This post begins a series on covid, which has been the main focus of my reading in retirement. Many things I’ll say in this series I’ve said before on Facebook or in emails to friends. Here, I’ll spend more time on them but still try to be as brief as possible.
My first target is highly esteemed Dr. Francis Collins, Director of the National institutes of Health (NIH), and in a moment I’ll show you a surprisingly bad and misleading contribution to the public debate over covid bearing Dr. Collins’s name.
Before doing that, I should say that I’m not a medical professional. My PhD is in theology. But I have worked for the past 13 years for two major healthcare organizations, as a cabinet-level speechwriter for the Department of Health and Human Services and the Department of Veterans Affairs. Over the years, I’ve talked to a lot of doctors about a lot of things. I’ve drafted or edited articles for medical journals. I’ve even written a chapter of a book on pandemic preparedness. (I don’t think it was ever published.)
I also have the benefit of other experiences relevant to the present panic. I’ve worked as a journalist for more than decade, much of it as the Washington bureau chief of Investor’s Business Daily. I’ve seen how editors often decide in advance what the news is and then send a reporter out to write it up. Woe to the reporter who comes back with a different story!
I’ve also sat at conference tables with cabinet secretaries, heard senior executives push plainly stupid ideas, and seen everyone else around the table sit silent for fear of confrontation and the likely consequences of offending the ego with the ideas. So I’m not at all surprised when elected leaders make bad decisions on bureaucratic advice, especially when the mainstream media is beating the drums for action.
And having made a bad decision, what else can a politician or bureaucrat do but keep making bad decisions in defense of past decisions? Each decision becomes an assumption that may not challenged within the bureaucracy. Whatever happens afterward must be made to fit a narrative justifying the chosen response to the supposed crisis.
The more obvious it is to others that the response is wrong, the more serious the crisis must be made to look by the bureaucracy. So good money follows bad as politicians and bureaucrats keep investing in failure to avoid admitting they were wrong. No one ever admits they were wrong in Washington, except those who plea-bargain their way out of jail.
Now to Dr. Collins.
In June, a post appeared on NIH’s Director’s Blog entitled, “Public Health Policies Have Prevented Hundreds of Millions of Coronavirus Infections.” Quite a boast to make, but others were also making it in June, after May’s drastic drop in daily covid deaths in the places hardest hit (more on the reasons for that in a later post).
Here’s Collins’s third paragraph, which is the “nut” of his post (“nut” is journalese for the story in a nutshell):
As difficult as the shutdowns have been, new research shows that without these public health measures, things would have been much, much worse. According to a study published recently in Nature, the implementation of containment and mitigation strategies across the globe prevented or delayed about 530 million coronavirus infections across six countries—China, South Korea, Iran, Italy, France, and the United States. Take a moment to absorb that number—530 million. Right now, there are 8.8 million cases documented across the globe.
Now, many readers will read what I’ve bolded and think, “Wow, if we hadn’t locked down, we’d have 530 million cases instead of just 8.8 million.” They will think this because Collins has mixed apples and oranges, rather sensationally, causing readers to confuse cases with infections: 530 million infections, 8.8 million cases.
That’s happening a lot these days because we’re testing people for no other reason than fear. Normally, you are only counted as a “case” when you get sick, seek treatment, and are diagnosed with a disease. Testing for infection helps your doctor decide on your diagnosis by telling him what might be causing your symptoms (might, not necessarily is).
But now we are testing people for covid who are not sick, not seeking care, and not needing care, yet they are being reported as “cases” when they test positive. Even medical professionals now confuse cases and infections, talking of “symptomatic cases” (people who are sick) and “asymptomatic cases” (people who are not sick but have tested positive).
All this makes covid look a lot more dangerous than it is, at least as popularly reported. Statistically, however, it has the opposite effect, lowering covid’s case fatality rate (CFR) and bringing it closer to its infection fatality rate (IFR), but that doesn’t make as many headlines because it means catching covid isn’t that dangerous.
It is telling that the study in Nature, the only source cited by Collins, was clearer about the difference between cases and infections, saying right upfront, in its abstract, that its estimated 530 million “infections” would have included just 62 million “cases.” These estimates have since been revised downward to 495 million infections and 61 million cases.
Take a moment to absorb those numbers (as Collins would say): 495 million infections and 61 million cases—that means seven out of eight people who are infected with covid don’t get sick (at least not sick enough to seek treatment) and therefore don’t become covid cases. Quite a different headline.
Interestingly, Collins’s post says nothing about the effects of covid. He writes about its “alarming spread” and “profound threat.” He says that because the covid virus was new, “everyone was susceptible” (as if antibodies are the body’s only defense, so T-cells could not possibly provide natural immunity). He writes that “without these [extreme] public health measures, things would have been much, much worse,” but he doesn’t say how. He doesn’t mention deaths or disabilities, hospitalizations or medical bills. That’s all assumed.
And yet they cannot be assumed for Collins’s post to be anything but an idle boast. Maybe our unprecedented sacrifice of freedom, wealth, and well-being has prevented hundreds of millions of infections. So what? That alone doesn’t tell us whether the sacrifice was worth it, since the vast majority of infections do not lead to sickness, much less death.
This is not the level of analysis we would expect from a medical expert and senior government official. It is, however, the level of analysis we can expect from a GS-12 Public Affairs Specialist. I suspect that Dr. Collins didn’t actually write the post; a not-so-sharp blog writer in his public affairs office did. That writer was tasked with a bureaucratic mission: justify extreme measures. His or her draft (more likely her these days) was then checked by someone in Collins’s office, who read it quickly and uncritically, looking mainly to see that it justified extreme measures loudly and clearly. If Collins himself saw the draft, I expect he also read it quickly and uncritically, expecting his staff to have done its job.
What about the study in Nature itself?
It must be remembered that the study concluded not that hundreds of millions of infections have been “prevented” but that they have been “prevented or delayed,” which we gives us even less reason to care about the study’s conclusions. Have we inflicted lasting misery upon hundreds of millions of people—destroying their livelihoods if not their lives—only to delay the consequences of covid a few months? That seems to be the case, since infections are still spreading.
As for the rest of the study, I’ll just quote three very interesting comments posted on Nature’s webpage when the article first appeared:
This article should not be published as is because it contains at least one major flaw that leads to the results overestimating the number of avoided Covid cases due to policies. The error is that the methodology assumes a constant growth rate for Covid cases per day for the entire study period, which for the US is almost 30% per day. While this might have been true for the first few days, it could not continue at such a high rate even without any mitigation policies in place.
There are many reasons why the rate would have to slow down for a geographically big country like the US. First of all, it takes weeks for the virus to spread to all parts of the country. Secondly, different people have very different degrees of vulnerability to any virus. Presumably, the virus will hit highly vulnerable people first, and then it will be harder/slower for it to infect others, such as retired single unemployed people who stay home anyway without policies.
There are many other time lags and different health vulnerabilities that would also lower the growth rate over the approximately 35 day study period. These factors must be considered prior to publication.
None of the numerical results of this article are correct, because of the major invalid assumption that I noted in my previous comment. Thus, it would be hard to draw any policy implications from the article.
We all know that if mitigation policies had begun earlier, fewer people would have died. That is obvious. But another problem with this article is that it does not describe in sufficient detail how the impact of specific mitigation policies such as closing the schools at a specific time had on over death totals. Thus, this article needs to provide readers with a lot more detail on the methodology used to analyze individual mitigation policies before any of the results would be believable. But since the no-policy case clearly inflates the number of deaths up until April 6, the entire analysis needs to be re-done.
Another major factor not sufficiently discussed in the article is the fact the most mitigation policies were not put in place until the last half of March. Given the lag time between exposure to the virus, and being a confirmed case of about 12 days, as a previous commenter stated, the few mitigation policies in few locations would have had any effect by April 6, the end of the study period. This is further evidence that the no-policy case is very inflated, since the actual historical death numbers would hardly reflect any positive impacts of mitigation policies by April 6.
The editors must withdraw their decision to publish this article. It is hard to understand how the peer reviewers could have missed these problems with the analysis.
There’s nothing interesting about this at all. A 5-year-old can tell you that keeping people apart from each other stops pathogens from passing between them.
What’s more interesting is how you balance those tradeoffs. My boyfriend works in a bar to earn a living while he gets his theater directing career going. Both are now sidelined, and some of the damage will last for many years.
Telling me that the only way to save people is for him to stay at home with nothing to do until there’s a vaccine that has been administered to billions of people doesn’t cut it. Compassion and sympathy starts to erode very quickly.
It’s pretty clear that poor health lifestyle directly accounts for 80% of the deaths. And don’t be misled by the ‘age’ factor. Most older people are surviving it, it’s just that there are more older people dying than younger people, but it’s still hardly ‘most older’ succumbing to it. And to the extent that they are succumbing to it disproportionately, it’s largely due to a lifetime of poor lifestyle that has compounded its consequences.
The emphasis needs to be a strategy for protecting those that are more susceptible to serious infections while not keeping us all ‘locked down’. That would be an interesting analysis to read about, but this isn’t at all.
