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Myths About COVID-19
A number of false ideas are circulating about this disease.
They surveyed 3000 people and found that 1.5% were positive for the antibody to COVID-19. This means that 80 times more people are asymptomatic with COVID-19 than symptomatic. So the lockdown wasn’t necessary.
Nope. 1.5% doesn’t exceed the false positive rate for this type of test, so it doesn’t prove any excess of asymptomatic cases at all. If, say, half of the people screened were positive it would be significant, but not if it’s just 1.5%. There is other evidence of asymptomatic cases, but not nearly 80 times as many; maybe twice to 7 times as many.
The projections for numbers of people infected have been repeatedly wrong and had to be revised repeatedly. We should pay no attention to them.
No, the projections have been reasonably accurate. (How could they miss? The range of uncertainty they published was huge.) Also, it’s normal to make revisions as data comes in. The worst mistake in interpreting these projections occurred early on when the Imperial College group published projections for various scenarios in the US. The first such projection of 2.2 million dead in the US hit the news and, understandably, captured the imagination. It was only later when the rest of the same study was considered that people found out that there was another scenario studied that predicted 60,000 deaths. People thought that this was a revision of the first, higher projection, but that was wrong. It was a scenario that estimated deaths if strong measures to suppress the virus were used. The first number was the estimate for what would happen if nothing was done. (And this was academic anyway since there was no way people would continue to act normally.) And so it has gone, with one failure to understand what the epidemiologists were saying following another. The epidemiologists said that the stricter the efforts of virus suppression the more the lives saved. What choice did politicians have? There’s no question that the efforts to suppress the virus have been successful. The decline in the daily death rates started just about when one would expect them to, 10 to 14 days after suppression efforts started. And there is nothing that will keep the virus from flaring up again if we try to go back to normal.
Efforts to suppress the virus are causing economic harm. We must end these measures to save the economy.
The damage will not entirely end if the economy is suddenly “opened” because people are not going to act normally. Especially not if the virus flares up again. The economic damage is going to continue, hopefully at reduced levels, until the virus is gone or nearly so. To be sure there are a number of unnecessary restrictions that can be dispensed with now, but things are not going back to normal any time soon. You can argue that the government didn’t need to act at all, that people would know to avoid dangerous activities, but people expected the government to act. Most of the work of opening the economy is to convince people that it’s safe to go out again, and to do that we’ve got to make it truly safe.
We’ll have a vaccine in 12-18 months.
Maybe, but don’t count on it. As it turns out they have been trying to produce a vaccine for coronavirus since 2003 when SARS broke out. It’s apparently very tricky. Vaccines strong enough to confer immunity so far have killed the monkeys. We have the advantage right now that there are far more people and labs working on it, but it may take more time or may never happen at all.
The pandemic will follow a bell shaped curve.
Maybe, but there is no guarantee of that. It may be like the Spanish Flu, with multiple waves, or like HIV/AIDS, with a long fat tail that simmers on and on.
Hydroxychloroquine…
This is being used in various places. Other than the occasional testimonies, which are hard to interpret, the evidence that this stuff really works is thin. The history of medicine is repleat with examples of promising treatments with many testimonials of effectiveness that turned out not to work when tested carefully. Our ability to fool ourselves that way is huge. Some antivirals like remdezivir have proven to suppress the virus in animals and show more promise.
Published in Healthcare
This is a sharp, well reasoned post and I hope it gets R> attention. We’re conservatives; that means we are, generally speaking, unsentimental about truth. Plenty of real-life truths are favorable to our political attitudes; I’d say most of them. But not everything is going to conveniently turn out to be a win-win-win for us.
There are liberal fairy tales, and there are conservative ones. One of the most popular lately has been “We don’t have to worry about trade-offs–it’s all a fake! Social distancing, the whole bit! It’s a Saul Alinsky plot! Why, I saw an article on Infowars that quotes the Debka File…”
This is not a myth, is is the closest thing about this we know with any certainty. The question, and at this point the most pressing issue is how to mitigate the damage caused by the virus and our response to it. If we can’t count on a vaccine, or a cure in a short time period, and if we are reasonably sure that we won’t overwhelm the healthcare system by ending most shutdown mandates, there is no other moral course of action. We were not overwhelmed. The purpose of flattening the curve was not to save as many lives as possible, it was meant to save the lives of those who would not receive the health resources necessary to save their lives because the number of cases came on so fast that there were not the number of available staff, beds, medicines, ventilators, etc available at that moment. The purpose was to solve a logistics problem. It was largely solved, not only by the shutdown, but by moving resources around to solve potential shortages. The areas under the two curves are the same. Without a cure or a vaccine, the number who were going to die from COVID-19 remains the same. The question only ever was “when?” We are now actually endangering the lives of those that flattening the curve was intended to save. And doing great and lasting harm. Removing the restrictions won’t put things back as they were, many people will behave differently. We did the best we could with the hand the CCP dealt us, we could have made better decisions (not necessary different) if we had timely information. It is time to do the rest of the comparison, is the benefit of the next public health decision equal to the benefit to everyone? I know several people who can’t get previously scheduled cancer and heart surgeries, because we’re slowing the death rate for COVID-19. These are the same people that flattening the curve was supposed to save, time will tell.
I don’t think you are disagreeing with the myth. You are saying we should stop the shutdowns because the cost is too high. I read what the OP is saying as simply that the options aren’t shutdown or a return to pre-COVID economic times. We should move towards stopping the shutdowns outside of a few metro areas but the country as a whole is still going to have a recession – my hope is that reopening will forestall a depression. But people’s behaviors will change, supply chains remain disrupted, certain business sectors (tourism, aviation, restaurants) hobbled for the foreseeable future, and manufacturing plants occasionally shut down by outbreaks as we’ve seen in South Dakota and now with two large meat packing plants. And if, after the shutdown is ended, we see upsurges in cases in previously lightly impacted areas all bets are off.
Some of your myths are not “myths,” but are simply claims that are not yet proven (and could be proven false). Same goes for virtually anything said about covid. If it is a call for humility, that is universally true. If it is a calling out of “myths,” that is just as silly as believing in things not proven.
Roderic, good post.
I think that you’re incorrect about the Bendavid/Bhattacharya study. It’s not accurate to use a generalized measure of false positives “for this type of test.” They actually addressed this in their paper (here), in three different ways, with details in the appendix).
However, the Bendavid/Battacharya study can’t necessarily be generalized to the entire country. It is specific to Santa Clara County. It is one important piece of evidence suggesting that the actual number of infections has been many times higher than reported, confirmed cases. I agree that there remains a great deal of uncertainty about that figure.
I also think that you’re incorrect in your confidence in the Imperial College London projection. You seem to assume that lockdown measures have been effective. This is not established. It is also not disproven. We just don’t know at this point, but it is not accurate to assume that the 2.2 million estimate would have been correct if drastic measures had not been taken. Of course, the really terrible thing about the ICL report is what no one seems to talk about. It projected a massive second wave once severe lockdown measures were ended. This, too, might or might not be correct, but it is a serious problem for those advocating lockdown, because it suggests that severe measures only delay the inevitable. I wish that we could reach even this conclusion with confidence, but at the moment, it remains uncertain because the model may be incorrect.
This is not correct. I’ve documented this based on the data that we’ve had, which was reported deaths, and there has been no noticeable change in the trend lines. However, reported deaths is not a good measure — I’ve been hoping to get information based on actual date of death. NYC just released this data, and I have a new post about it (here) that, once again, shows a steady decline both before and after the lockdown. This data is much smoother and more clear than the prior, somewhat erratic data that I’ve had based on date of reporting of each death.
However, I can’t conclude that the lockdown was ineffective, either. It is very surprising to me, though, that the % growth in the number of deaths started declining so early, and declined so steadily, in NYC, as I would have expected a lag of about 3 weeks. I think that you pointed out previously that there is a variable lag time between infection and symptoms, and another variable lag time between symptoms and death, which may well hide any effect of suppression efforts. I don’t dispute that they may be effective, but I do dispute the automatic attribution of any decline to such efforts. We just don’t know.
Note: Edited to correct a link.
This is a very important post because it really does focus some of the debate. In the section from the OP quoted above I agree with the observation but I wouldn’t label the statement “We must end these measures to save the economy” as a myth. Yes, people will not engage in economic activity in a pre-epidemic manner. The epidemic has modified the market for goods and services. But market behavior is readily adjusted when free and damage is mitigated much more quickly as people’s perceptions of risk change. Ending the measures and letting market forces loose again is critical to “saving the economy” if by using the word “saving” you mean to adopt the shortest course back to a healthy economy.
The myth is the idea that the economic damage can be ended by government fiat. Again, the economy will open up when people are sure that they can safely resume normal activities and not just on the government’s say so.
Right now the limiting factor is government. After it gets out of the way of the economy, other limiting factors will come into play. But getting the government out of the way will end a huge amount of damage. There will be plenty left to repair. Remember that the stock market went down several thousand points without the help of government lockdowns.
Thanks!
The link you provide seems to go to the wrong page. If their antibody assay really is specific enough to detect a 1.5% signal then I would be surprised. I have a lot of experience with this sort of assay, and they are not usually that good. Looking at their report don’t see where they demonstrate that sort of specificity.
Parenthetically, the other test for COVID-19 has the same problem, a lack of specificity and sensitivity, which is why it should not be the gold standard for the diagnosis. They tout massive testing as the answer, but that’s wrong headed. There will be problems.
Actually, I used the IC projection as an example, but most of my remarks refer to the more optimistic IHME estimations. They are up front about the huge uncertainty.
Regarding effectiveness of the suppression efforts, it’s simple. Measures to suppress the virus started and then after a delay the daily new case rate started to peak and later on the daily death rate started to peak. I see no other reason for these measures to peak. I point to dead bodies because they are pretty easy to count. I don’t think we’ll get better evidence of effectiveness than that unless we end efforts to suppress the virus and then see it flare back up, which would be further evidence of effectiveness.
I think you are missing the key fact that the shutdown started before there was any government order to do so. People had the good sense to stay away from dangerous activities early on.
I think that’s exactly right. The government isn’t as much a problem in some states, but it sure is in others. Parenthetically, the stock market decline is a pretty good index for when the shutdown really started. It hit bottom on March 16, and that’s probably when a lot of people were spooked and limited their activities.
If there is one certainty in the current sea of unknowns, it is that we have a surprising lack of understanding of immunity to viruses. It’s as if we know the consonants, but we’re missing the vowels. :-)
Reading this post a few minutes ago about humanity’s tragic encounters with other viruses, I can’t help wondering if our understanding of herd immunity is incomplete. Given what I know about daily life at the turn of the century from 1899 to 1900 and thereabouts, it would seem to me that some of the viral diseases that had such high death tolls in America and western Europe would have quickly spread and thus quickly established herd immunity. But that didn’t happen with some of them.
I think there’s something else going on here that we’ve been missing. I wonder if the virus remains active and if it spreads during times when we are not seeing symptoms in people. So when its optimal weather conditions–temperature and humidity–return, it’s not starting from patient 0. It’s starting from millions of infected people. Hence, the much worse second wave. That phenomenon would partially explain Typhoid Mary’s history. The virus remained active inside her, but she was not “allergic” to it (that’s why some people are asymptomatic in the first place), and so she spread the active virus to many other people.
This is probably how the weather and virus interact.
So in our hoping to establish herd immunity by resuming normal social interactions, I wonder if what we are actually accomplishing is sowing the virus more heavily throughout the population. This is what the people afraid of the “second wave” see happening. Herd immunity cannot and will not happen fast enough to prevent the second wave in November. Herd immunity as a solution may just be a pipe dream at this stage in the life of this virus as it has taken up residence inside the human population.
We’ve got to get a vaccine in the market over the next few months. Let us hope and pray for the Israelis’ success.
I haven’t reviewed the math carefully, but the Stanford study does account for false positives and does give (wide) uncertainty ranges — which include other variables as well. The 80x figure is the top. As I recall, the most likely was about 60x.
I realize we’re all angryface at academics these days, but to suggest they didn’t account for false positives is a bit uncharitable.
Oh, those were the days.
If asymptomatic carriers are not actually killing the virus by developing forceful antibodies, they will remain carriers of the live virus. Their numbers will multiply. A two-week quarantine isn’t going to be effective in stopping the spread of the virus from asymptomatic carriers.
I’m beginning to think that nothing will work to contain this except a vaccine.
Way back I remember reading the Debka File for a couple of months before realizing nothing they said had proved true.
Another possible myth is the idea that testing can help the economy open again. In theory I guess it could, but given the logistical problems and the fact that many people who test negative will still have to protect themselves, and others from themselves, the way they are doing now, it seems unlikely to work.
There’s a state prison in Goldsboro, North Carolina that has just released information on more than half of inmates having Covid with no hospitalizations and 98% not showing symptoms.
How does data like that factor into the analysis of how much this has spread and the mortality rate?
Don’t know the answer to that but reminds me of something I came across yesterday looking at the CDC website. I had been using the CDC flu case/mortality rate as a base to compare COVID but it turns out the CDC only counts symptomatic flu cases in its estimates. The literature cited by the CDC indicates there is a wide range of estimates for the number of flu cases that are asymptomatic but it looks like it is using an estimate of 40-45% of them being asymptomatic (but not including them in the flu case count). Turns out I wasn’t comparing apples to apples.
For some unknown percentage of patients, there is an allergy component to this equation. It’s the individual’s own immune system overreacting in some people to the stimulus of the virus (the cytokine storm).
Twenty years ago, I had a wonderful kitty I loved. She started scratching ridiculously on a particular spot on her little body until the fur all came off and sores opened up. The vet said that she had had a flea bite to which she was “allergic.” He said it was really rare, but once in a while, a cat could not quiet down his or her immune response to a flea bite. He put the cat on cortisone (prednisone perhaps?), and it helped for a while. But it never went away. She suffered terribly at the hands of her own immune system. She eventually died from it after two years of suffering with it.
We have got to figure out a way to kill (I know it’s not “alive,” but it sure seems to be to me :-) ) the virus that’s already living inside a human being. Some people may never be able to develop the necessary antibodies to do the job. Maybe that’s the mysterious covid-19 age factor. Perhaps an older immune system lacks the flexibility to create new antibodies to new diseases. Perhaps the kids with their brand-new operating system are identifying the virus quickly and dispensing with it. I wonder if there’s such a thing as a tired immune system. :-)
The rebuttals of these “myths” don’t inspire me with great confidence that they are indeed mythical. Your arguments amount to mostly saying, they are myths therefore they are wrong.
I just had a eureka thought. This doctor’s therapy for treating covid-19 patients is what we need to do for asymptomatic people. Instead of not treating them because they are not symptomatic, we need to kill the virus that they are carrying, which the vitamin C compound that creates the virus-killing hydrogen peroxide will do.
What do these patients get out of it? Protection from possibly developing symptoms later from the virus they are carrying. We get to quiet down the numbers of asymptomatic carriers out in the general population. So people who test positive for the virus but negative for an effective level of antibodies would get this IV treatment. This two-pronged strategy might actually work to forestall a the second wave.
That must have been very hard, and of course. We want to stop this from happening to as many people as possible. That goes without saying. But good words in your cat story are “very rare.” Covid reactions are not “very rare”, but isn’t it very good news that they are (possibly) “much more rare” than thought??? If the vast majority contract the virus but do not suffer a major problem from it, the mortality rate is much lower than thought. That changes people’s risk calculations and thus individual behavior….
I don’t know, Lois. I’ve read differing opinions on whether the fatalities are from cytokine storms (I’ve read that they are not) or other problems. The only thing I know for sure is that it is a factor in some cases. I don’t know the percentage
What we know now is that this virus is highly mobile inside the human body. It’s not staying in the lungs. It’s going into the kidneys and the nervous system and other vital organs.
It is a truly horrible microorganism.
Sorry about the link error. I’ve fixed it in the comment above, and here it is again.
The fact that the virus is showing up in locations other than the lungs is really bad news and creates a new kind of urgency in our war against it.
That’s why the vitamin C-to-hydrogen peroxide treatment interests me so much.
This is a plausible hypothesis, but not supported by evidence.
One possibility is that deaths have peaked in NYC because the IFR is quite low, and most of the population has been infected despite social distancing and lockdown. I don’t know that this is the case, as we’d need antibody testing to establish it. It is a plausible explanation, though, which also fits the data.
It’s hard to quantify at this point, but I agree that your hypothesis also fits the data, in theory. I’d like to see better evidence of the date on which informal suppression efforts began — something like the dates on which business declined at restaurants, or dates on which there was a decline in the number riding the subway. Such data may or may not be readily available. My general recollection is that there was little change in activities anywhere prior to around March 11-13, but I am going from memory and it is possible both that: (1) a few days might make a difference, and (2) the voluntary changes in behavior occurred at different times in different locations.
I think that we will see the virus flare back up when we relax controls. I don’t think that this can be entirely prevented, and I don’t think that it’s feasible to continue the lockdown. It is feasible to manage the relaxation of the lockdown wisely, to reduce the risk. I do not advocate a complete and immediate return to pre-COVID activities, but I do advocate a serious relaxation of lockdown measures. This should almost certainly vary depending on local conditions.
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