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

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A Liberal East Coast Science Writer Talks to a Pro-Trump Texan Strength Coach about COVID-19

A weight-lifting guru, author and podcaster calls the U.S. response to the pandemic an “exercise in hysteria" that might do more harm than good

By John Horgan on May 4, 2020

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That show aired March 20. A month later Rippetoe asked if I wanted to talk about “the current situation with COVID-19.” I said sure. Our talk was posted online April 24. I listened more than I spoke, because Rippetoe had a lot to get off his chest. He was still genial and jokey. Noting that fear can make you do “stupid things,” he recalled that while he was killing rattlesnakes on his property recently, one struck him and hooked a fang on his pant leg. “I did stupid things for about 10 seconds,” he said. But his anti-authoritarianism had a sharper edge than in our previous chat, and it was harder for me to relate to.

When I described myself as a “bleeding-heart liberal” who favors socialist policies, Rippetoe quipped, "Of course, you live in New Jersey." He is a “conservative libertarian” who doesn’t want to live in a “police state” that “controls every aspect of my activities.” He voted for Trump in 2016 and plans to vote for him again. “The trick to liking Trump,” he said, “is to pay no attention to what he says or types, and just focus on what he's gotten done,” like cutting federal taxes and regulations and trying to get us out of Afghanistan and other wars. Below are Rippetoe’s arguments about COVID-19, made in the podcast and via email, followed by my responses.

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The Libertarian View of COVID-19

Rippetoe, who has a degree in geology, assured me that he is not anti-science, anti-medicine or anti-vaccine. He gets a flu shot every year. But he believes that Anthony Fauci and other health authorities have grossly exaggerated the threat of COVID-19.
Rippetoe disparaged an influential model from Imperial College, London, that in March compared COVID-19 to the deadly Spanish flu of 1918-1919 and predicted more than 2 million deaths in the U.S. “There are no data to suggest that millions of people are going to die,” Rippetoe said. By late April the U.S. death toll had only reached levels comparable to a bad flu season, and it was already flattening out in New York City and elsewhere.


Rippetoe admires analyses of Stanford epidemiologist John Ioannidis (whom we also discussed briefly in the cancer podcast). In a controversial essay in mid-March, Ioannidis argued that, given uncertainty about its infectiousness and lethality, we might be overreacting to COVID-19. Shutting down businesses and ordering people to stay home might end up doing more harm than good.
In April, Ioannidis and 16 other researchers carried out a study in Santa Clara County, California, in which they tested asymptomatic people recruited through Facebook for Sars-Cov-2 antibodies. They concluded that the number of people actually infected by the coronavirus was more than 50 times higher than “the approximately 1,000 confirmed cases at the time of the survey.”

These results suggest that the coronavirus is much less deadly than indicated by earlier estimates, which divided confirmed deaths by confirmed cases. In early March, for example, the WHO estimated the lethality of COVID-19 to be 3.4 percent, greater than the 2.5 percent rate of the 1918 Spanish flu. The Santa Clara study estimated lethality at 0.2 percent, roughly twice the typical death rate of seasonal flu. Although the Santa Clara study has provoked harsh criticism, studies in Los Angeles and New York have produced similar results, Rippetoe noted.
Given these facts, Rippetoe contends, politicians, health authorities, the media and the public have overreacted to COVID-19. He called the national shutdown of non-essential businesses a “ridiculous exercise in hysteria” that is “powered entirely by fear.” Rippetoe blamed governmental “overreach” primarily on state and local rather than federal officials. “I’m not concerned with Trump,” he said.

As a libertarian, Rippetoe hates being told what to do by officials like the mayor of Wichita Falls, who designated his gym a non-essential business. If he chooses to risk his health by keeping his gym open, and his customers choose to keep working out, why should the government force them to do otherwise?

Rippetoe pointed out that New York City, because of its high population density, is anomalous. “The healthcare system has not been overwhelmed, or even challenged, anywhere in the country other than New York City.” Elsewhere, hospitals, clinics and doctor offices “are largely empty, and as a result are in very dire financial circumstances.” It’s wrong, Rippetoe said, “to put the rest of us under the same quarantine lockdown” as New York City. Sweden, he said, was handling the coronavirus well with far fewer restrictions than the U.S.

Old guys like us (Rippetoe is 64, I’m 66) face the greatest risk of dying from the coronavirus. It is irrational, Rippetoe said, to force tens of millions of Americans young and old into unemployment to save tens of thousands of people who might not have long to live anyway. Unemployment also leads to terrible harm, including increased rates of physical and mental illness, crime, substance abuse, domestic violence and suicide. “People are going to die as a result of this unprecedented overreaction,” Rippetoe said.

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Up to 300 Million People May Be Infected by Covid-19, Stanford Guru John Ioannidis Says

By Patricia Claus - Jun 27, 2020

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Dr. Ioannidis: We have learned a lot within a short period of time about the prevalence of the infection worldwide. There are already more than 50 studies that have presented results on how many people in different countries and locations have developed antibodies to the virus. These numbers are anywhere between 5 times (e.g. Gangelt in Germany) and 600 times (e.g. Japan) more compared to the documented cases, depending on whether a lot or limited testing was already performed in different locations. We know that the prevalence of the infection varies tremendously across countries, but also within countries, within states, and even within population groups in the same location. COVID-19 attacks some disadvantaged and deprived communities (harder), and disadvantage and deprivation means different things in different countries. Of course none of these studies are perfect, but cumulatively they provide useful composite evidence. A very crude estimate might suggest that about 150-300 million or more people have already been infected around the world, far more than the 10 million documented cases. It could even be substantially larger, if antibodies do not develop in a large share of people who get through the infection without symptoms or sparse symptoms.

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Dr. Ioannidis: 0.05% to 1% is a reasonable range for what the data tell us now for the infection fatality rate, with a median of about 0.25%. The death rate in a given country depends a lot on the age-structure, who are the people infected, and how they are managed. For people younger than 45, the infection fatality rate is almost 0%. For 45 to 70, it is probably about 0.05-0.3%. For those above 70, it escalates substantially, to 1% or higher for those over 85. For frail, debilitated elderly people with multiple health problems who are infected in nursing homes, it can go up to 25% during major outbreaks in these facilities.

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Greek Reporter: You had earlier extrapolated 10,000 total US deaths using the Diamond Princess cruise ship analysis, using the case fatality rate among those infected, which was .3% (mid-range guess), with 1% of the US population becoming infected. As we know now, the total amount of those dying with the disease was much higher but it was still not the astronomical, exponentially huge number that some had predicted. There had been only 68 American deaths by March 16, the day before your original article was published. The most pessimistic projection in March was 40 million deaths globally — the same as the 1918 flu. What do you really think it is now, bottom line?

Dr. Ioannidis: In the STAT article, I discussed two hypothetical extremes for illustrative purposes, one with just 10,000 deaths in the USA and another with 50 million deaths worldwide. I said that our data are so unreliable that the truth could be anywhere between these two amazingly different extremes. Based on what we know now, we seem to be closer to the optimistic end of the range. In terms of numbers of lives lost, so far the COVID-19 impact is about 1% of the 1918 influenza. In terms of quality-adjusted person-years lost, the impact of COVID-19 is about 0.1% of 1918 influenza, since the 1918 influenza killed mostly young healthy people (average age 28), while the average age of death with COVID-19 is 80 years, with several comorbidities.

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