WSJ 10/6/2020. By Holman W J
When the vice-presidential candidates meet in Wednesday night’s debate, Subject One will be the coronavirus. President Trump tested positive and was hospitalized. Vice President Mike Pence has, since Feb. 26, chaired an administration task force. Here’s my wish. Let this be an opportunity for the country to remove its blinders.
Some 7.4 million Americans have been infected with the virus. Or is it 74 million? According to Dr. Robert Redfield, head of the agency that the country relies on for such data, the Centers for Disease Control and Prevention, our testing as of late June was picking up perhaps 10% of cases. When we say 40,000 new infections are occurring daily, we might really mean 400,000 infections. When we imply that 2.2% of Americans have been infected, we may really mean 22%.
Astonishingly, the American people are inundated daily with a perspective on the virus that may be off by an order of magnitude. In January, when the Wuhan clampdown was just beginning, we could assert, without qualification or fear of contradiction, that the observed fatality rate was dramatically overstated. The Chinese were missing many mild cases; the disease is more widespread than we realize. Even then we recognized asymptomatic spread. It’s now believed that 40% of carriers are asymptomatic. This alone guarantees a large amount of undetected spread, which, if ignored, completely distorts our understanding of the challenge and how it should be faced.
The Economist magazine addressed exactly this question in a recent issue. Germany, a country celebrated for its testing regime, may be missing 82% of cases. The British, one of the first top-tier nations to face an outbreak, are identifying perhaps 1 infection in 12. Globally, the ratio of undetected to detected cases, says the Economist, may be around 20 to 1.
In my emails from readers, in Bob Woodward’s book, in the general perceptions of Americans, the effects are becoming bizarre from not leveling with ourselves about the disease’s true spread. When the president comes down with the virus, it is deeply concerning but not deeply shocking. We’re talking about a disease that has likely spread through 710 million people, nearly one-tenth of mankind, in nine months.
If we are missing 90% of cases in the U.S. and 95% in the world, this has obvious implications for the death risk from Covid—it is flu-like. And yet responsible news organizations and institutions like Johns Hopkins continue to invite their audiences to compare Covid’s death tally against a “confirmed” case count devoid of systematic meaning. This is the statistical equivalent of sampling subjects at the morgue and in kindergartens to estimate the fatality rate of people involved in car accidents. You will certainly find individuals who survived and didn’t survive car accidents, but your computed rate will be nonsense. I have news for Americans: All of our data about the prevalence and deadliness of the flu are estimates, except for pediatric deaths, which are actually counted. If, as we do with Covid, we relied on “confirmed” flu tests for how many are infected and what percentage die, we would be wildly and catastrophically misinformed about the flu’s real prevalence and its real deadliness.
Our country would have been better off if the reality principle had been drummed into its head from the start. An easily transmitted respiratory disease, with a longish incubation period and symptomless spread, is exceedingly likely to go world-wide before we even know it exists. That’s been the case with Covid. Of course politics makes it mandatory and unavoidable for politicians to be seen waving their arms to protect us from such a disease, but most of what they do will be ancillary in effect. The informed actions we take as individuals are the overwhelming factor in how rapidly the disease spreads, and whether the most vulnerable are shielded, buying time for vaccine makers and treatment developers.
At the same time—fasten your seat belts, media people, because we are introducing a second consideration—it would be irresponsible to subordinate all other human values and needs to avoiding Covid.
Dumping on Mr. Pence for a societal preference for denial and tomfoolery would not be fair. Still, I come back to a symbolically pivotal moment when, on March 27, he presented himself on CNBC, a news network where intelligent questions are asked. When the CDC was frankly but too quietly guiding the American people that most of us could expect to encounter the virus, when Angela Merkel was saying 70% of Germans could be infected, when New Jersey’s health commissioner was telling residents that she expected to be infected and so should they, Mr. Pence ducked a simple and straightforward question: Should most Americans expect to get the disease? That was a missed chance to start the country down the road to realism about the new coronavirus.