A well-educated friend with a graduate degree from an outstanding university sent me this video from Dr. Emily Porter of Austin, Texas and felt it was enlightening. She artfully and eloquently explains why we need lockdowns to cope with COVID-19 or millions will die. It has been received with great enthusiasm and numerous supportive comments. It’s viewed as credible, authoritative, and compelling. It’s also a classic example of how a failure to be careful with basic math can lead to terrible conclusions that can drive all of us to despair (for various reasons). Sadly, this video has served to exacerbate unnecessary fear and encourage trust in some policies that may do more harm than good. Regardless of the merits of lockdowns, understanding the nature of the mistakes and tactics in this video, as well intended as it may be, can help us stand up to more bad science from others for this or other crises.
I’ll break things down by looking at key portions of this video, marked by time. The video was posted to Youtube March 22, 2020, and thus data cited may be out of date, but some of the errors are timeless, or rather, happen all the time, even in discussions from experts that we are told to trust.
Setting: Some credentials for the speaker, Dr. Emily Porter, are established verbally and visually. She’s a doctor, she’s wearing a white laboratory coat, she has a stethoscope around her neck, and tells us she has a sister, Katie Porter, who got elected to Congress and is apparently pretty popular. She seems like a passionate, intelligent, eloquent, and sincerely
concerned medical doctor, and I’m sorry that there are some gaping
flaws that need to be pointed out. As I explain below, these may not be her fault, and I don’t want to criticize her personally. I suggest it’s the soundness of the widespread and popular message she is sharing that needs to be considered.
Video @ 0:55 to 1:20: “CDC is estimating that 40-70% of [America’s 331 million people] will get infected” with COVID-19. So, she says, let’s say 150 million, on the lower end, will be infected. For the infected population, “80% will be just fine. 20% will need hospitalization.”
Response: 20% of those infected need to be hospitalized? That’s a remarkably high number. Even when we didn’t know about all the asymptomatic people that don’t even feel sick (about 35% of those infected), such a high hospitalization rate was not on the table, as far as I can recall. That rate only applies to the very old. Below is hospitalization rate data from the CDC, and while it was published in April less than a month after Porter’s presentation, the knowledge of the hospitalization rate in March should not have been wildly off. The highest hospitalization rate listed is 17%, and it’s for those over 85 years of age. Not an average of 20% for everyone!
Porter’s error (if it’s even hers) is probably unintentional, but it is a critical one that blows the threat way out of proportion. Unfortunately, the nature of this questionable blunder is very similar to another even more egregious error made minutes later.
For the 150 million who might become infected, she does not say how long this will take. For a virus to
sweep through a population until herd immunity is established can take
years or at least many months. Part of the fearful impact to come
in this video is the implicit notion that we could have a huge population of sick people
all at once. This needs more clarity.
Video @ 1:20 to 1:35: She warns that Italian hospitals are being overwhelmed by the virus, and we have even fewer hospital beds per capita than Italy, so we’re in big trouble.
Response: Reasonable, but this neglects the vast differences in our populations, for Italy has a much older population with many more elderly people susceptible to the virus. Not exactly a fair comparison. (As we’ve seen since this video was made, our hospitals in almost every state were not overwhelmed, even in — or especially in — states like South Dakota that did not impose harsh lockdowns.)
Video @ 1:20 to 1:35:”5 to 10% of the 150 million that get infected will need vents.”
Response: This huge number requires the incorrect assumption that 20% of those infected will need hospitalization. New York’s early experience had about 1/3 of their hospitalized COVID patients on ventilators, so if 20% hospitalization were reasonable, then 5-10% on ventilators would make sense. OK.
Video @ 1:50 to 1:58: “5% of 150 million people is 7.5 million vents needed in America.” The caption drives this home: “7.5 MILLION VENTS.”
Response: 7.5 million people needing ventilators sometime does not mean that 7.5 million ventilators are needed all at once. This assumes that all of the hospitalized COVID-19 patients are sick at the same time and each needs their own machine. This is an utterly unrealistic, even an impossible scenario. The disease does not spread across the country in a day, sending nearly 8 million people to ICUs all at once. This is an blunder that builds on the prior mistakes. Don’t blame her personally — this kind of questionable math and logic seems to be sweeping the nation, sort of like a pandemic on its own.
Video @ 2:00 to 2:40: Porter explains that we only have around 100,000 ventilators in the nation. To be conservative, she assumes we actually have 150,000. With 7.5 million needed but only 150,000 available, only “0.02% [sic] of people could get a ventilator if they needed one.” She then explains that this means that only 1 in 50 people could get a ventilator.
Response: A relatively minor math error here is reporting 0.02%, which would be 2 out of 10,000 or 1 in 5,000, an utterly unreasonable number. But this is probably just due to overlooking the meaning of percentage, for 150,000 divided by 7.5 million is 0.02. As a percentage you should then say 2%, not 0.02%. Fortunately, when she then explains that 0.02% [sic] means 1 in 50, she’s at least back to a correct ratio, in spite of the confusion about percentages.
The important issue here is that she claims only 1 in 50 patients who need a ventilator can get one, when this is based on the bad assumptions that have already seriously tainted her analysis. It’s way off. But the worst is yet to come.
Video @ 2:40 to 2:47: “That means that 49 out of 50 are gonna die. That is scary. That should scare you. That scares me.” The big, bold captions hammer this home.
Response: Her presentation is based on the assumption that those who get ventilators live and those who don’t will die. Even back in early March, it was becoming clear that many or most COVID patients on ventilators died. Ventilators are a last resort for desperate cases and often don’t do any good. A more fair comparison would involve the number of seriously ill patients who will die without intubation versus those who will die even with intubation. Good data might not have been available for COVID-19 when she gave this presentation, but she should at least have recognized that there’s still a high death rate for intubated patients even before COVID came along, and that not getting a vent is not necessarily a death sentence. There’s no nuance here, all clear cut and dramatic without the caution demanded by science. Science demands a little nuance. Stirring fear, not so much.
A few weeks later, the evidence was indicating that things aren’t anywhere as clear cut as Porter says. Sometimes ventilators can do more harm than good, and patients who seemingly need ventilators based on old criteria might be fine without one. See Sharon Begley, “With ventilators running out, doctors say the machines are overused for Covid-19” at StatNews.com, April 8, 2020. Now we also know that New York, said to be in dire need of more ventilators, had plenty after all.
Video @ 2:47 to 2:50: “That should scare everybody who can understand basic math.”
Response: This is one of the most accurate and fitting statements made, but in an ironic way. What she is saying in this video should alarm those who can understand basic math and see through the errors, with the biggest and scariest yet to come. It is frightening to see how much fear, panic, and self-imposed harm on this nation is being spread through fearmongering and a failure to do the math and consider the science.
Video @ 2:55 to 3:17: “The doctors have to choose who that 1 in 50 is. Can you imagine?” She suggests that doctors will tell people that since they once had cancer or some other disease, that they “are not worth saving.” She also suggests that doctors will be force to let people over 80 die, “because that’s that they are doing in Italy right now.”
Response: Calm, authoritative fearmongering. That’s a harsh word, and she may just be reflecting what’s she gathering from other sources, but it’s still a reasonable term. Creating a horrific worst-case scenario, based on flawed math and bad assumptions, and then driving it home in an emotional way, is fearmongering. Scary and effective, but not accurate.
As for assuming Italy’s crisis would be ours, that’s again unfair given their much older population. As for the claim that Italy was choosing not to treat elderly people, that may not be completely accurate, either. USA Today’s fact check of March 20, 2020 on that Facebook rumor gives it a “false” evaluation, though I think they may have had to use triage in one overwhelmed region. But if that’s not completely accurate on her part, it’s a minor flaw relative to the key elements of this presentation.
Video @ 3:18 to 3:30: “Unless you want somebody to decide whether you’re worth saving or your dad or your sister or your baby or your grandma, you have to do your part to prevent us from having to make thse decisions.”
Response: Fearmongering that gets really personal, with a touch of added irrationality. She creates the most frightening, emotional scenario: having someone decide that your baby may have to die because the ventilator needs to go to someone else. By March, it was already abundantly clear that unlike the regular flu, COVID-19 is remarkably gentle on the young. The risk for infants and children is very close to ZERO. Even if there were only 1 ventilator in the country, it’s not reasonable to stir up fears that maybe your baby is going to be selected by heartless doctors to die unless we shut down our economy, shut down the schools, and force people to cower at home. This is just fearmongering that goes beyond a mere lack of nuance. Does she not know that the young have virtually no risk? It’s fair to worry about grandma, though, and it’s wise to encourage grandma to stay home, wear a mask, wash her hands, and be careful about visitors. But that’s not her message at all.
Video @ 3:35 to 4:21: She discusses the meaning of flattening the curve. She shows how cases can increases exponentially and create a curve where the number of patients exceeds the fixed capacity of the healthcare system. She shades the portion of the curve above the dotted line showing the capacity, and then tells us what happens to all those in the region above the curve: “If we don’t do anything, without protective measures, we’re going to end up up here, above the ability to take care of everybody. What that means is that all these people, and probably more, die. They die. Because we don’t have ventilators for them. And we have to start playing Russian roulette of who’s gonna get saved.”
Response: As discussed above, a ventilator for pneumonia or other respiratory diseases does not make a 100% plain-and-simple difference between dying or living. If you need a ventilator, you may still die and with COVID-19, it seems that most on ventilators still die. Not getting one if someone things you need it also does not mean you won’t survive. “They die,” end of story, is a dramatic oversimplification.
Video @ 4:21 to 4:46: Social distancing and protecting measures are discussed. She acknowledges the frustration of social distancing, not going out of the house except for groceries, having schools cancelled, of having to home school and work from home.
Response: Reasonable comments. (No mention of people losing jobs or the many adverse consequences of lockdowns and the ensuing economic devastation, but that has taken time for people to just begin to appreciate.)
Video @ 4:47 to 5:46: This is a key moment. We cut forward in her presentation to a scene with new numbers on her easel that aren’t explained. The numbers show what must be the mortality rate for infected patients by age groups, increasing sharply with age. For those over 80 years old, the mortality rate is listed as 14.8%. At the bottom of the pad is a huge number: 47 million. She says, “There’s a million reasons to be angry and just think this whole thing sucks because it does. But what really sucks is losing 47 million people.”
Response: The “basic math” here is not explained, and maybe it’s best that the methodology was cut to just focus on the fear. But it seems that she or someone she’s following has taken the 14.8% mortality rate for those over 80, maybe turned it into the 14.5% number written below, and applied that to the entire US population of 331 million, and generously rounding down to 47 million. That’s right, 47 million.
So after all the math errors and faulty assumptions before, now we get the granddaddy of them all. We are faced with this terrifying, gargantuan number of 47 million people who will die if we don’t do strict lockdowns, and it seems to be based on assuming that the terrible COVID death rate statistics for the most vulnerable age group, those few who are over 80 years old, suddenly applies not just to the 150 million who might eventually get infected, but to the entire population, eradicating one out of every six people. This is not just a slip of the tongue when she meant to say something like 470,000 people or something. She spoke it and has it written down. We are at risk of losing 47 million if we don’t comply and obey the experts in white robes who can do basic math much better than the rest of us.
The whole pandemic panic got started with a discredited model from
Imperial College that predicted 2.2 millions deaths in the US if we
didn’t take strong measured. That was wildly off. I just can’t fathom
how she or whoever provided her these numbers got 47 million and would
use it in this presentation.
Breathtaking! Sadly, I couldn’t find a single comment from hundreds made that pointed out the this bizarre and ridiculous gaffe and the other massive flaws in basic math, logic, and science in this video.
Incidentally, as a very minor point, the 14.8% mortality rate for 80+ may have been reported early on, but at least by the end of March a lower rate was being reported: 7.8% for the 80+ group. I think around 8% is still considered reasonable for that high-risk age group.
Wait, one last possibility to rescue this: could the 47 million be global deaths? Could that explain this huge number of deaths she’s thinking about? No, I’m afraid not. See the next section below.
Video @ 4:57 to 5:24: “I’m doing my part. I’m also just listening to what I’m being told by the experts.” “If you care about anybody other than yourself, including — especially — these 47 million Americans, that you will also do the same and just not complain about it.”
Response: The math leaves me speechless. Such unjustified fear. But her message continues to be the message of many: “1. Trust the experts and do what you are told. 2. If you complain, you don’t care about others. You’re a bad person.”
Conclusion: There’s more to this painful video than just some bad math to poke at. She seems like a passionate, intelligent, eloquent, and sincerely concerned medical doctor, and I’m sorry that there are so many gaping flaws that need to be pointed out. Perhaps much of this is sharing things she heard from the media rather than checking assumptions and math herself, so don’t blame here. These same kind of things are being shared and said from many sources.
At the time she made this video, we were being told we were just
flattening the curve for a couple of weeks and that’s all. She mentions
that in this final section, also, that it’s just two to four weeks. But
the goal of flattening the curve and avoiding the overwhelming of
hospitals was achieved, yet long past March we were being told in many
places to continue cowering, that it’s “cavalier” to send kids back to
school, that we must have slow, gradual plants that might take many
months of strict criteria before it’s safe to buy things anywhere but
Walmart and liquor stores, and that whatever the increasingly huge costs
of the lockdown, it’s “worth it if we save only one life,” as Governor
Cuomo put it, neglecting the cost in lives that is increasingly becoming
apparent from many of the neglected side effects of this terrible cure
in which the young and healthy with very low risk are locked up and the
vulnerable were not properly protected (at least in New York and some
other places), and in which everything from the media and some
politicians seems focused on driving the message of “be afraid, shut up,
and comply or you don’t care about others.”
I fear that education in basic math and independent thinking must simply
be widely lacking in our educational system. If someone with a lab coat and a
stethoscope around their neck tells you something, do you feel compelled to believe and comply, or do you have the
ability to question and push back when something is said that just doesn’t make sense? I suggest more of us should be willing to ask tough questions.
Excessive fear of COVID-19 has been used to force religious groups to stop meeting, even to the point of not allowing drive-in services. It’s been used to create a spirit of fear and trembling among many, including children who are really not at risk. The CDC’s current estimate of the overally mortality rate is around 0.26% when asymptomatic cases are included, which make it’s maybe twice as bad as what we face in most flu seasons, but does it really merit this level of fear and trembling? Does it merit prolonged lockdowns and insistence that we can’t go back to normal until a vaccine is available — when this class of virus doesn’t appear to have any examples of successful vaccines, and when other viruses like HIV don’t have vaccines yet after nearly 40 years of serious effort? The fear that most people are accepting is not nearly as science based as they have been led to believe. It’s time to ask tougher questions and not lose complete sight of the overall welfare of our nation and our young people. Look at the many unhealthy side effects of the lockdowns and the many deaths that will follow the self-inflicted economic wounds we are creating. It’s a time for thinking and asking better questions. It’s a time to really do the math — but carefully.
- A leaked internal report from the German government is leading many Germans to question the wisdom of their relatively mild lockdowns. Many are suspecting that the official narrative behind the panic has been exaggerated. Germany seems to have had some related “bad math” problems.
- 500 doctors sign a letter to the President warning that the lockdowns are doing more harm than good. The media is downplaying this as just a bunch of Trump supporters playing politics. The concern for lost lives and ruined health should not be so callously dismissed.
- Oxford’s Centre for Evidence-Based Medicine published a report on March 17 on global COVID-19 data, “Global Covid-19 Case Fatality Rates.” While this has been updated several times since then, it has long given us clear information that can help counter the urge to panic. “Taking account of historical experience, trends in the data, increased
number of infections in the population at largest, and potential impact
of misclassification of deaths gives a presumed estimate for the
COVID-19 IFR somewhere between 0.1% and 0.41%.”
- CDC’s latest estimates on mortality rates also gives much lower numbers than those used to create the panic over COVID-19. Their 0.4% number does not reflect the impact of asymptomatic cases, which may further reduce the effective rate. Still worse than the flu in most years, but not wildly so. It’s a deadly disease, certainly, especially for the elderly and those with severe health problems already. Perhaps we should focus on protecting those that are are risk and let the rest of the population leave their quarantine and get back to school, work, church, beaches, whatever. Just a thought.