The healthy don't need to shelter in place?

[Horace]

@jon-nyc said in The healthy don't need to shelter in place?:

I put it in quotes for a reason, the backlog of untested symptomatic patients has seemed more urgent.

Right. It's odd that tests which don't actually mean much regardless how they turn out, are considered more important than tests which could direct social policy which affects everybody.

[jon-nyc]

I had this conversation with Klaus a week or so ago (IOW, eons in pandemic time). I don't think it would have much of an effect on our actions in the short or medium term.

At least if you consider the range of feasible outcomes, not the range of theoretically conceivable outcomes.

[Horace]

You speak of directing social actions as if it's a thing distinct from shaping public opinion. I think these numbers have power to shape public opinion. Every study that comes out which implies lots of people having it and having no issues from it seems to make a splash.

[brenda]

@jon-nyc said in The healthy don't need to shelter in place?:

@Mik said in The healthy don't need to shelter in place?:

My experience with urgent care docs, limited as it is, leads me to believe they are not our best and brightest.

I don't mean this as an insult of any sort, but the field of medicine simply does not select for numeracy. Certainly some subfields do, and certainly some physicians are highly or reasonably numerate, but there's nothing about the course of study in itself that filters out those not particularly good with numbers.

This has been my experience over the last several decades with a number of doctors. Even simple stuff like how many four week cycles are there in a year. I went round and round with my gyn when in my mid 20s. He kept prescribing for 12 cycles per year. I finally asked him to divide 52 by 4. He had a blank look, so I gave him the answer: 13.

Three years ago in the ER, the docs asked if I had taken any fever reducing meds. I said I had taken 8-hour Tylenol at 650 mg. They went crazy. I tried to explain this is a delayed release product that lasts for 8 hours, not 4. They didn't understand that it would be comparable to taking 325 mg for four hours, and then repeating after the first four hours. They knew lots of things, but got hung up on that. More than one doc was in that conversation, and none of them grasped the delayed release idea.

Lots of other examples over the years, but those two are classics. I still laugh about the 52 divided by 4. I got a free pill pack for that one!

[Copper]

My previous primary care physician, an MIT graduate, was one of the guys in NASA's Houston backroom during Apollo that was calculating spacecraft trajectories. He, and the guys he worked with were arguably some of the best practical mathematicians you would ever need.

The Apollo program ended so he decided to go to medical school.

[Doctor Phibes]

@George-K said in The healthy don't need to shelter in place?:

@jon-nyc said in The healthy don't need to shelter in place?:

And in the short interview on the news channel, he gets into some tinfoil hat territory.

Basically, he's incorrectly extrapolated data, disparaged the head of the NIAID, and ended with a conspiracy theory.

NEXT!

[Mik]

My primary care is exceptionally intelligent, an luckily very well connected in the health system. He has the juice to get things done. I suspect he is pretty numerically savvy too, but he's not a statistician.

[George K]

Obviously, these guys are guilty of wrongthink.

YouTube has taken down the video for violating its terms of service. It was taken down within minutes of their appearance on Laura Ingraham. Apparently, saying something that disagrees with WHO policy is a violation of terms of service.

[jon-nyc]

Was Laura taking them to task for generalizing from the sample of symptomatic patients seeking medical help to the population at large???

[George K]

@jon-nyc said in The healthy don't need to shelter in place?:

Was Laura taking them to task for generalizing from the sample of symptomatic patients seeking medical help to the population at large???

No clue. I didn't watch it.

[jon-nyc]

I didn’t watch it either, but I have a clue.

[jon-nyc]

Re YouTube, obviously the WHO isn't the right standard but I do understand their dilemma. They took down the tide pod challenge too.

But there’s plenty of obviously defective medical advice they leave up.

[Klaus]

I think Youtube should really make decision whether they want to be publisher or utility company. I personally would prefer the latter, together with a "remove video only if forced by law" policy. If they want to be a publisher - fine, too, but then they also need to accept responsibility (including legal) for every video on their platform. But the current state of removing videos in an ad hoc manner, based on the news of the day and the direction of the wind, is just pathetic.

[George K]

@Klaus said in The healthy don't need to shelter in place?:

I think Youtube should really make decision whether they want to be publisher or utility company. I personally would prefer the latter, together with a "remove video only if forced by law" policy. If they want to be a publisher - fine, too, but then they also need to accept responsibility (including legal) for every video on their platform. But the current state of removing videos in an ad hoc manner, based on the news of the day and the direction of the wind, is just pathetic.

Facebook is the same.

[jon-nyc]

Yeah, I remember when they first censored search results I thought the we're accepting responsibility for the content of the internet from that point on.

[Klaus]

Yes, all the major social networks have the same policy of ad hoc censoring. They are all equally bad in that regard. I had high hopes for thinkspot, but it doesn't seem to really take off.

[Klaus]

Basically TNCR is the only website on the whole fucking internet that has a consistent censoring policy. :tncr-flag: :tncr-triotism:

[Mik]

We rule.

[George K]

The video is back up....

[George K]

https://www.acep.org/corona/COVID-19/covid-19-articles/acep-aaem-joint-statement-on-physician-misinformation/?fbclid=IwAR0XwslBAhdUxrsLsrJ0eFl_sqef18LJTiLZ5Xcpd_h60BQ7HpqdmwgMzv4

=-=-=-=-=-=-=-=

ACEP-AAEM Joint Statement on Physician Misinformation
Joint Statement issued on April 27, 2020:

*The American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) jointly and emphatically condemn the recent opinions released by Dr. Daniel Erickson and Dr. Artin Massihi. These reckless and untested musings do not speak for medical societies and are inconsistent with current science and epidemiology regarding COVID-19. As owners of local urgent care clinics, it appears these two individuals are releasing biased, non-peer reviewed data to advance their personal financial interests without regard for the public’s health.

COVID-19 misinformation is widespread and dangerous. Members of ACEP and AAEM are first-hand witnesses to the human toll that COVID-19 is taking on our communities. ACEP and AAEM strongly advise against using any statements of Drs. Erickson and Massihi as a basis for policy and decision making.*

Additional Information

While ACEP believes strongly that practicing emergency physicians have valuable insight into the COVID-19 pandemic, specialists in Immunology, Infectious Disease, and Epidemiology, including Dr. Anthony Fauci, are the most qualified at interpreting this data and making representations.

The data cited by Drs. Erickson and Massihi is extrapolated from a small population to the state of California, resulting in misleading conclusions regarding the mortality of COVID-19. Their data is flawed and represents selection bias. In order for data to be extrapolated to a population, the investigator must assure that the populations are homogeneous, and in this case they are not.

For example, it is stated in the video that in one area of California, there is a 12 percent positive test rate. That is then erroneously used to conclude that there are almost 4.7 million cases in the entire state of California. But that framing only looks at the 12 percent of people who had access to a test. California is a large, diverse state, and it is unlikely that any one area will be representative of the state at large. As testing nationally is limited, there likely is a larger pool of people who have yet to receive a test but have a high probability of having the disease or who are asymptomatic and potentially contagious. What we do know is that the number of cases in most states is growing. The same extrapolation was used in his New York example, when again, the only people tested were those who were symptomatic. Because of the limited availability of testing and the as yet unknown sensitivity and specificity of the various tests, we cannot use this data to extrapolate to larger populations.

The speaker discusses the fatality rate in New York and states that there are 19,000 deaths out of 19 million people in New York, so New York has a fatality rate of 0.1 percent. However, he is concluding a fatality rate based on the total population—both symptomatic and healthy, which is a contradiction to how he calculated the fatality rate in California. Further there are a large number of patients who have yet to recover, and many of them whom remain on life support or are likely to die.

Another concerning misuse of data include comparisons to the flu despite different methodology for calculating deaths. Comparing flu deaths and COVID-19 deaths are apples and oranges until the same methodology of calculating flu deaths is applied to COVID-19 deaths. Additionally, final flu data is calculated after the season is over. The physician in the video is comparing two months of COVID-19 data, which again at this point is incomplete. It is not scientifically valid to make a comparison to the completed six-month flu season.

There are other faulty data issues in their video, including basic scientific errors that call the conclusions into question (e.g., they call the flu and COVID-19 “DNA” viruses when COVID-19 and flu are both RNA viruses).

Most concerning for ACEP, they used their “emergency physician” titles to provide credence to their opinions. In any statement that proports to be based on science, data need to be carefully analyzed and the conclusions limited by the data source and integrity. By presenting themselves as authorities, and without fully disclosing their conflict of interest, they were misleading the public.

This is not to say that individuals should not have their own opinions, or that their opinions will turn out to be true. Emergency physicians should speak those opinions in controversies such as this. However, in doing so, we must be careful not to overstate our qualifications, particularly when we are in domains outside of medicine. As emergency physicians, we should be all too familiar with other specialties and providers who feel qualified to practice in our domain without our level of education. Opinions vary on one’s experience; emergency physicians in New York City are likely to feel differently.

ACEP feels strongly the traction and popularity of these dangerous conclusions had the potential to lead to bad policy decisions and public health outcomes.