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Coronavirus Data Is Still Misleading. Here’s What the Latest Numbers Don’t Tell You

When the existing prevalence of a virus is high and endemic, the rise in incidence of testing can create the appearance of a rise in incidence of a virus.

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The world is caught in the vortex of the coronavirus story. So what happens from here?

I don’t know, and no one else does either. That said, my intuition—based on the temporal and spatial dispersion of the first 16 domestic cases of coronavirus serologically confirmed in the United States—is that the situation is not inconsistent with a high-prevalence virus that has been endemic in America during this flu season and is still circulating. But what happens as more and more testing kits are delivered into an existing high-prevalence setting? Prevalence starts getting counted as incidence, and that could send people running for the hills.

Consider the following analogy. Think about prevalence as the gold that was sitting in the Sierras in early 1848, and incidence as the collection of eureka moments thereafter. Just because gold diggers discover more and more gold in the Sierras doesn’t mean gold is spreading. What is spreading is the word about gold, which attracts more gold diggers, who discover more gold, forming a self-reinforcing frenzy.

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The prevalence of coronavirus, of course, is more dynamic. Unlike gold, it does spread. But also unlike gold, it disappears when a patient gets better, which we know has been happening in the vast majority of cases so far. What we don’t know is the true prevalence, and how endemic it has been this season—it could be in the millions for?Americans already—because we weren’t looking for it until this particular story entered our collective consciousness in recent weeks. And now the labs are playing catch up.

But here’s the catch. A surge in testing—one that seems poised to commence after a slow rollout and criticism—will inevitably show a significant increase in serologically confirmed cases. When the existing prevalence of a virus is high and endemic, the rise in incidence of testing can create the appearance of a rise in incidence of a virus.

Nonetheless, the demand for such circumspection, or any circumspection for that matter, during the current hysteria is understandably anemic. Instead, this is that part of the horror movie where the good intentions of good actors—the companies and agencies rising to the challenge of producing testing kits at an exponentially faster rate than during the 2003 SARS panic—end up serving the interest of the antagonist (the mob) rather than the protagonist (public interest). In an environment when the increasingly unhinging mob is already competing with each other to paint the worst possible portrait of the next several weeks, the bad-news industrial-complex is about to strike gold: They will soon get to spread the word “spread.”

From there, the panic can drive itself. As more cases are serologically confirmed, perceptions of a spreading plague will spread, triggering demand for more testing, which will lead to more confirmed cases in a self-fulfilling prophecy. Such vicious cycles that promote runaway growth of fear are the anathema of a society that relies on stability, security and confidence. Feed-forward loops are the preferred algorithms of all self-expanding beasts, including cancer.

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Confidence is already in short supply in some quarters. Even basic things like numbers and definitions are being called into question. Meanwhile, people are panic selling the stock market and panic buying the remaining stock in supermarkets. Discretionary events are being cancelled in droves and handshakes are becoming an etiquette indiscretion. Adults are working from home, and kids with sniffles of any origin are being sent home from school to join them. During this “seeing-UFOs” phase of mass hysteria, everything from allergies and anxiety can start to look like the coronavirus given the fluidity of definitions and overlapping symptoms. Imagine the specter of this potentially absurd situation: The background prevalence of endemic coronavirus may be falling as the flu season fades, but the bad news bearers keep pointing to the rising incidence of test-affirmed coronavirus. The numbers are bound to look dramatically worse in the coming days and weeks, so the worst of the panic may be ahead of us.

If all of this feels a bit like we are in the Twilight Zone, that’s because we are. What I mean is that we are already in the twilight of the flu season. If SARS CoV2 turns out to be just a Kafka-esque guest who has been among us for the 2019 to 2020 flu season, then at some point the meticulously recorded and earnestly reported “incidence growth” of coronavirus will stall and fall—thereby releasing the spellbound public from self-captivity and other forms of quarantine. Before we know it everyone will be saying, “I knew it,” and this horror story about the plague of the century could fade into a vague memory as if it never happened.

But before that happens, we should really get to the bottom of this while we are caught in the vortex of fear lest we want to be visited by unwanted sequels every two to five years. At the center of this powerful vortex is the principal agent problem that infected human civilization at its roots at the end of the kin tribe age of human social evolution. Whereas humans were once fed, informed and governed by those who had our best interest at heart (a biological algorithm known as inclusive fitness), in post-diaspora melting pots we are fed, informed and governed by those who have their own best interest at heart. Without mutual kin skin in the game to protect against self-dealing, powerful institutions began arising all over the ancient world that ruled over instead of on behalf of the people. Today’s fake news, fake foods and fake leadership culture are all catalyzed by the same underlying cause of misaligned incentives that have been derailing human sociality and befuddling revolutionaries for thousands of years. It was The Who—not to be confused with the WHO—who pointed out that the new boss is always the same as the old boss.

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So what I hope happens to the story from here is that we begin addressing the first-order cause of human social dysfunctions rather than whack-a-moling its second-order symptoms. Simply put, our family values did not scale as we globalized, but virality has. The aggregate sum of everyone’s wonderful instincts to provide for family—the profit motive in today’s world—has produced the unintended externality of the principal agent problem in the post kin tribe era of human evolution. We propose a radically different path forward: by innovating new forms of inclusive stakeholding beyond just kin skin in the game—to align institutions with the people and people with each other—competition and natural inclinations will select for race-to-the-top global outcomes rather than race-to-the-bottom ones.

That’s a self-reinforcing trend I can get behind.

Joon Yun, MD, is the president of Palo Alto Investors and coauthor of the book Essays on Inclusive Stakeholding.

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