By SAURABH JHA, MD
The COVID-19 pandemic has been a testing time for the already testy academic discourse. Decisions have had to be made with partial information. Information has come in drizzles, showers and downpours. The velocity with which new information has arrived has outstripped our ability to make sense of it. On top of that, the science has been politicized in a polarized country with a polarizing president at its helm.
As the country awoke to an unprecedented economic lockdown in the middle of March, John Ioannidis, professor of epidemiology at Stanford University and one of the most cited physician scientists who practically invented “metaresearch”, questioned the lockdown and wondered if we might cause more harm than good in trying to control coronavirus. What would normally pass for skepticism in the midst of uncertainty of a novel virus became tinder in the social media outrage fire.
Ioannidis was likened to the discredited anti-vax doctor, Andrew Wakefield. His colleagues in epidemiology could barely contain their disgust, which ranged from visceral disappointment – the sort one feels when their gifted child has lost their way in college, to deep anger. He was accused of misunderstanding risk, misunderstanding statistics, and cherry picking data to prove his point.
The pushback was partly a testament to the stature of Ioannidis, whose skepticism could have weakened the resoluteness with which people complied with the lockdown. Some academics defended him, or rather defended the need for a contrarian voice like his. The conservative media lauded him.
In this pandemic, where we have learnt as much about ourselves as we have about the virus, understanding the pushback to Ioannidis is critical to understanding how academic discourse shapes public’s perception of public policy.
Saurabh Jha (SJ): On March 17th, at the start of the lockdown, you wrote in STAT News cautioning us against overreacting to COVID-19. You likened our response to an elephant accidentally jumping off a cliff because it was attacked by a house cat. The lockdown had just begun. What motivated you to write that editorial?
John P.A. Ioannidis (JPA): March seems a long time ago. I should explain my thinking in the early days of the COVID-19 pandemic. Like many, I saw a train approaching. Like many, I couldn’t sense the train’s precise size and speed. Many said we should be bracing for a calamity and in many ways I agreed. But I was concerned that we might inflict undue damage, what I’d call “iatrogenic harm”, controlling the pandemic.
To answer your question specifically, I wrote the piece because I felt that the touted fatality rate of COVID-19 of 3.4 % was inflated, but we had so limited data and so much uncertainty that infection fatality rate values as different as 0.05% and 1% were clearly still possible. I was pleading for better data on COVID-19 to make our response more precise and proportionate.
(With Thanks to Yusef for this link).DigWithin:
Has COVID-19 Testing Made the Problem Worse?
(With Thanks to Anastasia for this link).
COVID – why terminology really, really matters
Better get back to work, but thanks again for posting this.
ReplyDeleteIt is remarkable Ioannides quoted and then tactfully criticized Nassim Taleb. I recall one of our first conversations, when we discussed Taleb's contribution.
It really is a privilege to be able to follow your blog.
I've wanted to say for awhile: Google and who knows what else may be able to channel views to some pages and choke others out, but if what they are channeling views towards is garbage and away from is the truth, they will ultimately fail. I have complete faith the truth is all that matters and the truth will win out. It might be discouraging at times to witness the manipulations and their temporary successes, or worse than witness, to be one of the victims. The reversal may come very slowly, too. It will come. I will always believe this.
Well one thing to be said for the truth, and one reason why most people must wish it to prevail, is that it is both more interesting and more useful than lies.
DeleteWhat a blessing you think so.
ReplyDeleteThe disastrous countervailing force is most people don't want to think for themselves-- they want to be told what to think and do and they want to think and do what everyone else is thinking and doing. Utter conformity and to an arbitrary law.
If this were not so we would never have needed to witness the worldwide stampeding off a cliff, so very much similar to, as Ioannides infamously stated, an elephant jumping off a cliff to fend off an attacking cat.
“Man is timid and apologetic; he is no longer upright; he dares not say ‘I think,’ ‘I am,’ but quotes some saint or sage.” (Self-Reliance, Ralph Waldo Emerson)
and,
“Whoso would be a man, must be a nonconformist. He who would gather immortal palms must not be hindered by the name of goodness, but must explore it if it be goodness. Nothing is at last sacred but the integrity of your own mind. Absolve you to yourself, and you shall have the suffrage of the world.”
We have this striking situation where there do not appear to be any men anymore. Unbelievable. Now, six months into the lock down, when covid mortality is approaching zero and, hey, the damned virus has likely spread as much as it can spread, we see more people wearing masks than when the contagion was at its maximum. Ioannides continues to point out the lock down had to be as temporary as possible. Clearly, however, the lock down and the rest is permanent. Just as "The Patriot Act", presented as temporary, is still in effect.
https://www.congress.gov/bill/116th-congress/house-bill/6172/text
This is a very frustrating interview, and the commentators on the site and the interviewer himself at points both call Ioannides himself out on it. He is much too defensive and concedes too much to the pro-lockdown side.
ReplyDeleteIf you look at charts comparing actual deaths from all causes in nearly every country to the normal annual death tolls in non-plague years, you will find they match except in March and April in some western countries. This year's death toll was higher than normal in March and April. In other months, same deaths as in previous years. The March and April figures turn out to be entirely attributable to the killing of people by ventilators.
Also, deaths from flu are much lower this year, and except for March and April, the decline in deaths from flu turn out to match closely the COVID death figure. And to the extent there is variation by country, no lockdown and minimal lockdown countries clearly do better in terms of keeping down deaths than enthusiastic lockdown countries.
The data makes it pretty obvious that COVID was a scam all along, and this is also supported from what we are finding out, though lawsuit discovery and what investigative reporting is still happening, of how local governments in the US came up with the policies (it appears there was no consultation with medical experts whatsoever).
Now in my city in Northeast North America what happened is that people were pretty much under house arrest from March to April, and after that places reopened (there are still lots of things closed) but with lots of intrusive hygene theater, and a month ago everyone started wearing marks and the trend of mask wearing seems to have increased. The police are not arresting or fining people who don't wear masks outdoors, so there is no reason to do this except to signal your support of the regime. As Yusuf noted, this is getting very frustrating as we keep getting more evidence and data that there was really no health crisis in the first place.
"The March and April figures turn out to be entirely attributable to the killing of people by ventilators". That is astounding. Do you happen to have a link handy to relevant stats?
DeleteInteresting also that, as with Covid, deaths attributed to flu are said to show no moderation due to lockdowns.
It was actually ventillators plus nursing home deaths.
DeleteI will have to fish for a link. Some commentator at unz.com posted a chart and it was revealing. However, its possible to do research that will substantiate this point.
First, pick a country and find monthly deaths from all causes in 2020 and then in previous years. This will give a month by month comparison. After June at the latest, you will see that the total deaths from all causes in 2020 is not greater than that of previous years. In some countries it is lower.
Since there are deaths attributed to COVID in 2020, that means that after June some other cause of death would have had a decline, and that is usually other types of flu.
Now for the ventillators and nursing homes, take the total number of deaths in March and April in 2020 and find the equivalent for previous years. The total 2020 deaths number will be greater. The difference (or increase in deaths in 2020 from normal) should be equal or slightly lower to the COVID attributable deaths.
Then find the figure for nursing home/ ventilator deaths for those months, and this part will be somewhat hard. Then compare it to the difference between the total deaths for those months and what they are normally. If I and the unz.com commentator are right, these numbers should be about the same. It was pretty clear from the graph posted. But if I can't find a single source, it should be possible to recreate the data. And I have seen similar research on a few other sites.
"It was actually ventillators plus nursing home deaths.
DeleteYes, nursing homes have certainly proved deadly, here in Canada, accounting for 81% of Covid deaths to May 25, and of that group of victims, many were likely subject to forced ventilation.
"Yes, nursing homes have certainly proved deadly, here in Canada, accounting for 81% of Covid deaths to May 25, and of that group of victims, many were likely subject to forced ventilation. "
DeleteYes, you pretty much made the argument yourself without realizing it.
March, April, May in Western countries most COVID related deaths were people in nursing homes, not just in Canada. So in Canada a fifth of COVID related deaths were not nursing home deaths, pretty similar ratio in other countries.
In all western countries, deaths this year per month were greater than in previous years only in the Spring, eg March and April. The spike in deaths in March and April was caused by people dying of COVID. This did not cause a spike in June, July, and August because there was no spike, the monthly death rate at that time was not in excess of normal (and the CDC has stopped calling this a pandemic).
And in March and April, some four fifths of COVID related deaths were people dying in nursing homes. Take these out of the equation, and total deaths from all causes are not out of line from what you would get in previous years. There literally is no "pandemic" in western countries without the people being killed in nursing homes and ICUs.
"There is an age gradient of fatality with COVID-19. This fact has been shown in several studies. Not only is there an age gradient but a steep inflection point with age, around 70. The hazard ratios are striking. Age predicts mortality better than even comorbidities. This scientific fact can easily be hijacked by demagogues by calling people concerned about the negative consequences of the lockdown “heartless granny killers.” That isn’t helpful.
DeleteThe fact that COVID-19 disproportionately affects the elderly, i.e. older people are more vulnerable, means that they need more precise and thoughtful protection. I have been advocating for more attention to and protection for elderly people, not less. Unfortunately, that’s not what happened. For instance, Andrew Cuomo, governor of New York, told hospitals to send infected nursing home residents back to their nursing homes, which was like putting out a forest fire with kerosene. The same happened also in other states. This act alone may have caused countless deaths amongst nursing home residents. We failed to protect our most vulnerable, in part because of our “one-size-fits-all” approach. In Lombardy, there were disproportionate deaths in nursing homes. It is estimated that 45-53% of US deaths were in nursing home residents, and similar or even higher percentages were seen in several European countries.
We needed extra precautionary effort in high-risk settings such as nursing homes, prisons, meat processing plants, and homeless shelters. The corollary of having high-risk groups is that there must be low-risk groups, and low-risk people can continue working. We can’t treat everyone as “high risk” because then the high risk won’t get the extra attention and care they deserve. In our approach to controlling coronavirus we made no distinction between teenagers partying on beaches in Florida and debilitated, frail residents living in congested nursing homes in NYC. Our uniform approach was neither scientific nor safe."
You'd have to wish there would be accountability for poor decision making by our "elected" politicians, but of course there will not be. They will claim they were working with imperfect information and also relying on the experts, who, it turns out have been most unreliable.
I'd myself know in such cases as Cuomo sending people back to nursing homes was a dickhead move because I already knew-- and so did many others--of the age gradient factor and the people in nursing homes WERE MOST AT RISK and MOST IN NEED of quarantine or quarantine-like treatments.
I agree with you Ioannides concedes too much to the pro-lock down people. He does directly say at one point he supported the lock downs. At the same time, if you pay attention to what he's saying indirectly there are indications his support would have to be considered highly qualified. I wouldn't be surprised if the pro-lock down people got to him. There is a very threatening element against people who AT ALL have bucked the dominating narrative of the "pandemic." Here in Alaska I swear the people in power are prepared to ruin the lives of anyone of any significant influence who says, "where's the science? where is your data?" (Worst of all, the people in power claim they are being scientific and the people asking to see evidence of that are the ones who are dangerous and irrational. Along with this, the people in power will crush the others without qualms, without compunction.)
It was interesting to me Ioannides pointed out the 3.4% IFR came from the Chinese. It was the Chinese who fed that hideously inflated number to the WHO. I had not known this. So once again I have an example of how the Chinese have been far from exemplary and anyone, such as Ron Unz, who has credited their scientific skills and probity, as well as their totalitarian responses, cannot be forgiven. A gullible moron with an IQ of 214? I think not.
The United States has a weird, only in the world, political system where major policy changes are made by the judiciary, largely because the federal and state legislatures are too corrupt to make much policy, so everything happens either by executive fiat or lawsuits.
ReplyDeleteSo much as I hate the blue and red tribalism that will be on display in American blogs in the next month, the Supreme Court vacancy that opened yesterday (the USA is also unique in the world in having lifetime tenure for judges) is important in the COVID story.
In the Spring a church in Nevada sued the government of Nevada for closing the church, while keeping casinos open, and the case made its way to the Supreme Court, which backed the state government on a 5-4 vote, with oddly no opinion explaining the decision (the dissenting justices issued opinions). The four blue justices along with Chief Justice Roberts backed the government, the four other red justices dissented.
Some small businesses and local politicians in western Pennsylvania also sued the Pennsylvania government, and a Trump appointed federal district judge ruled that the Pennsylvania lockdowns violated the first and fourteenth amendments. These were the Spring lockdowns, not the current hygene theater, but the judge pointed out that the Pennsylvania governor only suspended the lockdowns and the governor threatens to reinstate them, so its still a live issue. The governor appealed, and the case will go to the federal appeals court, which is deep red, and then likely to the Supreme Court.
However, the 5-4 pro lockdown majority in the Supreme Court became 4-4, and Trump is likely to appoint and get confirmed a justice who will take the anti-lockdown side, before the Pennsylvania case reaches the Supreme Court. Also, the likelihood of another Bush v Gore type case over vote counting reaching the Supreme Court too. This isn't just about abortion and gun rights anymore.
This is the way things are going in Alaska:
Deletehttps://www.adn.com/alaska-news/anchorage/2020/08/08/city-seeks-contempt-of-court-hearing-after-anchorage-restaurant-defies-judges-ruling/
The mayor Ethan Berkowitz, shuttered many Anchorage small businesses a second time, starting on August 3rd.
There is virtually no indication of any kind this was necessary. As of September 18th, the CDC places the percentage of expected deaths in Alaska at 97%, so we are one of the places in the country with fewer deaths than forecast so far. There have only been 198 covid hospitalizations total for the entire state.
The mayor is bright blue and I am convinced he takes orders from someone. I just don't know who. Whoever it is obviously wants to destroy small businesses. Government projects proceed without hindrance and to the best of my knowledge there have been no furloughs or layoffs for government employees.
The owners of the diner backed down a few days after this article was published. Their lawyer was threatened with censure for attempting to represent them.
On August 28th, Anchorage restaurants were again allowed to offer dine-in service, but with heavy restrictions such as operating at no more than 50% total capacity. I noticed through a google search most continue to offer only take-out.
"Earlier Saturday, Kriner said he would lose half the restaurant’s revenue by going to take-out only. He said it 'would just be a slow, quiet death in the restaurant business if all you did was take-out. You would eventually not make it.'"
Kriner's is open again and offering dine-in service. What a wild, scary ride.
"the Supreme Court, which backed the state government on a 5-4 vote, with oddly no opinion explaining the decision"
DeleteAmazing. Perhaps the reason that the majority of judges would give if compelled to do so, is that people at casinos generally don't sing -- a supposedly hazardous activity.
In addition, if the judges were to be quite candid, is the fact that churches, unlike casino owners, rarely deploy millions for political purposes.
Biden would mandate masks on all federal lands in Alaska.
ReplyDeletehttps://mustreadalaska.com/biden-would-mandate-masks-on-all-federal-lands-in-alaska/
I often see no one at all when I am hiking and camping in wild Alaska, on federal lands. (Which, I believe, is about 60% of Alaskan land.) How absurd. This former VPOTUS is, however, the Democratic presidential candidate. Someone out there must take him seriously.
I can easily imagine Biden's mandate coming to pass, and some drone with video and face recognition software capability coming and keeping me in compliance. "For my own good."
"Biden would mandate masks on all federal lands in Alaska."
DeletePolar bears are already endangered due to global warming. They must not be further imperiled by exposure to unmasked hunters.
In March I had speculated that the real purpose of the lockdowns was to reduce industrial activity and counter climate change (global warning). Personally, I happen to be obviously a lockdown skeptic but not a climate change skeptic, an unusual combination. Other people have speculated this was the real reason.
DeleteSee the Daily Mail article here which addresses the linkage:
https://www.dailymail.co.uk/news/article-8753707/Charles-Climate-crisis-dwarf-impact-coronavirus.html
The really interesting point is that the earliest estimation is that the lockdowns did lower the global temperature, by all of 0.01 degrees Celsius (about 0.02 to 0.03 degrees Farenheit. Who would have thought keeping people from going to church wouldn't have had more effect?
The ecological crisis was driven by over-population, not by people patronizing small businesses. Though maybe, with the methane release already starting to happen in the Artic, all this was a panicked measure to keep things from getting suddenly worse, in which case it was too late.
There are probably multiple motivations and political forces attempting to manipulate the "pandemic" to serve this or that political purpose having virtually nothing to do with the health of the public.
DeleteI have the image of twenty people in a circle on a beach trying to keep a beach ball in the air but also to knock it over the heads of their "opponents" and thus "win". Mainly, though the ball does stay in the air, it gets chaotically batted back and forth. The image fails in that in reality while players are batting the ball back and forth there's a great likelihood all will "lose", big time.
The damned Democrats obviously would like to use this to make Trump look an ineffectual buffoon, so he'll lose the upcoming election. They really do seem to consider this objective worth any cost to the nation. I'm not a Trump fan, but his early questionings of the validity of the Chinese numbers and his statement "we can't let the cure be worse than the disease" keep ringing in my head as exactly right. Trump's initial idea we should block travel into the US from China, ridiculed as racism by the Democrats, also seems smarter than anything he's been forced to do by his "advisors" such as Fauci.
Did you know Fauci has a larger security detail of secret service agents than Donald Trump?
I have also speculated this lock down is a desperate response to climate change, but if so, along with some advantages, it has serious defects. The U.S. deindustrialized at the same time China industrialized. On advice from the U.S. "experts" Chinese industrialization was accomplished via coal-fired power plants. The air in China has been hideously polluted for decades now and this is a major factor in the increase of atmospheric CO2, particulates, and get this: mercury in the oceans.
DeleteThere was a sharp decline in Chinese industrial production in March and April, but it has rebounded sharply. NOT ONLY. Chinese industrial production is again growing.
"Economies in Europe and the United States are still languishing as the pandemic forces cities to shut down and shoppers to stay home. But one major country is growing once again: China."
https://www.nytimes.com/2020/07/15/business/economy/china-coronavirus-economy.html
What's happening is all "hidden in plain sight" for everyone with "eyes wide shut."
"In March I had speculated that the real purpose of the lockdowns was to reduce industrial activity and counter climate change
DeleteSome may see the slowing of economic activity as a benefit of the pandemic, but creating a pandemic hardly seems a sensible way to slow economic activity, which could have been achieved by a three or four percent rise in interest rates.
However, if the pandemic was deliberately loosed on the world, the country responsible -- assuming the action was by a national government -- may have been designed to achieve national advantage by (a) using unshared foreknowledge of the virus's spread to contain the disease at home and thus maintain economic activity as rivals are driven into severe economic slowdown; and (b) demonstrating apparent superiority in social organization (through greater discipline, regimentation, or tyranny) in dealing with the outbreak, thereby achieving recognition in the world-leadership stakes.
"I have also speculated this lock down is a desperate response to climate change, but if so, along with some advantages, it has serious defects."
DeleteYes, there must be better ways to limit carbon emissions -- a carbon tax, for example.
But here's a crazier theory: the virus was released to cure the Western nations of obesity, first by carrying off some of the most obese, and second scaring people into demanding a tax on sugar, consumption of which in the United States now accounts for about one third of total calories consumed.
To me. the most plausible explanation for Covid19 if it were deliberately released by a state actor, is that it was intended to push the Western states, and particularly the United States, into economic chaos and decline, thereby resulting in general and peaceful acceptance of China as the world's leading power.
ReplyDeleteI also find that most plausible.
DeleteI don't necessarily think we have to know whether or not the release was deliberate, or by a state actor, because if it was unintentional or from nature, its existence could be played to the same end result, economic chaos and decline.
We sure see economic chaos and decline in the U.S. And we ain't seen nothing, yet.
And, at the same time, we see what Larry Kudlow called a "sharp V-shaped recovery" of the economy, and also of the society, in China. There is an excellent graph of that in the NYTimes article I linked. (Note, however, the NYTimes focuses on the lag of China's consumer demand, as if that's worrisome. Yes, that lags, but its rebound is also a sharp V-shape and does not strike me as a meaningful negative indicator of softness in China's recovery. The Chinese consumer has simply been rational and cautious. If trends continue, consumer demand will also be growing soon on a year on year comparison.
I also have to say, and I find this most frustrating: the Chinese are investing vigorously in their infrastructure. The U.S. is not. So, we're sure to see the Chinese economy surpass the U.S., and we'll very likely soon after see the Chinese standard of living surpass the U.S. as well. It is irksome to me. The U.S. is squandering its wealth, not investing it. And the way that plays out is in poverty and need. It is so damned stupid.
Maybe we'll pick up on the internet pleas from the Chinese gov't to the Chinese people to give generously to aid the famine victims in the U.S.A., supported by heartbreaking photos of emaciated children suffering kwashiorkor.