tag:blogger.com,1999:blog-16355954.post124521084677288760..comments2024-03-28T08:57:53.180+00:00Comments on Darwinian Conservatism by Larry Arnhart: The Foolishness of the Coronavirus Panic and Trump's Economic Shutdown: A Darwinian Evolutionary AnalysisLarry Arnharthttp://www.blogger.com/profile/14619785331100785170noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-16355954.post-23879166825069781102020-03-20T18:34:30.658+00:002020-03-20T18:34:30.658+00:00W Bond,
Thanks for these clarifying comments, whi...W Bond,<br /><br />Thanks for these clarifying comments, which do raise some good objections to what I have written. I will have to think more about this.Larry Arnharthttps://www.blogger.com/profile/14619785331100785170noreply@blogger.comtag:blogger.com,1999:blog-16355954.post-46803380449131324672020-03-20T14:17:32.945+00:002020-03-20T14:17:32.945+00:00(continued) Many studies that estimate flu mortali...(continued) Many studies that estimate flu mortality, looks at excess death rates during the flu outbreak, and attribute those deltas to seasonal influenza. This is different than seeing pts directly die from the disease. So, these macro numbers and comparisons are often misleading. Ask practicing physicians how often they see pts requiring prolonged critical care from seasonal influenza? Very rare. In Kirkland 1/6 of a nursing home died in one week. This just doesn't happen during the seasonal flu outbreak -- including all respiratory infections, bacterial pneumonia, etc. Such an occurrence alone would prompt a public health investigation. In the initial case series from China, 30% were infected health care workers. Never would have been confused with the flu. In Italy, 20% of healthcare workers have become infected. Not the flu. The CFR is one thing, the % requiring oxygen, hospitalization, and prolonged critical care is another. The CFR goes up significantly, by the way, if we are one ICU nurse short. Anyone following this outbreak closely could never have made his statement. A grand international medical delusion? No one who can be taken seriously could write the above quoted statement. How then, does he get this so wrong? As you may know, there is a type of radical Evidence Based Medicine that did not develop the RCT, but has elevated the RCT to the only form of knowledge in clinical Medicine. Curiously, they tend to disparage not only common sense and observation, but also basic science in Medicine, even advocating for the the study of pathophysiology, etc to be dropped from curriculum. Ioannidis is the smartest of this school, but comes from this school. He focuses on the Cruise ship data, while ignoring China, Italy, Kirkland (and everywhere else) precisely because he is blinded by his own adherence to a single method. Here he is like the proverbial drunk looking for his keys under the streetlight. Or, if you prefer, he is like Eryximachus in the Symposium. <br /><br />In any case, he demonstrates a profound lack of the virtue of practical wisdom. Calling for better data is one thing, but here it is a cop out. Prudence requires acting wisely in the face of uncertainty, risk, and partial, emerging information.<br /><br /><br />Last, my personal 2 cents. It has been clear for at least one month that two seemingly (but not actually) contradictory statements are likely both true. Any individual's absolute risk of becoming critically ill from COVID-19 will be low. At the same, time the risk that this could overwhelm are medical resources is non-trivial. The CFR goes up in this case, not just from COVID, but from acute MI, hip fractures, perforated viscus, and every other non-COVID condition. I suspect it is difficult, if indeed not natural, for people to hold these two thoughts at the same time. Most responses are either panic or dismissal, where the truth lies in between. Social distancing as a mitigation strategy is for your neighbor, but hoarding behavior means people are doing it for themselves. This epidemic will likely continue to unfold unevenly across the country. When one adds in that it takes 1-2 weeks often for the ARDS to present after the initial infection, I do agree with you that many will likely grow restless.W. Bondhttps://www.blogger.com/profile/11876061563314623223noreply@blogger.comtag:blogger.com,1999:blog-16355954.post-16551665111241968842020-03-20T14:17:02.577+00:002020-03-20T14:17:02.577+00:00A brief note on your sources. First, I like Epste...A brief note on your sources. First, I like Epstein. I own several of his books, read his column, listen to his podcast. He gave a lecture, available on Youtube, "Natural Law in Ancient and Modern Guise" which is outstanding. If you read his column on this topic, however, there is an aside on the HIV epidemic where he gets the history and biology/Medicine completely backwards, I write as someone who was caring for those patients at a public hospital in training pre and post 1996. If he so misunderstands that story, I see no reason to trust his hastily thrown together thoughts on this one. <br /><br />Second: Ioannidis. An interesting case. To date, he is most famous for a single paper. After the piece this week, he may be best known for this one, which has been widely dismissed this week in the medical world as risibly myopic. Many wise rebuttals were instantly written. Here, however, you have not a polymath Law Professor towards the end of his career, but a Professor of (among other things Epidemiology) who is fellowship trained in I.D. at the peak of his powers. <br /><br />Yet, he writes (this week!): "If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from 'influenza-like illness.' If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to 'influenza-like illness' would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams." <br /><br />(cont)W. Bondhttps://www.blogger.com/profile/11876061563314623223noreply@blogger.comtag:blogger.com,1999:blog-16355954.post-3443523854026116512020-03-20T08:51:32.517+00:002020-03-20T08:51:32.517+00:00They are already rebelling by going on Spring Brea...They are already rebelling by going on Spring Break and insisting on holding large gatherings in church, but I thought that was stupidity, rather than people's natural right to rebel.MNewshamhttps://www.blogger.com/profile/17755380114546614331noreply@blogger.com