Are We Too Pessimistic?

With the usual caveats, namely that I know nothing about viruses or epidemics, I bring you a couple of articles that may or may not be relevant. By nature, I believe that we ought to question panic, that we ought to rely on rational thought, not emotional incontinence. If we are going to shut down the country, we ought to have a good idea about the nature of the threat.

For today, I bring you two articles that caught my attention. The first is by Josh Barro at New York Magazine. Given that NY Mag leans strongly to the political left, it is worth noting someone on the left who is not blaming it all on Trump and is not doing everything in his power to gin up mass hysteria. For all we know, we ought to be running for the hills, but still, when people panic they tend to do the wrong things. 

At a time when several Asian nations, apparently including China, have stopped the virus in its tracks, it is worth considering that this may not be the end of the world. And since the antiTrump movement has been prophesying the end of days for more than three years now, we ought to be less willing to accept catastrophic predictions without more evidence than the strength of our feelings.

So, Barro attempts to throw some light into the darkness. He sees an outbreak of excessive pessimism. He asks us to consider the cost of the measures we are taking-- shutting down the economy-- versus the risks of the pandemic:

But, for the first time in a while, 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.

As it happens, he declares, Asian countries have been using less social distancing and more testing. He does not mention that Asian citizens are more likely to obey government orders to limit social interactions than are Americans or Italians:

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. The Financial Times reports today on the town of Vò, Italy, which successfully stopped its local outbreak though a strategy that involved widespread testing of the population and isolation of those who tested positive, even as the rest of Northern Italy did not fare so well.

And also:

But at some point, the massive shutdowns we are undertaking in much of the U.S. (and ought to be undertaking in more of it) should make it possible to sharply reduce the rate of new infections to a point where widespread testing and monitoring can become a cornerstone of a strategy to prevent uncontrolled outbreaks — if we actually have the capability to do such testing and monitoring. This would not mean a complete end to the need for social distancing measures, but it could allow for a reduction in their intensity.

And, of course, some treatments are available. More are in the works. So, the news is not all bad.

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. Dr. Cyrus Shahpar, one of the public-health experts I spoke with for my story in our current print magazine, told me he thought widespread availability of effective antiviral drugs could come as early as late spring or early summer. This would be another important tool to save lives and reduce the burden on our hospitals, giving us additional space to rely less on societywide behavior changes.

And then there is the long article by John Ioannidis. Prof. Ionannidis is a Stanford University expert in medicine, epidemiology, population health and biomedical data science. He is also the co-director of Stanford’s Meta-Research Innovation Center.

While Barro is a journalist who has done his homework, Ioannidis is an expert. He brings a certain authority to our deliberations. And he also brings serious knowledge, not only of viruses but of epidemiology. He is not your friendly neighborhood general practitioner.

He begins by assessing the fatality rate from coronavirus. And he asks whether, given the relatively low fatality rate, whether it is a good idea to lock down the world. I would mention, in passing, that Chinese factories are reopening and shipping, as we speak. So, it’s more the Western world that is locking down:

A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.

Many question whether the coronavirus fatality rate is really as low as he says:

Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11% of those hospitalized in the U.S. with lower respiratory infections each winter.

Then, Ioannidis compares the coronavirus to influenza:

Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases. In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths.

If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams.

As of now, the number of coronavirus deaths in America ranges at a little more than 100-- which does not feel like a very large number. Yet, many serious scientists believe that the number will progress rapidly… until it is out of control:

Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?

In truth, it is devilishly difficult to predict the future. After all, the curve has flattened in several countries… after scientists were predicting  massive exponential increases. Ioannidis adds that the increased deaths might be produced because an overwhelmed health system does not have the resources to deal with other conditions:

Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.

And, he adds, we ought to consider the societal and economic costs of shutting down the economy and shutting in the nation:

One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.

In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.

He continues:

One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.