18 Mar 2020

In the Face of Scientific Uncertainty…

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John P.A. Ioannidis, professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center, warns that, as is very much standard operating procedure in the modern world, we are making serious decisions treating totally unreliable statistics as facts.

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.
The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different equencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.


We have a serious problem in the fact that most people, including the overwhelming majority of people in positions of power and responsibility do not understand math and think that statistical estimates and projections constitute scientific fact. How many times have you heard the network news talking head gravely report that “We know there are only [pick a number] of [pick an allegedly Endangered Species] left”?

Only old people like myself remember today the 1976 Swine Flu Epidemic Panic that Gerald Ford presided over which, when the whole thing petered out into a non-event, left the President and official Washington looking ridiculous.

HT: Frank Dobbs.

7 Feedbacks on "In the Face of Scientific Uncertainty…"


Making decisions with insufficient information. Gee, welcome to real life.

Everything that is happening today was predetermined two weeks ago. Of the 250 more or less people who died in Italy today their fate was determined two weeks ago while we all dithered about what to do and naysayers told us “this isn’t so bad”. We can’t afford to wait until we know everything to make some decisions on this.

I will concede that when this is all over it will be no worse than a typical flu season where 500,000 die worldwide. But understand that is still an additional 500,000 because the flu still takes it’s toll. Imagine the collective heartbreak right now in Northern Italy. This is not a large region and not a large population. It is likely that every citizen of Northern Italy will lose someone they love. This is serious stuff.


From ncov2019.like today:

World: 8886 deaths/217294 known cases =
0.04% mortality
US: 1200/7794 = 0.02% mortality

Yes, the information is very incomplete, since many people don’t even know (and probably will never know) they have it. If this is the case then mortality may be even lower.


My recollection is that the swine flu vacine killed more people than the swine flu.

Unfortunately the death count in Italy went up significantly today. By tomorrow more Italians will have died than Chinese (if China’s reported figures are accurate).

Schill McGuffin

Over the generations world events have transpired faster and faster, and communications and media have more-or-less kept pace. But while there are elements of epidemiology that have accelerated with global commerce and technology, the length of time for an infection to incubate and run its course still happens at more like an 18th century pace. However much we want to be proactive, the needed data’s only going to develop over weeks, not days.

Seattle Sam

In the last two months there have been a little over 100 deaths in the US attributed to the Corona Virus — or about the number of people who die in traffic accidents today.


Seattle Sam

You heard that joke about the guy who decided to jump off the Empire State Building? He was heard to say as he passed the tenth floor on his way to the sidewalk “so far so good”.

There was a point in time In Italy when there had been little over 100 deaths. Someone scoffed and compared them with the traffic death rate. We would ask him if he has changed his opinion but he died yesterday from covid19…


Yep. There is never the right information until it is all over, except for those who believe in the conspiracy and the swarm of paid actors. No one can afford absolute certainty nor can anyone ignore the possibilities.

One way or another, we are “Flattening the Curve”. Guard rails, redundant hydraulics, an independent ground conductor, that back-up parachute, etc. Just in case…..

Or you could still “self-isolate” at home in the dark, and still not be sure.


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