The reader should know upfront that I am completely unqualified to speak about pretty much every topic in this series. I am not a virologist, an epidemiologist, an infectious disease specialist, a biologist, a microbiologist, an immunologist, a mathematician, a statistician, a mathematical epidemiologist, an epidemiological mathematician, a doctor, a nurse, a nurse’s aide, a public health bureaucrat, an academic, an economist, a risk analyst, a politician, a journalist, a soldier, a policeman, a pundit, a podcaster, an op-ed writer, a thought leader, a content creator, an advertising executive, a marketing expert, a public relations specialist, a funeral director, a grief counsellor, a psychotherapist, a priest, a butcher, a baker or a candlestick maker.
There is an idea that is very fashionable these days that only experts may talk about things. One of the most poignant examples of that attitude I have seen was a video where one of my scientific heroes, Kary Mullis, was addressing an audience at a university in the USA. Mullis, a classic iconoclast in the Feynman tradition, inevitably spoke some dissenting opinions about some topic or other. A man arose from the audience during question time and, rather than disagree about the content of what Mullis had said, simply told him he was not qualified to speak. He was not an expert in that field and shouldn’t be talking about it. Mullis put the man in his place but it was quite clear that many others in the audience agreed with the man. For a second it seemed that a mob might form against a Nobel Prize winner for science for talking about, well, science.
Let me reiterate: I am not qualified and I am not a Nobel Prize winner. If you think these things disqualify me from speaking, you may as well stop reading right now.
That a blind faith in the experts is a big part of what caused the corona event is a central thesis of this series of posts. In my opinion, we need a society of free citizens who are willing and able to question their leaders and the experts. I don’t believe that’s just a moral issue, I believe it’s a practical one. We need that kind of society so that we don’t make the mistakes that we have seen in 2020.
We need it because both science and democracy require it.
The drift towards blind faith in expertise and the problems that it brings has already been subject to cogent and powerful intellectual critique. It was at the heart of the cybernetics and systems thinking movements in the 20th century. One of the best books in that canon is Gerald Weinberg’s General Systems Thinking. It explains in detail the kinds of errors that experts get into and how to avoid them.
One of the main ways to avoid the errors of the expert is not to get bogged down in details. This doesn’t mean that drilling down into the minutiae isn’t necessary sometimes, just that you must always be able to come up for air and incorporate what you found into a bigger picture. Like a deep-sea diver, you have to keep a connection back to the surface lest you disappear forever into the depths.
Another way to avoid error in complex domains is to have as many different models as you can. When dealing with complexity, you simply cannot put all your eggs in one basket. It is better to know the basics in ten different domains that to know everything about one.
The systems thinking outlined by Weinberg set itself the seemingly modest task of avoiding error. Those looking for heroism and grandiose, world-changing schemes will not find much inspiration in it. But egotism has always been a hindrance when it to comes to science and to my mind one of the defining features of the corona event is hubris. Belief in experts seems to go hand-in-hand with believing that we know more than we really do.
If these ideas are new to you, I invite you to use this series of posts to judge their worth.
These posts are the work of a non-expert, an amateur, a systems thinker. They are written in the spirit of science as defined by Richard Feynman as “the belief in the ignorance of experts.” They contain no definitive answers but best guesses. I believe that in the real world, with all its irreducible complexity, that is all we can hope for. We must avoid large errors so that we can keep making our best guesses and through them to keep reaching forward into the unknown to see what we might find.
I hope you find something here. I guess that you will.
I have mentioned Richard Feynman several times already in this series of posts. I consider him to be the ideal of a scientist – iconoclastic, disagreeable, stubborn, determined, curious to a fault.
The last chapter of Feynman’s great book Surely you must be joking, Mr Feynman is titled Cargo Cult Science and in it Feynman outlines what it means to have what he calls scientific integrity.
Scientific integrity has nothing to do with qualifications and degrees and titles. It has the same relation to institutions that a religious spirit has to do with the church. That is to say, there is no necessary relation. In times when institutions fail, you are more likely to find scientific integrity outside of those institutions than inside them just as you were more likely to find the spirit of Christianity outside of the church at various times throughout its history.
What is scientific integrity according to Feynman?
The first rule of Science Club is: you must not fool yourself. The second rule of Science Club is:…. (you know the drill). Although Feynman doesn’t say it in so many words, I think of this like a duty of care. Most of us have opinions and we throw them around without a second thought. But, if you’re doing science, it means you should have spent some time and energy trying to prove yourself wrong before you share something. It means saying something like: “I believe X is the case. What evidence is available to me to prove it? What evidence would I accept to disprove the statement? Have I even looked for that evidence or tried to produce it myself?”
Having tried to prove yourself wrong, you should tell other people what you did and let them try and prove you wrong by reproducing your work
In telling other people, you should also publish all the things that might be wrong with your idea including ambiguities, experiments that failed, facts that could disprove it or cast doubt on it. You shouldn’t just present the facts that back up your conclusion
As a scientist talking to a layman, you should explain to the layman in terms they can understand
When building on previous research, you must first reproduce that research. You must verify its truth yourself. You should not blindly trust other scientists
You must know the limits of your test technique. You must know what your test can say about the world and what it cannot say. Therefore, you will know what you can say about the world and what you cannot say
Other things could be added to this list but I think it provides a nice framework by which to judge whether proper science is taking place.
In this post we are going to use these criteria to judge the science behind the corona event. In fact, we only need to look at the first few weeks to see that (real) science had almost nothing to do with it. Let’s begin.
As part of infectious disease surveillance programs, the WHO and some other organisations listen in on media reports for anything that sounds like it could be a problem. While doing this surveillance, the WHO picked up a report by some local media in Wuhan. The information is sketchy. It seems rumours of SARS were spreading on social media but actual tangible medical information is lacking. The WHO asked Chinese authorities for more information on 1st January but, before even receiving that information, it issues health alerts that day and the next through its international networks.
Whatever this is, it is not science. The WHO apparently propagated a report from a local Wuhan news outlet and social media rumours without even waiting for authorities to confirm it.
Let’s review the facts as told in the official record. There was a cluster of people (about thirty) with “pneumonia or unknown origin”.
The questions to be asked are: is it unusual to have about thirty cases of pneumonia in China in the middle of winter in a city of 11 million people? And is it unusual to have cases of pneumonia where you don’t know what the cause is?
The answer to both these questions is: no.
It is absolutely not unusual to have lots of pneumonia cases in China and in particular in a big Chinese city where air pollution is very high and many people are lifetime smokers. It is also perfectly normal not to know what the cause of a pneumonia is.
The US CDC says: “…clinicians are not always able to find out which germ caused someone to get sick with pneumonia.”
The American Thoracic Society says: “Pneumonia can be caused by lots of different types of microbes, and no single one is responsible for as many as 10% of pneumonia cases. For most pneumonia patients, the microbe causing the infection is never identified.”
Depending on who you ask, it seems that we only know the real cause of a pneumonia in about 15% of cases.
So, what does “pneumonia of unknown origin” even mean? Why would something that seems to be a perfectly normal situation be cause for concern to the Chinese authorities and the WHO?
Turns out the phrase is specific to China and specific to a surveillance program that is run in China.
China implemented a special reporting system following the SARS episode in 2002 and the phrase “pneumonia of unknown origin” is part of that system. The purpose of the system was for doctors to report directly back to Beijing when something seemed wrong. The whole point of this system was to get around the local politics that go on in China and to give Beijing direct access to information on the ground. But the system didn’t work. Local bureaucrats still intervened and controlled the flow of information. In the case of the corona event, some whistle-blowers tried to go around local authorities in Wuhan. One doctor in particular became famous because he was arrested by police for messaging colleagues about what was happening. He died just a few weeks later. It was the actions of these whistle-blowers that caused the social media rumours and the media reports and presumably also got the China CDC involved.
So, we can see that neither the phrase “pneumonia of unknown origin” nor the number of cases on the ground in Wuhan had any scientific importance. What happened was that the WHO asked for clarification of a Chinese language media report that it had intercepted as part of its own surveillance program. In the meantime, the internal Chinese surveillance program had already been activated and the China CDC was on the ground in Wuhan.
Why hadn’t the China CDC notified the WHO directly? How many other times had the China CDC investigated such cases on the ground without the WHO finding out? How many other occasions have there been in China where local authorities prevented the registration of cases of ‘pneumonia of unknown origin’?
We will never know but bear in the mind that the whistle-blowers in this case were arrested by local authorities and forced to sign confessions. So, I think it’s pretty safe to say that there are lots of such events in China that never see the light of day. Let’s be clear about the situation from a scientific point of view.
All around the world every year most cases of pneumonia are of ‘unknown’ type simply because it’s too expensive to test every case. If even rich countries don’t test widely, you can imagine what happens in poorer countries.
We also know that any cold/flu virus can lead to pneumonia and that there are many cold and flu viruses that we simply don’t know about because nobody has bothered to come up with a test for them. Nobody has bothered because it doesn’t matter. The treatment you get is not based on the specific virus that causes the disease.
What happened in Wuhan has everything to do with internal Chinese politics. Corruption is endemic in China and the local population has about zero trust in the authorities there. This was especially true after the first SARS event where the government was seen to have blatantly covered things up. As a result, the average Chinese is already primed to be looking out for respiratory epidemics and assumes the government will try and cover any up. The authorities in Wuhan were seen to be covering up what could be the next SARS and rumours started flying in media and social media.
So, right from the start we can see that it is not science driving this story but internal Chinese politics. For reasons unknown, the WHO propagated that politics. As a peak scientific body in the world, they were seen to be giving scientific credence to a story before they had any official response from the Chinese authorities. If the Chinese authorities had wanted to handle the situation in Wuhan quietly, the WHO had just made that ten times more difficult.
We have to be very clear what the word ‘novel’ means here. It simply means ‘previously unknown’. It means, no human has identified this virus.
But we can be even more specific because in this case the definition was a genomic analysis conducted according to rules set by The International Committee on Taxonomy of Viruses (ICTV). Thus, ‘novel’ means:
Calculated by mathematical analysis to be genetically dissimilar enough to known viral genomes to be considered a new type for taxonomic purposes.
Let’s put that into perspective. Let’s say there was an International Committee for the Taxonomy of Animals. That Committee decides to start using genomic analysis to define the names for animals. Enthusiastic scientists on The Committee put the genome analysis to work and realise there are actually two types of Siberian Tiger. They give them the names: Siberian Tiger 1 and Siberian Tiger 2.
That’s nice for the scientists but if we want to find out whether, for example, species 1 is more dangerous to humans than species 2, we can only prove that by studying the behaviour of members of the group Siberian Tiger 1 and Siberian Tiger 2. The genome analysis cannot tell us that. It can only help us to identify Tiger 1 and Tiger 2.
Same with viruses. The fact that a ‘novel’ virus has been identified by genome analysis doesn’t tell us anything about how dangerous it is. Of course, the virus has been implicated in some pneumonia cases but that’s what respiratory viruses do. It’s not surprising. If Siberian Tiger 1 attacked somebody while Siberian Tiger 2 didn’t, that doesn’t prove anything about whether the species Siberian Tiger 1 is intrinsically more dangerous than Siberian Tiger 2. You don’t extrapolate from an arbitrary sample. You run proper scientific experiments to prove that theory.
This method of classifying viruses by genetic information alone was introduced by the ICTV in 2012. It is controversial even within virology and many virologists have objected to the new system.
For our discussion, it’s enough to know that the ICTV uses familiar terms we all know from high school biology class eg. Family – Genus – Species. At this point in our story, it was hypothesised that the virus was different enough to be called ‘new’. Later, on February 11, the ICTV would officially declare it to be a strain of the SARS-COV species of coronavirus giving the following taxonomy:
Family: coronavidae
Genus: betacoronavirus
Sub Genus: sarbecovirus
Species: SARS-COV
Strain: 1, 2
Where strain 1 relates to the SARS event from 2002 and strain 2 is the current corona event.
Because the ‘new’ virus was apparently 87.99% similar to a known bat coronavirus there was a further hypothesis constructed that the virus had somehow jumped across from bats. No attempts were made to prove this hypothesis and, in fact, it is not clear how it is even possible to begin to (empirically) prove it. Naturally, it was this story that made it into the media and has become part of the myth of corona.
Let’s be very clear about this from a scientific point of view. All that has happened by this stage in the corona event is that some scientists in China think they have found a virus that is different enough from known viruses to be taxonomically new. At this point there had been no official publication, no official scientific paper outlining their methods, no peer review to check those methods, no other scientists verifying the work, no official ruling from the ICTV that the virus is taxonomically new, no confirmation from the WHO that the disease was new, no proof and not even the attempt at proving that the virus in question causes illness or what specific sort of illness it causes, no empirical studies at all that this virus caused a unique or particularly deadly kind of illness.
Two days later, the WHO would issue a statement saying basically the same thing I have just said although in fewer words.
“The symptoms reported among the patients are common to several respiratory diseases, and pneumonia is common in the winter season; however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.”
It would have been nice if things were handled prudently. But prudence, and any semblance of scientific rigor, were about to get thrown out the window because…
1st-16th January 2020: the genome of the ‘novel’ virus is shared with researchers worldwide and PCR tests are created
The Chinese researchers had found a genome and mathematical analysis done on a computer told them it was ‘new’. On the basis of that result, they uploaded that genome to at least two international repositories. One of those repositories is called GISAID. GISAID’s mission in its own words is:
“…overcoming disincentive hurdles and restrictions, which discourage or prevented [sic] sharing of virological data prior to formal publication.”
“Prior to formal publication” means prior to even the first step in the peer review process so it seems the people who started GISAID were explicitly trying to bypass peer review. Sometimes restrictions and hurdles are there for a good reason. Sometimes it is good not share information when you haven’t spent the time to do basic checks of your own work. Like Chesterton’s Gate, if you don’t know the reason a scientific restriction is there, maybe you shouldn’t get rid of it (that’s a real application of The Precautionary Principle by the way). But getting rid of hurdles is apparently the whole point of GISAID.
We saw earlier that Feynman’s number one principle is: don’t fool yourself. In biological sciences all kinds of gates and hurdles and ‘restrictions’ have been put in place over decades for the primary purpose of ensuring that the scientist didn’t fool themselves. Among these are peer review, control tests, blind tests, placebo tests etc. These restrictions are built into science because they lead to good science. It’s no surprise that the corona event should explicitly feature the removal of such restrictions. (Of course, technically speaking, genome analysis is not empirical science, it is mathematics. But that’s a whole other discussion.)
With the genome data uploaded, virologists and other scientists around the world could now use it to do things like create PCR tests. That’s exactly what they did. The German virologist, Christian Drosten, was the first outside China to create such a test which he submitted to the WHO. The Chinese authorities were already using their own test kits early in January.
On the basis of the genomic information and the PCR test, authorities in Thailand and then Japan were able to test for and find ‘infections’ on 13th January and 15th January respectively. The Chinese government locked down Wuhan on 23rd January based on the results of the PCR tests. Other countries started testing and found ‘infections’. The rest, as they say, is history.
Health systems around the world started testing for ‘infections’ before the usual scientific process had got underway. There had been no formal publication showing the virus was the cause of the pneumonia in Wuhan. All they had at that point was correlation based off a very small sample. No peer review had been done and no experimental results had been published. Neither the WHO nor the ICTV had given official recognition to either the virus or the supposed disease.
I have said in earlier posts that the corona event was the ascendancy of the virologists and the public health bureaucrats at the expense of other actors. This is specifically what I mean. The genome and the PCR tests based on that genome were shared before there was any firm science on how dangerous the virus was.
Remember the first rule of Science Club: don’t fool yourself.
If you ramp up testing you are going to find ‘infections’ and it’s going to look for all the world like you have a problem. As a scientist, you must stop, take a deep breath and try and put things into perspective so you don’t fool yourself. But that didn’t happen. Public health bureaucrats started to find infections and they panicked. The Chinese government panicked so much they shut down an entire city of 11 million people.
Two months later at the end of March, when most countries in the west were already going into lockdown, a real scientific paper was published in the New England Journal of Medicine. Buried in it is this warning:
“Care should be taken in interpreting the speed of growth in cases in January, given an increase in the availability and use of testing kits as time has progressed.”
In other words, the more you test, the more you will find. This warning about naïve testing has been repeated many times during the corona event. Let’s take a moment to understand it.
A Brief Interlude: the more you test the more you find
What that warning in the New England Journal of Medicine meant was: if you test more, you will find more cases.
The WHO have stated the same thing in relation to coronaviruses in general: “As surveillance improves more coronaviruses are likely to be identified.”
The reason many people misunderstand this idea is because they have an incorrect understanding of how much we know about viruses. So, let me repeat what I stated earlier:
We don’t know about most of the viruses that cause respiratory illness.
This is literally true. You can check the influenza surveillance program in your country to confirm it. In Australia, we mostly test for influenza but even when we test for other viruses the result comes back negative in the majority of cases. That is, if you show up to hospital with advanced flu symptoms, if they even bother to test you, the test will probably come back negative. That is the normal state of affairs. And that’s just for the infections that get to hospital. Countless more infections will never get tested because the people who have them are asymptomatic or only mildly ill.
We don’t know about most of these viruses because we simply haven’t had the technology to enable us to find them.
Think about it this way. Suppose there is an area of the night sky that nobody has ever looked at before. Maybe there is some religious prohibition about looking at that part of the night sky. We know there will be stars in that part of the night sky and we know that if we started looking we would find stars. If somebody broke the rule and looked and found a star it would be completely obvious and nothing to write home about. Maybe that person would name the star after themselves and we would think they were an egotistical jerk. Maybe they would win an award for finding the star and then everybody else who wants to win an award will start looking and soon we will have found heaps of ‘new stars’. The stars were always there, we just never looked for them before.
Let’s extend the analogy to include the invention of the telescope. With the telescope you can find new things in the sky. You can run new tests. It is fully to be expected that you are going to find new stuff.
This is the exact situation with respiratory viruses. In the last few decades we have built new technology to identify them better so we are going to find more of them. Lots more of them. Get ready because in the years ahead we are going to find lots of ‘new’ viruses.
This eagerness and this ability to find new viruses is behind not just the corona event but all the well known pandemics of the past twenty years. I have already said in previous posts that it was the PCR test which drove the corona event, but more specifically it was the ability to identify the genome and test for it.
7th and 9th January 2020: “Chinese authorities” declare a “novel” coronavirus
On January 7, 2020, the China CDC released a statement declaring a novel coronavirus had been identified by genome analysis and was behind the pneumonia cases in Wuhan. I haven’t been able to find that document, presumably it is in Chinese. But two days later the WHO acknowledged it and went public with almost the same information.
The crucial information is in the first paragraph:
“Chinese authorities have made a preliminary determination of a novel (or new) coronavirus, identified in a hospitalized person with pneumonia in Wuhan. Chinese investigators conducted gene sequencing of the virus, using an isolate from one positive patient sample.”
Do I even need to point out to the reader the problem from a scientific point of view? It’s right there in the phrase “using an isolate from one positive patient sample”. A single sample.
The WHO acknowledges the weakness of this by pointing out that it is a “preliminary determination” but the very fact that this official document was made public is already a tacit acknowledgement of truth. The world’s leading health body is now spreading the story about a “new” coronavirus. In the days that followed, the WHO stepped up its activities including a “meeting on the novel coronavirus outbreak”.
So, we went from a “preliminary determination” to a “novel coronavirus outbreak” within the space of twenty-four hours based on a single patient sample out of group of about thirty people with pneumonia in a large Chinese city in the middle of winter. All this based on a statement by Chinese “authorities”.
When one of the peak scientific bodies in the world speaks, people listen. Just two weeks later, on 23rd January 2020, a team of scientists publishing in a European journal on infectious disease referenced the WHO’s statement and wrote as follows:
“A novel coronavirus currently termed 2019-nCoV was officially announced as the causative agent by Chinese authorities on 7 January.”
Note the language here: “officially announced”? What does “officially announced” have to do with science? And who made the official announcement? Chinese “authorities”? Who are they? Where is their evidence? Where is the scientific paper where these authorities show their work?
And what about the term “causative agent”. That the supposed virus was the “causative agent” had NOT been proven. Nothing had been published to try and prove it. These scientists weren’t referring to actual research. They weren’t referring to a published paper in a scientific journal. They were referring to unknown “authorities”. This is cargo cult science on steroids. It is the opposite of science.
Once upon a time, the “authorities” said the world was flat. The “authorities” said the sun revolved around the earth. The “authorities” said we should burn witches at the stake. History is full of the “authorities” saying all kinds of things. A scientist must have proof. That is what it means to do science. If you don’t have proof, if you haven’t even seen the proof, you are not doing science. What’s more, if the proof has not been provided, it’s your job is to ask for the proof, not parrot the edicts of “authorities”.
The way science works is that, over time, one paper usually becomes the definitive paper that proved a hypothesis. That becomes the paper that everybody refers to when making a claim like such and such a thing was the “causative agent”. Until that happens, you would reference other papers that purport to prove it and you would say something like Smith et al (2020) claim that such and such a thing was the “causative agent” however Johnson et al (2020) called the claim into question. The phrase “officially announced” simply has nothing to do with science.
If even trained scientists were propagating the official announcement just two weeks later, if the WHO was already treating it as a done deal, is it any wonder the public had assumed the science was settled? In truth, the science had not even begun.
On February 11, the WHO officially announced(!) the new disease: “covid-19”. This disease was named according to the WHO’s “best practice” rules for naming which are as follows.
That is an infection, syndrome, or disease of humans;
That has never been recognized before in humans;
That has potential public health impact; and
Where no disease name is yet established in common usage
It is clear that principles two and four were not fulfilled in this case. Pneumonia and Influenza Like Illness have been recognised in humans before. They are literally two of the most common diseases that affect humans. We have names for them already. We already know that coronaviruses cause these diseases. In short, we didn’t need a new name.
No surprise then that months later doctors and clinicians couldn’t diagnose covid-19 as a specific disease. It is not a specific disease. Most viral disease isn’t. That’s why we have the vague name Influenza Like Illness with a grab bag of associated symptoms that try to cover the possible outcomes of a viral disease.
At this point we can end our review. I’m sure the reader has gotten the point. To give credit, there were many scientists who qualified their language and didn’t simply parrot the position of authorities and there were some scientists who actively spoke out about what was happening. But most just went along with it. I’m sure the scientists, like the rest of us, had no idea what was about to happen and so they kept their mouths shut. Science normally works slowly and speaking out, whether as an academic scientist or a scientist who works in a corporation or research lab, has consequences. Most of us are not free to speak out in our own line of work and scientists are no different.
Even Richard Feynman couldn’t have stopped what happened. From the first, it was not really a matter of science.
Postcript 1:The gold standard test
Everybody knows how you test whether a virus causes illness. It is part of our culture and it is captured in the phrase “to be a Guinea Pig”.
It is the same process stated by microbiologist Robert Koch and is known as Koch’s postulates.
You take a sample from an infected person. You grow the virus in the lab. You expose some animals, probably mice or Guinea Pigs, to the virus and study the response. When they get sick, you take a sample from the animal and confirm as best you can that the virus was what was causing the illness.
It appears nobody has ever run this test for sars-cov-2. I have looked and not found it. I have come across others who also looked and found nothing. I’m sure it is a difficult test to run especially now that viral research labs resemble military facilities in terms of security.
Koch’s postulates are the only test that conclusively proves that a virus causes an illness. In an ideal world, it should have been priority number one right from the start of the corona event. We should have had as many scientists on it as possible so that we could be sure what the illness was and what the severity was.
On 29th January, researchers in Melbourne, Australia became the first outside of China to recreate the virus from a sample taken from an infected patient (as defined by the PCR test). This meant that it was feasible to do the test according to Koch’s postulates. Having grown the virus, it should have been possible to infect animals with it and see what happened. By Feynman’s principle of reproducing other scientist’s work and not just believing what you were told, this should have occurred. Reproducing work is the most basic part of science.
In this case you would think it would have also been a matter of great political importance. Shouldn’t the Australian government, shouldn’t all other governments in the world, have wanted proper research data to guide public policy making? Data provided by their own scientists rather than relying on overseas “authorities”.
But this was not apparently a priority at The Doherty Institute or any other research lab around the world. The priority was to get to work on a vaccine. Research labs are expensive to run and vaccines can make a lot of money. It may be good business, but it is not good science.
Postscript2
You could argue that this is all really silly. We don’t really need to prove that coronaviruses cause respiratory illness. We already know that. We shouldn’t be surprised to find a pandemic for a respiratory virus. We know there are many every year. We shouldn’t be surprised to find a new coronavirus. We know there are many out there that we don’t know about and as we look more we will find them.
Like with my Siberian Tiger example above, the thing we actually care about is: is this virus more dangerous than others that we know about and, if so, how dangerous is it?
That is the domain of epidemiology. But epidemiology takes time. It wasn’t epidemiology driving the corona event. It was “infections” and the fear of viruses. At any one time, each of us will be “infected” with any number of viruses but now we had a test to prove it and with that test the invisible world of microbiology with all its unfathomable complexity was reduced to a single point of fear.
When I was seven years old, I asked my parents for a pet cow. They bought it for me. I don’t remember if I was surprised at the time but as an adult it still surprises me. Sure, we lived on a farm and there was plenty of room but a pet cow? For a seven-year-old? I don’t really remember why I wanted a pet cow. But, I got one.
The problem with seven-year-olds is that they are seven years old. It took me all of two days to get completely bored with the chores of feeding and tending to the cow. My parents were none too pleased and told me that if I didn’t take care of the cow they would get rid of it. They weren’t lying. The following year we had the cow put down and butchered. We got about six month’s worth of dinner out of it.
The act of eating my pet cow didn’t strike me as particularly odd at the time. We also had chickens on the farm which we had eaten. One of my earliest childhood memories is watching a chicken that had just had its head chopped off run and jump over a fence that was about twenty metres away. How it knew where the fence was is a philosophical problem that still troubles me to this day. In any case, seeing animals killed and then eating them was just part of life on the farm growing up. I had been rabbit shooting. I had eaten freshly killed kangaroo. It was all perfectly normal.
I’ve always been something of a troll, especially when I was younger, and I’ve always had a fascination with how people react to stories that challenge something at the subconscious level. Every now and then I like to pull out my pet cow story and other gruesome farm tales to see how people respond. I’ve noticed these stories always seem to get a rise out of people who were born and raised in the city.
There’s another story I have that usually gets city people out of joint. Actually, this one is a thought experiment. I call it: The Meat Eater’s Licence.
The idea is simple: in order to be able to purchase meat, you first must get yourself a meat eater’s licence. How do you to that? Easy. You have to kill and butcher one animal with your own hands. You’ll show up at the meat eater’s licence facility and will be shown what to do and how to do it as humanely as possible. It can be a rabbit, a chicken or whatever. We’ll probably have to steer clear of larger animals in the interests of not violating RSPCA regulations. If you decide on the chicken, you’ll be given a hand axe and will cut the chicken’s head off. Once it has finished running around like the proverbial, you’ll do what my parents made me do as a kid and sit there and pluck its feathers and then you gut it. Job done. Now you have your meat eater’s licence and are free to buy as much meat as you like for the rest of your life.
When I started to run this idea past people just for fun, I was surprised by the strength of the reaction it got. Even though it’s just a thought experiment and hasn’t a snowflake’s chance in hell of being implemented, it seemed to touch on something deep. People would loudly insist that they would never do it. That they would rather become vegan (free idea for you vegans out there: badger your local politician to implement a meat eater’s licence).
One guy reacted especially strongly to the meat eater’s licence idea so I threw in the pet cow story too. He was mortified.
“How could you eat a pet”? he asked.
“How can you eat an animal you’ve never even seen when you yourself admit that you couldn’t bring yourself to kill it?” I answered.
My meat eater’s licence had accidentally touched on something very important. I’ve often thought it represents a divide that separates city folk from country folk. But now I believe it has to do with more than just what’s for dinner. It has to do with death in general.
The question of killing and eating an animal that you knew first-hand is an interesting one. For those who grew up in the country or had backyard chickens or rabbits, it’s simply not a big deal. As a child it doesn’t cause you any discomfort or emotional issues (at least it didn’t cause me any). It’s just part of life.
But now that I reflect on it as an adult I would go a little further than that. Killing and eating an animal that you knew makes you more grateful for the animal’s sacrifice and somehow for life in general. By contrast, there is something about buying pre-packaged meat that leads to the opposite attitude. The animal is reduced to body only. Not even a whole body. Just parts of a body. In the background are the industrial farming practices that every now and then make it to the news with all the horrifying images that come with it.
I can sympathise with the vegans for wanting to put a stop to that but I disagree with their solution which is to get rid of all meat eating. My solution would be to put meat eating back into its proper context. An animal had to die. A life was given. Death had to occur so that you might live. You should have to own that and be responsible for it if you want to eat meat.
In most hunter gatherer societies, the killing of an animal was accompanied by a ceremony that gave thanks to the animal for its sacrifice. There was also a lot of skill and effort expended to capture the animal. When we killed our backyard chickens, we knew which one we were eating by name. We had memories of feeding it and of its personality. Again, this was never a problem. Quite the opposite. The chicken had had a good life by chicken standards. It lived on a farm in the fresh air, was well fed and got to run around and live its life. The life of a chicken.
By now you might be thinking: what’s all this got to do with the corona event?
To revisit the story from earlier. My conversation partner said he would rather go vegan than kill an animal himself. He was, however, perfectly happy to keep eating meat that was killed for him. Another way to frame this is that he was happy to allow death to occur somewhere else where he didn’t have to see it but he couldn’t bear to see it with his own eyes and definitely not inflict it with his own hands.
In my role as amateur historian, I would say this attitude of hiding from or avoiding death became very prominent in our society after world war two. I think there are a lot of factors at play. An obvious one is that the extraordinary amount of death in the preceding decades had caused deep psychological scars. Another is the mass migration of people to large cities where there is simply less death around you as a daily fact of life and your odds of killing your dinner are about zero. As somebody who grew up on a farm but now lives in the city I still notice this because a lack of death also equals a lack of life. There is simply more life going on around you out in the bush.
There are two other factors I want to highlight. They relate more closely to the corona event because they have to do with human death, the medical industry and the public bureaucracy.
Firstly, there was the establishment of national health services and the massive expansion in the medical industry after world war two. In Australia nowadays, 6 out of 7 people who die will die in a nursing home or hospital.
Secondly, the increased size of the health bureaucracy led, as it inevitably does, to more and more regulations. In a classic example of regulatory capture, many of these regulations worked in favour of funeral services so that it is now mandatory in some states of Australia for a family to organise funeral services through a licenced company and where it is not mandatory the regulatory burden is simply not worth the effort for grieving relatives to deal with.
Both of these factors have led to a massive shift in the way in which we are exposed to the death of relatives and friends.
It is well known that spending time with a dead body helps the grieving process. In the Irish Catholic tradition the body would be kept at home for three days during which time family and friends were encouraged to visit to see the corpse and pay their respects. Family members would also be involved in the transportation and burial of the body.
Nowadays, all that is handled by a funeral company. In most cases the amount of time loved ones will spend with the dead body is very short and the system does not make it easy for longer periods to be organised as hospitals and nursing homes do not want to keep the body around and many people are simply unaware that they can take possession of the body and take it home. (Whether people would do this even if they knew is another question).
Although I am not a religious person, it seems to me that this is one area where the decline of religion has left a gaping void. We got rid of the time-honoured ceremonies and traditions that aided the grieving process and replaced them with, well, nothing much.
In a fashion typical of the modern world there is a now a disorder called prolonged grief disorder which is apparently suffered by 15-20% of people who do not grieve properly and suffer long term complications. The cure? Antidepressants.
Surely this is just a symptom of a larger problem in our society: we have forgotten how to grieve. Because we don’t know how to grieve, we have never learned how to deal with death. It seems to me this problem has been getting steadily worse in recent decades.
In relation the corona event, an interesting exercise is to find some news reports from the Hong Kong flu in 1968. Bear in mind that the Hong Kong flu was several times more lethal than covid when you adjust for population size and demographic shift. Despite that, the newspaper reports at the time were almost jovial about it. People had been ‘put on their backside’ by the illness which had done an ‘awkward Grand Tour’ of Europe. Any death counts were factual and unemotional. Compare the tone of those articles to the hysteria around the corona event and I think you get a feel for a cultural shift our society has gone through in the past decades.
I believe our society is now in complete denial of death and this denial of death reared its head with the corona event. There are many examples but the most poignant one in my mind was the absurd discussion around the elderly that was used to justify the lockdown measures.
I don’t believe it’s done consciously, but our treatment of the elderly is also a part of our society’s desire to avoid death. We hide the elderly away in aged care facilities and nursing homes. This might be done with good intentions; old people don’t want to be a burden on their families. The outcome, however, is to remove ourselves not just from the death but from the years leading up to the death. We no longer have the same first-hand experience of what it looks like for a person to become old and die. What would once have been a normal, everyday part of life is now almost invisible to us.
What it looks like to get old is that you rack up a series of chronic illnesses. Health problems that you once got over now stick around. You no longer get over them. You carry them with you. Eventually, something like a flu virus comes along and becomes the straw that breaks the camel’s back.
The corona death statistics bear this out exactly. More than 90% of the people who ‘died from corona’ had at least one co-morbidity. About 50% had four or more co-morbidities. The average age of death was about the average life expectancy. In other words, the people dying from corona were old people at the end of their life. This is perfectly normal. Almost every respiratory virus shows the same pattern.
And this is where things get really weird. Because if you pointed out this simple fact in public you were accused of wanting old people to die, which is a complete non sequitur. The tone of it and the obvious irrationality of it reminded me of the discussion mentioned above about killing your own food. That’s when I suspected that the larger issue of our problem with death was at play in the corona event.
Once again, Nassim Taleb deserves a special mention here because he was a primary culprit and in his case the absurdity is greatly exacerbated because Taleb had previously identified a category of fallacious reasoning he termed, in his usual inelegant style, paedophrasty: invoking pathos towards children to try and win an argument. Apparently, he couldn’t see that to do the same with the elderly is simply gerontophrasty and is no less fallacious for singling out the elderly rather than the young.
Gerontophrasty has been everywhere during the corona event. A thought-stopper. A moral high ground from which to beat back all dissent. Who wants to be accused of wanting old people to die? Who’s going to fight that battle in public?
As it turned out, the measures we have taken completely failed to protect the elderly. The majority of corona deaths occurred in nursing homes. In England there were about 10,000 excess deaths of people with dementia in April alone. That’s just the people who tested negative to corona. How many others tested positive and died. They died because conditions in the nursing homes deteriorated and because family members were not even allowed to visit. The lockdown which was justified as necessary to protect the elderly failed to do so.
I don’t believe the lockdown was ever really about protecting the elderly. It was about protecting ourselves. Avoiding death or at least doing what was necessary to avoid blame for it. A cheap moral posturing that hides a deeper problem in our culture: denial of death.
Denial of death is denial of life. The measures we have taken for the corona event have been a denial of life. We have locked healthy people in their homes. We have made healthy people wear masks. We have put a stop to life in the interests of avoiding death. None of that is a coincidence. It’s a systematic, ingrained part of modern western culture.
I think we deny death because we have never learned how to grieve. I also think we deny death because to ruminate on death is to question what you stand for in life and we no longer know what we stand for. I’ll return to that larger question in the final post in this series.
In the next post, I’m going to take a look at the issue of what it means for sars-cov-2 to be “new”. We’ll investigate the Sapir-Whorf hypothesis, the difference between folk language and scientific language and how that tiny little insignificant word “new” flapped its butterfly wings, the skies darkened and the corona hurricane rolled in from the west.
One of my all-time favourite books is Gregory Bateson’s Mind and Nature. In the first chapter, playfully titled Every Schoolboy Knows, Bateson lays out a list of things that he wished were taught in school. One of them is: science proves nothing.
What this means is that any theory, no matter how well established, can always be overturned by new data which contradicts it. It also means that prediction has limits. Though something worked a thousand times before there’s no guarantee it will always work.
I think of this quote often alongside a quote by Richard Feynman that “science is the belief in the ignorance of experts.” The scientific spirit is always about questioning and searching and probing. It is about admitting fallibility and welcoming correction. Even the greatest expert cannot have the whole picture. There may be something they missed or it may be that the next result simply overturns everything they thought they knew. In fact, what very often happens with experts is that they stop looking and, in fact, stop being able to see what is right in front of them.
That science proves nothing doesn’t mean we can’t trust in it. We can and do rely on scientific knowledge all the time and much of the modern world would be impossible without such knowledge. We can and do rely on everyday physics and chemistry but things get less reliable as we move into the life sciences.
This was a fact well known by the above-mentioned Bateson. The cybernetics and systems thinking movements of the 20th century, of which he was a part, set out to address this and try and put biology and the other life sciences on a more solid, scientific footing.
The trouble with biological systems (and by extension with medicine) is that they belong to what Gerald Weinberg called medium number systems. Medium number systems feature a large number of variables that can’t be easily simplified. Models of such systems are fragile and complex and small errors can magnify and render the whole thing useless. Worse than useless, in fact, because the models can seem to work for a time and this leads to over-confidence. That over-confidence creates blow-ups when the model eventually fails. Weinberg saw the systems thinking approach as being a way to avoid such large failures. It involves a scepticism of models. Such scepticism is, in fact, a natural part of science but our modern “scientific” society seems to lack it. In fact, the corona event represents the opposite of Feynman’s scientific spirit. We put absolute faith in the “experts”.
There is a famous thinker around today whose work touches on some of these ideas and who is especially relevant to the corona event because he took a strong pro-lockdown, pro-interventionist position: Nassim Taleb.
I’ll show later that Taleb violated his own position when it came to the corona event. For now, let me sketch out what I believe that position to be in the abstract. Let me call it: the risk approach.
The risk approach does not concern itself with scientific models of medium number systems because it knows they are subject to blow-ups. Instead, it concerns itself with risk and specifically with exposure. You don’t worry about trying to calculate how bad things will be, you worry about how you will be affected if things get bad. If the worst-case scenario happened, how would that impact you and what can you do to mitigate the risk?
I like the example of earthquakes in this respect. You know earthquakes are going to happen. They happen all the time. You know some are going to big and some are going to be really big but you have no idea when the really big one is coming. How do you orientate yourself around this situation? You implement building codes which require buildings to be earthquake-proof as much as possible. Maybe you prevent building in areas where the risk is highest. You educate the population on what to do in the event of an earthquake. You structure things so that when an earthquake comes you are prepared. This preparation need not involve prediction and science beyond the most basic observations i.e. that earthquakes happen. It can be purely risk-based.
Now here is a key question: as part of your risk-based preparations, do you put time and money into the science of seismology or geology or whatever other science might be useful to mitigate the risk posed by earthquakes? On the surface, this seems like a prudent investment. Why not spend a little money understanding the science better?
Let’s say you do this and the seismologists make what seems like great progress and they invent new technologies that seem to be able to identify earthquakes and predict when they are going to happen and what size they will be. Everybody gets excited and corporations are formed to take government money and turn it into early warning systems with advanced and complex testing run through government bureaucrats who specialise in earthquake management.
As a hardened risk expert, you are duty bound to be sceptical of all this. In fact, you should dismiss it entirely. Models are for suckers. You know that all models of medium number systems are subject to blow-ups. You won’t get fooled by randomness. You’ll ignore the models and the early warning systems and concentrate on risk.
The pandemic preparedness programs and influenza surveillance programs that were set up in the last twenty years were the equivalent of the earthquake early warning system described above. When they sprung into action at the start of the corona event, my expectation was that Taleb and the other risk-based thinkers would be highly sceptical of them. But they weren’t. Quite the opposite.
What happened with Taleb and many, many others is that they believed the early warning system without question. They were told a “new” virus had arrived on the scene. Having taken that at face value, they then proceeded to take all the infection statistics and death statistics at face value. The lack of scepticism and questioning was incredible in a man who has made a name for himself for being the destroyer of intellectual idols.
In the last post in this series I made the claim that what has happened in the last couple of decades is that the virologists and public health bureaucrats ascended and the doctors and epidemiologists were confined to second rung status. Somehow, Taleb exemplified this development perfectly. During the corona event he singled out the epidemiologist, John Ionnadis, for his special brand of ridicule. He made the exact criticism of him described above: models are for suckers. Small errors lead to blow-ups. You’d have to be a fool to listen to the epidemiologists.
What apparently didn’t occur to Taleb was that the virologists themselves are using very complex models and opaque test techniques. If Taleb is going to be sceptical of the epidemiologists, he should also be sceptical of the virologists. There is plenty to be sceptical about.
Setting aside all the problems with even identifying and testing for a virus (see the references in post one of this series for more detail on this), even if you assume you’ve found a virus and have fixed its genetic identity, you still need to know that it’s “new” and herein lies some basic analytic issues.
We are told sars-cov-2 was “novel” because its genetic signature was less than 90% identical to existing corona viruses? Why is 90% the cut off? What if it was 90.5%? Would it then not be “novel”? Given that RNA viruses are constantly mutating, how much genetic shift occurs simply by default? Will “sars-cov-2” still be the “same” in one year? In five years? In short, is it even valid to call a virus “new” based on a genetic analysis alone?
There are so many questions around the whole concept of “new” that I’m going to devote the whole of post 5 in this series to that issue.
For now, it is enough to say that Taleb was fooled by virology. Where he should have been sceptical he unquestioning believed what he was told. Taleb of all people should have been suspicious of all what was happening but he went off with the virological fairies.
It has been joked by Michael Driver that the Taleb position was The Panic Principle (a play on Taleb’s beloved Precautionary Principle). Taleb lost the scepticism which forms the foundation of his risk-based approach. Like so many others, this led him into frankly quite ridiculous speculation with rampant cherry picking of anecdotal evidence. Here is a story about some child getting sick, here is a story about embolism or brain issues, here is a story about how antibody tests results are coming back very low and we won’t get herd immunity. These were neither proper science nor proper risk analysis. Embolism, for example, is also seen in a small number of influenza cases. Shouldn’t we therefore shut society down for every influenza pandemic? Would the risk-based approach tell us to do that?
Taleb might respond to this with his story about how it is better to mistake a rock for a bear than a bear for a rock. In other words, it’s better to overreact to a possible pandemic than not to. But this is quite a useless point. There are always pandemics. Using this criterion we could justify locking down society permanently. Besides which, in this case we didn’t just mistake the rock for a bear, we tripped over and broke our leg while trying to run away. You can only have so much self-inflicted damage like that before a real bear catches up with you.
Viral disease does not exist in the virus but in the relationship between the virus and the individual (medicine) and the virus and the population (epidemiology). To focus on the virus alone is simply a category error.
Our society has not taken a risk-based approach to pandemics. We have taken a scientific approach. That scientific approach has led to a blow-up. The corona event is a huge error due to over-confidence in models that we had no right to be confident about. More specifically, it was faith in one model: the virological one to the expense other ones that could have balanced our perspective such as the epidemiological one.
Given that Taleb did not follow his own principles in this case, is it nevertheless still valid to use the risk approach to deal with pandemics? Is there a way to address risk that doesn’t rely on opaque scientific modelling? There certainly is and it involves forgetting about early warning systems and focusing on exposure to risk.
There are things we could do to reduce our exposure to communicable disease. Among these would be reduced movement of people at all levels. Make population centres as self-sufficient as possible so that when movement is restricted during a pandemic life can continue as normal. Building codes should ensure every building has appropriate ventilation and buildings are constructed from materials known to reduce disease transmission (wood, copper). Never allow public transport to get overcrowded. Reduce population density in general. Reduce lifestyle disease and chronic illness. Other public health measures to improve immune system health among the population. Promote healthy lifestyles. Re-structure the entire health model to move to preventative medicine rather than the current system of pill popping and symptom mitigation.
I’m sure the reader can think of more. Note that every single item on this list is the opposite of the direction our society has been headed in over the last few decades. Is that just a coincidence?
But is this purely risk-based approach the correct approach?
I don’t believe so.
Unlike with earthquakes, biological systems are adaptive. We are not defenceless against viruses. We have an immune system that knows exactly what to do with them. The system is not perfect. It doesn’t guarantee that you won’t get sick. But that’s life.
Over the past twenty years we have seen unprecedented movement of people around the world. In any of the major cities of the world you had people from all corners of the globe going through and bringing their microbiome with them. Has this led to an explosion in disease and illness? Not as far as I can tell. Ironically, people like Taleb flew all around the world without wearing masks or taking other precautions. They deliberately exposed themselves to ‘new’ viruses (viruses that their immune system had never seen before) and apparently never gave it a second thought. Now they are worried about a virus coming to them? That doesn’t sound like proper risk analysis to me.
The truth is, the number of variables at play when it comes to viral disease is enormous. There’s the viruses and their constant mutation. There’s the immune system and its response to viruses: antibodies, T-cells, other things we don’t even know about yet. There’s social and cultural factors around sanitation, body contact, hygiene. There’s issues of the general health of the population: diet, exercise, chronic illness. There’s environmental factors around climate, season, hours of sunlight, humidity etc.
Neither the risk approach nor the scientific approach is a silver bullet. They are tools in a toolkit and must be wisely applied. Simply dismissing one of them in the way that Taleb dismissed the epidemiological evidence is childish and dumb. It’s also incredibly dangerous. In the case of the corona event we relied exclusively on one tool in the toolkit – the PCR test – to the exclusion of everything else. We committed the grave sin about medium number systems that Gerald Weinberg warned about decades ago and put all our eggs in one basket. The result has been a disaster.
A mistake like the corona event is too large to be simply about one error. In my opinion, this is not really about science and it’s not really about risk. It’s about ethics. It’s about how you want to live your life. What you value in life. The corona event goes right to the heart of these matters because what is at stake ultimately is sickness and death.
Steve Jobs once said that he liked to focus on the question of his own death because it forced him to be clear about what was important in life. Maybe as a society we can’t deal with death because we have lost track of what is important to us. I’ll turn to this question in the final post in this series.
In the next post, I want to focus specifically on the question of death, why in modern western civilisation we are in denial of death and why this denial of death fueled the hysteria around the corona event.
Most people might not realise it, but we had practice runs for the corona event several times in the past couple of decades. For SARS-1, bird flu, swine flu, ebola and others, an illness was apparently noticed in hospitals leading to a suspected pandemic. Doctors around the world were primed to look out for symptoms of a “mysterious respiratory infection”. Models were produced predicting enormous numbers of deaths. Large amounts of government money were set aside. And then the problem went away all by itself.
So why was this time different?
There have been two big developments in the last two decades that changed the way we handle pandemics.
Firstly, a global bureaucratic structure was set up to monitor pandemics. Among these was the WHO’s influenza surveillance programs which had the effect of expanding the test infrastructure around the globe. Alongside this public health bureaucrats were being primed to respond to a serious pandemic at various conferences and committee meetings.
Secondly, and most importantly, the PCR test technology became the default for viral testing. Like any technology, it has its strengths and weaknesses but it was a step up from the old cellular testing in terms of speed and accuracy. I don’t think it’s an understatement to say that the corona event could never have happened without it.
Ironically, the man who invented the PCR technique and won the Nobel Prize for his efforts, Kary Mullis, said it should never be used for viral testing and Mullis himself was a strident critic of the biomedical industry.
As an aside: if there were patron saints of science, Kary Mullis would be one of them. I highly recommend his autobiography Dancing Naked in the Mind Field and there are some great interviews with him available online.
So, we had the test infrastructure, the test technology and the public health bureaucracy in place. For past pandemics like SARS-1, we had the early warning system, the apocalyptic models predicting enormous death, the public health bureaucrats ready to get to work. Why didn’t we have a corona event?
There is one very simple explanation: we didn’t have a specific test for a specific virus. Without a test we couldn’t track ‘infections’.
In order to test for a virus, you must first identify it. That is the job of the virologist. There have been some technological breakthroughs in virology in recent times that have made identifying viruses quicker and easier using a genome analysis approach. The amount of time to identify a virus has dropped rapidly. The one man who personifies these developments and who was front and centre for the corona event was the German virologist, Christian Drosten.
Let’s go back to SARS-1 in 2003. On the occasion, Drosten identified the virus five months after the first outbreak of disease was suspected to have happened. At the time, this was considered radically fast. So fast that Drosten won an award for his efforts where he was complimented thus: “the speed with which they succeeded in identifying the new virus…is remarkable.”
Despite that breakthrough in speed, the SARS pandemic was already pretty much over by the time the virus was identified. A few months later, SARS-1 was over entirely and a great deal of money that had been invested in vaccine research went up in smoke.
Fast forward to 2009 where it took six months to find the supposed virus for swine flu and create a test for it. Once again, this was too late in the game. Respiratory virus pandemics usually go up like a rocket and come down just as fast. Five or six months is too long if you want to make a difference.
That all changed with the corona event.
The sars-cov-2 virus had apparently been isolated and a test for it produced by early January, only weeks after the supposed initial outbreak. The China CDC put its own PCR test into use early on. Christian Drosten also came onto the scene and created a test at his lab in Germany. It was available on January 16. For the first time ever, we had a test for a virus at the start of a suspected pandemic.
Let’s review a timeline of what happened at the very start of the corona event:-
Mid-late December 2020: Doctors in Wuhan think they notice an unusual pattern of respiratory illness. These cases are recorded under the influenza surveillance program using the category “pneumonia of unknown origin”.
Note: in accordance with the rules of the influenza surveillance program, the China CDC is notified and they arrive to investigate and collect specimens etc.
Note: all that “pneumonia of unknown origin” really means as far as I can tell, is that they had some people with pneumonia and when they tested for known viruses the tests came back negative. Was this really unusual? It seems that many pneumonia cases are not tied back to specific viruses. The key point in this case seems to have been that there were a lot of unknown cases in a short period of time in the same location. But there are all kinds of questions here. How many cases of pneumonia every year are of unknown cause? If there are many, are all these cases investigated to find a virus? If not, why were these particular patient samples studied? What counts as a ‘lot’ of cases? What scientific criteria are used to determine when such an investigation should occur?
Note: at this point in proceedings there was no test for a virus and so a ‘case’ was defined by clinical symptoms alone. Specifically: “fever (≥38°C), radiographic evidence of pneumonia, low or normal white-cell count or low lymphocyte count, and no symptomatic improvement after antimicrobial treatment for 3 to 5 days following standard clinical guidelines.” Again, there are questions here. These criteria seem very vague and generic. Surely many pneumonia cases would fulfil these criteria. Surely cases like this would come up all the time so why was the alarm raised in this instance?
January 3 2020: Samples are taken from a patient and genetically analysed. A “novel” virus is apparently discovered.
Note: there are all kinds of problems with the use of the word “novel” here and I will deal with this in more detail in a future post. All it actually means is that we human beings had never found it before. Just because we never found it before doesn’t mean it actually is “new”. At this point its newness is just a hypothesis. How could we actually prove that it is “new”? Even if it was “new”, that doesn’t mean it’s necessarily going to cause illness. Nothing has been proven at this point and yet even the article referenced above refers to an “emerging” pathogen. It already assumes the “newness” is a fact. That is at best sloppy science.
Three more samples are genetically studied and tests created to match the genetic pattern.
NOTE: the authors here claim to have “isolated” the virus although they admit that Koch’s postulates or some variation thereof were not fulfilled. This means no causal relation has been proven between the virus and an illness at this point.
January 5, 2020: the WHO releases a statement saying the cause of the illness is still unknown. It states: “The symptoms reported among the patients are common to several respiratory diseases, and pneumonia is common in the winter season; however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.” Sounds like very sensible advice but things were about to take off because…
January 18, 2020: the “case” definition is now updated to include two positive results on the PCR test. This is a crucial change whose importance cannot be overstated. It represents the shift from clinical symptoms to genetic identification of ‘cases’.
Note: this is no longer about illness necessarily. Already at this early period “asymptomatic cases” were known and clinical symptoms seemed to vary widely. We are now talking about ‘infection’. The focus is now on the virus and not on the illness.
To summarise what appears to have happened in the early stages of the corona event:-
Some doctors noticed an apparently high number of pneumonia cases in Wuhan. The Chinese CDC came in to investigate. Based on what appears to be a very low number of samples, they identified a common genetic pattern among patients that apparently mapped to a previously unknown coronavirus. Within about two weeks, a genetic test (PCR) is developed and starts to be used to identify ‘cases’. This test was then put into widespread use and large numbers of ‘cases’ were found.
After about two weeks of such testing, on January 23, 2020 at 2am in the morning, the Chinese government announced it would lock down the city of Wuhan at 10am that day. 300,000 people are said to have left Wuhan in that eight-hour window (are people in Wuhan nocturnal?) and others got out before the highways were closed later that afternoon.
What stands out to me in this story is the speed in which everything happened. When I think of science, I think of slow, methodical, careful investigation. I think of peer review, control testing, blind testing. Normally in science there are disagreements and counter theories that need to be worked through over time. In this case we went from a hypothesised novel virus to shutting down cities in the space of a few weeks.
The truth is something had changed in the way we dealt with pandemics in the last two decades and that change represents the ascendancy of virology at the expense of epidemiology.
That slow and methodical approach is true for the discipline of epidemiology. But it is not true of modern virology. On the contrary, modern virology has been all about speed. Christian Drosten and his ilk have literally made it their life work to find viruses as fast as possible. In this quest they have been in league with the public health bureaucrats who have it in their heads that we must be able to find and respond to viral pandemics as quickly as possible. The problem is that just because you find a virus, even if it is ‘new’, doesn’t mean you have a problem. To know you have a problem requires epidemiology and that takes time. It’s not a coincidence that the epidemiologists were sidelined in the corona event. Other interests were being served.
The influenza surveillance programs, global lab networks, pandemic response conferences were all predicated on fast intervention. An entire system was set up for the purpose of intervening. In the past, it had never been able to justify an intervention because it didn’t have the test data. That was the crucial difference between this pandemic and past pandemics. With the PCR test in their hot little hands, the public health bureaucrats could start to identify ‘cases’, the number of cases seemed to explode and the panic button was hit.
That would have been bad enough but then the media got involved and through them, the public.
Respiratory viral pandemics are literally a yearly event, but they take place invisibly. They come and go without anybody paying them the slightest bit of attention. Remember that influenza pandemic in 2017 that killed 1.25 million people globally? Nah? Neither do I. Might have got a few reports on page ten of the newspaper if it was lucky.
Just as the first Gulf war was the first war to be broadcast live on television, the corona event was the first pandemic to get twenty-four hours a day news coverage and the centrepiece of that coverage has always been the ‘infection’ statistics. All anybody has been talking about is the number of people infected. You get up in the morning and check the ‘case’ count and wring your hands. Nobody thought ask whether any of the people who were ‘infected’ were sick or how sick they were.
Even the early epidemiological evidence for covid indicated that the corona event would be in the range of a severe flu. Symptoms varied widely, there were lots of asymptomatic cases, there were presumably lots of people who never got sick enough to go to hospital. An early case fatality rate of about 1-2% was expected to diminish by an order of magnitude over time as this is what always happens with such pandemics. These predictions by the epidemiologists turned out to be very accurate and covid is on track for a case fatality rate of about 0.1% when all is said and done.
As far as I have seen, there was never any epidemiological evidence that the corona event was something special or unusual. But the epidemiological evidence simply never made it into the public discussion. The epidemiologists were sidelined. One, Knut Wittkowski, was even censored by youtube for daring to suggest a number of sensible, fairly obvious reasons why the lockdown might be a bad idea and might actually be counter-productive to its stated intentions. Why is youtube censoring scientists talking about science now? Is calm, rational, objective disagreement now against the rules?
At various times throughout the corona event I have thought that it represents a failure of science, even a disgrace for science. But that’s too broad a brush to paint with. What happened specifically here is that the virologists and mathematicians (mathematical epidemiology) alongside the public health bureaucrats with their testing infrastructure created a perfect storm. For the first time in history we tracked an apparent viral pandemic in real time. Where they were listened to at all, the epidemiologists pointed out that there was no actual evidence that what was happening was particularly unusual or required radical measures. But they weren’t listened to. The slow, careful, methodical approach of epidemiology could never compete the speed and excitement of the ‘infection’ statistics and the doomsday models.
The corona event represents a watershed in how we react to pandemics. Public health bureaucrats had been just itching to intervene in a pandemic and they finally got their chance. The doctors and epidemiologists were elbowed aside and the virologists and public health bureaucrats ran the show. Whether we continue down this route or correct our course is going to play a massive role in what society looks like going forward. All of sudden, dystopian depictions of authoritarian societies are no longer the realm of science fiction. Will it turn out that Kafka wasn’t really a fiction writer but a Nostradamus in waiting?
To reiterate: the epidemiologists got it right in relation the corona event. Even the early predictions turned out to be accurate. We would have done well to listen to them.
However, there is arguably a weakness in the epidemiological approach and this is highlighted by people who say we should ignore the science and consider a pandemic from a risk mindset.
All epidemiology and medicine can do is look at the early pattern in a pandemic and say that it looks just like this other pattern that we have seen in other historical cases. Most of the time that’s going to be right. But what about when it isn’t? In that case, lots of people might die. That is a risk that comes from the fact that science never proves anything.
In the next post in this series, I’ll examine this statement and look deeper into the claim that pandemic response is not about science but about risk.