A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

Stat News ^ | March 17, 2020 | John P.A. Ioannidis

[daniel1212]

The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.

At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

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.

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. 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.

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%)....

[daniel1212]

See my last post above. How can New Jersey report 1,661 tests and 1,327 positives (+ 16 deaths), likewise Alabama with

152 tests and 124 positives, while states like California have done 12,528 tests with just 1,279 positives?

[Lowell1775]

Ping

[ladyjane]

We should know in about two weeks if all of this was overreaction.

You will never know. We'll only know if we didn't do enough.'

If we didn't do enough, as Megyn Kelly said on live tv, "you can kiss your $$ goodbye."

BTW Megan said that on live tv about 5 years ago about a dirty bomb in Times Square.

[RummyChick]

Not being a statistical person this is how I view it:

There are many many many cases of people with this that dont know they have it. Some are super spreaders..some think they have colds...etc

Some of those will cure up fine never realizing it.

Others will have to go the hospital.

Many people died from it that we dont know...chalked off to pneumonia.

What we do know is that it is about to overwhelm the health system.

What we do know that it is Wuhan roulette. You may get the mild kind..you may get the glass in the lungs pain level 15 kind.

So take precautions and have your plan ready if you think you have it.

And for me and my extended family...no taking Ibuprofen

[LegendHasIt]

They DON’T WANT reliable data.

That might get in the way of forcing their agenda on us.

[DouglasKC]

THis guy might not have all the data but I’m certain President Trump and his team do.

[kjam22]

Watching these virus experts is like watching storm chasers in oklahoma. Most are pretty decent people, but they are really hoping for a big storm....

[MeneMeneTekelUpharsin]

Probably true, but if you say it, people (especially liberals) want to kill you.

[amorphous]

:)

[TChad]

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers.

That should have happened, but did not. A large number of passengers refused to be tested.

https://abc7.com/6031214/

From the link above:

"Only 300 of the passengers at Travis took the test; 545, including the Kilcullens, refused."

Thanks heaps, passengers.

Passengers from the Grand Princess were transferred not just to Travis AFB, but to other locations. I do not know how many of the latter refused to be tested.

Since a possibly substantial portion of patients with COVID-19 show minimal or no signs of illness, I was looking forward to seeing the results of testing from the big cruise ships -- testing that included all passengers. The policy has been: Don't test people who have no signs or symptoms of the disease. There are good reasons for that policy, but it might -- just might -- miss many infected people. One good place to look for such patients was on the Grand Princess. Apparently that opportunity has been lost.

[Fitzy_888]

Consider, what are the life and health risks of 15 - 20 - 25 percent unemployment? Alcoholism, drug abuse, spousal/child abuse, child neglect, despair and OPPORTUNITY COST. At some point prevention of spread will be more costly than spread. I don’t think we’re there, but we will be soon.

Ok...so this is going to sound very cruel, but if your over 70 years old you’ve lived. You can’t rob younger generations of prosperity...the young their opportunity. (Besides, you’ve already left them $20 trillion in debt.)

Hate away on me!

[daniel1212]

Passengers from the Grand Princess were transferred not just to Travis AFB, but to other locations. I do not know how many of the latter refused to be tested.

As i understand it, those who refused to be tested did so so they could go home rather than imprisoned if they tested positive.

[Grampa Dave]

Cepheid Receives Emergency Use Authorization from FDA for Rapid SARS-CoV-2 Test

First Rapid, Point-of-Care and Near-Patient Molecular Test for Detection of Virus that Causes COVID-19

SUNNYVALE, Calif., March 21, 2020 /PRNewswire/ — Cepheid today announced it has received Emergency Use Authorization (EUA) from the U.S. Food & Drug Administration (FDA) for Xpert® Xpress SARS-CoV-2, a rapid molecular diagnostic test for qualitative detection of SARS-CoV-2, the virus causing COVID-19. The test has been designed to operate on any of Cepheid’s more than 23,000 automated GeneXpert® Systems worldwide, with a detection time of approximately 45 minutes.

“During this time of increased demand for hospital services, Clinicians urgently need an on-demand diagnostic test for real-time management of patients being evaluated for admission to health-care facilities. An accurate test delivered close to the patient can be transformative — and help alleviate the pressure that the emergence of the 2019-nCoV outbreak has put on healthcare facilities that need to properly allocate their respiratory isolation resources,” said Dr. David Persing, MD, Ph.D., Chief Medical and Technology Officer at Cepheid. “By leveraging the design principles of our current Xpert Xpress Flu/RSV cartridge technology, in which multiple regions of the viral genome are targeted to provide rapid detection of current and potential future variants of SARS-CoV-2, we have developed a test that provides reference lab-quality results in multiple settings where actionable treatment information is needed quickly.”

“Cepheid currently has nearly 5,000 GeneXpert® Systems in the US capable of point-of-care testing and for use in hospitals,” said Cepheid President Warren Kocmond. “Our automated systems do not require users to have specialty training to perform testing — they are capable of running 24/7, with many systems already doing so today.”

The test will begin shipping next week.About Cepheid

Based in Sunnyvale, Calif., Cepheid is a leading molecular diagnostics company that is an operating company within Danaher Corporation’s (NYSE: DHR) Diagnostics platform. Cepheid is dedicated to improving healthcare by developing, manufacturing, and marketing accurate yet easy-to-use molecular systems and tests. By automating highly complex and time-consuming manual procedures, the company’s solutions deliver a better way for institutions of any size to perform sophisticated genetic testing for organisms and genetic-based diseases. Through its strong molecular biology capabilities, the company is focusing on those applications where accurate, rapid, and actionable test results are needed most, such as managing infectious diseases and cancer.

For more information about Cepheid’s Xpert Xpress SARS-CoV-2 test, please visit www.cepheid.com/coronavirus. For more information, visit http://www.cepheid.com

[MAGAthon]

not only is Ioannidis correct - there is no reliable data - but scaremongerer Lipsitch who spread the story up to 70% of the world’s population would become infected, agrees Ioannidis is correct - there is no reliable date. nothing more to be said. everything is conjecture.

18 Mar: StatNews: We know enough now to act decisively against Covid-19. Social distancing is a good place to start
By Marc Lipsitch
(Marc Lipsitch, D.Phil., is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Center for Communicable Disease Dynamics)
In a recent and controversial First Opinion, epidemiologist and statistician John Ioannidis argues that we lack good data on many aspects of the Covid-19 epidemic, and seems to suggest that we should not take drastic actions to curtail the spread of the virus until the data are more certain.

He is absolutely right on the first point...
https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/

[MAGAthon]

Wikipedia: John Ioannidis
In addition, he has pioneered the field of meta-research (research on research). He has shown that much of the published research does not meet good scientific standards of evidence.
Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper “Why Most Published Research Findings Are False” is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science.”…
https://en.wikipedia.org/wiki/John_Ioannidis

[caww]

Very Short video of ‘reality’ sky news put out ...it’s plenty for anyone to understand what this is about.

https://www.youtube.com/watch?v=INmEciVm-6Q

[fireman15]

What we do know is that it is about to overwhelm the health system.

I was the member of a big city fire department for 25 years. My crews and I rode to the hospital in the back of cramp recue units with people with contagious respiratory ailments more times than I can remember.

I called my best friend who is a battalion chief on the department that I retired from to ask how things were going. One of the biggest problem they have been having is many, many calls from young people with no history of health problems and no symptoms who believe they have been exposed for various mostly irrational reasons. Even though Washington State is where this was first introduced by the huge population of recent Chinese immigrants tens of thousands who returned home for Chinese New Year... and we have the most per capita cases... we do not have the resources or capability to test people who have no symptoms and are not in a group that would be at risk even if they did.

We have no clue if it is likely that hospitals will be overwhelmed with actual serious cases. Since it has been going around this community for nearly three months with no more respiratory emergencies than in a normal flu season it seems a stretch. Although the hospitals just like the fire departments are facing a challenge dealing with thousands of fearful young people with no symptoms and no medical history who want to be tested.

[TChad]

As i understand it, those who refused to be tested did so so they could go home rather than imprisoned if they tested positive.

I read that too. Yet had they tested positive, they also might have been TREATED. Prison is vastly preferable to COVID-19 pneumonia.

They had a chance to provide very useful new information about a disease that has fueled a global pandemic. They did not know for sure whether or not they were infected, and they did not know whether or not they could infect and perhaps kill others.

A few swab samples, a wait of a few hours or a day, and most of them would have gone home with no worry about whether or not they were infectious. Also, they would have known that they had done their part for humanity.

Instead, they declined to be temporarily inconvenienced. It was massively selfish. Also, since possibly effective treatments now exist for COVID-19 infection, it was very stupid.

There is a good chance that none of them were infected. I hope that is eventually proved. The alternatives might be ugly.

[MAGAthon]

President Trump should add Prof Ioannidis to his coronavirus team. let him and Fauci fight it out.

after all, Fauci made it clear below he didn’t have a clue about the numbers - nobody does - so why is he trying to shut down the US economy indefinitely?

28 Feb 2020: New England Journal of Medicine: Covid-19 — Navigating the Uncharted
Authors: Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.
In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%)...
http://pennstatehershey.adam.com/content.aspx?pid=35&gid=11984

28 Feb 2020: Penn State Hershey: Health Day: China Study Puts Coronavirus Death Rate at 1.4%; Real Number May Be Lower
Source New England Journal of Medicine
By E.J. Mundell
That’s much higher than the rate seen with the seasonal flu, where only about 0.1% of cases end in death. But it’s far below the mortality rate of recent coronavirus outbreaks like SARS (9 to 10%) or MERS (36%), noted Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID).
Furthermore, the 1.4% figure cited in the new Chinese report, published Feb. 28 in the New England Journal of Medicine, is probably higher than the “real” death rate, Fauci added.
“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%,” Fauci and his colleagues explained.
“This suggests that the overall clinical consequences of COVID-19 ***may ultimately be more akin to those of a severe seasonal influenza pandemic [which has a case fatality rate of approximately 0.1%] or a pandemic influenza [similar to those in 1957 and 1968],” the experts wrote...
http://pennstatehershey.adam.com/content.aspx?pid=35&gid=11984

21 Mar: UK Independent: Coronavirus: Top health expert appears to do face palm after Trump mentioned ‘deep state’ during press conference
Nation’s leading health expert seemingly reacts to president’s bizarre attacks during Covid-19 update
by Chris Riotta, New York
On Friday, he (Fauci) once again avoided becoming a part of the president’s politically-charged statements and instead focused on the issue at hand, warning Americans that they would likely have to continue self-isolating for the ***foreseeable future.
https://www.independent.co.uk/news/world/americas/coronavirus-trump-briefing-dr-anthony-fauci-face-palm-a9416111.html

[daniel1212]

Consider, what are the life and health risks of 15 - 20 - 25 percent unemployment? Alcoholism, drug abuse, spousal/child abuse, child neglect, despair and OPPORTUNITY COST. At some point prevention of spread will be more costly than spread. I don’t think we’re there, but we will be soon. Ok...so this is going to sound very cruel, but if your over 70 years old you’ve lived. You can’t rob younger generations of prosperity...the young their opportunity. (Besides, you’ve already left them $20 trillion in debt.) Hate away on me!

Well, if some perspective is allowed, without marginalizing those suffering from Covid-19 and the need for prevention and treatment:

About 6 million motor vehicle accidents happen every year in America, with over 6,000 per day suffering injuries or disabilities , and over 90 Americans a day dying as a result. Teens aged 16-19 experience motor vehicle crashes higher than any other age group, and are nearly three times more likely than drivers aged 20 and older to be in a fatal crash, yet drivers age 80 and older have the highest rates of driver deaths. The economic and societal harm from motor vehicle crashes amounting to a whopping $871 billion in a single year!

Therefore henceforth travel is to be restricted to only essential needs, and street distancing of 6 car-lengths should be practiced when doing so, and otherwise all motor vehicle are to be garaged-in-place until a solution (bumper cars?) is found to prevent this dangerous and often deadly viral-vehicle transmission.

The media will provide a running tally of accidents and fatalities per state, increasing daily as more comprehensive monitoring takes place, and official will provide daily updates on this war.