There are several gigantic problems with foggy Joe’s idea: first, it’s not within a president’s power to impose a nationwide lockdown, as the chorus of experts reminded us last spring when Trump mentioned it. Second, the evidence suggests that lockdowns don’t work to eliminate the virus; they delay its spread at best. Third, as we’ve witnessed, lockdowns themselves have enormous public health consequences, leading to a variety of severe maladies, despondency, and excess non-COVID deaths. That’s simply unacceptable. Finally, the economic damage imposed by lockdowns is horrific and often permanent. We’re talking about destroying the independent livelihoods of people. Permanently! Lockdowns are especially hard on those at the bottom of the economic ladder, who are disproportionately minorities. That’s so obvious, and yet very difficult for elites to gather in.
Measures like those Biden contemplates are major assaults on our liberty. And the thing is, if any of it comes to pass, the restrictions might never go away. We’ll be asked to do this every flu season, or perhaps permanently to protect each other from “germs”. This is an authoritarian move, one that we should all resist, even if you’re freaked out by the virus. The best way to resist right now is to vote for Donald Trump.
And please, don’t give me any bullshit about our “responsibility” to lock down, and how mandatory masks are necessary to protect the vulnerable. Is poverty now a “responsibility”? The most highly vulnerable can be protected without masks, and maybe better. Beyond that, people must be free to determine their own level of risk tolerance, just as they have for millennia with respect to a broad spectrum of serious risks, pathogens or otherwise. That’s a dimension of freedom about which no one should be so cavalier.
The CDC changed its guidelines on completion of death certificates on April 5th of this year, and only for COVID-19 (C19), just as infections and presumed C19 deaths were ramping up. The substance of the change was to broaden the definition under which death should be attributed to C19. This ran counter to CDC guidelines followed over the previous 17 years, and the change not only makes the C19 death counts suspect: it also makes comparisons of C19 deaths to other causes of death unreliable, since only C19 is subject to the new CDC guidance. That’s true for concurrent and historical comparisons. The distortions are especially bad relative to other respiratory diseases, but also relative to other conditions that are common in mortality data.
The change in the CDC guidelines was noted in a recent report prepared for the Florida House of Representatives. It was brought to my attention by a retweet by Justin Hart linked tothis pieceon Andrew Bostom’s site. Death certificates are divided into two parts: Part 1 provides four lines in which causes of death are listed in reverse clinical order of events leading to death. Thus, the first line is the final clinical condition precipitating death. Prior clinical events are to be listed below that. The example shown above indicates that an auto accident, listed on the fourth line, initiated the sequence of events. Part 2 of the certificate is available for physicians or examiners to list contributing factors that might have played a role in the death that were not part of the sequence of clinical events leading to death.
The CDC’s change in guidelines for C19, and C19 only, made the criteria for inclusion in Part 1 less specific, and it essentially eliminated the distinction between Parts 1 and 2. The following appears under “Vital Records Criteria”:
“A death certificate that lists COVID-19 disease or SARS-CoV-2 as a cause of death or a significant condition contributing to death.”
How much difference does this make? For one thing, it opens the door to C19-attributed deaths in cases of false-positive PCR tests. When large cohorts are subject to testing — for example, all patients admitted to hospitals — there will always be a significant number of false positives even when test specificity is as high as 98 – 99%.
The elimination of any distinction between Parts 1 and 2 causes other distortions. A review of the Florida report is illustrative. The House staff reviewed almost 14,000 certificates for C19-19 attributed deaths. Over 9% of those did not list C19 among the clinical conditions leading to death. Instead, in those cases, C19 was listed as a contributing factor. Under the CDC’s previous guidelines, those would not have been counted as C19 deaths. The Florida House report is conservative in concluding that the new CDC guidelines inflated C19 deaths by only those 9% of the records examined.
There are reasons to think that the exaggeration was much greater, however. First, the Florida House report noted that nearly 60% of the certificates contained information “recorded in a manner inconsistent with state and national guidance”. In addition, almost another 10% of the fatalities were among patients already in hospice! Do we really believe the deaths of all those patients whose diseases had reached such an advanced stage should be classified as C19 fatalities? And another 1-2% listed non-C19 conditions as the immediate and underlying causes.
Finally, more than 20% of the certificates listed C19 alone as a cause of death despite a range of other contributing conditions or co-morbidities. This in itself may have been prompted by the change in the CDC’s guidelines, as the normal standards often involve a “comorbidity” as the initial reason for hospitalization — in that case a clinical event ordinarily listed in Part 1. The high rate of errors and the fact that roughly two-thirds of the deaths reviewed occurred in the hospital, where patients are all tested and often multiple times, raises the specter that up to 20% more of the C19 deaths were either erroneous and/or misclassified due to false positives.
(An exception may have occurred in New York, where an order issued in March by Governor Andrew Cuomo to return C19-positive residents of nursing homes (including suspected C19 cases) back to those homes, The order was made before the change in CDC guidelines and wasn’t rescinded until later in April. There is reason to believe that some of the C19 deaths among nursing home residents in New York were undercounted.)
All told, in the Florida data we have potential misclassification of deaths of 9% + 9% + 2% + 20% = 40%, or inflation relative to actual C19 deaths of up to 40%/60% = 67%! I strongly doubt it’s that high, but I would not consider a range of 25% – 50% exaggeration to be unreasonable.
We know that reports of C19 deaths lag actual dates of death by anywhere from 1 to 8 weeks, sometimes even more. This is misleading when no effort is made to explain that difference, which I’ve never heard out of a single journalist. We also know that false positive tests inflate C19 deaths. The Florida report gives us a sense of how large that exaggeration might be. In addition, the Florida data show that the CDC guidelines inflate C19 deaths in other ways: as a mere contributing factor, it can now be listed as the cause of death, unlike the treatment of pneumonia as a contributing factor, for instance. The same kind of distortion occurs when patients contract C19 (or have a false positive test) while in hospice.
There is no doubt that C19 led to “excess deaths” relative to all-cause mortality. However, many of these fatalities are misclassified, and it’s likely that a large share were and are lockdown deaths as opposed to C19 deaths. That’s tragic. The CDC has done the country a massive disservice by creating “special rules” for attributing cause-of-death to C19. If reported C19 fatality rates reflected the same rules applied to other conditions, our approach to managing the pandemic surely would have inflicted far less damage to health and economic well being.
Acceptance of risk is a necessary part of a good life, and extreme efforts to avoid it are your own business. Government has no power to guarantee absolute safety, nor should we presume to have such a right. Ongoing COVID lockdowns are an implicit assertion of exactly that kind of government power, despite the impotence of those efforts, and they constitute a rejection of more fundamental rights.
Lockdowns have had destructive effects on health and economic well being while conferring little if any benefit in mitigating harm from the virus. The lockdowns were originally sold as a way to “flatten the curve”, that is, to avoid a spike in cases and an overburdened health care system. However, this arguably well-qualified rationale later expanded in scope to encompass the mitigation of smaller and much less deadly outbreaks among younger cohorts, and then to the very idea of extinguishing the virus altogether. It’s become painfully obvious that such measures are not capable of achieving those goals.
In the U.S., the ongoing lockdowns have been a cause célèbre largely on the interventionist Left, and they have been prolonged mainly by Democrats at various levels of government. In a way, this is not unlike many other policies championed by the Left, often ostensibly designed to help members of the underclasses: instead, those policies often destroy or wrongly obviate incentives and promote dependency on the state. In this case, the plunge into dependency is a reality the Left would very much like to ignore, or to blame on someone else. You know who.
The lockdowns have been largely unsuccessful in mitigating the spread of the virus. At the same time, they have been used as a pretext to deny constitutional rights such as the free practice of religion, assembly, and a broad range of unenumerated rights under the “penumbra” of the Bill of Rights and the Ninth Amendment. What’s more, the severity of the economic blow caused by lockdowns has been borne disproportionately by the working poor and the small businesses who employ so many of them.
Lockdowns are deadly. It’s not clear that they’ve saved any lives, but they have massively disrupted the operation of the health care system with major consequences for those with chronic and undiagnosed conditions. The lockdowns have also led to spikes in mental health issues, alcoholism, drug abuse, and deaths of despair. A recent study found that over 26% of the excess deaths during the pandemic were non-COVID deaths. Those deaths were avoidable or accelerated, whereas the lockdowns have failed to meaningfully curtail COVID deaths. Don’t tell me about reduced traffic fatalities: that reduction is relatively small relative to the increase in non-COVID excess deaths (see below).
The Ethical Skeptic (TES) on Twitter has been tracking a measure of lockdown deaths for some time now. The following graphic provides a breakdown of excess non-COVID deaths since the start of the pandemic. The total “pie” shows almost 320,000 excess deaths through September 26th (avoiding less complete counts in recent weeks), as reported by the CDC. COVID accounted for 202,000 of those deaths, based on state-level reporting. Of the remaining 117,000 excess deaths, TES uses CDC data to allocate roughly 85,000 to various causes, the largest (more than half) being “Suicide, Addiction, Abandonment, and Abuse”. Other large categories include Cardio/Diabetes, Stroke, premature Alzheimers/Dementia death, and Cancer Access. Nearly 32,000 excess deaths remain as a “backlog”, not yet reported with a cause by states.
Also of interest in the graphic are estimates of life-years lost. The vast bulk of COVID victims are elderly, of course, which means that any estimate of lost years per victim must be relatively low. On the other hand, most non-COVID, lockdown-related deaths are among younger victims, with correspondingly greater life-years lost. TES’s aggregate estimate is that lockdown-related excess deaths involve double the life-years lost of COVID deaths. Of course, that is an estimate, but even granting some latitude for error, the reality is horrifying!
John Tierney in City Journal cites several recent studies concluding that lockdowns have been largely ineffective in Europe and in the U.S. While Tierney doesn’t rule out the possibility that lockdowns have produced some benefits, they have carried excessive costs and risks to public health going forward, such as lingering issues for those having deferred important health care decisions as well as disruption in future economic prospects. Ultimately, lockdowns don’t accomplish anything:
“While the economic and social costs have been enormous, it’s not clear that the lockdowns have brought significant health benefits beyond what was achieved by people’s voluntary social distancing and other actions.”
Tierney also discusses the costs and benefits of lockdowns in terms of life years: quality-adjusted life-years (QALY), which is a widely-used measure for evaluating of the use of health care resources:
“By the QALY measure, the lockdowns must be the most costly—and cost-ineffective—medical intervention in history because most of the beneficiaries are so near the end of life. Covid-19 disproportionately affects people over 65, who have accounted for nearly 80 percent of the deaths in the United States. The vast majority suffered from other ailments, and more than 40 percent of the victims were living in nursing homes, where the median life expectancy after admission is just five months. In Britain, a study led by the Imperial College economist David Miles concluded that even if you gave the lockdown full credit for averting the most unrealistic worst-case scenario (the projection of 500,000 British deaths, more than ten times the current toll), it would still flunk even the most lenient QALY cost-benefit test.”
We can now count the World Health Organizationamong the detractors of lockdowns. According to WHO’s Dr. David Nabarro:
“Lockdowns just have one consequence that you must never ever belittle, and that is making poor people an awful lot poorer…. Look what’s happened to smallholder farmers all over the world. … Look what’s happening to poverty levels. It seems that we may well have a doubling of world poverty by next year. We may well have at least a doubling of child malnutrition.”
In another condemnation of the public health consequences of lockdowns, number of distinguished epidemiologists have signed off on a statement known as The Great Barrington Declaration. The declaration advocates a focused approach of protecting the most vulnerable from the virus, while allowing those at low risk to proceed with their lives in whatever way they deem acceptable. Those at low risk of severe disease can acquire immunity, which ultimately inures to the benefit of the most vulnerable. With few, brief, and local exceptions, this is how we have always dealt with pandemics in the past. That’s real life!
I was updating my post from twelve days ago on the upward trend in new coronavirus cases when I came across a great tabular summary of a phenomenon that’s been underway since early April: significant delays in reporting deaths from COVID-19 (C19). Before I get to that, a quick word on what’s happened over the past 12 days. New coronavirus cases keep climbing in a number of states, and it’s been a grisly waiting game to see whether the severity and lethality of infections will follow the case counts upward. The following chart provides a very preliminary answer. It’s taken from Our World In Data, and it shows the seven-day moving average of C19 deaths in the U.S.
There has indeed been an upturn in reported deaths over the past week. Just prior to that, a temporary plateau in late June was caused by a set of “reclassifications” of earlier deaths in New Jersey (the “plateau effect is caused by seven-day averaging). These kinds of changes in reporting make it rather difficult to interpret trends accurately. Unfortunately, the reporting of deaths has been subject to continuing distortions that are even more difficult to discern than New Jersey’s spike.
Kyle Lamb provides the interesting table below, which might be difficult to read without either clicking on it or going to the link at Twitter. Here is another link to an annotated version of the table. The top row labeled “CTP Total” is the C19 death toll reported each week by the COVID Tracking Project. This is generally what the public sees. These reports show that deaths reached their highest levels during the weeks of April 11th through May 9th. However, the second column shows C19 deaths by their actual week of occurrence. This series shows a more distinct peak on April 18th with steady declines thereafter.
The weekly totals in the second column are not final, however. Take a look at the last reporting week in the far right column (July 11th). The CTP reported 4,286 deaths, an increase over the prior week consistent with the upturn in the first chart above. But the table shows that over half of that week’s reported deaths actually occurred in late April and early May! So the upturn in deaths is something of a mirage.
We won’t have a reasonable approximation of the death totals for the past several weeks (or how they compare) for at least several more weeks. In fact, one can argue that it might be a matter of months before we have a reasonable approximation of those deaths, but it’s worth noting that the vast bulk of “actual” C19 deaths tend to be reported within four weeks of the initial reporting week, and the additions or revisions to the two weeks in late April and early May in the last column were exceptionally large. Chances are we won’t see many more that big…. Or will we?
Aspects of this process hint at the ease with which the C19 death totals could be manipulated. The reported totals for all-cause mortality in the first column are incomplete; more recent weeks, especially, are not fully settled as to causes of death. Some of those fatalities are certain to be attributed to C19. Others might be reclassified as C19. And here is the scary part: the all-cause totals are certain to include a significant number of lockdown-related or COVID-phobic deaths: individuals who were unable or unwilling to seek medical care for urgent needs due to lockdowns or fears of rampant spread of C19 infections within hospital environments. To anyone with an interest in manipulating the C19 death toll, whether hospital officials seeking higher reimbursements, local or state officials seeking federal funds, or public officials at any level seeking to promote pandemic fears and/or political discord, these “extra” deaths might be tempting marks for reclassification.
I’m fairly confident that the uptrend of new cases will be far less severe than early in the pandemic. I believe much of the alarm I see on social and mainstream media is misplaced. More on that in a subsequent post, but for now I’ll simply note that those testing positive are concentrated in much lower ranges of the age distribution, and treatment has improved in a variety of ways. The table above shows that the downtrend in actual weekly C19 deaths is intact as of the admittedly incomplete July 11th reporting week. We won’t know the “actual” pattern of early-July C19 fatalities for another month or more. Even then, one might harbor suspicions that the totals are manipulated for economic or political reasons, but we can hope the reporting authorities are exercising the utmost objectivity in assigning cause of death.
In advanced civilizations the period loosely called Alexandrian is usually associated with flexible morals, perfunctory religion, populist standards and cosmopolitan tastes, feminism, exotic cults, and the rapid turnover of high and low fads---in short, a falling away (which is all that decadence means) from the strictness of traditional rules, embodied in character and inforced from within. -- Jacques Barzun