NEW YORK – Dr. Ioannis P.A. Ioannidis is the C.F. Rehnborg Chair in Disease Prevention, a Professor of Medicine, Health Research and Policy, Biomedical Data Science, and Statistics. He is also the co-Director, Meta-Research Innovation Center at Stanford University. Dr. Ioannidis spoke with The National Herald and expressed his belief that humanity can successfully deal with the threat of COVID-19 through the proper collection and use of data, in the hope that the "blind" solution – a solution not based entirely on the data – of lockdowns need not be used again.
Dr. Ioannidis also emphasized that he never questioned the need to adhere to the social distancing measures. Rather, he clarified, he said that he does not consider the mortality of COVID-19 to be as high as initially estimated, or that shutting down the economy should be a long lasting policy.
Regarding Greece, he expressed confidence that the outbreak will pass in Greece without painful consequences, but stressed that he remains concerned about the impact of the lockdown measures if they are of long duration.
Excerpts of the interview that appeared in TNH’s Greek edition follow:
The National Herald: Dr. Ioannidis, first of all, what do you think is the main reason why the COVID-19 models and curves we see are so different and have so many deviations and problems?
Dr. Ioannis Ioannidis: The reasons are twofold: the first is that many of the elements we use in mathematical models are uncertain. The measurements are not accurate enough to give definite results. Also, mathematical models utilized in epidemiological calculations to compute the final magnitude of an epidemiological wave and mortality (how many people will die) are based on estimates made by the modelers.
TNH: What do you make of the report from the Imperial College of London that discussed the need to maintain social distancing measures for more than a year?
Dr. Ioannidis: As you understand, these are exaggerations. An initial estimate by the team at Imperial College was that more than 2 million people would die in the United States and 500,000 in Britain. The parameters were uncharacteristic and have nothing to do with reality. They have now corrected some of the parameters, predicting a much smaller number of deaths.
The National Herald: Your scientific article in StatNews left open the possibility of government policies causing a "fiasco" - provoking strong reactions with some people saying you are essentially undoing the whole set of measures and questioning the dynamics of the pandemic itself. What is the true message of your article?
Dr. Ioannidis: What I said in that particular article is that in order to deal with this serious problem, we need to have data that is reliable. At first you do whatever you can do, even ‘blindly’ [without enough data] – you close down everything. But you don't have to stick to that policy. What you need to do immediately is gather reliable data to see what the next step is. You cannot remain in a lockdown state indefinitely. Then there will be deaths from the effects of lockdown’s consequences, such as suicides or heart attacks due to the stress of unemployment and inactivity. What I said is that the data we have is unreliable and would lead us to the wrong steps in the future if we did not correct them quickly. The probabilities that were being given for someone dying from COVID-19 were unrealistic.
In fact, the likelihood of someone dying from coronavirus is much lower than we initially thought. Word was getting around that if you caught the virus, you were going to die. I estimate that the mortality rate will be slightly – but not spectacularly – higher than the seasonal flu.
There are many more cases [than were being reported] and, I repeat, this is good news, because it means that the vast majority of people who become infected have no problems. They recover.
TNH: These messages are optimistic, but on the other hand, we have before us the example of New York, where wartime conditions prevail in hospitals and the number of infections and deaths keeps rising. How do you interpret the New York phenomenon?
Dr. Ioannidis: New York is a case similar to specific Italian cities. In New York…in some areas, hospitals are reminiscent war zones every day, areas containing many of our poor, neglected, and marginalized fellow human beings.
A second reason is that New York made the same mistake that as Italy: it is/was wrong to send masses of patients to hospitals. Patients should not be hospitalized if they do not truly need to be. We have seen in hospitals that are full that there is a problem with patients getting nosocomial infections – illnesses they pick up in the hospital – and doctors became infected with coronavirus. This causes secondary problems because infected doctors are withdrawn and available staff is reduced. I think that's what happened in New York.
TNH: How do you assess the situation in Greece?
Dr. Ioannidis: Greece is rather lucky to be protected by its good climate and despite the mistaken strategy of not conducting extensive tests in the beginning, we have avoided large numbers of deaths so far.
Even now, however, we have to do a lot more testing to see who is infected and to isolate those people. I believe that the deaths resulting from the coronavirus will be much less than the 1,000 deaths that result from pneumonia in Greece each year. But I am much more concerned about the consequences of blind measures, the possible destruction of an economy where 25% of the GDP is based on tourism, and the larger number of lives that can be lost in conditions of economic and social collapse.
I hope we avoid the worst and show calmness, solidarity, brotherhood, and courage instead of panic.
TNH: Looking at the huge number of infections in New York at the moment, is there a chance we will see similar numbers in other states?
Dr. Ioannidis: One cannot predict this with certainty. My opinion is that we will not see the scenarios of New York in other states. I am very optimistic that, in the end, the number of deaths in the United States will be less than the number of flu deaths, which will cost us 30,000-70,000 lives this year. We will see. Globally, I don't think the numbers will come close to the initial forecasts.
TNH: So, you think that the misuse of data is one of the main reasons for the bad management of the pandemic, both by the scientific community and by officials?
Dr. Ioannidis: The big mistake that has been made in many countries is that there has not been aggressive testing during the early stages. The countries that took an aggressive approach with tests and, at the same time, tracked all the contacts of each infected person, were fine. The usefulness of tests is to see what's going on and to know where you're going.
TNH: If we accept that a second wave of infections awaits us, do you think that it will be milder than the first?
Dr. Ioannidis: I think we should learn more from the first wave, and I do not know for sure that there will be a second. It's speculation at the moment, and I can't rule out the possibility that COVID-19 will return every winter – and how strongly it will return. Other well-known coronaviruses return every winter. If there is a second wave, I hope we are more prepared with more testing availability and with a higher level of immunity.
TNH: Many people used your article in communicating their views, saying that, "Dr. Ioannidis says everyone should go outside" or that “the measures of social distancing must be stopped immediately.” How do you respond to that?
Dr. Ioannidis: It is clear that I did not say such things. My approach was clear: for the next steps, we need to have more data that is as reliable as possible.