Should I visit Philippe? Pt. II

In my last post, I outlined the scope of my research. In this post, I’ll try and specify what information I need to find in order to answer my research question: “is the government’s prohibition that I do not visit Philippe a legitimate one?”

Well, I can think of a few different ways to address this. The first is legal. We could ask whether a health officer is legally allowed to make ordinances. We could ask whether the opposition and judges properly scrutinized the government. But I don’t think this should be our primary way to address this. I’m not a lawyer, and the legal status quo seems pretty legitimate. I’ll come back to this later.

Instead, what I would like to do is try and discern whether what the government is doing is right or not. To do this, I need to figure out the following things:

  1. what the government’s strategy is, what they hope to accomplish with a lockdown, with spot searches, and with forbidding socialization. I’ll likely find that they’re trying to lower the speed of the spread of the disease.
  2. I need to also figure out why they want to do this (ie. prevent the health care system from collapsing, allow for more economic growth after the pandemic).
  3. I must figure out whether this is reasonable (ie. has it collapsed before? what were the consequences?) and also what is the opportunity cost (how many more people are dying from missed cancer diagnoses? How many people are committing suicide? Drug overdoses? Can these be attributed to the lockdown? Or are these just secondary effects of COVID itself?).

So, what is the government’s strategy? What do they hope to accomplish with lockdowns? One thing we forget is that long-term care homes are a part of the health care system. We usually think of the health care system as hospitals, walk in clinics, and diagnostics. But there’s also long term care homes.

One issue I found was that governments don’t publicly post reasons with evidence for their restrictions. However, in Toronto, the Medical Officer issues “class orders” which do have reasons (admirable!).

Speaking of this, it looks like the way authority flows is that regional medical officers have their authority granted to them by a province’s quarantine act, which gets its legitimacy from the legislative assembly. So for example in Alberta, Deena Hinshaw makes orders ( like “CMOH Order 42-2020“) that forces people to work at home unless their work must be done from an office. She’s allowed to do so thanks to the Public Health Act. Section 29 lets her take necessary actions to protect people from a disease, to quarantine people who are diseased, etc.

I also found 2 sites which look like they’ll be helpful. One is the CCLA, and the other is this research compendium on enforcement.

But in the end, it doesn’t look like I’m really able to judge whether a government’s restrictions are reasonable because they don’t provide their reasons.

In the meantime, I think I should learn more about COVID itself. Its symptoms, risks, herd immunity, and vaccine, etc.

Let’s start with how likely I am to die.

There’s the crude mortality rate and the case fatality rate. The case fatality rate looks at how many people die from COVID compared to how many people have been diagnosed with COVID.

The crude mortality rate looks at how many people die from COVID (same as above). But instead of comparing this to how many people we’ve diagnosed with COVID, they compare it to how many people there are in total in the population. This means that the case fatality rate is usually bigger than a crude mortality rate, because the # of infected people is smaller than the entire population.

The infection fatality rate is like the case fatality rate, but more accurate (in theory). It compares how many people die from COVID with how many people actually have COVID in the population (as opposed to how many we’ve diagnosed – there may be people who have it who don’t know have it). As such, we can only estimate the infection fatality rate. The case fatality rate changes based on the population you’re looking at, and the time span you’re looking at too.

You’ve got to be careful measuring the CFR because you can only accurately calculate it after all the cases are accounted for – is the person dying of a shark attack or Covid? Does the cases we’ve diagnosed reflect the total # of people infected? These can make the CFR go up or down. SARS initially had a CFR of 3%, but that went up to 10% over time when the numbers were more accurately counted. However, people saw the increase from 3 to 10 and thought that it was getting more dangerous through time. Thus, when looking at a CFR, you’ve got to keep in mind that it isn’t the chance that you’ll die.

What then is my risk of dying from COVID-19? Looking at data from Johns Hopkins, it seems like Canada’s observed case fatality rate is 2.7%. That’s 1 in 37 people. But this data doesn’t look at age. Well, I’m 22 now. If we look at the case fatality rate for 22 year olds, 0.2% of deaths in China were people aged 20-29, and 0.22% of deaths in Spain (from ourworldindata.org). That’s 1 in 500, roughly speaking. That’s 3 people in my UBCO graduating class of 2020 (made up of 1,600 people). So, my chances of dying from COVID seem to be 1 in 500 right now. Or are they?

That number doesn’t take into account other underlying health issues. It could be the case that old people are dying simply because they’re the ones with the diabetes, hypertension, fat, and lack of exercise, rather than that they’re old. My dad has diabetes, and my mom has pre-diabetes. I haven’t been tested for diabetes, but I exercise daily, I don’t eat a lot of sugar, I fast once a week, and my cuts still heal quickly, so I doubt that I currently have it. That being said, I’m probably going to have it when I get older (if I don’t have it right now).

This study which I found tracked young adults (ages 18 – 34) who had covid in the US and were hospitalized. Around half of them were obese. A fifth had diabetes. Of the young adults who went to the hospitals, a fifth (21%) needed intensive care, a tenth (10%) needed ventilators, and 2.7% died. The factors most associated with death were morbid obesity, hypertension, and being male. 41% of those who died were morbidly obese. While I may not be overweight, it’s likely that Philippe is. And thus I think that if I were to give COVID to Philippe, he could be hospitalized.

It’s also hypothesized that people who take vitamins and have Omega-3 have less severe reactions (sources 1, 2, 3). Clinical trials are going on, but the studies haven’t come out yet! Furthermore, people who are vitamin D deficient are more likely to have severe symptoms, and are also more likely to die (source 1, another explanation). This likely explains why 80% of hospitalized COVID cases in Spain were Vitamin D deficient. That being said, just taking a big dose of Vitamin D will not help you when you’re in hospital (as this trial showed). And the UK’s official government health people stopped giving out free Vitamin D to vulnerable groups earlier this year when they couldn’t find strong enough proof that it works against COVID (source). And that’s why I’ve started to take cod liver oil with Vitamin D in it. It doesn’t hurt.

One interesting thing that popped up is that it seems like African Americans and Hispanics are more likely to contract COVID-19 than other ethnicities. There are a bunch of hypotheses out there for why this is, like there being discrimination (whether historical or present) in the health care system, they live too close together, they largely work jobs which require them to work alongside other people, etc etc. But I read a really interesting suggestion. Since people who are Vitamin D deficient are more likely to get a severe form of COVID, and people with more melanin produce less Vitamin D when exposed to sunlight, and Hispanics and African Americans have more melanin than others, they are more likely to react severely to COVID.

Unfortunately, I didn’t see a study which looked at all of the possible factors which help mitigate COVID. I just saw this part about Vitamin D, Omega 3, diabetes, obesity, and ethnicity. If you know about such a study, please email me at ef3n9r98 [at] ymail [dot] com, or leave a comment below.

The numbers above look pretty good for me. I’m not overweight/obese, and I’m young, and I’ve started taking Vitamin D supplements, so I’m probably not going to die from COVID. But the numbers above assume that I get COVID at all in the first place.

We also have a bit more clarity when it comes to answering my first and primary question: should I visit Philippe? Well, one way to answer “If Philippe will be hospitalized when he gets COVID, then don’t visit him.” This is too simplistic a premise. What if he knows the risks, and still wants me to come over? Then I should visit him (and wear a mask).

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