re: Covid 19: misunderstandings in statistics, ascertainment bias (more testing= more "cases")

https://www.cbc.ca/news/health/coronavirus-covid-pandemic-response-scientists-1.5502423

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Prominent scientist dares to ask: Has the COVID-19 response gone too far? Social Sharing Facebook Twitter Email Leading epidemiologists publish duelling commentaries, igniting debate on social media

Kelly Crowe · CBC News ·
Posted: Mar 19, 2020 4:00 AM ET | Last Updated: 3 hours ago

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It's a clash of titans — an epic battle between two famous scientists over the world's response to the COVID-19 pandemic. In one corner, influential Stanford University epidemiologist John Ioannidis, who wrote a commentary asking whether taking such drastic action to combat the pandemic without evidence it will work is a "fiasco in the making." Across the mat, prominent Harvard epidemiologist Marc Lipsitch punched back with a defiant response titled: "We know enough now to act decisively against COVID-19."

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Better information is needed to guide decisions and actions of monumental significance and to monitor their impact," Ioannidis wrote. "In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work." Ioannidis told CBC News he worries about the consequences of those measures. "Put a stall to the entire economy. Tell people to stay at their homes, get depressed, commit suicide, domestic violence. Who knows? Child abuse, children losing their education, companies crashing … unemployment, the stock market already dropping 20 per cent.

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Lipsitch said he talked to Ioannidis beforehand and found that they had more in common than it seemed. "I would say that his article did what contrarian writing should do: started a discussion." Lipsitch insists drastic action is required. "Waiting and hoping for a miracle as health systems are overrun by COVID-19 is not an option," he wrote. "For the short term, there is no choice but to use the time we are buying with social distancing to mobilize a massive political, economic, and societal effort to find new ways to cope with this virus."

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This mindset has played out before in medical science. A notable examples was the action taken by the government against dietary fat and cholesterol. The logic that was used:

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The touchstone is the precautionary principle, clearly articulated in the 2006 investigation into Canada's response to the SARS epidemic, written by Justice Archie Campbell of the Ontario Superior Court.

"Where there is reasonable evidence of an impending threat to public health, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat," Campbell wrote in a chapter called "Spring of Fear," citing Justice Horace Krever, who presided over Canada's tainted blood inquiry.

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And there it is...
*Although we may realize later that our logic was completely wrong and motivated primarily by fear leading to many unintended future consequences that may be far worse

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Prof. Ross Upshur of the University of Toronto is a public health expert, a physician and a scholar of the ethics and history of global health emergencies. He's also a veteran of the SARS outbreak. He has corresponded with Ioannidis over the years and respects the Stanford professor's expertise: "He is one of the most cited, most highly regarded researchers." But in this particular case, Upshur said, Ioannidis is making an error in his analysis by failing to view the current response through the lens of public health instead of evidence-based medicine. "Of course there's a lack of data," said Upshur. "It's all nice to stand on the sidelines and say, 'Hey, you know we don't have very good data. These are not evidence-based decisions.' Well, of course they're not, because we don't have the evidence."

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We desperately need to know, No. 1, the prevalence of infection, and No. 2, the incidence of new infections," he said. "If we make decisions with such tremendous uncertainty, we can get tremendous harms." The lack of data is one point on which Lipsitch and Ioannidis agree. "The U.S. has done fewer tests per capita so far than almost any rich country in the world," Lipsitch wrote. "And many critical details of the epidemiology — including the absolute number of cases, the role of children in transmission, the role of presymptomatic transmission, and the risk of dying from infection with SARS-CoV-2 — remain uncertain."

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