Streetwise Professor

April 9, 2020

Bullshit Numbers

Filed under: CoronaCrisis,Economics,Politics,Regulation — cpirrong @ 3:00 pm

You are seeing a lot of covid-19 numbers thrown around. Virtually all of those numbers are bullshit.

The death rates are bullshit. In a given country, there is considerable subjectivity regarding how deaths are qualified. The Great Scarfini* (Dr. Deborah Birx) pretty much let that cat out of the bag when she acknowledged that not only are the decedents who test positive (regardless of other co-morbidities) declared as covid-19 deaths, but those who have some colorable connection to covid-19 (clinical presentation, exposure to someone who tested positive) are declared to be covid-19 deaths.

It is likely that hospitals and physicians–and politicians–have an incentive to attribute deaths to covid-19. These incentives can be financial (a hospital could get greater compensation from covid victim than someone dying of something else) or power (death numbers are being used to justify draconian restrictions).

Further, different countries use different methods to count deaths.

What we are really interested in is people who would not have died but for covid-19. The official death statistics do NOT do this. And the fact that virtually all of the dead are aged and/or have multiple serious health problems, a but for attribution is dubious even in the presence of a positive test.

The only rigorous way to estimate these but for deaths is excess deaths (i.e., deaths in excess of expected deaths, conditioning on time of year, demographics, etc.). And preferably excess deaths from respiratory illness (or at least excess deaths from non-accidental causes). This is a good template for the analysis. This also presents some good cross-country data, which shows that in Italy and Spain there is evidence of excess deaths. Elsewhere? Not so much. Of particular interest is Sweden, which has implemented mainly voluntary social distancing measures, to the hysterical response of those deeply invested in mandatory lockdowns.

Do this for a variety of jurisdictions (countries, states in the US) and you would have enough cross-sectional and time series variation to do some real analysis that could provide reasonable support for policy decisions..

The case numbers are bullshit, at least if you want to measure infection rates. As I’ve been saying for weeks, there are so many selection biases that the numbers tell you NOTHING about the prevalence of the virus in the population, either at a point in time or crucially over time. Indeed, the CDC guidelines could be titled “How to Produce a Wildly Biased Sample”:

This testing protocol could be justified on clinical and diagnostic grounds, but it is a disaster from the perspective of generating data that is useful in shaping policy.

Further, trends in positive test numbers is driven to a considerable degree by . . . a greater number of tests.

The graphs that you see depicting trends deaths or cases across countries over time are bullshit. They are bullshit because the inherit all the flaws of the data discussed above (exacerbated by the fundamentally different data reporting methods across countries), and they almost fail to adjust for population size or demographic characteristics.

Chinese numbers are obviously bullshit. No need to elaborate this point.

The models that are being used to drive (or at least justify) lockdowns are bullshit. Their predictions went from apocalyptic to well, a small fraction of apocalyptic. Sometimes between one day and the next. Models should be evaluated on predictive accuracy. The predictions of these models have proved to be excessively pessimistic, i.e., bullshit.

And don’t buy the line that the lockdowns reduced the death tolls. For one thing, many of the models’ predictions included the effects of social distancing–and still came out way too high. For another, many countries’ death and case rates (above caveats apply) peaked before the lockdowns could have had any effect.

I keep hearing the IHME model referred to as the “top model.” Who says? On what basis? Basically because somebody else said it. And oh, Bill Gates is somehow involved. So that claim is bullshit too.

Also be very suspicious that the modelers are very opaque. We don’t see their assumptions or their methods. Notoriously, the most influential modeling team (at least initially) that did more than any to spark the panic, has not released its modeling code.

At least the honest modelers admit that social isolation and shutting down the economy doesn’t change the integral under the curve (i.e., the total number of deaths) but merely the time pattern of those deaths. And some epidemiologists claim that extending the period of time before the burnout may result in a higher number of total deaths.

But even putting that possibility for a higher total toll aside, the argument is made that it is necessary to “flatten the curve” in order to reduce the burden on the healthcare system. Well, one thing the models vastly overpredicted hospitalization/ICU visits as well. And I have yet to see any evidence of systematic shortages of ICU beds/ventilators. Yes, there are hotspots. But that just means that we need to understand the hotspots–and the non-hotspots–better.

Along those lines, I can’t say the numbers on ICU utilization are bullshit–because the numbers are largely non-existent. Instead we’ve had anecdotal journalistic (i.e., “if it bleeds it leads”) accounts that provide no objective quantitative standard by which to evaluate how binding the constraints are in the healthcare system.

But again the issue is cost-benefit. Basically what lockdowns do is discount future deaths/cases relative to present deaths/cases (since they accept an approximately equal number of future deaths for each death that does not occur today). And the discount rate is huge. We are losing trillions of dollars in lost output/income to push some deaths into the future. The interest rate is astronomical. Put differently, we are paying an immense price to kick the can down the road.

I understand the the supply of ICU beds, ventilators, physicians and nurses is pretty inelastic over the short run. But even given pretty substantial inelasticity, it would be far more efficient to throw billions at expanding capacity in the short run than to sacrifice ~25 percent of world income to reallocate the deaths over time. Capacity is not a fate. It is a choice.

And the fact that well into the crisis the foretold capacity disaster in hospitals has not been realized, the additional capacity required may well be quite small.

There is also the issue of how much the temporal pattern of deaths will really change. This depends on a variety of factors, including when the virus first spread and its virulence. The more we learn, the more likely it is that the virus has been spreading since late-fall/early-winter 2020. Which means that the lockdowns are reactive, not proactive, and that they have little impact even on the time pattern of deaths let alone the number: they are the proverbial locking the barn door after the horse done bolted.

In brief: our betters are destroying futures based on bullshit data. It’s as simple as that. And they are vastly increasing their power as a result, so they are destroying freedoms too.

In an earlier post I said that we have to grasp the nettle and decide what price are we willing to pay to save a life (usually of an aged, ill person). But it’s actually worse than that. It is very likely that the real question is: how much are we willing to pay to defer a death (of such a person) a few months? The cost that those who govern (or rule) us (and those who support them) are apparently willing to pay is astronomical.

*Dr. Birx is always adorned with a scarf. On my first trip to NYC in 1978, when NYC was near its nadir, I saw an obviously psychotic individual dancing on near Grand Central Station waving around a long scarf. Every once and a while he would shout “I AM THE GREAT SCARFINI” and then start dancing again.

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  1. Bullshit it is, but it’s runaway political bovine fecal material, not medicine.

    I found this interesting from AIER.

    Comment by The Pilot — April 9, 2020 @ 3:30 pm

  2. On average, 420 people die per day in NYC. I don’t know what the range is around that average.
    But it would be informative to know how that average changes over time (for instance, it must be somewhat higher during a normal flu season), and if any or all of those deaths are now lumped in as Wuhan Flu victims.

    Comment by Richard Whitney — April 9, 2020 @ 4:21 pm

  3. Have a look at Hector Drummonds site, he’s done great work sifting through the numbers for the UK.

    Numbers being reported are almost entirely ‘died with Covid’, there is no effort to accurately report actual causation. Quackery is in full flight, and anyone who questions it is vilified.

    More and more, I think there is just as much truth in the Chinese numbers as there is in any others.

    Comment by David Moore — April 9, 2020 @ 7:59 pm

  4. Very interesting. Sure seems sensible to me. My questions then become:

    1. How complicit is Trump on this failure?
    2. Who really owns this issue? I don’t think anyone in the CDC participates in Trump’s press conferences. (I could be wrong) I never heard how BIRX and Fauci got pulled in.
    3. Do any states do this? If not, why absolutely none of them? Are they too beholden to the Feds?
    3. I’ve said this before, but it seems like this is a straightforward way to do this, so what have they been doing all these years besides woke crap?

    Regardless of any answers, I don’t get any sense that the bureaucracy was ready for any of this. I thought the Department of Homeland Security was supposed to have biological attack plans which could be morphed to help with this, the CDC had a tried and true statistical regimen, and hospitals actually had emergency supplies. Apparently, it is, to coin a phrase, all bullshit.

    And to top it all off, I’m still freaking out whenever I get near anyone when there’s only been 44 deaths in Oregon, a pittance.

    Comment by Howard Roark — April 9, 2020 @ 8:08 pm

  5. @David–one of the links in my post was to Drummond’s site.

    Comment by cpirrong — April 9, 2020 @ 10:00 pm

  6. You raise very good points in your posting, and I suspect we have all seen various postings/articles over the last months raising the same issue. What is surprising to me is how little public attention has been paid to these in the debate that swirls around us. Its almost like we now inhabit a country different from that of a few months ago wherein we all were aghast at our excessive national healthcare spending, were disappointed in the outcomes, complained about our individual healthcare providers, and collectively filed countless malpractice suits against our medical professionals. But now nowhere does there appear to be any skepticism regarding the dominant narrative, nor does there appear to be any ability to ask basic questions as to why different environments are yielding different mortality outcomes. Sweden and Germany have never gone into lockdown mode and are doing very well, and Austria I have read is lifting its lockdown. There are seven or eight states in the US that haven’t gone into lockdown mode, but are also doing quite fine. When one looks at the US, we find that NJ and NY –which together are home to slightly under nine percent of the US population– consistently (over the last 1.5 months when I have been spot checking this) account for slightly over 50% of both the Covid-19 cases and fatalities. When one looks into the (very) limited info available on the locations of the cases in those states, one sees a concentration in lower income areas. This causes me at least to wonder if the issue is tied to deficiencies in the public healthcare infrastructure in those areas as opposed to the usual explanations so glibly tossed around.
    I mention these items because we need to recognize that slightly more than half of this national problem is confined to a relatively small geography and that the remaining 91% of the country can start the process of re-opening their local economies while understanding that NJ and NY may need different solutions and timetables for the issues they face.

    Comment by MM - WA — April 9, 2020 @ 10:25 pm

  7. Ha! Way ahead of me.

    I agree on the health care capacity issue. It’s really confused me to where the idea came from that all life must be put on hold due to ‘health care capacity’. You will notice on all the ‘flatten the curve’ graphics floating about, the capacity line is always flat.

    I can’t understand why expanding the capacity wasn’t the first priority before shutting down the entire economy. My home, NZ, is going to spend at least three years of health care spending this year on just surviving the economic meltdown. The loss in economic value will actually reduce health care spending for decades.

    Comment by David Moore — April 10, 2020 @ 6:19 am

  8. SO. WHAT ARE WE THE PEOPLE DOING ABOUT IT? Can’t calll the White House, but you can leave a message. CALL YOUR SENATORS! Any other suggestions? Are we just going to sit around and make comments to each other?

    Comment by shannon mcgraw — April 10, 2020 @ 7:57 am

  9. Ah. I will not feel very hopeful until I hear this sort of talk coming from the White House. Every day I see Fauci and Birx on TV, I grow less confident that my country has not been overthrown.

    Comment by jbspry — April 10, 2020 @ 8:10 am

  10. @Howard Roark–I think Trump buckled. I think his instincts (and he is intensely instinctual as opposed to intellectual) were/are correct. His aspiration to reopen things this weekend (Easter) was a strong indication of his instincts. But the onslaught of panic and the public health priesthood’s cataclysmic predictions overwhelmed him. He is obviously unafraid to confront the establishment on intensely partisan issues, but here he found himself in a completely novel and unexpected situation where the partisan lines were/are not at all clear. So he joined the herd. I can understand, but I am disappointed nonetheless.

    That said, I don’t know what he could have done. This crisis has given governors and mayors and hick and hack county judges powers that they could have only dreamed about in 2019. Many have seized it with a relish, and given our federal structure there is likely little Trump can do to oppose them. Indeed, if he tried these fascists would use his opposition to feed the partisan flames and justify grabbing even more power.

    As to who owns it–remains to be determined. It will depend a lot on how it plays out. Numerous duplicitous politicians (but I repeat myself) have done 180s on previous positions (cf. Nancy Pelosi). However things play out they will try to blame the opposition and who knows how that will shake out.

    You are absolutely right re the bureaucracy. It failed. See my post from early-March.

    Comment by cpirrong — April 10, 2020 @ 9:06 am

  11. The UK Cabinet Office estimates 150,000 premature / avoidable deaths from other causes in 2020-2021. More suicides, less cancer treatment, lat presentation at A&E. etc.
    Translated to the US that would be about a million.
    That million is the equilibrium point. More than a million CV19 deaths predicted, something should be done. Less than a million and the shutdown is not only trashing the economy it is actually killing people.

    Comment by philip — April 10, 2020 @ 10:05 am

  12. Richard Whitney- Comment # 2 above. Your numbers for NYC mortality are mistaken. 420 deaths per day is 153,000 per annum, almost 3x the actual rate, see The correct number of annual deaths from all causes for the years preceding 2020 has been under 60,000 per annum, or 165 per day. In the last two weeks coronavirus mortality in NYC has been well above 200 deaths per day, exceeding by itself all normal causes of death combined. This number needs to be adjusted downward by the number of coronavirus deaths incorrectly attributed to coronavirus rather than an ‘underlying cause’ but the picture is still serious.

    Comment by mark — April 10, 2020 @ 11:18 am

  13. Thank you so much for this post…I hope it gets a ton of views on Powerline. I have questioned a lot of these numbers and models from the start of this in China (and have the term bullshit multiple times)! I am just a dumb architect in Oregon, and although we have been lightly touched by this, the State is still using the IHME modeling for a peak on April 20. I can read a bar graph from the State’s own Health Authority stats(which they withheld at the beginning of March), and we peaked around March 20th. There has been a narrative built that we can’t question science and ‘medical professionals’. Why not? Ultimately, we need to keep pushing back on the cooked statistics and hype, and not be afraid of being called insensitive and uncaring. I pray that this was just an exercise in extreme caution and not something more sinister.

    Comment by trailblazer — April 10, 2020 @ 11:46 am

  14. Fauchi,the Westmoreland of Covid-19.

    Comment by Paul C — April 10, 2020 @ 11:50 am

  15. @Paul C–Very good analogy.

    Comment by cpirrong — April 10, 2020 @ 1:54 pm

  16. @trailblazer–Thanks.

    Re questioning medical professionals: I said on Twitter that just as war is too important to be left to the generals, pandemics are too important to be left to the public health establishment.

    The reason for this is that these individuals have a monomaniacal focus on one thing: deaths/cases. They are not capable of, or incentivized to, pay attention to trade-offs. Leadership is about making choices that have broad ramifications. Making the tough choices, in other words. Specialists are, well, specialized, and are incapable of and not incentivized to trade off their speciality against other things.

    As for caution vs. sinister. At present, the implications of these are observationally equivalent. It could go eithe rway.

    Comment by cpirrong — April 10, 2020 @ 2:00 pm

  17. @phillip–It will not even come close to 1 million. It might not be within an order of magnitude of a million.

    I said in an earlier post that if you shrink from trading lives for $, think of trading lives for lives. There are definitely mortality implications of a new Great Depression. And as you note, I don’t think the trade-off is a good one.

    Note further the point in my post. Re the virus specifically, we are basically trading deaths today for deaths tomorrow. When you take into account the excess mortality from an economic catastrophy, the accounting goes very much against these draconian measures.

    Comment by cpirrong — April 10, 2020 @ 2:05 pm

  18. This comment, based on UK data, argues against the assertion that co-morbidities are driving reported Covid-19 deaths, although I would dispute the idea that “able to function without assistance” indicates “pretty healthy”

    Other than that, I agree with what you have written.

    Comment by dcardno — April 10, 2020 @ 4:12 pm

  19. This has been a missed opportunity to bump off the old folk who are costing health services a fortune anyway. In any case, it’s the old and the weak who should be confined to their residences, which is perfectly feasible given the technology we already use for ankle bracelets on released prisoners. As a student of the great plague of the 14th century you will recall that Milan had the lowest mortality of any major city thanks to the tyrant’s policy of walling up any house where someone exhibited plague symptoms. Death by plague or death by starvation may seem a bit harsh but statistically it worked. I wouldn’t go as far as the Visconti, however. I think it would be perfectly feasible to introduce a feeding tube through the letterbox and funnel grub to the likes of me in the same way as farmers feed geese for foie gras.

    Alas, the public, dripping with the sentimentality of the age, appears to reject this solution. And the government is not yet authoritarian enough to impose it. Oh well, there’s always next time.

    Comment by philip — April 10, 2020 @ 6:19 pm

  20. @ Streetwiseprofessor
    Where do you get the idea that this thing has been around since early winter. Evidence?
    Also it is pretty clear that there is a difference in CFR for normaly operating Hospital capacity and a Triage based Environment – the integral under the curve is definitely NOT constant.
    BUT: the Focus on mortality is entirely besides the point, it is the high number of hospitalizations that is scary About this thing (About 5 percent of infections)
    And in Austria reported cases and fatalities do follow precisely the forecast pattern afer lockdown (my own simple model worked pretty well).

    You might be interested in the results of two Austrian randomized samples, released yesterday. From what I can see, that’s better than Nothing and most speculations on the web and in the comment section here.

    In Austria there have been two random studies conducted so far (sample size about 1500 each). Austria ist the first country in continental Europe to come out with such a study (Island is the famous other country in Europe). One sample focused on professions assumed to be at high risk of infection (health care, supermarket employees) whereas the other aimed at getting a representative sample for the enitere country.

    First the results of the random study whose results were released yesterday:
    About 0.33 percent of the population infected, or 28.500 people vs. 8.500 confirmed cases at the time (about 10 days ago), (95 percent confidence intervall: 10.200 and 67.400). As of today there are slightly more than 300 fatalities which equates to a CFR of around 1 percent – Austrian hospitals are not overwhelmed with capacity similar to Germany.

    One week ago, the results of another random study was published that focused on professions at risk:
    Result: 0.5 percent of health care workers were infected but, interestingly, out of 350 tested supermarket employees NONE were infected, suggesting the virus might be less contageous under certain circumstances than generally assumed. At the time of the study masks in supermarkets were not compulsory (they have become so since April 6th)

    I am surprised that there have not been any randomized studies conducted in the US so far – Island had one three weeks ago..

    Comment by viennacapitalist — April 11, 2020 @ 3:22 am

  21. Since the policy debate is essentially lock-down vs no lock-down, you’ll no doubt have the chance to more fully explore the latter when Trump and/or the States eventually (& reluctantly) agree to lift their shelter-at-home instructions, save they irreparably trash your economy and cast millions more Americans into unemployment and poverty. Given Covid-19 will still be circulating in the population, you’ll find out soon enough whether these model’s ‘no-lock-down’ projections were overblown.

    Comment by David Mercer — April 11, 2020 @ 9:49 am

  22. @viennacapitalist You probably heard about the study conducted in Heinsberg in Germany. It was widely reported in the UK, but I’ve just read that its findings are being questioned due to the accuracy of the test (quelle surprise).

    In the UK they are reporting three metrics on a daily basis: hospital admissions who tested positive, Covid hospital ICU admissions and Covid hospital deaths. Community Covid deaths (e.g. care homes) are added roughly weekly. Whilst by no means perfect they do give a good indication of our direction of travel. What would be helpful would be if they could somehow strip out deaths due primarily to patient’s age or underlying causes i.e. people may well have died within the next say 12 months anyway. I suspect the reason this isn’t done is that our Govt is keen to ensure we stick with the programme and don’t err. Quite how long people will/can is being actively debated.

    PS Its Ireland not Island.

    Comment by David Mercer — April 11, 2020 @ 10:01 am

  23. David

    It’s actually Iceland, not Ireland. Or Island.

    Whatever happens, lockdown or no lockdown, this virus will remain with us. We have to learn how to deal with it. The one way we should not deal with it is to, as some health experts (a word are use advisedly) are advising: lockdown for 18 months

    Comment by Recusant — April 11, 2020 @ 10:40 am

  24. @ David, I am familiar with the German study – it is not representative, I.e. it overestimates actual infections for certain, as the study authors keep pointing out themselves.
    In Austria there are hot spot villages around ski resorts which have about 15 percent confirmed cases- not randomly measured.
    Apart from the fact that the 15 percent, even if representative, still would be a far cry from herd immunity.
    The Austrian and Icelandic data are the best we have so far, as imperfect (sample size) as they are.
    There is no way this thing has been circulating for months…I haven’t seen a shred of evidence…

    Comment by Viennacapitalist — April 11, 2020 @ 11:16 am

  25. In Iceland, it is Island.

    Comment by The Pilot — April 11, 2020 @ 11:50 am

  26. As a further indication the numbers are bull crap, sewage analysis.

    Comment by The Pilot — April 11, 2020 @ 1:17 pm

  27. @Viennacapitalist – yes, those numbers don’t look encouraging. And if those reports of reinfections in Korea are true, then herd immunity may not be achievable anyway.

    Comment by David Mercer — April 11, 2020 @ 4:15 pm

  28. Great article, but could you edit it so that it’s easy to read? I keep wondering what different words were supposed to be.

    Comment by Ruth Castle — April 12, 2020 @ 1:43 pm

  29. I read that during Spanish flu, the social distancing /quarantine kept deaths much lower in st Louis vs Philly. Was that not the case?
    Also, wouldn’t delaying deaths until widespread testing, an anti viral, antibody tests etc are available have potential benefits as well?

    Comment by shaq fu — April 13, 2020 @ 3:27 pm

  30. @shaq fu–The 1918 Spanish Flu is the proverbial lamppost under which every drunk is searching for the keys to this epidemic. There are so many differences that the probative value of a century-old episode can tell us borders on nil. First, apparently the virus is quite different. This one does not kill young people: what made the SpanFlu particularly frightening at the time was that prime age adults were especially vulnerable and died in large numbers. Second, social conditions are hugely different. SpanFlu broke out during WWI when massive numbers of people were packed together in wet, filthy trenches or cold, filthy barracks. Stress and worsened nutrition during the war compromised immune systems, especially of those in armed forces, but among civilians as well. Smoking was more prevalent. Pollution was worse in urban areas. Sanitation was worse. Health care was worse. About the only advantage they had over us today is that fewer of them were obese (obesity being a major risk factor today). Extrapolating from that is a huge stretch.

    And basing 2020 policy based on 1918-1919 experience from a single pair of cities is an even bigger stretch. One data point? Seriously? And one generated by what was certainly a massively different mechanism and system than operates today?

    When all you have is a hammer . . .

    Delaying deaths would have some benefits, but you are missing the point. The hard reality is that benefits come at a cost. This is the point of my post. “Delaying deaths” is trading deaths today for deaths tomorrow–an intertemporal trade. But at what interest rate? The one we are paying is astronomical.

    Further, you are implicitly assuming that it’s either full lockdown or nothing. Again, this epidemic accelerates the deaths of people who are old, sick, or old and sick. Measures to protect these individuals could provide most of the benefits you describe, without costing trillions.

    Comment by cpirrong — April 14, 2020 @ 11:08 am

  31. “It will not even come close to 1 million. It might not be within an order of magnitude of a million”

    I’d be very careful about making any predictions on this front, particularly given its likely we’ll all likely experience subsequent waves. (What your top-end prediction before – 10K? You’ve already busted this by some margin).

    “Measures to protect these individuals could provide most of the benefits you describe, without costing trillions.”

    What measures would you propose to protect all those poor communities in NYC and beyond which seem so hard hit by this?

    Comment by David Mercer — April 15, 2020 @ 3:56 am

  32. Thanks for the thorough response.

    Comment by shaq fu — April 15, 2020 @ 2:28 pm

  33. @shaq fu–You’re welcome.

    BTW, I just saw a link to a journal article claiming that variations in responses to the Spanish Flu had little impact on outcomes. I’ll find it.

    Comment by cpirrong — April 15, 2020 @ 4:47 pm

  34. And, of course, there are other studies that contradict the Chinese flu cause of death claim above:

    Comment by dcardno — April 16, 2020 @ 9:17 am

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