I’ve been following the studies out of California with concern. Red flags have been raised. If you follow epidemiologists on twitter, you’ll have seen many of them. I won’t share the link, but if you search “Two ER Docs in Bakersfield,” you can find it.

Update: In an unprecedented move, two medical organizations made a joint statement.

I’m sharing here a summary response from my Yale Epidemiology classmate (from 28 years ago!) and current Yale Associate Research Scientist in Biostatistics (and olive oil advocate), Tassos Constantino Kyriakides, Ph.D.

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John Snow’s Broad Street Pump

There are his words, except where noted:

Since a lot of buzz about 2 ER docs from California talking about SARS CoV-2. I saw the video too. I am not an ER doc and let me state up front that I have a lot of respect for them; I am however but an infectious disease epidemiologist/biostatistician.

So here’s my quick take on what they said:

(a) Points about immunity are well taken and I agree with how the immune system is built and strengthened.

(b) They mention that estimates talked about millions of deaths in the US-not quite accurate; the highest model estimate was up to 2.2 million in the US in an unmitigated (key word) epidemic- i.e. doing nothing about it (figures from that famous UK Imperial College report).

(c ) They are educated ER doctors but don’t, in my opinion, understand epidemiology. That they use incidence and prevalence interchangeably and in the wrong context was a quick give away of their minimal understanding of what these terms mean.

(d) A big difference between SARS CoV-2 and the pathogens they keep mentioning we should be exposed to in order to build our immune system is that such pathogens are things that as a species, humans have seen and interacted with before. However, any time we humans see something new, the principles of immunology as we know it from prior pathogen experience might go out the window since we have no idea how our system will respond; and this is what is happening with SARS-CoV-2, our immune system, according to what I have read, goes into overdrive and shocks everything.

[Dr. Rohr-Allegrini here: I agree with Dr. Kyriakides on this, but offer a caveat. In epidemiology we base our understanding on what we do know, and caution with what we don’t. We don’t yet have evidence that COVID-19 induces long term immunity, but based on other, similar viruses, we have no reason to believe it doesn’t. As epidemiologists, we’re cautious to warn that we can’t rely wholly on one set of similarities, and we can’t base policy decisions on this hypothetical. We continue to learn, and SARS-CoV-2 has challenged the immune system in ways we didn’t expect. The cytokine storm effect is very real. Meanwhile, UT Health is enrolling donors for a plasma study, based on the scientific assumption that people who have recovered from COVID-19 have immune sera.]

(e) The ER Docs in Bakersfield keep repeating this is their real data. Agreed. But they omit that these are the data they are seeing now, in the context of and after measures have been taken (post mitigation- a key point).

(f) Not for anything, but Dr. Fauci was in the midst of the HIV/AIDS pandemic and other epi/pandemics, so a little credit other than calling him an Ivy tower inhabitant who just draws on boards, would be more appropriate.

(g) ‘Destruction of the oil company’-really?

(h) The other countries they mention, like Sweden, applied measures such as testing, tracing, tracking (isolating) and has a population that takes responsibility and understands that individual actions have impact on others and the public at large- far from what we sometimes see and experience here. Even better, look at Iceland, a model response that included all the basic principles of how to contain a pandemic.

(i) For this kind of virus we should be talking about 70% or more in terms of herd immunity. We are nowhere near that even if we extrapolate the numbers as they keep saying.

[ Dr. Rohr-Allegrini:The US has tested 1.71% of the population, with a 0.3% infection rate. In Texas, we have tested 1% of our population with a 0.09% infection rate.]

Their extrapolation approach is flawed since testing is not widespread but targeted. That is, we have been mostly testing people with suspected/assumed exposure, which skews us toward likely positives. If we were able to test the whole population, the extrapolated numbers and percents would be different.

Don’t forget the asymptomatic who are key in the spread in the backdrop of under-testing. And again these numbers they are extrapolating are products of post mitigation. Further, let’s not forget how quickly the UK back-pedaled on the idea of herd immunity when they had their ‘oh-shit moment.’

Note: the field of epidemiology owes a lot to U.K. epidemiologists over the years. for example John Snow, [Not that Jon Snow] considered by many the father of epidemiology, who, in order to stop the cholera outbreak in London he pulled out the Broad Street pump where people would go for water…

Dr. Rohr-Allegrini is an epidemiologist and tropical disease scientist currently working to prevent diseases through immunizations.

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