King Canute Knew Better

Every English schoolboy learns the story of King Canute who set his throne by the sea shore and commanded the incoming tide to halt.  The tide rose and King Canute reportedly declaimed “let all men know how empty and worthless is the power of kings, for there is none worthy of the name, but he whom heaven, earth, and sea obey by eternal laws”, before hanging his crown on a crucifix and never wearing it again.  The moral of the story is that Canute wished to demonstrate to his courtiers the natural limits of a King’s authority.

If only our rulers today had one iota of Canute’s wisdom and humility.

At this point, it is readily apparent to any honest appraiser of facts that the overwhelming majority of people dying of Covid-19 are dying of old age.  Of course government statistics don’t show that.  According to government nobody dies of old age.  People die of heart disease, or cancer, or pneumonia, or any one of a long list of causes.  But in actual fact people grow old, and when they do their organs fail and their immune systems grow weaker until they can no longer fight off diseases which their bodies once dealt with effortlessly.  And then eventually they die.  Of something.  And right now that list of “somethings” includes Covid-19.

And for the entirety of human history we have gracefully accepted the reality of old age and death.  Until now that is.  When it seems that our rulers have decided to set their thrones upon the sands of time and command death to lay down his scythe.  Only this time, unlike Canute in his wisdom, their intent is not to demonstrate the limits of their authority.  Instead they truly believe that the grim reaper will yield to their commands, and like some evil wight from a dark myth they will callously sacrifice legions of the living in their vain attempts to subjugate death.

No doubt this once-in-an-era combination of hubris, folly and evil will itself one day be an object lesson, of a different sort, for future generations of schoolboys.  I hope they learn more from it than my generation apparently learned from the story of King Canute.

UPDATE  I have discussed the premise of this piece to a few people and it turns out I need to explain myself in slightly more detail.

The hypothesis I am putting forward is as follows:

(1)  As people age their general health declines over time until they reach the point where they are unable to successfully fight off diseases.  Once they have reached that point they become “susceptible to death”.  We call this old age, and it is also accompanied by declining mental and physical capabilities.

(2)  As a consequence of (1), at any one time there is a percentage of the population who are “susceptible to death”.  These people are very likely to die from almost anything they catch at this point, whether it is seasonal influenza, measles, covid-19, or even a common cold.

(3)  If you have a mild influenza winter (as the 2018-2019 winter was), then fewer of these people were exposed to influenza and consequently more of them survive.  This means that you have a larger than usual population of people susceptible to death.

(4)  If you combine this larger susceptible population with a mild, but highly contagious disease like covid-19 the following year then the result is that a large number of people who are “susceptible to death” beacome infected with covid-19 and die.  But they are not really dying from covid-19.  They are dying because they have reached the point where almost anything would kill them and it’s just that covid-19 happened along.  This is why the demographic profile of people dying from covid-19 matches the demographic profile of general morbidity.

(5)  There is a lot of noise in the media about the difference in mortality rates between various countries.  There are many explanations proffered: the wearing of masks, the rigor of lockdown regulations and the degree to which they are enforced, different strains of the virus, early detection and isolation protocols etc.  My hypothesis would suggest that the single factor most likely to explain the apparent difference in fatality rates is the degree to which the elderly and vulnerable are successfully protected by, for example

(a)  the avoidance of returning recovering covid-19 patients from hospitals to nursing homes while they may remain infectious

(b)  the acquisition of herd immunity by the younger, invulnerable population which (like boron rods in a nuclear reactor) would prevent covid-19 circulating widely amongst the population in general and thus drastically lower the chance of being exposed for those who are susceptible to death in the first place.


The Road To Hell Is Paved With Collateral Damage

Only a very small number of people actively set out to be evil, the Hannibal Lecters of this world.  Most evildoers fall into one of three camps.

The first camp is those who genuinely believe that what they are doing or supporting is not evil because they lack the intelligence, the wisdom, or the experience to perceive the consequences of their actions.  It is easy to distinguish between good and evil at the micro level; we all know that stealing from our neighbors is wrong and most of us refrain from doing it.  But distinguishing between good and evil at the level of the nation state is much harder, evidenced by the level of disagreement between decent people about how societies should be organized.  That these people disagree is prima facie evidence of confusion, and I believe this confusion results both from concerted propaganda, and a total lack of education.  The necessity for education is not the point of this article, but it’s noteworthy that I attended one of the most academic “high schools” in England, and received my degree from one of the world’s greatest universities, without ever being exposed to a single word of economics or philosophy.

The second group are the corrupt self-deceivers.  At some level they know that they are doing something wrong, but they convince themselves that what they are doing is only a little thing which doesn’t really matter, or even rationalize to themsleves that what they are doing is not evil at all.  If you have ever “borrowed” a pen from your employer without explicit permission, or invented a traffic jam as an explanation for tardiness, or schemed to get a larger office then you have been guilty of such corruption.  Even politicians pocketing fat bribes will convince themselves that they are only taking the money to do what they would have done anyway, or that the cost of the legislation they will pass in return for the bribe is so small that it doesn’t really hurt anyone.  And they will look around and see that “everyone else” is doing it too, and allow that to act as a sop to their consciences.

The third group are those who believe that the end justifies the means, that “collateral damage” as the Pentagon likes to describe the death and suffering of countless innocent men, women and children is an acceptable price to pay for the greater good that will result from their bombing campaigns.  It is this idea, that the end justifies the means, which I wish to refute.

In the case of American foreign policy I find myself disagreeing even that the proposed goal is good rather than evil, so I will instead address the philosophical argument that underpins this consequentialist system of ethics.  The argument is usually introduced as a thought experiment known as the trolley problem.  The basic version postulates a runaway trolley heading towards a group of people tied to the tracks.  You are standing far away from the action next to a lever which will switch the train to a different track where only one person is tied.  Should you pull the lever?  Most people agree that they should pull the lever (although interestingly reframing the problem can elicit a different answer) and from there go on to accept that government is justified in incurring collateral damage in pursuit of its aims, whether the price is truth, liberty or even life itself.

But this is a philosophical trick; a deceit.  Even if you decide that our hypothetical railwayman should pull the lever, it does not logically follow that we should organize our society or legal system on this basis.  Let us leave aside the artificiality of the thought experiment in which the actor is faced with a choice where he is absolutely certain of the consequences of his action, where he cannot talk to or seek permission from any of the people involved, and where no other choice is offered than pulling the lever or declining to pull it; a set of circumstances which are never reflected in the real world.  Consider instead the entirely different question of whether we should adopt a system of justice for society based on such an ethical framework.  We would be unable to make any clear definition of what is a crime and what is not, because any action at all could theoretically be justified by the defense that it was for the greater good.  And so, if we choose in principle to allow such a justification then we must empower some judge or group of judges with the ability to decide any and every case completely arbitrarily, based solely on their judgment of whether the end justified the means.  Or we empower some group of people to act on our behalf according to this principle and grant them immunity from the law.  This is absolute power without any limit, and no man or group of men can possibly be trusted with such power.  Upon such justifications have rested all the great tyrannies in history including those of Stalin and Hitler.  As Lord Acton noted, absolute power corrupts absolutely and the result is certain tyranny as we are seeing unfolding around us more clearly every day.

And so, we have shown that accepting the premise that the end justifies the means leads only to a terrible end which most certainly cannot justify the means.  And that is what is known as the reductio ad absurdum logical fallacy.

New Study Suggests IFR 0.1%

This study from Oxford University suggests that the IFR may be as low as 0.1%, and the epidemic already close to its peak in Italy and the UK.  Antibody testing is required to confirm results and is expected to start imminently.

If confirmed, will the governments of the world reverse all the bailouts and remove all the new money from circulation?

UPDATE:  Wall Street Journal also suggests IFR <0.1%

UPDATE 2:  Latest Chinese study IFR 0.12%; R0 > 5.

UPDATE 3:  This site is a must read.

New Coronavirus Data

I thought it was worth penning a quick update based on additional infomation which I have stumbled across, or has come to light in the last few days.

The most interesting is this study which examines all the testing, hospitalization and fatality data from Wuhan itself.  The authors recognize that testing in Wuhan was inadequate to determine the true number of symptomatic cases and that many milder cases were never tested and therefore not counted in the statistics.  Therefore they have used testing data from the various expat evacuation flights from Wuhan, where all passengers were tested upon return to their native lands, to estimate the actual number of infections in Wuhan itself in order to more accurately estimate the overall CFR as 1.4%. I must confess that my mathematical skills have decayed somewhat through three decades worth of lack of use and that therefore I have not completely understood exactly how the authors have calculated their results, but as the authors themselves note, there are a number of reasons to believe that they might have overstated the CFR and/or it may be lower elsewhere.

  • The healthcare system in Wuhan was ovewhelmed which
    • would have resulted in inferior care to what could be expected where healthcare systems are not overwhelmed and therefore more fatalities
    • could also have affected the CFR by biasing the data sample (those who received tests) towards more seriously ill patients
  • Some number of cases will be asymptomatic, or exhibit symtpoms sufficiently mild as to escape diagnosis (strictly speaking this will lower the infection fatality rate or IFR rather than the case fatality rate)
  • The expatriates who departed Wuhan in the early stages of the epidemic may have been infected at a lower rate than the general population of Wuhan, for example as a result of moving in different social groups or as a result of already infected expats being too ill to travel.
  • As physicians discover treatments, outcomes should improve.

It is also possible that the number of deaths in Wuhan were undercounted, especially in the earlier stage of the epidemic, which would result in the CFR being understated although the authors consider this less likely to be a significant source of error.

The study also found that

  • compared to those aged 30–59 years, those aged below 30 and above 59 years were 0.6 and 5.1 times more likely to die after developing symptoms
  • the risk of symptomatic infection increased with age at ~4% per year among adults aged 30–60 years; in other words younger people were less likely to catch the disease in the first place as well as less likely to die from it when they did catch it.
  • the ascertainment rate was between 2% and 3% (i.e. the overwhelming majority of cases were not detected, although this is an area where my lack of understanding of how the results have been calculated makes me unsure as to exactly what is being claimed).

And finally the study also calculated R0, and estimated that, using a heterogenous model of societal interactions, we could expect between 25% and 50% of people to become infected.  In epidemiology the basic homogenous transmisson model assumes that everyone in society is identical, where more sophisticated heterogenous models make assumptions about factors such as the stratification of susceptibility to infection by age, and the differing potential for contact within and without specific social groups.  heterogenous models usually predict lower penetration rates for a disease than the simple homogenous model.  One input to such a model is population density and its worth noting that Wuhan is a very densely populated city, so the penetration may be lower in less populated areas.

It’s also worth noting this article from the FT which notes that Germany’s low crude CFR is likely a result of them running 160,000 tests per week, more even than South Korea.  As a result Germany believes it is detecting many infections with few or no symptoms and therefore much higher rates of survival which explains low crude fatality rate reported there.  Germany has also seen a higher rate of infection amongst younger people than older people as has the US which contradicts the both the data from the Diamond Princess and Wuhan, but may be a consequence of younger people not taking the threat seriously and continuing to meet in social groups in which case we should expect to see this trend reverse fairly soon.

Another datapoint is the director of the Ohio Department of Health estimating that 1% of Ohioans (i.e. 117,000 people) were already infected by March 12th despite only five confirmed cases at that time.   She appears to have based this assertion on a rule of thumb contained in a CDC publication from 2017, which strikes me as likely to be an overestimate in this case.  Nevertheless it gives some idea of the extent to which the number of reported cases in the US could possibly be out of whack, and reinforces the lessons from the swine ‘flu epidemic where initial crude CFR measures overstated the risk by as much as 500 times in at least one case based on similar problems with case counts.

Overall I still feel that the Diamond Princess continues to give us the best data, but the Wuhan study should not be ignored and perhaps it would be safer to estimate the CFR range for people with access to good healthcare as 0.2% – 1.0% than my previous 0.1% to 0.5%.

UPDATE  I just found the data from Italy on March 17thScreenshot_2020-03-23 Report-COVID-2019_17_marzo-v2 pdf

99.2% of fatalities were already seriously ill.  48.5% of fatalities were suffering from three serious illnesses.

Public Policy Implications of IFR

My previous article made the case that

  • CFR is significantly, perhaps wildly, overstated owing primarily to a lack of widespread testing and showed that the more a country tested, the lower it’s CFR.
  • Even the best testers are likely still missing cases and the real fatality rate (the infection fatality rate, or IFR) is likely between 0.1% and 0.5%, and probably at the low end of that range.

I also suggested that R0 might be significantly higher than currently believed, leading to a very large number of infections occurring in a short period of time, thus overwhelming our hospitals as a result not of virulence, but of prevalence.  It has also been suggested to me that data from the Netherlands shows that, compared to the flu, HB19 patients in ICU have a much higher probability to die, and the time they occupy the beds is also much longer, which again increases the load for healthcare systems (if anyone has a reliable source for this, please send it to me).

In addition the data from Italy shows clearly that fatalities are occurring almost entirely amongst the elderly and already sick.  The mean age of those that have died is 81, and two thirds of them were already seriously ill.

The final input we need to understand how best we should be responding to this threat as a society is what will cause the pandemic to end.  Every suggestion I have seen seems to suggest that the outbreak will only end once we have achieved herd immunity and this, as an approximation, requires 1-1/R as a fraction of the population to become immune.  While we all hope for a vaccine, I think the odds of getting one in a useful timeframe are slim:

  • vaccines are not trivial to develop
  • they require extensive testing to be safe; there are several examples of vaccines that were more dangerous than the disease even after testing, and given that this disease has such a low fatality rate it would be foolish indeed to administer an untested vaccine in response
  • previous coronavirus vaccines, e.g. the flu vaccine, have proven only marginally effective.  Yes they probably offer some protection on balance, but it’s nothing like full immunity and they seem to provide no direct benefit at all to the elderly.

So, for the purposes of this discussion let’s assume that we will have to acquire herd immunity the old fashioned way, by everyone getting the disease.

What measures then, should we then adopt in order to minimize the loss of life and suffering?

If we, as we seem to be doing today, shut down huge swathes of our economies and ask everyone to minimize contact with each other it is certainly true that we should be able to slow the pace of the epidemic, and consequently avoid overwhelming our hospitals and that will indeed result in fewer people dying than if we did nothing at all.  But it will come at a huge cost to people who will lose their educations, their social lives, their jobs and their businesses.  The elderly, perhaps still alive, may themselves be newly impoverished as their pensions collapse and inflation rages in response to the government’s epic upcoming money-printing spree.  And although people may receive better care as a result of our hospitals not being overwhelmed, the young and the elderly will all isolate themselves equally and will therefore be infected equally and in the end the same proportion of each group, we’re told about 70%, will catch the disease.

Surely it would be more sensible to ask the old, the sick and the immuno-compromised to isolate themselves as far as possible for three months while the rest of society carried on with their lives in an almost normal fashion.  By all means cancel sporting events, concerts and other large gatherings, avoid mass transit as far as possible and ask people to work from home who can do so without impacting their productivity too much.  But keep the schools open, the gyms, the restaurants and the bars.  The economy could continue without massive dislocations. And let’s let the disease run its course among the healthy people who are under sixty years old.  The overwhelming majority of these folks will have only mild symptoms or no symptoms at all, and the hospitals should be able to cope with the tiny proportion who do suffer more severe symptoms.   And once enough of them have had the virus and recovered they will act like boron rods in a nuclear reactor, making it much safer for the elderly to emerge from isolation.  And yes I realize that we will not be able to complete isolate all elderly people and prevent any of them from becoming infected.  But perhaps we can reach herd immunity with only 30% or 50% of them having to risk their lives instead of 70%.

Corona Virus Case Fatality Rate

I spend too much time browsing the internet these days so I’ve been tracking the coronavirus fairly closely since the middle of January when it was announced to the world and Johns Hopkins went live with their web-site which was conveniently all ready to go on day zero.

I am a firm believer in conspiracies.  Scrupulous men and unscrupulous men conspire to achieve their ends and always have done.  And the unscrupulous men, by definition, are not restrained by an ethical code in their choice of methods.  I also try to avoid wasting too much time worrying about exactly which conspiracy theories are correct and which are not.  Some undoubtedly are, many aren’t, it’s often hard to tell which is which and at the end of the day it doesn’t really matter.  Truth and good and right remain constant and unchanging, and that some men commit evil acts does not change the actions I should take to help realize a better world.

So the coronavirus may well have been the result of a conspiracy, or it may not.  It has undoubtedly been the subject of a great deal of propaganda.  It may be that it is entirely a psy-op, or it may be that psy-ops have been launched around it, or it may be that all the stories, rumors, theories and interpretations which erupted all over the internet were the result of an entirely spontaneous human reaction to uncertainty.

If it is a psy-op, then I initially reacted exactly as presumably intended, with panic.  I saw the statistics emanating from Wuhan and immediately focused on the case fatality rate; now there’s a phrase which has entered the vernacular faster than any other in living memory.  Having some facility with math, I jumped to the conclusion that the reported CFR must be much lower than the actual CFR because of the time lag, and my earliest estimates were frankly pretty terrifying.  I foresaw quarantines and school closures.  I wrote to my daughter’s university pointing out that they had 1,000 Chinese students, approximately 20 of whom, by my estimate, had returned from Wuhan following the Christmas break each with a 0.17% chance of being infected.  I demanded to know what they were doing to prevent an epidemic.  Then stories about asymptomatic and aerosol spread surfaced.  New and deadlier mutations were proposed as the cause of apparently higher CFRs in Iran and Italy.  In Hong Kong the virus was spreading through pipes.  Dr Li Wenliang died, was resurrected, and died again, managing to one up Jesus in the process.  I bought two 50lb bags of rice, a gas mask and a pulse oximeter; my wife assured me we already had plenty of toilet paper.

Nevertheless as time passed it became fairly clear that, notwithstanding the chaotic hospital scenes and undoubtedly significant number of tragic deaths, the CFR was lower than I had feared, and most of the deaths were amongst the already sick and elderly.  The majority of “sensible” sources now point to the 72,314 patient study from China indicating an overall case fatality rate of 2.3%, where most of the fatalities were ≥60 years of age, and/or had pre-existing, co-morbidities.  We are now confidently assured by our governments and the WHO that the CFR is somewhere between 1% and 3% provided sufficient hospital beds (15%) and ventilators (5%) are available.  And, in order to make sure that adequate resources are available, we must “flatten the curve” by closing our borders, closing our schools, closing our bars, cancelling sports, avoiding large gatherings, working from home, and bumping elbows should we somehow still manage to meet another human being.  At the same time we are told that these special measures should last a few weeks, perhaps two or three months at most before the peak has passed and we can return to normal.

The problem is that these two assertions cannot both be true.  The virus will continue to circulate until such time as somewhere between 60% and 80% of the population have become immune.  So 250 million people must suffer the illness here in the US before the outbreak will be over, and perhaps 150 million or so (this number is a finger-in-the-air estimate) before we can start to relax the special measures.  The US has 924,000 hospital beds and, as of 2010, approximately 160,000 mechanical ventilation devices, of which approximately 60,000 are full featured whatever that means.  If we assume that each patient requires a bed and/or ventilator for seven days and that half of these resources can be devoted to COVID-19 patients, then our hospitals can cope with 1.6 million new infections per week of which 80,000 will require access to a ventilator.  If we are able to throttle the number of new cases, it will take something like two years before we can start to relax the restrictions on behavior.  The US has significantly more mechanical ventilators per capita than other countries, so most nations will face an even longer timeline.

I do not believe these numbers.  Bubbling along all the while, just below the surface of the dominant narrative, has been the suggestion that the CFR was overstated owing to the number of uncounted cases.  Articles and blogs frequently make a passing reference to the undercounting of cases contributing to a significant overstatement of CFR in previous epidemics before going on to completely ignore this fact and later assert a fatality rate based on calculations from unadjusted data.  I believe that the number of uncounted cases is much larger than has been suggested elsewhere, and that the fatality rate, hospitalization rate and ventilation rate (for lack of a better term) are therefore all concomitantly lower.

Consider the following seven points.

Firstly the CFR from the Chinese study itself is calculated from 44,672 cases, 74% of which were from Hubei province during peak chaos, a period when the Chinses admitted they could not possibly test all or even most cases and it seems probable that a patient in serious condition was far, perhaps overwhelmingly, more likely to receive testing than a patient with mild or no symptoms at all.

Secondly, for the same reason that this study is heavily biased towards Hubei province during the period where hospitals were overwhelmed, this 2.3% case fatality rate is reflective of patients who, in many cases, did not receive adequate medical care.

Thirdly we now have significant data from several other countries to examine, and it makes for interesting reading.  Specifically we see large variations in the real time ratio of fatalities to confirmed cases.  Italy for example lists 2,978 deaths out of 35,713 cases today for a ratio of over 8.3%.  South Korea on the other hand lists 91 deaths out of 8565 cases for a ratio of 1.1%.  While some pundits are suggesting that the virus has mutated and Italy is being ravaged by a far more deadly strain, a quick look at the number of tests performed shows that as of March 9th Italy had conducted only 60,761 tests to find its claimed 9,172 cases on that date, while South Korea had conducted 210,144 tests to find only 7,478 cases.   Common sense would suggest that the reason for Italy’s apparently high CFR had a great deal more to do with the lack of testing, and therefore discovery of milder cases, than with a newly emergent killer strain of the virus.  Even South Korea has tested only 0.4% of its population, and almost certainly missed a great many cases especially as we know many people are completely asymptomatic.  The numbers from Iran also make for a very interesting analysis.  On March 9th, Iran was claiming to have 7,161 cases and a little over 400 deaths.  However this article from the Atlantic, published on that same day,  makes a very credible case that hundreds of thousands, perhaps even millions were already infected on this date.  Even if we accept that Iran might also have been understating the number of deaths as some sources have asserted, it would seem that the true CFR is likely to be significantly below 1%.  And then there is Germany with 12,327 cases and just 28 deaths for a ratio of 0.2%.  I have been unable to discover exactly how many tests Germany has been conducting, but I’m betting it’s a lot and the result is, quelle surprise, a very low CFR.

Fourthly my own personal experience tells me that we are missing large numbers of cases.  We’ve all read the stories of people who couldn’t get tested despite clear risk factors, classic symptoms, and the examining physician begging the CDC for a test.  I believe those days are now behind us, but I personally know at least four people who currently have symptoms (fever, malaise, persistent cough) which are a match for a mild case of the virus.  None of them has been tested.  Only one of them actually called his doctor and he was told not to worry and that he didn’t need a test.  I’m not suggesting that any of these people necessarily have the virus, but if we are not testing people who have these symptoms, let alone the people without any symptoms, then we are absolutely going to massively undercount the number of cases.

Fifthly there has been much discussion of R0, most of it focused on the relationship between this number and the difficulty of containing the epidemic, or showing how it results in a near-exponential curve of cases in the early stages of an outbreak, and perhaps a little on its impact on herd immunity which will only kick in and start to eliminate the disease once the proportion of immune people reaches 1 – 1/R.   Most studies have concluded that R0 is somewhere between 2 and 3, with outliers arguing for a higher value including this one which put the estimate possibly as high as 6.6.  However all these studies are based on a best fit analysis of the curve of recorded cases, and I am arguing that this is precisely the data which is most unreliable.  Given that this illness appears to last for quite some time and people are infectious during the average five day incubation period in addition to the symptomatic period, an R0 of 2.5 would appear to imply that the average infected person would manage to transmit the virus to someone else perhaps once every six or seven days, but we now have countless examples of the infection spreading much faster than this.  Four people attend a meeting in Singapore for a couple of hours with a fifth infected person, and all of them are infected by the time they leave.  One of them then goes on a ski holiday and infects everyone staying in his chalet.   A man sits on a long distance coach and infects nine other people sitting up to 14 feet away from him.  Trump meets with a Brazilian delegation, one of whom tests positive for the virus.  A few days later fifteen members of this delegation test positive.  “Super-spreaders” you cry, but super-spreaders are supposed to be rare, and while it is true that a random sample of anecdotes from the press is about as far from proper scientific method as you can get, these stories seem typical and some of them, by their nature, are not the result of selection bias.  We know that other viruses which can be spread by aerosol often have very high R0 values indeed.  Measles is one example where R0 is believed to be between 12 and 18.  If this virus had a much higher R0 than the frequently cited 2.5 then the consequences would be a much shorter doubling time for the epidemic (which appears to be the case in Europe), a much higher number of cases, and a much greater proportion of the population catching the virus over a much shorter period of time, than in a normal flu season.  This in turn could lead to hospitals becoming overwhelmed and a rapid surge in fatalities while the fatality rate itself remained low.

Sixthly China appears to be indicating that it believes the epidemic in Wuhan has peaked and they are demobilizing their emergency hospitals and starting to relax their controls.  Since we know that the epidemic will only subside once at least 60% of the population have been infected and Wuhan has a population of over 10 million people, then that suggests that the Chinese believe that several million people in Wuhan have had the virus.  A CFR of just 1% would imply tens of thousands of deaths, and even the Chinese would struggle to hide that many bodies.  I shall watch with interest to see if the number of cases in Wuhan starts to surge again as the quarantine is relaxed; if it does not then we can be pretty sure the CFR is far below 1%.

And finally the Diamond Princess cruise ship.  This is a particularly interesting dataset because, uniquely, all passengers were tested.  Out of 3711 passengers, 712 tested positive and there were seven fatalities for a CFR of just under 1%.  This study was written before all the cases were discovered, and shows that the average age of the passengers and crew was 58, and more than 1,200 passengers were over 70 years old.  Over 330 passengers under the age of seventy were infected, and the difference in apparent infection rates between age groups suggests to me that more passengers in this age group might well have been exposed to the virus and successfully fought it and completely recovered prior to testing.  Not a single person under the age of seventy, out of the more than 330 infected, died.

The net is that there is significant reason to believe that the virus has a CFR well below 1%.  I suspect it will fall in the range of 0.1% – 0.5% and quite probably at the low end of that range, provided patients have access to good medical care.   However it is extremely infective and spreads astonishingly fast.  It will therefore infect a great many more people in a much shorter period of time than the regular flu and consequently has the ability to overwhelm our hospitals by virtue of the number of cases rather than the virulence of each case.

If my conclusions turn out to be correct, the good news is that the pandemic will be gone before you know it.  We’ll all get it within a couple of months, 99.8% of us will live through it, and it will be over by May or June.

I hope and pray that I am right.

Oh – and if I did decide I wanted to waste my time thinking about conspiracy theories, I would start by wondering whether the astonishing testing debacle here in the USA was truly the result of an almost incomprehensible degree of incompetence and bureaucratic bungling, or whether not even our government could commit such a series of blunders except by somebody’s design.

UPDATE:  Also see this study from the UK’s top medical journal:

“Italy has had 12 462 confirmed cases according to the Istituto Superiore di Sanità as of March 11, and 827 deaths. Only China has recorded more deaths due to this COVID-19 outbreak. The mean age of those who died in Italy was 81 years and more than two-thirds of these patients had diabetes, cardiovascular diseases, or cancer, or were former smokers. It is therefore true that these patients had underlying health conditions, but it is also worth noting that they had acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, needed respiratory support, and would not have died otherwise. Of the patients who died, 42·2% were aged 80–89 years, 32·4% were aged 70–79 years, 8·4% were aged 60–69 years, and 2·8% were aged 50–59 years (those aged >90 years made up 14·1%). The male to female ratio is 80% to 20% with an older median age for women (83·4 years for women vs 79·9 years for men).”

UPDATE 2:  This is a study on the case fatality of swine ‘flu in 2009.

“There is very substantial heterogeneity in published estimates of case fatality risk for H1N1pdm09, ranging from <1 to >10,000 per 100,000 infections (Figure 3). Large differences were associated with the choice of case definition (denominator). Because influenza virus infections are typically mild and self-limiting, and a substantial proportion of infections are subclinical and do not require medical attention, it is challenging to enumerate all symptomatic cases or infections., In 2009, some of the earliest available information on fatality risk was provided by estimates based primarily on confirmed cases. However, because most H1N1pdm09 infections were not laboratory-confirmed, the estimates based on confirmed cases were up to 500 times higher than those based on symptomatic cases or infections (Figure 3). The consequent uncertainty about the case fatality risk — and hence about the severity of H1N1pdm09 — was problematic for risk assessment and risk communication during the period when many decisions about control and mitigation measures were being made”

In other words, the confirmed case fatality rate for swine ‘flu bore no relation to the actual fatality rate.  And it is very likely the same thing is true for coronavirus.

UPDATE 3:   Singapore has zero deaths from 385 cases.  The exact number of tests are also not tracked on worldometer, but this article notes that less than 1% of their tests are coming back positive so we know that they have tested at least 38,500 people (more than half as many tests as Italy) to find just 385 cases. Here’s what the article says about the testing process: “On testing, the threshold for getting a test is pretty low. For the first week, we tested only people from Wuhan or Hubei province, then we tested anyone who had been in China within the last 14 days.  By the end of January, all of our public hospitals could do tests. Then we moved to enhanced screening – we tested anyone coming to a hospital with a respiratory illness, anyone who had been in contact with a COVID-19 patient.  Now, it’s even become more liberal. If you’re a hospital staff member with a mild cold, we’ll give you a test.”   This recent study suggests that 86% of infected people are completely asymptomatic.  If this is correct then even Singapore is missing a large number of cases, and so has considerably more than 385 infected people and they still have zero deaths.

UPDATE 4:  With apologies to Mr. Lightwood who, forty years ago, made a sterling effort to hammer at least a minimal understanding of the German language into my skull, I don’t speak a word of German.  However I am told that this site indicates that the Germans have been doing more testing than most countries (over 100,000 tests more than a week ago) which is further confirmation of my hypothesis.

A Worldview

I’m still not really sure how I want to develop this blog.

I think in my heart of hearts I’d like to develop a complete, rational philosophical argument concerning the form an ideal society should take.  But that that is a huge task which I doubt would interest many of you, and much of it would turn out to be repeating what others have already said better.

I also find myself wanting to comment on day to day events and link them back to my worldview.  And for that to make sense to the reader, I think I need to explain my beliefs.  Hence this entry.

I’m not going to attempt any comprehensive proof or defense of my worldview here since that would be exactly the work for which I have just observed I am not fit.  But I will try to explain in broad strokes what I believe.

I believe our society has been deeply corrupted.  I do not know to what extent it may always have been this way.  I suspect the level of corruption is cyclical, and also that the internet has exposed more than the usual amount of dirty laundry thus improving our ability to perceive reality.

I believe that the vast majority of our rulers, irrespective of party affiliation or election platform, co-operate with each other to steal as much as they can from the rest of us, both directly through legislation, warfare and bribery, and indirectly through the institutions they create which serve their interests at the expense of ours.  To distract from these activities they busily disseminate propaganda and foster divisions within society to keep us at war with ourselves instead of united against them.  The mechanisms of their control are our education system, our banking system, our courts, the press, our police and the ever-proliferating plethora of government agencies.

I believe that the dominant political ideologies of our time: socialism, liberal democracy and fascism are all morally bankrupt confidence tricks.  Each promises to rob Peter and pay Paul and differ only in who is to play the role of Peter and who Paul.  No matter which system is chosen there is always a cut for the house, and in return for every false promise more power is centralized in the hands of our rulers who never fail to wield it for their own benefit.

Furthermore, I believe that not only are these ideologies confidence tricks in practice, but that they can never, even in theory, be anything else.  That, if the problems they are designed to protect against exist, then these systems will always exacerbate those problems instead of addressing them.

If we measure the success of a society by its ability to promote happiness for its members and eliminate suffering then I believe that a far better system is possible, but that a perfect system might be unachievable.  And that even if a perfect system were possible, it would not guarantee happiness for every human being, nor eliminate all suffering.

And everything I believe might be wrong.

Symptoms of Dystopia

Almost everyone I talk to these days seems dismayed by the state of our society.  Not everybody sees the same problems, nor do they see them in exactly the same way.  But there are many common threads and there seems to be an almost universal belief that things used to be considerably better, even though people struggle to pinpoint exactly what has gone wrong.

I’m not going to try to construct a comprehensive list of the problems, nor am I yet going to attempt to separate cause and effect.  Rather I will just list the things which concern me most:

  • corruption and hypocrisy in public life
  • the substitution of propaganda and lies for facts and truth from media, government, academia, and business
  • corporate immorality
  • government tyranny and the erosion of basic rights such as freedom of speech, privacy, the presumption of innocence, and the right to a trial
  • the widening gap between haves and have-nots, and the failure of our economy to deliver an acceptable quality of life to many
  • endless and morally unjustifiable wars
  • diminished quality and lower standards of education
  • destruction of family life
  • lack of justice in our courts
  • the replacement of principle, honour and tolerance with sanctimony, false piety and intolerance

Later blog entries will explore these various problems and how I believe they are related, and what we might be able to do to solve them.

But it seems clear to me, that if we do not reverse direction, we are heading for disaster.


I am creating this blog because I believe humanity is fast creating a dystopia for itself.  I want this blog to become a place where intelligent people can share their observations about and understanding of society, our ideas about what a better society might look like, and practical suggestions for creating such a society.

I of course have my own views, but I am a believer in free speech, and therefore all opinions are welcome here provided only that you remain civil, and that you come here with an open mind.  Indeed if this blog becomes only an echo chamber then it cannot serve its purpose.

So, should you find yourself disagreeing with my opinions, please stay and take the time to point out my errors.