Some Rational Perspectives on COVID-19

Currently our economy is being decimated, not by a disease but by a series of governmental shutdown orders that have closed most businesses and resulted in millions of layoffs. These orders were based not on experience, but on models that we now know were wrong.

It is critical to remember that the shutdown strategy was never intended to stop people from getting sick. When we all emerge from hibernation, the virus will still be there, and some of us (more or less the same number) will still get sick. The idea was to “flatten the curve” by prolonging the epidemic, so that hospital resources would not be overwhelmed at any one time. We now know that projections of hospital and ICU use were wildly inaccurate. That means that the “flatten the curve” rationale has ceased to exist (unless you think there will be a vaccine or a cure within the next month or two, which won’t happen). So why are our governments persisting in devastating the lives of tens of millions, if not hundreds of millions, of Americans?

A reader from the New York area writes:

The models, as you have noted, are not tracking reality well, at all. Models pointed to large outbreaks of the virus washing over the country this week. Right now hospitals are managing just fine almost everywhere—well below capacity, in fact.

Even in NYC, the estimates of the beds and ventilators needed has been grossly wide of the mark: they’d estimated a need for 140,000 beds by last Friday, but only needed 8,500. Looking around the country, it doesn’t appear that any hospitals are using the emergency facilities they urgently threw up around the country. Even Louisiana got through its surge without being overwhelmed. Washington DC is supposedly 8 days past the peak as gauged by IHME, and nothing of note has happened. The expected epidemics haven’t materialized, indicating that there are big problems with the models, likely focusing on their assumptions about either the disease’s case fatality rate or its contagiousness (or both).

Note that social distancing should only now just be affecting hospital capacity – given that there’s a 3-week lag between when social distancing can begin to bring down new infections that can then progress to hospitalization severity. Most places only locked down at the end of March, so the lack of hospital utilization right now isn’t due to social distancing.

She notes this article by Stanford epidemiologist John Ioannidis in the European Journal of Clinical Investigation, titled “Coronavirus disease 2019: The harms of exaggerated information and non‐evidence‐based measures.” It is well worth your time. A couple of excerpts:

An argument in favour of lockdowns is that postponing the epidemic wave (“flattening the curve”) gains time to develop vaccines and reduces strain on the health system. However, vaccines take many months (or years) to develop and test properly. Maintaining lockdowns for many months may have even worse consequences than an epidemic wave that runs an acute course. Focusing on protecting susceptible individuals may be preferable to maintaining countrywide lockdowns longterm.
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Leading figures insist that the current situation is a once‐in‐a‐century pandemic. A corollary might be that any reaction to it, no matter how extreme, is justified.

This year’s coronavirus outbreak is clearly unprecedented in amount of attention received. Media have capitalized on curiosity, uncertainty and horror. A Google search with “coronavirus” yielded 3 550 000 000 results on March 3 and 9 440 000 000 results on March 14. Conversely, “influenza” attracted 30‐ to 60‐fold less attention although this season it has caused so far more deaths globally than coronavirus.

Different coronaviruses actually infect millions of people every year, and they are common especially in the elderly and in hospitalized patients with respiratory illness in the winter. A serological analysis1 of CoV 229E and OC43 in 4 adult populations under surveillance for acute respiratory illness during the winters of 1999‐2003 (healthy young adults, healthy elderly adults, high‐risk adults with underlying cardiopulmonary disease and a hospitalized group) showed annual infection rates ranging from 2.8% to 26% in prospective cohorts, and prevalence of 3.3%‐11.1% in the hospitalized cohort. Case fatality of 8% has been described in outbreaks among nursing home elderly. Leaving the well‐known and highly lethal SARS and MERS coronaviruses aside, other coronaviruses probably have infected millions of people and have killed thousands. However, it is only this year that every single case and every single death gets red alert broadcasting in the news.

See original for citations. Our reader also points out this study by Dr. Ioannidis and others, which attempts to quantify the risk of death from COVID-19 in various demographic groups, based on data from nine countries including the U.S.:

The absolute risk of COVID-19 death ranged from 1.7 per million for people <65 years old in Germany to 79 per million in New York City. The absolute risk of COVID-19 death for people ≥80 years old ranged from approximately 1 in 6,000 in Germany to 1 in 420 in Spain. The COVID-19 death risk in people <65 years old during the period of fatalities from the epidemic was equivalent to the death risk from driving between 9 miles per day (Germany) and 415 miles per day (New York City). People <65 years old and not having any underlying predisposing conditions accounted for only 0.3%, 0.7%, and 1.8% of all COVID-19 deaths in Netherlands, Italy, and New York City. CONCLUSIONS: People <65 years old have very small risks of COVID-19 death even in the hotbeds of the pandemic and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.

Finally, this one doesn’t come from our reader, but if you want to see what an old-fashioned epidemiologist from Germany thinks about social distancing, it is worth reading for entertainment value alone.

DR. WITTKOWSKI: With all respiratory diseases, the only thing that stops the disease is herd immunity. About 80% of the people need to have had contact with the virus, and the majority of them won’t even have recognized that they were infected, or they had very, very mild symptoms, especially if they are children. So, it’s very important to keep the schools open and kids mingling to spread the virus to get herd immunity as fast as possible, and then the elderly people, who should be separated, and the nursing homes should be closed during that time, can come back and meet their children and grandchildren after about 4 weeks when the virus has been exterminated.

Interviewer: And so, what do you make of the policy that was enacted in the United States and England and most places throughout the world, this policy of containment, shelter-in-place, etc.? What’s your opinion of it?

DR. WITTKOWSKI: Well, what people are trying to do is flatten the curve. I don’t really know why. But, what happens is if you flatten the curve, you also prolong, to widen it, and it takes more time. And I don’t see a good reason for a respiratory disease to stay in the population longer than necessary.