It's a good time to be reminded of the fallacies that continue to pollute global dialogue about the pandemic.
Comparing Covid fatality rate to seasonal flu fatality rate
A few research groups are pursuing the hypothesis that Covid-19 is just a type of seasonal flu. These groups hope to show that the "true" fatality rate of Covid-19 is on a par with the seasonal flu. They have pushed for antibody testing, under the theory that many people have been infected but did not get symptoms. The much heralded study that claimed prevalence of over 15 percent is the study by the NY State Department of Health, much trumpeted by Governor Cuomo (about which no one involved either scientifically or politically has the guts to publish an official report. What are they hiding?)
This project was doomed from the start. It should be clear by now that data collected during any epidemic are subject to significant measurement errors, which are real scientific challenges, and exacerbated by political interference - perhaps expressing the desire to look good. But you already know this - and I'm not retreading this point today.
Even if we assume that the infection fatality rate of Covid-19 has been accurately measured, it is still inappropriate to compare that to the fatality rate of seasonal flu.
The fatality rate for seasonal flu is conditioned by widespread flu vaccination (at least in the U.S. where everyone is urged to take the flu shot) while there is currently no vaccine for SARS-CoV-2. This fact alone dooms the project. One would have to go back to the period before the flu vaccine was invented to find the right comparable.
What's more, how accurate is the flu's fatality rate? It also faces measurement challenges because the flu is endemic. Most flu infections are not reported, detected or confirmed. Undercounting is as much an issue with flu as it is with Covid-19. [Epis reading this, please correct me if the fatality rate of seasonal flu published by the CDC are not counts of actual confirmed cases but estimations based on modeling that imputes undetected cases.]
Hoping for herd immunity as well as flu-like fatality
Those who believe Covid is a type of flu also tend to advocate the strategy of "herd immunity." If enough people are infected, the remaining population will be naturally protected. I'm only interested in the analytical methods so I don't judge anyone on their beliefs. It's still possible Covid-19 becomes an endemic disease like the flu. What doesn't work is believe both the flu hypothesis and the herd immunity strategy.
Herd immunity requires immunity: someone who was previously infected develop antibodies that confer immunity to the virus upon recovery.
Most of the epi models adopt the SIR structure, for which immunity is built in. The R compartment consists of "recovered" (and dead) people. Recovered people and dead people are treated the same mathematically because neither can spread the disease to anyone else. That's only true if infected people who recover are not infectious.
And yet, no expert has been willing to say definitively that having antibodies for SARS-CoV-2 makes one immune to Covid-19.
Further, you'll learn that epidemiologists do not use SIR models for seasonal flu. Instead, the appropriate model is SIS. The SIS structure has no R compartment; anyone who recovers is susceptible again. That of course is our experience with the flu. Having caught it does not mean you won't catch it again - one might even catch the flu multiple times within one season.
If Covid-19 is indeed just like the flu, then immunity is irrelevant. Herd immunity is even more pointless.
Saying young people have a low risk of dying from Covid
This statement is literally true. What is missing is context. Young people have a low risk of dying, period. I'm sure if the overall death rate of flu is 0.1%, the rate for young people is much smaller than that. (Remember this post.) What matters is the excess risk over the normal risk of dying for each age group. Dave Spiegelhalter at Cambridge has done a lot of this work for the UK. Here is an example of the calculations involved. The bottom line is: having Covid-19 is like packing a full year's of risk into a few weeks, for all age groups.
That framing apparently confused some people so he re-wrote the headline later to say "Covid roughly doubles your risk of dying this year". That's because the normal risk of dying excludes Covid-19 and the risk of dying from Covid-19 is roughly equal (ages 20-49) or higher (50 and up) than the normal risk.
Thus, even for younger people, getting infected with Covid-19 doubles your chance of dying. It's one thing to say double the death rate is fine by me, it's another thing to say that the risk of Covid death is "low".
Claiming monitoring X could have predicted the outbreak
A slate of studies are making claims that sewage, parking lot volume, search engine traffic and so on are leading indicators, and could have alerted us to the outbreak before the first case was detected.
Studies that look for the virus in sewage are worth doing. They help epidemiologists nail down the spread of the virus at the early stage of the epidemic.
Such research goes off track when these investigators over-reach and claim predictive prowess. After the novel virus has been discovered, it is a straigthforward matter to find prior sewage samples, and test them for the presence of the virus. If we also know that the virus-infected sewage came from which buildings or households, we'd have learned a lot about how the virus spread. But this explanatory model does not predict.
It is utterly wrong to conclude that sewage monitoring is a leading indicator of viral spread. Dial time back to November before the first case was confirmed in Wuhan, China. We assume the local sewage company was testing the dirty stuff. But for what? At that time, no one knew anything about this coronavirus, there were no tests available, no virus samples to validate any tests. Is the lab supposed to test for every possible virus including all animal viruses that have non-zero chance of leaping to humans?
It's not just the sewage (link). It's also the parking lot images and search engine traffic (link). So, from here on out, if more people are searching for "diarrhea", we'll predict that a new virus is circulating in the population? Even if true, which virus is this?
This type of studies do not, and will never, become the basis of a predictive model. It is malpractice that scientific journals have allowed researchers to make such false conclusions.
Talking about metrics as if they aren't manipulated
All metrics are perverted. This is a theme in my second book, Numbersense (link), which starts with a chapter filled with every manner of statistical shenanighens practiced by deans of reputable colleges and universities. It is then followed by a chapter on rampant obesity in the U.S., which some medical researchers claimed was a result of "bad measurement". (This blog is a preview of that chapter.) Latter chapters focus on economic metrics like unemployment rate and inflation rate. You get the idea.
In the short history of the Covid pandemic, people started with case statistics. Then, they claimed that death statistics are less manipulated than case statistics, when they learned about testing. Then, they claimed that testing statistics are less manipulated, until they realized governments determined who got tested. Some governments counted tests shipped, not test results. Then, they claimed hospitalization statistics are less manipulated, until they learned that hospitals sent sick patients to nursing homes.
If you read Numbersense (link), you may recall some students with low GPAs or test scores are asked to spend their first year at other schools or part-time programs, so they disappear from the statistics submitted to U.S. News for the school rankings. Does it shock you that hospitals sent patients to nursing homes?
Only the naive takes a "see no evil" view. In the age of Big Data, taking such a view is simply irresponsible - as there is too much leeway to twist the data or analysis to whatever story one wants to spin.
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