Mistake or manipulation?

OPINION

BY LEN CABRERA

Dr. Ronald Brown had a paper accepted for the Cambridge Coronavirus Collection that suggests confusion between infection and case fatality rates in Congressional testimony may have caused mortality overestimation that led to overreaction to COVID-19. A review of the early events mentioned in Dr. Brown’s paper and the lack of any corrections to the record suggest that the misstatement before Congress was not a mistake.

On March 11, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), testified before the House Oversight and Reform Committee and said that COVID-19 mortality was ten times higher than seasonal flu. As Dr. Brown puts it, this testimony “helped launch a campaign of social distancing, organizational and business lockdowns, and shelter-in-place orders.” The problem is that the statement was false and Dr. Fauci (and his staff) should have caught it immediately.

In his testimony, Dr. Fauci claimed the mortality of flu was 0.1% and that the case fatality rate of COVID was 3% but could be as low as 1% with asymptomatic cases. This is an apples-to-oranges comparison of the flu’s infection fatality rate (IFR) to COVID-19’s case fatality rate (CFR). 

The difference between IFR and CFR is the denominator: infections or cases. All cases are infections, but not all infections are confirmed cases, so the number of infections always exceeds the number of cases, making IFR less than CFR.

According to the World Health Organization (WHO), the case fatality rate for the 1918 Spanish flu was 2-3% (see p26), roughly the same as Dr. Fauci’s claimed CFR for COVID. That claim likely came from a March 3 statement from the WHO Director-General: “Globally, about 3.4% of reported COVID-19 cases have died.”

But maybe Dr. Fauci did mean to misrepresent the flu’s mortality rate. In a New England Journal of Medicine (NEJM) editorial on February 28, he wrote, “the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatalityrate of approximately 0.1%)” (emphasis added). So here, in writing, he is confusing the CFR and IFR. Data from the CDC shows the average infection fatality rate for seasonal flu is 0.13% in the U.S. for all ages. It ranged from 0.1% to 0.18% for 2010-2019.

Several people have asked what changed Dr. Fauci’s opinion between February 28 (about the same as flu) and March 11 (10 times worse than flu). That is the million dollar question, but for now let’s focus on the IFR/CFR bait and switch.

On March 6, the WHO (sitrep 46) also used the 0.1% flu number: “for seasonal influenza, mortality is usually well below 0.1%.” The document is unclear if that is IFR or CFR, but it’s wrong either way. (Remember, the lowest estimated IFR in the U.S. since 2010 is 0.1%, so it’s hard to believe the global rate is “well below 0.1%.”)

The distinction between CFR and IFR doesn’t seem to matter to the CDC. As Dr. Brown writes, “a search of the keyword term ‘infection fatality rate’ on the CDC website returned no matching results, nor was the epidemiological term located in the 511-page CDC publication, Principles of Epidemiology in Public Health Practice. This terminology omission, in conjunction with questionable use of fatality rate terminology in the NEJM editorial, raises red flags.”

Dr. Brown suggests the IFR/CFR switch led to information bias (misclassifying infections as cases), mortality overestimation, and fear, all of which caused public health authorities to recommend strong containment measures (“severe mitigation to slow viral infection”). He had a generous interpretation: “even experts can make simple miscalculations which can lead to catastrophic results.”

A careful viewing of the testimony suggests the line was not a mistake. Dr. Fauci was specifically asked if COVID was less lethal than H1N1 or SARS. Rather than refer to his own NEJM article saying SARS had a case fatality rate of 9-10% (3 to 10 times worse than COVID), Dr. Fauci said, “Absolutely not… the 2009 pandemic of H1N1 was even less lethal than regular flu… this is a really serious problem that we have to take seriously.” He repeated that COVID’s “mortality is 10 times that [of influenza]” and concluded with, “We have to stay ahead of the game in preventing this.” (Watch the video for yourself. It’s less than two minutes.)

After Dr. Fauci’s testimony, the “10 times more lethal” line was echoed throughout the media (see ReutersBloombergCNBC, or The Hill). A month later, the WHO was quoting Dr. Fauci’s 10-times-deadlier claim. As of September 8, even the preeminent Johns Hopkins Health System still refers to COVID-19 being 10 times more lethal than flu.

Fauci’s NEJM article cited studies showing the COVID CFR was between 1.4% and 2%. It also pointed out that COVID has higher “mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza).” It pointed out that there were no cases in children under 15 and suggested a strategy of “isolating ill persons.” On March 6, the WHO (see p2) said pre-symptomatic spread “does not appear to be a major driver of transmission” and “children are infected from adults, rather than vice versa.” 

These studies were memory-holed in the U.S. until independent researchers used global data to rediscover their conclusions. Finally, on August 11, CDC provided age-stratified data, which confirmed what was known in February: 80% of COVID deaths were from people 65 and over, a group that makes up 16% of the population. A review of medical examiner reports confirms that people dying from/with COVID had an average of 4.5 other “contributory factors.” We now know that COVID is not dangerous to young, healthy people. Dr. Fauci knew that in February but recommended policies that treated everyone as equally vulnerable.

Two weeks after citing the lower COVID case fatality rates in the NEJM, Dr. Fauci’s testimony used the WHO’s 3% CFR. Several days after that, he was pushing for national shutdown (“15 days to flatten the curve”). This was not the strategy of isolating sick people suggested in the NEJM paper, but isolating everyone. Florida’s original emergency order (20-51) twice referenced a CDC recommendation for “voluntary home isolation when individuals are sick,” (emphasis added), but then everyone was presumed to be sick (asymptomatic), and everyone was locked down (in violation of Florida Statute 381.00315, which was invoked by the emergency order).

After the two weeks to “slow the spread,” Dr. Fauci used the discredited IHME model to extend the lockdown. On April 1, Dr. Fauci said we could not relax restrictions until there are “no new cases, no deaths.” 

This was a perfect series of switches: IFR to CFR, voluntary isolation for the sick to mandatory isolation for everyone, two weeks to flatten the curve to indefinite lockdown until there’s a vaccine. (If you think it will be voluntary, you’re not paying attention.)

The fear induced by the 10x claim was the key to the acceptance of lockdowns, business closures, and mask mandates, according to Dr. Brown. A paper in the International Journal of Mental Health and Addiction found that fear of COVID-19, not civic duty or political orientation, was the only “predictor of compliance with mitigating behavior.”

Fear and ignorance became the weapons of Team Lockdown. There was plenty of early evidence that isolation and social distancing made no difference in limiting the spread of the virus: Alachua County (FL) in early April, comparisons to Sweden by mid-April, and Kentucky State University Professor Wilfred Reilly comparing different strategies between states. Professor Reilly wrote, “The impact of state-response strategy on both my cases and deaths measures was utterly insignificant.” The only variable that was statistically significant in predicting deaths was population. By early May, the AP reported on a New York survey of COVID hospital patients that “confounded expectations” because the patients were older and isolated, not “essential workers.” (Here are some later articles about lockdowns not working: Places praised for lockdowns later had cases rise, Alachua & Miami-Dade Counties (FL) policies compared to daily cases, a comparison of cases per 100K population for various policies, and a TrendMicro study reported in the New York Post.)

Despite the evidence, polls show that the public credits lockdown policies with reducing predicted COVID deaths. At the same time, surveys show that the public greatly overestimates the number of deaths from COVID. 

Now parents are terrified of sending their kids to school, even though the data show that COVID-19 is less deadly to children than seasonal flu. In the UK, deaths for people 18 and under are only 0.35% of all COVID deaths, and all of them had pre-existing health problems. CDC data confirms these numbers: in the U.S., only 0.063% of COVID deaths are people under 18 (0.045% in Florida). A study from Newcastle University looking at 7 counties found that kids are 10-20 times more likely to die in an accident than from COVID. 

study in France looked at all-cause mortality data from 1946 to 2020 and concluded that “SARS-CoV-2 is not an unusually virulent viral respiratory disease pathogen” because there is no significant increase in mortality. Of the deaths in 2020, the study said, “unprecedented strict mass quarantine and isolation of both sick and healthy elderly people, together and separately, killed many of them.”

In his paper, Dr. Brown said the panic that was pushed after Dr. Fauci’s testimony requires “reassessing the ethics of fear-based public health campaigns.” At best, the lockdowns and mask orders were predicated on a mistake in confusing CFR and IFR, a mistake that could have easily been corrected once it became clear that the fear in the public was out of proportion to the threat. The fact that no one has corrected the mistake and the policy changes (toward ever-increasing mitigation measures) after the NEJM paper suggest it was more than a mistake.

Sadly, many politicians were duped and went along with the recommendations for lockdowns and masks that followed from Dr. Fauci’s 10-times-deadlier testimony. Don’t expect them to admit their mistakes, either. Perhaps the only thing harder for a politician than telling the whole truth is admitting a mistake.