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I am guessing John Ioannidas will come to regret his essay from last week

Brian Leiter

Professor Ioannidas, a Stanford epidemiologist and statistician (most famous for first calling attention to the problem with the standard use of p-values in medical research), obviously has a contrarian instinct, but sometimes those instincts are dangerous.   I had been ignoring this piece, which seemed obviously unsound even to a layperson like me, but since it continues to circulate, I thought I would mention it and one of the decisive replies.  (The comments on the Ioannidas piece also point out some of the obvious omissions from his analysis.)  There is a longer interview with him here, where he sounds somewhat more reasonable.

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7 responses to “I am guessing John Ioannidas will come to regret his essay from last week”

  1. Rollo Burgess

    I’m certainly not going to comment on the epidemiology, beyond noting that the principal points I take from the 2 major expert views dissenting from the prevailing wisdom that I have read (i.e. this one and that of the Oxford group) are that we don’t know exactly what is going on and that, until we have sufficiently robust data from serological testing to estimate accurately the total numbers infected and the proportion that develop symptoms, there is a wide range of potential scenarios compatible with the data we do have.

    I do think that there is an interesting point around what people refer to as the ‘precautionary principle’. This principle is often referred to but rarely actually stated. What is it? There does seem to be a school of thought sometimes referred to as this alleged principle that, as we don’t have perfect information, we should take the most extreme and risk-averse approach.

    I think that this is flawed. The measures that are being taken will have extremely bad consequences, and will with a very high probability result in suffering and deaths for years to come due to a severe recession, as well as harder to quantify but potentially dreadful indirect consequences (e.g. further accelerating the growth of nasty populist movements, wars etc.) All of this, of course, over and above the obvious immediate consequences of depriving children and students of their educations, people of their liberties etc.

    It is by no means clear to me that the risk of a worse covid19 outcome automatically justifies any and all possible measures to reduce it. Note that a) I am not saying that this can be solved from the armchair, it definitely can’t, it needs to be modelled and analysed and b) I am not opposed to measures taken to date, indeed perhaps they should have been faster and firmer. But I do think that when epidemiologists talk about maintaining lockdowns for a year or 18 months, non-epidemiological factors become progressively more important. And at some point this becomes not merely not ‘precautionary’ but actively dangerous.

    We are basically trying to solve an equation for the least restrictive measures compatible with numbers of people requiring hospitalisation and intensive care not exceeding available facilities over the period of the pandemic. This equation cannot be defined and calibrated a priori.

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  2. Brian Leiter

    I'm not aware of public health specialists proposing 12-18 month lockdowns. The consensus view (well-represented by the pieces by Drs. Gottlieb and Emanuel that I posted the other day) is that an initial 3-month lockdown would be followed by better testing and tracking, with a focus on separating the infected and a gradual easing of lockdowns, with occasional exceptions in extreme circumstances. One thing is absolutely clear from all the "natural experiments" that are being conducted with human lives: absent strict, immediate measures, infections soar and the sick do not get adequate treatment because healthcare systems can't cope. That's a certainty; everything else looks to me like speculation.

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  3. Nicolas Delon

    Something that is often lost in these conversations (frustratingly so to me) is:

    1) the odd but known fact that death rates tend to decline during recessions (see e.g. https://www.nature.com/articles/d41586-019-00210-0 and https://www.npr.org/2018/01/09/576669311/hidden-brain-great-recession-deaths and https://www.sciencedirect.com/science/article/pii/S0277953617304495). That's not to say prolonged drastic measures would not have adverse effects, whether in terms of life-years lost or other indicators of welfare. But we can't just assume from the armchair that recession = more deaths than letting the outbreak take its course.

    2) we've been overdue for a recession for a while; indeed, it's arguable that the coming one was over-determined. The relevant question is how much worse the recession that the current shutdowns are likely to cause will be than either a) the recession caused by the pandemic had we not taken such measures or b) the recession that would have happened anyway this year or the next for other reasons, had we somehow been spared by the pandemic (unlikely).

    I see a lot of contrarian arguments calling for genuine cost-benefit analyses but to date I haven't seen any serious attempt to take even these basic facts into account. These are extremely complex questions, and it's frustrating to read smart people peddling the Trumpian motto that the cure is worse than the illness.

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  4. Rollo Burgess

    It is not speculation to say that the social and economic costs of the lockdown will be very great (they already are) and that these will have real human consequences (they already do).

    Re 12-18 month lockdown, The highly impactful (in the UK anyway) report from Imperial (the 16 March one, here: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf) specifically contemplates this:

    'The main challenge of this approach is that NPIs [Non Pharmaceutical Interventions, measures up to and including lockdown – RB] (and drugs, if available) need to be maintained – at least intermittently – for as long as the virus is circulating in the human population, or until a vaccine becomes available. In the case of COVID-19, it will be at least a 12-18 months before a vaccine is available. Furthermore, there is no guarantee that initial vaccines will have high efficacy.'

    (Obviously the way that this was reported in even purportedly respectable newspapers was a lot cruder than the cautious statement above, but the point stands I think.)

    The report's authors acknowledge elsewhere that they are not considering the broader social and economic impact of such measures and that these may partially offset the benefits. I guess what I am hazarding is that at some point these other costs will potentially start to exceed the benefits of the lockdown. If this is so and when this point is is an empirical question, in large part.

    PS thanks v much for the public service you are performing by editing the enormous quantity of news and commentary on this topic! stay well

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  5. Roger Albin

    Ioannidis is a very smart guy but in some respects this is a cookie cutter response. He has spent years inveighing, accurately, about the often poor evidentiary base of much medical practice. This almost reads like he took one of his standard discussions and put in COVID-19.

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  6. Charlie Savelle

    This might be something as it is predicting next quarter. In comparison during the great recession unemployment rate was highest at about 10% and 24% in the actual great depression

    https://www.stlouisfed.org/on-the-economy/2020/march/back-envelope-estimates-next-quarters-unemployment-rate

    Reply
  7. Dean C. Rowan

    The precautionary principle does not prescribe "the most extreme and risk-averse approach." See, for example, Prof. Dan Farber's latest post at Legal Planet — https://legal-planet.org/2020/04/02/model-sensitivity-and-coronavirus-policy/ — in particular his third takeaway before he runs his exercise: "Your strategies need to take uncertainty into account. This means that a lot may depend on how precautionary you want to be. It also means that you have to be able to adjust your strategies as we learn more about the disease."

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