Pandemic—or Policy without “Good Science?”

The past two months have demonstrated an amazing response by many sectors of our nation joining in a coordinated effort to defeat the Coronavirus pandemic.  But the more Americans listen to the health experts and policy advisors, the more reason there is to question whether the policies of our government leaders are consistent with “good science.”  If they are not, we may find that the “medicine” they have prescribed in the form of very costly social and economic upheavals was much worse than the COVID-19 disease itself.

Most agree that any successful policy to defeat the COVID-19 pandemic must “follow the science.”  Or better, “must follow good science as I have defined the term elsewhere.  I will briefly list a few aspects where good answers are needed from “good science:” 
1.   Therapeutic Options:  What drugs or other therapeutics are safe and efficacious?
2.   Predictive models:  Are the data and assumptions that drive the models accurate?
3.   Death rates:  Do we have an accurate number of deaths actually caused by COVID-19?
4.   Epidemiology:  What proportion of specific populations already have COVID-19 immunity?
5.   Justification for Current Policy:  Does the science justify the policy actions taken so far?

Therapeutic Options
As of April 7, there were “no drugs or other therapeutics approved by the US Food and Drug Administration to prevent or treat COVID-19.  According to the Center for Disease Control and Prevention (CDC), “Interim guidelines for the medical management of COVID-19 will be provided soon by the Department of Health and Human Services COVID-19 Treatment Guidelines Panel.”  Hydroxychloroquine and chloroquine both have been shown to be efficacious and may have saved lives according to preliminary trials and antidotal reports.  A particularly newsworthy report from the Detroit Free Press and USA Today featured a State Representative Karen Whitsett (Democrat) of Michigan who credits President Trump’s support of doctors prescribing hydroxychloroquine to treat COVID-19 for saving her life.  It would seem of utmost urgency to establish whether hydroxychloroquine is a viable therapeutic option for treating the virus.

Predictive Models
The predictive accuracy of epidemiological models is only as good as the data and assumptions that are used to produce the model.  The Trump Administration Coronavirus task team has relied on the model created by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and funded by the Bill Gates Foundation.  However, this model conflicts with many other models in prediction of mortality and projected peaks.  The IHME had estimated that the epidemic would kill 93,000 people nationwide.  However, the projections have since been revised downward, presently predicting only 60,400 U.S. deaths by August.  The model forecasts the peak of those deaths to arrive in just four days, April 12 instead of April 16 as previously projected.   Considering the magnitude of the downward adjustment was up to a 75% reduction does not lend a great deal of confidence to model precision.  Nor is it clear that social distancing alone accounts for the unexpected lower mortality.  Most needed is a denominator of total community infections.  Bamba Gaye, et al writing in European Heart Journal explains how important the denominator is in estimating COVID-19 mortality rates.

Death Rates
To date, deaths associated with positive tests for COVID-19 are not distinguished between people who have died with COVID-19 from those who have died because of COVID-19.  Dr. Annie Bukacek, a 30-year practicing Montana physician has had the routine role of signing death certificates.  Dr. Bukacek is concerned that “the decision for unprecedented government-mandated lockdown has been based on the alleged death rate of COVID-19.”  But she asks, “Is this death rate based on truth?  Are the reported deaths from COVID-19 truly deaths from COVID-19?” Dr. Bukacek adds that being tested positive for COVID-19 does not mean you have the disease.  She explains how the CDC and the National Vital Statistics System (NVSS) are instructing physicians as follows: “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.”

Dr. Bukacek asked her Facebook audience the following question:  Do you know anybody personally with baseline good health who has been hospitalized for COVID-19 alone, or who has allegedly died from COVID-19?  She found, out of 350 comments, only 3 or 4 answered with a definitive “yes.”  Certainly not a scientific study, but who knows what the actual mortality due to COVID-19 is?  Why isn’t the CDC and NVSS pressing for more accuracy on death certificates?  Which leads us to the epidemiology factor.

Epidemiology
Epidemiology deals with the incidence, distribution, and strategies to control of diseases and other factors affecting health.  Maybe the most important still missing piece in the COVID-19 pandemic is the proportion of any given population that already has developed COVID-19 immunity through production of antibodies as a result of prior exposure.  Not only would widespread antibody testing which has begun in some countries already give us the denominator of total community infections, but it would identify donors of antibody-containing blood serum that could be used to treat patients infected with COVID-19.

“Good science,” if it is truly valued and used, ought to be aimed at answering other questions.  For example, Dr. David Hanson, a senior fellow at the Hoover Institution, questions the projected timeline of the outbreak of COVID-19, and believes it occurred before late December. He cites the CNN report that New York, the epicenter of the outbreak, has reported 32 times as many deaths per 100,000 residents as California.  His explaination:  “Californians developed some degree of herd immunity through earlier exposure to the virus than the rest of the country.”  Fascinating hypothesis and worthy of testing—and soon it will be tested.

Speaking of antibody testing, in Germany where “good science” seems to be progressing much faster than in the US, the so-called Heinsberg Protocol study has been launched in the town of Gangelt where the first fatalities occurred.  Health officials had estimated that approximately 5% of the population had been infected, but antibody testing revealed a surprising 15% had already had COVID-19!  These results suggest that the virus had spread three times faster than predicted and was only one-third as virulent.

Justification for Current Policy
We have briefly cites four areas in which “good science” is either lacking or is seemingly being ignored or rendered ineffective in guiding public policy toward the COVID-19 pandemic.  The results are unsettled debates about therapeutic treatment, models that disagree widely in their predictions, uncertainty of death rates with little interest in making death certificates more accurate, and an epidemiological gold mine of data still waiting to be collected—and so necessary to forming good public policy.

Given the areas of uncertainty that I have outlined above, many wonder what justifies the current policy of social distancing and isolation, and the resultant economic and social upheaval we are now experiencing with 10 million people filing for unemployment and $2 trillion being spent through the Coronavirus Relief Bill.  Most disconcerting is an analysis by the Mises Institute which compares total death statistics for all causes in March, 2018 with March, 2019 with the result that the deaths attributed to COVID-19 in March, 2020 (likely inflated as explained above).  The COVID-19 deaths this March was only 1.6% of the total deaths in March of last year; and, this 1.6% was smaller than the difference between March, 2018 and March, 2019.

In a March 30 article for The Spectator, former UK National Health Service pathologist John Lee writes what may be the question of 2020 if not this decade or century:

Total COVID-19 deaths could still increase significantly this season, but even then we must ask what percentage of total deaths warrants an international panic. Is it 5 percent? Ten percent? The question has never been addressed, and so far, a figure of 1 percent of total deaths in some places is being treated as a reason to forcibly shut down the global economy.

How About You?  
I welcome “Comments,” and meanwhile stay safe, be encouraged by this season of Hope in the Resurrection of Christ, keep investing time to be informed.