A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data By John P.A. Ioannidis March 17, 2020

https://www.statnews.com/2020/03/17/...reliable-data/



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.
Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?
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Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.


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.




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%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.





That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
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. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11% of those hospitalized in the U.S. with lower respiratory infections each winter.
These “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. Instead, they are lost as noise among 60 million deaths from various causes every year.
Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases. In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths.
Note the uncertainty about influenza-like illness deaths: a 2.5-fold range, corresponding to tens of thousands of deaths. Every year, some of these deaths are due to influenza and some to other viruses, like common-cold coronaviruses.
In an autopsy series that tested 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 kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” 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. The media coverage would have been less than for an NBA game between the two most indifferent teams.
Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.
In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work. School closures, for example, may reduce transmission rates. But they may also backfire if children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease.
This has been the perspective behind the different stance of the United Kingdom keeping schools open, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
Flattening the curve to avoid overwhelming the health system is conceptually sound — in theory. A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment.


Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.
One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.
The vast majority of this hecatomb would be people with limited life expectancies. That’s in contrast to 1918, when many young people died.
One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.
John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.

Comment - a sobering article from a well recognized and respected educational institution. and hardly a Trump proxy. And a respected epidemiologist.
Points- we are operating under assumptions made with very little data to conclude the actions of shutting down the economy are necessary and indicated. The consequences may be severe for the economy and last years. Data as interpreted by Dr. Ioannidis indicates the need for better data, and a very reasonable interpretation that the case fatality rate is much lower than the 4% trumpeted in the LSM.


China now reports -"No new cases of covid-19" - and anyone who believes China needs to get in line to purchase the Brooklyn bridge. It "FACT" that this Covid-19 virus originated in Wuhan China - and China is stonewalling the world to evade its' responsibility for denying the viral outbreak in Wuhan, trying to suppress the doctors who reported the outbreak, and exporting the virus on airplanes to many other countries as the virus spread in China.

LSM and fascist DPST's are now parroting the Chinese effort to coverup, and calling naming the Virus "Wuhan virus" as racist - doing the Chinese aid and comfort in their coverup to evade their responsibility. not to mention attacking Trump as "murderer" for the viral outbreak, and holding trump responsible for the virus mutation and origination in China!.

LSM and Fascist DPST's have no shame in their Lies.

Hear that - J666 and ilk???

I seriously doubt any of the Fascist DPST posters on site will read, much less understand/comprehend Dr. Ioannidis article. We will see the usual "fake news" because this does not jibe with the Fascist DPST "narrative" that includes mandating the economic shutdown they have been praying for in their hatred for Trump. All this shut down by the governments may well be not indicated.


At least there is some progress - Quinine in its' various forms may be of some benefit - the studies are out of china - untrustworthy - and korea. There are some lab cell studies of mechanism of action. But, enough information on a FDA approved anti-malarial drug to fast-track clinical studies - and the drug can be used "off-label" for severely affected patients.

Perhaps a treatment "might" be in the offing.


Now for the chorus from the unthinking China parroting numbskulls of the Fascist DPST Party, and ChiCom Party - this does not fit their Orwellian narrative - so "Fake news"!
Right j666 and ilk?!!!



Author - John P.A. Ioannidis

jioannid@stanford.edu
@METRICStanford

You’re 10-ply, bud.

Nobody here has the attention span to read a 10,000 word cuts and pastes, and yous know it.

Yous have Trump to thank for that.

If yous can’t say it in 280 characters, you’d obviously can’t say it.

LOLLING!

Great article, exactly what every medical professional I talk to thinks. We’re purposefully trashing the economy for no reason, unless you’re a democrat of course and rooting for maximum death and impoverishment.

Exactly right J - the Fascist DPST revel in absolute control - and the devastation of the economy - and are playing into the hands of Putin and China.

Great article, exactly what every medical professional I talk to thinks. We’re purposefully trashing the economy for no reason, unless you’re a democrat of course and rooting for maximum death and impoverishment. Originally Posted by Jacuzzme

You're right. We are getting information from the MSM and they are giving us exaggerated information on this pandemic in terms of it's spread, number of cases and deaths. Question everything, that's the way I see it. Get some cash and have it on hand. It wouldn't surprise me if their next step would be to fake a computer glitch and the Banks close down. I think there is something shady about this incident and it's more than just a virus.

China and Xi are trying to change the facts of the virus origination in Wuhan - and the LSM is playing in their corner. Altering historical fact benefits Xi in his efforts to evade responsibility for the viral outbreak - and blame the US for originating the virus.

The biologic warfare center in Wuhan - has been postulated as the viral source - and obviously no cooperation from China. Was this virus deliberately cultured and released in an effort to create this Fear Pandemic and economic collapse.??
China is not cooperating - and the LSM are cooperating and giving aid and comfort to China.

Hopefully Quinine is a treatment - and that might go a long way to reverting all the government restrictions back to normal.

except on East and west coast Fascist DPST enclaves - those leaders like the total control - and will be loath to give up their rule by fiat. Totalitarians do not change - they have One goal- Total fascist DPST Control - and to be controlled by China and Russia.

Just watch the latest news conference with virtually every reporter in the room more concerned about Trump calling it the China virus than how much of this is China's fault and how China continues to downplay their role in all this. The media is more concerned with "xenophobia" than holding China responsible for their initial reactions and their actions now.

You’re 10-ply, bud.

Nobody here has the attention span to read a 10,000 word cuts and pastes, and yous know it.

Yous have Trump to thank for that.

If yous can’t say it in 280 characters, you’d obviously can’t say it.

LOLLING! Originally Posted by HoeHummer

Oeb 11 is obviously bored and just likes to peddle some kind of gobbledegook.i guess these folks are convinced it’s all a hoax and overblown. Even a Trump has changed his tune. The whole country could be shut down..

Contrary to what these Trump sheep think and accuse the Dems..
8 REPUBLICAN Senators voted against the $850 bn aid package to help folks weather the crisis.
Marsha Blackburn TN, Jim Inhofe OK, Mike Lee UT, Rand Paul KY,
Ben Sasse NE, Tim Scott SC, Ron Johnson, WI.

These are the real culprits and have shown their vicious hatred of the American people, as well as hatred of their country...I don’t know how these people can sleep at night not wanting to help regular folks who have been laid off their jobs and have bills to Pay.
Let’s hope they get voted out in disgrace.

Lots of good can and, with Trump as President, likely will come of this. China controlling a large percentage of our medications and supplies is completely unacceptable. We’ve managed to become energy independent, medically independent needs to be a top priority.

HF and J - +1.

Agree entirely!

China and Xi are trying to change the facts of the virus origination in Wuhan - and the LSM is playing in their corner. Altering historical fact benefits Xi in his efforts to evade responsibility for the viral outbreak - and blame the US for originating the virus.

The biologic warfare center in Wuhan - has been postulated as the viral source - and obviously no cooperation from China. Was this virus deliberately cultured and released in an effort to create this Fear Pandemic and economic collapse.??
China is not cooperating - and the LSM are cooperating and giving aid and comfort to China.

Hopefully Quinine is a treatment - and that might go a long way to reverting all the government restrictions back to normal.

except on East and west coast Fascist DPST enclaves - those leaders like the total control - and will be loath to give up their rule by fiat. Totalitarians do not change - they have One goal- Total fascist DPST Control - and to be controlled by China and Russia. Originally Posted by oeb11

I don't have a link readily for this article.

there's a group of scientists who've studied the covid19. they say there's no evidence that its bio-engineered.

it appears to be naturally occurring.

they say, a virus would have a "tell" if it was bio-engineered.

from what they are saying they analyzed the DNA of the virus and determined that it came from a bat or a pangolin (armored ant eater thats common in asia).

at some point the virus cross-jumped to a human.

it apparently came out of the chinese wet market.

HF and J - +1.

Agree entirely! Originally Posted by oeb11

Its the Flu -- Trashing the economy to get Big-T The numbers Don't add up to the end of the world like the LSM is hoping for ,,,,,,,,,,,,,,,,,,,,,,,,,,

Its the Flu -- Trashing the economy to get Big-T The numbers Don't add up to the end of the world like the LSM is hoping for ,,,,,,,,,,,,,,,,,,,,,,,,,, Originally Posted by rexdutchman

Here are the Fascist DPST's and faux handles - trashing a scholarly article from a Stanford professor.
Why - they cannot comprehend the message, the method, or the presentation of Dr. Ioannidis.

Pathetic idiots - useful only to the Chinese.