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Some wrong lessons people will learn from the president’s illness, hospitalization, and expected recovery

Jonathan Falk writes about the president’s illness:

I [Falk] would think it provides a focused opportunity to make a few salient statistical education points.

First, a 6 percent mortality rate (among old people with comorbidities) is really bad, but any single selected person is really quite unlikely to die, or even be really sick. Same with all the reports about blood clots, six month recovery times, etc., etc. Even more unlikely. A prediction: when Trump feels fine in a couple of days this will be taken as one more piece of evidence that this is not a serious disease, which is statistically illiterate on a number of levels.

Second, the reference group (old people with comorbidities) implicitly assumes a standard level of care. (Changes in the standard of care is one of the main reasons the death rate has fallen so much from the average.) Trump’s probabilities are way better than that because he gets care that very few other people in the world get.

Third, it will be interesting to see retrospective assessments of the impact of whatever treatments he got. And of course how poor such retrospective inferences are.

That first point reminds me of the hookah story.

80 Comments

  1. jonathan says:

    Aren’t there two basic reference groups within people above say 65? One is people with comorbidities. The other is people in long term care facilities. Data in MA is ⅔ of all deaths are in care facilities, and this trend has continued, meaning it isnt derived from early infection of care homes. MA no longer reports deaths by age (!), but they are required to report care facility data. So, each day I look at that: the trend is more than 2/3 over the last month or so. Today was 12 of 16, yesterday was a bit under 60%, day before a bit over 72%, etc. We do not seem to be getting any better at keeping people in care facilities from dying.

    The reporting varies greatly from state to state, but I check a handful that give this kind of data, and all are above 50%. I would guess they are where many excess unincluded deaths are, especially given the spottiness of reporting I see when going from state to state.

    You could consider being in a care facility a comorbidity, but it’s an extreme one. The spotty reporting makes understanding comorbidities difficult. MA, for example, reports on underlying conditions, but it says 98% have them, but prior hospitalization of the dead include 52% yes, 16% now, and thus almost one third unknown. That’s a lot of unknown. But it indicates that you’re really hurt by having been hospitalized for the underlying condition. This is the kind of data I would normally expect to take years to harvest.

    So Trump is not in a care facility, though many believe he belongs in one, nor to my knowledge has he been hospitalized for his obesity or whatever issues he has.

    • jonathan says:

      correction: i realized I mistyped. MI, for example, reports something closer to one third of the deaths in care facilities. This may reflect that so many of the deaths in MI are in Detroit, which means a higher concentration among elderly minorities who arent in care facilities. I say elderly because MI reports deaths by age and it is very highly skewed to 80+, so I would bet people who cant afford to be in care facilities are being hit in my hometown.

    • Passaic says:

      Yes “spotty reporting” makes understanding very difficult for the actual societal threat/impact from COVID.

      There is also an extreme emotional/panic/focus/bias in general reporting– and disregard for COVID-19’s lesser severity relative to the multitude of normal threats faced by humans historically.

      This is a ‘serious’ disease, but history is full of much worse diseases — and staggering levels of death & suffering from other human calamities worldwide.

      Statistical analysis is worthless without accurate data — and the tsunami of alleged COVID-19 statistical data/analysis is highly suspect.
      The very wide international proportional variations in alleged COVID “cases” & “deaths” do not pass the common sense test.

      It is of no consequence now what popular opinion is about Trump’s COVID … after we have endured a bizarre six month media circus & government destruction of the economy.

    • Carlos Ungil says:

      Even if you calculate, including additonal data about how many people is in each group , a probability P(death | age, LTC) which is larger than P(death | age, non-LTC) [*] that doesn’t tell you much about the relative risk of death conditional on infection.

      P(death | age, LTC) = P(death | age, LTC, infected) P(infected | age, LTC) and
      P(death | age, non-LTC) = P(death | age, LTC, non-infected) P(infected | age, non-LTC). Both factors are arguably larger in the LTC case [*] than in the non-LTC case but it’s not obvious which one is the main driver.

      [*] When conditioning only on age. As more relevant factors get added lethality may become lower for LTC residents as we can imagine that, everything else being equal, an infected person would have better outcomes living in an institution with some level of health care and monitoring than living alone.

  2. Anoneuoid says:

    According to the press conference they gave him an experimental antibody treatment and remdesivir because they were “maximizing all aspects of his care and hes the president and didnt want to hold anything back and if there there was any possiblity it would add anything to his care they wanted to take it”.

    Apparently not the most obvious treatment of vitamin C though. They didn’t even mention testing him for vitamin C levels despite that they have been reported to be very low in covid patients.

    https://www.youtube.com/watch?v=vD7B5X2QjG0
    https://pubmed.ncbi.nlm.nih.gov/32847620/
    https://pubmed.ncbi.nlm.nih.gov/32964205/

    This is not treatment guided by science and cost-benefit analysis. And that is the president of the united states…

    • Rahul says:

      Well, on the other hand, that means no elitism criticism. By your argument even the president gets crappy treatment.

      • Anoneuoid says:

        It seems like he is getting the most expensive treatment rather than the best. But the FBI under him was raiding places giving vitamin c for covid (ie, for probable vitamin c deficiency) so it’s not very surprising.

        If people received proper treatment for the vitamin C and oxygen deficiencies (HBOT) seen in severe covid, that we’ve known about since at least April, no one needs to die. It can end tomorrow.

        • Phil says:

          I was with you until the last two sentences.

          • Anoneuoid says:

            It is the most obvious thing in the world to correct these deficiencies. Both treatments were reported very effective in China back in Feb and all subsequent reports have been consistent with this (50% drop in mortality even when done very late in the illness).

            That it’s taking so long to be widely recognized shows there are huge problems with how medical research is done. But people are apparently satisfied listening to the same experts that recommended the most dangerous and expensive treatment of putting patients on ventilated without delay based on no evidence.

  3. Not Trampis says:

    It is the access to the best medical treatment in the world that is the killer ( pun intended). Boris did not have that.

    How Trump would go in an overcrowded ICU ward with people run off their feet is very problematic

  4. Mendel says:

    I’ve always suspected that some people’s approach to Covid-19 is the same as their approach to unprotected sex: “as long as the prostitutes are tested regularly, you’re safe” (and feel manly). It’s not an approach informed by the actual risk, is it?

  5. Molly says:

    Is the quote from Jonathan Falk part of a larger article?

  6. Looking ahead: cutting out saturated fats and sugar is a good strategy for anyone over 30. I would go vegan as it is possible to prevent/delay metabolic disease which compromise the immune system. Just looking out for you all.

    • Chris Wilson says:

      One thing that has impressed me since the beginning with Covid is that all the co-morbid risk factors are basically some stage of metabolic syndrome: obesity, diabetes, hypertension. If our population was generally lean, muscular and aerobically fit, the course of this disease (and many others) would be much much different!

      • Another thing that’s interesting is that there’s evidence that people eating the same calorie intakes and with the same exercise levels today are generally fatter than similar people 30 or 40 years ago. I strongly believe that there’s something else going on than change in diet and activity level. Something like changes in gut bacteria, endocrine disruptive environmental chemicals, or patterns of activity (everyone doing short stints on the elliptical machines rather than working at low levels all day long) or something.

          • Sure, but also prevalence of anti-depressant medications, of proton pump inhibitors, of ibuprofen intake, of changes to farming practices, of processed foods, etc etc etc

            • Anoneuoid says:

              Yea, but smoking is already known to have a huge impact on appetite via increasing blood sugar. The high carb diet (food pyramid, etc) promotion and anti-smoking campaigns were introduced around the same time obesity started rising.

              One addiction was replaced with another.

          • Fred says:

            If reduced smoking were indeed a big factor, you would expect obesity to increase more in males than females. That is not the case in the US.

            • Anoneuoid says:

              Based on reported smoking and weight by age?

              • Fred says:

                What I said was incorrect, but for an interesting, if obvious in hindsight, reason.

                “Consider a hypothetical example of 1000 people. A decline of 10% in smoking prevalence is a relatively large decline but only affects 10% of the population, or 100 people in this example. If, for example, the probability of obesity among smokers is 20% then 20% of those 100 people would be obese if that group were smokers, equivalent to 20 people or 2% of the total population. If the probability of obesity among nonsmokers is 30% then 30% of those 100 people would be obese if that group were nonsmokers, equivalent to 30 people or 3% of the total population. The remainder of the population would be unchanged. The population-level effect on obesity if that 10% of the population were nonsmokers rather than smokers would only be the difference between 2% and 3%. So the expected effect of 10% of the population being nonsmokers rather than smokers would only be a 1% increase in obesity in the total population. Thus, even though smoking cessation can have a considerable effect on the weight of an individual, and even though smokers tend to have a lower prevalence of obesity than nonsmokers, and even though drops in the prevalence of smoking have been large, nonetheless the likely effect of changes in smoking prevalence on obesity in the whole population is not large.”

                https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931461/

              • Anoneuoid says:

                From the numbers I see it used to be that ~40% of adults smoked and ~15% were obese, now ~15% smoke and ~40% are obese.

                https://www.cdc.gov/nchs/data/hestat/obesity_adult_13_14/obesity_adult_13_14.htm

                https://www.statista.com/chart/14879/us-smoking-rate-falls-to-record-low/

        • Chris Wilson says:

          Yea I’ve seen similar things. I worry about measurement problems here. Dietary calorie intake is notoriously hard to pin down with high granularity- for various reasons, people are terrible at estimating their own intakes. We have some good indirect measures though too. So we know directionally that calories have gone up steadily since 1970s, probably mostly due to the steady intrusion of ultra processed foods as you brought up elsewhere.

          Smoking cessation part of it for sure. But I’d also believe that chronic stress and exposure to endocrine disrupters may be playing a role.

          Per exercise, I am increasingly convinced that mitochondrial health and function is the central key to metabolic health. This is developed from the right kind of exercise. My guess is if we had measurements of metabolic flexibility (mitochondrial efficiency) and VO2 max from gold standard graded tests over a large cohort, we could predict the hell out of cardiometablic disease risk, immune status, risk of dying from Covid, etc etc

          • Chris Wilson says:

            Basically, my point is I see a lot of people exercising but never moving the needle on the biomarkers that matter most- muscle mass, leanness, aerobic capacity and efficiency. There’s a lot of low quality advice out there!

            • Martha (Smith) says:

              Can you give some good references discussing the evidence that the biomarkers you list are indeed the ones that matter most? And on what types of exercises develop these qualities (especially for older people)?

              • Chris Wilson says:

                Hi Martha, sure! Bear in mind this will necessarily be very abbreviated since I don’t want to do a long essay here.

                For basic framework of biomarkers: Evans and Rosenberg book (“Biomarkers”), more recently Joseph Signorile (“Bending the Aging Curve”)

                Aerobic capacity and mortality:

                Mandsager, K., Harb, S., Cremer, P., Phelan, D., Nissen, S. E., & Jaber, W. (2018). Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA network open, 1(6), e183605-e183605.

                Feldman, D. I., Al-Mallah, M. H., Keteyian, S. J., Brawner, C. A., Feldman, T., Blumenthal, R. S., & Blaha, M. J. (2015). No evidence of an upper threshold for mortality benefit at high levels of cardiorespiratory fitness. Journal of the American College of Cardiology, 65(6), 629-630.

                Blaha, M. J., Feldman, D. I., & Nasir, K. (2014). Coronary artery calcium and physical fitness–the two best predictors of long-term survival. Atherosclerosis, 234(1), 93-94.

                Lakoski, S. G., Willis, B. L., Barlow, C. E., Leonard, D., Gao, A., Radford, N. B., … & Jones, L. W. (2015). Midlife cardiorespiratory fitness, incident cancer, and survival after cancer in men: the cooper center longitudinal study. JAMA oncology, 1(2), 231-237.

                -The work at CERG-NTNU in Norway is also good. They have done large cohort studies in Norway and elsewhere. https://www.ntnu.edu/cerg/advice
                https://www.ntnu.edu/cerg/vo2max

                Leanness: This one is easy. There is a *ton* of research on obesity and risk of disease. The understanding is that visceral and especially ectopic fat are the key drivers of pathology. The waist-height ratio is therefore easiest anthropometric quantity to track – superior to BMI, although broadly similar in an average population.

                Muscle mass/strength:
                Carbone, S., Kirkman, D. L., Garten, R. S., Rodriguez-Miguelez, P., Artero, E. G., Lee, D. C., & Lavie, C. J. (2020). Muscular Strength and Cardiovascular Disease: AN UPDATED STATE-OF-THE-ART NARRATIVE REVIEW. Journal of Cardiopulmonary Rehabilitation and Prevention, 40(5), 302-309.

                Abramowitz, M. K., Hall, C. B., Amodu, A., Sharma, D., Androga, L., & Hawkins, M. (2018). Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PloS one, 13(4), e0194697.

                Ruiz, J. R., Sui, X., Lobelo, F., Morrow, J. R., Jackson, A. W., Sjöström, M., & Blair, S. N. (2008). Association between muscular strength and mortality in men: prospective cohort study. Bmj, 337, a439.

              • Chris Wilson says:

                Hi Martha,
                At any rate, happy to chat further. There is also growing interest in myokine signaling, which originates in skeletal muscles, etc.
                In terms of how to move these biomarkers – I don’t have anything revolutionary to say :)

                Regular, whole-body progressive resistance exercise, based around compound movements, performed with a high degree of focus, effort and control. Allow enough rest and recovery to progress strength from session to session – this will be consistent for a while, and then you will start to slow down as you reach intermediate and advanced training status. At that point, it’s a dance of undulating gains, losses, cycles, etc.

                For the all-important cardiorespiratory fitness. Start with daily walking. Then find a safe modality to do one or two higher intensity sessions per week (that CERG page has good advice IMO). For metabolic optimization, I think a couple hours per week of low intensity training around aerobic threshold are needed – this is right around the pace where you can still breathe comfortably (around 4-5 out of 10 RPE). For those used to high intensity it feels “too easy” to be exercise :) but it is the universal foundation on which every successful endurance athlete builds. The idea is to get the right dose for the health benefits, not trying to be elite!

                Hope this helps.

              • Martha (Smith) says:

                Chris said,
                “…. Then find a safe modality to do one or two higher intensity sessions per week (that CERG page has good advice IMO). “

                Finding a safe modality for the individual is crucial to being able to follow the program. The CERG page doesn’t really get at this. For me (and I think many older people) a “safe modality” means one that doesn’t strain or otherwise injure the joints, tendons, cartilage, or ligaments. For example, the CERG page has pictures of a woman doing pushups with hands and arms forming a 90° angle — with no mention of the alternatives (which I have needed to use for years) of pushups with the hands in fists or wrapped around a dumbbell, so that the wrist is straight rather than bent.

              • Chris Wilson says:

                Hi Martha, yep. Unfortunately, there’s no one stop shop source for this. I’ve spent 20 years in ‘physical culture’ (aka nerdy meathead) and still learning and tweaking. Anyway, for interval structure they have useful guidance on 4X4, which is quite potent IME. For cardio respiratory training you want a rhythmic, cyclic movement that you can work out good biomechanics for, so running, rowing, cycling, XC skiing are king. Swimming is also fine. Or you could use a treadmill and set an incline if you want a very joint friendly starting point…

              • Martha (Smith) says:

                Chris said,
                “For cardio respiratory training you want a rhythmic, cyclic movement that you can work out good biomechanics for, so running, rowing, cycling, XC skiing are king. Swimming is also fine. Or you could use a treadmill and set an incline if you want a very joint friendly starting point…”

                Running is too harsh on my rib cartilage; I suspect that rowing or skiing would have the same problem. Outdoor cycling is too risky. Stationary cycling works with some cycles, but right now (with most gyms either closed or risky for coronavirus), getting access to a suitable cycle is problematical. Trying to purchase one would probably be a major task.

              • Chris Wilson says:

                Can’t go wrong with one of these:
                https://www.concept2.com/bikeerg/concept2-bikeerg

              • Martha (Smith) says:

                Thanks for the suggestion — but this doesn’t look like what I would need. The “sport-based” label appears to dictate a position that’s not good for me — I need a cycle where I can sit more upright, or even slightly leaning backward. Also, the seat on this one looks pretty brutal.

                In fact, looking at the specs: They say, “*Suitable for inside leg measurements between: 28 in (71.1 cm)–37 in (94 cm)”. My inside leg measurement is 27 in.

        • Graham says:

          It’s widely known that top-line comparisons of caloric intake are not useful, as the composition of the calories determines health outcomes. Also, extended low-level exercise is terrible for your heart as it leads to inflammation. Shorter but more intense exercise is better for your heart.

          • Andrew says:

            Graham:

            What is “extended low-level exercise”? Is that like taking a long walk? If this is really terrible for your heart, I’ve not heard that claim before. I’m not saying you’re wrong, I’m just saying that this is a pretty stunning claim, given everything else I’ve heard from all sources. I have heard the bit about shorter intense exercise being good for your heart—I have no idea if this is true either, but I’ve heard it before. The bit about extended low-level exercise being terrible, that’s completely new to me.

        • Navigator says:

          30/40 Years ago people moved more. Forget structured exercise. That doesn’t fix the other 23 hrs. of immobility. The concept of ‘exercise’ is new. Just the fact we need it is problematic. We should be moving around so much that we crave rest, not exercise.

          I suspect environmental pollution and the synergistic effect of all that toxic stuff as one of the culprits.

          • Great discussion on exercise. Thank you

          • Martha (Smith) says:

            Navigator said, “30/40 Years ago people moved more.” Any evidence backing this up? I briefly tried thinking about how much I move now compared to 30/40 years ago. My best guess is that such differences would be related more to my physical condition in a given time (or period of time) than the time (or period of time) itself. So I think backing up or refuting your conjecture would need to take into account a lot of factors.

    • confused says:

      Healthier diet in general, absolutely. I am more than a bit skeptical of full veganism as good advice for *the population in general* though — humans are not naturally pure herbivores, and I think it takes more care to get a fully balanced diet than most people will bother with.

  7. Matt Skaggs says:

    Count me as someone who does not think we will learn anything from Trump being sick, because no one will tell the truth. First of all, the timeline is all wrong, he did not get exposed on Wednesday and hospitalized on Friday. Just based upon the average of cases, Friday was probably day 6 or so after exposure. From there, he can be expected to head down hill for a few days. No doubt after his scare Friday, they loaded him up with steroids and acetaminophen, so that he could breathe on his own on TV and be reported to have no fever.

    Peak viral loading tends to occur around day 11. He is definitely not “out of the woods.” And his odds of severe disease are barely impacted by his care, this is a disease with no cure.

  8. jim says:

    The Hooka Story is amusing to me on a different level. It’s wrong.

    My grandad lived to 94 and ate eggs and bacon all his life. For most of the last five decades, I’ve been told this is a mere anecdote, eggs and bacon are nails in your coffin, not safe to eat! I’ve been sneered at by turd-brained doctors many times for claiming otherwise.

    But **now** it comes out! Cholesterol isn’t bad for you after all!! Whoa, how could you have possibly known that from all those 94-year-olds who ate eggs all their lives? No, just ignore that information! It doesn’t tell you anything!!

    So beware telling people that their stories are mere anecdotes. The world is not yet owned by probability.

    • Dale Lehman says:

      This reminds me of the Woody Allen movie Sleeper, where he awakes after decades to discover that the dietary advice has been turned on its head while he was gone. But, seriously, the fact that our understanding and advice may change, perhaps is even likely to change, means what exactly? Too many people interpret this to mean we should ignore all “expert” advice. Too many people. I’m all for telling people not to believe “experts” automatically, especially if their “expertise” derives from their pedigree or number of publications. But don’t we need to be more careful about what we tell people? Isn’t the “truth” more nuanced and complex than your anecdote suggests?

      • Not to mention that Jim is mostly likely misinterpreting modern advice. It’s been known for a LONG time that *dietary cholesterol* is relatively meaningless, and that *dietary saturated fat* is what drives blood cholesterol levels. Turns out eggs and bacon and etc have both high cholesterol, and high saturated fat. It’s not the cholesterol in the eggs and bacon, it’s the saturated fat. So the advice hasn’t changed, but the mechanistic reason behind the advice did change somewhere back in the late 80’s (that cholesterol itself wasn’t particularly important was already part of a food science class I took around 1995 so it’s not exactly new information).

        • Carlos Ungil says:

          The advice did change. Until 2015, the Dietary Guidelines for Americans recommended to limit cholesterol intake to 300 mg/day. One egg is ~200mg and they suggested using egg substitutes to achieve compliance.

        • Carlos Ungil says:

          By the way, this is not correct (as far as eggs go):

          > Turns out eggs and bacon and etc have both high cholesterol, and high saturated fat.

          • I don’t know that “high” really has a precise meaning. Compared to a plant based diet which is often advocated vs animal products, say a diet of beans and rice, eggs will have high saturated fat and cholesterol for example.

            https://fdc.nal.usda.gov/fdc-app.html#/food-details/748967/nutrients

            Under lipids it shows: 3.2 g out of about 10g total fat, so 32% of the fat is saturated fat

            for cholesterol: 411 mg

            both for 100g portion of whole egg

            Compare say to a pork chop, stewed, lean and fat:
            https://fdc.nal.usda.gov/fdc-app.html#/food-details/781910/nutrients

            10.5 g of total fat per 100g serving, cholesterol 84mg, saturated fat 3.2g out of 10.5 so similar percentage.

            So by this example measure a pork chop and an egg have very similar saturated fat, but the egg has 50x the cholesterol. Both of them have a lot more saturated fat than a plant based diet:

            https://fdc.nal.usda.gov/fdc-app.html#/food-details/786321/nutrients

            in 100g of beans and rice: 4.8g of total fat, 0mg of cholesterol 0.70 g of saturated fat.

            • Kyle C says:

              but the egg has ~7g of protein, much more than you will get from the beans. I agree with Carlos, it is not “high sat fat” from the perspective of a whole diet.

              • well the beans and rice were listed at 5g… so whatever. I’m fine with saying the egg is high in cholesterol but only moderate quantity of saturated fat. I eat plenty of eggs, but no bacon at all. so there you have it.

              • Russ Lyons says:

                I think 100g of egg has about 12-13g of protein, which is LESS than has the same weight of boiled soybeans (about 18g). Of course, the amount of protein in beans depends on the type of bean.

              • Kyle C says:

                Right. I looked at the label of a can of black beans on my shelf. And Daniel’s hypo is rice AND beans, not just beans. Search “rice and beans recipe” and you’ll find about 4.5g of protein per 100g. Ironically, I eat a lot rice and beans (or tofu)! But not based on the fat content.

            • Carlos Ungil says:

              And beans and rice have high saturated fat content compared to onions and potatoes. The point was that eggs and bacon were going to kill Jim but now it’s going to be bacon alone.

              The Dietary Guidelines for Americans went in the latest release from telling people to limit egg consumption to four per week due to the high cholesterol content to saying that a few foods, notably egg yolks and some shellfish, are higher in dietary cholesterol but not saturated fats and eggs and shellfish can be consumed along with a variety of other choices within and across the subgroup recommendations of the protein foods group.

              • Yeah, I think that’s all fair. To be honest when I was originally saying “Turns out eggs and bacon and etc have both high cholesterol, and high saturated fat. It’s not the cholesterol in the eggs and bacon, it’s the saturated fat.”

                I was thinking of “eggs and bacon” as a meal, in the same way I was thinking of “rice and beans” as a meal. I wasn’t really saying that eggs are high in saturated fat, and bacon is high in saturated fat, rather that eating a lot of meals of “eggs and bacon” was a way to consume a lot of saturated fat (relative to the typical plant based alternatives suggested by those who want people to reduce their cholesterol, such as rice and beans, or oatmeal with raisins and nuts).

        • Kyle C says:

          I know this a dead thread, but I just noticed an article on eggs on Yahoo News and I see it’s still being widely reported that USDA recommends no more than 300g of cholesterol a day—advice that was rescinded in 2015.

    • Navigator says:

      Jim,

      You maybe confusing the direction of the effect with its magnitude. All ‘they’ recently found is that the previous evidence was based on noisy studies in past.

      That doesn’t mean the evidence is in the opposite direction. Of course, once it gets to the media, it will assume the new, opposite, non-existing direction.

  9. Kyle C says:

    My HMO still has posters on the walls of the exam rooms warning people to avoid “fat [all fat] and cholesterol” for a “healthy diet.” You may perceive that the advice changed 30+ years ago, but for the general public, I assure you it did not. People are filling up on pastas with sugary sauce because they are so afraid of “fatty” foods.

  10. Tom says:

    What about the fact that masks don’t reduce the probability of transmission to zero? Most of the current reporting is that more diligence wearing a mask would have been 100% effective in preventing transmission.

    • Dale Lehman says:

      What “current reporting” are you referring to? I’ve not heard too many people say masks are 100% effective. Admittedly, I am not listening too carefully since so much nonsense is being said (latest example, from the President, don’t be afraid of COVID). But your assertion just seems too extreme and unsupported to me.

    • Martha (Smith) says:

      Both Tom and David need to provide references to their claims.

      • David J. Littleboy says:

        I saw essentially this headline various places. (Sorry, my “would” should have been “might”. Probably the best statement would be “universal mask wearing is quite good at preventing Covid-19 infections, and it will be hard for a vaccine to do that well.”)

        https://www.msn.com/en-us/health/medical/cdc-director-robert-redfield-said-face-masks-may-be-more-effective-than-a-vaccine-in-preventing-individual-coronavirus-infections/ar-BB196I1M

        I’m surprised other people didn’t see these headlines: living in a country that has largely gotten away with rank incompetence at the national government level simply because everyone wears a mask has made me more sensitive to the question.

        • confused says:

          Hmm. I think that is pretty pessimistic on the effectiveness of a vaccine. (There was another post on here that had a study that said 40% reduction from masks in, IIRC, Germany; that would be pretty poor for a vaccine).

          But the real benefit from a vaccine may be more in reducing severity of cases than preventing infection. The flu vaccine doesn’t always prevent the flu, but it also tends to reduce the severity. If a vaccine makes COVID not dangerous anymore, we wouldn’t really need to care about preventing infection; it would become just like any other upper respiratory infection we don’t really think about.

  11. Tom says:

    Reporting is of the form “Trump mocked wearing masks and now has virus” ergo if he wore a mask he would not have the virus. None of the reporting is careful to report that masks are not 100% effective although they point out that vaccines are not 100% effective. To get back to the title of this blog post “Some wrong lessons people will learn from the president’s illness, hospitalization, and expected recovery,” do you think it is reasonable to conclude that the headlines and reporting focusing on the mask wearing is leading the public to conclude that a mask definitely would have prevented the illness?

    • Andrew says:

      Tom:

      I had the impression that everybody knows that masks are far from 100% effective either at stopping the virus in either direction. What I’ve been getting from all the news reports on masks is that if everyone wears them when in close proximity to other people, and also reduces the time spent in close proximity to other people, that this will reduce the rate of transmission, thus stopping the explosive exponential spread that we were seeing during the early part of the year.

      If the reporting leads the public to conclude that a mask definitely would have prevented the illness, I agree this would be bad. If the reporting leads the public to conclude that distancing and mask wearing could have reduced the spread of this mini-outbreak, I’d think that’s a reasonable conclusion for the public to draw.

      • David J. Littleboy says:

        Someone needs to point out the differences in severity of the problem between the US and Japan (where everyone wears a mask). More Americans per 100,000 population are dying a week (right now) in the US than died in Japan this whole year. Japan is puttering along at 400-600 cases a day, but only 10 deaths a day. (Roughly). And Japan’s not doing a very good job other than the masks…

        • Martha (Smith) says:

          The difference in mask usage probably reflects a general difference in culture — Japan has a strong emphasis on courtesy and collective good; the US doesn’t.

          • David J. Littleboy says:

            As I’ve mentioned before, Japan replanted its forests after WWII with the fast-growing and beautiful Japanese Cypress, which is also one of the most prolific generators of airborne pollen amongst gods creations, making spring here hell for allergy suffers. Thus the Japanese are used to masks. And the density of jerks is lower, too.

            But culture is something that can be changed if it’s killing you and your government isn’t insane…

            • confused says:

              Eh the individualist aspect is pretty deeply rooted in a good chunk of the US. This is IMO one of the drivers for increased political division in the US, especially urban vs rural. (There is a *huge* difference in the day-to-day attitude toward government in a big city, vs. a rural area where people have their own wells and septic system and there’s like one policeman/sheriff that everyone knows.)

              I don’t think the locally-observed effects of COVID are going to be major enough to change that. In a lot of these rural areas people just aren’t that concerned. (210,000 deaths in the US as a whole isn’t really “relatable” in the way someone *you personally know* getting it is. And the vast majority of individual cases aren’t that serious, as pointed out in the post.)

              I would say this fact is a big part of how we *got* the government we currently have (combined with a “perfect storm” of circumstances in 2016).

        • confused says:

          Frankly, while I agree masks help, the difference seems too large to be explained by *just* that.

          I wouldn’t draw strong conclusions from any one nation’s experience. There are too many oddities that seem rather hard to explain. Why is tropical Latin America generally hard-hit but tropical Africa generally not, for example? There are odd geographical trends in COVID numbers that don’t seem easily explained.

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