Can you win an argument with a lockdown enthusiast?

Breaking down a conversation with a former friend

I haven’t written a newsletter in a while, but when a Facebook “on this day” reminder took me down a rabbit hole of COVID-lockdown interactions, I couldn’t put this stream of comments by a friend from my Berkeley co-op days, out of my mind.  I was inspired to dissect his circular arguments because his comments provide a perfect springboard for addressing what we have been hearing for the past two years, and to understand where the roadblocks to communication are. It’s important to continue to look at these arguments, because the COVID-19 response is unlikely to be an isolated example of medical tyranny and we need to be prepared to double down on this illogic. In a series of exchanges, I had presented him with all of the information that went into my article on COVID myths (link below). Pay close attention to how he side-steps the evidence, while accusing me of doing the same.

I will start with this gem he threw at me: “You clearly have no real understanding of public health and its imperatives - or is it that you aren't paying attention? We live in a world where a number of countries have endured the wash of the virus into their territories. In a good number of striking cases, their adept handling of same usually has involved a combination of getting control of the virus (some modicum of lockdown and distancing, and face masks) and contact tracing and ubiquitous testing and that has meant that, now, in real time, they are living lives of relative openness and normalcy. As I've told you, I see my Asia-based friends out in bars, things are completely open. In the right contexts, lockdowns clearly do work, they have. But to be most effective they must be well-engineered and part of a well-architected program.” The author of this comment is highly educated, and in charge of Asian relations for the Development office of an elite university. He often uses his extensive traveling through Asia to give extra weight to his words. What his experience in Asia really gives him is expertise on the culture and the behavior of people there, nothing more. We see words like he threw at me on CNN, NPR, MSNBC… coming out of the White House. People listen to arguments like this because they sound intelligent, despite a lack of substance.

What does he mean when he says “an understanding of public health and its imperatives”? Woven into this statement is a sentiment that we have seen in full force these past years: your personal health is not private, but part of the community’s health; therefore, the government has the right to regulate it. An infectious disease inflates the importance of bureaucrats with  degrees in the vague sociological field that is known as public health, because they can claim that it is imperative that they contain it. From their perspective, preventing transmission takes precedence over all else-including treating the disease. We are told we have to rely on models because we are trying to stop a future spread, rather than treat a disease. Only they can determine what constitutes a threat so severe that “public health imperatives” are at play. If you disagree, you don’t understand; it’s that simple. My friend here defines that imminent threat as many countries having “endured the wash of the virus into their territories”, a flowery way of reiterating the definition of a pandemic. Is there some scientifically determined level of severity that defines “the wash”, at which we agree the potential costs of the response are outweighed by the threat of the virus? Certainly not a mortality rate that is less than 1%, or lower among the young and healthy. These arguments rely on emotional descriptions or out-of-context numbers.

Another telling claim in my friend’s tirade, is that Asian countries have done a good job controlling COVID, something we have heard from bureaucrats and politicians, alike.  As he states this claim, he completely glosses over  the intrusive nature of the strict lockdowns, and invasion of privacies by governments, that were enacted by these countries  (calling them “some modicum of lockdown and distancing, and face masks, contact tracing and ubiquitous testing”).? How do we debate cost-benefit of these strategies with someone who believes a little government oppression, Communist China-style, is cool? His evidence that these strategies worked is that his friends in Asia  are  “living lives of relative openness and normalcy”. I already know that his perspective of normalcy is not the same as mine, given his example of such is a country with an exceptional level of government overreach.

He went on to utter this fascinating straw man wrapped in a scientific absurdity: “The burden is on you to show why these real world examples are somehow irrelevant. This is the laboratory of the world. This is the intellectual battlefield on which this fight should be occurring.” I’ll deal with the scientific absurdity first. The scientific method is guided by paradigms, and a major paradigm in the field of infectious diseases is that asymptomatic transmission is not a significant driver of pandemic spread. The burden of proof, when proposing something that goes against the paradigm, is on the paradigm challenger, not those who are skeptical of this challenge. In this case, you would be required to prove that transmission of SARSCoV2 by people without symptoms (preferably focusing on public spaces) is significant.  Of course, there would also have to be some agreement as to what percentage of asymptomatic transmission would be considered sufficiently significant to warrant imposing restrictions on healthy individuals. Controlled studies (discussed in my earlier article) have shown no secondary infections among the contacts of people who never  experience symptoms (asymptomatic), and less than 6% of total transmission occurring among household or very close contacts of people just prior to symptom onset (presymptomatic). To claim universal lockdowns work, you are required to prove that locking down HEALTHY people results in a lower transmission rate, something that cannot be discerned when both healthy and sick are locked down at the same time. You would have to compare universal lockdowns to situations where only the sick were quarantined.

The straw man in his argument is that I am claiming real-world examples are irrelevant. I have done no such thing; on the contrary, real-world examples are very relevant. I have challenged the idea that HIS real-world examples are evidence for the success of lockdowns. A bit further down he added “don't hide behind a rather specious rendering of ‘scientifically supported’. You've pretty much totally ignored a huge bevy of evidence that shows that a judicious combination of distancing (lockdowns, masks) and ubiquitous testing and contact tracing are effective. Test your own assumptions, Katie.” There is no bevy of evidence showing mandatory mitigation strategies are successful, but part of the problem there is that we haven’t agreed on what constitutes success. The specific paper he presented was this one, which he suggests shows South Korea handled the virus better than the US through “well-engineered social distancing and testing”. In a nutshell, this study consists of an epidemiological model, based on data extracted from public health sources, which they use to estimate cases and deaths, and then plot them vs time.  They then overlay these charts with the dates at which various measures (border control, widespread testing, school closures, mandatory social distancing implementation) were implemented or lifted. They see numbers of cases rise and fall, with no obvious correlation to the measures enacted, but they posit that the rapid implementation of these measures, prior to the spike in cases, resulted in the later decrease. This study was completed in July of 2020. If you look at the pattern of reported COVID-19 cases and deaths in South Korea since the conclusion of this study, you see several peaks in both, all of which are larger than the peak that was the focus of this study. Thus, even the “success” to which they point becomes irrelevant as the disease ebbs and flows over time. If we take the reported numbers from the worldometer at face value, South Korea has had a significantly lower-case fatality rate (not the same as an infection fatality rate) than the US (48 vs 300/100,000), but a similar case-rate. That would suggest that, if there is any difference between the two countries worth examining, it would be in how South Korea handled those who became ill, or the overall health of their population, as they did not differ significantly in the prevention of viral spread. There is absolutely no evidence that any of their mitigation strategies were correlated with the rise or fall of cases at any point in time.

I want to focus now on the statement that the scientific evidence I have presented is  “specious”. This is essentially the accusation thrown at Scott Atlas,  Jay Bhattacharya, and others, by the media and their peers. It’s a trick of the trade among academics-discredit naysayers with a pithy phrase rather than addressing specific points. First, we must ask: what is considered NOT “specious science”? His evidence for the severity of the pandemic is, “Our hospitals are currently undergoing a wave of Covid patients. My wife works in a hospital. These things are real.” We have all heard the personal anecdotal claims, and “friends with expertise” name-dropping. He does not counter my explanation of why case-counting by RT-PCR is faulty, or the importance of distinguishing between died with vs died of COVID. He cites the fact that his “wife works in a hospital”. (She is a physical therapist.) How does he define a wave? How many people constitute that wave? How sick are they? Are they dying? He doesn’t give numbers or even specific hospitals. At the time he wrote this, we both lived in the San Francisco Bay Area; he lives in San Francisco. No hospitals were overrun with COVID patients there. Only 116 San Franciscans under the age of 60 have died with/of COVID since the beginning of the pandemic. In stark contrast, by the end of 2020, 322 people in that same age range died as the immediate result of an opioid overdose, not even counting those who died as a result of the lifestyle associated with drug addiction. (Age-related data on opioid deaths have not been updated for 2021-2022, so I am comparing a single year of opioid deaths to 2.5 years of COVID.) In other words, COVID was not a major cause of illness or death where he lives. He went on to tell me, “You point out all these things which to me are rather obvious, but also irrelevant at this point to the larger challenge we face.” What is the larger challenge? A new world order? Global health? He did not define this. None of them do. The points he calls “obvious but irrelevant” are the damages associated with small business and school closures. Who decides these are irrelevant, and compared to what? We have seen the powers-that-be dismiss freedom as some sort of trivial privilege that only the selfish value.

He went on: “But you are shutting down that debate instead by posting a bunch of esoteric irrelevancies about viral transmission. I'll grab a CDC study that appears to show you are wrong and you give me some esoteric reason why it is weak or incomplete. Enough. That's not really what is at hand here.” This is a fascinating argument because he is referring to viral transmission -the driving assumption behind ALL of the responses to which I object - as “esoteric irrelevancies”. How do you argue with that kind of logic? The sources on which he and almost everyone in control rely are opinion pieces, watered down to be easily understood by the public, or a handful of case studies. As someone who has to read a diverse set of scientific journal articles (from epidemiological to biochemical) in order to run my research projects, as well as analyze data and design my own experiments, I can explain the experimental set-up and hypotheses tested in these articles he finds too technical (aka esoteric) to understand, but this he writes off as “shutting down the debate”.

An article he presented to me as evidence that lockdowns are essential, and that the Barrington Declaration approach of protecting the vulnerable is flawed, is this opinion piece published in The Lancet. The authors make number of statements with no data to back them up, followed by a series of straw men. To defend their argument for more government control, the authors state, “The infection fatality rate of COVID-19 is several-fold higher than that of seasonal influenza, and infection can lead to persisting illness, including in young, previously healthy people (i.e., long COVID).” The reference for claiming COVID-19 fatalities to be so much higher than seasonal influenza is an epidemiological model, based on 24 deaths in Hubei, China early on in the pandemic, when only severely ill patients were readily identified as cases. The study did not look at influenza deaths, but merely mentioned them in the discussion section, citing two articles conducted on the 2009 H1N1 epidemic that used a completely different means of quantifying cases (antibody positivity) and a different method for quantifying deaths (estimating flu deaths from  excess mortality data for that year). It is a fine comparison for an author to make in the discussion section of a study, but it is far from a proven fact that can be then used to defend strict limitations on individual freedoms. Citing this article when defending policy, is greatly inflating the intended reach of a minor point in the discussion section of a paper. It would have been possible, during this pandemic, to get closer to such a comparison, by universally testing for influenza by RT-PCR along with COVID-19, and quantifying flu deaths in exactly the same manner that COVID deaths were quantified --but we did not do this. The article they cite as evidence of persistent illness (long COVID) is a story in the news section of Nature magazine suggesting that the definition of COVID symptoms be changed to include any persistent effects patients report having. It contains no data showing the frequency of such symptoms or their connection to COVID.

This article goes on to attack the “protect the vulnerable stance”, conflating it with advocating for herd immunity. This is a giant straw man. Protecting the vulnerable, i.e., elderly and those with co-morbidities, is a sensible approach to combating a disease that only presents a threat to those groups. The reason for allowing others to live life normally, is that this is a healthy approach to public policy. Going to work and school, exercising, socializing-these are all parts of a healthy existence. Economic viability is crucial to public health. Those are the benefits. The risk for those in the healthy population, going about life as normal, is potentially contracting a virus that does not pose a grave danger. A possible outcome of that approach is herd immunity, which is not a bad outcome, but it is not the goal. The goal is a healthy existence. If their argument is that  this approach risks the healthy infecting the vulnerable, that is why we advocate for protecting the vulnerable.

The CDC “study” he cited is a loose correlation between positive tests and a single choir practice in a small town in Washington state. On the surface, one might think that this is similar to the study I frequently cite that took 100 positive subjects and identified as many of their contacts as possible, to assess the rate of transmission. However, what the CDC reported was COVID positivity and symptoms in 78 choir members who had all attended a practice with an individual who had symptomatic COVID-19 (3 days after his symptom onset). The report claims 53 people became ill, but this is a loosely-defined statement based on phone interviews with people who reported a variety of symptoms from mild fatigue to a fever and pneumonia. There were 33 people who actually tested positive, only 6 of whom developed significant respiratory symptoms, one being the original patient. This CDC report was actually consistent with the one I mention above, in which the majority of secondary infections came from a handful of individuals with more severe symptoms. The difference is the studies I provided work from the other end-taking COVID positive individuals and determining how many of their contacts become infected, which allows for statistical analysis. This study essentially looked at transmission from a single symptomatic individual at a single event. If the choir director used that experience to shut down his own choir, that is a rational use of the findings, especially given the advanced age of most participants. For the government to use it to enact universal mandates is unscientific.

In conclusion, my reasoning, that I have repeatedly laid out for this friend, has always been that the COVID-19 responses (lockdowns, mandates, etc.) are predicated on several false premises which I discuss in my previous article:

1) That asymptomatic transmission is a major source of the spread and it readily occurs by transient interactions in public spaces (e.g., standing in line, passing each other in a grocery store aisle, sitting at different tables in the same restaurant). This assumption goes against existing paradigms on respiratory viral spread and studies on SARSCoV2 found negligible transmission in the absence of close contact with a symptomatic individual.

2) That a positive RT-PCR test with very low stringency in terms of cut-off (i.e., counting a reaction that took 40 cycles to generate a product as a positive test) indicates an infection even in the absence of symptoms. For most of the tests used, 40 cycles detects less than 2 copies of virus per microliter, which is below the lower limit of detection, and below what can be shown to demonstrate measurable infectivity.  In other words, you may or may not be infected if the cycle threshold for your test is above 30.

3) That the mortality count accurately reflects people for whom SARSCoV2 was the sole cause or primary cause of death. The CDC acknowledged that less than 10% of those listed as COVID deaths had no other condition that was a clear cause of death, and admitted later that at least 25% of the deaths originally scored as COVID deaths were unrelated to the virus. While it is unlikely that COVID had nothing to do with over 90% of the deaths reported, it is also likely that far more than 25% of the reported deaths were primarily the result of underlying conditions rather than COVID-19. My conjecture here is based on the fact that many of the comorbidities associated with COVID-19 have life expectancies below 1 year; nearly 14% of individuals over the age of 80 die each year and the overall yearly survival rate in most nursing homes is below 70%. The “experts” also assume that the number of deaths were not increased because of their actions (such as encouraging people to avoid the hospitals until their oxygen levels dropped, preventing doctors from using early treatments, sending infected patients back to nursing homes, and preemptively putting patients on ventilators).

This is not specious science or shutting down debate. This is the debate people like my friend do not want to have.