Coronavirus -- NY Times biased statistic #2

I received another email daily briefing after Sep. 2 from David Leonhardt including the following.

In his latest column, Ross Douthat of The Times Opinion pages took issue with a recent item in this newsletter. He suggested that it was unfair for me to compare the U.S. share of official coronavirus deaths around the world (22 percent) with the U.S. share of global population (4 percent).

The U.S. is simply too different from much of the world — like Asia, Africa and Oceania — for global comparisons to be meaningful, Ross argued. To him, the better comparisons are the countries closest or most similar to the U.S., like big countries in Western Europe and the Americas.

“When you compare deaths as a share of population within that group of peer countries, the U.S. starts to look more mediocre and less uniquely catastrophic,” he wrote. Germany has done better, for instance, while Britain, Spain and Italy have done worse. I encourage you to read Ross’s full column.

I still think the evidence points to the U.S. being an outlier. It has a per capita death rate 80 percent higher than all of Europe’s and more than twice as high as Canada’s. In many of those other countries, the virus is also well enough under control that more parts of normal daily life — like in-person school and indoor restaurant dining — have returned.

What do you think? Send us an email at themorning@nytimes.com.

Mr. Douthat regarded Leonhardt's comparison as unfair, but he did not challenge Leonhardt's statistic as flawed. I sent an email to the address above with a link to my Sep. 2 post that showed it as flawed. No response yet. 

Friday I received another email daily briefing including the following.

The virus is a marathon

Last week’s newsletter comparing the U.S. coronavirus death toll to the global average helped spark a continuing debate: What’s the fairest expectation of how bad the pandemic should have been in this country?

Your answer to that question guides your judgment of the Trump administration’s response. Ross Douthat of The Times has argued that it was merely mediocre, while Vox’s German Lopez and The Atlantic’s David Frum consider it to have been far less effective than other countries’ responses.

One of the people who’s weighed in — via email — is Donald McNeil. By now, you may know him as the Times science reporter who has frequently appeared on “The Daily” podcast to talk about the coronavirus.

Donald makes a fascinating point: Don’t look only at snapshots, like a country’s per capita death toll. “It’s not fair to pick one point in time and say, ‘How are we doing?’” he writes. “You can only judge how well countries are doing when you add in the time factor” — that is, when the virus first exploded in a given place and what has happened since.

The pandemic, he adds, is like a marathon with staggered start times.

The virus began spreading widely in Europe earlier than in North America. Much of Europe failed to contain it at first and suffered terrible death tolls. The per capita toll in a few countries, like Britain, Italy and Spain, remains somewhat higher than in the U.S. But those countries managed to get the virus under control by the late spring. Their caseloads plummeted.

In the U.S., the virus erupted later — yet caseloads never plummeted. Almost every day for the past six months, at least 20,000 Americans have been diagnosed with the virus. “Europe learned the hard lesson and applied remedies,” as Donald says. “We did not, even though we had more warning.”

This chart makes the point:

By The New York Times | Sources: Johns Hopkins University and World Bank

The earlier email says the U.S. has a “per capita death rate 80 percent higher than all of Europe’s.”

Estimating the rightmost plotted numbers on the above chart, I get 584 for the U.S. and 432 for Western Europe. 584/432 implies the U.S. death rate is about 35% higher, not 80% higher. How does he make such inconsistent numbers? The graph still shows what Leonhardt wanted, and it doesn't show the countries - Belgium, Spain, UK -- that do have higher death rates per million population than the U.S.

Most Obamacare health insurance co-ops shut down

A Fortune article reports that soon only 3 of the 26 "co-ops" created will remain. The rest were or will be shut down due to financial failure. I suspect the federally-run "marketplace," healthcare.gov, is not one of the 26. It is not one of the 3.

A major feature of Obamacare was health insurance "co-ops" or "exchanges" or "marketplaces" where people could purchase subsidized health insurance. The buyer could not be denied coverage for health-related reasons and obtain a policy from a private health insurance company. The health insurance company is subsidized by government. The buyer might also get a subsidy from the federal government to help pay the premium. 

Premium amounts could not be based on pre-existing conditions, health status, claims history, duration of coverage, gender, or occupation. They could only vary by age, smoker/nonsmoker, and geographical region. More details are here.

Due to the large majority of working people getting health insurance via their employers, the individual health insurance market for people less than age 65 is small. For this reason alone, it is difficult for an insurer to charge premiums high enough to cover claims, even with being able to (1) not accept higher risks and/or (2) charging higher premiums to higher risk people. Also, if a person can pay a smaller premium by passing a health exam given by an insurer off the exchange, why would that person buy on the exchange? The effect is that only higher risk persons buy on the exchange. Adding to the problem by outlawing #1 and #2 and an inadequate government subsidy make it even more financially difficult for the insurer, and the result is Obamacare "exchanges." That is what health insurers face on the "exchanges." It is a recipe for financial failure.

Coronavirus - remdesivir #2

 A Wall Street Journal article says that nearly three dozen attorneys general are attempting a legal act of theft of Gilead's patent on remdesivir. Since the article is behind a paywall, the following are some excerpts.

The attorneys general effectively assert that remdesivir belongs to the government because taxpayers helped fund its development. 

First, Gilead’s scientists are entirely responsible for the invention of remdesivir.

The government didn’t get involved until later, when it teamed up with Gilead to test whether the drug was effective against Ebola. 

Later, Gilead collaborated with academic and government institutions to test remdesivir against coronaviruses like SARS and MERS. But the total government expense for research adjacent to remdesivir, about $70 million, is a fraction of the more than $1 billion Gilead has committed to the drug. 

Coronavirus -- HCQ, RCT, politics

This article, title Hydoxychloroquine: A Morality Tale, is sort of long (> 15,000 words), but well worth reading. It is about the drug (HCQ), randomized control trials (RCT), facing a pandemic due to a novel virus, and how they have been so politicized.

Remdesivir has been politicized, too, but not as much. Many people on the political left favor it. Its success in treating Covid is modest. Some had a change of heart when they assumed the FDA was unduly influenced by the Trump administration when the emergency use authorization was broadened for remdesivir. See my September 1 post.  

The article gets philosophical: "We live in a culture that has uncritically accepted that every domain of life is political, and that even things we think are not political are so, that all human enterprises are merely power struggles, that even the idea of “truth” is a fantasy, and really a matter of imposing one’s view on others. For a while, some held out hope that science remained an exception to this. That scientists would not bring their personal political biases into their science, and they would not be mobbed if what they said was unwelcome to one faction or another. But the sordid 2020 drama of hydroxychloroquine—which saw scientists routinely attacked for critically evaluating evidence and coming to politically inconvenient conclusions—has, for many, killed those hopes." 

Coronavirus -- NY Times biased statistic

Yesterday's The New York Times here included the following by David Leonhardt.

Here’s a jarring thought experiment: If the United States had done merely an average job of fighting the coronavirus — if the U.S. accounted for the same share of virus deaths as it did global population — how many fewer Americans would have died?

The answer: about 145,000.

That’s a large majority of the country’s 183,000 confirmed coronavirus-related deaths.

No other country looks as bad by this measure. The U.S. accounts for 4 percent of the world’s population, and for 22 percent of confirmed Covid-19 deaths. It is one of the many signs that the Trump administration has done a poorer job of controlling the virus than dozens of other governments around the world.

End quote. Is Leonhardt trying to say that the USA has the highest number of deaths per million population in the world? I knew this isn't true, so I suspected he either erred or something reeked.

I copied some numbers from the Worldometer late yesterday and did some calculations.

					Deaths/	Col 3
	Deaths	% World	Population	% World	1M_Pop.	– Col 5
San Marino	42	0.00%	33,943	0.00%	1237	0.00%
Peru	29068	3.38%	33,047,700	0.42%	880	2.96%
Belgium	9895	1.15%	11,598,176	0.15%	853	1.00%
Andorra	53	0.01%	77,286	0.00%	686	0.01%
Spain	29152	3.39%	46,757,881	0.60%	623	2.79%
UK	41504	4.83%	67,946,337	0.87%	611	3.96%
Chile	11321	1.32%	19,143,709	0.25%	591	1.07%
Italy	35491	4.13%	60,446,519	0.77%	587	3.35%
Brazil	122596	14.26%	212,813,742	2.73%	576	11.53%
Sweden	5813	0.68%	10,109,890	0.13%	575	0.55%
USA	188827	21.96%	331,330,464	4.24%	570	17.72%
Mexico	64414	7.49%	129,158,631	1.65%	499	5.84%
Iran	21672	2.52%	84,171,055	1.08%	257	1.44%
World	859917		7,808,984,000		110

The numbers in the 7th column -- rightmost and Leonhardt's statistic -- for the USA, Brazil, Mexico, UK and Iran are very close to Leonhardt's. So something reeked. How can the USA rank 11th in column 6 but way ahead of all the other countries in column 7? It would clearly be biased to compare only the numbers in column 2, which depend on population size. Leonhardt's statistic manages to magnify the role of a larger population. Brazil and the USA are pretty close in deaths per million population. Leonhardt's statistic magnifies their difference.

USA, Brazil, and Mexico are the top 3 using Leonhardt's statistic. Their populations and deaths are also the top 3. The ranks of columns 2 and 7 match almost perfectly. If Leonhardt had simply based his comparison on column 2, it would have been more honest, but his bias also very obvious.

A simple example will shed more light on how Leonhardt's statistic is biased. Imagine a world of 100 million people, 4 million deaths, and only 3 regions, with people and deaths as follows.

Region       Population       Deaths
#1              30 million        3 million
#2              10 million        1 million
#3              60 million        none

Regions #1 and #2 have the same death/population, 10%. Region #1 has 75% of deaths and 30% of the total population. 75% - 30% = 45%. Region #2 has 25% of deaths and 10% of the total population. 25% - 10% = 15%. Eureka! Leonhardt's statistic much depends on population size, even magnifying the role of a larger population. He built in a bias. Clearly his motivation was to blame President Trump and his administration as much as possible.

Next assume Region #1 and #2 have half of the above death counts, or double them. Leonhardt's statistic remains the same, meaning death rates really don't matter! His statistic is nonsense.

Leonhardt claims that only 183,000 - 145,000 = 37,000 Americans would have died if its death per million population was as low as the world's. That's a big "if", because the USA had a much higher infection rate than most other countries. So did several other countries such as Belgium, Spain, UK, and Italy, but Leonhardt had no blame for their politicians. The USA's cases/population is about 5.6 times the world's.

"There are three kinds of lies: lies, damned lies, and statistics." -- Mark Twain

I wrote another post about Leonhardt's bias here.

Coronavirus - remdesivir

'Without evidence': Once again, FDA expands use of COVID-19 treatment without research to back it up is the title of a USA Today article about remdesivir, a drug being repurposed to treat Covid-19.

Without evidence?? The NIH said otherwise four months ago! The author Karen Weintraub even named two recent journal article that gave some evidence in favor of remdesivir. "Without research to back it up" sounds like a mantra alluding to randomized controlled trials (the "gold standard") and used as a "weapon."

Weintraub much disapproved the FDA decision. She found an ally in Dr. Topol. Dr. Marty mildly approved the FDA's decision. Dr. Meyer mildly disapproved.

There are at least three things the article says nothing about.

1. Weintraub did not name any alternative drugs. Is there an allegedly better one than remdesivir or is remdesivir as good as or better than any alternatives at this time? Context matters. Is it reasonable to denounce what is one of the best or better than others by a good margin because it isn't perfect?

2. At clinicaltrials.gov one can search with keywords Covid19 and remdesivir and find 48 studies underway or completed. Only two are completed, but maybe they gave some evidence favoring remdesivir.

3. Have practicing doctors encouraged the FDA to extend emergency authorization use (EAU) like the FDA did for only medical reasons? 

So what is Weintraub's motivation for saying "without evidence" and "without research to back it up"? My guess is that she wanted to smear the Trump administration. Weintraub writes, "[T]hose who follow the [FDA] said they have never seen such consistent politicization." What about her, USA Today's, and other main stream media's politicization?