“What is a Person to Believe” Sydney Williams
We are told we live in an era of science. Neil deGrasse Tyson wrote, “the good thing about science is that it’s true, whether or not you believe in it.” But is that really so? Does not science change as new evidence is gathered? Statisticians use models to justify their findings. Yet models are only as good as their inputs. The epidemiologists’ models we have seen regarding COVID-19 have changed markedly over the past few weeks. In mid-March, Imperial College in London predicted 2.2 million deaths in the U.S., with no mitigation. By the first of April, modelers at Oxford saw that number drop to a range of 100,000 to 240,000, with some mitigation. Now the estimate is 60,000. A University of Virginia model shows COVID-19 will peak this summer, while Health Metrics Evaluation at the University of Washington suggests the virus will “peter out” in May. Models make assumptions about, among other factors, human behavior, the measurement of which is an art? What is a person to believe?
If we are to base our beliefs about COVID-19 on the basis of “evidence,” it is unsurprising that confusion abounds. We presume, with strong reason, that it came from the city of Wuhan in Hubei Province, China, but whether from a live bat sold for human consumption at a wet market or the Wuhan Center for Disease Control has never been made clear. We are told coronavirus is highly contagious. Ten days ago, the Los Alamos National Laboratory published an article in which they claimed that the transmission rate for COVID-19 is between 4.7 and 6.6. For comparison purposes, the seasonal flu, the transmission rate is 1.3. (The transmission rate is also referred to as the regeneration rate, or the R0.) At the midpoint, 5.7, over ten rounds, one person could infect 36 million people. The chief epidemiologist at the Chinese Centers for Disease Control in Beijing puts the transmission rate at between 1.0 and 5.0. At the midpoint of 2.5, and after ten rounds, one individual could infect 9,538 people. Which are we to believe?
Mortality rates are equally confusing. Is the rate calculated only for confirmed cases, or do deaths recorded include those with underlying conditions from which recovery was not probable?? Recently, some deaths attributed to COVID-19 include those who were suspected of having COVID-19, but on whom no tests were made. Is that fair? What about obesity, diabetes and lung disease. Should the asymptomatic or mildly symptomatic be included in the denominator? And what about perspective? In 2018, 7,779 people died every day in the United States. That would suggest that since the first two deaths in the U.S. from COVID-19 on February 26, more than 388,000 Americans have died from other causes. As of April 15, 30,844 Americans have died from COVID-19, (a number that includes 4,059 “probable” deaths in New York City). – a tragedy, but one that needs be kept in perspective. At the end of March, mortality rates from COVID-19 in the U.S. were estimated at 3.4 percent. Today, with millions more having been tested, that number is around 0.3 percent. Will that number continue to decrease as more tests are performed, or will a relaxation of lockdowns and social distancing, necessary for re-opening the economy, cause that number to rise?
Has the virus spread more widely than is known or acknowledged? Wuhan is China’s sixth largest city with a population of 11.1 million people. It has the largest student body population of any city in the world, which means that thousands of U.S. students were in Wuhan through the end of 2019, a month to six weeks after the virus was established. As well. In the 2017-2018 academic year, 360,000 Chinese students were enrolled in U.S. universities. Presumably, the numbers were similar for the 2019-2020 academic year. Most of those students would have returned to their U.S. college campuses following the Christmas holidays. Yet, the first person in the U.S. to be diagnosed with the novel coronavirus, 2-nCoV019, was a thirty-five-year old man, with “underlying health issues,” on January 19. He had returned to Washington State after visiting family in Wuhan. He claimed that when in Wuhan he had had no contact with anyone who was ill. After eight days in the hospital, he was asymptomatic and discharged. But are we to believe, with 3,000 to 4,000 people arriving in the U.S. every day from China through the end of January, that no one else had contacted this novel, contagious virus before then? Is it not possible that there are thousands, if not millions, in the U.S. who are asymptomatic or mildly symptomatic and have developed immunity?
And what about China, the source of this contagion? Hubei Province includes 58.5 million people. As a stand-alone country, it would rank as the 26th largest in the world, just behind Italy and just ahead of Spain. For all of its economic success over the past two or three decades, China remains a Communist dictatorship. Two hundred million surveillance cameras keep watch over its 1.4 billion people. The Chinese Communist Party, at 90.5 million members, may be the second largest political party in the world, but the other 93% of the population lack basic rights and opportunities. Despite the enormous wealth of Chinese Communist leaders, China is a poor country. Household incomes in urban areas average about $6,000 a year. One point five million Muslim Uighurs are being held in 1,000 re-education camps in Xinjiang Province, in China’s northwest. This is the country that allowed the novel coronavirus to spread around the world for two months, with tens of thousands of people flying into and out of Hubei Province, before notifying the rest of world. Worse, the WHO (World Health Organization) was their willing partner. Should we believe them now, as they claim to want to help stop the spread of the virus they started?
Besides Chinese disinformation and the natural political exaggerations in an election year, part of the confusion lies in the fact that COVID-19 is a novel virus, which means it is a new strain never before seen in humans, so doctors and scientists had to learn on the go. Part of the problem is ours, for when we heard from those who make evidenced-based decisions we believed their predictions were accurate. Like sheep, we accepted the most extreme of the forecasted death rates, which resulted in an economic shutdown, the proportions of which have not been seen in at least eighty-seven years. We were led away, without debate, from the concept of a “herd” immunity, which might have ended the blight without risking the economy. In years to come, when historians review the virus and the reaction, will they say we acted wisely, or will the judgment be we reacted with a “herd” mentality, and that when attacked we assumed the hedge hog’s defense. It goes without saying that the aged and the health-vulnerable need protection, but like lemmings, have we run off the proverbial economic cliff? What is a person to believe?
Last evening at the President daily press conference with the coronavirus task force, Dr. Deborah Birx laid out guidelines for re-opening the country in three phases. These are guidelines – not directives – and the timing is left to the states. They will be using CDC’s influenza-like maps that they have for every county and city. The guidelines appear sensible, so one would expect that governors will likely adopt them. Before a state can enter phase one, it must show a downward trajectory for fourteen days of those infected. The guidelines include continuation of good hygiene, the wearing of masks when in public and staying home when sick. Employers must ensure that social distancing is maintained, counters and public areas disinfected regularly, employees’ temperatures are taken daily, and non-essential travel is prohibited. Phase two will allow non-essential travel to resume and some schools and camps to open. In phase three the vulnerable should be allowed back into public places. Throughout all phases, good hygiene and common sense should rule. How long each phase would last would be up to the individual governors. Nevertheless, this was a moment of sunshine at a bleak time, and I hope does not betray our belief.
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