Revenge of the data: COVID19 vs health care science

This year’s flu season is very mild. The number of cases, hospitalizations, and deaths due to influenza are nearly non-existent this year compared to long established baselines and trends.

From a layman’s perspective, this defies common sense. We have been taught that the influenza condition is an escapable threat that the community must face every year. Our lived experience has confirmed this year after year, and in my case over an experience of over a half a century. We learn that while there are vaccines for influenza, the vaccine needs to be reinvented every year to cover the latest strains, and the vaccines are not very effective even if they happen to match the particular strain encountered.

Even in normal years, there is a loss in confidence in the flu science in terms of its assurance that they have anticipated a season’s strain at least a year in advance so there is time to develop and produce an appropriate vaccine to be administered before the season really starts. The loss of confidence comes from the evidence of the vaccines ineffectiveness.

This year is very different because there is a collapse in the number of flu cases. This defies common sense.

There are several proposed explanations that satisfy only the incurious.

The first explanation I heard, many months ago in fact, was that there is a kind of zero-sum game among viruses. When one virus dominates, such as this year’s SARS-Cov2, it overwhelms other viruses from causing their version of harm. This sounds reassuring when stated from scientists, but it does not make sense to me. Viruses infect cells, and particular viruses infect particular types of cells, and particular vulnerabilities within the cells. Normally, we have multiple viruses infecting our cells at any time, but usually the immune system is keeping them in check.

I can’t see how one virus can prevent another virus for infecting even if the first is causing illness. If anything, the immune reaction to the first virus would leave the body less capable of fending off other viruses. If anything, a dominating virus should open opportunities for many other viruses to attack their specialized targets especially of those targets are no reachable by the first virus.

The data does not support the assertion either. Most confirmed COVID19 cases also have confirmed significant influenza infections, many to the point where it is not obvious which virus is most responsible for the patient’s health condition. On the other hand, there is the problem that influenza and SARS-Cov2 target very different populations. SARS-Cov2 is mostly harming older populations while typically influenza presents a substantial risk to younger people. Also, SARS-Cov2 is not impacting many regions so in these regions there should be no competition for influenza. Any virus is not aware of anything other than a cell: it would not be slowed because of other people being infected with another virus.

I am unpersuaded that the dominance of one virus would suppress another virus, especially at population scales. However, I understand that epidemiologist assure us that this is real and has been observed in the past. Accepting this assurance makes me even more suspicious about the science of viruses. This is not the behavior I would expect from viruses based on the scientific description of how viruses work.

An alternative explanation is that the extreme public policy measures this year, put in place to slow the spread of SARS-Cov2, has actually been very effective against influenza. This explanation may compliment the above explanation in that it may be combination of both. From what I can tell, these public policies of social distancing, lockdowns, mask-wearing, and frequent hand-sanitizing have not had much impact on the spread of SARS-Cov2, and certainly these have not been as effective as hoped with slogans such as “2 weeks to flatten the curve”.

As a layman, it defies my common-sense that policies would be vastly effective for one virus (influenza) while being almost entirely ineffective against another (SARS-Cov2). Because scientists assure me that this is the case, I have to conclude that this reflects the quality of modern science.

There is another problem with the explanation that lockdowns are effective for influenza. This means we have finally found a social-policy cure for influenza outbreaks. Remaining in perpetual lockdown would save us from ever having to experience influenza or of having to deal with the news of others getting it. In contrast to the earlier discussions, this actually makes sense. In fact, this is not news at all. I recall in my youth being told that risking exposure to influenza is something to accept in order to participate in society, whether it is attending school, socializing, or just engaging in normal commerce with others. This should not be a revelation, but our government and news sources are promoting this as if it were some new discovery. Their conclusion is that we should wear masks in public for the remainder of our lives because of this discovery about influenza. The problem is that we lived just fine with influenza for all the years until now.

We are at risk of forgetting that the public emergency is about SARS-Cov2. Masks and other social distancing is not helping with COVID19 spread. I do not doubt that social-distancing policies will now be perpetual for this unexpected consequence of helping with influenza even though influenza is not a public emergency. This becomes another indictment of science in that it seeks recognition for solving a nonproblem as a consolation for being unable to solve the more immediate emergency.

In addition to the anomalously low influenza cases, there are other problems emerging from the data about this epidemic.

One area I have been paying close to attention to is the comparative impact of COVID19 in different countries. If this were just one virus of a very specific variety, my layman’s understanding viruses as explained to me by scientists, is that the virus infects cells. It is not aware of the individual hosting those cells, and certainly not aware of political or economic borders. Yet, the evidence show that the virus has vastly different impacts on different countries or provinces.

This pattern became apparent very early on with severe outbreaks in certain cities such as New York. The explanation, seeming reasonable at the time, is that New York is very dense, not just in terms of housing, but also in the commuting patterns within the city. Over time, however, this pattern was not replicated in other comparable cities. Instead, a different pattern emerges suggesting, counter-intuitively, that the impact of the disease is worst where the quality of health care is highest. Poorer countries are having much less impact, and some having virtually no impact. Even among the poorer countries, those that are having larger impacts of the virus are the ones receiving the most assistance from the richer countries. An example is the widely different experiences of Haiti and Dominican Republic, two nations sharing a small isolated island, where the richer and most westernized of the two, Dominican Republic, is having the poorer COVID19 outcomes. There are other examples in the far east, Africa, and Central and South America, where the disease is not a major concern. They share in common a remoteness from the medical systems of the western power centers.

The data of impacts on different countries is at least hinting that there may be a problem with our medical systems, or at least that our pride is misplaced in how advanced our medical systems are. I observed this early in the pandemic where it appeared that medical practices were mostly at fault for the initial high mortality rate. That observation concerned the excessive eagerness to sedate and ventilate patients, a practice that proved fatal for most undergoing the procedure. There was the excessive caution of health providers to minimize normal health care assistance in order to avoid spread of disease. Also there was a widespread promotion of do-not-resuscitate orders for the greater good.

This pandemic could have turned out to be much more fatal than it was. In that case, the richer nation approach might have faired better than the poorer nations. It was not as fatal as first feared, and the result is that western nations over-reacted and suffered the consequences of that over-reaction. In the end, this should be an embarrassment of our medical system. Most of the rest of the world responded more rationally with an approach that respected the threat of an unusually virulent disease but within normal expectations. Countries that did not react as if this were a civilization-ending existential threat fared as well as they had in past bad flu seasons.

This variability on political boundaries raises a suspicion that the science itself has become politicized, particularly in those countries allowing themselves to dictate new policies that so called follows the science. The science appears to have always adapted in the direction to provide increasing support for the oppressive policy and to encourage extension and expansion of the policies. Watching the progression of the science over this pandemic, I see repeated cases where the good news was suppressed (such as the case fatality rates being lower than emergency levels, and such as masks not being effective against the spread), and bad news was exaggerated if not even fabricated to support the policies that conveniently coincided with political agendas. Countries that chose minimal to no policy responses to these sciences generally faired better than the countries. Countries make decisions based on politics. For politics to have this kind of impact on a virus, where acting on the science worsens the outcomes, this means that the virus is political, or that the science is corrupted politically.

The data exposes a flaw in our medical systems being unrealistically pessimistic about health risks, and about natural immunity capabilities. Our medical systems are overreacting out of a systemic hysteria of the entire discipline that increasingly believes that each day is the first day of the end of the world. In the particular disciplines of virology and epidemiology, the data raises serious doubts about whether these sciences are correct and mature enough to drive public policy. The evidence of this years experience points to these disciplines not being deserving of belonging to science.

If this is where science is, science has become unhelpful for policy making. With COVID19, science, or at least medical science has jumped the shark.

Countries boasting very expensive and advanced healthcare appears to have lower success in understanding and dealing with this situation than countries that have more basic health care area that are more resistant to scientific persuasion. There is a third approach that I have imagined in this blog as the dedomenocracy approach. This approach only invokes policies when a sufficient portion of the population expresses some urgency. In the the context of the past year, I doubt this urgency ever would have been met. The panic of the population that did exist came as a result of encouragement by politicians and media. When the problem did become acute, the data should have shown the problems were primarily localized to long-term care homes housing people whose health conditions already demand assistive living. In any case, if dedomenocracy would have imposed some policy, that policy would have already expired and there is no widespread demand for more policies, at least not that the super-majority levels required to trigger the policy. The policies, if needed, would come from algorithms considering the available data, prioritizing recently observed data over old data, and in particular treating theories such a virology and epidemiology as expressions of very old data of lower importance than recent observations. As I described in earlier posts, a dedomenocracy’s policies are entirely based on algorithm and are beyond any modification or veto by any human. This makes the policies immune to immediate politics. Humans have a role in choosing and tuning the algorithm, but that occurs long before the crisis started so the policies are based on long-term and stable goals instead of short term agenda-based decision making we experienced.

In this case, the disease was not the existential threat we feared. Even if it were as bad as the 1918 flu, our society would have survived it, especially if the impact was primarily among older people at the ends of their lives. Dedomenocracy would have performed better than our governments.

Eventually, perhaps, our much feared existentially threatening pandemic (of black death proportions) may finally arrive. When that happens, perhaps then our over reaction of our paranoid science would have outperformed the alternatives. Based on the observations above, I doubt the science would have come up with the right solution. As I described in an earlier post about flattening the curve, the science made the ludicrous recommendation to shut down the economy in order to keep cases within health care capacity, completely neglecting the fact that that capacity depends on the economy to supply it with material and funding. If there were a real existentially-threatening pandemic, science would have condemned us to a collapsing medical system watched by an impoverished population who probably would not care any more. Even when facing such a huge threat, doing as little as necessary is more likely to succeed than the kind of over reaction we have experienced over the past year.

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