Link to Part 1: Dr. Erickson and the 3rd kind of lie (Statistics)
So the video has resurfaced (thank you to all who provided the links), and rather than any “DOCTORS CRUSH COVID-19 CONSPIRACY!” headline, it has been posted with the much more subdued (though still fairly inaccurate) “Doctors report from Front Lines.” The whole point of their video is that they really haven’t been at the front lines because the surge isn’t there yet; but since that is exactly where I find myself as well (albeit gratefully), maybe I shouldn’t put too fine a point on it.
A note on timing: Since the original video on YouTube was removed, I’ll be working off of the video on Facebook here, which is about 12 seconds ahead of the video used in part 1.
In the last post we went through the first 15 minutes or so of Dr. Erickson’s video, addressing the gross errors in his statistics methodology that leads him to the clearly erroneous conclusion that COVID-19 is not very dangerous. For state after state and country after country, he multiplies the total population by the results of non-random testing that is not representative of that population, to arrive at outrageous figures for prevalence (number of cases) of COVID-19. This mathematical trick shrinks the death rate, certainly, but it isn’t founded in reality; these are figures that can only exist in Dr. Erickson’s mind and on his calculator. He does this while ignoring the best data we have available that shows very high case fatality rates for known COVID-19 patients, framing that data as a good thing. “New York has a 92% Recovery Rate! If you get COVID, 92% of you will recover!” This is exactly the same as saying that COVID has an astronomically high 8% case fatality rate, but he has chosen to frame this as a good thing by flipping the statistic.
Now that the video is available again (for better or for worse), we will move on to the other arguments in the video.
9:16 “Is this significantly different than Influenza A and B?”
This is a question I have already addressed here, but frankly it’s absurd to still be comparing COVID-19 to influenza this late in the game. We are less than 2 months in from the first reports of deaths from COVID-19, and already it has killed as many people as the worst flu seasons we have experienced; and most places have not yet experienced a surge in cases. Our comparisons for COVID-19 are the bubonic plague and the Spanish Flu, not seasonal influenza; even in a very bad year like 2017-2018.
Comparisons to the flu do not match the reality of the people facing this virus as patients or healthcare workers, and can only be clung to by those who have not yet been affected by the pandemic. This is an argument from privilege, pure and simple. And yet, all of us in healthcare sincerely hope that as many people as possible will still go on unaffected; I sincerely hope Dr. Erickson never has to recant this silly argument because the deaths in his own community have made him do so.
But a few more lines on statistics won’t hurt the discussion.
9:24 COVID-19 Vs. Flu in the USA.
- USA – COVID-19
- Tests: 4,000,000
- Cases: 802,590
“Which gives us a 19.6 positive rate out of those who were tested (emphasis mine). If this is a typical extrapolation (his term for ignoring all sound statistics and epidemiology principles for arriving at accurate prevalence data)”… ‘That’s 64 million people with COVID-19.’
So to summarize his math for the USA:
- Known COVID-19 cases in the USA: 802,590
- Dr. Erickson’s number of COVID-19 Cases: 64,000,000
- 63,197,050 without a confirmed diagnosis.
- Actual number of cases: Unknown, because we do not yet have large scale, random antibody testing; in other words, we cannot yet actually do the type of math that Dr. Erickson is only playing at, because we do not have the data.
By the way, this also means that of the imaginary 64 million people who have had COVID-19, 79 times more people had the virus and didn’t have symptoms, or didn’t meet testing criteria, than those who actually had a confirmed case. This is a big, big logical leap from the rallying cry of ‘we need more testing’ that we have all been saying for a month, and it should be another check for Dr. Erickson when deciding whether or not to trust his data. He has talked briefly about quarantining the sick only, but the implication that his data leads to is that only a very small number of cases will even have symptoms. It’s hard to say if this is simply another oversight on his part, or if he is deliberately playing into the ‘we all had this back in December’ myth that has already been popular.
10:06 Why not the data for 2018-2019 you ask? Or average over multiple years? Because 2017-2018 was the worst flu season we’ve had in decades, and did nearly overwhelm the healthcare system in many places. He is cherry-picking his data; deadliest flu season vs. artificially minimized COVID-19 deaths.
10:00 “50-60 million with the flu (compared to his 64 million for COVID-19). 43,545 deaths. Similar death rate.”
Estimates vary, but most commonly reported is closer to 60,000 deaths from flu that year (not sure where he got the 43k figure from). But how is this data derived? Well, what they didn’t do was multiply the ratio of tests that were positive by the total US population (his methodology); this method would give us over 180 million cases. No, they used actual statistical modeling (https://www.ncbi.nlm.nih.gov/pubmed/25738736). They also didn’t then divide the number of deaths by some crazy high number to get a low case fatality rate; instead they did much more complicated math to determine the excess attributable mortality. So already we are comparing apples to oranges, except that since his data is the product of his imagination, we are really comparing apples to… well, to some made up fruit.
Oh, and they didn’t do any of those calculations early in December before most places had even experienced their peak flu season, which is what attempts to ‘close the book’ on COVID-19 data right now amount to.
10:25 Again, he is talking about a flu season that lasts for 4-5 months, for which there is a vaccine (he will say this in a moment), and which has a much, much lower mortality rate. And we probably should be considering some of those things, to some extent, each flu season anyway.
10:55 Resisting the urge to dig on Urgent Care’s here. Testing everyone for flu is not sound clinical medicine. But that’s a different rant entirely.
13:47 Here he compares California to Sweden briefly. Again, do not trust anyone to do statistics work for you if they are comparing regions without looking at population size. He is comparing the number of deaths in California (“with isolation; 1,220”) to the number of deaths in Sweden (“without isolation; 1,765”) and saying they are similar, with just a quick nod to their populations; “we have more people, but…”
Here’s how he should have phrased these numbers, if he really wanted to compare the impact to date of COVID-19 in these two regions:
- California Population: 39.51 million
- Number of Deaths: 1,220
- Deaths per 100,000 People: 3 “with isolation”
- Sweden Population: 10.23 million
- Number of Deaths: 1,765
- Deaths per 100,000 People: 17 “without isolation”
It isn’t fair to compare these two places in the first place, since a true surge hasn’t hit California yet (at least partially because of social distancing/mitigation measures), and because California and Sweden have very different healthcare structures and very different population vulnerabilities and demographics. But if we did a Dr. Erickson style extrapolation from Sweden to California, we would estimate 6,817 deaths so far in a California “without isolation”, 5.7 times higher than “with isolation.”
But again, these aren’t meaningful comparisons because statistics is a real field of mathematics and it doesn’t work that way. You can’t just take number of deaths from one place and multiply it by the population of another place and say ‘well this is the best data we have so we might as well trust it’, just like you can’t take data from very limited symptomatic testing and ‘extrapolate’ it to the entire population. The assumptions underlying the calculations are every bit as important as the calculations themselves, and so these particular ‘statistics’ I’ve just made up are probably only marginally more helpful than the ones Dr. Erickson made up.
14:00 Brief discussion of Sweden (1,765 deaths) and Norway (182 deaths) in Part 1 as well; the difference in how these nations have been affected by COVID-19 is only “statistically insignificant” (and not even then) when you invent tens of millions of phantom COVID cases to minimize the deaths, injury, and suffering of real life people.
14:58 Weird one to include, but ok.
15:14-16:47 Secondary effects of COVID-19
It’s pretty ridiculous that I’ve been trying to finish this overlong video analysis for 4 days now, writing between patients and during lunch, at the end of long days of clinic and pausing to read the Hobbit to my children, and have only made it to the 15 minute mark. But this is where I’ve been trying to get to, wading through all of the bad statistics and the misleading numerical comparisons, because it is this segment that I’ve been wanting to get to.
Because here, at least, I 100% agree with Dr. Erickson.
Doctors hate disease. We hate suffering. We hate abuse and neglect. We hate that people find themselves in dark places where there seems no way out. We probably hate it more than anyone except those experiencing them and the people who love them. The less wise among us take on far, far too much of that anguish in hopes of offloading a little of it from our patients; sometimes with tragic results. We took an oath to First Do No Harm and we take it pretty seriously. There’s a cultural myth that doctors like illness because without it we wouldn’t have jobs; which is a bit like saying that teachers like ignorance or soldiers love the enemy… although in the latter case, they really ought to, even if they still must fight them. Every doctor I’ve ever met would joyfully find a new line of work tomorrow (most of them are very talented) if they woke up to suddenly find disease, mental illness, physical pain, and all human suffering had suddenly ended forever (and some of us firmly believe that this is exactly what will happen).
In spite of everything, I believe this is probably true even of Dr. Erickson, and that when he is speaking of the suffering that will result from the necessary measures to fight COVID-19, he is speaking for the first time in this video as a Physician and not as an Entrepreneur. I think that’s why he’s had to dive so deeply into his false numbers in order to justify essentially ignoring COVID-19; because if he didn’t really convince himself that it wasn’t the threat that it so clearly is, he probably couldn’t bring himself to risk lives by making this video. At least, that is my sincere hope.
We are all concerned about the secondary effects he is talking about here. I wrote over a month ago, “All of us are afraid of a second spike in COVID-19 deaths if social distancing measures are discontinued too soon, but we are also concerned about a third spike; a spike of all-cause mortality and morbidity from the disruption this pandemic is causing to our normal modes of treating patients. That’s why we are working around the clock to figure out the best way to take care of the patients under our charge while at the same time preparing for and fighting the battle with COVID-19.”
I’ve written about it elsewhere, so I won’t go into details about all the things my clinic has done to work hard to address these very real threats. I work with some amazing people and they have been working their butts off. Since day one we have talked about what this would do to mental health in our community, about children trapped at home with abusive parents, about those with already tenuous chronic medical conditions or severe anxiety and depression, those with addiction, those with food insecurity, those with so-far silent conditions that need to be caught early.
Honestly, these are the things we worry about anyway. I worry about my mental health patients every time I take a vacation. I worry about patients with severe chronic illnesses not being able to get seen every time I make the difficult choice to cut back in clinic, in any way, because I’ve been drowning at my job since 3rd year of medical school. When I don’t have the mental bandwidth or the time to ask a more in depth question or allow a few more seconds of silence that gives the patient time to respond in a less guarded way, I worry what might have been missed. These are the realities of being a Physician in modern healthcare.
Which means that at whatever point doctors can in good conscience advocate for lifting the burden of social (physical) distancing and quarantine and sheltering-in-place off of our patients, friends, families, and selves, we will be the loudest and most persistent voices. If Dr. Erickson’s numbers were at all reputable, we would be thrilled; we would shout it from the rooftops. But they aren’t. And as someone who takes care of many of the patients in my city that our data tells us have the highest risk of complications and death from COVID-19, the only choice I can make is to work hard on my patients’ and community’s behalf to mitigate not only the very real risk of this one deadly virus, but also all of these secondary threats he is naming.
16:55 See discussion of the flu above (didn’t realize he was going to jump around so much). All I’ll add here is a reminder that the CDC is calculating the death rate as a comparison of deaths to estimated cases based on the best methodology available. If we used the Dr. Erickson method, the death rate for flu in 2017-2018, the worst flu season in decades, would be 0.03% instead of 0.13%. But again, it’s not a method any statistician would be tempted to use, not on a dare.
17:26 “The lethality of COVID-19 is much less.” There it is; don’t let anyone tell you that this doctor is just saying that COVID-19 is like the flu in some vague way. He is definitively telling you one is more dangerous than the other, and he’s got it exactly backwards.
17:28 Could someone explain to me how a ‘hotbed’ of a not-at-all-dangerous virus can overwhelm an entire city and kill thousands?
17:44 “I’m sick of following the science. I’m just going to ask it where it’s goin’, and hook up with it later.” -Mitch Hedberg if he were a doctor, probably.
18:00 I would like to know where Dr. Massihi taught immunology. Maybe they will fill in the gaps later, but at this point this could mean absolutely anything. I taught Kaplan MCAT and LSAT test prep courses after college and I was fairly bad at it I’m afraid; do I also get to claim to have taught immunology? What about logic and analytical reasoning?
We all have courses in microbiology, biochemistry, immunology, pathophysiology, virology, etc. It’s part of our curriculum from pre-med onward; what he is describing is the same education that all Physicians have. But the thing is, just because we’ve all had that training doesn’t make us experts; relative experts compared to the general public, sure, but there are people who have studied these systems a lot more. It certainly doesn’t mean we are each entitled to our own opinion about how the human body works, because medicine is a hard science. If he is going to make claims about the immune system, his authority as a doctor isn’t going to get him very far; the immune system is the authority on the way that it works, so we need to check his facts against it.
18:18 – 19:38 This is something that seems to crop up in almost every single medical misinformation video. I’ve written about it here, and here, and did an entirely overwrought Star Wars analogy about it here; and other people have written about it much better and in more detail than I have. It’s a common theme among alternative health “experts” who are spreading misinformation right now; don’t hide from the virus they say, your body needs it to build up the immune system! It plays into a lot of the cultural myths that Physicians are only interested in giving chemicals and harsh drugs, think all bacteria are bad, and don’t know anything about the body’s own immunity; ideas that are popular in alternative health spheres. So it’s pretty shocking to hear it from a doctor.
The major failure here is to distinguish between microbes and pathogens. Pathogens are microbes that can cause disease in humans, and some pathogens are so dangerous that either vaccination or avoidance are the best strategies to prevent the terrible, possibly life-long suffering and death that can result. Yet these misinformation purveyors want to pretend that when public health experts and epidemiologists recommend practical methods to decrease transmission of just such a deadly virus, they are actually saying that you can’t go outside, you should live in a sterile room, and your kids can’t play in the mud. Dr. Erickson wouldn’t tell you to touch your face and not wash your hands if you had been around Ebola. He wouldn’t tell you not to wash the surface of your kitchen counter if you had been cutting up raw chicken. He wouldn’t tell you that exposure to viruses is important to building a healthy immune system if you were about to pet a rabid dog.
But because his fake statistics have convinced us and especially himself that COVID-19 is about as dangerous as the common cold, he is willing to spend several minutes expounding the value of touching your face and eyes and not washing your hands so you can get that good IgG and IgM and have a healthy immune response… in the middle of the worst pandemic in a 100 years.
19:26 Just to be clear, you do NOT need SARS-CoV-2 to survive.
With that I am going to pause for the night. Thank you to all who have read these two very lengthy posts, despite my failed endeavor at choosing a format specifically intended to force me into some sort of brevity.
If this video continues to be widely circulated among friends and family in the coming days, I will return to finish the other half. I haven’t even met Dr. Massihi yet; maybe he’s a super reasonable guy who is going to give a balanced counterpoint to Dr. Erickson’s perspective? (Update: Nope.)
But my guess is that we are only hours away from the Next Big Thing in COVID-19 misinformation, and I’ll be forced to abandon this particular analysis at 19:26, just under halfway. If there is anything that particularly needs to be expounded on later in the video, I’ll quietly post it above; but feel free to leave a comment if there is a statement or section you would like me to address. Otherwise, I hope my perspective as a Physician has helped you to make sense of the dangerous errors my peers have fallen into in this video.
“Without education, we are in a horrible and deadly danger of taking educated people seriously.”
― G.K. Chesterton