Dr. Hall’s question and my own flawed predictions

Earlier this summer, Dr. Harriet Hall received a “surprising email saying the pandemic has been over for months.”  “Where did that idea come from?” she asked.  Before I try to answer her question, let me revisit my own history with premature optimism in two prior articles on this site.
June 4, 2021:

Barring a nasty variant, the worst is over for America and its children. Cases and deaths are falling. It’s beautiful. Thanks to vaccines and the virus itself, there’s enough immunity that COVID-19 will never overwhelm an American city again… However, COVID-19 is not gone, and it probably never will be. Vaccine uptake remains depressingly low in large swaths of the country. Millions of children have been vaccinated, but most are not and many never will be. COVID-19 remains nearly as dangerous as ever for the unvaccinated.

July 25, 2021:

We will almost certainly never have months in a row where over 1,000 Americans die daily. Again with the caveat that a nasty variant could change everything, I am confident the worst is over for the US as a whole, at least for vaccinated people.

In these articles, I was careful to note that the virus remained as dangerous as ever for the unvaccinated and that new variants could change everything. Still, I was very wrong about some big things. Sadly, over 1,000 people a day have been dying in the USA for a while, and some cities were overwhelmed with COVID-19. Though my own optimistic predictions definitely don’t deserve an A+, I also don’t think anyone reading my articles would have concluded the pandemic was over. I certainly hope no one thought that.

The pandemic is over?

Having acknowledged my own flawed forecasts, let’s explore the origins of the myth that the pandemic is over. In preparation for this article, I put out a Twitter request for instances where people, specifically those with scientific credentials, declared the pandemic was over. I received several replies implicating COVID-19 denialists and minimizers of all sorts from around the world. Since I am an American doctor, I will focus my discussion on my country and my profession.

Clearly, much of blame lies at the feet of the people like Drs. Kelly Brogan and Christiane Northrup, who are part of the Disinformation Dozen and are responsible for a large amount of misinformation this pandemic. These luminaries of the anti-vaccine movement often deny that viruses cause illness to begin with and therefore never acknowledged the pandemic ever started. This was all predictable. However, what I did not anticipate was the steady stream of so-called contrarian doctors with stellar credentials and academic appointments who essentially declared the pandemic over several times already, clearly implied it was over by “just asking questions“, or minimized concerns over variants. A sampling of their statements are below, and I expect readers will share further examples in the comments.

Dr. John Ioannidis

  • April 17, 2020:

    Acknowledging for the fact that the epidemic is still evolving, and we cannot be sure whether we will hit even higher peaks in the future, although this doesn’t seem to be the case, at least for the European countries, and it seems to be that even in the US, in most states we’re very close to the peak, if not past the peak, the risk is something that should be manageable as opposed to the panic and horror stories that are circulating about.

  • August 25, 2020:

    However, very few hospitals were eventually stressed and only for a couple of weeks. Most hospitals maintained largely empty wards, expecting tsunamis that never came… Tragically, many health systems faced major adverse consequences, not by COVID-19 cases overload, but for very different reasons.

Dr. Marty Makary

  • December 22, 2020:

    There’s a false construct out there. There’s a recommendation that we need to get every American immunized in order to get a handle on the pandemic. There reality is that about 25-50% of Americans have already had the infection and have some natural immunity…So we may only need to get an additional 20% of the population immunized by say February or March to really hit those 70% herd immunity levels.

  • February 18, 2021:

    At the current trajectory, I expect Covid will be mostly gone by April, allowing Americans to resume normal life.

  • May 4, 2021:

    In February, I projected that “based on the current trajectory” we’d see significant population immunity take hold in April from the combination of vaccinated and natural immunity. While most states are now witnessing the strong suppression of the epidemic today, other states will get there in May. But herd immunity is not a finish line. In that article, I maintained that “coronavirus will be here for decades to come.” The question is, at what point is it no longer a major public-health threat? For most states, it’s now.

  • May 21, 2021:

    COVID cases are collapsing in front of our eyes… Projections for the coming weeks and months are even more favorable. That’s because roughly 80% to 85% of adults are now immune — more than 6 in 10 adults are now vaccinated and more than half of unvaccinated adults have natural immunity from prior infection. In public health, when a virus has trouble jumping around because more than 8 in 10 adults in a community are blocking its transmission, we call that herd immunity.

  • June 8, 2021:

    With more than 8 in 10 adults protected from either contracting or transmitting the virus, it can’t readily propagate by jumping around in the population. In public health, we call that herd immunity, defined broadly on the Johns Hopkins Covid information webpage as “when most of a population is immune.” It’s not eradication, but it’s powerful.

  • June 8, 2021:

    There’s a lot of good news out there, and I think that people need to hear that good news right now. People have an entirely distorted perception of risk. (People) need to be careful if they’re unvaccinated and not had the infection, but we need to move on at some point.

Dr. John Mandrola

  • May 1, 2020:

    I recoil against the idea that moderation of distancing measures in places in the US and Sweden is akin to human sacrifice. That sort of hyperbole and fear-mongering in medicine always leads to bad decisions. Also, no US hospital is now unprepared. It’s May, not March 9.

  • March 10, 2021:

    The pandemic is essentially done. Human life has to be more than avoiding one pathogen. Millions have natural immunity. The pandemic (of bad disease) is nearly over.

  • March 11, 2021:

    I wish I had wrote “almost done here in the US.” Frustration with fear-mongering got the best of me.

  • June 11, 2021:

    It appears to me that we have crushed COVID by simply vaccinating susceptible adults. Why not wait for more data before extending these novel therapies to young people?

  • July 29, 2021:

    If you were vaccinated and had mild to moderate URI symptoms, why on earth would you get a COVID test? Have the vaccines not transformed SARSCOV2 into just another regular respiratory virus?

Dr. Monica Gandhi

  • February 22, 2021:

    I started in April, 2020 and I hope I can stop it in April, 2021. I think that may be a little soon, but we will get to herd immunity and it will all fall away. It will all fall away. All this anguish, all this yelling at each other, all this politicization, all this depression, it will fall away.

  • February 23, 2021:

    Interviewer question, “Do you believe we’re truly near the end?” Dr. Gandhi, “Yes. I truly believe we’re panicking way too much about the variants.”

  • March 4, 2021:

    I genuinely with all my heart apologize for anyone who continues to try to scare you about variants; we have been through so much already. This is not like coming down from another surge; this time we have the increasing protection from vaccines as cases/hospitalizations drop. Honestly, it makes me so sad. Like the public has not been terrorized already by the reality of this virus. The decreasing cases and hospitalizations in places where vaccination is occurring quickly (variants notwithstanding) is the only reality we need to understand now.

  • May 26, 2021:

    Children should return to their normal lives this summer and in the upcoming school year, without masks and regardless of their vaccination status. Overall, the risk to children is too low to justify the remaining restrictions they face…This low risk for children nearly vanishes as cases plummet. As we saw in Israel and Britain, vaccinating adults indirectly protects children. The same trend is evident here in the United States: Adult vaccination has lowered covid-19 incidence among children by 50 percent [note second link – Ed.] in the past four weeks.

  • Jun 8, 2021:

    June 15th is when we’re (California) going to be done…get to herd immunity. He’s (Governor Newsome) going to have to open up more without masks. All of that will show us as we mingle, the cases aren’t going up….that we have enough of the population being immune.

  • June 23, 2021:

    Know we are all delta variant right now but look- plummeting cases since April 14 when we passed 40% 1st dose, cases continue to go down, deaths reached <300, this is the impact of vaccines on the US epidemic. Instead of doom, celebration that we have means to end epidemic in US.

  • June 24, 2021:

    Children are not more susceptible to the delta variant, they’re threefold less likely to get any infection with any variant with any ancestral strain, and they’re half as likely to spread it. And they can mask on the plane, as they should. You yourself are completely protected against the delta variant, and you should go and enjoy your summer. It’s been a hard time, and people should have their summer. Delta variant, delta shmariant.

  • July 15, 2021:

    As the virus that causes Covid-19 evolves and mutates, the same concerns pop up about whether the variant evades vaccines, makes people sicker than the old versions, and increases transmissibility. What we know about the Delta variant is reassuring.

  • July 15, 2021:

    1st step is to show hospitalizations not increasing in kids with delta.

  • September 4, 2021:

    I truly, truly think we are in the endgame. The cases will start plummeting in mid- to late September and by mid-October, we will be in a manageable place, where the virus is a concern for health professionals, but not really for the general public.

Dr. Michael Levitt

  • July 25, 2020:

    US COVID19 will be done in 4 weeks with a total reported death below 170,000. How will we know it is over? Like for Europe, when all cause excess deaths are at normal level for week. Reported COVID19 deaths may continue after 25 Aug. & reported cases will, but it will be over.

  • August 1, 2021:

    With no move in added reported COVID19 deaths & Delta Variant CFR from UK of 0.14%, it seems that FL (Florida) is likely to be fine.

Dr. Jay Bhattacharya

  • March 31, 2021:

    I think one of the things we need to recognize is that this is an RNA virus. It will undergo mutations from the ancestral strains, and the overwhelming majority of those changes are neutral or detrimental to the virus. They’re not things we need to worry about.

  • July 26, 2021:

    I don’t think the delta variant changes the calculus or the evidence in any fundamental way… In Florida in this past wave, the number of deaths have not risen proportionally. Why? Because we protected the vulnerable.

  • September 4, 2021:

    The emergency phase of the disease is over. Now, we need to work very hard to undo the sense of emergency. We should be treating covid as one of 200 diseases that affect people.

Some caveats

I recognize it may appear unseemly to dredge up these failed predictions, and I don’t do so to rub salt in anybody’s wounds. I am sure these predictions reflected genuinely held beliefs (though not always it seems). Like me, these contrarians were mostly careful to note that unvaccinated people – at least older adults – were still in great danger. Moreover, several of them acknowledged (here, here, and here) the obvious reality that their predictions were flawed. Certainly, some people will think these statements of regret mean these predictions should now be completely off limits for further discussion. While I commend these doctors for admitting error, which is not easy to do, these retractions often came many months later and rarely garnered the same attention as the initial flawed forecast.

We also need to be wary of the hindsight bias, our unconscious tendency to judge predictions as wise or foolish after the facts are known. Early in the pandemic, several antibody studies suggested the virus was much more widespread than previously thought. Though it can be hard to put ourselves in the same mindset at that time, it may not have been completely outlandish then to think the pandemic might be a short-lasting event. Similarly, a prediction in the spring of 2021 that variants wouldn’t be of concern may have been reasonable given the information that was known then. At that time, we thought that vaccines virtually eliminated the spread of the virus, and millions of people were getting vaccinated every day. The end of spring and early summer, when I made my overly-optimistic projections, was a time of great optimism in the USA. A lot of us thought the worst was over and the fall could be close to normal. Additionally, other people overestimated the virus at times, though some who were derided as prophets “of doom and fear” by contrarians for predicting 800,000 deaths in the US have been sadly proven right.

Not every flawed prediction indicates a character flaw or unscientific thinking, of course. After all, I am sure some people reading this sanitized their groceries and mail last year, something that seems like a silly ritual today. The only people whose reputations remain unblemished are those wise individuals who heeded the aphorism, “It is better to remain silent and be thought a fool, than to open your mouth and remove all doubt”.

Not isolated errors

With these caveats in mind, it’s important to recognize that these flawed predictions were not isolated errors. All these contrarians suggested the pandemic was over more than once, and their continued message will likely be: the pandemic is over, again. Even as I was preparing this essay, one wrote an article titled “It’s Time to Contemplate the End of the Crisis“, which began by saying “Americans should be asking ourselves what else needs to happen before we can declare an end to the crisis phase of the pandemic”. I found much of this article plausible, and the author may be right – I desperately hope so – but it’s exactly what she’s been saying for most of this year.

Currently, cases are gradually inching up again after a decline from Delta’s large summer spike. 114,000 people contracted COVID-19 on 11/17/2021, and over 1,000 Americans are still dying of COVID-19 every day. These figures absolutely would have been considered a crisis prior to the current pandemic – especially considering safe and effective vaccines are now widely available. The pandemic has warped our sense of what we consider tolerable.

It’s not yet time to contemplate the end of the crisis, and this illustrates an interesting phenomenon this pandemic. In the same way that the anyone accused of “doom” by contrarians has almost always been vindicated in the end, contrarians’ predictions that we’ve reached herd immunity and sarcastic requests to wait “two more weeks” (here and here), have often turned out to be reliable indicators of when cases would start soaring again. This is not just limited to the US, as several of these contrarians claimed India had reached herd immunity (here, here, and here) right before the virus devastated that country. As Dr. Andreas Backhaus quipped about the Great Barrington Declaration and one of it’s authors, Dr. Sunetra Gupta,

I thought about writing a paper that estimates how long it takes for a country or region to suffer from a severe COVID19 outbreak after the GBD crew said that it had already reached herd immunity. One might call this new relationship the “Gupta predictor”.

Erroneous predictions, COVID-19 minimization, vaccine misinformation: a package deal

In addition to false forecasts, these contrarians also have also falsely minimized the dangers of the virus for young people, saying things like:

The statements are all nonsense. Children under age 19 have a higher than a one in a million chance of dying of COVID-19. The Delta variant was not threefold less contagious for children. Healthy children have absolutely died from COVID-19 in the US. A five-second Google search is all it takes to find multiple news reports of such tragedies, and all children including those with comorbidities matter. COVID-19 is much more dangerous than the flu for children. With mitigation measures in place, COVID-19 killed hundreds of children and sent many thousands to the hospital. Meanwhile, the flu killed just one child and hospitalized just 9 children between the ages of 5-11 years.

According to the CDC’s COVID Data Tracker, the virus has killed 4,624 young adults ages 18-30 years and 923 children younger than this thus far. Tens of thousands of children have been hospitalized, some very sick, needing ICU-level care and intubation. Over 5,500 children have developed MIS-C, most of these children go to the ICU, and 48 children have died from it. The vast majority of young people do well with COVID-19, thankfully. However, prior to the pandemic, no reasonable person would have said a virus that did this much damage posed “almost no risk” to children and young adults. It bears repeating, the pandemic has warped our sense of what’s tolerable.

Not surprisingly, many of these contrarians have also downplayed the benefits and hyped the flaws of vaccines for young people. One contrarian claimed that the vaccine trial for adolescents didn’t measure “clinical outcomes…because so few kids get sick with COVID-19”. This is false. In reality, the trial measured whether or not children got COVID-19. The vaccine worked. Sixteen children who received the placebo got the disease, while zero children who received the vaccine got the disease. Real-world data demonstrates the vaccine’s amazing efficacy in keeping adolescents alive and out of the hospital. This contrarian has yet to share this good news, though he eagerly Tweeted about vaccine-related myocarditis the entire summer and authored a “howlerpaper on the subject that has yet to be published. Another contrarian oddly warned that “too many boosters will exhaust immune system”. Another contrarian suggested that vaccinating young people could spread the disease to older people, while yet another said that vaccine mandates could lead to “More COVID spread b/c vax does not stop infection”. That’s right, these contrarians think vaccinating people will lead to more COVID-19.

Declarations that the pandemic is over and false statements minimizing both the dangers of the virus and the efficacy of the vaccine for young people are generally a package deal with contrarians. (Notably, Dr. Monica Gandhi recently wrote an excellent essay on vaccinating children.) Moreover, I’ve not seen any contrarian overestimate the virus in any way. All of this indicates their flawed predictions were not merely the errors of people caught off guard by a tricky new virus. Rather, these are individuals who have been consistently biased in underestimating the virus, usually since the pandemic’s first days.

An answer to Dr. Hall’s question

As these contrarians all have had very large platforms since the pandemic’s first days, their biases get passed around. Their writing is published in major news outlets, and their ceaseless media appearances are spread widely on social media where commentators routinely praise their “relentless optimism and positivity“. They say what we all want to hear, a phenomenon termed hopium. So now we have an answer to Dr. Hall’s inquiry that kicked off this essay: esteemed members of our profession repeatedly spread the myth that the pandemic was over.

There are consequences

Sadly, repeated declarations the pandemic had ended and that young people have no risk from the virus have not been without consequences. Most likely, some people adjusted their behavior accordingly, perhaps declining vaccination against a virus they believed posed no threat to them. One contrarian said in October 2020 that his goal was to “oppose fear mongering, faux certainty“, and other contrarians made a video that same month about “How to Stop Living in Fear” of a deadly virus. As a result, some people likely stopped being afraid of a deadly virus. The same likely happened this May when one contrarian authored an article titled “Risk Of COVID Is Now Very Low — It’s Time To Stop Living In Fear”. Under the direct influence of several contrarians, Florida Governor Ron DeSantis spread the message at the start of August that “vulnerable” people were protected and made terrible policy decisions based on this flawed premise. Later that month, Florida suffered a record average of 227 COVID-19 deaths per day and 17,200 people were hospitalized on a single day. Moreover, in the number of COVID-related child deaths more than doubled in August. Nearly 70 children per day were being hospitalized during the recent peak, and some were sick enough to need life support. This all happened after a safe and effective vaccine was available to anyone over age 12. Vulnerable people were not protected, they were very purposefully exposed.

 

It wasn’t just Florida. The news this summer was full of stories of regretful people from all over the country who wished they had been a bit more fearful of COVID-19. One 45-year-old man who spent 45 days in the hospital after declining the vaccine said, “If I would have known six months ago that this could be possible, this would have been a no-brainer. But I honestly didn’t think I was at any risk. That is the naïve portion on my end”. While contrarian doctors are by no means responsible for vaccine-refusal, their narrative that those who warned about the virus, especially the Delta variant, were just “fear mongering” certainly didn’t help anything. Graveyards have plenty of people who didn’t fear the virus. Over 1,000 Americans are joining them every day. Fear is unpleasant, but it’s not useless, and as Loretta Torrago said, “The best way to reduce *fear* is by reducing *danger*”. This is exactly right. And the best way to reduce danger would have been to get people to take COVID-19 seriously, not to tell young people they have no risk and the pandemic is over anyways.

 

As they do not work with COVID-19 patients, aside from criticism on social media, these contrarians have been largely sheltered from the consequences of their poor predictions and COVID-19 minimization. Notably, I’ve not seen a doctor who has significant real-world responsibility for treating COVID-19 patients declare the pandemic was over. I am not the only person to notice this. Dr. Taylor Nichols said “It’s always the physicians who never actually have to take care of COVID patients with the absolute worst takes on this. No real world responsibility and all of the real world hubris”. Similarly, Dr. Abraar Karan said:

One thing I guarantee you will notice if you pay attention, Doctors who have cared for COVID-19 patients will never underestimate what this virus is capable of… I have yet to meet a fellow physician who has spent the majority of their time caring for these cases who would claim to know exactly what to expect from SARS-CoV-2, because we continue to be surprised.

Though these contrarians don’t care for COVID-19 patients, they have little trouble criticizing the exhausted frontline healthcare workers who warned about the virus, even though most of their warning were prescient and accurate. Despite frequent calls for “trust“, “humility“, and “debate“, these contrarians routinely excoriate those who disagree with them, accusing them of having “addiction to doom and gloom“, and “perhaps an addiction to being on TV or in the paper“. It gets worse. One wondered in a since-deleted Tweet if “those pushing that children younger than 12 will need to be immunized to have school/full life have any connections with vaccine companies”. Another said this May that those who warned of variants were “fear-mongering” and those who doubt the US had reached herd immunity “want the pandemic to stretch out longer“. Another suggested, in direct contradiction to the evidence, that frontline doctors killed COVID-19 patients through inappropriate intubations and then filled out their death certificates fraudulently as “Some financial incentives may promote coding for COVID-19”. Another suggested just before the devastating winter wave in the US that those worried about this outcome were promoting “fear” to “gain followers during the pandemic“. Another said that Dr. Anthony Fauci is “probably the number one anti-vaxxer” because he encouraged people to be cautious after they had been vaccinated.

Though my criticisms of these contrarians may seem harsh, they pale in comparison to their suggestions that those who rightly warned about COVID-19 did so for social media clout, because they “want” the pandemic extended, because of an “addiction” to gloom and TV appearances, or because of perverse financial incentives. I’ve don’t think I’ve ever questioned anyone’s motives this way, and hopefully my criticisms have the advantage of being grounded in reality.

If you think the pandemic is over, act like it

Despite their pleas to “move on” and treat “covid as one of 200 diseases that affect people”, these contrarians continue to speak about COVID-19 all the time, proving that COVID-19 is not just still here, but worthy of their constant attention. Every article they write, every Tweet they send, and every interview they give on the subject refutes their previous predictions that the pandemic is “essentially done”. If they feel otherwise, they should act like it and stop talking about COVID-19.

One day, perhaps soon, COVID-19 will fade into the background. I expect some of these contrarians will then say “I told you so”. Until then, I can’t help but wonder if one of the reasons the pandemic isn’t over yet, is because contrarian doctors repeatedly said it was.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.