What if we are approaching this all wrong?
If you have some time, listen to the interview below with Dr. John Ioannidis of Stanford University. He’s a a Greek-American physician-scientist and epidemiologist who studies scientific research itself.
Ioannidis published a paper titled, “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data.” It’s a fascinating, non-emotional, look at COVID-19 that should at least cause us to question the way we are tackling it.
“At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact…
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.”
If you prefer to listen than read, here’s a recent interview about his article:
I bring this up because many crusaders have condemned those who buck conventional wisdom and question the cost of a crippling quarantine policy as not just ignorant, but morally reprehensible. What if there is a third way?
But there’s some goods news too, even if we are overreacting. The Los Angeles Times ran an upbeat editorial yesterday drawing historical parallels between the current epidemic and the 1918 flu. Not so much in the viruses themselves, but in societal reaction and how social distancing worked then and will work now.
In a sense, we are left with more questions than answers when comparing the two articles. The good news, it seems, is that even if we “stay the course” in a manner that ends up costing even more lives, history predicts we will bounce back. That should bring a smile to our faces, even during this particularly difficult time.
CONCLUSION
I know this post isn’t exactly travel-related, but I was impressed by the interview…I think we all need to think more critically and admit we may not have all the answers before us on a short-term solution. Hopefully we are doing it right, but let’s all be open to the possibility we are not.
I always enjoy the term “non-emotional” as a keyword for a persons mindset. We have hundreds of scientists saying similar things, but they don’t match the blog-owner’s personal views. So instead of re-evaluating his views he dismisses them as “emotional”. It is the poster himself, who has no personal scientific background, most susceptible to forming these views based off of emotion.
To be clear the argument put forth by Dr. Ioannidis is well formed and reasonable — and these kinds of non-mainline arguments are necessary and vital for proper scientific discourse. It is rather Matthew’s cherry picking of this singular argument to signal boost and code as “non-emotional” — in implicit contrast to the other arguments — which is the only irresponsible, emotion-based reaction here. The other scientists who have put forth their best analysis deserve better.
I think your nitpicking on the choice of the word “non-emotional” is fair, but let me frame my perspective. As I watch COVID-19 unfold around us, I do see actual emotion, often expressed in terms of morality, play out constantly. Those who do not tow conventional wisdom are judged not only obtuse or ignorant, but dangerously subversive and morally reprobate. And that MAY be. I’m not saying Dr. Ioannidis is correct or conventional wisdom is wrong, but what he said made a lot of sense to me. And there was no emotion in it. There was no preaching or hand wringing, just a call to dig deeper and a refreshing amount of skepticism.
So please don’t see my word choice as an attack on other scientists. Rather, as I watch the news play out around us, I just appreciated hearing a POV that lacked an emotional appeal or partisan political calculus.
Amen. John. Amen.
Italy didn’t overreact when things started getting serious. How’d that work out? The guy is correctly stating that we need more data, but has aluminum foil hat ideas: “School closures, for example, may reduce transmission rates”. May? Yes they do, that’s why the schools are closed. When kids stay separated, they don’t catch illnesses from people on the next street. Then he starts with the “herd immunity” stuff that the Netherlands tried and found out that it only works if you’re willing to let a lot of people die. It’s like being lectured on something subjective by Sheldon Cooper.
Speaking of the importance of data points — this article was published on March 17 — so three weeks ago. The interview was published 10 days later, but I’m not sure when it was actually given. Three weeks of additional data points shows that the worst fears weren’t unfounded and that the extrapolated death rates (based on insufficient data in and of themselves) aren’t anywhere near accurate.
The article is is right — we need more data. We need to have more testing and all over the place. We need antibody tests. But given how contagious this virus is and how unprepared most places are to handle widespread cases (read the New Yorker article about rural Georgia — https://www.newyorker.com/news/news-desk/what-the-coronavirus-is-doing-to-rural-georgia), this isn’t really about overreacting or not. And yes, it’s an interesting intellectual exercise to consider if the response is even worse than the event itself — but that makes an assumption that if there were not shutdowns and you had infection and death totals what we’ve seen and spreading/growing, that the world wouldn’t be irreparably impacted anyway.
If the best case scenario was that 1% of the world’s population would die — and die quickly, especially as health care would would essentially become impossible on any level — how would that not lead us to the same type of economic impacts we’re seeing on our society right now? To borrow from the professor’s analogy — what if the elephant let the house cat continue to attack — rather than trying to avoid it and accidentally falling to its death — and still winds up dying at the hand of the cat anyway? The elephant dies either way. At least with avoidance, there was a chance at no tripping over the edge.
Good point. Actually Dr. Ioannidis predicted in his STAT article: “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”
As of today (April 8th) the number of deaths is 12,935.
Not nit-picking, but just out of curiosity: What’s the significance of “Greek-American”?
I’m curious because an epidemiologist I follow on twitter is also Greek-American, but damned if I could tell you why that fact lends credence.
Just being descriptive. Not really relevant.
Your city of Glendale has a couple hundred known cases. Your city immediately to the East today has 32 admissions for corona virus at its only hospital. If that number was 70, they’d be overwhelmed.
Oh, and don’t ask me how many healthy men under 50 have not made it or been intubated within 15 miles of u. The number ain’t zero. I have never seen that with the flu.
Better to be safe. The economy is screwed. But really, the last recession started 13 years ago (longest in our 250 year history) and for some reason or another, all expansions come to a stop at some point. But u know what? Recoveries always quickly flow.
Who said I live in Glendale?
Glendale/Burbank, somewhere within 10 miles no?
He bemoans the lack of data…but isn’t that a function of the way the virus has spread, eg, until yesterday the US had only tested 4,400 per million population , and then only for those presenting with symptoms/history demanding it. Setting aside the issue of the SNAFU over testing rollout, the US has not had the luxury of widespread ‘random’ testing in the way Iceland has (181,000 per million). When 200 die in their homes each day in NYC, of acute respiratory distress, but are not classified as COVID-19, or even tested for it, it’s a reflection of a system in total overload. One can only imagine the consequences of a Swedish style approach .
The widespread testing will come during the next phase, as restrictions on movement are loosened, and a period of extreme vigilance commences , in order to minimize any resurgence.
I’m not convinced by the ‘they would have died very soon anyway’ argument ( it’s contradicted by the EXTREME increase in the death rate in the UK…not just a marginal, spike, as he seems to suggest)
Lots of good arguments though.
I am a medical researcher and I have always respected Ioannidis. He keeps it real.
From a purely scientific point of view, “we need more data” is almost always true. Yet the pressing issue with related to a fast transmitting disease like COVID19 is that decision makers are always faced with tough choices with very limited information and rapidly changing situations. IMO making decisions before reliable data becomes available is part of the very nature of a pandemic.