As shown in this chart from the CDC for the last five years, pneumonia and influenza take an average of 40,000- 60,000 American lives and that each year and the peak occurs around March
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Covid-19: Cognitive Dissonance and Cognitive Bias

This is an ambitious blog in which I want to explore the essence of human cognition. To do this, I hope that you will spend a little time with the phenomenon of the spinning dancer where the same image, shaded differently, produces different cognitive/visual perception and bias.

If you look at the gif on the left, then all three images appear to spin clockwise; if you look at the right image, they all spin counterclockwise. Try as I may, when I look at the center image, I cannot make the direction reverse without “cheating” and looking at the appropriate image to reverse the spin.

In time, I might be able to train myself to create a subroutine to reverse the spin without the shading cues but that is not the point. The point is that if you are like me, it is VERY difficult to reverse directions without using appropriate dancer. Even more impossible is trying to get the dancers to spin in the “wrong” direction. So which way is the dancer “really” spinning?

There are two quotes that come to mind: The first is attributable to F. Scott Fitzgerald:

“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

In truth, we all have must have first-rate intelligence because we all understand that driving is both “safe” and “dangerous”.

If I were to give test subjects only three seconds to determine which direction the dancers were spinning, then perhaps 45% might say clockwise and 45% might say counterclockwise whereas perhaps 10% might answer “both, neither, or it depends”. 

This leads us to the second relevant quote, which appears to be a misattributed quote with the exact opposite subtextual meaning: 

“It is the mark of a truly intelligent person to be moved by statistics”.

– George Bernard Shaw

If you wish to understand where this quote likely comes from and why it was ironically meant to imply the opposite subtext (i.e. “that statistics are boring” then you can read this investigation. 


So here we are in the midst of a pandemic and we run up against the problems inherent in the human condition: confirmation bias is inherent in all cognitive schemata and statistics are tools that can be manipulated to prove a point of view. By analogy, if 90% of people say the dancer spins one way, it shouldn’t mean anything to a person who has understood the nature of the illusion. 


Cognitive dissonance, or trying to hold two opposed ideas and still function, is a very uncomfortable obligation of the modern age. Earlier in human history, we had such limited access to alternative views, that it was easy to believe that religious authorities held all the answers. Attempts to engage the nuanced power of human intellect once took the form of “how many angels can dance on the head of a pin” but now a post-modern person can question the very existence of angels and the definitions of dancing and the existence of a pin.

When faced with cognitive dissonance, people are apt to change, justify, trivialize, or ignore conflicting beliefs. If an urban person were forced to slaughter animals for a month on a factory farm, they might become vegetarian, justify that animals were treated ethically, state that those creatures are less worthy of mercy, or simply ignore the existence of suffering.

When the secret sauce of fear or tribalism are added to cognitive dissonance, the effects can be particularly toxic to rational thought as people easily justify political assassination, war crimes, and crony capitalism because they raise questions of ethics that feel too daunting to consider. It so unsettling to live with conflicting ideas that much of the human experience consists of trying to choose identities that we can live with just so we can function without Hamlet-like ambivalence or complete paralysis.


In this current Covid-19 situation, we encounter many levels of cognitive dissonance that have degenerated into low-functioning thought paradigms. Here are some examples:

  • Coronaviruses comprise 15-25% of the common colds that we encounter and the majority of us have some immunity to them.
  • Coronaviruses can degenerate into flu-like illnesses that usually claim the lives of elderly and infirmed patient but that can also overwhelm younger and healthier ones.
  • Coronavirus immunity from vaccination may or may not confer resistance to future exposure just as natural immunity can be of limited value to future exposures to the same or related viruses.
  • Aggressive use of ventilators titrated to oxygen saturation may be associated with unusually high rates of mortality from the increased mechanical damage and inflammation.
  • A person who is hospitalized with Covid-19 “deserves” free treatment whereas a person without health insurance and any other medical condition should be refused care or go bankrupt to receive treatment.
  • Weekly death rates currently appear lower than usual, probably due to lower rates of motor vehicle accidents and iatrogenic outcomes although the latter “benefits” may be delayed as more people will present to hospitals with more advanced disease.

I will close by admitting that my own cognitive bias led me to believe that the disease would be less impactful than it has been. Whereas the numbers of cases and deaths has exceeded my expectations, there are potential problems in the data set that we must acknowledge. Firstly, the false positivity of testing was quite high, secondly, there are financial incentives for municipalities and hospitals to find Covid-19, and finally the dubious practice of assigning Covid-19 as a cause even without laboratory evidence of the virus.

All that said, the examples of Italy (with older patients) and NYC (with late social distancing and aggressive ventilator use) are not the entire story. The majority of nations and their local health systems have not been overwhelmed with cases and deaths. Despite the repeated revisions of  predicted US deaths from 2 million to 200,000 to 60,000, no one knows what would have happened without mitigation but we know that many of the so-called curves appear to have peaked. I certainly do not have the ability to predict what will happen and Covid-19 may have gotten “a late start” but I know that experts have used the worst-case scenarios to justify unprecedented changes to civil liberties and our perceptions of human experience that will have lasting impact upon us all. 

Not only has there been a massive redistribution of wealth to “rescue” the corporate banking system, there has been a destruction of wealth, employment, and health benefits for countless Americans who live in a nation without the universal health care that so many other citizens of industrialized nations take for granted.


In the final analysis, as we have learn more from the actual statistics, despite the cognitive dissonance, it appears that the pandemic falls within the usual virulence of the flu-like illnesses and deaths from pneumonia that could have been attributable to previous coronaviruses in previous years. The fact is that no one cared about them and standard of care was to not look for them before. Yes, people have died and that is horrific. Yes, the mitigation efforts may have saved lives. Yes, there may be loss of life from the socioeconomic impact of the shutdowns. Yes, there may be higher rates of child abuse, depression, domestic violence, crime, substance abuse, and suicide from prolonged lockdown. Yes, there may be mitigating medicines and treatments. Yes, the standard of care may been to change with regard to late implementation of mechanical ventilation. Yes, serological testing may have ambiguous results and may be used to approve certain workers returning to work. Yes, there will be a tendency of politicians to extend the shutdown because of their unusual lack of accountability for overestimating risk while not diminishing their own job security during a time of rampant fear. Yes, compulsory vaccination may be proposed as well as mandatory contact tracing and unmasking via smart phones despite privacy concerns. Yes, more people will die and may continue to die from Covid-19, 20, and 21. Yes, relatively more people will die from suicide, malaria, tuberculosis, heart disease, and motor vehicle accidents. Yes, well-meaning people are making questionable decisions with good intentions. 

Yes, the dancers can be said to spin in either direction. But no, there in fact are no real dancers except those our mind conjures up. As the data becomes more clear, we will better understand the limitations of our abilities to predict epidemic behavior in public health situations. Accurate and available testing, contact tracing, basic public health measures, and vaccine and serology-based policy decisions may be coming but they need to be weighed against rights to liberty and privacy as well unless and until it can be shown that coronaviruses represent high consequence diseases such as syphilis, HIV, and tuberculosis.

I beseech you all to hold the opposing beliefs that prolonged shutdown of society can be beneficial and harmful and that those assessments are dynamic and should not be based solely on worst-case scenarios by now abandoned epidemiologic models. I also ask that you find the ability to be moved by statistics that might suggest there are larger problems than Covid-19 that we are actively creating and others that we are ignoring. As with the disease itself, it is the reaction of the body that kills you and there are ways that doctors, researchers, and politicians will devise that can guide us through the dangers ahead no matter which direction most believe the dancers are spinning.

I realize that many, if not most, believe that Covid-19 represents something very special. I want to remind you that until this year, we never tested for coronaviruses and they were lumped into pneumonia and influenza-like illnesses. There may be some special angiotensin2 receptor binding properties, gain-of-function proteins, relation to 5G, or abnormal hemoglobin impairment but those are still theories.

As of April 14th, 2020 there have been something like 26,000 deaths in the US attributed to this Covid-19. It will be interesting to know whether the deaths due to other respiratory infections are reported as lower given the dubious presumptive diagnosis practice that the CDC is recommending. Keep in mind that you can and usually do have multiple viruses and bacteria that lead to pneumonia and ARDS and that host factors are the most important in determining who will be most adversely affected.

As shown in this chart from the CDC for the last five years, pneumonia and influenza take an average of 40,000- 60,000 American lives and that each year and the peak occurs around March.

I realize you may not be “moved by statistics” but I thought I would try anyway. When you consider total deaths from pneumonia, this may end up being a bad year or merely average. We have to wait and see but in the meantime, there are undeniable costs associated with the “new normal” that can be measured in suspension of civil liberties, joblessness, bankruptcies, foreclosures and evictions, trillions of national debt, and reduction in health care coverage and 401k values.


POSTSCRIPT:

Many of my readers may be “triggered” by anything with the Fox logo on it; that said, consider the arguments presented by this physician about the financial and political incentives for reporting Covid-19 deaths:

 

To read the previous six blogs in this Covid-19 series, see below:

  1. Public health context of reducing spread: hand washing, fomites, and quarantine
  2. The emergence of an apocalyptic death cult. People harbor religious beliefs about COVID-19
  3. The greater scale of aging as a threat and how it contributes to all-cause mortality
  4. Coronavirus biology: origins, testing, and therapeutics
  5. How inflammation produces ARDS, the final common pathway for death from flu-like illnesses.
  6. Epidemic modeling. 

15 Responses

  1. Thank you for speaking so clearly to such a foggy matter that is transforming everything we know. I have been compiling through diligent research information to write an article to clarify the issues and alarms I see around this phenomena of covid-19 social dislocation.

    You touched on every point I wanted to make and better than I could. Instead I will now fire up my Twitter account again and pass on your very helpful article.

    1. Thank you for your comment. Particularly concerning is the introduction of financial incentives to admit and intubate more Covid-19 patients for profit. Also linking federal aid to cases will tend to inflate reporting.

  2. This is one of your strongest posts! This is worth sharing with the world too. I get it. It says a lot more was going wrong with society & covid is a social disease. I believe its here to teach us – and at my twitter i have been saying so for two months. But your article made it more clear to me.

    I dont quite get WHY ventilators light be killing people.
    Can you tell us why in layman’s terms?
    JA

    1. It appears that the disease deactivates hemoglobin. Usually, we treat to oxygen saturation so in order to get the saturation up, you need to increase oxygen concentration. When that is insufficient, doctors increase the pressure to the lungs. This causes mechanical damage, like overinflation of balloons until they pop. The result is more lung dysfunction, more inflammation, and less oxygen exchange. This causes ARDS unless the body can clear the infection and downregulate inflammation as it attempts to heal. The mechanical ventilation may be needed but it also may be harmful. The doctors who are less dogmatic are adjusting and using methods like CPAP that don’t require intubation and escalation of lung damage.

  3. In their research, the cognitive psychologists Daniel Kahneman and Amos Tversky have found humans to be prone to the cognitive error of “neglecting the base rate.” The builders of the epidemiological models being used in establishing state and federal policies on COVID-19 appear to neglect the base rate with the result that the values of the probabilities of the outcomes of the events are wildly inaccurate. A technology for building a model without neglecting the base rate is available. See Ronald Christensen’s book “Multivariate Statistical Modeling” (ISBN 0-938-87614=7) for details. This technology is rarely used, a testament to human tendency to neglect the base rate.

    1. Good point. Sadly, it appears that the incentives for reporting Covid-19 are forms of self-fulling prophecies. It is possible that they will cannibalize the deaths that might have occurred due to other infections in compromised hosts. The data from the CDC for all pneumonia and influenza deaths is looking similar to date. In pockets like NY where the mayor was encouraging socialization as late as March 19th, ventilator use was aggressive and the adoption of hydroxychloroquine was passive aggressive, there was clearly a lot of impact.

  4. undeniable costs: suspension of civil liberties, joblessness, bankruptcies, foreclosures and evictions, trillions of national debt, and reduction in health care coverage and 401k values.

  5. Joe and I are trying to get the word out on FCC licensed community radio in Woodstock, New York. I have noticed that our “lefty” station still has no alternative viewpoints such as Dr Park expressed Mar 23rd although we had one call in when we went out live. In the old days “talk radio” would fill the air waves…..thank you for your dedication and service of real health knowledge to mankind.
    Paula Gloria Barton
    Woodstock 104 WIOF-LP

  6. Thank you, Dr. Park. This was my favorite blog of yours on the pandemic, too, After hearing the nonstop 24-7 media frenzy on all channels, your fact-based and balanced approach is always refreshing. Your blogs made me understand that we willfully ignore the 60,000+ deaths from regular flu and pneumonia every year, yet were willing to give up everything—our wealth, our livelihoods, our civil liberties, our very way of life—to protect people from this virus. It is truly wonderful that we are willing to give up so much to protect the weakest among us, but my heart whispers that we didn’t have to risk giving up our way of life to accomplish this. We could have been more like Sweden and taken less invasive measures much earlier to slow the viral spread. We could have been more like South Korea and used mass testing to shut down the virus. We could have treated it like we did Ebola and taken extraordinary measures to keep it out of our country. We could have simply educated folks on how to protect our immune-compromised loved ones from getting this virus (I’ve taken extreme measures to avoid the flu for most of my adult life, and they work). There were other ways to respond short of risking the destruction of our way of life and economy. Since I’m not in government management these days I no longer have a say in our response to situations like this. Our elected leaders decided to take these extreme measures to slow the spread, and I’m sure they did so with the very best of intentions. Like carrying Bambi across the minefield, these extreme measures appear to be working. But in doing so we have changed our way of life and I fear there may be no going back. Gone with the Wind tells the story of the Civil War through the eyes of 16-year-old Scarlett O’Hara. She watched with shocked horror and amazement as her boyfriends willingly gave up their youth, health and very lives to fight for the Cause. Poor Scarlett just wanted to dance. The South could have negotiated ways to free the slaves while she danced. They could have freed the slaves slowly, easing them back into society, while she danced. They decided to take the most extreme response and fight a war. They lost. You don’t always win, especially when you’re not right. I hope taking these extreme measures was the right thing to do. I hope we haven’t already started another Dusk of the Gods.

  7. You’ve done it again! Great perspective and points! I enjoyed interviewing you a couple hours ago too!

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