Accelerated Nonsense on COVID19

May 1, 2020

Among the COVID19 experts cited by lockdown critics, perhaps only these two are seen in medical scrubs, as if pausing from their front-line response. They did take off any PPE they were wearing … and they seem well rested and relaxed.

Drs. Dan Erickson and Artin Massihi are co-owners of Accelerated Urgent Care (AUC) in Bakersfield, California, which I read has the city's only "private walk-in COVID-19 testing site." Let's consider that. COVID19 testing is important right now, but there are others doing the bulk of it, if not all these days. The other services they provide ae also valuable, but have generally been classed as optional while people focus on containing the virus. As such, private "walk-in" businesses are have largely been closed. It seems AUC is open, but in the video, Dr. Erickson mentions reduced "volume" of patients, people staying home out of fear.

Drs. Erickson and Massihi (hereafter the "AUC doctors.") became famous for an April 22 video presentation posted on Youtube, wherein they argued essentially that COVID19 doesn't kill anyone, and the tens of thousands it hasn't killed so far isn't that bad, being comparable to a regular flu season. And so they're clear there's no good reason for a lockdown, and in fact that might accelerate the spread in at least two cited ways, aside from creating other and deadly problems they're gravely concerned about. As far as I can tell, they're even less expert in these areas then they are on the reality of COVID19, making for a pretty worthless comparison.

Early in the video, Erickson describes his presentation as offering an "ER physician entrepreneur perspective." That might have saved you, dear reader, from more over-explaining than I would otherwise squeeze into this post.

The April 22 video has now been pulled by YouTube over an unspecified "community guidelines" violation; either for being a public health danger or for exposing the truth, opinions differ. I decided to finally have a look to help answer that question. At least two other postings of the video I found had been removed. But there's a later one from 4-29 I didn't watch yet, if it's still available. And the first one, and a transcript of what's said are still available here:
"Open Up Society Now, Say Dr. Dan Erickson and Dr. Artin Massihi" Edward Peter Stringham, American Institute for economic research (right-wing free-market stuff, maybe not so good with the science)
https://www.aier.org/article/open-up-society-now-say-dr-dan-erickson-and-dr-artin-massihi/

For this article, I'll cite that and the following rebuttal articles, but will mainly make my own points:

The Prepared
https://theprepared.com/blog/dr-ericksons-viral-covid-19-briefing-video-is-dangerously-wrong/

ACEP-AAEM Joint Statement on Physician Misinformation
https://www.acep.org/corona/COVID-19/covid-19-articles/acep-aaem-joint-statement-on-physician-misinformation
"ACEP feels strongly the traction and popularity of these dangerous conclusions had the potential to lead to bad policy decisions and public health outcomes."

Washington Post via Yahoo News (video, includes segments)
https://news.yahoo.com/two-doctors-became-central-push-183302182.html

KQED
https://www.kqed.org/news/11814749/bakersfield-doctors-dubious-covid-19-test-conclusions-spread-like-wildfire
Dr. Carl Bergstrom, a University of Washington biologist who specializes in infectious disease modeling: “They’ve used methods that are ludicrous to get results that are completely implausible.”

Bakersfield.com
https://www.bakersfield.com/news/two-bakersfield-doctors-cite-their-testing-data-to-urge-reopening/article_eb1959e0-84fa-11ea-9a07-2f2bea880bf9.html

Flu Comparisons
KQED: the AUC doctors found "12% of Californians tested so far have been infected. Extrapolating that to the general population, they estimated that as many as 5 million Californians have likely contracted the virus. They then used the total number of COVID-19 deaths statewide (roughly 1,200, as of last week) to calculate a death rate of just 0.03% - similar to the average death rate from seasonal flu." That's from the statewide data published by the World Health Organization; they cited 33,865 COVID19 cases, out of a total of 280,900 tested, which is about 12%.

Bakersfield.com: "Does that (low death rate) necessitate sheltering in place? Does that necessitate shutting down medical systems? Does that necessitate being out of work?" Erickson asked." An  associate professor of public health at UC Irvine, Andrew Noymer, answered: "The people tested in California were not a random sample; they were mostly people who were symptomatic, Noymer said. Therefore, extrapolating the positive test rate across the entire population of the state is not an accurate way to arrive at how widespread the virus is. And even if 12 percent of the state has had the virus, that still leaves 88 percent vulnerable to it, Noymer said." (if the surviving majority of that 12% were then immune).

A "death rate of just 0.03%" as put in the KQED article is an incorrect reading. That would yield just 10 dead (rounded off). Erickson actually says "you have a zero point zero three chance of dying." That's 0.03, where 1 is 100% certainty. In those terms, he's giving a rate of 3%. By his numbers, that comes out at 1,227. The actual toll recorded for April 22 is a bit higher: 1,419 dead vs. 33,743 cases. So 4.2% of confirmed cases wound up lethal at the time. And the number of dead just a week later is 50% higher: 2,050 fatal out of 50,463 cases. That's about the same: 4.06% are fatal so far (more of those cases are still dying).

So their "96% of people in California who get COVID would recover" may not be that far off, noting it refers just to confirmed cases. But the flipside is 4% of those will die. Considering how extremely contagious it is, that percentage could be applied to an enormously wider population - the 88% he estimates still remain susceptible. How does up to 4% of all Californians dying before this is all over sound? Like … a cash register to some?

Erickson: "the deaths the United States were 43,545 — similar to the flu of 2017-2018. We always have between 37,000 and 60,000 deaths in the United States, every single year. No pandemic talk. No shelter-in-place. No shutting down businesses..." Implicitly, this flu-corona season is done (spoken of in past tense) and shaped up to be about average. If he just meant that was the toll last he checked, that didn't come through clearly. The number of deaths had reached 47,750 on the 22nd as he spoke.
see: https://bing.com/covid/local/unitedstates?form=COVD07

A week later, it's risen nearly 20% to 65,603 dead - so far. We're still far from the end or even the peak, and it's already worse than any prior season. And that's WITH lockdown measures as they exist. The peak here is the steepest rise followed by a clear turn to more horizontal angles, eventually becoming horizontal = 0 new cases or deaths. This is a cumulative graphing, so there's never a downslope, just a plateau, eventually. You don't see much of that here, but try to honestly imagine what it would be if everyone had been running around all this time, punching the clock at work, hitting all those bars, and high-fiving each other over their amazing freedoms.

Here's how it had played in the UK by April 24, as deaths hit 20,000. The UK situation much worse than California's and not much better than New York's, and also reflects some lockdown limitation. since then it's hit 27,000 and still climbing steadily, if a bit slower. 2017/18 is the bad year people compare it to, and that had just 14,000 UK deaths in the end.

https://twitter.com/MichaKobs/status/1253275576493899776

In the end, the US death toll will probably be at least 50% higher than it is now, maybe 2-300% or higher if it keeps going. Without lockdown ... it could easily be twice what it is now, headed for 4-6x or more in the end. Will it end after flu season? probably not, judging how it hasn't ended yet, and how it recently STARTED in many nations NOT in flu season, and has accelerated badly in Brazil, which has only used local lockdowns; the national government headed by Jair Bolsonaro, "the Trump of the Tropics" only  frustrates such efforts, ordering people back to work and firing his health minister. Over 5,000 have died and it's just getting started.

"95% of those around the globe" would live if they all got it, Erickson says at one point, and just 5% would die. That would only be 390 million people. But he meant 4% and we all understand the actual infection rate is much higher, with the light cases not reported. The proportion is unclear, but likely at least doubles the case number and halves the lethality. Something like 1-2% is more likely. And as not everyone will get it, with most of the most vulnerable protected, the averaged global death toll is unlikely to surpass 1% of everyone. And that would only be 78 million dead. That's still a bit high, but it's not hard to see 50 million perishing before this is all over.

"Seasonal Flu Deaths More Common Worldwide Than Expected. Between 291,000 and 646,000 people die each year globally from seasonal influenza-related respiratory illnesses" https://www.medscape.com/viewarticle/890082

By Dr. Erickson's reckoning, 78 million would be no big deal, just some 100-150 times more deadly than a seasonal flu. That is comparable; I just compared them.

Furloughed Doctors?
Aside from the death toll, hospitals will be swamped with most of those who die and many of those who will recover, all taking several intensive days to decide, and coming in far faster than they can be released. This, again is an issue the AUC doctors don't have to deal with as they worry more about some downturn that might be effecting them (Decelerated Urgent Care?). They're not an ICU hospital swamped with patients on ventilators struggling to survive. They have time to put on their clean scrubs costumes and hold a long BS session on video.

Video, part 1, 1:25 "severe disruption for Accelerated ... our volumes has dropped significantly. The hospitals, their ICUs are empty, essentially. And they're shutting down floors. They're furloughing patients. They're furloughing doctors. So the health system has been evacuated in certain places. In New York, the health system is working at maximum capacity. In California, we're really at a minimal capacity, getting rid of doctors and nurses because we just don't have the volume. The hospitals don't - I've met with our CEOs twice in the last wee we don't as well."
Transcript "One of the most important things is we need our hospitals back up. We need our furloughed doctors back. We need our nurses back. Because when we lift this thing, we’re gonna need all hands on deck. I know the local hospitals have closed two floors."

What is he talking about? Orthopedics, cancer, plastic surgery? Are doctors that can help being sent home? How hard would it be to call them back in if needed? ICUS are closed? Just to close them, or maybe to have space ready if COVID19 spreads more sharply, due to idiots?

In New York, as I've read around, it IS "all hands on deck," working long shifts, and they're using volunteers (some of those "evacuated" from other areas) to help meet the intense demand, and still can't keep up, contributing to a higher death toll. Some of the reasons are described by an Idaho nurse volunteering on the frontlines in New York: “For people back home, it’s hard to grasp what is happening … We have a very high mortality rate. I definitely stay inside after seeing what I’ve seen.”
This is the "volume" AUC seems envious of, as they urge the virus to be set free. https://inland360.com/top-headlines/2020/04/lewiston-nurse-shares-her-experience-at-ground-zero-of-the-us-pandemic/

COVID19 doesn't kill?
AUC doctors: "we think [COVID19] has nothing to do with the actual cause of death. The actual cause of death was not COVID, but it’s being reported as one of the disease processes and being added to the death list. COVID didn’t kill them, 25 years of tobacco use killed." It killed them right after getting COVID19 - coincidence? A lot of people were set to croak in a mass die-off that was coincidentally about to keep getting worse? No, that's absurd. Clearly, they'd agree, the virus ravaging their systems at least hastens their death. And dead is dead, and today vs. weeks to decades from now matters greatly. End of discussion on died-from vs. died-with.

Natural Immune Defense?
Dr. Erickson argues people need exposed to germs so their bodies can fight the germs; "I don’t want to hide in my home, develop a weak immune system, and then come out and get disease." In general, I like that idea and live by it, whatever scientists say. I never get sick, or very sick. But in this case, all kinds of immunity levels have been tested worldwide, and far too many prove inadequate. That was the friggin' problem to begin with, but he didn't seem to catch that detail.

It seems when you get exposed to COVID19, you get sick, not immune. Some don't even feel it, some struggle, and others die, and all of them tend to spread it. If you live, it seems you have at least temporary immunity, though some evidence says people can get re-infected, and to bad effect. With the wrong mutation, that problem could get worse. At the moment, lysol and avoidance are good ideas. Get your general immune system back up later. It might do no good here, and risks harm if people think they're immune now but aren't.

https://www.independent.co.uk/life-style/health-and-families/coronavirus-immunity-reinfection-get-covid-19-twice-sick-spread-relapse-a9400691.html

https://www.sciencetimes.com/articles/24912/20200226/covid-19-reinfection-is-possible-experts-say.htm

The AUC doctors note COVID19 lingers on plastics for up to 3 days, and points to all the possibly contaminated things in your home. If those water bottles were packed or handled by a sick person 2 days ago and you can't wait another day to unpack it, well … it may be safer to run outside and start grabbing things to build up that immunity. Or, wait … can't you build up immunity inside with all those germs? Are they being logically consistent here?

"There’s two ways to get rid of virus: either burns itself out or herd immunity." What virus "burns itself out" except - allegedly - this one? And if those are the only ways, which way did Ebola's spread stop? Did it burn out, or did we get herd immunity? Or is there a third way where you stop transmission so it vanishes when the last case clears up? Yes, there is. COVID19 is unlikely to go that easily, but every limit we can put on its spread will help.

Cause-and-effect
Bakersfield.com Erickson asked "Does that (low death rate) necessitate sheltering in place ... being out of work?" He should ask if the low rate REFLECTS that, relies on it to exist, for him to lean on in suggesting and end to the rule. As they used to say in the TV commercials: "Head and Shoulders? But you don't have dandruff!" The idea is "exactly, and that's why."

The AUC doctors claim "we’ve never, ever responded like this in the history of the country why are we doing this now?" Check response to "Spanish Flu" 1918: "San Francisco had the 1918 flu under control. And then it lifted the restrictions. A cautionary tale about the dangers of reopening too soon."
https://www.nbcnews.com/politics/politics-news/san-francisco-had-1918-flu-under-control-then-it-lifted-n1191141

San Francisco had public gathering places closed, and masks required in public (the first but not last city to do this), enforced with fines and arrests. Even churches were closed - people gathered outside them if at all. This article says nothing about shelter-in-place orders or "quarantining the healthy," nor such a wide shutdown of business as we see now, but similar concepts. When cases dropped after a few weeks, the orders were lifted in November:

"A blaring whistle alerted gratified residents across the city and, as the San Francisco Chronicle reported at the time, "the sidewalks and runnels were strewn with the relics of a torturous month," despite warnings from the health department to maintain face coverings. As celebrations continued and residents flocked to theaters, restaurants and other public spaces soon thereafter, city officials would soon learn their problems were far from over."

Three weeks later, the article continues, a clear resurgence and then spikes of cases and deaths had the rules re-imposed. An "Anti-Mask League" was formed to protest. They probably cited outsider opinions by the 1918 versions of these AUC doctors. That flu was finally licked globally by early 1920, no thanks to some people. Some 50 million were killed by then, or more by some counts.

Weighing the Costs
The AUC doctors were sudden experts in various areas besides epidemiology, ready with a list of ills lockdown has contributed to horribly, just in its few weeks of existence: "child abuse, alcoholism, loss of revenue—all these are, in our opinion, a significantly more detrimental thing to society than a virus that has proven similar in nature to the seasonal flu we have every year." - "Child molestation is increasing at a severe rate. We could go over multiple cases of children who have been molested due to angry family members who are intoxicated, who are home, who have no paycheck. Spousal abuse: we are seeing people coming in here with black eyes and cuts on their face. It’s an obvious abuse of case [sic]. These are things that will affect them for a lifetime, not for a season. Alcoholism, anxiety, depression, suicide. Suicide is spiking; education is dropped off; …"

Does this feel a bit heavy-handed to anyone else? What data shows increased child molestation in the last couple weeks? Are they reporting the clear abuse cases? This will happen, and even if it's not common, the scale is huge so it will add up. But then there are others who beat their children to take out the stress of their work, who'll be beating them less now. There suicides from stress, workplace accidents, school bullying and school shootings that have dropped off, and a lot of traffic fatalities will have been prevented. And I don't think I'm the only one enjoying a paid staycation, so far. These differences might be small, but again the scale is huge, so they would add up and partly mitigate the downsides.

I wouldn't ague that they balance out for everyone - lockdown is a lesser of two evils. It's surely saved thousands of lives, and allowed medical systems to keep up, but only at a high cost.

The spread of COVID19 should have been aggressively contained early on, but it wasn't. It spreads like hell to very many people, and a lot of those wind up too sick to be anywhere but the hospital. So we are all in some kind of crash here. The idea, as I gather, is to slow that down and control it, spread the load so each sector takes a hit and no sector breaks. The "herd" can hardly be kept from getting it and becoming partly immune, at least. But whatever degree, it's best done in shifts - its natural speed is just too great. No world government wants broken sectors, medical or economic. None of them wants too many of their useful people sick at once, or too many dying. A scant few governments have been ambivalent and risked it, while the vast majority have enacted variations of "lockdown." These include "Communist" China (with the most "repressive" and effective response yet) to the Islamic Republic of Iran, their allies in in Iraq, Syria, Lebanon, and their arch-enemies in Saudi Arabia and Israel, in Egypt, Tunisia, Russia, India, Singapore, South Africa, Italy, Spain, Germany, France, Netherlands, Norway, even Sweden and Turkey to some degree, UK, US, Canada, Mexico, and most of the other countries that exist. Even Brazil and Belarus to some degree and on some levels have told people not to do things they'd rather do. This is not all for the fun of it, and not I think for some global conspiracy. They consulted their experts in health, epidemiology, economics, and other fields, between them all surely forming a better view than these two … let me just be the asshole here and risk overstating it … these two fairly young, apparently inexpert, disgruntled businessmen in work uniforms that, in context, serve as misleading doctor costumes.

Back to Dr. Erickson's exploration of lockdown's downside: "...economic collapse. Medical industry, we’re all suffering because our staff isn’t here and we have no volume. We have clinics from Fresno to San Diego and these things are spiking in our community. These things will affect people for a lifetime, not for a season." There we go - lost volume, lost revenue. THIS is something they'll be in a position to really know about. It's the one area they mention where I'd trust their expertise. AUC wants it more like New York, more "volume" where they're operating at full capacity. But something in California was keeping people from getting massively sick with COVID19, and other classes of business had dropped of as well; unwarranted fear, as Erickson paints it, was keeping a lot of AUC's patients away. That fear - along with direct orders to avoid "walking in" to places you don't need to - is the same issue faced by so many BUSINESSES. In their case, maybe being a walk-in clinic for largely symptomatic people wanting tested for COVID19 might add the valid concerns of other patients even more than any government fearmongering.

Don't we Humans make the economy? Does it control us? Yeah, it does, but still … it can be recovered, re-built as needed (keep an eye on the HOW). It's true some businesses may not recover from this crisis, even after people do get mobile again. I think I can name one in Bakersfield, California that just increased the danger of that.