I want to trust The Atlantic more than the White House. I used to subscribe to the magazine, and I am always skeptical of politicians.
It would take a long time to carefully fact-check this article. But I can start at the beginning and see how it goes.
It opens by describing a White House science advisor saying
- “It doesn’t matter if younger, healthier people get infected,” Atlas said in a July interview with San Diego’s KUSI news station. “I don’t know how often that has to be said. They have nearly zero risk of a problem from this … When younger, healthier people get infected, that’s a good thing.”
This sounds interesting, and a little crazy. It seems clear that young people rarely die of the disease. But they can infect other, more vulnerable people. I thought this would be the correction to the White House position.
But after acknowledging the low death rate, the article turns to "health challenges that are serious, if not imminently fatal." This implies that young people should fear harm from the disease.
The next sentence says "The disease occasionally sends people’s immune system into a frenzy, wreaking havoc on their internal organs" with no source provided.
Then "Several studies of asymptomatic patients revealed that more than half of them had lung abnormalities."
Then "A March study published in the Journal of the American Heart Association found that 7 to 20 percent of sick patients showed heart damage associated with COVID-19."
The claim about heart damage sounds like one I looked into earlier, when it appeared that the heart damage was, or at least could have been, present before the COVID-19 infection. So this sentence made me skeptical. It didn't have a clickable link, but the previous one about lung abnormalities did link, alas, to Twitter.
When evidence is weak, it's a common to make the argument more impressive by adding more weak evidence. The order of these links appears arbitrary, so I checked the first one in The Lancet. Does it support the claim in The Atlantic that more than half of asymptomatic patients had lung abnormalities? Does it show that the infection caused the abnormalities, rather than revealing a pre-existing condition?
The abnormality appears to refer to ground glass "changes" which were found in 56% of patients.
56% means five out of nine.
A single-digit sample size is pretty disheartening for the first solid piece of evidence. The patients were nine passengers who had been on board the Diamond Princess and tested positive, out of 215 passengers tested.
The Atlantic is arguing that young people are at risk of harm. The five patients with ground glass changes were
56-year-old male
58-year-old female
61-year-old female
68-year-old female
59-year-old female
(Table 2)
Maybe it gets better. I feel like it's a waste of time to continue fact-checking an article when the first link is completely contrary to the main idea.
I'd say it's a waste of time. It will be a while before we know the long term health effects of COVID19 on young people. For that reason, it's irresponsible to speak conclusively about how safe or how dangerous it is for them, or whether or not it is a good idea (individually or from a social perspective) to be exposed. I sent an email last week to someone whose brother had a massive stroke from COVID19 and is suffering from paralysis and aphasia. I believe he is younger than I am. By the data, he's recovered. There are aspects of this virus that are not very flu-like. It's not well-understood. My grandfather had rheumatic fever as a child, and as a result, had a weakened heart that led to an early death. We do know that SARS-CoV-2 infects heart tissue as it is rich in ACE2. It's going to be a long while before we know if mild or asymptomatic cases have long term effects upon the heart, or other systems, for that matter. It would be more responsible of the Atlantic to just say that there are unknown risks to getting COVID19, and for that reason, we might be cautious about the notion that young people needn't worry about it. IMHO the Atlantic is not a standout in abysmal scientific reporting. We really ought to have PhD's with research backgrounds as scientific journalists. From Amazon, the author Derek Thompson:graduated from Northwestern University, in 2008, with a triple major in journalism, political science, and legal studies. He hasn't done much with the latter two.
The evidence is not conclusive, yet we must draw conclusions about how to live. What might Socrates say, if Socrates were an economics professor? Caplan is one of the few people I have seen explain what he is doing and why using quantitative risk analysis, the way we should decide how much junk food to eat, how often we see the doctor, or when to spend more for a safer car. Everything is a trade-off.
I don't understand Caplan's thinking. If his behavior was generalized, even to healthy low-risk people, it would result in a significantly higher risk for him and vulnerable people. It's like the matter of voting. Your one vote is arguably not worth the effort, yet if everyone decides that, it has great consequence. Doing something for the public good often looks irrational on an individual basis. It's that type of approach that led us to this situation where it is widespread in our country, but not in others that acted differently. It seems common sense to me that you don't allow a virus to spread by reacting swiftly and uniformly, then deal with pockets. That would be a good quantitative risk driven approach. Contrarianism is at most, half of dialectic thinking. :)What might Socrates say, if Socrates were an economics professor?
If everyone decides to do what, to specifically refrain from voting, or to do a sober cost-benefit analysis of voting? If people voted rationally, they would put far more value on participating in a civic rite and feeling like their voice is heard, and very little value on the prospect of changing election outcomes. Perhaps many people already think this way, explaining why about half of eligible voters don't bother. If no one cared about rites and signaling, far fewer people would vote, and at some point an individual vote would have enough potential power to make it worthwhile to do the research and make the effort to vote, so the system would not collapse. Can you give an example of this outside of voting?Your one vote is arguably not worth the effort, yet if everyone decides that, it has great consequence.
Doing something for the public good often looks irrational on an individual basis.
The same if conditions apply; the specific answer depends on circumstances. Is your friend elderly? Do they socialize a lot? Do you embrace, or maintain distance? Do you spend a lot of time close together talking? In the kitchen or on a breezy porch? It is rational to do things that benefit the public good (at reasonable cost). How could this not be the case, if someone is not a predator or parasite? We are the public, we benefit from a healthy public.
Caplan is 49 years old and in apparent good health. There is little risk* that COVID-19 will affect his personal health, whatever his behavior. *EDIT: little risk, relative to other risks that he already accepts, such as driving a car or drinking sugary soda. How is it rational for him to buy and use gloves for grocery shopping, if not to reduce the risk of spreading disease to others? I'm not sure I understand what you mean by generalizing. His behavior is to become informed about the risks and make carefully calculated, emotionally neutral decisions that balance the positive and negative consequences of his choices. I would like to see that pattern generalized. His specific choices (on restaurants, or gloves) are tailored to his individual situation and preferences, and should not be generalized. Note that Caplan does not pretend to have all the answers. Admitting to confusion, he points out the value in relaxing behavior and restrictions to measure the risk that comes with a more open posture. A more effective and ethical approach might be paid voluntary human experimentation to improve our understanding of the risks.
Which behavior, the decisions he makes based on his individual situation, or his behavior of reacting to risk quantitatively rather than qualitatively, approaching the uncertainty analytically rather than emotionally? His specific behavior, based on his individual circumstances, is to wear a mask and gloves when he goes to a grocery store, which is more precaution than most stores require. He has postponed a social event in his home that draws scores of people, suggesting that he would discourage events like the Sturgis rally. He is pleased to accommodate nervous friends by socializing outdoors and otherwise putting them at ease. He has Socrates say that a traveler should take different precautions from someone who stays at home, to avoid being a conduit of disease. It seems unfortunate to me that doing a sober cost-benefit analysis incorporating the best available evidence about risk, and being prepared to update conclusions as the evidence changes, is seen as contrarian (though I agree, it is highly atypical). Isn't it more important that the response be "effective" rather than "swift and uniform"? Swift and uniform adherence to bad practices won't help.If his behavior was generalized, even to healthy low-risk people, it would result in a significantly higher risk for him and vulnerable people.
That is his behavior, that if generalized, would have the effect of increasing risk for all. In the case of a pandemic, the effective response is a a swift and uniform one.Above all, I am now happy to socialize in-person with friends. I am happy to let my children play with other kids. I am also willing to not only eat take-out food, but dine in restaurants.
Isn't it more important that the response be "effective" rather than "swift and uniform"? Swift and uniform adherence to bad practices won't help.
Fair, given the alternatives of isolating kids at home and letting them socialize, the latter plausibly has the consequence of increasing risk of spreading disease. Isolating kids at home for months has negative consequences as well. Socializing has always entailed the risk of spreading disease, and we had to find a balance. The risk has graver consequences this year, so we should make adjustments. There are different ways of letting kids socialize. You can take them to an amusement park and let them run around with strangers, or you can try podding, allowing your kids to play with kids from selected families you trust. Cost-benefit analysis is a way to decide which of these alternatives is the best balance. Dining in a restaurant might increase risk of spreading disease more than getting take out, at the cost of less enjoyment of life and less employment for restaurant staff. In my few recent experiences, the extraordinary precautions taken in restaurants make me doubt the risk is very high: disposable utensils, seating spread out, all staff wearing masks and maintaining distance, surfaces sanitized between seatings rather than the usual wipedown with a germ rag. Plenty of restaurant workers are out of a job now. That's a definite risk to their life quality and health. Perhaps the best solution is a stimulus check. That entails a non-zero risk of hastening an economic meltdown caused by unsustainable debt. These trade-offs are all around, and we have to find balances. Swift and uniform sounds great if you are doing the right thing. How do you figure that out, if not by carefully weighing the evidence and considering all the pros and cons? Telling everyone to leave the masks to the professionals was a bad call, no matter how swiftly and uniformly the advice was followed. If there is a shortage of PPE, we should prioritize protecting elderly people. That's not a uniform response, it's tailored to the risk. Cost-effectiveness should be the standard (where costs are not financial, but overall benefit and harm).In the case of a pandemic, the effective response is a a swift an uniform one.
You're pointing to a much bigger problem than one that is covid specific, and that's the trouble with retrospective studies generally, and small retrospective studies in particular. Retrospective studies area great for a singular purpose, which is to find interesting questions to test on a prospective study. Being that they are close to worthless. And yet...everyone uses them to make a point. Typically this is confined to advocacy groups trying to advance an agenda. However, lately it's gotten really bad because of the stakes and the politics. Every loves was quick to point out how shitty the Henry Ford hydroxychloroquine study was (and they were correct), but apparently just because the president was satisfied. When it comes to making a point we agree with however, the ends clearly justify the means. Science is hard. Data interpretation is hard. They're are no easy answers here, so we need to always keep an open mind about what the data say, and not what our favorite or least favorite politicians or media sources say. Even a blind squirrel can find a nut sometimes.
Here’s the interview with the crazy claim: The ellipsis in the quote covers about a minute and a half (around 3:00 to 4:30). After saying it’s good for young people to get infected, he rhetorically asks “Why?” and explains that young exposed people will develop immunity with little risk of complications, thereby breaking up the network pathways of infection, leading to herd immunity. Doesn’t sound so crazy that way. The evidence is still more limited than one would like, but what I have seen doesn’t support the Atlantic narrative.
The third source on the bird feed is to an unreviewed preprint, which is fine. It describes ten asymptomatic patients. “We reviewed the initial chest CT images and radiographies taken on admission for each patient.” GGO was observed in all ten. “Among the 139 patients with COVID-19 who were hospitalized, 10 (7.2%) were asymptomatic. Their mean age was 65 ± 12.8 years (age range: 52-95 years) and the sex ratio was 6:4 (male:female)(Table 1).” 100% of sources used by The Atlantic to support the idea that young people should worry about COVID-19 hurting their lungs describe old people (N=3).
A quick glance at the second Lancet link shows a youngest subject age of 40. The ground glass condition appears in a table under “Radiographical findings on admission” suggesting that the condition could have preceded infection. (Evidence of GGO appearing while infected and under observation would be more convincing.) I may be mistaken. This is five minutes of investigation while walking with a phone. Surely The Atlantic tries a little harder...
Fact-checking is tricky, and I made a mistake. If I am reading the right table, and reading it correctly, only six of the nine patients were asymptomatic, and three of them are noted for ground glass changes (the first three in my list). So Twitter says and the first source shows three out of six, which is not "more than half" to nit-pick, but mainly the sample size is ridiculous. I think the worse crime is The Atlantic using this to imply harm to young people, when the youngest case in the study was 56 years old.There are now 3 series of lung CT scans in people who were asymptomatic. More than half of these patients show distinct GGO abnormalities consistent w/ #COVID19