Wednesday, March 18, 2020

If 18 Months of Extreme Social Distancing Is What It Takes To Stop Coronavirus, We're Doomed

By Robby Soave - March 18, 2020 at 09:48AM

Imperial College London's influential analysis of how various coronavirus prevention measures would affect the spread of the disease has estimated that doing nothing would result in 510,000 deaths in Britain and another 2.2 million in America. That report, which convinced the British government to abandon its strategy of largely letting the disease tun its course, is now available to the public.

The report also finds that disease-suppression policies—extreme social distancing, self-imposed quarantines, school and university closures, etc.—will need to be maintained until a vaccine is developed, which could take as long as 18 months.

"To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population—which could be 18 months or more," write the report's authors. "However, there are very large uncertainties around the transmission of this virus, the likely effectiveness of different policies and the extent to which the population spontaneously adopts risk reducing behaviours."

It is difficult to imagine people continuing to follow self-quarantine policies for weeks. It's impossible to imagine them doing it for a whole year. If that's what it's going to take to fully stop the spread of COVID-19, it's worth wondering whether we should admit defeat before we do any additional damage to the economy. Eighteen months of extreme social distancing isn't feasible.

John Ioannidis, a professor of medicine at Stanford University, raises some of these issues in a terrific post for Stat. Ioannidis wonders whether long-term and "draconian countermeasures" to combat coronavirus can be justified, given how uncertain they are to work and how little data we have about COVID-19's true mortality rate:

"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 are being missed. We don't know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror—and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

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 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%.

That huge range markedly affects how severe the pandemic is and what should be done. 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. It's like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies."

Ioannidis also notes that "in the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns," but "we do not know if these measures work."

The worst-case scenario may be extremely bad—much worse than his numbers suggest—but again, bringing much of human civilization to a halt for multiple months or years is not really a viable solution.

FREE MINDS

Facebook's spam-detection algorithm went haywire, causing the social media site to mistakenly take down tons of legitimate articles about COVID-19. People attempting to share information about the coronavirus were told that they had violated community standards. Articles from a number of publications—Reason included—were flagged.

The issue—a bug in an automated system—was fixed late Tuesday night.

FREE MARKETS

The federal government wants to work with tech companies to track the spread of the coronavirus by analyzing the movement patterns of smartphone users. According to The Washington Post:

"Public-health experts are interested in the possibility that private-sector companies could compile the data in anonymous, aggregated form, which they could then use to map the spread of the infection, according to three people familiar with the effort, who requested anonymity because the project is in its early stages.

Analyzing trends in smartphone owners' whereabouts could prove to be a powerful tool for health authorities looking to track coronavirus, which has infected more than 180,000 people globally. But it's also an approach that could leave some Americans uncomfortable, depending on how it's implemented, given the sensitivity when it comes to details about their daily whereabouts.

In recent interviews, Facebook executives said the U.S. government is particularly interested in understanding patterns of people's movements, which can be derived through data the company collects from users who allow it. The tech giant in the past has provided this information to researchers in the form of statistics, which in the case of coronavirus, could help officials predict the next hotspot or decide where to allocate overstretched health resources.

'We're encouraged by American technology companies looking to leverage aggregate, anonymized data to glean key insights for covid-19 modeling efforts,' said an official with the White House's Office of Science and Technology Policy, who spoke only on condition of anonymity."

On the one hand, it's incredible that advances in technology have produced the possibility for real-time tracking of the spread of a pandemic. This data could be put to very good use in efforts to thwart the disease. On the other hand, collecting data on people's movements and giving it to the government sets off civil libertarian alarm bells.

QUICK HITS

  • Donald Trump has officially won the Republican Party's presidential nomination.
  • Former Vice President Joe Biden cruised to victory over Sen. Bernie Sanders (I–Vt.) in the Illinois, Arizona, and Florida primaries.
  • More regulations that should be eliminated forever, not just in the face of the coronavirus:

  • The D.C. metro is reducing service even further.
  • Titania McGrath is wisely addressing the real issues: "There is a pandemic sweeping the globe and it has to be stopped. It is called 'free speech.'"
  • Still more regulations that should be eliminated forever:


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