Guest Post by Willis Eschenbach [Note updates at the end]
Since the earliest days of the current pandemic, Italy has been the scary member of the family that you absolutely don’t want to emulate, the one cousin that gets into really bad trouble. The Italians have the highest rate of deaths from the COVID-19 coronavirus, and their numbers continue to climb. Here’s the situation today.
Figure 1. Deaths from the COVID-19 coronavirus expressed as deaths per ten million of the country population. Percentages of the total population are shown at the right in blue. All countries are aligned at the date of their first reported death. Most recent daily chart and charts of previous days are available by going here and scrolling down.
Italy, with over six thousand dead, is up well into the blue range. This is the range of annual deaths from the flu in the US. If the US coronavirus patients were dying at the same rate as in Italy, we’d have 38,000 coronavirus deaths by now in addition to the same number of flu deaths …
As a result, there has been much debate about why the Italian death rate is so high. People have suggested that it’s because they have one of the older populations in Europe. Others have noted that they often live in extended families. Some say it’s high numbers of smokers and polluted air. And some have pointed to their social habits that involve touching, kissing cheeks, personal contact during church rituals, and the like.
But we haven’t had good data to take a hard look at the question, or at least I hadn’t seen any.
In the comments to my post entitled END THE AMERICAN LOCKDOWN, wherein I passionately advocate just exactly that, I was given a link by a web friend, Mary Ballon, hat tip to her. It’s a report by a Swiss medical doctor about the COVID-19 deaths in Italy, well worth reading.
And in that document, there’s a further link to an Italian Government report. It’s in Italian of course, I have it on good authority that’s what they actually speak over there, who knew? They reported on the statistics of a large sample of the Italian deaths (355 out of 2003 total deaths at the time of the report). I got it, and the numbers are very revealing.
Let me start with the age distribution of the 2,003 Italians who had died at the time of the report. Figure 2 shows that it’s almost entirely old people.
Figure 2. Age of 2,003 Italians who had COVID-19 at the time of death.
Out of the 2,003 deaths, seventeen were people under fifty, and only 5 people under thirty died, while almost two hundred deaths were of people over 90. I’d read that the people dying in Italy were old, but I didn’t realize quite how old they actually are …
One thing I learned on this voyage was that the Italians distinguished between dying FROM the virus on the one hand, and dying WITH the virus on the other. Once I looked at the state of health of the Italian victims, however, I could see why they had to do that. Figure 3 shows the generous apportionment of serious diseases and conditions among the unfortunates.
Figure 3. Numbers of diseases in the sample of 355 Italians who had COVID-19 at the time of their death.
WOW! Yeah, they all had COVID-19. But three-quarters of them also had hypertension, a third had diabetes, a third had ischemic heart disease, a quarter of them had atrial fibrillation tossing clots into the bloodstream, and so on down the list.
As you can see from Figure 3, some people must have had more than one other disease besides COVID-19. Figure 4 shows the breakdown of the number of other diseases per patient.
Figure 4. Other diseases (comorbidities) of a sample of 355 of the 2,003 Italians who had COVID-19 at the time of their death.
For me, this was the most surprising finding of the entire study. Of all 355 people who died, only three did not have any of the diseases listed above. Three!
Looking at all of this as a whole picture, I had a curious thought about who they were representing. I thought … consider the characteristics of the people who died:
- More of the patients were over 90 than were under 60.
- The average age was 79 years.
- All but three of them had at least one other disease, so basically all of them were already sick.
- Three-quarters of them had two other diseases, and half of them had three or more other diseases. Half!
My thought was … that’s not a sample of the people in the street. That’s not a sample of an Italian family.
That’s a sample of a totally different population.
I was forced to a curious conclusion, both discouraging and encouraging. It is that most of these diseases were probably not community-acquired. Instead, I would hazard a guess that most of them go by the curious name of “nosocomial” infections, viz:
nos·o·co·mi·al
/ˌnōzōˈkōmēəl/
adjective MEDICINE
(of a disease) originating in a hospital.
Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.
And in some fashion, it got into the medical system. Doesn’t matter how. But once there, it was spread invisibly to other patients, in particular the oldest and weakest of the patients. It went from patient to patient, from patient to visitor and back again, and it was also spread by everyone in the hospital from administrators to doctors and nurses to janitors. In many, perhaps most cases, they didn’t even know they were sick, but they were indeed infectious.
And that’s why the pattern of the Italian deaths is so curious, and their number is so much larger than the rest of the world. It’s not a cross-section of the general population. It’s a cross-section of people who were already quite sick, sick enough that they were already visiting doctors and having procedures or being bedridden in hospitals. It was 85-year-olds with three diseases.
And it’s also why the death rate in Italy is so high—these people were already very ill. I can see why the Italians are distinguishing between dying FROM the virus and dying WITH the virus.
DISCUSSION AND CONCLUSIONS
As I said, this is both discouraging and encouraging. It’s discouraging because getting the virus out of a modern medical facility and a dispersed medical system isn’t easy. Italy has a big job ahead. And it’s discouraging because it means that the medical personnel who are so needed for the fight are getting the disease as well. Very likely they won’t die from it, but they will be hors de combat for three weeks or so. No bueno.
On the other hand, it is encouraging in a couple of aspects.
First, it lets us know what we need to do to prevent the Italian outcome. We have to, must, keep the virus out the medical system.
- We need to seriously quarantine the sufferers away from other sick people.
- We need to set up testing facilities at all medical centers and test the medical personnel daily.
- In areas with a number of COVID-19 infections, we need to set up separate field hospitals. There are a number of commercial versions of these that are expandable by adding modules, and are pathogen-tight, with airlocks at the doors, HEPA exhaust filters and negative air pressure maintained throughout. We know how to do this stuff, we’ve just got to do it.
- We need to test in-hospital patients at the time of their arrival and continue to test them at intervals during their stay.
- We’ll have to be very careful with visitors to patients in the hospitals
It’s a big job, and we absolutely have to do it.
Second, it cautions us to not claim that everyone who tests positively for COVID-19 after death actually died FROM the disease. They may very well have died WITH the disease.
Finally, the other reason it’s encouraging that Italy’s infection is likely nosocomial is that it removes Italy as the mysterious bogeyman of the COVID-19 pandemic. In addition, it points to just what we have to do.
IF (and it’s a big if) we take the proper precautions to protect our vulnerable medical system and personnel, I don’t think that the US will get as high a death rate as Italy has today.
Note that this makes me seriously question the idea of “flattening the curve” … if you let the virus into your hospitals and medical system you’re toast, no matter how flat the curve is.
So let’s end this crazy American lockdown, there’s a whole raft of work to be done shoring up our medical sector to withstand the coming wave, and it can’t be done at home with our heads in the sand, hundreds of thousands of people not working, jobs disappearing daily, and our economy in a shambles …
My very best regards to all, stay well in these parlous times,
w.
As Usual: I ask that when you comment, QUOTE THE EXACT WORDS YOU’RE DISCUSSING. Knowing who and what you’re referring to avoids endless misunderstandings and arguments.
[UPDATE]: Just after publishing this, I was reading about loss of the senses of smell and taste being symptoms of coronavirus infection. In the article, I found this:
Hopkins says an Italian doctor shared that “he and many of his colleagues had lost their sense of smell while working in northern Italy dealing with COVID-19 patients.”
… “many of his colleagues”. Kinda support my theory of nosocomial infection in Italy.
[UPDATE 2]: In the news today, the headline Coronavirus: 4,824 Italian Health Workers Are Infected … one in ten of their coronavirus cases are health workers …
[UPDATE 3]: Here’s a graph showing just how different Italy is from the other countries with numbers of cases …
PS—Let me take this opportunity to provide a wider readership to a comment that my obstropulous (yes, it’s a real word) good friend Steve Mosher posted on my blog yesterday. He’s living in Korea and has been a close observer of just how they are succeeding in controlling the virus. He spells out the level and the details of what we have to do. His comment is below, my thanks to him.The key is changing the criteria for testing. Here [in Korea] we test and track.
An employee of a call center in Seoul, was infected.
Office had 207 people.
March 8th. he tested positive.
EVERY person in that office was tested. today 152 have tested positive, they tested floors above and below his floor. Today 3 more from the 11th floor were found and 1 contact.
They are now tracing the contact, and the contact’s contacts. All will be tested. The business was in a residential building. 553 of the people in that building were tested. floors 13-18
This little beastie lives on surfaces for up to 3 days. See that elevator button? the hand rail on the stairs? the bathroom door handle? the coffee cup that pretty girl behind the counter handed you? it’s there. Now in my building we have hand sanitizer by the elevator buttons. you get in the habit of not touching public pretty quickly. Trust me I am not a germ phobe, but the changes have been simple when they are reinforced.
Let me give you a little taste of the highly detailed info we get.
Info that is shared daily in one spot, I will include some of the earlier call center case snippits
“In Daegu, every person at high-risk facilities is being tested. 87 percent completed testing and 192 (0.8 percent) out of 25,493 were confirmed positive. From Daesil Covalescent Hospital in Dalseong-gun, 54 additional cases were confirmed, which brings the current total to 64. In-patients on 6th and 7th floors are under cohort-quarantine.”
“From Guro-gu call center in Seoul, 7 additional cases (11th floor = 2; contacts = 5) were confirmed. The current total is 146 confirmed cases since 8 March. (11th floor = 89; 10th floor = 1; 9th floor = 1; contacts = 54)”
“From Bundang Jesaeng Hospital in Gyeonggi Province, 4 additional cases were confirmed. The current total of 35 confirmed cases since 5 March (20 staff, 5 patients in inpatient care, 2 discharged patients, 4 guardians of patients, 4 contacts outside the hospital). The 144 staff members who were found to have visited the hospital’s Wing no. 81 (where many confirmed cases emerged) were tested, 3 of whom tested positive.”
“Five additional confirmed cases have been reported from the call center located in Guro-gu, Seoul, amounting to a current total of 129 confirmed cases from the call center since 8 March. As of now, 14 confirmed cases in Gyeonggi Province has been traced to have come in contact with a confirmed patient who is a worker at the 11th floor call center at a religious gathering. Further investigation and tracing are underway.”
Test, Trace, Test more.
A random test in Iceland found 1% infected. 50% asymptomatic.
If the US persists in only testing the symptomatic you won’t squash this bug.
Our cases are going up in Seoul. So we will have 15 days of voluntary social distancing.
go to work
stay away from crowds
wash your hands
wear a mask
don’t touch your face
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Interestingly there are 80 countries with corona and without a death.
Surprising which countries as well. Maybe they have a younger , survival of the fittest population.
People generally do not start dying for about a month after the virus enters an area.
A month ago the list of places with known virus was very short.
IOW…give it a while and look again.
Meaning in those countries other communicable diseases lay waste.
So far 2,998,924vCommunicable disease deaths this year.
When Corona is over in a few months who will be thinking of the above.
who will be thinking?
police probably
https://www.npr.org/sections/coronavirus-live-updates/2020/03/24/820711855/spanish-military-finds-dead-bodies-and-seniors-completely-abandoned-in-care-home
just the flu
you prove my point!
millions dying elsewhere.
Stephen, I never thought that I would find myself agreeing with you (referring to Climate Change), but on COVID19 I agree.
Ther are many aspects of COV that make it useless to compare it to Flu, for anyone who thinks this “is just flu” take a look at Worldometer data and pay attention to cases Vs active cases Vs serious/critical cases.
Flu is usually a few days in bed and a week after getting it you are fine, for some it might lead to pnuemonia.
COVID19 is not like that, it is for about 70%-80% of the cases, but for the rest it attacks the lungs and other organs directly as well as leading to viral or bacterial pnuemonia and scepsis, patients spend weeks on ventilators.
This is the cause of the Health System overload, once that point is reached all other critical health deaths also increase, but do not get counted as COVID19, they die because they can’t get critical care.
As to Mr Eschenbachs ideas, I applaud them, especially Quarantine away from current Hospitals.
The western world seems to have forgotten the principle of “Isolation Hospitals”.
Except for his idea of ending the lockdown immediately that is, every country needs a period of time where what he is suggesting has time to be put in place, for the COVID hospitals to be built/erected, for the ambulances to be converted to transfer ICU cases, for equipment & medicine to be made and/or distrubuted, for extra nurses and doctors to be trained in ICU and isolation techniques.
The last because you cannot strip the current hospital ICUs of staff, because all the non COVID cases still need them.
To remove social distancing until you have it in place will mean thousands of extra COVID ICU cases and complete saturation of the current hospitals, which by the way will need complete decontamination once the COVID cases have been removed.
The fact that the Princess Diamond surfaces still have living COVID viruses 17-21 days after the last patient left is scary.
As to applying SK or Singapore type controls it is too late for any country that already has 1000s of cases, it needed to be used when China started exporting the virus to the rest of the world.
For those countries just started on the curve with only a few cases it makes sense to to copy SK or Singapore if they can.
Thanks again Willis for your clarity. I noted on the Order-Order blog yesterday that the head of the Italian Civil Protection Agency, Angelo Borrelli, stated the likely number of infections was around ten times the quoted figure, this reduces the actual death toll to around 1%. Still not good, but less alarming than the near 10% being mentioned elsewhere.
This is correct. The tests are made ONLY to whom shows the symptoms, so we don’t know how many has a virus but symptoms!
To those whom show the symptoms and go and seek medical care. I would imagine most people are now avoiding doing that at all costs until they can no longer breathe on their own.
It is COMPLETELY overblown.
Using the data from the following figure: Figure 4. Other diseases (comorbidities) of a sample of 355 of the 2,003 Italians who had COVID-19 at the time of their death.
We find that only 1 PERCENT of Italians that die WITH COVID-19 (approximately 10% of those confirmed to be infected), were otherwise healthy. (yes it is a small sample,but it is data W chose to present)
So (based on the data presented) the risk of death for an OTHERWISE HEALTHY ITALIAN infected with COVID-19 is .1%
ONE-TENTH of ONE PERCENT
HOWEVER,
Figure 2 shows ZERO deaths under age 30, and 17 between the ages of 30 and 50, with a total number of deaths being approximately 1900 (not the same data set as the 355 from Figure 4)
The bins are rounded, erroneously raising the death rate metric (30-50yrs) to 1.2% from the correct .89%.
Now fun with extrapolations (well, if the media can fear monger by extrapolating data from one place to another I can use it to be reasonable).
If we extrapolate that only 1% of all fatalities are otherwise healthy based on figure 2, we get a HEALTH-ADJUSTED risk of fatal COVID-19 infection for HEALTHY persons between 30 and 50, of
.0089%.
(1% of .89% from Figures 4 and 2)
AND ZERO for people under 30 per Figure 2.
Willis there is a very, very interesting interview in an article ( title: “In der Todeszone”) published yesterday in a German newspaper, the „Süddeutsche Zeitung“. It is with a priest from the little town of Nembro (11,000 inhabitants) about 10 kilometers northeast of Bergamo, until now the most hardly hidden bigger city in Italy. The statement of the priest extremely supports your conclusion „that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.“
The priest states in the interview (translated from German by Google translator):
(Heading of the chapter:) Apparently, however, the epidemic had already spread over a period of time.
“The thing has been around since the beginning of the year – or even since Christmas”
Don Matteo emphasizes that he is not a doctor – and that is why he does not want to go too far. The Vicar of Nembro therefore confines himself to describing the facts that have caused so much devastation in his community.
“We believe,” he says, “that this thing has been going on since the beginning of the year or even since Christmas without being identified. First, the nursing home in Nembro had an increasing number of abnormal deaths: in January, twenty people died of pneumonia “There have been only seven deaths there in the past year. So the number of funerals grew week after week and everyone was talking about this severe pneumonia. Before the carnival, half of the city was in bed with a fever. I remember that we were.” , while we were discussing whether we should hold the celebrations and the parade with the children, had to close the ‘homework room’ because most of the volunteers who looked after the children were sick, but there was no corona virus in Italy at the time. Who knows how many of us were sick and then got well. ”
The article could be findet under:
https://www.sueddeutsche.de/politik/corona-italien-nembro-1.4854246
The article is a translation from the blog:
https://www.mariocalabresi.com/
Let’s keep calm-
Israeli virologist urges world leaders to calm public, slams ‘unnecessary panic’
‘People think this virus is going to attack them all, and then they’re all going to die,’ says Prof. Jihad Bishara. ‘Not at all. In fact, most of those infected won’t even know it’
A leading Israeli virologist on Sunday urged world leaders to calm their citizens about the coronavirus pandemic, saying people were being whipped into unnecessary panic.
Prof. Jihad Bishara, the director of the Infectious Disease Unit at Petah Tikva’s Beilinson Hospital, said that some of the steps being taken in Israel and abroad were very important, but the virus is not airborne, most people who are infected will recover without even knowing they were sick, the at-risk groups are now known, and the global panic is unnecessary and exaggerated.
“I’ve been in this business for 30 years,” Bishara said in a Channel 12 interview. “I’ve been through MERS, SARS, Ebola, the first Gulf war and the second, and I don’t recall anything like this. There’s unnecessary, exaggerated panic. We have to calm people down.
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“People are thinking that there’s a kind of virus, it’s in the air, it’s going to attack every one of us, and whoever is attacked is going to die,” he said.
“That’s not the way it is at all. It’s not in the air. Not everyone [who is infected] dies; most of them will get better and won’t even know they were sick, or will have a bit of mucus.”
But in Israel and around the world, “everybody is whipping everybody else up into panic — the leaders, via the media, and the wider public — who then in turn start to stress out the leaders. We’ve entered some kind of vicious cycle.”
Prof. Jihad Bishara (Courtesy)
He urged the public to internalize that “we’re talking about a virus that is not airborne. Infection is via droplet transmission… Only if you are close to someone who has the virus, and you get the saliva when he sneezes or coughs, can you get ill. And if you don’t then maintain personal hygiene,” primarily by washing hands.
He said the virus did not appear to be “too intelligent” — unlike flu, “which is very intelligent, it changes, adapts, and it infects people via their airway passages.”
Bishara said some of the harsh steps taken in Israel — which has essentially closed its borders, limited gatherings to no more than 10 people, closed all educational facilities, and shut down malls, restaurants and places of entertainment and culture — were motivated by the leaders’ acknowledged awareness that the Israeli health system will buckle under any further strain.
Home quarantine has been ordered for “everyone who has passed by someone who may have been infected by someone else,” he protested, “because they know that our health system cannot withstand coming under any more strain, because we are perennially stretched to the limit.”
Referring to Italy’s national lockdown, he said that “quarantine is an effective precaution, but there has to be temperate use. You can shut down a whole country, but there are other means.”
Prime Minister Benjamin Netanyahu (left) with Health Minister Yaakov Litzman (right) and Health Ministry General Manager Moshe Bar Siman-Tov at a press conference about the coronavirus, at the Prime Minister’s Office in Jerusalem on March 11, 2020. Netanyahu is explaining how the coronavirus can spread from a sneeze. (Flash90)
At this stage, he said, “we know how the virus behaves, how it spreads, and which groups are in danger. We know now that his virus is primarily dangerous to old people, and to people with a history of chronic disease, and those who are immunocompromised.”
Appealing to Israeli leaders “who are appearing every night at 8 p.m. to announce all kinds of steps, some of them very important,” he said, they should “first and foremost calm people down.”
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COMMENTS
The basic problem is…”most people” are scientifically illiterate.
And it is even worse when it comes to medical science.
Comments from people here on this site reveal that to be true.
Many seem willing to throw logic itself out the window when it comes to medical issues.
Even people that in other contexts understand the difference between emotional and logical arguments.
Good work, Willis. I and other Italians reached similar conclusions, but it’s good to see them validated by an external observer that can be regarded as immune from cultural biases and tunnel vision.
However, I think that total of COVID-19 in Italy is much higher than reported, at least by a factor 5, as high as 10. No conspiracy or coverup there, just a heavy sampling bias towards symptomatic cases. This would make mortality rate less outstanding.
That said, also later analyses of the deceased health situation confirm what’s written here: overwhelingly elderly, with a number of pre-existing pathologies, in particular high blood pressure. There is evidence that ACE inhibitors make not only lungs but also myocardium more susceptible to viral attack. The view that the infection spread largely in hospitals (due to lack of proper PPE and isolation procedures) is gaining ground.
Personally I think that coronavirus came in two waves: one, undetected and with lower mortality, hit Italy in the autumn of 2019, when some GPs and medical rescue doctors reported an unusual number of pneumonia cases (again, among the elderly). This first wave induced at least partial immunity to a significant fraction of the population, which reduced the impact of the second and more deadly wave hitting in february.
Willis,
Hopkins says an Italian doctor shared that “he and many of his colleagues had lost their sense of smell while working in northern Italy dealing with COVID-19 patients.”
Influenza- and other viruses can destroy the cells of the olfactory epithelium. The sense of of smell is lost and returns in a few days. I experienced that several times. But there is a chance that the damage is permanent.
Some years ago, at the age of 65, I got a cold and lost my sense of smell on the fifth day. But before that, on the third day, every substance lost its proper smell which was replaced by a strong phantom smell, poorly described as ‘burned acrylic plastic’. On the eighth day a very slow recovery of the sense of smell started, but my sense of smell did not return completely, I estimate a recovery of about 90%.
I learned from your articles that that cold-virus was probably a SARS-virus.
Best to you,
Dirk
So, three sailors aboard a US Navy aircraft carrier have tested positive.
The ship was last in port 15 days ago in Vietnam.
Vietnam currently has 117 active cases listed for the whole country.
Presumably the number was even lower two weeks ago.
Obviously in every place with the virus spreading, the case numbers are the small tips of very large icebergs.
It will probably be two weeks before the Navy knows how many people on that carrier were infected by those three before they became symptomatic and got tested?
How many will those second generation of infected on the ship, infect themselves before they show symptoms.
The progression of a virus which is contagious, highly contagious, long before people show symptoms, and for which half or more get it, spread it, and keep spreading it because they never show symptoms, ever, is predictably very fast.
Obviously something that can infect a planet in a few months can never be stamped out until either everyone has had it, or a vaccine is developed and everyone is vaccinated.
So…we get a vaccine, and a whole subset of people refuse to take it, being antivaxers.
What does the world do with such people?
After all of this, what is the appropriate thing to do?
How “highly contagious” is it, really?
Wuhan has a population of 11 Million people, and LESS THAN 80,000 were confirmed infected, over the course of MONTHS.
COVID-19 is either
A. Highly Contagious –AND — highly asymptomatic
or
B. Not very contagious, actually.
That , despite initial restrictions simply put the whole city in quarantine for the outside. People could still circulate freely in the city.
It started out with zero people.
By the time the number was in the tens of thousands a few weeks into it, behaviors changed.
There are specific instances where one person very efficiently infected many others in a short span of time, and then some of those people infected others in a short span of time.
Is a virus that multiplies from one animal in a cage in late November, to all around the planet and almost certainly millions of people by mid March…at which point an entire industrial civilization ground to a halt in many of it’s sectors, and hundreds of millions of people stopped leaving their home for weeks on end…is that “highly contagious”?
If it is not, what is?
Besides for all of that, Karl offers a totally false dichotomy.
There is no such either/or as the above choices A and B asserts.
What does “highly asymptomatic” mean? Compared to what?
Some large percentage of people who are exposed get an infection which they are able to spread but for which they get either no symptoms of relatively mild ones.
But that sure is not what some other people experience.
The people who die are not the only ones that are being badly harmed here.
Some 20% of the people infected wind up in a hospital, many for several weeks, and many in a fraught struggle for their life.
One, two, and in some cases four weeks of fighting for every breath in order to survive, is not something everyone emerges from unharmed.
Five percent of the people who are infected are winding up in an ICU, and for them it is even more unlikely they will ever be the same again. Something like one in five of them are dying.
And unlike what many seem to think, there are a large number of these people being hospitalized who are not old and are not otherwise sick.
I am pretty sure that if every cold and flu bug going around was landing this many people in such a life or death predicament, we would not have so many people living as long as we have seen in recent decades.
I am also pretty sure that someone with well controlled high blood pressure getting the flu and then dying has not previously been explained away, because that someone had a “comorbidity”.
The co-morbidity seems to be especially high blood pressure in Italy where they heavily prescribe ACE inhibitors and ARBs. We know in full biochemical detail how that opens the door to COVID via the ACE2 receptor.
Still waiting on a QUANTITATIVE VALUE for “highly contagious”
State a QUALITATIVE value, that is supported by EVIDENCE
Put up or shut up.
In the meantime, re-read your Philosophy 101 textbook re: False Dichotomy
Put up or shut up?
Did you really say that to me?
Are you giving me orders, Karl?
Who the hell do you think you are?
You have given zero reasons for anyone to even begin to take you seriously.
I believe that Willis follows the data. He makes decisions on analysis. Willis is one person that leaves his opinion out of his work. It is why his work is so powerful.
Willis is very good at being open about his findings, but there really is no such thing as a person who purely follows the data.
It is a matter of choice what data to investigate.
watch
Korea’s situation was simplified by the fact that the majority of the initially infected people were members of the quasi-Christian sect (forgotten its name) and thus easy to find.
I think there is one chance to get ahead of an outbreak.
We missed ours.
Under normal circumstances, one might trace contacts of people who were going about their day, but how does one do that for people who have been panic shopping in a dense horde or strangers?
Or waiting for 6+ hours to get out the door of an airport, while shoulder to shoulder with thousands of people who just arrived from overseas?
People who should have been sitting at home watching TV were waiting in a mob so they could but three years of TP and hand sanitizer.
Respectfully,
Mr. Eschenbach,
China let people run into and out of Wuhan for quite a long while, before they let them ONLY run around Wuhan.
And there were 60-some-odd thousand cases inside Wuhan, approximately half a percent of the population.
It is my contention that the COVID-19 virus is not a particularly robust, not a particularly contagious, and not a particularly symptomatic virus that quickly burns itself out.
Evidence you presented shows a possible 1% INFECTION rate, yet seasonal influenza is estimated to INFECT 20% of the population EVERY YEAR. (yes I know that = up to 60 Million cases in the US alone, and guess what? INFLUENZA HOSPITALIZES more people in the US EVERY YEAR, than have been infected by COVID-19 WORLDWIDE) -per the CDC
have not read everything yet but wanted to post this as I found it interesting
https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/?fbclid=IwAR0QkEmrIJHo575gU86SUiUpntWD3wD0xoJlnzZ34Ebs8uKmh_jqlNgVnrw
H/T to https://legalinsurrection.com/2020/03/what-about-the-coronavirus-excess-death-rate/
If natural selection because of better medical treatment is postponed you create a huge group vulnerable for anything new. Most American’s native population was killed by new diseases not by war.
What I had to learn today in Germany:
Our son has been averted from a fellow student he worked together in a common project for the university two weeks ago, that she has some possible symptoms of Corona, light fever, than difficulties breathing in.
She phoned the given registration number asking for a test.
She was told, if not having had contact to a verified positiv tested person, a test isn’t possible, b’cause of a lack of kits !
Have to say, I feel well secured here.
“Here’s what I suspect. I think that the COVID-19 disease got established in a couple of areas in Italy well before anyone even knew the disease was there, perhaps even before the Chinese recognized it as a novel disease.
And in some fashion, it got into the medical system”
Thanks Willis for the hard work! I think this is a very plausible hypothesis: that most of Italy’s infections are nosocomial which would explain their abnormal rate of death. I read somewhere about an interview with prof. Remuzzi (?) – not sure I remember correctly the name – who mentioned what he called ‘strange cases of pneumonia’ in Oct-Dec ’19 which could be covid and could explain how the virus got into the hospital chain.
Italy is a full fledged member of the PIGS – see financial history. As is Spain.
However, there really is no proof of isolating those exhibiting symptoms has ever “stopped”, “slowed”, “flattened” the spread of any respiratory flu, cold virus. Only conjecture. These class of viruses are hardy, can last for years on various surfaces, float around in the air ignoring the 6 foot stop signs. What happens is most, if not all, modern Western communities will have every member exposed. Quite possibly by the time even the first case appears at the hospital doors.
There’s a complete disconnect of calling a virus “highly contagious” and “isolate, quarantine” those with proven symptoms. Take another virus labeled “highly contagious” – measles. All it takes to become infected in a classroom setting is for one kid to enter the classroom, sneeze, and all non-vaccinated kids are infected. One kid, entire class, one sneeze, one time. That’s a virus (about the size of all flu and cold viruses – range of 0.1 mircons) that’s highly contagious. One might even say the one sneeze in the classroom exposed all the kids that one time.
Yet popular medicine would have you believe that quarantining, after the fact, only of those with symptoms (and half of those infected never produce symptoms, most of the others too mild to notice) somehow set up an invisible boundary of containment? Toss out the myth flag please.
Same with washing hands or social distancing. For example, meta studies (2016) of clinical trials of hand washing to reduce the incident of flu like symptoms stated there was no statistical difference in washing versus not washing. Washing for bacteria (orders of magnitude bigger than viruses) works due primarily to their size. So wash to get rid of bacteria. Obtw, same with hand sanitizers. Most do not have enough alcohol and then most to not let it stay, wet, on their hands long enough (10+ seconds). Search PubMed.
The only method which might work for quarantine is that proven to work with other mammals – all entries (travelers) entering a nation are isolated in quarantine for 3 to 6 months. You can research the whys. For humans, quarantine could work if (1) we could test all incoming travelers crossing national borders quickly and 100% reliably AND scan all surfaces they carry along which can harbor these viruses (and note, the workers would have to be decontaminated that handle or process the travelers/luggage. Even just shipments would need to be scanned/decontaminated. This simply will never happen in this millennium. Maybe on Star Trek?
What should, and is now feasible considering the huge advances in biochemistry, sequencing, genetic and cellular engineering, would be detection and treatment. We actually have the technology to develop rapid production of anti-bodies when one of these viruses start circulating. Rapid testing is possible but only after initial detection. Capitalism is a perfect environment to reward those that can engineer this technology. Recall how many decades a few years ago they were saying it would take to sequence just one humans genome. Today, with competition and capitalism, it’s done in minutes (see 22andme for example). It’s truly astounding.
Meanwhile, wash your hands, shelter in place, keep social distancing, hoard supplies – in short do the things that comfort you and feel secure in the fact that you’ve already been exposed to the Wuhan along with a host of other respiratory viruses. For the Darwinist, be secure in the knowledge that we’ve evolved fighting, and winning, these viruses for millennia – they’ve even found active corornaviruses at paleo digs from 6,000 years ago.
The country has to work to survive. The human body is the same in a way, if it does not move it will die.
Just a thought about something I know little of, but am curious about:
It involves ACE, which is what I know little of. But I read where many current blood pressure drugs work on the ACE whatevers and that CoVid-19 also involves the ACE whatevers, and that the blood pressure meds could make a person more susceptible to death by CoVid-19 as a result. Then I see that the largest comorbidity is hypertension which made me wonder.
I realize that most older people are dealing with high blood pressure, hence the chart. What I’m wondering is what percentage of the younger people, say 50 and under, also had high blood pressure and were on the meds that deal with the ACE whatevers.
Just putting it out there in case there’s something to it. Sorry I know so little about whatever the ACE is/are.
Angiotensin Converting Enzyme Inhibitors
A large body of evidence indicates that ACE Inhibitors suppress the synthesis and release of TNF-alpha, and IL-1 (interleukin -1). Both cytokines are involved in the regulation of both the immune and inflammatory response to viral challenge.
The link below identifies that ACEi interfere with cytokines, it also mentions the interference is not completely understood.
A hyper-inflammatory response, a weak immune response, or a combination of both could potentially be the cause, but I have not found any explicit ‘smoking gun’.
https://www.sciencedirect.com/science/article/abs/pii/S1043466685700713
“From the call center building in Guro-gu, Seoul, no additional cases were confirmed. The current total is 158 confirmed cases since 8 March. Of the 158 confirmed cases, 97 are persons who worked in the building (11th floor = 94; 10th floor = 2; 9th floor = 1), and 61 are their contacts. The KCDC shared the interim result of their epidemiological investigation in collaboration with Seoul City, Incheon City, and Gyeonggi Province during the monitoring period of 9-22 March. The call center on the 11th floor had the highest infection rate (43.5%), compared to 7.5% and 0.5% for 10th and 9th floors, respectively. There was no confirmed case from other floors. Of the 226 persons identified as family members of the 97 confirmed cases who worked in the building, 34 (15.0%) were infected. Of the 97 confirmed cases, 8 (8.2%) were asymptomatic cases. Of the 16 persons identified as family members of the 8 asymptomatic confirmed cases, no confirmed case was found.”
n Daegu, testing has been completed for every person at high-risk facilities. Of the 32,990 test results, 224 (0.7%) were positive results.
So basically if you target your testing SPATIALLY and follow lines of causation, you have a chance
to wake that mole.
Or you can limit testing to symptomatic people and skew your death rate
“In light of the recent surge in COVID-19 cases in the United States and the rise in the number of imported cases from the US, starting 0:00 of 27 March, a stronger screening process will be applied for inbound travelers from the United States. All symptomatic persons entering from the US, regardless of nationality, will be required to wait for testing in a facility within the airport. Persons who test positive will be transferred to a hospital or “Life Treatment Center”. Persons who test negative will enter self-quarantine at home for 14 days. Korean nationals and foreigners with a domestic residence who are asymptomatic at the time of entry will enter self-quarantine in their home for 14 days and get tested if symptoms begin to occur. Foreigners who are on a short-term visit without domestic residence and thus are unable to self-quarantine will be tested in at a temporary facility. If they test negative, they will be allowed entry under enhanced active monitoring.”
“The Central Disaster and Safety Countermeasure Headquarters will strengthen the management of inbound travelers under self-quarantine. Persons subject to self-quarantine will be issued a self-quarantine notice at the airport. Failure to comply is punishable by imprisonment up to 1 year or a fine up to 10 million won. They are also required to install the self-quarantine mobile app (made by the Ministry of the Interior and Safety) on their phone, so that their local government can monitor their self-quarantine.”
Mosher’s comment to WE got me thinking about the data and CFR. Previously, I had been using the Diamond Princess final report from Japan, knowing it was skewed high by passenger age and viral titer so was an unrealistic worst case.
South Korea now provides a much better statistical figure because of the aggressive testing. WorldoMeter has most of the data. About 270,000 tested, as of yesterday 9037 positive with 20% asymptomatic 14 days after testing positive. So the CFR denominator is known: 120 deaths/ 3507 recovered = 3.4% CFR in a medical system that is NOT overwhelmed like Italy. Not good.
Infection rate in the country using masks and social distancing is 9037/~270000 =3.3%. 5410 active cases. 11% of active cases go to serious (supplemental oxygen) / critical (ventilator). 3.4/11=> ~1/3 of S/C become fatal. Lets hope chloroquine works to change that number towards zero.
Typical social distancing guidance
“In light of the continued emergence of outbreaks in various venues such as religious facilities and workplaces, the KCDC urged everyone to participate in enhanced social distancing campaign for the next 15 days (22 March – 5 April). Citizens are advised to stay home as much as possible other than for going to work, visiting a healthcare provider, and purchasing necessities. Working citizens are asked to maintain a distance from other people during lunch breaks, refrain from using break rooms and other social venues, and pay closer attention to maintaining personal hygiene (e.g. washing hands). Employers are advised to implement various methods of minimizing person-to-person contact for employees, such as reorganizing workspaces to ensure greater distancing and implementing work-from-home and flexible hours systems. Those who show symptoms should be advised not to show up at work. Workers who develop symptoms mid-day should be sent home immediately. The government has also limited the operation of high-risk facilities including religious facilities, some indoor fitness facilities, and nightlife venues. Venues that remain in operation must strictly comply with infection prevention guidelines (e.g. disinfecting, ventilation, distancing, mask wearing) set by the authorities.”
https://coronavirus.1point3acres.com/en
“COVID-19 in US and Canada
Real Time Updates With Credible Sources
This site is made with (heart) by first generation Chinese immigrants”
It has graphs and stats by state and you can click on the map to see details at the county level.
I’m obviously missing something here. I have contracted pneumonia twice from seasonal influenza, 1973 and 2014, both times aged between 15-64. Given less fortunate circumstances, I could died on either occasion. Neither occasion was even remotely pleasant but neither was atypical of a British winter, nor occasioned the shut down of the entire economy
In fact, in 2014/15, 701 people aged 15-64 in Britain did die of influenza, out of 25,143 of all ages. In 2015/16, over 10% of deaths in Britain from influenza were aged 15-64. In 2017/18, 1,462 people aged 15-64 in Britain died from influenza.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/839350/Surveillance_of_influenza_and_other_respiratory_viruses_in_the_UK_2018_to_2019-FINAL.pdf (Table 7)
Coronavirus is, according to the W.H.O., less contagious than seasonal influenza. Its lethality may very well be similar, possibly even a great deal less, given the lack of any clear infection numbers globally. Underlying health conditions, advanced age and obesity, appear to be the common denominators of lethality. Ingestion of harmful chemicals of one sort or another also appears to be a major contributor to fatality. All of this is also true of seasonal flu.
https://swprs.org/a-swiss-doctor-on-covid-19/
So I have a crisp red £50 note that says, once the dust has settled, fatalities in Britain from Flu/Covid 19 2019/20 will prove to have been less than those from seasonal flu in 2014/15 or even 2017/18.
And who will be held responsible for the economic meltdown in progress? That would be no-one……..
Tim
I was watching a news program on TV last night when the reporter asked an epidemiologist how the COVID-19 was different from seasonal flu. It was my judgement that the doctor’s face showed distress at the question. He came back with what I would call a “non-answer.” He said, without any qualifications or explanation, that COVID-19 was worse. If I were the reporter I would have pressed him and asked, “How is it worse? We have fewer cases than seasonal flu (>1,000,000), and fewer deaths than seasonal flu (>30,000). Are hospitals turning away patients because of a lack of resources?” From my perspective, there are a lot of unanswered questions.
Entirely agree. Talked to some people today, at some distance. He was hospitalised with a still undiagnosed respiratory infection in November 2019. His son shows Leeds University students around accommodation. Leeds University has an exchange program with Xi’an Jiaotong University in China….hmmm…….
Leeds has program with Southwest Jiaotong which is in Sichuan not Hubei.
Was there social distancing and lockdowns and handwashing advice for the Flu in either of those UK epidemics?
Where the hospitals completely overloaded?
The WHO lied about COVID19 being transferable by humans (based on Chinese info), they lied about Mask usage and I am pretty sure that they are lying about it being less infectious than the flu, especially considering that there are 4 flu viruses to 1 CORVID19.
Why do you think it is more infectious than the FLU?
Karl,
You give every indication of having absolutely no idea of what you are tanking about, and of being an opinionated blowhard who speaks in absolutes, and of babbling incoherently while demanding information from other people.
Relative values for infectivity are estimates, they vary, and besides there is no general precise consensus value for many viruses.
What exactly do you mean by “infectious”
Are you talking about the Basic Reproduction Number?
Are you talking about how “contagious” it is?
What criteria are you using to disagree so rudely with people here?
This virus is objectively far more “infectious” than any strains of influenza, even Spanish Flu, and certainly seasonal flu strains.
It just is.
Do some reading.
Or cite a source.
Prove it is far more infectious with objective data.
The Diamond Princess falsifies your assertion regarding.
Objective Data —
Spanish Flu Infected 500M out of 1.5 Billion THIRTY PERCENT OF THE WORLD POP
https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html
COVID-19 Infected
500K out of 7 Billion World
60K out of 11.8 Million (Wuhan)
Not even ONE PERCENT
TRY AGAIN
Yes of course with the Spanish Flu they tested 500M people didn’t they?
They guessed the numbers.
The people in the Diamond Princess were in Isolation in their cabins almost from the start and still were infected.
Nobody knows how many people have actually had COVID19 because they haven’t been testing everybody.
” Since the earliest days of the current pandemic, Italy has been the scary member of the family that you absolutely don’t want to emulate, the one cousin that gets into really bad trouble.
The Italians have the highest rate of deaths from the COVID-19 coronavirus, and their numbers continue to climb. ”
Maybe it was recently. But the member we all should by no means emulate is named in between ‘Spain‘, which just bypassed China for the death toll.
This was predictable since days for everybody having followed the situation described at the web site
https://www.worldometers.info/coronavirus/#countries
If instead of producing a logarithm-based chart of the death toll / Mio, Mr Eschenbach would have concentrated on a linear representation of the case / death toll ratio, i.e.
last day’s deaths / (total deaths – last day’s deaths)
he would have shown us this for March 23:
USA: 0.34
Germany: 0.31
Spain: 0.30
France: 0.28
Italy: 0.11
and this for March 24:
USA: 0.41
Spain: 0.29
Germany: 0.29
France: 0.28
Italy: 0.12
(The numbers and ratio for cases btw are quite similar to those for deaths.)
These numbers vary day by day – but not in a way contradicting the trend. I’ll store them by now; I should have done that since mid January.
*
Many comments on this page are strange: nearly everybody tries to diminish what happens, if necessary by publishing amazingly wrong numbers when comparing the seasonal flu with the current viral disease. Why?
While flu in the US has a mortality rate of about 1 death per every 1,000 cases (i.e. 0.1 %), SARS-CoV-2 won’t show much less than 1.5 %. That is a little bit more, isn’t it?
We all shouldn’t panic. And the best way no to do still is to show things simply as they are.
Rgds
J.-P. Dehottay
“While flu in the US has a mortality rate of about 1 death per every 1,000 cases (i.e. 0.1 %), SARS-CoV-2 won’t show much less than 1.5 %. ”
This is a common mistake. The estimated flu mortality rate is this equation:
Deaths With Flu / Estimated Cases of Flu
The coronavirus mortality rate is this equation:
Deaths with Coronavirus / Tested Positive Cases of Coronavirus
Do you see the difference?
Josh Postema
Yes.
https://theintercept.com/2020/03/25/coronavirus-flu-comparison-trump/
[UPDATE 2]: In the news today, the headline Coronavirus: 4,824 Italian Health Workers Are Infected … one in ten of their coronavirus cases are health workers …
__________________
That is just tragic. The world will owe an enormous debt of gratitude to these largely under-paid and under-appreciated folks once this finally settles.
“ these largely under-paid and under-appreciated folks once this finally settles.”
I know lots Of well paid and appreciated folk.
ya happens every flu season
sarc off
Willis, thank you for your essay.
And for your ongoing graphing of the worldometers data, especially the use of the log scale.
And for including the informative comment by Steven Mosher.