Experts Question How Long the Lockdown Should Last

US officials defending the mandatory lockdowns and social distancing measures, which have crippled the American economy since March 15, claim that they are merely responding to the recommendations of science. At the daily White House coronavirus press briefings, President Donald Trump and Vice President Mike Pence have stood beside Dr. Anthony Fauci and Dr. Deborah Birx, two of the world’s leading experts on the control of infectious diseases. They confirmed and authenticated the need for the government to take drastic measures to keep predictions that millions of Americans would likely die from the COVID-19 virus from coming true.

That alarm was first raised by public health researchers at Imperial College in London. They predicted more than 2.2 million coronavirus deaths in the US if it did not impose drastic “control measures or spontaneous changes in individual behavior.” The study was published March 16, the same day the Trump administration released its “15 Days to Slow the Spread” initiative, which included strict social-distancing guidelines and began the systematic lockdown of American businesses in states across the country.

These dire warnings have been also been repeated by public officials in the Greater New York area, where the rapid spread of the virus threatened to overwhelm the hospital system and has accounted for more than 20,000 deaths so far. Outspoken Democrat opponents of President Trump, including New York State Governor Andrew Cuomo, New York City Mayor Bill de Blasio, and New Jersey Governor Phil Murphy, have defended the lockdowns in the face of growing opposition from voters in their cities and states whose normal lives have been totally disrupted.

California’s Governor Gavin Newsom insisted, “We are going to do the right thing, not judge by politics, not judge by protests, but by science,” he said last week. Michigan Governor Gretchen Whitmer, a possible Democrat running mate for Joe Biden in November, defended her statewide order that, among other things, banned the sale of paint and vegetable seeds but not liquor or lottery tickets. “Each action has been informed by the best science and epidemiology counsel there is,” she insisted in an op-ed.

IS IT SCIENCE OR POLITICS?

But in the real world of cutting-edge research into a novel virus, opinions are almost never unanimous, and appeals to “science” by elected public officials are more often driven by the needs of partisan politics or ideology than statistical data and proof.

In this case, the initial predictions of the scientists about the COVID-19 epidemic turned out to be wrong, because they were based on falsified data from China, overstating the lethality of the virus and seriously underestimating its powers of contagion.

The initial scientific models predicting the course of the epidemic in the United States assumed that the virus would follow the same pattern as in China. The experts initially believed that Trump’s January 31 ban on travelers from China entering the US and a similar ban on March 13 on travelers from Europe had significantly slowed the arrival of the virus on American shores. They were wrong.

HIDDEN EARLY US CASUALTIES

Until last week, US public health officials thought that the first American fatality from the COVID-19 virus took place on February 29 in Washington State, and that the initial virus outbreak was centered in a nursing home in the Seattle suburb of Kirkland.

But now we know that the virus had begun spreading on the West Coast much earlier. The first American casualty was Patricia Dowd, a 57-year-old manager for a semiconductor company who lived in San Jose, California. She died on February 6 of a ruptured heart, five days after complaining of flu-like symptoms. She had been in good health and had never visited China. Her death was not attributed to the coronavirus, until an autopsy conducted last week at the request of her family revealed that the virus had infected her heart. The second victim of the virus also lived in California’s Silicon Valley region. He was a 69-year-old man who died on February 17. Both deaths appear to have been caused by community transmission of COVID-19, which had been spreading through the American population, undetected, for at least three weeks before public health officials were aware of its presence.

CRUISE SHIP NUMBERS DIDN’T MATCH WUHAN’S

The first hard indication that the Chinese medical data from the initial epidemic in Wuhan City and the Hubei province might be unreliable was a study published in March in Stat News by Professor John Ioannidis at the Stanford School of Medicine. It was based upon the passengers and crew members infected with the COVID-19 virus who were quarantined aboard the Diamond Princess cruise ship starting on February 4 off the coast of Japan. Only nine of the 700 infected people died, even though many of the passengers aboard the ship were elderly and therefore at a much higher risk from the virus. Adjusting for the demographics of those aboard ship, Dr. Ioannides argued that the virus had a fatality rate on the cruise ship of 0.12% to 0.2%, making it much less deadly than the initial Chinese epidemic statistics suggested, and no more dangerous to the American population as a whole than the common seasonal flu virus.

“If that was the true rate,” Dr. Ioannidis told the Wall Street Journal, “locking down the world with potentially tremendous social and financial consequences may be totally irrational”— an over-reaction whose immense costs are now more difficult to justify in light of the reduced mortality risk posed by the virus.

He believes that the coronavirus pandemic is a case in which the initial results were so alarming that they caused the scientific community and the public at large to panic. That panic has now blinded many to the fact that the initial conclusions were based upon Chinese misinformation which has been contradicted by new and much more reliable evidence, based upon direct scientific observation.

A STORM OF WRONG ESTIMATES AND EXAGGERATION

According to the Stanford professor, the coronavirus pandemic is “the perfect storm of that quest for very urgent, spectacular, exciting, apocalyptic results. And as you see, apparently our early estimates seem to have been tremendously exaggerated in many fronts.”

Dr. Ioannidis says he has great respect for epidemic modeling, but that their usefulness depends upon the accuracy of their assumptions about the disease. With regard to the Imperial College projection, “they used inputs that were completely off in some of their calculation. If data are limited or flawed, their errors are being propagated through the model. . . The magnitude of the final error in the prediction. . . can be astronomical.” Another part of the problem is that modelers do not always fully disclose their assumptions or the data upon which their projections are based, making it hard to judge the accuracy of the resulting projections. “At a minimum, we need openness and transparency in order to be able to say anything,” Dr. Ioannidis says.

Most important, he added, “what we need is data. We need real data. We need data on how many people are infected so far, how many people are actively infected, what is really the death rate, how many beds do we have to spare, how has this changed.”

NEW DATA LEADS TO SURPRISING CONCLUSIONS

Dr. Ioannidis and his colleagues at Stanford have followed up their study of the COVID-19 patients on the cruise ship with a new study published two weeks ago based on blood tests of 3,330 volunteers from the San Jose area taken during the first week of April. They found that between 2.49% and 4.16% of the population had antibodies in their blood, indicating that they had been infected. That is 50 to 85 times more than the roughly 1,000 confirmed cases and 32 deaths in the area at the time, and implies about the same low COVID-19 fatality rate observed aboard the Diamond Princess.

Even though the team made statistical adjustments in its results to account for possible bias by gender, race and ZIP code, the Stanford study immediately came under attack by some experts who pointed out that the population it sampled may have been healthier than the norm. Nevertheless, Dr. Ioannidis says he is confident that the overall conclusions of his study—that the presence of COVID-19 antibodies is far more widespread than the number of confirmed cases reported would indicate—will be confirmed by other groups doing antibody testing across the country.

That seems to be the case in two new studies published last week, one by USC, in conjunction with the Los Angeles County Department of Health, and another in New York state.

The Los Angeles study tested 863 adults for antibodies to the virus in early April. About 4 percent of them tested positive, indicating that the number of adults in the county who had been infected was roughly 40 times the number of confirmed cases at the time. Los Angeles Public Health Director Barbara Ferrer chose to interpret the outcome as reinforcing her current policies.

“These results indicate that many persons may have been unknowingly infected and at risk of transmitting the virus to others,” Ferrer said. “These findings underscore the importance of expanded [virus] testing to diagnose those with infection so they can be isolated and quarantined, while also maintaining the broad social distancing interventions.” She also claimed that the fact that about 95% of the adult population of Los Angeles remains uninfected shows that her policies are working as intended.

However, Ferrer conceded that “the mortality rate now has dropped a lot,” compared to earlier estimates as high as 4.5% based on data from China and Italy. The Los Angeles study indicated a 0.1 to 0.2 percent fatality rate, nearly identical to the results of the San Jose area study conducted by Dr. Ioannidis and his Stanford colleagues. It is also about the same fatality rate the Centers for Disease Control (CDC) estimates for seasonal influenza.

The New York study found 13.9% of the sampled population statewide had been infected, but that in New York City the concentration was 21.2%, more than 10 time the rate of confirmed cases in the city’s population.

GOOD NEWS AND BAD NEWS

The California and New York results, if they hold up, represent good news in one sense, and bad news in another. They are good news in that they indicate that the vast majority of people infected by the COVID-19 virus will experience few if any noticeable symptoms. The bad news is that asymptomatic carriers will be totally unaware that they have the virus and pose a potentially serious threat to those who are vulnerable to it.

The duration of the presence of the virus in the body, and the length of immunity that antibodies to the virus in the blood provides, are still not firmly established. A large percentage of potentially infectious people in the general population would make it difficult to relax social distancing measures without putting the elderly and sick population at risk, until an effective vaccine can be developed and made widely available.

A more serious problem with the findings of the New York study is that if more than 20% of the population has been exposed to the virus, it becomes more dangerous to relax the lockdown and social distancing conditions needed to safeguard the more vulnerable segments of the population. In theory, once the level of new cases being reported has been reduced sufficiently, it becomes possible to control the further spread of the disease through a process called contact tracking.

That calls for identifying every likely disease carrier, systematically tracing every individual to whom they may have spread the virus, and then putting each of those individuals into quarantine for as long as they are infectious to halt the further spread of the disease. Effective tracking is only feasible if you have a relatively small number of people that have to be traced, comprising a small percentage of the overall population. But in the context of the COVID-19 virus in New York City, one cannot expect people to remember and identify everyone they may have passed the virus to while they rode the subway or bus during rush hour, or at the grocery store when they were shopping.

WHY SUBJECT THE COUNTRY TO NEW YORK RULES?

New York Times columnist Bret Stephens points out that the New York metropolitan area is uniquely vulnerable to the COVID-19 epidemic because it has, by far, the highest population density of any comparable area in the country. “Commuters crowd trains, office workers crowd elevators, diners crowd restaurants. No other American city has the same kind of jammed pedestrian life as New York. . . or as many residents packed into high-rises.”

If you are dealing with region where 20 million people live, and as much as 20% of them are potential carriers of the disease, it won’t be possible to track them all once the lockdown is ended and they resume mingling as before, even with social distancing guidelines still in place.

In that respect, the New York region is fundamentally different from other COVID-19 hotspots around the country. The recent outbreaks localized in Chicago’s Cook County Jail or the Smithfield Foods processing plant in Sioux Falls, South Dakota, can be easily addressed by standard contact tracking procedures without the need to impose wide-area lockdowns to confine millions of people.

But the nationwide policy for controlling the epidemic has been driven since March 16 by the drastic situation which arose in the Greater New York City area, and fears voiced by the experts that it was likely to be replicated in other metropolitan areas across the country.

According to Stephens, “Americans are being told they must still play by New York rules—with all the hardships they entail, despite having neither New York’s living conditions nor New York’s health outcomes.” He quotes Tomislav Mihaljevic, the CEO of the world-famous Cleveland Clinic, who believes that the current national strategy to contain COVID-19 using the lockdown methodology from the “14th century to combat the biggest pandemic of the 21st century” is not sustainable.

LEARNING TO LIVE WITH THE VIRUS

Dr. Mihaljevic claims that, in the short run, we have no choice—COVID-19 is “a disease we have to learn to live with.” There is no guarantee that we will be able to develop effective therapies or a vaccine in time to halt the current outbreak. Neither is it realistic to expect this country to be able to quickly ramp up its coronavirus testing capabilities sufficiently to cover all 330 million Americans.

Since it is not possible to eliminate the risk from COVID-19, Mihaljevic suggests that short term public health policy has to be redesigned. The goal should be to mitigate and manage the risk from the virus as much as possible, consistent with maintaining other vital public health capabilities, while setting realistic public expectations for the unavoidable COVID-19 death toll. He would like to see fewer restrictions on younger people and those living in lower density population areas who face a lesser risk from the virus, while providing more protection for those at higher risk.

That is not what had been happening until last week. At that time, the White House task force introduced a three-phase approach to lifting coronavirus restrictions based upon specific statewide or regionwide conditions. It is the basis for a more rational approach which recognizes that there is no one-size-fits-all solution to managing the epidemic across the country.

Nevertheless, the studies which support the conclusions reached by Dr. Ioannidis have come under vigorous attack by public officials and many in the mainstream media who seem to believe that current lockdown must remain in place everywhere until there is an effective treatment or vaccine available to protect the most vulnerable segments of the population.

According to Dr. Ioannidis, these officials believe that the consequences of his findings are so horrible that they simply refuse to accept them. “There’s some sort of mob mentality here operating that they just insist that [relaxing the lockdown] has to be the end of the world.” The result is that those who are still supporting the lockdowns are “attacking studies [supported] with data based on speculation and science fiction,” rather than the facts.

THERE IS LIFE BEYOND NEW YORK

Dr. Ioannidis believes that the sensation-seeking news media has compounded the problem, and New York Times’ Bret Stephens agrees. He writes, “Right now, there’s a lot of commentary coming from talking heads (many of them in New York) about the danger of lifting lockdowns in places like Tennessee. Perhaps the commentary needs to move in the opposite direction. Tennesseans are within their rights to return to a semblance of normal life while demanding longer restrictions on New Yorkers.”

So far, the governors of both Rhode Island and Florida have stated that all cars with New York license plates should be stopped at their state borders and placed under quarantine. At one of his daily coronavirus press conferences, New York Governor Andrew Cuomo mentioned that he had gotten similar requests from public officials in the upstate Adirondack region, asking him if there was any way to keep potentially infectious NYC motorists from driving up to their area.

Upstate New York has also suffered due to Governor Cuomo’s blanket statewide response to the virus crisis. In mid-March, when he issued strict statewide lockdown and social distancing orders in response to the epidemic that was rapidly developing in downstate New York—including the city, Long Island, and Westchester and Nassau counties—he applied the same restrictions to the struggling economy in the rest of upstate New York State, a much larger area which was responsible for only 7% of virus cases reported statewide. On April 26, Cuomo announced that the first phase of reopening would not begin until May 15. It will be limited to areas of the state that have experienced a 14-day continuous decline in COVID-19 hospital admission, and for “businesses that have low risk” such as construction and manufacturing.

In his daily briefings on the COVID-19 crisis, Cuomo has often said that his operating principle has been, “do no harm.” But many New York business owners and residents who have already been economically devastated by Cuomo’s restrictions would question whether the harm to those people’s livelihoods had been factored into his lockdown orders.

MEDIA HYPE IS NOT HELPING

Dr. Ioannidis says the public has not been well served by reporting which has emphasized the relatively few cases in which young and healthy people are also suffering horrible deaths due to the virus. In a separate study, he and his wife, Despina Contopoulos-Ioannidis, an infectious-disease specialist at Stanford, found that people under 65 without underlying health conditions accounted for only 1.8% of coronavirus deaths in New York City. His conclusion from that observation is that “compared to almost any other cause of disease that I can think of, [the coronavirus] is really sparing young people,” and that fact should be taken into consideration when considering taking the next step, such as when it is safe to start opening schools again.

Former Education Secretary William Bennett and Claremont Institute Senior Fellow Seth Leibsohn write that, “The closing of our schools is an increasing curiosity. We drastically transfigured over 55 million children’s educational and social lives to protect them from a virus that affects them less than the annual flu. As of this writing, a total of three children have died from the virus in New York City—each of whom had underlying health conditions. Fewer than 10 children have died nationally from COVID-19, although about 80 have died from the flu. . .

“All perspective was lost. We have needed to hospitalize just over 80,000 people for this illness. The previous two flu seasons in America required nearly half a million hospitalizations.”

Bennett and Leibsohn also point out that the effectiveness of the lockdowns as measured by their correlation with infection and death rates from the virus have varied widely from state to state. The original best-case scenarios for the application of the mitigating factors of lockdowns and social distancing predicted between 100,000 and 240,000 deaths when they were announced on March 16. Today, the data indicates there will actually be much closer to 60,000 deaths nationwide due to the virus, one-quarter of the higher of the two original numbers. That is, of course, a much better outcome than had been feared, but now it is time to re-evaluate the national strategy to deal with the facts of the epidemic as we now know them to be, and adjust our response more realistically relative to other known national health problems.

OVERREACTION TO THE VIRUS DOING OTHER HARM

Republican Congressman Tom McClintock of California suggests that the current over-reaction to the COVID-19 epidemic will make many other health problems worse.

“How many of the 1.8 million new cancers each year in the United States will go undetected for months because routine screenings and appointments have been postponed?” he asked. “How many heart, kidney, liver, and pulmonary illnesses will fester while people’s lives are on hold? How many suicides or domestic homicides will occur as families watch their livelihoods evaporate before their eyes? How many drug and alcohol deaths can we expect as Americans stew in their homes under police-enforced indefinite home detention orders? How many new cases of obesity-related diabetes and heart disease will emerge as Americans are banished from outdoor recreation and instead spend their idle days within a few steps of the refrigerator?”

Dr. Ioannidis insists that these considerations must not be ignored, and that the public health response to the virus needs to be adjusted to reflect a broader perspective. “We need to be open-minded; we need to just be calm; allow for some error; it’s unavoidable.”

He also warns about drawing overly broad conclusions about the effectiveness of lockdowns and assuming that their impact on the infection and fatality rates will be the same everywhere in the world. “Different prime ministers, different presidents, different task forces make decisions, they implement them in different sequences, at different times, in different phases of the epidemic. And then people start looking at this data” and can draw logical conclusions about what works and what doesn’t, based upon the actual results. The same logical argument is being applied by governors who are relaxing the lockdowns in their states in other parts of the country where the virus has not been as prevalent as in the northeast and which are not nearly as densely populated, reducing the risk of contagion.

The professor believes that those public officials issuing “big statements about lockdowns [being necessary to] save the world. . . are tremendously immature. They may have worked in some cases, they may have had no effect in others, and they may have been damaging still in others.”

He does recognize that the lockdowns are clearly protecting the elderly and sick. “I’m not saying that the lives of 80-year-olds do not have value—they do,” Ioannidis says, but he is also concerned about the panic and attendant disruption being created among others by continuing the current lockdown and social distancing measures. “We will see many young people committing suicide . . . just because we are spreading horror stories with COVID-19. [There are] far more young people who get cancer and will not be treated, because again, they will not go to the hospital to get treated because of [fear of] COVID-19. [There are] far more people whose mental health will collapse.”

A DIFFERENCE IN PERSPECTIVES, NOT FACTS

Dr. Ioannidis argues that disagreements among his fellow scientists about the best course to follow in the current coronavirus situation reflect differences in perspective, not facts. Some find his study worrisome because it indicates that the virus is more easily transmitted, while others are encouraged because it suggests that the virus is far less lethal than originally believed. “It’s basically an issue of whether you’re an optimist or a pessimist,” Dr. Ioannidis concludes, calling himself an optimist in this case.

Recent increases in the amount of traditional virus testing and results from the newer test for antibodies to the virus have revealed that a large majority of the people with the virus are either asymptomatic or have such low-grade symptoms that they are unaware that they are infected. This undermines a basic assumption—since the epidemic first started, the number of “confirmed cases” was regarded as a reliable indicator of the true extent of the virus’ spread.

The current worldwide death toll from the virus now exceeds 200,000, and there are now more than three million confirmed cases in just about every country in the world. We are now learning that the virus can kill in many different and unexpected ways, so we don’t know the actual number of fatalities the virus caused that were attributed to other reasons. We also have every reason to believe that, counting asymptomatic individuals, the virus has already infected tens of millions of people. It is so infectious that it will remain a constant threat to all humanity until an effective vaccine or other drug treatment is available, which will likely take at least a year, or the general population develops a natural “herd immunity” to it through exposure.

Because the virus is so stealthy, it was able initially to penetrate the United States despite early foreign travel bans, almost without detection. Its presence became apparent only after it reached nursing homes with a frail elderly population, and gained a foothold in the most densely populated part of the northeast region of the country.

TIME TO END THE EMERGENCY LOCKDOWN?

The extremely close contact that is a defining aspect of daily life in the New York City region caused the epidemic to explode, revealing the frightening ferocity of the virus. More than two-thirds of coronavirus patients in ICUs who had to be intubated did not survive, many due to one of many possible organ failures and complications above and beyond viral lung infections.

As originally conceived by the members of the White House coronavirus task force, the lockdown was an emergency measure designed to “flatten the curve” of fatalities and prevent the need for ICU beds and ventilators from overwhelming the capacity of local and regional hospital systems. That goal was achieved two weeks ago. New York hospitals now have enough equipment and capacity to meet the demand, with some to spare for other parts of the country, such as Detroit, Chicago and New Orleans, where local hospitals may need help handling a coronavirus surge.

As John Hindraker, one of the founders of Power Line, an American conservative political blog, explained, there is no longer an urgent need to further flatten the curve to protect hospitals, so “the shutdowns no longer have a coherent purpose, but have taken on a life of their own.”

The health crisis has evolved into a crisis of political leadership. This country now needs elected officials with the courage to talk to the American people honestly about the realities of the COVID-19 virus we face today:

  1. The virus cannot be contained via lockdowns, social distancing or contact tracing, because it’s too widespread already.
  2. We don’t (and won’t) have the capacity to test everyone anytime for the virus in the near future, because we can’t produce the huge volume of chemicals needed to process the tests.
  3. The virus will not be defeated until a reliable vaccine or treatment is available, or herd immunity reduces the threat to roughly the same level as the seasonal flu or the common cold.
  4. The virus is, for now, part of our environment. We need to figure out how to manage the disease and enable our society and economy to resume functioning while we live with it.