical doctors, then, probably have neither the time nor the expertise to perform detailed data analyses in these areas. They rely on others, and the news reports aren’t very helpful — often, they seem actively designed to mislead and induce panic.
But unlike lawyers, doctors are expected to be experts in this area, for some reason.
This seems quite dismissive. The linked article has a great deal of useful information, which appears reasonably accurate to me.
Mendel, I am concerned that you want to dismiss these more favorable reports. If he made an error in one area, it doesn’t mean that the rest of his information is incorrect.
Finally, as to China and South Korea, you are the one speculating. If you have empirical evidence showing specific steps taken by China and S. Korea that would help, and quantifying it, then present the data. I have seen no such data.
What I have seen, over and over again, is insistence that the US must be on the path of Italy — which is not catastrophic yet, by the way — rather than on the path of S. Korea because of something speculative.
And S. Korea did not do a lockdown.
There’ve been any number of posts disecting the government response, it’s ramifications, and the cost/benefits to our lives.
Some of the more compelling points–at least from one side of the debate–have questioned the loaded use of terms such as “hysteria” and “panic.” But let’s wonder whether lawyers know more about disease than doctors.
I’d like to know how many were taking Calcium channel blockers. I’ll explain why, later.
Dr. Bastiat,
Two more papers for you to review, the first one is *extremely* detailed, so be forewarned:
High-dose Intravenous Vitamin C Treatment for COVID-19
by Adnan Erol, M.D.
Successful High-Dose Vitamin C Treatment of Patients with Serious and Critical COVID-19 Infection
by Richard Cheng, MD, PhD
For you to be right you present me with two things I have to believe (one or the other)
one: You have it figured out better than the CDC with less information than they have
Two: The CDC, which has more information, experts and data, is either just wrong, or lying.
Sorry, I don’t buy that. I just think the CDC is not staffed by morons, or incompotents. Nor do I think they are part of some leftist consperisy to rob us of our rights.
Ricochet is starting to sound like Dale.
At the other end from the Diamond Princess passengers who were not infected, I’d expect doctors to be looking for markers in the members of the family in New Jersey who’ve seen their mom and three siblings die within a matter of days to figure out why they seem to be hyper-susceptible to the worst effects of the coronavirus, or if they somehow ran afoul of a strain of the virus that is far more virulent than others.
The fact that the medical community and researchers are still feeling their way through the unknowns here can serve to justify the near-term caution. But like I’ve said in other threads, if we gt to mid-April and we don’t see more cases like the Fusco family, and instead the vast majority of people infected are more like Kevin Durant or Tom Hanks, with no negative effects or just minor ones, then a decision is going to have to be made on how long the economy is going to be shut down, as temperatures rise and if the mortality rate is only slightly higher than a normal bad flu season.
If we’re going to start treating any flu strain that arrives each winter that was not part of the annual vaccine dosage as an emergency on the current COVID-19 reaction level, economic collapses every few years are going to become the rule, not the exception. Parameters are going to have to be set up for future situations, based on isolating the most potentially vulnerable people
There is a principle in ICU medicine that says in some instances it is “Don’t just do something, stand there.”
I have been saying this for years. Very few doctors know anything about Bayesian algebra. Surgeons (I’m one) are always biopsying breast lesions with 10% risk.
https://www.analyticsvidhya.com/blog/2016/06/bayesian-statistics-beginners-simple-english/