Category Archives: Opinion

Where is our next Joe Strummer?

By Kent R. Kroeger (Source:; May 17, 2022)

Nearing the 40-year anniversary of the mostly forgotten US Festival concerts (which were held in 1982 and 1983), I am reminded of one of the bands that performed in the 1983 concert…

“The only band that matters.” That was The Clash’s moniker among the London-based punk band’s fan base.

Yes, it was a pretentious, overwrought slogan, but nearly 40 years removed from the band’s meteoric rise and fall, I’m still reminded of how different they were from other bands, past and present.

Along with The Sex PistolsThe Clash — Joe Strummer (lead singer/songwriter), Mick Jones (lead guitar/songwriter), Paul Simonon (bass), and Topper Headon (drums) — were the vanguard of the British punk movement in the mid-1970s. No exaggeration, they were The Beatles of punk rock — or, closer to what Strummer might say, they were the anti-Beatles.

[Strummer once mentioned he preferred The Rolling Stones over The Beatles, in part because The Beatles didn’t sing with British accents like The Stones.]

Where the Pistols were known more for their ceaseless, drug-fueled nihilism than their musical talent (predictably ending in the drug overdose death of their mercurial front man, Sid Vicious, in February 1979), The Clash were musically tight and smart, often preferring parabolic, socially observant lyrics over the Pistols’ self-destructive paganism. The Clash gave us elegancia punk.

[That isn’t to say the Pistols were bad — they were, in fact, great. And while most music critics will recommend their only studio album — Never Mind the Bollocks — in my view, no song better represents the Pistols than their rendition of Jingle Bells (…if that song doesn’t put you in the Christmas spirit, check your heartbeat).]

As talented and politically-conscious as U2 (and Bono) were in the 80s and 90s, their uncredited mentors were The Clash, because of all the rock bands I’ve admired over the years, no band has ever been as uncompromising and consistent in its politics, and that was a reflection of their lead singer, Joe Strummer.

The Clash were to the left of the leftiest on the left — and that is back when the term ‘left’ meant something politically in the U.S. and U.K.

Andwhen Joe Strummer sang ‘I’m so Bored with the U.S.A.,” I knew he was sincere — he really was bored with the U.S.A.

While Jones often wrote pop-influenced, self-reflective songs (“Lost in the Supermarket” and “Should I Stay or Should I Go” come to mind), Strummer would put listeners in a figurative headlock and noogie the bourgeois delusions out of them.

And no moment in rock-n-roll history better exemplifies this point than the 1983 US Festival concert held in San Bernardino, California over that year’s Memorial Day weekend.

The dreamchild of Apple co-founder Steve Wozniak and concert promoter Bill Graham, the US Festival was the Reagan generation’s answer to Woodstock —and like its 60s precursor, was a money loser.

And no concert is more poignant to Clash fans, as it would be the last time the band would perform together.

Perhaps knowing that, Strummer let out a timeless, scorching onstage rant against Western materialism and inequality, at one point taking aim at the organizers of the US Festival, the well-compensated musical acts appearing there, and even the audience itself:

“Alright, then here we are, in the capital of the decadent U.S. of A. This here set of music is dedicated to making sure that, those people in the crowd who have children, there is something left here for them later in the centuries…

…I know the human race is supposed to get down on its knees in front of all this new technology and kiss the microchip circuits. It don’t impress me ever much. It ain’t nothin but a “You buy! You make, you buy, you die!” That’s the motto of America. You get bums to buy it. And I’ll tell you those people out in East L.A., they ain’t gonna stay there forever. And if there’s anything gonna be in the future, its gonna be from all parts of everything — not just from one White way down from the middle of the road. So, if anybody out there grows up, for fucks sake!!!

Yeah, I suppose you don’t wanna hear me go about this and that and what’s up my ass, uh? Try this on for size…well, hi everybody, ain’t it groovy…ain’t you sick of hearin’ that for the last 150 years. Look, I know you’re all standin’ there lookin’ at the stage, but I’m here to tell you that the people that are on this stage and are gonna come on and have been on it already, we’re nowhere! Absolutely nowhere! Can you understand that?”

Strummer didn’t make many friends in the music industry that day, some eagerly pointing out that The Clash were paid $500,000 for their US Festival appearance — a large sum for a one-night-only performance.

Van Halen’s David Lee Roth would respond to Strummer the next day during their US Festival performance: “The only people who put ice tea in Jack Daniels bottles is The Clash, baby!”

I’m still not sure of David’s point. The Clash weren’t real rockers? The Clash were British? Who knows. I’ve never considered David Lee Roth remotely funny — which is one opinion I share in common with the late Eddie Van Halen.

A bland but more coherent response to Strummer came from U2’s Bono.

“Nobody twisted my arm to come here,” the self-consciously inoffensive Bono said during U2’s performance on the Festival’s third day. “I’m here because I want to be here.”

Bono then proceeded to pick out a big-breasted woman from the crowd, have her carried on stage next to him by a couple of stagehands, and let her bounce her ample mammaries for the next few minutes.

In the early 1980s, the political correctness memo hadn’t reached rock bands.

So went the 1983 US Festival — a four-day musical menagerie that may not have generated any additional wealth for its organizers, but nonetheless provided some great music, an entertaining pissing-match between a few bands, and one of The Clash’s greatest concert performances, albeit its last.

I can count on one hand how many times I’ve listened to an entire U2 or Van Halen album in the last twenty years. I listen to entire Clash albums at least three or four times a year — a frequency I only exceed with The Beatles, Kate Bush and Neil Young.

I don’t miss David Lee Roth’s schtick or rock vocal stylings. It had its day. And, anymore, I turn off U2 songs when they start on the radio (except when its “One”).

But I miss Joe Strummer. He was truly unique and the band that made him famous matters more than ever.

  • K.R.K.

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A Starter’s Guide to the “The Clash” Song Catalogue

Strummer’s singing voice is a cross between someone’s excessive gargling and a dying woodland animal.

I’ll admit, he’s not for everybody. But neither is Bob Dylan or the late Janis Joplin, and they certainly don’t have to apologize for their singing careers.

So here is my list of not necessarily The Clash’s or Strummer’s best songs, but the easiest songs to appreciate for first-time listeners, starting with songs from Strummer’s last band before his death, The Mescaleros.

Mondo Bongo” —Joe Strummer & The Mescaleros (2001)

This may be Strummer’s most famous song as it was included in Mr. and Mrs. Smith, the 2005 movie starring Brad Pitt and Angelina Jolie. But beyond the mainstream accessibility of this tune, it is also incredibly lovely and hypnotic. In fact, you’ll want to find a dance partner from the moment the song starts.

Redemption Song” — Written by Bob Marley; performed by Joe Strummer & The Mescaleros (2003)

From the album Streetcore, Strummer starts this Bob Marley masterpiece by saying, “People can change anything they want to.” Whether I agree with the sentiment, you can hear the emotion in his voice and he not only does the Marley song justice, he gives us the song’s best cover version, in my opinion.

Minstrel Boy” — Lyrics by Thomas Moore; arranged and performed by Joe Strummer & The Mescaleros (2002)

Lyrics written by the Irish poet Thomas Moore, The Mescaleros’ arrangement in combination with Strummer’s voice is heartbreaking — in a good way. It may be cliché to say the song transports you to a different place and time, but it really does.

Know your Rights” — The Clash (1982)

My favorite song from Combat Rock — The Clash’s last studio album under the original group lineup — there is probably no Clash song that could be plunked down in today’s music scene and be more pertinent. What “Know your Rights” lacks in lyrical sophistication, it more than makes up for in it’s political sensibilities. Sings Strummer:

“You have the right not to be killed. Murder is a crime. Unless it is done, by a policeman. Or an aristocrat. Oh, know your rights.

You have the right to food money. Provided you don’t, don’t mind a little investigation, humiliation…and if you cross your fingers, we have rehabilitation.

You have the right to free speech. Unless you’re not dumb enough to actually try it.”

As neoliberal political forces worldwide continue to suck the life out of working class people through their ongoing effort to stop the formation of worker unions, kill universal health care, spend public monies on ‘guns over butter’, and censor any speech they fear, this song deserves a relisten.

Atom Tan” — The Clash (1982)

The Clash loved the ‘call and response’ technique and this song from 1982’s Combat Rock album beautifully displays their penchant for that lyrical pattern. ‘Atom Tan’ is an unabashedly catchy Clash tune with lyrics I don’t fully understand…and who cares? It’s a fun listen.

The Clash’s ‘Combat Rock’ album was their most commercially successful effort, even as some hardcore fans dismissed the preternaturally catchy “Should I Stay or Should I Go?”; but for the rest of us, danceable songs like “Rock the Casbah” (the music video’s embarrassing Arab stereotypes notwithstanding) gave us some solace knowing that our favorite band would probably not survive into the next year. Strummer-Jones wrote Lennon-McCartney level songs and this album mostly proved that point.

Armagideon Time” — Written by Willi Williams; performed by The Clash (1980)

My best friend in high school would mock The Clash because they couldn’t spell ‘Armageddon.’ But the song was written by Jamaican reggae musician Willi Williams and was, by intent, a mocking critique of end-of-times theologies — the title’s improper spelling was part of the song’s point.

For me, as it wasn’t a Clash-written song, I loved how Strummer mangled Williams’ lyrics, such as when he replaced the original lyric of “remember to praise Jah-hov-iah” with “remember to kick it over.” Like John Lennon, Strummer was never against forgetting a few lyrics now and then — often for the better.

And if you love inventive drumming, pay attention to Topper Headon’s work on this song. Before heroin compromised his reliability as a band member, Headon was as good a drummer as any in the rock-era.

Hitsville U.K.” — The Clash (1980)

Sure, this song is a too consciously unpunk to be taken seriously, but at this point in the The Clash’s career, I’m not sure they cared.

“Here I am, thirty years later, in f**king Serbia, on the brink of crying because of a song celebrating bands I’ve never listened to. Is there any other band like this? Probably no,” posted gorgvalhal on YouTube about this song.

Found on The Clash’s three-album mega-opus, Sandinista!, an album that still divides Clash fans. Apart from George Harrison’s All Things Must Pass and a few live concert and best-of releases, no band had ever issued a triple-album before The Clash. In fact, The Clash gave up a good chunk of their royalties because they priced Sandinista! as a double-album release, instead of as a triple-album. Their break-up a few years later was, in part, because of this brave by costly financial decision.

Ivan meets G.I. Joe” — The Clash (1980)

Also found on Sandinista!, “Ivan meets G.I. Joe” might have been the most divisive song on the band’s most divisive album. Even I tended to skip over it.

But, in retrospect, it couldn’t be a better reflection of the times. In the context of a Cold War that was about to end, the use of video game sound effects was too unsubtle, but upon a renewed listening, the song’s goofy charm is hard to deny.

Charlie Don’t Surf” — The Clash (1980)

The Vietnam War had ended five years prior to this song, but The Clash couldn’t help but take a post-mortem slap at American military adventurism. The lyrics still work:

Charlie don’t surf and we think he should.
Charlie don’t surf and you know that it ain’t no good.
Charlie don’t surf for his hamburger.
Momma Charlie’s gonna be a napalm star.

Its another Clash song from Sandinista! that mashes any musical style they can get hold of, and they somehow make it work.

Junkie Slip” — The Clash (1980)

Elvis meets Stanley Clarke and Sid Vicious. This Sandinista! song about heroin addiction defies easy explanation. And, frankly, I’ve never met anyone who has liked this song. “It’s too kooky,” one of my fellow Clash-loving friends would say. Nonetheless, it’s on my short list of great Clash songs.

The Sound of the Sinners” — The Clash (1980)

This song combines message and humor as well as any the band ever wrote. So much so, Elvis Costello called this his favorite Clash song. The Clash have better songs, but this is one of the hidden chestnuts on Sandinista!

Death and Glory” — The Clash (1979)

This is my favorite Strummer-dominated song from their classic London Calling album, probably because I first heard it while in Catholic school and it was a bit naughty. But, forty years later, I appreciate its musical maturity, and any song with Strummer’s cackling scream and Jones’ McCartney-like harmonies ages well.

Jail Guitar Doors” — The Clash (1979)

This Jones-led song is a pure rocker with a sharp British accent.

The “Wayne” referred to in the beginning of the song is MC5’s Wayne Kramer who started a non-profit that plays concerts, donates guitars, and has song writing workshops for incarcerated people in America. He called the program “Jail Guitar Doors.”

The song was released on the U.S.-version of The Clash’s 1979 self-titled album, probably the best pure punk album ever recorded. These Strummer-featured contributions on this album are all punk rock classics: “I’m So Bored with the U.S.A.,” “Career Opportunities,” “White Riot,” and “Janie Jones.”

London Calling may have been their Sgt. Pepper, but The Clash self-titledalbum was their Revolver.

Gates of the West” — The Clash (1979)

I love the lyrics to this song that was an outtake from the band’s Give ’Em Enough Rope album:

So, I’m standing at the gates of the west.
I burn money at the lights of the sign.
The city casts a shadow of the perfect crime.
I’m standing at the gates of the east.
I take my pulse and the pulse of my friend.
The city casts a shadow, will I see you again?

Mick Jones penned this masterpiece of punk melody, as he was always Strummer’s songwriting equal. He was McCartney to Strummer’s Lennon and it worked so organically that in the short period in which they were songwriting partners, they wrote as many great songs as The Beatles did in a similar period of time.

Remote Control” — The Clash (1979)

Musically, Remote Control is one of The Clash’s most sophisticated songs. Only Strummer and Jones can write a punk song about repression and injustice and unapologetically include Beatlesque harmonies, which would have gotten any other punk band at the time jumped in an alley. “Beatlemania has bitten the dust,” Strummer once snarled, but that didn’t mean Strummer and Jones weren’t willing to occasionally pay homage to Lennon and McCartney’s musical genius.

[In my humble opinion: For all of the presented toughness of the British punk bands of the 1970s, a young John Lennon could have easily pummeled any two members of The Clash or The Sex Pistols in a straight-up fight. ]

Rush” — Big Audio Dynamite (Mick Jones)

I throw this Mick Jones post-Clash song for its great drum beat, its mashup of musical styles and its inclusion of one of my favorite lyrics of all time: “Now I’m fully grown. And I know where it’s at. Somehow, I stay thin, while the other guys got fat.”

Wishful thinking and medical research are a dangerous mix

By Kent R. Kroeger (Source:; May 13, 2022)

Disclaimer: I am statistician by training, freelance writer by choice, and an auditor at Amazon out of financial necessity. All grammatical errors and factual inaccuracies in this essay are mine alone. And, as always, do not make financial, medical or personal decisions based on the contents herein.

“Wishful thinking is one thing, and reality another.”
— Jalal Talabani (former President of Iraq)

“Where there is life, there is wishful thinking.”
— Gerald J. Lieberman (author)

One controversy I’ve generally avoided writing about is the disputed effectiveness of ivermectin in the treatment of COVID-19, a drug that is an empirically-proven treatment for parasites in humans and animals and whose discoverers won the 2015 Nobel Prize in Medicine for their effort.

But a drug that works for parasites is not necessarily effective in treating (or preventing) COVID-19. That conclusion requires significant direct evidence.

The initial optimism in ivermectin’s use for COVID-19 was rooted in indirect evidence with multiple pre-COVID-19-pandemic studies showing that ivermectin has antiviral properties against a variety of viruses, including influenza, Zika, HIV, and Dengue (a representation of these peer-reviewed studies is found hereherehere and here).

But the interest in ivermectin as a COVID-19 treatment accelerated after an in vitro study by Caly et al. (2020) reported that ivermectin significantly inhibits SARS-CoV-2’s replication in a cell culture model. [SARS-CoV-2 is the virus that causes COVID-19.]

At the onset of the COVID-19 pandemic there was substantial scientific evidence to warrant calls for more systematic research on the potential use of ivermectin in the treatment or prevention of COVID-19, but it was the intersection of this prior research with an understandable desire to find a cost-effective treatment for COVID-19 that ultimately drove mass interest in ivermectin.

No conspiracy theory or fake news fancy drove interest in ivermectin — to the contrary, it was scientists, physicians, and public health experts who wanted to find a cost-effective COVID-19 treatment that could be deployed in parts of the world where prohibitively expensive treatments and vaccines were not an affordable option.

The current list of “Centers for Disease Control and Prevention (CDC)-approved” COVID-19 treatments is currently defined by expensive drug treatments:

Remdesivir costs $2,340 for a five-day course treatment for COVID-19. While Pfizer’s antiviral, Paxlovid, costs $530 for a five-day course, and Merck and Co.’s antiviral, Molnupiravir, costs $700 per five-day course. In addition, Sotrovimab, an intravenous monoclonal antibody drug developed by GlaxoSmithKline and Vir Biotechnology Inc. costs $2,100 per treatment course.

By comparison, the vaccines are significantly more affordable than post-infection treatments, but in a world where two-thirds of all people live on less than $10-a-day, the costs for COVID-19 vaccinations are also exceedingly exorbitant to billions of people.

Among the mRNA vaccines (i.e., Pfizer and Moderna), the Centers for Medicare & Medicaid Services is reimbursing providers about $40 for each shot of the vaccine they administer in order to cover the labor involved.

If you are like me, you are on COVID-19 booster shot number two.

Simply put, even if these vaccines were available to everyone on the planet (they aren’t!), the costs associated with them are not an option for the majority of humans.

Hence, a deep and profound interest in cheap treatment alternatives — call it wishful thinking— has driventhe worldwide interest in drugs such as ivermectin.

In contrast, the mainstream media in the U.S. has aggressively (and cruelly) impugned the motives of anyone suggesting ivermectin is a useful treatment for COVID-19.

Unfortunately, for everyone invested in this debate, the science for and against ivermectin in the treatment of COVID-19 is not clear enough from a statisticians point-of-view to justify either side from claiming the highroad.

I do not know what value ivermectin offers in combating COVID-19.

Instead, wishful thinking seems to be driving most of the narrative on ivermectin. On one side are the ivermectin advocates who are driven by an understandable belief that affordable treatments for COVID-19 already exist and will be crucial in mitigating the impact of this virus, particularly in the developing world. On the other side are economically powerful entities (with well-funded lobbying efforts) who are determined to stamp out resistance to the proprietary, highly-profitable vaccines and treatments currently approved by the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC). However, these anti-ivermectin forces cannot wish away the evidence showing that ivermectin may work to some degree against COVID-19.

Personally, I don’t believe the statistical evidence is strong enough to support ivermectin as a substantive treatment for COVID-19. From the reported clinical results I’ve seen, ivermectin offers, at best, only a marginal improvement in COVID-19 outcomes.

But that is not the same as saying ivermectin has no medical value in combating COVID-19. That conclusion is not obvious.

Even good science contains flaws

To shame those interested in ivermectin, the news media’s chosen posterchild for allegedly biased and fraudulent ivermectin research is an 2020 Egyptian clinical study led by Dr. Ahmed Elgazzar, a medical researcher at Benha University (Egypt). The randomized-controlled-trial (RCT) study he led of ivermectin’s effectiveness against COVID-19 was rightfully questioned for its poorly-documented random assignment protocols in which the control group (i.e., did not receive ivermectin treatment) was entirely drawn from intensive care units (ICU), but where the treatment group (i.e., received ivermectin) was drawn from both ICU and normal hospital care instances.

The critical component of an RCT study is that assignment to the control and treatment groups is entirely random. It is not clear that Elgazzar’s Egyptian study followed that requirement.

Though Elgazzar contends his study was withdrawn from publication before he was given a sufficient opportunity to address the study’s problems, the consequence is that his study contaminated the credibility of other ivermectin study’s that found some treatment effectiveness against COVID-19.

So when a meta-analysis of ivermectin’s effectiveness by Kory, Pierre, MD, et al. (“Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19.” 13 Nov. 2020) originally included the Elgazzar et al. study in its analysis (see Figure 1 below), the news media understandably questioned their conclusions.

Figure 1: Meta-analysis of the outcome of mortality from controlled trials of ivermectin treatment in COVID-19 [reprinted Figure 3 in original Kory, et al.(2021)]; (Odd-ratios estimates below 1.0 with credible intervals not containing 1.0 indicate ivermectin’s effectiveness against COVID-19)

The original publisher of the Kory et al. study sensibly issued a disclaimer:

That is exactly what good science should be doing — questioning the findings of researchers using flawed or questionable methods.

If only the large pharmaceutical companies faced similar challenges.

Dr. Kory and his coauthors issued a response to the editors of the American Journal of Therapeutics:

Their revised meta-analytic summary of ivermectin’s effectiveness was mostly unaffected by the exclusion of the Elgazzar et al. study (odd-ratios below 1 indicate ivermectin’s effectiveness against COVID-19):

Figure 2: Revised Figure 3 table in Kory, et al.(2021)

Because of the obvious flaws in the Elgazzar et al. study, are we to assume all research supporting ivermectin as an effective treatment for COVID-19 are equally suspect?

It is an archetypalexample of white European arrogance to suggest good science is not conducted in countries like Bangladesh, Brazil, India, Iraq, and Iran.

There are well-trained medical research methodologists in all of those countries.

The developed world’s impulsive rejection of ivermectin as a treatment for COVID-19 is unfortunate. The objective facts suggest ivermectin has some value against COVID-19.

Which brings us to the media-trumpeted study that purportedly proved that ivermectin does not positively impact COVID-19 outcomes.

The news media openly promotes bad research

The Together Study conducted in 2021 by Brazilian medical researchers concluded that ivermectin had no substantive impact on COVID-19 outcomes.

The American news media couldn’t be happier, as evidenced by these emphatic headlines:

Ivermectin Does Not Reduce Risk of Covid Hospitalization, Large Study Finds — The New York Times, March 30, 2022

Ivermectin does not prevent COVID-19 hospitalization, a new study says — NPR News, March 30, 2022

Study finds ivermectin, the horse drug Joe Rogan championed as a COVID treatment, does nothing to cure the virus —, March 31, 2022

Unfortunately, the research the mainstream media used to dismiss ivermectin was hardly better than the research supporting its effectiveness.

Like the Elgazzar et al. study, the Together Study had a curiously suspicious treatment/control group problem. A significant percentage of the control group in the Together Study (i.e., did not receive ivermectin) did not complete the study (see Figure 3). Where originally 679 COVID patients were assigned to the control group, only 228 were included in the ‘per-protocol’ analysis (i.e., followed the proper control procedures).

Figure 3: Sample disposition from the 2021 Together Study

Graphic courtesy of Phil Harper

More in-depth statistical critiques by Phil Harper and Alexandros Marinos of the Together Study can be found here and here, but the strange dropout of 451 control group participants during the course of the study begs one fundamental question: What happened during this study that would cause 451 people in the control group to violate protocols?

A plausible explanation is that these control group participants “learned” that they were not receiving the ivermectin treatment and decided to drop out of the study in order to receive that treatment. But that is pure speculation.

Harper states the potential ramifications of the control group dropout problem:

The ivermectin arm should have reported 21 deaths in 624 patients, as that’s how many patients fully completed the study. The placebo group should have reported 24 deaths in 288 patients, as that’s how many patients fully completed the study.

Instead each arm reported the number of deaths among the number of patients initially enrolled even though those patients did not complete the study. By not comparing like for like groups, all notions of ‘randomized control’ are gone from the trial, and it drastically alters the results.

These issues warrant an official response from the New England Journal of Medicine.

Putting aside the Together Study’s per-protocol sample problems, I am nonetheless drawn to the study’s statistical analyses that found a roughly 80 percent probability that ivermectin’s treatment value exceeded that of the placebo (see Figure 4). It is not significant by strict statistical standards, but it is suggestive that a more rigorous study might reveal a genuine benefit from ivermectin’s inclusion in a COVID-19 treatment program.

Figure 4: Probability of efficacy and Bayesian relative risk of COVID-19 hospitalization or extended emergency room observation for ivermectin vs. placebo taken from the 2021 Together Study

If anything, the Together Study increases my belief that ivermectin might be an effective treatment option for COVID-19 patients. But, of course, that is in direct opposition to the conclusions drawn in the news media.

We may never know the motives of control group participants who left the Together Study without significant follow-up research, but the more important point is that flawed research posed against other flawed research is not a formula for understanding the value of ivermectin against COVID-19.

Partisan and corporate interests are destroying the credibility of scientific inquiry.

That is not a good omen for our ability to incorporate quality science into the public policymaking process going forward.

Final Thoughts

As noted, there was enough circumstantial evidence at the beginning of the COVID-19 pandemic to justify calls for RCT research on ivermectin’s potential repurposing for use against COVID-19.

Did it happen? Yes, but not in the U.S. or Europe. Rather, the early ivermectin RCT research occurred in countries where there was already substantial human-treatment experience with the drug for parasites (BangladeshBrazilIndiaIraq, and Iran).

Among the first RCT U.S. studies of ivermectin and COVID-19 is ACTIV-6a nationwide, double-blind clinical study led by Duke University’s Clinical Research Institute, which announced in August 2021(!) that the study would start including ivermectin as one of the repurposed drugs to be tested (along with Fluticasone and Fluvoxamine).

August 2021? Really? If ivermectin warranted study in August 2021, why not in August 2020? Or April 2020? Why the delay? My hunch…my fear…is that the combination of powerful private interests (i.e., the pharmaceutical industry, which funds most clinical trials in the U.S.) and toxic political partisanship killed any chance ivermectin ever had to be included in the early COVID-19 treatment research.

Even ivermectin is not an effective treatment for COVID-19, the fact that it took a year-and-a-half before the U.S. medical research community took any meaningful effort to study its treatment value is scientific malfeasance. If it turns out that ivermectin is an effective treatment option, it becomes criminal negligence.

  • K.R.K.

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The Lab-Leak Hypothesis is not dead

By Kent R. Kroeger (Source:; April 16, 2022)

Disclaimer: I am statistician, freelance writer and a serviceable Tex-Mex chili cook. All grammatical errors and factual inaccuracies in this essay are mine alone. And, as always, do not make financial, medical or personal decisions based on the contents herein.


The lab-leak hypothesis proposes that the SARS-CoV-2 coronavirus was leaked from the Wuhan Institute of Virology. While the theory does not necessarily require the virus to be “man-made,” that is often a key component of this theory.

The natural-origin hypothesis, in contrast, posits that the coronavirus is natural in origin (e.g., bats and/or raccoon dogs) and was spread from a host animal species to humans, most likely occurring initially through a food market in Wuhan, China.

When news broke last November that the first known COVID-19 case was, in fact, a Huanan Seafood Wholesale Market vendor in Wuhan, China and not an accountant with no clear link to the market, a couple of ‘I told you so’ emails appeared in my inbox.

When, four months later, a team of scientists released two papers offering the strongest statistical evidence yet that the epicenter of the COVID-19 pandemic was the Huanan market — thereby, presumptively, supporting the natural-origin hypothesis for SARS-CoV-2 — my inbox was flooded with personal rebukes.

“You should be ashamed of yourself for pushing the lab leak conspiracy theory,” said one email. “Congratulations Kroeger, you fell for another Trump con,” started another.

But the most hurtful admonition of them all was this one: “You chide others for letting their partisan biases infect their judgement. But face it. You’re no better.” My wife knows how to cut to the bone.

In my defense, I never claimed the lab-leak hypothesis was the definitive explanation of SARS-CoV-2’s origin. I said the lab-leak hypothesis should be seriously considered along with the natural-origin-theory and that partisan attempts to shut down legitimate inquiries into it only creates distrust and division.

And its not like interest in the lab-leak hypothesis has been limited to xenophobic Trumpers, anti-China activists, and garden-variety conspiracy theorists. In his January 2021 article — The Lab-Leak Hypothesis — New York Magazine writer Nicholson Baker was one of the first mainstream journalists to sincerely lay out the facts supporting the lab-leak hypothesis. He offered no smoking gun, just a compelling litany of circumstantial evidence that cut through the partisan hackery attempting to the drown the lab-leak hypothesis in its infancy.

By the time Jon Stewart appeared on The Late Show with Stephen Colbert in June 2021 mocking those still clinging to the belief that SARS-CoV-2 was a natural creation, the lab-leak hypothesis had gone fully mainstream — perhaps the dominant view.

But the natural-origin hypothesis has made a comeback, and for good reason. While not definitive, significant evidence still supports the animal-to-human scenario.

What we know with some certainty about the early pandemic

U.S. Intelligence Community assessments concluded that Chinese officials became aware of SARS-CoV-2 in November 2019 and, according to Dr. George Gao of the Chinese Center for Disease Control and Prevention, Chinese officials collected extensive environmental samples from the Huanan Seafood Market in January 2020, including from 18 animal species present at the market.

From all outward appearances, Chinese officials made the Huanan market the prime suspect from the beginning.

Along with the recently released geospatial statistical analysis that found the earliest Wuhan cases of COVID-19 clustered around the Huanan market, analytic efforts have resulted in three generally accepted findings:

(1) The first known human infection of SARS-CoV-2 was a vendor at the Huanan market and the subsequent spread of COVID-19 clustered around the that market.

(2) The two original mutations of the SARS-CoV-2 virus — lineage A (which is related to similar bat coronaviruses, though its discovery in humans has been less frequent than lineage B) and lineage B (which was the first to infect humans and has been more common in humans) — were present in the Huanan Seafood Market in early January 2020. Finding these two mutations in the same geographic location supports the theory that the jump to humans occurred at the Huanan market.

(3) While there were animals at the Huanan market capable of carrying and spreading SARS-CoV-2, among those tested in January 2020, none were found to have the SARS-CoV-2 virus. However, according to Gao, Chinese officials did not test every species available at the Huanan market, including raccoon dogs which are capable of spreading the virus to humans. Is there any wonder why conspiracies theories form when such inexplicable government decisions occur?

Was it not in the Chinese government’s interest to identify the animal origin-species for SARS-CoV-2 as fast as possible? Nothing would have killed the lab-leak hypothesis faster.

And it is not like Chinese scientists are inexperienced in the virology forensics required to identify a virus’ animal origins. They identified the probable animal source of the 2003 SARS-CoV virus within months of its spread to humans.

And, most discouraging, it may be too late to find the original animal-carrier(s) of SARS-CoV-2 and, thereby, definitively confirm the natural-origin-hypothesis.

“The clincher would be direct evidence that some mammals at the market were infected with the SARS-CoV-2 virus,” wrote Michael Le Page for the The New Scientist about the virus’ possible origins. “But that almost certainly doesn’t exist any more.”

As of now, no such direct evidence exists and perhaps never will — which is a nagging problem for proponents of the natural-origin hypothesis, whether they are willing to acknowledge it or not.

Why the lab-leak-theory will survive…for now

The fact remains, prior to the COVID-19 pandemic, no virus in nature was found to have the same (or nearly the same) genetic structure as SARS-CoV-2. The closest known match (RaTG13), found in bats in southern China, is considered by virologists, including a nationally-known virologist I consulted with before writing this essay, as too genetically different from SARS-CoV-2 for any man-made genetic modification techniques (e.g., gain-of-function research) to bridge the gap.

But there are still too many questions to close the book on the lab-leak hypothesis.

SARS-CoV-2 has no known direct antecedent in nature, and lacking concrete evidence otherwise, the lab-leak hypothesis has an oxygen supply.

Lab-leak hypothesis supporters are probably not persuaded by the geospatial studies showing the earliest COVID-19 sufferers clustered around the Huanan market. Their sample of those individuals were drawn from Chinese/WHO records and Weibo, China’s most popular social media platform — but how can we be certain they are representative of the early SARS-Cov-2 infected population in Wuhan? It is not clear from these recent geospatial studies how the investigators tested for sample biases or corrected for it if it existed.

If early assumptions about the source of the SARS-CoV-2 virus centered on the Huanan market, it is not surprising that Chinese government, WHO and social media reports may have concentrated on finding infected patients in its vicinity. It is potentially a serious selection bias problem.

Furthermore, who is to say a virus housed in the Wuhan Institute of Virology — natural or man-made — didn’t leak into Wuhan’s natural environment and subsequently emerge in its local food supply (i.e., the Huanan market)? Would that scenario play out differently in geospatial analyses?

The Huanan market resided in one of the most densely populated sectors in Wuhan. How many WIV employee lived near the Huanan market or frequented its vendors?

The latest research on SARS-CoV-2 origins is persuasive but raises as many questions as it answers, and while it has shifted my confidence between the two competing hypotheses (I now lean slightly towards the natural-origin hypothesis), it hardly closes the book on the debate.

The lab-leak hypothesis remains alive.

  • K.R.K.

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Was the Russia-Ukraine war predictable and preventable?

By Kent R. Kroeger (Source:; April 4, 2022)

Could anyone have predicted, years in advance, Russia’s February 24th invasion of Ukraine?

The answer is so emphatically ‘Yes!,’ it is hard to fathom what the counter-argument might be.

Perhaps we should start with the main instigator himself, Russian President Vladimir Putin, who said to American film director Oliver Stone four years ago during an interview, “I believe that Russians and Ukrainians are one people … one nation. In fact, when these lands that are now the core of Ukraine joined Russia … nobody thought of themselves as anything but Russians.”

And we are surprised that, as U.S. and NATO allies supplied Ukraine over the past five years with millions of dollars with some of the most sophisticated anti-armor and anti-aircraft weapons in existence, Russia would decide to respond?

Barack Obama’s administration was at war with itself over whether to significantly arm Ukraine in its defense against Russia, but it took Donald Trump’s deep-seeded insecurities to end that debate. Trump poured gas on a flammable situation when he approved the sale of anti-armor Javelin missiles to Ukraine in 2019. The Biden administration’s subsequent increase in military assistance to Ukraine, including 300 additional Javelin missiles as part of a $200 million military package delivered in January 2022, only ensured that war would break out between Russia and Ukraine.

Is Russia ultimately responsible for this war? Of course. Did the U.S., Europe and Ukraine make a credible effort to prevent it? The answer appears to be ‘No.’

Why does this debate about predictability even matter?

Because, as predictable as the invasion may have been, it was most likely preventable. And because it was preventable, what alternative paths could have been followed that could have preserved Ukraine’s independence without the current bloodshed?

Ukrainian President Volodymyr Zelensky, elected in 2019, placed a negotiated peace with Russia near the top of his agenda.

Whether or not, due to the actions of others or his own failure, Zelensky did not achieve his most central promise to the Ukrainian people.

As of today, as many as 4,600 Ukrainian soldiers have died, along with 3,400 civilians and, as yet, unknown damage has been inflicted on Ukrainian infrastructure and economic capacity.

Today, as the Russians are apparently withdrawing from areas around the Ukrainian capital, Kyiv, the Ukrainian people can’t be blamed for asking, was this bloodletting necessary to ensure Ukrainian independence? Is NATO membership for Ukraine this valuable? And is NATO even relevant anymore given Russia’s demonstrated inability to conduct an effective military operation against a significantly weaker country along Russia’s most important defensive border?

Russia’s conventional military is clearly not a meaningful threat to democratic Europe anymore. They wouldn’t get past Warsaw if they tried.

And while the Ukrainians may have won their freedom on the battlefield, at what cost did it occur? And could an equal, if not superior, outcome have been achieved without the needless bloodshed?

That is for the NATO allies to ponder and the Ukrainian people to decide when they go to the polls to elect their next president, most likely in 2024.

  • K.R.K.

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More research needs to be done on hormone therapies meant to address gender incongruence among children

By Kent R. Kroeger (Source:; April 3, 2022)

The need for objective research research cannot be compromised simply because the issue is socially sensitive or politically contentious.

I recently watched a conversation between Joe Rogan and Adam Conover, the comedian host of truTV’s Adam Ruins Everything, about trans-athletes. The conversation was from two years ago, but it remains relevant, even if it was only a semi-cogent conversation between two people marginally qualified to talk about the fairness of allowing trans-women to compete in women’s sporting events.

At one point in the dialogue, Conover justified his acceptance of transwomen competing in women’s athletic competitions by citing his podcast conversation with a transwoman who had served as a U.S. Army helicopter pilot before her gender transition.

“There’s an author named Brynn Tannehill who’s a former military helicopter pilot I just interviewed. She’s one of the people affected by the Trump’s military ban on trans-service people who wrote a fantastic book called “Everything You Ever Wanted to Know about Trans (But Were Afraid to Ask),” Conover told Rogan. “She is now a researcher and went into deep detail about the medical science.”

Subsequent to the Rogan-Conover debate, the University of Pennsylvania’s Lia Thomas, a transgender athlete, winning the 500m freestyle at the NCAA swimming championships arguably offers supporting evidence to those concerned about the fairness of allowing trans-woman to compete in women’s athletics.

After agreeing to disagree on trans-athletes, the Rogan-Conover moved into whether there is enough research to understand the impact of hormonal therapies and transition surgeries on adult and pre-adult individuals.

Writes Tannehill for The Huffington Post:

“Given the level of harm involved when medical care is denied (to trans-persons), and given how unusual regret is, denying medical care to everyone based on the outliers makes no logical or ethical sense. In other words, you would do more harm to more people by denying everyone access than by keeping the system we have in place or even expanding access. Every major medical organization supports access to transition-related care and deems it medically necessary for a reason: The actual peer-reviewed evidence supports it.”

The Rogan-Conover conversation, however, turned much more combative when discussing hormonal therapies and other conversion procedures for gender incongruence among children (‘trans-children’).

Unintentionally, Tannehill’s book highlights how genuinely limited the research has been on the impact of gender-transition, hormonal therapies conducted on pre-pubescent children.

In the absence of definitive research, Rogan and Conover were left with their instinctive feelings and crude understanding of the transgender issue as it relates to children.

But, after all, that is how public opinion forms. People talking about things they don’t fully understand, helping others form opinions based mainly on gut instincts in lieu of anything more substantive. And this is O.K…that is how our social system works.

It isn’t perfect, and it typically doesn’t solve any issue to an acceptable extent. As social scientist Charles Lindblom observed many years ago, our institutions (including the scientific establishment) tend to muddle through, or to borrow a phrase from actor Will Smith’s son Jade Smith in a more contemporary context, “That’s how we do it.”

Unfortunately when it comes to effective public policy, it is usually not defensible just to say ‘that’s how we do it’ and proceed to ‘muddle through.’ At some point, analysts and policymakers must acknowledge their personal biases and intellectual limitations and help us all form more evidence-based opinions.

It’s a tough process, and not always linear in its progress.

Furthermore, it is always necessary to assess the objectivity the research, particularly when the researchers hold known, pre-existing opinions — such as Tannehill’s belief that hormonal trans-therapies are safe and optimal for pre-pubescent children.

Why would anyone reading “Everything You Ever Wanted to Know about Trans (But Were Afraid to Ask)” be surprised on the author’s conclusions? They were most likely determined before one word in the book was written.

In fact, her conclusions are far from conclusive, particularly with respect to children.

But that doesn’t necessarily mean Tannehill’s conclusions are without merit either. It does mean, the existing research doesn’t definitively inform us about the long-term effects of altering natural hormonal processes during pre-pubescent periods. There are early attempts at addressing this issue, but they are just that…early attempts.

“Gender-affirming hormone therapy is considered safe, but is not without risk,” says Julia Cartaya, MD. The benefits include a general improvement in mental health functioning, a decrease in body dissatisfaction and an improved sense of wellbeing, according to Cartaya.

But policymakers need better information than that to make long-term decisions.

The long-term impact of hormonal trans-therapies on pre-pubescent children is a legitimate analytic question that is yet to be fully answered by existing research. Admitting that and doing something about it, sooner rather than later, will be critical to moving society forward on policies related to the trans-community.

  • K.R.K.

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The necessary takeaway from the Will Smith-Chris Rock kerfuffle

By Kent R. Kroeger (Source:; March 29, 2022)

Are we still so culturally backward that men have to defend the ‘honor’ of their wives when verbally attacked? Are we still in the Miocene epoch? Are we living in Saudi Arabia?

Insult my wife. She can defend herself.

Women aren’t property or frail flowers who need men to defend them. Frankly, the women in my life are especially adept at using words to turn their antagonists into puddles of feeble mush.

Too much has already been written and broadcasted about the now infamous Will Smith slap attack on comedian Chris Rock during the 2022 Oscars awards ceremony.

Apparently, Smith thought an insult by Rock directed at his wife — Jada Pickett Smith — warranted a face slap before an international audience.

Lacking any quantitative data at this point, my impression is that public opinion is evenly split as to whether Smith’s actions were justified (or, at least, understandable) given the meanness of Rock’s joke about Smith’s wife.

Shocking to me, however, is the number of celebrities and pop culture commentators who offered their support to Smith, none more surprising than British TV personality, Piers Morgan, who opined:

“Making fun of a woman who’s losing her hair isn’t funny, it’s just unkind.

As for Will Smith, as the cancel culture mob race to destroy him, hysterically demanding he be stripped of his Best Actor award and charged with assault, I find myself moved to defend him.

He was standing up for his wife, the woman from whom he blew off the dust when she was going through a rough time, and said he was going to make shine, and created a safe space for her to get healthy and to grow and define herself.

In previous eras, he’d have been saluted for defending his girl, not savaged by an overly sensitive snowflake society.

And I say that as someone who was once punched in the head by Jeremy Clarkson at the British Press Awards in 2004 after publishing something embarrassing about his private life, and I have no problem with what he did.”

Morgan may not care that he was physically assaulted for something he wrote, but I do.

If someone says something cruel or unfair about your spouse (or anyone else), you do not have the right to physically assault them. Period. There is no gray area here.

“I know we’re all still processing, but the way casual violence was normalized tonight by a collective national audience will have consequences that we can’t even fathom in the moment,” tweeted Janai Nelson, president and director-counsel of LDF, the NAACP Legal Defense & Educational Fund, Inc.

While acknowledging that Rock’s throwaway joke about Pinkett Smith was “beneath him,” Howard Stern, one of our nation’s most important cultural interpreters, made clear that the more urgent problem was with Smith, not Rock: “He (Smith) clearly has an emotional problem. Here’s Hollywood that’s so outraged by every little thing — not one person got up and said, ‘Hold on, we’ve got an out of control situation here.’ How this guy was allowed to sit there for the rest of the awards, and he’s laughing it up and having a good time with his wife… he just assaulted Chris Rock.”

I, too, didn’t think Rock’s joke about Pinkett Smith’s shaved head was funny or comprehensible (GI Jane? Who gets that reference?). But that is not the paramount issue surrounding Will Smith’s unhinged reaction to it. The issue is (and must be) whether it is acceptable for someone aggrieved by a comic’s joke — no matter how cruel — to use physical violence to relieve their anger (or appease their spouse).

Was this a criminal assault or civil assault or both? The law is unequivocal on these questions.

“The answer to both questions is ‘Yes’,” according to Drew Page, co-owner and partner of Randall Page, PC, a Virginia law firm. “In criminal law, assault and battery assault is a harmful or offensive touch of another with the intent to create reasonable apprehension of imminent harm. Will Smith went up to Chris Rock with the intention of creating a reasonable apprehension of imminent harm and actually completed that by smacking him in the face with a harmful, offensive touching to his face.”

Should Smith be arrested or possibly go to jail for this act? No. As human beings, we have to accept our inherent flaws and allow for a certain margin of error when it comes to individual behavior. While we can’t criminalize all aspects of human nature, we should always be pushing ourselves to follow “the better angels of our nature,” particularly when our instincts plead otherwise.

Smith committed a crime on an international stage, and he is unlikely to face civil or criminal charges for it because of the good nature of the man he assaulted and the complicity of the industry he works in, not the righteousness of his act.

  • K.R.K.

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Are democracy and freedom on the run?

By Kent R. Kroeger (Source:; March 17, 2022)

“Truth is what you get other people to believe.” — Tommy Smothers

Larry Diamond, a senior fellow at the Hoover Institution and at the Freeman Spogli Institute at Stanford University, summarized the mainstream view of Vladimir Putin’s Russia by the American foreign policy and defense establishment in a 2016 article for The Atlantic:

“Since the end of World War II, the most crucial underpinning of freedom in the world has been the vigor of the advanced liberal democracies and the alliances that bound them together. Through the Cold War, the key multilateral anchors were NATO, the expanding European Union, and the U.S.-Japan security alliance. With the end of the Cold War and the expansion of NATO and the EU to virtually all of Central and Eastern Europe, liberal democracy seemed ascendant and secure as never before in history.

Under the shrewd and relentless assault of a resurgent Russian authoritarian state, all of this has come under strain with a speed and scope that few in the West have fully comprehended, and that puts the future of liberal democracy in the world squarely where Vladimir Putin wants it: in doubt and on the defensive.”

Replace the word “Russian” in the above excerpt with “Iranian” or “Venezuelan” or “Chinese” or “Islamic” and you’ve captured the essence of U.S. security policy since the fall of the Soviet Union in 1991: Protect existing liberal democracies, guide others into becoming one, and isolate those that resist the transition.

And have we been successful?

Figure 1 shows democracy/freedom indices that summarize current freedom levels for a selection of countries — the sum of which account for over half of the world’s population.

If the existing freedom and democracy landscape is any indication, there are tremendous success stories on display. Taiwan, South Korea, Chile, Brazil, Poland, and Indonesia are good examples of countries who have made successful transitions to democracy since the 1980s. Many of these new democracies remain fragile; but, apart from China and Russia and their few confederates, variations in the liberal democratic model dominate the international order today. If our time frame is the last 40 years, the conclusion remains that it is autocracies that not only are on the run, but cornered and isolated.

Figure 1: Freedom/Democracy Indices for Selected Countries (2020/21)

Data sources:

Human Freedom Index 2021 — World Population Review (
The Economist Democracy Index 2021 (
Quality of Democracy Index 2020 — Univ. of Würzburg
Global Freedom Scores 2021 — Freedom House
Corruption Perceptions Index 2020 —

Combined Freedom Index computed by the author (K. Kroeger)

But if our time-frame is shorter, it is also apparent that liberal democracies aren’t thriving either.

As Figure 1 suggests, some countries often portrayed as “liberal democracies” in the news media are, in fact, significantly below the standards of full democracies. A noteworthy number of them are former Warsaw Pact countries (e.g., Hungary) and former Soviet Republics (e.g., Armenia, Ukraine, Georgia) — which are often called ‘hybrid’ systems as they combine characteristics from both authoritarian and democratic systems.

Common among their growing democratic deficiencies is increased governmental control of the justice system, civil society, and media, while rolling back many basic human and political rights, according to separate reports by the Civil Liberties Union for Europe, which is a Berlin-based civil rights advocacy group, and Economist Intelligence. The targeted harassment of migrant and minority groups especially has been on the rise in many of these countries.

Despite the sweeping goodwill generated by the international community’s near-unanimous condemnation of Russia’s invasion of Ukraine, can it be interpreted as an endorsement of liberal democratic ideals? Given the recent backtracking on liberal democratic principles by many of the countries now censuring Russia, it is hard to conclude one has anything to do with the other.

Are full democracies a dying breed?

At the end of the original Cold War, political scientist Francis Fukuyama conjectured: “What we may be witnessing is not just the end of the Cold War … but the end of history as such: that is, the end point of mankind’s ideological development and the universalization of Western liberal democracy as the final form of human government.”

Fukuyama has since pulled back from his original optimism, and as we stand on the brink of a new Cold War, it may be fair to wonder if we are witnessing the slow death of liberal democracies instead of their immutable primacy.

The Canadian government’s ability (and craven willingness) to freeze the bank accounts of truckers who organized or blocked roads in a three-week protest over the nation’s COVID-vaccine mandates indicates freedom and democracy are not immutable conditions.

According to Economist Intelligence (EIU), which ranks Canada as the 12th most democratic country out of 167 countries, Canada’s EIU Democracy Indexscore dropped 3 percent between 2020 and 2021 (i.e., during the pandemic).

If Canada can backslide on democracy, even if just in the margins, any country can. And, over the past 30 years, the world has witnessed cases many such cases: Democratic experiments that failed spectacularly include Egypt, Russia, and Venezuela, while some more successful new democracies like Brazil, Hungary and South Africa have experienced smaller, but significant, declines in civil freedoms — and add a disheartening coup in Tunisia last year, one of the few democracies in the Arab world.

We see these democracy declines in Figure 2 which shows changes in the EIU Democracy Index since 2006 for seven world regions. Since 2006, the EIU Democracy Index declined in every region except Asia/Australasia.

Figure 2: Economist Intelligence’s Democracy Index (2006 to 2021)

Data Source: Economist Intelligence

Democracy is on the run in many places…but not everywhere. Figure 3 offers some positive examples where democracy and freedom are on the rise.

Since 2006, the most consistent increases in EIU Democracy Index scores occurred in Israel (+0.7), South Korea (+0.3) and Taiwan (+1.2). And despite score declines since 2015, Indonesia and Nigeria nonetheless score significantly higher on the EIU Democracy Index today than they did in 2006 (+0.3 and +0.6, respectively).

Figure 3: Economist Intelligence’s Democracy Index— Selected Countries

Data Source: Economist Intelligence

Methodological issues

Are small changes (e.g., ±0.1)in the EIU Democracy Index truly significant? From a statistical perspective, the average margin of error (i.e., standard error multiplied by 1.95) for the 167 countries in the EIU dataset was ±0.16 — which is why, to be conservative, I only report changes of 0.3 points or higher in this essay.

However, before accepting the democracy/freedom indices discussed here, realize the substantial criticisms of these indices.

The criticisms include (but are not limited to):

  • Universalism versus relativism: Is democracy a universal concept understood the same way worldwide or is its understanding relative to the culture or context in which it operates? If it is a relative concept, summarizing it using one index across all countries is problematic.
  • Temporality: The concept of modern democracy has evolved over time. To the Greeks, it meant “rule by the people.” Post-American Revolution, the definition added consideration of constitution-based rights and protections, and post-WWII, the importance of free market liberalism became essential. And at what extent do these democracy/freedom measures consider the relevance of people’s freedom from worries over the availability of quality health care, housing and education? The point is that comparability over time, including potentially short periods of time, cannot be assumed for any democracy/freedom measure.
  • Non-normality: Most democracy indices are not normally distributed when all countries are tabulated. This is not necessarily a problem if that is how the world’s political systems are distributed, but if a researcher wants to use distribution-based statistical methods to test hypothesis, non-normality makes analyses somewhat thorny.
  • Interchangeability: “Different measures of democracy can lead to substantially different findings and interpretations,” according to Andrea Vaccaro, a former PhD Fellow at United Nations University’s World Institute for Development Economics Research whose research focuses on cross-national measures of democracy and state capacity.

Faced with the problems inherent in cross-national democracy measures, particularly interchangeability, Vaccaro concludes, “To overcome problems related to weak interchangeability, if a single measure cannot be credibly chosen on theoretical grounds, this author recommends users of the measures to validate their findings with multiple measures of democracy.”

Any single democracy/freedom index or aggregate combinations of them must be viewed with abundant caution, particularly given their likely normative bias that favors the liberal (“free market”) democratic model. For this reason, it is best to view the data presented in this essay as evocative rather than definitive.

Is the Russia-Ukraine war part of the democracy-authoritarianism struggle? Probably not…

Attempting to explain the timing of Russia’s invasion of Ukraine, Canadian Prime Minister Justin Trudeau recently surmised that democracies weakened through the spread of misinformation on social media prompted Putin’s decision:

“We see a bit of a slippage in our democracies — countries turning towards slightly more authoritarian leaders, countries allowing increasing misinformation and disinformation to be shared on social media turning people against the values and the principles of democracies…unfortunately (this) emboldened Putin to think that he could get away with this (invasion of) Ukraine.”

An emboldened Putin invaded Ukraine because of misinformation on social media?

That is an adventurous (reckless) claim given the evidence is substantial in other directions as to why democracy has experienced significant declines over the past decade. Near the top of that list is the COVID-19 pandemic:

“The pandemic has had a negative impact on the quality of democracy in every region of the world,” concludes EIU in their 2021 report. No world leader should know that better than Trudeau. Among the most advanced economies, only Italy and Greece have implemented more draconian pandemic restrictions than Canada, according to Oxford University’s Covid-19 Government Response Tracker (OxCGRT).

The other major stresses on democracy over the past decade have been declines in press and religious freedoms (civil liberties), political party financing increasingly dependent on wealthy elites, lack of government transparency, financial profiteering by political elites, and low accountability (e.g., incumbency advantage). “Citizens increasingly feel that they do not have control over their governments or their lives,” says the EIU 2021 report.

Could social media have contributed to citizens’ awareness of these deficiencies in their country? Absolutely.

Does some of the information passed through social media contain misinformation? Of course, as happens through establishment information sources as well.

But did social media and the misinformation passed through it break down democracies to the point Putin decided now was the time to invade Ukraine?

All I can say is, Mr. Trudeau, show us your data.

To my eyes and ears, Mr. Trudeau’s causal model seems dubious and, most likely, untestable. Ivermectin has more quantitative support than his “social media has weakened our democracies and therefore Putin attacked”-thesis. But that didn’t stop him from throwing his geopolitical folk theory into the social ether.

Trudeau’s message is clear: Canadians, if you disagree significantly with me, by definition, you are spreading misinformation and must be stopped. In other words, according to Mr. Trudeau, censor dissenting views by any legal means possible.

But it is not just in Canada. Increasingly, political (and media) elites across the globe are endeavoring to control the content and flow of information under the guise that only “they” know the truth. The democracy/freedom indices cited in this essay offer indirect but suggestive evidence of this reality.

However, such an elitist worldview as expressed by Trudeau (and others) defies the well understood dynamic on how human knowledge advances —Knowledge growth is both a bottom-up as well as a top-down processKilling one half of the process, kills both sides.

But Trudeau is only doing what democratically-elected leaders across the world are attempting to do (and increasingly succeeding at) — controlling the information allowed to disseminate over the general population.

The prevailing belief among the political class is that controlling information is tantamount to controlling their own prosperity and destiny. On that point, they are probably correct.

But if the wider goal is to protect our liberal-democratic principles and institutions, then I contend that the most dangerous threat to their existence is not Vladimir Putin’s Russia or misinformation found on social media, but rather the political and economic elites that dominate the liberal-democratic landscape.

  • K.R.K.

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Freedom also dies in the light of day

By Kent R. Kroeger (Source:; February 28, 2022)

“My definition of a free society is a society where it is safe to be unpopular.” Adlai Stevenson

“If liberty means anything at all, it means the right to tell people what they do not want to hear.” George Orwell

Freedom can never be taken for granted.

Russia’s violent and ill-advised invasion of Ukraine brings this reality into immediate focus.

But the events in Ukraine overshadow decidedly smaller, long-festering threats that nonetheless, in the collective, may be eroding freedoms worldwide with as much certainty.

One such small threat was highlighted by a recent news story that warranted little more than a minor headline on sports news websites such as and CBS

On February 25th, Callaway Golf, the largest golf equipment manufacturer in the U.S., decided to “pause” its business relationship with legendary golfer Phil Mickelson, a six-time major champion, over “controversial” remarks he made in an interview about Saudi Arabia, the country financing a new professional golf league to compete with the dominant PGA Tour.

Earlier in the week, KPMG (a Big Four accounting firm), Workday (a large U.S. software firm) and Amstel Light terminated their relationship with Mickelson.

What did Mickelson do?

He told a journalist that, while he recognized Saudi Arabia was using the new golf league to “sportswash” the country’s well-documented human rights violations, he was prepared to look past that in order to put pressure on the PGA Tour to increase compensation for that tour’s golfers.

“We know they killed (Washington Post columnist Jamal) Khashoggi and have a horrible record on human rights. They execute people over there for being gay,” Mickelson told The Fire Pit Collective’s Alan Shipnuck. “Knowing all of this, why would I even consider it? Because this is a once-in-a-lifetime opportunity to reshape how the PGA Tour operates.”

Mickelson, who also described the Saudi’s as “scary,” issued an apology within days of news getting out about his Saudi-related comments:

“Although it doesn’t look this way now given my recent comments, my actions throughout this process have always been with the best interests of golf, my peers, sponsors and fans,” he wrote on Twitter. “There is the problem of off-the-record comments being shared out of context and without my consent, but the bigger issue is that I used words that do not reflect my true feelings or intentions. It was reckless, I offended people, and I am deeply sorry for my choice of words. I’m beyond disappointed and will make every effort to self-reflect and learn from this.”

Mickelson’s fellow golfers offered little support to the backlash over his comments, exemplified by Rory McIlroy who called Mickelson “naive, selfish, egotistical, (and) ignorant.” [A description that could apply to almost every celebrity I’ve ever met.]

Rarely mentioned or hyperlinked in the news reporting about Mickelson’s comments were details of Saudi Arabia’s most egregious human rights violations. So here is an attempt to remedy that oversight:

Human Rights Watch 2021 Report on Saudi Arabia

Amnesty International 2020 Report on Saudi Arabia

U.S State Department 2020 Report on Saudi Arabian Human Rights Practices

It is understandable to think the public admonishment of a multi-millionaire golfer over critical comments about Saudi Arabia is not relevant to the average citizen, but consider this — If an independently wealthy golf hero can be forced to publicly prostrate himself over statements he made based on widely accepted fact, imagine how an average schlub would be disciplined? Or someone from a marginalized community? Or someone who dares to challenge the status quo or the powerful?

The words of Stevenson and Orwell have never been more germane, but it is perhaps this quote that is more pertinent: “In a time of universal deceit, telling the truth is a revolutionary act” (a quote falsely attributed to George Orwell).

I respect the right of private corporations and entities to censor those who use their services or are under their employ. But it is unfortunate when the news media fails to challenge them for such practices.

It is particularly worrisome when people who speak their mind in good faith are then threatened with the loss of their livelihood.

The tyranny of the thought police does not always operate in darkness. Anymore it appears to happen in the light of day.

  • K.R.K.

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State policies mattered during the COVID-19 pandemic

By Kent R. Kroeger (Source:; February 24, 2022)

In a previous essay, I shared a statistical model that partitioned variation in COVID-19 death rates across the 50 U.S. states (plus the District of Columbia) based on a variety of factors, including the stringency of state COVID-19 policies, vaccination rates, preexisting economic conditions, the availability of nurses in nursing homes, and the healthiness of the state’s population.

The primary conclusion was that stringent state-level COVID-19 policies had a discernable association with death rates, all else equal, but that preexisting levels and changes in a state’s unemployment rate had a comparable, if not stronger, relationship.

Lockdowns and other COVID-19 mitigation policies worked in minimizing COVID-19 death rates, but their positive impact was betrayed somewhat by the extent to which they harmed a state’s economy and employment levels.

In the midst of a worldwide virus pandemic, unemployment and economic distress can kill just as ruthlessly as a virus.

It is far too easy in our highly partisan political environment to see the world in oversimplified motifs such as: Democrats trust the science and Republicans deny it.

That lazy conceit is not only inaccurate, it is unconstructive to a public debate on how to handle a viral pandemic.

Throughout this public health crisis, the science has been understandably tentative, sometimes ambiguous and too often nakedly political.

Wear masks. Don’t wear masks. Just kidding…wear masks…properly…but they must be the good ones.

People exposed to COVID-positive individuals should quarantine for 10 daysmake that 5 days.

If you are vaccinated, you don’t need to wear a mask…scratch that…yes, you do.

Getting the virus doesn’t produce a natural immunity comparable to the vaccines…or, maybe, it does.

And why would anyone expect the public policies issued in this environment to be consistent and coherent?

The reality is that the science on COVID-19 is evolving along with the virus itself. Science is never perfect. It makes mistakes. Politicians and media personalities can lecture others to “trust the science,” but actual scientists don’t have that luxury. They can’t trust the science. By training, it is their job to always question it. Poke it. Prod it. Unrelenting skepticism is a virtue in their line of work, not a vice.

More crucially, science doesn’t operate in a vacuum. When science is translated into policy — as it has been throughout the COVID-19 pandemic — it is a political act. Scientists can’t be expected to understand the social implications of their research findings and recommendations — which is why, in our system of government, we purposefully put elected representatives between the scientists and their policy recommendations. The U.S. is a representative democracy, not a technocracy — and for good reason, policymaking requires a wholistic view of issues that few scientists possess.

In an article for the American Institute for Economic Research, economist Jon Murphy outlined how the disconnected perspectives between elected leaders and scientists explain the cascade of mistakes and contradictions that regrettably define many of the policy decisions made during the COVID-19 pandemic:

“Experts are just like us. They are experts in their specific fields, but not beyond them. The problem with a pandemic is that it is not simply a medical phenomenon. There are economic issues at play, political issues at play, mental health issues, educational issues, etc. Dr. Fauci may be a brilliant immunologist, but he is no economist.”

State policies mattered during the COVID-19 pandemic

At the beginning of the pandemic, World Health Organization Director General Tedros Adhanom Ghebreyesus warned that “this virus does not respect borders.”

Two years later, he has been proven right — no jurisdiction has been spared.

But a handful of Republican governors confused the easy transmissibility of the coronavirus with the belief that strict, broadly-targeted statewide policies could not contain the virus’ spread and reduce the number of deaths. [Early in the pandemic, I believed the same thing.]

They (including me) were dead wrong.

However, these same governors rightfully recognized that strict COVID-19 lockdowns also cause significant economic harm, particularly to people who were financially vulnerable heading into the pandemic. Florida Governor Ron DeSantis repeatedly resisted lockdown policies because, in his words, they would “hurt families who can’t afford to shelter in place for six weeks.”

Was he wrong?

The answer is complicated. Still, I prefer simple displays of data whenever possible.

So, my first stab at answering the question is looking at a basic bivariate plot of state-level COVID-19 deaths per capita versus the average daily stringency of state-level COVID-19 policies from March 1, 2020 to December 1, 2021.

Figure 1 is that initial plot…

Figure 1: COVID-19 deaths per 1 million people by the OxCGRT Policy Stringency Index (March 2020 to December 2021)

Data sources: Oxford University’s OxCGRT and

It is evident from Figure 1 that Republican states disproportionately pursued less stringent COVID-19 policies and suffered disproportionately higher COVID-19 deaths per capita.

Mississippi, Arizona, Alabama, and South Dakota are not COVID-19 success stories. They largely ignored the virus and the consequences can be measured in deaths among their residents. In contrast, Hawaii, Vermont, Maine, Alaska, Oregon and Washington seemed to do pretty well. They instituted strict COVID-19 policies which resulted in significantly fewer deaths per capita.

But Figure 1 does not consider the economic impact of COVID-19.

Figure 2 plots COVID-19 deaths per capita at the state-level versus the change in unemployment.

Figure 2: COVID-19 deaths per 1 million people by the Change in Unemployment Rate (March 2020 to December 2021)

Data sources: U.S. Bureau of Labor Statistics and

Now we have a better picture as to which states performed better than others during this pandemic.

Figure 2 is quadrant analysis. The upper-left-hand quadrant (high COVID-19 death rates and small changes in the unemployment rate) and the lower-right-hand quadrant (low COVID-19 death rates and large increases in the unemployment rate) are non-exemplary cases. These states either chose to minimize the pandemic and suffered disproportionately high numbers of deaths, or chose to shutdown their economies and suffered economically.

The other two quadrants separate out the genuine failures and leaders of the COVID-19 pandemic. In the failure category are states like New York, New Jersey, Michigan and Massachusetts — all “Blue” states — who suffered high COVID-19 deaths rates and large increases in unemployment.

Their COVID-19 policies failed by any objective measure.

On the positive side are states that minimized COVID-19 deaths rates while keeping their economies relatively strong. Those states include Vermont, Utah, Washington, New Hampshire, Nebraska, North Carolina, Minnesota, and Wisconsin — three of which are “Trump” states.

It is convenient to assume “Blue” states outperformed “Red” states during the COVID-19 pandemic. If COVID-19 death rates are your preferred metric, they did. But when considering the impact of COVID-19 policies on state economies, the biggest failures were, by far, some of the biggest “Blue” states and a meaningful percentage of the successful states were “Red.”

Mississippi and Arizona kept their economies open (and successful) during the pandemic and paid a significant price in human lives.

In contrast, Hawaii, Maine, California and Maryland shut their economies down during the pandemic and saved many lives in the process.

Who was right and who was wrong?

In the end, voters will decide which states pursued the best COVID-19 policies…but don’t assume voters will choose human lives over economic growth.

  • K.R.K.

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State COVID measures made a difference, both positive and negative

By Kent R. Kroeger (Source:; February 14, 2022)

Recently, Dr. Anthony Fauci declared the COVID-19 pandemic in the U.S. is “exiting the full-blown stage.”

Unfortunately, Dr. Fauci, like the rest of the medical and scientific community, has been more hostage to the coronavirus than a prescient sage as to its future trajectory.

Like a broken analog clock, Dr. Fauci may be right this time, but what a price the world continues to pay for a virus whose behavior often has been unpredictable and whose origins still remain unknown.

However, getting more attention than Dr. Fauci’s declaration about the next phase for COVID-19 was a working paper (i.e., not peer-reviewed) by three economists who conducted a meta-analysis on the effects of public policy on COVID-19 mortality. In this study, economists from Johns Hopkins University, Lund University (Sweden), and the Center for Political Studies in Copenhagen, Denmark — Jonas Herby, Lars Jonung, and Steve H. Hanke — found that “lockdowns in Europe and the United States only reduced COVID-19 mortality by 0.2 percent on average.”

Apart from the predictable efforts by news media elites to smear the credentials of the study’s authors and the intellectual value of a non-peer-reviewed working paper, sober academics and medical experts found the study interesting but far from conclusive. [For example, the study only covered outcomes during 2020.]

Dr. Vinay Prasad, MD MPH, offers a balanced perspective on the this new lockdown study: “(This) early meta-analysis suggests (lockdowns) didn’t do that much. I don’t find it that incredible but I also think it’s not the right moment to do a meta-analysis because the lockdown’s effect is a massive perturbation on the economy and society (and) it’s not just about the short-run mortality. What about the long-run mortality? What about the mortality you’re paying for down the road because of all the disruptions to society?”

A common analytic tool employed in the studies analyzed by Herby, Jonung, and Hanke was Oxford University’s Covid-19 Government Response Tracker (OxCGRT) which collects systematic information on policy measures that governments have taken to tackle COVID-19. Included in their tracking data is a “stringency index” summarizing these policy measures for each U.S. state which is computed on a daily basis and made available to the public on GITHUB.

According to the creators of the OxCGRT Stringency Index, the index summarizes the strictness of COVID-19 policies that primarily restrict people’s behavior, including containment, closure, economic, health system and vaccination policies.

[All variables used in this analysis are available in my personal GITHUB repository or can be obtained directly from the original sources listed at the bottom of Figure 2.]

Figure 1 shows 12 selected U.S. states to represent three levels of the stringency index (High Stringency States, Medium Stringency States, and Low Stringency States).

Figure 1: Stringency Index scores for selected U.S. states from February 1, 2020 to February 2, 2022

On its face, the OxCGRT Stringency Index appears to strongly correlate with a common understanding of the states that have implemented restrictive COVID-19 policies and those that did not during this two-year pandemic.

A linear model of state-level COVID-19 death rates

Is there any evidence that stringent state-level COVID-19 policies helped reduce death rates?

Since it is unwise to make causal statements in the context of a linear model using aggregated, cross-sectional data, the answer is an emphatic ‘maybe.’ But the associations in the state-level COVID-19 data are strong enough to increase the plausibility of such conclusions.

[In general, I tried to avoid causal statements in this essay and preferred to use terms such as ‘association’ and ‘correlation.’]

Using the variables displayed in Figure 2, I estimated a linear model to explain state-level variations (51 cases) in the number of COVID-19 deaths per 1 million people.

[Model estimates and diagnostic measures can be seen in the Appendix below. More detailed diagnostics are available upon request.]

Figure 2: The relative importance of predictor variables on state-level COVID-19 death rates from February 1, 2020 to February 2, 2022

According to the linear model, state-level unemployment rates at the beginning of the pandemic, changes in those unemployment rates between March 2020 and December 2022, and the number of confirmed COVID-19 cases (per 1 million people) are positively associated with higher state-level death rates. In other words, states with relatively weak economies heading into the pandemic and states that experienced the most economic stress during the pandemic have significantly higher death rates. In fact, they are the two variables most associated with COVID-19 death rates.

But what factors helped to lower state-level COVID-19 death rates?

Among those factors which associate with lower state-level death rates, the number of nursing staff hours per nursing home resident day appears to be the strongest, followed by aggregate measures of people’s exercise habits, the strictness of COVID-19 policies, and a state’s vaccination rate.

By interpreting the standardized regression coefficients in Figure 2, the concrete impact of the predictor variables are stunning.

For example, given that state-level COVID-19 death rates have a standard deviation of 740 deaths per 1 million people, a one standard deviation increase in the unemployment rate change associates with an increase of 363 deaths per 1 million people (or about 117,600 nationally if the unemployment rate change is applied to all 50 states and the District of Columbia).

If every state entered the pandemic with a higher unemployment rate by one standard deviation, the COVID-19 death rate might have been higher by 296 deaths per 1 million (or about 96,000 people).

By comparison, a one standard deviation increase in the stringency index associates with 200 fewer deaths per 1 million people (or about 65,000 people nationwide).

Cautionary note: Due to the high level of collinearity between state-level vaccination rates and COVID-19 stringency policies, it is preferable not to interpret their standardized coefficients separately and more instructive to combine these parameters to estimate their combined impact.

When we do that, it appears the reduction in COVID-19 deaths rates associated with higher vaccination rates and stronger COVID-19 policies is comparable in their impact to similar changes in unemployment rates.

The implication is that policymakers in the future would be smart to explicitly weigh the potential costs and benefits of those COVID-19 policies before making decisions. Through their impact on state economies, strict COVID-19 measures (such as lockdowns) have the potential to kill as many people as they save.

Final thoughts

A complete analysis of the impact of policy choices on COVID-19 death rates should also consider “collateral” deaths, which are deaths not directly related to COVID-19 but the result of strains on hospital resources such as ICU bed utilization rates and staffing availability.

This analytic augmentation would bring to the forefront the question of the total impact of the unvaccinated on state-level death rates.

In other words, the unvaccinated not only increase their personal risk of dying from COVID-19, but they increase the probabilities that other people will die of other causes when hospital and ICU beds are filled to capacity.

How many collateral deaths should be added to the current U.S. COVID-19 death count of almost 950,000 people?

A credible estimate of collateral deaths comes by way of a statistical model computed at the Centers for Disease Control and Prevention (CDC) which calculates the number of “excess” deaths occurring in the U.S. each week. Through these models, the CDC estimates “excess” deaths caused by COVID-19 and “excess” deaths by other causes.

Since the widespread availability of the COVID-19 vaccines after March 2021, the CDC estimates almost 80,000 non-COVID-19 “excess” deaths have occurred through January 1, 2022, almost all of which occurred during COVID-19 surge periods when the most stress was placed on hospital resources (beds, staff availability, etc.). Even if we deduct the probable impact of vaccinated people hospitalized for COVID-19 during this period, the unvaccinated still account for about 66,000 collateral deaths, according to the CDC numbers.

That is a big number which accounts for around three percent of all U.S. deaths during that period, or about 270 collateral deaths per day.

When President Biden said last July that anti-COVID-19 vaccine propagandists are “killing people,” he was articulating what most fully vaccinated Americans believe — the unvaccinated are indirectly guilty of killing thousands of their fellow citizens.

Was he right in saying that?

In a simplistic sense, yes, but not if one rightfully considers why so many Americans remain skeptical of the COVID-19 vaccines, effective as they are in preventing severe illness from the virus.

As I’ve written elsewhere, despite my own aggressive eagerness to vaccinate myself and my family, I understand why many people are resistant to receiving these vaccines.

The reasons are easy to list:

(1) The COVID-19 mRNA vaccines are based on a new technology with debatable levels of long-term research to add confidence in their widespread use,

(1) The mainstream U.S. news media too often serves partisan interests and subsequently is untrustworthy to dispense non-partisan public health recommendations according to millions of Americans.

(2) The U.S. government’s acquiesced to pharmaceutical companies’ insistence on liability immunity for the COVID-19 vaccines which were developed under President Trump’s taxpayer-financed Operation Warp Speed.

(3) The pharmaceutical industry’s ongoing intransigence in releasing their full vaccine testing data to independent researchers.

(4) Research suggesting the risks associated with the COVID-19 vaccines and myocarditis incidence among young males (i.e., they have a minimal risk of dying from COVID-19 and are more likely to experience myocarditis [heart inflammation] from the receiving the vaccines than from the catching the virus itself).

(5) Two scientists from the Food and Drug Administration’s vaccine advisory committee resigned last year over what they believed to be a rushed (‘political’) decision to recommend booster shots in relatively young populations. Writing with a group of other scientists in a September 2021 Lancet editorialthey said: “Although the benefits of primary COVID-19 vaccination clearly outweigh the risks, there could be risks if boosters are widely introduced too soon, or too frequently, especially with vaccines that can have immune-mediated side-effects (such as myocarditis, which is more common after the second dose of some mRNA vaccines [footnote],or Guillain-Barre syndrome, which has been associated with adenovirus-vectored COVID-19 vaccines [footnote]). If unnecessary boosting causes significant adverse reactions, there could be implications for vaccine acceptance that go beyond COVID-19 vaccines. Thus, widespread boosting should be undertaken only if there is clear evidence that it is appropriate.

According to Dr. Prasad, as yet, there is no persuasive evidence suggesting that boosting is necessary in healthy people between the ages of 12 and 50.

I don’t expect unvaccinated Americans are closely following the scientific debates over COVID-19 vaccines in medical journals, but I am constantly amazed in my interviews with the unvaccinated how often they possess at least a basic familiarity with some of the more complicated issues within the vaccine research community (e.g., myocarditis).

Yes, misinformation is abound about COVID-19 in the cyberverse — but so is a lot of valid information finding its way into the everyday conversations people have over these vaccines and the COVID-19 pandemic in general.

Some people want to assume the unvaccinated are stupid. I believe the exact opposite is true — they are awash in information and given their overactive levels of distrust and skepticism, are over-thinking what should be a fairly simple decision.

Furthermore, I find it immoral to incriminate the unvaccinated when other European countries with a similar percentage of unvaccinated still have a substantially lower number of COVID-19 deaths per capita.

According to the New York Times, 65 percent of Americans are fully vaccinated, which is comparable to Europe (64%) as a whole.

And, yet, when we observe countries with similar vaccination rates to the U.S., they have substantively lower COVID-19 death rates:

Netherlands — 71% vaccination rate (1,242 deaths per 1M)
Greece — 69% vaccination rate (2,300 deaths per 1M)
Switzerland — 68% vaccination rate (1,532 deaths per 1M)
Austria — 68% vaccination rate (1,624 deaths per 1M)
Israel — 66% vaccination rate (1,066 deaths per 1M)
U.S. — 65% vaccination rate (2,882 deaths per 1M)

Why are they doing better?

It is still too early to draw strong conclusions when the pandemic is ongoing. But early research is finding that a health care system’s characteristics have helped some countries better handle the exigencies of the COVID-19 crisis.

Among those characteristics are country’s health profile, the number of nurses and doctors, the availability of hospital and ICU beds, and the level of trust citizens hold towards their fellow citizens, government, and health care experts.

The U.S. health care system is left wanting on these factors.

As evidence, since 1960, the U.S. has seen a consistent decline in the number of hospital beds per 1,000 people. According to World Bank data, the U.S. went from 7.9 hospital beds in 1970 to 2.9 in 2017.

The U.S. clearly wasn’t preparing for a future pandemic when it allowed so many rural hospitals to close over the past 50 years.

When comparing the European countries with similar COVID-19 vaccination rates to the U.S. by the number of hospital beds per one thousand people, the U.S. comes in dead last, according to the World Bank:

Netherlands — 3.2 hospital beds per 1K
Greece — 4.2 hospital beds per 1K
Switzerland — 4.6 hospital beds per 1K
Austria — 7.3 hospital beds per 1K
Israel — 3.0 hospital beds per 1K
U.S. — 2.9 hospital beds per 1K

But it is not just hospital beds that put the U.S. at a disadvantage in handling the coronavirus pandemic, it is a health care system in which job loss and financial insecurities drive too many citizens to forgo early and sometimes life-saving medical care.

The U.S. was not pandemic-ready in early 2020, and that is not the fault of the unvaccinated — it is the fault of our political, news media, health insurance, and medical community leadership.

Before shaming and blaming the unvaccinated — which doesn’t vaccinate one person and most likely leads to greater resistance to the jab — would it not make more sense to address the structural problems in a health care system where the most economically vulnerable suffer disproportionately during a national health crisis?

If anything, we all share in the blame for a national health care system that has been outperformed by Mexico in the COVID-19 pandemic (2,823 deaths per 1M vs 2,386 deaths per 1M, respectively). If we were doing as well as Mexico — where about 60 percent of its citizens are fully vaccinated — the U.S. would have 144,000 fewer deaths right now.

But it is so much easier just to blame the unvaccinated.

  • K.R.K.

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Appendix: Linear model estimates and selected diagnostics.

Is the partisan echo chamber more myth than reality?

By Kent R. Kroeger (Source:; February 6, 2022)

A popular political narrative in the U.S. news media is the story of a deeply polarized electorate where voters restrict their news consumption to partisan-friendly sources, avoid dissenting viewpoints, and remain loyal to their preferred party.

November 2021 report by Pew Research summarizes this political landscape: “Partisan polarization remains the dominant, seemingly unalterable condition of American politics. Republicans and Democrats agree on very little — and when they do, it often is in the shared belief that they have little in common.”

In such a political landscape, major legislative compromises become rarer and important domestic and international problems remain unsolved.

Roll Call writer Stuart Rothenberg echoes this viewpoint: “Partisan polarization with two relatively equal parties takes its toll on the country and on voters. It is difficult for Washington to address important issues, since each side can essentially veto what the other wants to accomplish. And it breeds distrust of the opposition’s motives and allegiances.”

Gridlock isn’t all bad, however: Corporate America flourishes in this environment as tax and regulatory policies are more predictable since major changes to them are less likely — but that is an issue for a different essay.

How can we lessen our political divide?

One hypothesis on how our partisan divide will lessen over time — and thereby start the process to solve our nation’s most intractable problems (e.g., economic inequality, rising public debt, addressing climate change, rising health care costs, etc.) — assumes secular trends in national demographics will over time benefit one party (the Democrats) to the disadvantage of the other (the GOP).

But, if anything, recent evidence suggests the emerging Democratic majority may be the Democrats’ castle in the sky. Though he lost the 2020 election, Donald Trump increased his support among minorities compared to 2016, as the Democratic Party struggles to keep Hispanic and Black men in the fold.

Others political observers theorize that the paralyzing effects of extreme partisanship and political gridlock could give rise to a reform movement that crosses political lines and values compromise and civility over partisan rancor.

Writes Rothenberg: “…the resulting paralysis could eventually produce a reform movement — either inside one party or outside of the two parties — that would place a high priority on political compromise, civility and the rule of law.”

Political scientists Robert Putnam and Shaylyn Romney Garrett offer a more detailed description of this argument in their 2020 book The Upswing in which they argue our current political environment mirrors the Gilded Age (1890s) in terms of the conditions that preceded a long era of political consensus and reform — the Progressive Era (1896–1916).

The past is prologue, in their view.

How real is the partisan echo chamber?

Any conjecture on how this country will rediscover political harmony, however, must contend with a highly politicized media environment in which, according to some observers, few voters ever read or hear enough opposing points of view necessary to change their own points of view.

Research has generally found increases in an electorate’s political polarization relates to patterns in their media consumption. Its a symbiotic relationship where voters over their lifetime tend to restrict their news consumption to news sources aligned with their preferred political attitudes.

It is not necessarily a straightforward relationship, however. For example, research has found that exposure to opposing viewpoints on social media can increase a voter’s political polarization, not lessen it.

Still, on average, conservative Republicans are more likely to watch Fox News while Democrats turn to CNN or MSNBC.

But is this characterization accurate?

Based on evidence from the 2020 American National Election Study (ANES), I conclude that the partisan echo chamber assumption is inaccurate and misrepresents a common tendency among Americans to watch, listen and read news from more than one partisan perspective.

While 48 percent of Americans do not regularly watch cable TV news (CNN, MSNBC, or Fox News), the other 52 percent do so and most of them do it across the partisan spectrum, according to the 2020 ANES.

Any attempt to explain the growth in political polarization (or conjecture how to lessen it) cannot rely on the belief that most voters lack exposure to alternative points of view as expressed in the news media. Most Americans who regularly consume cable TV news do so from media outlets across the political divide.

The partisan echo chamber is more myth than reality

The 2020 ANES asked 8,280 U.S. adults which television programs they regularly watch at least once a month. Using that information, I defined three cable TV news viewer categories based on whether they regularly watch at least two news shows on that network each month. Accordingly, a Fox News Viewer is someone who watches at least two Fox News shows each month, a CNN News Viewer watches at least two CNN shows each month, and an MSNBC Viewer watches at least two MSNBC shows each month.

[Note that the three viewing groups as I defined them— Fox News viewersCNN viewers, and MSNBC viewers — are not mutually exclusive categories. Some ANES survey respondents belong to two or more of those groups.]

Figure 1 (below) shows the extent to which these three cable TV news viewing groups watch other cable TV news networks. If you believe most Americans who watch cable TV news limit their viewing to sources aligned with their personal political views, the following results are enlightening.

In reality, 22 percent of Fox News viewers regularly watch two or more CNN shows and 33 percent watch two ore more MSNBC shows. Likewise, 48 percent of CNN and MSNBC viewers regularly watch two or more Fox News shows.

Forty-four percent of Fox News viewers regularly watch two or more CNN or MSNBC shows.

Figure 1: Cross-network viewing among regular viewers of the three cable TV news networks (Fox, CNN, and MSNBC)

If we expand our news universe to the broadcast networks (CBS, NBC, ABC, PBS) and online news sites (Bloomberg News, Huffington Post, NPR, New York Times, USA Today, Washington Post, and Yahoo News), 83 percent of Fox News viewers tap into these news sources on a regular basis, compared to 91 percent of CNN viewers and 87 percent of MSNBC viewers.

The oft-repeated assumption that the average Fox News viewer lives in a (mis)information bubble that reinforces pro-Republican, conservative talking points is wholly inaccurate. Surprisingly, Fox News viewers routinely reach across the ideological divide for their cable news consumption, as do half of CNN and MSNBC viewers.

The 2020 ANES media consumption data do not allow for a comprehensive volumetric analysis but it still offers tangible evidence refuting the assumption that Americans live in their own personal “news and information bubble.”

Most Americans who routinely consume cable TV news do so by distributing their consumption across the mainstream political spectrum.

The strange interactions of Fox News, CNN and MSNBC viewership

If we sum the number of cable TV news network shows regularly watched by network for each 2020 ANES respondent, we can roughly approximate their viewing volume.

Thus, I categorized Fox News and CNN/MSNBC viewers into one of four volumetric categories: No Cable TV news viewing (0 shows), Light viewing (1 show), Moderate viewing (2 shows) or Heavy viewers (3 or more shows). I then crossed their cable news viewing status with their party identification (Party ID), which was measured on a 7-point scale where 1 = Strong Democrat and 7 = Strong Republican. Hence, any cell in Figure 2 with an average Party ID over 4 is considered to be “Republican-leaning,” while an average below 4 indicates “Democrat-leaning.”

The results of this analysis (in Figure 2) are illuminating, as well as puzzling.

First, as seen in the upper-left-hand cell in Figure 2, almost half of Americans (48%) do not watch CNN, MSNBC or Fox News.

Figure 2: Cross-network viewing among regular viewers of the three cable TV news networks (Fox, CNN, and MSNBC)

Concentrating on the first row in Figure 2 (i.e., people who do not regularly watch CNN or MSNBC), as regular viewing of Fox News increases, the probability of being a strong Republican also increases. Among heavy Fox News viewers who do not watch CNN or MSNBC, the average Party ID is 4.52 — the strongest Republican group among the 16 cells in Figure 2. That makes intuitive sense.

Also notice that only one percent of U.S. adults are heavy Fox News viewers who do not watch any CNN or MSNBC shows. But if we look at the counterpose cases in the first column of Figure 2 (i.e., people who do not regularly watch Fox News), there is not a clear linear trend in Party ID. Light CNN/MSNBC viewers who do not watch Fox News skew slightly Republican (avg. Party ID score = 4.05), but among heavy CNN/MSNBC viewers, the average Party ID score decreases to 3.77 — a difference that is not statistically significant, but is in the expected direction.

But now where things get strange…

Column 4 in Figure 2 contains heavy Fox News viewers (3+ shows). As noted, the most Republican group in Figure 2 is heavy Fox News viewers who do not watch CNN or MSNBC. No surprise there.

Also expected, as CNN/MSNBC viewing goes up, the average Party ID becomes more Democrat — going from an average Party ID score of 4.52 to 3.06 in the bottom right-hand cell.

But among heavy CNN/MSNBC viewers (the fourth row in Figure 2), the average Party ID gets progressively more Democrat as we increase Fox News consumption, going from a score of 3.77 (heavy CNN/MSNBC viewers who do not watch Fox News) to a significantly lower score of 3.06 among people who are heavy viewers of CNN/MSNBC and Fox News.

What the heck?! Among CNN/MSNBC viewers, increased Fox News viewing is associated with an increased chance of someone being a strong Democrat?

My first reaction is to assume I coded the variables wrong. But after a series of check-double-check routines, I could not find a coding mistake (Note: My SPSS code and dataset are available on GITHUB here — feel free to double check my work).

My second hunch is that we are looking at ‘News Junkies’ in the lower right-hand cell and perhaps they are just more likely to be strong Democrats than strong Republicans. But what social or pyschology theory explains that asymmetry?

Earlier in this essay I cited a 2018 study that found political partisans who are exposed to opposing viewpoints on social media tend to, on average, become more partisan. The authors of the study write: “Republican (study) participants expressed substantially more conservative views after following a liberal Twitter bot, whereas Democrats’ attitudes became slightly more liberal after following a conservative Twitter bot — although this effect was not statistically significant.” Explanations these researchers offered to explain their results included:

(1) A ‘backfire’ effect where “people who are exposed to messages that conflict with their own attitudes are prone to counterargue them using motivated reasoning, which accentuates perceived differences between groups and increases their commitment to preexisting beliefs.”

(2) the relative anonymity of social media “emboldens people to act in an uncivil manner…in the absence of facial cues and other nonverbal gestures that might prevent the escalation of arguments in offline settings” and thereby reinforces preexisting partisan preferences.

(3) An asymmetric version of the ‘backfire” effect where, because conservatives hold values that prioritize certainty and tradition, compared to liberals who value change and diversity, conservatives are more likely to act defensively to opposing information.

All of these explanations sound a bit hobbledy-gobbledy-goo to me, but until I hear better ones, I’ll accept their hypotheses.

But if I could offer my own hypothesis as to why this ‘backfire effect’ might operate more on Democrats more than on Republicans, it would go something like this:

Mainstream media content, especially within entertainment TV, movies, music, etc., is overwhelmingly oriented towards liberal social values and narratives. The natural consequence of this intrinsic bias is that anyone who increases their media consumption will get their liberal beliefs reinforced more often than someone with conservatives beliefs. That there are people who are heavy viewers of CNN/MSNBC and Fox News — an apparent contradiction — may simply be an artifact of their heavy consumption of all media.

The ANES 2020 data on media consumption lacks the breadth and fidelity to address these hypotheses as to why increased Fox News viewing might increase partisan polarization among Democrats, but increased viewing of CNN/MSNBC among Republicans might soften the partisan divide.

I suspect the mechanisms at play are far more profound than simply assuming CNN and MSNBC are persuasive while, to the sane, Fox News comes across as batshit crazy. As I hope I’ve demonstrated over the years I’ve written about politics and news, there is plenty of batshit crazy to go around for both political parties and their propaganda outlets.

Final thoughts

The main thesis of this essay is that a significant number of Americans do not live in a partisan media bubble, though a near majority eschew cable news in general. Notably, the vast majority of regular Fox News viewers consume news across the political divide. Likewise, almost half of CNN/MSNBC viewers watch Fox News on a regular basis.

The partisan echo chamber is more myth than reality.

As a result, there remain substantive avenues through which partisan political actors and their surrogates can create significant opportunities for opinion change within the voting public.

However, even with this potential for persuasion to occur, it may be more likely to benefit the Democrats than Republicans. The 2020 presidential election may be the textbook example of this dynamic.

In a study of the 2020 presidential election conducted by Harvard University’s Shorenstein Center on Media, Politics, and Public Policy, a content analysis of CBS News and Fox News coverage of the presidential election found that almost 90 percent of CBS’s statements towards Joe Biden were positive, while only five percent were for Donald Trump. Conversely, Fox News was positive towards Biden and Trump at roughly the same rate (41 and 42 percent, respectively).

From the ANES 2020 data, we know that many loyal Fox News viewers were exposed directly to CBS News’ 2020 election coverage, as well as coverage from other establishment news outlets with a discernable anti-Trump bias (e.g., CNN and MSNBC).

Could this have had an effect on the 2020 outcome, not just by discouraging voter turnout among weak Trump supporters (and encouraging turnout by weak Biden supporters), but also through genuine opinion change?

Since a large number of Americans do not live in the oft-assumed partisan echo chamber, the answer to this question is likely Yes!

  • K.R.K.

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When can we get off the COVID-19 rollercoaster?

By Kent R. Kroeger (Source:, January 7, 2022)

The headline photo is not meant to imply the COVID-19 pandemic has been an amusement ride. Quite the opposite. But it has gotten to the point where some of my family, friends and colleagues, who were originally terrified of this virus, are ready to get off this ride and get back to some form of relative normal.

“At this point I’d rather just get it,” I overheard at the Stop and Shop grocery storein Pennington, New Jersey yesterday.

Personally, I expect to be wearing a mask at indoor locations for many months going forward, if not years. Even as I oppose mask mandates and other Karen-generating policies, I consider it no inconvenience to wear a mask or maintain a healthy distance from strangers. I’ve never liked being physically close to people in the first place. [I guess my sensory processing problems are finally paying off!]

A recent news story out of the U.K., which was given little attention here in the U.S., concerned comments from one of the scientists that helped create the Oxford-AstraZeneca vaccine for COVID-19.

“We can’t vaccinate the planet every four to six months. It’s not sustainable or affordable,” Professor Andrew Pollard, the director of the Oxford Vaccine Group and head of the U.K.’s Committee on Vaccination and Immunization, told The Daily Telegraph.

This man cannot be dismissed as a crank trying to spread misinformation.

Dr. Pollard noted the much slower vaccine rollouts in countries outside Europe and North America as problematic for humans trying to control the coronavirus. The vaccines are too cost prohibitive and too transitory in their effect, he says.

Instead, he believes, in the future countries “need to target the vulnerable” rather than trying to vaccinate everyone, including healthy children, who are not at great risk from this virus.

Pollard further argued that we do not have enough evidence to warrant offering a fourth (‘second booster”) COVID-19 vaccine shot.

I fully expect Dr. Pollard will be banned from Twitter and Facebook if he keeps talking like this.

Is Omicron scarier than other COVID-19 variants?

Sadly, the Omicron variant has given new life to the COVID-19 panic cult, though, admittedly, there appears to be something different (and potentially scary) in the latest epidemiological data.

Normally, I would go straight to national or worldwide data to support this point, but some more localized numbers just startled me. The first was a from New Jersey’s Department of Health: On January 5th, 106 new COVID-19 deaths were reported in New Jersey.

New Jersey hasn’t seen numbers like that since the peak of the Winter 2020–21 surge. And we are a state that has implemented some of the most draconian COVID-19 measures to go along with one of the country’s highest vaccination rates. [My teenage age son received his booster shot the day the CDC approved it for his age group — and he had to stand in line behind other teenagers to get it.]

Predictably, Democrats and news pundits have made sick sport of victim shaming and blaming the unvaccinated for our nation’s growing COVID-19 cases and deaths. Unfortunately for their narrative, it was a second number from the county government in Bucks County, Pennsylvania (which neighbors my county) that really caught my attention: 38 percent of the 199 people hospitalized with COVID-19 during the week ending January 4th were vaccinated.

Figure 1: COVID-19 Hospitalizations in Bucks County, PA (week ending January 4, 2022)

Source: Bucks County Government (PA)

Maybe more distressing is that 27 percent of ICU patients during that week were vaccinated, as were 31 percent of COVID-19 patients on ventilators.

This is not my way of saying, vaccinations don’t matter. They absolutely do (and in a big way). But, as I increasingly hear people say they are weary of worrying about COVID-19, the public policy analyst in me recognizes that this country may be near its peak level of vaccination. As the second dose and booster jabs slowly wear off (in roughly 5 to 6 months), it may be difficult to get Americans to go back online to make reservations for future booster shots at the pace they did the first time. The current 62 percent full vaccination rate may be as good as it gets.

It is fantasy to think a country of 330 million people will ever achieve even an 80 percent full vaccination rate. As we start to vaccinate small children, who are not generally at risk for serious symptoms from COVID-19, the U.S. vaccination level will rise faster, but current trends according to New York Times’ statisticians estimate the end-of-year full vaccination rate will be around 75 percent. Notably, these statisticians admit their earlier long-term projects for U.S. vaccinations levels were far too optimistic.

The U.S. is probably nearing its maximum vaccination level. And it is not just because of “misinformed,” plaid shirt Republicans. In reality, it is hard to get people to do anything, even when it is in their best interest. People are busy with their lives. But, more importantly, they have a genetic propensity for misestimating their own risk probabilities. Life is much happier with your head in the sand. I can vouge for that.

It also doesn’t help that most people in this country will NOT die from COVID-19, no matter how long it stays with us. The odds are in the favor of those with meh amounts of concern about COVID-19. 

I estimate from CDC’s reported numbers that there is about a 1-in-130 chance that an unvaccinated person will die from COVID-19 in the next 12 months. [I don’t like those odds, but many people do.]

You can’t build public policy around wishful thinking and an exaggerated sense of politicians’ power over nature. We need to develop a vaccine against such delusions and jab our political leaders and policy experts as soon as possible. Omicron, oddly enough, may be the vaccine to do just that.

Its hard to imagine that the American public can keep riding this rollercoaster as we are right now. Politicians from both sides of the aisle are already losing their appetite for strict COVID-19 related mandates

When asked last month about expanding mask mandates in California as Omicron began to rise in his state, Governor Gavin Newsom punted: “I think a lot of people will self-enforce and do the right thing.”

What Gov. Newsom is really saying is that we can look forward to more mask-less Karen videos on YouTube.

So, without minimizing the seriousness of Omicron — which, by early scientific accounts, appears to be much more contagious than prior COVID-19 variants but less virulent — perhaps a look at the numbers might be in order.

Three caveats must be made before showing the latest COVID-19 case, hospitalization and death numbers. First, I am using aggregated data instead of individual-level data. For example, to estimate the percentage of COVID-19 positive people that are hospitalized or put in ICUs, individual-level data is ideally needed. I can only approximate those estimates using nationally aggregated data. Second, it is too early to know precisely the virulent nature of Omicron. Granted, we are not yet seeing the daily rise in deaths that followed case increases during the previous surges; but it will take more time to see the full picture. Third, because I am using aggregate time-series data, I cannot make definitive conclusions, particularly with regard to Omicron’s virulence. It is true that we are seeing falling fatality rates, but that does not necessarily mean Omicron is less dangerous. Those falling rates are also a function of better COVID-19 treatments, the healthier status of those contracting the virus and rising vaccination levels, among other factors that can affect fatality rates.

Early signs are that Omicron, even if it is less virulent, is more contagiousness will lead to record or near-record hospitalization and ICU rates, though we may not see fatality levels like those during the Winter 2020–21 surge (i.e., Third Wave).

Is Omicron more contagious?

In the aggregate Omicron appears more contagious, despite some uncertainty over whether the current numbers are a reflection of the Delta variant or Omicron. They are circulating at the same time.

There is a also a question of whether the current fast rise in cases is due to an increased number of people getting tested. Figures 2, however, should put that last question to rest. The recent change in the daily number of news COVID-19 cases does not appear to be following a similar surge in COVID-19 tests.

Figure 2: New COVID-19 Tests per 1K and New Daily Cases in U.S. (14-day moving averages)

While the number of daily tests have increased in the last two weeks, it has not been on a scale similar to the daily rise in new cases. The U.S. is in unchartered territory right now in terms of case numbers.

So what happened?

By all appearances, Omicron is more contagious. We see that when we plot the number of daily tests (per 1,000 people) against the daily positivity rate of these tests (see Figure 3).

The daily positivity rate is at record levels right now.

Figure 3: New COVID-19 Tests per 1K and Positivity Rate (U.S.)

New COVID-19 test data points represent 14-day moving average

When we regress daily COVID-19 tests on the daily positivity rate, there are two extreme outlier periods: (1) the initial COVID-19 surge in Spring 2020, and (2) the most recent surge (presumably, Omicron).

The first outlier can be explained by the preponderance of early tests being dedicated to people showing strong symptoms. As testing became more prevalent and routine, that positivity rate moderated to some extent and rose more modestly during every new surge. That has changed in the latest surge.

Based on these aggregate numbers, I would conclude, even with the remaining presence of the Delta variant, Omicron is the cause of the recent positivity rate increases.

Is Omicron less lethal?

As noted earlier, it is difficult using aggregate time-series data to make definitive statements about Omicron’s lethality. Other confounding factors are in the mix (e.g., vaccination levels, treatment improvements, characteristics of the infected population, etc.).

Figure 4 plots two versions of the case fatality rate (CFR) for COVID-19. The black line represents the cumulative CFR, while the blue line represents the CFR calculated over a 30-day period. Also, shown are the daily vaccination numbers (as the orange dotted line). The recent drop in vaccinations should not be over-interpreted as the newest numbers tend to be revised upwards over time.

The CFR is calculated as the proportion of people diagnosed with a certain disease, who end up dying of it. It is inevitably an overestimate of the incidence fatality rate (IFR) which estimates this proportion of deaths among all infected individuals. Unlike the CFR, the IFR requires knowing the incidence of asymptomatic cases (which can be a large percentage for some illnesses).

The number we care about is the IFR. The number I have data for, however, is the CFR. Keep in mind, therefore, my estimates for the cumulative IFR of around 1.5 percent and 1.6 percent for the 30-day CFR are likely overestimates of the IFR. 

As a crude estimate for COVID-19’s IFR, I consider the fact that the seasonal flu (prior to the pandemic) typically has an IFR around 0.1 percent and kills, on average, 40 thousand Americans every year. COVID-19 will have killed around 900,000 Americans in two years, or about 11.5 times the number of the seasonal flu. Ergo, I estimate COVID-19’s IFR to be around 1.2 percent. [If I’m close to the right number, that is horrific!]

Figure 4: 30-Day and Cumulative COVID-19 Case Fatality Rate (CFR) in U.S.

Back to the issue at hand: Is Omicron more lethal? According to Figure 4, the U.S. is at an all-time low for its cumulative and 30-Day CFR estimates (1.5 and 1.6 percent, respectively). Therefore, I believe this is evidence of Omicron’s lower lethality, with one caveat — we simply haven’t seen the full impact of Omicron on death counts.

Also supporting the conclusion that Omicron is less lethal is the experience of other advanced economies where Omicron is rapidly growing in appearance.

As of January 1st, of the 31 advanced economics I analyzed in Europe and Asia, 74 percent were at or near all-time low in cumulative CFRs (Data available upon request to The average cumulative CFR for these countries is 1.0 percent — giving me another opportunity to point out how the U.S. health care system again grossly underperforms relative to our other economic partners.

Those countries seeing significant increases in CFR included Taiwan, Russia, Liechtenstein, Greece, India, Singapore, Austria, and South Korea.

Maybe Omicron isn’t more deadly, but is it causing higher hospitalization and ICU rates?

With the rise of Omicron, the news stories are multiplying about rising hospitalization levels across the U.S.

But an equally important question is the probability an infected person will go to the hospital or ICU. By early accounts, Omicron is filling hospitals because of its high contagion rate, not necessarily its virulence.

As seen in Figure 5, hospital (yellow line) and ICU (dark orange) admissions per 1 million people are surpassing last summer’s surge and could very well surpass all-time highs before this current surge is over.

Figure 5: Hospital and ICU Patients (per 1 million) in the U.S.

But as the hospitalization and ICU rates, the story is different.

Figure 6 attempts to show the relationship between changes in the number of COVID-19 hospitalizations with changes in the number of new cases. Are new COVID-19 cases more or less likely to get admitted into a hospital over time?

As noted, since I do not have access to individual-level patient data, I can only approximate that relationship.

The important line in Figure 6 is the dotted blue line, which represents the trend in the ratio of new COVID-19 hospitalizations to new cases.

There appears to be no trend in this ratio. A new COVID-19 case today is just as likely to be admitted into a hospital as it was in Summer 2020.

Figure 6: Ratio of Change in COVID-19 Hospitalizations (per 1M) to New Cases (per 1M) in the U.S.

But what about the probability of a new COVID-19 case ending up in an ICU?

With the same caveat as in Figure 6, the graph in Figure 7 shows the ratio of COVID-19 ICU patients (per 1 million people) to new cases (per 1 million people). Ideally, I would have calculated the ratio of ICU patients to current “active” cases. However, I consider the “active” case numbers for the U.S. as unreliable as not every state consistently tracks patients from start to finish of their illness.

States, however, have been doing a fair job of registering new COVID-19 cases and Figure 7 indicates that the probability of a new COVID-19 patient ending up in an ICU has been going down since Summer 2020 (see dotted blue trend line). This, of course, may be due to many factors such as vaccinations levels, characteristics of patients, and improved treatments. But do notice the steep drop in this ratio in recent weeks. This could be a further indication of Omicron’s lower virulence.

Figure 7: Ratio of COVID-19 ICU patients (per 1M) to New Cases (per 1M) in the U.S.

And, finally, in Figure 8 we have the ratio of COVID-19 deaths (per 1 million people) to hospitalizations (per 1 million people). Again, the trend line (dotted blue) has been going down since Summer 2020. The probability of a hospitalized COVID-19 patient dying from COVID-19 appears to be going down over time.

Figure 8: Ratio of COVID-19 Deaths (per 1M) to Hospitalizations (per 1M) in the U.S.

Final Thoughts

The findings in this essay are consistent with the most reported research on COVID-19. My intention here is more to demonstrate that publicly-available COVID-19 data in the aggregate is potentially useful in capturing the 30,000-foot view of the COVID-19 pandemic. 

In clinical and epidemiological research, there is no substitute for individual-level patient data. However, much can still be learned with sub-optimal data if accompanied by sufficient care and caution.

Stay safe. Wear a mask. Keep your distance. And get vaccinated.

  • K.R.K.

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The politicians aren’t fooling anybody about COVID-19…or are they?

By Kent R. Kroeger (Source:, January 6, 2022)

[Author’s Note: The opinions and errors found in this essay are mine alone. And do not make personal health or financial decisions based on this essay.]

From the start, this blog has been about the democratization of policy data and public policy analysis. Today, every internet-connected human has access to more quality scientific and social data than the most sophisticated policy experts did thirty years ago.

With only a modest background in data management and statistics, an average citizen today can independently assess the performance of their political leaders on a level that would have been impossible a generation ago.

It is no longer necessary to depend on the national news media to learn how things are going in this country, you merely need a high-speed internet connection, free statistical and database software, some basic math knowledge and an ounce of gumption. Or, know somebody with those resources.

Is it a coincidence that the public’s respect for politicians and policy experts has been in a near lockstep decline with the rise in publicly accessible raw data on their performance? No longer does information about our leaders and policy experts need to be filtered and interpreted by the elite-centric national news media. And, increasingly, it isn’t.

In 1997, the Gallup Poll reported that 68 percent of the U.S. public had a “great deal” or “fair amount” of trust in the federal government’s ability to handle international problems and 51 percent had that level of trust in the government for domestic problems. In 2021, those trust numbers stood at 39 percent.

Nowhere have the policy results generated by our political and expert class been more observable than the COVID-19 pandemic.

In what Arizona Democratic Party leaders call a Faustian pact, Arizona Governor Doug Ducey has kept his state’s economy open during the pandemic, arguably leading to 5,600 more COVID-19 deaths than his state should have had given the national COVID-19 death rate (3,376 deaths per 1 million people in Arizona versus 2,609 per 1 million people nationally). 

Has it been worth it? According to the U.S. Bureau of Economic Analysis, Arizona had the 5th fastest growing state economy between Q1 2020 and Q1 2021.

If COVID-19 deaths are your preferred metric, one can understandably claim Ducey’s COVID-19 policies failed on an epic level, just as easy as it is for Governor Ducey (who is not running for re-election in 2022) to claim glorious success.

Arizona’s strong economy cannot be dismissed, but neither can 5,600 excess deaths. In the end, the voters will judge.

But will this information really matter? Are we so distracted by the partisan theater featured daily on the news that we don’t need to think anymore about such things before filling in the ovals on the ballot?

In 2014, Ducey won the Arizona gubernatorial race by almost 12 points. Current projections say the Republican nominee in the 2022 race will win by 0.3% of the two-party vote. Not all of the decline can be attributed to COVID-19, but it is more than plausible that the failure of Ducey’s COVID-19 policies account for a big share of it.

Georgia shares a similar story to Arizona’s, with a Republican governor championing his pro-growth COVID-19 policies (9th fastest growing state economy between Q1 2020 and Q1 2020) while his state experienced an above average COVID-19 death rate.

Georgia’s 2022 governor’s race is called a toss-up by The University of Virginia’s Larry Sabato.

Arizona and Georgia, once solid red states, were slowly turning blue (or at least a deep purple) before the pandemic began. The electoral story is startingly different in some key red states led by Republican governors, however. In Alabama, Arkansas, Florida, South Carolina, South Dakota, Tennessee, and Texas — which are all experiencing higher COVID-19 death rates than the national average — Republicans are poised for easy gubernatorial victories in 2022, according to Sabato. Not coincidently, perhaps, these same states experienced average or above average economic growth during the first year of the pandemic. (Figure 1 shows Sabato’s current predictions for all of the 2022 gubernatorial races.)

Figure 1: Predictions for 2022 gubernatorial races (Univ. of Virginia Center for Politics, Prof. Larry Sabato)

Graph courtesy of Prof. Larry Sabato (University of Virginia Center for Politics)

A better test case of the influence of state-level COVID-19 policies and economic growth on electoral outcomes may be the 2022 Wisconsin gubernatorial race, where Democrat incumbent Tony Evers is seeking re-election. In 2018, he won the race by one percent of the vote. Current predictions consider Wisconsin a similar toss-up.

It is unfair, in my opinion, to suggest voting for a pro-growth, anti-lockdown Republican is tantamount to turning a blind eye to the suffering caused by COVID-19. As one of my workmates put it recently, “This is a virus that kills unhealthy people. Who do I blame for that?”

[Our overpriced, inadequate health care system, perhaps?]

Does it make a difference that the average age of the person who died during the 1918 Spanish Flu was 28 years, where most U.S. deaths from COVID-19 have been people aged 65 years and older. It may sound macabre to ask the question, but it must be considered as we head into the midterm elections.

Are undecided and disaffected American voters going to allow their mourning for the COVID-19 dead (and fear of future deaths) heavily influence their final vote decisions? Or are a decisive number of these voters going to weigh economic growth under the banner of personal freedom above the death of thousands of their own state’s residents?

(And, of course, it is possible none of these factors play an important role in many of the midterm elections.}

We will likely find out the answer in about 10 months.

  • K.R.K.

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Nursing home liability waivers may have been our nation’s worst public policy during the COVID-19 pandemic

By Kent R. Kroeger (Source:; August 1, 2021)

The ultrastructural morphology exhibited by the 2019 Novel Coronavirus (2019-nCoV) (Image created by CDC/ Alissa Eckert, MS; Dan Higgins, MAM; This image is a work of the Centers for Disease Control and Prevention, part of the United States Department of Health and Human Services, taken or made as part of an employee’s official duties. As a work of the U.S. federal government, the image is in the public domain.)

[All data used in this essay is available on GITHUB here.]

Last week, the Biden Justice Department decided not to open a civil rights investigation into the possibility that New York state officials intentionally manipulated data regarding nursing home deaths in an attempt to obfuscate the relatively high number of COVID-19 deaths within nursing homes.

A Justice Department letter sent by Deputy Assistant Attorney General Joe Gaeta to congressional Republican lawmakers read: “Based on that review, we have decided not to open a Civil Rights of Institutionalized Persons Act investigation of any public nursing facility within New York at this time.”

A similar letter was sent to state officials in Michigan and Pennsylvania. Apparently, the Justice Department is still considering investigations in New Jersey nursing homes.

Though New York Governor Andrew Cuomo’s office did not immediately respond to press inquiries about the Justice Department decision, it would not surprising if Governor Cuomo is feeling some vindication right now.

Unfortunately, the COVID-19 data continues to indicate something unusual may have happened in states such as New York, New Jersey, Massachusetts, Michigan and Pennsylvania where nursing homes were required to take in elderly patients previously hospitalized for COVID-19. To ensure cooperation among nursing home operators, this policy was supported by state laws or governors’ orders granting nursing homes and other long-term care facilities legal immunity from prosecutions related to COVID-19 deaths.

In the first few months of the pandemic, at least 19 states had some form of a nursing home liability waiver: Alabama, Arizona, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Nevada, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.

Richard Mollot, executive director of the New York-based Long Term Care Community Coalition — a group that advocates for nursing home residents across the country — offers a grim critique of these liability waivers: “It’s basically a license for neglect.”

The state-level COVID-19 data summarized below will bear out Mollot’s concern.

It is not shocking that the Biden Justice Department wants to avoid risking political damage to Democratic governors heading into the 2022 midterm elections. But it is surprising that there is no groundswell among news organizations, government health experts, and academic researchers to demand answers on how the nursing home liability waivers may have impacted the number of COVID-19 deaths during this pandemic — if one of your loved ones was among the more than 15,800 New York nursing home residents who have died from COVID-19, you might be particularly interested in the answer.

An in-depth inquiry into the impact of these liability waiver policies does not need to imply criminal conduct. Cuomo, better than other governors, aptly defended the nursing home liability waivers when New York lawmakers began to question their rationality during the pandemic’s first wave.

At the time, Cuomo correctly noted that ICU beds in New York were rapidly being filled by COVID-19 patients and there was an urgent need to move recovering patients out of hospitals to other care environments. Wholly unfair and irresponsible are insinuations by some (including me) that Cuomo may have implemented the policy, in part, as a favor to nursing home owners who had historically been generous donors to Democratic candidates. Partisan politics brings out the worst in us all.

And if ever there is a time to avoid a partisan inquisition, an open and comprehensive investigation into the impact of the nursing home liability waivers on COVID-19 deaths would be that time. Considering four of the 19 states with nursing home liability waivers at the start of the pandemic had Republican governors, no political party can universally claim the moral high ground.

Nursing home liability waiver laws are not all the same, so assessing their collective impact is not necessarily straightforward

In an August 2020 analytic essay, I concluded that a state’s population density was the strongest correlate with the relative number of COVID-19 deaths in that state (from 18 January 2020 to 13 August 2020), but that nursing home liability waivers were also a strong correlate, associated with perhaps as many as 22,500 additional deaths over the period.

Has anything changed since then to require a different conclusion regarding these liability waivers? As with any public policy whose impact is closely monitored, bureaucrats and politicians can incorporate new learning into revising those policies. That happened with New York’s liability waiver policy soon after it became apparent — in mid-April 2020 — that a disproportionate number of COVID-19 deaths were occurring among nursing home residents. In early May, Cuomo announced that New York would no longer require nursing homes to take COVID-19 patients from hospitals.

“We’re just not going to send a person who is positive to a nursing home after a hospital visit. Period,” Cuomo said at a news conference announcing the policy change.

But the damage in human lives was already done and the extent to which other states with similar liability waiver policies changed their implementation policies appears varied. Connecticut, for example, decided to move COVID-19 positive elderly patients from hospitals to nursing homes dedicated to housing only COVID-19 patients. Healthy residents were not mixed with COVID-19 positive residents.

But, by all indications, the liability waivers remain intact, even while states have stopped moving patients from hospitals to nursing homes. In fact, some states passed their own liability waiver laws in the aftermath of New York’s tragic experience with the law. Iowa, for example, passed a liability waiver law in June 2020 giving businesses, such as nursing homes and medical facilities, protection from civil lawsuits regarding COVID-19. In July 2020, my mother — who was in her 90s — contracted COVID-19 while in an Iowa nursing home and was initially moved to a hospital, but returned to her nursing home days later, despite still suffering significant symptoms from the illness. She thankfully survived, but the experience now appears indicative of the risks associated with liability waiver laws.

Since June 2020, Iowa has had one of the highest COVID-19 death rates in the country and it is fair to ask if Mollott and other critics of liability waiver policies are correct in suggesting they are a “license for neglect.”

The circumstantial evidence suggests nursing home liability waivers cost some people their lives

It is hard to avoid the conclusion that early in this pandemic a significant number of elderly Americans died from COVID-19 because they were moved prematurely from hospital care to a nursing home.

Figure 1 (below) shows the state rankings for COVID-19 deaths per 1 million people (as of 27 July 2021). Nine out of the top 10 states in COVID-19 deaths per capita were states that had a nursing home liability waiver law in place at the start of the pandemic.

Figure 1: Top 20 U.S. states with highestCOVID-19 death rates through 27 July 2021

Source: RealClearPolitics

As noted, by May 2020, states such as New York, New Jersey and Connecticut had made significant changes in their implementation of nursing home liability wavier laws. In most cases, they either stopped forcing nursing homes to take on elderly COVID-19 hospital patients or segregated nursing homes by COVID-19 negative and positive residents.

Subsequently, it may be interesting to see if, statistically, there has been a noticeable drop in COVID-19 death rates in the 19 states that had liability waivers at the start of the pandemic.

Methodological Note: At least 10 states worked to pass nursing home liability waiver laws after the start of the pandemic. At the time of writing this analytic essay, I had not determined exactly how many of those states actually passed such laws and therefore leave the analysis of their possible impact on COVID-19 death rates for a follow-up essay.

Figure 2 (below) shows the ranking of U.S. states (+D.C.) by COVID-19 death rates from 18 January 2020 to 31 May 2020 (Pandemic Phase 1). The red bars indicate states that had nursing home liability waivers laws in place at the start of the pandemic. The point biserial correlation statistic — appropriate for correlating a continuous variable with a binary variable (see Appendix A for its calculation) — between a state’s COVID-19 death rate in Phase 1 and whether it had a liability waiver law was 0.49 (significant at p<.05).

Figure 2: COVID-19 deaths per 1 million people from Jan. to May 2020 (Phase 1)

Data Sources: New York Times (COVID-19 data) and Time Magazine (Liability Waiver data)

To test whether nursing home liability waiver laws continued to impact COVID-19 death rates after May 2020, I calculated the point biserial correlation using data from 1 June 2020 to 7 July 2021 (Pandemic Phase 2). The resulting statistic was 0.24 (significant at p<.10).

Figure 3: COVID-19 deaths per 1 million people from 1 June 2020 to 7 July 2021 (Phase 2)

Data Sources: New York Times (COVID-19 data) and Time Magazine (Liability Waiver data)

Apparently, the relationship between liability waiver laws and COVID-19 death rates weakened during the pandemic’s Phase 2, but may not have disappeared completely.

Notable in Figure 3 is how New York and Connecticut performed better than most other states in terms of COVID-19 death rates during Phase 2, but New Jersey, Massachusetts, Illinois continued to experience above average death rates. Also notable is the extremely poor COVID-19 death rate performance by states such as Arizona, Mississippi, South Dakota, Alabama and Arkansas — the explanation for which most likely goes beyond liability waiver laws and probably includes cultural, economic, and public policy factors.

Figure 4 shows a scatterplot of COVID-19 death rates by the two pandemic phases. Again, the states with liability waiver laws are in red and which tend to cluster in the upper right-hand quadrant of the scatterplot (indicating high COVID-19 death rates in both pandemic phases).

Figure 4: Scatterplot ofCOVID-19 deaths per 1 million people (Phase 1 versus Phase 2)

Data Sources: New York Times (COVID-19 data) and Time Magazine (Liability Waiver data)

Nothing presented so far is conclusive about the impact of liability waiver laws, but the results are suggestive of something potentially consequential.

A mediation model of COVID-19 deaths per capita

The final statistical analysis I ran attempted to account for the other major factors that may have impacted state-level COVID-19 death rates (from 18 January 2020 to 7 July 2021), including nursing home liability waivers.

The other factors considered in the model were:

  • Population Density (natural log)
  • Trump vote percentage in 2016 — a proxy variable for the various COVID-19 policies that tended to cluster based upon Red States vs. Blue States.
  • Stay-at-Home orders — an additional policy control based on whether states ever instituted stay-at-home orders during the pandemic.
  • GDP per capita (natural log) — an indication of a state’s level of economic activity
  • Percent uninsured — an indication of the percentage of a state’s citizens lacking health care resources.

The model’s mediating variable through which these factors may have indirectly operated on COVID-19 death rates was the number of COVID-19 cases per 1 million people.

The mediation model was estimated in JASP and whose total effects results and path plot are summarized in Figures 5 and 6 below.

[The full model estimates are in Appendix B.]

Figure 5: Mediation model of COVID-19 deaths per capita — Total Effects (18 January 2020 to 7 July 2021)

Figure 6: Pathmodel of COVID-19 deaths per capita (Jan. 2020 to 7 July 2021)

LN_D = LOG(Deaths per 1M); LN_C = LOG(Cases per 1M); PCT = Pct. Uninsured; LN_G = LOG(GDP per capita); STA = States w/ Stay-at-Home Orders; TRU = Trump Vote % in 2016; NUR = Nursing Home Liability Waiver states; LN_P = LOG(Population Density)

The model results indicate a strong relationship between state-level COVID-19 death rates, population density, and Red State/Blue State status (as measured by the 2016 Trump vote percentage): Densely-populated states (z = 4.89; p < .001)and Red States (z = 4.24; p < .001) had significantly higher COVID-19 death rates over the study period.

[Overall, this model explained 78 percent of the state-level variance in COVID-19 death rates.]

Densely-populated states like New York and New Jersey, however, should not feel exonerated by these results. Nursing home liability waiver states had significantly higher COVID-19 death rates. In fact, it was the most powerful correlate with COVID-19 death rates (z = 2.83; p = 0.005), after population density and Red State/Blue State status.

The other statistically significant variable in the model was the percentage of a state’s residents without health insurance (z = 2.04; p = 0.04).

While not statistically significant, there is a weak indication that economically active states — that is, state’s with high GDP-per-capita — also had slightly higher COVID-19 death rates. It is possible, an active economy inevitably brings with it higher mortality risks, irrespective of a state’s policy attempts to control the spread of a pathogen. Any benefits a state’s citizens might gain from having more financial resources to protect themselves from a dangerous virus may be dampened by the state’s higher levels of economic activity.

Final Thoughts: Our politicians, media, and government experts have a credibility and honesty problem

These results are admittedly suggestive, not conclusive. For example, methodological improvements — such as accounting for the count-data nature of the dependent variable — must be considered.

Nonetheless, it is unimaginable how anyone could look at the COVID-19 death rates and not see how major policy-related differences have been associated with variation in state-level outcomes. Equally apparent, the policy failures cut across partisan lines. Democratic-dominated states made major policy mistakes, as did Republican-dominated states.

And the previous statistical analysis doesn’t even consider the economic and social damage done by states through their COVID-19 policy strategies (lockdowns, mask mandates, crowd limits, public health care, school closings, etc.).

But the policy failures go far beyond liability waiver laws or health insurance coverage. The failures are at every level of government and society.

At one point, we had the leading virologist in the federal government tell us masks were not effective in slowing the spread of SARS-CoV-2, despite privately knowing they were, only to publicly reverse that recommendation — thereby damaging the credibility of anything he said later, no matter how factually correct. Do I harshly judge Americans now hesitant to heed Dr. Fauci’s advice about getting vaccinated? I do not.

Do I personally trust Dr. Fauci when he says the relatively new mRNA vaccine technology has no long-term health implications? For good reason, I do not— though I was still among the earliest to receive both “jabs” (Moderna) and did not hesitate to get my teenage son vaccinated (and he had previously contracted the virus).

This same government scientist slandered and shamed anyone suggesting the SARS-CoV-2 could have leaked from a Chinese lab, only to admit many months later that such a possibility could not be ruled out.

Credibility and honesty are everything in a public crisis like the COVID-19 pandemic. Occasionally being wrong is forgivable (and expected). But to fail on both accounts, as Dr. Fauci and other political-media elites have done more than once, is public service ineptitude.

Dr. Fauci should have been fired after his lies to Congress about mask-wearing — and certainly should have been fired after backtracking on the ‘lab leak’ hypothesis — but in today’s partisan environment, he’s instead lionized.

Dr. Fauci’s disingenuous behavior is more than matched, however, by the rogues gallery of Republican governors — Arizona’s Doug Ducey, Alabama’s Kay Ivey, Mississippi’s Tate Reeves, Iowa’s Kim Reynolds, and South Dakota’s Kristi Noem are the first names that come to mind — that chose to ignore common sense state measures — stay-at-home orders, mask mandates, and crowd size restrictions — at the expense of citizens’ lives.

Recall the 20 states in Figure 1 with the highest COVID-19 death rates. The high uninsured rates in southern U.S. states is bad enough — the likely product of systemic poverty and racism — but it is unfathomable how states with the population density and socioeconomic advantages of the two Dakotas and Iowa could still end up in the Top 20 for COVID-19 death rates. California Governor Gavin Newsom faces a serious recall challenge in a state that has done reasonably well, both in terms of COVID-19 deaths and economic impact, but those three Midwest governors remain overwhelmingly popular in their respective states (IowaSouth DakotaNorth Dakota).

Life and politics are not always fair.

Is it coincidence the Americans who disproportionately died during this pandemic — elderly, working class, overweight, Black and Hispanic Americans — are also underrepresented by the policies coming out of our political establishment during this pandemic?

For evidence of this claim, I present nursing home liability waivers — what may be the pandemic’s worst public policy.

  • K.R.K.
  • I am a survey and statistical consultant with over 30 -years experience measuring and analyzing public opinion.
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Appendix A: Point Biserial Correlation

Appendix B: Full Mediation Model

Dependent Variable = COVID-19 Deaths per 1 million people