Guest Post by Willis Eschenbach
I’ve been saying for some time now that the number of confirmed cases is a very poor way to measure the spread of the coronavirus infection. This, I’ve said, is because the number of new cases you’ll find depends on how much testing is being done. I’ve claimed that if you double your tests, you’ll get twice the confirmed cases.
However, that position was based on logic alone. I did not have one scrap of data to support or confirm it.
Max Roser is the data display genius behind the website Our World In Data. He has recently finished his coronavirus testing dataset, covering the patchwork quilt of testing in various countries. The data is available here.
Being a ‘Murican myself, I first looked at the US daily new testing versus number of US daily new confirmed cases. I have to confess, when I saw it, I did laugh …
Figure 1. Scatterplot, daily new tests versus daily new cases, United States. Yellow/black line is linear trend.
Just as I have been saying, in the US, new cases is a function of new tests. For every one hundred additional tests that we do, we find an additional nineteen confirmed cases of coronavirus.
Of course, when I looked further there were other countries which were nowhere near as linear as the US. Here’s Australia, for example:
Figure 2. Scatterplot, daily new tests versus daily new cases, Australia. Yellow/black line is linear trend.
However, there are also plenty of countries that are just as linear as the US.
Figure 3. Scatterplot, daily new tests versus daily new cases, Turkey. Yellow/black line is linear trend.
Poland shows the same type of mostly linear relationship.
Figure 4. Scatterplot, daily new tests versus daily new cases, Turkey. Yellow/black line is linear trend.
So … how about for the whole world? Glad you asked. Here’s that chart.
Figure 5. Scatterplot, world total daily new tests versus total daily new cases. Units are thousands of tests and thousands of cases. Yellow/black line is the linear trend. Black “whiskers” show the uncertainty (one sigma) of the individual mean values for the various days.
One item of interest is the difference in the rate of discovery of new cases in various countries. In the US there are nineteen new confirmed cases per hundred new tests; Turkey is 13/100; Poland is 4/100; Australia is 1/100; and globally, there are eleven new cases for every one hundred new tests.
I suspect that this variation depends directly on at least a couple of things — the underlying number of cases in any given country, and exactly which subgroup is being tested.
For example, in the US we’re still short of tests. So the tests are being reserved for people who are showing obvious symptoms … and as a result, the US tests would be expected to come up with more new cases than the global average.
This leads to a curious situation. In addition to being a function of the number of tests, confirmed cases can also be a function of the scarcity of tests …
Conclusion? Don’t use confirmed cases as a metric of the spread of the virus—the number of cases is indeed a function of the numbers of tests.
w.
PS—When you comment, please quote the exact words you are discussing. It avoids endless misunderstandings.
PPS—While I’m here, let me shamelessly recommend the Watts Up With That Daily Coronavirus Data Graph Page. I create the daily graphs and maintain the page. I’ll also recommend my own blog, Skating Under The Ice. I note that it’s been one full month since I publicly called at my blog for an end to the American Lockdown. Finally, I’m on Twitter here. Enjoy.
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Look at state testing data.
Anyway the problem is that as tests grow, the disease may also be spreading.
Further problem is no consistent criteria for testing.
Testing only the symptomatic or only severe will also undercount.
Undercount of asymptomatics is all over the map.
From .4% in some samples to well over 50% in others.
No controls.
No consistency
Not science
No conclusion.
Sort of backing up what you said Steven as to why Australia doesn’t fit the conclusion is because the amount of testing per day has remained somewhat constant (the test kits are rationed on a per day basis).
Here is the link for Australian testing … its the ninth one down
https://www.abc.net.au/news/2020-03-17/coronavirus-cases-data-reveals-how-covid-19-spreads-in-australia/12060704
As you can see it wobbles between 4K and 18K
The telling part is the next graphic number 10 showing the daily tests done versus the new cases found.
Ok now the explaination.
In the beginning Australian testing was limited to only International arrivals and those who had contact with a known covid carrier because there was no known community transmission. There was excess tests so the criteria was widened to anyone in frontline services who had flu like symptoms. Finally there were again excess tests so it was widened to all and anyone with flu like symptoms. So basically what you are seeing now at the end there is a lot of testing being done on people who have the flu but few have covid.
I suspect all the linear relationship shows is countries that don’t have effective control on the countries infection.
Yes, this whole issue is not a simple a Willis seems to suggest in this analysis.
Now suppose that you have a limited number of tests so have to reserve them to A&E admissions where the need to identify the pathogen is the most urgent.
The more admissions you need to treat, the more tests you perform. The more test you perform, the more +ve you get. This correctly reflects the REAL state of the epidemic in that population. The correlation does not prove the stats are spurious. As we are constantly reminded CORRELATION IS NOT CAUSATION.
What Willis seems to have missed is an uncontrolled variable, the link between the number of tests done and the number people showing symptoms. What his US graph probably shows is that the number testing positive is a fairly consistent proportion of all people showing flu-like symptoms, reporting or taken to hospital.
I have done a detailed analysis of Italian case data and it shows pattern that is NOT consistent with the idea that the number of available tests is the CAUSE of 90% of the variation in case data:
https://climategrog.wordpress.com/2019-ncov-weekly-projection-italy-2/
It certainly may be a perturbing factor. There are many others.
The Italian data is already showing the first signs of the expected up tick due to relaxation. Following this analysis may help gauge the usefulness of simply delaying COVID cases into future months at enormous social and economic costs which will last for years.
Some simple questions:
If someone is confirmed positive for C-19, how many more times is that person tested on average before full recovery? Do those extra tests get added to the total test count? How does this very between countries and medical groups within countries?
Number of tests conducted may not equate well to number of people tested. This could also be skewed if the medical system exceeds capacity.
For Australia there is no average we had one minor celebrity Richard Wilkins dragged on for 4 weeks and used up 4 tests but he was unusual because he was asymptomatic and only tested because of a close contact. Due to how the test were rationed most had to have symptoms and were never retested until the symptoms cleared and most cleared 1st time.
No idea if the re-tests count towards the total test but the numbers are so small it wouldn’t really matter we only had 6661 positives while the tests done is 466,659.
In addition, medical workers are likly tested multiple times. Are those C-19 tests included in the total count?
Yes I would say frontline worker tests would be in the number because they are the single most likely to return a positive test but again they have to have symptoms or a very good story :-).
According to a local radio host who has been following and researching the local/state testing data, the testing numbers are based on test performed not individuals. Some people have been tested multiple times, ie one tested positive twice and negative once. All three results were included in the totals.
If this is true, the total number of cases could be lower, possibly much lower than reported.
What if it is shown that the demographic of totally asymptomatic, untested pos rate is anything from 10-50 times the expected rate,apparently assumed to be close to zero? The denominator of mortality as fraction of number positive for corona changes dramatically if so.
Not sure what it does to the linear nature of the number of tests performed to number of positives as we are only testing symptomatic people at present who are therefore much more likely to have a positive result
If the graph is still linear then,wow!
Can only speak for Australia and that is impossible, we would have random outbreaks of people who weren’t asymptomatic crop up in the public … we don’t so by default it isn’t right.
In support of LdB, if there is a pre-selection mechanism (ad hoc filter) of “obvious symptoms” the result isn’t going to predict much about the whole population, only the tested population+the filter rules.
It is interesting that testing of those with the single symptom of “being dead” before any suspected cases were around has turned up people (bodies) testing positive a) before there was a test or b) before anyone thought to consider a novel virus.
Unless there is random, representative testing (which is certainly not the case in Canada) we have no idea what is going one.
Everything done along that line so far (precious little) shows the number of positive responses to be far above any modeled spread. Now with word coming from the W USA and Italy that there were cases as early as the second week of January – before “official spread” we may have to revise the whole infection map, starting with testing all available possible deaths from say, mid-December.
Patient Zero in China certainly was not in the wet market of Wuhan, which is a sea food market. The fact that it spread from there means nothing. It was already spreading by other paths, as far back as October at least. The patient identified on 17 Nov was not patient Zero and had no connection to the Wuhan market. It may have been circulating and adapting in pets, snakes or pangolins for months before that.
In many areas it is precisely as Willis suggests. Testing stations will not allow testing of anyone that has not already been symptomatically diagnosed as having COVID-19 and testing stops each day when the number of test kits run out. Test kits often ran out only a couple of hours after testing started. Increases in the number of test kits increased the number of positive tests minus the very few that were incorrectly diagnosed by another means. Patients are not allowed into the COVID-19 wards unless they have received a positive test.
Testing needs to be far more rapid and far more widespread. At the same time more concentration needs to be put on increasing resistance to infection for example by avoidance of zinc deficiency and increasing Vitamin D levels. It is not feasible to lock down the world.
Those areas in lockdown seem to be following a similar infection profile as those not in lock down except that the locked down countries/regions are suffering extreme economic damage that is already leading to deaths due to other causes and will eventually lead to inability to afford health care for any patients. I realize that there is a race to become rich as Croesus from selling vaccines but that goal may be illusory as the vaccines may need to be handed out ‘free’ as the dead economies will not support paying for them.
The initial intent was to avoid a peak load that the health systems could not handle, and that has probably been achieved. A return to work while avoiding large gatherings and parties and perhaps wearing masks most of the time is necessary. Continual house arrest while being driven into penury by well paid politicians will not be tolerated for very much longer.
I’m with you In
I no longer care much about the testing. It is becoming clearer every day that the lockdown is doing more damage than the disease, except possibly in areas of high population density.
This despite the efforts to inflate the mortality numbers.
Obviously the Governor of NY is a far weaker breed than the likes of Patrick Henry and so many others and totally unable to relate to their American values.
Indeed, the priority now is unraveling this mess they have got us into as quickly as possible.
That is why I took the effort of providing an analysis of the progress of relaxation efforts in Italy. They are playing the role of crash test dummy once again in this.
We are starting to see the effects there NOW, so this can give some guidance on how to go without taking baby steps and waiting two weeks to see what happens at each step.
https://climategrog.wordpress.com/2019-ncov-weekly-projection-italy-2/
Ian
You said, “Testing stations will not allow testing of anyone that has not already been symptomatically diagnosed as having COVID-19 …” Therefore, another way of looking at the correlations is how often the symptoms are NOT diagnostic. That is, for countries testing based on symptoms, less than 20% of the suspected cases are actually COVID-19! Symptoms alone give a very high rate of false-positives, reinforcing the need for reliable testing.
Ian and Clyde,
Well said.
Response to Greg G:
Then you are testing only the most urgent cases, the most likely instances of getting a positive test result, leaving the less urgent population unaccounted for, including asymptomatic carriers of the virus or carriers of the virus with minimum symptoms, especially minimally symptomatic people who just brush it off and never seek out a test (I would be one of those types, if I came down with it).
This speaks directly to what Willis was writing about. On other non-COVID issues, I can be in serious disagreement with Willis, but on this issue, I find myself in complete agreement with him, and my own plots of my own state’s data are directly in line with his plots.
Thanks for the detailed reply Robert. I think you are rather misunderstanding my point.
This post was about Willis’ straight line graphs which he claims prove case data is almost totally determined test numbers and thus is not worth even looking at. That is certainly not consistent with the highly structured nature of the Italian case data:
I am not saying that case data reflects the number of non symptomatic or low symptomatic cases in the wider community and what that implies about overall death rate. That is a different issue.
If A causes B and A causes C , B and C will likely be correlated. That does not mean that B causes C. Willis has plotted B and C , gets a strong correlation and concludes that B causes C and thus B is nothing to do with A.
He set out with a pre-declared opinion that case data was useless, found what looked like proof so obvious it made him laugh. He failed to question his own bias. That reminds us of Feynman’s famous ” the easiest person to fool is yourself”.
Steven Mosher: Not science
Don’t forget to add unknown false positive and false positive rates.
However, it is the “beginning of science”, rather than “Not science”. Hardly anyone in science has gotten anything right the first time.
We may face a “second wave”; the practice now will improve results during the second wave. That is not a negligible achievement, imo.
Quite right. The testing is not random, and despite numerous requests, I cannot get the UK authorities to tell us what the sensitivity and specificity of the test is either.
So we have numbers that are completely meaningless.
Not completely meaningless.
think harder
Geez, it must be tough for you; being so much more intelligent than everyone else. We’re lucky we’ve got you here to enlighten us all.
Mosher
BUT, it is not science. I have that on the best of authority! So, the philosophical question becomes, “Can the answer to a scientific question have meaning if the answer is derived from a non-scientific method?” think hard
But very useful to those who wish to scare; not just politicians, some people must be doing alright, the èxperts`and `researchers`for example.
as far as I can see the UK authorities don’t even seem to want to volunteer who’s doing the ‘testing’ either – of was supposed to be run by Public Health England ( which is a semi-detached NDPB bureaucrat stuffed “quango” ) – but beyond some numbers being tossed about – no details of who’s doing them or which tests are being run seems to be getting out.
Not impressed…..
Steven,
Thank you, you highlighted a major factor that I have not yet seen adjustment made for. ” … as tests grow, the disease may also be spreading”.
A second confusion is that not all tests are the same. As a non-epidemiologist, I am quite confused by what is actually being tested for, in various exercises.
Then there is the complication of false positives and negatives, There might be standard stats to cope with these, but Ihave not seen much more than a mention in passing. The measurement of false readings feeds back into what you wrote.
Geoff S
from everything thing I have seen the test accuracy is not a first order impact.
Say it may lead to some single digit errors.
while test protocol… only test people with fevers who have travel to china histories
( the first criteria the CDC laid out)
is likely to give you order of magnitude errors.
with state data I do a chart of
tests per million
versus
Positive rate.
quite illuminating about two different extreme results:
high positivity & low test penetration
low positivity and low test penetration
Try scattering test rate against death rate. There are no cases of high death rate and low test rate. A high test rate however means nothing about the death rate.
Low test rates occur because tests cannot be afforded or procured or are simply not really needed in populations where the prevalence is very low. Testing (as opposed to quarantine) does nothing to suppress deaths. It’s a WHO sticking plaster because they have nothing better to say.
Let’s not just beat up on Mosher when he didn’t say anything wrong.
I think the point is that in his climate science posts, Mosh takes the opposite position in regards to “no control, no consistency”.
Nope.
I recognize however that people here do.
Holy smokes, i agree with Mosher 100% !
The true mortality rate is overestimated without representative random sampling. And the first patient to die with covid-19 in the US died Jan 19th (9th?), if memory serves, as a local news release in California just showed.
The idea that this virus was not already here this past winter is fiction.
personally know 2 people who had symptoms last week October and first week November 2019.
flu like symptoms that were really rough and…heres the kicker…loss of smell.
both middle aged fairly healthy and survived.
Loss of smell in upper respiratory infections is not unique to C-19.
its the combo of all the symptoms…the exact same symptoms used to diagnose today.
thought that was clear in my post guess I need to make sure to clarify every concept when posting for obtuse and/or speed readers.
or for those who want to purposely muddy the waters.
and FWIW I am a speed reader and often make errors.
all kinds post here.
this is not an attack on you but a general statement about everyone that posts.
just to clarify…
Living in Palo Alto, CA (silicon value central), I had a really tough flu in early mid-November 2019. Four days of fever peaking at 102 F (38.9 C), about 10 days of general malaise, and two weeks to recover after that. No coughing, not much sinus or lung involvement.
Some local siblings and relatives came down with the same symptoms in December. It was just as tough on them. My brother had been on a commuter flight to SF a few days before he got sick.
Was it early covid-19? I don’t know. But I’d never had a flu like that before, either.
We all are middle-aged or past and recovered.
my friends had 102 fever, dry cough, very weak and tired (took 10 days for one and 3 weeks for other to feel somewhat normal) and hurt all over. they also had the nasal component, runny nose (was oct/nov in Maine…) with sneezes and loss of smell and taste. should have clarified taste loss in org post I failed there.
they are unable to get tested to see if they actually had it or not.
I had a really bad cold (I thought) Nov 30 or so that lasted long time. fever was only 100 (for whatever reason I generally don’t get fevers like most) with dry cough and nasal issues. did not have smell/taste issues, but I was weak for weeks. however due to multiple disabilities I am often weak so I have just attributed my issue then to general crappy week(s). who knows. whuhan knows… 🙂
With a 50%+ asymptomatic rate, and test being reserved for patients showing symptoms, the confirmed cases-test relationship is rubbish for determining the actual number of infected individuals. Period, end of story.
“No controls. No consistency Not science No conclusion.”
LOL… given the state of climate science and the models, this really is serving up a softball.
The parallel between the modeling of SARS-Cov-2 spread is quite similar to the efficacy and skill of climate models, particularly those produced in Canada (U-Vic).
Still waiting for the CDC to do perhaps 10 randomized or representative tests of ~1000 randomly chosen people in random parts of the country. 10,000 test kits. Real data of the actual cases, non-symptomatic cases, cases with symptoms, # of hospitalizations, and type and incidence of serious or lethal complications.
Any of the major drug companies could fund this out of pocket change in their budgests.
[bad email address – mod]
My logic says the number of new cases vs the number of tests is a function of the maturity of the development of the disease in the population. If and when a vaccine becomes available the number should drop because of fewer new cases. I guess we will see what happens.
My logic says that if the proportion of people in the population who have been infected increases over time, then (assuming random and accurate sampling) the proportion of tests that are positive should increase over time.
Is there enough good data to be sure about anything?
I loved the part about “random and accurate sampling”.
w.
Perhaps you misconstrued, Willis.
Random – a truly random sample, rather than those who turn up in a hospital, or volunteer to be tested.
Accurate – testing done by professionals, and not self administered.
Ralph
We’re certainly not there (yet), but self reliable administered tests is where we need to go.
And there is no reason we can’t get there – several established examples in circulation for decades, think diabetes.
Willis is correct, one thing this is not is random testing.
Under the sever lack of test kits available testing is mostly to hospital admissions, where they test those displaying “corona-like” symptoms to detect if they are dealing with a COVID case.
That preselection bias is almost certainly the reason for the straight line graphs. The more suspected case you have turn up, the more tests you do. Number of tests is not the independent variable it is the dependent variable.
The proper conclusion to draw from Willis’ graphs is probably : correlation is not causation.
However, having a critical eye and having these questions thrown up is very valuable. The data are messy and may often be biased by such confounding variables.
Thanks, Ralph. I was laughing because nobody is doing “random and accurate sampling” as the writer “assumes”.
w.
Since the epidemic reaches a peak and then falls back, the proportion testing positive will fall once the peak is passed unless the testing regime is changed. If spare tests are used to test more widely, the peak in acute cases gets masked by the rise in detected mild and asymptomatic cases caused by the change in test regime. But that too will peak (or may have already peaked). So the answer is no.
Following acute (i.e. hospitalisable) cases is probably as good an indicator as we have, in that it clearly leads deaths by some days, and given that effective total population testing to try to identify infections as soon as they occur is simply impossible.
Not true. You can model an “infection” rising and then falling simply by modelling your testing. It’s a simple exercise on Excel. Try modelling say people with a Y chromosome through non-random testing that increases each day. Lo and behold theres a Y infection!
Phoenix44
You said, “Lo and behold theres a Y infection!” Militant feminists have maintained this for years. 🙂
State numbers
https://docs.google.com/spreadsheets/d/18oVRrHj3c183mHmq3m89_163yuYltLNlOmPerQ18E8w/htmlview#
Thanks, Steve. That’s the data I use for my states graphic over at the Daily Coronavirus Data Graph Page.
BTW, do you know how to scrape data from google spreadsheets into R? Despite extensive searches, I’m still copying and pasting the data into R. Boring.
w.
Theres a csv
At lunch now
Why is the CSV at lunch?
Would your csv like a blt?
Here csv
https://covidtracking.com/api
sorry I was at lunch and phone was running low
https://covidtracking.com/api/v1/states/current.csv
States<-read.csv("https://covidtracking.com/api/v1/states/current.csv", stringsAsFactors=F)
Willis,
“Conclusion? Don’t use confirmed cases as a metric of the spread of the virus—the number of cases is indeed a function of the numbers of tests. ”
Can you expand on this? I accept your conclusion that the more you look the more you find, but having made the suggestion that confirmed cases is not a useful metric, what IS a useful metric? Or is there a useful metric at all?
Not questioning your analysis, more looking additional ‘useful’ information for my own (selfish and greedy) reasons.
thanks
Confirmed antibodies seems like to be the most useful.
Between the antibody tests which have been done, dubious as some of them are, and the examination of sewage for the virus, it seems to indicate that a large percentage of the population have probably had this with no serious effects.
Craig, I use deaths. It’s the least dependent on testing.
However, sadly the CDC recently changed the definition of a COVID-19 death. Now, COVID-19 deaths include those where it is SUSPECTED that the virus MIGHT have CONTRIBUTED to the death …
Could they possibly be more vague and at the same time more all-inclusive?
Sigh …
w.
Willis,
“Now, COVID-19 deaths include those where it is SUSPECTED that the virus MIGHT have CONTRIBUTED to the death “
Snopes looked at this.
“Are CDC Guidelines for Reporting COVID-19 Deaths Artificially Inflating Numbers?”
False!
The relevant CDC guideline is:
“In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as ‘probable’ or ‘presumed.’ In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely. However, please note that testing for COVID–19 should be conducted whenever possible.”
I think people forget the reporting can only be done by doctors who have no interest in a political agenda. They don’t get extra pay or incentives for declaring someone died from something they didn’t.
I believe they do in the USA, or at least the hospital does.
Well then it’s a US problem stop trying to make it out as something world wide.
Nonsense. Many doctors are political. Why would they not be? We have numerous activist doctors in the UK. Are there none in the US?
And that’s before we get to unconscious biases, which have always been an issue for death certificates – numerous studies show that doctors de late a cause of death based on defaults and diseases that are prevalent at that time.
LdB,I work in the business and I can tell you the cause of death is often a guess made by the certifying doctor.
Its one the main reasons for the difference between say German numbers and those of other countries. Most doctors left to decide themselves whether or not to use the new advise from WHO will use the previous method, ie a heart attack caused death irrespective if CV-19 was present ( Germany). If the national health body insists their employees use the new definition ( ie UK) they will. US hospitals get paid a significant $ for each cv-19 patient and more for ICU patients, so guess what that means…
The only statistic that is stable, without manipulation is the overall morbidity stat. This should be used for strategic planning.
LdB
April 23, 2020 at 12:02 am
It is very simple.
The “doctores” do not do tracking and monitoring of every freaking flu virus out there during a season.
Aka flu death numbers listed as seasonal flu, non specified.
“Doctores”, can not check for every type of flu…only do follow only the prevalent one during the season.
This season the seasonal flu very suddenly closed shop, boom…globally.
Because COVID-19 became the prevalent infection-disease to follow… globally.
The overall season flu deaths will be listed specifically to COVID-19…
as the rest can not be tracked efficiently under the load… globally.
It is not about politics and agendas in principle,
is about how it is done and how it works… the rest is only exploitation on top of it.
So if there is no any considerable overall death increase for this season, it will be like a seasonal flu death, even when the scale of infection wider, very specific even in global term,
and quite concerning and “alarming” due to it’s sudden appearance allover the place as a new unknown infection-disease.
There is no any infection-disease, that ever had or has the record of such a sudden allover the place appearance globally, like this one…
zero to hero globally in a “boom”, within 2 months period, every where.
cheers
But it isn’t working like that we test thousands of cases of flu a day, death from covid19 is a tiny number. Second what the death rate is or isn’t in US, UK or Italy have no bearing on us we were locked down when we had near zero deaths it simply isn’t a factor. If things were better than thought they would simply lift some restrictions and that would be welcomed. I can’t speak for all countries but it is a bit of stretch to suggest that is universal.
I guess even if I took countries I don’t know I can’t for the life of me figure what forging figures to lock down a country that doesn’t need to be achieves. Call me always a skeptic but I would need proof and at least some plausible reason.
FWIW – Here’s a comment from a Minnesota physician and republican state senator
——————————————-
“Right now Medicare has determined that if you have a COVID-19 admission to the hospital you’ll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000; three times as much. Nobody can tell me, after 35 years in the world of medicine, that sometimes those kinds of things [have] impact on what we do.
“Some physicians really have a bent towards public health and they will put down influenza or whatever because that’s their preference,” Jensen added. “I try to stay very specific, very precise. If I know I’ve got pneumonia, that’s what’s going on the death certificate. I’m not going to add stuff just because it’s convenient.”
https://www.foxnews.com/media/physician-blasts-cdc-coronavirus-death-count-guidelines
Salute !
Thank you rickk
If your $ numbers are verified, then its another reason why our “semi-socialized” Medicare system is breaking the bank. I cannot see where the extra effort to use one of those “magic” machines can cost many times per hour of medical worker costs.
Gums wonders….
When you pay people per Covid 19 case, you’ll get a lot more Covid 19 cases. The same happened with skin cancer in Oz, and everyone thinks we’re all dying of skin cancer. Quote from an Australian doc at the time “It’s the easiest way for me to earn $50.”
The same holds here in the U.K. where patients in hospital are tested positive and subsequently die, then CoViD19 is put on the death certificate as a contributing cause.
The total mortality data are showing excess deaths exceeding the number of Covid attributed deaths. It is as yet unclear whether that is due to under reporting particularly outside hospitals, or whether it is a rise in deaths from other causes because people are not getting treatment.
So…? The criteria could be inflating the numbers. Doctors are human, they will have a bias towards COVID at the moment.
Is that because they need the highest death toll possible to justify draconian measures?
take a couple of countries Australia only has 78 deaths, New Zealand 16, so lets play your game and they faked them all. Yet both countries are in lockdown.
Your argument doesn’t work so perhaps it’s only true in your country 🙂
I am not sure I follow your argument either. The 2 countries you cited have draconian measures. Ben just stated they needed the “highest Death toll possible.” 2 could be the highest possible 🙂
So 2 is all you need to justify a lockdown then, so USA was justified in the lockdown make sure you tell Willis that I am sure he will agree.
and almost all were OS travellers on cruise ships students and a very few community transfers.
and regional areas are almost unscathed as we banned tourism caravan parks etc very quickly so coty folks didnt spread it out into the boonies:-)
in 6 weeks the very large west vic has 15 or less intotal from Ararat outwards, even horsham had only 3, and the poor hospital staff there were having severe anxiety as modellers….predicted 300 a day could be incoming.
most of the people here apart from community sport dont do the social large crowd things very often, local shows field days and fishing comps would have been the other risks and they got canned as well.
LdB – is it reasonable to compare Southern Hemisphere C-19 case data with Northern Hemisphere data? They are 6-months apart related to flu season.
Derg writes
I dont think I’d class Australia as having draconian measures. People (eg Tradies) are still going to work. People (eg Office workers) who can work from home, do so. The draconian part would be – there is no “unnecessary” travel, no going to friend’s places and no large gatherings, not even weddings or funerals.
People accept social distancing for the most part and lots of sanitizing happens.
Australia acted early and has the right balance for controlling the spread of the virus. It was also probably lucky to control it so well.
Without a vaccine or effective treatment, Australia has backed itself into a virus free corner.
Farmer Ch E retired we are entering our flu season the flu vaccine for this year is out and being administered.
Now to put that in perspective you can only get a test done if you have flu like symptoms or are a front line worker … we have no random testing. So numbers for yesterday 14,218 tests and 12 positive. Even if you allowed some stupidly huge number like 4000 for frontline workers that means over 10,000 people with the normal flu fronted for testing.
I don’t know how that compares to countries in Northern Hemisphere but we are definitely testing massive numbers of ye olde flu.
LdB
April 23, 2020 at 12:11 am
Summer time in AUS and NZ… not the flu season… not yet.
If these two nations really facing the COVID-19 wave now, then you see how dangerous is this new disease…78 or 16 deaths during this new disease wave.
cheers
LdB – We’ll need to wait and see once SH flu season is in full swing. Fewer deaths may be related to SH summer season.
It’s Autumn and it’s the start of our flu season .. we can hardly get this wrong the government has been running the flu shot adds for weeks now.
Clearly you don’t live in Australia and must think we make this stuff up … so here this is the program
https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/flu-vaccination-more-important-than-ever-during-the-month-of-april
As per the announcement all age care workers MUST be immunized by 1st May so 8 days from now.
Farmer Ch E retired I would be very surprised if we don’t have similar numbers of deaths to Flu as per last year around 1000 … so I guess that is our benchmark. So we fully expect it to dwarf our Covid19 deaths unless we lose control. Explain what you think should happen?
Farmer
Yes, the Aussies and Kiwis may be singing a different tune in 2 or 3 months.
Clyde what do you think will happen make a prediction?
I am trying to get a feel for what you think will happen?
My only personal concern is when we lift the lock down up people go silly and we then get slammed back into a level 4 lock down like happened with Singapore.
LdB
April 23, 2020 at 8:44 am
So we fully expect it to dwarf our Covid19 deaths unless we lose control. Explain what you think should happen?
—————————
There is still a problem there you not realizing.
The rest of the world, is trying a get out of the lock downs and heavy restriction.
If there is sign or indication of considerable increase of infection and COVID-19 disease
in AUS, the world will not care at all about the control and dwarfing of COVID-19 deaths.
It will isolate and restrict your country, regardless, unless there is no indication of infection risk.
There better be no increased infection risk, either because it will not happen,
or better you get a firm control on hiding it, if it does.
Same I think goes for NZ too.
The vaccines will not help you much there, as vaccines cannot actually stop the infection or the disease… especially the overall seasonal one.
Flu vaccines have not stopped any season of flu.
cheers
Whiten we fully expect to be almost isolated from the world for quite some time you won’t be entering Australia anytime soon without doing a 14 day isolation unless there is a vaccine. Tourism is the only main industry we have that will be in the air going forward.
Most people in Australia take the flu to try to reduce severity and time off work (often paid by employer) and not kill vulnerable people (many age home care facilities demand it). It isn’t sold to us that it will somehow stop a flu season. The prediction is the same as last year 13.5 million people will have the needle so close to 1 in 2 and no we don’t expect a mild flu season.
LdB
You asked for a prediction. With the caveat that if COVID-19 turns out to be strongly seasonal, as other similar diseases are, then I see a strong possibility that someone (or several) will re-introduce CV in the Fall to one of your larger cities with international airports, and it will spread undetected for a few weeks because of the long incubation period, high frequency of asymptomatic carriers, and lack of immunity in the general population. After a couple of confirmed deaths, it will be firmly entrenched and the politicians will panic and reimpose restrictions to strangle the economy.
Australia and New Zealand may get lucky and an efficacious cure or effective treatment of symptoms will have been developed by then, allowing an early lifting of lockdowns.
If a cure or effective treatment isn’t available early, Australia and New Zealand may then see an epidemic not unlike what Canada, Norway, Denmark, and Finland are experiencing. In any event, without a vaccine, the lockdowns will mean Australia and New Zealand will remain vulnerable to future flare-ups of the virus.
The development of an effective coronavirus vaccine is problematic. If it turns out to not be possible then, as island nations, you have a couple of choices: Isolate and forego tourism, or allow a ‘controlled burn’ to develop immunity.
I agree without a cure Autralia and New Zealand will have to keep 14 day isolation for anyone entering … that is definitely a given.
LdB – imo what should happen is that we should wait and see – and prepare. I’m not saying I agree or disagree w/ the AUS and NZ approach. In late January, Trump’s travel ban from China was very controversial. Not so much anymore now that the MSM has developed a severe case of amnesia about the China travel ban.
In the SH, time will tell if the actions were too much or not enough as our understanding of C-19 continues to evolve. Yogi Berra was spot.
I really have no view on US, your country social safety nets and your whole economy is very very different to ours. At the end of the day all you hope is that governments act in the interests of the country. I certainly don’t think US should mindlessly follow the lock down path but I also think it is wrong to criticize countries who decide that path.
“I certainly don’t think US should mindlessly follow the lock down path but I also think it is wrong to criticize countries who decide that path.”
Ldb – I agree – my initial comment was related to comparing C-19 cases and responses in the NH with the SH since they are 180 degrees out of sync related to seasonal flue.
My impression is that Australia wasn’t trying for eradication. It may be happening (this is not guaranteed because of the asymptomatic cases) because we were too effective at tracing imported cases and isolating. Now we seem to be stuck waiting to see if a viable treatment develops.
So, maybe only NZ tourists for a couple of years, but presumably antibody testing will soon be reliable enough to admit tourists from elsewhere. I’m not sure how governments here are going to be able to enforce lockdown outside of the large cities much longer.
Ah well. Sometimes big numbers lead to a bigger grant.
Probably because they were seeing their predictions of imminent disaster falter as time went by, so they loosened the criteria. I think there must be many people, the panic mongers, the wolf-criers, the chicken littles, the charlatans, who are hoping it is worse than is slowly becoming apparent.
Where have we seen this behaviour before. Climate catastrophy anyone.
Willis is correct. I’ve read the CDC published PDF Stokes takes his quote from via Snopes. The issue is that the CDC is including those probable and suspected cases of cocid-19 listed under “underlying cause of death” and is including them in their covid-19 death counts. The CDC also says that their definition is just one of many different definitions that are out there and that their numbers will likely differ from other sources. That said, it seems fair to assume that the models use the CDCs mumbers, which is very xoncerning! (Which is really what Willis’s point was about)
Willis is asserting what has been the experience of numerous contagions. For example, in the US after the Swine flu in 2009, analysis was done to estimate that infections were many multiples of confirmed cases. Carrie Reed et al. reported at CDC Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009.
“Through July 2009, a total of 43,677 laboratory-confirmed cases of influenza A pandemic (H1N1) 2009 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million–5.7 million cases occurred, including 9,000–21,000 hospitalizations.”
“Using this approach, between April and July 2009, we estimate that the median multiplier of reported to estimated cases was 79; that is, every reported case of pandemic (H1N1) 2009 may represent 79 total cases, with a 90% probability range of 47–148, for a median estimate of 3.0 million (range 1.8–5.7 million) symptomatic cases of pandemic (H1N1) 2009 in the United States.”
Paper is here: https://wwwnc.cdc.gov/eid/article/15/12/09-1413_article#tnF1
My synopsis is https://rclutz.wordpress.com/2020/04/23/crash-course-in-epidemiology/
Deaths are a lagging indicator. Whilst you have clearly demonstrated that there are big differences in testing regimes, within a particular locale, so long as the testing regime is kept reasonably consistent, positive tests at least allow peaks in the local epidemic to be picked up much sooner. Of course, it says nothing about general prevalence, and we know even less about the circumstances and progression of mild and asymptomatic cases than those that become more serious. I’ve not seen that anyone is researching them.
Willis, can’t you just look at total mortality for the US?
The number of deaths above the average for the week has got to be pretty close to the number caused by Covid-19. The UK has this data released weekly (ONS data) and runs about 2 weeks behind. ie for the UK the week 3rd-10th April had 8000 more deaths compared to the 5 year average and the week 26th March-3rd April had 6000 deaths above the 5 year average. I would guess we won’t see more than 8000 excess deaths in the UK now.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales
Where do you get the same stats for the US?
“However, sadly the CDC recently changed the definition of a COVID-19 death. Now, COVID-19 deaths include those where it is SUSPECTED that the virus MIGHT have CONTRIBUTED to the death …
Nope they added a second category
Politically, and operationally from the perspective of managing the outbreak, the only metric anyone cares about is the death rate.
We can all be armchair academics interested in theoretical models of the disease, and bemoan the lack of clear data to validate them, but the crunch figure for anyone in charge of medical facilities or government policy is how many are dying, which way their families vote, and what can be done to lower the figure.
We may not be able to test the all living, but we should be able to test the newly dead.
You can’t tell the death rate unless:
1. You know how many people caught it.
2. You have accurate death numbers for people who died of Chinese Flu, and didn’t just happen to die while infected with Chinese Flu.
Given that deaths from other diseases like cancer and heart disease have dropped off the charts in some areas with heavy Chinese Flu infections, it seems pretty clear that many have been counted as Chinese Flu deaths instead.
One way round that, for statistical purposes at least, is to do a separate attribution that assumes that the heart disease/cancer deaths are in line with averages and reduce the severity of the pandemic numbers accordingly.
This obviously does nothing for the actual number of deaths but might, if the numbers are properly crunched, provide useful information on the severity of the pandemic virus. Would these same people have died in a bad ‘flu year for example? And if so would influenza have been recorded as the cause of death?
If a man has a severe heart attack while swimming and drowns what goes on the death certificate??
“If a man has a severe heart attack while swimming and drowns what goes on the death certificate??”
An infant in Conneticutt drowned and tested positive postmortem. The governor of the state publically lamented how the infant died from covid and that no one was safe. He was exposed as a liar after the family talked with a social influencer. The coroner subsequently refused to register the death as being from Covid.
Heart and everything else burnt out plus old age just might ,repeat MIGHT change all
“Can you expand on this? I accept your conclusion that the more you look the more you find, but having made the suggestion that confirmed cases is not a useful metric, what IS a useful metric? Or is there a useful metric at all?”
We are sort of looking for Rolling Stones fans outside the stadium where the Stones are playing tonight…you are going to get lots of positives. You will get some non fans, say those invited along for the evening. You will also get those just walking by in the neighborhood. But this is not a measure of how many Stones fans there are in that community. You need to test ‘randomly’ in a ?10 block radius – then see what the results are of how many Stones fans there are in that community.
Current Wuhan virus testing of those that show in front of a healthcare provider with slight symptoms, or with real symptoms and perhaps associated family thereof, will reveal more positives. You need to test wider – say a 20 block radius – all comers – then you get a better idea of prevalence in the community. You need to do this across your county, state, province etc to have meaningful numbers (denominator).
That said, you also need an accurate test that tells you who really has when they really have it. Right now, some of the estimates say our tests are only 70% accurate (meaning we are telling 3 people out of every 10 that don’t have the virus when they really do).
Craig from OZ asks: “. . . what IS a useful metric? ”
Early this year in Washington State an elderly care facility presented a tragic beginning to this issue. Three to 7 people per month routinely died. Medical responders, staff, family and friends were coming and going as usual. A facility-wide Mardi Gras party was held. The next day, from various means, it was recognized that the virus was the cause of a spike in deaths above the normal 3 to 7.
In Italy a Champions League match (Feb. 19th) – Atalanta versus Valencia – brought many thousands of soccer fans to Milan and 40,000 in the San Siro Stadium. Many watched from crowded bars. Parties followed. Then people went home.
Such situations ought not to be used as templates for disease progression.
We live in a small population, large area, county. To date, there have been only a few “cases” (under 20) and Zero deaths.
The ancients found Zero a difficult concept.
https://www.youtube.com/watch?v=MuuA0azQRGQ Willis I’m with you 100% one of the few sane voices. Lockdowns are not working anywhere this virus spreads like the flu re Sweden. Why do we not do lockdowns for the flu??. My guess is that when the antibody tests comes out nearly everybody in NY will test positive meaning that the mortality rate will be well BELOW the common flu. However Cuomo will not allow the release of that data if true for political reasons my 2 cents worth cheeers!
Usually, when facing the seasonal flu, a part of your population already have some immunity and there might be vaccines available to those who have a compromised immune system.
In this case, with whole countries shutting down due to overflowing hospitals, we are no longer facing similar conditions as a typical flu season.
You mentioned Sweden. Well, here we haven’t shut down schools and people are still allowed to move freely about, BUT: People behave differently. People work from home (when possible) and the kindergartens are on high alert (you got the sniffles? Then both you and your siblings will stay home for a couple of days!). Our kids now come home washing their hands like they are about to perform open heart surgery. Our consumption of soap has risen sharply.
I live close to the Norwegian border. Our closest shopping center shut down their parking garage and reduce opening hours to roughly half of what it used to be. With Norway shut off, there are no plagueridden Norwegians riding into town anymore. Hence no business. The only Norwegians present are those of us who live here permanently (and now cannot visit our relatives on the other side of the border). Despite the empty shops, we still struggle finding fresh yeast in the store shelves. (again: people here act differently than they used to!)
People are encouraged to keep their distance when socializing. I haven’t visited a bar or restaurant in ages, but I’m told most people respect this advice.
Most of these precautions were introduced at an early stage.
But to do a complete shut-down is ridiculous. Norway went too far when they closed the schools. But OTOH Norway, I guess, have less hospital capacity than Sweden. Sweden has a reduced capacity compared to 20 years ago AFAICT, but is still ahead of Norway. It is my belief that Norwegian politicians have a guilty conscience about this, and are overcompensating as a result.
Sweden is hit relatively hard when it comes to the elderly part of the population. There is an interesting situation developing where Sweden has chosen a less restrictive policy on Covid-19 compared to Norway. At the same time, the current numbers in Norway are 1/10 of the Swedish numbers when it comes to mortality. The testing regime is fairly similar, and Norway has about 1/2 the confirmed cases of Sweden. This is not surprising, given that there are twice as many people in Sweden than in Norway.
The difference between the policies will be apparent in the long term. It might end up with similar numbers, or it might stay the way it is. At this point in time, no-one knows.
The policy of shutting down society is being debated in both countries. One of the many fall-outs of the Norwegian restrictive policies is now showing when restrictions are slowly lifted on schools and kindergartens. The population has been told that shutting these down was an important part of stopping the virus. Now they are opening, and that is because there is no rational, medical evidence that schools and kindergartens are important arenas for the spread of the virus (there never was any such evidence). But the anxious will not believe this, and according to polls about 10% of parents will not send their kids back to school or kindergarten.
When you scare people there will always be those who remain scared. And we are more and more a society of the anxious – I’ve always thought that we are not in the (I know it was not accepted) anthropocene but the anxiouscene – the age of the anxious.
I guess (hope) you were toungue-in-cheek when you wrote of the “plagueridden Norwegians”, since currently it is the exact opposite ;-).
It is my understanding that in Sweden, when discussing mortality rates, they count everyone who had covid-19 at the time of death.
In Norway they try to only count those who likely passed away due to covid-19.
So that accounts for some of the difference and further invalidates the strict approach to a lock-down. Someone else commented further down that a typical old folks home in Norway houses, on average, less people than a typical old folks home in Sweden. It sounds plausible. Ten on average sounds a tad low, but 20 feels about right. (I do not currently have any old relatives at this point, my dad is 70 and quite fit)
“The population has been told that shutting these down was an important part of stopping the virus.” Indeed! Actually, my recollection is that at the time, the health authorities said “meh” while the politicians said “we must act now!” (and “think of the children!”).
My impression is that Norway took a more emotional approach to their decision making, while Sweden approached this much more rationally.
Norway still has one advantage: A sizable pension fund that can be squandered on rebuilding the country. We could afford the experiment. (but queue the climate activists who argue Norway should remain locked down and not resume oil production)
Norway is interesting. Enormous wealth due to oil. I wonder what impact there is now due to a lower price for oil?
@Derg: The highest unemployment rate since the war.
I believe Norway will soon be hit with a collapse in the real estate market. Many unemployed people will have to reevaluate their living situation and find cheaper housing.
My hope is that the government will take this opportunity and invest in infrastructure. Plus move more government departments and offices out of the crowded capital. If there was ever a time to do that, it is now. And if I may be so bold: Reduce the focus on public transport. Let people ride in their own private (and virus free) cars. It is time to forget the socialist dream of living in one giant anthill.
The tourist industry is rotting away. Many hotels were closed before what should have been the high point of their main season.
Newspapers focus on hairdressers being shut down, but IMO the focus should be to preserve the kind of industries where it is difficult to get wheels rolling again when we return to a more normal situation.
Sweden’s policy may lead to early herd immunity at the cost of more deaths in the short run, but with far greater preservation of their economy and way of life. This may be a wise choice. Time will tell.
Actually Norway has more beds (3.6) per 1000 persons than Sweden (2.2), which has fewer than the UK (2.6).
https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds
“My guess is that when the antibody tests comes out nearly everybody in NY will test positive meaning that the mortality rate will be well BELOW the common flu. However Cuomo will not allow the release of that data if true for political reasons my 2 cents worth cheeers!
wrong
Cuomo released. you are wrong
Well done Willis.
Testing sick people showing symptoms tells us only so much. To find the number of sick people in our country, and to reveal the fatality rate, two other things should happen:
1) Random testing, which will show how many are infected with this disease which frequently is asymptomatic, and,
2) Deaths, from the disease, not those with co-morbidities, in other words Really Sick People who happened to die, after becoming infected, are not a Covid 19 Death. The Death Certificate is a hugely important thing.
Stanford study, USC study, showed maybe 40 to 80 times more with the infection than confirmed tests. This means maybe 40 to 80 times LESS fatalities. Of course, I am frantic to get off my couch, but, this is the real science, not the “science” from risk-averse Public Health officials who will only state worst-case.
Apparently CDC has mandated, if you Had it when you died, you died From it.
This is a lie. THIS IS A LIE!
The lock-downs, 22 Million Americans on Unemployment from the Lock-Downs, are based on this decision by the CDC.
The disease is bad enough, let us not make it far Worse because the medical professionals give us Worst-Case, instead of the Truth. I am 61, quickly becoming an at-risk male, but no co-morbidities, feel fine, still working out daily.
Let us quarantine the at-risk, elderly, elderly plus diabetes, obesity, Hyper-Tension, heart disease, and as you and I so desperately want, Put Healthy People Back To Work!
Solidly on your side tonight…
Moon
The antibodies tests produce significant rates of false positives, depending on the particular test at a rate somewhere between 1 and 10%. Even at the low end of this error rate the results of the Santa Clara study are meaningless, across 3300 tests they got 50 positives, even at a false positive rate of just 1% they’d get 33 false positives, at a false positive rate of 1.5% there might not have been a single true positive in the entire study.
Stanford and Southern Cal both checked carefully for false positives, found none.
Michael Moon April 23, 2020 at 7:31 am
From the Abstract: “We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer’s data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both.”
(i) is not a scientific test, it’s an act of faith, (ii) is ridiculously as a check on a test that needs to be better than ~99.5% accurate on not giving false positives.
Andrew_W
April 23, 2020 at 4:03 am
Extraordinary math.
Since when 33 happens to be 1% of 50, when 10% happens to be 5!!!!!
Is false positives, not false negatives.
Why did you not consider the 10% false positive of the test instead?
According to your math you would have proved once and for all, beyond any doubt, with your brilliant math, that antibody test of any kind is just irrelevant and a joke… and not applicable or useful.
cheers
whiten April 23, 2020 at 7:49 am
Extraordinary reading comprehension.
” . . across 3300 tests they got 50 positives, even at a false positive rate of just 1% they’d get 33 false positives, at a false positive rate of 1.5% there might not have been a single true positive in the entire study.”
All very simple.
What do you think is the false rate for any test at all out there?
It ain’t zero, mate.
Do you think the virus test for COVID-19 has 0% falsity?
Or do you know of any test at all that has a better than 99% accuracy?
1% there is the test error itself mate, same or maybe even better than the viral test error.
I am sure you do not understand how such tests work.
Virus test is a diagnose test for the disease, not 100% accurate also there.
No any direct possible connection to the infection disease clause, not any need to validate it for or in relation to the infection… still misses a lot of infected outside the window of disease detection… misses a lot of asymptomatic that have passed the disease.
But still very good in what it supposes to do if at 1% falsity.
The antibody test a detection test for infected, also not 100% accurate there.
Due to the test needing to be validated by the disease condition, we get the relation of the disease to infection, the 10% false positive.
Accuracy of diagnosing for the condition of the disease 80-90%, when accuracy for detection of the infection 98-99%.
The primary function for antibody test, detection of the infection,
secondary, disease relation detection in consideration of the infection.
Virus test only one function, diagnoses of the disease, more accurate for confirmation of the disease, kinda of 98-99% at the best case… no good at all for the infection…
especially in the case of a new infection-disease.
100% miss of infection outside the disease window… 100% miss of the disease also, outside the disease window.
In consideration of a virus test, the number of infected will be a guess estimate, also the true number of people that have passed the disease, depending on an assumed factor, which in the case of a new infectious disease will be like pulling a rabbit or two or more from a hat.
But in proper application of an antibody test, identifying the scale of infection is quite very accurate, and the scale of disease still directly assessed, by a real established factor… not a purely assumed guess estimate.
Application of both tests properly, gives a much much clear accurate real picture.
Your math really bizarre, as there no any 100% accurate test in existence, unless in the consideration of Planet B of Billy Nay.
All very simple on that Planet, I am sure of it, but you see, I do not live there.
cheers
whiten April 23, 2020 at 11:28 am
“What do you think is the false rate for any test at all out there?
It ain’t zero, mate.”
I’m glad to see you agree with me on that point, No doubt you realize that because the Santa Clara study was dependent on there being a zero false positive rate that that study is junk.
“…Let us quarantine the at-risk, elderly, elerly plus…”
Are you promoting elder or comma abuse in the above suggestion?
There’s a parallel relationship between the acceleration and deceleration of the daily cases, and the daily death curves:
One is a test, one is a corpse.
The stated purpose of the lockdowns – in all countries – seems to have been to slow the spread to avoid overwhelming the country’s health service. (If I’m wrong and some country decided to lock down for another reason, then please tell me).
Is there is an effective treatment for the disease? I HAVE READ THAT THERE IS NOT? There seems to be no agreement on what product(s) to use. There seems to be no agreement that ventilators actually help – I’ve read opinions that say they are actually worse than leaving the patient untreated.
So, if we can’t cure the infected, what is the sense in trying to “avoid overwhelming the health service ?”. Why not lift the lockdowns, let those who are going to die expire (hey, we can’t help them !) get the deaths over with and stop trashing the economy? Just asking…
Willis, I agree with your statement that the number of confirmed cases is a direct function how many you have have tested. It seems bleedin’ obvious. I seems to recall that Lord M disagreed with that idea, about 7-10 days ago. If he is reading, maybe he will re-iterate his thoughts. I’m willing to be shown to be an old fool – my wife calls me that all the time.
As some of the commentator pointed out, the ratio positive_tested/test_number can be misleading if the sample is not randomly chosen; in many countries the people tested are already those with some symptoms. In the Czech Republic (we are dealing with the disease relatively well, at least so far, similarly as our neighbour Austria) we are now starting a big testing of ~30 000 people randomnly chosen to better estimate the real ratio of the COVID19 penetration. The results should be available in ~14 days.
Correct that is why his Australian data doesn’t work. To get what Willis is trying to do you would have to have a truely random selection of people for testing and no country is really going to waste what is a limited number of available tests. We have the flu going around in Australia at the moment so there is a hell of a lot of testing going on per day like 10000 tests for 8-12 detections of covid19.
No!
They are not the same test! The most important test (Antibody/serology) testing is available en-masse from Australian and international companies right now.
It is illegal in Australia to test for antibodies (Serological testing) $20,000 fine in South Australia; just ask yourself why… If you really have to! ;-(
Two tests are are available, one can only tell you if you have the virus at the moment (PCR and that is best, well before 10 days after infection) and one can tell you if you’ve had it (Serological, that works best 10 days or more, after infection) neither test can tell if you will be sick, are sick or have been sick!
The current figures are legisltatively designed to sex-up / bias death rates. It is very well documented in long standing literature that testing only the symptomatic with single PCR tests leads to both to more false negatives and a greater than zero false positive figure, which inflates the death rate of any cohort (sample group).
To be clear, it is of very great importance that random tests** of a large sample of the asymptomatic population are done as soon as possible, in order to fully establish the virulence of this new “disease”.
It has been clear from the earliest date that we are all being gaslighted by the supposed “rates”of infection and death! ;-(
** Firstly using antibody testing and including PCR if available.
Initially I was scratching my head thinking you were making the slightly crazy claim that hundreds of thousands of Australians were infected and we never noticed 😉
However I assume I just don’t get what you are saying so are you saying the 78 deaths is sexed up? Given 90% of the cases we know the source (all from outside Australia) you can basically say we have had close to zero deaths from community transmission. I don’t get how changing the death number changes anything?
You probably need to have another go because I don’t see what you are saying.
Yours words:
To get what Willis is trying to do you would have to have a truely random selection of people for testing and no country is really going to waste what is a limited number of available tests. -LdB
Tests are limited only by government regulation not but availability.
Is that clear enough you gutless nameless troll.
Initially I was scratching my head thinking you were making the slightly crazy claim that hundreds of thousands of Australians were infected and we never noticed – LdB
Yes, hundreds of thousands of Australians have been infected and we have not noticed!
Why? Because we have not tested the infected we have only tested the symptomatic.
It amazes me that “you” can claim not to see this but perhaps my appreciation of the average IQ is too optimistic or perhaps you are just a bot.
Ok you do believe that .. I don’t have a tinfoil hat .. no comment … leave you to it.
Ok you do believe that .. I don’t have a tinfoil hat .. no comment … leave you to it.
LdB
What do you mean by “waste?” What good does it do to know if a particular patient has COVID-19 when there is no cure, only palliative care for flu-like symptoms? The available test kits would be better used with random testing to follow the development of the disease over time and get a better understanding of the percentage of asymptomatic carriers.
May be, ingenius, but really not so much.
The linear shows that the medicine is well organized in the country.
If the plot is scattered, the medicine is a havoc, like in Australia.
The German medics have a clear narrative that the number of confirmed cases in testing must be less than 20% and more than 10%.
If you get more than 20% positive, you test more people with mild and irrelevant symptomatics.
If you get less than 10% positive, you have to test only those who were exposed.
They do not want to waste tests. Each test costs $300.
It is that simple.
Still wondering about the linear correlation?
The graphs are linear if the rate of growth of COVID 19 is matches the growth in testing. Look at
Australia and NZ and you will see that the opposite. The more they test the few cases they find.
Over the past week NZ has substantially increased the number of tests it has performed and yet
the number of cases has dropped to 2 as of today.
Isolation works. Australia’s last high peak of daily new cases was 528 new cases, on the 28th of March.
There are 8 new cases today, 12 new cases yesterday and 20 new cases the day prior.
Sufficient Isolation for long enough ends it.
They won’t believe you but look at the bright side we get armchair seats for the covid19 olympics.
COVID-19 Para-Olympics
fify
What concerns me about the very “successful” Australian approach is .. what happens when we reopen our borders? Will Australia go through it all again while the “unsuccessful” countries are down to very low rates? IOW, is the success an illusion? Are Donald Trump and Jair Bolsanaro actually getting it right?
Too many unknowns.
Amazes me how few people understand what quarantine is, how simple it is, and how reliable it is. I really would like to know why people presume we would be so silly as to let people into the country without serving a sufficiently long quarantine to prove they don’t have the disease before being allowed entry. Especially given almost everyone here is convinced testing will never work well enough. But quarantine sure will.
Somehow ‘critics’ never seem to have any reply, but will insist on repeating the exact same fake ‘question’ and play of consternation the next day, and pretend they never got a perfectly adequate answer the first time.
You want to isolate Australia from the rest of the world indefinitely, fine. We might get lucky and come up with an especially effective vaccine and problem solved. Or we might not.
In that case the only way we get through this is it passes through the population, those especially susceptible succumb; those fortunate with the health and immune systems to fight it off become immune to it and life continues on. How many times has this happened in the past 2000 years? In this scenario, quarantine only moves the time you have to endure the disease out a ways. The virus will always be lurking out there. Probably the best scenario in this case will be better treatment protocols, but even that isn’t guaranteed.
Australia becomes a North Korea. No one in, no one out. Standard of living declines and everyone can’t go past their city limits without getting dragged back in. Good luck.
WXcycles
You asked, “… why people presume we would be so silly as to let people into the country without serving a sufficiently long quarantine …” There goes your tourist industry when most people only get two or three weeks vacation. They may not want to spend it all indoors looking for red-back spiders in their room.
Yeah, if the native Americans could have just practiced effective quarantine for the last 400 years they wouldn’t have been decimated like they were.
If this virus becomes one like influenza, and continually lives and cycles through in resistant populations, then your proposal sounds like indefinite isolation.
I see all three of you wish to take an extremist nonsense position to avoid the real possibility of completely defeating it, with minimal disruption to life and economy, rather than a practical intelligent adaptive one, which works.
“… The virus will always be lurking out there. Probably the best scenario in this case will be better treatment protocols, but even that isn’t guaranteed. …” – rbabcock
So modern medicine just might not work. Right! OK, let’s just write that off as useless time-wasting, and give up sooner, so we can also fail, as there are tourists and airlines who’s priorities and balance sheet is so much more important.
I’m convinced – NOT.
We will be stopping it at the borders and investigating every opportunity to defeat it, and we’ll succeed.
The UK’s Covid-19 latest update:
http://www.vukcevic.co.uk/UK-COVID-19.htm
In the UK you cannot get a test until you have a fever. In which case the assumed infection rate is going to be far higher than it should be – it takes no account of asymptomatics.
I know loads of people who have had suspicious colds after visiting European Cov-19 hotspots, but none have been tested because they did not have a fever. (I do lots of international travel.)
Ralph
Willis,
You say that “it’s been one full month since I publicly called at my blog for an end to the American Lockdown.”
So I am curious to know what you make of the recently published article
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561934
claiming that the lockdown and social distances has saved the US over 5 trillion dollars.
Don’t know what Willis would say, but I say its a MODEL. Bet they used a case fatality rate of over 2%, and ignored the evidence of a large number of cases that are mild or asymptomatic.
Thanks, Willis. Australia’s scatterplot’s scattered pattern is unlikely to be because we’re all rugged individuals. I think, off the top of my head, that it could be some big outbreaks hitting a small population with a low background infection rate, when the number of daily tests has been variable.
A single ‘event’ here can make a big difference.
Willis Eschenbach, thank you for another fine focused essay.
I’m not sure if this is a general problem but analysis of UK test data is that the criteria for testing has changed over time. There have basically been 3 changes which have at least partly been driven by testing capacity, i.e
(a) Contact tracing – this involved testing suspected cases and all known contacts. While not random this covered a broader range than (b)
(b) Hospital attendances – resulted in an increased positive to test ratio for obvious reasons
(c) As (b) + Healthcare workers
(a) to (b) was a fairly abrupt change. (b) to (c) was more gradual.
It’s probably possibly to disentangle the data to get more consistent trends but I can’t be bothered. I suspect the UK new infection numbers peaked some weeks ago. Exactly when is a point of real interest. Given that there is a ~5 day incubation period it’s quite possible that the peak in new infections occurred BEFORE the big lockdown.
Hand washing & self isolation of those with symptoms might have actually been working .
The peak in identified cases across the UK occurred on 4th April, as measured by taking a centred 7 day moving average to get rid of weekend effects, implying that the peak in infections was at least 5 days earlier – probably more, since only hospital cases were being tested, so perhaps more like 7-10 days after infection that 5. I have estimated when the peak occurred (or is yet to be certain) across England and mapped the result here:
https://datawrapper.dwcdn.net/eFD6C/1/
Thanks Willies, I Eliza and Rune got me thinking of what a pensioned Swedish virologist said some time ago. He said that difference in size and isolation of nursing homes is significant.
For example in Sweden most nursing home count about 100 elderly and much traffic of personnel in and out of the institution. I Norway the average nursing home count more like 10 elderly and most personnel live more less integrated with the facility.
The virologist also assumed that about 50% of the general population at the time would have been infected. He therefore advised to pay serious attention to the nursing homes to protect the vulnerable elderly and regarded the lock-down as counterproductive, both economically, socially and health vise.
If anybody here have an idea how to get data about nursing homes in various countries, we might be able to see if the virologist is correct or not.
I used to work at Biofire, and they have a cool site that tracks infection rates.
https://www.syndromictrends.com/
I’ve watched that website for years, and it’s never done what it’s doing now. Usually their respiratory panel detects something 40 – 60% of the time it’s run, in the last couple months that has plummeted to 10%. The same is true of the gastro intestinal panel, plumbing new lows in detection frequency.
If we have 11 covid positives out of 100, and only about 10% with anything else for a respiratory or stool sample, there must be an enormous amount of hypochondria out there, or physicians ordering these very expensive tests have lost their minds.
Sorry, 19 covid positives out of 100 tests. Note that the BioFire respiratory panel does not yet detect covid, but it does detect other garden variety Coronaviruses.
My thoughts exactly … well sort of. My mind didn’t leap to hypochondriacs … but to Flu. 81 people out of a 100 presented with Flu … not COVID? They were tested because they had symptoms, including high temperature (not impossible, but tough to fake). That’s a LOT of Flu relative to COVID. A lot. Kinda makes me want to never touch another human for the rest of my life … hahaha … *cringe* … we’re headed for that dystopian future, aren’t we? Hopefully … we will eventually test EVERYONE, and discover just how HEALTHY we all are (for the most part).
Let’s get back to work!
And, Jeffrey Epstein did NOT commit suicide … neither should we.
If the tests are not randomized, we can’t conclude anything.
–
There is probably a linear relationship with deaths and number of tests. STOP TESTING NOW!
Or, in countries where number of daily cases is growing linearly, there is a correlation with tests. In Australia, we were very fortunate that isolation stopped community spread so number of cases grew linearly for only a short time.
Of the half dozen countries with most tests, 4 have had negative trend in cases per day for about 3 weeks. Doubtful that tests have tapered off.
Before having a dig at my lack of data, I’ve rattled this off in a few minutes.
There isn’t. High rates of testing are associated with both high and low death rates – compare e.g. San Marino and Singapore or the Faroes. There are also low rates of testing in places with low death rates, because essentially they remain largely uninfected – e.g. Indonesia and most of Africa. The Singapore/Indonesia comparison is interesting. Essentially next door, with very different health services, yet identical death rates. Perhaps their shared climate has more to do with it.
You might have missed my point. Just look at countries where deaths are increasing linearly.
I grabbed cases/1m against test/1m for European countries – for UK, France, Switzerland, Italy and Sweden, the R2 was over 99%!
But a word of caution – the number of TESTS in the UK is significantly higher than the number of PEOPLE tested. A significant percentage of people are being tested multiple times. I assume the same is true in other countries.
I know for certain that the statistics for Wales only report one test for each individual (a positive one replaces any prior negative) for each six week period. A new period starts 6 weeks after the first test.
See the interpretation notes here:
https://public.tableau.com/profile/public.health.wales.health.protection#!/vizhome/RapidCOVID-19virology-Public/Headlinesummary
I’ve not seen as clear a statement for England or Scotland or Northern Ireland, but it does seem likely that they have adopted a similar standard.
The Veneto Region in Italy has the highest world ratio between the number of throat culture per million inhabitants (at 04/22/2020 270,000 throat culture per 4.8 million inhabitants). The small town of VO EUGANEO has been fully tested twice in February 2020. The tests performed indicate: 1) in the first test 2.6% of the people were infected; 2) in the second test 1.2% were infected; 3) the infections occurred before the containment measures (lockdown); 4) infections occurred due to asymptomatic people with whom they lived together. 43.2% of positive swabs are asymptomatic. Researchers at the University of Padua did not find great differences in the viral load between symptomatic and asymptomatic people. See pre-printer (https://www.medrxiv.org/content/10.1101/2020.04.17.20053157v1).
Crisanti’s study, with which Imperial College of London collaborated, shows not only the effectiveness of measures of social distancing in the interruption of the transmission chain of contagion, but also the need for timely tracing of cases and their cases and their contacts, followed by possible isolation.
I completely agree with dr. Eschenbach when writing not to use confirmed cases as a metric for the spread of the virus. The real link is “number of cases” vs “number of tests”. In addition, tests are essential to identify asymptomatic people, otherwise the epidemic will never be stopped.
Are you comparing ‘like’ with like’ as I thought different tests were being used by diff. countries
yep.
diferent tests
different protocols
dogs breakfast.
As long as the tests are consistently in error, and therefore different from each other, they will produce meaningful data.
It will not be precisely accurate data, but you can track trends from it.
R
Willis
When you first called for an end to the lockdown on 21st March, you gave a properly caveated forecast of only 670 deaths in US.
The current forecast is two orders of magnitude larger.
It seems a reasonable time to ask what number of deaths *would* justify a lockdown? If an earlier lockdown in NY had saved lives there, would that have been worth it?
Does your call still stand despite the increase in deaths? If so, waht number of deaths would cause you to change your all? Do you think a localised lockdown in NY implemented earlier would have been worthwhile?
I would have thought this would be of more use
https://pharmaphorum.com/news/roche-develops-new-covid-19-antibody-test/
In the UK “Scientists at the University of Oxford have been working on a vaccine to prevent people from catching Covid-19”
https://www.telegraph.co.uk/news/2020/04/17/human-trials-coronavirus-vaccine-set-begin-uk-next-week/
If many of the five and a half thousand test volunteers have had the virus without knowing it there’s likely to be problems with the results???
In the UK “Scientists at the University of Oxford have been working on a vaccine to prevent people from catching Covid-19”
Forget about that. Dr Whitty was crystal clear yesterday during daily briefing: no reasonable chance for vaccine till end of next year.
There is a good chance. The US allowed a vaccine to go out before proper testing in the late 70s. It would be reluctant to repeat this but this might be a time for it to happen again.
Not sure about that. Primum non nocere still stands and this vaccine business may be quite risky. Unless we will be in total desperation vaccine may not come for the good 12 months or so.
https://www.realclearpolitics.com/2009/04/28/the_great_swine_flu_epidemic_of_1976_212900.html
Some interesting parallels