Good and Bad Data are Intermixed
We have to use all the data we can get, even while we know that a lot of the data is misleading.
The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.
This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future. __ STAT
Most of the tests that are circulating now, have not been put through the type of rigorous quality control process that would allow for the kind of disease modelling that epidemiologists like to do. And the disease information from China is almost never the kind of thing you can take to the bank.
The most interesting thing about the graph is how a few countries (Japan, Singapore, South Korea, Hong Kong) seem to have separated from the crowd in terms of growth of cumulative cases. Taiwan is another country with a divergent trajectory of cumulative cases. These divergences tell us that we cannot reliably predict the course of the “Wuhan Flu Pandemic” for countries at any stage of outbreak.
Keep in mind that “cumulative case counts” do not tell you how many people have recovered and are presumably now immune. The data is useful, but is not entirely reliable and does not tell you all you need to know. Limited and somewhat unreliable information can lead to wrong conclusions.
A new factor in the pandemic analysis is that countries such as China, Korea, Taiwan, and Singapore are being hit by multiple new waves of infection clusters. These “new waves” are a reflection of both importation of new cases from overseas, and of previously undetected clusters in-country due to asymptomatic carriers who serve as disease reservoirs. Certainly China has been caught under-counting its new cases on multiple occasions in multiple cities. If you are in China and you point out the problem, you are likely to be either deported or jailed (or worse).
Another thing to keep in mind is that countries may successfully contain the initial outbreak — in order to avoid a dangerous overloading of healthcare infrastructure — only to be hit hard six months later with another large outbreak.
This is just a model, and models are always wrong. But it is useful data that should be kept in mind. Unless useful vaccines and treatments are developed and made affordable and widely available, the “can” may only be kicked down the road for a future confrontation. How many times can an economy deal with being shut down for weeks or months? Of course it is worth an initial “flattening of the curve” while we are trying to get a grip on the data, with a better understanding of the prevalence of disease and the best means of containing the spread.
If the South Korean efforts are successful, they can provide a model for how to ease up on the restrictions needed for suppression. And add a new wrinkle to any epidemiological models of this coronavirus outbreak. __ https://arstechnica.com/science/2020/03/new-model-examines-impact-of-different-methods-of-coronavirus-control/
There is no perfect approach for everyone. South Korea found itself in the midst of a catastrophe, and devised a way to slow things down abruptly. Along with Singapore, Taiwan, Hong Kong, and Japan, South Korea is a country to watch and perhaps to emulate. Taking the “China approach” is a certain route to ruin.
We Do Not Yet Understand the Picture that is Unfolding
Most of those who have died from novel coronavirus have been elderly persons and/or persons with serious underlying medical conditions. And some of those may have died with coronavirus, but not of coronavirus.
In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise. __ STAT
Are We in an Epistemic Crisis?
If we are floating in a sea of ignorance regarding novel coronavirus — which we likely are — when will be become grounded and more secure in our knowledge of the problem?
F.A. Hayek was right that the use of knowledge in society is the central issue in economic and social organization. We had been cut off from the knowledge flow that otherwise would have been ours had we left this issue entirely to the private sector, which would have brought a Coronavirus test to you as quickly as you can order a pizza.
… Lacking that knowledge, public officials freaked out. Stay home. Keep your distance. Everyone is a suspect. Anyone and everyone could be positive for Corona. Socially shame anyone out and about. Board up the bars!
It was this sense, along with utter panic on the part of public officials, that led the markets to crash. After all, you can’t have an economy if people cannot engage and trade, can’t go to work, can’t distribute goods and services, and forget about investment.
And here we find the key to understanding why this Coronavirus has produced a social and economic calamity, whereas the H1N1 (Swine flu) from ten years ago is barely remembered by most people. It came and went with a large health cost (infections: 57 million; fatalities 12,469) but low cost otherwise. The critical difference was that the CDC worked with private laboratories and medical facilities to get the test out there. A few public schools closed for part of the day but there was no panic, no large economic loss.
… In the midst of all of this, this panic learning and trying, this speculation and searching, this mass national confusion, this endless and chaotic longing to know, this constant grasping for intelligence, one thing became certain: states at all levels decided to act. As if they knew the right course. And they acted with extreme force. And their message was always the same: stop whatever you are doing and do nothing instead.
This was and is the ultimate expression of nihilism, the chaos that follows ignorance. Officials in this country decided to shut down society – as if this were even possible – as a replacement for reliable, usable, actionable knowledge that we were all forcibly prevented from gaining when we most needed it.
… The ray of hope is that reliable tests are going to be distributed widely in the coming days, and that will solve the great epistemic crisis created by the CDC/FDA. There is hope and light at the end of this very dark tunnel of ignorance. __ https://www.aier.org/article/an-epistemic-crisis/
Reliable testing plus the prospect of viable treatments and effective vaccines, will all come together to provide a bit of clarity and perspective on what may be coming next. Perhaps when the air clears and we can see what is what, the panic will dissipate.
We Also Need to Listen to the Skeptics
Since much of what we “know” about this coronavirus pandemic is probably wrong, we should be both humble in making predictions, and skeptical about most of the predictions being made by others.
Recall that the Spanish influenza pandemic, fully worthy of the name, resulted in perhaps as many as a half-billion infections and between 50 and 100 million deaths, world-wide, of which some 675,000 were Americans, many coming back from Europe in the aftermath of the First World War. The World Health Organization recently declared coronavirus a pandemic at a time when the death count was at 4,000, presently being just over 6,500. It will surely rise no matter what precautions are taken going forward, but what is critical is some estimate of the rate.
By way of comparison, the toll from the flu in the United States since October ran as follows: between 36 to 51 million infections, between 370 thousand to 670 thousand flu hospitalizations, and between 22 thousand to 55 thousand flu deaths. That works out to between roughly between 230,000 to 320,000 new infections per day, and between 140 to 350 deaths per day for an overall mortality rate of between 0.044 percent to 0.152 percent.
… Note that Washington state, with 676 reported cases and 42 deaths, has a mortality rate of 6.21 percent, which can be traced to a nursing facility in Kirkland Washington. While only contributing 57 cases, it was the source of 27 of the reported deaths, almost two-thirds of the fatalities. (We should expect, as has been the case, that the mortality rate in Washington will decline as the newer cases will not come exclusively from that high-risk population.) The next three states have 1,577 diagnosed cases and 11 deaths for a mortality rate of 0.69 percent, a number which has trended lower over the last few days. Unlike the deadly exposures in Kirkland, the exposures in New York state produced many documented illnesses, but only two deaths even after two weeks of exposure. And while it is easy to miss latent cases, it is harder to miss any virus-related death. Given that the incubation period is about two-weeks, the pool of cases before March 1 should be small.
We need to distinguish between prudent social distancing to “flatten the curve,” and panic behaviors that can easily lead to serious financial hardship for large numbers of people.
I think part of the coronavirus conventional wisdom has become too pessimistic. Yes, the fight to stop the spread of the virus is going to have to be ongoing unless, and until, we develop a vaccine or highly effective medical treatments, which is to say for at least several months. But the nature of the disruption does not have to stay constant. It is necessary now to close schools and businesses, and tell people to drastically reduce social contacts in a way that is economically devastating to many businesses and workers. But there is a trade-off: The better we get at interventions to identify and isolate specific people with the virus, the less we should need to rely on interventions that isolate the entire population. That’s a reason the ramp-up of widely available testing remains such an important goal for the U.S.: More testing should, in time, allow for more normal living.
We are seeing this already in other countries: South Korea and Singapore have been successfully addressing their coronavirus epidemics with less extensive social-distancing measures than are currently seen in Italy, France, and parts of the U.S., in part because of their effective testing and surveillance regimes.
… It is also possible that effective antiviral treatments to treat the sick will be available much sooner than a vaccine that protects the healthy. This is partly because ongoing trials are testing whether already existing antiviral drugs, approved and on the market to fight other viruses, can reduce the severity of COVID-19 and save lives. __ https://nymag.com/intelligencer/2020/03/how-long-will-the-coronavirus-shutdown-last.html
The World Will Change, But in What Ways?
When this particular global outbreak is finally snuffed out, how will the world have changed?
Unsurprisingly, China [has] enablers abroad helping to whitewash Beijing’s culpability. World Health Organization Director-General Tedros Adhanom Ghebreyesus refused for months to declare a pandemic, and instead thanked China for “making us safer,” a comment straight out of an Orwell novel. This is the same WHO that has refused to allow Taiwan membership, due undoubtedly to Beijing’s influence over the WHO’s purse strings.
China-based globalization was meant to be a “golden ticket” to global dominance, for the totalitarian dictatorship. But if other countries decide to move their manufacturing and supply chains outside of China, the prospects for Beijing’s future would shrivel.
It is likely that a lot more people will become comfortable with expanding their online purchasing, and other things such as online schooling and online work.
Hardest hit of all, however, is the media, whose anti-Trump mania, reliance on manipulative if not imaginary “anonymous sources,” eagerness to be seduced by former members of the intelligence community, general ignorance of almost every specialized field they encounter, political naiveté, and absolute fidelity to the party line (“Wuhan” is now racist) has rendered a once-proud profession little more than a mouthpiece for the Democratic National Committee and a constant reproach to truth, justice, and the American way.
In the meantime, as we start to get better information and learn what containment measures are useful and what can be discarded, life will slowly move closer to an approximation of normal. And as treatments and vaccines begin in time to snuff out this particular emergent pandemic, fear will subside — hopefully with a growing immunity to the excesses of the largely dishonest news media.
Stock Market Crash Reflects Political Class’ and Media Apocalyptic Thinking
The real history of this crash is that the market began to fall exactly as the political class began to panic, speak of shutdowns, demand flight cancellations, talk of closing up and stopping history. Whatever you think about the virus threat, and even if you think all this is justified in the name of stopping the spread, let’s not be confused about what drove this disaster from the beginning: the fear that politics would attack commercial society at its root.
For some years ago, the apocalyptic mentality has been gaining in our politics, with the right wing screaming about rampant immorality, globalism, and the breakdown of nations, while the left has been calling for the end of fossil fuels, wealth, and capitalism itself. They share a common enemy, the free and peaceful commercial society that empowers individuals over collectives. That the social order that has made everyone rich must be destroyed is something on which they agree. And now these gangs are demanding your allegiance in a time of grave crisis.
The calamity before our eyes is beginning to look like some version of their imagined dystopia while the rest of us are left to struggle through this disaster the old-fashioned way, not with ideological delusion but with intelligence, calm, and rational planning for the future. There is indeed a virus among us, one far more damaging than that which goes by the name COVID-19.
Draining the swamp may necessarily involve beginning to hold the media to a certain minimal standard of truthfulness.
Again, some level of social distancing seems wise. Working and schooling from home — where possible — may lead to wiser long-term approaches to both. Reliable and available testing is on the way which will point to more effective and less disruptive containment measures. Eventually good treatments and effective vaccines will make our choices easier, and our outlook sunnier.
Reality Check — for the 2009/2010 H1N1 pandemic there were approximately 60.8 million cases, and 12,469 deaths in the United States alone! Globally, it likely infected between 700 million and 1.4 billion people, resulting in 150,000 to 575,000 fatalities. [Source]
For the Wuhan Coronavirus of 2019/2020 there have been 9,028 documented cases in the US with 150 US deaths so far. Globally there have been 218,220 cases with 8,937 deaths so far.
At least in the US, there were no 2009/2010 mass closings or quarantines, no stock market crash, no panic buying at the Costco, no mass cancellations of sports events or trade meetings.
They must have been a much tougher breed way back then.