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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
I think 0.006% is based on the numerical assumption of everyone in China being exposed to the virus. That provides a very large denominator (1 billion plus people) for a smallish numerator (people reported as infected). Gives a tiny result. But not everyone has been exposed….
I don’t think so. We don’t know what their procedures were for the entire cruise.
When did they go into lockdown? Did they then have a 14 day quarantine following that decision?
Did they institute different procedures while in lockdown to reduce the spread of the disease?
How did they make the decision to quarantine, was it because cases emerged then lockdown or did an exposure incident trigger the lockdown?
What happened once they evacuated the ill passengers.
For them to be an actual controlled study group for person to person transmission, a portion of the ship would have to be on lockdown, while another portion interacted normally and with both portions having the same unknown number of infected to start – that didn’t happen.
As to being a controlled study in lethality – Well the sample size of the rest of the world will give us that when the outbreak is over.
The Diamond Princess is an interesting case, particularly when the timeline is overlaid with the decisions and the implementation of those decisions.
I just don’t think it is as applicable as people think it may be.
I’m with you on this.
Hygeine in Italy is notoriously bad (is that racist?) . . . and they have the oldest population in Europe. I think that might help explain some of it.
I don’t trust any of the numbers coming out of China or Iran.
OK, so I am not a microbiologist, however when my dear uncle was diagnosed with HIV early in that viral scare, I reviewed the research. There were people who were immune to the disease. This immunity, it turns out, was also protective of small pox. It seems that there was a small regional population in France where folks carried a specific genetic mutation that allowed their immune response to quickly recognize smallpox infected cells, mark and destroy them. More recent folks found to be immune to HIV shared this mutation. I’m no expert, however, it seems that Small Pox and HIV share structural features that makes immune identification difficult. This particular human mutation resolves that identification difficulty allowing detection of the infected cells of either virus and their destruction. A person with a pair of these mutated genes has a immune system capable of destroying both HIV and smallpox. Persons with one such mutation has protection against these viruses allowing a lesser infection and eventual recovery
From what I have read, the SARS CoV 2 virus has an outer structure and injection mechanism that shares characteristics of HIV. Is this also similar to smallpox? Could this mutation also provide protection or partial protection against SARS CoV 2?
If so, it would make sense that HIV antivirals (which are very effective when several are used in a kind of cocktail) might help with SARS CoV 2. Sure enough, these drugs are being enlisted in this fight.
One also has to wonder whether or not, if these structural and injection mechanisms are so similar to other horrible viruses, why? Is this a natural phenomenom or is it something else at work here?
Thanks to a helpful Ricochet exchange with Mendel earlier today, I was finally able to ask Google the right question about the high number of people on the Diamond Princess who appear to have been resistant to Covid-19. I found an excellent article “Genes and Immunity” (September 2014) that explains this problem that we have yet to solve (and that we really need to solve going forward as a small global village dotted with Airbnb rentals):
Dr. B,
Perhaps you don’t understand our response because it’s irrational. After 20 years of preaching that “the facts don’t matter only the narrative matters” large portions of the ruling class actually believe this cr*p.
We are brainless at a time which requires hard analysis and then swift decision making. How far we have fallen.
Regards,
Jim
Yes, you are missing something, and it’s this: COVID-19 has the potential of crashing our medical system like it’s doing in Italy. That means that people will not be able to get the care they need if the virus continues to spread like it is. They will not be able to get care for a serious virus infection and anything else that might come up.
The case fatality rate in Italy is very high now because their medical system is swamped and some people are going without adequate care. Doctors have to decide who will get an ICU bed; usually they choose to treat the younger people.
Seasonal flu has never crashed our modern medical system. That’s a big difference.
Some hospitals in New York are already getting pounded with COVID-19, and the rate of spread of the disease has not begun to come down.
There is a lot of noise but no evidence of medical system collapse in the United States. Where is the evidence?
Edit: I see the stories at the links.
That link by Ginn has been nuked by Medium.
I guess it didn’t match what medium wants the message to be.
Doctors are the top of the esteem chart, and the image is of someone wise and authoritative. My sister said the docs she works with aren’t saying much, because they don’t know either.
Part of the role of a health care worker is to be supportive & reassure people they are in the best hands. The news begs to differ and emphasises that our health care system isn’t up to the job. People believe that. When a hospital worker posts on facebook asking if anyone has new masks they will donate, it isn’t a huge boost of confidence either. If they fail, the health care system crashes with the economy.
I tell myself that just a few weeks ago the main topic of discussion was if men who believed they are women are women. I sense we are so silly we can’t think rationally anymore.
You just proved my point. Thank you.
This is not a question of disease. It is a question of epidemiology, which is actually mathematical. It is neither law nor medicine.
My expertise in this area has nothing to do with being a lawyer. I majored in mathematical economics, and did a year of grad school in math, focusing on probability, statistics, and mathematical modeling.
My guess is that I know more about probability, statistics, and mathematical modeling than 99% of lawyers, or 99% of doctors.
I actually helped my dad in a medical study published in the Annals of Thoracic Surgery, back in 1989, when I was an undergrad. My dad was a doctor, and did some pioneering work in hematology (specifically, blood banking and related techniques). Here is the paper.
My dad designed the study and wrote the paper. I gathered the data and performed the statistical analysis. I actually did the work during the summer between my junior and senior year in college, when I was 20 years old. The other authors did little of the work, though their contribution was important — they were the cardiac surgeons and anesthesiologists who actually performed the 373 cardiac surgeries that we analyzed.
So, actually, I’m smarter than the average bear with respect to data analysis, or the average doctor.
Maybe the L-strain verse the S-strain. (see here) It might be that Italy got the early L-strain from Wuhan because of those direct flights. The S-strain will replace the L-strain, because of survivor bias.
Not that this is directly related to the thread, but I thought it was interesting — America’s most famous stat-geek wants to ID coronavirus based on where it originated, gets attacked by cancel culture (link goes to Deadspin, so of course they’re happy about the attack)
How do we know that 15 million Chinese have dropped off their cellphone network?
But yes, I don’t believe anything out of China.
Like Iran and North Korea on Nukes is China on anything that makes them look bad. Like a 3-year-old lies that he didn’t each the fudge when he’s got fudge on face and hands.
15 million people is chump change to CCP. And that is why America responds differently.
We need to stand still and give our medical people time to get data and understand the unknowns of this virus. And come up with a plan.
Excellent.
Here’s one example of why I am skeptical of some of the official information, which seems to be designed to stoke panic. I have seen several news stories about hospitals and medical personnel facing “critical shortages” of protective equipment, including gloves and masks. Just think about that for a second. They are not saying that, in some worst case scenario, they might face a shortage at some time in the unspecified future. They say there is a shortage right now.
Now wait just a minute. How could that be? How could that possibly be? So far we have had about 25,000 cases in the US. That’s minuscule. In 2009 we had a pandemic of a new virus (Swine flu). There were about 60 million US cases. That’s more than 2,000 times the current number of Corona virus cases. And yet in 2009 nobody said a word about any shortage of masks or gloves. Did the medical personnel who treated Swine flu cases not bother to wear masks or gloves? How could we possibly be facing a “critical shortage” of masks and gloves as a result of a virus that has had only a tiny fraction of the number of cases that we have handled easily in the past? Not just Swine flu, but the regular flu every year. And many other infectious diseases.
I wanted to find out the “official” explanation on this, so I went to the FDA’s web site. Here’s what they say:
Did you get that? “Increased use may exceed the available supply of PPE, resulting in shortages at some health care organizations.” Duh. Use that exceeds supply is the definition of a shortage. Saying that there may be a shortage if use exceeds supply is saying absolutely nothing. It’s a meaningless tautology. I think if the FDA was telling the truth they would be saying “relax, there are plenty of gloves and masks to fill our needs for the foreseeable future.”
Don’t you have to start getting suspicious when you see “official” information that consists of this kind of unhelpful double-talk? Where are the numbers? Where is the actual answer to the question?
Welcome to the wonderful world of gov-speak. You think that is bad, you should see the systems requirements documents they come up with. Speaking out of both sides of their mouths is SOP. When they are truly inspired, they employ another orifice as well.
I can see it coming. Some lefty journalist is going to go back and tally up all the flu deaths during the Obama years, do the same thing for the Trump years, then come up with a story about how much better Obama handled a crisis epidemic . . .
I don’t remember where I read it, somewhere on RICOCHET…
This year “flu-like” illness and deaths are up.
Sick with the flu, but not A or B?
Flu-like illness.
Where are the charts that show that?
As far as PPE, theft in medical institutions is real. Nurses are taking PPE from regular storage, into central locked storage.
Midwives outside institutions can’t get PPE.
China makes all the stuff, and has a disrupted supply.
So, even if demand doesn’t outrank previous use, everything to replenish normal use is back-ordered.
This is a giant Cluster-F. 😲
It is interesting to compare the 2009 public response to the H1N1 epidemic (or pandemic, as Wikipedia calls it) to this 2020 one. It’s interesting to me especially because I don’t remember the panicky response I’m seeing to this one. Did I sleep through the 2009 pandemic? I must have. It was pretty bad:
There’s more here.
I remember reading something about it, but as I recall, I wasn’t in more than one or two of the risk groups that the CDC and my local public health department mentioned, so I ignored the rest of it.
The main difference I can identify is that the current one began with the horrifying pictures and stories out of Wuhan two months ago. Imagine the difference between reading a four-inch newspaper story about a volcano in some remote place on the African continent versus watching a real-time news video of a volcano erupting in a city in Hawaii.
Human beings are visual. They felt tremendously sympathetic to the residents of Wuhan, and they did not want to see such a terrible event happen here to their own family and friends.
In my experience, when I feel like I am missing something, it’s usually because I am missing something. So I keep looking. There must be something.
And you may be right. I may be missing the approaching catastrophic failure of our health care system, when it is overwhelmed by huge numbers of very sick COVID-19 patients.
But I don’t think so. And here is part of the reason why.
Best estimates from this flu season so far say that we’ve had about 40-50 million cases of influenza, with around 400,000 – 600,000 hospitalizations, with around 30,000 – 50,000 deaths. And that is pretty routine for a flu season, and it does not even come close to overwhelming our health care system. We’re ready for it. We know it’s coming. It happens every year. It can be much worse than that some years. So we’re ready.
Flu season is ending. When the weather gets warm, influenza disappears. If it’s not over now, it will be in a couple weeks or so.
So as I see it, one of two things is likely to happen:
Either COVID-19 is seasonal like the flu, and it’s about to disappear as well (this appears very likely from what we understand about COVID-19 right now).
Or, COVID-19 will continue to spread through the summer, but with flu season over, we’ll have the capacity of what just got done treating 50 million cases of influenza – all open for business and ready to receive the COVID-19 patients.
Will our number of COVID-19 patients go from 27,000 to 50 million? I don’t think so. But if it does, we have the capacity to treat them. In June, at least. If that happened in February, it might get a bit tricky…
This is obviously simplistic, and there are many unknowable variables at play here.
But I find it unlikely that our healthcare system will get overwhelmed this summer by COVID-19. Not impossible. But unlikely.
You make a good point, and you may be right. But I think that’s unlikely.
Stat padding is usually not a sign of a legitimate case.
Reminds me of when the climate scare mongers pointed to the…dare I say “exponential”…increase in annual hurricanes as the sign of the end of times. The proof was right there in front of us….the number of named storms was way up. Then, upon further review, one just may notice that, instead of issuing names when the data indicated “hurricane” status, “they” started naming tropical storms…then tropical depressions…then sub-tropical depressions. The game goes on…
And don’t get me started on the use of “pre-diabetic”…
I see this as the most likely scenario too. I wish President Trump would pat himself on the back for buying us some time by stopping air travel from China in February. By the time the new virus takes root here, we will be into April. Good call, Mr. President.
I wish his advisers would read your comment here and pull back on the quarantine measures that are killing the economy. Killing jobs and businesses will have longer-lasting dire effects than the virus will.
As I mentioned in an earlier comment, in the Italian region of Lombardy (pop. 10 million), SARS-CoV-2 has killed an entire flu seasons’ worth of patients in two weeks. With full-on lockdown. And the death rate is still rising exponentially.
Do you think any regional or municipal healthcare system in the US has enough excess capacity to deal with a bad flu season’s worth of patients in a 2- to 3-week period without chaos ensuing? Especially given that medical professionals themselves are at a much greater risk of having to leave work due to coronavirus infection than seasonal flu?
A serious question, as I don’t have enough of an insight into the delivery side of US healthcare. But in my German city with excellent medical facilities, my ICU doctor friends are saying the predicted numbers here in Germany (where we’ve had it good compared to Italy) could easily overwhelm their capacity, even with the excess ICU beds they’ve jerry-rigged in the past two weeks.
Because of geographic and temporal issues S Korea could take steps that are no longer viable here.
The S Korea outbreak was centered in one city. Because of this concentration and the early availability of widespread testing, health officials were able to trace and identify contacts of the infected, along with doing large scale random testing, and then isolate and quarantine individuals when the numbers were still small.
In the case of the U.S. the initial infection sources arrived in January and early February at multiple points across the country. Moreover, testing was not available early so identification and then following and isolating was not done allowing for further spread. The current number of confirmed cases in the U.S is just under 27,000 so the real infected number at this point could easily be 250,000 or more. We have passed the point of being able to implement S Korea measures.
I point this out not to support lockdowns but to emphasize that S Korea had options we do not as of today.
No. But when an article in, say Vox, about gun control makes statements or uses graphs that are either as faulty or as negligent as the ones I mentioned, every single person on this site (including me) considers that grounds to fully ignore the article – even though even a poorly-argued Vox article probably also does make a legitimate point or two.
The type of solid data we would really want is simply not available as far as I know. For China, there’s a correlation in time. For both countries, there are very plausible and convincing mechanistical explanations as to why their approaches could have actively stemmed viral spread. Yes, that’s very weak – that’s the reality we live in. But it’s still stronger than the evidence that the halt to virus spread in these two countries was a natural phenomenon that would have occurred without massive intervention.
I don’t think the US is on the Italian path at the moment. There could always be a sleeper cluster that’s fallen through the testing net, but I have faith that’s not the case.
Would you say the situation in Lombardy is catastrophic? They’ve had as many deaths in 2 weeks as the flu kills in an entire year, despite being on full lockdown, and the death rate is still increasing exponentially (since it lags the new case rate). Doctors are routinely choosing which patient gets a respirator and which one dies. The citizens want to self-quarantine with or without a government order.
I never claimed they did. I said massive intervention. In this case, testing and contact tracing/quarantine to a degree for which the US is not currently prepared. If/when the US (or specific regions) have ramped up their testing capacity and properly trained enough tracers, I certainly hope that those regions will implement those programs aggressively while reducing their restrictions on the public.
Bring up Italy as much as humanly possible and mention South Korea a grand total of zero times. That’s how governments are justifying it. They are citing the worst-case-scenarios (as portrayed by the Imperial College London, an organization that is not comprised of perfect beings without bias) as if they are the only likely scenarios, without looking at the actual success stories in the world and working to emulate them.