Dr. Daniel Erickson (on left) and Dr. Artin Massihi of Accelerated Urgent Care in Bakersfield, Calif. express their opposition to California’s stay-at-home order.

According to Dr. Daniel Erickson, co-owner of Accelerated Urgent Care in Bakersfield, Calf., his urgent care clinic has completed 5213 COVID-19 tests, of which 340 (6.5 percent) were positive. He and his business partner, Dr. Artin Massihi, during a press conference, further say that 12 percent of all California COVID-19 tests have been positive. And here is where they make their FATAL FLAW in their methodology. 

They extrapolate that finding (12 percent of those tested were positive) and conclude that 12 percent of the California population is positive. That assumption is flawed and doesn’t even make common sense. 

The problem here is known as SAMPLING BIAS in Epidemiology. The patients tested are NOT a represented sample of the general population. They had symptoms that prompted testing. Their findings cannot be generalized to the general population. It’s the equivalent of trying to estimate the average weight of Americans by measuring the weight of individuals visiting a weight loss clinic. 

Based on this flawed assumption, they conclude that 4.7 million Californians have had COVID-19 and use that figure in the denominator of their fatality rate. They incorrectly figure the case fatality rate as 1400/4.7M or 0.03 percent. This false claim of a minuscule fatality rate is why they are getting attention. 

Erickson clearly does not understand the problem with sampling bias as he goes on to try to estimate the population prevalence from the proportion of positive tests in New York State, the USA, Spain, Sweden, and Norway. 

He correctly points out that physicians take classes in microbiology, molecular biology, and immunology. Medical training also includes basic epidemiologic principles, among which this is about as basic as it comes. 

To give you an idea of how implausible a fatality rate of 0.03 percent is, let’s look at New York City. NYC has a population of 8.4M and has experienced 12,500 deaths. If you make (the incorrect assumption) that everyone in the city has had COVID-19, you get a fatality rate of 0.14%…nearly five times the fatality rate of Dr. Erickson’s California calculation. 

Now, since we assumed that EVERYONE in the city was positive, this gives us a floor rate. The rate cannot be any less than 0.14 percent. Of note, the case fatality rate of influenza is about 0.1 percent. So, the absolute floor case fatality rate of coronavirus is greater than influenza.

As I have stated before, I do not know if it is safe to open things up or safer to keep things locked down. While there is evidence to support each argument, I lean toward the latter. 

However, Dr. Erickson’s evidence is complete FICTION. He is entitled to his own opinion, but not to his own facts. You can’t just make stuff up. YouTube keeps removing his video for violating its terms of service. Now, I have mixed feelings about this. I feel that YouTube, as a non-government business, has the right to make decisions on what they host; removal of content does not constitute a violation of constitutional rights, as I understand it. That said, I don’t favor removing opinions from the public discourse. 

It’s less clear to me what to do with demonstratable false claims, which may have a significant public health impact. Although I may not agree entirely with its removal, YouTube is trying to remove FALSE information, not UNPOPULAR opinions. 

Side note, they repeatedly point out that they are in a better position to know what is going on because they are seeing patients, unlike those epidemiologists in an “Ivory Tower” who have not seen patients in decades. I am a Pulmonary & Critical Care Physician and Epidemiologist. I am writing this at the end of my shift, seeing patients in a COVID ICU.

18 comments
  1. You obviously didn’t watch the video at all. Even your first assumption is wrong. They DO NOT say that there are only 12 percent infected because of the number of positive tests. Watch the video again and comment on what is really important.

    1. I watched it, and watched it again after your comment, and yes they did. I suggest you rewatch it.

  2. Thank you for writing this. Thank you for your attempt to make sense of the doctors information. I appreciate all you are doing to help those in need.

    1. Oh hilarious, yes the pulmonary & critical care physician and epidemiologist who is an assistant professor of medicine at the University of Nebraska doesn’t get it, but you do. The guys who misinformed are the two physicians in the video you support because if confirms what you likely believe.

      Unfortunately, it’s completely false. Anyone with any familiarty with statistics could tell you what they were doing was flawed. Dr. Krutsinger doesn’t even go into their statement about the immune system, which is also problematic.

      Then you have this statement from the American College of Emergency Physicians which was brutal. I’m sure they don’t know what they are talking about either. They’re “misinforming” I’m sure.
      https://www.acep.org/corona/COVID-19/covid-19-articles/acep-aaem-joint-statement-on-physician-misinformation/?fbclid=IwAR1AwrfH8JsCzuboHMYofU5ThuqFgiW0Kxrknpi0VTlU6mvXfykPYo1qjsI

      Why would Dr. Krutsinger and the ACEP do that? What do they gain from that? Absolutely nothing. You can believe we shouldn’t have shut the U.S. down over COVID-19, but make reasonable arguments, not arguments based on poor science and bad math. There are arguments to be made. Embracing arguments like what this viral video represents just undermines the message.

  3. That’s why people should be able to watch the video for themselves and make their own judgements. There are a lot of mathematicians out there who can do the figures too. Leave the video on you tube with a disclaimer if they wish. This is crap that we have to hear from others opinions and we, the people, can’t see the video again!!

    1. There is a link where you can watch the video in the article. You can still find it on Facebook.

      Math and statistics don’t care about your judgment or opinion. It’s either right or it’s wrong. In this case, it is wrong.

  4. Well, if you are going to quote statistics, you better begin with the correct numbers. New York City does in fact have about 8.5 million people, but the Metro area has closer to 20 million. The Bronx, queens, Manhattan etc. are not part of the 8.5 number. The 12,900 plus deaths reported in NYC are the entire metro area, not just the city proper. As of today, we have about a .06% fatality baseline number assuming all are infected. Now obviously not everyone is infected. From everything I’ve looked at, areas of dense population have a probable infection rate of 20-25%. Less dense areas have about a 10-15% infection rate. These numbers seem to pop up and reoccur in everything I see from “experts”. Clearly there a lot of people who have been infected and show no or very minimal symptoms. Knowing how long this disease has been spreading and how infectious the “experts” tell us it is, I see no way that NYC does not have an infection rate close to the 25% if not more. That said, even if you apply only 20% infection rate to the entire city, you have a death rate of about .32%.
    For the record, I have not watch the video yet by the two Urgent care Doctors, but I thought it fair to point out that they may not be the only ones using bad numbers…..

    1. Sorry, I’m not using bad numbers.

      The (currently) 12,571 deaths in NYC include deaths in the 5 boroughs only:
      https://www1.nyc.gov/site/doh/covid/covid-19-data.page?fbclid=IwAR3D2HA0zhArF6WUDoFrQYFglerqthtOr1HDZsGWz1XP3xvs_ppBE3ClIkY

      Those 5 boroughs have a population of 8.4M:
      https://www.census.gov/quickfacts/fact/table/newyorkcitynewyork,bronxcountybronxboroughnewyork,kingscountybrooklynboroughnewyork,newyorkcountymanhattanboroughnewyork,queenscountyqueensboroughnewyork,richmondcountystatenislandboroughnewyork/PST045218?fbclid=IwAR0Ayb8IwYsSn9A4tTZfQzevxbfK-p0QdFhi8lm6YxNni-Cs1Sr-9NoqcSU

      So the correct math is 12,571/8.4M = 0.15

      Slightly different than the article, but using today’s numbers. I’m using the same 5 boroughs for both the deaths and the total population. You are not…you are using bad numbers.

      1. Everyone is worrying about numbers but the Doctors made some good points about quarantining the sick. So why would the NY state Dept of Public Health let sick people into a nursing when they are the most vulnerable population.? Why weren’t the homeless quarantined first instead of letting them sleep in the subways ? Why can’t somebody go surfing in Orange County California but the homeless are left on the street ?

      2. Doctor am I doing the math wrong? To get to your quoted number do I divided 12,571 by 8.4Mil? If yes is not the answer .001497?

      3. 0.15 percent

        The article says percent, I forgot to add the percent in the comment.

  5. Yes. There is a lot of bad math and misinformation in the video, but that doesn’t stop other uploaders from posting the most irrational, hateful or dangerous material. It may be possible that Erickson’s last statement is the one that actually got the video removed: At minute 1:08:00 Dr. Erickson talking about the lack of ammunition for him to buy says, “…if you stomp on our freedoms, that has one ending. And it’s violence.” It’s an unambiguous threat. There may have been many complaints. And 5million views can generate a lot of coin, so Google, as a private business, can take down any video that they don’t agree with, as you say.

  6. You can’t escape the fact we are destroying ourselves to protect a tiny percentage of the population. Dr Erickson points this out. Everyone has an opinion, but common sense says it’s time to go back to work.

    1. That’s an argument certainly, but it doesn’t change the fact Dr. Erickson’s math was wrong.

  7. To Shane Vander Hart:

    What an ego trip you’re on trying to prove somebody wrong so you can look good, certainly not an attitude worthy of respect!

    The whole point is that this lockdown is destroying lives and the economy and it needs to end NOW, so you can put Dr. Erickson down all you want but he’s RIGHT about that, end if story!

    1. I am not on an ego trip and, BTW, I did not write this article. I understand what the lock down is doing AND I support opening things back up.

      A faulty argument is a faulty argument.

  8. I don’t think the doctors were perfect in their presentation but I think they have been treated extremely unfair in the media and articles like this. Facts are meaningless without context. New York and California are very different places with many different variables ie, density, weather, etc. Not to mention that one possible variable not mentioned in your article is that scientists are saying there are at least 2 strains of Covid-19. Could it be that New York and California have different strains? If so, would that not allow for both the doctors to be correct. You also failed to mention that the doctors didn’t just test incoming patients but also employees who were required by their employers to get tested before returning to work. I’m not sure if they stated it in the original video but they have definitely mentioned it since the controversy around them has picked up. Either way, that makes your self selection argument shaky. Furthermore, as time is passing and there is more testing, their numbers seem to be holding up quite well. It seems that populations around the world are reporting an infection rate between 10-20%. (Which should have been easier to find with all the Covid 19 reporting and testing going)The latest numbers out of GA where I live is around 13%. New York infection rate is around 20%. So their findings are in line with what the experts are now reporting. Speaking of reporting, where were all the experts yelling about sampling bias and self selection when news outlets were reporting death rates of 4% among confirmed cases while at the same time reporting that the virus was highly contagious and many people who contracted the disease were asymptomatic. Where were the people yelling “selection bias” when those numbers were being published everywhere? The fact that Covid 19 is highly contagious and asymptomatic in many people made reporting a death rate of confirmed cases irresponsible and misleading. Why is there an expectation of perfection from these doctors but not the news outlets? (I say news outlets because I find that the “experts” and “facts” are more nuanced than they are reported.) Where was the push back when the news were reporting models that predicted millions of deaths? But hey…let me not be so hard on the fact checkers, cause like the 2 doctors said in their controversial press conference…decision were made based on the information available at the time. And now we have more info than we did when this video was published, it seems that the doctor’s premise is pretty accurate regarding infection rate as far as I can see. So I think you actually owe them an apology. If you find something different regarding infection rate, I invite you to share. But until you do, It looks like you have egg on your face IMO.

    New York infection rate -https://www.usnews.com/news/articles/2020-05-07/cuomo-new-yorks-health-care-workers-have-lower-coronavirus-infection-rates-than-the-public

    https://www.google.com/amp/s/www.nbcnewyork.com/news/local/2-7-million-in-new-york-may-have-been-infected-study-finds-nj-poised-to-top-100k-cases/2388182/%3famp

    Georgia Infection Rate-
    https://dph.georgia.gov/covid-19-daily-status-report

    Different strains of Covid-19- https://abcnews.go.com/Health/scientists-identified-strains-covid-19/story?id=69391954

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