The Perfect Meme

∗
Cognitive errors in understanding the 2019-2020 coronavirus crisis

Wryc Gozo Guzzler

gozoguzzler@yahoo.com

April 16th, 2020

”Three men make a tiger”

Chinese proverb

1 Introduction
As of the beginning of April 2020 the following claim is prevalent and widely accepted as fact:

The new virus resulted in a very high mortality rate and caused the pandemic endangering global
population.

We examine a selection of cognitive errors and social phenomena that contribute to spreading
the above and related more specific claims. The article does not assume knowledge of epidemiology.

2 Cognitive errors
2.1 Selection bias
Selection bias occurs when the selection of participants is not random or complete. The common
source of this error lies in taking a sample not from the general population, but from a subpopu-
lation that is not representative of the population intended to be analyzed.

Specific claim

The mortality rate is very high. In Italy every 8th infected person dies. For example, as of April
15th, the number of confirmed infected cases is 165,000 and number of related deaths tested posi-
tively with coronavirus is 22,000. By dividing these numbers we get mortality rate greater than 13%

The main problem here is that the 165,000 positively tested cases were not taken from the gen-
eral population. Instead, only people with severe symptoms who have been admitted to hospitals
were taken into account. It means that we ignore infected people showing mild symptoms or no
symptoms at all. In order to realize how grave error it is, let’s imagine the following setup. We
take the sample of terminally ill patients from the intensive care unit. Before they die, we test
them against some trait.
∗ This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0)

1
 Figure 1: Coronavirus naive mortality rate depends on the prevalence of testing

The trait may be a rare thing like being blind or a common thing like being right-handed.
Regardless of what trait we choose, because we took terminally ill patients as a sample, we will
always receive 100% mortality rate associated with that trait.
The selection bias makes a person draw an absurd conclusion that being blind or being right-
handed is related to high mortality rate.

If this example might seem far-fetched, let’s see what happens during the coronavirus crisis.
According to the director of the infectious disease unit at Sacco Hospital in Milan [46], “Italy
focused its testing only on people showing severe symptoms in areas with high epidemic intensity.
This causes an increase in the fatality rate because it is based on the most severe cases and not on
the totality of those infected.”
Also the researchers from Istituto Superiore di Sanità, Rome note the following [45], “After
an initial, extensive testing strategy of both symptomatic and asymptomatic contacts of infected
patients in a very early phase of the epidemic, on February 25, the Italian Ministry of Health issued
more stringent testing policies. This recommendation prioritized testing for patients with more
severe clinical symptoms who were suspected of having COVID-19 and required hospitalization.”
These reports show that selecting candidates for testing against coronavirus in Italy is not far
from our hypothetical absurd setup. Unfortunately data coming from other countries is laden with
similar selection bias.

In case of data coming from various countries we don’t have random samples however, we know
that some countries do more intense testing than others. If any country had tested the entire
population then we would have quite reliable data to calculate mortality rate. This is unrealistic
because, by the middle of April 2020, only four countries tested more than 3% of the population.
It’s not much, but we may expect that data from these four countries is less affected by selection
bias.
Selection bias is not eliminated, but it’s clear that the more comprehensive testing, the more
reliable data. Based on the Worldometers [32] data, we plot Naive Case Fatality Rate as a function
of Test Intensity on Figure 1. We know that the more intense testing, the more reliable data. The
chart also reveals a clear trend, with more reliable data we get the lower case fatality rate.
Four data points stand out in terms of test intensity: Iceland, United Arab Emirates, Luxem-
bourg and Bahrain. Out of all data points they are the most reliable ones and at the same time
show the lowest case fatality rate.

2
 Naive Case Fatality Rate Test intensity
Country
[%] [tests/1000 of population]
Iceland 0.46 109.6
UAE 0.62 77.6
Luxembourg 2.05 49.1
Bahrain 0.41 45.0
Estonia 2.51 27.2
Norway 2.21 24.0
Switzerland 4.75 23.8
Israel 1.11 21.6
Germany 2.84 20.6
Portugal 3.34 20.4
Spain 10.46 19.9
Qatar 0.17 19.6
Italy 13.11 18.5
Ireland 3.54 18.4
Slovenia 4.81 18.3
Lithuania 2.75 17.8
Austria 2.72 17.4
Hong Kong 0.39 15.5
Australia 0.97 14.9
New Zealand 0.64 14.5
Denmark 4.67 14.2
Czechia 2.66 13.6
Singapore 0.27 12.4
Canada 3.63 12.4
Belgium 13.95 11.6
Russia 0.83 11.1
South Korea 2.16 10.5
USA 5.12 9.9
Finland 2.23 9.0
Netherlands 11.35 8.6
Belarus 0.95 8.6
Azerbaijan 1.17 7.4
Sweden 10.63 7.4
UK 13.32 6.2
Turkey 2.19 5.7
Chile 1.19 5.1
France 11.61 5.1
North Macedonia 4.26 5.0

Table 1: Naive Case Fatality Rate and Test Intensity

3
 We should beware of naive extrapolation but the trend is clear and expected. The selection bias
is reduced with test intensity (size of the sample). With the sample covering the entire population,
the real case fatality rate converges to the value much below 0.4%.

The most comprehensive data comes from the Diamond Princess cruise ship, where selection
bias while significant is not disqualifying.
The cruise ship was quarantined on February 2nd 2020. There were 3711 total people on board
out of which 3011 were tested. By 20th February 2020, there were 634 confirmed cases with 328
of these having no symptoms, and 37 required intensive care. [12, 13, 33]
As of March 1st 2020, 7 passengers died (three of them aged 70-79 and four aged 80-89), what
gives mortality rate 1.1% (7/634) relative to the infected and 0.19% (7/3711) relative to the exposed
(it’s safe to assume that everyone on board was exposed because the food service workers have
been the main route of spread). 37 passengers required intensive care what gives 5.8% (37/634) of
severe cases relative to the infected and 1% (37/3711) of severe cases relative to the exposed.
The cruise ship sample is far from being random or complete for several reasons. There are factors
that contribute to underestimating mortality rate like:
• a number of unresolved cases (as of March 1st 2020)
• likely higher socioeconomic status and better general state of health of passengers

There are also factors that contribute to overestimating mortality rate:

• testing was not complete. 81% (3011/3711) people on board were tested, so we miss an
unknown number of cases with mild or no symptoms

• testing started among the elderly passengers, descending by age

• age structure of the subpopulation on board was dramatically different from the world av-
erage. There were 2165 people aged 60 years or over what makes 58% (2165/3711) of total
number people on board. For the world population people aged 60 years or over constitute
14% of total. Table 2 presents the detailed age structure breakdown.

There are various techniques to adjust for delay from confirmation-to-death and age structure.
Detailed estimates produce mortality rate at 0.5% [48] although margin error is high because the
sample size is small.

To summarize, one cannot infer mortality rate from samples that are not random or complete.

When we look at most available data: the number of deaths related to coronavirus and the
number of confirmed cases, we need to understand that the former number is adequately reliable,
and the latter is meaningless because it depends on the arbitrary testing-sampling strategy.

2.2 Ignoring baseline

Numeric data representing change, scope, magnitude or impact is useless without a baseline that
serves as a point of reference or an initial value. Things have to be compared in similar contexts,
otherwise the comparison is meaningless. Evaluating data without knowing the baseline is like
measuring without specifying units.

Specific claim

Even if we don’t know the true mortality rate, the number of deaths is staggering. From December
1st 2019 to April 15th 2020, there are about 140,000 deaths related to coronavirus.

4
 In order to evaluate whether the number 140,000 is significant or not we need a baseline. As a
starting point, let’s estimate the expected total number of deaths for the same period in a non-crisis
situation. We can estimate it from publicly available data.
The world population is around 7.7 billion. The globally averaged baseline crude death rate is
estimated at 7.6 deaths per 1000 population per year. In normal conditions we expect 59 million
expected deaths per year. There are 137 days in December 1st, 2019 to April 15th, 2020 period. It
means that we expect 22.2 (137/365*59) million deaths during this period. 140,000 deaths related
to coronavirus is 0.6% (140/22200) of total deaths. [37]

We are more interested how coronavirus related fatalities look in the context of other influenza-
like infections. The estimated number of deaths from lower respiratory infections (mostly pneu-
monia) is about 2.5 million [], and deaths from various types of influenza is about 300,000. It does
not include deaths from chronic respiratory diseases which would add another 4 million expected
fatalities per year. [14, 17]
During the relevant period, we expect 1.05 (137/365*2.8) million deaths from lower respiratory
infections and influenza. 140,000 sounds like a huge number, but it is buried within the noise of
the estimated number of deaths from pneumonia and influenza-like illnesses.
Because our attention is focused on the perceived danger from a single pathogen, we close our
eyes to 85% of fatal cases caused by other viruses and bacterias producing similar symptoms.

We did a simplistic comparison that has many problems

• it does not tell if the 140,000 we consider is part of the estimated 1.05 million or the excess
over this baseline
• it assumes uniform distribution while mortality rate fluctuates during the year. If we look
at shorter period like week or month we expect fluctuations from the yearly average. The
question is what divergence from the average is normal and what abnormal.
To make it easier to compare new data to baseline, statisticians use the z-score. It’s a metric
that shows how much a single data point stands out from the average. The z-score is normalized
by the standard deviation and is often adjusted for seasonality. A positive z-score indicates that
data point is above the average, a negative - below the average. It simplifies tracking time series
and comparing new data with historical data. In particular, in the ongoing mortality monitoring,
the z-score allows detecting when excess mortality occurs.
We are going to use the European monitoring of excess mortality for public health action
(Euromomo) [11]. It aggregates actual mortality reports for Europe.
Without relying on coronavirus data, we can check if the crisis of last weeks increased total
mortality. For the most affected countries like Italy, Spain and France, the z-score for the last
week of March and the first week of April 2020 rose to 18, 17 and 14 respectively, what means
that all-cause mortality is much higher than average. Neither is it extraordinary high. In January
2017, the z-score in the mentioned countries were 12, 14 and 12 respectively.
The effect of increased mortality at the turn of March and April is clearly visible in statistics
but not unusual. It is comparable to the increased mortality during seasonal flu outbreaks in the
past years.

2.3 Missing baseline

Specific claim

This coronavirus is unlike anything in our lifetime. The current situation is a once-in-a-century
pandemic. It’s the worst global crisis since World War II, etc.

These are basically content-free statements, but it’s worth to point out the same error - missing
baseline. With the difference that this time we cannot estimate baseline by ourselves because of
lack of data to compare. What is actually unique is that it’s the first time in history, when the

5
general public is focused so obsessively on a very specific epidemiology phenomenon, and that the
related incidence data is widely accessible for naive interpretations.

2.4 Naive extrapolation

Naive extrapolation is a forecast without attempting to understand causal factors or adjusting for
boundary conditions. One of the most common errors is to assume linear dependence between two
variables when there is no basis to do so.

Specific claim

As of April 15th, in Italy the number of confirmed positive cases is 165,000 and the number of
related deaths is 22,000. If all people in Italy (60 million) get infected we may get 8 million (60
million * 22/165) fatalities.

In this example, naive extrapolation is combined with selection bias. It has been explained
before that 22,000 is a reliable number here, 165,000 is not.
There are an unknown number of people in Italy who already have been exposed to the virus
and are either immune or developed no symptoms. We can do only rough estimates of this number.
For example, we can use the fatal/exposed = 0.19% ratio from Diamond Princess cruise ship (with
a big margin of error).
Reversing the equation and applying reported number of fatalities we get:
The exposed on April 1st in Italy = fatal/0.19% = 22,000/0.19% = 11.6 million
Knowing that the upper bound is a total population of Italy (60 million) we can extrapolate
only up to 5 fold (60 million / 11.6 million) what gives the maximum number of fatalities around
110,000 (5*22,000)

One cannot just scale numbers, it is necessary to understand what they mean and what are the
bounds.

2.5 Correlation is not causation

We cannot deduce a cause-and-effect relationship solely on the basis of observation data. Even if
the correlation in observation data is equal one.

Let’s consider the following example. We are trying to find a cause of death. In order to
eliminate selection bias, we collected observation data of the entire population. We measured the
number of hours spent in bed during one week by a person and we checked if the person died the
last day of the week. We will find a strong correlation. The more hours a person spends in bed,
the more likely is dead at the end of the week. Obviously it is an error to conclude that lying in
bed is causing death. Life experience tells us that there is a third factor - a serious illness that is
the common cause for both: lying in bed and death. In this case the third factor creates a spurious
correlation. We cannot use two events occurring together to imply a cause-and-effect relationship.

One reliable way to deduce cause-and-effect is to collect experimental data. Such data must
come from the experiment with at least one independent variable. Independent variables are con-
trolled inputs. In our example the controlled input is time spent in bed. We would have to make
people spend various numbers of hours in bed and measure how it affects the probability of death.

In the absence of experimental data it is a common practice to use observation data combined
with common sense judgement. In our example, we would have to exclude from our sample cases
related to serious illness. Since human judgement is fallible and subjective, it becomes a source
of new errors. Another issue is that the choice of the illness as a factor was somewhat arbitrary,
based on everyday experience. There may exist a number of other distorting factors that we are

6
not aware of.

Specific claim

As of April 15th, 2020, in Italy there are over 22000 deaths caused by coronavirus.

The problem here is that we cannot talk about causality because we don’t have experimental
data. The experiment with controlled input would require taking a random sample of healthy
people and contracting them with the virus. Since nobody is going to run such a cruel inhuman
experiment, we are compelled to take observation data and use common sense judgement to classify
which cases of death are related to coronavirus and which are not.

Let’s evaluate the modified claim then:

As of April 15th, 2020, in Italy there are over 22000 deaths related to coronavirus.

There is no error in this statement however, there are inevitable errors in defining related death
criteria, because it is based on fallible human judgement. Since the way we define coronavirus
related death is fraught with pitfalls, we are going to do it in steps.
1. The starting point is that we test a person for coronavirus. If the test is positive and a person
died within one month we classify it as a coronavirus related death.
2. The problem is that we include suicides, car accident casualties and all kinds of unrelated
incidents. We need to narrow down to specific likely death cause, i.e. ARS (acute respiratory
syndrome).
3. There is still a problem with the death cause. We include people who had preexisting diseases
that would independently lead to death.
4. ARS has many causes. In order to include the case as related we need to test negative for
other pathogens.
The list goes on. There are still plenty of problems with these criteria, but let’s say these four
steps would make a reasonable filter.
Reports show that steps 3 and 4 are not even taken into account, “Case-fatality statistics in Italy
are based on defining COVID-19–related deaths as those occurring in patients who test positive for
SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death.
This method was selected because clear criteria for the definition of COVID-19–related deaths is
not available.“ [45]
”Electing to define death from COVID-19 in this way may have resulted in an overestimation
of the case-fatality rate. A subsample of 355 patients with COVID-19 who died in Italy under-
went detailed chart review. Among these patients, the mean age was 79.5 years (SD, 8.1) and 601
(30.0%) were women. In this sample, 117 patients (30%) had ischemic heart disease, 126 (35.5%)
had diabetes, 72 (20.3%) had active cancer, 87 (24.5%) had atrial fibrillation, 24 (6.8%) had de-
mentia, and 34 (9.6%) had a history of stroke. The mean number of preexisting diseases was 2.7
(SD, 1.6). Overall, only 3 patients (0.8%) had no diseases, 89 (25.1%) had a single disease, 91
(25.6%) had 2 diseases, and 172 (48.5%) had 3 or more underlying diseases. The presence of these
comorbidities might have increased the risk of mortality independent of COVID-19 infection.“ [45]

It’s a faulty judgement to classify the death of anyone who tested positive as related to the
coronavirus, because it includes cases with underlying illnesses that could have independently led
to death.

Again, Italy is not unique in this respect. Data coming from other countries is skewed in a
similar way - because of media and medical circles attention, the positive test result often makes
the fatal case to be automatically classified as caused by coronavirus without examining the real
cause of death.

7
2.6 Ignoring time in processes
Specific claim

Since we cannot calculate mortality and morbidity for lack of reliable data, let’s put the dubious
ratios aside and use only the most accurate reports we have - the Diamond Princess numbers.
Coronavirus caused an unusual number of deaths, seven on a single ship. It cannot be compared to
the flu.

Diamond Princess quarantine wasn’t an instantaneous event. It was a process that took about
four weeks. It’s a relatively short time, so it might seem that adjustments for baseline mortality
are negligible. It turns out otherwise.
Let’s examine the numbers. From February 2nd 2020 to March 1st 2020, 7 people died on
Diamond Princess. How many people would have died in normal circumstances (in the absence of
coronavirus)?
Since the majority of the passengers were Japanese, for best approximation we use data from the
mortality database from the Japan National Institute of Population and Social Security Research.
[22, 23]
In Table 2 we use the crude mortality rate per age group to estimate the expected number of
deaths per year that would happen on Diamond Princess in the absence of special conditions.

Crude mortality rate

Persons Expected deaths
Age group (actual data for Japan from 2016
aboard per year
that serves as an estimate for 2020)
0-9 0.002260 16 0.04
10-19 0.000276 23 0.01
20-29 0.000756 347 0.26
30-39 0.001122 428 0.48
40-49 0.002524 334 0.84
50-59 0.006265 398 2.49
60-69 0.015194 923 14.02
70-79 0.038053 1015 38.62
80-89 0.124751 216 26.95
90-99 0.390717 11 4.30
Total: 3711 88.01

Table 2: Expected deaths per year for the Diamond Princess population

We limit our analysis to the quarantine period from February 2nd to March 1st which is 29
days. Assuming a uniform distribution we expect 7 (29/365*88) deaths during this period.
If we redo the calculations with the updated data on the resolved cases on March 28th, we get
12 actual deaths on Diamond Princess and 13 expected deaths in the period from February 2nd
to March 28th 2020
We need to remember that this number is encumbered by selection bias. We are applying
crude mortality rates of population of Japan to the subpopulation that is not matching in terms
of ethnicity and social status. In particular the cruise ship population is likely characterized by:

• higher than average socioeconomic status

• better access to health care
• healthy enough to be able to travel

Time cannot be ignored. We should consider the expected number of deaths in the same period
in normal (infection-free) circumstances. Although there is an unknown margin of error related
to selection bias, knowing that with the number of actual deaths on Diamond Princess we didn’t

8
even cross the expected baseline, should make us refrain from making statements about untypical
mortality rate.

Large cruise ships are sometimes called ”floating nursing homes”. It might seem inappropriate
or offensive, but in many cases, it is what they really are. Pensioners often choose cruise ships over
residential elder-care facilities for better care quality and lower price.
This metaphor comes handy to have another common sense view at the numbers. Numerous
reports from pre-coronavirus crisis state that colds and flues are often overlooked despite being
one of the biggest threat in nursing homes, where it’s not uncommon that a single flu infection
outbreak is fatal for 5% of residents. [43]

The comparison to the flu actually turns out relevant. We can compare the Diamond Princess
incident to influenza outbreaks on cruise ships that happened in the past.
For example in September 2000 an outbreak of influenza-like illness was reported on a cruise ship
sailing between Sydney and Noumea with over 1,100 passengers and 400 crew on board. Laboratory
testing of passengers and crew indicated that both influenza A and B had been circulating on the
ship.
”Of the 1159 passengers on the cruise, 366 (32%) sought medical attention at the ship’s clinic
between days 1 and 13. Of these, 203 (55%), or 18% of all passengers, presented with respiratory
tract illness. Five patients had a primary diagnosis of pneumonia. Of the 203 passengers presenting
to the ship’s clinic with respiratory tract illness, 60 were identified as suspected cases on medical
record review by the ship’s doctor. 40 passengers hospitalized, two of whom died” [35]
The influenza incident actually gives a higher rate of hospitalized patients than on Diamond
Princess.

2.7 Mediator variable

It happens that experimental data proves causality between two variables but it does not give
insight to understand the relationship. Mediator variable is introduced to split the original rela-
tionship into the chain of cause-and-effect links. It allows clarify the nature of the relationships.

It might seem a bit abstract, so let’s proceed with an example.

The Aztecs believed that solar eclipse preceded the apocalypse, so they practiced ritual human
sacrifice to appease the gods and save the world. There is an evidence that eclipses led the Aztecs
to kill slaves and prisoners. If we could ”generate” more eclipses, we would have observed more
massive homicides. Is it fair to say that eclipse caused the massacres? Could a distant neutral
cosmic phenomenon cause manslaughter?

The relationship makes more sense if we introduce a mediator variable and realize that it was
the Aztecs’ fear and belief system that caused killings. Then we get a chain of two valid causal
relationships:

• Solar eclipse caused people’s fear

• People’s fear caused killings

In reasoning, sometimes we need to go deep to find the underlying cause. At times, on the
contrary, we must search for the more direct cause. Otherwise, if we trace back the cause-and-effect
relationships too far, we will find the cosmological Big Bang to be the cause of all events which is
not very helpful.
Identifying mediator variables is important in making rational decisions. Without understand-
ing that human fear is the more direct cause, the hypothetical progressive Aztecs had not been
able to make a right conclusion, that in order to prevent eclipse inspired homicide, they needed to
educate people and eradicate religion and superstition.

9
 Specific claim

In Italy the new virus caused so many deaths that corpses pile up and must be transported out of
the city by the army trucks [34, 47, 38].

Let’s start with a side note that it is an example of our selective attention. The above caption
makes such a good news story and the topic for water-cooler gossips, that a few days before it
actually happened, a fake news with a similar headline appeared in social media. It was showing
the footage of army trucks allegedly transporting the bodies. The news was quickly debunked and
refuted by finding that the video of army trucks had been recorded in a different part of the world.

Nevertheless, the fact is that on March 18th, 2020, there was an isolated incident of using 15
military trucks and 50 soldiers to transport about 60 coffins from Bergamo to remote cremation
sites.
The demand for cremation increased. What was the cause? It’s so easy to come to the
immediate conclusion that some disastrous plague produced extraordinary death toll. It’s not
supported by data, though. As we checked using the z-score data from Euromomo [11], the all-
cause mortality in Italy increased in the middle of March, but the increase was comparable to the
seasonal flu mortality upsurge in previous years [30, 36, 7]. The caveat is that these are country-
wise statistics that may flatten out regional anomalies. Nevertheless, it is fair to compare, because
the previous years seasonal flu outbreaks also had regional character. For example, in January
2017 the z-ratio increased to 12, the same as in the middle of March 2020. If we assume the
most unfavorable delay in reporting we get z-score equal 18 for late weeks of March 2020. For
Italy mortality data, z-score 12 corresponds to about 40% increase relative to the yearly average
of 12500 deaths / week; z-score 18 corresponds to about 60% increase. It means that in January
2017, Italy had to handle about 17,500 dead per week, and in March 2020 they had to handle
20,000 dead per week [17, 16].
The raw mortality increase does not explain why the crematoria are overwhelmed in 2020 and
why they were not three years earlier.
We need to understand the background first and look for the mediator variable then. Cremation
in Italy became fully legal and made equal to the burial only in 1987. Such late adoption was the
result of the Catholic Church influence that was in strong opposition. Cremation popularity reached
15% in 2012 nationwide, but it is still one of the lowest ratios in Europe.
The numerous reports reveal the following:
1. The government has put a stop to funerals and religious ceremonies. There is no ban on
burials, but often there is no such possibility, because many funeral homes have closed for
fear of catching the virus by staff. The ones that remain open are no longer able to manage
the high demand for the service.
2. Since February 2020 Italian authorities increasingly recommend cremation over burial [6]
3. During the coronavirus crisis, more families are choosing cremation over burial, for fear of
catching the virus from the dead.
The initially low cremation popularity in Italy explains the lack of proper infrastructure. There
were not enough crematoria to handle the sudden increase in cremation needs. This increase was
caused by the government decisions and overall state of fear that changed the behavior of the
relatives.

This example of mediator variable is not all-or-nothing. It does not invalidate the fact that
the actual mortality in Italy increased in March 2020 however the increase was not sufficient
enough by itself to cause the discussed incident. We had to identify a set of mediator variables
to explain why crematoria are overwhelmed and why it required using military to transport coffins.

Specific claim

The new virus caused hospitals overload.

10
 As of March 2020, in many parts of the world hospitals are overwhelmed with patients and
suffer from inadequate staffing and supply shortages. The medical staff is extremely tired, working
long hours and is struggling to get enough protective equipment.
This dire situation cannot be explained only by the sudden surge in cases of severe pneumonia.
By itself, it wouldn’t be enough to put some hospitals to a stress. There are many other factors
that contributed.

1. Lower hospitalization thresholds

In most cases coronavirus infection symptoms are mild. The particular attention to this
single illness lowered admission criteria to hospitals in the unprecedented way. Mild cases
are also hospitalized.
Hospital beds are also being used to quarantine healthy people returning from abroad [42, 39].
Most patients are elderly with multiple underlying conditions. Unless the present-day un-
healthy excitement over very common symptoms, these people would be passing away sur-
rounded by families in homes, hospices and elder-care facilities. Now, in the state of unwar-
ranted emergency, they are being pulled out from the nursing homes, hospitalized, treated
like lepers and die afraid, alone and isolated.
Over a few weeks, the hospital admission criteria have dramatically changed. It is not
directly caused by the new disease, but it is a result of new policies, health organization
recommendations and overall public focus and fear.
Normally the above cases would never consume health care system resources.
2. Medical personnel quitting for fear of infection
Severely exaggerated mortality rate repeated by health authorities and overall contagious
anxiety amplified by the media made many health care workers to quit a job as a way to
protect themselves and their families.
Also with the lockdown, schools and childcare facilities closed, some had no other choice than
to quit a job and take care of children themselves.
3. Supply chain of medical equipment disrupted by lockdown
Despite the medical supplies being exempted from the government restrictions, the general
disruption of transport and logistics caused that they are not reaching hospitals [40, 49, 19].
4. Panic shopping drained the medical supplies
Declaring a state of emergency led to stocking masks and gloves by citizens. In many cases,
health authorities recommended buying face masks and gloves in excess by everyone. It led
to depleting supplies and shortage for medical personnel.
5. Harassment of health care workers
Health care workers who remained at their posts are praised by authorities for their dedication
and sacrifice. There is another side to the story though. The same authorities, by overstating
the deadliness of the new disease and repeating claims unsupported by evidence, incited panic
to the level that citizens worry about coming into contact with health workers and contracting
disease. There are reports of discrimination and attacks on medical staff. They are being
evicted by landlords, refused rides on buses and dispirited by insults [28, 21, 24, 2, 20, 44].
6. Special safety precautions, the extreme measures that make the simplest things difficult
In particular, medical staff complains about excessive new procedures that were never needed
before. Whenever a single coronavirus case is detected the entire hospital ward must be
isolated, what disrupts normal operation.
7. Health care workers strikes over hazardous working conditions
The resulting shortages in protective equipment, the hastily imposed changes in hospital
procedures caused strikes by medical staff [4, 8, 50].

11
 All these factors let us better understand what happened.
The media, health organizations and general public fixation on one topic, the resulting insecurity
and the aura of looming disaster ensued disproportionate response that disrupts normal operation
of hospitals more than the inflow of new patients.
We can see more clearly the mediator variable now.

• Obsessive focus on a single pathogen caused the change of people’s behavior and rules, the
overall disruption
• The disruption contributed to health care system overload

Specific claim

The virus caused a disaster in Ecuador, where corpses are lying on the streets and 450 bodies were
registered on the waiting list to be removed from the houses [10, 3].

Undoubtedly the situation in Ecuador is critical, but what is the cause?

In statistics, there are a few methods of checking if the hypothetical variable is valid. One of
them is to forget about the original cause and test if the last link in the chain makes sense. For
the Aztecs reformers, it would be helpful if they hadn’t noticed the eclipse and looked at things
happening on Earth as they really were.

Let’s do the same in 2020 and imagine we know nothing about the virus or pandemic. We are
looking at Ecuador, the country inhabited by 17 million people with average death rate 5.2/1000
(2020 estimated) which gives 88,400 deaths per year or 242 deaths per day.

Imagine that one day the government decided that non-essential activities are to be stopped,
by a decree made public services dysfunctional, introduced the curfew, and made funerals effec-
tively banned. Additionally the government found some reason to incite fear and panic, endorsing
alarmist claims about some unfathomable danger, with prime minister advising ”not to have a
false sense of security, because everyone can get it” [27] and the president threatening anyone who
leaves home with 3 years of jail [25] The police backed his words by arresting over 1,500 people for
breaking the curfew and scaring the population to the level that people are afraid to do anything,
touch anything, and the last thing they might want to do, handle the bodies of their deceased
relatives [9]. This is exactly what happens in Ecuador since March 12th when the government
entered the scene with new legislation. What kind of output should we expect two weeks later?
How Ecuadorians are supposed to deal with the deceased? What other thing can they do than to
leave the coffins in the streets?

The mediator variable here is the government actions which are the real cause of the crisis. If
anyone thinks that the cause of actions of Ecuador citizens can be traced back to coronavirus, then
rightfully it may also be traced back to solar eclipse or Big Bang.

2.8 Nosophobia
Nosophobia is an irrational fear a specific disease that leads to obsessive behaviors. What differ-
entiates it from hypochondria is that the individual doesn’t think they are sick at the moment.
Nosophobes are very attentive to their diet, pollution, radioactivity, electromagnetic waves, etc.
They are vigilant in preventing any possibility of contamination, they take extreme measures to
avoid contact with germs, and are fascinated by the field of medicine. Their lifestyle is guided by
a desire to live in a sanitized and safe world.
Nosophobia has been described over 50 years ago and was frequently reported in medical stu-
dents, who perceive themselves to be experiencing the symptoms of a disease that they study.

12
Students who learn ”frightening diseases” for the first time routinely experience vivid delusions of
having contracted such diseases.
In the past, this psychological condition was limited to medical students because information
about most diseases was not easily available to the general public. In recent years, it became
widespread and exacerbated by an easy access to health information on the Internet. Nowadays
everyone can find a description of symptoms and complications associated with any disease online.

Specific claim

It’s not possible that the fear by itself had such tangible consequences. How could people’s state of
mind have the devastating effect on the health care system?

Even during non-crisis time, nosophobia had a huge detrimental effect on the health care system.
In September 2018, researchers from Imperial College London concluded that nosophobia is leading
to a health anxiety epidemic in the UK.
According to the authors, 20% of appointments at the UK’s National Health Service were
related to internet-induced irrational concerns. The study estimated the costs to the public health
care system of such visits to be at £420 million per year ”in outpatient appointments alone, with
millions more spent on needless tests and scans”.
The access to medical information on the Internet is feeding a ”silent epidemic” of medical
anxiety, and the fear of contamination can lead to ”mass psychogenic illness” in which people
avoid things like gluten, sugar, planes, or windmills simply because others do.
The excessive use of Internet medical sites fuels health anxiety and it is not hard to imagine
the effects of this condition when amplified by the alarming and by an order of magnitude wrong
estimates by health authorities and round-the-clock media coverage of one specific disease.

2.9 Zero-risk bias

Zero-risk bias is an irrationally strong preference for situations with absolute certainty. People
prefer one particular risk being eliminated instead of merely mitigated, even at a high price and
increasing other risks.
Most of risks cannot be reduced to zero, but people tend to overweigh the value of certainty
in comparison to very small risk and are ready to pay a lot for solely the reassurance of complete
safety, even if the promise of safety is unfounded.
Businesses often take advantage of the zero-risk bias. Customers are willing to pay a high
premium to sign the allegedly ”risk-free” contract that gives them all possible guarantees, forgetting
that the major risk of impossibility to enforce the contract remains.
Another example from the corporate world is the usually detrimental decision to eliminate risk
in one manager’s department at the expense of increased risk for the larger organization.

Specific claim

I understand that the virus is not as dangerous as they paint it, but I want to be sure that I’m safe,
so I expect the government to deal with it at any cost.

Zero-risk bias is especially harmful on the line of citizen-state interrelation. It often manifests
itself in cases concerning health, safety, and the environment where decision makers are urged to
resolve a specific problem to its complete eradication instead of mitigation. Usually the popular
demands to further reduce the risk can only be harmful. Unfortunately the decision makers un-
dergo pressure. Otherwise, they are lambasted for inaction.

We will never live in a sanitized world, nor is it a healthy objective. The risk of infections
cannot be eliminated. It can only be minimized by systematic policies, preparations, steady devel-
opment of vaccines, better control over pharmaceutical companies, recommending basic hygiene,

13
strengthening the immune system by balanced nutrition, exercise and getting fresh air and sun-
shine. Sadly, the consistent and reliable implementing these policies is not as spectacular as making
prominent decisions about the lockdown, which achieved the opposite effect. The impulsive and
reckless decisions by the leaders who were expected to give the impression that ”there is someone
in charge who is taking care of it” left people stranded at homes, with essential needs unfulfilled,
with no access to basic services, all these things detrimental to people’s immune systems.

In the Middle Ages it was believed that the ringing of church bells would disperse evil spirits,
drive away infections and avert the lightnings. There are various theories on the origin of this
belief, but it also goes in line with people’s expectation for conspicuous action from authorities.
Centuries ago these unnecessary actions like ringing the bells during the plague could only
give people a headache. Nowadays the governments are more powerful. The demand for salient
response by authorities can bring about much worse damage.

2.10 Focalism
Focalism is a cognitive error that makes people focus too narrowly on a single event and neglect
the extent to which other, nonfocal events affect their lives. It happens when feelings are driven
by a single concern in current focus and not the complexity of events we experience. As a result
a person neglects other important considerations, cannot make proper judgments and predictions,
objectivity and balance are lost.
Focalism is easy to develop even by very rational and intelligent people. Extreme focalism may
lead to persecution mania and conspiracy theories.
The special version of focalism is anchoring which occurs when a person depends on an initial
piece of information (anchor) to make subsequent judgments. Once the anchor is set, all future
negotiations, arguments, estimates, are discussed in relation to the anchor.

Specific claim

I start my day with checking new cases statistics. I’m 23, but I know that I’m not safe at work.
Coronavirus kills young and healthy people too. I have to quit my job.

Monitoring statistics might be just an unhealthy habit on a par with compulsive email checking
or gambling on the performance of the favorite sports team, unless it affects the ability to evaluate
the risk.

In this case a person focuses on one danger, to the exclusion of all else. Rough calculations
indicate that for the age group less than 40 years old, a fatal case of coronavirus is less likely than
being diagnosed with terminal cancer within a year. The person gives too much weight to one par-
ticular piece of information, and at the same time ignores long term consequences of quitting a job.

Specific claim

No matter how severe the outbreak is, it’s better to prevent. The lockdown may be inconvenient
and painful, but any countermeasure is justified to save peoples’ lives.

A rational person understands that prevention is needed and must be balanced.

First, we need to ask ourselves why we want to prevent this particular danger and not the
thousands of others that may be more likely to happen. Usually the danger in focus is not the one
we should be most afraid of. The evidence shows that the coronavirus threat is real, but it’s tiny
comparing to other dangers we face every day. It’s especially difficult to keep the balanced view
when the mass hysteria about one threat reached the level, that permeates all spheres of life. The
continuous exposure to media coverage and emotional contagion from the peers is the reason we
consider taking preventive action against one particular disease to the exclusion of everything else.

14
 Second, we need to consider what will be the consequences of disproportionate preventive
measures.
We already demonstrated that the health care system overload, to a large extent, was caused
by the preventive actions and not by the unusual virulence of the disease.
Other consequences of the lockdown are already noticeable:
• home violence, women stranded at homes with oppressors

• mental health issues

• no access to health care services for people affected by other diseases
• lack of children’s education and resulting video game addictions
• unemployment being also a great threat to public health

• bankruptcies and recession

• increased suicides
• political instability and social unrest
• disruption of normal life on every level

Severe restrictions like prohibiting travel, locking universities, introducing the curfew were
normally associated with extreme dictatorship and would be unacceptable unless labeled as coun-
termeasures to the one thing that is in the spotlight.
The resulting actions are radical and reckless. It’s hard to find logic or any long-term thinking
in the lockdown. We cannot stop the nature from evolving. The viruses mutate all the time and
the new ones of similar virulence may appear every month. Is the world going to be put to a halt
forever then?

The reaction of the authorities recalls the picture of a child who found itself in the middle of
the thunderstorm and being afraid of getting wet hides under a tree and ignores the more deadly
risk of being struck by lightning.

Focalism fueled by fear is so harmful because it makes people hold unbalanced views, distorts
judgment and leads to radical actions. Because a single danger is in our focus we ignore the harmful
effects of an overreaction when evading it.

Specific claim

People who are HIV positive are of greater risk of complications and dying of coronavirus.

We are not going to prove or disprove this claim. To demonstrate the fallacy, it’s enough to
change the order in the claim:

People who are coronavirus positive are of greater risk of complications and dying of HIV.

This is an example of anchoring and it is important to understand how it affects the classifica-
tion of fatal cases and statistics. Because the anchor ”the new deadly disease” is initially set, the
further judgment occurs in relation to this anchor, including the way we determine cause of death.

2.11 Single cause fallacy

Single cause fallacy also known as oversimplification is the assumption that there is a single, simple
cause of an outcome when in reality it may have been caused by a number of multiple causes. One
factor stays in focus, while other possibly contributing causes go undetected, are ignored or are

15
minimized.

Specific claim

The nursing home resident had many underlying diseases, but died of coronavirus.

In many cases we actually don’t know it. The reports from Italy and other countries state that
the clear criteria for the definition of COVID-19–related deaths are not available [45].
The uncertainty arises not only from the lack of criteria or data. The difficulty of determining
the cause of death is more fundamental. When multiple chronic diseases are involved, the cause
of death is often a compound of many factors. The physician filling the death certificate must
choose one. It is a frequent but necessary oversimplification. If there are multiple possible causes,
selecting a single one is a subjective choice that depends on the current focus.
We should be particularly aware of this inaccuracy and uncertainty in the context of coronavirus
crisis, because most of the fatal cases had multiple other conditions.
According to the report from Italy’s National Institute of Health released on March 17, 2020,
99% of COVID-19 patients who have died in the country had at least one preexisting condition
and nearly 50% had three preexisting conditions. Specifically 76% had hypertension, 35% had
diabetes, 33% had heart disease, 25% had atrial fibrillation, 20% had active cancer in the past five
years, 18% had chronic kidney disease, 13% had chronic obstructive pulmonary disease, 10% had
previously had a stroke, 7% had dementia. [45, 1]

Additionally, prior studies from many countries indicate at least 25% misreported causes of
death on death certificates [31, 18]. In this context it’s important to realize what happens today
and how it affects diagnosing the cause of death.

Let’s imagine a typical case, the 85-year old patient with a long history of heart, kidney and
pulmonary diseases who had tested positively for coronavirus and stopped breathing. The reports
confirm that nowadays it would be classified as COVID-19 related death. Before 2020, no coron-
avirus tests have been made in such situations, and the physician filling the death certificate was
choosing one of the chronic diseases as the cause. They could keep the thought like ”some common
cold virus only worsened the condition” to themselves.

All the above shows how the single cause fallacy combined with focalism distorts the statistics,
although we don’t know to what extent.

2.12 Law of truly large numbers

The law states that with a large enough sample, any outrageous (unlikely) thing is likely to happen.
Because we never find it notable when likely events occur, we highlight unlikely events and notice
them more.

Specific claim

We cannot wait for herd immunity. Coronavirus is a danger not only to the elderly population.
On March 31st, 2020, the BBC reported that a 13-year old boy who tested positive for coronavirus
has died [5].

Apart from being an example of media sensationalism and argumentum ad misericordiam this
is an example of the law of truly large numbers.
What the media reported is very sad. Moreover, it is sad that over 100 other 13-year old boys
died the same day [14]. It is likely that a few of them died of influenza-like illnesses. What makes
this boy different is that he was unlucky to be tested positive for coronavirus, so his death made
the breaking news on the BBC.

16
 It is the state of mind and prior interest of the readers that incentivized BBC to make a good
story of the death of the poor immigrant Muslim schoolboy, whom the mainstream media wouldn’t
even touch with a ten foot pole if he died not of SARS-CoV-2 but of influenza or other so-called
”mild coronavirus”.

2.13 False authority

False authority is the misconception that a perceived authority must know better and that the
person should conform to their opinion.

Specific claim

”COVID-19 is a new virus to which no one has immunity”

”Only 1% of reported cases do not have symptoms”
”Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu gener-
ally kills far fewer than 1% of those infected”

Tedros Adhanom, WHO Director General

March 3rd, 2020

These claims are blatantly wrong. We know it now and we had enough data to know it at the
beginning of March 2020.
It is outside of the scope of this article to explain the motives of this egregious disinformation,
so we can only provide a few pointers for individual research.
World Health Organization was established in 1948 as a noble effort to guide nations in ensuring
the highest level of health of the world population. It was initially funded by member countries,
but in 1980s the structure has changed and currently over half of the funding, in the informal way,
comes from private donors, notably from the pharmaceutical industry.
Over the last 20 years it became one of the most corrupted subsidiaries of the United Nations
and for the attentive observer, it completely lost its credibility in 2017 by electing Tedros Adhanom
as a director general, the first in the organization history not to be a medical doctor (although
Tedros Adhanom insists on calling him ”Dr Tedros”). Incompetence is a trivial objection in com-
parison to the new director’s horrifying biography that was partially rewritten by Mercury Public
Affairs, a US-based lobbying company hired by Mr Tedros.

Although apparent experts are supposed to give legitimacy to an argument, authority has no
place in searching the truth. We should always ask for evidence. One should especially beware of
false authorities that used to be true authorities in the past.

2.14 Bandwagon effect

Bandwagon effect refers to people’s propensity to do something because other people are doing it
regardless of whether it aligns with their original beliefs and regardless of the underlying evidence.
When it seems that everyone is doing something, there is a tremendous pressure to conform.
Part of the reason people conform is that they look to other people in their social group for
information about what is right or acceptable. The need to belong pressures people to adopt the
norms and attitudes of the majority to gain acceptance and approval from the group. The rate of
uptake of beliefs, ideas, fads and trends increases the more that they have already been adopted
by others. Once the trend gains momentum it becomes the subject of communal reinforcement;
the idea is repeatedly asserted and turns into a strong belief until it is regarded as fact.
The bandwagon effect can be very detrimental. The notable example is creation of market
bubbles.
Medical bandwagons have been identified as ”the overwhelming acceptance of unproved but
popular ideas” and described already in 1970s [41]

17
 When certain ideas begin to take hold, such as particular attitudes toward health issues, band-
wagon beliefs can have serious and damaging consequences.

Specific claim

”I think the 3.4 percent number [mortality rate] is really a false number. I’d say the number is way
under 1 percent [15]”
Donald Trump, March 7th 2020.

”Even with the social distancing the US is doing now, a quarter of million Americans will likely
die as a result of the ongoing outbreak [29]”
Donald Trump, March 31st 2020

This example may be controversial because the quote comes from one of the most dividing
political figures of our times. Let’s suspend personal sentiments and have a look at how the
president’s attitude has changed between the beginning and the end of March 2020.
Mr Trump is the last person who can be accused of conformity, yet after initial strike of common
sense intuition, he succumbed to public pressure and changed his view from healthy skepticism to
unsound fatalism.
However, this example has an individual touch. It would be naive to think that he actually
abandoned his original belief. It’s rather the instinct for political survival prevailed and Mr Trump
realized that the truth is less important than political gains and losses. Ultimately no one is likely
to lose support for being too tough on coronavirus.

Bandwagon effect is often explained as having its roots in peoples’ inherent social instincts,
the need for peer approval or animal-like herd behavior. In this context, Mr Trump example
is particularly interesting because it shows that the elaborate anthropological explanations are
not necessary here. Once the movement reaches critical mass, even the most nonconformist ratio-
nal actor may hop on the bandwagon of nonsense as a result of a pragmatic and calculated decision.

2.15 Groupthink
Groupthink is a tendency among members of the group to agree at all costs. The desire for harmony
or conformity in the group results in an irrational or a dysfunctional decision-making outcome.
Similar to the bandwagon effect, it makes people adopt beliefs of others. Groupthink is different
in two aspects.
First, the source of groupthink lies in the desire for cohesiveness. It aims to minimize conflict
and reach a consensus without critical evaluation.
Second, groupthink generates additional pressure on the members of the group. It requires
individuals to avoid raising controversial issues or alternative solutions. It may also produce
dehumanizing actions against the ”outgroup”.
Groupthink creates an atmosphere of mob derangement, where any skeptical view or doubt
is seen as an attack on the dogma, dissent is sidetracked, questioning is diverted into conspiracy
theories and rational discourse is not possible anymore.

Specific claim

Almost all countries are on coronavirus lockdown, with severe restrictions on movement and harsh
penalties. Except Sweden. They are going to suffer for not imposing lockdown. World Health
Organization (WHO) demands the Sweden government must be stricter and increase measures to
control spread and ensure physical distancing.

This is an example of groupthink on the level of governments and organizations.

Almost all countries adopted draconian restrictions. Most of them without evaluating pros and
cons. Other factors played a role instead:

18
 • relying on the authority of other organizations

• trust that governments of other countries know what they are doing
• the belief that ”you are not wrong if everyone else is equally wrong”
• overall fear and citizen expectation demanding action
• the belief that ”no politician has been jailed for too much precaution”

Sweden took a slightly different approach to handling the situation. As a consequence, it experi-
ences critique and pressure from outside. Such intolerance to alternative solutions is characteristic
to groupthink. The desire for cohesiveness is so strong, that despite having no vested interest,
other governments and organizations try to persuade Sweden government to change the policy.

The reason Sweden is immune to groupthink can be found in the structure of its Public Health
Agency. It is an independent organization protected from political interference. No government
minister oversees the agency, so it has the autonomy to make informed and balanced decisions
without being a subject to populist pressure. [26]

Specific claim

Social media platforms need to take a more aggressive stance on coronavirus misinformation.

Content moderation is necessary for civil discourse on the Internet. Without moderation any
medium that allows user contribution deteriorates into a ”troll feast”, attracting users who are
unable to contribute and only need to feed their ego by posting anything that spreads. A single
Internet troll may convert a constructive discussion into the inflammatory stream of emotional
responses. As a remedy there must exist clear rules to filter out irrelevant, harmful, or insulting
content.
There are decades of experience on how to moderate content in the online communities. Over
years social media platforms developed the rules and guidelines that worked reasonably well and
were tested in the field in many discussions including controversial topics.
There is no reason to believe that these rules are not adequate or applicable to one particular
topic.
Yet, in March 2020 social media platforms were obliged to expand content moderation rules to
include specific guidelines around coronavirus. They were aimed to reduce the information noise
and clear the Internet from ”crackpot” theories. The problem is that, along the way, the new
rules threw the baby out with the bathwater and eliminated the possibility to express doubt or
skepticism.
As an example Twitter broadened the definition of harm ”to address content that goes directly
against guidance from authoritative sources of global and local public health information” and
decided to remove the content that includes ”denial of global or local health authority recommen-
dations to decrease someone’s likelihood of exposure to COVID-19”.
Additionally Twitter introduced ”COVID19 verified accounts” endorsed by global public health
authorities. Content from verified accounts is prioritized over regular accounts for COVID-19
updates.
It means that a user who would like to discuss or question government policies is at the risk of
removal and the content representing the view that is not in line with authorities will be ”depri-
oritized”.
Other social media platforms were even more specific and announced that they do not accept
the content that downplays the severity of a global pandemic.
Simply put, the dogma has cemented and the guards of the dogma have been assigned. This is
the hallmark of the late stage of groupthink when the desire for cohesiveness is so irresistible that
censorship must be implemented.

The censorship is particularly dangerous here. Critical decisions have been made based on
the information about the 3.4% high mortality rate from global health authorities, which was so

19
obviously wrong that it left many commentators speechless. Now they are speechless for a different
reason. By simply raising doubts about the validity of information, they risk being labeled heretics.
Now the devotees got another tool to silence them.

2.16 Conspiracy theory

A conspiracy theory is an explanation of an event or situation that invokes a conspiracy by sinister
and powerful actors.

Specific claim

Who created the virus? Who incited panic? Who stands behind?

Conspiracy requires a grand plan, coordination, secrecy and a competent entity behind. It
is complicated and difficult, so we could end speculations of this kind by using Occam’s razor.
Elaborate constructions with lots of assumptions are not necessary to explain the situation when
a simple explanation is possible.
Trying to demonstrate why one or another theory is unfounded is usually a waste of time be-
cause the tendency to follow conspiracy theories is often linked to a serious psychological condition
of the person pursuing them. To the individual captivated by the conspiracy idea, no logical ar-
gument is able to dissuade from speculating.

Instead, let’s try to understand why people are looking for malevolent agents and so often ask
”who is behind?”.
Pursuing scientific knowledge and understanding complex systems is relatively new in the his-
tory of human evolution. In prehistoric times, human life revolved around dangerous animals,
hostile tribes and ferocious hunters. Identifying a threatening or friendly agent was critical to
human survival. Understanding the phenomena, mechanisms, and laws, although useful, was sec-
ondary to differentiating between friend and enemy. The savage life was too short and fragile
to make it possible to use systematic knowledge. Natural selection favored answering the ”who”
question over ”how”.
Also the validity of these two questions depends on the scale. In the scale of a tribe, village or
even a small town, if a cow disappears from the shed, it is reasonable to ask ”who stole the cow?”.
When we analyze complex global systems, asking ”who” is no longer justified because thousands
or millions of interacting actors are involved. In such context, it is more important to ask ”how”,
to understand processes, mechanisms and dependencies.
Asking ”who” and looking for intentional agency is a part of the primitive religious instinct and
is deeply woven into human mental fabric. Whenever we see a person that holds beliefs that call
upon a supernatural being or pursues a conspiracy theory that invokes a sinister actor or merely
attributes intentional agency to a machine or a robot, it’s the remnants of the troglodyte brain in
action.
It is also worth to make the general observation on how futile conspiracy considerations are.
Conspiracy requires secrecy and it leads us to the conspiracy paradox:
• if the conspiracy is successful, we will never find out, because secrecy was kept efficiently
• if the conspiracy is not successful (secrecy was broken), it is no longer conspiracy

In the context of intricate social systems, reasoning in terms of a single cause or single agent
requires a lot of unlikely assumptions and is usually an error. Complex phenomena can only be
reasonably explained by natural laws, mutual connections, incentives, interactions and dependen-
cies.

What can be the natural explanation then?

At this moment it should be clear that the crisis was caused not by the disease itself, but by
the emotional, excessive reaction to information about it.

20
 Such pieces of information that can propagate and influence our actions can be called memes
by analogy to genes, because they are also a subject to Darwinian evolution. The meme can be
a fact, idea, belief, behavior, anything that makes a good topic for a chat at a cocktail party or
anything that spreads well over the Internet.
It’s worth to change the perspective and imagine civilization as the environment, medium, and
habitat for the memes. Nowadays, more than ever before, our culture can be described as a global
network of interconnected human minds that are transmitters of information. Memes compete for
human attention and take advantage of our ability to replicate them.

What was so special about the coronavirus meme that it was able to replicate to every human
mind on the planet, almost completely consume global resources of people’s attention and prompt
them to irrational, self-destructing behavior?
Our susceptibility to cognitive errors created a fertile ground for memes regardless of whether
they represent a genuine fact or a lie. There exists an infinite number of possible memes and the
coronavirus meme must have individual specific features that made it so successful. As usual, there
is no single factor. The list is long and remains open:

1. Most of the generally shared information about the new virus is true which helps to spread
it.
2. The pieces that are not true (mortality rate, morbidity, asymptomatic case rate) are difficult
to verify in an immediate way

3. It invokes strong emotions. The fear of invisible, mysterious, unknown, unexplored danger
makes it impossible to remain indifferent.
4. The virus can be anthropomorphized and vilified by the journalists who tend to attribute
human qualities to inanimate objects.
5. It satisfies the need for the common enemy. It’s another atavistic human need that unites
people and gives them positive feelings.
6. It takes advantage of the dramatically raising nosophobia, fueled by the easy access to medical
information.
7. The virus related information could be accompanied by computer animations and visualiza-
tions that further imprinted it on people’s minds. Visually attractive statistics and interactive
infographics became an interesting form of pastime to many.
8. It has an excellent branding effect. Comparing to previous virus outbreaks, the coronavirus
name, while not new for epidemiologists, didn’t exist in popular mind awareness and sounded
exotic. Previous years ”bird flu” and ”swine flu” memes didn’t spread so well because the
names lacked the novelty. They contained the familiar word ”flu”, what made them less
mysterious and less scary.
9. It takes advantage of the saturation of people’s senses with high quality passive entertainment
delivered by streaming services with the simultaneous increasing demand for the more in-
teractive entertainment like reality game shows, augmented reality games. The coronavirus
meme satisfies the need for exciting news that affects our lives, incites emotions (even if
negative), gives the feeling of being a protagonist in the catastrophic movie.
10. It coincides with the World Health Organization (WHO) becoming faster and more efficient
in alarming about new outbreaks. The WHO helps spreading the meme because the orga-
nization has all the incentives to be overalarmist (and impunity for exaggerated claims) and
no incentive to provide realistic and balanced analysis.

21
3 Conclusion
Identifying cognitive errors and logical fallacies let us better understand the situation and draw
somewhat shocking conclusion.
There is no doubt that the new virus poses a big risk to the elderly. The increase in cases of
severe pneumonia is undeniable. In some regions of the world, the ensuing diseases make hospitals
work at capacity.
Nevertheless the direct global effects of the new disease are comparable to the effects of a
seasonal flu. The truly harmful outcome and the crisis situation come from the public and the
authorities unprecedented amount of attention to it and the resulting decisions. More damage to
public health has been done by unnecessary focus and overreaction than by the disease itself.
No matter how strong we are going to resist this dreary conclusion, the evidence is overwhelm-
ing. We brought the civilization to a halt solely because of the lack of evidence-based rational
evaluation.
As a society, with regard to critical thinking, we are still Mesoamerican Aztecs, who discovered
that solar eclipse leads to mass killings. Unfortunately, instead of replacing fearmongering priests
to cease the rampage, we resort to space engineering to stop the moon from rotating, so that eclipse
does not happen again.

22
References
[1] 10 common health conditions that may increase risk of death from the coron-
avirus, including diabetes and heart disease. [ https://www.businessinsider.com/
hypertension-diabetes-conditions-that-make-coronavirus-more-deadly-2020-3?
IR=T ].
[2] As some health workers get ovations, others come under attack during
coronavirus pandemic. [ https://www.inquirer.com/health/coronavirus/
coronavirus-covid19-health-workers-reaction-applause-harassment-20200408.
html ].

[3] Cadáveres en las calles de guayaquil, tras colapso del sistema sani-
tario de ecuador. [ https://www.yucatan.com.mx/internacional/america/
cadaveres-en-las-calles-de-guayaquil-tras-colapso-del-sistema-sanitario
].

[4] Chicago covid-19 nurse quits over critical lack of personal protective equipment. [
https://www.democracynow.org/2020/4/1/headlines/chicago_covid_19_nurse_quits_
over_critical_lack_of_personal_protective_equipment ].
[5] Coronavirus: 13-year-old boy dies, says london hospital trust. [ https://www.bbc.com/news/
uk-52114476 ].

[6] Coronavirus deaths are so high in italy that some places have a waiting list for burials and
funerals are happening with no family members there. [ https://www.businessinsider.com/
coronavirus-waiting-list-for-funerals-in-italy-coffins-pile-up-2020-3?IR=T ].
[7] cremazione.it. [ https://www.cremazione.it/la-cremazione-oggi/ ].

[8] Doctors threaten to quit nhs over shortage of protec-

tive kit. [ https://www.theguardian.com/world/2020/mar/24/
doctors-threaten-to-quit-over-protective-equipment-shortage ].
[9] Ecuador: 57.000 policı́as se mantienen activos para vigilar el
toque de queda por covid-19. [ https://www.france24.com/es/
20200402-ecuador-policias-toque-queda-coronavirus ].
[10] Ecuador: Bodies of coronavirus victims are on streets. [ https://www.aa.com.tr/en/world/
ecuador-bodies-of-coronavirus-victims-are-on-streets/1791407 ].
[11] European monitoring of excess mortality for public health action (euromomo). [ https:
//www.euromomo.eu/graphs-and-maps/ ].

[12] Field briefing: Diamond princess covid-19 cases. [ https://www.niid.go.jp/niid/en/

2019-ncov-e/9407-covid-dp-fe-01.html ].
[13] Field briefing: Diamond princess covid-19 cases, 20 feb update. [ https://www.niid.go.jp/
niid/en/2019-ncov-e/9417-covid-dp-fe-02.html ].

[14] Global health data exchange. [ http://ghdx.healthdata.org/gbd-results-tool ].

[15] How deadly is coronavirus? what we know and what we don’t. [ https://www.nytimes.com/
interactive/2020/03/07/upshot/how-deadly-is-coronavirus-what-we-know.html ].
[16] Human life table database. [ https://www.lifetable.de/cgi-bin/country.php?code=ita
].
[17] The human mortality database. [ https://www.mortality.org/ ].
[18] Inaccurate cause of death recorded for one in four patients. [ https://www.theguardian.
com/society/2012/aug/10/inaccurate-cause-death-one-four-patients ].

23
[19] Lockdown resulting in drugs, medical devices supply disruption. [ https:
//economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/
lockdown-resulting-in-drugs-medical-devices-supply-disruption-industry/
articleshow/74810847.cms?utm_source=contentofinterest&utm_medium=text&utm_
campaign=cppst ].
[20] Man attacks nurse on cta bus after accusing her of trying to spread covid-19. [ https:
//abc7chicago.com/cta-bus-attack-nurse-punched/6074852/ ].

[21] Medical staff in japan harassed for carrying ‘germs’ after tending to coronavirus
patients. [ https://www.scmp.com/week-asia/health-environment/article/3052274/
medical-staff-japan-harassed-carrying-germs-after ].
[22] National institute of population and social security research, japan. [ http://www.ipss.go.
jp/p-toukei/JMD/00/index-en.html ].

[23] Nipssr, japan, life table. [ http://www.ipss.go.jp/p-toukei/JMD/00/STATS/Mx_5x1.txt ].

[24] Philippine health workers battle coronavirus, harassment. [
https://www.voanews.com/science-health/coronavirus-outbreak/
philippine-health-workers-battle-coronavirus-harassment ].

[25] Por coronavirus, toque de queda en ecuador de 14:00 a 05:00. [ https://www.elcomercio.

com/actualidad/toque-queda-ecuador-coronavirus-covid19.html ].
[26] Sweden’s government has tried a risky coronavirus strategy. it could backfire. [ https://www.
vox.com/2020/4/9/21213472/coronavirus-sweden-herd-immunity-cases-death ].

[27] Toque de queda se amplı́a en ecuador desde el sábado 21 de marzo por 10

horas. [ https://www.eluniverso.com/noticias/2020/03/19/nota/7788777/
toque-queda-se-amplia-ecuador-sabado-21-marzo ].
[28] ’treated like lepers’: coronavirus fears take toll on french nurses. [ https://www.thelocal.fr/
20200329/treated-like-lepers-coronavirus-fears-take-toll-on-french-nurses ].

[29] Trump’s coronavirus death toll estimate exposes his failure. [ https://www.vox.com/2020/
4/1/21202987/coronavirus-pandemic-trump-deaths ].
[30] Un data, deaths by month. [ http://data.un.org/Data.aspx?d=POP&f=tableCode%3A65 ].
[31] A whopping 1 in 3 death certificates list wrong cause
of death. [ https://www.ozy.com/news-and-politics/
a-whopping-1-in-3-death-certificates-list-wrong-cause-of-death/89516/ ].
[32] Worldometers. [ https://www.worldometers.info/coronavirus/ ].
[33] Public health responses to covid-19 outbreaks on cruise ships, March 27, 2020. [ https:
//www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm ].

[34] Bill Bostock. Video shows italian army trucks transporting coffins from
italy’s worst-hit city to remote cremation sites because morgues can’t
cope with more coronavirus deaths. [ https://www.businessinsider.com/
coronavirus-italy-army-transport-coffins-bergamo-morgue-crisis-video-2020-3?
IR=T ].

[35] Julia Brotherton, Valerie Delpech, Lyn Gilbert, S Hatzi, P Paraskevopoulos, and J McAn-
ulty. A large outbreak of influenza a and b on a cruise ship causing widespread morbidity.
Epidemiology and infection, 130:263–71, 05 2003.
[36] Sabina Castelfranco. Surprising reason northern italy crematoria are over-
whelmed. [ https://www.voanews.com/science-health/coronavirus-outbreak/
surprising-reason-northern-italy-crematoria-are-overwhelmed ].

24
[37] cia.gov. The world factbook. [ https://www.cia.gov/library/publications/
the-world-factbook/docs/rankorderguide.html ].

[38] corriere.it. Coronavirus, troppi morti a bergamo: l’esercito porta le bare fuori re-
gione per la cremazione. [ https://bergamo.corriere.it/notizie/cronaca/20_marzo_
18/coronavirus-troppi-morti-bergamo-l-esercito-porta-bare-fuori ].
[39] Sarah Kliff. Kept at the hospital on coronavirus fears, now facing large medical bills. [ https:
//www.nytimes.com/2020/02/29/upshot/coronavirus-surprise-medical-bills.html ].

[40] Ambrish Kumar. Covid 19: Effect of the pandemic on logistics and supply chain. [ https:
//www.entrepreneur.com/article/349420 ].
[41] Henry Rothschild Lawrence Cohen. The bandwagons of medicine. Perspectives in Biology and
Medicine, 1979.

[42] Robert Mackey. An american evacuated from china was quar-

antined on cdc orders. [ https://theintercept.com/2020/02/28/
american-evacuated-wuhan-us-billed-flight-mandatory-quarantine/ ].
[43] Ana Montoya and Lona Mody. Common infections in nursing homes: A review of current
issues and challenges. Aging health, 7:889–899, 12 2011.

[44] Lucia Newman. Health workers harassed and threatened in

chile and beyond. [ https://www.aljazeera.com/news/2020/04/
health-workers-harassed-threatened-chile-200417101234226.html ].
[45] Graziano Onder, Giovanni Rezza, and Silvio Brusaferro. Case-Fatality Rate and Characteris-
tics of Patients Dying in Relation to COVID-19 in Italy. JAMA, 03 2020.
[46] Virginia Pietromarchi. Why is italy’s coronavirus fatality rate so
high?, March 24, 2020. [ https://www.aljazeera.com/news/2020/03/
italy-coronavirus-fatality-rate-high-200323114405536.html ].
[47] Reuters. Military fleet carries coffins of coronavirus victims out
of overwhelmed town. [ https://nationalpost.com/news/world/
covid-19-italy-videos-show-military-fleet-transporting-coffins ].
[48] Timothy W Russell, Joel Hellewell, Christopher I Jarvis, Kevin van Zandvoort, Sam Abbott,
Ruwan Ratnayake, , Stefan Flasche, Rosalind M Eggo, and Adam J Kucharski. Estimating
the infection and case fatality ratio for covid-19 using age-adjusted data from the outbreak
on the diamond princess cruise ship. medRxiv, 2020.
[49] Shruti Srivastava. India shutdown hits medical supply deliveries key in
virus fight. [ https://www.bloomberg.com/news/articles/2020-03-25/
india-shutdown-hits-medical-supply-deliveries-key-in-virus-fight ].

[50] Wikipedia. Strikes during the 2020 coronavirus pandemic. [ https://en.wikipedia.org/

wiki/Strikes_during_the_2020_coronavirus_pandemic ].

25