A pair of doctors just proved that medical training doesn't keep you from being amazingly ignorant
Over the last three weeks, tests for SARS-CoV-2 antibodies have begun to be available in the United States. These tests can be used to check not only the number of people who have active cases of COVID-19, but those who have been exposed the the virus that causes it at some point in the past, including those who never developed any disease symptoms. And the ability to test them is a very good thing. The problem is not that these tests are being used, but that they’re are being misused. And not by accident. Right-wing outlets, desperate to “prove” the pretense that COVID-19 is really no big deal, are deliberately misapplying these tests and exaggerating the value of the data collected to present not a medical outcome, but a political one. That’s already happened twice in California.
But last week, a pair of doctors in Bakersfield, California proved that you don’t need a test to present data that’s wildly misleading. Not even a bad test. Because mangled statistics have always been a go-to factor for people trying to generate a predetermined political outcome, and these two doctors are using some of the worst ones.
As television station KBAK reported last Wednesday, a pair of doctors at an urgent care clinic in Bakersfield held a press event during which they called for the reopening of the county and discounted the threat represented by COVID-19. In this single press conference, the urgent care doctors—Dan Erickson and Artin Massihi—managed to present not only horrendous distortions of the data, but to make additional arguments that are already being amplified by the media and turned into talking points for the right.
First, the pair suggested that America isn’t doing quarantine correctly because it’s isolating healthy people. "When someone has measles you quarantine them. We've never seen the healthy, where you take those without disease and without symptoms and lock them in your home. So some of these things from what we've studied from immunology and microbiology aren't really meshing with what we know as people of scientific minds who read this stuff," said Erickson.
To reach this conclusion, Erickson—who apparently took a class in “this stuff” at some point—pivoted right past the whole point of the statewide lockdown, which is that we don’t know who’s sick. (That’s the outcome of insufficient testing.) The point of social distancing guidelines is not to reduce transmission from those who have been confirmed to be infected with the novel coronavirus, it’s to protect against the spread of the virus from infected people who have not been identified. In at least one study, 80% of all cases in a given area originated from people who did not know they were infected at the time they spread the disease.
Next, the two doctors suggested that the reason they were coming forward was because people with “heart disease, people with cancer, hypertension and various things” are choosing not to come into urgent care for fear of COVID-19. This is obviously true. Deaths from heart disease are clearly up since the pandemic began, and not just in the United States. Some of this comes explicitly from patients who are, just as they stated, afraid that coming into the doctor’s office will expose them to COVID-19. Those potential patients have good reason for this fear. National stories about the lack of protective gear, the high rate of infection among medical professionals, and stories about aerosol transmission in virus-laden facilities have all contributed to the idea that visiting any healthcare facility is taking a huge gamble.
Also, as doctors have learned more about how COVID-19 operates, it has become clear that heart issues are the No. 1 comorbidity factor. In New York, 57% of those who died also had hypertension. There have been a significant number of patients who have apparently recovered from COVID-19, then died soon afterward from heart attack or stroke. Anyone who believes they are experiencing a heart attack should call an ambulance or proceed to the emergency room (not an urgent care). But every patient can expect to weigh the cost of making a less-than-emergency visit.
But really it’s the numbers where these two excel, and it’s the numbers that are getting unwarranted press. See if you can spot the issue with this statement:
"In Kern County, we've tested 5,213 people and we have 340 positive COVID cases. Well, that's 6.5% of the population, “ said Erickson. If you haven’t spotted the problem already, he went on: "So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases out of a total of 280,900 total tested; that's 12% of Californians were positive for COVID." But Erickson wasn’t done. “We've seen 1,227 deaths in the state of California with a possible incidents or prevalence of 4.7 million,” said Erickson. “That means you have a 0.03 chance of dying from COVID-19 in the state of California.”
It’s hard to know where to begin. What Erickson has done in his astounding demonstration of basic mathematical ignorance is to take the percentage of positive tests in the state and equate that with the number of people who have the disease. Many media outlets have treated statements from this amazing press event as if Erickson and Massihi had conducted over 5,000 tests. That’s not what they’re saying. They’re just quoting the number of existing tests and positive results at a time when almost all of those tests have taken place on patients demonstrating strong symptoms.
It’s as if you went into the cancer ward at Johns Hopkins and determined that 12% of Americans have lymphoma. Then Erickson has divided the number of deaths across the state of California, and divided by 12% of the entire state population to come up with a 0.03% case fatality rate. So … everyone back to work! This thing is no big deal!
Even more amazingly, this is Erickson’s next sentence: “I also wanted to mention that 96% of people in California who get COVID recover.” What happens to the other 4%? It’s apparently impossible to know.
Right now in New York City, 0.15% of the total population is already dead from COVID-19. Not 0.15% of those with symptoms. Not 0.15% of those infected. 0.15% of everybody in New York City. Is dead. Right now. Because of this disease.
And while New York certainly waited too long to lock down, the city’s response to the outbreak once it was underway has been very good when it comes to preparing additional medical facilities and making sure that every COVID-19 patient—along with patients for every other kind of serious illness—still had a bed, an ICU, or a ventilator when needed. Those numbers in New York City are not there because people are getting good treatment. The numbers are there in spite of what has proven year in and year out to be among the best healthcare delivery systems in the nation.
Despite the staggering examples of innumeracy and pure misdirection in the statements from Erickson, both social media and national media have been repeating both the “12% infection rate” and “0.03% death rate” as if they provide some value to the national conversation. They don’t. In fact, they’re so actively harmful that they are a genuine threat.
So are Erickson and Massihi. If you do need to go to an urgent care, don’t make it Accelerated Urgent Care in Bakersfield, California. The doctors there clearly either weren’t paying attention during their required statistics courses or are deliberately misrepresenting information. Either way, at this moment they’re doing immense damage.