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Rich Rifkin: Unreliable data is guiding public health policy

365体育投注When it comes to the novel coronavirus, we lack solid science to make rational policy.

365体育投注Before you get angry, I need to make one thing clear: I am not saying that what public health officials are doing in the face of COVID-19 is wrong. I am personally practicing social distancing and I would never suggest anyone else should violate the advice and orders of county and state officials.

365体育投注That said, in the most important respect, we are flying blind.

Behind our response to COVID-19 — to require social distancing, to close most businesses and all schools, to instigate a severe economic collapse and to purchase every last roll of toilet paper — is a big guess: That this virus is so virulent and so deadly to so many that we must shut down almost everything everywhere.

We don’t know that. We don’t have solid scientific evidence to show that. We have not tried to acquire that evidence. 

What we and most countries have done is test people who have serious symptoms of the disease and those directly in contact with them, and assumed conclusions from this biased sample. 

365体育投注Doing that is not science. In no sense does it give us a true picture of the deadliness of this coronavirus. It also does not tell us much about the ability of people to survive this disease.

This is not simply my opinion. That is what our most respected epidemiologists are saying. 

John Ioannidis — professor of medicine, epidemiology and population health, biomedical data science and statistics at Stanford University — recently this:

“The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to (COVID-19) are being missed. 

“We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population. 

“Patients who have been tested for (COVID-19) are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.”

As everyone who has studied statistics knows, drawing broad conclusions from a non-random sample group is specious. 

Dr. Ioannidis is not alone in this view among epidemiologists. Here is a quote from Dr. Larry Brilliant, chairman of the board of Ending Pandemics, taken from in Wired Magazine:

“Tests would make a measurable difference. We should be doing a stochastic process random probability sample of the country to find out where the hell the virus really is. Because we don’t know,” Brilliant said.Maybe Mississippi is reporting no cases because it’s not looking. How would they know?”

Without a doubt, we know the new virus can kill. As I write (on Monday morning), there have been 15,436 fatalities worldwide and 474 in the United States, including 35 in California. But those numbers, which will undoubtedly grow, need to be seen in context. In a typical year, 650,000 die globally from the seasonal flu — roughly 35,000 in the United States.

365体育投注A great worry expressed by public health professionals is that this novel virus may overwhelm our medical care system. Unfortunately, because we don’t have scientific sampling to know the approximate death and hospitalization rates of everyone infected, we don’t know if that is a reasonable fear.

Keep in mind that we had a very flu two years ago. Hospitalizations (900,000) and deaths (80,000) were more than double a typical year. Yet even with that virulence, our hospitals were mostly not overwhelmed.

365体育投注But, in hotspots, some were. That is the same, so far, with COVID-19. If the virus hits a vulnerable population, there will be a big spike of hospitalizations and deaths. That is what happened in Washington state, where 96 people have died.

Italy (5,476 deaths, 59,138 positive tests) has had it even worse. This virus struck a large, highly vulnerable population of mostly elderly people who were already sick.

So far, despite its severity in Lombardy, healthy Italians are not getting seriously ill from coronavirus. Almost 99 percent of Italians who have died from this virus previously had one or more fatal conditions. This is known as comorbidity. 

Hypertension preexisted in 73.8 percent of Italian coronavirus deaths; diabetes, 33.9 percent; heart disease, 30.1 percent; atrial fibrillation, 22 percent; chronic renal failure, 20.2 percent; recent cancer, 19.5 percent; COPD, 13.7 percent; dementia 11.9 percent; stroke, 11.2 percent; and chronic liver disease, 3.7 percent. 

In Italy, 48.6 percent of those who have died from this virus had three or more comorbidities; another 26.6 percent had two comorbidities; 23.5 percent had one comorbidity; and only 1.2 percent had no known comorbidities.

The great shame is that we could have responded much faster. 

When we learned late last year that a new coronavirus was spreading in Hubei province in China, our federal government failed to act. Part of the reason we didn’t know what to do is that President Trump his pandemic response team in 2018.

Also, according to , “Several months before the coronavirus pandemic began, the Trump administration eliminated a key American public health position in Beijing intended to help detect disease outbreaks in China.”

As Trump dithered, science burned.

Until we test a random sample of our population in the United States, we won’t know if the threat to our hospitals will be far worse than a bad flu year or not. Public health officials don’t have good data, as epidemiologists know.

— Rich Rifkin is a Davis resident; his column is published every other week. Reach him at [email protected] We’ve put all COVID-19 news stories and local columns outside our paywall, to make sure all the information on local coronavirus response gets disseminated as widely as possible. To subscribe to The Enterprise and support local journalism, click here.

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