100,000 Deaths from COVID-19!

Last Tuesday as rumors of new guidelines asking everyone to wear facemasks spread, I decided to watch the Task Force briefing. There was no such guidance at that time, but I was impressed by how the reporters never seem to listen to the speakers. Are they distracted by the opportunity to ask their prepared questions and ability to get airtime? I spent a good deal of the time telling the TV, “They just said that!”

In any case the first question was about one of the graphs projecting 100,000 to 240,000 deaths, even with full mitigation. This was a modeling result and was in no way guaranteed. No one asked about confidence in the model or how it could change. They just focused on the numbers, because they are scary numbers. The primary reason for the question appeared to be to get the president to say the number, so they could pin it on him. He handed it off to Dr. Birx to show the chart again and repeat the projection.

The next day those scary numbers were all over the news. CBS said, "The White House projects 100,000 to 240,000 Americans will die from coronavirus if ‘full mitigation’ measures are taken.” NBC called it a “dire warning” and only used the upper limit of the projection. ABC chimed in with, “Grim Trump, doctors say prepare for potential 100K to 240K deaths.” That story emphasized the president “abruptly” changing his mind when given new information – I wonder what ABC does when they get new information. 

I cite the mainstream media here, because so many editorials like to pick only on “cable news” when criticizing incomplete or slanted coverage.

Now let’s do what neither the media nor the task force made an effort to do, put it in perspective.

First, are all these incremental deaths? – Probably not. Some of the people who die from the virus would likely have died anyway, especially those in nursing homes. In addition, with so many people staying home, traffic deaths and other accidental deaths may be avoided, but all deaths will be recorded as virus-related and extraordinary.

Second, America is a land of big numbers. The government just passed a law to spend a huge amount, over $2 trillion! Each year Americans drive over 3 trillion miles, personal and commercial, and 2.8 million babies are born. It wasn’t too long ago we were stressing over news like this, “more than 130 people in the United States die of an opioid overdose every day.” And today: “School closures due to coronavirus have impacted at least 124,000 U.S. public and private schools and affected at least 55.1 million students.” The CDC considers over 107 million American adults obese. In America, charities, activists and politicians wanting to raise money, awareness or votes easily find such big numbers to elicit support. 

The CDC estimates 24,000 to 62,000 deaths from the flu this last season, and that’s with a vaccine available. In 2018, the number was 55,672 from flu and pneumonia. If we had 100,000 deaths from coronavirus in 2018 (the last year with complete numbers), it would have ranked seventh among leading causes of death just ahead of Diabetes. 

In fact the total number of deaths in the US from all causes was 2,813,503. On average over 234,000 people die every month from other causes. It’s all counted in big numbers.

Relative to some of these numbers, 100,000 across the entire population is not that large; but taken by itself it can be scary. The task force uses it without perspective to motivate people, to shock them into doing the right thing. The media piles on by using it without perspective to attract viewers and to sell newspapers.

We should be able to cooperate in the containment effort without fear and be able to stay calm knowing the media agenda is to upset us enough to ensure we buy more of what they are selling. But that's not what's happening.

Is It False Advertising?

A couple of years ago plaintiffs brought a class action suit against Boiron Inc., the maker Oscillococcinum, a homeopathic cold and flu remedy claiming that it didn't work. What was unusual in this case is that it went to a jury trial. Most of the time, in fact twice in the past in other lawsuits against Boiron, these types of cases are settled before they go to trial. Apparently this time the company decided it was time to take a stand and risk the decision of a jury. Surprisingly, the company won in court. The jury simply felt that the plaintiff hadn’t presented sufficient evidence that the product did not work as advertised, that is, they had not shown that it did not relieve flu symptoms.

 The reason this is coming to light now is that the plaintiff appealed to the 9^th Circuit, but the court sided with the company. The court found that “the jury appeared to have believed Boiron’s expert, clinical studies, and anecdotal evidence more than it believed the plaintiff’s expert." According to the court, there was no legal reason to overturn the verdict.

 But what exactly is going on here? Is there a scientific reason to doubt the claims of the company?

More can be learned from the website Rxlist.com. “Homeopathic products are extreme dilutions of some active ingredient. They are often so diluted that they don't contain any active medicine.” Due to legislation passed in the 1930s this type of product can be sold in the U.S. but, like dietary supplements, are not held to the same safety and effectiveness standards as approved drugs.

Oscillococcinum claims to relieve flu symptoms, but not cure the flu. It’s effectiveness is based primarily on self-reporting. The website finds “no reliable evidence that taking Oscillococcinum can prevent the flu and evidence of any beneficial effect at all is questionable “due to flaws in the study design.”

It is made by highly diluting in water a compound extracted from the heart and liver of the Muscovy duck. Its dilution rate is coded in homeopathic terms as 200C. This means there is one part duck in a solution containing 1-followed-by-400-zeros parts water. That is an insanely huge number. There isn't even a name for this number. It is more than the estimated number of molecules in the entire universe! It is physically impossible for any part of any active ingredient to survive that level of dilution. But homeopaths explain this away by saying that the water retains the essence of the ingredient (even though there is none left). The remaining water is then combined with inactive ingredients of lactose and sucrose.

“Most experts believe that it will have no beneficial effect and also no negative side effects.” How could it not be safe when it’s primarily sugar water, unless the sugar was somehow contaminated? The company relies on the placebo effect to influence customers and then uses endorsements and personal accounts in their advertising and in this court case.

In my opinion this is nothing but snake oil and that people are basically throwing money away. However, I agree with the jury and the court that they did not advertise falsely. People who are willing to pay about a dollar per dose and take three doses per day really believe in its power to reduce flu symptoms. That belief alone is often enough to make them think they feel better and to report a reduction of symptoms. (Note: Some people take it to prevent the flu, a benefit the manufacturer doesn’t even claim.)

 We each get to decide how to wisely spend our dollars. (Annual sales of Oscillococcinumin in the U.S. were $20 million in 2013, and they probably only had to use one duck!) Information on homeopathic medicines is so easy to find, but the ability to overcome most people’s longstanding beliefs is so difficult to sway.  And suppose those people who still have the flu, but strongly believe they feel better, decide to come to work or school and spread it around. What then?

Perspective About Health Scares (and other things)

Don’t the media love to scare us!  When I hear the talk of Zika virus this summer, I don’t know how seriously to take it.  I was wishing I had kept a diary of the previous health scares (not to mention the year of the shark attacks and the rest).  But a little research went a long way.

Back in 2003 we were warned about Severe Acute Respiratory Syndrome (SARS).  It was the big health story that year but, according to the CDC, it resulted in no SARS-related deaths in the United States and only eight Americans with laboratory-confirmed SARS who were infected abroad.

The following year West Nile virus took the front page, and we still hear about it every summer.  According to CNN by 2013, “More than 1,800 people have died of West Nile virus in the United States since it was first detected in New York City in 1999.”  That would have been a little over 100 deaths per year, which equals less than one-half of one percent of the number of people who died from accidental falls.  But accidental falls rarely make the news.  “According to the CDC, only 1% of people bitten by West Nile-infected mosquitoes become seriously ill.”  Still, we want to keep using repellant, but watching your step to avoid falls is many times more important.

In 2005 it was the Bird Flu.  In 2006 Methicillin-resistant Staphylococcus aureus (MRSA) made the news.  It is one strain of the bacteria that resists many available antibiotics.  In 2007 the scare was not over a disease, but over the possible health effects on children from lead paint in toys imported from China.

2009 brought us Swine Flu (H1N1).  It spread worldwide and caused over 18,000 deaths, but by August 2010 the World Health Organization declared the pandemic over.  In 2011 came an Ecoli scare.  In 2012 we were warned of Middle East Respiratory Syndrome (MERS).  0nly 2 people in the US ever tested positive for MERS.

In 2014 as Ebola ravaged western Africa, the news was so scary that people cancelled trips they had been planning to safaris in countries in eastern Africa, half a continent away.  After the final count was in, media reported that only two people had contracted Ebola in the US.  Both were nurses who treated an Ebola patient and both recovered.

This summer, at least up until the conventions stole the spotlight, the media was all agitated about the Zika virus, especially in Brazil for the Olympics.  Any virus should be taken seriously, but where is the perspective?

Undoubtedly some of these were potentially serious and we should be grateful for the good work of the health agencies.  We should also not become complacent about such issues, but in retrospect most didn’t deserve such hysterical coverage.  It is difficult enough to use perspective to separate the important from the trivial without major news agencies conspiring to put us in a panic over every new outbreak just to feed their commercial needs – selling newspapers and keeping an audience.   (Playing on this manufactured fear, the scammers come out with products like wristbands, patches and stickers claiming to prevent these problems.)

And speaking of perspective, that is, moderation along with that ability to separate the important from the trivial, consider two more examples.

Dwayne “The Rock” Johnson is worth about $256 million as a result of his earnings from his wrestling and now his movie career.  His box office popularity helped push his per movie fee to $10 to $20 million. “With estimated percentages of box office take, that climbs as high as $40 million for Furious 7.”  He is reported to be the world’s highest paid actor.  This information reflects not on his perspective but on that of moviegoers who put such a high level of value on his skills.  (Don’t complain about the 1% without including The Rock and your other heroes with those evil Wall Street hedge fund managers.  He didn’t trick you out of your money – you gave it willingly, and now he is rich and you are not.)

In another example of poor perspective from overseas, French President Francois Hollande has been caught in a scandal as it’s been reported that he pays about $11,000 (9,895 euros) every month for haircuts.  How does he expect to maintain credibility with the French voters?  Oh well, that’s their problem.  We have enough politicians in the US, along with many ordinary citizens who struggle everyday to find a little perspective.

Believing in Onions!

Here’s one that’s been going around the Internet for a number of years and has recently been resurrected on Facebook, the one place you can rely on for completely accurate scientific and medical advice.  (Not!)

The medical guidance is that putting an onion in the room of a sick person will absorb the illness leading to a complete cure in an unbelievably short time.  The truth in this statement is totally contained in the one word “unbelievably.”  Onions are said to so easily absorb bacteria that it’s not safe to store a partially cut up onion in your refrigerator for fear it will later infect you and your family with the gobs of germs it has collected from the air.

If you or someone in the family has the flu, place an onion sliced in half in a bowl in their room and not only will it cure the patient, it will also prevent the flu from spreading to others in the family.  Supposedly cutting it in half exposes more onion to the air.  But if that’s the case, why not dice it to expose so much more surface area?  Apparently no one asked that question, so the explanation stops at halves of an onion.

But it gets even better.  Sleeping with onions in your socks, or from another source, rubbing them on your feet and then wrapping plastic around them and your feet, and tying the whole package in place with white socks, helps alleviate the flu.  (I wonder why the socks have to be white – apparently another question no one has asked.)  There is probably some scientific reason for the color of the socks.  (I imagine a comedy routine about two people trying get intimate in bed feeling inhibited by the bags of onions each has tied to the feet.)

But people who get their medical advice from a site called healthybliss.net probably don’t get too worked up about real science.  They are satisfied with the fact that this cure has been used for thousands of years and that the ancient practice of Ayurveda has some good things to say about onions.

Speaking for real science, this article from McGill University Office of Science & Society, and subtitled Separating Sense from Nonsense, makes it clear that onions are not especially prone to bacterial contamination.  “Onions feature a variety of sulphur compounds that have antibacterial activity.  (Of course that doesn’t mean they can in any way protect against the flu which is a viral disease.)”  They don’t attract or absorb bacteria from the air, although they may absorb bacteria from a contaminated cutting board in the kitchen that was improperly cleaned.

There is some good news and some bad news here.  First, your leftover half onions should be perfectly safe in the refrigerator and better kept there than in the bedroom.

Second, there is hope for the problem of over-prescription of antibiotics that leads to antibiotic-resistant bacteria that leads to the emergence of super bugs and 23,000 deaths per year, which I referred to in the Epidemics posting of May 27, 2016.  Patients who insist on antibiotics to fight viral diseases like flu and the common cold can be prescribed an onion instead.  Their misunderstanding of medicine is obvious from the fact that they don’t distinguish between a bacterial and a viral infection and think antibiotics are the cure.  This sets them up perfectly to accept an onion as a valid cure for their cold and flu symptoms.  Problem solved!

The bad news, of course, is that these same people who apparently slept through science class and are so weak in critical thinking that they readily accept this kind of advice at face value from dubious Internet sources without doing any research on their own, also vote.  And their vote counts exactly the same as yours.

What Are You Afraid Of?

A couple of weeks ago USA Today ran a summary of the results of a Chapman University survey asking people what they were afraid of on a personal level.  The top 5 were:  walking alone at night, becoming the victim of identity theft, safety on the Internet, being the victim of a mass/random shooting and public speaking.  They went on to point out that “crime was rated at the high levels of fear, despite the fact that violent crime has been on the decline in the past 20 years.”  When it comes to fear we are often not rational.

Take Ebola as an example.  This article from one day later tells of the Ebola panic spreading across the nation.  This based on just four cases and one death, but driven by the “increased media spotlight."  The scientific term for this is Baader-Meinhof Phenomenon referring to “how once we learn about something new, we start thinking that we see or hear it everywhere.”  People are more fearful of Ebola than they are of the more common diseases like the annual flu that kills about 30,000 Americans per year and leads to untold amounts of economic loss as adults miss work and children miss school. 

Meanwhile they shun the flu vaccine for reasons based on rumors and personal beliefs rather than on any real science.  Many just refuse to be vaccinated:  “Flu vaccine coverage in the 18- to 64-year-old group in November 2013 was estimated at about 34%, compared with about 41% in children and 62% in those 65 and older.”  In 2013 it was found to be 61% effective and this year’s estimate is 70% to 90%.  A shot that people skip for various reasons, many unfounded, can keep most of us healthy.

But the media attention (along with Twitter and Facebook) focuses on Ebola (just as it did on ISIS in September, unaccompanied minors from Central America in July, and Russia invading the Crimea before that – remember the Crimea?).  When are we going to stop trusting the media, and rightly expect them to over-hype each crisis as it comes along?  They’ve got news to sell; balanced information is just a rare byproduct.  When are we going to stop making medical decisions based on undocumented evidence and opinions on social media?  They have no more expertise than we do, often just a friend or relative who tried a weird cure and got better – sometimes it just happens, but it’s not science and it may not even be safe.

We must start thinking for ourselves, doing the research and being skeptical.  I couldn’t look for a better endorsement of this than one from John McWhorter, Professor of Linguistics at Columbia University, as he writes about what languages do and don’t tell us about the people who use them.  “(Skepticism) is certainly a keystone to sophisticated thought.  It would not be inappropriate to even state, for general purposes, that skepticism – that is applying one’s mind to taking the measure of things before coming to judgment – is the heart of intelligence.”  (Source: The Language Hoax, p. 41.)

If we do the homework we will find not only what we should be scared of and what are figments of our own or other people’s imaginations, but also what we should be doing to avoid the real dangers.  The CDC lists below the top five causes of death in the US and what behaviors will help us reduce the risk of each.

"Modifiable risk factors are largely responsible for each of the leading causes of death:

• ·      Heart disease risks include tobacco use, high blood pressure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity.
• ·      Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances.
• ·      Chronic respiratory disease risks include tobacco smoke, second-hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents.
• ·      Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity.
• ·      Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments."

Fear is a powerful emotion.  It can affect our health and overall wellbeing.  It can lead to foolish decisions.  As technology and communication get more sophisticated, they can either work for us or against us.  Not trusting everything you read is much safer than marching in step to the drumbeat of the news or social media.  What a waste it is to be afraid of the wrong things because we fail to do the research and to think for ourselves.

Flu Season

Flu season gives the media another excuse to trot out experts to give us advice about how to live.  If we exhibited a little more critical thinking behavior, they might decide that this is not necessary.

Much of critical thinking is pretty simple.  It doesn’t require an understanding of experimental design, statistics or other mathematical concepts.  Mostly it comprises what used to be called common sense or what I call “the rules of the game.”

These rules of the game we have heard often.  They make sense and lead to a happier life.  Despite hearing them over and over, apparently many people ignore them.

Flu season is just one example.  Every year people are advised to get flu shots.  This year, when the outbreak is worse than normal, the call is longer and louder, but it’s not new.  We are also advised to wash our hands more often and to keep them away from our faces.  This article repeats that advice with some very interesting data.  Children who wash their hands regularly miss less school.  “When 40,000 Navy recruits were instructed to wash their hands five times a day, their rate of respiratory infections fell by 45 percent.”  We know we should, but do we?  “Ninety-one percent of Americans say they wash their hands after using a public toilet, but an observational study conducted in the six US airports found that only 26 percent of men and 17 percent of women actually did.”

Once we get through flu season, we will hear from financial experts telling us to "pay yourself first," that is, put aside savings before you start spending.  They will advise us to have an emergency fund and to make a list before going to the store to avoid the temptation of impulse items or unneeded purchases.  They will tell us how much we can save by making our coffee at home or brown bagging instead of buying lunch.  The list is always the same.  The rules of the game don’t change.

In the summer we will be told to use sunscreen.  Before school starts we will hear about the importance of vaccinations and be reminded that rumors about a link between vaccinations and autism are completely untrue.  Don’t forget to see the dentist twice a year and, between visits, to brush and floss.  Eat well and exercise.

The rules of the game don’t change.  They are basic.  We should know them by heart.  If we can’t follow through on these simple, common sense behaviors, how do we expect to grasp and solve more difficult issues like gun violence, education, healthcare, poverty, legalizing drugs, or the national debt?