There is a recurrent motif in both the public pronouncements of politicians and their advisors, and media coverage of COVID-19: War. We are told that the virus is a dangerous enemy, invading our bodies; we must unite to fight it; patients are battling for their lives; our healthcare workers are valiant soldiers serving at the front lines (or in the trenches); we must build our arsenal of weapons against the virus; and only the development of a vaccine will defeat the threat that it poses to us.
But as the Greek dramatist Aeschylus wrote over 2500 years ago,
“In war, truth is the first casualty.”
Media coverage of real wars shapes the public’s perception of them, with serious political ramifications; older readers may care to reflect on the stark contrast between the uncensored reportage of the Vietnam War and its tragic civilian casualties, and the fawning paeans to military heroism filed by reporters who were embedded with American troops during the Iraq War of 2003-11.
Likewise, the media play a pivotal role in framing the public’s perception of the current ‘war’ on a newly-emerged coronavirus whose official name is SARS-CoV-2. It’s the disease associated with this virus that is called COVID-19; its original name, ‘2019 novel coronavirus’, sounded like it could be kind of fun at a New Year’s Eve party, and ‘SARS-CoV-2’ perhaps does not have a menacing enough ring for the media’s taste.
(A rather lengthy side-note: there is nothing unique about this ‘new’ disease, whose symptoms are those of any other respiratory tract infection. One of the first case reports after the emergence of the new virus in Wuhan identified 59 patients in whom SARS-CoV-2 infection was suspected, but only 41 tested positive to the virus; there was no difference between the symptoms of those whose illness was attributed to the new virus, and those whose illness was not.)
The term ‘Fourth Estate’ refers to the implicit ability of the media to frame political issues, and its explicit capacity (and, it could be argued, responsibility) to represent and advocate for the people.
Martin Hurst, Associate Professor of Journalism & Media at Deakin University, summarised it neatly:
“The ‘Fourth Estate’ describes the journalists’ role in representing the interests of ‘the people’ in relation to the business and political elites who claim to be doing things in our names.”
Don Chipp’s slogan for the now-defunct Australian Democrats political party that he founded, expressed it rather more colourfully:
“Keep the bastards honest.”
So how well are our Australian media outlets performing their sacred duty as the Fourth Estate, with respect to COVID-19 disease?
In a word, abysmally.
Both the commercial and publicly-funded media, in all their manifestations – television, radio, print and online – maintain a constant barrage (hey, even I can’t resist the military metaphors) of stories that appear custom-crafted to terrorise the public: computer graphics featuring menacing-looking viruses that appear to burst out of the TV screen; video footage of ICUs full of patients on ventilators; interviews with people who have recovered from their infections and are happy to impart their experiences in grisly detail; heart-rending reports of families grieving for their loved ones who succumbed; and of course the hourly recitation of the numbers of new cases and attributed deaths, redolent of the ‘body counts’ in war reporting.
Yet nowhere in this minefield (sorry, can’t help myself) of gloom and doom reporting are any of these stories contextualised in a manner that helps people understand what the virus and the disease associated with it actually means to their own and their family’s health. Instead, media coverage serves to whip up the public’s fear into panic and even hysteria.
As Mark Twain quipped,
“There are three kinds of lies: lies, damned lies, and statistics.”
In this part of the series, I’ll cover the way in which statistics about SARS-CoV-2 infections and COVID-19 are reported.
Cases
When you hear that there are 100, or 1000, or 5000 new ‘cases’ of COVID-19, what that actually means is that a certain number of people have either tested positive to SARS-CoV-2, or are assumed to be infected with the virus based on their symptoms and history.
First, testing. How does one ‘test positive’ to SARS-CoV-2? The test uses polymerase chain reaction (PCR) technology to detect viral genetic material within host cells, which are obtained by swabbing the nose and throat, or collecting sputum. PCR tests can detect a single viral genome lurking amongst tens of thousands of human cells from the sample.
This remarkable sensitivity means that strict procedures must be followed to avoid cross contamination of samples.
Shockingly, a shipment of SARS-CoV-2 test kit components that were being imported into the UK were found to be contaminated with the virus itself! Fortunately, the contamination was detected before the components were shipped, but the case highlights the potential for major errors in the calculation of infection rates in the population, due to faulty tests.
It also means that even if an individual has an extremely low viral burden in their body, which their immune system may be capable of successfully combating, they will still test positive.
Testing does not mean they have COVID-19 disease, or that they are sick in any way, shape or form, let alone that they are going to become gravely ill, need a respirator, or die.
In fact, extensive testing in Iceland has revealed that up to 50% of people who test positive for the virus are asymptomatic (that is, they have no symptoms of illness).
Chinese medical authorities began publishing daily figures on the number of asymptomatic, test-positive cases on April 1; so far 78% of newly-identified cases have been asymptomatic.
For context, a review of 56 different studies with 1280 healthy participants who were experimentally infected with influenza virus found that one in three infected individuals developed no symptoms at all, while another study found that up to two thirds of influenza-infected people may have no or very mild symptoms.
Yet there is no clamour for identification and quarantine of these asymptomatic carriers of influenza viruses, even in the worst flu season.
The information booklet on the test issued by the US Food and Drug Administration reads as follows:
“Positive results are indicative of active infection with 2019-nCoV but do not rule out bacterial infection or co-infection with other viruses. The agent detected may not be the definite cause of disease. [My emphasis.] Laboratories within the United States and its territories are required to report all positive results to the appropriate public health authorities.”
Translation: merely having the virus present in your body does not mean that it is responsible for any symptoms you’re experiencing, and you may well have other pathogens present in your body at the same time. However, if you do test positive to SARS-CoV-2, you will be reported as a ‘case’ and any sickness that you experience will be deemed as a ‘case’ of COVID-19, not of influenza or infection with any of the other pathogens present (which aren’t notifiable to the authorities).
The media breathlessly report on the number of new cases identified each day, without ever setting this number in its proper context: governments throughout the world are ramping up the number of test kits available, therefore more testing is being performed.
German researcher Dr Richard Capek has argued that the ‘coronavirus epidemic’ is in fact an ‘epidemic of tests’. His reasoning is straightforward: If the number of test-positive individuals was increasing at a faster rate than the number of tests, we would have evidence of a true epidemic.
A simple example: if in one week 10 000 tests are performed and 1000 infections are found, and the following week, 20 000 tests are performed and 2000 infections are found, there is no increase in the rate of infections. But if 4000 infections were found out of 20 000 tests performed in the second week, the virus would clearly be spreading in a dramatic and concerning fashion.
However, in countries with the most widespread testing (including Capek’s native Germany), there has been an exponential increase in the number of tests, while the proportion of infections has remained stable and the death rate has decreased.
Data from the Robert Koch Institute, Germany’s central agency for infectious diseases, which collates and publishes the results of testing, confirm Capek’s assertion. In one week, the number of people who tested positive to SARS-CoV-2 in Germany shot up from 8000 to almost 24 000, a fact that the mainstream media feverishly reported… without mentioning that the number of tests performed in the same time period almost tripled from 130 000 to almost 350,000. The actual increase in ‘cases’, then, equates to roughly 1% in 1 week, hardly a figure that an epidemiologist would lose sleep over.
Analysis of US data has revealed the same phenomenon – as the number of tests performed increases, the number of test-positive ‘cases’ increases but the proportion of people who test positive is rising very slowly, strongly arguing against rapid spread of the virus throughout the population:
There seems to be little doubt that SAR-CoV-2 will steadily make its way through the world’s population, as have previous coronaviruses, but the number of test-positive cases give little indication of its true rate of spread, and certainly do not warrant the attention they are being given in the media.
Now let’s discuss presumptive diagnoses. When a person is admitted to hospital, doctors record the reason for their admission using a standardised code, drawn from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
When SARS-CoV-2 was declared a pandemic, the following ICD codes were recommended for use:
- B34.2 for both COVID-19 confirmed cases and probable cases
- Z20.828 for possible cases and contacts of those who were confirmed and/or are probable cases.
In other words, if the doctor concluded that a patient probably has COVID-19 based on their symptoms (which, by the way, are clinically indistinguishable from those caused by influenza and a grab-bag of other viruses) and the fact that there is currently a pandemic of SARS-CoV-2, the patient would be coded as having COVID-19 even if the presumptive diagnosis had not been confirmed by testing.
In addition, Dr Gabriela Segura has reported on the widespread confusion in applying the new ICD-10 codes:
“At the beginning of this, many people were being labelled B34.2 [‘confirmed’/’probable’] when they should really have received the other code [Z20.828 – ‘possible’]. Additionally, those whose tests were inconclusive (probable cases), were nevertheless grouped together with ‘confirmed’ cases. While these codes of distinction make sense for managing a crisis situation, they unfortunately also leave much room for subjective interpretation.” [Emphasis in original.]
In Part 2 of this series, I’ll discuss the media’s reporting of deaths due to COVID-19.
Remember, taking good care of your health is even more important than usual due to the high levels of stress generated by the world’s response to COVID-19, and the fact that people with pre-existing chronic disease are at higher risk of serious complications of infection.
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[…] had COVID-19 (defined as at least one positive PCR test for SARS-CoV-2; yes, I know this is a nonsensical diagnostic criterion but it’s the one the Branch Covidians use, so I’m happy to […]
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