A group of skeptics who deny the severity of the coronavirus and the need for or effectiveness of the lockdown, recently piled up on me on Twitter bombarding me with dozens of tweets presenting their arguments with links and videos that “proved” their point. I decided that it was pertinent to write a blog post to deal with these issues.
Recent results of preliminary antibody titers against the coronavirus in New York State have revealed that an estimated of 14.9% of the residents of the state (24.7% in New York City) have antibodies against the virus, which indicates they have been infected. The skeptics pounced on this and similar data from other places to argue that the true death rate from COVID19 is lower than had been calculated based on confirmed cases (which we knew already). So for example, if this number (14.9%) can be extrapolated to the total US population of 330 million people then 14.9% is 46.2 million people, then with 64,000 deaths so far from COVID19, the true death rate due to the virus is 0.13%. They claim this shows COVID19 is no worse than the flu for which the overall death rate is (as can be calculated from data from the CDC) about 0.13-14%. Thus, they argue, the lockdown was not justified, we harmed the economy for nothing, this whole thing has been a hoax perpetrated by the fake news media, and the so-called experts like Dr. Fauci have egg on their faces.
Even if you are not a scientist, I hope you smell a rat in this argument. You have probably seen the social media posts of healthcare workers and residents from places like New York, Italy, and Spain stating that they had never seen something like this before. You may even know some of them. You have also seen the images. Morgues overflowing, bodies piling up, patients lying on the floors in corridors, shortages of personal protective equipment, and overworked health care workers coming down with the illness right and left. These people have dealt with the flu before, and this ain’t no flu. Indeed, in New York and in the U.S. as a whole, there was a spike in deaths compared to the past.
So what’s going on?
First of all, the influenza cases presented in the CDC website are the influenza illnesses that show symptoms. This is important because as much as 50% of the influenza infections may be asymptomatic which indicates that the true number of infections, and therefore the true influenza death rates, are overestimated (I have made the mistake of quoting these inflated deaths rates for influenza too). You cannot use one figure derived from antibody titers in a calculation and compare it to another figure derived from symptomatic illnesses.
Also, let’s not compare apples to oranges. The death rate in a region will depend on various local factors such as how early mitigation was begun, the population density of the region, how many people introduced the virus to the community, the quality and quantity of the health care, the overall health of the people, etc. Therefore it may be misleading to extrapolate the 14.9% total infection rate derived from antibody titers in samples from the State of New York to the whole country. According to the titer results, 2.9 million people are estimated to have been infected in New York State. If you take into account that New York State had 18,274 deaths, this is a death rate of 0.63 % for COVID19 in New York State. If you take the titer results of a 24.7% infection rate for New York City, which has a population of 8.4 million (2,074,800 infected), and has 12,287 confirmed deaths due to COVID19, that gives you a death rate of 0.59% (and using these death figures is an underestimation due to the time lag between infection and death, and the undercounting of COVID19 deaths). These figures are considerably higher than the flu’s overestimated rate of 0.13-0.14%, which is really closer to 0.04-0.05%. Although calculations from titers and numbers in other regions yield different death rates, all estimates are higher than the flu’s.
Be it as it may, the antibody titer estimates are preliminary and there are several problems with the test kits used and the methodology employed to obtain the samples. We don’t know yet what the true number of infected people in the United States is, but we know this. So far we have had 64.000 deaths. If these deaths occurred as a result of even 10% or 20% of the people being infected (an unlikely high number for the country as a whole), that means that there are 90-80% of people who have not yet been infected. Thus there is substantial potential for more infection and more deaths, at least until herd immunity sets in. Depending on the local situation, the only thing protecting many people from COVID19 infections right now is mitigation and/or the lockdown. The only consistent thing about the preliminary antibody data so far is that it has not revealed very high titer estimates, which indicates that the mitigation/lockdown measures have been successful and were needed. And this makes sense, mitigation and lockdowns are working here and in other countries today and have been shown to have worked in the past too.
There are also additional things to consider. COVID19 spreads faster than the flu and asymptomatic carriers can spread the disease for a longer time than the flu. Additionally, many people infected in the past with one strain of the flu have cross immunity to current strains of influenza and others have immunity due to the influenza vaccine. This limits the number of people that influenza can infect. On the other hand, COVID19 is a novel virus, and there is no immunity against it in our population. The number of people influenza can infect is limited, while the number of people that COVID19 can potentially infect is much higher (at least until herd immunity sets in). In a population without immunity, mitigation, or lockdown, this virus can spread like wildfire leading to steep increases in the number of infected, hospital admissions, and deaths depending on the quality of the health care system and the overall health of the population. Finally, the SARSCoV2 virus, which produces the COVID19 disease, is different from the flu virus, not only at the level of the virus, but also at the level of the disease.
So, it’s not true that COVID19 is no worse than the flu, and it’s not true that social distancing and the lockdown were unnecessary. People who promote this misinformation and spread conspiracy theories are harming our society. However, the majority of people that do this are not evil. In fact, what they are doing is predictable, and we have a good idea why they are doing it. People are being laid off and facing the loss of their livelihood, and these people are genuinely concerned about their future due to circumstances they can’t control. They are angry and afraid for their loved ones and for themselves, and they fear the uncertainty of their economic situation more than they fear the virus. It is understandable that these people will fall for the simple “us vs them” arguments peddled by conspiracy mongers who are essentially selling them snake oil. But I have a message for these people.
Spreading misinformation and lies, and protesting irresponsibly with no masks or social distancing is unnecessary. There is no need to smear the truth and be unsafe. The lockdown can’t go on forever, and everyone including those who had anything to do with putting it in place want to end it. We just need to do it in a responsible way that does not lead to a full-fledged second wave of the virus that overwhelms our health care system. Getting involved in the process and working with the system is better than attacking it. Call your representatives, learn about the local situation with respect to COVID19 and how it’s being dealt with, offer to get involved in the process, and contribute ideas to reopening while respecting and heeding the advice of health experts. This is the way to go.
Conspiracy sign by Nick Youngson from Picpedia.Org used here with modifications under a Creative Commons 3 - CC BY-SA 3.0 license. Coronavirus image by Alissa Eckert, MS; Dan Higgins, MAM, from the CDC's Public Health Image Library is in the public domain.
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