Once in a blue moon, you read something that makes a heck of a lot of sense. It provides reason amid the chaos and asks questions that sorely need answers. Such is the case with an article published on the website STAT by John P.A. Ioannidis, a medical professor at Stanford University, about the decisions we are making to combat COVID-19 using very little in the way of data. The good professor of medicine, epidemiology, and biomedical data science from Stanford is asking if we should push the pause button here.
Shoot First, Ask Questions Later
Under the direction of the president and the nation’s top infectious disease experts, unprecedented social and economic measures have been instituted regarding the Coronavirus. It may take years, perhaps decades, to fully understand the consequences of these decisions – both financial and sociological. In other words, have we unloaded a Howitzer when a .22 would do?
This in no way damns the president or the American medical experts who are moving forward with an abundance of caution. But now that we are holed up in our homes and the government is preparing to dole out billions of dollars, can we take a moment and try to gather some pertinent statistics? Perhaps this data will even lead to a hiatus and guide us to make better decisions. The reason to hit that all-important pause button is that we are functioning in an atmosphere of very little reliable information. Ioannidis points out:
“The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 (COVID-19) are being missed. We don’t know if we are failing to capture infections by a factor of three or 300.”
Professor Ioannidis calls this an “evidence fiasco” that “creates tremendous uncertainty.” He goes on to say, “fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless.” But there is one closed population situation we can look at and that should be examined more closely to gather reliable – albeit not perfect – information: The Diamond Princess cruise ship.
The once-quarantined Diamond Princess represented a closed population. It’s relatively well-known that the case fatality rate on the ship was 1.0%, but the average age aboard the cruise liner was older than the U.S. average, and we now know that COVID-19 affects the elderly at a higher rate. But if we tease out the Diamond Princess data, here’s what we get, according to Ioannidis:
“Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 (COVID-19) infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.”
This appears to be a technical way of saying that things may not be as bad as they seem at the moment. As the Stanford professor points out, “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.”
There’s no telling what we will find when we look back on the COVID-19 crisis. However, since we are still in the middle of this mayhem and madness, maybe we should be asking the medical community to plow through the statistics available and come up with more reliable data? These experts who are on TV every day telling us what not to do might do well to hole themselves up in a room and crunch some numbers. That way, when our elected officials all but declare something akin to martial law, we will have good reason to listen.
To read Professor Ioannidis' full article click here.
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Read more from Leesa K. Donner.
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