I honestly don’t know what to make of this metastudy by John P.A. Ioannidis from medRxiv (PDF):
While COVID-19 is a formidable threat, the fact that its IFR is much lower than originally feared, is a welcome piece of evidence. The fact that its IFR can vary substantially also based on case-mix and settings involved also creates additional ground for evidence-based, more precise management strategies. Decision-makers can use measures that will try to avert having the virus infect people and settings who are at high risk of severe outcomes. These measures may be possible to be far more precise and tailored to specific high-risk individuals and settings than blind lockdown of the entire society.
I pass it along not as advocacy but as an additional data point.
I just read this piece on another site. However, I’ve been impressed with Ioannidis’s work and consequential opinions months ago. There are other physicians who have come to similar conclusions., that the predictions dealing with this virus’s virulence were off, as were the dramatic responses to curtail it%’s spread. Such opinions, however, have been labeled as “misinformation,†and are either derided or completely dismissed by a media not even covering them
My three comments would be that (1)there looks like a lot of heterogeneity in the sample studies. That makes a meta-analysis more difficult. The next (2) issue is time. I think that we are seeing the mortality rate drop compared with what it was at the start of the outbreak. It is what we saw and I expect (hope) to see that confirmed elsewhere. The other part of the time issue is that deaths lag diagnosis by 2-3 weeks. So if they look at the total number of cases on April 19, then look at the total deaths on that date, then they are missing a lot of deaths.
The last is what I teach medical students. Dont just look at the numbers in the study, ask yourself if they make sense. Do they fit with the world as you and others know it. With the flu we have not seen hospitals overwhelmed like we have with Covid. We have not seen the large number of excess deaths. So when someone tries to tell you this is just like the flu make them prove it and then have them explain why we never had the same issues we have with Covid. Also ask them why they look only at deaths.
Steve
That’s easy to answer. Because diagnosed cases tells you practically nothing unless you assume that you can infer something about undiagnosed cases based on those that have been diagnosed which seems like a stretch. New cases is mostly just a measure of testing.
WRT cases and deaths, what’s interesting to me here in Colorado is that the number of new cases per day is almost flat – declining slowly, while the death and hospitalization rates have plummeted. I’m not sure what the best explanation for that is.
https://www.reddit.com/r/CoronavirusColorado/comments/gn0f3c/graphs_of_cases_hospitalizations_and_deaths/
I can’t tell much about the data coming from the Illinois Department of Health on either new cases or deaths. They MAY be starting to decline slowly but it’s so noisy I can’t distinguish between reporting irregularities and a trend to decrease slowly.
Example: when there’s a huge spike followed by four smaller days and three slightly larger days, followed by another huge spike, is that due to changes in the what’s happening or weekly periodicity in the reporting?
” Because diagnosed cases tells you practically nothing ”
Not what I meant. I have been supporting using deaths and ICU admissions all along to judge disease spread. What I am talking about is morbidity. If you spend two weeks in the hospital, have a stroke and cant walk doesnt that count. Permanent respiratory dysfunction? Even just having a 2 week admission where it feels like you cant breathe is pretty awful. Unlike almost anything else in health care (some) people are only looking at deaths.
Steve
“Dont just look at the numbers in the study, ask yourself if they make sense. Do they fit with the world as you and others know it.”
Yeah, try that sometime. You can’t be serious. Dave covered the first part. In FL, GA, NC and SC the hospitals are not overwhelmed, as predicted by the experts. They aren’t even stressed. Nor is NY metro. Despite all the dire warnings this was a big nothingburger. Most locals are the same. Prove otherwise, steve. Here’s the world as I know it: you are destroying the small businesses of the world, the engine of employment and livelihoods, for a boogeyman and political reasons. How do you live with yourself?
This has been about NY metro, including NJ, Wash DC, Boston, Chicago proper, perhaps, to a degree, Miami and some isolated outbreaks. All those adopted ignorant or bizarre policies, and have had media hype behind them. But the reality is that half of US deaths have been nursing homes, especially NY metro nursing homes decimated by St Cuomo policy, same as in any serious flu strain. Same as it ever was…….
I’m shaking my head in disbelief. In downtown Bluffton, SC today people are going about their business. The local radio out of Savannah reports same. No one is gasping their last breath in the gutter……….. They won’t be in two weeks either.
This is just shameful.
In Illinois ICU bed utilization by COVID-19 patients (the only statistic the IDPH gives me) has been flat for two months.
“as predicted by the experts.”
Not what the experts predicted. You may not know how to read studies but pretty sure you had to take some math, probably a lot more than I did. Just a shame you forgot how to use it. Of course you would have to actually read what they wrote.
“as predicted by the experts.”
NYC was overwhelmed. I know people working in the ORs and ICUs there. They were using their ORs for ICU beds. They were double ventilating pts. (This was something people had written about years ago as a possibility in a what if scenario, but no one had ever actually tried it before.) We have a total of a little bit under 100 ICU beds in our system. We had over 90 of those filled with Covid pts, over 80 of them intubated. In our worst flu season we have 20 pts with flu in the ICU. Those flu pts either die or get better in 5-7 days. These pts linger on the vent for 2 weeks or longer.
So when the guy says this disease has mortality rate 1/3 that of the flu? Hard to believe. And again, why are we looking only at mortality? Strokes dont count? Kidney disease? People disabled and being unable to return to work for many weeks after leaving the hospital?
“This has been about NY metro, including NJ, Wash DC, Boston, Chicago proper, perhaps, to a degree, Miami and some isolated outbreaks”
Isn’t this how it is everywhere? Look at the numbers for Italy. There were more deaths in Lombardy than in the next 15-20 provinces/regions put together.
Link goes to when Italy had its lockdown. They waited until they had over 7000 cases to have a significant lockdown, over 9000 beef rest was national. The first lockdown of the provinces occurred on the same day they went over 100 deaths in a day. Early? Not if exponential. Note that they went from 100 deaths a day to 800 in 11 days.
https://www.axios.com/italy-coronavirus-timeline-lockdown-deaths-cases-2adb0fc7-6ab5-4b7c-9a55-bc6897494dc6.html
Steve
Andy, there are multiple factors to your observation.
1. Treatment protocols have changed since March. That would bring down the ICU / death rate.
2. Increased testing means more mild cases are being recorded. Testing has increased 5x since March 19th. The real number (as opposed to test confirmed) cases is declining.
3. Summer. The Sun through not well understood mechanisms boosts the immune system.
4. The most vulnerable succumb fastest. And we are two months from the beginning of the outbreak.
5. More effective approaches to the most at-risk populations. Only took 2 months, but even New York is paying attention to nursing homes.
6. Social distancing and viral loads. It is disputed by how much, but there is a relationship between the amount of virus one is exposed to and the severity of symptoms. Facemasks and 6ft rules tend to reduce the amount of virus people are exposed to.
Unfortunately, we will figure out exactly how COVID-19 attacked people, killed people, and how to treat it effectively about the time it because functionally extinct as a dangerous disease. Which is nothing new regarding epidemics, I’m afraid.
Steve: If your hospitals and the NYC area hospitals were so completely overwhelmed, why weren’t the hospital ship and the Javits Center hospital utilized? Not complaining or criticizing, just asking. I have an ugly hypothesis as to why, but I’ll keep it to myself for now.
As I understand it, the hospital ship, taking that first, was intended to take non-Covid overflow. What would have been more helpful, in retrospect, was a floating giant ICU with hundreds of ventilators. I was on a hospital ship in the early 70s, so dont much about them now, but dont think they have that big of an ICU. So after a few days they agreed to also take Covid pts but IIRC they were not accepting intubated pts, which is what NYC pts really needed to offload.
The story is pretty much the same for Javits. The place didnt have ventilators, didnt have an OR. With those issues in mind they set up pretty strict selection criteria which resulted in relatively few transfers. (See link.)
The other problem was most pts on vents were so sick that transfers risked killing them. Just moving an intubated pt around the hospital is a big deal. Moving them around with drips and on a vent is a chore. These pts were prone to rapid and deep desaturation (O2) episodes.
In short, what they needed were real, full service hospitals that could accept pts directly rather than just take transfers. Also, thousands of volunteers poured in which helped a lot.
https://www.businessinsider.com/why-nycs-largest-emergency-hospital-javits-center-pretty-much-empty-2020-4
Steve: Thanks for the quick and informative reply. The political spinning around the ship and the Javits center didn’t discuss the lack of ICUs or ventilators on either.
I like your last note about volunteers coming in drives to help. That’s America at its best. Unfortunately it looks like Cuomo intends to make them pay for their having gone above the call of duty.
Nice try, steve. You didn’t address anything. You can’t admit the government/expert response to this has been complete horse shit.
Complete and total horse shit. The costs have been incalculable.
Show of hands. DeSantis or Cuomo if your mother is in a nursing home.
Well, do you want her to live or die? The numbers don’t lie…………. And wasn’t this how policy all started?
No one wants to talk about empirical results, just dogma.
Link goes to kind of articles we need more of to help plan. (Actually, we need real studies, but this is a start.) This compares San Francisco with NYC. Note that San Fran shut down when they had 40 diagnosed cases, NYC waited until they had over 7000. San Fran was early, NYC was not. Note that some people have claimed that Italy shut down early. They did not. They also waited until they had over 7000 diagnosed cases. Remember the term exponential and it is easy to see why both Italy and NYC exploded. (OK, I will make the caveats. There are probably other factors. I would go out on a limb and say there must be other factors, but if we are going to throw around terms like early and late we ought to have meaningful comparisons.) One of the interesting things about this virus is that it seems to attack mostly in just a few areas in any given country. Not that I have spent tons of hours on this but going country by country for where they have the data it seems localized to certain areas rather than being broadly spread anywhere. Big cities yes, but not every city and there are clearly non-city areas hit hard.
https://www.propublica.org/article/two-coasts-one-virus-how-new-york-suffered-nearly-10-times-the-number-of-deaths-as-california
Drew- This will be easy for you. Please find the stories where we had 90,000 flu pts die in 3 months and the hospitals were quadrupling their ICU capacity to care for them. Go ahead.
Steve