Coronavirus - worldwide spread and control

That's an interesting study. It estimated the number of influenza-attributable excess deaths at around 20.000 - 25.000 per year in Italy. Given that COVID-19 lead to a death toll of more than 10.000 in about two months, this seems to indicate that COVID-19 is much more deadly than the common flu (which already makes lots of victims). I wonder what 'skeptics' like Ioannidis or Gotzsche would make of that.

On a related note, I noticed that the Centre for Evidence-Based Medicine (CEBM) has published an opinion piece by Tom Jefferson and Carl Heneghan that includes the following nuanced statement:

The Centre for Evidence-Based Medicine says it "develops, promotes and disseminates better evidence for healthcare" so I'm not sure what this is doing on their website.

 

I still think there could be external factors, modulating the impact from the virus. E.g. the colder North America is not as mild as Europe with its gulf stream. On the southern half of the world its now turning autumn-like, what ever this could mean. And climate might be only one parameter among others, and for example searching in Iran.

Still another question is how the morality will show to have changed. This morning German virologist Gantis - another expert - said, he don´t want to sound cynical, but it can be that the people who have died or are dying now were to die within the next few months anyway, and this question can only be answered from hindsight. I am not sure, I just saw on BBC some expert (?) saying, be careful with interpreting these numbers, though I only got the last sentences and he might not have said the same as Gantis.

On BBC the tiny rest I heard was also on health carers who have died when dealing and being infected with the virus. I am inclined to think that this is tragic and may be avoidable. I don´t know if there are any statistics are (probably not). This is a new virus, and accidents happen, it would better though to anticipate things and hopefully avoiding accidents.

The virus is teaching a hard lesson, but I think it is still much more unclear than it might seem.

 

But this year it was commonly a very mild season in comparision to otheres, normal and heavy ones. And the season has just been now, so numbers would have occured now, not over the whole year. So maybe 5.000 per months or so. And then we were - so far - still within normality.

So this might even contribute to the decline of the number of complications with this new virus, seen in some countries right now (and if continuing).

This question is not a medical one. I am getting a fan of Streeck, he said that as a virologist he can not do any recommendations, this is a task for politicians, but he as a citizen indeed has an opinion (on the other side this should only be normal). I personally find their statement [in some sense] reasonable enough, but it´s not up them to make any. Otherwise the evidence of medicine may recommend to do more market or to do more socialism ...

 

We already know this from the southern hemisphere data. Temperatures in most parts of Australia were high at the time the infection took off (now looking well under control, but not for reasons of temperature). Temperatures in the 30s or even 40s are not uncommon in March in many parts of Australia, and this even includes Melbourne, the most southern mainland city.

 

Presumably we don't yet know what the Covid 19 death rate would if everyone has ready access to fully available appropriate medical support. There is presumably going to be a particular death rate for that scenario, and then once the medical system hits is capacity limit, then the death rate would rocket due to lack of medical care. There will also likely a secondary, but no less heart-breaking, increased death rate for people with other life threatening conditions who would normally have been saved by the health services, but were not due to the over-capacity problem.

 

Surely this is not beyond the wit of experts to compare the normally expected death rate with what is happening now? Medical statisticians must have a very good insight into what figures would normally be expected.

 

I think this is a message that could easily be lost in transmission - the key is to look at all-cause mortality trends over time. The lockdown also has both positive and negative impacts on death rates due to reasons other than the virus itself - less motor vehicle deaths, more suicides, lack of medical care for other illnesses and so on.

 

Every major problem that concerns me in the world has an exponential growth. People in daily life are used to seeing linear growth. Trying to convince people who have no mathematical training is difficult, but they could dive into the subject and come out understanding ... but in my experience most don't do that.

Exponential growth is counter-intuitive. Its not the kind of problem we are intuitively able to see. The brain just does not do exponential. Every time it comes as a surprise to those without training, sometimes alarming. Hence warnings are seen as alarmist. I have had no success in getting someone I know who is quite intelligent to even consider the issue.

A problem, to me, with the viral response curve (hint: what does it mean for something on social media to go viral?) is that its so counter-intuitive that people naturally do not take it seriously, even though its very predictable. The very phrase "go viral" is indicative. In nature these events occur frequently, and with living species unable to change their fate it sometimes results in die-back or extinction. It increases until a natural limit is found.

Fortunately we have the capacity to change our fate, to impose a human made limit. However this requires action, and everyone needs to be part of the solution.

 

Just ask yourself in what normal year do the morgues overflow into makeshift morgues, with bodies stacking up so fast they cannot be buried fast enough to cope?

 

I was surprised by how polemical parts of that were.

This BMJ piece from 2nd April quotes from it, and talks about data from China which could indicate asymptomatic cases are much more common than had been thought: https://www.bmj.com/content/369/bmj.m1375

A rapid response claims that those figures are a result of a misreading:

https://www.bmj.com/content/369/bmj.m1375/rr-9

All of these sorts of things remind me how little I'm really confident of!

 

NZ growth curve (log scale) to today:

 

I think it was yesterday when German director of the Robert-Koch-Institute Wieler said that we are now about at R=1, so each infected person would infect one other. And then he said it should be less than 1, obviously conveying that then the virus would fade away.

But how does he know that we are about at R=1, the tests they do will hardly catch all infected persons, so an underdetermination is taking place, and we don´t know how much underdetermination it is. A Chinese modulation even estimates that 20% of inhabitans in Wuhan have been infected so far, way above the given tests (it might be wrong, of course).

So how can Wieler say that we are at R=1. And how can he draw any strategy to deal with the virus from this non-fact? I was speechless.


A tiny bit later in a press conference. The speaker of the Ministry for Health was asked and answered that they (and the official Robert-Koch-Institute) don´t intend to estimate how many people of the population already had been come in contact with the virus. I couldn´t believe it. I though ask myself, might it be 1%? 5% 10% 15%? And the officials, any interest? What´s up next?


True, nobody even CAN know what situtation we are in. But this seems to be too complicate to admit. I rather don´t know why. It is completely normal that we currently don´t know what´s up with this virus.

I though think that being interested in the statistics of mortality would be currently of quite some importance, especially for these and surrounding months. But Wieler said that he thinks that even more people would die from Covid, because not every infected person will be identified. Making a possibly non-problem even bigger.

This is illogic thinking (from the director of the CDC).

hmm

acute respiratory diseases in Germany (no death rate though)



death rate in Italy



I stole these three from pamoija at PR, I don´t think it´s any fake. Likewise:

 

This article highlights issues with timescales in reporting numbers- impacts on the accuracy of assessing where we are on curve.

https://www.theguardian.com/world/2...about-the-uks-coronavirus-death-toll-is-wrong

 

A really interesting -- and old -- piece in the New York Review of Books about an outbreak of cholera in Hamburg in the 1890s in which the intersection of politics, economics, and medicine created a public health catastrophe. Eerie similarities to how governments are grappling with COVID19. What I found most interesting was how the medical profession was still resisting germ theory and followed their contemporary medical media tart Dr. Max von Pettenkofer, who believed the problem was miasma rather than Robert Koch, of Koch's postulates fame and discoverer of the TB, who understood that it was likely bacteria in the water causing the problem. Cities leaders went with Pettenkofer because it meant less threat to the economy. I sense the problem we have today is less a problem with the medical community believing in multiple theories and more an issue of those who know math and those who don't.

 

Its an old chart, so the line for each country stops on the day the chart was made. Its value is that is plots number of cases relative to the same timepoint in other countries (after the first 100 cases were detected).

For my purposes the relevant comparison is between our line and the other countries up to day 13. Will work on a more up-to-date version of that to plot against ours.

 

@Hutan, I did this one by hand on excel, from the worldometer spreadsheet, which you can download (but I used our official figures, which include probable cases, rather than what the worldometer had).

 

This is why leaders are supposed to listen to experts, and why they should choose experts who will tell them the real truth, without fear or favour.

 

I see homeopathy as being nothing more than a placebo, and I very much doubt a placebo could influence Covid 19 symptoms. But he may well have used it nonetheless, and may be convinced it helped. I imagine that being given the best possible chances of good health, and any existing conditions being inevitably best managed, would presumably help. And there is certainly not going to be any issue of limited medical resources if they were needed. But as you know, I have no medical training, so just my thoughts.