COVID19: Some Quick Q&A
by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)
Well, my last post (about the Bakersfield Duo) went a little viral, and much of spare my time since has been spent answering a deluge of questions from new readers. Most have been respectful, but a few have not been. It’s really quite sad that this crisis has brought out such vitriol in people, and that whether or not objective statistics are accepted is now determined by the same old political tribalism that infected the world before all this began.
Most common is people arguing over basic mathematical calculations that should be evident on their face. As best as I can tell, this is the product of decades of a failed public education system that has allowed innumeracy not only to go unchecked, but to be openly celebrated. Add to that the incredible unearned confidence that comes from very little knowledge (the famous Dunning-Kruger effect), and I am rapidly being sapped of both hope and energy.
Neil deGrasse Tyson famously implored his fellow scientists to more openly engage with the public. I’ve always tried to do this. But Dr Tyson is an astrophysicist. No one has their identity, values or self-worth tied to whether or not they think dark matter is baryonic. So his discussions of science in the pub are always pleasant and respectful (unless the flat-Earthers get involved). But once you enter the health domain everyone has a strong opinion, almost never evidence-based. The public then gets aggressive, confrontational, and insulting pretty fast.
It’s no wonder that most scientists eschew the public eye.
It’s exhausting. And I don’t have a lot of patience for it anymore. But it was expected, unfortunately. When this pandemic began, I said to some students that when this is all over, no one will thank us (the scientists and doctors). Half the world will say we did too much, and half will say we did too little. No one is coming out of this looking good.
This quote from Dr Christian Drosten, the scientist leading Germany’s response to COVID-19, thus resonates with me:
I for one am grateful that brilliant people like Dr Drosten are at the global forefront, guiding us through this unprecedented global emergency. I am also humbled by the science communication skills of Angela Merkel, who is simply masterful at it.
Also relevant, satirical artist Michael Murray shared this great map of social media’s current understanding of the COVID-19 crisis. It makes me weep:
I’ve had some requests to write about a variety of related topics, such as the validity of the emerging antibody tests, and my thoughts on the controversial approach taken by Sweden. I plan on getting to those things when I have some more time.
But today I wanted to catch up on some older questions and answers, including some comments I’ve given to various journalists in past days. In the interest of transparency, I’m sharing those comments here, as I feel some readers might find them useful.
Question #1. Journalist: “Why or why not it’s important in Canada to have current mortality counts that are publicly accessible in a national registry of some sort?”
My ongoing mantra: this is not so much a health crisis as it is a health systems crisis. To navigate our way out of a health systems crisis requires data-driven decision making. And one cannot make data-driven decisions without accurate data. The kinds of data we need are varied, but they include accurate and timely mortality statistics.
It’s important that these data be freely and publicly available. This information is paid for by tax dollars. So ethically it is already owned by the public, so should be available to all — with appropriate privacy protections in place, of course.
It is doubly important that as many expert data analyst eyes as possible be applied to the same data sets to ensure reproducibility of any computed results. This is an all-hands-on-deck civilization-level emergency, after all, and we should leverage as much data analysis expertise as our society can muster. This means that government scientists, academics, and even independent and amateur number-crunchers should be recruited into this venture.
Moreover, there is currently a crisis in public trust. In the USA, there are ridiculous conspiracy theories about doctors deliberately over-counting COVID deaths to service dark agendas. Allowing multiple reputable sources to transparently assess the quality of our mortality data would go a long way toward quashing those ludicrous claims.
No health emergency response has ever been slowed by having too much or too accessible data.
Lastly, one of the more interesting characteristics of this pandemic is the way it has propelled public education around scientific methods. Much of the public is now very curious about data science, epidemiology, and even about how medical records are kept and processed. This is the time to act on that curiosity by showing the richness and power of health surveillance systems, how they can inexpensively keep us safe, and how an invisible army of number-crunchers has always acted in the background to help keep our population healthy and functioning.
Question #2. Journalist: “How do you defend the various quarantine and social distancing rules and the disruption they cause in terms the public can grasp?”
Public health is an inexact science. Unlike evidence-based medicine, in which we set a high bar of evidence before we act, in public health the threshold for overwhelming action is actually quite low, because the cost of not acting is unacceptable.
The tools of public health are also hammers, not scalpels. They include quarantine, vaccination, and unfortunately wholesale suspending of civil liberties.
These two truths, when combined, can make a pandemic response seem heavy handed and over reaching. But really they are the best alternative to a likely scenario of widespread suffering and death.
Unfortunately, the price of these actions is hefty. We must not lose sight of the fact that a heavy assault on the economy is its own public health crisis. So these current measures cannot be indefinite.
At present, closing businesses and borders and shuttering ourselves indoors may seem to some to be medieval. But the idea is to prevent people from interacting with each other in order to slow the rate of production of new cases of COVID-19. Absent these measures, the rate of growth would be astonishing. And given the relatively high hospitalization and death rate associated with this disease (as compared to the flu or other infectious respiratory illnesses), such growth would mean rapid overwhelming of our health care system, leading to thousands of deaths, not only among the affected, but also among others needing hospital care –heart attacks, strokes, car accidents– who could not get care in an overwhelmed system.
The extent of draconian restrictions is entirely dependent upon the discipline of the population. If people could be relied upon to be physically distant and to engage in constant personal infection hygiene, then the need for compelled lockdown would be obviated. But as the citizenry continues to show an inability to display discipline, the state’s hand is further forced to protect the majority.
No one loves this solution. But as with all crises, the choice is always up to the people how they wish to face this challenge: with discipline and freedom, or with flagrancy and resulting curtailed rights.
Question #3. Journalist: “What are your thoughts on so-called immunity passports?”
Here are the issues with the immunity passport idea:
1) we don’t yet know if recovery confers immunity. It probably does for most people, but we don’t know for sure, and we don’t know who it WON’T confer immunity on
2) if we test for antibodies and find them, we don’t know what level of antibodies are needed to confer immunity… if indeed it does at all
3) if we test for antibodies and find them, we don’t yet know if those antibodies are specific for SARS-CoV-2 or for another coronavirus, like the common cold
4) if recovery does indeed confer immunity, we don’t yet know how long that immunity lasts…. weeks? months? years?
5) the current antibody tests have a high false-positive rate, meaning they think they are finding people who were exposed but who actually weren’t. No antibody test will be perfect, so we have to figure out what error margin is tolerable, because a single infected person can infect many others if left uncontrolled.
6) all of this does NOT mean that a vaccine cannot confer immunity. It is theoretically possible to calibrate a vaccine to create a larger immune response by doing such things as requiring multiple doses
7) immunity passports might one day be an important tool for us. But we are not there yet.
Question #4. Journalist asked me to comment on New Brunswick’s plans to re-open their economy. My answer:
Based on 118 cases, 88% recovered, test-positivite rate of 1%, I think NB has a good handle on the extent of their epidemic and is in a good position to CAREFULLY re-open.
The outdoor activities seem safe. I’m unclear about how the post-secondary education situation will look, but I’m assuming distancing will be in place, as well as proper hygiene controls. I don’t know if they have thought about how to manage public bathrooms in such institutions.
I don’t think mass religious services are a good idea, given that most churches and temples have close seating for a prolonged time.
Of the Maritime provinces, NB and PEI are best positioned to re-open somewhat, given their low caseload.
However, I would like to know that both provinces have in place a plan for heavy disease surveillance, intense random testing, contact tracing, and closed borders. Absent those features, I hope the NB government has a plan to quickly pull the plug if things go awry.
Question #5. Journalist asked me to comment on this pre-peer reviewed study by this country’s leaders in infectious disease modelling, which found that COVID outbreaks in nursing homes in Ontario were being driven by asymptomatic personal support workers. (As a policy, they don’t cite non-peer reviewed science, which is great. So my comments served as their peer review.) My comments to her:
This is a very solid paper written by the leaders of the field in this country. I see no glaring errors or weaknesses other than those acknowledged by the authors themselves (specifically, the possibility of misclassification bias, which is a small risk since those who died in LTCs (long term care centres) were presumably well investigated post-mortem to ensure a proper determination of cause of death.)
Furthermore, by comparing the LTC rates to the general public, in a variety of age brackets, they minimize the risk of further bias. Therefore, the finding that LTC residents aged 70 and above had a 13X greater risk of dying of COVID19, as compared to those aged 70 and above NOT living in LTCs, is chilling.
It would be tempting to assume that institutionalized people are by definition more vulnerable, therefore we expect them to die at a higher rate. But a 13-fold increase in risk is well beyond the pale.
I would think that this paper would get published as-is in most peer-reviewed journals.
The key takeaways are:
1) LTC residents in Ontario have a MUCH HIGHER risk of dying than age-matched people living in the community
2) Those deaths were most likely driven by infected staff members more than by infected residents
3) The infected staff who infected the residents were able to do so because of ‘infection lag”, meaning that they were spreading the disease before symptoms arose and before their infection was acknowledged
It’s an important study that really underlines how badly we failed the LTC population in this province. We can probably take some of these lessons to other restricted communities, like prisons, group homes and work camps.
Some Thoughts on Conspiracy Theories
As I’ve been reflecting on the challenges in confronting misinformation during this crisis, I’ve noticed the cycles of the public’s responses to supposed expertise. I find that so far the phases have been thus:
- Denial – There is no emergency; this thing is no worse than the flu
- Panic – OMG! People are dying! Where are the experts?!
- Gratitude – Thank you for describing this thing, for foreseeing the suffering and the deaths, and for putting together a plan to avoid it all
- Anger (once the deaths have been avoided) – Why are you making us stay inside for 6 weeks? This is intolerable!
- Denial (again, since memories are short) – This thing is no worse than the flu!
- Resentment – You created this crisis! It never existed in the first place!
This was all predicted by very quotable Dr Drosten, of course:
“We brought the reproduction number below one. Now, what I call the ‘prevention paradox’ has set in. People are claiming we over-reacted. There is political and economic pressure to return to normal.”
For those who do not yet grasp the scope of the misinformation tsunami that science educators are battling against, I present to you a small taste of one evening’s casual browse (unedited) through the fringes of COVID Twitter & Facebook:
- “Do we even know for fact if there is coronavirus I mean how reliable are the test amd when the test is taken is anyone actually putting it under a stain and microscopes to analyze its actuality I mean at this point they could of made a test to show positive covid19 on a influenza or swine flu like seriously isn’t anyone suspicious of this?”
- “They are going to start Killing kids and tell you it’s covid19 They added murdering children to the euthanasia They added murdering children to the euthanasia law. Children are going to be diagnosed with covid19 and murdered”
- “If China recovered without a vaccine, then why are we desperately seeking one?”
- “I’m not taking any electronic tracking vaccine.”
- “Bill Gates and all of his buddies are evil people. They feast on the ignorance of others. They play it off very cool, like the care. But the only thing he wants is more power”
- “Bill Gates is pushing for his vaccine. Hell no. He’s not going to force his vaccine on my family.”
Overall takeaways from this saddening stroll through conspiracy boulevard:
- Because cell data is being used to track quarantine compliance, everyone should get a burner phone
- Bill Gates is obsessed with population control, so wants the economy to suffer so that people die
- Old people are dying in residential homes because they were vaccinated against their will, and that’s what’s killing them
- Media has manufactured the coronavirus story to make Trump look bad
- The pandemic is a ploy to get us all to accept the vaccination agenda
- Refusing a mask, testing, and vaccination is an expression of liberty
And I will leave you with my absolute favourite COVID-19 conspiracy theory, which was offered unironically by its originator: that the disease was created by…. aliens… in partnership with the hidden world government in order to make us compliant to a worldwide vaccine which would then grant them access to all of our genetic material.
I’m sure there are people reading this blog who believe one or all of these theories. And I’m further sure that I’ll be hearing from several of them very soon. Because apparently that’s my life now.