"Public health lessons learned from biases in coronavirus mortality overestimation"
Journal: Disaster Medicine and Public Health Preparedness
Public health lessons learned from biases in coronavirus mortality overestimation | Disaster Medicine and Public Health Preparedness | Cambridge Core
Author:
Ronald B. Brown, PhD
School of Public Health and Health Systems
University of Waterloo, Waterloo
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Abstract
In testimony before U.S. Congress on March 11, 2020, members of the House Oversight and Reform Committee were informed that estimated mortality for the novel coronavirus was tentimes higher than for seasonal influenza. Additional evidence, however, suggests the validity of this estimation could benefit from vetting for biases and miscalculations. The main objective of this article is to critically appraise the coronavirus mortality estimation presented to Congress. Informational texts from the World Health Organization and the Centers for Disease Control and Prevention are compared with coronavirus mortality calculations in Congressional testimony. Results of this critical appraisal reveal information bias and selection bias in coronavirus mortality overestimation, most likely caused by misclassifying an influenza infection fatality rate as a case fatality rate. Public health lessons learned for future infectious disease pandemics include: safeguarding against research biases that may underestimate or overestimate an associated risk of disease and mortality; reassessing the ethics of fear-based public health campaigns; and providing full public disclosure of adverse effects from severe mitigation measures to contain viral transmission.
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Selected quotes from the article (boldface mine):
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As health authorities responded to the COVID-19 pandemic by implementing lockdowns and other mitigation measures with minimal supporting evidence, scientists warned of “a fiasco in the making,†Caution was also raised against violations of fundamental principles of science and logic, such as the mistaken assumption that correlation implies causation. For example,
the public’s belief that mitigation measures were responsible for reducing coronavirus mortality may be a post hoc fallacy if lower mortality was actually due to the overestimation of coronavirus deaths.
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Exaggerated levels of fear were driven by sensationalist media coverage during the COVID19 pandemic. And yet, while the public was ordered to lockdown, overall costs and benefits to society from severe mitigation measures had not been assessed. Fear of infection also prevented people from seeking needed healthcare services in hospitals during the pandemic. The ethics of implementing fear-based public health campaigns needs to be reevaluated for the potential harm these strategies can cause. Dissemination of vital health information to the public should employ emotionally persuasive messaging without exploiting and encouraging overreactions based on fear.
In addition, legal and ethical violations associated with mitigation of pandemic diseases were previously investigated by the Institute of Medicine in 2007. People should have the right to full disclosure of all information pertinent to adverse impacts of mitigation measures during a pandemic, including information on legal and constitutional human rights issues, and the public should be guaranteed a voice in a transparent process as authorities establish public health policy.
Lastly, severe mitigating measures during the COVID-19 pandemic caused considerable global social and economic disruption. Enforced lockdowns increased domestic violence, closed businesses and schools, laid off workers, restricted travel, affected capital markets, threatened the security of low-income families, and saddled governments with massive debt. Between February and April 2020, U.S. unemployment rose from 3.5%, the lowest in 50 years, to 14.7%. A recession in the United States was also officially declared in June 2020 by the National Bureau of Economic Research, ending 128 months of historic economic expansion. Of relevance, economic downturns are associated with higher suicide rates compared to times of prosperity, and increased suicide risk may be associated with economic stress as a consequence of severe mitigation measures during a pandemic.
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In closing, nations across the globe may fearfully anticipate future waves of the coronavirus pandemic, and look bleakly toward outbreaks of other novel viral infections with a return to severe mitigation measures. However, well-worn advice from a famous aphorism by the poet philosopher George Santayana should be borne in mind, which is relevant to public health lessons learned in this article: "Those who cannot remember the past are condemned to repeat it."
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I was always glad to not fit in among them though.
