I am writing this post because over the last days I have noticed a strong growth on social media of conspiracy theories and misinformation about the Corona virus.
It is not easy for a humble non-expert to know what to think when even trained medical doctors spread disinformation. How to you know what to believe?
I think the key is to read several sources which can provide data and conclusions collaborating with each other. For those of us who are not experts in this field it is safest to trust well respected publications and magazines with a good reputation over lesser known videos and blog posts.
Don’t trust a video or article simply because it says something you want to hear. Most of us would love to go back to work and live a normal life, but we should relate to how the world actually is rather than how we wish it to be.
To show the dangers of disinformation and how easily people fall for it I call attention to Drs. Dan Erickson and Artin Massihi from Accelerated Urgent Care. They provide an analysis of the COVID19 outbreak available on youtube.
If you look through the comments the responses are very strong and supportive frequently with laced with hints at conspiracy theories. Suggesting authorities will shut down the video. That politicians have a hidden agenda. That youtube is part of an agenda to destroy the economy to remove Donald Trump etc.
Breakdown of Factual Mistakes by Dr. Dan Ericksson
So let us go through this video to highlight the many ways it takes liberties with facts. At 3:30 Dr. Erickson talks about quarantine e.g.
you quarantine the sick when someone has measles you quarantine them we’ve never seen where we quarantine the healthy where you take those without disease and without symptoms and lock them in your home so some of these things from what we have studied from immunology microbiology aren’t really meshing with what we know as people of scientific minds that read this stuff every day…
This is a rather embarrassing factual mistake for a doctor to make. He is confusing quarantine with medical isolation. You can see an introduction to quarantine here from wikipedia:
A quarantine is a restriction on the movement of people and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been exposed to a communicable disease, but do not have a confirmed medical diagnosis. It is distinct from medical isolation, in which those confirmed to be infected with a communicable disease are isolated from the healthy population. Quarantine considerations are often one aspect of border control.
I am shocked by a doctor not knowing rather simple stuff like this. If you studied history in high school you would have heard about the use of quarantines in medieval Europe during the black plague. But quarantine is mentioned even back to biblical times.
The word quarantine actually means 40-days, because that was the number of days a ship entering harbors during the plague had to wait in a designated area. So contrary to what Dr. Erickson speaks of this was for ships without anybody onboard who was proven sick. Rather this was isolation of seemingly health people. The intention was make sure nobody was carrying an infection of the black plague because it had an incubation period of 37 days. Hence by staying quarantined for 40-days, if nobody showed symptoms it would be safe to let the ship into harbor.
Dr. Erickson tries to sound scientific and impressive by namedropping immunology and microbiology as if those fields deal with quarantine. Immunology is the study of your immune system. Microbiology is the study of micro-organisms. Quarantine has little to nothing to do with these fields. It is an effective policy used long before either of those scientific fields even existed. Pick up a history book and you can learn about it.
Dr. Ericksson’s Testing Data
Ericksson begins by stating COVID19 testing data in Kern County. He says they have tested 5213 people and found 340 who are positive. That amounts to 6.5% of those tested are positive.
He goes onto quote California numbers where there are 32 865 COVID19 cases out of 280 900 tested, which equals about 12% positive among those tested.
Next comes a horrible mistake: Dr. Ericksson points out California has 39.5 million people. He then extrapolates and says 12% of those have COVID19 meaning 4.74 million people.
39.5e6 * 0.12 = 4.74e6
He then points out that there are 1207 deaths registered for COVID19. Out of 4.7 million that is 0.025%. Suggesting COVID19 is totally harmless.
This death rate is considerably lower than the estimate for seasonal flu at 0.1%. That ought to set off the alarm bells ringing about what the good Doctor is trying to say. You don’t see collapsing health care systems in hard hit areas by a disease which is less harmful than a seasonal flu.
In fact this is considerably lower than the the ranges often estimated elsewhere at 1.4% to 3%. In fact these estimates are 56 to 120 times higher than Dr. Ericksson’s estimates.
If you just studied basic statistics it is not hard to know his numbers are so off. Basically he is using sampling completely wrong.
When you want to study a population, e.g. to find out how many vote for a party or are sick it will often be too expensive to check everybody so we perform a sample instead. The frequency of e.g. sick people within the sample would then indicate how many people are likely sick in the population at large.
However for this to be true, a very important property must be true: The sampling must be random. The COVID19 samples are not random instead they are what we call convenience samples. It is just data that Dr. Ericksson has ready on hand, which he likes to use sweeping generalizations on flimsy foundation.
Norway and Sweden Comparison
Our good doctor compares Norway and Sweden but seem to screw up even his own calculations.
He quotes Norway has having tested 4.9% as positive out of 145 279 tested. Again he extrapolates and says that equals 1.3 million people with COVID19 in Norway. Except he does such a trivial calculation wrong.
5.4e6*(4.9/100) = 264 600
His own estimates should suggest 264 600 COVID19 case not 1.3 million. To get his number you need 24% to have tested positive.
100% * (1.3/5.4) = 24%
Of course the whole premise of his estimation are totally wrong. And in this case since I am in Norway and live here I have first hand knowledge about our situation.
The idea that our COVID19 tests represent anything close to a random sample is not remotely true. He could not be more wrong to assume this. Most people with COVID19 symptoms are not given the test. Only in serious cases are you typically given a test. I have had the test myself and so I know how strict this regime is.
Thus when only the most serious cases are tested it means we are picking a sample of fairly high probability cases for COVID19. This sample should thus have significantly higher occurrence of people testing positive for COVID19 than the population at large.
Hence we must assume the total number of people with COVID19 in Norway is considerably lower than his method assumes. Which also helps explain why our health care system is not overrun and doing very well.
Now let us look at his assertion that Norway and Sweden are basically doing equally well while Sweden has hardly any measures in place. This claim is patently wrong. Here are the Nordic numbers:
Country Total Deaths Death per 100 000 Finland 193 3.5 Norway 206 3.8 Denmark 434 7.5 Sweden 2 355 23.3
These numbers are recorded 29 April 2020 from vg.no.
The Swedish death numbers are almost 7 times higher than Norway Dr. Ericksson thinks this difference is insignificant. I think it is profound.
We have to put this in context. It this just some random statistical anomaly or fluke?
First of all the idea that Sweden is all just business as usual is a myth. Business has been hard hit in Sweden because people are a lot less out and attend far fewer activities. A large number of Swedes are working from home.
So Sweden does not represent outcomes in a totally open society. Government may not have passed lots of strict rules but people have significantly changed their behavior and a lot of business is going bankrupt in Sweden as elsewhere.
Let us talk about the numbers. Can we explain them. Finland was the best prepared Nordic country as they had large stockpiles of medical supplies. They also have the lowest death rate at 3.5. Is that an accident?
Norway and Denmark closed down at similar times with similar measures. Norway has quite a lot lower numbers however Norway has 15 people per square kilometer while Denmark has 134 people. That is a big difference in density and we know disease spreads a lot easier in densely populated areas. It is not accident that New York is among the hardest hit in the US. This trend can be observed all over Europe.
Thus we can say for Finland, Norway and Denmark, the numbers make sense. Sweden is a big outlier, despite having similar population density to Norway. They should be between Denmark and Norway in death rate. Yet they are far above even Denmark a far more densely populated country.
It would be very strange to assume this is not caused by the profoundly different policies towards the Corona virus followed. Swedish hospitals are starting to approach a breaking point. They have more than 10 times as many patients on intensive care for COVID19 than Norway presently.
They are rapidly approaching Italian conditions. Let us hope they don’t get there.
But it is fair for people to ask why is Sweden still among the better areas in the world? Maybe strict measures are not needed?
That would be premature. Despite relatively good numbers in an international setting they can be explained by attributes shared among many Nordic countries:
- Government tends to be trusted and guidelines followed. Swedes are better than Norwegians at following rules and guides e.g.
- Sweden like Norway has low population density. That gives you a free lunch. Swedish policies would have had profoundly different outcomes in Spain.
- Sweden has a lot of single households and old people live separate. Compare to Spain and Italy where larger families live together, often with older relatives.
How do we Estimate COVID19 prevalence and Death Rate?
A much better estimate of prevalence of COVID19 is a test of anti-bodies. These have been randomly sampled to my knowledge. Based on this test 13.9% of New Yorkers had COVID19 as of April 23 2020.
This is a completely different number from Dr. Dan Erickson who assumed 39% of New Yorkers have had COVID19 based on how many tested positive on the COVID19 tests they carried out.
From this he get an estimated chance of dying from COVID19 of 0.1% in New York.
Now let us compare that with numbers based on more solid statistics. A lot of COVID19 deaths don’t get reported. The Financial Times looked into a good way of measuring this by looking at how high the death rate has been above the normal rate for the same period last year.
In New York the number of people who die are 300% higher than normal! That is a staggering number. This matches fairly well the current official number of deaths of around 12 000. If we take New York City’s 8.4 million people and 14% of them of which 12 000 died.
100% * 12000/(8.4e6*0.14) = 1.02%
Then we get a death rate of 1%. That is 10x the estimate of Dr. Dan Erickson.
Maybe people died from other stuff. Maybe people are scared of going to the hospital. Well if we look at Financial Times data that death rate above normal correlated well with size of outbreak. E.g. Denmark has few Corona deaths and they are only 5% above the normal. While places which has had major outbreaks like Bergamo province in Italy has had death rate almost 500% above normal.
The Flu Myth
All over the internet people trivialize COVID19 by comparing it to the Flue. However the idea that it is no worse than the Flue collapse quickly under scrutiny.
Dr Erickson e.g. is quoting flawed data on the Flu to downplay the significance of COVID19.
He quotes 62 000 deaths from the flue in the US in 2017. However if you look at CDC numbers you will see that this is an atypical number. Usually the number is far lower.
This is the number of deaths for a whole year. While COVID19 has thus far killed at least 59 000 in the US as of 29th of April in just about one month! And this has happened during a lockdown, unlike the flu which has spread in an open society.
And judging by the Financial Times these deaths are like a lower range. The true number is likely higher, since death rates for same month are much higher.
And here is the second fact knocking the air out of this argument: COVID19 deaths are actual counted deaths. The flue deaths are not counted. They are estimated.
Read this article in Scientific American for an explanation.
The author observes:
in four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu. I could only remember one tragic pediatric case. Based on the CDC numbers though, I should have seen many, many more. In 2018, over 46,000 Americans died from opioid overdoses. Over 36,500 died in traffic accidents. Nearly 40,000 died from gun violence. I see those deaths all the time. Was I alone in noticing this discrepancy?
In other words the high flu death numbers seemed really fishy. The reason is simple. They are not actual counted deaths. They are just estimates.
The 25,000 to 69,000 numbers that Trump cited do not represent counted flu deaths per year; they are estimates that the CDC produces by multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms.
Most likely actual deaths from flu are considerably lower. The number of deaths from flu counted the same way as Corona virus deaths has in the US been in the range 3 448 to 15 620.
Think about that for a second.
In the worst case scenario according to this count the flu killed 4 times fewer people in a whole year than COVID19 killed in a single month!
Dr. Erickson in contrast is trying to tell us that COVID19 is less deadly than the Flu.
Why Focus on Dr. Erickson?
So why did I centre this piece around Dr. Erickson? I did in fact not intend to when I started writing. However I came to realize a couple of very important things about his video:
- The stuff he says is riddled with the same flawed logic and flawed assumptions that all the COVID19 conspiracy theorists or deniers are peddling in some form or other.
- He is a medical doctor. We are supposed to be able to trust people like him.
The last part is what is scary to me. I am not a medical professional. I don’t do research and I have not studied statistics specifically. I am a computer scientist. My job is to write computer programs. So all I got is that I know how to think logically about stuff and read about technical subjects.
Still why is a specialist doing such a long list of basic mistakes in his analysis, that somebody like me can uncover in less than a day?
He speaks of models for estimating spread of COVID19. Yet his approach to this is so trivial that calling it a model comes across as a form of lame name dropping: “look how smart and sciency I am!”. That kind of extrapolation can be done by any middle school student. It has nothing to do with the sophisticate models people are building to estimate COVID19 spread, deaths etc.
He did not know about the different ways COVID19 and the flu deaths are counted.
He was unaware of the anti-body tests New York had carried out or chose to hide that info. Instead he picked numbers inflating statistics in his favor.
He failed to mention or address the data about the death rate having increased significantly prior to earlier years.
All this has been known to me, a person of just a bit above average interest in the topic, but not someone who studies this or is paid to have an opinion.
Dr. Erickson has either done shoddy work, is incompetent or is deliberately trying to deceive us. The scary thing is that among the feedback to his video there is an absolutely overwhelming support and exceedingly few critical voices.
I hope those of you who care about reason and facts will join me in trying to push back against this anti-science movement. You cannot just sit back and assume it will all be fine. People laughed and said Trump would never get elected. If people of reason don’t speak up, you can bet the conspiracy theorists will. You may not be able to convince them individually, but we cannot let them flood social media with their conspiracies unopposed.