Last week, I interviewed New York University law professor Richard Epstein based on a contrarian article he had written for the Hoover Institution, where he is a senior fellow (video of the interview is here and a podcast version is here). The Washington Post reports that "conservatives close to Trump and numerous administration officials have been circulating" the law prof's article, which "plays down the extent of the spread and the threat" of coronavirus.
While Epstein does not have a medical or epidemiological background, he is a fellow at the Center for Medical Ethics at the University of Chicago and had worked on research about the spread of AIDS during the 1980s and 1990s. Amid what he called a "full state of panic," his March 16 article boldly declared that the total number of deaths from COVID-19 would top out under 50,000 and that in the United States we would see "about 500 deaths at the end."
In fact, at least 537 Americans have died from COVID-19 as of today. I wrote Epstein last night to ask for a response and he emailed me to say that he had committed "a stupid gaffe the first time round" and that correct number for U.S. deaths should have been 5,000. He pointed me to his latest column for Hoover, "Coronavirus Overreaction," which was published yesterday. From that article:
In my column last week, I predicted that the world would eventually see about 50,000 deaths from the novel coronavirus, and the United States about 500. These two numbers are clearly not in sync. If the first number holds, the total US deaths should be about 4 to 5 percent of that total, or about 2,000–2,500 deaths. The current numbers are getting larger, so it is possible both figures will move up in a rough proportion from even that revised estimate. Indeed, the recent run-ups in Italy and perhaps Spain suggest that those countries have yet to turn the corner.
Yet Epstein remains steadfast in his belief that current projections of millions of deaths globally are based upon faulty extrapolations from the number of existing cases.
The implicit assumption behind…my earlier column is that the worst way to model growth in deaths from the coronavirus is through a geometric progression that runs rapidly through a large number of cycles, each of which generates more cases than the cycle before. If the exponent at each of these stages is greater than one, the model will quickly explode. Thus, if we assume that each infected person infects 2.3 other persons, a world that starts with 100 infections in the first period will have about 2,800, infections by the fifth period, and the rate would grow even more rapidly after that. If the periods are close together, it is easy to see how the fearful analyst could conclude that the world will be soon consumed….
But there is no reason to assume that the doubling is a constant, and therefore there is no reason to accept the ratio of 800 to 1 for true cases compared to deaths. The situation in South Korea alone should dispel that narrative, where pervasive COVID-19 testing has revealed 8,897 cases against only 104 deaths…. Political leaders predict rising rates of infection, running perhaps for three months, while more cautious analysts think that the cycles turn down far sooner than the doomsday models predict. All of the stay-at-home orders that we see assume that the growth of cases (and of deaths) will be exponential, which is the sole justification for imposing the draconian measures that have wrecked both the economy and upended the lives of millions of people.
Epstein believes that such straight-line extrapolations fail to account for changes in behavior and new information that inevitably reduces the case fatality rate (CFR), or the number of infected people who die. In this, Epstein is hardly alone. There are at least two reasons why the worst-case scenarios for COVID-19 seem unrealistic.
First is that when more people get tested, the CFR declines as patients with few or no symptoms are included in official statistics (due to a lack of tests, only people in high-risk categories or with visible symptoms have been tested so far). As Brett Giroir, assistant secretary for health at the U.S. Department of Health and Human Services, explained, early CFRs of 2 percent to 3 percent are almost certainly too high. "The best estimates now for the overall mortality rate for COVID-19 is somewhere between 0.1 percent and 1 percent," said Giroir, who is in agreement with a New England Journal of Medicine (NEJM) commentary co-authored by the Centers for Disease Control and Prevention (CDC)'s Anthony Fauci. Based on a study in Science that used comprehensive infection data from China, Sullum estimates that the CFR is actually closer to 0.2 percent rather than "the current crude CFR of 1.2 percent." For his part, Fauci has amended his position since the NEJM article and now believes coronavirus fatalities are likely to be about 10 times worse than seasonal flu and thus have a CFR of 1 percent.
Second, the rate of transmission responds to changes in behavior. The CDC's worst-case scenarios assume that efforts to reduce infections are largely unsuccessful and that each carrier infects another 2.3 people, leading ultimately to about two-thirds of Americans being infected. However, the Science study found that the infection rate in China was reduced from 2.4 to 0.99 in short order once lockdown measures were put in place. So there are ways to reduce the spread, although the methods used in China counter the tactics supported by Epstein.
"We need a public debate on the political response to COVID-19, and we need it now," insists Epstein in his new column. He argues that high-risk populations such as people over 70 are already removing themselves "out of harm's way" and that members of lower-risk groups should be given more latitude in their work and social movements. This sort of targeted response is appealing and fits with the proscriptions of David L. Katz, the president of True Health Initiative and the founder of the Yale-Griffin Prevention Research Center, but other epidemiologists warn that it will become impossible to sequester the old for very long under such circumstances. "Our government fiats will probably save very few, if any, lives saved over what we can obtain through more focused voluntary precautions," Epstein writes, another prediction that will be tested over the coming months.