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Sunday, March 29, 2020

COVID-19 -- Think, Don't Panic

SUMMARY:
There has been 
a flu pandemic 
every year 
of your life.

Usually during 
the colder months.

And usually ignored, 
unless you, or
someone you know, 
dies from the flu.

All other types of flu 
kill far more people 
each year than the 
COVID-19 version.

Imagine that 
we had not known 
about the new COVID-19
flu out there, and we had
not checked any individuals
with COVID-19 tests ?

Without that information, 
what would we conclude 
about the flu this year,
based solely on deaths ?


I believe we would look at 
the TOTAL number of deaths 
due to “influenza-like illnesses” 
this year, and we would have
only concluded the year
was "worse than average". 


We don’t know 
just how long 
social distancing 
and lockdowns 
can be maintained 
without huge 
damage to family 
and business 
finances.

We do know that 
some areas have 
very little COVID-19,
and other areas are 
overwhelmed.



The 1918 Spanish flu 
infected an estimated 
500 million people 
worldwide, and killed 
tens of millions. 

A century later, 
we have vaccines, 
antibiotics, advanced 
life support, and 
high-technology 
monitoring networks. 

And yet, 
we still have
disease 
outbreaks 
that continue 
to surprise 
the "experts".



DETAILS:
This year
there have been 
many public 
decisions made 
without having
reliable data.

We lack any
reliable evidence 
on how many people 
have been infected 
with the virus 
SARS-CoV-2, 
which causes 
COVID-19.


A vaccine will take 
many months 
( or even a year ) 
to develop, and 
test properly. 


How many people 
are infected ?

Some deaths, 
and probably 
the vast majority 
of infections due 
to SARS-CoV-2, 
are being missed. 

Most countries, 
including the U.S., 
lack the ability to test 
a large percentage 
of the population.

No countries have 
reliable data based on 
a large random sample 
of their general population.

Testing a random sample 
of a population, and 
then repeating the test 
at regular time intervals, 
can be used to estimate 
the incidence 
of new infections.

The reported 
3.4% fatality rate,
from the World Health 
Organization, is 
really meaningless. 

Because patients 
who have been tested 
for SARS-CoV-2 are 
disproportionately those 
with severe symptoms.



The one 
"closed population" 
tested was 
the Diamond 
Princess cruise 
ship passengers.

There were seven deaths 
among the 700 infected 
passengers and crew.

So the fatality rate 
there was 1.0%.

Passengers were mainly 
an elderly population, 
most likely with 
a much higher 
death rate than people 
under 40 years old.

Projecting the Diamond 
Princess mortality rate 
onto the age structure 
of the U.S. population: 
  The death rate among 
people infected with
COVID-19 could be 
as low as 0.1%  to  0.2%
( similar to other flu deaths).

If the true COVID-19
death rate is similar 
to all other flus, then
locking down the world 
may be irrational. 

Could the COVID-19 case
fatality rate be that low? 


Some mild or common
cold-type coronaviruses, 
that have been known 
for decades, can have 
case fatality rates 
as high as 8%. 
when they infect 
elderly people 
in nursing homes. 

In fact, such “mild” 
coronaviruses infect 
tens of millions 
of people every year, 
and account for 
3% to 11% 
of all people 
hospitalized 
in the U.S. 
with lower 
respiratory 
infections 
each winter.

These “mild” 
coronaviruses 
may be implicated 
in thousands 
of deaths every year 
worldwide, though the 
vast majority of them 
are not documented 
with precise testing. 

They are lost as noise 
among all 60 million 
deaths, from all causes, 
every year.

Influenza is confirmed 
by a laboratory in a 
tiny minority of deaths. 

In the U.S., for example, 
a typical flu season 
is 30 to 60 million victims, 
with 30,000 to 50,000 deaths.

Some of these deaths 
are due to influenza,
and some are due to
other viruses, 
such as common-cold 
coronaviruses - few flu 
victims will be tested.



In one autopsy test 
for respiratory viruses, 
in specimens from 
57 elderly persons 
who died during the 
2016 to 2017 
influenza season, 
influenza viruses 
were detected in 18% 
of the specimens, 
while any other kind 
of respiratory virus 
was found in 47%. 

A positive test 
for COVID-19
does not mean
that COVID-19
was primarily 
responsible for a
patient’s demise.



"Flattening the curve" 
to avoid overwhelming 
local hospitals makes 
sense in theory. 

If hospitals
do become 
overwhelmed, 
the majority of the 
extra deaths 
may be due to
common diseases 
and conditions, such as 
heart attacks, strokes, 
trauma, bleeding, etc.,
that are not getting
adequately treated. 

"Flattening the curve" 
could even make 
things worse
in the long run: 
  Instead of being 
overwhelmed during 
a short, acute phase, 
the hospital could
remain overcrowded
for a longer period. 



School closures 
may reduce flu
transmission rates. 

But they may backfire, 
if children socialize anyhow.

Especially if 
the school closure 
causes children to spend 
more time at home with 
susceptible family 
members, especially 
elderly family members.

School closures 
may also reduce
the chances of 
developing "herd 
immunity" in an 
age group that 
does not seem to be
at high risk for 
getting COVOD-19.


Below are quotes
from some doctors 
who do not have
mainstream 
opinions:

Dr Wolfgang Wodarg: 
is a German physician specializing in Pulmonology, politician and former chairman of the Parliamentary Assembly of the Council of Europe. In 2009 he called for an inquiry into alleged conflicts of interest surrounding the EU response to the Swine Flu pandemic.

What he says:

"We should be asking questions like “How did you find out this virus was dangerous?”, “How was it before?”, “Didn’t we have the same thing last year?”, “Is it even something new?”

That’s missing."




Dr Joel Kettner: 
is professor of Community Health Sciences and Surgery at Manitoba University, former Chief Public Health Officer for Manitoba province and Medical Director of the International Centre for Infectious Diseases.

What he says:
"I have never seen anything like this, anything anywhere near like this. I’m not talking about the pandemic, because I’ve seen 30 of them, one every year. It is called influenza. And other respiratory illness viruses, we don’t always know what they are. But I’ve never seen this reaction, and I’m trying to understand why."




Dr John Ioannidis: 
Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director of the Meta-Research Innovation Center at Stanford (METRICS).

He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.

What he says:
"Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from COVID-19 is much higher."

Could the COVID-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes.

If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average.

– “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data”,    Stat News, 17th March 2020




Dr Yoram Lass: 
is an Israeli physician, politician and former Director General of the Health Ministry. He also worked as Associate Dean of the Tel Aviv University Medical School and during the 1980s presented the science-based television show Tatzpit.

What he says:
"Italy is known for its enormous morbidity in respiratory problems, more than three times any other European country. In the US about 40,000 people die in a regular flu season ... In every country, more people die from regular flu compared with those who die from the coronavirus.

… there is a very good example that we all forget: the swine flu in 2009. That was a virus that reached the world from Mexico and until today there is no vaccination against it. But what? At that time there was no Facebook or there maybe was but it was still in its infancy. The coronavirus, in contrast, is a virus with public relations.

Whoever thinks that governments end viruses is wrong."
– Interview in Globes, March 22nd 2020




Dr Pietro Vernazza: 
is a Swiss physician specializing Infectious Diseases at the Cantonal Hospital St. Gallen and Professor of Health Policy.

What he says:
"We have reliable figures from Italy and a work by epidemiologists, which has been published in the renowned science journal ‹Science›, which examined the spread in China. This makes it clear that around 85% of all infections have occurred without anyone noticing the infection. 90% of the deceased patients are verifiably over 70 years old, 50% over 80 years.

In Italy, one in ten people diagnosed die, according to the findings of the Science publication, that is statistically one of every 1,000 people infected. Each individual case is tragic, but often – similar to the flu season – it affects people who are at the end of their lives.

If we close the schools, we will prevent the children from quickly becoming immune.

We should better integrate the scientific facts into the political decisions."
– Interview in St. Galler Tagblatt, 22nd March 2020




Frank Ulrich Montgomery: 
is German radiologist, former President of the German Medical Association and Deputy Chairman of the World Medical Association.

What he says:
"I’m not a fan of lockdown. Anyone who imposes something like this must also say when and how to pick it up again. Since we have to assume that the virus will be with us for a long time, I wonder when we will return to normal? You can’t keep schools and daycare centers closed until the end of the year. Because it will take at least that long until we have a vaccine. Italy has imposed a lockdown and has the opposite effect. They quickly reached their capacity limits, but did not slow down the virus spread within the lockdown."   – Interview in General Anzeiger, 18th March 2020




Prof. Hendrik Streeck: 
is a German HIV researcher, epidemiologist and clinical trialist. He is professor of virology, and the director of the Institute of Virology and HIV Research, at Bonn University.

What he says:
"The new pathogen is not that dangerous, it is even less dangerous than Sars-1. The special thing is that Sars-CoV-2 replicates in the upper throat area and is therefore much more infectious because the virus jumps from throat to throat, so to speak. But that is also an advantage: Because Sars-1 replicates in the deep lungs, it is not so infectious, but it definitely gets on the lungs, which makes it more dangerous.

You also have to take into account that the Sars-CoV-2 deaths in Germany were exclusively old people. In Heinsberg, for example, a 78-year-old man with previous illnesses died of heart failure, and that without Sars-2 lung involvement. Since he was infected, he naturally appears in the Covid 19 statistics. But the question is whether he would not have died anyway, even without Sars-2."   – Interview in Frankfurter Allgemeine, March 16, 2020




Dr Yanis Roussel et. al. :
– A team of researchers from the Institut Hospitalo-universitaire Méditerranée Infection, Marseille and the Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, conducting a peer-reviewed study on Coronavirus mortality for the government of France under the ‘Investments for the Future’ programme.

What they say:
"The problem of SARS-CoV-2 is probably overestimated, as 2.6 million people die of respiratory infections each year compared with less than 4000 deaths for SARS-CoV-2 at the time of writing.

This study compared the mortality rate of SARS-CoV-2 in OECD countries (1.3%) with the mortality rate of common coronaviruses identified in AP-HM patients (0.8%) from 1 January 2013 to 2 March 2020. Chi-squared test was performed, and the P-value was 0.11 (not significant).

…it should be noted that systematic studies of other coronaviruses (but not yet for SARS-CoV-2) have found that the percentage of asymptomatic carriers is equal to or even higher than the percentage of symptomatic patients. The same data for SARS-CoV-2 may soon be available, which will further reduce the relative risk associated with this specific pathology"   – “SARS-CoV-2: fear versus data”, International Journal of Antimicrobial Agents, 19th March 2020




Dr. David Katz: 
is an American physician and founding director of the Yale University Prevention Research Center

What he says:
"I am deeply concerned that the social, economic and public health consequences of this near-total meltdown of normal life — schools and businesses closed, gatherings banned — will be long-lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order."   – “Is Our Fight Against Coronavirus Worse Than the Disease?”, New York Times 20th March 2020




Michael T. Osterholm:
is regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

What he says:
"Consider the effect of shutting down offices, schools, transportation systems, restaurants, hotels, stores, theaters, concert halls, sporting events and other venues indefinitely and leaving all of their workers unemployed and on the public dole. The likely result would be not just a depression but a complete economic breakdown, with countless permanently lost jobs, long before a vaccine is ready or natural immunity takes hold.

[T]he best alternative will probably entail letting those at low risk for serious disease continue to work, keep business and manufacturing operating, and “run” society, while at the same time advising higher-risk individuals to protect themselves through physical distancing and ramping up our health-care capacity as aggressively as possible. With this battle plan, we could gradually build up immunity without destroying the financial structure on which our lives are based."   – “Facing covid-19 reality: A national lockdown is no cure”, Washington Post 21st March 2020




Dr Peter Goetzsche: 
is Professor of Clinical Research Design and Analysis at the University of Copenhagen and founder of the Cochrane Medical Collaboration. He has written several books on corruption in the field of medicine and the power of big pharmaceutical companies.

What he says:
"Our main problem is that no one will ever get in trouble for measures that are too draconian. They will only get in trouble if they do too little. So, our politicians and those working with public health do much more than they should do.

No such draconian measures were applied during the 2009 influenza pandemic, and they obviously cannot be applied every winter, which is all year round, as it is always winter somewhere. We cannot close down the whole world permanently.


Should it turn out that the epidemic wanes before long, there will be a queue of people wanting to take credit for this. And we can be damned sure draconian measures will be applied again next time. But remember the joke about tigers. “Why do you blow the horn?” “To keep the tigers away.” “But there are no tigers here.” “There you see!"   – “Corona: an epidemic of mass panic”, blog post on Deadly Medicines 21st March 2020