Over the past two weeks, a growing number of people have questioned the dramatic measures being taken to stop the spread of Covid-19. The chorus began with John Ioannidis of Stanford, who has argued that we have under-counted cases of Covid-19, leading to an overestimation of the death rate.
Since then, Covid-19 skepticism has found a home on the right. The Federalist, the Wall Street Journal and the American Thinker have all published similar arguments.
Superficially, these arguments make sense. Many celebrities and athletes have tested positive for Covid-19, despite experiencing only mild symptoms or being asymptomatic. Most people don’t go to the doctor because they have a sore throat and a fever, ergo a dramatic undercounting of cases seemed possible.
However, the number of undiagnosed cases is not quite as dark a dark number as Dr Ioannidis and the editors of the Federalist believe. In countries that successfully contained the spread of Covid-19, you can place a ceiling on the total number of undiagnosed cases. This allows you to account for undiagnosed cases when estimating case fatality rates.
In an infectious disease, the basic reproduction number (R0) represents the number of people to whom the average infected person transmits the disease. For example, if the R0 of a disease is 10, the average person who has the disease spreads it to 10 people.
To stop the spread of a disease, you need to push the R0 below 1. You can accomplish this by finding those with the disease and placing them under quarantine. Scientists estimate that Covid-19 has an R0 of around 3. To contain Covid-19 through quarantine, you would need to detect at least two thirds of all new cases and place them under quarantine.
We know of two places that have succeeded in containing Covid-19: South Korea after 11 March and Hong Kong before 13 March. During the periods in question, the number of new cases per day remained constant. From this, one can infer that the number of contagious people not under quarantine remained the same. To maintain this equilibrium, these localities must have detected at least two thirds of all cases.
As of today, 28 March 2020, South Korea has recorded 9,478 cases, 144 deaths and 4,811 recoveries. This works out to a 1.5% fatality rate, if you divide by total cases, and a 2.9% fatality rate, if you divide by closed cases. If we adjust these numbers to reflect a two thirds detection ratio, we are left with a 1–2.9% case fatality rate, depending on whether we divide by total cases or by closed cases.
On 13 March, the number of new Covid-19 cases in Hong Kong started rising. On 12 March, Hong Kong had 131 total cases and 3 deaths, which works out to a death rate of 2.3%. Performing the same adjustment gives a death rate of 1.5%, using total cases as our denominator.
Readers should keep in mind that my estimate of the number of undetected cases represents an upper bound. We know that Covid-19 patients spread the disease to doctors, nurses and non-Covid patients. If we accounted for new infections caused by known Covid cases, it would lower our estimate of undetected cases.
Dr Ioannidis would likely attribute the reduction in R0 to social distancing and the use of masks. This wouldn’t alter our estimates by much. If social distancing and masks reduce the R0 of Covid from 3 to 2, we would lower our estimate of the Hong Kong death rate from 1.5% to 1.2%. That would still be a death rate of above 1% for a novel disease to which we have no immunity.
In his article, Ioannidis estimates that the true case fatality rate for Covid-19 could be as low as 0.05%. For that to be true, 29/30 cases in South Korea would have to go undetected, and masks plus social distancing would have to completely explain their success. One would love to believe that, but it is mathematically untenable.
The dark truth is that South Korea and Hong Kong represent best case scenarios. Their populations are healthier than America’s, and their health care systems weren’t overrun with patients. If we look at Spain and Italy, we see what a worst case scenario looks like, with official death rates of above 8–10% and older patients left to die.
Hopefully, we can dispense with the pangloss and address the issue. If we don’t figure out a solution, we will face a catastrophe similar to the Spanish flu or possibly worse. We need to find a solution to this medical and economic problem, and we need to find it soon.
I would hate to see measures as dramatic as these go unquestioned, even if they are justified. A people that can do that are a people ready to accept oppression. In a free society, if governments can’t do this without being questioned, then good! It helps keep them honest.
Either as a people too free to stop a disease in its tracks, or as a people too obedient to prevent the rise of tyranny, lives are at stake. States with too much power and authority have been known to kill people by the millions too, you know.
The important arguement is one of quantitative response. What is the cost of the response? The shutting down of the economy to “protect” us. The deaths of those who, in all likelihood have reached their expiration date anyway, or close to it, or, who have lived their lives in such a way that their health and/or medications put them at advanced risk? How many generations will now suffer due to the financial setback their families will incur from this political response of shutting down the economy? Businesses ruined, livelihoods evaporated. We are economic creatures that must labor for our nourishment. We do not go out into the fields to graze. This is an attack of government on the people and on the economy. It is a psyops of perception management. Why they are doing this I know not. There is a quantifiable value placed on human life. Somewhere around 35,000… Read more »
“but the entire world being plunged into dire poverty as a result of lockdown”
Surely this should be taken into account? I myself can’t sort this out. On the one hand we have supposed mortality rates not above the usual winter flu season, on the other hand they have emergency morgues in Spain and New York. Somehow it all seems very strange.
This article is elementary foolishness — and fatuous in lumping all skepticism as ‘Right’ (in the UK much of it’s from Spiked!, formerly Living Marxism magazine). The issue is the mortality due actually to the new virus, NOT mortality of all those simply who have contracted the virus. These are very different things, as is shown by the absence of any significant overall rise in mortality from all causes! Even those who do actually die of the new virus would likely shortly have died of their co-morbid conditions in any case. The reason why the figures from Germany are so vastly better than from elsewhere is that they are trying to count only deaths due to the new virus. As regards the policy of ‘lockdown’, the big issue is the vast number of undetected cases. In the UK Oxford University estimate about a third of The UK population already have… Read more »
The widespread test for the COVID-19 virus is called the PCR. Now let’s go to published official literature, and see what it reveals. Spoiler alert: the admitted holes and shortcomings of the test are devastating. From “CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel”: “Detection of viral RNA may not indicate the presence of infectious virus or that 2019nCoV is the causative agent for clinical symptoms.” Translation: A positive test doesn’t guarantee that the COVID virus is causing infection at all. And, ahem, reading between the lines, maybe the COVID virus might not be in the patient’s body at all, either. From the World Health Organization (WHO): “Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans”: “Several assays that detect the 2019-nCoV have been and are currently under development, both in-house and commercially. Some assays may detect only the novel virus [COVID] and some may also detect other… Read more »
What has happened to the quality of Areo? The one most persuasive argument against skepticism is the fact that the markets tumbled precipitously long before most people knew their n95 respirator from their ventilator. Now it looks like the markets were predicting not a terrible death toll from a pandemic but the entire world being plunged into dire poverty as a result of lockdown.