June 2020 – Let's Sort Some Things Out

The goal of “The Real Issues Concerning COVID-19” series of posts has been to sort out the real issues that will determine when and how economies will reopen in an economically effective and reasonably safe way. I’ve been frustrated that the information broadcasted by the Heath Experts Advising Politicians and The Public (“HEAPPAs”) has (1) caused too many people are too scared to begin to consider when and how to ease nonpharmaceutical interventions (“NPI”), (2) used incorrect and misleading data, and (3) generally failed to advise the public concerning the real COVID-19-related issues facing the American people. HEAPPAs sowed confusion rather than clarity. Confusion fostered doubt that stymies the adoption of useful strategies to move forward.

Having ushered the country into NPI strategy without an exit strategy, HEAPPAs owed the American people useful advice on how to get out of the mess they created. Instead, the little guidance they offered was typically impractical or uselessly sketchy.

Examples include:

HEAPPAs, without explanation, moved the goalposts concerning the purpose of “flattening the curve.” At first, it was to prevent hospitals from being overwhelmed. Then it was a general-purpose means “to save lives.” Their explanations concerning the first were clear and sound. The reasons concerning how lives would be saved by “flattening the curve” in the absence of hospitals being overwhelmed were virtually non-existent. Their failure to respond to credible critiques of “flattening the curve” being a general purpose life saver by many respected epidemiologist and others left the impression that HEAPPAs could not defend their position or were motivated by non-health objectives.
HEAPPAs have been mostly mum about the mental and physical harm and death inflicted by NPI — information essential to reasonable decisions about the costs and benefits of reopening. HEAPPAs ignoring their responsibilities to inform on these critical health issues have added unhealthy angst, stress, and discord to an already tum situation.
After months of silence on the subject, Dr. Fauci’s recently said^[i] that he “totally supports” easing NPI because longer lockdowns could do “irreparable damage” to local economies. (Note: He couches the issue in terms of health vs. money, i.e., he talks about the thing about which he has no particular expertise and is silent on the negative health consequences of NPI). Then, he neutered the comment by adding “in a proper way in the appropriate setting,” without providing details concerning what way is proper and what setting might be appropriate.
The CDC adds to the messy messaging by publishing reopening strategies that are impractical.^[ii] While Dr. Fauci’s and the CDC’s lips are saying “carefully reopen,” the practical effect of their words is “remain closed” — without explaining why staying closed is better than reopening. In other words, they have not explained why delaying the COVID-19 deaths is with measures that are killing people is the right approach.

Politicians and the public desperately needed information and constructive advice to make informed decisions and to get the required buy-in by the public so that customers and suppliers would be willing to engage in commerce. They have gotten roughly squat from the HEAPPAs.

As I’ve mentioned before, respected epidemiologists, who were not HEAPPAs (although some have testified to Congress), have disagreed with leaving NPI entirely in place.^[iii] Yet, to my knowledge, until a few days ago, no one has advanced a concrete proposal as to how to proceed. Dr. Katz came close on May 7 but did not pull the trigger.^[iv] A few days ago, Dr. Darria Long and Dr. David L. Katz came through with a sound framework, which, hopefully, will soon become the basis of a strategic plan.

I highly commend to you:

As Cities Move Toward Reopening, How to Manage Risks

[i] “After Weeks of Silence, Dr. Fauci Is ‘Totally in Favor’ of U.S. Reopening if Done ‘the Proper Way’”

[ii] For example, see “Considerations for Schools.” How can enough busses be built, bought, and delivered between now and the start of school to achieve 6’ spacing, i.e., two kids per row and only odd or even rows are available. That means that only 14 kids per trip can be transported in a bus designed for 39 kids. Will the kids in the bus at the back of the long que of busses get to the school house door before first period is over?

[iii] “WHO hails Sweden as a ‘model’ for fighting coronavirus without a lockdown” (pulling the rug from under Swedish model bashers), “Why lockdowns are the wrong policy – Swedish expert Prof. Johan Giesecke,” “Perspectives on the Pandemic | Dr. John Ioannidis Update: 4.17.20 | Episode 4,” “Perspectives on the Pandemic | Dr. David L. Katz | Episode 3,” “Perspectives on the Pandemic | Professor Knut Wittkowski Update Interview | Episode 5,” Michael Levitt– Explains this Viral Lockdown – Fully!” and Carl Heneghan “UK coronavirus outbreak peaked before ‘unnecessary’ lockdown,” and “Dr. David Katz | Real Time with Bill Maher (HBO).”

[iv] “A More Surgical Strategy: Dr. David Katz | Rich Roll Podcast.”

Before states started easing non-pharmaceutical interventions (“NPI”) to “reopen” their economies, misguided, but empathetic prophets of doom (“Doomsters”) gnashed teeth, wailed, and jeered those who they thought were enabling COVID-19 to slaughter people for the sake of money, leisure, spite, or political gain. They declared that easing NPI would cause spikes in deaths. They never bothered to provide theories as to how slowing the spread of the virus might decrease the ultimate number of infections, much less how such slowing could save lives during times when no hospitals were at risk of being overwhelmed. Neither did they offer data showing that carefully easing NPI would cause the ultimate number of COVID-19 deaths to be higher. Instead, they validated their beliefs only with assertions, mantras, and chants and ignored the deaths and damage to physical, mental, and fiscal health inflicted by NPI.^[i] (Sadly and irresponsibly, the people advising politicians and the public neither validated nor refuted the Doomsters’ claims — but that is the subject of a future blog post.)

Though epidemiologists who speak from government podiums have not weighed in on the Doomsters’ claims, all epidemiologists assure us that the truth is in “the data.” So, let’s look at how Doomsters’ claims fare in light of data on how the epidemic has played out in Texas before and after NPI easing.

Texas’s first confirmed COVID-19 death occurred on March 15. Dallas/Ft. Worth officials ordered some business closures on March 16. “Shelter-in-place” orders for Dallas and Houston came on the 22nd and 24th, respectively, when just a few COVID deaths had occurred in Texas.^[ii] Texas’s COVID-19 dashboard started on March 26. (That dashboard has all the problems I previously described the COVID Map ^[iii] has plus some others,^[iv] but it is the best available information.)

Interesting items revealed by the above data include: Texas’s daily confirmed infections at the end of the first were 3.35 times the rate on the first day. Deaths were 3.83 times higher. At the start of the epidemic, COVID-19 was rapidly expanding. Note also that from the end of the first week, both rates have steadily declined. The confirmed cases and deaths on May 30 were only 1.14 and 1.1 times higher than the week before. Until May 5, the percentage increases in deaths were consistently higher than the increases in infections. Since then, the opposite has been the trend.

What is most striking, however, is that when Texas began reopening on April 20, the increase in infections was 4% per day. Forty-two days and six phases of NPI easing later, the rate of growth had fallen to 1% for a week. During that time, Texans progressively relaxed their NPI practices more than recommended by NPI guidelines, and some people abandoned NPI altogether. In short, despite the progressively greater social interaction since NPI started easing, the rates of infections and deaths have fallen steadily. There is reason to believe that the reported daily infection rate will soon show falling rates of infections despite increased easing.^[v]

In reality (as opposed to the reported numbers), if it were not for the significant increases in antibody testing in May.^[vi] Part of the increase in confirmed cases was due to testing more people in the later period. In other words, in reality, Texas’s daily infections are likely falling rapidly right now. The Doomsaying has been debunked by the data!

What is especially remarkable about this news is that, while NPI has proven to be mostly ineffective in protecting the vulnerable (despite politicians solemnly swearing to protect them), progress toward herd immunity has advanced while infection rate increases have fallen. Wherever tried, reopening economies will hasten the day herd immunity is achieved. That will be the day people will be less scared to engage in normal commerce, and vulnerable people can finally breathe easy and be comfortable around their loved ones.

That the Doomsters vehemently continue to insist that not following NPI will cause more ultimate deaths makes clear they have been relying on emotions rather than data and analysis. To their great discredit, epidemic experts who have commanded the stage and bathed in its limelight have neither validated Doomsters’ declarations nor clarified what is wrong with them. Rather than debate the epidemiologists and others who do point out the errors in the Doomsters’ thinking, they stand idly by as YouTube, Facebook, etc. takedown contradictory content. (That they prefer silence to losing the debate is a fair assumption.)

Doomsters’ claims fly in the face of the too few experts who are brave enough and willing to counter the established groupspeak on these subjects. For example, Yale’s Dr. David Katz^[vii] says, “If all we do is flatten the curve you don’t prevent deaths, it simply changes the date of their death.” Variations on that theme have been provided by Dr. John Ioannidis,^[viii] Knut Wittkowski^[ix] and Professor Johan Giesecke,^[x] Professor Sunetra Gupta,^[xi] and others.^[xii] As the Doomsters shouted, “Wear a mask, save lives,” the data and many responsible experts are saying calmly and convincingly that the Doomsters do not know much about what they are wailing (while Dr. Fauci or Dr. Birx remain mostly mum on the subject).

The Doomsters’ “thinking” did include a true factoid. Until the virus fades out, increases in social interaction/contact will cause the rate of infections to be higher than would otherwise be the case — at least for a while. Easing NPI increases social interaction/contact. Increased social contact causes increased infections until a high enough percentage of the people interacting are immune to the virus, i.e., when herd immunity is near or achieved.

Unless a sound argument that NPIs still saving lives is made, worrying about increased infections is misplaced. It is like fearing that a bucket will drain faster if a hole in its bottom were enlarged. The same amount of water will leak out regardless of the rate at which the water leaves the bucket. The only sure way to drain COVID-19 from the environment is for the population to achieve herd immunity. Delaying easing is delaying the inevitable number of infections that are needed to achieve herd immunity will ultimately save no lives. However, NPI will ring up deaths until eased out of existence.

When fears of hospitals being overwhelmed, insufficient medical supplies being available, and/or doctors needed time to discover how to diagnose and treat the new virus, “lockdowns” may have been justified, i.e., the damage from “lockdowns” might have been less than the damage the lockdowns were inflicting while those problems persisted. Now that those reasons for aggressive NPI no longer apply, ignoring the compounding damage NPI designed for bygone concerns inflicts is irrational. By ignoring the damage NPI inflicts, Doomsters are blind to the goal the ultimate goal of epidemiology, “draining” the environment of COVID-19 as quickly as possible without overwhelming the healthcare system.

As is so often the case, Doomsters are harming (killing, sickening, weakening, and otherwise ruining lives of) people they believe they are helping.

^[i] “The Real Issues Concerning COVID-19—Part II“

^[ii] “Timeline: Tracking the spread of COVID-19 in Texas.”

^[iii] “COVID-19—THE DATA or ‘the data’?” and “It Was ‘the data.””

^[iv] “‘How Could the CDC Make That Mistake?’”

^[v] “Stanford Professor and Nobel Prize Winner Explains this Viral Lockdown – Fully!”

^[vi] “Texas COVID-19 cases rise, governor’s office says more testing being done”

^[vii] David L. Katz, MD, MPH, FACPM, FACP, FACLM is a Preventive Medicine specialist and globally recognized authority on lifestyle medicine. He is the founding director of Yale University’s Yale-Griffin Prevention Research Center (1998-2019).

Preview(opens in a new tab)

^[viii] “Perspectives on the Pandemic | Dr. John Ioannidis Update: 4.17.20 | Episode 4”

^[ix] “Epidemiologist Dr Knut Wittkowski: ‘Lockdown Has No Benefit, Only Negative Effects’”

^[x] “Webinar: Weekly COVID-19 Pandemic Briefing – The Swedish Approach”