Ah John, this issue re-emerges... I had half hoped it was in perpetual sleep mode.

I won't try to further explain the CDC's report. Tomorrow we will hopefully have a new weekly version, and we may have a better idea of the number of flu cases, hospitalizations, and deaths.

While I still believe that the CDC is one of the best sources of epidemiological data, I understand all too well how deeply the CDC has been impacted by the reckless indifference to scientific method of the current potus.

The problem from my perspective, is that if there is political influence being exerted it is most likely to be to minimize the threats of flu and most certainly Covid-19.

But, let's consider something that we have not addressed. The utility costs of efforts at containment.

We both agree that more than normal efforts need to be made to prevent Covid-19 from becoming a pandemic. I suspect we both also tend to think that that particular train has left the station.

But SHOULD we engage in "radical" efforts to stem the spread? Here, we need to consider at least actual economic costs, as opposed to mere academic reputation costs. There are also human suffering costs - but I don't know how to qualify them, and both action, and inaction will have different sorts of human suffering costs.

The Chinese appear to have successfully stemmed the development of new cases. Personally, I have some doubts that they have been as successful as the data indicates. But the costs of their success have been extremely high. But China is a centrally organized economy. Quarantining millions of people, closing factories, restricting travel, were relatively easy compared to implementing the same approaches in the USA. The UK, on the other hand, has already achieved considerable isolation, as a result of the withdrawal from the EU.

If donald trump were to follow the path of President Xi in China, and try to restrict domestic travel, close factories, close schools he will face a huge cost politically and huge resistance. First, because such government intrusion into the private choices of American citizens is anathema to his own political party and fan base. Second, because the impact on the economy would be quite severe, potentially leading to a deep recession, collapsing the DJIA/NASDAQ stock markets, and in a short 8 months, he would be facing the same economic collapse as GWB at the end of his 8 year reign of terror and poor economic policy.

Then too, and I suspect of far more concern to this particular narcissistic potus, he has a very great personal stake in the matter. If, as has been done in China, travel restrictions, cancellations of large meetings of people, and extensive quarantines are implemented, his own business interests will suffer dramatically. Since, much like Ponzi schemer Bernard Madoff, trump's personal fortune (?) is largely debt and investor financed, any dramatic reduction in revenues to Trump Inc will impact both his actual wealth (?), and perceived business acumen. A personal/business bankruptcy would have huge economic and political costs.

Now, given that widespread quarantines, business shutdowns, increasing unemployment, possible economic collapse, stock market price declines, all of which will operate synergistically, on a downward spiral will have extremely grave consequences throughout the world, the question is not whether the final lethality rate, calculated decades from now, will be 0.2% or 20%, but can we statisticians help policymakers make the right call, right now?

The problem for policymakers is not whether there are 310,000 hospitalizations, or 172,000 hospitalizations, or whether the relative lethality rate compared to the flu, is 0.2% or 20%, but do we implement Draconian measures with grave economic consequences when it may be shown to have been unnecessary 20 years from now, or do we fail to implement Draconian measures now, risking even graver consequences that will also only be known with certainty 20 years from now?

Worse still, even if the rapid implementation of Draconian measures seems like the best choice now, there is the added difficulty that it could well be that the Draconian measures could conceivably exacerbate the situation.

To the degree that we indulge in largely academic argument about sources of data and the accuracy of estimates, we encourage troglodytes like donald trump, to ignore scientific data completely on the basis that there is significant disagreement among informed people. Here I consider donald trump's flat out denial of anthropogenic climate change, despite overwhelming consensus in the scientific community.

So, in particular, I tend to believe that statisticians who are proactive, skeptical about government statistician's performance, and who are willing to sound alarms are crucial at this moment.

In the US, it will clearly be difficult to get donald trump to implement Draconian measures. He will absolutely resist making any decision that will have certain known consequences that would lead to his exit from the white house, in favor of dragging his feet, and betting on the measures not being necessary. Donald trump has always been willing to take risks with other people's wealth, and well being. So, it will take an enormous amount of influence to get him to make the right choice, whatever that choice might actually be.

Here, I am always guided by Woody Allen's dictum:

“More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly.”


Thomas Cox PhD RN
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