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Infection fatality rate of Covid-19 inferred from seroprevalence data [pdf] (www.who.int)
80 points by wsc981 11 days ago | hide | past | web | 382 comments | favorite





Here's another recent meta-study (preprint) on the same topic: 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...

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)


>This isn't good news, really, not for middle-aged-adults anyway.

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.


BTW, for those substantially younger than dirt. You may be wondering why your elder elders aren’t particularly frightened by this, but folks 40 to 60 are more sensitized.

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...


That older people aren't frightened by this seems like a gross generalization. Plenty of the people disturbed by the rather poor and haphazard against Covid are older people who feel personally threatened.

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...


I think it's "memento" not "momento".

That was always a risk even before COVID-19. Regular seasonal influenza can be deadly, especially to the elderly. Patients can transmit it to others when they are asymptomatic or presymptomatic. COVID-19 has a longer incubation period and a significantly higher fatality rate but the same fundamentals still apply.

Any of us could have inadvertently killed someone by giving them the flu without even realizing it.


This is all true, but COVID hysteria has taken hold across the entire world, and HN is no exception unfortunately.

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”.


I can only speak for myself here, but COVID-19 has increased my awareness of the impact of flu season and I will endeavor to mitigate the risk of infecting others in the future. In the past, I hardly gave it a second thought—it never occurred to me that I could kill or harm someone by being careless (e.g. riding the metro to/from the climbing gym during flu season and indiscriminately spreading germs). Masks, giving people space, combining shopping trips, biking or driving, etc.—all are super easy ways to reduce potential harm to myself or others, so I’m more than happy to do these things as necessary going forward. There is no sense of fear or guilt, since I know I’ve done what I can reasonably do.

In that sense, I think comparing COVID-19 to the flu is helpful.


This is something I really worry about: that people are so risk averse and so invested in the COVID response that society is going to permanently become more cold, more closed off, and less human. 2020 life is no way to live long term, and I don’t even want to take a step in this direction. If I found out tomorrow that there would never be a cure or vaccine for COVID, I would just go back to living like I lived before.

If you know you have the flu (or COVID-19), surely you know you are likely contagious and can spread it to more vulnerable people. Yes, it is your fault and you deserve blame if you knowingly spread it to others through negligence. Stay home if you're sick.

I agree those who are symptomatic should stay home. But for COVID we go further and tell asymptomatic people to perform (flawed) transmission control measures. Where do we do that with Flu?

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.


I don't see the point. There are rules now, so not following them would indeed make it your fault if someone gets sick because of your actions that were not in accordance with the rules.

Because if I go out into the world and get infected with a disease, that’s one of the risks of living life, and we have always understood that. That’s why if you catch the flu nobody blames the man next to you at the grocery store.

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.


>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.

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.


Wear a mask and stay 6 feet away.

Thankfully the flu has an effective enough vaccine.

Effective enough for what? In some recent years seasonal influenza vaccine effectiveness was as low as 19%. That's still much better than nothing and I encourage everyone to get vaccinated, but let's be realistic about the level of protection.

https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates...


Flu is about 1/10 as deadly as coronavirus. And there’s a vaccine.

This is a debunked claim that arose from conflating IFR vs CFR. Please source your claim.

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.


This is trivially disproven by the excess mortality figures from earlier in the year.

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.


All of your analysis falls apart at one crucial point: all of the data we have are for Covid19 IFR given the massive lockdowns and dedicated hospital infrastructure.

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).


Influenza mortality rates are subject to exactly same problems as covid rates. The same caveats apply. And, influenza deaths are estimated - we assume that some percentage of pneumonia deaths are flu deaths without ever doing test.

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.


Thanks for all your comments in this thread. I looked at your profile to try and find an email address to say this personally but I figure it's good to say this in public too. You're writing all the things I would if I had a bit more time and inclination. I know it takes a good chunk of time and courage and mindspace to go against the current like you are, but just know there are a lot of people reading comments like yours and nodding their head but just don't want to join the fray. There are also a lot of people waking up from the virus fear only to confront the way scarier danger of the agendas driving things. Your comments are helpful to them too. Anyway keep it up!

Your linked study is much better than Ionnadis' one! This one actually followed the proper protocol for a meta-analysis for one. The results here are better stratified, the data more solid (because they did their meta-analysis properly), and the justifications better.

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.


Bt it's great news for people who want some turnover in the US Senate.

> > reaching 0.4% at age 55 > This isn't good news, really, not for middle-aged-adults anyway.

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.


> 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%.


Maybe I’m crazy, but I view doubling a chance of dying in a year, and then returning to normal mortality for the next year, as far preferable to mass business closures, suspension of civil liberties, pulling kids out of school without evidence, mandating everyone wear masks, etc.

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.


I was quite amused early on when people were talking about how brave truck drivers were for risking a COVID-19 infection. The per-year-worked fatal injury rate for truck drivers(1) is 0.024%. Meanwhile, a COVID-19 infection for the 20-49 age group has just a 0.02% fatality rate. Logging is even worse, at 0.14%/year-worked.

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.

1) https://www.trucks.com/2017/12/26/trucking-deadliest-jobs/


[A]n English person aged 55–64 years who gets infected with SARS-CoV-2 faces a fatality risk that is more than 200 times higher than the annual risk of dying in a fatal car accident.

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...


I glanced at the study and the fatality rates they use are absurdly high. They estimate .7% IFR for that age range which is way too high.

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.


The US has a mortality rate from car accidents per capita of 0.01%/year(1). The CDC's best guess infection fatality rate estimate(2) for the 20-49 age group is 0.02%/infection.

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.

1) https://en.wikipedia.org/wiki/List_of_countries_by_traffic-r... 2) https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...


Why are you assuming that you would return to normality for the next year? If this becomes endemic, the mortality rate doubles forever, especially since there doesn't seem to be long-lasting immunity to this virus.

Double 0.5% is 1%. Where'd you get 50%?

I believe the parent was making a rhetorical point: if your base fatality rate were 50%, then doubling it would mean you’d be guaranteed to die. Therefore, saying something “only” doubles your risk of death can understate the impact of what that doubling means in practice.

It's pretty simple: at my age randomly dying isn't something I'm concerned about at all. So doubling those chances is still not something I'm concerned about.

It's certainly not an existential threat to society.


For comparison, from what I've read the typical annual influenza fatality rate is around 0.1% (don't know what the under-70 rate would be). So, this puts covid-19 solidly in the uncanny valley of viral mortality rates; not low enough to be "just like a flu", not high enough to justify shutting down the world. No wonder opinions on it are so divided.

Daily reminder: new respitory diseases come and go, nobody usually cares.

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.


We flattened the curve... we bought time... most of us took active measures. It's helped. We have evidence it works.

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.


> It's not as if we decided out of thin air the virus was dangerous.

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.


In the worst flu seasons we have 50k people die. In the easiest flu seasons we have 3k people die.

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.


> 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


Sweden doesn't contradict anything. Search for the news right now and you will see their cases are increasing and they're dealing with trying to control it.

Really, the only hysteria there is, is from people like you projecting it.

Wearing a mask and socially distancing is rational.


That's not happening anymore. Time to be adults, instead of terrified children, and find alternatives to lockdowns and mask-shaming with the occasional assault, and arrests from local governments.

>and find alternatives to lockdowns and mask-shaming with the occasional assault

assault for wearing masks, or failing to wear masks? I'm only aware of the former.


"No regular influenza could do that."

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:

https://www.baruch.cuny.edu/nycdata/population-geography/pop...


450 deaths a day was not the total, those were only those from confirmed COVID patients. Excess mortality was more like 650.

Citation required (I've looked, and all I can find are annual mortality rates per capita, which are higher, certainly, but not double the rate for a year). Even if you're right, a doubling of baseline mortality per day is certainly something plausible for influenza in specific scenarios.

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:

http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h...

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.


Source: https://www.corriere.it/dataroom-milena-gabanelli/covid-risc... (in Italian). 45000 excess people are estimated to have died in about 60 days, for an average of 750 per day so I was even remembering fewer than the actual value.

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.


(1) A COVID-19 infection can have long-term effects even in young people.

(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.


> 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

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:

https://time.com/5107984/hospitals-handling-burden-flu-patie...


It happened, but it is not even close to what COVID does. During influenza season, the hospital I work at sometimes cancel elective procedures if it's a particularly bad year for influenza. Luckily influenza season has an end date. With COVID, we hardly even had any capacity left for oncology, the last thing we might cancel. Luckily the lockdown effects happened just in time before we had to take drastic measures there. This was not just a local problem, as patients here are centrally spread over all hospitals in the country.

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.


(1) Is generic and not entirely true. Long term effects are indeed present but only in those genetically predisposed. Doesn't apply to the majority.

(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.


> (2) Actually we didn't. My wife works in a small city hospital.

"It didn't happen to me so it must not be happening anywhere else"


If I were to use the "It didn't happen to me so it must not be happening anywhere else" logic I would say something sily like: - "We tested positive(including at blood tests for the exact strain) and none of us had any simptoms so nobody is dead or even sick. It's all a lie."

It's about as valid an argument as appealing to the pictures of "overwhelmed hospitals". Yes, we've all seen those pictures. We've also seen pictures of empty emergency care units that were created in anticipation of a wave of illnesses that didn't materialize.

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.


Two things: first, you don't need every hospital to be overwhelmed for it to constitute an issue.

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.


2 is obviously a real concern, where the cases spiked the hospitals ran into serious trouble - and they will spike if left unchecked.

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.

[1] https://forward.ny.gov/daily-hospitalization-summary-region [2] https://www1.nyc.gov/site/doh/covid/covid-19-data.page


> (1) A COVID-19 infection can have long-term effects even in young people.

What is the rate of this?



That's interesting, thanks. First study I've seen with more than a handful of participants, doing something other than self-reporting of symptoms.

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.


There are beginning to be data on this available around well defined, young, and ultra healthy groups such as athletic leagues. Look within a given league at these long term effects / organ damage / health problems among those who recovered to rule out a lot of the self-selection or other variables.

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.


We don’t know yet, which is a reason to be cautious.

Feel free to be cautious for any reason you want. But don't expect it of others if you can't provide evidence there is reason to be cautious.

We've got plenty of concrete evidence COVID infections can result in long-lasting chronic symptoms. That's sufficient reason to be cautious until we know the rate.

(1) So can the flu but we move along hunkey dorie.

(1) is totally unproven speculation. We can’t even prove this happens for SARS-1 which per case is far more severe than SARS-2, its less deadly yet more infectious brother.

(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.


> its less deadly yet more infectious brother.

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.


Thanks joshua.

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.


Just a note to thank you for your extraordinary contributions to this thread. You’re dead on the money. If I had more time on a Saturday, I would be writing many of the same things.

> It does undeniably exhibit PRE-SYMPTOMATIC spread however.

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.


3 deaths per 1000 infections is a pretty strong motivation to prevent infections, it doesn't need to be a contest between doing nothing and shutting down the world, strategies for reducing transmission can be independently evaluated.

And when you add in fewer older people getting infected when there are fewer infections in general, well, there you go.


Why 3 in 1,000 and what’s the threshold you’d accept and why?

The initial headline of the article stated that the infection fatality rate for people under 70 is 0.3%.

'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.


Extreme poverty is expected increased by 150 million people world wide bc of Covid.

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 don't understand what part of my comment you are responding to.

The flu also affects older people more. If you compare flu IFR to COVID by the same age group, covid is more dangerous across all age groups.

(I did the math myself using CDC estimates for both the flu and covid and assuming a 50% asymptomatic rate for the flu.)


Covid-19 is perfectly evolutionarily adapted to fit into this gap. Its divisive ability has practically been evolutionarily selected for.

That's wonderful, the virus is literally political.

What you need to look is not fatality rate, but total fatalities caused by the disease. Flu kills 60000 a year max in US, Covid kills 5x that number. And it is unclear what will be a fatality rate for younger people whose organs are damaged by previous infection.

Actually you need to look at both. IFR shows you how dangerous the disease is once you contract it. The yearly fatality rates shows how much risk you have from the disease in a given year. Covid is much more contagious than flu - so there is bigger risk that you will contract it eventually, but once contracted it might be not much worse.

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. """


Your math doesn’t add up.

Clarify please.

Well, the 2017 flu was a little over 60,000, but it was close to 60k, so we could say that, but the 1968 and 1957 flus were worse than that. Covid-19 isn't to 300,000 (5x 60k) yet, but I suppose it could get there. However, the idea of organs damaged, resulting in future fatalities, is not just "unclear". We could speculate the same about almost any virus, or for that matter any vaccine. Until time has passed, we won't know, but at this point neither northern Italy nor any other region that had early waves of Covid-19 have reported any such problem in even 1% of cases (not even 0.01% of cases, that I'm aware of).

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.


> Until time has passed, we won't know, but at this point neither northern Italy nor any other region that had early waves of Covid-19 have reported any such problem in even 1% of cases

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.


> Flu kills 60000 a year max in US

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.


It's usually less than that (but still in the tens of thousands). But 2017-18 was estimated at >60,000. https://www.cdc.gov/flu/about/burden/index.html#:~:text=Whil....

You are of course welcome to ignore the CDC. You have a lot of company these days.


I dunno, CDC says that.

Your logic is actually backwards. Flu is extrapolated but it’s extrapolated fairly. Whereas for COVID-19 we perform mass testing and label every PCR-positive death a COVID death. I hope it’s self evident why that approach will massively inflate COVID deaths but if you would like I can break it down in detail for you.

That’s why you look at excess mortality to see what’s actually happening and see how covid is being undercounted. You can’t hide the bodies:

https://www.economist.com/graphic-detail/2020/07/15/tracking...

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/


0.1% for flu is of symptomatic infections. I think covid would get another near ~2X multiplier under the same measure.

Currently, CFR for covid is 4%, so 40x multiplier.

I'm talking about flu IFR not CFR though, even it is usually cited only of symptomatic infections and not counting fully asymptomatics.

I guess not so many people get flu? I don't regularly get vaccinated, and I only had 1 flu-like disease in the last decade.

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.


> 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?


Apple and oranges. That flu fatality rate is without social distancing.

No, IFR is the infection fatality rate. It's the number of fatalities divided by the number of infections. If you reduce the infection rate, the proportion of those infections that results in death will not change. This of course doesn't apply if healthcare systems are overwhelmed, but that's not what we're talking about here.

For flu the commonly cited IFRs out there are restricted to symptomatic people (though still lower than flu CFR, this inflates it relative to seropositivity IFR estimates on covid).

We don't test for who has flu.

That does not affect the IFR, it just make it harder to measure.

You don't know the number of people who die who were infected if you didn't test them. I think your argument is only valid when the death rate is the same amongst tested and untested people.

> We don't test for who has flu.

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.


They're referring to testing people who aren't sick. I don't know how much it's done in studies in order to get asymptomatic estimates, but we definitely don't try to test everyone who was only exposed, like we are with SARS-CoV-2.

Social distancing reduces the number of infections - but it does not change the course disease once a patient is infected. So out of the infected (for IFR or out of the reported case for CFR) there should be the same fraction of fatalities with and without social distancing. Fatality rate is that fraction.

And 40% of the population getting a influenza vaccine yearly.

As others say, this is way too much to say "meh", but I do think it needs a rethink of the lockdown strategies.

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.


This is more or less what Texas has decided to do. I’m in California, but my entire family is there, and many of my younger family members are going about their lives relatively normally.

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.


Florida went even further and removed all state level lockdown orders on September 25. So far it's too early to tell what effect that will have on the death rate. Case numbers are roughly flat.

https://www.worldometers.info/coronavirus/usa/florida/

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.


>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?


For patients who are going to die, that typically happens about three weeks after initial infection. After the lockdown orders will lifted it still takes a while for businesses to reopen and for people to change their behavior. There are delays in state level data reporting.

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.


Well, you'd need a couple weeks before you expect to seeing measurable impact on cases/hospitalizations and another couple weeks before it starts really showing up in deaths. The daily data is noisy to start with so it's hard to eyeball trends, but it looks like cases have started to trend up recently and deaths are still mostly flat, which is about what you'd expect at this point in time if the lockdown that was lifted was having a significant effect on limiting COVID impacts.

> 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.

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.


'Lockdown' is only one artifact of net social distancing.

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'.


You have no idea how it would affect you or your family members until it does. This person lost 8 family members. https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-fa...

"Then, despite all precautions against the virus, a family member got sick. Then another and another and another. Now, seven months after the shutdown, seven people in Ricardo Aguirre's extended family and his father, Jesús, 67, have died of Covid-19 complications."

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.


> First, this happened despite all precautions

... in this family.


The sad reality is that broad, indiscriminate lockdowns are the only real tool available to some "world powers". We know we can manage the covid pandemic with ubiquitous testing and targeted temporary lockdowns. But there is no testing capacity.

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.


One of the more... interesting things about Covid-19 is that the countries everyone thinks are stuck with indiscriminate lockdown as their only tool due to lack of testing capacity actually have the most testing capacity, and the one everyone points to as a mass testing success story has about an order of magnitude less in per capita terms and is likely severely limited in their ability to actually detect cases as a result. It's the result of cached facts from like 6 months ago that have never been refeshed because the media have carefully avoided drawing attention to the new information in order to preserve their narrative, whilst using language that leads people to think it's still true.

Do you have details? A quick glance here shows low positive test rates in the countries that seem to be doing the best. Low positive test rates seem like adequate testing.

https://ourworldindata.org/coronavirus-testing


Low positive rates are an indicator that a country is having to do more testing to locate their cases than a country with a similar amount of cases, but higher positive rates. Nothing more, nothing less. At best, it indicates that the country has a relatively low infection rate (which is why countries that are doing better have low positive test rates), at worst it's because they're testing the wrong people.

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.)


I understand that low infection rates don't follow testing. But low infections rates _also_ means there are adequate tests for infections. What I was after was any kind detail about these countries being test constrained. Links, etc. Anything like that?

> 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.


It feels to me in some cases there is a bit of a point of principle here: "look, we're inflicting so much pain on everyone, just to make sure you're safe".

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.


We could do age-based lockdowns. Stores near me have ~2 hour periods in the day where you can only shop if you're 65+, I don't see why they can't make that the only time 65+ people are allowed to enter.

It's not even clear that lockdowns prevent deaths. A recent peer-reviewed study found lockdowns aren't associated with a statistically significant decrease in the number of deaths; what matters is social distancing: https://www.jpost.com/israel-news/social-distancing-more-imp...

There's plenty of evidence of long-term damage even in young and barely symptomatic cases - it's not a binary "dead/not dead" outcome.

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.


> 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.


This is a very important point. We don't know enough about long term effects yet.

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 has never happened without a vaccine.

https://en.wikipedia.org/wiki/Herd_immunity

> 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.)


The concept makes no sense. As soon as a carrier hits a group that does not have widespread immunities, you will get a disease cluster.

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".


I guess I should have said 'Successful herd immunity'. The sentence after what you quoted is:

"Mass vaccination to induce herd immunity has since become common and proved successful in preventing the spread of many infectious diseases."


While I agree, we must always consider the impact of lockdown. This is what is missing to me in the current strategies. For example, how do the rare, and very significant, long-term health issues compare to the fairly prevalent mental health issues caused by lockdown, unemployment etc?

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.


For example? I haven't seen a single paper showing such long-term consequences in healthy people are significantly more likely than from other viral infections. We'd especially expect to be seeing a large number of such cases in Sweden, should it be common, given they had no lockdown and a large number of infections.

It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious.

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 [1]. The virus has been around for less than a year, so a quantitative comparison with something we have studied for decades makes no sense.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/


That depends on what you mean by "little immunity". Many people appear to have some immunity based on prior exposure to similar coronaviruses. That won't prevent infection but tends to reduce disease severity.

https://www.jci.org/articles/view/143380


That "some immunity" is clearly insufficient, because people who actually got infected with Covid itself and then again with Covid, in many if not most cases have more severe symptoms. In fact, the scarce evidence suggests Covid might be a subject to Antibody Enhancement; that would mean that every next infection will get worse and worse. In any case, Coronaviruses have long be known to cause very short term immunity. Even more importantly, constant reinfection may debilitate the organism so much, that even a healthy person will eventually fall into the risk group.

>It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious.

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.


We have a chance at eradicating COVID-19, unlike other viruses that have been endemic for decades.

Of course you haven't seen papers describing long-term effects, simply because the virus hasn't been around long enough for any long-term conclusions.

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.


> Of course you haven't seen papers describing long-term effects, simply because the virus hasn't been around long enough for any long-term conclusions.

So you'd support locking down based on something for which we don't have any evidence yet?


We have seen evidence that the virus kills. That alone warrants action. In the beginning, the general lockdowns were fine, simply because we didn't know enough yet to come up with better solutions, and frankly didn't really have the time to rectify this before taking any action. Now whether or not to lockdown and what to lockdown can be applied more fine-grained. Of course, everything is still in flux, and some decisions will turn out to be wrong later. The entire response is trial-by-error, for lack of alternatives

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.


It appears however, that the whole strategy of "learning of living with Covid" might turn out to be unrealistic, we'll be forced to go for virus eradication route. NZ and TW, and partially CN did it, and they are doing very good.

I haven't seen any evidence, but there was a paper published recently that said that the lung damage dealt by covid is usually healed in ~3 months.

You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people?

> 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).


> You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people?

> 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.


Food delivery and direct financial support don’t protect people from getting covid by themselves. They would help people isolate... so you’re still talking about locking people down to protect them.

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.


> Lockdowns kill people

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.


I'm not demonizing lockdowns. They have a use, for sure, and they save lives. I just mean, they have their own downsides too, and we should use new data to evaluate how we implement them.

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.


Nowhere outside of places New Zealand and Taiwan has had long-term, unconditional lockdowns, and nowhere in the US has reached anywhere near this level of restrictions. I live in a state that ostensibly had “extreme” lockdowns and whole cities and communities decided themselves exempt from the orders with zero consequences.

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.


UK put everyone who cannot work due to Covid on 80% of their salary (sort of). So surely it could do that to a smaller cohort too.

That US cannot do it is no reason to not consider it.


Oh, certainly. Apologies for my US-centric framing. I hope the rest of the world follows South Korea, Taiwan, Vietnam’s example and not our’s. South Korea has only had limited, regional lockdowns and never closed their borders. If everyone followed their examples, lockdowns would likely be unnecessary to begin with.

The UK did this once. It's probably not going to happen again, certainly not on such generous terms, and one lockdown was not enough to stop Covid - just to delay it until right on top of the winter flu season.

Depends on the social security network, doesn't it?

It does. This is part of what I mean: if say 70% of the country can go about its business as normal, this frees a lot of resources for the state to help the remaining 30%. Stable-ish economies can foot the bill for this as well.

Simply caching away the unfit is not what I meant.


Me neither. In Europe we are lucky enough that most countries can maintain social networks for quite a while despite having mass unemployment and the like. But this only buys time. Hopefully enough.

Antibody tests do miss many cases, especially those with mild or no symptoms. Some patients are able to fight off the infection before antibodies are produced, or antibody production fades away quickly.

https://www.bmj.com/content/370/bmj.m3364


This same comment posted 3 or 4 months ago would have been downvoted into oblivion. Now it's the top comment on this article. It's good to see peoples' perspective is becoming more reasonable on this issue.

It was! I just refuse to optimise my posting for karma...

Only two states have continued preventing elective surgeries, one state (Texas) that was overwhelmed stopped but has since re-allowed them.

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...


In Poland, cancer prevention literally got obliterated this year. That's thousands people whose cancers could be found early and treated, but won't be.

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.


>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...

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 still 1/4th the death toll of the virus itself.

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.


In medicine, people like to talk about quality-of-life-adjusted years. Why? Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good. When it comes to policy-making that affects us all, it's time to extend that to the collective level.

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.


>Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good.

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. Flaxman of IHME reviews the paper as unsalvageable.

https://rapidreviewscovid19.mitpress.mit.edu/pub/p6tto8hl/re...

Dr. Ioannidis makes some of the same statistical mistakes he made in his Santa Clara seroprevalance estimate paper in April.

https://www.the-scientist.com/news-opinion/how-not-to-do-an-...



What percentage of people who get the flu are asymptomatic?

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?


Stories like this are the reason for all the social disrancing measures and work from home. Not everybody can follow this of course. But those jobs that can be done from home should be done from home. And social distancing should be followed as much as possible. Sadly, people have to be forced to do so it seems.

It doesn't seem remotely possible to enforce measures like these--even in an authoritarian state with martial law, strict curfews, etc., the ratio of police to population is way too low to enable such microscopic control of individual behavior. Some percentage of people are going to do as they wish without regard to law or the interests of anyone else.

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.


The only really sad thing is that so many people believe others should be forced (through the use of the monopoly of force the state holds) to do whatever they believe is "right"

It's generally illegal, outside of narrow circumstances, to fire guns in populated areas largely because stray bullets will kill people.

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?


While I'm not against the lockdowns for covid, following this line of logic would justify a lockdown 100% of the time due to influenza, which is also a fatal disease spread by respiratory droplets. The hard question is where to draw the line.

True. I don't dispute that absolute safety is impossible.

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.


The idea of a "causal nexus" is not accepted in any law system (natural or positive). The fact something can happen due to your actions can't be used as an ethical argument to limit your freedom of action.

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.


Yes, this is why there are so many shooting deaths in the UK, because they have strict gun control laws /s. I see this argument all the time from otherwise intelligent people and its amazing to me. Why bother making murder illegal? It will only stop law abiding people from killing anyone, and criminals will still murder people! Yes I know this is a reducto fallacy, however the argument you're making is fundamentally that no laws should ever be created for anything since some people are going to end up breaking them. The argument I hear commonly sited is that guns are easy to get in Chicago, or Mexico, which both have very strict gun restrictions. Although this is true, it fails to take into account that the guns are so easy to get because of the incredible lax rules in the nearby suburbs/across the boarder. The reason guns are being used to kill people in Mexico is because how stupidly easy it is to get them in Texas.

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 [1].

[1] https://en.wikipedia.org/wiki/List_of_countries_by_firearm-r...


"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"

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.


> populations that live under strict gun control surprisingly have more people being harmed by guns than populations that don't have strict gun controls

Last time I checked the US was firmly at the top of the charts for homicides within developed countries.


Bullshit, not only the bit about enforcement of restrictions to your freedom to prevent you from harming others (can't drive at 200kph, can't drive drunk, etc), but also the bit about gun controls is objectively wrong.

To paraphrase Charles Babbage, I am not able rightly to apprehend the kind of confusion of ideas that could provoke such an answer.

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.


The state is forcing people to go to work so much in the first place, via the debt treadmill. If most people were allowed to accumulate savings, and so could take time off without losing the roof over their heads, then it would make sense to talk in terms of voluntary choices.

eh, welcome to living in a society. Also there's a lot more going on behind the anti-mask/social distancing nonsense than freedom. Trump supporters chanted 12 more years at a rally the other day, that doesn't sound like a group that's actually concerned with authoritarianism. So what is it really? I don't know. But stop chanting freedom while flaunting public safety.


If only it were only that. In the UK at least, they reckon 80% of people with a positive test aren’t isolating at all.

The study is here [1]. The relevant passage is:

"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.

[1] https://www.kcl.ac.uk/news/effective-test-trace-and-isolate-...


A large fraction of disease transmissions are occurring in private homes. UK homes tend to be smaller than in other developed countries which makes it difficult to effectively isolate an infected person.

http://news.bbc.co.uk/2/hi/uk_news/magazine/8201900.stm


Some people will misinterpret the conclusion. It varies significantly by age brackets not considered in the paper.

A 40 year old would be mistaken to assume their fatality chance is 0.31%.


Right, according to https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v... (table 3) its probably just a bit over 0.06% for 40 year olds.

In context - this is less for you than for the "COVID is no big deal" folks - that's 5x the annual likelihood of a 40-year-old dying in a car crash in the United States, and about 60x the likelihood of a 40-year-old dying of the swine flu during the 2009 epidemic.

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.


I confront people who think they'll be ok because "the fatality rate for my age is only, like, 0.1%" with this question:

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.


I take that bet. Easily. 1/ 1000? Ha! Anytime. If it means my kids can go to school, economy doesn't have to crash hard and I don't have to waste a year or more of my life, it's an obvious choice.

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.


Make a list of 20 ~40 year olds you know. Are you ok with there being a 2% chance that at least one of them dies of COVID?

Big time. This is a different disease based on different age brackets.

Under 48 there basically similar chance of dying as the flu.

National health policy should not be based on personal outcomes.


> Under 48 there basically similar chance of dying as the flu.

Numbers? Or maybe "basically similar" means "an order of magnitude larger".


An order of magnitude times a minuscule number is still a minuscule number. It would take orders of magnitudes of orders of magnitudes to make it un-acceptable levels of risk.

The author, John Ioannidis, is a discredited researcher on Covid-19. He and his Stanford colleages are responsible for a terribly written antibody study done back in March on residents of Santa Clara County. The statistics in that paper were egregiously bad and seem cooked to meet foregone political conclusions. Some reporting:

https://www.buzzfeednews.com/article/stephaniemlee/ioannidis... https://www.mercurynews.com/2020/05/24/coronavirus-research-...


This is a peer-reviewed article published by the World Health Organization, not a press release from an individual Stanford lab.

Could you please enumerate your specific concerns with this study?


My main concern with this study is that it uses reported Covid-19 deaths to infer the fatality rate.

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.


Researchers in India conducted an antibody seroprevalence study of poor people in Mumbai and calculated a fatality rate under 0.1%. The tests were free, subjects didn't have to pay anything.

https://mumbaimirror.indiatimes.com/coronavirus/news/sero-su...


Do people in Mumbai get Covid-19 positivity tests for free? If not, then I'd be surprised if all of the 18 million people in Mumbai have been able to afford them.

Did you read the article? They gave free tests to a random sample of Mumbai residents.

> in many other places like China outside Wuhan and in India, the inferred death rate is close to 0.0%

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.


singapore has a special factor that you didnt mention.

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.


>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.


Indeed. The Economist recently analyzed excess deaths data and concluded the true number of COVID-19 deaths is likely about twice higher as of September, or about 2M: https://mobile.twitter.com/JamesFransham/status/130956007032...

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...


Speaking of Pakistan, a friend who is a pediatrician there said that childhood vaccinations have declined by 50% since the start of the pandemic, possibly because parents are too scared to go to a medical facility to have it done out of concern of being infected by covid19. The secondary impacts from the pandemic and our response are going to start becoming more apparent.

Suicides, hunger + starvation due, cancers and other diseases or illnesses not caught early, domestic abuse incidents, civil unrest (people get antsy when they have nothing to do). I'd say they are already pretty apparent, people are just fine to have their heads in the sand.

The only data I've seen (Peru) suggests that lockdowns significantly 𝗱𝗲𝗰𝗿𝗲𝗮𝘀𝗲𝗱 homicides, suicides, traffic accidents, and other accidental deaths. I wonder if the same effect exists in other countries: https://mobile.twitter.com/zorinaq/status/131484402784650035...

Sounds like we need to restructure our social safety nets in America to prevent hunger + starvation and make sure people get the health care they need regardless of their ability to pay.

If you look at China, but omit Wuhan, then wouldn’t the better comparison be to the U.S., omitting Louisiana? Why take the highest region in the U.S., and compare to another country while specifically omitting the highest region there?

From the paper:

"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."


Would data about excess death vs COVID death prove the matter?

Ioannidis has been trying to publish this study for a while. He frequently updates the preprint on medrXiv and others reviewed it and criticized it extensively over the last few months.

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.


Plenty of other folks in this thread have done a great job linking to critiques or pointing out flaws. The part I'm contributing is the corrupting influence, the political agenda.

He references his own terrible seroprevalence study in this paper.

The paper you’re criticizing was upheld by many other subsequent papers, around the world, which have found similar IFR estimates.

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:

https://news.ycombinator.com/item?id=24810409


Media reaction was to an advance, not-yet-reviewed draft of that study.

Your comments are a textbook ad hominem attack.


Please invite all your friends who are sophisticated enough to actually know the names for rhetorical strategies to post more on HN and Reddit.

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...


Wait, is that the same John Ioannidis who wrote "Why Most Published Research Findings Are False", pretty much the most influential paper on statistical error for the last 50 years?

The irony is remarkable.

Technically it would be consistency not irony.

Yes it is and that doesn't make his current fraudulent shenanigans any better. It makes them more disheartening, however.

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".


It's a widespread problem in science:

https://www.nature.com/news/1-500-scientists-lift-the-lid-on...

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.


How is reporting an IFR you disagree with the same as denying germ theory?

He first reported an IFR estimate that was lower than New York's total state-wide fatality rate (amongst all population, not just infected), and did it with a pretty explicit agenda if you read his opinion piece from before the study.

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).


I think, as mentioned here in the comments, his IFR estimate could be off by a factor of 2 or 3, but given that when he made his Santa Clara study, people were still worried about vastly higher fatality rates, he was still likely closer in absolute terms than many others. If he says the IFR is 0.27% and it is really 0.6% that is only off by 0.33. Anyone who thought it was 1.5% or 3% would've been off by a much higher amount.

I didn't say Ioannidis denied germ theory. What I implied was that he seems to put findings based on germ theory in the same category as the often/generally false/debatable findings of experimental psychology. Then he publishes findings based on completely selective uses of data, apparently with the attitude "nothing is true, I'll take the truth I like".

Did you read his California study? He sampled blood, and came up with a number. You are inferring a whole lot from that.

As with all statistical bullshitters, Taleb has smelled it back it April. Think of the man what you want, but whenever he is putting his reputation on the line and publicly accuses someone else of statistical ignorance, he turns out to be correct.

He embarrassed himself with Nate Silver, Stephen Pinker, and most other disputes I've ever seem him wage. Not to mention being notoriously moody on twitter, and cozying up to alt-right trolls. If you are just relying on the supposed credibility of Taleb, you are relying on nothing.

I haven't yet seen any serious attempt to dispel his attacks on Pinker, specifically the lack of statistical evidence concerning the "the world is getting more peaceful" thesis - can you point me towards anything substantive?

He didn’t really embarrass himself with Nate Silver. I’m not a big fan of Taleb personally, but his criticisms of Silver were sound.

The seroprevalence study was indeed awful, but this isn't so remarkable on its own. Bad science gets published all the time.

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.


Science isn't a matter of simple data. Science is a matter of trust. A scientific cannot "stand on it's own" without the assurance that it was produced by someone with a minimal amount of integrity. There are too many elements in the process of research that can be "fudged" to allow this.

> Science is a matter of trust

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.


I should clarify science does require data, does descriptions and so-forth. But if scientists are free to fake data until caught and to essentially be untrustworthy, it becomes impossible to make progress.

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.


Okay that's fair, I agree with that. No one has time to disprove quacks.

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.


"discredited" means stripped of his credentials?

It means some people didn't like what he said, so now this eminent researcher is not to be trusted again until he says something they like.

Ah that explains why this is not a properly conducted meta-analysis. This guy seems to think he is somehow better than all the checks and safeguards put in place to ensure people do meta-analysis properly. I personally found this meta-analysis was done okay, considering it was not properly anyway, and defends itself well. But it is clear this man is pushing an agenda and that the meta-analysis itself is standing on some very shaky foundations.

I'm interested, but it seems like you'll need more than buzzfeed news as a source if you're claiming that Stanford scientists are unreliable.

Here’s a rebuttal from a statistician at Columbia University: https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaw...

Buzzfeed is a solid journalism source. Yes, they also are famous for stupid clickbait articles, but if you read the article you will find it's quite solid.

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:

https://www.buzzfeednews.com/article/stephaniemlee/stanford-...

https://www.mercurynews.com/2020/04/20/feud-over-stanford-co...

https://twitter.com/carlzimmer/status/1251176233594949632

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.


AFAIU Buzzfeed News is their serious branch. Think 90s Microsoft (Buzzfeed) and 90s Microsoft Research (Buzzfeed News).

That’s such a creative way to make journalism relatable to the nerds on hn lol XD XD

For what it's worth, I saw him on a TV interview saying that COVID was less bad than the flu:

https://www.youtube.com/watch?v=WF4lKVFpREU


Curiously, Stanford excels at poor research methodology these days, with MIT a close second. It turns out that faculty positions are competitive enough at the elites that few make it in without cheating. There has been a steady decline in research integrity (with a parallel incline in research impact) as competition went up.

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.


> 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.


Can you summarize the objections? I skimmed the BuzzFeed article and it is very long, filled with vague innuendo. I couldn’t find any argument on the merits.

Similarly your post is an ad hominem, but you didn’t make any arguments based on merits.



...? So it’s just an ad hominem?

Let's take John out of the discussion.

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?


Where are you getting 750m cases from? Their own dashboard only shows 35m.

https://covid19.who.int/



Those numbers are entirely different.

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.


here is some commentary from an epidemiologist https://twitter.com/GidMK/status/1316511734115385344

So, can someone tell me again what fatality rate defines a pandemic?

As far as I know a pandemic is defined by the spread rate not by fatality rates. Doesn't include flu and the sorts.

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.


Thank you.

Extreme poverty is expected increased by 150 million people world wide bc of Covid.

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.


Money quote:

> 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.


We could reduce the IFR worldwide with a coordinated effort to test vitamin D levels, give supplements to those who need them, and administer a bolus to those in the early stage of the disease. While it's not a cure or substitute for other pandemic control measures, multiple peer-reviewed studies have now shown that vitamin D can significantly reduce risk. This is a cheap and effective intervention that could be applied almost everywhere. The WHO should be making that happen.

https://vitamin-d-covid.shotwell.ca/




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