By Nic Lewis
The course of the COVID-19 pandemic in Sweden is of great interest, as it is one of very few advanced nations where no lockdown order that heavily restricted people’s movements and other basic freedoms was imposed. As there has been much comment, some of it ill-informed, on how the COVID-19 epidemic has developed in Sweden, but relatively little detailed analysis published in English, it is worth exploring what their excellent publicly-available data reveal.
I present here plots of weekly new cases and deaths, with accompanying comments. I have been able to access detailed daily data from 2 April on.[1]
Overall development of the epidemic
Figure 1 shows the overall picture for confirmed weekly total new COVID-19 cases, intensive care admissions and deaths in Sweden. The dashed line normalises new cases by the dividing by the number of tests carried out each week, relative to those for the week to 10 April. Both actual and normalised weekly new cases have been divided by 10 in order to make their scale comparable to that for ICU admissions and deaths.
Fig. 1 Total weekly COVID-19 confirmed cases, intensive care admissions and deaths in Sweden
Several points are noteworthy:
- Recorded new cases continued rising until mid-April, and after gently declining from then until late May have doubled since then. All or most of that increase appears to have been be due to a decision on 5 June to expand testing. By the end of June testing was at about double the rate in May, which in turn averaged approximately 25% higher than in April.
- Allowing for the increase in testing over time, the incidence of COVID-19 appears to have declined by about 30% from mid-April until the late May and has since remained broadly stable.
- Deaths peaked in mid-April and have fallen by two-thirds since then.
- It follows that the infection fatality rate has fallen substantially since early in the epidemic.
- Deaths have been remarkably high in relation to confirmed cases. To a substantial extent this reflects Swedish policy of focussing testing in hospital, where the disease is severe, prior to June. It also reflects the spread of infections to care homes, where death rates are very high, relatively early in the epidemic.
- Far more people have died than have been put into an intensive care unit (ICU). This likely reflects a combination of deaths outside hospital and an apparent Swedish policy of not generally putting people aged 80+ into intensive care.[2] For admissions before late April, 49% of 70+ year old patients (who only comprised 15% of total ICU patients) died, and most of those were people in their seventies, for whom the prognosis is much better than for older patients.
Analysis by age group
The changing age composition of new cases over time is shown in Figure 2. The number of cases among people aged 70+ has been declining since mid-April. Until the end of May this more than countered gently rising infections in age groups younger than 60, with infections among 60-69 year olds broadly stable. But since then confirmed infections in people under 60 have rocketed, and there has also been a noticeable increase in infections among people aged 60-69.
It is likely that the bulk of these increases simply reflect the widening of testing in June. The total number of tests in the latest week was double that four weeks previously. The Swedish Public Health Agency estimates that the current reproduction number, Rt, in Sweden during mid- June was approximately 0.9, implying a decline of about 10% a week in the true number of new infections. However, comparing Figures 1 and 2 suggests that while infections in the oldest age groups are reducing steadily, this is being counterbalanced by an increase in infections among young people, resulting in little overall trend in the total number of infections.
Fig. 2 Weekly COVID-19 confirmed cases by age group in Sweden
Weekly COVID-19 recorded deaths have declined very substantially since mid-April, across all age groups (Figure 3). The data show the number of people with confirmed COVID-19 who died, regardless of the cause of death.
Fig. 3 Weekly COVID-19 recorded deaths by age group in Sweden
Figure 4 shows weekly deaths by age group as a proportion of new cases two weeks previously. Since most cases are only confirmed after hospitalisation, the average delay from a case being confirmed to death occurring is around two weeks.[3] This ratio therefore should provide a reasonable estimate of the hospital case fatality ratio (CFR). It has declined substantially for all age groups, albeit proportionately less for ages 80+, where it remains very high, although not unusually so.
The estimated hospital CFR for ages 50–69 has declined by an order of magnitude, while that for ages 70–79 has declined by a factor of three. The reasons for this extremely welcome trend are not entirely clear. Much of the reduction over the last few weeks is very likely due to a widening of the testing regime to include milder cases of disease, with more cases now being found outside hospitals.[4] Nevertheless, a good part of the decline is likely real: most countries have seen a decline in the hospital CFR over time.
Fig. 4 Weekly COVID-19 deaths by age group in Sweden as fraction of new cases 2 weeks before
Infection fatality rate over time
The decline in total deaths (Figure 1) is to a fair extent due to the changing age composition of new cases, as well as a moderate reduction in total infections, with an increasing proportion of cases among younger age groups and a substantial decrease at ages 80+, which account for most deaths. But within some of the key older age groups, which account for the vast bulk of deaths, the number of deaths (Figure 3) appears to have dropped in relation to the number of cases as adjusted for the widening of testing – certainly for ages 60-69.
The Swedish Public Health Agency estimated the infection fatality rate (IFR), based on a selection of confirmed cases that have been tested in Stockholm County and who fell ill on March 21-30, 2020, after adjusting by the estimated proportion of infections that resulted in confirmed cases.[5] Of all people who they estimated to be infected with COVID-19 around the second half of March, 0.58% died.[6] In the group At age 70 and over, mortality was 4.3% (1.9% for ages 70-79) , while it was 0.09% for persons younger than 70 years.[7] [8] The overall deaths were pushed up by the spread of infections to care homes, residents of which accounted at that point for 40%–50% of total deaths.
The order of magnitude decline in COVID-19 CFR at ages below 70 since mid-April implies that, even assuming that all the change in confirmed cases between early April and mid June is due to the three-fold expansion of testing, the IFR below age 70 is now much lower than the previously estimated 0.09%. The data indicate a current level of circa 0.015%. Even for ages 60-69, where the IFR for infection in mid-March was estimated at 0.45%, the implied IFR is now little over 0.1%.
It is not clear what has caused such a large reduction in IFRs for COVID-19 at ages below 70 years. Sweden is not the only country in which the IFR appears to have declined. There is little evidence of the SARS-CoV-2 virus having mutated and become less damaging. However, treatment of serious cases has no doubt improved; less use of invasive ventilation could be one factor here. Seasonal factors may also play a role. The body’s ability to fight infections and heal damage appears to be affected by sunlight exposure, with vitamin D and nitric oxide pathways perhaps both being involved.
Another important factor in the decline in the IFR over time could be population heterogeneity in susceptibility to COVID-19 infection, in particular variability arising from biological rather than social connectivity factors. More susceptible individuals may not only be more likely to succumb to COVID-19, but more likely to die of the disease once infected. Since more susceptible individuals will tend to become infected earlier in the epidemic than less susceptible individuals, a correlation between susceptibility to infection and risk of death if infected would automatically lead to the IFR declining over the course of the epidemic.[9]
Regional analysis
I turn now to regional analysis. Figure 5 shows weekly confirmed new cases for each of the 21 regions in Sweden. Although widening of testing varied between regions, it is evident that Västra Götaland dominates the overall increase in cases over time. However, the increase in testing during the first half of June appears to have been much larger in Västra Götaland than elsewhere, so the true increase in disease incidence is likely far smaller than the increase in confirmed cases suggests. Cases in Jönköping also rose sharply in June, albeit from a much lower level. Cases in the Stockholm region remain high.
Tracking serious cases only, so as to adjust for the widening of the test regime, comparison of the latest analysed week (24 – week ending19 June) with the average of the previous three weeks shows an increasing number of cases in Västernorrland, decreasing numbers in Jönköping, Stockholm, Sörmland, Uppsala, Västra Götaland and Östergötland, and an unchanged number for other regions.[10]
Fig. 5 Weekly COVID-19 confirmed cases by region in Sweden
Regions have varying populations, so confirmed cases per 100,000 head of population give a better picture of relative disease incidence (Figure 6).
Fig. 6 Weekly COVID-19 confirmed cases per 100,000 head of population by region in Sweden
Deaths by region are shown in Figure 7. They are dominated by deaths in Stockholm region, which continue to be higher than elsewhere, although since mid-May deaths in Västra Götaland have become a much more substantial proportion of the total.
Fig. 7 Weekly COVID-19 recorded deaths by region in Sweden
The very large and almost monotonic decrease in deaths in Stockholm region, confirms that the less steep decline in cases from mid-April to the end of May (which occurred despite some increase in testing) is genuine. As already indicated, the sharp increase in confirmed cases in June is an artefact produced by the widening of testing; serious cases decline in Stockholm county.
Prevalence of COVID-19 infections
Analysis of samples collected at week 21 (late May) shows that antibodies were detected at 6.3% of the studied population. Seroprevalence remains lowest among adults 65-95 years (3.9%), compared to adults 20-64 years (7.6%) and children 0-19 years (7.5%). The Stockholm region had the highest proportion of antibody positive (10%) followed by Skåne (4.5%) and Västra Götaland (2.7%). The number of collected samples for other regions were less than 100 and therefore cannot provide reliable results.[11]
Cumulative confirmed cases as a proportion of population up to the end of week 19 (15 May), who would be expected to develop antibodies by early in week 21, were 0.32% for the whole of Sweden, 0.47% for Stockholm region, 0.11% for Skane and 0.29% for Västra Götaland. So, up to mid-May, if the foregoing prevalence estimates are correct then confirmed cases represented about 1 in 20 of people who had developed antibodies to the SARS-CoV-2 virus, but with an inter-region range of at least 1 in 40 to 1 in 10.
However, previous results showed higher prevalence, and prevalence cannot decrease over time. A fairly large sample study that sought response from a random sample of households in the Stockholm area obtained 446 valid results from tests on an average date of 11 April (week 16), reflecting infections up to late March. It found 10% prevalence.[12] And a study based on blood donors showed about 11% had developed antibodies in mid-April, although the sample size was only 100.
Moreover, the antibody tests used appear to have a sensitivity of only 70-80 percent, so 20-30% will test negative even though they have been infected. But the tests have 100% specificity – no one will test false positively.[13] There is no indication that any of these seroprevalence results have been adjusted for the relatively low sensitivity of the test used. So it seems likely that in all cases the true prevalence was 25-43% higher than that reported.
Many people with mild COVID-19 symptoms or asymptomatic infection probably do not develop antibodies in their blood, either developing antibodies only in their mucus or not at all. Antibodies are only one component of the adaptive immune system, and immunity conveyed by the development of SARS-CoV-2 specific T-cells may be more important; it is likely to be longer lasting.
Having regard to all these factors, it seems entirely possible that 20% rather than 10% would be a better estimate of the proportion of the population of Stockholm region that had been infected by late May.
Future outlook
It seems clear from the trend in cases since then that, as I intimated previously[14], by mid- April the herd immunity threshold had been reached in Stockholm county. Moreover, both there and in Västra Götaland, the two regions that have dominated deaths to date, deaths have been declining since mid-May. Regression of the logarithmic change in deaths over the last seven weekly data points gives similar results in both regions. The fits are good[15] and the slope estimates, averaging them, imply that each week’s death figure is only 81% to 86% ( at ± 1 standard error) of the previous week’s figure. Skåne, the next largest region by population, also has a downward trend in deaths, but the regression fit is less good and the slope estimate is not significant (p = 0.1). Those three regions make up 53% of Sweden’s population. For Sweden as a whole the fit is as good as for Stockholm country and Västra Götaland , with a slightly slower rate of decline: each week’s estimate deaths are 84% to 88% of the previous week’s. This range is slightly below the R value in mid-June estimated by the Swedish Public Health Agency, which has fluctuated around 0.9. The difference is likely to reflect the declining proportion of new cases made up by older age groups (Figure2) and the declining infection fatality rate for ages under 70.
If the estimated logarithmic rate of decline in weekly COVID-19 deaths in Sweden seen over the last six weeks continues, only about 1,100 further deaths would occur. That would bring total deaths up to approximately 6,400, or 0.06% of the total population. Of the first 4,500 deaths, some 40% involved people living in care homes,[16] a slightly lower proportion than earlier in the epidemic. To date, the average age at death was 82, and in only 6% of cases did a death not involve a co-morbidity (other health condition).
Conclusions
Notwithstanding that a month ago antibodies were only detected in 6.3% of the Swedish population, the declining death rate since mid-May strongly suggests that the herd immunity threshold had been surpassed in the three largest regions, and in Sweden as a whole, by the end of April.
In the absence of a change in trends, it seems likely that the epidemic will peter out after a thousand or so more deaths, implying an overall infection fatality rate of 0.06% of the population (0.04% excluding COVID-19 deaths of people in care homes). This is broadly comparable to excess deaths from influenza infections over two successive above-average seasons, such as 2016–17 plus 2017–18.[17]
The absence of a lockdown order, with the government largely trusting people to make their own individual decisions regarding their behaviour, informed by their particular circumstances, has enabled life to continue with less disruption and reduction of people’s autonomy in Sweden than in most other western European countries. While this has also meant that COVID-19 deaths to date have been higher than in some (but not all) other countries in which a lockdown was imposed, the wider spread of the epidemic in Sweden means that the future COVID-19 outlook there is better.
The herd immunity threshold is likely lower at present than it would be if people were behaving completely normally; it may also be seasonally lower. However, the continuing spread of infections since the peak of the epidemic, particularly among young people, should provide some margin of safety against its resurging when behaviour returns closer to normal and summer ends. That is, there is less risk of a second wave of the epidemic next winter. And if a second wave occurs, fewer measures should be needed to control it than in other countries.
Nicholas Lewis
Originally posted here, where a pdf copy is also available
[1] On 2 April 2020 the cumulative number of cases was only one-twelfth its current level, and only 5% of the deaths recorded to date had occurred. Updated data for 19, 20 and 21 June were not prepared. In order to avoid these days and plot as many weeks as possible, I use data for Thursday 2 April 2020 and each 7 days thereafter, ending 25 June. For consistency between the breakdowns by age and region, I use the data as originally reported on each date, not the final adjusted daily figures (which are not reported by age group). There is some lag in reporting, particularly for deaths.
[2] Such a policy would be understandable, as the prognosis for 80+ year-olds given invasive ventilation in ICUs is extremely poor, with many of those who do survive then having a poor quality of life.
[3] The average delay between a case being confirmed and death occurring is 12 days. (https://www.folkhalsomyndigheten.se/publicerat-material/publikationsarkiv/t/the-infection-fatality-rate-of-covid-19-in-stockholm-technical-report/) However, there is a significant delay between sickness arising and cases being confirmed. On average, it takes 11 days between sickness and the start of intensive care.
[4] The earlier increase in testing, from mid-April to mid-May, appears to have largely been targeted at, and detected more cases in, health and care staff. In week 20 (mid-May) the proportion of confirmed cases comprised of healthcare and care staff was as high as 74% in the Kronoberg region. https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-20-final.pdf
[5] They assumed that the estimated infections were spread evenly over the population of the Stockholm region, that is an age-independent atack rate.
[6] Measuring instead by the number of excess deaths in the relevant period over the estimated average number suggests a slightly higher overall mortality rate of 0.7%. However, mortality earlier in the 2019-20 winter period was lower than average, as it also was in the 2018-19 winter, so there were probably more than usual very old people likely to die from infection when COVID-19 struck. By week 23 (week ending 5 June 2020) the difference between the two measures was only about 10% (4,811 vs 5,353). (https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-25-final.pdf)
[7] https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-24_final.pdf
[8] https://www.folkhalsomyndigheten.se/contentassets/53c0dc391be54f5d959ead9131edb771/infection-fatality-rate-covid-19-stockholm-technical-report.pdf
[9] If much of the variability involved arose from whether and how many cross-reactive T-cells – such as arise from previous exposure to common cold coronaviruses – an individual possessed, the much smaller decline in IFR for 70+ age groups might perhaps be due to the T-cell senescence that occurs in old people.
[10] https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-25-final.pdf
[11] https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-24_final.pdf
[12] https://www.kth.se/aktuellt/nyheter/10-procent-av-stockholmarna-smittade-1.980727
[13] https://www.svt.se/nyheter/inrikes/11-procent-av-stockholmarna-har-antikroppar-mot-covid-19
[14] https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/
[15] The R-squared is close to 0.90 in both cases.
[16] https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-22-final.pdf
[17] https://www.folkhalsomyndigheten.se/contentassets/4b4dd8c7e15d48d2be744248794d1438/rapport-overdodlighet-vecka-23-2020.pdf
> However, previous results showed higher prevalence, and prevalence cannot decrease over time.
Well,
(1) The findings of analyses to determine prevalence can decrease over time – if the methodologies have problems, which appears to be the case
– particularly if the base rate is low.
(2) The researchers who conducted the LA seroprevalence study argued that a lower prevalence in a later study could be explained by the vagaries of the presence of antibodies in those tested – in other words, that there was a “waning” level of antibodies over time.
THANK YOU for beating me to it.
THANK YOU! I was just about to say that!
> Notwithstanding that a month ago antibodies were only detected in 6.3% of the Swedish population, the declining death rate since mid-May strongly suggests that the herd immunity threshold had been surpassed in the three largest regions, and in Sweden as a whole, by the end of April.
Not a shock that your analysis confirms your own conclusions.
Nonetheless, the death rates in Sweden steadily climb up the charts relative to virtually ALL other countries – despite starting lower for a number of reasons that have nothing to do with their “herd immunity” policy, and despite many, many structural advantages over the countries that have the most similar death rates at this point.
> While this has also meant that COVID-19 deaths to date have been higher than in some (but not all) other countries in which a lockdown was imposed, the wider spread of the epidemic in Sweden means that the future COVID-19 outlook there is better.
This is a dubious statement. It’s a cherry-pick and it’s a comparison that lacks context.
Sweden is waaaaay behind in death rates compared to those countries which don’t have significant structural disadvantages (Finland, Denmark, Norway). They have been climbing the charts dramatically relative to ALL other countries except those that are likewise climbing dramatically on a relative scale.
If you want to make the argument that they will realize a significant economic advantage from their policy – go for it. I say it’s too early to tell. But to try to argue that in terms of prevalence of deaths and illness, the results in Sweden aren’t clearly quite bad by any reasonable means of comparison, seems like confirmation bias to me.
Joshua, you once again find “bias” everywhere when you don’t like the conclusion. In any case, this is largely a meaningless issue as the real question is how many will ultimately die before herd immunity is reached. That number will likely not be dramatically different between Sweden and its neighbors. The myth that somehow if we instituted draconian testing, contact tracing, and monitoring of all human to human contact that we could “stop” the epidemic is wishful thinking no matter how utilitarian it may be for those who want maximum economic damage.
If Nic is correct that the ultimate population fatality rate will be 0.06%, that’s much much less than expected annual mortality, which in the US is roughly 1%. That seems like a relatively mild epidemic to me by historical standards. And it raises the question of why we went through the mass panic attack we went through.
Does that 0.06% fatality rate include victims of DIY coronavirus cures, including chloroquine aquarium cleansers and disinfectants traken internally ?
https://vvattsupwiththat.blogspot.com/2020/06/curiously-refreshing.html
> If Nic is correct that the ultimate population fatality rate will be 0.06%,
Already higher in Belgium. And according to a number posted by a “denizen” here, already considerably higher than that already in Spain. So it looks like Nic isn’t correct.
> And it raises the question of why we went through the mass panic attack we went through.
Sorry to hear that you panicked, David. Try some Xanax?
You guys didn’t even respond to anything I wrote. And you came with nothing interesting in your comments either.
I didn’t panic, the media paniced and I believe reverted to their MO to exaggerate (in this case dramatically) and get people scared unnecessarily. For those who are healthy and under 70, covid19 is much less serious than the flu as Nic’s post shows. Quibblng about country to country comparisons changes nothing and is rather childish.
I also don’t understand the eternal pessimism and carefully crafted merchants of doubt behaviour. The return of Democrat run cities to the bad old days of the 1970’s with their astronomical crime rates is vastly more serious. This will cost a lot of black lives. Activists and blind partisans didn’t care then and they don’t care now. Does Josh care?
Is this one of those Hasidm funerals underboss De Blasio has ordered the NYPD to squash?
https://twitter.com/NYScanner/status/1277336104228839429
I don’t see confirmation bias. The “Conclusion” section is a rhetorical “Here endeth the article.” In it, he conditionalizes his assertions. You can’t project bias if you’re not categorically asserting.
Example: “In the absence of a change in trends…” Things can change and he acknowledges this. It’s also the case though that the rather substantial change in April indicates change in a desirable direction. Clearly there’s no bias in pointing that out. It’s just the numbers as reported. (I started tracking these around the first of April myself and left off at the end of May as the 1/2 wave turn had clearly happened and persisted.)
> If Nic is correct that the ultimate population fatality rate will be 0.06%,
Already some 25% higher than that in Belgium. And I’d guess that if they were social distancing it would go far higher still. Imagine they opened up completely, games in stadiums full of fans, accepting travelers from Arizona, holding campaign rallies indoors in stadiums, etc.
Now admittedly they have a relatively high % in nursing homes, but they also claim that they’ve been more accurate in counting deaths.
Weren’t social distancing.
Sweden’s death rate will continue to decline as the herd immunity threshold is reached in more regions of the country.
All the rest of the world will continue to see generally lowering but higher fatality rates than Sweden going forward.
On the other end of the spectrum, New Zealand is closed off from the rest of the world until a viable vaccine is developed and administered countrywide.
Sweden will be open for travel (and business) before any other country, and their economy won’t be in tatters from economic suicide by tight mandatory lockdowns.
Nostradamus, eh?
“On the other end of the spectrum, New Zealand is closed off from the rest of the world until a viable vaccine is developed and administered countrywide.”
Good argument. Old accounting trick: Shift something into another time frame. NZs fears will have been shifted into the future. A bell curve distribution of responses. Practice makes perfect.
Great post Nic. The IFR for those under 70 being below 0.1% is interesting and shows that for most people covid19 is comparably or even less serious than the flu, something Ioannidis has been saying for months. He’s received ridicule and some very nasty personal attacks for saying it, particularly from climate alarmists, who also seem susceptible to viral alarmism. It really is a shame that this played out the way it did, with massive self-inflicted economic (and resulting mortality) damage. I personally blame a hyper partisan and dishonest media to a large extent. They have portrayed endlessly the high CFR rates (often above 10%) as meaningful when scientists know they are not. And they always seek out the worst and most alarming examples to film and constantly replay. They do this with natural disasters and particularly hurricanes too. Conversely, we are told that massive violence is “mostly peaceful protests.” It will go down as the largest mass panic since the worst financial panic of the Gilded Age. This one will do more lasting damage to humankind however.
I also do agree however, that the failure of governments to more effectively shield care facilities should be the biggest scandal of this epidemic. A heavier focus there (and less focus on forcing everyone to stay at home) could have cut the death toll by roughly half. For some reason, the US media show little interest in this issue however. I have my suspicions that they won’t cover it because it casts some of their political favorites in a negative light.
Another very big scandal is how less alarmist scientists have been smeared. I can only shake my head at how public and scientific discourse has been dragged into the gutter over the last 20 years.
“the failure of governments to more effectively shield care facilities should be the biggest scandal of this epidemic.”
this is low hanging fruit and not sure it is ripe. It is statistically true of many states in the US as well and my first instinct was to question the extent of population scale mesaures to those undertaken with regard to congregate facilities for the elderly.
But I ran into a friend who works in healhcare in a nursing home in Rhode Island (a state with a much higher percentage of deaths in these facilities, like mid 70%) and he added some context. He is a commercial fisherman who took a nursing degree at midlife when looking for an occupation that was less physically taxing and rife with accumulated injury. He’s been at it going on a decade and he was matter of fact about this, not cynical or political.
His perception is that people go to nursing homes to die (that is of course distinct from assisted care settings and finer grained inquiry charting the spread and virulence in different facility contexts is the kind of information we don’t yet see that may help us to further understand the demographic that succumbed to covid). It is apparently common knowledge from inside these institutions that there are regular spikes in death from communicable disease that does not pose serious risk to younger populations following the Christmas holidays every year. It is taken for granted that the quality of life associated with visiting celebrations outweighs the isolation that might result from an overly rigorous anti-disease policy–such as has been instituted for Covid now that the focus on elderly institutions is front and center. Not only can’t people from the outside visit, but the patients can’t visit with each other generally and the staff are in protective gear that accentuates the isolation.
Now, I don’t mean to say that these measures are therefore wrong, overdone or that there aren’t other than these obvious protections one could institute, including for these regular waves of infection nevermind covid. I think only informed hindsight and trial of differing policies will really tell the story of best practice in these settings.
Florida has kept patients hospitalized who no longer need hospital facilities but where their return to an elderly care facility might have threatened further spread. New York did the opposite. There is some anecdotal allegation in these threads that Sweden simply didn’t hospitalize, or at least did not provide ICU level treatment for their oldest cohort.
Some of these facilities have created somewhat isolated wings or corridors for positive patients or they have cooperated in establishing some facilities where infections spread that will be receiving facilities for infected residents from outside facilities. With all the rush to create overflow hospital facilities, it does seem eminently possible that one could reconcile concern about transporting elderly patients between facilities and hospitals by providing hospital grade care, or something like that, in the nursing home setting during this pandemic.
But one predominant concern here is that even those convinced that government can’t get policy toward everyone else right are quick to lay blame for nursing home outcomes with the government. The relegation of nursing home care to a public institutional charge seems to be an outcome worth reconsidering. Of course social family patterns and cultural habits have given rise to this trend, but far more people seem to want to question the government response to eldercare when some particular failure can be cited–rather than the macro contemplation of whether eldercare should be up to the government. Indeed, in the most cynical scrooge like contemplation, regular circulation of communicable disease in nursing homes could itself be a policy to educe the surplus population and make room for the next patient from our expanding older cohort.
This looks like Nic is correct.
https://adamaltmejd.se/covid/deaths_lag_sweden_2020-06-28.png
Nic was projecting 6400 deaths, or 0.06% of Sweden population. The graph projects 5563 deaths, or 0.05% of Sweden population.
Sweden has a ton of structural advantages over most other countries to keep the deaths down. Low population density. High % of single-person households. High % of people who can work from home. Good general health (low comorbidities). Highly functional healthcare system. Low levels of travel from/to China and Lombardy compare to other counties with similar rates of death. Extensive social safety net. Generous policies to give people leave in absence from work.
They’ve done far, far worse than other counties with similar advantages. Their death rate is multiples higher.
It doesn’t firm a good comparison for basing policies in most other countries.
Joshua’s comparison is largely meaningless. The important question is whether neighboring countries will have a similar death rate when herd immunity is reached. Don’t understand Josh why you persist with this flawed comparison.
In any case, regardless of other countries, 0.06% fatalities is about 8% of expected annual mortality and thus this “epidemic” will hardly be a noticeble blip on annual mortality. Normal people would see that they are vastly more likely to die from cancer or heart disease or even from accidents within a few months and not favor causing the worst Depression in history with the millions of ultimate fatalities.
Just out of curiosity, are you also in favor of lowering the speed limit to 10MPH in order to prevent 45,000 deaths each year? If not, why not?
Joshua
Your comment about advantages in such as single person households omits the matter that some 30 percent of Stockholms population ( where most deaths occurred) is of an immigrant background and very many live in intergenerational households.
These migrant areas have a disproportionately much higher infection and death rates than ethnic swedes. With some 50 percent of deaths being in care homes and a higher than normal rate amongst immigrants in multi roomed houses, the number of ethnic swedes below 75 years of age succumbing to covid 19 is relatively small, so all the clubbing and visits to restaurants that the younger age group indulged in probably did not have much of an effect. The other Nordic countries do not have the same ethnic make up.
In the uk we have the same effect as in stockholm to the extent that there is talk of a new lockdown in Leicester where there is a very large Asian population who have a similarly greater than average death rate and tend to mix in houses in large numbers for prayer or for socialising.
Let’s hope that Anders Tegnell’s reverse version of “Stockholm Syndrome” gets wider appreciation.
Regarding reasons why you would expect Sweden to do better in death rates irrespective of more extensive government intervention vs. more limited government intervention…forgot to mention – time of onset of the initial government intervention:
–snip–
William Hanage, associate professor of epidemiology at Harvard’s School of Public Health in Boston, said “Sweden’s policy is unusual in that it took a much less stringent approach to preventing transmission, but interestingly it implemented those measures at a very early stage in the pandemic, before large amounts of community spread had occurred.”
–snip–
Could be the most predictive variable? Imagine if the US had acted more quickly, both regionally and nationally. And imagine if we had ramped up testing, tracing, and isolating early in the game.
https://www.google.com/amp/s/www.bloomberg.com/amp/news/articles/2020-06-28/sweden-s-covid-expert-says-the-world-still-doesn-t-understand
These interim projections are interesting. While Sweden may look like they are losing by some measures, it is still early days. The trends in Sweden are certainly looking good. If herd immunity is being reached there should be very little second wave. For those countries who have not reached herd immunity they may still be dealing with wave after wave of the plague for a long time, disrupting people’s lives and ‘normalizing’ anti-virus behaviors.
It ain’t over ’til it’s over.
bigterguy, in places that have done antibody testing indaications are that 10 to 20 times more people were infected than tested positive. They were younger and in good health, and did not seek to be tested or to receive professional care. And that is happening now that governments are protecting the elderly and infirm, and letting the others resume their lives. The new infections are not killing the non-elderly, and many cases are mild, so that health care system is not overtaxed.
Joshua, I keep coming back to the fact that your premise is wrong. Without a vaccine, nothing can prevent reaching herd immunity and suffering roughly 0.06% fatalities. All your moaning about contact tracing, etc. is magical thinking. The outcome won’t change but the costs in money and intrusion into people’s lives is huge.
The purpose of mitigation is not to reduce total fatalities, but to flatten the curve, remember?
> all your moaning about contact tracing, etc. is magical thinking.
If we put the HIT at a ridiculously low 20%, a country like S. Korea might reach the HIT in about what, 400 years at the current rate?
Contact tracing is a way to keep deaths down at least over the short term. No uncertainty there. It is a proven fact.
As of right now, if we had people dying at the same rate of the overall population as S. Korea, we would have on the order of 8,000 dead instead of 128,000 dead. It’s only getting worse on a daily basis. Sweden has people dying at an even faster rate. Add what, another 30k or so? Is that of value? I’ll let you decide. What is the value of 120k lives? You decide.
Is 400 years short-term? I’ll let you decide for yourself.
What is the HIT? Will a vaccine get developed? Is there immunity from infection? How long does it last? What is the relative long-term economic impact of more extensive shelter in place vs. more limited shelter in place? What are the long-term sequelae of mild infections? Do mild infections infer immunity or durable immunity? What treatments will be developed?
What is the infection mortality rate? What are the values influences on infection rate morality and what is the magnitude of their influence? How many people have been infected? How many people have really died from the disease?
All unknowns.
… what are the variables that influence infection rate…
Actually, there another way to look at the comparison than how I got 8,000. Korean’s a bit under 1/6 our population. Let’s call it 1/6. Multiply their dead by 6…let’s call it 1,500.
Hmmm. 1,500 vs. 128,000.
Yeah. Magical thinking.
Well, The problem for Korea is that eventually they will want to open up to international travel. Perhaps they should test everyone who wants to enter the country for covid19 and maybe flu, leprosy, tuberculosis and maybe 20 other serious contagious diseases. But you get the idea. Just like hundreds of other communicable diseases, no country will be able to totally prevent their spread in the long term absent a horribly expensive policy that violates fundamental rights to privacy. Effective treatments or vaccines are the only way to defeat any disease.
I’m sure Koreans are saying “Damn, if only we’d have followed Sweden’s strategy, we could have had 25,000 dead instead of 282”
Much higher population density. More multi-family and multi-person households (I’m guessing). Higher comorbidity rate (guessing). Same median age. And yet. 1/18th the number of deaths with 5 x the population.
Yeah. I’m sure they’re locking themselves on that one.
As usual, Josh, you didn’t respond to any point I made. Covid19 is going to be like any other communicatible disease. Treatments and perhaps a vaccine (if we get lucky) are the only way to address it effectively. Your argument is not bought into by any epidemiologist. They all say that herd immunity is our ultimate destination. Mitigation only flattens the curve. You are getting dangerously close to science denial here.
In any case, you would be happier if you cheered up and were optimistic about the good news and its very good. IFR for people under 70 is lower than the flu and even Sweden will probably have a PFR of 0.06%. You are a beacon of negativity amid a vastly better outcome than most doom and gloom alarmists were expecting. This level of focus on saving every life through causing the deaths of many more due to economic coillapse is just cruel and shows you are not doing adult thinking. Every public policy implicitly accepts some significant risk of loss of life and health for a greater good. Speed limits are a perfect example to which you didn’t respond. Why is that?
Tony –
They are all factors that should be considered in any reasonable comparative analysis.
Indeed, I’ve been arguing in these threads for weeks that the disparate impact in different communities is an important consideration when evaluating different policies to address the pandemic, and one that deserves more consideration than it currently gets. IMO, it’s unfortunate that the group of people making policy decisions are not representive in that sense.
We can extend that problem. For example, have a relatively small % of people in this country who think that they’re being oppressed by a tyrannical government because of an expectation that they might do something as simple but slightly inconveniencing as wearing a mask when they are in public.
Yet that % of people have a vastly outsized amount of political power. Not the least because the most powerful person in the world wants to pander to that % for the sake of his political fortunes.
Public health officials in Sweden have acknowledge the importance of addressing the disparate impact in different communities, and that there were shortcomings in their approach to this pandemic in thst regard.
Public health officials in this country have also acknowledged the issue, but unfortunately they are not leading the policy repsonse, and those who are empowered to lead the policy response are concerned with responding to the self-victimization of one, relatively mall, whining, self-important group that already has outsized power, but less interested in the welfare of other groups who are actually being disproportionately impacted in very real ways.
tony –
> Your comment about advantages in such as single person households omits the matter that some 30 percent of Stockholms population ( where most deaths occurred) is of an immigrant background and very many live in intergenerational households.
No doubt, that’s an important consideration when making comparisons across different localities. That said, even Stockholm is likely to have certain structural advantages with regard to the impact of demographics (and SES more generally) when it comes to the outcomes of the pandemic, as compared to many other localities. So when you imply that the demographics of Stockholm are a disadvantage, to what other locality are you making the comparison? I would suggest that many other places that people are typically comparing to Stockholm, or Sweden more generally with Stockholm as an important component, actually have a larger problem with the health impacts on immigrant communities than Stockholm/Sweden do.
At any rate, I’ve been arguing for weeks in these threads that there should be more consideration of the disparate impact of the pandemic on different communities. Unfortunately, in this country (and in many others as well), the group of people making policy decisions is not representative of the population as a whole – and thus the disparate impact on certain communities is not sufficiently considered.
In Sweden, public health officials have been pretty up front about acknowledging that they didn’t sufficiently consider the disparate impact in different communities. In this country, however, even though public health officials here have also acknowledged the problem, the group of people empowered to make the policy decisions have insisted that their policies have been “perfect” and the constituency that supports them politically has no interest in having those politicians being held accountable for their nonsense.
Actually, it gets even worse, as in this country we have another group that has disproportionate power to shape the public health response to the pandemic. That would be the group of whining, self-victimizing and self-important snowflakes who think that something like an expectation that they should wear masks in public is some kind tyranny. Unfortunately, the most powerful man in the world wants to cater to that group because he thinks it’s in his political interests to do so.
“You are getting dangerously close to science denial here.”
These are the folks who want “science” to be post-normal: “scientists” are supposed to find whatever it is the politicians on the left want them to find. In fact, it’s required now in most universities.
Josh -.” That would be the group of whining, self-victimizing and self-important snowflakes who think that something like an expectation that they should wear masks in public is some kind tyranny.”
The objection to the masks mandates is that they are required every where even in environments where the risk of transmission is already very low. The mask provide virtually zero additional benefit in those environments.
But you already knew that
Joe +
> The objection to the masks mandates is that they are required every where even in environments where the risk of transmission is already very low.
There is no “the” objection. I’m sure that there are a variety of objections among a variety of people.
That includes some people who like to play freedom tighter who see governmental tyranny behind any policy that might cause them some minor inconvenience. Why should they have to alter their behavior or of consideration for others?
How do we know this? Because they say a mask requirement in principle is a violation of their civil liberties. They are whining and fighting mandated that specifically require masks outdoors, only when social distancing can’t be maintained.
They’re are even “patriots” who object because masks “literally kill people and because….God
cleveland.com/coronavirus/2020/05/ohio-legislator-cites-god-for-refusing-to-wear-face-mask-during-coronavirus-crisis.html%3foutputType=amp
https://roguerocket.com/2020/06/25/florida-viral-videos/
But you knew that.
But I do have to admit that it’s fun watching y’all arguing that we should follow the lead of a SOSHLIST!!! 1!!!11! country.
Yah. Let’s start giving sick leave like they do, provide universal health coverage like they do, provide other social services like they do, provide free education through university like they do, pay taxes like they do so we can afford all that stuff.
You boyz must have been upset when Bernie dropped out.
But before you want to cherry pick their “herd immunity” strategy from their Scandinavian socialism (as you no doubt want to do), consider that to the extent its been effective it is largely because of their Scandinavian socialism.
Anyway, I’m on board. Let’s go!
“…we should follow the lead of a SOSHLIST!!! 1!!!11!”
Sweden isn’t socialist, you guys just like to pretend it is for political reasons because of the socialized medicine. Which works financially only if you define “health care” as simply keeping people over 80 comfortable on pain meds until they die.
One day Bernie will be honest about what he wants- capitalist economy, 60% tax rates on the middle class, and rationing of health care. Until then, he keeps losing because we all know that’s what he wants, and think it’s odd that he keeps pretending otherwise.
It’s actually a serious problem for people on the left in the US – nobody is quite sure if people on the left just have no idea what they’re talking about or think the rest of us can’t use calculators. Neither is a good look on election day.
Jeff –
Maybe you missed that I was mocking the fear-mongering labeling of Sweden as SOSHLIST!!!
And we ration healthcare – on the basis of ability to pay. But maybe that’s not a problem for you. I’m guessing because you have the ability to pay and perhaps because you think that ability to pay is the end result of a meritocratic society, or gods will.
“I’m guessing because you have the ability to pay and….”
It’s either that or I’m aware of Medicaid and Medicare. One of the two.
Google health care spending by age cohort. The US is expensive because of the amount of money spent on older people and end of life care. Then google wealth by age cohort.
Wanna know why we haven’t passed socialized medicine in the US? Because it’s wealth redistribution from young people and the middle class to older people- the wealthiest cohort in America. And older people vote, so any single payer plan in the US has to include today’s access to unlimited health care for the aging, so it’s really just a plan to force young people and the middle class to pay more for medicaid and medicare.
That’s why it failed in California. To make the numbers work they needed a 15% payroll tax plus an income tax increase, and it still wasn’t enough even when they assumed every federal medicaid and medicare dollar continued to flow into the state (and increase). I assure you that no 29-year-old tech worker employed by a big company in Silicon Valley and pulling in $100k is paying $1,250 a month out of pocket for “health care” nor could they afford to given the cost of living there.
Even the liberal state legislature realized they couldn’t pull that one off.
Summary: euthanasia is good. Sweden are to be commended for being the last country to abandon euthanasia last century and the first to bring it back for covid19 now. After hopelessly old covid19 cases – who’s next?
Phil, Are you in favor of lowering the speed limit to 10MPH to save 45,000 lives a year? Preserving every life is not an absolute for any of us who are actually thinking and breathing. We all take health and life risks every day.
Sweden’s policy on covid19 has been the same as general Zhukov’s directive to WW2 Soviet soldiers encountering a minefield – continue as if it isn’t there. Their determination to star as the “smart country” that has had a rational response to the virus has led to some brutal policies. I have been told this by friends who live there. Covid sufferers in care homes slowly suffocate, gasping like goldfish for days on end and “carers” are forbidden to apply intensive care. This is emphatically not about allowing extreme senile patients peacefully pass away. Furthermore, care staff who complain about the lack of PPE are sacked for it.
There is nothing common-sense or compassionate about Sweden’s covid19 policy. It’s all about national image, nothing about individuals.
You are judging the race when it has only been half run.
phil salmon says, “Covid sufferers in care homes slowly suffocate, gasping like goldfish for days on end and “carers” are forbidden to apply intensive care.”
Got any evidence for that? Sweden admits their biggest mistake was failure to protect the elderly sufficiently.
Look at the US: in NY State, Covid patients were farmed out to nursing homes and nursing homes were forbidden to test incoming patients for Covid. And yes, I have proof of that: https://www.theblaze.com/news/ny-health-website-deletes-gov-cuomos-order-forcing-nursing-homes-to-take-covid-19-patients
IMO, Nic’s article is pretty good. As above in a response to Joshua, I was tracking Sweden from around the 1st of April until the end of May. By then all metrics I was tracking were trending downward or flat.
As an aside, I had trouble getting accurate info for Sweden periodic Covid cure rate. If anyone can refer me to a source that’s updated regularly, I’d appreciate it. (WorldOMeters is not good for this)
I do think here in the US though the problem is a bit different. We (as a nation) are large enough both geographically and in terms of population that we have de facto, multiple herds to infect/immunize. Thus we see the regional spikes…and are therefore treated to daily breathless accounts of hyperventilating talking heads. (The Smacking My Head emoji has recently been elevated to the status of being my favorite spirit animal.)
jb, it seems to be the case that recoveries and cures are not reported carefully. In Canada where I live, the only stats are from hospital releases, which ignore all those infected but without admission, and in many cases, with only mild discomfort. I attempted an estimate from Canada case and death statistics.
https://rclutz.files.wordpress.com/2020/06/canada-covid-19-outcomes.png
Recoveries are calculated as cases minus deaths with a lag of 24 days. Daily cases and deaths are averages of the seven days ending on the stated date. Recoveries are # of cases from 24 days earlier minus # of daily deaths on the stated date. Since both testing and reports of Covid deaths were sketchy in the beginning, this graph begins with daily deaths as of April 24, 2020 compared to cases reported on May 31, 2020.
This assumes that taking the delay period estimated by Nic from infection to symptioms to death averaging 24 days. It also assumes that a recorded death was one of the recorded cases.
I forgot to mention that on this basis the recovery rate has gone from 83% up to 98% as of yesterday. Recoveries are running 3 times the number of new cases.
Full discussion is at my post https://rclutz.wordpress.com/2020/06/22/in-search-of-covid19-recoveries/
> . By then all metrics I was tracking were trending downward or flat.
How did they compare to other countries. There is more than one question at hand.
One question is whether they’ve reached a herd immunity threshold – and as an extension of that, where they’ll wind up in death rate compared to other countries. To evaluate that you need to compare apples to apples and control for obviously explanatory influences on outcomes.
Another question is whether they’ll realize economic advantages relative to other countries who employed different policies. Again, you need to compare apples to apples and control for variables. Please let me know who you’ve seen that does that.
And a big missing piece is whether a vaccine is developed on a relatively short time frame. If one is, Sweden likely sacrificed many lives for nothing. Scale up to a larger country such as the United States and… If one isn’t, then their gamble may pay off. But obviously it’s too early to judge.
Josh, You keep repeating the same largely meaningless country to country comparisons.
You should know that fully effective virus vaccines are usually not possible. For most viruses there is no vaccine at all. The flu vaccine is only partially effective. Counting on that for covid19 is grasping at straws.
And still another question is: “are you ready to live without large-scale gathering, private contact tracing, incredibly intrusive health measures and subject to quarantine on a whim”. Economic outcomes are not the only problem of the current measures. Private liberties have been incredibly reduced, it’s not like a classic dictature in the sense that political opponents and/or scapegoat groups are not especially targeted, but in some respect, for the average non-political, non-discriminated citizen (especially young adults) it’s even worse. In fact it’s only because measures are more and more ignored that it has not caused more unrest in western europe, but this in itself is a problem: Police intervention is largely arbitrary at this point…
The post-covid future does not look bright to me, as covid is just an acceleration of broad trends in western europe (as the speed limit example illustrate). Restrictive regulations are freewheeling, all for protection (your health, environment health) of course, and victim-rent-seeking is of course rising.
How I wish most would take the time to listen to and then think about your statement relative to the US and geography. Which is why we need to manage this on a geographical basis. Seems we are starting to learn this but I still see so many in the media and of my friends insisting we must take national, drastic actions which simply are not warranted.
“In Sweden, Will Voluntary Self-Isolation Work Better Than State-Enforced Lockdowns in the Long Run?
“There’s a lot of debate over the Swedish model of coronavirus response, but there are good reasons to think a Hippocratic approach to policy may pay off.
JOHAN NORBERG | 4.17.2020 11:50 AM
“Sweden reports the number of people who die with COVID-19, not of COVID-19.
“Even in a culturally and geographically similar country like Norway—celebrated for its low death rate—they do things differently. The Norwegians only count something as a COVID-19 death if a doctor concludes that someone was killed by the disease and decides to report it to the country’s public health authority.”
https://reason.com/2020/04/17/in-sweden-will-voluntary-self-isolation-work-better-than-state-enforced-lockdowns-in-the-long-run/?utm_medium=email
In the US, there are people dying outside of hospitals that aren’t tested. Presumably some of them have died of covid-19 but have not been identified as such.
How many people are dying outside of hospitals in Sweden? Are they tested?
There are certain to be efforts in due course to normalise ‘Covid-19 death’ rates across different countries despite different attribution/reporting methodologies. It may well be that this will never be possible to a high degree of confidence unless you start digging people up and conducting autopsies.
Interestingly, this problem is not confined to Covid-19. I had a friend who worked on the development of expert systems for medical diagnosis back in the 1990’s. As part of their testing of how well their software fared compared to the human experts used to train it, they also tested how well experts fared when compared to objective diagnostic tests – particularly postmortems for terminal illnesses. An alarmingly high proportion of diagnoses by human experts were wrong.
We may have to settle on statistically-derived ‘excess death’ rates which only count bodies and attribute otherwise unexplained temporal anomalies to a likely ‘Covid-19 factor’. This may not be very accurate in absolute terms, but may be better than all other alternatives for comparative purposes because it disregards clinical attribution methodologies altogether.
Nic, you wrote:
“That is, there is less risk of a second wave of the epidemic next winter.”
That implies a seasonal effect. However, in the US in recent weeks the largest increase in infections have been in the warmer, southern states. Does that suggest there is no seasonality or is there something special about these US states?
Some suspect that people spending many hours in air-conditioned spaces are at risk of infection. However, it is not yet clear that a serious viral load can be passed that way. Part of the pandemic disinformation is to conflate the virus SARS CV2 with the disease Covid19. They are not the same, in the same way that HIV is not AIDS.
Andrew,
I’m not sure what the explanation for relative trends in southern vs northern US states is – I don’t follow them in any detail. But there are many possibilities.
There is certainly good evidence of strong seasonality in infections by common cold coronaviruses, which peak in January or February in the N hemisphere, and in flu/flu like infections – which moreover in Australia peak in their winter months.
It might be more behavioural than weather related. We found no correlation with temperature, humidity or UV radiation when analysing data at high spatial resolution
https://www.medrxiv.org/content/10.1101/2020.06.08.20125377v1
Where it is getting hot more people are staying inside in air-conditioned spaces. As we know the rate of transmission is greater in confined spaces with recirculated air.
This was a very informative article. Now, something not mentioned but which people should keep in mind: Sweden’s death statistics are very accurate.
You can go to this site and download the all-cause mortality data. They already have calculated the 2015-2019 average so you can compare it to the 2020 numbers.
https://www.scb.se/om-scb/nyheter-och-pressmeddelanden/scb-publicerar-preliminar-statistik-over-doda-i-sverige/
Sweden first had significant Covid-19 mortality in week 13 (March 23rd-29th); the last week with complete data is 23, that is to say June 1st-7th. Assuming the 2015-2019 average is “normal” mortality, then for weeks 13-23 the “implied” mortality was only about 2% higher than the officially reported one (120 deaths or so). Furthermore, in weeks 22 and 23 the gap shortened significantly; by now official mortality may have overtaken the “implied” number.
Sweden’s “performance” as measured by data aggregators like OWID looks worse than it really is, because other countries are under-estimating deaths but Sweden isn’t. In Spain the real death toll has been about 44,000, rather than 27,000 or whatever the latest number from the government is. My impression is that almost all the countries and regions with high mortality under-estimated the death toll: Peru, the UK, New York, etc.
Good point. The low level of deaths currently showing over the last 10 days is no doubt due to reporting delays. But over the 24 months to 17 June 2020, excess deaths over the 2015-19 mean (2006) are substantially lower than for the previous 24 months, to 17 June 2018 (2928).
Moreover, there were a lot more old people in Sweden in 2019 than in 2015: 112,450 more aged 65+, which age groups accounted for nearly 90% of total 2019 deaths. Against that, the Swedish mortality rate had been fairly steadily declining from 2009 to 2019, by little under 1% a year. I therefore measure the effective 2015-2019 change in population by age group (0-64, 65-79, 80-89 and 90+, as death statistics are given for these age groups) by subtracting 1.039 times the 2015 population from the 2019 population. I then multiply the thus-adjusted change by the 2019 mortality rate of that age group, and sum these products. That gives an expected increase in total deaths over the four years of 1,270, or 317 per year on average.
It follows that, adjusting for population and mortality rate changes, excess deaths in the 24 months to 17 June 2020 were some 1,560 lower than in the previous 24 months, rather than (on an unadjusted basis) 920 lower.
I think the best way to assess Sweden’s covid-19 response is to look at total (all causes) death rates over 20 years. I don’t think anyone thinks Sweden has been some kind of post-apocalyptic hell-hole anytime in the past 20 years.
Total (all causes) death rates by age group and year can be found at http://www.statistikdatabasen.scb.se/pxweb/en/ssd/START__BE__BE0101__BE0101I/LivslangdEttariga/.
Sweden is on track for about 10,000 covid-19 deaths in 2020. Covid-19 deaths by age group can be found at https://www.statista.com/statistics/1107913/number-of-coronavirus-deaths-in-sweden-by-age-groups/. Assuming the baseline 2019 total death rates, adjusting for 2020 population and adding 10,000 covid-19 deaths (distributed into the various age groups based on the data) we can get an estimate for total (all causes) death rates by age group in 2020.
The results (to the hundredth of a percent):
Ages 0-9: the 2020 death rate will be lower or equal to the rates of the past 21 years.
Ages 10-19: the 2020 death rate will be lower or equal to the rates of the past 21 years.
Ages 20-29: the 2020 death rate will be lower or equal to the rates for 19 of the past 21 years.
Ages 30-39: the 2020 death rate will be lower or equal to the rates for 20 of the past 21 years.
Ages 40-49: the 2020 death rate will be lower or equal to the rates for 20 of the past 21 years.
Ages 50-59: the 2020 death rate will be lower or equal to the rates for 19 of the past 21 years.
Ages 60-69: the 2020 death rate will be lower or equal to the rates for 19 of the past 21 years.
Ages 70-79: the 2020 death rate will be lower or equal to the rates for 15 of the past 21 years.
Ages 80-89: the 2020 death rate will be lower or equal to the rates for 15 of the past 21 years.
Ages 90+: the 2020 death rate will be lower or equal to the rates for 3 of the past 21 years.
> In Spain the real death toll has been about 44,000, rather than 27,000 or whatever the latest number from the government is.
Wait. Nic thinks it’s probable that the population fatality rate tops out at 0.86%. So obviously there can’t be that many dead in Spain as 44,000 dead would come in at 0.094%. And that’s if no one else dies.
So I guess that maybe people have undied?
And clearly, no more social distancing necessary. I’m sure that the people of Spain will be as relieved as the people of Belgium to realize they have nothing more to worry about!
And let’s look an the estimate of 20% infections to reach the HIT. That would mean with the current # of people who have died, if no one else dies going forward, the infection fatality rate would be 0.47%. But I’ve been told that Covid-19 is no more fatal than the flu. And the flu fatality rate is much lower than that. So, clearly, the HIT must be lower than 20%, right?
Or more likely that 44,000 dead number is a hoax/conspiracy.
At 44,000 in Spain.
If they reached a total of 40% of the population infected, with the 44,000 already dead, that would work out to an infection fatality rate of 0.24% – which is the CDC’s “best” estimate that many on here think is most likely.
So something’s afoot, right? No way that 40% of the population is infected in Spain because I’m quite sure that the HIT kicks in much earlier than that, right?
Must be some kind of hoax/conspiracy going on.
There are a number of scandals associated with Covid-19. In my book the biggest scandal is the failure to test the Zelenko early-treatment protocol in anything close to a timely manner. Close behind this is the failure to test HCQ with its partner, zinc, since it’s zinc, not HCQ, that actually stops viral replication, while HCQ is it’s ionophore allowing zinc to enter cells. Another scandal is how, instead of testing the Zelenko protocol, states worked to limit the supply of a key ingredient of that protocol, HCQ. Another scandal is how NY State forbade nursing homes from testing incoming patients for Covid-19. And then there’s the FLCCC group, whose effective treatment for hospitalized Covid patients is being virtually ignored. And now we have revelations for how HCQ is being prescribed in clinical trials to sick patients in lethal doses. https://ahrp.org/covid-19-has-turned-public-health-into-a-lethal-patient-killing-experimental-endeavor/
Sweden has it right for an important reason: it refrained from issuing orders infringing on individual liberties and instead viewed the individual citizen, and not the state, as the primary actor responsible for their own well-being. Most other countries opted for the view that citizens are subservient to the needs of the state, and thus orders can be issued that assume that the well-being of the state is supreme and individual rights can be discarded. Nothing good has ever come from such a philosophy, yet here it is again, rearing its ugly head just as it did in Hitler’s Germany and Stalin’s Russia. This is not a trivial matter, yet is treated as if it is.
When we’re told to “stay safe,” we’re not told this in the manner of Sweden, where the instruction is that you, as citizens, have the information and now you need to act on it and use your good judgment. We’re told this in the manner of Stalinist Russia, wherein you’re expected to obey or else risk the consequences, which will be visited upon you by the police.
Right on Don. The US is suffering from collective condemation that characterized Soviet Russia. The insights of a Russian American are summarized here: https://rclutz.wordpress.com/2020/06/27/american-soviet-mentality/
But they are testing it. The trial started in April and underway.
https://clinicaltrials.gov/ct2/show/NCT04370782
James Cross, my point is that this trial should have been done long ago and completed, because it’s an extremely simple protocol. In the meantime, when we should have been testing this protocol we’ve had numerous other trials of HCQ put out that repeatedly warn us of the danger of HCQ, including one published in The Lancet that was retracted.
So why is it that we have all these trials finished and not one trial done on an extremely simple protocol using a well-tolerated dosage of HCQ for a mere five days? And with zinc and azithromycin? That treatment protocol makes all the sense in the world to help stop viral replication so that the body’s own defenses can kick in, and the body’s own defenses kicking in is exactly why young people, with robust immune systems, are able to fight this virus so successfully. The body needs zinc to fight infections; we knew this back in 1998 and even decades earlier; the elderly are often deficient in zinc, especially when sick: https://academic.oup.com/ajcn/article/68/2/447S/4648668
As I’ve pointed out numerous times, HCQ is an ionophore for zinc, and we know that zinc stops coronavirus replication in vitro. So the Zelenko protocol makes perfect medical sense for early outpatient treatment of Covid-19.
I find it hard to believe that Dr. Fauci has never heard of this protocol, or that the CDC is unaware of it, or that no one in the entire NIH has ever brought this protocol to anyone’s attention. Yet the NIH has acted as if it doesn’t exist.
Sorry, Don, but actual trials take time.
You know recruiting patients, informing them, making sure they meet criteria, following up (that could take weeks in itself) etc This one got started in April not that long after Zelenko produced his 2 page study (or 2 pages is all I have ever seen). Maybe your complaint should be with Zelenko that he didn’t do a thorough enough study in the beginning. Where is Zelenko’s data if it is so convincing? I haven’t seen it anywhere but maybe I’ve missed it.
I’m certain if this study produces some early positive or negative results, the results are likely to be released early.
James Cross says that studies take time.
Yet since March 1, twelve studies on hydroxychloroquine have been completed, including the Minnesota study that began on March 17 and was completed on May 20. https://tinyurl.com/yavzzanz
Notice what the study you linked to says: “[E]lderly patients and patients with co-morbidities have high incidence of zinc deficiency.”
We’ve known that zinc can inhibit replication of certain viruses, including coronavirus, since 2010. https://pubmed.ncbi.nlm.nih.gov/21079686/
We knew since 2014 that chloroquine is a zinc ionophore. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180
In 2008 we had evidence of the antiviral properties of zinc in conjunction with ionophores. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612303/
In 2005, we knew that chloroquine inhibits SARS coronavirus. https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-2-69#Sec10 Half of the authors of this study are from the CDC, an agency of the NIH, as is Dr. Fauci’s NIAID.
This is what Dr. Zelenko said: “The rationale for my treatment plan is as follows. I combined the data available from China and South Korea with the recent study published from France (sites available on request). We know that hydroxychloroquine helps Zinc enter the cell. We know that Zinc slows viral replication within the cell. Regarding the use of azithromycin, I postulate it prevents secondary bacterial infections. These three drugs are well known and usually well tolerated, hence the risk to the patient is low.”
So granted that studies take time, my point is that in a time of world crisis when many governments throughout the world imposed lockdowns because people were dying of a novel virus, why haven’t bright minds around the world figured out that zinc with an ionophore might be helpful against Covid-19, and why, when the Zelenko protocol came out, haven’t thinking physicians around the world considered that this was potentially promising enough to test immediately, even at a simple scale and design to get some initial results to possibly save lives?
Why, in light of the above research on zinc and an ionophore (like HCQ) that I’ve linked to, did Dr. Fauci, the head of the NIAID, broadcast to the entire US and the world a dismissal of HCQ as “anecdotal” instead of directing immediate staff investigation that would have easily discovered the above research, particularly if someone under him had the bright idea of picking up the phone and calling Dr. Zelenko after he published his communication on March 23, three days after Dr. Fauci publicly dismissed HCQ as “anecdotal”?
Here’s what NIAID’s mission is, according to Wikipedia: “NIAID’s mission is to conduct basic and applied research to better understand, treat, and prevent infectious, immunologic, and allergic diseases.” Or, not.
James Cross says that studies take time.
Yet since March 1, twelve studies on hydroxychloroquine have been completed, including the Minnesota study that began on March 17 and was completed on May 20. https://tinyurl.com/yavzzanz
“Sweden’s per capita death rate was 36 per 100,000, which is higher than the United States at 27 and neighboring Denmark at 9.” ~Healthline
And, interestingly -“Over half of Swedes live in single-person households, which makes it easier to do physical distancing.” (Ibid)
Pingback: Testing-Adjusted COVID | Runaway Logic
Reblogged this on Utopia, you are standing in it!.
I am not familiar with what’s happening in the southern states, but it seems that inflenzas have a very different epidemiological curve depending if in northern or southern hemisphere. It not just seasonal, or due to colder damper weather, it seems that viruses behave differently depending on if NH or SH, but no-one knows why. This was discussed by Ivor Cummings on twitter here a few days ago:
https://twitter.com/FatEmperor/status/1275841060204396551
who made a short video to explain what Edgar Hope
https://www.dropbox.com/s/4yda40j4hf9nbad/11th%20The%20Transmission%20of%20Influenza%20BOOK.pdf?dl=0
Or it could just have to do with when the virus arrived and reached a critical threshold. That explains a lot more than seasonality. It explains why Italy, NYC, Guayaquil in Ecuador were hit hard early and why the Southern US is being hit hard now.
Pingback: The progress of the COVID-19 epidemic in Sweden: an analysis |
Nic,
The fact that this pandemic is reducing dramatically in Sweden as in any other Country in Europe may Not find its origin In a so/called herd immunity threshold, simply in the fact that in our climate our ecological system, such type of virus routinely weakens and disappears under a Gaussian curve.
Immunity herd for vaccines are extremely high, above 50%. It appears that prior immunity from other coronavirus (From antibodies or lymphocytes T) may also partly explain why the pandemic did not spread further.
But when you see how people in large cities such as Paris do no longer protect themselves from virus spreading, the idea that the virus is no longer able to spread makes sense.
An other story may apply to intertropical zones ( including part of the US), where the virus did not Originally spread as quickly and may remain active all the time.
At the end of the day the concept of immunity herd may be falsified as soon as next winter if the COVID-19 pandemic resumes.
Regarding the 0,04% FR in Sweden, it can be compared to the 0,01% achieved in Marseille, France (163 deaths for a 1,5m population and 4500 COVID-19 cases identified and cured- HCL+AZT representing 18 deaths for 3700 cured cases)
https://www.sciencedirect.com/science/article/pii/S1477893920302817
The quality of cure and regimen may have an impact
Daniel
Daniel
I did mention seasonality as being a factor that might be important.
I know that herd immunity rates for vaccines are above 50%. But the herd immunity level for an infection that has spread naturally in an epidemic can be far lower. That is because vaccination is at random, whereas infection during an epidemic preferentially selects those people who are most susceptible to the disease, whether due to making more contacts with others (which also makes their infectivity higher) or due to having poorer ability to fight off the virus. That reduces the average susceptibiity (and infectivity) of the remaining uninfected population.
Interesting re Marseille. They may have done a better job at protecting old people there, which is the key to achieving a really low IFR.
Thanks Nic,
Seasonality is – in my understanding- not an assumption, but reality in Europe and North of North America (plus NZ) for virus affecting respiration such as flu and coronas. Of course until it gets falsified by a black swan under the form of a new virus whose pandemic is different from all previous. Still not there.
Seasonality also take place in intertropical zones, but to a lesser extent, with wet season more « virus active » than dry.
When you have such in France 3 to 5% of infected people, this definitively cannot trigger an immunity; you still have many exposed to the virus, but the virus is now very weak and R0 below 1. But you probably would have many new infected people after an indoor rock concert.
I understand research is around immunity from former yearly coronavirus, which explains why young children did not in the main spread the COVID-19 pandemics, a unique feature compared to flu. There are also research on T « Memory » lymphocytes which may explain actual immunity on Covid-19.
Regarding Marseilles very low rate of fatality, it comes directly from 3 combines features:
– test, test, and test all those feeling the need ( by the way, demand followed exactly the pandemics wave)
– cure each case, even if apparently benign, this in order to reduce contagiousness time, avoid hospitalization and ICU, and to avoid secondary effects (including on a symptomatic cases)
– cure all patients with HCL + Azt, except those with counterindications.
The effect is the quasi total absence Of death below 65 (to compare with 8 or 10% share otherwise)
Quality of care is also very important, as the FR for hospitalized cases is extremely different between Regions, with Paris behaving poorly ; there are figures in UK trials (Recovery) which cannot be understood, such as 20%+ FR among hospitalized cases (vs 16% for ICU in Marseilles)
In the end the computation of a herd immunity threshold remains a theoretical computation based on unwarranted assumptions . Not entirely different from Imp College !
-:)
Daniel
“The course of the COVID-19 pandemic in Sweden is of great interest, as it is one of very few advanced nations where no lockdown order that heavily restricted people’s movements and other basic freedoms was imposed.”
wrong.
Wikipedia disagrees with you Steven
“Sweden has not imposed a lockdown, unlike many other countries, and kept large parts of its society open. The Swedish Constitution legally protects the freedom of movement for the people, thus preventing a lockdown in peace time. The Swedish public is expected to follow a series of recommendations[note 2] from the government agency responsible for this area”
So say which other advanced countries did not impose a lockdown order. Are you thinking of Norway?
We are forced to generalize with a wide range of responses or not participate. We are not forced to advise policy but others are advising policy.
Steven Mosher: wrong.
Are you saying that the course of the COVID-19 pandemic in Sweden is not of great interest?
Is that why you skipped reading Nic Lewis’s essay?
Don’t forget everyone- “lockdown” is unfortunately political now, therefore if Sweden is fine, it is because there really was a “lockdown” you just didn’t know it, and if Sweden is a comparative disaster, it’s because there was no “lockdown.”
This goes hand in hand, apparently, with the assertion that a country that did poorly AND had a lockdown AND has a conservative PM (the UK), it’s because the lockdown was “late.” And for places that did very poorly and had a “lockdown” and have leadership that isn’t conservative (Belgium), this is entirely meaningless and ignored.
New science: lockdowns exist or not exist and work or don’t work depending on the need of party for the moment. Data is irrelevant to the discussion.
No restrictions on travel and other basic freedoms? How about they can’t travel to 15 – 20 other European countries, some have total bans, others require quarantine and again others have other restrictions.
Try re-reading what I actually wrote.
I did, but you are wrong when it is claimed that Sweden did not have travel restrictions, they had about the same travel restrictions as Norway. But they did not close pubs, fitness centers and other high-risk activities like Norway did. Norway never had a lock down. Everyone could move around the city, go shopping and work as long as the workplace was suitable for distancing. Restaurants were open with restrictions on how close people could be seated, this also applied to Oslo in the beginning, but there, and only there, the restaurants were also closed as a result of a series of serious breaches We closed kindergartens, schools and universities for a few weeks, a tool of questionable effect. In Norway, the amusement parks are now open, in Sweden the amusement parks have been told that they must expect to stay closed throughout the summer. Folkparkarna, a Swedish institution, will not have any concerts this summer, for the first time in 115 years.
Amazing how politically motivated conclusions based on broad generalizations break down when you actually start to consider the real world details.
Since the beginning of May, Norway is averaging probably less than 1 death per day.
Sweden, on the other hand, is averaging around 30 deaths per day. Of course, a larger population…
But even if Sweden were to have no more deaths after today, and the relatively higher impact in deaths weren’t to continue expanding as it is now, how long would it take for Norway to catch up in total deaths, or deaths as a % of population, at the current rate of deaths in Norway?
Norway has had about 5,000 fewer deaths than Sweden.
Hmmm.
The descriptor of “basic freedoms” is similarly subjective in the original post. Is a basic freedom to gather in large groups? To attend university?
It seems that “restricted movement” and “basic freedoms” can be whatever Nic wants them to be so as to confirm his conclusions.
“I did, but you are wrong when it is claimed that Sweden did not have travel restrictions”
No I’m not wrong: I never made that claim. What I indicated was that Sweden hadn’t “heavily restricted” people’s movements.
Norway didn’t have anything like a full lockdown either.
Totally subjective determinations – just like “basic freedoms” was. It would be better if you defined your terms and didn’t use emotive and subjective rhetorical descriptors.
Speaking of politically motivated, Joshua. Try to remember that you’re on team “lockdowns are super-important”. Then re-read Valaker’s comment:
“Norway never had a lock down. Everyone could move around the city, go shopping and work as long as the workplace was suitable for distancing. Restaurants were open with restrictions on how close people could be seated, ”
In other words, all of those eeeeevil red states that “re-opened” in the US are currently more restricted than Norway ever was. And Norway has almost the lowest death rate of any nation.
So… do lockdowns work?
Jeff –
I know you like to fantasize about what I (and others you don’t agree with) think, and then react to your fantasies as if you’re reacting to me…
And I don’t want to upset you but…
> Try to remember that you’re on team “lockdowns are super-important”.
What I think is that shelter in place orders can serve a function – but context is all important. To the extent that a country does extensive testing, tracing, and isolation from the start, then there becomes less of a need for shelter in place orders. For example, in Taiwan they conducted extensive planning to implement shelter in place orders, including running simulation scenarios – but they never thought they needed to implement all aspects of their planned shelter in place orders because of the success of the other strategies they put into place (they did implement some aspects of what ideologues term as a “lockdown.”).
There are other relevant aspects of context as well – such as how likely the members of a society are to have a proactive attitudes towards social responsibility – as they have in Sweden and places like Korea. And then there are other, more straight-forward factors such as how many people live in single-person households or population density or % of people with comorbidities, etc.
> In other words, all of those eeeeevil red states that “re-opened” in the US are currently more restricted than Norway ever was.
That works both ways. For example, Sweden shut down universities and banned large gatherings. So they “restricted basic freedoms.”
> So… do lockdowns work?
See, that’s exactly the problem. Define lockdowns and provide context and then we can begin, and only begin, to discuss the relative merits of different government interventions.
Let me repeat that.
Define lockdowns and provide key context and then we can begin, and only begin, to discuss the relative merits of different government interventions.
All else is just rhetorical posturing so as to advance identity-protective and identity-aggressive reasoning.
Nic,
Let’s hope that later figures show your ideas correct. It is hard to find satisfactory analyses because so many have possible political or financial taints.Trying to make sense of all this for an Australian aged 79 (me) who had pneumonia and pericardial effusion a year ago. so is in a high risk category.
The State of Victoria is having a far higher new case count now than other States, so we ask if a State boundary is too artificial and some form of boundary related to medical factors is better to devise and control within.
Political spin is trying to un-relate a Melbourne protest of a few thousand Black Lives Matter that could be the cause of Victoria’s poor performance now. (Our State Govt is leftist and China-loving).
Still uncertain why New Zealand and Australia globally rank so low in cases and deaths per capita. Is this simply flattening of the curve with no consequences for my risk except the inevitable might be delayed a few months to adjust for the flattening.
Much research here for a vaccine, some are being trialled already.
The quality of global data seems rather poor, making it hard to even compare countries. More effort needed for uniform definitions, should have been WHO work, but many here are suspicious of WHO and China for not calling it sooner. Geoff S
Still uncertain why New Zealand and Australia globally rank so low in cases and deaths per capita.”
–
The answer is easy.
The virus is a lot weaker in Australia.
-backing that up is a less crowded population. Even the big cities have a Lower person to COVID area.
Finally we are a mobile phone talk to people at a distance culture.
Watch number one.
I would suggest bottling the Australian Covid strain and selling it as a vaccine it is so weak
angech –
Can you link to some clinical/empirical evidence that (1) it is a (singular?) different strain and (2) it is less virulent?
More than happy to try though I do prefer as you do pure logic : empirical. based on, concerned with, or verifiable by observation or experience rather than theory or pure logic.
Will this do? 6/5/2020.
A group of leading international researchers has concluded the coronavirus behind the global pandemic has already mutated into a second strain, which appears to have spread faster and wider than the original one, potentially undermining efforts to create a vaccine.
The research found the newer strain of coronavirus, or the ‘G-strain’, may undermine any immunity gained from infection by the original strain
It also found the second strain spread faster, possibly meaning it was more contagious
The research, which has not been peer-reviewed, has divided the scientific community with one expert saying he was “sceptical”
The research, yet to be peer-reviewed but posted online by scientists from the US and UK, also found the newer strain, or G-strain, may undermine any immunity gained from infection by the original strain.
Some independent experts described the research as “impressive”, while others have argued the conclusion the mutation is more contagious is not yet proven, and should be treated with caution.
The second strain of SARS-CoV-2, the virus which causes COVID-19, appeared to have first emerged in either Europe or China in January, some time after the first strain emerged.It quickly became the dominant variant in each region, suggesting it may be more transmissible than the original D-strain.
The pattern appeared to have been followed in most European countries, most American states, and in many countries including Australia, where the new strain was already dominant.
Asked about the G-strain on Wednesday, Australia’s Deputy Chief Medical Officer Paul Kelly said newer strains were not unexpected.
Further. March 31 2020
“Scientists around the world are racing to study the novel coronavirus strain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Now, it appears that there are eight strains of SARS-CoV-2 circulating the globe.”
12/5/20. “Two-thirds of the sequenced strains (or “isolates”) globally and half of the sequences in some countries (such as Australia and India) now have this D614G mutation , which is apparently increasing its representation among newer strains.“
And
a source a bit dodgy?
“Dr. Ramin Oskoui, a cardiologist and CEO of Foxhall Cardiology, reacted on Tuesday to a study that found a new coronavirus mutation reportedly mirrors a change that occurred as the SARS virus began to weaken, saying, “it’s well-known that as viruses progress, they typically mutate to weaker forms.” “The phenomenon is known as ‘Muller’s Ratchet,’”
–
Personally I would go for the logic as I know you prefer it.
Simply put, Australia’s first 7000 cases basically just squeezed in a 100 deaths, mainly very old people.
1 in 70 or about 1.4% of very vulnerable people.
In Italy it was close to 12% for the first 7000 cases 10 times higher.
Now there are always a lot of confounding facts.
Age, sex, smoking, health, affluence etc but 7000 cases first up is 7000 cases.
Why such a marked difference?
The virus has weakened is the most sensible answer.
angech –
I was hoping for links. From what I’ve seen the evidence of mutating to less virulent strains was thin early on. Seems there more solid evidence of mutations recently that lead to more infectiousness, but not associated with reduction in virulence as you might expect. I haven’t seen anything w/r/t mutations in Australia.
You seemed so certain I assumed you’d seen some empirical/clinical evidence, not just arguing by assertion 😊
Joshua | June 30, 2020 at 7:29 am |
“angech – I was hoping for links. From what I’ve seen the evidence of mutating to less virulent strains was thin early on.”
–
I guess when you have an agenda to push you have to keep pushing, Josh.
1. “the evidence of mutating to less virulent strains was thin early on.”
That is because evidence is always light on very early on Josh.
Detectives need tine to build cases.
The evidence for deaths was thin on when they only had 3 deaths as well.
So no this excuse for an argument does not wash.
There are general scientific studies, not recent Covid, about viruses that show conclusively that viruses mutate and weaken over time.
Rudd Istvan did a great discussion of this in one of his early Covid essays.
Not that you would take anything he said, well researched as it was, when you are blinkered by some need to argue about any good points at all with this disease.
–
Lets try it from the top.All here.
Link 1
“Spike mutation pipeline reveals the emergence of a more transmissible form of SARS-CoV-2 on behalf of the Sheffield COVID-19 Genomics Group,
“. By early April, G614 was more common than the original D614 form isolated from Wuhan, and rather than being restricted to Europe (red) it had begun to spread globally. B) The same tree expanded to show interesting patterns of Spike mutations that we are tracking against the backdrop of the phylogenetic tree based on the full genome. Note three distinct patterns: mutations that predominantly appear to be part of a single lineage (P1263L, orange in the UK and Australia, and also A831V, red, in Iceland); a mutation that is found in very different regions both geographically and in the phylogeny, indicating the same mutation seems to be independently arising and sampled (L5F green, rare but found in scattered locations worldwide); and a mutation in sequences from the same geographic location, but arising in very distinct lineages in the phylogeny (S943P), blue, found only in Belgium.”
As Willard would tell you, there are so many links like this out there you would have to be blind to refuse to see them.
Do your own research by typing in mutations of the phrase Corona virus mutations.
You will notice that there are many mutations occurring and Australia has a particular mutation dominant.
This is just one of many papers pointing this out.
As to low virulence look at the Australian figures [Do not use the Lancet!]-
–
Wuhan Coronavirus–a WUWT Scientific Commentary
February 10, 2020 Guest post by Rud Istvan.
Check this post for a basic understanding of RNA viruses and mutations.
Fantastic articles on the science of virus reproduction.
–
Joshua, some of my replies have either gone into the sin bin or more likely not transmitted by the I pad [using computer at moment.
Look at this paper
“Spike mutation pipeline reveals the emergence of a more transmissible form of SARS-CoV-2”
Ticks all the boxes you have requested
Explains it all exactly like I said.
mutations are occuring all the time [ See Rudd Istvan re RNA viruses Wuhan Coronavirus–a WUWT Scientific Commentary February 10, 2020 ]
to understand mutations, mutation rates and why mutations generally tend to milder illness.
angech –
I thought you might be referring to that older news. That’s why I asked for your reference.
W/r/t that older news:
https://amp.theatlantic.com/amp/article/611239/
On the other hand…
https://www.scripps.edu/news-and-events/press-room/2020/20200612-choe-farzan-coronavirus-spike-mutation.html
Notice what the Scripps research says about virulence.
I see no mention of Australia in the research. I was hoping you had some references to clinical or empirical evidence supporting your claims about Australia.
Rud says masks have no benefit because he once worked with Fauci. I’ll stick to other resources.
> As Willard would tell you,
He would never tell anyone else to do your own research, Doc.
Willard | July 1, 2020 at 9:52 pm | > As Willard would tell you,
He would never tell anyone else to do your own research, Doc.”
Well worded, beyond my pay grade.And it was a compliment.
–
Back to Joshua’s points, yes Judith is a saint but for other reasons, Joshua is great for helping flesh out positions and sharpen arguments, most of the time.
–
“Notice what the Scripps research says about virulence”.
Yes they explained that they had no idea about effects on virulence.
–
“It is still unknown whether this small mutation affects the severity of symptoms of infected people, or increases mortality”
–
The Scripp’s piece is riddled with problems.
From stating ” In this cryogenic electron microscope image” which is really a drawing, not an image.
To claiming “The mutation had the effect of markedly increasing the number of functional spikes on the viral surface” when all ot really showed was that there were, indeed , more spikes when she had no way of proving that the extra spikes were indeed functional or ornamental.
Or this bit of gobbledygook
“The addition of the D614G mutation means that the amino acid at that location is switched from aspartic acid to glycine. That renders it more bendable”.
An utterly meaningless statement. The amino acid switch is in the Genome RNA , not the spike protein but the statement makes it read as if the genome is more “bendible”
“More flexible spikes allow newly made viral particles to navigate the journey from producer cell to target cell fully intact”
Really? perhaps they can Pogo stick their journey with their greater flexibility.
“greater flexibility to the spike’s “backbone,” and “the virus becomes much more stable with the mutation”
are statements that would usually be mutually contradictory.
–
“Over time, it has figured out how to hold on better and not fall apart until it needs to,” “The virus has, under selection pressure, made itself more stable.”
Not natural selection at all but a real thinking virus that reacted to the pressures by becoming both more stable and more flexible.
–
Of they contact me I could do a good proof read for them and they could put it in the Lancet.
Joshua,
“I see no mention of Australia in the research.”
–
angech | June 30, 2020 at 4:12 am | “‘and in many countries including Australia, where the new strain was already dominant.
Asked about the G-strain on Wednesday, Australia’s Deputy Chief Medical Officer Paul Kelly said newer strains were not unexpected.”
–
angech | June 30, 2020 at 4:18 am |
“Two-thirds of the sequenced strains (or “isolates”) globally and half of the sequences in some countries (such as Australia and India) now have this D614G mutation , which is apparently increasing its representation among newer strains.“
–
angech | June 30, 2020 at 11:02 am |
Note three distinct patterns: mutations that predominantly appear to be part of a single lineage (P1263L, orange in the UK and Australia, and also A831V, red, in Iceland)
–
I had a similar problem at age 20.
Had to drive onto the footpaths to read the street names.
Girlfriend at the time fixed the problem.
Suggested an optometrist , worked really well.
I could give you the phone number, Optometrist, not the girlfriend, but you probably live in America.
Now, now, angech
The time stamp sequence of the comments is different than the actual time sequence of when they appeared.
When I posted my comment there was nothing posted (or linked) that mentioned Australia.
my bad.
I apologise for having a bit of unwarranted fun.
darn time stamps.
angech –
No problem. All in a day’s blogging.
But maybe as penance, you could explain what my agenda is. I asked before and got no answer.
What is a virus mutation? Do they all do it in synch? A transforms into B. There is one Eve new strain or many Eves.
Sweden entrusted their citizens to act responsibly as they no doubt do every time there is a threatening and contagious disease doing the rounds. No one will ever be sure doing something else would have saved more or less lives. You cannot play the same game twice.
Had ‘saving lives’ been meaningfully at the top of the agenda on day one of SARS-CoV-2 then surely all our national public health departments would have been functioning very effectively from the smallest villages, thru’ all towns and cities to every border entry point including seaports and airports, at least every influenza season, if not all the time. Track and trace systems would have been operating 24/7, be polished and able to check out how and where transmissions occurred (e.g. in annual influenza seasons etc.), in the knowledge that when a much greater health threat arrived all essential facilities would be well prepared, exercised and experienced. Lockdown on anything other than an extremely limited and focused scale would have demonstrated a complete failure to be both responsible and prepared. Such failure in government should be reasonably measured on a criminal scale.
We may also need to recognise that weaknesses in UN and world organisations arise because of weaknesses at a national level. Perhaps the whole concept of contractually outsourcing tasks and roles causes individual responsibilities to collapse and perhaps, one day, there’ll be many studies revealing how and why it happens.
In the UK at least, we have, IMO, just seen why our ancestors put so much effort into building strong public health resources and hospital A&E provision and so I don’t believe anyone who tells me politicians were interested in saving lives. Most politicians were only interested in saving their own sorry faces and little else, because they not only knew their personal negligence was stretched over years, they also knew they had actively ignored warnings from experts throughout those neglects.
There is a knock-out-strategy against the covid virus in many European country. They have gone away from “flattening the curve”. And the virus has been eliminated in many parts of the countries. It is a success-story. But the problem is people travelling. Norway take in healthworkers from Sweden. In two cases recently Swedes had infection, one doctor and one nurse. So hospital units had to lock down. Nurses and patients in quarantine. I would think that this happens in a much larger scale in Sweden.
And healthworkers are the most dangerous species out there. In Norway they have found out that 80% of the infections in nursery homes comes from nurses, doctors and other healthworkers.
Nic Lewis, thank you for this essay.
Nic, thanks. Just nitpicking: I stared in disbelief at Figure 1, where total deaths go down – do they resurrect dead people? You are using the word “total” in an unconventional manner. What is the difference between “total deaths per week” and “deaths per week”?
lol.
“Total” does not necessarily imply a cumulative amount.
The y-axis label states that what is plotted is deaths in the previous 7 days, not cumulative deaths.
The text says “Figure 1 shows the overall picture for confirmed weekly total new COVID-19 cases, intensive care admissions and deaths in Sweden”.
Total deaths per week refers to deaths in the week involved summed over all regions and all age groups; deaths per week refers to deaths for individual regions or age groups.
Nic,
Thanks for your excellent analyses and articles. They are always interesting and informative. They include information and insights not available many places. It really helps to put the nonstop media BS in perspective.
Alex Berenson is another excellent source.
I also appreciate the post by Ron Clutz on the situation in Canada.
Joshua……………………………..ugh.
Now we know his surname. Just as we had surmised, about a decade ago.
I always thought his surname was putz.
Some things never change.
Putz is his aka.
Thanks!
“Analysis of samples collected at week 21 (late May) shows that antibodies were detected at 6.3% of the studied population.”
Later research shows that an equal amount of the population has no antibodies but are immune by their T-cell.
Lars,
Interesting comment
“Later research shows that an equal amount of the population has no antibodies but are immune by their T-cell.”
T cells and natural killer cells work by destroying the host cell after it is infected.
A bit late.
I doubt any can prove immunity, if possible, due to TCells
They are more like tow trucks clearing up farther the crash
Pingback: Sweden’s Outbreak Will Peter Out After 1000 More Test-Positive Deaths for a Total Infection Fatality Rate of 0.06% – Anti-Empire
See me in December
We will see if developing herd immunity early whether than later saves more lives when the second wave hits
>>> See me in December ….
Then we have:
– a much better knowledge of how the infection spreads and how it can be prevented
– better and faster tests with better knowledge of how to track and limit any outbreaks
– how best to treat infected and sick people, there are already methods with a certain effect today, there is reason to believe that in six months this will be better
– we may even have a vaccine or the virus may have been attenuated, it has happened before
– why do as the Swedes to infect large sections of the population without being near herd of immunity, and run the healthcare system on high gear month after month which is guaranteed to impair the treatment of other diseases and they must also maintain a number of restrictions after the situation in neighboring countries are more or less normalized
– the Swedish method seems to be extremely successful in one area, namely achieving the highest mortality rate pr. capita, they are now in fifth place behind Belgium, UK, Spain and Italy. They will catch Italy in a couple of weeks, then they can start hunting for Spain
Rune
Some of your assumptions are based on speculation and, in some cases, wishful thinking. There may be some of the things you talk about or there may not be.
Sweden may have based their strategy on false assumption as well ie overly pessimistic about how long a vaccine would take and the subsequent lack of ability to manage cyclical shutdowns but it is far too soon to tell
One thing we can say is that there is some validation of their assumptions seeing how difficult it has been to manage coming out of lockdown and this pressure will only increase as we approach autumn or winter.
It is far too early to say to declare who has been successful or not – there is a lot of praise for NZ at the moment but flickers of discontent on their forced isolation are starting to arise and only time will tell if you can really completely isolate yourself like this.
All I can say from where I see it is that this is an odd disease – such a variability in the symptomatic response and inconsistencies in its behaviour. Some of this will be down to things we do not fully understand yet and I agree with some of your points on transmission and treatment.
This race is not yet run as someone mentioned above and it is too early for the medals to be awarded – especially when based on perceptions rather than data
It’s not hard to get me to agree that there is a lot of speculation, but speculation is in many areas the only thing we have, anyway one has to decide a strategy. Norway now has approx. 0.2 new cases of infections per 100,000 inhabitants each day, Sweden has 10. Denmark has 0,4, but the Danes is mass testing, something we don’t do in Norway. Both in Sweden and Norway, the infection is concentrated in areas, and none of the countries have an even spread. Even within the areas that has most cases, it’s gathered in clusters, without exception in the less affluent parts of the cities, where other parts of the city has very few cases. Herd immunity was never a option I Norway. To achieve that within September 2020, we would need 16.000 new cases per day, at the most we had 300. And Sweden has a long way before they reach herd immunity. I simply do not understand the Swedish strategy. Are they to continue to slowly infect the population for months with a health care system in high gear where the corona suppresses other health needs, and with a few hundred new deaths each week. How long will this be going on, and when will they begin to actively infect the large sections of the population living in areas with a very low rate of infection?
It’s possible that they will be fortunate with the whole T-cell thing (as will we all be if it pans out).
It could prevent the worst case scenario for them – even if they have decided to sacrifice some thousands of people for an as yet unproven benefit. It’s basically a gamble against a vaccine – but given the structural advantages in Sweden and what seems to be an acceptance of an idiosyncratic attitude about end of life care (one for which I have some sympathy), there is a reasonable logic. But it’s a big leap to just assume that what works in one way in Sweden is suitable for very different countries in many respects.
Good to see the Swedes doing the right thing for a change.
Great novels and a lovely dish called bubble and squeak if you can find one
Bubble and squeak is a traditional British breakfast dish that bears some resemblance to the Scandinavian pyttipanna, considered not “lovely” in any known meaning of the word “lovely.”
And great novels? Knut Hamsun was Norwegian.
You are wrong on four out of four possible topics
So, his opinions are “wrong”? Thanks for dropping in.
Zero for four is an outstanding performance for Don .
Among the mass of conflicting information about COVID-19, there are at least two things which are very clear.
The first is that almost every European country failed to take adequate measures for the protection of care-homes. Wherever the information is accessible it is generally bad news. In late May, Lena Hallengren, the Swedish Health Minister acknowledged the failure, when reporting that about one half of recorded COVID-19 fatalities in Sweden were in care-homes. Belgium, with the worst population mortality rate in Europe so far, also records the same dismal percentage – 50%.
The second thing is that wherever granular information is available at a level below national aggregation (esp. Europe and USA) there is an extreme spatial non-uniformity of infection rates and deaths. In Italy, the Lombardy region was devastated, with over 0.4% population mortality rates in some cities, while some Italian regions to the south, including Rome and Naples, have so far been relatively untouched. TonyB in a previous thread spoke about the West Country in the UK, which so far has been only lightly affected, even while the UK as a whole seems to have set itself the target of becoming the European worst record-holder for fatalities. France was hard hit in its Nord-Est region and around Paris (Ile de France) and Lyon, while the Nouvelle Aquitaine region in south-west France with a population of 6 million has seen only about 150 fatalities, and 90 of these were in Bordeaux and Toulouse, both of which are connected to Paris via the TGV (highspeed) rail link.
While Stockholm may be approaching herd immunity, many other towns in other parts of the country still have a long way to go. Similarly, the susceptible population in the West Country of the UK, in Naples or in Nouvelle Aquitaine is about the same as it was before the outbreak.
Within Nouvelle Aquitaine is the Dordogne department, which before the epidemic would typically receive about 3 million tourist visits per year. UK tourists have cancelled their reservations this year because of uncertainty on restrictions, but over the last month those cancelled UK bookings have been largely replaced by French, Belgium and Dutch tourists, taking advantage of relaxation of lockdown rules and trying to get away to a safe place in July and August. I imagine that for similar reasons, there will be an influx of tourists to Devon and Cornwall, since I note that holiday visitors will be allowed there from 4th July. And Italy has declared itself re-opened for tourism (although a large number of hotels have decided not to re-open). I am sure that this story is repeated in almost every country in Europe.
There will inevitably be a large surge in new infections in these places. It is inevitable and completely predictable, since the local populations have no developed immunity, and hundreds or even thousands of infections will be imported to source outbreaks. These regions will go from safe areas to high-infection areas very quickly. Whether the surge in infections is matched by a surge in fatalities is however a function of how well the vulnerable are protected in those regions. At present, these three countries seem to be taking no special measures for the holiday season, which I find very disturbing. At the very least, the authorities should be temporarily re-establishing tight physical and policy barriers to infection entry into local care-homes during the holiday season, actively discouraging the vulnerable from holiday-making for the present, and running hard-edged campaigns to warn the locally vulnerable to be extra vigilant in their own protection during this period of imported infection.
This represents a positive opportunity for these regions to develop herd immunity among the young and fit, making use of all of the lessons available from past mistakes. Instead, I fear that instead of health authorities using the opportunity to build resistance with few fatalities, we will see inadequate anticipation and a panic reaction as local infection statistics mount.
Test
This is a very interesting discussion. Thank you.
It sparks lots of thinking about the many networks involved.
This thread is largely about “macro” networks – large populations – herds – interacting with each other, the air around them, surfaces and substances around them, etc.
There is another whole world of CV19 networks going inward toward the “micro” environments of organisms.
The biological networks of the organism that are in many ways as vast and complex as the “atmosphere” – and equally dynamic.
I was also intrigued by the discussion on particle/ion analysis of history – a dive into the micro that is very similar to modern genomic exploration.
So what?
I was originally trained as a biologist and worked on the early extraction of genomic material from animals and micro analysis. So, I have practitioner’s grasp of how hard it is to capture, bound, and measure complex networks – that interact with many other complex networks (like lab techs removing their masks for a minute and polluting 2 months of genomic sample collections).
This means I have been fascinated with the many layers and derivatives of CV19 RNA into the genomic “microsphere” – as well as its spread in the “macrosphere” outside the human body.
Because the genomic microsphere is in some ways easier to “capture in a bottle” than the external ‘eco-sphere’ of the air and surfaces around humans…
….it is (somewhat) easier to run many more, bounded, fast-sequence tests on beating the virus from inside the human organism.
We call these experiments “trying to save people who are flooding hospitals- by any means”.
(This also means holding at bay the lawyers who make billions of dollars on treble-damage ‘malpractice’ lawsuits in the name of “science”.)
And, in simple terms, both the macro environmental sciences and the micro genomic sciences are trying to converge on one positive outcome…
…herd immunity….
It strikes me that this Covid effort is very similar – in structure and mental models – to trying to forecast “the” temperature of the global “climate”.
Both very important human missions.
Both seeking to solve physical, information, social, political, imagistic phenomena simultaneously.
Again, so what?
Notice also the modern human herd instinct to solve never-ending new “lessons” (pollution, disease) with a single big, expensive “hammer”.
Hammer CO2 back into the bottle.
Hammer CV19 RNA back into a form that does not kill humans – then spread this modified RNA as a “vaccine” to some tiny fraction of 7 billion humans – and hope that the non-vaccinated DNA in the remaining humans can beat back the CV RNA as it enters the body.
The “science” in each of these domains is – honestly speaking – useless – unless the mass of people who are not scientists go along with the new – often miraculous – scientific discoveries.
Science is great.
But only mass behavior fixes mass problems.
And no central-command administration of ‘truth” has ever prevented biological masses from self-harm.
See outliers roaming streets spitting on people wearing masks.
See dozens of government officials contradicting each other hourly.
I’ve worked in Sweden often over decades. It is so small, one can document social systems very easily.
There is one characteristic of Swedish culture that is largely ignored in the massively complex scientific modeling of CV19 there.
Respect.
For life. For each other. For ‘the gods’ – Odin and such.
The only – scientifically-proven – process that can reduce social hostility is the end state of “respect”.
And reaching “respect” is sort of like trying to reach the “ideal temperature” of Earth’s atmosphere.
When I was looking at Sweden’s healthcare system, which is built from the common (county) upward…not from central government downward…
….one of the officials said about us Americans…”in Sweden, we still believe that the government is PART of the people”….not some separate entity that tells “the people” what to do.
Hypothesis: the only thing that will defeat CV19 is highly contagious MUTUAL RESPECT that allows the massive biological human mass to behave with respect.
Just sayin’…
You win the thread. I mean it.
Respect doesn’t necessarily require trust; one can respect what another is proposing but still ask for evidence, guarantees, etc., and providing such is reciprocal respect. And one can question authority in a civil and respectful manner, even with penetrating and relentless criticism that calls actions and policies to account, without burning buildings.
Hypothesis: Only by eliminating anonymous users on all networks can a foundation of trust be created and sustained.
Technically feasible. All we is the right kind of crises for a tipping point.
All we *need* is…
I might be mistaken but before you can instill mutual respect you must have TRUST. Fix that and we can proceed with mutual respect.
https://www.edelman.com/trustbarometer
“Trust” and “Respect” come as a result of governments that operate to the benefit of the people. In the US, our governments operate to the benefit of their governmental employee unions.
What passes for a “school system” in most American cities wouldn’t be tolerated in Europe. In Washington DC, people died on the extravagantly funded Metro system (subway) because the unionized maintenance staff declined to perform maintenance.
It’s a real problem. For example, everyone in the US knows that if you want a good idea of how single payer health care would work here- look at the quality and cost of the Washington DC or Detroit school systems. Ie, absurdly expensive and dangerously poor quality. This is larger impediment to single payer than hatred of “socialism”.
Respect, or lack thereof, is a common thread in Sweden, Italy, NYC, etc. etc.:
https://foreignpolicy.com/2020/04/21/sweden-coronavirus-anti-lockdown-immigrants/
Interesting side note: I talked in-person to a financial advisor who divides his time between his home in Vermont and Hong Kong. He says that the virus is gone in Hong Kong and life is back to normal.
Here is the saga of a NY doctor telling of his success with the HQC regimen in a Hassidic community. Of course, it is now politicized since Trump used it too as a preventive. There are some sorry ignorant folks out there….
This is exactly right. As Zelenko says, these studies on HCQ were designed to fail.
It’s the synergy between zinc and HCQ that’s the key.
Not that crazy about the interviewers.
Don132: For the record, the HCQ study you linked below is deeply flawed. It is the summary of experience from a large hospital, not a random assignment clinical trial. There were massive differences between the HCQ-treated and -untreated groups. Look at their data:
1) The average patient in the untreated group was 5 years older than in the treatment group!
2) The average patient in the treated groups was twice as likely to have been given a steroidal anti-inflamatory drug to suppress the “cytokine storm”. In properly-controlled clinical studies, dexamethasone has been shown to increase survival by 30% – the biggest improvement in treatment discovered so far. However, the benefit of steroids fell slightly short of statistical significance in this study, because so many variables were out of control in this study. The authors failed to statistically correct for the massive beneficial effects of HCQ because they couldn’t find that effect because of the limitations in their study.
3) Patients with serious cardiac problems were not given HCQ. In other words, those already more likely to survive COVID were given HCQ! In a proper clinical study, those for whom HCQ was too dangerous would be randomly assigned to receive or not receive HCQ and those for who HCQ was too dangerous would be excluded from the study.
It would be appropriate to remember and cite these gross problems next time you cite this study.
Zinc competes with magnesium in literally thousands of enzymatic reactions and is an essential ion in other enzymatic reactions. IMO, it is extremely unlikely that some magic amount of zinc can exert a beneficial antiviral effect without having a toxic effect on normal cellular processes. Abnormally low zinc would be detected in a patient’s blood work and excess zinc would be quickly washed out of a patient with an IV. Only after someone has done a proper study comparing HCQ+zinc with HCQ without zinc would it make sense for you to claim that HCQ without zinc studies were invalid. Furthermore, if zinc enhanced the benefit of HCQ, this effect would have been clearly characterized in cell culture experiments which show the (weak) antiviral effect of HCQ and narrow gap between antiviral activity and toxicity to host cells.
https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
Results
Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10 days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital mortality was 18.1% (95% CI:16.6%-19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%-31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9-3.3]), white race (HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001).
franktoo says,
“For the record, the HCQ study you linked below is deeply flawed. It is the summary of experience from a large hospital, not a random assignment clinical trial. There were massive differences between the HCQ-treated and -untreated groups.”
Not sure which study you refer to. This one? https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
If I ever said the HCQ studies without zinc were invalid (I hope I didn’t say that) then I was wrong, but most likely I was referring to the Zelenko protocol, which uses zinc, and my point would have been that those studies not using zinc (or the proper dose of HCQ given at the right time, for that matter) are not valid tests of the Zelenko protocol.
In any case, thanks for pointing out the errors of the study.
cytokine storms in COVID-19?
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767939?guestAccessKey=0e61c2d0-f10e-4cdc-8918-397e4dacbac3&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=063020
“Mined” quote: Putting the unsubstantiated theory of the cytokine storm aside, the more intriguing question to ask is why are clinical outcomes in COVID-19 so unfavorable despite relatively low levels of circulating IL-6? One hypothesis is that severe viral pneumonia from COVID-19 produces primarily severe lung injury, without the same magnitude of systemic responses in most patients with COVID-19 as reported in prior studies of the hyperinflammatory phenotype in ARDS.7-9 For example, a recent postmortem report of patients with COVID-19 ARDS identified severe vascular injury, including alveolar microthrombi that were 9 times more prevalent than found in postmortem studies of patients with influenza ARDS.10 Ongoing research may identify more specific mechanisms of COVID-19–mediated lung injury.
It seems slow compared to our needs, but research is being done at high speed compared to research on previous pandemics.
This is why you give patients vitamin C, as in the FLCC protocol that uses methylprednisolone (whose cousin dexamethasone is now getting attention) vitamin C, and heparin. Vitamin C has many functions in the body and its use is medically sound. https://covid19criticalcare.com/medical-evidence/#1591257950324-8917855f-f9e7
This research is being ignored despite the positive results.
Don132: (whose cousin dexamethasone is now getting attention)
This research is being ignored despite the positive results.
There are more leads, due to the complexity of the virus attacks, than there are research groups that can conduct clinical trials properly.
But the reliable knowledge is accumulating.
matthewrmarler, I agree. But it seems to me that absent clinical trials, attention should be directed to what seems to be working best.
Don132: attention should be directed to what seems to be working best.
Different treatments “seem” to work best to different clinicians and other experts. The only reliable guidance now is from the results of the clinical trials.
matthewrmarler yes, but the actual clinical results are what they are; if you have 100% of ICU Covid patients surviving, I’d say that’s something to look into. Do you disagree with that? I understand your concern with clinical trials as proof and I agree 100%, but during a time of crisis it seems to me that we have to go on the best evidence we have.
The medical community is prejudiced against vitamin C; I understand. I’m not going to debate that because that’s getting too far outside this thread and would take too long. Although I think we probably agree more than we disagree, for now let’s just have differences of opinion and let it go at that.
Yesterday’s briefing from Thomas Glass:
https://thomasglassphd.com/category/daily-briefings/
About this: U.S. now in exponential growth of daily cases, fastest rate of increase since the epidemic began. Does anyone care?
Where I am following, e.g. USA, TX, and FL, “growth rate” of daily deaths is declining or stationary, and definitely not following the growth rate of new cases. US has tested about 10% of population.
Well, This is more media panic porn. You will notice that its only Florida and Texas that are the focus and not California. That’s transparent bias.
Florida’s average age of those testing positive has declined from 65 to 37. Most of these new cases are going to recover just fine. I’ll be concerned if deaths start rising rapidly. So far there are increasing a little.
Panic porn is right. The media trys to compare Texas with NY, but deaths is the metric to focus on; Texas has under 2,500 deaths total from COVID, NY has over 31k, inconvenient facts for the hysterical press.
Hello!
When you guys say “new cases” what do you mean by this?!
As a denizen, I continue to be amazed by how Joshua is able to so easily hijack a guest post when he choses to do so,
He is too timid and weak to topple statues. So, he makes his contribution to the cause here.
Anyone could do it. All you need to do is express some opinions that don’t line up with politically correct rightwing dogma.
Just try pretending for a minute that Trump isn’t infallible and post a comment accordingly.
He’s been doing it for years. I guess Judith has a soft spot for low life jerks.
The only good thing about Joshua is that we get to hear more from Don.
Josh is a classic ankle biter. He never really states or tries to defend a position or provide any facts and data. Instead he is like a house cat attacking an elephant, hoping the elephant doesn’t notice while he scratches the elephants toes.
On this post Josh does a classic rendition. Refusing to accept the good news that Sweden hospitalizations and deaths are way way down from the peak and that fatality rates will end up under 0.1%, he wants to focus on how much “better” neighboring countries did (while ignoring that they will do worse in the future while Sweden has herd immunity) and then whines that comparisons between countries don’t mean much. A mass of contradictions and evasions that is hard to state with a straight face.
dpy,
Some facts.
1. Sweden’s mortality rate to date is more than five times Denmark, the second worst hit Nordic. Sweden has, objectively, done far worse to date.
Source: ourworldindata.org
2. Sweden’s antibody positive rate is only 5-10%, way off herd immunity.
Source: https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2020/juni/forsta-resultaten-om-antikroppar-efter-genomgangen-covid-19-hos-blodgivare/
3. Sweden’s ongoing high infection rate means that measures are being relaxed less than in other Nordics, and travel restrictions remain out of Sweden that have been removed elsewhere.
Your assertion that Sweden will do better in future is just that. An assertion.
Given that treatments are already better than at the peak of Sweden infection,
vaccines are possible and well over 90% of the population is yet to be exposed, it seems very, very unlikely.
We will see.
0.05% of the Swedish population has died from Covid-19, which means that 99.95% of the population has not.
Sweden determined that individual decision-making was more important than the unnecessary expansion of government power.
About 0.04% of the US population has died from Covid-19. This means that 99.96% of the population has not, yet the US has determined that liberties could be curtailed and that government power could be expanded because of a threat that kills 0.04% of the population, many of whom would have died this year in any case. This disease almost never harms young people who have robust immune systems.
The Founding Fathers of the US were more concerned with preserving liberty during a time when early death was everywhere than they were with preserving life because their main concern was checking abuses of power and preserving individual liberties. Now we run scared at a virus that leaves most victims unharmed and give up liberty when someone from Imperial College says “boo.”
Stay safe? How about, stay free?
> 0.05% of the Swedish population has died from Covid-19, which means that 99.95% of the population has not.
You have no idea whether or not a higher % of the population would die here. In Belgium, close to 0.09% of the population has already died. In Spain even more if you go with the estimate of the number dead that Nic seems to have agreed with elsewhere in this thread. And obviously the number will go higher.
Y’all are arguing as if there is some universal fixed limit due to some kind of natural laws of epidemics, and that it kicks in at 20% of the population and is a function of some low (flu-like) infection fatality rate – and that therefore you can extrapolate across context.
That thinking is obviously wrong. Context specifics are obviously very important.
Your determination of “liberties curtailed” is subjective. You are entitled to your opinion, but it is an opinion and different stakeholders all get a voice. Your voice has been heard and our representative government has chosen a different path because your view is a minority one. Some people think that wearing a mask is an unreasonable expectation. Others think it is a minimal compromise for the sake of your community. Why should the opinion of a privileged minority who have disproportionate power take precedent?
It’s easy to get confused by the minutae of comparisons between countries and cross the line into science denial.
1. No reputable expert I know of says that mitigation will reduce the ultimate number infected. Mitigation can “flatten the curve” and keep hospitals from being too stressed. But to think that any country can “stamp out the virus” is wishful thinking. Most experts think herd immunity is the ultimate destination. Nic has presented evidence here that herd immunity could happen with a 20% infection rate.
2. Also viral vaccines have a bad track record. We may be lucky and find a reasonable effective vaccine, but historical evidence is not encouraging.
3. It is almost certainly true that we are getting better at treating covid19.
4. Sharply declining deaths and hospital admissions at a time of strongly rising cases in Sweden and in the US indicate either that we are testing more or that in fact most of the vulnerable population have already been infected. That’s really good news.
5. There is no question that the US media has descended into propaganda and yellow journalism when reporting on both the covid19 epidemic and the recent protests. The contradiction of experts warning people to wear masks and social distance except when “peacefully protesting” is just another example of why people don’t trust experts.
Generally, this looks like a good news story to me and indicates that for the vast majority of people getting back to normal will entail a small increase in mortality. For people under 70 who are healthy, covid19 does not pose a significant risk of death beyond that due to the flu and poses a smaller risk of death than heart disease or cancer.
> This means that 99.96% of the population has not, yet the US has determined that liberties could be curtailed and that government power could be expanded because of a threat that kills 0.04% of the population, many of whom would have died this year in any case.
This ignores:
1) There is a risk that it could have been significantly higher – resulting in tens or hundreds of thousands of additional deaths. Even if you consider that a low probability, other people are entitled to view the probability differently, and to judge their risk tolerance for so many deaths differently than you. You don’t get to dictate to others how to assess either the probability or what rhe risk tolerance should be.
2) different groups are affected disproportionately. The groups most affected do not have proportional representation in how these decisions are getting made. And different people attach different values to the issue of disproportionality.
3). Deaths are not the only relevant metric. Illness is as well, as well as all the outcomes associated with morbidity. And don’t even yet know the sequalae of the virus.
4). The impact on those who are directly sacrificing for the sake of keeping others safe (front line healthcare workers, essential workers)
5) the impact of increased deaths over the short term might equalize over the long term or they might not. Whether they will or not could spend on a vaccine or development of more efficacious therapeutics.
I’m sure I’ve left others out – but gotta run.
I know it feels good to be a freedom fighter protecting liberties. But it’s complicated. Maybe your right to avoid the inconvenience of a mask needs to be balanced against the concerns of your fellow citizens?
Joshua,
Not worth it to answer your objections, which miss the point.
Once again, a lot of long winded fact free deflection. In the US expected mortality is a little bit shy of 1% per annum. In nursing homes, expected mortality is 35% per annum. Total deaths in the US are right now about 0.04% or about 13 days of expected mortality. You are still vastly more likely to die of heart disease or cancer in the next year than of covid19.
For Josh’s benefit, non-fatal disability from cancer and heart disease are also huge.
Delaying routine screening tests (as has happened in the US) by even a few months will result in tens of thousands of excess deaths too. The excess mortality caused by lockdowns and the worst economic depression in American history is always ignored by the alarmist faction.
“There is no question that the US media has descended into propaganda and yellow journalism”
Please do try to keep your political views under control. You seem unable to make a single post without it.
Stating facts about the media is not political. I linked below a well documented article listing some of the lies. You might try reading it.
and on the substance, re your
3. It is almost certainly true that we are getting better at treating covid19.
This nicely shows that even if your assertions on herd immunity prove correct, Sweden will almost certainly end up with the highest death toll in the Nordics (and one of the highest in Europe). It’s also notable that other Nordics in many areas now generally have less restrictions than Sweden (eg much larger mass gatherings allowed).
We cannot know definitively whose approach has been best for some time, but it looks really very unlikely it will have been Sweden, almost regardless as to your success criteria.
““There is no question that the US media has descended into propaganda and yellow journalism” is not a fact.
It is a political opinion.
To be unable to acknowledge this, is an excellent measure of just how strongly your politics overrides rational analysis.
“…different groups are affected disproportionately. The groups most affected do not have proportional representation in how these decisions are getting made.”
As it has been for the past 50 years. Are you smuggling in something? How about the GND?
We should limit the redistribution for now to help reach some kind of agreement.
No VTG you are wrong. I gave a link with all the evidence of media malpractice. Reading I know is challenging but it would help you with your error rate.
dpy,
You’re funny.
“There is no question that the US media has descended into propaganda and yellow journalism” is purely a statement of fact. Hilarious.
But you do now seem to agree that Sweden will almost inevitably end up with the highest Nordic death toll.
So I guess you’re not yet totally beyond all reason.
Verytall,
A recent paper (https://www.biorxiv.org/content/10.1101/2020.06.29.174888v1)
suggests that there is effective T-cell mediated immunity among those who were exposed to the virus but showed either no symptoms of very mild symptoms, even though they had not measurable level of serum antibodies. There are two important implications: 1) antibody screening alone does not accurately measure progress toward herd immunity, and 2) herd immunity will be reached when the total of the population with antibody reaches ~20-25%.
I’ve seen a report on two earlier studies on T-cells that are hopeful.
https://www.sciencemag.org/news/2020/05/t-cells-found-covid-19-patients-bode-well-long-term-immunity
On the other side, there’s this small, observational study that isn’t so hopeful.
https://www.cidrap.umn.edu/news-perspective/2020/06/chinese-study-antibodies-covid-19-patients-fade-quickly
stevefitzpatrick,
Let us hope they are right.
The progress of the virus in places such as Bergamo makes it seem unlikely.
We will see.
On an earlier thread, Joshua wrote, quoting a comment by someone else:
“> Also, the social distancing policy is not a problem in Sweden, because that is how it works normally. It is more than a joke when quoting the swedish reaction to the distancing rule of 2m: “that close?!!”.
and added his own comment:
“Funny.
Sums up well how knuckle-headed these cross-country comparisons are.”
The comment quoted by Joshua related to one in which I had written that, when I was in Stockholm fairly recently (2019):
” I didn’t find social behaviour to be very much different from that elsewhere in Europe, excluding very crowded cities.
to which Joshua responded:
“I’ll compare your anecdote-based science to someone who presumably has more expertise from actually being Swedish:
Here’s a nice picture of “social distancing” in Stockholm last week, so open-minded readers can judge for themselves:
https://images.theconversation.com/files/344521/original/file-20200629-155330-cgb6qn.jpg
The article it is embedded in is worth reading: https://theconversation.com/coronavirus-could-it-be-burning-out-after-20-of-a-population-is-infected-141584
For balance, here’s a nice picture of “social distancing” in the UK last week, so open-minded readers can judge for themselves.
https://static.standard.co.uk/s3fs-public/thumbnails/image/2020/06/26/08/liverpoolfans2606.jpg
And here is Sweden’s chief epidemiologist claiming that the Swedish approach is more sustainable because the Swedes are moving less and traveling less than their Nordic neighbors:
https://www.expressen.se/nyheter/coronaviruset/nya-siffror-svenskarna-skoter-sig-bast-i-norden/
That is: Sweden is more locked down than their neigbors. Therefore their approach is better.
How does that fit with niclewis’s narrative?
nic –
I’m not sure what your point is.
I have little doubt that there are factors specific to the context in Sweden (demographics, social factors, % of people who live in single-person households, mean baseline health status, treatment of seniors in need of care, etc.) that are at least partially explanatory for why (1) Sweden chose a different policy approach than other countries to begin with (e.g., less spread initially, less travel to/from China, more distant from Lombardy, more ability to work from home, more generous leave of absence policies, etc.), (2) has a particular set of outcomes associated with their policy choices, and (3) is not a particularly good point of comparison except for maybe other Scandinavian countries.
Trying to make these kinds of cross-country comparisons is extremely complex. There are a ton o’ confounding variables to contend with across many domains of society. And perhaps more importantly, we don’t have good quality data and it is too early to judge outcomes longitudinally.
I don’t discount the possibility of a lower HIT than what is typically envisioned. Or maybe more likely is what Michael Levitt calls “burnout” as distinct from herd immunity – but surely we don’t have solid evidence yet and again there are probably many context relevant variables (that might, for example, explain why there are places that have reached significantly above 20% prevalence).
But even if a HIT is reached in Sweden quickly, or a “burnout” phenomenon truly exists (at least in some locations) at 20%, that could still result in a much higher number of deaths in the short term compared to the outcomes in other areas. For example, South Korea is still stamping out Covid brushfires, but it would take years and years for them to reach a death rate comparable to Sweden at the rate they’re going now. Will they experience more economic hardship that Sweden due to their approach? We don’t know yet. Would economic outcomes actually have been worse in countries that issued shelter in place orders absent those shelter in place orders? We don’t know. Counterfactual reasoning requires a lot of carefully calibrated evidence. We aren’t well served by seat of the pants speculation – especially since we all have ideological biases that tend to strongly influence counterfactual reasoning because the controlling evidence is so difficult to establish.
And all these types of assessments could hinge diametrically depending on whether or not a vaccine is developed on a relatively short time frame (or they could change significantly, even if not diametrically, depending on the progress with therapeutics).
And then there’s the whole subjectivity in foundational definitions, such as what comprises a “lockdown” and which countries fit which descriptors.
What I argue for is for people to respect all the uncertainties and not treat the uncertainties selectively.
The arguments about what constitutes an infringement of “basic human freedoms” is a subjective argument. I think it’s one worth having. But, IMO, people should be careful about mashing up those discussions with a more scientific analysis, and then acting as if there isn’t subjectivity to what comprises “basic human values” or “infringement of freedom” or what policies are justified on the basis of how many or who it benefits, etc.
Joshua: What I argue for is for people to respect all the uncertainties and not treat the uncertainties selectively.
You never argue for anything clearly and directly. It’s always unclear and indirect. Usually on the order of “All sides are wrong” without elucidating any particular details.
Re: “Of all people who they estimated to be infected with COVID-19 around the second half of March, 0.58% died”
Regions of Sweden can get higher than that, but that’s a discussion for another day:
https://www.norrbotten.se/sv/Halsa-och-sjukvard/Smittskydd-i-Norrbotten/Information-om-nya-coronaviruset/The-seroprevalence-of-covid-19-antibodies-in-Norrbotten-County-Sweden/
“On another note, an overall infection rate of 6.1% implies an overall IFR in Sweden of 0.69%“
http://archive.is/ll5Zm#selection-701.0-761.19
But to return to that “0.58%” value; it sure sounds familiar. Ah, it’s a lot like the infection fatality rate (IFR) Verity et al. said for China, but now applied to Stockholm, Sweden:
“We obtain an overall IFR estimate for China of 0.66% (0.39%-1.33%), again with an increasing profile with age.”
https://web.archive.org/web/20200701065815/https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf
“Our estimated overall infection fatality ratio for China was 0·66% (0·39–1·33), with an increasing profile with age.”
https://www.sciencedirect.com/science/article/pii/S1473309920302437
Verity et al. sound bright. Yay, accurate epidemiological modeling, FTW!
…But wait, someone disagreed with one of Verity et al.’s predictions:
“Accordingly, the Verity et al central estimate for the Diamond Princess death toll, of 12.5 eventual deaths, is 50% too high. This necessarily means that the estimates of tCFR and sCFR they derived from it are too high by the same proportion.”
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/
Hold on a second. Doesn’t giving a death estimate of ~8 amount to right censoring, an introductory-level mistake in epidemiology? Given that, I wonder if Verity et al. were right in their prediction of the number of deaths…
Joshua (who suffers needless insults for being right):
“Time for another update – deaths up to 13″
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/#comment-914951
“As of May 14, 2020, 712 (19%) of the 3711 passengers and crew had been infected with SARS-CoV-2, and 13 deaths had occurred among those with confirmed infection.”
https://www.sciencedirect.com/science/article/pii/S1473309920303649?casa_token=dhEihFCV9wgAAAAA:wH_aP5keWkZOIiA6E9Yo0HpZ6O95VqVRG-_TAZFu9319jFWg4ez2nn-1snpjFJfGBvsAihCI
June 30: 13 deaths
http://archive.is/XLlJ5#selection-1131.0-1150.0
Verity et al., and accurate mainstream predictions, FTW! Again! Oh, if only someone had been wise enough to use Verity et al.’s nice IFR work:
“The Ferguson et al. study used estimates of the IFR[2] from another paper from the same team, Verity et al. (2020)[3], which had been published a few days earlier on 13 March. Very helpfully, Verity et al., unlike Ferguson et al., published the computer code and data that they used.”
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/
Thanks to the Imperial crew for releasing their code and having it be reproducible. But next time, they should make it prettier and easier to use, not just functional and based on great work:
“Influential model judged reproducible — although software engineers called its code ‘horrible’ and ‘a buggy mess’.”
https://www.nature.com/articles/d41586-020-01685-y
“We present calculations using the CovidSim code which implements the Imperial College individual-based model of the COVID epidemic. Using the parameterization assumed in March 2020, we reproduce the predictions presented to inform UK government policy in March 2020. We find that CovidSim would have given a good forecast of the subsequent data if a higher initial value of R0 had been assumed.”
https://web.archive.org/web/20200701090431/https://www.medrxiv.org/content/medrxiv/early/2020/06/22/2020.06.18.20135004.full.pdf
But what about Imperial’s unmitigated IFR of ~0.9% for Great Britain?:
“These estimates were corrected for non-uniform attack rates by age and when applied to the GB population result in an IFR of 0.9% with 4.4% of infections hospitalised (Table 1).”
https://spiral.imperial.ac.uk:8443/bitstream/10044/1/77482/14/2020-03-16-COVID19-Report-9.pdf
Clearly, that’s gotta be Anthony-Fauci-level baseless guessing, even if it used Verity et al.’s validated work on IFR:
“Yes, Well Fauci also published a paper saying the fatality rate was 1%. According to Nic’s analysis its an order of magnitude less. No one knows what the outcome will be. He is guessing.”
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/#comment-912497
Surely their unmitigated IFR couldn’t match observed mitigated IFR, right? Otherwise, that would mean Imperial likely under-estimated IFR, instead of over-estimating it like so many people on “epistemic trespassing” blogs kept saying:
“New seroprevalence data indicate 6·8% (5·2–8·6) of the UK population have had previous severe acute respiratory syndrome coronavirus […] infection as of May 24. […] With 36 000 deaths, this suggests an IFR of 0·8%; with 44 000 deaths (using death certificate data4), this suggests an IFR of 1·0%.“
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266600/
https://twitter.com/GidMK/status/1277804390603059201
[with: https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930247-2 ]
“After the adjustment, distributions of the IFR across the USA, Spain and the UK look very similar; the most likely range for IFR is between 0.2 and 1%, with values beyond this looking less likely.”
https://www.tandfonline.com/doi/full/10.1080/13669877.2020.1778771
“Third, and finally, a strong and consistent relationship exists between the prevalence of antibodies to SARS-CoV-2 and mortality from COVID-19 in European populations, consistent with an IFR of 0·5–1·0%.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289569/
Darn you, Imperial College experts! Your unmitigated IFR was about the same as observed mitigated IFR, which means your modeling likely under-estimated the fatality risk from SARS-CoV-2-induced COVID-19. Imperial’s Neil Ferguson needs to be dragged up to Parliament (or whatever it is England uses) for the travesty of not giving the world a stronger warning on COVID-19’s fatality risk based on accurate predictions. Projections are predictions, because the climate realists told me so!
And, I certainly hope no one wrote a blogpost that hinged on a predicted death estimate of less than 12 (~8, then ~10) for the Diamond Princess, in order to criticize the experts in epidemiology at Imperial College + Verity et al. Because that would be a really bad prediction, to the point that some might want to avoid having it pointed out, lest it undermine folk’s confidence in certain subsequent fatality predictions about Sweden. Bad predictions made on limited data are just for those dastardly climate alarmists, where climate modeling is probably just as bad as Verity et al.’s epidemiological modeling, amirite? Realists be out there making accurate assessments of data that stand the test of time.
“There are by now at least 10 serologic data sets around the world. They pretty much uniformly show an IFR less than 0.5% with the best ones showing perhaps 0.12% to 0.31%.”
https://statmodeling.stat.columbia.edu/2020/05/08/so-the-real-scandal-is-why-did-anyone-ever-listen-to-this-guy/#comment-1333886
You’ve made multiple confused, invalid comparisons. I’m not going to waste my time demolishing them.
Re: “Notwithstanding that a month ago antibodies were only detected in 6.3% of the Swedish population, the declining death rate since mid-May strongly suggests that the herd immunity threshold had been surpassed in the three largest regions, and in Sweden as a whole, by the end of April.”
Neither Stockholm, nor Sweden in general, hit the herd immunity threshold. You’re conflating the results of interventions, behavioral changes, etc., with herd immunity.
I explained some of the relevant immunology on that to you weeks ago:
https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/#comment-916999
https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/#comment-917050
“These early onset peak rates should arise not because of herd immunity but because of changes in behavior. […]
The peaks occur at levels of infection far from that associated with herd immunity. Post-peak, shoulders and plateaus emerge because of the balance between relaxation of awareness-based distancing (which leads to increases in cases and deaths) and an increase in awareness in response to increases in cases and deaths.”
https://web.archive.org/web/20200701170752/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273247/
“This allows us to “bend the curve” and predict temporary equilibrium states, far away from the equilibrium state of herd immunity, but stable under current conditions [26]. Yet, these states can quickly become unstable again once the current regulations change. Our dynamic SEIR model allows us to study precisely these scenarios.”
https://web.archive.org/web/20200604114159/https://www.medrxiv.org/content/medrxiv/early/2020/05/10/2020.05.01.20088047.full.pdf
“In summary, there are large differences in patterns of per-capita deaths in different countries that are difficult to reconcile with herd immunity arguments but are easily explained by the timing and stringency of interventions. Seroprevalence studies also provide an independent source of information that is highly consistent with mortality data. The herd immunity argument is therefore at odds with both mortality and seroprevalence data, whereas the intervention argument provides a parsimonious explanation for both.”
https://web.archive.org/save/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289569/
“A method is presented for estimating the model parameters from real-world data. It is shown that increase of infections slows down and herd immunity is achieved when symptomatic patients are 4-6% of the population for the European countries we studied, when the total infected fraction is between 50-56%.“
https://web.archive.org/web/20200610041948/https://arxiv.org/pdf/2006.00045.pdf
I also encourage people to compare COVID-19 deaths per capita for Sweden vs its 8 closest neighbors who each underwent lockdowns, since you won’t show them that comparison for some convenient reason:
https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&deathsMetric=true&totalFreq=true&perCapita=true&smoothing=0&country=SWE~FIN~NOR~DNK~DEU~POL~LTU~LVA~EST
https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&deathsMetric=true&dailyFreq=true&perCapita=true&smoothing=7&country=SWE~FIN~NOR~DNK~DEU~POL~LTU~LVA~EST
[ https://euromomo.eu/graphs-and-maps
https://www.reuters.com/article/us-health-coronavirus-estonia-restrictio/estonia-opens-healthcare-schools-to-follow-in-easing-of-lockdown-idUSKCN2242MR ]
Anyway, feel free to claim you’re capable of “demolishing” points like 13 > 8.34. I’ll go back to actually understanding immunology, etc., and to not relying on ‘epistemic trespassers’ who have less relevant expertise on this topic than I do. I’m getting tired of people abusing/misusing immunology concepts they learned about in just the past few weeks (and don’t really understand), to support their pre-determined ideological opposition to policies like lockdowns.
“Antibody titers are good, rough metric to start with for immunity, but they’re not the sole determining factor of immunity. Take the following 2 examples:
1) Vaccinations can result in the production of memory CD8+ T cells that kill virus-infected cells, without necessarily needing antibody production [possibly with indirect help from other immune cell populations, such as iNKT cells].”
https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/#comment-916999
https://twitter.com/AtomsksSanakan/status/891040491214688257
Re: “You’ve made multiple confused, invalid comparisons. I’m not going to waste my time demolishing them.”
If only Resplandy et al. had known to respond that way.
13 is closer to 12.5 than it is to 8.34.
Period.
“As at 21 March the Verity et al. model estimates that 96% of the eventual deaths should have occurred, so we can scale up to 100%, giving an estimated ultimate death toll of 8.34, allocated as to 3.58 to the 70-79 age group and 4.77 to the 80+ age group.”
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/
~0.9% is close to 0.84.
~0.9% is within the ranges of:
0.8% – 1.0%
0.5% – 1.0%
0.2% – 1.0%
Period.
Ferguson et al.’s Imperial model likely under-estimated risk of a large number of COVID-19 deaths (due to under-estimating R0, and/or under-estimating Rt, and/or under-estimating IFR).
Period.
“I think he means that Ferguson et al assumed a doubling time of 5 days at a time when a fit to available data would have shown it to be less than 3 days. This meant that they may have under-estimated R0, which in turn may explain why the current UK deaths exceed Ferguson’s forecasts for the lockdown scenario.”
https://statmodeling.stat.columbia.edu/2020/05/08/so-the-real-scandal-is-why-did-anyone-ever-listen-to-this-guy/#comment-1332269
atomsk’s sanakan: ~2.0% (Connecticut)
~1.2% (New York City metro region)
~0.8% (western part of Washington state)
~0.5% (southern Florida)
~0.3% (Missouri)
~0.2% (Utah)
If I understand you, your point is that we do not have enough accurate data on infections and deaths to be confident in any of our current estimates of the IFR. But you surely go round in circles.
Atomsk’s Sanakan (@AtomsksSanakan) | July 1, 2020 at 5:28 am |
There might be interesting content in that disorganized post. I recommend that you revise it and resubmit it.
This is the usual cherry picking. Omitted were current CDC estimates as well as a whole raft of recent papers.
You typically lie about the Diamond Princess studies. Ioannidis assumed there would be additional deaths. You can easily redo Nic’s analysis if you can. DP epidemic still shows an IFR adjusted for population demographics of roughly 0.2%.
Re: “This is the usual cherry picking. Omitted were current CDC estimates as well as a whole raft of recent papers.”
Yet I actually cited research, while you didn’t. Your CDC point is particularly funny though, since the IFR from their actual research is greater than what you claim. But since I’m in the mood for some fun…
CDC director Redfield:
““Our best estimate right now is for every case reported there were actually 10 other infections,” Dr. Redfield said.”
http://archive.is/YIwQI#selection-711.0-711.116
Let’s do a rough correction for right-censoring in the general population, as opposed to a constrained environment (like a ship):
“Regional death rates were taken from the John Hopkins University CSSE dashboard (12) 10 days after the serosurvey completion where no IFR was calculated to account for right-censoring of these estimates (13), and used to estimate the IFR given the population.”
https://web.archive.org/web/20200628211604/https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v3.full.pdf
Now: ~127,000 US COVID-19 deaths
http://archive.is/wBt2v
https://coronavirus.jhu.edu/data/mortality
About 10 days earlier: ~2.26 million cases
Cases x 11: ~24.86 million infections
http://archive.is/T9uqt
That gives an IFR of ~0.5%, which is above what you claim. It’d probably be higher if I instead went with excess deaths to estimate COVID-19 deaths, but I’m not in the mood for that:
NY times: http://archive.is/1mezL
https://www.economist.com/graphic-detail/2020/04/16/tracking-covid-19-excess-deaths-across-countries#eid-united-states
https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441
The implied IFRs from their seroprevalence work in individual regions don’t really help your case much either. That’s what Redfield seems to have been relying on. Their use of convenience samples from blood draws of people who know to go for medical care isn’t really representative of the population as a whole. But let’s see what it implies for IFR anyway:
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html
“Seroprevalence of antibodies to SARS-CoV-2 in six sites in the United States, March 23-May 3, 2020”
~2.0% (Connecticut)
~1.2% (New York City metro region)
~0.8% (western part of Washington state)
~0.5% (southern Florida)
~0.3% (Missouri)
~0.2% (Utah)
https://twitter.com/AtomsksSanakan/status/1276754955928514560
Oh look, quite a number of IFR values of 0.5% or more, contrary to what you claim.
Re: “Ioannidis assumed there would be additional deaths.”
Didn’t mention him. So your goal-post move is noted.
Re: “You can easily redo Nic’s analysis if you can.”
Still avoiding the fact that Lewis said there would be ~8 deaths, when there were actually ~13 deaths, as Verity et al. predicted.
Re: ” DP epidemic still shows an IFR adjusted for population demographics of roughly 0.2%.”
Your evidence-free personal opinion is noted. I’ll go with what the peer-reviewed literature shows on this, with its larger percentage than what you claim:
Russell et al.: “Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020”
Verity et al.: “Estimates of the severity of coronavirus disease 2019: a model-based analysis”
Re: “You typically lie about the Diamond Princess studies”
And JCH is still right about the selective moderation here, as always.
This is the part, dpy, where you can say, ‘but your post is too long!’ again.
I’m not going to read much less debunk most of this latest cherry picking and deflection exercise from a serial obfuscator and anonymous internet political hacktivist (as your twitter page clearly states).
The CDC’s best estimate of IFR is 0.4% of symptomatic people and 35% asymptomatic which works out to 0.26%. That’s well within the range ofd the Santa Clara, Los Angeles, and Miami Dade county studies. I’ll take the CDC report over your convoluted and unverified by anyone calculations any day.
You deflected on the DP data without saying anything. Ioannidis’ original study I think is still valid. It came up with something like 0,.24% if memory serves. Just multiply Nic’s IFR by a factor of 2 and you will get a correct number. It’s in this same range.
https://twitter.com/CT_Bergstrom/status/1277076600358498310
“With about 125K deaths to date, this gives a fatality rate of >0.5 percent, because total deaths will climb somewhat as some of the currently infected people die.”
The IFR can go down as total deaths climb. New infections skewed towards younger folks. IFR likely going down. Sorry to disappoint.
Don is right of course. This is why cases are rising strongly in the US but deaths are on a downtrend. Similarly in Sweden where the trend is much more striking. Cases doubled over the last 3 weeks where new hospitalizations are down under 10 per day from a high of around 40.
It is true that worldwide a large portion of all fatalities have been among nursing home residents, who are very highly vulnerable but who would be likely to die within a year in any case.
This is an effect that every competent scientist has been saying from the beginning and has been observed with most previous epidemics. Estimates of IFR falls over time, often dramatically so.
Also every epidemiologist says that vaccines are very difficult for viruses and the few that exist are only partially effective. Without an effective vaccine, we are going to get to herd immunity. The only question is how many vulnerable lives are lost as collatoral damage from our futile “mitigation” efforts.
Atomsk’s Sanakan: ~2.0% (Connecticut)
~1.2% (New York City metro region)
~0.8% (western part of Washington state)
~0.5% (southern Florida)
~0.3% (Missouri)
~0.2% (Utah)
If I understand your post, we do not have enough reliable data to compute a reliable estimate of IFR. You do go in circles.
Re: “[“With about 125K deaths to date, this gives a fatality rate of >0.5 percent, because total deaths will climb somewhat as some of the currently infected people die.”]
The IFR can go down as total deaths climb. New infections skewed towards younger folks. IFR likely going down. Sorry to disappoint.”
You confused “IFR” with “total deaths”. The point is not that IFR goes down; the points is that the total number of deaths goes up, as some of the infected cases die. It typically takes awhile for infected cases to die:
“Estimates of the severity of coronavirus disease 2019: a model-based analysis”
“Case-fatality risk estimates for COVID-19 calculated by using a lag time for fatality”
So when looking at infected cases to date X, one needs to wait for awhile after that date X for those infected cases to die and thus for the total number of deaths to increase in response. Otherwise you end up with the right-censoring Lewis screwed up on in comparison to Verity et al., when Lewis discussed deaths on the Diamond Princess (Lewis should have waited much longer in this, given that this was a contained population of known size, as opposed to one mixing with the general population). That was Bergstrom’s point in the quote you responded to. This is introductory-level medicine and epidemiology, Don, just like the fact that plasma therapy doesn’t involve the intentional transfer of CD4+ T cells ( https://judithcurry.com/2020/05/06/covid-discussion-thread-vi/#comment-917411 ):
“Regional death rates were taken from the John Hopkins University CSSE dashboard (12) 10 days after the serosurvey completion where no IFR was calculated to account for right-censoring of these estimates (13), and used to estimate the IFR given the population.”
https://web.archive.org/web/20200628211604/https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v3.full.pdf
https://twitter.com/CT_Bergstrom/status/1279612720489234434
“Scientists Say New, Lower CDC Estimates For Severity Of COVID-19 Are Optimistic”
https://www.npr.org/sections/health-shots/2020/05/22/860981956/scientists-say-new-lower-cdc-estimates-for-severity-of-covid-19-are-optimistic
Re: “Without an effective vaccine, we are going to get to herd immunity.”
False dichotomy. For example, public health interventions suppress the pathogen to the point at which it doesn’t spread, outbreaks are controlled, and medications given both limit mortality and limit spread. So mitigate mortality and infections, without pursuing wide-spread immunity until a vaccine is made. If you knew about the huge amount of pathogens humans are exposed to, then you’d know that many of them fall outside the 2 categories of ‘we have herd immunity’ and ‘we have a successful vaccine we’re using for it broadly.’ Look up Zika virus (and other sexually-transmitted pathogens like HIV) and ebolavirus. We restrained the latter without herd immunity, and before having a successful vaccination to it.
There are also pathogens for which herd immunity is not really pertinent, because they keep leaping from non-human animals to humans. The classic example is Yersinia pestis. SARS-CoV-2 already infects non-human animals like cats, dogs, and ferrets, likely via human-to-animal transmission. If it becomes able to do animal-to-human transmission from those domesticated animals, then aiming for herd-immunity-based strategy without a vaccine is even more insane.
Re: “Also every epidemiologist says that vaccines are very difficult for viruses and the few that exist are only partially effective.”
What virtually every competent medical expert [outside of Sweden] said from the beginning is that letting infection spread to directly pursue herd immunity to SARS-CoV-2 without a vaccine, is lunacy that will kill huge numbers. And unlike you, David, I actually cite sources when I claim people said stuff:
“I’m an epidemiologist. When I heard about Britain’s ‘herd immunity’ coronavirus plan, I thought it was satire”
https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19
“There are two possible approaches to build widespread SARS-CoV-2 immunity: (1) a mass vaccination campaign, which requires the development of an effective and safe vaccine, or (2) natural immunization of global populations with the virus over time. However, the consequences of the latter are serious and far-reaching—a large fraction of the human population would need to become infected with the virus, and millions would succumb to it. Thus, in the absence of a vaccination program, establishing herd immunity should not be the ultimate goal. Instead, an emphasis should be placed on policies that protect the most vulnerable groups in the hopes that herd immunity will eventually be achieved as a byproduct of such measures, although not the primary objective itself.”
https://www.sciencedirect.com/science/article/pii/S1074761320301709
“In the face of the lack of an antiviral treatment and the lack of a protective vaccine one must state Taiwan has made the best out of the pandemic situation whereas Sweden failed completely.”
https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch209006
“Early herd immunity against COVID-19: A dangerous misconception”
“Herd immunity is not a realistic exit strategy during a COVID-19 outbreak”
“Mitigation and herd immunity strategy for COVID-19 is likely to fail”
“COVID-19 herd immunity strategies: walking an elusive and dangerous tightrope”
Also:
HPV
measles
hepA
hepB
rotavirus
inactivated poliovirus
influenza
varicella
Etc.
What do all of those have in common? They’re all viruses or viral conditions for which we have successful vaccines. Look up the CDC vaccination schedule:
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
I know the topic of vaccination like the back of my hand, David. Mentioning un-named epidemiologists who (supposedly) said something that any 2nd year medical student could debunk, won’t work on me. Don’t try that again.
https://twitter.com/AtomsksSanakan/status/1244883247873564672
You can now return to saying ‘your post is too long, too many words to read’.
Re: “If I understand your post, we do not have enough reliable data to compute a reliable estimate of IFR. You do go in circles.”
You don’t understand my post. IFR differing by region within a country doesn’t change the fact that one can have an average IFR for a country overall. Similarly, just because income differs in various parts of the US doesn’t change the fact that there can be an average income for the US.
Regional differences =/= Unreliability
And it’s not a matter of going in circles; it’s a matter of understanding what an “average” is + what “regions/subsets” are.
My goodness.
https://twitter.com/geoffmprice/status/1282056816755568640
https://twitter.com/AtomsksSanakan/status/1282062474544582656
stream of unconsciousness
Lewis was even more wrong than I thought:
“As at 21 March the Verity et al. model estimates that 96% of the eventual deaths should have occurred, so we can scale up to 100%, giving an estimated ultimate death toll of 8.34, allocated as to 3.58 to the 70-79 age group and 4.77 to the 80+ age group.
Accordingly, the Verity et al central estimate for the Diamond Princess death toll, of 12.5 eventual deaths, is 50% too high. This necessarily means that the estimates of tCFR and sCFR they derived from it are too high by the same proportion.”
https://judithcurry.com/2020/03/25/covid-19-updated-data-implies-that-uk-modelling-hugely-overestimates-the-expected-death-rates-from-infection/
” The Stockholm infection fatality rate appears to be approximately 0.4%,[20] considerably lower than per the Verity et al.[21] estimates used in Ferguson20″
https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/
Wikipedia and a peer-reviewed paper put the death toll at 14:
“Deaths
14”
http://archive.is/ECsu7#selection-243.0-251.1
“In the Report “Estimating the burden of SARS-CoV-2 in France,” the authors used data from the coronavirus disease 2019 outbreak aboard the Diamond Princess cruise ship to help calibrate their model. They made the assumption that in addition to the 14 deaths already recorded, the four individuals still in the intensive care unit (ICU) after 2 months would also ultimately die from their infection. This assumption was arrived at after speaking to physicians about long-term outcomes for those in the ICU.”
https://science.sciencemag.org/content/368/6498/eabd4246
Wikipedia’s cited source from Japan includes only 13 deaths, but that’s because it likely leaves out a death from a patient transferred to Australia. That’s clear from the Wikipedia link above, when they pair each death to their cited source:
https://www.theguardian.com/world/2020/mar/01/dutton-says-extending-travel-ban-not-possible-and-defends-coronavirus-response
https://www.mhlw.go.jp/stf/newpage_10870.html
So contrary to what Lewis claimed, Verity et al. actually under-estimated deaths on the Diamond Princess (14 > ~12.5), and thus likely under-estimated IFR. That’s consistent with what I noted before about Ferguson et al.’s Imperial team under-estimating IFR: they used Verity et al.’s work, leading to them having a projected *unmitigated* IFR that was on par with the observed *mitigated* IFR.
And, of course, this also means Lewis under-estimated IFR even more than Verity et al. did (14 > ~8.3).
The Ruby Princess case is another interesting example:
https://en.wikipedia.org/wiki/COVID-19_pandemic_on_cruise_ships#Summary_of_confirmed_cases_on_board
https://www.abc.net.au/news/2020-05-13/australia-coronavirus-death-toll-rises-ruby-princess-fatality/12239626
https://www.abc.net.au/news/2020-04-13/coronavirus-concerns-for-international-ruby-princess-passengers/12143544
https://www.sciencedirect.com/science/article/pii/S2590198220300476
https://www.medrxiv.org/content/medrxiv/early/2020/07/09/2020.07.08.20148775.full.pdf
Many people on the Ruby Princess weren’t tested for SARS-CoV-2, unlike for the Diamond Princess in which most people were tested. But even if one assumes that basically everyone on the Ruby Princess was infected, that still gives at least 22 deaths for ~3800 infections, with an IFR of at least ~0.6% (without country-specific age-stratification). And obviously, not 100% of people onboard were infected, so the real IFR will be substantially higher than 0.6%.
For example:
– ~19% of those on the Diamond Princess were infected
– at least 22% of those on the Ruby Princess were infected
– the highest infection rate I know of on a ship is ~59% ( https://www.acpjournals.org/doi/full/10.7326/M20-3012 )
So it’s very unlikely that 100% of the people on the Ruby Princess were infected. Assuming the maximum infection rate of 60% for the Ruby Princess gives an IFR of ~1.0%, without country-specific age-stratification. A more modest infection rate of ~30% gives a corresponding IFR of ~1.9%, matching the result from the Diamond Princess.
A similar pattern repeated for the Grand Princess, in which enough people were tested for it to be pertinent:
https://en.wikipedia.org/wiki/COVID-19_pandemic_on_cruise_ships#Summary_of_confirmed_cases_on_board
https://www.usatoday.com/story/travel/cruises/2020/03/25/coronavirus-cruise-grand-princess-two-passenger-deaths/5081851002/
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm
So (IFR is without country-specific age-stratification):
– Ruby Princess : >>0.6% IFR, 22 deaths, ~3800 people, >22% infected and
– Diamond Princess : ~1.9% IFR, 14 deaths, ~3800 people, ~19% infected
– Grand Princess : ~1.8% IFR, 7 deaths, ~3800 people, ~11% infected
Verity et al.’s (under-estimated) Diamond Princess IFR of ~1.8% translates to an age-stratified IFR of ~0.7% for China. Russell et al. also use the Diamond Princess results to reach a similar IFR of ~0.6% for China:
https://www.sciencedirect.com/science/article/pii/S1473309920302437
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.12.2000256
None of them support Lewis’ under-estimated IFR of ~0.4% for Stockholm, Sweden, as expected and consistent with much of the rest of the literature. Not even Sweden’s results support that:
supplemental figure 1C:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289569/
Stockholm, Sweden:
“Our point estimate of the infection fatality rate is 0.6%, with a 95% confidence interval of 0.4–1.1%.”
https://www.folkhalsomyndigheten.se/publicerat-material/publikationsarkiv/t/the-infection-fatality-rate-of-covid-19-in-stockholm-technical-report/
Norrbotten County, Sweden:
https://www.norrbotten.se/sv/Halsa-och-sjukvard/Smittskydd-i-Norrbotten/Information-om-nya-coronaviruset/The-seroprevalence-of-covid-19-antibodies-in-Norrbotten-County-Sweden/
https://twitter.com/GidMK/status/1277804390603059201
“A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates
[…]
Given issues with mortality recording, it is also likely that [0.68% (0.53-0.82%)] represents an underestimate of the true IFR figure.
[…]
However, when taking quality into account, and only analysing those serosurveys that had a low risk of bias, it is interesting to note that the inferred IFR rises substantially to 0.76% (0.37-1.15%).
[…]
It is not unlikely that, after correcting for excess mortality not captured in official death reporting systems, the IFR of COVID-19 in most populations would be higher than 1%.”
https://web.archive.org/web/20200709054242/https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v4.full.pdf
Game. Set. Match.
https://twitter.com/GidMK/status/1285020775892709377
“The metabias and metafunnel commands were used to examine publication bias in the included research, with Egger’s test used for the metabias estimation. It was challenging to formally rate the risk of bias of the included modelling studies, as there was very significant heterogeneity in methodology and implementation, with the result that the risk of bias in these studies was considered to be high across all included research. Serological surveys were rated using a the risk of bias in prevalence tool with a resulting estimate in line with Cochrane GRADE criteria of low, moderate, or high (13). This tool asks a series of 10 questions about the sampling and data collection of prevalence studies, with a final rating based on the previous questions. Each question is answered yes/no, with a lack of information presumed to be no/unclear.”
https://web.archive.org/web/20200708043833/https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v4.full.pdf
It just gets worse and worse for Nic Lewis’ COVID-19 predictions, as more and more of Ferguson et al.’s work gets confirmed:
“Finally, while not included in our formal meta-analysis, it should be noted that the pathbreaking study of Ferguson et al. (2020) is broadly consistent with our findings. That study was completed at an early stage of the COVID-19 pandemic, drawing on data from expatriation flights to estimate infection rates in Wuhan and then computing age-specific IFRs based on reported fatalities in Wuhan. As in our meta-regression results, the IFR estimates in that study increase exponentially as a function of age, with rates near zero for ages 0-39 and far higher rates for older adults.”
https://web.archive.org/web/20200731003543/https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v2.full.pdf
Lewis’ prediction for the 70-79 age-range was particularly bad:
https://twitter.com/AtomsksSanakan/status/1289089921916051456
The above study later cites work with residual sera for “seroprevalence studies of six U.S. geographical areas”. Those are convenience samples and not necessarily representative of infection rates in the general population:
https://threadreaderapp.com/thread/1285696432478052355.html
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768834
https://www.medrxiv.org/content/10.1101/2020.06.25.20140384v1.full.pdf
Their being non-representative is further confirmed by them over-estimating the ratio of total infections vs. reported cases, in comparison to later studies with a more randomized + representative design. Those more representative studies also often result in infection fatality rates (IFRs) larger than Lewis would have predicted in his early attempts to downplay the risk of COVID-19 [downplaying in order to avoid lockdowns and other policies he disliked]:
– ~1.6% IFR , ~5X ratio : https://www.medrxiv.org/content/10.1101/2020.06.23.20138321v1.full.pdf
– 3.6% , 2X : https://www.ri.gov/press/view/38594
– 0.3% , 3X : https://healthcare.utah.edu/publicaffairs/news/2020/07/utah-hero-project-phase-1.php
– 1.0% (NY state) , 6X : https://www.governor.ny.gov/news/governor-cuomo-announces-us-open-be-held-without-fans-august-31st-september-13th
– 1.7% , 4X : https://news.iu.edu/stories/2020/06/iupui/releases/17-fairbanks-isdh-second-phase-covid-19-testing-indiana-research.html
– 0.8% (0.9% w/o right-censoring) , 5X : https://washoecounty.us/outreach/2020/07/2020-07-08-jic-update-0708.php
– 1.3% , 4X – 6X : https://louisville.edu/medicine/news/phase-ii-results-of-co-immunity-project-show-higher-than-expected-rates-of-exposure-to-novel-coronavirus-in-jefferson-county
Those antibodies stick around for months in seroprevalence:
https://web.archive.org/web/20200720222438/https://www.medrxiv.org/content/10.1101/2020.07.14.20151126v1.full.pdf
https://web.archive.org/web/20200722020304/https://www.medrxiv.org/content/10.1101/2020.07.18.20155374v1.full.pdf
“However, using a virus neutralization assay, considered the golden standard of serology testing, all patients with undetectable IgG using commercial methods had NAbs.”
https://www.medrxiv.org/content/10.1101/2020.07.11.20151324v1.full.pdf
I generally agree with you that Stockholm may be in a better position than most in terms of approaching some form of herd immunity.
I would like to make two points and a prediction for what is going to happen over the next two months in Europe.
The first point is that, with the benefit of hindsight, very few European countries did well in taking adequate measures for the protection of the most vulnerable, and this applies especially to long-term care-homes. In late May, Lena Hallengren, the Swedish Health Minister acknowledged the failure, when reporting that about one half of all recorded COVID-19 fatalities in Sweden were in care-homes. Belgium, with the worst population mortality rate in Europe so far, has recorded a similar percentage – 50%.
An LSE study reported that in Italy, France, Ireland, Spain and Belgium, care-home deaths were between 42% and 57% of all fatalities. Deaths in care homes in Scotland were greater than 50% of fatalities in early June; England recorded 12,200 deaths IN care homes to the end of June, but this does not include the substantial number of patients who were transferred from care homes to hospital during May and June (in a reversal of direction of flow from previous policy), and who died in hospital. Moreover, Sweden, like some other countries, has had more than its fair share of nosocomial infections – related to (acknowledged) poor decisions on hospital policies and logistics as well as failure to make timely provision of PPE. These two elemental failures account for a very large percentage of deaths not only in Sweden, but also in many other countries in Europe. (They also, IMO, need to be considered separately from deaths arising from, or avoided by, other imposed interventions.)
The second point is that wherever distribution information is available at a level below national aggregation (esp. Europe and USA), it shows an extreme spatial non-uniformity of infection rates and deaths, which cannot be explained by demographics. For example, in Italy, the Lombardy region was devastated, with over 0.4% population mortality rates in some cities, while some Italian regions to the south, notably Lazio and Campania, which include Rome and Naples, have so far been relatively untouched. TonyB in a previous thread spoke about the West Country in the UK, which so far has been only lightly affected, even while the UK as a whole may be heading towards the unenviable position of being the worst record-holder for fatality rate in Europe. France was hard hit in its Nord-Est region, around Paris (Ile de France) and in Lyon, while, in contrast, the Nouvelle Aquitaine region in south-west France, with a population of 6 million, has seen only about 150 fatalities, and 90 of these were in Bordeaux and Toulouse, both of which are connected to Paris via the TGV (highspeed) rail link.
While Stockholm may be approaching herd immunity, many other towns in other parts of the country still have quite a way to go. On any measure, Sweden still has a substantial susceptible population in relatively untouched areas. Similarly, the susceptible population in the West Country of the UK, in Naples or in Nouvelle Aquitaine is about the same as it was before the outbreak. The same story is repeated in great swathes of Europe which are so far relatively untouched.
Within Nouvelle Aquitaine is the Dordogne department (where I live), which, before the epidemic, would typically receive about 3 million tourist visits per year. Following widespread cancellations earlier this year, bookings have been largely replaced over the last month by people taking advantage of relaxation of lockdown rules and wanting to get away to a safe place in July and August. I would guess that, for similar reasons, there will be an influx of British tourists to Devon and Cornwall, since I note that holiday visitors will be allowed there from 4th July. And Italy has declared itself re-opened for tourism (although a large number of hotels have decided not to re-open). This morning, for the first time this year, there were a very large number of UK tourists shopping in our local supermarket. This really surprised me. I did not expect many UK visitors at all this year because of the uncertainty of travel restrictions, and, moreover, there is in theory a voluntary 14 day quarantine for UK visitors, which was evidently being completely ignored by this particular influx.
There will inevitably be a large surge in new infections in these untouched regions, since the local populations have no developed immunity, and hundreds (or even thousands) of infections will be imported to source outbreaks. These regions will go from being safe areas to being high-infection areas very quickly. Whether the surge in infections is matched by a surge in fatalities is however a function of how well the vulnerable are protected in those regions. At present, these three countries (France, UK, Italy) seem to be taking no special measures for the holiday season, and I find that fact very disturbing. At the very least, the authorities should be (a) temporarily re-establishing or reinforcing tight physical and policy barriers to infection entry into local care-homes during the holiday season, (b) actively discouraging the vulnerable from holiday-making for the present, (c) running hard-edged campaigns to warn the locally vulnerable to be extra vigilant in their own protection during this period of imported infection and (d) anticipating an increase in local hospitalisations.
This mass holiday mobilisation represents a positive opportunity for these and similar regions to develop herd immunity among the young and fit, making use of all of the lessons now available to safeguard the vulnerable. However, I predict that instead of health authorities using the opportunity to build resistance with few fatalities, we will see inadequate anticipation followed by a panic reaction as local infection statistics mount. I hope that I am wrong.
This manifesto linked on Judith’w twitter link is quite big news.
https://environmentalprogress.org/big-news/2020/6/29/on-behalf-of-environmentalists-i-apologize-for-the-climate-scare
https://medium.com/analyticaper/covid-19-what-the-data-tells-us-3a08e42ee36f
Is almost a month old but is a great analysis and debunks media malpractice and scare mongering.
voluntary change vs lockdown, continued:
https://reason.com/2020/06/30/did-covid-19-lockdowns-reach-back-in-time-to-affect-behavior-before-they-were-imposed/
I read that this morning Matt. It’s a good article. There is little evidence that lockdowns did much that voluntary actions didn’t do.
Same deal. What percentage of the warming did we cause? How many deaths do lockdowns prevent. One point of view is the control knob. Just turn the control knob. The control knob doesn’t work.
Interesting study from Sweden:
https://news.ki.se/immunity-to-covid-19-is-probably-higher-than-tests-have-shown
“T cells are a type of white blood cells that are specialised in recognising virus-infected cells, and are an essential part of the immune system,” says Marcus Buggert, assistant professor at the Center for Infectious Medicine, Karolinska Institutet, and one of the paper’s main authors. “Advanced analyses have now enabled us to map in detail the T-cell response during and after a COVID-19 infection. Our results indicate that roughly twice as many people have developed T-cell immunity compared with those who we can detect antibodies in.”
Yes, an excellent study. There are now a number of T-cell studies that indicate a substantial proportion of the population – far higher than that which shows positive on serological antibody tests – is immune to COVID-19, either wholly or partly (reduced susceptibility).
The early COVID-19 T-cell studies were one of the reasons why I felt confident publishing my article on May 10th about the herd immunity threshold probably being much lower than most supposed experts were – and still are – claiming.
What’s more interesting is that the herd immunity threshold varies within Sweden. Ex much lower threshold in Skåne than Stockholm (far fewer deaths pr million).
Why not run the same immunity threshold analysis with the Nordic neighbors? Different herd immunity thresholds there too?
Or how about this: New ICU admissions in Stockholm peaked in the first week of April. Does that imply herd immunity threshold was hit in mid March?
ehak
In all models, the herd immunity threshold is an increasing function of R0. And R0 is positively related to population density. So one would expect the HIT to be lower in Skåne county, where the population density is 120 /km2, than Stockholm county, where it is 360 / km2.
Also, the reason why the death rate is lower could perhaps be due to Malmo having done better at isolating care homes from infection than Stockholm did, and/or other specific local factors.
In all models? How does that compare to observations? Same observed R0 in Norway as Sweden at the beginning of the outbreak. Or do a comparison with Copenhagen/Sjælland. More dense population than Stockholm. Are we to believe all of Sweden has hit the threshold, but not Denmark, Finland, Norway?
You are simply denying that Sweden has taken measures to reduce the spread. For example they have had stronger advice and restrictions for the elderly than Norway. Or as you say “heavily restricted people’s movements and other basic freedoms was imposed”. In additions people there as elsewhere have acted and increased social distancing.
Do you believe Stockholm got to the threshold mid March?
HIT is lower in Skåne than Stockholm according to Lewis because of lower population densitiy Well. In Västra Götaland populatiion density is 60 /km2. Half of Skåne. If Lewis’s theory holds up that would mean even lower HIT and infection and death rate. Is that so? Nope. Skåne; 1,2mill pop. 252 deaths. Västra Götaland; 760 deaths 1,6 mill pop.
Lewis’ is just making up theories re herd immunity threshold. Desperation.
–snip–
“I think the range of R0 consistent with data for COVID-19 is larger than most people give credit to,” said Marc Lipsitch of Harvard University, who has been advising health officials in Massachusetts and abroad. He cited data indicating it could be more than twice as high in some urban settings as the overall U.S. average.
–snip–
https://www.quantamagazine.org/the-tricky-math-of-covid-19-herd-immunity-20200630/
The main point made in the article that you cite is that the herd immunity threshold for infections acquired in epidemic is lower, potenially much lower, than the ‘classical’ herd immunity threshold, which applies only where the population is homogeneous (or for randomised vaccination).
That is something which I pointed out here in a previous article: https://judithcurry.com/2020/05/10/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought/
If the serial interval is about 6.5 days, as assumed by the Imperial College modelers and various others, then R0 would have to be ~4 to explain the doubling time in the early days of epidemics in at least some countries. One would expect R0 to be higher then, as the epidemics typically started in capital cities or other densely populated areas. In other areas of a country R0 would be expected to be lower.
I meant a 6.5 day generation time. However, using a standard SEIR model with the sum of the exposed (latent) and infectious periods set at 6.5 days an R0 of under 3 would be adequate to explain early epidemic doubling times.
Thanks for ‘splaining what the “main point” is.
But I actually read it myself and I think there were a number of important points. One is that the HIT might be much lower than widely expected. Another is that there’s a lot of uncertainty.
Another is that its possible the HIT could vary by context specific factors, and so for that reason generalizing about HITs (as well as generalizing about other policy outcomes) from one context to another (especially cross-culturally) is quite problematic and should be done only with a careful control for confounding variables (something we don’t have enough evidence to do). That is a point that I’ve raised over and over in these threads and that as far as I can tell, you’ve failed to address.
And BTW, that’s why I excerpted that quote from Lipsitch – becsuse in it he references the variability across context.
Nick and Judith are saints for putting up with Joshua.
Nick for keeping his cool when responding and Judith for her extensive snipping in lieu of outright banning.
Reblogged this on HiFast News Feed.
Fascinating stuff. A good bit of passive aggressive, illogical stuff from people trying to sound erudite and logical. But all in all, more thoughtful exchange than not. Thanks Nic, and Thanks Judith Curry for hosting.
A reasonable take from the IMF – if brief and a month old.
https://www.imf.org/en/News/Articles/2020/06/01/na060120-sweden-will-covid-19-economics-be-different
Study co-author Hans-Gustaf Ljunggren told The Telegraph that if the study’s findings are replicated, they would apply to any country. London, for instance, might have about 30 percent immunity and New York above 40 percent. If so, some parts of the U.S. are much closer to herd immunity than population-wide antibody testing currently suggests.
https://reason.com/2020/07/01/covid-19-herd-immunity-is-much-closer-than-antibody-tests-suggest-say-2-new-studies/
It seems to me one needs the right immunity number. If it is higher, game over, grasping at straws. Next hoax please. Trump now an agent of China. Leaks forth coming.
Joshua | July 2, 2020 at 3:30 pm
“But maybe as penance, you could explain what my agenda is. I asked before and got no answer.”
–
Leading with the chin or Brer Rabbit?
I must have missed that question but happy to try.
In a good way.
–
This is helped immeasurably by the addition of AtomS to this thread.
–
There are two groups of bloggers on these subjects.
Both claim to be on the side of science and both selectively use said science to push agendas. Will get back to that.
On your “side” a fair list would include luminaries like.
Michael Mann, Bill McKibben, Tim Flannery , Al Gore, Hansen and Ramanathan. Mosher, Moyhu [update that chart, Nick, please] Gavin and Hilary Clinton.
AtomS, the Polar Bear scare men and Jim Hunt, ATTP’s commentators, and gentle Tamino.
Not to mention low lights, some of those are in the luminary list not rated by candle power
–
O’er the divide the Pielkes, Soon, Judith, the two UAH men, and a rag time bunch of politicians. WUWT and the auditor, Steve [one of the best], Nic Lewis, and a slight majority of the commentators here.
–
Apologies to the countless hundreds of important people brevity cut out.
–
A certain Dikranmarsupial, amongst others, gets very annoyed at people ascribing his ideas to him, the height of rudeness, blithely ignoring his own commandment. However, since you asked.
–
Whether it is Covid, Climate change, or saving the world, the subjects argued over can change but generally the commentators do not.
The agenda is basically Free will for good versus Forced will for good.
–
Both sides argue for using science rationally.
Only one side argues for forcing people to do what is needed to fix the problems they declare to have found.
–
The list of subjects is endless but the message is clear,
…X… is going to happen, [Scientific Facts].
… Bad things will happen…. [Predictions, always bad].
…Children [always children], Grandchildren, People, Wildlife, the Planet….
…will die, be exterminated, suffer horribly over the next
…. months, years decades centuries…
and if only you do what we say we can save not only you but
…Children, Grandchildren, People, Wildlife, the Planet….
Truly a sad side to be on..
–
Good agenda, I applaud you, but skeptics always kick the tires first.
Due diligence it is called.
and Trust is something that should never be given to politicians and priests, that is evidence based logic 101.
–
In your particular case Joshua, [sorry DM] I would say that you carry your convictions heavily and the only way to get your message across is to stir the pot on each of the messages.
Go for it, Dialogue is endless and ideas and truth can blossom in light and darkness along with their counterparts.
angech,
“The agenda is basically Free will for good versus Forced will for good.”
The smartest thing I have seen you write. It is always the question of forced behavior which divides most consistently. “Do as I say, or else” is not conducive to compromise, nor even to honest discussion. I also liked the rejection of trust toward politicians and priests; those with an agenda unrelated to the merits of an issue are usually unable to make honest reasoned arguments….. the agenda is always first.
“those with an agenda unrelated to the merits of an issue are usually unable to make honest reasoned arguments.”
–
honest arguments are what set Judith on the course she has taken.
honest arguments are what we would all like to see and respond to.
Both sides do have people who push their own agenda’s.
–
An inability to concede any point at all in case it is seen as a weakness.
A need to denigrate every possible point and any person who makes those points is a prima facie proof that one is defending or putting forward an unscientific and unacceptable thesis.
–
Sadly these point are known to and raised facilely at some other sites, treated glibly and then trashed and left in the gutter.
The horrible personal attacks on R.P jun, McIntyre, Spencer, Judith and others should be a flashing warning sign to anyone writing or reading them.
–
“Do as I say, or else” is not conducive to compromise, nor even to honest discussion”. Well said. Hope some ears are burning.
angech –
> There are two groups of bloggers on these subjects.
I’d say that only if you choose to view it as a binary construct. Also, the identification of groups is also subjective. You might see one pair of groups, e.g., “skeptics” vs. “realists.” Another might see another set of groups, i.e., people who are engaging in good faith vs. those who aren’t. Or another might see them as those who create subjective binary frames for evaluating the engagement versus those who see it as more of a complex continuum along a variety of vectors.
> Both claim to be on the side of science and both selectively use said science to push agendas. Will get back to that.
Well, yes, a lot of people do claim to have science on their side. And you could certainly fit that into your binary framework. We might see something similar with claims that “the media” is unfair to one side and favorable to another. Or we might see it with claims that one side rests on personal attacks, or “censorship,” etc.., while the other side doesn’t.
But what is more interesting to me, as opposed to the specific group labels applied and the specific attributes assigned to the groups, is that you can easily predict (in most cases) how those attributes will be assigned if you look at the label-assigner’s ideological orientation. These are general patterns that show up over and over – be it in the area of climate change or in association with the pandemic.
Now a convention al view is that values determine political orientation, which then determines which “side” people belong to, and which types of policies they prefer. I think there’s a lot of evidence of another dynamic in play (not to see that it’s necessarily 100% one or the other), whereby people gravitate towards an “identity” and then frame the values and positions as a way to maintain an identity integrity.
IMO, these “sides” often share far more values than they disagree on, but the specific positions they take on any number of controversies and even the expression of “values” is actually are mediated by identity. In other words, in basic terms, we all share the value of balancing and integrating freedom and equality, and we all share the value of balancing and integrating “government” playing an assistive and protective role of the citizenry without extending too far into the realm of dictating. But we also all share the tendency to polarize issues as if no such balance exists, and then assigning a positive value-orientation to “us” and demonizing “them” for being out of balance.
We can see this with policies to address the pandemic – where instead of recognizing the difficulty of developing and implementing policy, and recognizing that mistakes will inevitably be made and that there is no perfect solution and that policies will inevitably have variable effects depending on context, and that there are huge, huge uncertainties that in the very least will only be partially clarified over time, people would rather point fingers and fight for freedoms because they’re being victimized. Where one person sees governmental tyranny because of government mandates to wear masks, another person sees a collective body of elected representatives legislating to crate policies that are minimally invasive for the sake of maximizing benefit for as many people as possible.
And then when we look at another politicized issue right now, where on person sees government supporting law enforcement so as to create the maximum benefit to as many people as possible, another person sees a tyrannical government that is disproportionately influenced by the moneyed and privilege using military force to violently stifle freedom of speech so as to create a photo op so that a politician can cynically exploit religious ideals to create a politically expedient photo op.
In both cases, one side sees themselves as freedom fighters rallying for the “values” of the good of the common person against to fight against the tyranny of an oppressive ruling class. But depending on the issue the positioning shifts and the same “values” play out in a diametric fashion.
> On your “side” a fair list would include luminaries like.
Michael Mann, Bill McKibben, Tim Flannery , Al Gore, Hansen and Ramanathan. Mosher, Moyhu [update that chart, Nick, please] Gavin and Hilary Clinton.
In that list, you have many people whom I don’t identify as being on my “side” in an meaningful fashion. For example, Clinton is only on “my” side in comparison to someone like Trump – but even that is only in the most general terms as on very many specific issues it’s quite likely that Clinton is no more on my side than Trump is. And in comparison to many, many people – perhaps even a plurality of the public – Clinton is on my “other” side on a wide array of issues.
And then there’s the fact that you’re framing this whole matrix on a subset of subset – a group of outliers who are exceptionally “motivated” along a particular ideological/political/policy vector. You’re trying to generalize from an unrepresentative sampling.
> However, since you asked.
I asked you to describe the agenda that you ascribed to me. Thus far, you have certainly not described any agenda that I identify with. At best you have loosely assigned me membership in a group without really even defining that group, using a set of inclusion/exclusion criteria that are highly subjective and rather arbitrary, that only even marginally works when you’re examining the world through a highly focused microscope on a particular issue by orienting me according to a group of outliers.
> The agenda is basically Free will for good versus Forced will for good.
This is a false dichotomy, in my view. It doesn’t come close to describing any agenda that I have. And for all the reasons I discussed above, IMO, it is extremely subjective and ignores much evidence which breaks down this binary view of the world, and of people. It’s based on a subjective orientation on a tiny slice of the world.
Consider, for example, Haidt’s work, which shows that the “right,” in general, is more accommodating of authoritarianism than the left. Now I have problems with much of Haidt’s work; generally for the same reason I’ve criticized you above – because it doesn’t recognize (1) the variability in how people align themselves contingent on the political valance of the issue being examined and, (2) the matrix of “groups” is largely arbitrary, and (3), it doesn’t recognize that the difference across groups is tiny in comparison to the variability within “groups.”
> Both sides argue for using science rationally.
And both do so from an identity-oriented basis,
> Only one side argues for forcing people to do what is needed to fix the problems they declare to have found.
Not true, for the reasons I’ve elaborated on above. We can find many examples where your binary framework will fall down. The opposition of “freedom” vs. “forcing” here is subjective – by definition – and a big problem is that people confuse their subjective orientation in that regard as some kind of objective one. In a nutshell, that, to me, is the main issue – people confusing their opinions with fact. I could provide many examples if you want. But it would be better if you examine your own beliefs yourself.
> In your particular case Joshua, [sorry DM] I would say that you carry your convictions heavily and the only way to get your message across is to stir the pot on each of the messages.
What are my convictions, angech? And how do they differ from yours. I’m offering you a challenge to back up your confident assertion that you know. You have an assignment. And it is necessary that you describe my agenda in a way in which I agree it is my agenda. If you’d like, I’d be happy to accept the same challenge. But, I must insist, “you first.”
> Go for it, Dialogue is endless and ideas and truth can blossom in light and darkness along with their counterparts.
Bingo. I agree with that there.
Dear Joshua: I have been following these commentaries for some time, and I find I agree with yours repeatedly, and almost nobody else. I want to make a couple of suggestions: (1) Instead of monitoring deaths, the sum of deaths plus stays in ICU should be the figure of merit. I had cause to be on a ventilator two years ago, and I can vouchsafe that a couple of weeks on a ventilator is almost as bad as dying. (2) Also, it might make sense to subtract off cases and deaths in nursing homes from the totals. Nursing homes probably amplified earlier data in April and May, and the residual might show current trends more clearly (recent increases are amplified even more compared to April and May).
So, you would count yourself among the dead? Very smart. But if someone died in a nursing home, they aren’t really dead dead. Berry berry smart. You are in with the right crowd.
Donald –
> Dear Joshua: I have been following these commentaries for some time, and I find I agree with yours repeatedly, and almost nobody else. I want to make a couple of suggestions: (1) Instead of monitoring deaths, the sum of deaths plus stays in ICU should be the figure of merit. I had cause to be on a ventilator two years ago, and I can vouchsafe that a couple of weeks on a ventilator is almost as bad as dying. (2) Also, it might make sense to subtract off cases and deaths in nursing homes from the totals. Nursing homes probably amplified earlier data in April and May, and the residual might show current trends more clearly (recent increases are amplified even more compared to April and May).
Sorry to hear about your time on the ventilator. Glad you pulled through.
Yah, the data we seem to have is really a problem. There’s a massive amount of data being collected with no consolidation. Studies and treatments are conducted without any uniformity. So many missing variables. I’ve heard some medical researchers talking about this problem in addressing the pandemic. The sad thing is that it’s completely unnecessary. So much potential missed
I agree with both of your points. Just counting deaths misses a lot of very serious impact from the disease. Presumably, many multiples of those who have died will have very serious health implications from being ill from Covid, Seems to me that ICU admission with Covid even without death s enough to qualify as a serious enough event to be considered, when it happens on the scale of hundreds of thousands, to be an important public health concern. Not the least because the age profile of those with serious illness, it is my impression, is less skewed towards the very old than deaths would be.
And I have been wondering if the contrast in the growth in cases compared to the flat trend in deaths isn’t largely due to improvements in long term care facilities. (there could be other factors as well, such as just the simple fact of time lag, the increase in identifying mildly symptomatic or younger infected people, etc.).
I did see this earlier today – which is on point:
https://www.cnn.com/2020/07/02/opinions/steady-death-rate-covid-19-infections-spike-sepkowitz/index.html
Which suggest that currently the contrast in trends is due to reduction in the Northeast, but that will change as more older people are infected in the South and West. It also calls into question whether or not the case fatality rate among older people is decreasing.
Joshua,
You spent a lot of word salad there.
The basic principle is that individuals should be allowed self-determination and that the state should refrain from usurping the right to self-determination. The “state” is not some supreme entity. The state is us; we are the state, we compose it, and the state is most vital when its citizens are self-determining actors.
To take that right of self-determination away and to say that you must obey the state to “stay safe” is wrong. This is why Sweden is correct and the rest of the world is wrong. Sweden said, here’s the information, we’re giving you broad guidelines and even some restrictions, but the rest is up to you, use your best judgement.
I’m strongly opposed to the dictatorial powers of the state being used in a time of supposed emergency because at any time an “emergency” can be declared, and in fact we’ve set the precedent for recurring viral “emergencies” that supposedly require the heavy hand of government to “stay safe.” If the danger is really so great, then the people aren’t stupid. The reason young people in the US and in Sweden are out at the beaches is because they know that Covid-19 rarely harms them. Let’s put this into perspective: 0.05% of the US population has (maybe) died from Covid, and that means that 99.95% has not. As for those who are older, as I am, and might be more vulnerable, my advice is to grow a pair and get over how you think everything should stop so you can live a few more years, or else just stay home.
Don132 –
> The “state” is not some supreme entity. The state is us; we are the state, we compose it, and the state is most vital when its citizens are self-determining actors.
Right. That was part of my point. That you don’t like what the majority of society wants is unfortunate, but sometimes that’s the way the cookie crumbles. You already have disproportionate power. And you ate part of the state that is setting policy.
You can complain and you can try to change it. That’s entirely your right. But complaining that it’s tyranny is melodramatic and self-indulgent.
If you lived in Sweden, you’d be complaining even more about how unfair your plight is and how much you’re a victim, because there you’d actually not have disproportionate representation and power as you have here. Just because everything doesn’t go your way doesn’t make you a victim.
You live in a culture that in general expects that you have some measure of social responsibility. In return for that you have far more privilege than the vast majority of people alive today and the vast, vast majority of people who have ever lived. It’s a trade-off. Your privilege only exists because, in part of that expectation of social responsibility.
Most people assess the risk from COVID differently than you. Just because you think you should have even more disproportionate power than you already have, such that you should be able to dictate to others what they should be willing to accept as risk, doesn’t mean it’s going to happen. Just because you believe that you live in some sort of dictatorship because your assessment of the risk is a minority opinion (even though you have disproportionate power and representation), doesn’t make it so. Not getting everything you want doesn’t make you a victim of tyranny, even if it feels like it to you.
Joshua | July 3, 2020 at 11:01 am | Table tennis
“angech > There are two groups of bloggers on these subjects.
I’d say that only if you choose to view it as a binary construct.”
–
That is why I said it that way.
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“In other words, in basic terms, we all share the value of balancing and integrating freedom and equality,”
–
Clearly not true. The whole purpose of having an agenda is to intrude forcibly on other people’s freedom. Hence “‘people would rather …. fight for freedoms because they’re being victimized.”
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“Thus far, you have certainly not described any agenda that I identify with.”
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Yes, I have. The fact that you know it is there but do not wish to acknowledge it openly is your problem. A bit like James denying Jesus three times.
“Michael Mann, Bill McKibben, Tim Flannery , Al Gore, Hansen and Ramanathan. Mosher, Moyhu [update that chart, Nick, please] Gavin and Hilary Clinton.”
Response ? “In that list, you have many people whom I don’t identify as being on my “side” in an meaningful fashion”
–” a group of outliers ”
“You’re trying to generalize from an unrepresentative sampling.”
Yup, that’s three.
Well if you choose to disassociate yourself from them and the agenda feel free but he thread of the association and the added agenda is
Birds of a feather flock together.
You really are only as good as the company you keep and remember that line “And with that, the pig got up and walked away”
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“Consider, for example, Haidt’s work, which shows that the “right,” in general, is more accommodating of authoritarianism than the left.”
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Haidt was wrong.
Being accommodating of authoritarianism is a personal choice by each individual. You know that. It belittles you to choose to use a selective nasty quote and illustrates the point that when you have a losing argument or attitude the best defense seems to be to cherrypick and manipulate words and thoughts to attack the other side rather than sticking to the truth. Authoritarianism, which is part of the agenda you ascribe to, is equally bad whether from right , left centre up or down.
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“it would be better if you examine your own beliefs yourself”
What are my convictions, angech?
I asked you to describe the agenda that you ascribed to me. At best you have loosely assigned me membership in a group without really even defining that group,
–
Well you said, quote,
“In that list, you have many people whom I don’t identify as being on my “side” in an meaningful fashion”.
–
So to be clear you admit clearly to having a side that you are on.
You admit to there being a meaningful fashion to being on your side which means you have an agenda.
Your agenda, should you choose to accept it, is to make an improvement in the human condition by fighting views, in print , that you disagree with.
Your convictions are very conservative, you hate change and individualism.
You know that we need more authority to put things back to the way they were intended by making all the people in the world behave in the right manner. No matter the cost.
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“how do they differ from yours.”
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I am a skeptic and a contrarian. My first response to requests is no, then a questioned why?. Then I try to think think about it at my own, unforced pace.
Convictions? Life is a joy we have to go through and people appreciate kindness but not charity. Every thing we know can be turned on its head in an instant and often is.
Josh: “Just because you think you should have even more disproportionate power than you already have, such that you should be able to dictate to others what they should be willing to accept as risk, doesn’t mean it’s going to happen.”
I didn’t say that. I said that each individual can assess risk and take appropriate measures for themselves with minimal interference from the state as possible. The state can support those afraid to leave their homes– that’s appropriate. To force them to stay home is not.
The elevation of the state as the pre-eminent expression of an abstraction called “the people’s will” is what led to fascism on the right and Stalinism on the left.
Don132 –
You didn’t say that. But it is effectively what you are staying. The majority wants the government to play a protective role.
I don’t support our government’s military policies. I saying want so many taxes sketch on weapons we don’t need. I see it as government playing a bigger role than I feel is right. That doesn’t mean I snowflake out and claim I’m living in a dictatorship.
Look at Canada and their response to the pandemic. Do you see an oppressed citizenry?
Joshua,
Please don’t butcher my words or my position.
I’m not saying that everyone must go to restaurants and refuse to wear a facemask; I’m making no such proclamation. I’m saying it’s not anyone’s place to determine for individuals how they must respond to infectious diseases when individuals are perfectly capable of deciding for themselves how they want to respond. I’m 100% for the government to support individual decisions to “stay home, stay safe” through subsidies, for example, or food deliveries, etc. This is not the same as dictating business closures.
We were duped into “flattening the curve” but the projected surge never came in many places, leaving newly-built surge facilities largely empty and hospitals bleeding money for lack of patients.
What about Canada? They had lockdown. What’s your point?
angech –
I just read a story about Oregon state troopers in uniform saying that they weren’t going to wear masks in a store because they weren’t going to have their civil liberties infringed on by the Governor.
Think about it – they were in uniform, with guns and basically an explicit threat that they were going to enforce restrictions on people’s “freedoms” to do whatever they want at the threat of violence.
It made me think of the famous “Keep; the government out of my Medicare” pronouncement.
I think of close to 1/2 of the American public supporting a president who, on the one hand thinks there a “War on Christians” going on if people prefer to say “Happy Holidays” rather than “Merry Christmas.” Or who on the one hand thinks it’s “censorship” if a private sector business chooses to exercise controls over the use of its services but on the other tries to use state power to prevent his niece from publishing a book about her family.
People like to have a noble cause in life. They like to be freedom fighters, struggling in a noble cause against an tyrannical oppressor. It feels good. It gives a sense of greater purpose.
But unless you live in a cave somewhere, or in some society I don’t know about where there are no established behavior norms or form of government that at some level enforces those norms, you are being engaged in a struggle of balancing such life forces such as freedom and equality.
These struggles exist in a continuum across many vectors. People have a tendency to select those vectors and then elevate them in status. Sometimes this happens against a background of fundamental values – to varying extent. But almost always, also, it happens against a background (or perhaps foreground) of identity. So we have people who on one issue weigh in on the side of equality, and ostensibly accept a limiting pressure against “freedom.” And on another issue, those very same people weigh in on the side of “freedom” and ostensibly accept a limiting pressure against “equality.”
This is a condition of life.
But what make more fun is to glorify these rather mundane trade-offs, and turn them into a glorified struggle. Perhaps it’s a “realist” struggling for justice against oil companies on behalf of future generations. Or it could be a “skeptic” struggling against Lysenkoist environmentalists on behalf of the starving children who lack access to inexpensive energy.
But here’s the bottom line here. Your are arbitrarily chunking this broad condition of life across all contexts – the need to balance sometimes oppositional momentum such as freedom and equality – into a particular alignment *because it is an interest of yours, that you’re focused on, and heavily identified with in terms of your identity.* Yes, you like the identity of “skeptic” and “contrarian” within the context of climate change. It feels good for you to take on a noble struggle for a critical cause. But in any number of other areas you will see a more nuanced balance, or flat out accept an identity which puts you on the other side of the divide.
As will I.
You have decided to arbitrarily place me into a particular frame, where I am with a group of people on one side of some putative global balance between oppositional forces that play out in myriad was in myriad contexts.
It’s your right to do so, but your doing so only reinforced my point: You are reconstructing a complex world into a simplified model – because it serves your sense of identity to do so. All models are wrong, some are useful – for a variety of purposes.
Don132 –
> I’m saying it’s not anyone’s place to determine for individuals how they must respond to infectious diseases when individuals are perfectly capable of deciding for themselves how they want to respond.
Actually, you are. You are saying that it is your place to determine what the government’s response should be to the pandemic, despite that your views are in a distinct minority, and despite that you already have disproportionate power to influence our government’s behaviors, and despite that your risk and probability of risk are different than is the case for many other people for whom you wish to dictate the rules.
> I’m 100% for the government to support individual decisions to “stay home, stay safe” through subsidies, for example, or food deliveries, etc. This is not the same as dictating business closures.
You want to dictate that a representative government shouldn’t act in accordance with the views of a significant majority – because of how you evaluate the probabilities and the risks. In so doing, you want to dictate, at least indirectly but in some ways actually, directly, the level of exposure other people will have. Some people want to be free to live in a less risky environment than what you think is more appropriate.
But the irony here, once again, is that those with views similar to yours already have disproportionate power w/r/t how society balances the oppositional perspectives here. That’s part of life. Life ain’t perfect. In our society, certain people have disproportionate power. We can work to change that.
And it feels good, even if you are part of a group that has disproportionate power, to see yourself as fighting a noble cause against a tyrannical oppressor. But ti’s just a little ironic to me when people who have disproportionate power, and who live under a condition where they have greater agency than the vast majority of people who have ever lived, to claim that they are victims of an oppressive state.
I’m not minimizing that accepting limitations can be hard. I, myself, don’t like the limitations of my freedom such as when my tax dollars go for weapons that I think are a complete waste. I’m advocating that you see your legitimate changes and concerns in proper context. Sometimes that can be hard.
> What about Canada? They had lockdown. What’s your point?
My point is that they had nothing like the consequences that we’re experiencing and will likely have fewer restrictions going forward precisely because they more successfully implemented shelter in place policies, and did a better job of testing and tracing and isolating than we did. In the end, the issue of government-supported restrictions should be seen in a full context, over time, with consideration of the range of outcomes.
Joshua,
When the next authoritarian government gets installed under the guise of “keeping us safe,” it’ll be because of people like you.
What was Hitler’s Enabling Act called? Ah yes, it was “Law to Remedy the Distress of People and Reich.”
The point is not that this is what’s happening today (although yes, a good number of people believe that it is) the point is that it could happen if we allow our liberties to be taken away whenever the Imperial College, or anyone else, says “boo.” “Staying safe” could easily become a tool of authoritarian designs.
99.95% of us have not died from Covid-19. Is this really such a grave emergency that calls for dictatorial powers?
Don132 –
> When the next authoritarian government gets installed under the guise of “keeping us safe,” it’ll be because of people like you.
I might say the same about you. It’s easy to argue by ad absurdum. It’s easy to apply Godwin’s law in online discussions.
But I won’t do it. I don’t think it’s likely that your views will lead us to an authoritarian state. I think that you and I disagree about where we should locate, along a continuum, on certain issues. I think that we probably locate at different points long that continuum, either towards one end or the other, respectively on different issues.
In balance, there is some evidence that people more aligned with your view might more commonly align along the authoritarian end of the scale (see Haidt). I don’t think that evidence is likely to be explanatory more than an artifact of the collection of issues investigated. I don’t think that orientation along some grand scale of authoritarianism is likely determined by, or even in association with, political identity.
But you’re entitled to demonize me as an appeaser for authoritarianism. If it makes you feel better, and more noble, and as engaged in some vital struggle against oppression – go for it!
You can discuss as long as you want, however Covid-19 IS on exponential course in the USA since 15. of June with more then 90% certainty.
https://i.imgur.com/aiFqZh5.gif
If one tries to avoid 100.000 new positive tested cases/day on the 17th of July ( tau is about14 days) and many,many deaths there must be a lockdown at least in some states ( Flo, TX ect), if one likes it or not. This is NOT a blame game, this is the realtity! And no: the virus is NOT designed to attack the US, it attacks the whole world. Other countries had more success. Why?
Frank –
With respect to uncertainty, I will say the following:
We don’t as of yet know the degree to which deaths, ICU admissions, hospitalizations, serious illnesses, and strain in healthcare workers, will parallel the increases in identified cases – particularly given possible regional variances.
We don’t yet know the longer term implications, economic and health-wise, of a faster, more unconstrained spread versus a slower, more constrained spread.
In the condition of decision-making in the face of high damage function risk, and high uncertainty, I’d rather place my money on the relative merits of a slower, more constrained spread. And I wish that the policy development was less polarized and politicized.
There’s little to be gained here, imo, from appeals to authoritarianism.
Thanks, frank. We didn’t realize the trouble we are in. Been busy toppling statues and setting up little Marxist-anarchist ghettos. We will get right on this virus thing. Lock it down.
“We didn’t realize the trouble we are in.”
Seems a fair summary.
frankclimate: You can discuss as long as you want, however Covid-19 IS on exponential course in the USA since 15. of June with more then 90% certainty.
What’s being counted is the result of continued spread, at an unknown rate, and increased testing. CDC and the states are combining new cases (virus tests via RT-PCR) and old cases newly discovered (antibody tests). Deaths are occurring at a much lower rate, slower than exponential increase.
It’s harder to make the case that closing factories, restaurants, and beaches will protect the sick and elderly.
Josh,
Sorry, authoritarianism is the opposite of a society composed of free, self-determining individuals wherein the state supports, instead of undermines, self-determination. Think Sweden.
Godwin’s law is junk because it will reject any discussion of a descent into fascism/authoritarianism even as that fascism or authoritarianism takes root, perhaps largely unrecognized.
frank, “Cases” are surging but I’m not worried by that. It is also true that the average age of those cases has declined in Florida from 65 to 37 over the course of the epidemic. That means a much smaller percentage of those cases will require hospitalization. I heard today from a physician in the Texas area that the reason hospitals are more full than previously is not due to covid19 but to pent up demand caused by the lockdown. People defered elective and in some cases emergency care for strokes, heart problems, etc. Those people are now coming in for treatment.
If you look at the Wikipaeda page for the Swedish epidemic you will see that cases have surged in the last 3 weeks too, while new hospitalizations continue to decline and are now in single digits and deaths also continue to decline. Surging cases is in my view a phony statistic because its an strongly related to how extensive testing is.
Joshua, The problem with your long winded deeply ambiguous comments here is that they are virtually meaningless and give little clue about what you really think about any issue. It’s clear that you hate Trump and have bought into the media narrative about him.
It’s pretty clear that the main danger at the moment is the totalitarian left. Cancel culture is now rampant in corporate American with executives forced to resign for 30 year old editorials that are completely in the mainstream. There is violence in the streets and crime is surging in all the Blue cities where the police have been demoralized by leaders who don’t care about black lives that are being lost every day to shootings. Antifa and Black Lives Matter are Marxist organizations dedicated to violence and to an ideology of collective guilt for a fictitious version of history embodied by the fraudulent 1619 project. Even Andrew Sullivan has recently written with alarm about how dangerous these ideologies are to democracy.
Joshua,
“You have decided to arbitrarily place me into a particular frame,”
Actually I had no desire to place you anywhere,
And I did not do so arbitrarily.
I did so only because you requested me to do so.
Arbitrarily.
You are the one who asked
“What are my convictions, angech?”
While it seemed odd that you had forgotten them it would have been churlish of me not to help you out.
It may be that you do know your own convictions and agenda but that begs the question,
If you do know them why bother asking me for help?
Why not have the conviction to just spell them out as they are so important to you?
Show me the particular frame you claim to be in so I can be more accurate next time you ask for help.
Frank’s window on the U.S. is CNN.
He’s in the zero self-awareness frame, angech.
angech –
> Actually I had no desire to place you anywhere,
And I did not do so arbitrarily.
I did so only because you requested me to do so.
Arbitrarily.
+++++++++
There are different meanings of the term arbitrary.
I was using it in this sense:
–snip–
based on or determined by individual preference or convenience rather than by necessity or the intrinsic nature of something
–snip–
I asked you to put some flesh in the bone of this putative agenda that I have.
In response, you didn’t actually elaborate any agenda that I have, but instead you merely associated me with a group of people with whom I may have some views in common and many, many views not in common. And you have yet to actually elucidate any actual issues that I have in common with them. Instead you have hand-waved towards some supposed desire that I have to force some unspecified people to do some unspecified things – again, without elaboration.
My point is that there is a vast array of issues that can be overlayed on some theoretical matrix of freedom versus unfreedom – but from that vast array you have decided to isolate only in vector, and place me with my “agenda” at a certain place on the spectrum of possible places, along with a group of people with whom I only have some marginal agreement on a specific set of issues. It is an arbitrary choice because you have done so to bolster an asserted agenda that I have without actually elaborating in what that agenda is.
Apparently, you think that associating me with a certain group of people (whom you don’t even know) in such a way as to fit your pre-conceived taxonomy suffices for describing my “agenda.”
But yah, that doesn’t work for me. What I’ve asked you to do is actually describe an actual agenda – one which I agree is one which I have.
Now you may feel justified in ascribing to me an agenda which I say I don’t have. You might decide you can do so because I’m a liar. Or maybe you think it’s justified because I’m in denial. Or maybe you think it’s justified to do so because you’re just much smarter and more insightful and wise than I am. I don’t doubt that you are
But again, nonetheless, I will offer that if you can actually describe an actual agenda thet you think that I have, I will be happy to vet your opinion, and then describe which agendas I think you might have so as to check my opinion with the due diligence that real skepticism requires.
Remember, angech, you are the easiest person for you to fool.
Frank –
Here’s one perspective.
https://twitter.com/mbeckett/status/1278750652160634880?s=20
I’m not convinced he’s right. I sure hope he’s wrong. Given the onset of the surge in cases, I think he may be wrong, but he may be right.
I’d be curious as to your thoughts.
dpy
“It’s pretty clear that the main danger at the moment is the totalitarian left…” (etc etc etc)
It’s very good of you to be absolutely transparent once more that you have no political motivations whatever dpy.
Thank you so much.
Another idea:
https://twitter.com/MLevitt_NP2013/status/1279447153367289856?s=20
Not sure how that lines up with #’s of hospitalizations and ICU admissions.
Frank –
> Don Monfort | July 4, 2020 at 1:56 pm |
Frank’s window on the U.S. is CNN.
Keep in mind that Don predicted @ 6,000 deaths in the US.
Which, bad a prediction as it was, is significantly closer than Trump’s belief that cases (let alone deaths) was going to top out at 15.
At any rate – no matter what your “window” is – its guaranteed it’s closer to reality than Don’s.
J:
You are a Marxist. Through and through and through. Not really, but it might help if you were defined.
I want all daycares and schools open and they get to make their own rules no matter how lax. Do you agree? Do you trust them to do so? I do.
You can define yourself.
I am going to have to help the little AOC acolyte, again. Predictions are not reality, silly. Get your spray cans and graffiti something in your hood. We have had enough of it here.
Don –
> Predictions are not reality,
Ah, OK. So when you made your prediction of 6,000 deaths, you weren’t actually basing it in any actual (and obviously VERY wrong) information. It was just a wild guess.
Thanks for clarifying.
Ragnaar –
> I want all daycares and schools open and they get to make their own rules no matter how lax. Do you agree? Do you trust them to do so? I do.
That’s a tough one. I have a vested interest – got an adorable 3-year old that spends a lot of days and nights with us. It’s fun, but exhausting. It would be great if she could go back to daycare. She was going to a great one before COVID. On a farm with a woman who’s been running a very small daycare for decades. This woman decided, to some extent due to regulations post-COVID, to limit her group to two kids. Even with the five kids as it was before, all the regulations were a burden for her. Our little munchkin is out of the running for a spot because she comes in last in seniority.
We weren’t sure when we’d want her to head back anyway. It’s a really tough issue, and there is an extended family pod that includes people at significant risk.
But we’re lucky and can afford to choose from really good daycare options. As such regulations are kind of superfluous for us. For people who have less financial wherewithal, I think that regulating daycare is pretty important – even that much more so in the time of COVID. How do you have regulation for some but not for others?
So basically, as an adult, I accept sometimes choices that are less sub-optimal. I stopped whining about what’s not perfect in middle school – and as I grew older I also learned to not limit myself to binary thinking. Just because something has downsides, doesn’t mean that it isn’t better than the alternatives, at least some of the time. Everything, including regulations, have unintended consequences. That would include unregulated daycare.
I’ve traveled a lot in places where there were little to no regulations. For all the inconvenience and counterproductiveness of an overly regulated society, I’d rather live in one than one that is under-regulated. That’s not to justify over-regulation. Over-regulation is bad. Regulations should be carefully calibrated.
Yah. It’s complicated.
I guess that to many leftists or Marxists every statement of history or fact is political. That’s a twisted view of the world, but some hold it for a lifetime. Does anyone here want to try to claim that ANTIFA is “mostly peaceful?”
Josh, You are employing cheap attacks against Don. Everyone who makes predictions is going to be wrong sometimes. That’s means nothing. Usually, these predictions are of the form, if IFR is X and Y million are infected, there will be Z fatalities.
Don is right about CNN. Most of the country recognizes that they are untrustworthy and often peddle fake news from single anonymous sources to try to further their political narrative.
We can always count on our little left loon crusader to reply with some dumb irrelevant BS.
dpy
“I guess that to many leftists or Marxists every statement of history or fact is political. That’s a twisted view of the world, but some hold it for a lifetime. ”
Immediately followed by
“You are employing cheap attacks against Don”
I mean, I know you’re normally good dpy, but this material is red hot. Have you considered stand up?
“For people who have less financial wherewithal, I think that regulating daycare is pretty important – even that much more so in the time of COVID.”
In the situations where the poor have the least choices, we regulate that. Rich people don’t need regulations. The minimum wage for instance.
I said something like, for day cares, deal with this any way you want. You said, some amount of regulation, but I don’t know what they means. If you win, we get some stuff, but we are not sure what, let’s ask some experts or bureaucrats.
If I win, we get people doing what they think they should do without worrying about the government. This isn’t quite true. They still have to worry about plaintiffs attorneys. Said problem could be fixed by dragging governments back into it. Or by funding poor day cares with voluntary defense funds. Which would be a libertarian idea, so I say.
Which is another thing. What Republican Party? Still hiding in their, ‘Don’t Cancel Me Please’ shelters. Black lives matter.
> If I win, we get people doing what they think they should do without worrying about the government.
This isn’t some philosophical battle between black hats and white hates, regulation vs. no regulation.
It’s a balance between what to regulate and how much.
Ragnaar;
You are truly a man of compassion and righteous virtue.
Give me some of that old time religion.
PRAYER TO MAMMON. (Dec. 31, 1899)
God of the diamond mine.
God of the golden hand, Let thy sparkling glances shine On thy faithful robber hand !
Help us to kill the weak. Help us to rob the poor, Sharpen thy claws and beak, Make assurance doubly sure!
Let the peasant’s life-blood flow And the raffle be chained at his tasks
Let the pirate empire grow ;
All this, and yet more, we ask! While we silently watch and prey let others flight and bleed ;
While the maxims blaze away grant a riot of lust and greed !
Madden the mob with lies and quicken thy Yellow Press ;
Make the price of Stock rise and the voice of conscience less !
Abundantly bless and prosper the small arms trade,
Let all the wide world know the way that an Empire’s made!
What matter if honor frowns or the widow mourns in the slum ?
We adore the those golden cow for Great Mammon, thy kingdom come !
verytrollguy never adds anything substantive to a discussion. Always with the drive-by snide irrelevant BS. Pathetic.
J:
It is a battle. Between you and the government. You say it’s not binary. But then you don’t say what it is you are. What is some regulation? The position of some regulation is not having a position. To judge an act, one has to say what that act is.
I said let people figure it out for themselves. Some undefined regulation isn’t a counter point. I can be wrong. ‘Some regulation’ is wrong because it is undefined. It’s a surrender.
jacksmith4tx
You can do it. You can thrive with liberty. It is your right. But it helps if you want it.
————————-
Civilization is the progress of a society towards privacy. The savage’s whole existence is public, ruled by the laws of his tribe. Civilization is the process of setting man free from men.
————————–
You’ll be fine.
Ragnaar –
> The position of some regulation is not having a position. To judge an act, one has to say what that act is.
I’m rejecting the instinct to assign labels and group people for the purpose of finger-pointing and playing identity-protective and identity-defensive games that are a distraction created by a drive towards tribalism. It might feel good. You get to demonize others and agree among your friends how great you all are, but it actually gets you nowhere except mutual a mutual back-scratching party.
I say that you judge in context, with an understanding that there a continuum and a need for balance.
My “position” is to judge in context from a place of balance.
> I said let people figure it out for themselves.
OK then – just hand out clubs and let the better clubber win.
And so you want no regulations – no police, no public health policy, no legal protections, no government theft from taxes, etc. Sounds like Somalia might be right up your ally?
> Some undefined regulation isn’t a counter point.
Give me a context and I’ll describe a range of regulation. The details get worked out and adjusted this way or thst over time.
> I can be wrong. ‘Some regulation’ is wrong because it is undefined. It’s a surrender.
I think that ” no regulation” is a surrender – because its an escape to never-never land. It’s flying off to binary world, where it’s either regulation of no regulation. A planet that doesn’t exist in the real world. It’s capitulation to the messy world and seeking out some Shangri-la that will never exist. It’s an idealist fantasy in a world where you never have to compromise and can pretend that fantasies exist. I suppose Somalia might be close – but I doubt that’s what you’re actually looking for.
Ragnaar, Belated holiday greeting.
Your declaration of “Civilization is the progress of a society towards privacy.” seems paradoxical and in opposition to the reality of how much of our lives and personal data is being collected by our government, private industry and criminal hackers. Welcome to the Technium.
You being a tradesman in the odious task of tax accounting I think you might find this an enlightening discussion with State University of New York economics professor Stephanie Kelton about modern economic theories and whether they hold up today.
https://www.c-span.org/video/?473167-1/the-deficit-myth-the-price-peace
With global debt well north of $250t not counting COVID-19 spending, declining credit worthiness and a impossible amount to pay off with existing monetary policies could MMT be the answer?
We’ve driven into the ditch. The issue is daycare and regulating for the Covid. I said none. That’s not people people hitting each other with clubs. I don’t think you said anything more than some undefined regulation. Why you think people pick up clubs for no good reason is beyond me.
I can be wrong about regulating daycare. But you are wrong upfront by not saying what regulations you’d have. You even half way went to saying parents should decide by personalizing it. I can’t imagine you’re arguing against your own kid in favor of the state.
I can be wrong about whatever my version of libertarianism is, but you likewise don’t know what that is. And I don’t want to get into it other than to say, some middle age person who wants to do daycare in their town can work it out with some other people who want to use it.
How you get to anarchy from Covid regulations has got to be a weak chain. When you take away government, we have J and Ragnaar.
In the clarity department. My position should be clear. Let’s do better than, Anarchy is Bad.
Ragnaar –
This is getting absurd. Last comment in daycare.
I’m certainly no expert. If it were up to me to determine daycare regulations, I would familiarize myself with the context so I could decide. Off the top of my non-expert head…
I’d want to make sure that they don’t hire ped*files or other criminals.
I’d want to make sure they have at least a minimal representation of trained staff – enough to hopefully ensure a minimal standard in some resoeces like basic knowledge of child development.
I’d want to make sure they meet basic safety and health requirements.
I’d want to make sure there are some minimal standards for adult to child ratios.
I’d want to make sure they don’t hit the kids or abuse them on some other way
I’d want to make sure ths they have basic plans for age appropriate activities – for example that rhe kids will be getting some exercise and that they’re not getting it from running heavy equipment.
Again, my lint is thst there is no doubt that you, also, beliece on some regulations. We prolly differ in where they’re needed and how much are needed. That’s fine. We can work it out of you aren’t a stone cold ideologue.
I explained how I lost out because of regulation. If I knew the details, I might even say because of over-regulation. A very good daycare provider that took care of someone I love stopped being able to provide a service for us ar least in part because she eventually found the regulations too onerous (in particular in the time of covid).
Yah. I don’t like that. I want to get everything I want. But you know, life just doesn’t work out that way sometimes. I’ll get over it.
J:
And I want to end war and world poverty.
I didn’t argue to repeal existing regulations. But to let the daycares make their own decisions about the Covid and being open.
I heard someone argue against a Mott and Bailey the other day. https://www.quora.com/What-is-the-Motte-and-Bailey-doctrine
Libertarianism is bad. Not the subject.
jacksmith4tx:
Our Government issued a lot of debt. I decided to buy some bond funds the include that debt. You all are paying that interest to me. You all better pay up.
“Civilization is the progress of a society towards privacy.”
Communism collapsed pretty much everywhere in the space of a decade. Mostly because everyone figured out there is no such thing as socialism or communism, there is only capitalism with variation in the size of the black market- large in socialist countries, small in free market.
Any government that wants some control over the economy, ironically has to free its markets to bring commerce out of the black market.
There are still a few holdouts who don’t get it- like the fans of MMT who think that if they simply destroy money everything will be great. And it will- for people who have something to barter with.
Ragnaar;
I’m on SS now so I’m collecting money based on my paid in contribution plus the bonds+interest that the treasury holds in it’s name.
I haven’t looked at my Lockheed pension portfolio recently but they used to hold a good percentage of government debt.
I have been doing quite well with my rental property too. Taxable property value up 200% in 7 years and I only raised the rent 25% over that time frame.
As an accountant how do you record the value of tax avoidance? Say you applied a 50% tax on a income stream or the value of a real asset and then you legally deducted 20% of the value of the asset/income giving you a cheaper tax rate/base. Should that surplus (tax – deduction=surplus) be added back to the value of the asset or increase the net worth of the person getting the income stream? This is at the heart of MMT.
angech –
Response went to moderation automatically. I assumed as much and saved it. It may appear. If not, I’ll break it into parts and re-post to find what which words so offended the capricious gods of blog comments.
I will help you. The moderation gods can’t take that much attention seeking blabbering, in one dose.
Hi don
Did you see this report in the uk daily mail that trumps vaccine does work in certain types of situations? Scroll to foot of page
https://www.dailymail.co.uk/health/article-8487315/50-fewer-COVID-19-patients-died-treated-hydroxychloroquine.html
Tonyb
I just posted link to the journal article and it disappeared. Will try again:
https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
Results
Of 2,541 patients, with a median total hospitalization time of 6 days (IQR: 4-10 days), median age was 64 years (IQR:53-76 years), 51% male, 56% African American, with median time to follow-up of 28.5 days (IQR:3-53). Overall in-hospital mortality was 18.1% (95% CI:16.6%-19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%-31.0%]). Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes. From Cox regression modeling, predictors of mortality were age>65 years (HR:2.6 [95% CI:1.9-3.3]), white race (HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001).
This very likely explains the difference between treatment wih HCQ alone and + AZ:
"The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors."
Always helps when smart people ‘splain things to me, Don. Thanks.
I just tried twice to post a link to the journal publication and both disappeared. It’s in the International Journal of infectious diseases. Title:
Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19
The difference in the outcome of treatments with HCQ vs, HCQ + AZ is very likely due to:
“The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors.”
Also of interest:
“Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001)."
Henry Ford Hosp. also has another study underway that is prospective with 3000 subjects:
https://www.henryford.com/whip-covid-19
The “Will Hydroxychloroquine Impede or Prevent COVID-19,” or WHIP COVID-19, study is a 3,000-subject look at whether hydroxychloroquine prevents front-line workers from contracting the COVID-19 virus. This is a randomized, double-blinded study designed to produce a scientific answer to the question: Does it work? Henry Ford Health System, as one of the region’s major academic medical centers with more than $100 million in annual research funding, is also involved in numerous COVID-19 trials with partners around the world.
Yeah…the findings are.interesting.
So HCQ really works great by itself. HCQ plus azithromycin, well, not nearly as good. Azithromycin by itself…not as good as that. Adding azithromycin has a detrimental effect when paired with HCQ, (reducing the efficacy of HCQ), but a beneficial effect compared to usual care if administered by itself. Very interesting.
Can someone explain the mechanics of how all that takes place?
You don’t have a clue.
“Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001)."
> The difference in the outcome of treatments with HCQ vs, HCQ + AZ is very likely due to:
“The combination of hydroxychloroquine + azithromycin was reserved for selected patients with severe COVID-19 and with minimal cardiac risk factors.”
Ah, that helps to ‘splain it. So they selected which patients to give which treatmentst o, and then they evaluated the results.
Interesting methodology.
–snip–
“Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group.
–snip–
Yah. That’s interesting also. I wonder if the steroid treatment might have been a confounding variable? Might be worth more investigation. But in the meantime let’s just start handing out the HCQ,
Because…hazard ratio.
Interesting stuff on HCQ but why haven’t they picked up on the zinc part, since we know that zinc will prevent viral replication and HCQ is an ionophore for zinc? Zinc is harmless, is often depleted in the sick and the elderly, and is essential for immune function. We have studies that prove all the above points.
Aside from that, I think the studies that are looking for whether HCQ will prevent Covid infection are missing the point. Who cares if it does? The real question is, can HCQ (with zinc please?) halt viral replication to the extent of preventing hospitalization, or to the extent that cases are largely asymptomatic even if the virus is present? Asking HCQ to stop the virus completely, even with zinc, is asking too much. The essential function of the HCQ/zinc/azithromycin protocol, as I understand it, is not to kill every last viral particle, but to halt viral replication enough so that the body can mount its own defenses before being overwhelmed, much as the immune systems of young children seem to do with no problem whatsoever. It might be beneficial to society to test this instead of wondering whether or not HCQ by itself can kill every last viral particle and elicit a negative test.
Josh,
I haven’t actually looked at the study but I think we can safety assume that the only variables were HCQ and azithromycin. That’s usually how these things work. Everyone getting the same dose of steroid wouldn’t be a confounder. People getting different doses of steroid would be, but then it wouldn’t be a study testing HCQ and azithromycin, would it? It would be a study testing these as well as different doses of steroid.
“Ah, that helps to ‘splain it. So they selected which patients to give which treatmentst o, and then they evaluated the results.”
It was a retrospective study. Google it.
You should be out with your brave comrades toppling statues and blocking Flatbush Ave.
Read the study, Mr. 132. It was retrospective. There a lot of variables. This study is not definitive. We are still waiting for that.
don132
> Everyone getting the same dose of steroid wouldn’t be a confounder.
So you have evidence that the following isn’t true?:
–snip–
Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group.
–snip–
Don –
> It was a retrospective study. Google it.
They decided which therapeutics to use based on patient presentation. Google it.
In other words, they decided how to treat the patients and then studied the outcomes (retrospectively).
Don –
Shouldn’t you be out leading a squad cheering for old people to die in NY nursing homes?
“They decided which therapeutics to use based on patient presentation. Google it.”
“They” were not following a study protocol, when “they” made treatment decisions. “They” were not involved in the study. The study was done post hoc by a different “they”, silly. You still don’t know the difference between a prospective and retrospective study. Pathetic. AOC would be proud of you, if she knew of your existence.
The Henry Ford Hosp. trial for PEP is a thousand times better than the University of Minnesota home brew DIY trial that got a lot of attention, because TDS:
https://clinicaltrials.gov/ct2/show/NCT04341441
This trial actually involves seeing the subjects, to complete face-to-face questionnaires, taking blood, baseline and follow up diagnostic testing, real clinical stuff.
I’ve skimmed through the study that Don Monfort linked to, and I see no mention of a difference in steroid treatment. https://www.sciencedirect.com/science/article/pii/S1201971220305348 In fact, I see no mention of steroids. I may be looking at the wrong study, or I may have skimmed too quickly,
It doesn’t matter if it’s a retrospective study. If you treat the same except for the two variables (HCQ and AZ) in the patient group you’re examining, then what you’re looking at are the two variables. If steroid use varies among those patients, then yes, that’s a confounder, I agree. If steroid use varied but not among the group of patients you’re examining, then that’s not a confounder.
I’m OK if I’m wrong. Just show me how I’m wrong.
Don132 –
Different write-ups have different info. Seems reasonable to wait to try to draw any conclusions. That said, I’m sure you think that CNN is a reliable course, (heh) and they had the following:
> Researchers not involved with the study were critical. They noted that the Henry Ford team did not randomly treat patients but selected them for various treatments based on certain criteria.
“As the Henry Ford Health System became more experienced in treating patients with COVID-19, survival may have improved, regardless of the use of specific therapies,” Dr. Todd Lee of the Royal Victoria Hospital in Montreal, Canada, and colleagues wrote in a commentary in the same journal.
And they also had:
> “Finally, concomitant steroid use in patients receiving hydroxychloroquine was more than double the non-treated group. This is relevant considering the recent RECOVERY trial that showed a mortality benefit with dexamethasone.” The steroid dexamethasone can reduce inflammation in seriously ill patients.
Now I have no particular reason to think that any of that is true if there’s direct evidence in contradiction, but I didn’t see any. It seems unlikely to me that the journal that published the Ford article would publish a commentary on the paper that states flat out inaccurate information.
So over time, these patients on HCQ were beneficiaries of more individualized treatment. There’s no way that the the practitioners held back on treatments that they thought might be useful for one patient in comparison to another based on a differential diagnosis for the sake of the study. Do we know if the only variables that changed were the administration of HCQ and azithromycin? Do we know the clinical presentation by which practitioners decided to administer those two medications as opposed to not administering them? I don’t know. And I certainly don’t know if its true that the patients on the HCQ protocol were or weren’t more likely to get steroids (or more steroids).
I hope the significant reduction in mortality plays out. It could be a game-changer. I see no alternative but to wait to see what more research says. This study is hopeful, but there doesn’t seem to be. lot to hang your hat on there. If as you say, the only variable that changed was the existence of the HCQ protocol, yes – that would be something to hang your hat on – whether it is a retrospective study or not. But given that it was a retrospective study – that seems unlikely to me.
Joshua,
It’d be extremely helpful if, when you give a quote, you reference the source. For example, I believe I’m actually looking at the study and it’s here: https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
And no, I do not watch or read CNN.
I find nothing at all about steroids in the paper. However, if I take the time and search further, I find a “Table 1”, and in that table I do indeed find a difference in steroid use, so you’re right. https://www.ijidonline.com/action/showFullTableHTML?isHtml=true&tableId=tbl0005&pii=S1201-9712%2820%2930534-8
Notice how I give a reference for my findings.
In my opinion, in the body of the paper they should have included the difference in steroid use under the paragraph on “limitations.” It’s not a good study. I’m generally in favor of HCQ, but to be honest this study does nothing to convince me.
Mr. 132,
“It doesn’t matter if it’s a retrospective study.”
It does matter. Google “prospective vs. retrospective clinical study”.
Your skimming is not helping you understand what’s going on. See:
Table 1. Patient Characteristics by Treatment Group
Given Steroid, n (%) 1733 (68.2) 146 (35.7) 948 (78.9)* 57 (38.8) 582 (74.3) <0.001 ***
*The HCQ alone patient group received steroid treatment = 78.9%.
Looks like my comment got lost in moderation.
In Table 1, I found that groups weren’t closely matched for treatment except for variables tested, and that steriod use varied significantly in the groups. So no, this isn’t a good study.
This type of information should have been put in the body of the paper under “limitations.”
https://www.ijidonline.com/action/showFullTableHTML?isHtml=true&tableId=tbl0005&pii=S1201-9712%2820%2930534-8
Don132 –
> This type of information should have been put in the body of the paper under “limitations.”
On this we are in complete agreement. I wish more people spent more time taking “limitations” sections more seriously.
DonMonfort: https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
Thank you for the link. I posted up a link to a Detroit newspaper. Best chart review so far, imo, but still a chart review.
Nic,
I was thinking about death rates in Covid and the many different ways they are expressed and exploited.
Due to a multitude of factors including spread, community sensitivity and time of year we can never get a true comparator of yearly deaths per head of population of viral illnesses.
When Australia had 1 case and he subsequently died, this gave a projected death rate of 100%.
On the other hand if the first person in Wuhan to be exposed lived the survival rate would be 100%.
When Wuhan hit the new the death rate was horrific because they were only counting the clinically very ill people with pneumonia pre testing and the rate might have been as high as 15%
In Australia for that first cohort of cases of comparable size, 7000 cases only 100 have died so 1 in 70 or 1.4% , Ten times less but also from a wider population base including known none sick people.
As the disease is better identified it seems capable of spreading 10 times more than is recognised [CDC USA] without that being reflected in the registered cases hence another x10 lowering of the death rate for those presume to be infected.
Using Australia as an example, number wise, though not clinically true yet we could say 0.14%.
Finally if the true population ability to be infected in a year was as high as 10%, the percentage at risk of death is only 0.014% at worst.
If Sweden has crunched a years worth of statistics into 4 months the outlook might be much better for them in a year and certainly going onwards over years will be better than what their neighbours can expect over time.
More hope for HCQ:
https://www.detroitnews.com/story/news/local/michigan/2020/07/02/michigan-henry-ford-health-study-finds-hydroxychloroquine-lowers-covid-19-death-rate/5365090002/
Another chart review. Contra official Michigan policy.
Yeah – it is hopeful. But this is confusing to me about the article – I’m hoping someone can explain:
Later in the article it says:
> The study found about 20% of patients treated with a combination of hydroxychloroquine and azithromycin died and 22% who were treated with azithromycin alone compared with the 26% of patients who died after not being treated with either medication.
But earlier in the article, they say:
> The study analyzed 2,541 patients hospitalized among the system’s six hospitals between March 10 and May 2 and found 13% of those treated with hydroxychloroquine died while 26% of those who did not receive the drug died.
So a 13% difference in one description and a 6% difference in the other.
Is the 13% number with HCQ alone? Are they saying that the mortality rate with HCQ alone was 13%, with HCQ and azithromycin 20%, and azithromycin alone 22%. Which would mean adding the azithromycin lowered the efficacy? Can’t be, right? And would it mean that there is only a 2% difference between HCQ + azithromycin and azithromycin alone? That can’t be either, right?
I must be missing something obvious. It happens when you’re not very bright. Someone please explain..
Did they control for treating with steroids?
Is the 13% number with HCQ alone? No
–
This is those who had chloroquine as one of the treating agents during their stay
–
26% of people , just over one in 4, not using chloroquine died
Using chloroquine with any other treatment led to a halving if the death rate.
Massive result.
–
Are they saying that the mortality rate with HCQ alone was 13%, No
–
They are saying that with the best treatment available, including steroids, ventilators, antibiotics, physio that the addition of HCQ halved the death rate compared to those who did not use it.
with HCQ and azithromycin 20%, Yes
and azithromycin alone 22%. Yes
Which would mean adding the azithromycin lowered the efficacy? No
–
Azithromycin helps marginally
Both help marginally.
The combination reduces the effectiveness of the HCQ alone.
–
Easy to postulate multiple reasons for this, have a try.
–
Can’t be, right? Yes it can.
–
And would it mean that there is only a 2% difference between HCQ + azithromycin and azithromycin alone? That can’t be either, right? Yes
–
See above, combinations of drugs do Not have to work additively
angech
> They are saying that with the best treatment available, including steroids, ventilators, antibiotics, physio that the addition of HCQ halved the death rate compared to those who did not use it.
Yah. That’s what they are saying. But is it a legitimate claim given that, for example, those receiving HCQ had double the treatment with steroids? Despite that treatment conditions varied across the HCQ usage?
> Are they saying that the mortality rate with HCQ alone was 13%, No
“HCQ alone” meaning not in conjunction with azithromycin. In which case, actually the answer is “yes.”
My question has been answered in the affirmative – no thanks to you!
> The combination reduces the effectiveness of the HCQ alone.
Which was my point. Please explain what mechanism would explain why azithromycin would be marginally effective when given without HCQ, but then rather significantly reduce the effectiveness of HCQ when they are administered together. (Btw, it is interesting that this seems to be in contrast to much of the claims about the use of those two treatments together).
I like it when people don’t just look at associations and assume causality, but instead look at associations and provide plausible mechanisms for causality.
Go for it.
angech | July 3, 2020 at 7:53 pm |
Thanks for the post.
Matthew R Marler
Thank you for the link to the Henry Ford trial.
In reading this, I came across a reference to the Recovery trial in the UK (the “Oxford study”) that was testing HCQ and found no benefit. Now, that’s interesting, I thought, because I’d just read a piece that stated that the Recovery trial was using a lethal dose of HCQ. https://ahrp.org/covid-19-has-turned-public-health-into-a-lethal-patient-killing-experimental-endeavor/ Investigating further, I followed the links in that piece to the Recovery trail protocol but the links were dead, and nowhere could I find any information on the HCQ dosage of that protocol to verify for myself. However, I did find some reference to the dosages on Twitter, #Recoverygate; apparently others had noticed the dosage.
In short, a lethal dose of chloroquine has been determined to be in the neighborhood of 1.5 grams, yet the Recovery (“Oxford”) trail was starting sick patients with a dose of 2.4 grams in the first 24 hours, for a cumulative dose of 9.2 grams over 10 days. The only confirmation of this protocol that I’ve been able to find is a Belgian document that asserts that the Recovery trial used 9.6 grams over 10 days (don’t know why this differs from the 9.2 grams on the AHRP website.) https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_InterimGuidelines_Treatment_ENG.pdf (see page 6, above the yellow highlight.) It appears that the information on the HCQ arm has been removed from the Recovery trial website.
Zinc is continually left out of these trials yet we know that zinc will kill “coronavirus” (as a general term, not specifically Covid-19.) https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176
Don132 | July 3, 2020 at 1:56 pm |
Thank you for the response.
Don “In short, a lethal dose of chloroquine has been determined to be in the neighborhood of 1.5 grams, yet the Recovery (“Oxford”) trail was starting sick patients with a dose of 2.4 grams in the first 24 hours, for a cumulative dose of 9.2 grams over 10 days. “
–
I think this comment is wrong and dangerous and needs quoted proof Don132.
It is needlessly misleading about a very safe and extremely widely used drug.
It may well be true that the Recovery trial used too high a dosage:
http://www.francesoir.fr/politique-monde/recovery-trial-brexit-and-overdose
But I suspect the HCQ didn’t kill anybody, it was the NHS what done it. If they typically lose 23-25% of their COVID 19 patients, they got some serious issues.
angech,
Sorry if my reference wasn’t clear.
The original reference was to https://ahrp.org/covid-19-has-turned-public-health-into-a-lethal-patient-killing-experimental-endeavor/ where I found the information on the dosing of the REMAP, Solidarity, and Recovery trials, as well as further links.
The specific information on chloroquine dosing can be found on page 5 of this document, “Review of Side Effects and Toxicity of Chloroquine,” which states that a single dose of 1.5-2.0 grams of chloroquine base may be fatal. https://apps.who.int/iris/bitstream/handle/10665/65773/WHO_MAL_79.906.pdf?sequence=1&isAllowed=y
A 200 mg dose of chloroquine or hydroxychloroquine contains 155 mg of “base” drug, see here: https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/009768s041lbl.pdf
So unless my math is wrong, a 2.5 gram dose of HCQ would contain about 1.9 grams of HCQ base.
My intention was not to discredit HCQ, which I’m in favor of. But a typical therapeutic dose of HCQ is 200-400 mg daily, and yes, used safety for years. I should have mentioned that. My point was that these trials weren’t using an accepted therapeutic dose but instead were using a toxic dose, and by doing so they may have been designing the trials to fail, i.e., kill patients taking HCQ. It’s hard to believe that no one knew that the dose makes the poison and that large doses of HCQ were in uncharted waters, which in fact had been charted; again, see “Review of Side Effects and Toxicity of Chloroquine,” the WHO, 1979.
Thank you both for clarifying. I am surprised to see it toxic at that level but you both are right , it could be getting up a little high depending on whether the 2.4 gms was given all together.
Literature is not clear on an LD 50 for humans and 40 mgms\ KGm about 2.8 gms would be that for a 70 kgm person.
I was under the impression it had a much wider safety margin
Don132: angech,
Sorry if my reference wasn’t clear.
Thank you for the followup.
angech,
My understanding is the large doses of HCQ are being given in the first 24 hours of the trials, and that’s the concern. Not all of the 2.4 grams, for example, is given all at once although it is given within a day, and eventually over the course of the trial the HCQ adds up to something like 9 grams.
The strongest part of the Ford Medical study was when they ‘matched’ the untreated group with a very similar hydroxychloroquine treated group, matching every measured characteristic (average age, same co-morbidities, blood oxygenation level on admission, etc). It was the comparison of the matched groups where they had a 50% reduction in rate of death by the end of the study. A prospective study with placebo controls would have been more convincing, but the data they present for the matched groups looks pretty strong.
I agree with what Don Monfort and Joshua have said: steroid use wasn’t matched across treatment groups, so this study really isn’t that useful. https://www.ijidonline.com/action/showFullTableHTML?isHtml=true&tableId=tbl0005&pii=S1201-9712%2820%2930534-8
It could’ve been the steroids, as recent news about the steroid dexamethasone suggests.
I didn’t say the study is not useful. It is not definitive, but it is useful. What steve said is correct.
Compare the results of the HCQ study with the dexamethasone study results:
https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1
“The primary outcome was 28-day mortality. Results: 2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. Overall, 454 (21.6%) patients allocated dexamethasone and 1065 (24.6%) patients allocated usual care died within 28 days (age-adjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). The proportional and absolute mortality rate reductions varied significantly depending on level of respiratory support at randomization (test for trend p<0.001): Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0% vs. 40.7%, RR 0.65 [95% CI 0.51 to 0.82]; p<0.001), by one-fifth in patients receiving oxygen without invasive mechanical ventilation (21.5% vs. 25.0%, RR 0.80 [95% CI 0.70 to 0.92]; p=0.002), but did not reduce mortality in patients not receiving respiratory support at randomization (17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61]; p=0.14). Conclusions: In patients hospitalized with COVID-19, dexamethasone reduced 28-day mortality among those receiving invasive mechanical ventilation or oxygen at randomization, but not among patients not receiving respiratory support."
The steroid is not an early intervention treatment. Has no effect on the progression of the infection.
“The order of magnitude decline in COVID-19 CFR at ages below 70 since mid-April implies that, even assuming that all the change in confirmed cases between early April and mid June is due to the three-fold expansion of testing, the IFR below age 70 is now much lower than the previously estimated 0.09%. The data indicate a current level of circa 0.015%. Even for ages 60-69, where the IFR for infection in mid-March was estimated at 0.45%, the implied IFR is now little over 0.1%.”
I am missing an explanation on how you derive to the conclusion and what underlying numbers/maths you used to get to a lower IFR based only on CFR. And more importantly, I am missing a prove. For me it sounds like you take it as a given fact, but as far as I know you haven’t done another seroprevalence study getting to more up to date data to prove your hypothesis. Is there anything in work? Otherwise, I would suggest to reconsider the text passages discussing a possible lower IFR.
Great analysis. I did an in depth analysis of Sweden back in mid April to assess the effectiveness of their soft lockdown. The model contains heterogeneous variation for behavior and connectivity. I did not do an age based segregation (that has been applied to later models). Check this out:
https://covidplanningtools.com/sweden/
Thanks! Your website, which I hadn’t come across, looks very impressive. I’ll take a good look at your model.
analysis of excess deaths in US:
https://jamanetwork.com/journals/jama/fullarticle/2768086?guestAccessKey=a41c1ad0-ef8f-41aa-b478-e3eff3f1e566&utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email
Just a SMALL heads up for the fellows…
For EVERY RT-qPCR positive test we can have for the same sample another RT-qPCR negative test!
So good luck with this lovely Circus we call “pandemic”!
The study from Detroit’s Henry Ford Hospital:
https://doi.org/10.1016/j.ijid.2020.06.099
Several questions raised in the above remarks may be answered as in the issue of “steroids”.
Of course, positive results from the use of Hydrochloroquine is a real downer for the media and possibly Dr. Anthony Fauci’s image, particularly, as in an election year and their efforts to reduce President Trump’s chances at re-election.
In an election year, everything is about elections.
> In an election year, everything is about elections
No. Not true.
Trump is all about his love of “the people” and his love of his country.
That’s why he has a cult following.
Your TDS is showing. If you had any guts, you would be out with your comrades toppling statues.
https://www.covid19treatmentguidelines.nih.gov/whats-new/, July 5:
Chloroquine or Hydroxychloroquine
The Panel recommends against the use of chloroquine or hydroxychloroquine for the treatment of COVID-19, except in a clinical trial (AII).
How is that for the best science? Not only does the Panel not recommend HCQ; they recommend against it. The best politics ..
This is interesting:
–snip-
The benefits of hydroxychloroquine in our cohort as compared to previous studies maybe related to its use early in the disease course with standardized, and safe dosing, inclusion criteria, comorbidities, or larger cohort
–snip–
Would have been nice if they had explained that in more detail. I wonder which inclusion criteria might have differed from other studies?
is there ignore button
From Oxford’s web page on covid.
https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/
“We could make a simple estimation of the IFR as 0.28%, based on halving the lowest boundary of the CFR prediction interval. However, the considerable uncertainty over how many people have the disease, the proportion asymptomatic (and the demographics of those affected) means this IFR is likely an overestimate.
In Swine flu, the IFR ended up as 0.02%, fivefold less than the lowest estimate during the outbreak (the lowest estimate was 0.1% in the 1st ten weeks of the outbreak). In Iceland, where the most testing per capita has occurred, the IFR lies somewhere between 0.03% and 0.28%.
Taking account of historical experience, trends in the data, increased number of infections in the population at largest, and potential impact of misclassification of deaths gives a presumed estimate for the COVID-19 IFR somewhere between 0.1% and 0.41%.*”
Some of us including John Ioannids are owed a lengthy apology especially from alarmists like Schmidt and Annan who have relentlessly smeared him. Sanakan of course is a self-proclaimed political hacktivist which means never having to admit error.
““We could make a simple estimation of the IFR as 0.28%…”
Wasn’t this discussed here about a month ago? Seemed reasonable to me. 1 in 400 with a bias towards the old. Bad luck.
Barely actionable. Who can jump off the highest cliff? Choices are made.
Just looking at case numbers, hospitalizations, and deaths it appears that the epidemic is almost over in Europe and the US. In the US cases are surging but deaths continue to decline. This trend is even more clear in the Swedish data. Spain has had only 30 or 40 deaths in the last 2 weeks. Now we will see the slow excess mortality caused by mass unemployment, delayed screenings, delayed treatment for strokes and heart attacks, and cancer. When the history of this mass panic attack is written, it will become obvious that something is deeply dysfunctional in the West.
My own hypothesis is that the vulnerable population has already mostly been exposed, leading to an early high IFR which will decline as time goes on.
What is your source for numbers on hospitalizations?
I’ve been tracking my state – Virginia – for the last two weeks. Mostly because I live a few miles from the beach and our city is packed with tourists from all over the northeast and midwest right now and our restaurants are “open”.
Statewide: 11,000 new cases, 847 new hospitalizations, 500 new cases at the beach.
The number of people statewide in the hospital currently with confirmed or suspected Covid is down 10% from 2 weeks ago and the number on a ventilator is down 34%. The beach is not spiking relative to the rest of the state.
How can that be? My theories are:
1. intubation doesn’t really work for most and they are probably doing less of it.
2. testing is more than double what it was in early May so they’re catching mild or asymptomatic cases they never caught before.
3. People are being prudent even with re-opening. I wear a mask when indoors with people and automatically keep 10 feet away outside- which is not hard to do even on a crowded beach. Ironically, because a crowd seems more dangerous than a neighborhood barbecue, people are being more careful in crowds.
4. Thanks to media panic anyone who tests positive, even with mild or no symptoms, rushes to the hospital certain they are dying and must, before expiring, be intubated in an ICU. These are counted as “hospitalizations” even as hospitals check their vital signs and send them home with strict quarantine orders. It’s actually more dangerous to keep them in the hospital than it is to send them home.
Actually – i was interested jn states such as Arizona, Texas, Florida, etc., that I presume account for most of the spike in positive tests. If you have a source for that info I’m interested in, please pass it on.
> Thanks to media panic anyone who tests positive, even with mild or no symptoms, rushes to the hospital certain they are dying and must, before expiring, be intubated in an ICU. These are counted as “hospitalizations” even as hospitals check their vital signs and send them home with strict quarantine orders.
So are you saying a positive test at the hospital, then sent home, is categorized in official stats as a “hospitalization?”.If so, could you pass on a source for that as well? I wasn’t aware of that. Then we really should be counting admissions – as I assumed that’s what “hospitalizations” meant.
“So are you saying a positive test at the hospital, then sent home, is categorized in official stats as a “hospitalization?”.
My theory as to why “hospitalizations” went up by 847 during a two week period while the number in the hospital with covid or suspected covid fell by 10% is that people who tested positive went to the hospital believing they needed to, were admitted and checked, and then sent home because they didn’t need to be hospitalized.
It’s a theory. There are other possibilities for the strange numbers- 1. there was no increase in hospitalizations, they’re still working through weeks old backlogs of lab tests. 2. Covid-free people in the hospital for something else caught Covid in the hospital and became “hospitalized” covid cases. 3. Hospitals are suffering financially and reclassifying anything they possibly can to “presumed Covid” for financial support. 4. Hospitals have found some treatment protocol that shortens hospital stays and lowers fatalities or 5. younger people have it and need shorter, less invasive treatment protocols before release. 6. Hospitals have discovered that there isn’t much you need to do (or can do) for most Covid patients so they send them home with the understanding that keeping them around just endangers the staff and other patients. I’ve two anecdotal pieces of evidence for that one. A woman in my neighborhood died of Covid, at home, after testing positive, about five days after the hospital connected her with Hospice and sent her home. The other is a family member of
a co-worker who rushed themselves to a hospital after getting a positive result from one of those drive-thru testing sites only to be checked over for vital signs, sent home and told to stay home and call 911 if they had trouble breathing. The person is fine now. Scared half to death and felt terrible for a short while, but otherwise fine.
> that people who tested positive went to the hospital believing they needed to, were admitted and checked, and then sent home because they didn’t need to be hospitalized.
So you think that people went to the hospital, were admitted because they thought they should be admitted, and then checked?
Interesting. I’ve not seen hospital admissions work that way.
It would be good if you could supply some verification for your theory.
” I’ve not seen hospital admissions work that way.”
I have. And it depends on the definition of “hospitalizations”- whatever the threshold is to get paid is what the hospital will write down for a Covid case, and who could blame them given the paucity of elective surgeries?
What’s your theory for why case counts are growing, people are being “hospitalized” for covid and the number of people in the hospital for Covid is going down?
Jeff –
> What’s your theory for why case counts are growing, people are being “hospitalized” for covid and the number of people in the hospital for Covid is going down?
I don’t really understand what you’re talking about. You haven’t actually provided data or the sources from which such data come.
I get that you think there is some kind of a contradiction in need of an explanation, for which you’ve developed a theory as an explanation – but my guess is that there may be some kind of category impreciseness or overlap that creates an appearance of a contradiction that doesn’t really exist.
I really don’t have any idea what you’re describing let alone what the explanation might be. But even if the contradiction exists as you say, the explanation for its existence being a widespread phenomenon where people are officially categorized as “hospitalized” before testing – simply because a patient wanted to be admitted – and then sent back home after testing, seems unlikely to me. I’ve never seen hospital admission processes work like that.
But you say you have, so…maybe you’re right and your theory explains a real contradiction.
But you could be mistaken
I’ve seen a whole lotta people comin’ up with “theories” on the Interwebs, to “explain” their impressions based on anecdote. And very, very, very of those “theories” ever panned out.
So absent any actual information, I’ll remain agnostic and skeptical.
If you have actual evidence of people being officially categorized as “hospitalized” merely because they wanted to be tested (prior to any test results or prior to presenting symptoms that would justify admission), I’d love to see it.
What I wrote: “…people who tested positive went to the hospital believing they needed to, were admitted and checked, and then sent home because they didn’t need to be hospitalized.”
Your version of what I wrote: “widespread phenomenon where people are officially categorized as “hospitalized” before testing – simply because a patient wanted to be admitted – and then sent back home after testing, ”
i knew you were off the deep end but I retained some hope there was still a spark. There isn’t.
There are four places within two miles of me with big tents in parking lots for drive through Covid testing. One of them is WalMart. People are discovering in grocery store parking lots that they have a disease that CNN swears will slaughter their whole family and their little dogs too. Where do you think they go when they hear that?
My evidence? I wrote down the number of cases, tests, people in the hospital and people on ventilators (there is an association of hospitals that tracks it in Virginia and the state department of health tracks case counts and test counts) I wrote the numbers down on a Monday morning two weeks ago and wrote them down again today and compared them. Do it yourself, it doesn’t take long, just the waiting until future days.
Jeff –
You have a “theory” as to how people who aren’t hospitalized are being counted as hospitalized.
You’re entitled to come up with theories. It’s your right.
I’ll remain skeptical just as I do with any number of other “theories” that people peddle on the Interwebs – unless you show some actual good ol’ evidence.
“You have a “theory” as to how people who aren’t hospitalized are being counted as hospitalized.”
It must be difficult to have motivated reasoning so weak that it cannot survive contact with fact. I wouldn’t know.
My theory, in words you can understand, is that people find out they have contracted what is reported to be a deadly disease and they go to the hospital. These “hospitals” are buildings with medical professionals designed for the care of the injured and sick. The hospitals have medical professionals- doctors, nurses, labs, x-ray techs etc – and this staff examines people who have contracted what is reported to be a deadly disease. When the medical professionals at a hospital examine someone who has contracted what is reported to be a deadly disease, they report to the various local, state, and federal health authorities accurately: “one person, with this disease, in our hospital.” That count is maintained in a database, along with the count of people currently in the hospital. In Virginia, the former number is going up, the latter number is going down. My theory is that this means the people showing up in the hospital and being seen by the medical staff of the hospital are not staying in the hospital long enough for the cumulative number of people in the hospital to be going up. The exit door is busier than the entrance door.
If you were clever, you’d be arguing that the people leaving are older cases. But that would mean the “surge!!!” in hospitalizations is weak stuff. Or you’d claim Virginia isn’t like Florida (but it is, we’ve been “open” longer than Florida actually and are a big tourist destination, we just have a Democrat as governor and, therefore, our “surge!!!” or “experiment in human sacrifice!” doesn’t count.)
Right. Like I said. You’re arguing that a significant number of people who aren’t hospitalized are being counted as hospitalized
It’s an interesting “theory.” When you find some actual evidence of what you’re theorizing his happening – do let me know.
Meanwhile, it seems that a lot of hospitals are being overwhelmed with people who, according to your theory, likely aren’t even there.
In Florida and Arizona, that is.
Or is you theory that people are being miscategorized in Virginia only?
You can mark me down as a steady follower of the dysfunctional society via mass panic hypothesis, but is it new? Currently doing the rounds in the UK are hidden complications and longer term damage to ‘mild’ Covid-19 cases ranging, it would seem, from the reportedly asymptomatic to those who didn’t require medical intervention, although there isn’t any reliable way of knowing who has been accurately tested and who has not, either for presence of the virus or at least some effective immune response. This virus is going to be around for the duration and it clearly seems from the Swedish experience that lockdowns are not going to stop it any more effectively than normal social behaviour when disease is doing the rounds.
We see this panic very clearly in climate science where we have embraced environmentally challenged solar and wind as ‘green’ answers when they are not only nothing of the sort, but are also incapable of providing reliable baseload electricity at least in terms of our energy transmission system technology to date. In the meantime nuclear, once hailed as the cheapest and greenest answer to energy needs, remains side-lined by a belief that it will do us more harm than good because previous hyperbole said so, and yet is providing baseline power very reliably TYVM all over the planet.
Coupled with all this hyperbole is the censorship that abrades anything that doesn’t conform to a concensus view of the world. That means us ‘lay folk’ cannot be trusted to make our own minds up – about anything. We need experts in everything to tell us what is good for us and those experts rely upon multi-complex algorithm computer models that only they can understand and interpret, and anyone who doesn’t agree with them really doesn’t know anything. Gone are the days when you could listen to what someone has to say and then ask questions about anything dubious, doubtful or senseless. You decided if they were expert enough to win your vote ….
ukweather lass
It will be seen there are three major sources of deaths, care homes, hospitals and our own homes.
Experts are now telling us to wear masks inside our own homes because of risk of infection in small tightly sealed houses.
I know we have had this conversation before, but we knew very early on that we were all much better off outside than in, yet were put under house arrest.
Care homes were a disgrace but again the problems there were obvious from day one. Hospitals themselves became killing fields with the likelihood that if you went in you would catch the virus and it might tip you over the edge. Why the empty Nightingales were not used in order to provide a covid free environment for our regular hospitals I do not know
If you did not need to go into hospital for any unrelated reason or into a care home your chances of death were extremely small.
The house infection mortality however we will not know until all the stats are in.
What will be interesting is the cost in millions of pounds for each month of life bought. The vast majority of deaths were in those who had little time left anyway and according to a variety of reports would have died within months anyway.
Whether scaring everyone to death, changing society and wrecking our economy was worth the billions to buy a bit more life for the already very sick and elderly will no doubt be the subject of much future discussion
tonyb
“We need experts in everything to tell us what is good for us and those experts rely upon multi-complex algorithm computer models that only they can understand and interpret, and anyone who doesn’t agree with them really doesn’t know anything. ”
The new bible in Latin…
Very good Covid Analysis from Ivor Cummings on YouTube https://youtu.be/cSKjcltDkng
Well worth your time
Pingback: COVID-19 Epidemic in Sweden: an Analysis | US Issues
Judith,
Are you planning any posts on the new books by Shellenberger and Lomborg?
I’ve had enough of Joshua for a lifetime.
Mark,
We keep him around, for the exercise:
He, he. I thought this was the short version.
5 out of 6
good topic for discussion. I have bought both books but haven’t read them yet
Do you think either author would consider a guest post?
I have read Shellenberger’s book and pre-ordered Lomborg’s.
Shellenberger had an article in Forbes that was taken down and then re-posted,
Link to the Shellenberger article:
https://www.forbes.com/sites/michaelshellenberger/2019/11/25/why-everything-they-say-about-climate-change-is-wrong/#782c387012d6
I don’t seem to be able to post the link to the Forbes article here.
Nic: The success of various Asian countries at suppressing the COVID-19 pandemic conclusively demonstrates that the pandemic can be effectively halted with a negligible fraction of the population being seropositive. (Yes, if the pandemic went on for a decade or more, seropositivity might approach the levels you think are slowing the pandemic in Sweden, but optimistically we need to worry about the next one or a few years, not decades.) So the modest decrease in cases in older people seen on your graph could be due to a combination of effective government measure and changes in behavior OR it could be due to rising seropositivity in the more susceptible part of the population (as you suggest). Both are viable hypotheses. Right?
Rightly or wrongly, I think the key parameter in an pandemic are inflections, not deaths:
1) The pandemic is spread by infected people, mostly by symptomatic infected people, a possibly-constant fraction of whom are likely to get tested at some point. Younger symptomatic adults are more likely to feel well enough to be out spreading the pandemic than the elderly, and this is especially true for super-spreaders. The tiny fraction of those who have died have nothing to do with the spread of the pandemic (except amoung health care workers), but any increase in cases in any adult age group places the oldest people at more risk of dying. (Children tend not to be symptomatic and so far appear to be a negligible factor spreading the disease.) So it makes sense to focus mostly on new cases and seropositivity, not death.
2) Furthermore, treatment is improving with time. Dexamethasone reportedly reduces deaths among hospitalized patients by 1/3. Mutant viruses that evolve as the pandemic progresses can (and apparently have) spread more rapidly and be more or less deadly.
https://curryja.files.wordpress.com/2020/06/sweden-fig2-weekly.cases_.by_age.25jun.png?w=768&h=493
Fig. 2 Weekly COVID-19 confirmed cases by age group in Sweden
The heart of my concerns about your post arise from whether your Figure 2 supports your hypothesis that the pandemic is slowing significantly due to increasing seropositivity or the alternative hypothesis that changes in behavior and policy are responsible. If the number of cases among older people is falling because their seropositivity is approaching herd immunity (as you hypothesize), then what began happening among younger people after May 28. You said the number of tests doubled between the end of May and the end of June, but it’s hard to believe that happened in ONE week among those aged 30-60. A complete analysis of what happened depends on knowing how the fraction of positive test results over time changed for each age group. It is possible that such data will show that the startling rise in cases in some age groups the week after May 28 wasn’t caused by a doubling in testing. If so, the spread of the infection in the 30-60 age groups was not being slowed by approaching to herd immunity. This raises the question of how seropositivity varied and varies with age. If the number of younger people being tested did double after May 28 and the number of older people being tested didn’t change, I would be forced to take your hypothesis more seriously. The same would be the case if it turns out that seropositivity approached a critical threshold early among older people and not younger ones.
The alternative hypothesis – the one I instinctively favor – is that the behavior of those 30-60 changed with the beginning of summer and perception that things were safer. Europe had gotten much safer (but the US outside the NYC area had not). The putative change in behavior of those aged 10-30 was a little slower, and there is nearly a 10-fold(!) increase in infections among those aged 10-20. Was that really caused only by a 10-fold increase in the number of people in this age group getting tested simply because more tests were available? No likely. It is really hard to look at the 10-19 subpopulation and believe that it is approaching herd immunity.
FWIW, anecdotal observations where I live (northern Virginia) show a dramatic increase in traffic, parking lot fullness, kids playing outside in groups and families outside without obvious social distancing. The fitness center at a religious community center has even re-opened – THE most danger place I can think of, except for the crowded beach bars I once patronized in the summer. The US states with the largest increases in new cases also apparently report an unusually large number of younger adults who are hospitalized. It sure doesn’t seem like the US is approaching herd immunity in younger adults, which is exactly the same conclusion I draw from your graph above (albeit with caveats). Unfortunately, confirmation bias means that I have probably better retained news reports that agree with the hypothesis I prefer. Nevertheless, those who personally risk little more than a bad case of the flu are certain to change their behavior before older people and those with more at stake. I have no proof that an age-dependent change in behavior took place in Sweden after May 28 or is a significant factor here in the US right now, but the timing of the changes makes sense to me.
Respectfully, Frank
Frank, Check the Sweden covid19 wikipedia page. While cases have surged from about 4 weeks ago, deaths and hospitalizations have continued to decline. Both are way down from their peak. There is perhaps a 10 day lag in the data so discount the last 10 days.
If indeed a lot of younger people are getting infected, that’s not a bad thing because very few will die and they will recover and help us ultimately get to herd immunity.
dpy6629 wrote: “If indeed a lot of younger people are getting infected, that’s not a bad thing because very few will die and they will recover and help us ultimately get to herd immunity.”
Frank replies: “If indeed a lot of younger people are getting infected, that’s not a bad thing because very few will die and they will recover and help us ultimately get to herd immunity … but in the meantime, younger adults who are sick are starting to fill up hospitals and, after a lag, transmitting more infections to older, vulnerable people – and these are bad things.
Here is a story about the surge in Florida from 6/20:
https://www.msn.com/en-us/news/us/as-florida-covid-cases-rise-among-younger-people-desantis-says-state-has-hospital-beds/ar-BB15JqMu
And the way things look 20 days later:
https://thehill.com/homenews/state-watch/506344-56-florida-icus-at-capacity-as-virus-surges
In my FANTASIES, we would be paying to send all of the young adults who want to party and socialize regardless of the risk to island resorts for the summer so they gain herd immunity without any risk to the vulnerable population. The program could be voluntary or a consequence of repeated violations of social distancing or masking. Then perhaps colleges could safely re-open this fall with minimal risk to the large number of ordinary people who work on college campuses (and a few elder faculty), to their families, and the local community.
In reality, caseloads in many European countries have fallen 90%, making new outbreaks easier to contain and it much safer for them to re-open their economies. Unless Nic is right about already nearing herd immunity, the best solution to the problem is bringing the pandemic to a near halt until a vaccine is available, not reaching herd immunity through a continuing pandemic that surges to threaten civilized health care in hospitals followed by repeated lockdowns. Evidence from some countries says that this is possible; we just need to implement what is working elsewhere. Like many wars, the best thing to do is to go all out to win as fast as possible, not merely try to stave off defeat indefinitely. Unfortunately, in the US, public confidence in experts and government programs is at a low due to exaggerated problems false propaganda from both the left and right and politically-motivated science and social science from our liberal universities.
As I have discussed elsewhere with Nic, I believe evolution has optimized our immune system to fight infections and cancer with minimal risk of auto-immune disease. Any subpopulation of humans half as resistant to viral diseases in general would have died out long ago. The same is true for a subpopulation that is only 90% as resistant. In both cases, this assertion assumes that there are no compensating benefits to reduced resistance – but those benefits would need to be huge, given the toll formerly taken by viral childhood diseases. Could there be some resistance factor unique to COVID, for example people who express lower levels of ACE2 receptors? Sure, but I suspect the survivors of incidents like the Washington choir have been studied. A few people (less than 1%) don’t express one of two viral receptors used by HIV and don’t develop AIDS despite HIV infection.
franktoo:
“Here is a story about the surge in Florida from 6/20.”
It’s often good to look at comments; I often find comments more interesting than the actual piece. For example, here’s a comment on the article with the headline, “56 Florida hospitals report ICUs at capacity as virus surges,” with the very clear implication that THIS IS ALL DUE TO COVID-19! Here’s what an enlightening commenter says:
“What is not being reported is the percentage of ICU beds attributed to Covid care.
“When you stop elective surgeries for 5 months and then remove the restriction, more surgeries will be scheduled to address the back-log and fill those ICU beds during post-op recovery, and/or when complications arise.
“In Texas, the only state I’ve seen data on, only 15% of ICU beds were being used for Covid patients. Reporting percentage of ICU beds in use without breaking down the use of those beds is just poor reporting. If hospitals are hitting thresholds that give them concerns, they can return to a more selective scheduling approach…but of course its elective procedures that generate the most revenue…any surprise that they ramped back up to full surgical loads?
“In California, I’m told by relatives in the medical profession that hospital admissions are down and attribute it to the fear that is being generated in the press. People are afraid to go to the hospital and unfortunately, but predictably, then wind up in intensive care when they finally hospitalized.”
But of course the comment below that by “Not Fooled” assures us that the press isn’t fear-mongering, just reporting “the facts,” like for example the fact that ICU’s are at capacity as virus surges.
Don wrote about a comment posted below a newspaper article I linked:
“When you stop elective surgeries for 5 months and then remove the restriction, more surgeries will be scheduled to address the back-log and fill those ICU beds during post-op recovery, and/or when complications arise.”
Did Florida really ban elective surgeries for 5 months? Do you really believe nonsense like this? Does it make sense to you that something this insane persisted for that long? Why not think twice and check before contributing to the misinformation that is circulating?
According to this link, Florida banned elective surgery for about five weeks back in April:
https://www.nbcmiami.com/news/local/elective-medical-procedures-to-resume-in-florida/2227164/
It was a stupid idea copied from states like NY that really needed to take such drastic measures in April.
OK franktoo, got it. The commentator might have meant five weeks instead of five months … right? But same difference: if you stop elective surgeries for five weeks you’re going to get a backup, and I’d imagine that hospitals are desperate to make up for lost income, which means scheduling as many surgeries as possible, which means taking up ICU beds.
But you’re right, I should have caught that.
Frank, I’ll just respond on some particular points that you raise.
“The success of various Asian countries at suppressing the COVID-19 pandemic conclusively demonstrates that the pandemic can be effectively halted with a negligible fraction of the population being seropositive.”
Some of them seem to be seeing a resurgence of cases now, and India hasn’t suppressed COVID-19.
There are other factors. Airborne viruses spread far less well when specific humidity is high, which it will be in many hot, non-desert-like Asian countries.
Also, seropositivity seriously undercounts immunity. Many people with asymptomatic infection or mild /brief symptoms do not become seropositive, but do develop SARS-CoV-2 specific T-cells (whihc remain far longer than antibdodies) and hence almost certainly become immune. And more people in Asia than in the West may have been exposed to somewhat similar coronaviruses in the past, and have thereby acquired cross-reactive T-cells.
“So the modest decrease in cases in older people seen on your graph could be due to a combination of effective government measure and changes in behavior OR it could be due to rising seropositivity in the more susceptible part of the population (as you suggest). Both are viable hypotheses. Right? ”
I’m doubtful that mandatory government measures made huge difference from mid-April on, as cases in younger people were rising then. Behavioural changes by older people (from their pr-COVID-19 norm) no doubt made a continuing difference. Seasonal factors are another possible important factor in the decline in the epidemic. As I wrote:
“The herd immunity threshold is likely lower at present than it would be if people were behaving completely normally; it may also be seasonally lower.”
I expect that a reversal during June among younger age groups of previous behavioural changes does account for a substantial part of the apparent increase in infections, as well as recorded cases, in those age groups. Indeed, I wrote:
“comparing Figures 1 and 2 suggests that while infections in the oldest age groups are reducing steadily, this is being counterbalanced by an increase in infections among young people”.
I suspect that older people, who know they are at much higher risk of serious illness or even death, have changed their behaviour much less over the last two or three months.
“A proper analysis of what happened depends on knowing how the fraction of positive test results over time changed for each age group.”
That would be very useful data. I asked my contact at the Swedish PHA if such data were available, but she says not.
I’m not convinced that case data are more useful than deaths data. It is difficult to disentangle the effects of increased testing.
Nic,
There’s also the standard curve profile of respiratory illnesses across the year. Those in the tropics follow a more normal curve pattern than those in temperate region which follow a long tail curve pattern.
They tend to start up and stop at certain times of year.
These patterns are well known from influenza research.
Nic wrote: “There are other factors. Airborne viruses spread far less well when specific humidity is high, which it will be in many hot, non-desert-like Asian countries.”
Frank replies: The vast majority of COVID is transmitted indoors. Major influenza pandemics have occurred in all seasons and the COVID pandemic is continuing into the summer in the US and other places. The tricky question is: Why does ordinary influenza peak in the winter? Let’s hypothesize that gradually diminishing immunity to a swarm of influenza viruses means the US is about 30 million cases short of herd immunity in an average year. Some seasonal event would then initiate an outbreak every year: Children returning to school in the fall? Drier air indoors in the winter, reducing aerosol transmission? With pandemic influenza and COVID, we are by traditional measures 200 million infections short of herd immunity, not just 30 million infections short. Therefore these pandemics ignore modest seasonal changes in transmissivity.
Nic writes: “Also, seropositivity seriously undercounts immunity. Many people with asymptomatic infection or mild /brief symptoms do not become seropositive, but do develop SARS-CoV-2 specific T-cells (whihc remain far longer than antibdodies) and hence almost certainly become immune. And more people in Asia than in the West may have been exposed to somewhat similar coronaviruses in the past, and have thereby acquired cross-reactive T-cells.”
Since the concept of “immunity” can be somewhat vague, I’ll provide a devil’s advocate reply to your sensible comments. Asymptomatic or mildly ill patients infected with SARS-CoV-2 are “immune” to this virus by some definitions, but can infect others who do get symptoms or even die. I am unaware of what characterizes a “super-spreader” of COVID, but Typhoid Mary is an example of someone who was “immune”. From the pandemic perspective, we must define “immunity” as an inability to pass the virus to others. In this case, “immunity” means a patient’s ability to keep viral RNA levels in the respiratory system low enough that the patient’s respiratory droplets and aerosols pose negligible threat to others. Your comment refers to the discovery of T-cells presumably left over from an earlier coronavirus common cold that appear to be capable of being activated by fragments of SARS-CoV-2 proteins. Since COVID patients are typically infectious (often most infectious) for two days before the development of symptoms, these T-cells may not be providing the kind of “immunity” needed to suppress transmission, even though they may be preventing or minimizing symptoms. Finally, vaccine developers define “immunity” in terms of neutralizing antibodies (from memory B-cells), not activated T-cells. This may be the most effective form of “immunity”.
“Immunity” derived from infection by other coronaviruses is not an explanation for the success of some Asian countries at limiting this pandemic. The common colds caused by other coronaviruses are highly transmissible infections like influenza and COVID. In our interconnected world, the idea that a coronavirus causing a common cold would remain localized in South Korea is more absurd than our hopes that SARS-CoV-2 wouldn’t reach the US or Europe. In the latter case, we were making a significant effort to contain that virus. So I will predict that the fraction of South Korean blood samples with T-cells that can be activated by peptides derived SARS-CoV-2 proteins be similar to the US and not explain their success.
No measure of the pandemic is ideal, but infection rates come closer to ideal than hospitalization rates or death rates. The latter are very sensitive to changes in age of those being infected and death rates to gradually improving treatment. In the US at least, most states show a slow steady rise in the number of tests run. The percent change in number of tests run early in the pandemic was large, but the percent change since re-opening began is a minor factor.
Frank,
At least two important changes happened in Sweden after the 28th May.
Firstly, there was not just an increase in testing in Sweden after the late May, there was an expansion of target population to include workers in socially important functions outside healthcare (police, emergency services personnel, social workers etc). This would tend to lead to an apparent surge in cases in working -age groups. See local newspaper report of 27th May:-
https://www.thelocal.se/20200527/how-skane-sweden-is-planning-to-increase-coronavirus-testing
Secondly, Sweden’s Health Ministry acknowledged in late May the errors made with respect to care-homes, and tightened up physical and policy barriers to inhibit infection entry. Up to that time, Sweden had lost about 2.8% of LTCH residents (LSE report), which apparently represented almost 50% of all attributed COVID-19 fatalities.
However, I do not think that the change in testing regime is the only reason for the apparent increase in infections seen after 28th May. Some of it is real.
A strange factoid is that, if you consider any large country and rank the towns by population, the largest being 1, the second largest 2, etc, you will generally find that a graph of log(population) against the rank of the town approximates a straight line except for the largest two or three towns. This is true in Sweden. (It doesn’t work in Russia, thanks to Joe Stalin.)
The three largest towns in Sweden are Stockholm (in Stockholm County), Gothenburg (in Vastra Gotenland) and Malmo (in Skane). They account for 24% of the total population of Sweden. If we consider all Swedish towns with a population of more than 20,000 people, we find there are 61 towns. These towns account for 54% of the population of Sweden. If we consider all towns with a population of more than 10,000 people, they sum up to only 57% of the population of Sweden. A large proportion – over 40% – of Sweden’s population live in villages, hamlets and rural environments.
Stating the obvious, the profile of infections in Sweden as a whole is given by the summation of the individual profiles of the towns, villages, hamlets and rural areas. The shape of the profile for all of Sweden is heavily determined by shape and timing of the profiles of its largest towns.
While Stockholm County progressed to peak active cases sometime in April according to hospital records, Vastra Gotenburg (which includes Gothenburg) seems to have peaked some two months later; Southern Sweden was left partially isolated by traffic restrictions on the Oresund Bridge and was only slowly affected; so Skane, which includes Malmo, was only lightly affected until late May and then saw a real increase in active cases in June.
The all-Sweden profile of infections is heavily influenced by just these three large population centres. However, it is also controlled by the rate at which infection is cascaded to smaller population centres. Playing with scenarios on a simulator, it is possible to produce for Sweden a single peak, or a double bump, or a plateau followed by a peak (similar to the “observed” profile) just by playing with the timings of the individual profiles.
In summary, the all-country profile of infected is determined not just by within-town transmission, which may possibly be characterized by the intelligent choice of continuous distributions and correlatives, but also by the between-town transmission, which must IMO be considered separately, and possibly using a quite different modeling approach.
A corollary is that it is possible that Stockholm County has already passed HIT, while Sweden as a whole, still has a long way to go.
Sweden is far from being unique in this non-uniformity of attack rates. Great swathes of Europe are so far untouched. Inevitably, therefore, we will see some surges in infections as travel restrictions between cities and between countries are relaxed, and additional relatively untouched, still susceptible populations come under attack.
The only strategy which makes sense to me with what we now know is to maximize the rate of spread of infection within health service constraints, while maintaining the tightest practicable protection on the most vulnerable groups. The alternative is metaphorical starvation of the world economies, followed by real starvation on a massive scale, while we wait in hope for the virus to mutate to a less lethal form, or the appearance of an effective therapy or a safe and effective vaccine.
kribaez –
> The only strategy which makes sense to me with what we now know is to maximize the rate of spread of infection within health service constraints, while maintaining the tightest practicable protection on the most vulnerable groups.
Sweden is uniquely configured to do this, and failed, with a huge cost. Scale that cost up for the US, with millions of multi-generational households, and relatively few people able to work from home, and a poor safety net to isolate older people, and enormous densely population centers, and much fewer single-persin households. and far fewer peoole who can take paid leave, etc.
> The alternative is metaphorical starvation of the world economies,…
How has Sweden’s economy fated compared to the other Nordic countries? How has it fared on terms of health outcomes?
All the differential cost in death and illness will be completely unnecessary, at little benefit, apparently, if a vaccine is developed, and increasingly unnecessary as therapeutics are developed.
Joshua,
The alternative to the strategy I am proposing is one of cower and pray.
I would also emphasise that I do not believe that Sweden has pursued the strategy I outlined. One of the serious mistakes made by Sweden was that it did not establish strong policies to bar infection entry into care homes until late in the process. They have the 6th worse record in Europe when measured on the percentage of carehome residents who died with COVID-19 – and this accounted for 50% of attributed deaths upto the end of May. Nor did they take any special measures to protect the vulnerable outside of care homes.
“All the differential cost in death and illness will be completely unnecessary, at little benefit, apparently, if a vaccine is developed, and increasingly unnecessary as therapeutics are developed.”
I am reminded of an old joke about the Israeli cabinet discussing their terrible economic situation in the late 70s. They noted that the only countries that were doing well were those who had lost a war with the United States. They eventually decided therefore that they had to declare war on the United States. They worked on that for a while, before a frightened voice asked: “But what if we win??”
kribaez –
> I would also emphasise that I do not believe that Sweden has pursued the strategy I outlined. One of the serious mistakes made by Sweden was that it did not establish strong policies to bar infection entry into care homes until late in the process. They have the 6th worse record in Europe
My question is whether your strategy is realistically achievable – especially in countries without all if Sweden’s structural advantages, of which the are many, which are hugely influential.
I think your strategy is a huge gamble in the very least, even in a county like Sweden. Gambling isn’t in itself wrong, but it’s a bad idea if you don’t even know the odds. In a country like the US, I think your strategy isn’t reality-based. Many, many vulnerable people are primary-caregivers for children, need to take public transportation to shop or go to the doctor, can’t work, from home, live in densely populated housing, don’t even have dick leave benefits, don’t have health insurance, etc.
> The alternative to the strategy I am proposing is one of cower and pray.
Robust testing, tracing, and isolating is not cowering and praying. It is the least sub-optimal approach. At current rates, it will take years, (if not decades) , for countries like Finland or Taiwan to reach the per capita deaths of Sweden even if no one else dies in Sweden.
“Robust testing, tracing, and isolating is not cowering and praying.” It is cowering and praying because this can never be very effective in most Western countries. You seriously think that Antifa thugs will agree to such tracing or isolation. Last month, millions didn’t social distance and wear masks, but instead went to massive protests and riots where thousands were right next to each other and all were shouting. Hundreds of people have died and continue to die (some are children) as police have retreated from effective enforcement amid a rapid rise of violence. Once the police are defunded, you think everyone is just going to play nice for the contact tracers? Naive in the extreme. Where are the success stories of states doing this? Even the most left wing governor realizes it is impossible. In every state in the Union there is resistance to for example enforcing mask requirements, which are much less onerous than contact tracing. Many police departments and sherifs have said they will not do so.
It is essentially impossible to “get rid of” the virus before herd immunity arrives. It is possible however to isolate those in nursing homes by asking staff to live in for a few weeks at a time. We can also encourage those over 70 or who are seriously ill to stay at home. This population will be much more likely to do so than the general population and the economic impact will be small.
Oh and we should prepare for the surge in cancer and heart disease deaths as well as deaths of despair in the coming months as mass unemployment and bankruptcies continue.
Kribaez wrote: The only strategy which makes sense to me with what we now know is to maximize the rate of spread of infection within health service constraints, while maintaining the tightest practicable protection on the most vulnerable groups. The alternative is metaphorical starvation of the world economies, followed by real starvation on a massive scale, while we wait in hope for the virus to mutate to a less lethal form, or the appearance of an effective therapy or a safe and effective vaccine.
Why do you reject the possibility of suppressing the pandemic and then containing outbreaks. They have done so in South Korea, Taiwan, China (whose economy is recovering nicely). Cases in many places in Europe are down to about 10% of peak and their economies have been partly re-opened. New York state is down to about 5% of peak incidence.
The number of new cases rises and falls with the average number of new people who are infected by each sick person while he is infectious (about a week). The number of new cases in the US fell in late April and May, even though we weren’t doing everything possible to slow the pandemic: mandatory masks in public (at least where risk is substantial), mandatory forehead temperature (a measure Hong Kong applied travelers from China on January 1 based on warnings on the Wuhan city website), faster turn around on testing, encouraging quarantining of those exposed to someone who has tested positive (say free room and delivered food at empty hotels and college dorm rooms for those want to protect their families). With a little more effort, each sick person would have been infecting only an average of 0.5 or 0.7 new people – enough reduce new cases by 99%. And we could have re-opened our economy with local outbreaks to contain, but not today’s surge in new cases.
Open your eyes to what is going on in the rest of the world! The only choices are not intolerable permanent lockdowns or a pandemic raging until herd immunity is achieved, possibly with the help of a vaccine. The other choice is to make personal contacts between people safer and safer so we can return to normality as much as possible.
A recent Nature Briefing contains some information that argues against some of what I have written above:
“T cell reactivity against SARS-CoV-2 was observed in unexposed people; however, the source and clinical relevance of the reactivity remains unknown. It is speculated that this reflects T cell memory to circulating ‘common cold’ coronaviruses. It will be important to define specificities of these T cells and assess their association with COVID-19 disease severity and vaccine responses.”
https://www.nature.com/articles/s41577-020-0389-z?utm_source=Nature+Briefing&utm_campaign=0dde152fa9-briefing-dy-20200710&utm_medium=email&utm_term=0_c9dfd39373-0dde152fa9-43368041
For those like me who aren’t sure was T-cell [cross] reactivity means, the adaptive immune response begins with the binding of about 10-15 amino acid peptide from degraded viral proteins to a receptor (the Major Histocompatibility Complex MHC) on the surface of T-cells. Recombination of genes within T-cells and selection produces antibodies that tightly bind that peptide AND the intact viral protein. By chance, some antibodies bind the spike protein that is critical for viral entry. These are neutralizing antibodies. Upon re-infection, when the same peptide binds to the MHC, T-cells are activated respond and reproduce without have to go through the genetic recombination and selection process. We now know that peptide from SARS-CoV-2 can bind to and activate T-cells that produce antibodies that recognize coronaviruses that cause the common cold. What this accomplishes is a mystery to me, since those T-cells don’t produce neutralizing antibodies against SARS-CoV-2 – they would already be providing immunity to CARS-CoV-2.
As best I can tell, know one knows what cross-reactivity does and whether it is responsible for less severe infections, of asymptomatic infections or reduced transmissibility that could result in herd immunity after fewer infections.
https://judithcurry.com/2020/07/06/covid-discussion-thread-part-x/#comment-920568
I didn’t read the whole thread, but infection rates of SARS CoV2 suggest that herd immunity is reached when 60 – 70% of the population has been infected.
With the numbers that we have, Sweden is NOWHERE NEAR that (75 000 cases out a population of 10 million = 0.75%), and therefore none of the current statistics can be attributed to herd immunity.
If the real numbers are hiding untested, then none of Sweden’s statistics are reliable and the entire OP is a waste of time.
If you estimate the total population infected by toting positive tests to total tests, you get 12.5%. Nowhere near herd immunity. Not to mention that Sweden is testing mainly people with severe symptoms, asking the rest to stay home, so that ratio is almost certainly inflated compared to a random sample.
Barry,
What population susceptibility assumption are you making in the first place?
None of the curves on the planet have fitted anything other than a standard respiratory illness curve for the latitude of the country involved. And they are all an order of magnitude lower than the armageddon predicted by the initial modellers.
Which suggests that the population that is in play to this virus is far lower than many assume.
All of which sounds very like the “CJD” scare in the late 1980s – when we were all supposed to die from brain rot because we’d eaten meat pies. I ate loads. I’m still here.
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