Abstract: This paper assesses the age specificity of the infection fatality rate (IFR) for COVID-19 using results from 29 seroprevalence studies as well as five countries that have engaged in comprehensive tracing of COVID-19 cases. The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain nearly 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortality.
I think those results are in the same ballpark as what Ioannidis calculates. This isn't good news, really, not for middle-aged-adults anyway.
IFR(age) = 0.1 x 10^((age-82)/20)
Or for anybody who knows middle aged and older people, especially if you spend time with them. I am honestly more concerned about killing my parents than dying myself of covid-19. This is why I skipped my mom's birthday for example, because I had pretty mild cold-like symptoms... or maybe mild covid-19.
After a certain age momento mori, a reminder that you will die, start coming at you fast and furious. This is just one more. They probably care more about seeing you than this next scheduled flight to Heaven.
What unique about the shutdowns and social isolation, for the 40s-60s, are this is a momento senesci (if I have the Latin right). It’s a reminder that they will mostly likely enter a stage in life called old age, the slo-go/no-go stage of old age. A time when there will be fewer friends to visit, or the logistics become too difficult. A time when they will stay at home much more, and wouldn’t it be nice to have a comfortable home to be in. A time when that next flu won’t be so easy to shake, so maybe they skip that concert. The grim reaper isn’t knocking at the door, but rather an older, frailer version of themselves. These shutdowns and social distancing are a disconcerting trial run.
My take on things...
Everyone experiences aging but in this highly individualized culture, how one interprets the experience is also individualized - varying from welcoming to acceptance to various fitness/health measures aimed to stave it off - plus there's denial and anger.
Someone looking forward to enjoying old age might not want life to end in middle age, etc...
Any of us could have inadvertently killed someone by giving them the flu without even realizing it.
You are being reflexively down voted because people view any comparison to Influenza as illegitimate, not realizing that you are making a broader point about risk management and attribution of blame for infection as opposed to saying that SARS-2 and Influenza are literally the same viruses.
Personally I find it fascinating that I was never told it was my fault if I gave someone the flu in the course of both of us living our normal lives, but if I go to a grocery store and an elderly person does too and they get COVID-19 from me (imagine in this hypothetical there is no doubt that I gave them the virus) then somehow it’s my fault and I’m guilty of any harm that befalls then.
Incredibly dangerous precedent. I hope people see where it leads. And I hope they learn from the history of public health, such as when “public health officials” used to shut down gay bars “for the greater good”.
In that sense, I think comparing COVID-19 to the flu is helpful.
The point is if I don’t know I have COVID and spread it to Grandma at the grocery store, in your eyes I’ve killed Grandma. I wonder why we don’t apply that logic everywhere.
For COVID we throw this out the window.
When you take the approach to its logical conclusion you end up in a very scary place.
You ignore an important factor. Those who are vulnerable to serious complications/death from influenza can and should be inoculated with the latest influenza vaccine. That significantly mitigates the risk for the vulnerable.
There is no corresponding vaccine for Sars-Cov2. As such, the similar group who are vulnerable can't mitigate the risk.
That's why I (and many others) are trying to be much more careful. I'd also add that while the IFR for those under 55 are quite low, they aren't zero.
In terms of overall IFR Influenza and COVID-19 appear to be comparable. Influenza kills at least an order of magnitude more children, and for those in between roughly 35-55 they both kill about the same, and for the very elderly COVID-19 is multiple times more deadly.
The overall IFRs are very comprable except COVID-19 preferentially kills the very old. This also means when you calculate YLL (years of life lost) Influenza takes more life-years away.
I’d say at most if you take a .1% IFR of Influenza then COVID-19 is about 3x as deadly. Note however that we fundamentally classify Influenza deaths differently than with COVID-19. Almost any country considers any PCR-positive person who dies to be a COVID-19 death regardless of whether it’s a baby born with intestines outside of its body, or a young man in Orange County who died in a motorcycle accident, or George Floyd. All 3 of those examples I gave are real individuals who were PCR-positive at time of death. I know for a fact that the first two were initially labelled COVID-19 deaths, not sure about Floyd.
There’s a concept I call the pathological vs physiologixal distinction that is crucial to understand and has been totally violated with COVID—19. The short of it is that it is a mistake to confuse a virus with a disease. (This is also why the phrase “asymptomatic COVID-19” is an oxymoron; if you have no symptoms you have a virus but not a disease)
I have acne; if you culture my skin you will find the bacteria C. Acnes, which is naively believed to “cause” acne. Yet if you culture the skin of a healthy individual without acne, they also have C. Acnes. The question then is what combination of factors leads C Acnes to be pathogenic in one case (me) and not for another. The answer like most things is complicated, some combination of lipid peroxidation compromising the skin barrier, genetic skin turnover rates, etc, but most pop-sci articles will simplify it to “bacteria cause acne”.
Similarly, it is a mistake to assume that if someone dies and has a positive SARS-2 PCR test that they died of COVID. First of all due to egregiously absurd cycle thresholds, you stay PCR-positive months after infection (again, see George Floyd’s hennepin county autopsy, he “had COVID” despite having recovered from it over a month prior to his death). But more importantly even if you truly have active, replicating SARS-2 in you at time of death, you didn’t necessarily die from COVID.
I really got off on a tangent there but to wrap up, even if you take the official COVID-19 numbers - which I believe are grossly inflated - at most COVID-19 is 3x as lethal. To say it is an order of magnitude more deadly means you’re still stuck in April. It’s October now, please follow the new developments in the field. There was actually a paper released recently that traces the origins of the 10x deadly meme, debunked it and attributed its genesis to conflating CFR vs IFR. I’m on mobile travelling now without my laptop so I don’t have my megalist of research articles at my fingertips but if you search around maybe you can find it.
By the start of the Summer the UK had around 60,000 excess deaths above the five year median - which included at least one fairly severe flu season.
Later in the Summer when lockdown was still in place and/or infection rates were still very controlled, the number of excess deaths dipped slightly below the median - as you would expect it to, given that people weren't commuting and there were far fewer road accidents.
The figures also disprove the usual talking point that other deaths had increased dramatically because hospital care and chronic medical attention were hard to access. There were certainly some extra deaths, but not on the scale of COVID itself.
Unless you're going to claim that some other lethal illness was stalking the land and no one had noticed, COVID is the only remotely plausible explanation for those excess deaths.
If you look at regions that were ineffective in handling the spread and had their hospital capacity overwhelmed, mortality jumps through the roof - I think it was higher than 10% in Lombardia before the lockdowns. And remember that hospitals can't work at anywhere close to 100% ICU occupancy for extended periods of time, so if the high inflow persists, mortality is likely to increase much more.
The vast difference between Covid19 and influenza is anyway plain to see if you look at ICU rates, even with all the lockdowns.
So even though your analysis sounds convincing at first read, it is a very bad interpretation of the data. The reality is that Covid19 is a much worse disease than Influenza, and that drastic measures are required to keep it under control (barely).
You debunked nothing. All the per age IFR comparisons of flu vs covid I had seen has covid killing more people for 30 years old too.
For those not familiar with biostatistics and meta-analysis. There is a standard and well defined pathway for doing a meta-analysis. It exists for a reason. Namely that it is really easy to misinterpret the results of aggregated studies if you do it wrong. The fact that the Ionnadis' article does not follow these procedures is enough to disregard it and instead focus on understand the studies that have done proper meta-analysis.
Overall mortality at age 55 is about 0.5%: https://www.statista.com/statistics/241572/death-rate-by-age...
In general, COVID-19's IFR by age is pretty close to overall mortality. So even in unrestricted spread, limited by only herd immunity, at worst direct deaths from it would less than double your chances of dying in a year.
The way this is phrased makes it sound like it's not a big deal. Doubling every individual's chance of dying within an entire generation is not something we should say lightly. Imagine if the base fatality rate was 50% rather than .5%.
I guess I never realized how risk averse people apparently are. I imagine these same people never drive a car since those things are deathtraps by comparisons.
More than just risk adverse, I think a lot of people don't understand how risky life in general is.
edit: ...and I'll point out, those truck drivers may still have been brave! If you mistakenly think the risk is higher than it actually is, you're still brave for taking it on.
Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v...
Anyway, my point was simply that if we took the same attitude towards risk that you all do with COVID and applied that elsewhere, we’d all be rolling around in hermetically sealed hamster balls until we died of boredom.
With a conservative herd immunity threshold of 50%, that'd put an uncontrolled COVID-19 pandemic and random car accidents about equal for that age group. For the 50-69 age group, the CDC estimates a 0.5% IFR, so COVID-19 would be 25x higher mortality than random car crashes.
It's certainly not an existential threat to society.
What makes Covid different and what caused the shutdowns was when Lombardy alone had 450 deaths a day. No regular influenza could do that.
It's not as if we decided out of thin air the virus was dangerous.
Yet, people, who i assume are smart people, say that we're overreacting and we're causing societal harm and taking away their freedoms.
I can only laugh and cringe...
History shows that those cities that took active measures in every prior epidemic survived better and recovered better and thrived after.
This isn't our first pandemic, wont' be our last. Where we failed is we were woefully unprepared, our administration convinced people it's not that bad but here we are months later, deaths are still pushing upwards of 1,000 americans a day and people are saying its no worse than the flu.
There is no evidence to support this argument unless you're trying to deceive people.
You don't even need to know statistics. Take the worst flue year where we had 48k deaths that year. Covid is 5x worse that and we still haven't even made it through an entire year.
Take our best flue year - 1986-87 - where only 2,868 or so died. We'll be 100x times worse than that year with COVID alone and we're just NOW entering the common flu season.
The basic math doesn't support some of these studies that seem to use statistics for political gain rather than simple math for communicating the obvious differences.
And lets not forget - the death toll is only under control because we are taking active measures.
But this is kind of exactly what we did. Go look at a yearly all-cause mortality chart going back the last 110 years. You’ll see this year is a noticeable but not so great uptick (of which many of the deaths will be overdoses, suicides, lack of medical treatment for preventable diseases etc btw). Whereas say the 1918 Flu pandemic was much more deadly in absolute and relative terms both.
Remember we’re talking about a disease that for many is so mild that they never realize they have it. For others like the very elderly it can be very bad, with a 5% chance of dying if infected, but it’s no surprise that surveys that ask people to estimate COVID-19 mortality show that on average people overestimate the fatality by between 10-100x.
SARS-2 is real, but the real virus really is in our minds. I hope one day you will come to see things my way too.
I also hope more commenters here will go mode out what happens when you perform universal rather than targeted mitigation measures: universal ends up with more mortality by slowing down infections in those who are not at risk, which delays hers immunity for almost no benefit.
So if you take the worst flu season - which we count as a year - we're almost 5x that with covid and its not even a full year yet...
If you take the best flu year, we're pushing 100x that.
Where are we over estimating anything when we break it down into simple terms?
Which btw, these current death rates are with active measures in place. If we didn't have these measures then the trends set early on would be off the charts by now.
Sweden contradicts this.
> So if you take the worst flu season - which we count as a year - we're almost 5x that with covid and its not even a full year yet...
The way we count COVID deaths is fundamentally different from how we count Flu deaths.
It's much better to look at total deaths and compare to previous years. You'll see we've experienced an uptick this year but not one that is nearly as massive as you would predict based off the hysteria
Really, the only hysteria there is, is from people like you projecting it.
Wearing a mask and socially distancing is rational.
assault for wearing masks, or failing to wear masks? I'm only aware of the former.
Sure it could. The whole point of the IFR calculation is that it gives you an average perspective on how fatal a disease is, relative to other diseases. It's not an absolute maximum fatality rate, for every circumstance.
Put a strain of "normal" flu in a vulnerable population with no pre-existing immunity, and it would do a lot of damage. But if you don't count all the other people who had it without symptoms, then you get a misleading picture.
Also, of course, you have to realize that the population of "Lombardy" (~10M) is a bit larger than the population of New York City (~8M), where we see 100-300 deaths per day as a baseline mortality rate:
Italy as a whole is now seeing new cases per day roughly twice that observed in the spring, and yet deaths are up a tiny fraction of what you would expect from the Lombardy example. So it's not clear that Lombardy represents a typical outcome, even for Italy:
Point being, again, it's difficult to draw conclusions from data points that are on the extremes of the distribution. The IFR is a measurement of average behavior.
Testing was awful in the spring, serological surveys were made in June and estimated that only 15% roughly of the cases were caught and other surveys estimated even lower percentages (as low as 6%). The territorial distribution is also much more even this time, so it is easier to cope for the healthcare system.
My point is that any a priori estimate of the IFR falls apart if the healthcare system fails and the purpose of lockdown is to avoid that. You don't lock down because it's the only way to keep the IFR down; you lock down when you realize that tracing is failing to capture and/or isolate many cases, and therefore lockdown is the only remaining way to keep the IFR down.
(2) We all have seen the images of hospitals overwhelmed with COVID-19 patients, not having enough breathers, etc. For some reason this doesn't happen with the typical annual influenza ...
If you reduce everything to statistics about mortality rates, you are missing very important parts of the picture.
Are you sure about that? it's probably not the same extent as what has happened with covid-19, but some hospitals do get overwhelmed during flu season.
A quick google search pre-2019 returns a lot of results, for instance:
That's the real problem with the disease, not only the fatality rate and long-term effects, but how quickly and severely it can bring a hospital system and all associated healthcare to its knees.
(2) Actually we didn't. My wife works in a small city hospital. They only have 4 beds with respirators and almost never had more than 2-3 people at a time there. The city is being locked down the second time because we have 5 infected in 20k. We also had in the region of 20 (real) COVID deaths since March. All over 80.
There is no complete picture as all hospitals and clinics have a financial incentive to declare COVID deaths as opposed to anything else. Some do keep internal unofficial stats but even those are rare.
"It didn't happen to me so it must not be happening anywhere else"
In general, we can say that in the overwhelming majority of cases, hospitals did not get overwhelmed with COVID patients like some of the models predicted. That may change as we move into the second winter season, but it's not a foregone conclusion.
Second, every successful preemptive measure is by definition an overreaction. Perhaps you don't see more overwhelmed hospitals precisely because lockdowns are effectively preventing that.
Also, consider that they have to mostly shut down the rest of the hospital due to staffing issues - but also the highly infectious nature of COVID.
Left unchecked, every hospital will hit their limits quickly. That'a a distinguishing characteristic of this one.
Edit: here is what the curve looks like without suppression measures in place. In NYC they came essentially to capacity very quickly. Imagine if that curve had of kept going, it would have been very bad.
It's the same R0 everywhere, the 'effective R' will come down to the difference being the age and relative health of the population, and of course other suppressive measures being taken.
What is the rate of this?
That said, it's notable that:
* They don't have a control group (makes it impossible to know what the baseline rate of these symptoms is in the population).
* They don't measure the various criteria for "organ impairment" before the participants caught covid (makes it impossible to know if the people who were found to be abnormal were abnormal before catching the virus -- there are a fair number of smokers and obese people in this sample, so this isn't an idle concern).
* They find a fairly strong association with hospitalization (i.e. the people who are sickest, end up having the most lingering symptoms).
* The people who were sickest tended to have the most pre-existing risk factors for the same outcomes being measured by the study (i.e. there's a hidden correlate).
Because of these limitations, you can't really draw any broad conclusions from this study. In general, I'd say that it shows that older / obese / unhealthy people are more likely to have both severe Covid, as well as concomitant symptoms of severe Covid.
To some of your other points, the high end leagues are quite well medically documented, and the individuals are quite healthy.
That said, it also appears for some individuals, initial “long term” damage (ongoing heart or liver problems three months after recovery) may be less or gone some six months in.
Seems answers are as yet by and large unresolved. In situations where one does not yet know the actual risk, one may prefer an abundance of caution over unknown “calculated” risk given the long tail of possible effects.
(2) absolutely does happen in bad flu seasons, and by the way most of those images are misleading or taken from prior years. Seriously. Even in say, New York, you’d have hospital A overflowing yet hospital B 10 miles away was at 30% capacity remaining. At least in the US a true overrun scenario never happened yet most don’t realize this.
You have to understand the role that mass collective delusion has played in our misguided response. And the media’s selective reporting doesn’t help.
Nitpicking here, Sars-1 is, as I understand, more infectious but also more obvious. So you don't have asymptomatic spread and other things. This ultimately comes down to exactly what you mean by "infectious" though.
> is totally unproven speculation.
At this point we have more known Covid-19 long haulers in the US than there are Sars-1 infections globally. Comparisons to SARS-1 don't much matter.
> absolutely does happen in bad flu seasons
Indeed it does, most people weren't aware of this, and covid-19 making people more aware of the danger of the flu isn't a bad thing. Get vaccinated!
> you’d have hospital A overflowing yet hospital B 10 miles away was at 30% capacity remaining.
There was a period of time when NYC was globally short on ventilators and ICU beds. Raw hospital beds were never a real concern.
Also worth remembering that NYC would have run out of hospital beds entirely if they didn't implement strict lockdown measures. The NYC (or really NY) stay at home order went into effect on March 20, and daily cases peaked plateaued 1.5 weeks later.
By infectious I meant the basic reproduction number, but I believe SARS-2 is also more infectious (in the sense if likelihood of infection per exposure event) given its incredibly high binding affinities. It seems to be unusually good at infecting humans in a way SARS-1 wasn’t. Not sure if that’s due to furin cleavage or what. I’m a bit rusty on the mechanics there so open to dissenting opinions.
Also I don’t believe SARS-2 exhibits asymptomatic spread; that seems to be largely a myth. It does undeniably exhibit PRE-SYMPTOMATIC spread however. My hunch is that the early course interferon mediated immunosuppression explains that phenomenon.
IMO the true asymptomatics (never showing symptoms) are asymptomatic largely because of T-cell cross reactivity which theoretically will reduce or entirely prevent spread. Thus why we really don’t have good evidence of asymptomatic spread but we have a wealth of evidence on pre-symptomatic.
> Also worth remembering that NYC would have run out of hospital beds entirely if they didn't implement strict lockdown measures. The NYC (or really NY) stay at home order went into effect on March 20, and daily cases peaked plateaued 1.5 weeks later.
There is absolutely no way for you to prove this nor for me to disprove it, which tells you about its explanatory value. I personally find it much more likely that the dropoff in cases is purely explainable by timing; NY was already rounding the bend when it enforced its (IMO pseudoscientific and deleterious) measures.
Basically everywhere in the globe, including Sweden, showed a large uptick for some time followed by a peak and wind-down. That’s just the pattern infectious diseases show. To immediately attribute it to human intervention when SARS-2 landed on our shores months earlier than originally thought just seems like hubris to me. In any case the statement is not falsifiable so I won’t focus on it any further.
> There was a period of time when NYC was globally short on ventilators and ICU beds.
New York as a whole was a huge proponent of early invasive ventilation which probably ended up killing people
unnecessarily. NY’s implied IFR was something like .7%, a number so bad it is unmatched by anywhere else in the US. My guess is not good pre-existing Vitamin D3 levels exacerbated by being directed to stay inside, combined with stress, fear, lack of exercise and lost sleep attributable to lockdown + general hysteria, and finally the aforementioned iatrogenic harm caused by excessive ventilation.
In retrospect it seemed the ventilator panic was only marginally more rational than the toilet paper panic.
I should note that, if we assume every use of a ventilator prevented a certain death, ventilators still had only a marginal effect since something like 90% of those ventilated died, and it’s only those with incredibly severe COVID-19 who end up ventilated (well, ironically except NY which seemed to ventilate “early and often”, so the cases were still severe but not incredibly severe)
> At this point we have more known Covid-19 long haulers in the US than there are Sars-1 infections globally. Comparisons to SARS-1 don't much matter.
I have a lot of trouble believing in a bunch of anecsotsl cases of people on Twittwr with very obvious political leanings, given that most long haulers I have seen are in popupations with next to no risk or SARS-2. It’s much more likely to be that the 20-something year olds are either inducing psychosomatic symptoms, or exaggerating their actual symptoms, or coincidentally got Epstein-Barr virus or similar at the same time.
I would expect bad COVID cases to have lingering effects for a few months, sure. But not “long-term” - although maybe we have different definitions there. Fatigue 1 month after successful resolution of infection doesn’t really say anything to me. But to give you something more tangible, I don’t believe anyone who’s in their 20s and otherwise healthy is really experiencing this mysterious syndrome, with a few very rare exceptions of course. You have to keep in mind the incredible psychoemotional environment we are living in currently.
Yes, I mostly agree with this characterization.
> There is absolutely no way for you to prove this nor for me to disprove it, which tells you about its explanatory value. I personally find it much more likely that the dropoff in cases is purely explainable by timing; NY was already rounding the bend when it enforced its (IMO pseudoscientific and deleterious) measures.
There are multiple studies that support my assertion (that lockdowns reduce R0 and without them cases continue growing at near-exponential rates). Thanks to a wide variety of government policies, we have reasonable sample sizes. See for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268966/ (longitudinal) and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293850/ (correlational). So yes, I'd argue your assertion here is wrong and there's strong evidence to state that.
> Basically everywhere in the globe, including Sweden, showed a large uptick for some time followed by a peak and wind-down.
This is a misconception. While not as extreme as other places, Sweden did implement social distancing measures. And you're actually incorrect about the shape of sweden's case count graph. It went up, paused, went up again a month later, and then went down some.
You can argue all kinds of things about herd immunity and whatnot, but that's not well supported. From the evidence we have the only conclusion you can make is that lockdowns do work in reducing spread, and they keep spread low later. That's the only conclusion based in evidence. Anything else is based on conjecture about things unseen.
> My guess is not good pre-existing Vitamin D3 levels exacerbated by being directed to stay inside, combined with stress, fear, lack of exercise and lost sleep attributable to lockdown + general hysteria, and finally the aforementioned iatrogenic harm caused by excessive ventilation.
Like this. This is not supported by any evidence. It was possible to go outside, it was possible to exercise. Stress and fear would be raised independent of lockdown measures. You're being just as hysterical about stay at home orderers as you accuse lawmakers of being about covid.
> I have a lot of trouble believing in a bunch of anecsotsl cases of people on Twittwr with very obvious political leanings, given that most long haulers I have seen are in popupations with next to no risk or SARS-2. It’s much more likely to be that the 20-something year olds are either inducing psychosomatic symptoms, or exaggerating their actual symptoms, or coincidentally got Epstein-Barr virus or similar at the same time.
I generally agree that long haulers are probably at least somewhat exaggerated, but we have indisputable evidence that serious, but non-fatal cases cause long lasting side effects in many (most!) severe patients (https://www.nature.com/articles/d41586-020-02598-6). If that eventually wears off, that's good, but until we understand these things further, we should be cautious. A disease with a .4% IFR is very different than one with a .4% IFR and a 2% or 5% chance of leaving you with lifelong severe breathing problems, and there's a reasonable chance that Covid-19 is the second and not the first.
And when you add in fewer older people getting infected when there are fewer infections in general, well, there you go.
'threshold you'd accept' isn't a response to my comment, which expressly rejects the idea that there are only 2 options. Some mitigations are only justified by very high levels of risk. Others are justified by much lower levels of risk.
I'd wager there's a lot of people whose kids are running around a shantytown shoeless who would disagree with your levels of risk.
(I did the math myself using CDC estimates for both the flu and covid and assuming a 50% asymptomatic rate for the flu.)
We still don't have comparable stats on that - even for flu the stats are really all over the place: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029
There is very substantial heterogeneity in published estimates of case fatality risk for H1N1pdm09, ranging from <1 to >10,000 per 100,000 infections (Figure 3). Large differences were associated with the choice of case definition (denominator). Because influenza virus infections are typically mild and self-limiting, and a substantial proportion of infections are subclinical and do not require medical attention, it is challenging to enumerate all symptomatic cases or infections.2, 45 In 2009, some of the earliest available information on fatality risk was provided by estimates based primarily on confirmed cases. However, because most H1N1pdm09 infections were not laboratory-confirmed, the estimates based on confirmed cases were up to 500 times higher than those based on symptomatic cases or infections (Figure 3). The consequent uncertainty about the case fatality risk and hence about the severity of H1N1pdm09 was problematic for risk assessment and risk communication during the period when many decisions about control and mitigation measures were being made.
If a vaccine is tested on 10,000 people, and appears safe, we call it good enough, without waiting for several years to check on the possibility of long-term affects. It's not like vaccines have never had problems, but at some point you need to go by what you actually know and have seen, and the same logic applies to viruses (or any other risk). We haven't in fact seen anything that suggests a widespread problem in people who recover from covid-19, and given past results with SARS, MERS, and the four other coronaviruses which cause "colds", we don't have much reason to expect it. Could it happen in some significant percentage? Sure. The same is true of any virus, or for that matter any vaccine. But we don't gain anything from speculating on that.
Did they actually do any monitoring and reporting? There is aplenty of people around with long Covid, I know personally one guy, who was actually diagnosed with myocarditis he never had before.
> We haven't in fact seen anything that suggests a widespread problem in people who recover from covid-19, and given past results with SARS, MERS,
Actually lots and lots SARS survivors did develop long-term problems. Besides, experiments on animals show, both SARS-1 and MERS caused very severe Antigen-dependent enhancement, which made the attempt to produce a vaccine futile. Not many viruses are capable of doing this, mostly flavivuruses and betacoronaviruses.
These numbers are patently false. If this was even remotely true pretty much every family would know someone who has died from the flu at some point.
The flu numbers are statistical evaluations based on no actual death counts. The real numbers of deaths from the flu are very likely much, much smaller.
You are of course welcome to ignore the CDC. You have a lot of company these days.
You can look at past graphs here for a number of European countries to see how countries like Norway and Finland compare to e.g. the U.K. and Sweden. This helps dispel any myths about lockdowns themselves causing significant excess mortality: https://www.euromomo.eu/graphs-and-maps/
Covid is way more virulent. If 10x more people get it, it doesn't need to be more deadly in terms of IFR to be a concern.
Sure, but what sort of concern? A "shut down everything, COVID-cases are rising!" sort of concern?
What? Of course we do. Influenza rapid tests are among the most common diagnostics during flu season. Epidemiologists rely on these tests as well as serological surveillance to derive IFR estimates for the various flu bugs, just as they do for covid.
But it doesn't matter. Your assertion was that flu and covid IFR's are "apples to oranges" because we're taking measures to reduce covid infections. This is nonsense on the simplest logical level. Reducing the infection rate doesn't reduce the danger to the individuals who do get infected, as long as the standard of care remains stable.
Lockdowns kill people; people with cancer, people who need surgeries, people who lose income to support themselves. Clearly, so does Covid, and we need to balance it.
Can we do better, as societies, if we aggressively protecting old and vulnerable people, and let fitter people continue with their lives? This can avoid the economic collapse of lockdowns, bring about some degree of herd immunity, and yes, trading some lives saved by lockdown for lives saved by "normality".
Suppose 70% of the society is under 50, and has a IFR of 0.1%. Take UK (65mn people), and suppose everyone in that group gets it. That would lead to 45k fatalities (very close to what was already experienced), plus herd immunity, and lack of economic collapse. It's clearly not so simple, but it's start.
I'm in no position to question the research, but I spoke once to a professor of respiratory diseases at UCL, who quoted that mild Covid cases often do not register in antibody testing (for reasons unclear), so I wonder if even the 0.3% is an overestimate.
At least one of my cousins caught it and their whole young family (parents 30’s, kids <10) were fine. My 90+ year old grandparents are obviously being kept very isolated. Their kids (my parents’ generation - 60’s) are being careful, but not cancelling their entire 2020.
Everybody hated on Texas because of the Lt. Governor’s over the top declaration of sacrificing grandparents for the economy, but there are definitely aspects of their approach that I prefer to what’s happened in California.
I'm not advocating for other states to follow Florida's approach. But it serves as a natural experiment. Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.
It's already been more than a couple weeks since September 25th; how many more "couple weeks" do we need until we can draw a conclusion?
So I would say that if we don't see a sustained rise in death rates in about three more weeks from today then that would confirm the "null hypothesis" of lockdowns being ineffective. Or if they have a major spike in deaths then that would indicate that lockdowns are effective.
Less than you might think, because we know the value of lockdowns for an contagious respiratory disease varies based on conditions, including the current infection and immunity rates on the local population, for which we have inadequate surveillance pretty much everywhere. It also varies by the degree of enforcement, which is also inadequately measured but probably was lowest in the same places that are inclined to remove lockdowns entirely. So we're missing lots of data necessary to interpret both the local meaning and the meaning for other places of any numbers that come of a one-jurisdiction top-level policy change.
People's individual decisions to distance probably are the most important factors - in soft-lockdowns, some people might not have trouble having parties, hanging out with friends etc. but depending on the culture, directives by government, the level of 'fear' from the daily results ... people may adjust their behaviour.
I wish there was much more study on exactly what social distancing means in material reality, not just 'policy'.
Two observations: First, this happened despite all precautions. Secondly, extended families can be hundreds of people, including many elderly. Lastly, in a large-enough population you will inevitably find clusters that are more affected by some illness than the average person. That's why you need to observe solid data, not a media spectacle, to come to rational conclusions.
... in this family.
Which means ... it's not really possible to rethink the lockdown strategies. Given a choice between a thing that directly kills people, and something that more people die from in indirect ways, people are always going to default to preventing the direct deaths.
Think about it this way. Currently, countries like the US or much of Europe tend to offer testing to anyone with mild potential symptoms that are caused by many common diseases. If they ever reach the point where Covid-19 cases make up such a substantial proportion of people with those generic symptoms as to affect the number of tests required, the country is in really deep, Lombardy-level trouble. The idea that the level of testing required depends on the size of the outbreak is nonsense created to continue the narrative that Western countries like the UK and US are still failing on testing and that's why we have so many cases well past the point it should've been put to bed. It made sense as a metric of testing aggressiveness in February when everyone was looking for cases linked to travel from China, since it tended to indicate how wide a net countries were casting when doing this, and a little bit back in March and April when many countries were only testing people with serious and obvious symptoms. Not so much these days.
(Note also that South Korea doesn't routinely offer testing to people with mild symptoms. Anyone can get tested if they pay out of pocket for it, but it's discouraged and at a tenth of the testing capacity of most Western nations I don't think they could handle many people demanding it. Which means they can't reliably detect cases not linked to ones they already know about, and of course those unlinked cases grow exponentially... Makes meaningful comparison of case figures and test positivity figures hard.)
> The idea that the level of testing required depends on the size of the outbreak is nonsense created to continue the narrative that Western countries like the UK and US are still failing on testing and that's why we have so many cases well past the point it should've been put to bed. It made sense as a metric of testing aggressiveness in February when everyone was looking for cases linked to travel from China, since it tended to indicate how wide a net countries were casting when doing this, and a little bit back in March and April when many countries were only testing people with serious and obvious symptoms. Not so much these days.
If an evil alien race came and threatened to kill everyone unless we isolate everyone over 45, I'm sure humanity could do it.
If we can't be smart about fighting the pandemic, that's a super sad statement about humanity's ingenuity.
What if the virus causes substantial disease burden years to decades down the road? We can't know, and should take every precaution to prevent its spread.
This is the precautionary principle selectively applied, and it’s what’s so wrong with the “lockdown” debate.
What if lockdowns cause substantial health problems years to decades down the road? We can’t know that either. Acting like Covid is the only thing whose aftereffects might be worse than we can tell right now is ignorance.
In the same vein, we do not even know if herd immunity really is a thing here, and what thing it would be. E.g. the guy from Hong Kong who got reinfected (first time severe symptoms, second time no symptoms) was probably infectious the second time again. Herd immunity only works if the people who are immune are not infections and therefore cannot (re-(infect each other and more importantly the vulnerable population.
> Herd immunity was first recognized as a naturally occurring phenomenon in the 1930s when A. W. Hedrich published research on the epidemiology of measles in Baltimore, and took notice that after many children had become immune to measles, the number of new infections temporarily decreased, including among susceptible children.
(To be clear, though, I don't think the herd immunity strategy is a good one for COVID-19.)
Not only do you have to have a huge portion of the population exposed to the disease, you need to maintain that proportion indefinitely AND will still deal with occasional flair ups among vulnerable communities.
That's not what most people think when they hear the word "immunity".
"Mass vaccination to induce herd immunity has since become common and proved successful in preventing the spread of many infectious diseases."
I'm in no position to make that call, maybe lockdown is still the right answer. But we absolutely must do this analysis seriously, publicise the results and debate it widely.
This is like saying "COVID isn't worse than the flu" - even if it was true, having another flu-sized disease burden would already be bad, so it's a bit of a weird goalpost.
That being said, there's a lot of literature describing post-covid symptomes and hypothesized mechanisms of action, like . The virus has been around for less than a year, so a quantitative comparison with something we have studied for decades makes no sense.
But it does make it highly inconsistent to adopt policies so extremely destructive to economic and mental health when the same wasn't done for other viruses with similar long-term effects.
Therefore there are no studies saying there are NO long term effects either.
There are clues that long term effects/permanent effects even in mild cases may exist. E.g. some six scuba divers with mild symptoms/asymptomatic progression were checked afterwards (Innsbruck, Austria) and had what looked like permanent lung damage. Then again, the sample size here is far too small and the cohort far to "exotic" to draw any conclusions yet.
So you'd support locking down based on something for which we don't have any evidence yet?
In regards to potential long term effects, those should be a concern as well when making decisions, yes. Not the only concern of course, but not something to be ignored either.
> and lack of economic collapse
In your model you’re calling for a strong lockdown of 30% of the population. How is that not going to have a powerful negative impact on the economy?
Also, as a practical matter, I doubt society will accept a strategy that minimizes the impact of covid-19 on one group of people at the expense of another group of people when the other group of people are politically powerful (and, not incidentally, a great number of various types of leaders are part of the other group).
> In your model you’re calling for a strong lockdown of 30% of the population
Why ask a question and then assume an answer?
Precautionary measures for the elderly can be food delivery, direct financial support, free N95 masks, free healthcare, priority vaccination, etc.
Free N95 masks would help to the extent it increases the number of people wearing them. But that’s hardly aggressive. Aggressive would be mandating that old/vulnerable people wear masks (which is another form of lockdown).
Free healthcare would help with the financial situation of those that get the virus and survive, which isn’t exactly the goal.
Priority vaccination... well, there is no safe and effective vaccine. Maybe that will be a good path six months from now. But if we had one, the goal would be to vaccinate everyone. Priority would be nice, but would ultimately only shorten the months-long window for infection (vs those without priority) by a matter of weeks. So that would be helpful, but not a game changer.
Agreed. But what causes lockdowns? An uncontrolled pandemic. What does uncontrolled pandemic also cause? Collapse of healthcare infrastructure, which is a civil emergency that also results in countless deaths.
Lockdowns, as implemented in places like the US, are a reactive measure because of a system-wide failure to adopt and maintain proactive measures needed to control things. You don’t arrive at “herd immunity” without them, but mass deaths, both from the disease and being unable to receive other routine or emergency healthcare.
It is now clear societies cannot really afford full, long-term, unconditional lockdowns. We have to pick and choose what we do, stratifying by age/health conditions seems a good way about it to me.
It’s also impossible to stratify people on the basis of health in the US because not everyone is cognizant of their health status or risk factors, certainly the government has no insight into these beyond the crudest levels. Age also doesn’t really work because the lack of social safety nets mean older workers have to remain employed or rely on younger cohorts in order to survive.
That US cannot do it is no reason to not consider it.
Simply caching away the unfit is not what I meant.
Around 60,000 cancer patients will be under-treated due to corona virus. The current estimates are that 10,000 people will die due to missed treatment. Just for the "fun" of it, lets assume all of them died due to under-treatment, that is still 1/4th the death toll of the virus itself.
If the goal is fewer deaths, why don't we encourage more treatment AND continue practicing social distancing? We can have both in this case.
I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid...
That's not to mention any other long-term disease.
Just the GDP drop, and the ensuing under-financing of healthcare etc, I think may well easily kill more people than Covid.
Are you sure? The economic fallout of lockdowns is pushing millions of people in poorer countries into poverty, and causing thousands of children to starve: https://www.france24.com/en/20200728-coronavirus-linked-hung...
That is the wrong comparison. We all die.
One better comparison could be expected years of life. The number I read was that Covid causes an expected decrease of 10 years in lifetime. What was the expected decrease in lifetime for those cancer patients because they missed out on treatment? I know you are only calculating a ballpark figure, but I suspect your ballpark is too inaccurate to be useful.
A sibling comment mentions quality-of-life-adjusted years.
We need to ask ourselves, how much suffering can younger generations be expected to endure to make the older generations live statistically a bit longer? Remember, the average COVID death is in their eighties, which is already beyond life expectancy.
This also applies to locking down the elderly, as lockdowns cause more loneliness, which increases the risk of mental deterioration: https://medicalxpress.com/news/2020-07-highlights-loneliness....
Dr. Ioannidis makes some of the same statistical mistakes he made in his Santa Clara seroprevalance estimate paper in April.
I think the biggest issue with covid is people spreading it who don't even know they have it. A friend of mine just happened to get a test and was found positive. The only symptom they had was a headache.
Who can take a day of work because of a headache?
Not even in brutal military occupations can anything approaching this level of control be achieved, and even if it were possible, the totalitarian infrastructure required would have far worse consequences than a disease.
The best bet seems to be unified messaging and economic safety net programs that allow everyone who might be willing to comply under the right circumstances to do so. The US response has been a spectacular failure in both of these areas.
Stray respiratory droplets exhaled by people infected with SARS-CoV-2 will also kill people.
Presumably you're OK with rules that prevent people from firing guns in public. Why are you not OK with rules that are intended to reduce the risk of people unnecessarily spreading fatal infectious droplets in public?
Your right to shoot firearms ends at my body. Why should your right to spread a fatal disease extend into my lungs?
And, before you say that I should take some 'personal responsibility' to protect myself against infection, should that premise extend to wearing type IV body armor in public just so others can shoot guns in populated areas?
I'd argue that the socially accepted response to influenza in the west is an awful lot weaker than it should be, however. People who have flu should be self isolating and wearing masks if they must be in public.
From the perspective of individual freedoms the ban of guns is unacceptable under the pretense they might end up harming others by chance; if that's the case, the police and the military themselves shouldn't have guns. Besides, populations that live under strict gun control surprisingly have more people being harmed by guns than populations that don't have strict gun controls (case in point: criminals don't care about laws, by definition).
Also under the perspective of individual freedoms, the enforcement of masks is not justifiable. If you feel unsafe due to a potential virus outbreak, take your precautions but don't force others to do whatever they want to do. Otherwise, we'd fall into authoritarianism.
The police in the United Kingdom DONT HAVE GUNS, because the general populace dont have them and the number of per capita gun deaths is < 1/1000 what it is in the US .
How about a slight rewrite:
"Also under the perspective of individual freedoms, the enforcement of restrictions on release of toxic or radioactive substances is not justifiable. If you feel unsafe due to a potential radiation release, take your precautions but don't force others to stop releasing radioactive substances into the environment. Otherwise, we'd fall into authoritarianism."
You understand that masks are meant to protect others, not the wearer?
"Besides, populations that live under strict gun control surprisingly have more people being harmed by guns than populations that don't have strict gun controls (case in point: criminals don't care about laws, by definition)."
People in Germany, France and many other countries would probably not agree with that.
Last time I checked the US was firmly at the top of the charts for homicides within developed countries.
Might I suggest that you take advantage of open course syllabi from a major college/university and do some undergraduate readings on the history and moral foundations of law?
There is far more to philosophy and jurisprudence than Ayn Rand.
"Of those who reported having experienced symptoms of COVID-19 in the last seven days,
only 18.2% (95% CI 16.4 to 19.9) said they had not left home since developing symptoms."
There's a big difference between complete noncompliance (not isolating at all), or incomplete compliance (reducing social contact but not strictly complying with the guidelines).
They don't seem to try to measure the extent of the behavioural change amongst the 82% who left the house.
A 40 year old would be mistaken to assume their fatality chance is 0.31%.
So COVID is in fact very dangerous for 40-year-olds. Pose a thought experiment: if someone said "would you go out drinking with your friends tonight if there was a 10% chance that, for the next 12 months, you'll be 5x as likely to die in a car crash than baseline?" I would say "absolutely not, why would you even ask me this?" and I certainly wouldn't take that risk over-and-over again for such a petty reason.
You would play the lottery with those odds, wouldn't you? But you don't want to play that lottery.
People don't realize how high odds of 1 in a 1000 are until you flip it around like that.
1 year is ~1.25% of my life that I will not get back no matter what.
Now, anyone is free to stay in their pod and eat bugs, if they're scared.
Under 48 there basically similar chance of dying as the flu.
National health policy should not be based on personal outcomes.
Numbers? Or maybe "basically similar" means "an order of magnitude larger".
Could you please enumerate your specific concerns with this study?
According to the paper, the fatality rates in the US are far higher than the rates in China and India. While the inferred fatality rate in the US is as high as ~1.3% (Louisiana), in many other places like China outside Wuhan and in India, the inferred death rate is close to 0.0%. I highly doubt that's actually the case. It seems much more likely that Covid-19 deaths have been under-reported in China and India.
Anecdotally, my Pakistani friend called Covid-19 a "rich-person" disease because only rich people in Pakistan can afford a Covid-19 test. That may account for the lower number of reported Covid-19 deaths in poorer places.
it's very plausible that it's < 0.1%. Singapore and large parts of Africa or the ME have seen few deaths. Young populations, low rates of obesity, diabetes and other diseases that probably plague regions like Louisiana will change the outcomes quite drastically.
Singapore in particular is probably a high fidelity case. It has one of the highest testing rates on the globe, likely clean data and they've registered 28 deaths on >50k cases.
the very large majority of their cases were in foreign worker dorms. almost none of these workers are over 40, and are generally in good health.
so the demographics are very different.
yeah sure but that's the point. the demographics in much of the world are more favourable. The median age in Nigeria is 18 years, on the African continent 20. Much of Asia is relatively young as well. It's the Western places who are the outlier.
In any case we know India and Brazil (2nd and 3rd country with highest death toll) are underreporting deaths: https://www.bmj.com/content/370/bmj.m2859 and https://mobile.twitter.com/muradbanaji/status/12844812155635...
"Locations are defined at the level of countries, except for the USA where they are defined at the level of
states and China is separated into Wuhan and non-Wuhan areas."
Here's a review by an actual epidemiologist pointing out specific flaws: https://mobile.twitter.com/GidMK/status/1316511734115385344
In a nutshell he uses clearly inappropriate samples to estimate population prevalence, and inexplicably ignores multiple large high-quality samples that contradict his findings.
The methodological criticisms of the paper that you’re making, while relevant, in no way invalidate the work. While the estimate may have been off by a factor of 2-3, overall, that’s well within the margin of error for a study of IFR on a small sample.
This comment, downthread, cites a paper which finds similar estimates to Ionnadis’ original paper:
Your comments are a textbook ad hominem attack.
If you can, post a definition of the terms you use to get more people familiar with the terms and concepts, even if it just boilerplate copypasta.
It warms the cockles of my heart to think we can actually tighten up discussions and get the heart of matters by avoiding rhetorical sillinesses that have been well-known in some circles for over 2000 years.
Maybe a good use for GPT-4+ will be a bot that will identify these rhetorical devices in forum threads.
And yes, it is an ad hominem attack. The basic point may or may not be correct, but the post immediately loses cred for using such a device. OK, now let’s try post hoc ergo propter hoc...
I'm not an expert in the replication crisis but I have to say that as a conceptual framework, it has the problem of pointing a finger at all research - saying "Most Published Research" etc, when the replication crisis is quite concentrated in experimental psychology, complex biomedical causation research and fields with pretty specific difficulties (humans taking simple psychology tests seem to be easily influenced by outside factors, the biochemistry of mammals seems to incredible variations in it's operations). The germ theory of disease doesn't by itself fall into this paradigm (even if humans are complex, the transmission mechanism of a germ is simple). And there's the problem, it's as if Ioannidis decided, "nothing is true, I'll claim what I want".
A domain where results are easily reproducible is settled science, and not what people are researching anymore. Every field moves on till they get stuck on problem areas that hinder progress. Kind of a Peter principle for research. And what's worse, bad studies act as a hindrance since they make an unsolved question look like settled science, and you can't get support for pursuing a competing hypothesis.
And epidemiology seems really complex to me. Every person is unique in many ways and behaving based on effects stretching back over their entire lives.
Several articles revealed conflicts of interest behind the study such as the CEO of Jet Blue promising lab funding for someone who didn't want their name on the study if they would sign on, or something roughly along those lines (maybe with another layer of indirection).
The emails suggesting a foregone conclusion make Ioannidis look even worse.
Nonetheless, the work stands on its own and should be evaluated as such. You would be forgiven for going in with the prior that Ioannidis has a poor track record in this area - but your prior alone is not enough to dismiss the work.
Well that's simply not true, by definition.
That's like the whole point of science. You can do something and write a report on it, and if I don't believe you I am free to try and reproduce it and publish my own account.
Track record is an excellent reason to be skeptical. Skepticism alone is not enough to invalidate a study.
That someone has engaged in bad faith and bad methology previously doesn't invalidate their findings. It doesn't prove they're wrong. But it makes people justified in ignoring them.
The world is full of, uh, bullshit, full of unjustified claims on this and that. These have to be ignored because otherwise you waste all your time. Being a credible scientists engaging credible research is a reason to take someone out of the this category and pay attention to them. But once someone has discredited themselves as a scientist, they're back in the bullshit category and no one has an obligation to look at their stuff. Sure, maybe their stuff is true, who knows.
I do think that some mistakes should be recoverable from though. Outright data forgery should be career ending event full stop - but the burden of proof should be high.
I already posted a second link for you, from the SJ Mercury News, which you chose to ignore. Perhaps you didn't see it. Here are some more:
These are all popular articles (and one tweetstorm) because that's what I have collected. If you spend just moments looking in scientific community discussions you will also find many, many critiques. But really it's that first Buzzfeed article you have to go back to because it establishes the motive for the badly conducted and analyzed study, a political agenda and a foregone conclusion. It's the worst form of scientific corruption.
I'm not sure what to do about it. I know MIT better than Stanford, and fixing the culture would involve firing a big chunk of the faculty. You can't fire tenured faculty, even if you could get people to acknowledge the problem.
Integrity at 2nd and 3rd tier schools is still a lot higher, but we do need to fix incentive structures, or the rot will take over academia.
Softer disciplines (like social sciences) are way ahead of harder disciplines like CS on the rot curve. In CS, it's a lot harder to bake data.
You've never read a machine learning paper, I take it. Those results are by far the easiest to bake.
Similarly your post is an ad hominem, but you didn’t make any arguments based on merits.
On Oct 05 the WHO officially announced there were 750m cases worldwide. On that day their official fatality count was ~1m. This comes out to an IFR of 0.13%
Do you have an issues with this statistic as well?
The 750mn cases is an estimate based on seroprevalence studies. The 1mn deaths are based on deaths following a positive PCR test. A more appropriate comparison is 1mn deaths over 35mn cases, leading to a CFR of over 2%.
Odd how no one ever quotes that number.
You can have a virus that doesn't qualify as pandemic but can reach 100% kill rate or one that can hit 100% of planet with 0 dead.
I'd wager there's a lot of people whose kids are running around a shantytown shoeless who would agree that this is acceptble levels of risk.
> Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%.
These ranges are so broad as to be meaningless.