argumentation, CDC, Covid-19, Evidence sources, Masks, NPI, Public health, SARS-CoV-2, WHO
— Kevin B Korb, 8 Dec 2020 (Revised 12 Dec 2020)
Here I put together some of the key arguments for some of the important issues concerning the Covid-19 pandemic (alternatively, the SARS-CoV-2 pandemic, since that is the virus causing Covid-19). (Nota Bene: Much of this was written well before the date of publication. Rather than update the content, which would take some time, I now fill it out and publish as is, since I believe it still makes a contribution.)
The arguments themselves are mostly quite simple. The disagreements about the issues largely lie in disagreements about what the underlying facts are, with covid deniers mostly using unreliable sources of information (I’ve had unsourced youtube videos offered as scientific evidence) or misunderstanding statistical reasoning or scientific methods. The fundamental solution, or mental repair work, has to do with learning methods of critical reasoning, properly checking sources, learning scientific and statistical methods, etc. I will point out specific problems of this kind, but readers may also wish to consult general guides to such matters. (I had written one, which Extinction Rebellion deleted without making any backup; I will recreate it someday.)
Some active commentators think that critical reasoning means rejecting anything “the authorities” might have to say, calling this “healthy skepticism”. In fact, it is unhealthy skepticism. Critical reasoning involves testing relevant propositions, neither rejecting them because you don’t like the source nor accepting them because you do. To be sure, critical reasoning is also compatible with this kind of out-of-hand acceptance or rejection on the grounds of time and effort. No one can become an expert in every scientific field, so that’s why we have experts and that’s why sciences and other social activities establish vetting and review processes to test and publicize their own standards for reliability. (If you’d like to learn about critical reasoning, the Stanford Encyclopedia of Philosophy article “Critical Thinking” is a good place to start.)
For my part, I give proper references, unlike conspiracy theorists.
It doesn’t help that both the CDC and WHO have lost a good deal of credibility on Covid-19. The CDC appears to have been captured by the Trump administration and is now taking political orders instead of (or more exactly, in addition to) promoting science-based policy. There are, of course, many good scientists remaining in the CDC, but their bosses are owned politically, with the result that pronouncements by CDC are more suspect than ever before. (See also CDC Director Redfield’s letter to governors of 17 August 2020, effectively announcing vaccines will be considered safe prior to Phase 3 trials.) The WHO depends upon financial support from member nations, with the result that their pronouncements are subject to influence by those nations. The silver lining to the US’s withdrawal from the WHO is that the US no longer has such influence.
Early doubts about masks expressed by US and WHO health authorities were partially motivated by political aims rather than science, such as Dr Anthony Fauci’s publicly stated goal of reserving better masks for health care workers. Unfortunately, he actually said, falsely, that there was no scientific evidence supporting the public use of masks. One of the major principles taught in public health education is to tell the public the truth: losing the public’s confidence is one of the sure-fire ways of losing the public health war. Dr Fauci violated the public trust. That does not, of course, mean that his subsequent statements are also false. For the most part, they appear to be accurate. Similarly, the WHO publicly repeated messages from the Chinese government uncritically, in particular claiming that there was no evidence that covid-19 is transmitted between humans and also claiming there was no evidence that covid-19 can be transmitted by pre- or asymptomatic people (e.g., “WHO Comments Breed Confusion Over Asymptomatic Spread of COVID-19“). Both claims were known to be false at the time. The WHO has, of course, retracted those comments, but only after much damage was done.
Where I reference the CDC or WHO below, I have found their comments to be well sourced in the case at hand; the reader can always follow those sources. I now briefly treat some of the more contentious public health claims about Covid-19.
Covid-19 is not a significantly harmful disease
Covid-19 is both highly infectious and, in comparison with the most common respiratory diseases, highly virulent. The median R0 estimate from a review of numerous other studies (i.e., the expected number of people an infected person will infect without public health measures being put in place) is 2.8 (Liu et al., 2020). That rate implies rapid exponential growth in the early stages of an epidemic; indeed, anything above 1.0 does that, however the larger the number, the more rapid the spread.
Common flus have R0s ranging from 0.9 to 2.1 (Coburn, Wagner and Blower, 2009), which, while lower than that for SARS-CoV-2, is generally enough to cause problems. The main relevant differences between these flus and Covid-19 are: there is considerable partial immunity to influenza through prior exposure in the population; there are vaccines to help protect vulnerable subpopulations; the virulence, in both mortality and morbidity, is far less (multiple studies support an estimate of around 0.5% for the infectious fatality rate of Covid-19; e.g., the meta-analysis by Meyerowitz-Katz and Merone, 2020).
Much of the outcry over public health measures is fueled by a denial that the mortality rates for Covid-19 is as high as some have claimed. The very first point to make is that this claim, even if true, would be insufficient to make their case that the common health measures, including wearing masks, are unnecessary. It entirely ignores the very large morbidity of the disease. To be sure, we do not yet know the long-term damage this disease does to survivors. But the simple-minded assumption that asymptomatic, or subclinical, victims bear no consequences (e.g., Trump claiming children are virtually immune) is, at best, willful ignorance. Instead of that, the growing weight of the evidence is that subclinical victims suffer significant health damage (see, e.g., “Asymptomatic COVID: Silent, but Maybe Not Harmless“,
Schools should be open since children do not suffer significant harm from Covid-19
A recent BMJ study (27 Aug 2020) reinforces others showing that children and young people have less severe acute covid-19 than adults. Some early reports indicated that very few spreading events had been traced to schools; however, that has less evidentiary value than it might seem, since early on many schools were shut, and so could not have been sources of spreading events. Nevertheless, studies have shown that: when infected, children carry viral loads comparable to adults (Jones et al., 2020); children appear to spread the disease and have been the source of superspreader events (Kelly, 2020). Furthermore, the studies showing a high morbidity load for Covid-19 sufferers, including those with few or no symptoms, do not bode well for the future health of infected children. The disease affects every major organ in the body in many cases (e.g., Robba et al., 2020). Imposing those burdens on the children, and on their families and communities, is not a step to be taken lightly. Of course, as with all public health measures, the choice is not automatic; there must be a weighing up of benefits and harms. If the testing and contact tracing regime in a region or country is sufficiently robust, then schools may well be the first institution worth opening up.
Economics trumps health
It is widely and loudly argued that the health of the economy, affecting everyone and especially the poor, should come before the health of the few and, in particular, the health of the old and frail. The welfare of the 0.5% should not be allowed to dictate the lives of the remaining 99.5%.
This argument is fundamentally simply ignorant. The first thing it ignores is the very heavy morbidity load imposed on society by unchecked Covid-19. Subclinical sufferers may continue to work, but only by way of spreading the disease to coworkers. Assuming that’s not what “open economy” advocates have in mind, then subclinical victims will be out of the economy for the duration of their infectiousness only, one or two weeks. That’s around 40-50% of those infected. The rest will be out for the duration of their symptoms, ranging from a couple of weeks to many months. And there’s a very large tail of “long covid” patients who are incapacitated for at least months, perhaps years (Marshall, 2020). The “open economy” option implies allowing the spread of the disease, its consequent damage to the health of a very large percentage of the population, resulting in severe economic disruption for at least the duration of the pandemic.
The alternative view, one endorsed by many economists, is that caring for the health and well-being of society is the first step to sustaining, or rebuilding, the economy. A simulation study of the economics of pandemics by Barrett et al. (2011) directly supports this view. So too does the history of the 1918 Spanish Flu: a study of US cities shows that those which had more aggressive public health interventions, including masks and lockdowns, performed better economically (Hatchett, Mecher and Lipsitch, 2007).
Wearing masks is an individual choice, so the state has no right to mandate them
Assuming masks are effective in slowing a deadly pandemic, and that a deadly pandemic exists, this amounts to the claim that public health interests cannot override individual freedoms. Extreme libertarians might be enamored of such an argument, although libertarianism traditionally does not endorse the right to harm others, which violating mask mandates in these circumstances certainly can do. For example, the Stanford Encyclopedia of Philosophy article on Libertarianism states:
While people can be justifiably forced to do certain things (most obviously, to refrain from violating the rights of others) they cannot be coerced to serve the overall good of society, or even their own personal good.
Infecting others with a deadly disease violates others’ rights, of course. There is no accepted principle that absolutely asserts public health rights over individual rights, or vice versa. Society as a whole, through its institutions and public opinion, must adjudicate particular cases. But the claim of some that their individual freedoms always trump public health orders is simply stupid.
Masks are ineffective
Of course, mandating masks is pointless, an arbitrary and unnecessary restriction of people’s choices, if they have no effect on the disease. However, we have known for around one hundred years that they are effective in slowing and reducing the spread of many respiratory diseases such as Covid-19. The history of the 1918 flu epidemic includes an interesting episode of the response in San Francisco (see also Anti-Mask League of San Francisco). The short version is that mask wearing was accepted initially, and the first wave of the flu was bad enough, but after relaxing the rules a second wave came, when resistance to masks was much greater. In partial result of that, the second wave was far more devastating.
More direct evidence has become available in the meantime. Respiratory diseases such as Covid-19 are spread in the first instance by air, through water droplets ranging from large to extremely small, the former generally being called “droplets” and the latter “aerosols”. There are notable differences between masks, with some being more effective than others. So, any claim that masks are helpful in reducing Covid-19 spread most likely is making some restricted claim about a subset of possible masks. Finding that, say, a shawl or balaclava doesn’t help does not negate the claim.
Most masks have been proven effective at inhibiting larger droplets spreading (see CDC’s Considerations for Wearing Masks)
UCSF has an overview report on the effectiveness of masks that is worth reading, “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus.” To be sure, their update, indicating that valved masks are ineffective is mistaken on multiple points. First, they (along with the CDC and various other health authorities) ignore the simple and obvious point that if you do effective “sink control”, eliminating transmission at the recipient end, then you eliminate transmission. It takes two to tango. Second, there is in fact no evidence that significant (infectious) amounts of SARS-CoV-2 escapes through the valves; this is possible, but the evidence is thin. (Here is an interesting Salon article on this subject.) On other matters, however, the UCSF report is solid, in my opinion.
Masks are dangerous
Granted that masks are effective, some have claimed that they are dangerous. The danger may well counterbalance, or overbalance, the benefits, so, if true, this would make existing mask advice and mandates suspect. On the face of it, the claim is absurd, since medical practitioners have been wearing masks without observed ill effect for over one hundred years. Beneath the face of it, the claim is still absurd. You can read this Fact Check put together by the BBC.
- Barrett, C., Bisset, K., Leidig, J., Marathe, A., & Marathe, M. (2011). Economic and social impact of influenza mitigation strategies by demographic class. Epidemics, 3(1), 19-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039122/
- Coburn BJ, Wagner BG, Blower S. Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1). BMC Med. 2009;7:30. Published 2009 Jun 22. doi:10.1186/1741-7015-7-30 https://pubmed.ncbi.nlm.nih.gov/19545404/
- Gideon Meyerowitz-Katz, Lea Merone (2020). A systematic review and meta-analysis of published research data on COVID-19 infection-fatality rates. medRxiv https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v4
- Hatchett, R. J., Mecher, C. E., & Lipsitch, M. (2007). Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proceedings of the National Academy of Sciences, 104(18), 7582-7587. https://www.pnas.org/content/104/18/7582
- Jones, T. C., Mühlemann, B., Veith, T., Biele, G., Zuchowski, M., Hoffmann, J., … & Drosten, C. (2020). An analysis of SARS-CoV-2 viral load by patient age. medRxiv. https://zoonosen.charite.de/fileadmin/user_upload/microsites/m_cc05/virologie-ccm/dateien_upload/Weitere_Dateien/analysis-of-SARS-CoV-2-viral-load-by-patient-age.pdf
- Marshall, M. (2020). The lasting misery of coronavirus long-haulers. Nature, 339-341. https://www.nature.com/articles/d41586-020-02598-6
- Morgan Kelly (2020). Largest COVID-19 contact tracing study to date finds children key to spread, evidence of superspreaders. https://www.princeton.edu/news/2020/09/30/largest-covid-19-contact-tracing-study-date-finds-children-key-spread-evidence
- Robba, C., Battaglini, D., Pelosi, P., & Rocco, P. R. (2020). Multiple organ dysfunction in SARS-CoV-2: MODS-CoV-2. Expert review of respiratory medicine, 14(9), 865-868. https://www.tandfonline.com/doi/full/10.1080/17476348.2020.1778470
- Ying Liu, Albert A Gayle, Annelies Wilder-Smith, Joacim Rocklöv (2020). The reproductive number of COVID-19 is higher compared to SARS coronavirus, Journal of Travel Medicine, Volume 27, Issue 2, March 2020, taaa021, https://doi.org/10.1093/jtm/taaa021 https://academic.oup.com/jtm/article/27/2/taaa021/5735319