Exaggerated Fears of Infection: A Basic Part of Human History
Excerpted from the essay: A Rapidly Changing View of Covid-19
Matt Irwin, M.D., M.S.W.
Everyone wants caring people around them when they are ill, and having this support helps people to recover. In my 17 years as a home hospice doctor I have seen that when adequate caregivers are available, the caregivers, themselves will also have positive effects. However, when exaggerated fear of epidemics and infectious diseases occurs, quarantine and isolation make high quality care challenging, and in extreme cases, nearly impossible. Good public health policies encourage healthy immune systems and healthy caregiving systems, but the over-protective emphasis on microbe containment, social isolation, and solitary confinement undermines these very systems. This isolation affects people with fragile underlying health the most, but it can also have powerful impact on people who appear otherwise healthy.
For thousands of years these fears have caused unnecessary quarantines, including for many disease that are now known to be noninfectious. Vitamin deficiency diseases such as scurvy, Beri-Beri, and pellagra, for example, were believed to be contagious for centuries. Pellagra was even called “Asturian Leprosy” for decades before concerted efforts established simple nutritional measures to prevent and cure it.
This paper will describe a small sample of these in some detail including a false epidemic that saved thousands of Jewish Poles from the Nazi’s. After the infectious fears are discovered to be false, it usually takes decades for underlying beliefs to change. Research has accumulated steadily since January 2020 that covid-19 is filled with very similarly exaggerated fears, and that when people get good quality care, including healthy social support, the virus has a similar mortality to other common viruses. Although many people find this hard to believe, it is extremely well documented and this research is summarized in prior papers by this author (Irwin, 2020-a, 2020-b, 2021). This pattern of exaggerated fears of infection has been repeated throughout human history, and to reduce suffering with covid-19, it may help to look back at some prior examples.
Fear of illness, and fear of death, are basic parts of the human condition, and fear of contagion is a logical extension of this. However, when careful research is applied, the risks are seen to be dramatically less than widely believed, and the self-fulfilling prophecy that is created becomes more obvious. We live in harmony with trillions of viruses, bacteria, and fungi, that are in our personal “microbiome” at all times (Lynch, 2016, Mun-Keat, 2020). These false fears of contagion have been present for thousands of years, with many different names given to the illnesses. In recent years, swine flu in 2009, zika in 2016, and covid-19 in 2020, have continued this very long tradition. Initial selection bias results in dramatically erroneous estimates of morbidity. In the case of swine flu, a 50 fold overestimate of mortality was found, and this error was widely accepted only a few years after the epidemic had disappeared and had faded from public awareness.
In the swine flu epidemic of 2009 selection bias was also quite severe, and estimated fatality rates were off by many orders of magnitude. Initial claims of high death rates created a wave of fear and intense media focus, but death rates were quickly scaled back in the first few months as better data became available, just as has happened with covid-19. The early prediction for the death rate was 1%, based on testing of only very ill people. A 1% fatality is about ten times more deadly than the regular flu, which has an estimated death rate of about 0.1%. However, in 2013, several years later, a large study found that it had spread far wider than believed, and the death rate was “probably less than 0.02%”, a reduction by at least a factor of 50 from the original 1% rate (Kelland, 2013; Van Kerkhove, 2013; Lane, 2020). This reduced rate was not reported until after the epidemic was out of the public eye, and was almost completely ignored. They also reported that over 20% of the world population had been infected with swine flu 12 months after its initial "discovery", a similar figure to the 37% infection rate estimated for the United States by May 2021 for covid-19 (Block, 2021). This 50 fold reduction in case fatality rate is also very similar to the reduction found for covid-19 after initial claims of 3% mortality raised unrealistic alarms.
The zika epidemic also had severe selection bias and confirmation bias due to over-reporting in the initial months in Brazil in 2015. It was initially claimed to cause high rates of a severe deformity in newborns called microcephaly, an abnormally small head size. However, when it spread to neighboring countries no increased numbers of microcephaly were found over what would be expected in a normal population (New Doubts on Zika 2016, Phillips 2016). In addition to population based studies, a high quality prospective study in Colombia followed 12,000 pregnant women who had tested positive for zika, but there were no increased birth defects when the babies were born (Bar-Yam 2016). When examined more closely, it was seen that there was widespread over-reporting by health clinics, and in previous years there had been under-reporting creating a false picture. This was described early in 2016 by investigative journalists, and again two years later in a more formal comprehensive analysis published in the journal, Annals of Epidemiology (Bautista, 2018, Carless 2016, University of Wisconsin, 2018). Many epidemiologists who were aware of the swine flu fiasco, saw this pattern repeated in zika.
Some experts immediately admitted that there must have been other explanations, but in general the reduced risk was ignored or explained away, saying that it was too early to make conclusions. Researchers began immediately to focus on non-specific problems that might appear later in life, and partly because of this dramatic change in diagnostic criteria, zika infection is still claimed to cause relatively high rates of problems in newborns. Phillips (2016) describes the failure to find birth defects in other countries when zika spread out of Brazil: “The virus has infected at least 650,000 people in Latin America and the Caribbean, including tens of thousands of expectant mothers. But to the great bewilderment of scientists, the epidemic has not produced the wave of fetal deformities so widely feared when the images of misshapen infants first emerged from Brazil”. Phillips provided a simple table showing that several countries had zero birth defects, despite following tens of thousands of pregnant women who tested positive for zika.
Although these two recent examples appear to apply best to covid-19, ancient examples such as leprosy are just as relevant. It is known today that most of the people confined for life in leper colonies did not even have leprosy. Appropriate diagnostic criteria and equipment, such as the microscope, were not used until the late 19th century, and at that time it was learned that beliefs about the infectiousness of leprosy were unrealistically exaggerated. However, despite finding a cure in the 1950’s, some people were still confined against their will and stigmatized well past the year 2000, including in industrialized countries such as Japan.
Leprosy – More than a thousand years of stigma
Leprosy has a fascinating history, and was an infamous disease for over a thousand years. It is also known as Hansen’s disease, and although infectious, it is now known that it is extremely difficult to transmit. Only about 3% of people can even get infected with the bacteria that causes it. It more easily affects people with fragile underlying health and is much more common in people living in poverty. The International Textbook of Leprosy (Brakel et al, no date) has an entire chapter on stigma, and comments that “Leprosy is particularly prevalent in countries with large population groups living in poverty”. This makes the diagnosis even more damaging to people’s health. The lifelong quarantines that were used worldwide until the 1950’s also undermined people’s immune systems, even in industrialized countries, making recovery more difficult, no matter what illness they suffered from.
Most of the people sent to leper colonies did not actually have leprosy. For centuries leprosy was diagnosed based on non-specific criteria, and the use of the microscope was not even adopted until the late 1800’s. Prior to that anyone with a skin problem could be diagnosed with leprosy, including people with allergic rashes, fungal infections, and many bacterial rashes. Peripheral neuropathy, or numbness in the hands and/or feet, was also considered a primary symptom of leprosy. However it is known today that there are many common causes of neuropathy, such as untreated diabetes, exposure to toxins such as mercury and arsenic, and many vitamin deficiency diseases, which were all common in the past. Arsenic and mercury were commonly used as medicines for thousands of years, up until the 1940’s (Kang, 2017), and vitamin deficiency diseases were common, as well, due to extremely limited diets. Some of the vitamin deficiency diseases, such as scurvy, pellagra, and Beri-Beri, were well described and not confused with leprosy, but they were also blamed on infection for centuries (Duesberg, 1996). The case of scurvy will be covered below in a separate section.
Unfortunately, once the heavily stigmatizing label of leprosy was applied, people often had no choice but to be quarantined for life in asylums. Although conditions in some asylums were quite humane, run by charities and various religious communities, the level of social isolation was severe. People were not able to visit their families, including their parents and children. Even after antibiotics were developed to cure the illness in the early 1950’s, some regions of the world such as Japan continued the severe stigma against sufferers with forced lifelong isolation in leprosy facilities for another 40 years, well into the 1990’s (Macgregor, 1996).
A famous example of leprosy comes from the patron saint of Hawaii, Father Damien, also known as Saint Damien of Molokai. He volunteered to work in a leper colony in Hawaii in 1873 as their temporary priest, and decided to stay and live among them. He helped them build homes, hospitals, roads and chapels, and ministered to the sick. After 11 years of constant close contact he started to develop symptoms which were blamed on leprosy, and died five years later, in 1889. However, it is not certain that he died from leprosy, because his primary symptom was peripheral neuropathy, and a more likely cause would be a noninfectious one such as untreated type-2 diabetes.
Japan is an example of a society that had difficulty abandoning the fear of infection from leprosy. Harsh laws of forced sterilization and forced confinement were not repealed until 1996, forty years after antibiotics were discovered (Macgregor, 1996). It then took another twenty years after 1996 before the stigma and discrimination was finally reversed due to continued public education efforts, as well as several high profile lawsuits. In June 2019, a Japanese court ordered the government to pay $3.4 million in damages to the relatives of former leprosy patients because of the extended social and psychological harm caused by severed family ties, long-lasting prejudice, and social stigma (Hosoda, 2010; Ciomal, 2020).
Scurvy – A nutritional deficiency blamed on infection for centuries, including for another 40 years after the cure was discovered
Scurvy is now known to be caused by a deficiency of vitamin C, but for over two hundred years it was thought to be an infectious illness, and sailors stricken with it were quarantined, which took further tolls on their health. In one fortunate case, some extremely ill sailors were left marooned on a tropical island, with access to fruits and vegetables, and their shipmates were surprised to find them healthy and thriving when they returned to the island several months later. The cure for scurvy was discovered in the early 1750’s by a Scottish naval physician, James Lind, who performed one of the earliest clinical trials in history. By trying different approaches in different groups of sailors, and recording his results, he found consistent cures with a diet that included fresh fruits and vegetables. He published a book in 1753 describing his results in detail. However, his findings were widely rejected for decades. Despite his continued efforts, including numerous publications as well as continued improved clinical results with ill sailors, it took 40 years before the British Navy finally adopted his findings (Duesberg 1996).
Sirois (1974) wrote a thorough summary of dozens of episodes of “epidemic hysteria”, thought to be psychological in nature. In early episodes the infection was believed to be spread by demonic forces, such as with the dancing manias in the 1800’s where crowds would “dance and sing in a disorganized manner” (Page 10). In the 1900’s toxins or microbes were more likely to be blamed, but no biological cause could be found and the symptoms did not match a biological cause. Sirois concluded that in times of social stress and rapid technological change, such spreading fears were more likely to occur. Hefez (1985) wrote a very detailed summary of a case of “mysterious gas poisoning” stemming from fears of a gas leak at a school during a time of high social stress. Hundreds of young people became ill, but no gas leak could be found and the symptoms did not resemble gas poisoning. Over 900 people were affected before outside experts convinced the community that there was no gas leak, and the epidemic finally resolved. More recently, Jones (2004) wrote an article summarizing this phenomenon, which he called “Mass psychogenic illness”. These events show how difficult it can be to change underlying beliefs about contagious illnesses, and how nonspecific symptoms such as fatigue and malaise spread when these fears are present.
Nazi Germany and the “epidemic” that saved a Jewish town
Although many people think that the horrors of Nazi Germany were driven by anger and hatred, actually the main underlying emotion was fear. The Nazis had adopted unrealistic exaggerated fears that their “Aryan race” would cease to exist due to genetic spread from “biologically threatening genes”. This paranoid belief stemmed in large part from American eugenicist Madison Grant who wrote an influential book that strongly influenced Hitler and which was used by the Nazis to justify their most sinister programs. The Holocaust Encyclopedia describes how this fear drove their policies: “Echoing ongoing eugenic fears, the Nazis trumpeted population expert’s warnings of ‘national death’ and aimed to reverse the trend” (US Holocaust Museum. n.d.).
They first passed laws banning unions between the “hereditarily healthy” and persons deemed “genetically unfit”, and then passed a law requiring forced sterilization of over 400,000 Germans who had one of several conditions they believed hereditary, including several types of mental illness and even chronic alcoholism. These events happened before they began the mass expulsion and mass killing of Jews and other people who were deemed to be a genetic threat, as well as political dissidents and Germans who acted against the regime. This exaggerated fear of genetic spread resembles the exaggerated fears of infection described above, and was used to justify increasingly harsh removals of human rights, something that is mirrored in the way normal rights have been removed due to fear of covid-19, described in chilling detail by Corbett (2020). However, this fear of infection was also used in a positive way against the Nazis to protect over 8000 Polish Jews from being sent to the death camps.
Two young Polish physicians, Eugene Lazowski and Stanisław Matulewicz, devised a plan to convince the Nazis that the village where they worked had an out of control epidemic of typhus. They sent repeated samples of blood to German labs which they had doctored to test positive on typhus antibody tests. Because of Nazi fears that the illness would spread to German soldiers and civilians, the primarily Jewish town was left alone. After the war, Dr Lazowski stated “I was not able to fight with a gun or a sword, but I found a way to scare the Germans” (Kreston, 2016). Fortunately the town’s population knew of the ruse, and were able to keep their social contacts and society working smoothly, unlike more recent epidemics such as covid-19, swine flu, and zika.
Some Other Examples of Exaggerated Fears of Infection
In addition to leprosy, scurvy, swine flu, zika, and covid-19, there have been many other examples where claims of new viruses and bacteria have generated fears and predictions of the possibility of massive worldwide deaths, all of which have proved greatly exaggerated. These include avian influenza (aka “the bird flu”), SMON virus (later found to be a medication adverse effect), West Nile virus, Ebola virus, and the human immunodeficiency virus (HIV). It was predicted that HIV would spread rapidly, killing millions in the US, and dramatically reducing the populations of many countries in Africa where infections rates were between 20 and 40%. However, after about ten years it became clear that the populations of all of the affected African countries continued to grow steadily, and predicted death rates in Europe and the United States were dramatically off base. People diagnosed HIV positive did not die as predicted (Duesberg 1996, Population of Congo 2018), and it also became very clear that it is extremely difficult to transmit HIV from one person to another. Studies found that it takes over 1000 acts of intercourse for couples to transmit it, and with such a low rate other explanations such as false positive results may be more likely (Boily et al. 2009, Padian et al. 1997).
The exaggerated claims of public health risk in all of these illnesses have negative impacts on populations, often for decades, both economically, physically and psychologically. Tourism drops, emigration increases, and existing public health challenges worsen. Credit for the reduced death rates may be improperly given to quarantine efforts, or to medical treatments, ignoring the fact that the virus in question was weaker than originally thought. Sometimes there are claims that new, more nonspecific problems are associated with the virus, as happened with zika. However, the primary reaction is to ignore the issue, and the exaggerated claims continue to be believed for many years by the general public, as well as most medical and health professionals, even after they have been disproven.
False Positive test results: more likely in people with active symptoms
The issue of false positives and false negatives is another confounding factor that amplifies the fear of these epidemics, leading to exaggerated fears of contagion. One thing commonly ignored in these discussions is that false positives are more likely to occur in people who are ill, not in asymptomatic cases. Conversely, false negatives are more common in people with mild or no symptoms. This is because mild cases have less RNA and less antibodies in their body to react to the tests. When someone has moderate to severe symptoms, lots of viral RNA is available and more likely to be detected, as well as RNA from the person’s own cells, which can cross react creating a false positive. This means that if both false negatives and false positives are accounted for, the number of mild cases counted will be increased, and the number of severe cases will be reduced, further lowering the fatality rate. This is true of both antibody tests and PCR/RNA assays, and a previous paper by this author documented high false positive rates in the PCR assays used in HIV to determine a person’s viral load (Irwin, 2001).
If a significant percentage of the positive test results are false positives, then the virus may also be much less contagious, and therefore pose a reduced risk to the rest of the population. In a very detailed discussion of the RNA test written by Crowe (2020), he sums up the problem, “Even a small false positive rate is critically important. A 99% accurate test would produce 100,000 false positives in a city of 10 million, like Wuhan. And if the number of positives in sampling is around 4%..., then 1 out of 4 positives would be false” (Page 7). It is very difficult to assess the accuracy of these tests, because viruses are very difficult to isolate. Adding to this problem is that the illness itself does not have any specific symptoms to guide clinicians, and most people only have mild symptoms or no symptoms at all.
All tests have some false positives, especially screening tests, which are designed to have more false positives than false negatives, in order to err on the side of not missing any cases. This problem is worse when a test is created rapidly, which is what occurs when a new health threat is believed to be occurring, such as with covid-19, zika, and swine flu. The primary covid-19 test uses polymerase chain reaction (PCR) to look for tiny fragments of RNA thought to be specific to the covid-19 virus, and is intended to find active infections. The test gives a quantity of RNA, and uses an arbitrary cutoff to decide who is positive and who is negative. This means that people who test “negative” often have a measurable quantity of what is supposed to be covid-19 virus RNA their blood, just a smaller quantity than what is considered “positive” based on the cutoff value (Crowe 2020). A thorough review of studies of false positive viral loads for HIV found that false positive PCR tests “occur commonly in 3% to 10% of people who have no risk factors for HIV and who test negative on HIV antibody tests” (Irwin, 2001, Page 1).
False positives are more likely to occur when a person’s body is in an inflammatory state such as an acute infectious illness, an active autoimmune condition, or during an allergic reaction. During these states the body has rapid turnover of cells, and expanded production of very active immune system cells, with resulting increased production of antibodies, RNA and DNA, which increases the chance of a cross reaction. When a false positive test occurs, often none of the person’s contacts are positive, leading to fears of contagion from unlikely sources. Many well documented covid-19 cases suggest that it is actually difficult to transmit the virus, in contrast to widely held beliefs about covid-19, as discussed previously.
When someone is diagnosed with covid-19 and has had no known contact with anyone who was infected, the assumption is made that they must have caught it from a fleeting contact, such as viral particles that stayed active for many hours or days, perhaps on shopping carts, on door handles, or simply floating in the air. Similar to the media focus on death stories, stories of extreme infectivity are covered in detail, accepted by mainstream infectious disease experts, and help propagate exaggerated fears of contagion. A false positive test is a more likely explanation, and with newer data showing that about 50% of people are asymptomatic, close contact with asymptomatic people is another possible cause. However, if the data showing that covid-19 is a much weaker virus was widely known, the concern about viral particles staying active on surfaces and in the air would naturally be greatly reduced, regardless of how infectious it actually is.
Final thoughts: Quality and Quantity
In hospice and palliative care a false choice is often presented: choose care that emphasizes quality of life, or care that aims to prolong life. However, usually improving quality will help improve quantity, which is also simply common sense. Many people have died and suffered from covid-19, but this suffering could be greatly reduced by the knowledge that the vast majority of people diagnosed with covid-19 have mild or no symptoms and that death rates are many times lower than originally claimed.
Fears of covid-19 cause increases in deaths, especially in long term care facilities where understaffing combined with quarantines often make good care impossible to provide. The fear also results in deaths being presumed to be from covid-19 with corresponding increases in death counts. Thus, the fear itself is a major factor in increasing mortality and morbidity, and one of the main efforts of public health policy would be to provide accurate data based on research studies, something woefully lacking in the public health measures across the world. While more people would likely survive covid-19 if this information was presented clearly, even those who do not survive would have more compassionate care and suffer less. Humans have deep seated instincts to protect and care for one another, and they also have very strong self-healing systems. Bolstering these, instead of undermining them, would be a welcome change in the defense against covid-19.
Bar-Yam, Y., Parens, R., & Morales, A. (2016, November). Is Zika the cause of microcephaly? Retrieved from https://necsi.edu/is-zika-the-cause-of-microcephaly-status-report-november-4-2016
Bautista, L (2018). Maternal Zika virus infection and newborn microcephaly-an analysis of the epidemiological evidence. Annals of Epidemiology. 2018 Feb;28(2):111-118. doi: 10.1016/j.annepidem.2017.11.010. Epub 2017 Dec 14. PMID: 29277550. https://pubmed.ncbi.nlm.nih.gov/29277550/
Bendavid, E., & Bhattacharya, J. (2020, March 24). Is the Coronavirus as Deadly as They Say? Wall Street Journal. Retrieved from https://www.wsj.com/articles/is-the-coronavirus-as-deadly-as-they-say-11585088464?ns=prod/accounts-wsj
Bendavid, E., Mulaney, B., Sood, N., Shah, S., Ling, E., Bromley-Delfano, R., . . . Tedrow, J. (2020, April 11). COVID-19 Antibody Seroprevalence in Santa Clara County, California. Retrieved from https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf
Block J. (2021). Vaccinating people who have had covid-19: why doesn’t natural immunity count in the US? BMJ 2021; 374n2021 doi: https://doi.org/10.1136/bmj.n2101 (Published 13 September 2021)
Bogan, A. (2020, April 17). New Data Suggest the Coronavirus Isn't as Deadly as We Thought. Wall Street Jourmal. Retrieved from https://www.wsj.com/articles/new-data-suggest-the-coronavirus-isnt-as-deadly-as-we-thought-11587155298
Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M. (2009). Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009 Feb;9(2):118-29. doi: 10.1016/S1473-3099(09)70021-0. PMID: 19179227; PMCID: PMC4467783.
Brakel et al (no date). International textbook of Leprosy. Chapter 4.5: Stigma Related to Leprosy – A Scientific View
Carless, W. (2016, January 29). The sketchy numbers behind Brazil’s Zika crisis. Retrieved from
CDC - Coronavirus Disease 2019 in Children. (2020, April 10). Retrieved May 6, 2020, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm
CDC Global Road Safety. (2020, January 8). Retrieved April 1, 2020, from https://www.cdc.gov/motorvehiclesafety/global/index.html
CDC National vital statistics mortality data. (2018). Retrieved March 28, 2020, from https://www.cdc.gov/nchs/nvss/deaths.htm
Condon, B., Sedensky, M., & Peltz, J. (2020, April 20). 'Under Siege': Overwhelmed Brooklyn Care Home Tolls 55 Dead. US News. Retrieved from https://www.usnews.com/news/politics/articles/2020-04-20/under-siege-overwhelmed-brooklyn-care-home-tolls-55-dead
Ciomal Geneve (2018, March 3). The Unsettling History of Leprosy in Japan. Retrieved April 26, 2020, from https://ciomal.org/en/unsettling-history-leprosy-japan/
Corbett K (2020) Monograph Two. An Interactive ‘Anti-Coronavirus Toolkit©’ . The Coronahysteria Series: ‘SARS-CoV-2’, the ‘novel Coronavirus’. London, KPC Research and Consultancy Limited, May. ISBN 978-1-5272-6229-4. Available at: https://kevinpcorbett.com/onewebmedia/An%20Interactive%20AntiCoronavirus%20Toolkit.pdf
Crowe D. (2020, March) Is the 2019 Coronavirus Really a Pandemic. The Infectious Myth. http://theinfectiousmyth.com/book/CoronavirusPanic.pdf
Dong, Y., Mo, X., Hu, Y., Qi, X., Jiang, F., Jiang, Z., & Tong, S. (2020). Epidemiological
Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics.
Retrieved from https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf
Duesberg, P. (1996). Inventing the AIDS Virus. Washington, DC: Regnery
EbhardtT,, Remondini C., & Bertacche M. (2020, March 18). 99% of Those Who Died From
Virus Had Other Illness, Italy Says. Bloomberg News, Retrieved from
Fund, J., & Hay, J. (2020, April 6). Has Sweden Found the Right Solution to the Coronavirus? National Review. Retrieved from https://www.nationalreview.com/2020/04/coronavirus-response-sweden-avoids-isolation-economic-ruin/
Galea, S., Tracey, M., Hoggatt, K., DiMaggio, C., & Karpati, A. (2011). Estimated Deaths Attributable to Social Factors in the United States. American Journal of Public Health, 101(8), 1456-1465. Retrieved from https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2010.300086
Hefez, A. (1985). The Role of the Press and Medical Community in the Epidemic of "Mysterious
Gas Poisoning" in the Jordan West Bank. American Journal of Psychology, 142(7), 833-
Hosoda, M. (2020). Hansen's disease recoverers as agents of change: a case study in Japan. Leprosy Review, 81, 5-16. Retrieved from https://europepmc.org/article/MED/20496565
Irwin M. (2001). False Positive Viral Loads. [Medical school research project and literature review] https://www.drmattirwin.com/pcr.html
Irwin, M. (2020a, September 3). Restarting School, Performing Arts, and Youth Athletics [Unpublished working paper]. http://www.drmattirwin.com/restart.html
Irwin M. (2020b, November 20). Data from US Colleges and Swedish schools confirms extraordinarily low risk in young people, including those with underlying health conditions [Unpublished working paper]. www.drmattirwin.com/college
Irwin, M. (2021, March 12). Summary of research into the lack of efficacy and harms of wearing face masks [Unpublished working paper]. https://www.drmattirwin.com/mask.html
Jones, T. (2000). Mass Psychogenic Illness:Role of the Individual Physician. American Family
Physician, 62(12), 2649-2653
Kang, L. (2017, October 22). Mercury was considered a cure — until it killed you. Toronto Star. https://www.thestar.com/news/insight/2017/10/22/mercury-was-considered-a-cure-until-it-killed-you.html
Kelland K. (January 25, 2013) Swine flu infected 1 in 5, death rate low, study shows. Reuters.
Retrieved from https://www.reuters.com/article/us-flu-h1n1-pandemic/swine-flu-infected-1-in-5-death-rate-low-study-shows-idUSBRE90O0T720130125
Kreston, R. (2016, May 31). Sheep in Wolf's Clothing: The "Epidemic" that Duped the Nazis. Discover Magazine. Retrieved from https://www.discovermagazine.com/the-sciences/sheep-in-wolfs-clothing-the-epidemic-that-duped-the-nazis
Lewis, C. (2020, April 23). 21 Percent Of NYC Residents Tested In State Study Have Antibodies From COVID-19. The Gothamist. Retrieved from https://gothamist.com/news/new-york-antibody-test-results-coronavirus
Lane, R. (2020, March 9). We don't know the most important fact in the world right now. The
Washington Post. Retrieved from https://www.washingtonpost.com/opinions/we-dont-know-the-most-important-fact-in-the-world-right-now/2020/03/09/f992a7c4-621d-11ea-b3fc-7841686c5c57_story.html
Lynch, S., & Pederson, O. (2016). The Human Intestinal Microbiome in Health and Disease.
New England Journal of Medicine, 375(24), 2369-2379. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1600266
Macgregor, H. (1996, June 30). After Decades Locked Away, Japanese Lepers Salute Life. Los Angeles Times. Retrieved from https://www.latimes.com/archives/la-xpm-1996-06-30-mn-20038-story.html
Marsland, A., Bachen, E., Cohen, S., Rabin, B., & Manuck, S. (2002). Stress, immune reactivity and susceptibility to infectious disease. Physiology & Behavior, 77(4). Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S147149060300173X
Mettler, K. (2020, March 10). How the coronavirus compares with the flu. The Washington Post. Retrieved from https://www.washingtonpost.com/health/2020/03/04/coronavirus-flu-comparison/
Mullins, L., & Jolicoeur, L. (2020, April 14). Testing Reveals 'Stunning' Asymptomatic Coronavirus Spread Among Boston's Homeless. WBUR News. Retrieved from https://www.wbur.org/commonhealth/2020/04/14/coronavirus-boston-homeless-testing
Mun-Keat L. (2020). The human microbiome: Everything you need to know about the 39 trillion microbes that call our bodies home. BBC Science Focus Magazine. Retrieved from https://www.sciencefocus.com/the-human-body/human-microbiome/
New doubts on Zika as cause of microcephaly. (2016, June 24). Retrieved from https://www.sciencedaily.com/releases/2016/06/160624150813.htm
Padian N, Shiboski S, Glass S, Vittinghoff E (1997). Heterosexual Transmission of Human Immunodeficiency Virus (HIV) in Northern California: Results from a Ten-year Study, American Journal of Epidemiology, Volume 146, Issue 4, 15 August 1997, Pages 350–357, https://doi.org/10.1093/oxfordjournals.aje.a009276
Patina NS, Shiboski SC, Glass SO, Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study. Am J Epidemiol. 1997 Aug 15;146(4):350-7. doi: 10.1093/oxfordjournals.aje.a009276. PMID: 9270414.
Pesce, N. (2020, April 10). Iceland finds that half its citizens with coronavirus have shown no symptoms. Retrieved from https://www.marketwatch.com/story/iceland-finds-that-half-its-citizens-with-coronavirus-have-shown-no-symptoms-2020-04-10
Phillips D, Miroff, N. (2016, October 25). Scientists are bewildered by Zika’s path across Latin
America. The Washington Post. Retrieved from
[Population of Congo, Uganda, and Rwanda 1960-2018]. (2018). Retrieved March 29, 2020, from
Romo, V. (2020, May 9). For Most States, At Least A Third Of COVID-19 Deaths Are In Long-Term Care Facilities. Retrieved May 10, 2020, from https://www.npr.org/sections/coronavirus-live-updates/2020/05/09/853182496/for-most-states-at-least-a-third-of-covid-19-deaths-are-in-long-term-care-facili
Saltzman, J. (2020, April 17). Nearly a third of 200 blood samples taken in Chelsea show exposure to coronavirus. The Boston Globe. Retrieved from https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/
Sirois, F. (1974). Epidemic Hysteria. Acta Psychiatrica Scandinavica Supplementum, 252, 6-45.
Sullum, J. (2020a, April 3). What We Should Have Learned From Iceland's Response to COVID-19. Reason Magazine. Retrieved from https://reason.com/2020/04/03/what-we-should-have-learned-from-icelands-response-to-covid-19/
Sullum, J. (2020b, April 20). L.A. County Antibody Tests Suggest the Fatality Rate for COVID-19 Is Much Lower Than People Feared. Reason Magazine. Retrieved from https://reason.com/2020/04/20/l-a-county-antibody-tests-suggest-the-fatality-rate-for-covid-19-is-much-lower-than-people-feared/
Sullum, J. (2020c, April 22). Shouldn't COVID-19's Lethality Inform the Response to It? Reason Magazine. Retrieved from https://reason.com/2020/04/22/shouldnt-covid-19s-lethality-inform-the-response-to-it/?itm_source=parsely-api
Sullum, J. (2020, April 26). Miami-Dade Antibody Tests Suggest Local COVID-19 Infections Exceed Confirmed Cases by a Factor of 16. Reason Magazine. Retrieved from https://reason.com/2020/04/26/miami-dade-antibody-tests-suggests-covid-19-infections-exceed-confirmed-cases-by-a-factor-of-16/?itm_source=parsely-api
Sutton D, Fuchs K, D’Alton M, Goffman D. (2020, April 13). Universal Screening for SARS-CoV-2 in WomenAdmitted for Delivery. New England Journal of Medicin., Retrieved from:
Tan, J., & Wang, Y. (2019). Social Integration, Social Support, and All-Cause, Cardiovascular
Disease and Cause-Specific Mortality: A Prospective Cohort Study. International Journal of
Environmental Research and Public Health, 16(9). Retrieved from
University of Wisconsin (2018). UW study questions link between Zika, microcephaly, in 2015 Brazil case.
Virgin, H. (2014). The virome in mammalian physiology and disease. Cell, 157(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977141/
Virginia Department of Health, Updated Guidance on Testing for COVID-19. (n.d.). Retrieved March 28, 2020, from http://www.vdh.virginia.gov/content/uploads/sites/182/2020/03/VDH-Updated-Guidance-on-COVID19-Testing_FINAL.pdf
World Hunger Education Service (n.d.) Retrieved March 28, 2020, from
Zorzoli, M. (2020, April 9). ESCLUSIVA I nuovi dati di Robbio, unico paese italiano a fare il test sull'immunità a tutti i cittadini. 70% di asintomatici [EXCLUSIVE The new data of Robbio, the only Italian country to take the immunity test for all citizens. 70% asymptomatic]. Business Insider. Retrieved from https://it.businessinsider.com/esclusiva-cosa-rivelano-i-primi-test-di-robbio-primo-paese-italiano-a-fare-i-test-sullimmunita-a-tutti-i-cittadini/