An epistemic crisis underlying a possible epidemic crisis

From A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data by John P.A. Iannidis making the same point I have been. This is a possibly catastrophic epidemic exacerbated by a certainly dangerous epistemic crisis.

All the drastic measures and firmly worded warnings? All opinions and all actions taken with only part of the equation taken into account.

he current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.

At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.

Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?

Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

Read the whole thing. We still do not understand what we are dealing with because we have insufficient data and too many contradictory events. Covid-19 in South Korea, Singapore, Japan, and Taiwan is not similar to the Covid-19 we are seeing in Italy, Iran and other locales. I am not saying they are different diseases. I am saying that the data we have from each of these locations seems to describe an entirely different progression. The variance is almost certainly one based on the fact that we have insufficient information.

Other examples where data engagement yields views highly variant from the mainstream news.

Has Cornavirus Been Here… Since Last Year!? by Justin Hart

Diamond Princess Mysteries by Willis Eschenbach

Singapore, Taiwan and Hong Kong Face Second Wave of Coronavirus Cases by Liza Lin and Joyu Wang.

In an epistemic crisis where we are unable to quantify the nature and magnitude of an unknown event, in this case, Covid-19, free speech and the capacity to analyze and speculate in a logical fashion is critical for the emergence of new knowledge and ultimately effective policy.