Recapitulation, or Where We Are Now

The “novel coronavirus,” also called the Wuhan virus and COVID-19, incubates in horseshoe bats. We are not sure when the virus jumped from bats to humans. In February we wrote that the epidemic began at a seafood market, or “wet market,” in Wuhan, where all kinds of wild and domestic animals that God never intended for food are sold and eaten. Other evidence indicates that the virus escaped from the Wuhan Institute of Virology, China's first biosafety level 4 laboratory, where it was being studied.

Last fall, probably in early November, the virus began to infect people in Wuhan, China. It causes a spectrum of reactions, ranging from a complete lack of symptoms, to flu-like symptoms, to breathing problems that mimic pneumonia. Most patients recover, but some develop acute respiratory distress syndrome (ARDS); oxygen levels in their blood plummet and they struggle ever harder to breathe. They are often put on ventilators, but most ventilator patients never recover. By December 1, the first Chinese case was confirmed by laboratory testing. The disease quickly spread throughout Wuhan, and from there to northern Italy, because the textile factories of Lombardy employ many Chinese laborers from Wuhan.

Epidemiology is all about numbers and mathematics, and the numbers coming out of China and Italy last winter were very frightening. The confirmed case death rate—the number of fatalities divided by the number of confirmed cases—was ranging between three percent (3%) and ten percent (10%). Scaling up to the number of Americans who typically catch the flu each year—somewhere around 30 to 60 million—indicated that millions would die from the Wuhan virus. Neil Ferguson, an epidemiologist with Imperial College London, built a model of the epidemic estimating that if nothing was done to arrest the spread of the virus, as many as 2.2 million Americans and 510,000 Britons would die. American epidemiologists associated with the University of Washington were singing the same dirge.

Based upon these models, federal and state authorities ordered a public “lockdown” of a type and scope never attempted in American history. They banned large public gatherings, then all gatherings, public and private, of ten people or more. They ordered the closure of all “non-essential” businesses. Restaurant dining rooms were closed, and restaurants limited to take out or delivery.

The economic consequences of the mass shutdown were immediate and severe. In just six weeks, 26 million people were thrown out of work and filed for unemployment compensation, a rate of job loss never before seen. Just a month and a half ago, unemployment stood near a 50-year low at 3.9%; since the shutdown about 4 million Americans per week have lost their jobs, and the unemployment rate is approaching 20%.

The Wuhan Virus is Everywhere, and the Death Rate is Comparable to Seasonal Flu

Keep in mind that these unprecedented, draconian actions were predicated on a death rate that was based upon confirmed cases, not total infections. There is a huge difference, at least one order of magnitude, between these two numbers.

By way of example, last winter 250,000 people tested positive for the flu, about 25,000 of whom died. Therefore, the confirmed case death rate for seasonal flu was ten percent (10%). But, of course, we know that flu doesn’t kill ten percent of the people who catch it. Most of us who come down with flu don’t bother to get tested, because we don’t care what strain of flu we caught; we just stay home, rest, drink water, and recuperate. Only those with very severe cases ever get tested, usually at the hospital. Hence, the confirmed case death rate is dramatically higher than the infection fatality rate. Experts think the infection fatality rate for flu is around 0.1% or one in every thousand.

What we did not have for the Wuhan virus, until very recently, was some idea of the total infection rate. Only seriously ill people were tested. In the test, the subject’s nostrils are swabbed with a cotton swab, which is then placed in a machine that does a polymerase chain reaction (PCR), which “amplifies” the sample DNA—making millions or even billions of copies—to search for the Wuhan virus DNA. But it only tests positive for those who currently have the virus, not those who have had it but have recovered.

Recently, however, Minneapolis-based Premier Biotech made available a blood serum test that searches for coronavirus antibodies—the germ-fighters the body naturally produces in response to the coronavirus. With this test, we should get a much more accurate picture of the number of infections and hence the real death rate. Several studies have already been done, and the news is good.

Researchers at Stanford tested 3,300 people in Santa Clara County, California, and found that between 2.5% and 4.2% of the county’s residents had been exposed to the Wuhan virus, which is 50 to 85 times the number of DNA-confirmed cases. At that time, Santa Clara County had 1833 confirmed cases, and 69 deaths, a confirmed case death rate of 3.7%. But the fatality rate based upon the antibody study is only 0.12 to 0.2%, which is close to the estimated fatality rate of seasonal flu.

Shortly after the Santa Clara study was announced, the other California shoe dropped. Researchers at the University of Southern California released a study of 863 adults in Los Angeles County, representative of the county’s demographic makeup. The USC researchers found that 4.1% of adults have antibodies to the coronavirus in their blood. That translates to roughly 442,000 adults who have recovered from the viral infection, as opposed to fewer than 8,000 confirmed cases in L.A. County. Just as in the Stanford study, the USC researchers found an infection fatality rate of 0.1 to 0.2%

Just three days ago, on April 23, New York announced the results of its own coronavirus antibody study: statewide, 14 percent tested positive, 21% within New York City. Crunching these numbers gives a death rate of 0.56%, substantially higher than in California, but still far closer to seasonal flu than to the confirmed case fatality rate in New York, which is about 7.5%. Jonathan Geach believes that the difference between California and New York may be because those exposed in enclosed, tightly confined spaces like New York’s subway trains and building elevators—which were deemed essential and never shut down—were hit with a much higher viral load than someone who acquired the virus in a more open setting, putting their immune systems in jeopardy from the beginning.

The confluence of three different studies by different sets of researchers in different parts of the country means that these results are very robust and trustworthy. Moreover, there have been many previous indications that the number of actual infections must be enormous. For several weeks in March, Columbia University Medical Center tested for the Wuhan virus in every woman going into labor, finding a 15% positive rate, 88% of whom were asymptomatic. Another study tested 400 homeless people at a shelter in Boston: 146 tested positive, all of them without symptoms. On March 24, researchers at Oxford University created a model of the infection which predicted that half of the population of the UK was already infected, and predicted a total infection fatality rate of 0.1 percent.

But perhaps the most convincing evidence came from data compiled by our own Centers for Disease Control. The CDC monitors reports of influenza-like illness; patients report these symptoms to local physicians and hospitals, who then relay the data to the CDC. The CDC recorded a sharp spike in flu-like symptoms in March. Researchers studying this data compared the reports from March 8 to March 28 to the past several years and found an excess of 28 million cases in this 20-day span! In other words, there were 28 million more “flu” cases this March than prior years would have predicted. Obviously, this was the Wuhan virus at work.

Thus, the antibody testing studies dovetail with several lines of evidence regarding the prevalence of this virus that were already known. The overall picture should be conclusive to any fair-minded person. Although there are under one million confirmed cases as of this writing, there have been 30 to 50 million Wuhan virus infections in the United States, and the fatality rate is comparable to seasonal flu, probably in the range of 0.1% to 0.2%.

If you are struggling with this reality, and do not want to believe that our governments ordered us to stay at home, ordered the shuttering of “non-essential” businesses, and pitched 26 million people into unemployment over something that is not significantly more deadly than seasonal flu, I don’t blame you. I struggled with it, too. On various blogs, I stubbornly argued with knowledgeable people who were patiently trying to explain to me the difference between the confirmed case fatality rate and the infection fatality rate. It wasn’t until the antibody studies were announced in just the last few days that the scales fell from my eyes.

What are the Implications?

First, open the economy. We do not destroy our economy and leave dozens of millions jobless over seasonal flu, and the Wuhan virus is essentially a form of seasonal flu. That fact really should be the end of all further discussion. Based upon what we now know about the real fatality rate, no businesses should ever have been closed, and everything should be opened immediately.

Moreover, the shutdown was ill-conceived and poorly implemented ab initio. Restaurant dining rooms could have been kept open by spacing the tables slightly further apart. The retail businesses with the highest density of patron traffic are grocery stores—no other type of retail business even comes close—and since they could not be shut down, what was the point of shuttering other retail businesses if not to inflict needless economic damage? Brick-and-mortar retail establishments were already in trouble; they didn’t need this gratuitous injury.

Furthermore, this virus was already loose in the land before the shutdowns were initiated on March 13. The epidemic began in China last November. With most infected persons completely without symptoms, and with thousands daily flying back and forth from the U.S., where companies are headquartered, to China, where everything is manufactured, the likelihood is that the contagion was already in America and spreading before the China travel ban went into effect on February 2. We tried to close the barn door after the horse was out.

There was also a one-size-fits-all mistake. Most of the infections and deaths in the United States have been in the New York City metropolitan area consisting of New Jersey, southern New York, and Connecticut. Because of Gotham’s population density—it is far more densely populated than any other American city—maybe the authorities were right to try a never-before-attempted total-population quarantine. Why, however, would anyone think that such a universal shutdown would be appropriate in the thinly populated middle of the country? But even in New York City, it could not effectively be implemented; the subways, the most likely environment for contagion, were never shut down and got even more crowded as the number of train runs was reduced. With 21% already infected, the best public health strategy for Gotham is herd immunity, not quarantine.

Our public health authorities justified the economic shutdown based on the need to “flatten the curve.” If we heard this once, we heard it a thousand times. The authorities feared that if the infection ran its natural course, our health system would be overwhelmed by Wuhan virus cases, and people would die needlessly for lack of treatment. That did not happen. It will never happen, because cases and deaths have crested and are now descending. In fact, they were starting to turn the corner two weeks ago, but the CDC suddenly changed its definition of what constituted a Wuhan virus death, causing an uptick in what should have been—but is not—the most solid and reliable statistic about this pandemic: the number of deaths it has caused.

By the way, it is time to re-open hospitals for everything people normally use hospitals for. Keeping non-emergency patients away from hospitals is creating a whole other set of health problems, as well as causing financial problems for hospitals, doctors, and nurses who are being furloughed because there is no work for them. All restrictions on non-emergency and/or elective procedures should be lifted immediately.

Finally, people have asked me about the religiously liberty implications of closing churches. I responded that our religious leaders were right to defer to the public health authorities. Our First Amendment rights are not absolute; to paraphrase Justice Oliver Wendell Holmes Jr., you cannot yell “fire” in a crowded theater. In other words, you cannot, by the exercise of your fundamental rights, place others in imminent peril of their lives.

But we now know that holding a worship service during a Wuhan virus epidemic is not placing anyone’s life in imminent peril. In fact, it is not more dangerous than attending church during flu season. That being the case—and it is indisputably the case—of course it is a gross violation of the First Amendment for government to decree the closure of houses of worship.

Most disease is more dangerous to the elderly and infirm than to the young and healthy, but this is even more true of Wuhan virus than it is of seasonal flu. Only 3% of Wuhan virus deaths have been people under age 45, and all of those had serious “co-morbidities,” i.e., other health conditions that might have killed them anyway. Eighty percent (80%) of Wuhan fatalities are over the age of 65, and a large majority are over age 75. During a Wuhan outbreak, we should advise people over 75 with other significant health conditions to stay home and watch church on television or over the internet. But we should not close church over a virus that poses no significant health risk to worshipers ages 1 to 65.

We should learn a lesson from this. We need not always defer to public health authorities. Our ruling elites are currently under the sway of an ideology hostile to religion in general, and especially disdainful of evangelical Christians. They will not always have our best interests at heart, even though officially they are supposed to. No denomination has a finer medical school and set of hospital systems than the Seventh-day Adventist Church. Perhaps we should form a committee, chaired by Dr. Eric Walsh, that includes Adventist pastors, laymen and epidemiologists to issue advice on when it is necessary to close the sanctuary doors. It is not necessary now.

UPDATE on Antibody Studies:

Dade County, Florida has conducted an antibody study that puts the number of infected at 165,000 and gives a fatality rate of 0.2%, similar to the two California studies.

John Iafrate and Vivek Naranbhai, pathologists at Massachusetts General Hospital, collected blood samples from 200 passersby on a street corner, Chelsea, a suburb of Boston. Sixty-three were positive, or about 31.5%. Upscaling a 31.5% infection rate to the population of MA gives 2,171,295 infections and a fatality rate of 0.14%.

Iceland has not done antibody testing, but because their country is so small, they've been able to test a far higher percentage (over 5%) of their population than any other country with the PCR DNA test, and they have also done some randomized testing. Their confirmed case death rate is 0.55%. Again, that is a confirmed case death rate, not an IFR based upon an antibody study. An antibody study would likely drive that fatality rate down even lower, because about half of infections are completely asymptomatic and would never have any reason to seek out the PCR test.

A German antibody survey by Hendrik Streeck from the University of Bonn found antibodies to the virus in 14% of the 500 people tested, giving an IFR of 0.37%.

A Dutch study conducted by its National Institute for Health and announced on April 16, found that around 3% have developed coronavirus antibodies. That would mean over 518,000 have been infected and the fatality rate is around 0.7%.

A Belgian antibody study announced on April 25 found antibodies in about 4.3% of the population, which would yield a fatality rate of 1.3%

Dr. Scott Atlas has written a good summary of the epidemiological knowledge that we have gathered thus far:

Fact 1: The overwhelming majority of people do not have any significant risk of dying from COVID-19.

Fact 2: Protecting older, at-risk people eliminates hospital overcrowding.

Fact 3: Vital population immunity is prevented by total isolation policies, prolonging the problem.

Fact 4: People are dying because other medical care is not getting done.

Fact 5: We have a clearly defined population at risk (seniors over age 65) who can be protected with targeted measures.