Epidemics 101

So much of what Twitter “experts” say about reopening the country is wrong, misleading or irrelevant.  What most of them are missing is a basic understanding of the nature of an epidemic such as Covid-19.  In order to address this problem, I’ve created a little chart to show how an uncontrolled epidemic behaves.  

The earliest known case of Covid-19 goes back to November, 2019, so I start there.  I assume that an infected person spreads the disease to two others.  I also assume that 1 out of 6 infected is symptomatic enough to seek care and is tested positive, and that the infected mortality rate (IFR) is .007.  These numbers seem to be within the range of estimates for Covid-19, and they suffice for illustration purposes.  It is not intended to be accurate historically, or a prediction of anything.  It is merely an example of how an uncontrolled epidemic spreads.

Week BeginningWeek #InfectedSymptomaticDead
Unrestrained Epidemic

For what it’s worth, as of this writing (May 8, 2020), there are just over 4 million confirmed cases and 276 thousand deaths.  

The most important number in terms of containment is how many people catch the disease from an infected individual.  The only guaranteed way to prevent further infection is to make sure that an infected person does not come into contact with somebody who has not been infected.  The problem is that not everyone who is infected is symptomatic, and the virus can spread before the symptoms manifest themselves.  Therefore, we don’t know who to keep isolated, which is why there is social distancing and stay at home policies.  

In my chart, I assumed that an infected person would spread the infection to two more.  In reality, an infected person who is not symptomatic, or who is presymptomatic, would likely spread the infection to 3 or more individuals.  This is easy to understand, because my chart is based on unrestrained spread, and there have been worldwide efforts to contain the virus for months.  It is much more likely that the initial spread was faster than my chart shows and slowed as a result of the containment measures taken.

Now, just imagine what happens when those restraints are removed.  Of course, individuals who have been diagnosed will be isolated, but we know that there are many more undiagnosed cases.  A recent study in New York estimated that there were about six undiagnosed cases for each confirmed case.  That means that there are likely several million individuals who are currently infected, and if social distancing rules were immediately lifted, there would be an explosion of new cases as those individuals start interacting with others.

One argument you are likely to encounter is that the only people who die from the coronavirus are people in nursing homes or those who are already sick.  If you’re not at risk, the argument goes, the worst you’ll experience is something comparable to the flu.  There is a bootstrapping component of this argument, because they define a healthy person as one who did not suffer severe symptoms from the coronavirus.  Over 100 New York City transit workers have died of the virus, and as far as I know, very few of them lived in nursing homes.  Another interesting thing is that there is a significant overlap between those who are willing to let nursing home residents die en masse and right to lifers.  Go figure.

If we are going to dismiss the lives of nursing home residents as worthless, we might as well be up front about it and euthanize them.  After all, they are a drag on the economy, but in fairness, we should have a bailout for the For Profit Nursing Home Operators who will lose their customer base.  

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Monday Perspective

A couple of articles in today’s New York Times provides some useful perspective on a couple of things that the pandemic deniers have been hanging hats on.

The Santa Clara Study.

The Santa Clara study purported to find that the “true” rate of infection was 50 to 85 times greater than reported figures.  Home schooled amateur epidemiologists have used this study to calculate the true IFR (infection fatality rate) as roughly equivalent to the flu.  

As I was reading about the death of Paul Cary, a paramedic from Colorado who came to New York to help with the crisis, it occurred to me: when have you ever read about health care workers dying because they treated patients with the flu?  I don’t know the number of health care worker who have died from Covid-19, but I’ve seen reported that over 100 doctors in Italy have died from it.  Do you really need to know any more than this to know that Covid-19 is not like the flu?  

The Bakersfield Doctors.

For some reason, a couple of doctors in Bakersfield California who run a number of for profit “urgent care” clinic garnered a stupendously unwarranted amount of publicity by announcing that all social distancing restrictions should be lifted immediately. They base their conclusion on the results of coronavirus tests administered at their clinics.  Their web site, which lists “sprains and strains” and “nosebleeds” among the problems they address, should be enough to know that these guys are way out of their league.

An article in today’s Times on Italy’s experience with using serological tests for antibodies for guiding the reopening of their county shows just how complicated and vexing these issues are.  But as one Twitter genius recently noted, the Bakersfield doctors have treated a lot more patients than Dr. Fauci, so they would know better.  

It’s a free country folks, and one has every right in the world to hold stupid opinions. 

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Bill Maher: Dunce

All of a sudden Bill Maher is the darling of the right, because the segment below aligns with a current right wingnut talking point, namely that stay at home and social distancing policies were a monumental overreaction, a violation of civil and constitutional rights, and medically and scientifically unwarranted.

Who needs scientists when all we need is common sense?  You have no reason to fear the coronavirus, because your immune system is all you need, as evidenced by the fact that you let your dog lick you.  Voila!  Q.E.D.

Do we really need to spend a lot of time explaining how monumentally stupid Bill’s rant is?  Before antibiotics came on the scene, infectious diseases were often fatal.  Before vaccines were developed, polio and smallpox and numerous other diseases that are now as rare as an honest politician ruined millions of lives every year.  Do we even need to mention syphilis?  The point is simple: your immune system is really effective against whatever it is that is lurking in dog saliva, but it is often defeated by scores of diseases.

Here’s another thing to think about: the common cold.  Adults catch a cold on average 2 to 4 times a year.  There is no cure for the cold, but your immune system eventually eliminates it from your body.  But why does it keep coming back?  There are two reasons.  One, there are many different viruses that cause a cold, so even if you develop immunity against one, you can still catch a different one.  Second, the immunity built up against a cold virus does not necessarily last your lifetime.  In other words, you might lose the immunity after a couple years and become susceptible to the virus again.

Covid-19 is caused by a new coronavirus.  We know very little about it.  We have no vaccine for it, and we do not know how long antibodies to it last or whether those antibodies confer immunity against the new coronavirus.  For most people, the immune system is enough to eliminate the virus after a couple weeks, with no or mild symptoms.  It causes a significant minority, however, to become sick, really sick, needing hospitalization and intensive care units.  

I guess Bill doesn’t get this, so maybe it needs to be expressed in a way he would understand — dog licks.  Imagine that getting licked by your dog was harmless, usually, but fatal about 1 percent of the time.  Would you still let your dog lick you?  I didn’t think so.

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Tara Reade

Undoubtedly, and unfortunately, Tara Reade will be a staple of this season’s political discourse.  The gist of the problem, according to the spin on the story I see most often, is not whether Ms. Reade’s allegations are true, but that Democrats are caught in a vise of inconsistency created by the near universal support given by Democrats to Christine Blasey Ford in her allegations against Brett Cavanaugh.  This really should not pose much of a problem at all.

Part of the problem is caused by the misguided notion that every woman’s allegations should be believed, until proven otherwise.  While maybe politically expedient, that’s a dangerous presumption and flies in the face of experience and established principles of law and justice.  In our system of justice, the accused is presumed innocent and the accuser has the burden of proof.  There are sound policy reasons behind this, and it is not unique to the United States.  It can be found in the Declaration of Universal Human Rights.

Now, I understand that political discourse does not follow the rules and precepts of criminal procedure, but it is not only contrary to entrenched norms, but completely unnecessary, to presume the truth of a woman’s allegations of sexual abuse.  It is sufficient to take them seriously and give them an impartial and thorough investigation.  Let judgment follow the facts.  If judgment comes before the facts, it is far too easy to find the facts to fit the judgment and ignore those that don’t.

I do not intend to delve into all of the details of the Tara Reade case.  There is much written already, and there is much to come I am sure.  I merely want to point out some of the differences between the Tara Reade and Christine Blasey Ford cases.

Tara Reade has a history of making up stories and being a very unreliable relator of facts.  Ms. Ford has no such history.

Both women waited decades to make their stories public, but Ms. Ford was 15 years old at the time, while Ms. Reade was a grown woman with the means and know how to lodge a complaint.  

Brett Cavanaugh was not a public figure until his nomination to the Supreme Court, while Mr. Biden has been a national figure for decades.  Ms. Ford had no particular reason to come forward until Cavanaugh was nominated, Ms. Reade has no plausible explanation for why she has not come forward until now.

Ms. Ford was reluctant to make her allegations public and had to be convinced to do so.  Ms. Reade complains that she is not getting enough television interviews.

Ms. Ford has never contradicted her allegations, while Ms. Reade was an ardent advocate for Mr. Biden until recently.

If you want to know more about how Ms. Reade’s story and behavior is full of holes, there is a comprehensive account at https://www.usatoday.com/story/opinion/2020/04/29/joe-biden-sexual-assault-allegation-tara-reade-column/3046962001/.  

By all means, let there be an investigation and a full and fair airing of the facts, but to suggest that it is hypocritical to have supported Ms. Ford but not Ms. Reade is completely absurd.  No one need apologize for being skeptical of the latter.

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A Vast Right Wing Conspiracy? Maybe.

In the late 1990s, Hilary Clinton was widely derided for claiming that the various “scandals” of the Clinton Administration as orchestrated by a vast right wing conspiracy.

In 2004, David Brock (founder of media matters) wrote a book called “The Republican Noise Machine” which described how various right wing media organizations create a loud chorus of “noise” to drown out whatever news or information they want obfuscated.

Yesterday, I learned that Twitter had taken down a couple of tweets by media conservatives for violating its rules against spreading false information, aka “fake news.” Here are the tweets:

What I find interesting about these tweets is not that they are false. Charlie Kirk is a shameless purveyor of right wing misinformation. What interests me is that his tweet was followed up 11 minutes later by an identical tweet from Rudy Giuliani.

Giuliani did not merely retweet Kirk, but went to the trouble of copying, pasting, and putting it in quotes. Why does Giuliani, allegedly a very important person, have nothing better to do at 7:40 a.m. on a Saturday morning than to jiggle around a tweet from a conservative back bencher?

In my opinion, Kirk is a certifiable crackpot who has no ideas of his own. Presumably he got the memo (figuratively speaking) that noise is to be made about Whitmer, because Trump has picked a feud with her, dismissively and disrespectfully referring to her as “that woman from Michigan.” I’m not suggesting that Kirk was actually given instructions by some shadowy operative. A dog knows how to curry favor with his master.

Before we go any further, let’s apply a little critical thinking to the tweet in question.  It begins with “Hydroxychloroquine has been shown to have a 100% effective rate treating COVID-19.”  We are in the midst of a world-wide health crisis that has afflicted hundreds of thousands of people, killed tens of thousands, shut down the world’s economy as a cost of trillions and trillions of dollars, it has a significant portion of the world’s population sitting at home, either because they’ve been ordered to do so by their governments or because they’re scared out of their wits, and the cure is no more difficult than administering a pill that is widely available and ridiculously inexpensive to manufacture. Seemingly oblivious to this fact are the hundreds of thousands of scientists feverishly working to come up with something to treat, slow down, prevent or just cast shade on the virus.

Either the world is turned upside down, or Kirk’s statement is not true. Let’s suspend belief and move on.

Next we are told “Yet, Democrat Gretchen Whitmer is threatening doctors who prescribe it.”  This is something that is not hard to track down. This is what came out of Governor Whitmer’s office:

The Department of Licensing and Regulatory Affairs has received multiple allegations of Michigan physicians inappropriately prescribing hydroxychloroquine or chloroquine to themselves, family, friends, and/or coworkers without a legitimate medical purpose.

Prescribing hydroxychloroquine or chloroquine without further proof of efficacy for treating COVID-19 or with the intent to stockpile the drug may create a shortage for patients with lupus, rheumatoid arthritis, or other ailments for which chloroquine and hydroxychloroquine are proven treatments. Reports of this conduct will be evaluated and may be further investigated for administrative action. Prescribing any kind of prescription must also be associated with medical documentation showing proof of the medical necessity and medical condition for which the patient is being treated. Again, these are drugs that have not been proven scientifically or medically to treat COVID-19.

Which of the following statements culled from the above troubles you:

      • Doctors should only prescribe drugs when there is a medical necessity for doing so.
      • Doctors should not needlessly prescribe drugs in order to stockpile them.
      • Stockpiling drugs in this fashion can deprive people who actually have conditions for which the drugs are proven treatments, and the State will investigate any such activity.

Moving on . . .

The next statement by Kirk is the only one with a germ of truth: “If Trump is for something – Democrats are against it.” This is often the case, but in fairness, Trump campaigned by promising to do all sorts of things that Democrats were against, so it might be a chicken or egg type of thing. Nevertheless, Democrats just approved a 2 trillion dollar spending bill that Trump was for, so that statement clearly has some holes in it. Maybe this is a good time to note that Kirk, a fiscal conservative, might question why Trump was agreeing to add trillions to the deficit if he truly believed that hydroxychloroquine was 100 percent effective against Covid-19.

“They’re ok with people dying if it means opposing Trump.” The syntax here is a little tortured. The most natural meaning would seem to be that Democrats are ok with people who oppose Trump dying, presumably because they believe that opposing Trump is worth the ultimate sacrifice and not because they think that people who oppose Trump deserve to die. I do not believe that this is what Kirk meant, and I am not aware of any registered Democrats self-immolating in protest.

I believe that what Kirk is trying to say is that Democrats would rather let people die than let Trump save them. This assumes that using hydroxychloroquine to save people’s lives is somehow a political and not a scientific issue. Which brings us back to my original point.

Why did Giuliani repeat Kirk’s crackpot tweet 11 minutes later? I can say many unflattering things about Giuliani, but he is not stupid, as least not in the technical sense of the word. Perhaps he was simply trying to drum up interest in the next segment of his ironically named podcast “Common Sense.” But Giuliani knows that there is little evidence that hydroxychloroquine is effective against Covid-19. He certainly knows the ludicrousness of the assertion that it has been shown to be “100 percent effective.” Kirk’s and Giuliani’s tweets were retweeted a combined 30,000 times. Who knows how many gullible souls were exposed to this lie?

For whatever reason, somebody in the GOP camp has decided to politicize this issue. It’s probably a no-lose scenario. If it turns out to be an effective treatment, Republicans have positioned themselves as for it and they have painted Democrats as being against it. If it fizzles out, they know that people’s memories are short, and the list of lies foisted upon the American public by the GOP is long, and this will be just one more.

If you are interested in the current state of information regarding hydroxychloroquine and Covid-19, this is probably the best article out there:


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