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Why the Bakersfield Doctors Should Not Be Believed

Screen Shot 2020-04-28 at 1.28.07 PMBy Robert Canning

         Two physician-entrepreneurs who own a string of urgent care clinics in Bakersfield claim the data they have collected from testing for coronavirus proves that the current “stay-at-home” and physical distancing orders need to end and that COVID-19 is “just like the flu.” Their YouTube video interview from last week has been viewed more than five million times. It has garnered attention from the likes of Elon Musk who tweeted “Docs make good points” and Fox News host Laura Ingraham who played excerpts Monday night. But their claims have sparked wide controversy from experts in academia who say their assumptions are flawed, their sample biased, and their extrapolations “implausible.” The Kern County health office has stated it does not agree with their claims. And yesterday their original video was removed for what YouTube says are violations of its “community guidelines.”

         The doctors claim their sample of 5,213 tests for coronavirus, in which they found 340 positives (6.5%), can be extrapolated to not only Kern County (population 700,000) but to the entire state of California (population 39.5 million). They claim that this shows that the coronavirus is more widely spread than previously thought, is less virulent, and is just like the flu. But experts like Carl Bergstrom, an evolutionary biologist and expert in modeling biological systems, say the physicians’ statements and assertions are flawed. Writing on Twitter, Dr. Bergstrom noted that estimating the proportion of infected patients from an urgent care clinic sample is a bit like “estimating the average height of Americans from the players on an NBA court.”

         The doctors, using what they say is data from Norway and Sweden additionally claimed there is “no statistical difference” in deaths in the two countries, despite the differences in how Sweden and Norway have approached the pandemic. Norway has closed schools and businesses and mandated social distancing while Sweden has chosen to keep its businesses and society open. The data would suggest otherwise. Google searches for “Sweden COVID-19 cases” and “Norway COVID-19 cases” yielded the number of reported COVID-19 cases for each country along with the number of reported deaths as of April 28. The rate of deaths per capita in each country might shed some light on the doctors’ claim of no differences. For Norway and Sweden the per capita mortality rate for COVID-19 are 0.1% and 0.2% respectively. Epidemiologists estimate the severity of an outbreak by calculating the Case Fatality Rate (CFR) – dividing the number of deaths by the number of confirmed cases. Using the data from the Google search, Norway’s CFR is 0.3% (205 deaths / 7,599 confirmed cases) and Sweden’s is 1.2% (2,355 deaths / 19,621 confirmed cases) - four times higher. When statistical tests are used to compare these last two rates, they are very significantly different.

         Beyond the implausibility of their calculations and extrapolations, the Bakersfield doctors make statements about statistical modeling that are false. They claim in one video that because the number of deaths and cases is lower than the models originally predicted, the models must have been wrong. This is a logical error in that models only model based on current conditions and the assumptions built in. Good modelers are aware of their assumptions, build them into the model and then when predicting biological processes that can change over time, adjust their models using new data. And this is exactly what the most commonly quoted models have been doing. The doctors in Bakersfield criticize modeling as divorced from reality because they treat patients every day thus they know what is “really” going on. (They also criticize Dr. Anthony Fauci saying that he has not seen a patient in twenty years.) It may be that they know some things the modelers do not, but since they only know who they see in their Bakersfield clinics, their observations may be biased and are small in number.

         Finally, on a number of points in the video they assert that COVID-19 is “just like the flu.” They assert that because we don’t shut down the society because of the flu, ergo we should not be doing it for the coronavirus. But coronavirus is not the flu. The flu may kill upwards of 40-50,000 individuals in the U.S. annually, but that is over an eight month flu season. The COVID-19 pandemic has killed over 55,000 people in the U.S. in just over two months. The mortality rates for the flu have been suppressed by a combination of antiviral treatments, vaccinations, and the build-up of immunity in the community. Additionally, there is no evidence (like there is for the SARS-COV-2 virus) that the flu is spread by infected but asymptomatic individuals. And although experts believe that we may be “over the hump” in this wave of coronavirus deaths, we can still expect thousands more deaths before the fall. And some expect a second wave will hit this fall (on top of the beginning the next flu season), before we have been able to develop effective treatments and possibly a vaccine that will provide some increased level of immunity from infection.

         So, in sum, the doctors in Bakersfield make irrational arguments and use their limited and biased sample to make arguments that should not be believed.

Comments

Eileen Samitz

I completely agree that these two doctors are "off the rails" and have no idea how much damage they are causing with this ridiculous video.

I am retired for several years now, but I can tell you as a clinical microbiologist that worked in the field for over 35 years, these doctors have no idea what they are talking about. One just needs to look at what happened during the Spanish Flu in 1918 to see what happened when cities who prematurely "re-opened up” resulted in massive mortality and morbidity. More people got sick and died because of pre-mature re=openings in these cities than they experienced than when the first "wave' of impacts for the Spanish Flu hit.

So our choices are to learn from history, or let it repeat itself, and frankly, I do not want to see any of my friends or family, or anyone else nationwide getting sick or dying for COVID-19 because we were foolish enough to be impatient and repeat a terrible lesson that we can and should heed from historical date and experience.

Please hang in there folks. It is totally worth NOT getting dangerously sick and having consequences like permanent lung damage or worse, dying. We all owe it to our family, friends, community and our nation, to hang in there and our efforts will result with us surviving COVID-19. Many are struggling with financial impacts, and I completely understand and sympathize with that serious issue. But, if your life is lost due to COVID-19, monetary issues are no longer an issue to you, and your family would suffer even more, as well as the community from losing you to COVID-19.

The video posted by these doctors is based on their personal views, not science or the experience of so many real experts in the field of infectious disease and pandemics. It is irresponsible and dangerous for these two doctors to post such a video which would endanger so many view it, who might believe these personal opinions of theirs, which are NOT based science, and history.

Victoria Whitworth

Just hearing their breezy self-description as "ER Physicians/Entrepreneurs" was enough for me. It's impossible to believe a physician who chooses to practice healthcare as a business rather than as a calling and a basic human right, especially in the wealthiest country on earth.

Glen Holstein

A number significant to me is that COVID-19 has killed about as many Americans in two months as the Vietnam War did in seven years. Watch Ken Burns' series on that war if you doubt it was a very big deal. So is COVID-19.

Lauren Ayers

Thanks for the counterpoint. Although I passed college statistics, I haven't needed to understand the inner workings of stats since then, so I couldn't spot the flaws in the Bakersfield doctors' talk.

However, there are others who find fault with the strong ordinances we now live under. Economists warn these might lead to another Great Depression.

So what does a working statistician say to these critics?

https://off-guardian.org/2020/03/24/12-experts-questioning-the-coronavirus-panic/

Dr Joel Kettner is professor of Community Health Sciences and Surgery at Manitoba University, former Chief Public Health Officer for Manitoba province and Medical Director of the International Centre for Infectious Diseases. He says:
"I have never seen anything like this…. I’m not talking about the pandemic, because I’ve seen 30 of them, one every year. It is called influenza. And other respiratory illness viruses, we don’t always know what they are. But I’ve never seen this reaction, and I’m trying to understand why…. In Hubei, in the province of Hubei, where there has been the most cases and deaths by far, the actual number of cases reported is 1 / 1000 people and the actual rate of deaths reported is 1 / 20,000. So maybe that would help to put things into perspective." – CBC podcast

Dr. David Katz is an American physician and founding director of the Yale University Prevention Research Center. He says: "I am deeply concerned that the social, economic and public health consequences of this near-total meltdown of normal life — schools and businesses closed, gatherings banned — will be long-lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order."

– “Is Our Fight Against Coronavirus Worse Than the Disease?”, New York Times, 3-20-20

Here are more points about pandemic panic:

https://off-guardian.org/2020/03/28/10-more-experts-criticising-the-coronavirus-panic/

Dr Eran Bendavid and Dr Jay Bhattacharya are professors of medicine and public health at Stanford University. They say: "[P]rojections of the death toll could plausibly be orders of magnitude too high … The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.
The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million.
.… A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns." ~~ “Is the Coronavirus as Deadly as They Say?”, Wall Street Journal, 3-24-20

Something else that undermines my confidence that our enforced seclusion will make a difference: the rate of infection in each country is hard to set because the RT-PCR test uses surrogate factors to determine if a person is sick from COVID-19 or if it’s another corona virus. Also, I keep reading about countries that label a mortality as "a COVID-19 death" yet the COVID-19 virus wasn't found in a test but their diagnosis came from other indications (such as contact with someone who had traveled in China or x-rays showing "ground glass" shadowing in the lungs). In other words, they may actually have died of their underlying heart condition or diabetes or some other disease (this was particularly true in Italy, where most patients had 1-3 underlying conditions).

There are so many variables! One thing I do recall from that long-ago statistics course is that it's complicated, i.e. GIGO applies (garbage in, garbage out).

Eileen Samitz

Since these two "entrepreneurs" own a string of urgent care facilities, it seems like since business may be slow for them due to shelter-in-place since people in their area likely calling into their regular doctor if it is not an emergency, rather than going to one of these guys urgent care facilities. So it is likely motivation behind this bogus video by these guys, is more about their personal financial situation rather than the health, welfare, and safety of the public.

Eileen Samitz

Here is an update on these two doctors whose conveniently jeri-rigged "data" and conclusions have been formally condemned by the American College of Emergency Physicians and the American Academy of Emergency Medicine. Below is the link to an article covering this today and some excepts from it.

The bottom line is that these guys need to have their licenses taken away from them for advocating for putting so many lives in danger with their ridiculous and aberrant advocacy. Their actions were reckless and inexcusable.

https://www.pasadenastarnews.com/2020/04/28/california-doctors-with-dubious-covid-conclusions-debunked/

"In a rare statement late today, the American College of Emergency Physicians and the American Academy of Emergency Medicine declared they “emphatically condemn the recent opinions released by Dr. Daniel Erickson and Dr. Artin Messihi. These reckless and untested musings do not speak for medical societies and are inconsistent with current science and epidemiology regarding COVID-19. As owners of local urgent care clinics, it appears these two individuals are releasing biased, non-peer reviewed data to advance their personal financial interests without regard for the public’s health.

The doctors had set up Bakersfield’s only private walk-in COVID-19 testing site and performed about half of all tests conducted in the area. They did not respond to a CalMatters request for comment today.
A Kern County public health spokeswoman told reporters that officials did not support the doctors’ call to reopen the region. Other epidemiologists echoed that sentiment.

But already the Bakersfield doctors — who tout their support of President Donald Trump and refuse to wear masks in public — had become heroes on social platforms and conservative media outlets, with some commenters calling them “brave.” Others who support continuing to shelter-in-place described the doctors as self-promoters whose chain of urgent care centers would benefit from reopening. Non-COVID medical visits have plummeted during the pandemic, endangering the practices of many doctors.

“As struggling business owners, their economic frustration is understandable. But it can’t be mistaken for science. People trust doctors,” Michigan emergency room doctor Rob Davidson wrote on Twitter. “When they tell Fox viewers to ignore recommendations from real experts, many will believe them…The impact of rejecting science-proven recommendations in exchange for these erroneous ideas would overwhelm health systems and cost lives. While re-opening the economy might be good for their Urgent Care Centers (sic), it would kill medical personnel on the actual front lines.”

Robert D Canning

Thanks for the comments Eileen. Especially the link to the CalMatters piece.

John Troidl

Wow, what a trip!

While it is important to be open to all voices, perhaps we should emphasize listening to epi-demiologists when we want to understand epi-demics. They are experts in understanding the incidence and prevalence of disease, what people get sick from and what they die from.

Let's praise well trained epidemiologists.... there are not enough of them!

PS And shame on those physicians for their sophistry!

Greg Rowe

People with different perspectives on how dangerous COVID-19 may be can obviously have equally divergent views on the economic impacts of current government policies. I have found it extremely informative, however, to learn about the amazing parallels between the current pandemic and what has rightfully been labeled the deadliest pandemic in history, the 1918 so-called Spanish Flu. (Most experts concur that it actually originated in Haskell County, Kansas and spread globally because of the ramping up of the U.S. military as our country entered WWI.)

That pandemic, along with a fascinating description of how medicine has evolved, can be found in a great book I've been reading, The Great Influenza, by John M. Barry. It is interesting that places that had many people in close contact, such as military encampments, had the greatest number of cases and deaths. On the other hand, some towns that went into self-isolation, to the extent of turning away visitors at the town borders and not allowing trains to stop, had virtually no cases. There are many parallels between the manner in which public agencies and officials dealt with the 1918 pandemic and how the current situation is being handled. I'll leave it to readers to discover for themselves by reading this great book.

It is interesting that former President George W. Bush also read this book. It impressed him so much that he instructed his staff to activate a program for dealing proactively with pandemics in this country. Regardless of what one thinks of "W," he at least deserves credit for being a reader (unlike the current president), and for acting on this information. It is the very same apparatus Bush set up that Trump reportedly defunded and disbanded. Hopefully the next president will reactivate those efforts.

Robert D Canning

Lauren Ayers: I appreciate your comments. My reaction to the statements by the authorities you quote is that they sound like the climate change deniers and others who pooh-poohed the facts and agreed-upon science of climate change. There are a lot of comparisons to influenza, which the coronavirus is not. There are quotes that are factually wrong (the coronavirus infects the upper respiratory tract only - which is false), and a lot of sniping at other labs and modelers. Also, these quotes are all from March, before the peak of cases in many countries, certainly in the U.S.

I would expect there to be counter voices. After all, scientific progress comes in fits and starts. There are a lot of ill-founded theories and bad experiments in science. And to add to this, in the heat of an emerging pandemic due to an unknown virus, there's a lot of crazy stuff flying around.

But overall, the folks you quote and that the OffGuardian include are not my picks for the most authoritative or well-informed.

Connie S

I see that this article does not give these doctor's names. So... are they really MDs or are they imposters? I suspect the latter.

Nancy Price

When my mother was twelve years old, her father died in the 1918 flu.

Robert Canning

Connie, the Bakersfield doctors are Dan Erickson, MD and Artin Masihi, DO. Here’s a link to their clinics: https://acceleratedurgentcare.com/

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