When does government intervention make sense for COVID-19?

Reposted from Dr. Judith Curry’s Climate Etc.

Posted on May 29, 2020 by niclewis

By Nic Lewis

Introduction

I showed in my last article that inhomogeneity within a population in the susceptibility and infectivity of individuals would reduce the herd immunity threshold, in my view probably very substantially, and that evidence from Stockholm County appeared to support that view. In this article I will first provide other evidence pointing to such population inhomogeneity being very considerable. I will then go on to consider how the overshoot of infections beyond the herd immunity threshold could be reduced.

I’ll start with a recap. The basic reproduction ratio of an epidemic, R0, measures how many people, on average, each infected individual infects at the start of the epidemic. If R0 exceeds one, the epidemic will grow, exponentially at first. But, assuming recovered individuals become immune, the pool of susceptible individuals shrinks over time and the current reproduction ratio falls. The proportion of the population that have been infected at the point where the current reproduction ratio falls to one is the ‘herd immunity threshold’ (HIT). Beyond that point the epidemic is under control, and shrinks.

The higher R0 is, the greater the HIT will be. I used  an R0 value of 2.4, the baseline value used in the influential Imperial College model (Ferguson20[1]). Standard simple compartmental models of epidemic growth, which assume a homogeneous population, imply that the HIT equals {1 – 1/R0}. For R0=2.4, they imply the HIT is 58%. For R0 value of 3, which is towards the upper end of most estimates, the HIT is 67%. These naïve, unrealistic values probably account for the HIT range of 60–70% for COVID-19 often cited by epidemiologists quoted in the mainstream media.

There is no doubt that inhomogeneity within a population in the susceptibility and infectivity of individuals will reduce the HIT. I cited the Gomes et al.[2] paper as showing this and I adopted, with some modifications, its susceptible – exposed – infectious – recovered (SEIR) compartmental model (Figure 1). I also adopted its gamma probability distribution for population inhomogeneity that arose from varying social connectivity – different rates of mixing with (being in contact with) other people, which affects both susceptibility and infectivity. The gamma distribution can represent the existence of a small number of highly connected “superspreaders” with a very high susceptibility and infectivity, together with a far larger number of people who have a much lower connectivity. I used illustrative coefficients of variation (CV) – a measure of the extent of inhomogeneity – of 1 and 2 in my article for inhomogeneity related to social connectivity. Those levels are consistent with the evidence.[3]

Figure 1. SEIR 4-compartment epidemiological model diagram. Initially all individuals are susceptible. A tiny number are seeded with infection at the start of the epidemic. Exposed individuals are susceptibles who have been infected, but who remain uninfectious until a probabilistic latent period has expired. Once they become infectious they remain so for a probabilistic infectious period and then become ‘recovered’ –  which includes some who are still ill and may die, and some who have died while infectious. In the standard model version, the rate of new infections is proportional to the product of the numbers of infectious and susceptible individuals. In the modified model, these numbers are weighted by respectively the infectivity and susceptibility of each of the  individuals involved, both of which vary between individuals  according to their social connectivity. Individual  infectivity and susceptibility also vary separately, with factors specific to each.

Other evidence regarding the effects of population inhomogeneity

Another recent paper, Britton et al.[4], also shows that varying social connectivity will lower the HIT for COVID-19. They use, for illustrative purposes, a much simpler probability distribution, with the population divided into only three segments, with arbitrarily chosen social mixing levels, giving rise to a smaller CV of 0.56, and assume R0=2.5 The result is a reduction of the HIT from 60% to 46%. They point out that it is only the disease-induced HIT that is reduced; the HIT for vaccination is unaffected by population inhomogeneity.

It is becoming evident that, in addition to individuals’ general resistance to infection varying, around  half the population may well have pre-existing partial immunity to COVID-19 due to previous encounters with other coronaviruses.[5] [6] [7] Variation in susceptibility related to resistance to COVID-19 infection is therefore an important factor.

A 20th May preprint paper, McGeoch and McGeoch,[8] which divides the population into only two parts, considers variability in susceptibility that is related only to resistance to infection, and not  to social connectivity. In my model, such variability was included in the probabilistic factor that reflected non-social connectivity related variability in susceptibility. I used probability distributions with CV values of 0.42 and 0.95[9] to represent that factor, while the CV of their susceptibility distribution is 0.6.[10] They find a significant reduction in the projected HIT and final infected proportion, but a smaller one than in my model. That is to be expected, because their model omits the social connectivity factor, which affects both the susceptibility and infectivity of each individual.

A recent working paper[11] from the US National Bureau of Economic Research reviews models for the spread of COVID-19, both simple and complex, and their policy implications. It has a whole section on heterogeneities that are not included in standard simple compartmental models, limiting their realism. However, it is not very complimentary about more complex models. Regarding the highly influential, complex Ferguson20 model, it says regarding how it treats the effects of policy intervention:

“The changes in contact rates assumed in this model are never justified and, in fact, appear to be entirely arbitrary and in some cases clearly inaccurate”

They are also strongly critical of the simplistic and very limited treatment of uncertainty in Ferguson20.

As I stated in my original article, the Ferguson20 model appears to account for inhomogeneity in susceptibility arising only from a very limited set of factors, with only a modest resulting impact on the growth of the epidemic. Although their model does account for substantial inhomogeneity in infectivity, using the same gamma distribution as I did, in their case inhomogeneity in infectivity appears to be uncorrelated with inhomogeneity in susceptibility, and thus has a negligible effect on the HIT.[12]

Reducing the overshoot beyond the herd immunity threshold

Although inhomogeneity can greatly lower the herd immunity threshold, the ultimate proportion of the population that becomes infected will exceed the HIT, since further infections occur after the HIT is reached. Although such infections are continuously diminishing, if the epidemic is unimpeded they have a major impact on its ultimate size. In the examples I gave, I used a R0 value of 2.4. On that basis, I showed that the final infected proportion is about 1.5 times the HIT if the population is homogeneous, and about twice the (far lower) HIT if the population is inhomogeneous in the way that I modelled. Figure 2 shows the moderate inhomogeneity case that I illustrated, for which the HIT is 24% (against 58% for a homogeneous population) but the final infected proportion is 43% (down from 88%), a lesser reduction. The reason for the large overshoot of the HIT is that there are still many infectious individuals at the time the HIT is reached.

Figure 2. Epidemic progression in an SEIR model with R0=2.4 and a population of 1 million with CV=1 common factor inhomogeneity in susceptibility and infectivity and also unrelated multiplicative inhomogeneity in susceptibility with a CV of 0.42. The latent and infectious periods are 3 and 4 days respectively.

Intervention early on

Government intervention at an early stage appears to have been designed mainly to avoid health systems being overwhelmed, but the subsequent paths of the epidemics show that in most cases it was unnecessarily strong for that purpose. Moreover, as Figure 3 shows in the homogeneous population case, imposing a lockdown early in the epidemic, with the effect of reducing R0 from 2.4 to 0.8, and maintaining it for six months, merely delays the progress of the epidemic, with the final infected proportion barely reducing, from 88% to 86%.

Figure 3 Epidemic progression in an SEIR model with a homogeneous population, where R0=2.4 until a lockdown is imposed (dotted red line) at day 30 after which R0=0.8 until lockdown is ended 180 days later (dotted green line). The latent and infectious periods are as in Figure 2.

The effect of an early imposed,  long lockdown is also minor in the heterogeneous population case (Figure 4). The ultimate proportion infected falls by slightly under 5%, from 43% to 41% – still far above the HIT level.

Figure 4 Epidemic progression in an SEIR model with an inhomogeneous population, where R0=2.4 until a lockdown is imposed (dotted red line) at day 30 after which R0=0.8 until lockdown is ended 180 days later (dotted green line). The latent and infectious periods and inhomogeneity are as in Figure 2.

Moreover, intervention can have dangerous longer term effects in relation to infections.[13] Absent vaccination becoming available and providing long-lasting immunity, the virus is likely to resurge in the future if herd immunity is not reached in the original epidemic, and vulnerable people may repeatedly be at risk if not totally isolated.

Intervention at a later stage

However, government intervention at a later stage, as the HIT is approached, could enable the overshoot to be greatly reduced. Suppose the intervention, again reducing R0 from 2.4 to 0.8, is instead delayed until the HIT is being approached.

As Figure 5 shows, applying a short lockdown (30 days) later, hugely enhances the reduction in eventual total infections, compared with an early intervention lasting six times as long. The final infected proportion falls from 43% to 27%, rather than only to 41%. The reason is that dramatically slowing the infection as the HIT is approached greatly reduces the number of active infections as the HIT is crossed, and the lockdown also greatly increases the rate at which infections decline thereafter.

Figure 5 Epidemic progression in an SEIR model with an inhomogeneous population, where R0=2.4 until a lockdown is imposed (dotted red line) at day 53, after which R0=0.8 until lockdown is ended 30 days later (dotted green line). The latent and infectious periods and inhomogeneity are as in Figure 2.

If  the population were prepared to obey a lockdown for 60 days at that stage, and its timing were perfect, it would potentially be feasible virtually to eliminate the overshoot of the HIT. Figure 6 shows this case. To three significant figures, the final infected proportion equals the HIT.

Figure 6 Epidemic progression in an SEIR model with an inhomogeneous population, where R0=2.4 until a lockdown is imposed (dotted red line) at day 52, after which R0=0.8 until lockdown is ended 60 days later (dotted green line). The latent and infectious periods and inhomogeneity are as in Figure 2.

Conclusions

The take home lessons are, first, that imposing stricter restrictions early in an epidemic than are necessary to prevent a health system being overwhelmed is likely to have little impact on the proportion of the population that is eventually infected, in the absence of a vaccine becoming available before restrictions are relaxed. And secondly, that a well-timed imposition of strict restrictions for a fairly short period as the herd immunity threshold is approached can hugely reduce the overshoot of the eventually infected proportion above the HIT. States that imposed strict restrictions early on and then relaxed them may find their populations unwilling to see such measures reintroduced. However, the populations of states that introduced milder restrictions and are in reality pursuing a herd immunity strategy may find the imposition of strict restrictions for a short period bracketing the crossing of the HIT to be an attractive option. In either case, the serious illness and fatalities associated reaching the eventual level of infections can be very greatly reduced if elderly and vulnerable people are shielded from infection, as discussed in an earlier article.[14]

Nicholas Lewis                                               29 May 2020

110 thoughts on “When does government intervention make sense for COVID-19?

  1. It was old people with underlying health conditions in crappy nursing homes in a dozen US states and countries.

    The herd’s immunity was just fine.

    • And Governor’s putting COVID patients in nursing homes along Governor’s failing to protect nursing homes became a double whammy 🙁

      • BoJo did pretty much the same thing in UK dumping any old people in hospital, irrespective of COVID status, back into “care” homes which were ill-equipped and untrained to deal with them.

        It is hard not to see this as a cynical and criminally irresponsible manslaughter of costly and “expendable” older population .

    • Exactly right. In NSW here in Australia, the first 3 reported deaths were people, with comorbidity issues (Not reported at the start) in “care” homes over the age of 90. Then the lockdowns started.

  2. Show me the virus.

    Purify it. Associate it with a sick person. Let’s have a look at it under the electron microscope. Now do this again, with another person, and another.

    I suggest that, until you do this, all the current talk and cool graphics are show biz.

    • It’s a great racket. Proclaim emergence of a new disease when someone notices an unusual occurrence of something somewhere, immediately blame it on a virus, and then discard Koch’s postulates to avoid having to actually prove viral causation. Then disavow the Hippocratic oath to treat patients with experimental toxic drugs and treatments that ki!ll them, and then pat yourself on the back for saving some (who were strong enough to survive the abuse).

      • Are you saying there’s no SARS-2 ChiCom virus? Are you saying there is a virus bu no proof it’s causing a global pandemic? Or there is no global pandemic?

      • It is a great racket. And it’s not like it’s the first time they’ve pulled off a racket like this. HIV and AIDS proceeded in much the same fashion. Fauci was neck-deep in that one too…

  3. “Absent vaccination becoming available and providing long-lasting immunity…”
    “in the absence of a vaccine becoming available…”

    But if a vaccine does become available, delaying strategies are looking pretty good. This can’t be ignored. Even improvements in treatment makes delay attractive.

      • Would the economy survive a failed health care and funeral system? imo it would tank anyway. How was the economy in the Lombardy region before the lockdown?

        • Given that the Wuhan virus tends to kill the very old, a runaway pandemic would probably have the net effect of improving an economy by removing the burden of caring for those elderly.

          Not saying that’s a good thing, of course.

      • He wants Biden to win. He is for tanking the economy all through this summer even though 40 million people are unemployed because of it. I think that those 40 million people ought to consider that their lives probably AREN’T going to get better if they vote for somebody who politically benefitted from vast segments of the American workforce being unemployed. Consider that some people, Stokes probably included, are ecstatic about “emissions” being down with all of the job losses. Who’d seriously elect that?

        • Nick Stokes’ comments are always thoughtful, rational, well-argued, and polite. Which is how ALL comments should be. They may, or may not be, correct – that’s not the point. This site is, and hopefully will continue to be, a place where evidence can be presented, debated and evaluated. Not an echo chamber of ‘scientific consensus’. Certainly not a forum – yet another one – for tribal politics, of whatever persuasion. I have learnt so much from so many people on here, including Nick Stokes – and, while the conversation continues and new ideas and ways of thinking are evaluated and assimilated, I will keep coming back, and keep on learning.

    • There has never been a vaccine for a Coronavirus. There is no evidence that the lockdowns have saved even one life. There is plenty of evidence that the lockdowns have destroyed prosperity, which creates unemployment and frantic terrified Moms and Dads, who subsequently do horrible things, suicide, child abuse, opioid overdoses, binge drinking, domestic violence. People are terrified to go to the hospital, generating spikes in untreated cancer, stroke, heart attack, and lots of other nasty stuff you would not wish on your worse enemy.

      “Delay.” You are not stupid, but you come from an angle I just cannot find. Wow. Describe to me your utopia…

      • “There is no evidence lockdowns have saved even one life”.
        What kind of nonsense are you thinking ? Take Italy for example, due to initial test equipment shortages, many people who did NOT have the virus but some other respiratory ailment were put in wards and exposed to the virus, and subsequently died. About 19 out of 20 people who think they need to be tested end up testing negative. Lockdown makes a lot of these people stay home instead of becoming infected. You can’t just assume anyone “forcefully exposed” in this manner will eventually catch it anyway. Lockdowns were effective at preventing overloading of hospitals, with subsequent saving of many lives.

        • 2/3 of NY state’s Covid-19 cases happened during the lockdown. Some states and countries never went on lockdown.

          The data show Sweden did better than some countries with lockdowns and worse than others.

          Your conclusions are based on assumptions, not facts.

          • Sweden, Sweden, yada, yada, blah, blah….Swedish higher education went online, Sweden implemented social distancing at restaurants and businesses, cancelled mass gatherings, isolated and traced breakouts….basically just didn’t make police hand out tickets to enforce recommendations, and kept kids in daycare and elementary school so that parents could go to work. Call it a non-lockdown if you want, it was a long ways from business-as-usual, especially in cities. Swedish citizen’s reaction of being careful and responsible resulted in an average infection rate for European countries. Check Willis’ chart under the WUWT banner.

          • DMacKenzie,

            I think you proved my point. If the lockdowns were clearly effective, we would see much higher rates of infection in places without lockdowns. Of course, there are many factors to consider.

          • Can you say “apples and oranges”? I knew you could…

            Of course a lot of cases in NY appeared (not “happened”) during lockdown, given that the disease takes awhile to show symptoms. Suppose New Yorker X got infected a couple weeks before lockdown. Then they had much of those weeks to distribute the disease to other New Yorkers, who can in turn pass it on to others, before lockdown. And then you have a pool of people with the disease, many of whom are going to become symptomatic. And even once the lockdown has taken effect, carriers will be infecting family members who are in constant contact with them.

            As for states and counties that never went on lockdown, I’m not sure which states you’re referring to, but there’s a big difference between a wide open state like Wyoming or Montana, and a crowded place like NYC. So the fact that there were far fewer cases in Wyoming or Montana is simply due to the fact that people in those states (and for that matter, in rural NY state) have much less contact with other people.

            So I think your implicit conclusions are based on ignoring the facts.

        • ‘ Lockdowns were effective at preventing overloading of hospitals, with subsequent saving of many lives’

          That is only true if people actually survive the hospitalization, if i recall correctly 50% or more of the people that end up in the ICU unfortunately die anyway. Lockdown or no lockdown. For a large percentage of those infected COVID seems to be a death sentence NO MATTER how hard the ICU staff (while risking their own lives) tries to help the patient recover.

          For keeping the hospital from being overwhelmed an alternative to the lockdown would be to perform a form of triage, i.e. only treat those patients that have a high chance of recovery and help the terminal cases in such a way that they are comfortable, don’t occupy a bed that could be used for someone who is likely to recover and can’t infect other high mortality risk people, so don’t send them back to the nursing homes, how stupid is that!

          As stated in the article a lockdown only delays the spread of the virus and a 100% lockdown is impossible anyway. Just think of how many people are still working in the ‘essential’ parts of society like agriculture, (food) distribution, police, fireman, medical staff, utilities etc etc.
          So at best a (partial) lockdown can only ‘save’ a part of the infected people and currently we don’t know how many people have actually been saved by the lockdowns.

          Anyway, fact of the matter is that a percentage of those infected will die no matter what we do as there is no cure or treatment currently available. Seriously protecting the vulnerable from being infected and letting the virus run its course through the rest of the population seems to be a better alternative to a lockdown.

          Stay sane,
          Willem

        • It is really hard to demonstrate that lockdowns actually did prevent the overloading of hospitals. From the reports I’ve seen, the infection rate was never high enough to threaten the hospitals. With only 3-4 really seriously infected areas other errors, such as sending patients with active disease to retirement homes caused many more deaths than it prevented.

          The whole episode dramatically shows how political showboating and lack of information, plus misuse of information(models), and bad statistical analysis caused most of the trouble. From November 2019 through March 2020 there were no reliable figures for infection rates, deaths, cause of death, except in the large fraction of states that had relatively low levels of infection.

      • ““Delay.” You are not stupid, but you come from an angle I just cannot find. Wow. Describe to me your utopia…”

        Think “Ebola”

        If it was a very infectious Ebola virus, you wouldn’t be saying what you are saying. Just because the Wuhan virus didn’t turn out to be as lethal as Ebola, doesn’t mean we shouldn’t have considered that it might be, when we first encountered it, and knew nothing about it, so the initial “delay” was the only move a rational person would take until we gain understanding of the virus.

        The next unknown virus might just be a bad one like Ebola. We have to take every unknown virus seriously. We have to assume they could be very lethal until proven otherwise. That means social distancing right off the bat. There can be no rational argument against mitigation when an unknown virus shows up.

        • The next unknown virus might just be a bad one like Ebola. We have to take every unknown virus seriously. We have to assume they could be very lethal until proven otherwise. That means social distancing right off the bat. There can be no rational argument against mitigation when an unknown virus shows up.

          Any clue how many unknown viruses there are? — One headline I read claimed over a million, but how would we even know that, because they are unknown? Anyhow, there’s probably so many unknown viruses that to take every one of them seriously would drive us mad right off the bat (right off the Pangolin?) The rational argument against irrational mitigation is, “Calm the F down.”

    • Tell that to the 41,000,000 U.S. Citizens who are now unemployed and can’t pay their Rent/Mortgage/Utility payments and have growing concerns about putting food on the table

        • “And the increasing suicide rate.”

          The suicide rate would be “in the noise” if we were faced with a really infectious, very lethal virus like the Ebola virus. All the collateral damage would be “in the noise” in such a situation.

          The good news is more and more people are going back to work, so the suicide rate should be diminishing.

      • If this whole debacle flips the election onto China and the utter GRAFT of Washington DC, resulting in a landslide for anti-Washington candidates … it will turn out to be an economic benefit.

        A lot of moving parts, yes. Those elected would have to follow through – deregulate, lower compliance costs, enact TORT REFORM and other measures to lower the non-labor COST of bringing “back” (quotes because we’re talking new, automated manufacturing here) production to the USA. But one can aspire, eh.

      • “Tell that to the 41,000,000 U.S. Citizens who are now unemployed and can’t pay their Rent/Mortgage/Utility payments”

        Pay attention. People are going back to work. Most of those who are not back to work now are receiving government payments of one kind or another. Have you talked to 41,000,000 U.S. citizens? If not, then how do you know their particular circustances?

        Aren’t you indulging in wild speculation?

        • Not at all…
          A number of those are actually considering NOT going back to work as Unemployment and the additional $800 COVID ASSISTANCE is paying them more per month than they made on the job. These non-forward thinking individuals will become hard pressed to find work once the COVID ASSISTANCE payments are removed and their unemployment payments reach their typical 180 day limit. After their positions have been refilled by someone else…
          The 41,000,000 are the latest figures as reported, I have no proof as to correctness…Do you have hard data proving it otherwise?

          • “A number of those are actually considering NOT going back to work as Unemployment and the additional $800 COVID ASSISTANCE is paying them more per month than they made on the job.”

            Yes, we are in such bad shape that people who could work won’t work because they are making more money sitting at home.

            Btw, I apologize for my tone towards you in my previous post. It wasn’t called for.

          • Unfortunately for those thinking this way, they’re only making more for a few months, then the (actually $600 COVID ASSISTANCE) $$ will vanish as will their ability to draw unemployment but their old jobs will be gone … either to someone else or simply eliminated by a leaner employer

    • Really Nick? About 100 actual deaths (And no way to confirm it was ACTUALLY COVID-19) in Australia when 150,000 was predicted? Really?! Your complete ignorance shows, so please, lower your skirt!

      • Patrick
        But surely you are aware of the latest adverts by Aussie politicians, especially Dan Andrews.
        Because of the lockdown, THEY have saved us, but if YOU don’t keep up the social isolation, there may be a second wave.

        • I was curious when that was going to start, I thought it might begin sometime around the middle of April, but then I’m always an optimist on timelines.

          Next will be: “it could have been MUCH worse! Good work everyone!” My prediction on that edict is sometime in September.

    • “But if a vaccine does become available, delaying strategies are looking pretty good. This can’t be ignored. Even improvements in treatment makes delay attractive.”

      Nick makes some good points.

      I wonder what the effects of hydroxychloroquine have had on this pandemic? Lots of people from around the world have been taking it as a preventative and lots of people have taken it to supposedly cure them.

      I hear a new study of hydroxychloroquine from Yale is saying good things about hydroxychloroquine. Laura Ingraham mentioned it on her program a couple of days ago, but I haven’t been able to find it with a search.

    • And if a vaccine never becomes available?

      I lack a crystal ball to say there will be a safe an effective vaccine in the next 6 months, next year or next decade. Still, it’s obviously not practical for lockdowns to continue until a vaccine becomes available. We need to lean how to live with this virus. I’m in favor of the herd immunity strategy.

    • But if a vaccine does become available, delaying strategies are looking pretty good.
      ≠=========
      Currently, the WHO says there is no evidence that infection confers immunity. As such talk about a vaccine is premature and speculative at best.

      A much more likely scenario is that through trial and error doctors become better at treating the infection.

      For example, the MATH+ therapy. Both WHO and CDC very early on said to not use steroids to treat covid-19. However, this now appears to have needlessly killed 10’s of thousands of people.

      Steroids and anticoagulants along with supplements when given early on after hospital admission are nearly 100% effective in preventing patients from progressing to the ICU and death.

    • Tautologies are the best form of argumentation, I find. What is the average development time for a vaccine? What is the fastest that has been achieved? How long are you willing to lockdown in preparation for what remains a hypothetical vaccine?

      You’re making an awful lot of assumptions here, either that the lockdown can be maintained until a vaccine arrives (months to years), or that a highly contagious virus will be suppressed sufficiently by an early lockdown that by the time a vaccine arrives (again, much later) it hasn’t once again gone wildfire. Interestingly, those points are directly addressed in this piece.

  4. How many successful corona-virus vaccines have been developed? I am guessing not too many. Hope for a vaccine may be good politics, but not good science.

    • The DNA SARS-CoV-2 vaccine was tested recently in rhesus macaques and challenged with SARS-2. The results were underwhelming for the sponsors of these very expensive set of live experiments. While the full Spike protein expressing DNA vaccine did confer protection to the macques it was not the sterilizing immunity that the study authors obvioulsy had hoped for.

      While the vaccine reduced viurus shedding by about 3 log in the SARS-2 challenged macaques, they still shed lots of virus in thier nasla secretions. So it seems likely that the DNA vaccine my protect the individual from the full brunt of the COVID-19 symptoms, it likely will not stop the transmission.

      In my estimation, the only vaccine modality that will stop this virus is live, attennuated virus vaccine that evokes both a strong antibody (humoral) response and a strong T-cell response. DNA and mRNA vaccines likely won’t do that, as this study showed in the macaques. And in fact in many people, these limited response vaccines but actually induce immunopathology in a small subset of people and probably kill people as a result.

      • creating an extreme response was what the prior failed SARS vax did
        why we dont have any others after that.
        the Ivermectin trials are ongoing
        be even better if it works as its safer than hydroxychloroquin for themajoroty
        and further reading on levels acceptable showed even far larger doses than FDA says are the max didnt create edverse events worth mention ie serious harm to anyone at all.

        Id rather take that than a mRna vax, unknown and prob irreversible effects

      • Joel O’Bryan
        May 29, 2020 at 9:29 pm
        and
        ozspeaksup
        May 30, 2020 at 2:51 am
        ——————-

        May not make sense as put so simply;
        Achieving the impact of “reinventing the wheel” is a condition with very dire consequences in matter of nature, natural order and evolution.

        It means a reset back to “stone age”, very dangerous for non “stone agers”.

        ” …it was not the sterilizing immunity that the study authors obvioulsy had hoped for.”

        In nature, there is no block or sterilizing of viral infection-diseases,
        as it simply consist in the reaching and maintaining the best balance-equilibrium.

        The very problem of modern vaccination programs, consists with the very sterile minds deciding and moving towards a very dangerous path in consideration of vaccinations:
        “the sterilizing immunity”.

        With the vaccination, ” the sterilizing immunity”, happens to be considered significantly these days due the secondary effect of vaccines, aka a side effect of vaccines, a short temporary block to infection,
        which in many kinds of infections is very very small and minimal, not even observable.

        Is this expected “sterilizing immunity” and the urge of achieving results through it, that gets the vaccination programs to the clause of
        “reinventing the wheel”,
        where even the subjects already have gained immunity due to infection and the disease experience, but still never the less are subjected to vaccination.
        Where at some point ending up with the condition of one single specific viral infection but with two completely different diseases…
        one of the herd, very very soft and benign (natural),
        and one of hospitals, very very severe and very fatal. (artificially enhanced)

        The bigger problem with this pandemic, happens to be the total lack of addressing this very weird and significant problem,
        of one specific viral infection and two very different diseases… where one of these diseases, the fatal one, very much prevails in modern rich developed countries.

        Is this big “leap forward” in vaccination, due to the urge of actually achieving the impossible “sterilizing immunity”, that has got the vaccination programs operating backwards and becoming very dangerous, to the the point that we even end up with cocktail vaccines, the most stupid and dangerous of all…
        where the immune system of subjects ends up in a “drilling” condition of three or more disease parameters at once… total jeopardy…
        with lasting significant negative side effects… at times very very costly.

        Oh well, in the end as always, the “sterile” minds do no much care about the mass “sterilization” procedures and protocols they forward,
        and the projected following consequences,
        as still overpopulation happens to be always the core problem for anything and everything there in the universe of such “sterile” unnatural mentality.

        Sorry for being so blunt, maybe.

        cheers

  5. I have been puzzled by the sharp peaks and decays of flu viruses in general. The explanation, that a population with highly variable susceptability has a lower HIT makes intuitive sense. It is estimated that, on average, a person gets flu every 9-10 years. This includes me who has had 2 flues in 70 years, and my husband who has had every epidemic that came around. It looks to me that this model explains something that puzzled me about the regular flu seasons.

    • FranBC — Indeed the “seasonal influenza” looks to be an interesting cross-check on Nick Lewis’s work. (It’s not seasonal in the tropics BTW which suggests that it isn’t warm weather per se that typically makes it go away in early Spring). Basically what we seem to have in influenza is a fairly infectious disease where the population typically has a rather high degree of existing immunity thanks to existing antibodies and, in the developed world,somewhat effective vaccines. Nick’s models would seem to suggest that influenza epidemics shouldn’t happen at all many years. There just wouldn’t be enough susceptible individuals for the disease to propagate beyond the occasional very small cluster.

      Instead, every year 10% or so of the world’s population comes down with the current influenza(s). That number may be low as the testing seems to be uncommon and possibly none too accurate and a lot of cases are almost for sure asymptomatic or unreported. Every quarter century or so (1889,1918,1957,1968,2009) there is a serious outbreak — which can be REALLY severe as in 1918. Those, I think are probably best regarded as a different phenomenon even though we know they are actually influenza variants. They behave differently. They MAY behave somewhat as Nick projects although I find the multiple (increasingly lethal) waves of the 1918 H1N1 epidemic troubling.

      Anyway, I’m no epidemiologist and I’m certainly no statistician. But I really can’t see how to reconcile the behavior of our second most common viral disease (after the common cold) with Nick’s modelling. Maybe I don’t understand the modelling. Or maybe it doesn’t apply to the seasonal flu for some reason. Or maybe both.

  6. It’s just ten comments, but yeah, exactly that is what is undermining any credibility for the storyteller!

    • It’s Friday night (at least here in the US), and this is just a re-post from Judith Curry’s webpage. Judith’s blog is where more math & sci-technically inclined tend to hang out and make technically literal comments/critiques.

      The inhomogeneity of the population because of various levels of pre-exisiting T-cell cross reactive responses, a response largely dependent on age (not being too old), is quite likely and is not considered in the simplistic early SEIR models that have almost universally been badly wrong in their projections of infections and death about the progression of COVID-19. There needs to be explanations of why this is so. Inhomogeneity of susceptibility is a leading candidate explanation. But knowing what that “lack of susceptibility” is at the individual level is key to understanding both how to proceed with a vaccine and how to lock-down if at all. Trillion dollar questions.

      • The superspreading events argue against any substantial hidden background immunity. Many countries, many ethnicities, same outcome.

        Also, what scientist talking about when it comes to T-cells is more of something that likely explains the asymptomatic cases than making people immune. They still can spread the virus.

        Stochastic is sufficient to explain what we see in the epidemiological data.

        • Just because we currently don’t understand something doesn’t mean there isn’t an explanation. Invoking “stochasticity” is a population-epidemiology dodge. It is the Individuals who appear immune are the ones to most interesting study, not those whi get most sick. Because what did they have?

          The phenomenon of Superspreaders are entirely consistent with 30% -40% of the population having a pre-existing partial immunity to the worst effects of the virus on the host.

          • The phenomenon of Superspreaders are entirely consistent with 30% -40% of the population having a pre-existing partial immunity to the worst effects of the virus on the host.

            No, it’s not. You can’t explain the number of infected people in a superspeading event with “partial immunity”. Even less so with 30-40%.

            Every infected person can be a superspreader. Only the personal behavior seems to define if it happens or not.

  7. A recent paper out of the La Jolla Institute of Immunology strongly supports the hypothesis that a large percentage (30-50%) of the US population may have pre-existing cross-reactive T-cell recall responses to SARS-CoV-2.

    “Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals”
    https://www.cell.com/cell/fulltext/S0092-8674(20)30610-3

    quoting the last sentence of their Cell paper abstract:
    “Importantly, we detected SARS-CoV-2-reactive CD4+ T cells in ∼40%–60% of unexposed individuals, suggesting cross-reactive T cell recognition between circulating “common cold” coronaviruses and SARS-CoV-2.”
    The basic picture is this:
    https://marlin-prod.literatumonline.com/cms/attachment/28d3d80b-517f-4ba5-93fa-3a9f34d18dfa/fx1_lrg.jpg

    This finding, if accurate across the US population, would substantially lower the HIT. As having pre-existing pool of memory T-cell recognition of the SARS-CoV-2 mosre conserved epitopes across the betacorona virus family would greatly reduce the severity of the infection (very limited if any spread through the lungs ) and the length of time of viral shedding before the full, combined force of the adaptive humoral (antibodies/B-cells) arm and a more refined T cell repertoire of effector T cells crushed the viral infection for the host.

      • 20. yes low sample size. but suggestive of why we see many who get the virus, seroconvert (become SARS-2 IgG antibody positive, but report no symptoms.

        • It’s 10. The other ten are the SARS-CoV-2 ones.

          It is not clear yet if the T-cell cross-reactivity has any impact on the development of symptoms, the severity of the disease or not. Scientists are speculating about it but there is no direct evidence.

  8. Nic-

    Thanks for an excellent analysis. The take-away I get is that various levels on government (in the U.S. at least) clamped down too hard at an early stage of the epidemic. This is not a criticism. This was a new experience for everyone. It’s just a lesson for the future.

    But that action leaves the current number of cases, for many areas of the country, far below even a 20% HIT. For instance, the Texas county that I live in, Bexar County (San Antonio), has a population of about 2 million. After almost 12 weeks since our first case, there are only about 2500 confirmed cases. If it was only 20%, the HIT would have to be 400,000 cases. At our current rate of about 50 new cases a day, it will take us well over 20 years to reach it. Either we live with the virus and restrictions forever, or we accept a far greater daily infection rate.

    A vaccine may or may not happen. But what about effective preventative medications, such as those espoused by the Eastern Virginia Medical school? How would those affect your model?

    • I think goes like this
      The pre lockdown R0 of New York, San António and rural Texas would all be different.
      If similar lockdowns were introduced to all three, the R0 would reduce but not consistently.

      I think most readers now accept that we can move to targeted lockdowns

      • The major problem in the US is that none of these lockdown orders from Governors and Mayors are constitutional. None, not a single one where they use executive authority to arbitrarily decide what is “essential” and what is “nonm-essential.” Or to order a church that it can only have services for x number of people. Completely unconstitutional. Or to order otherwise healthy people to stay home, or to wear a mask in public. Completely unconstitutional. Not even a question. To believe otherwise would be akin to ignoring or throwing out 77 years of US Supreme Court civil rights case law against abusive Governors and Mayors.

        Yes, some courts where challenges have been presented have let the lockdowns continue, but these questions on lockdowns will likely eventually get to the Supreme Court if they continue, and the Supreme Court likely won’t be so “unconstitutional” in their opinions as some of these lower court judges have been in bowing to governors.

        • The Supreme Court just upheld the California church limitation of no greater than 25% capacity or 100 parishioners, whichever is smaller. It was a 5-4 John Roberts liberal majority. This while rioters burn down America.

          • The answer to preventing riots, is to stop your police from murdering black people.

          • An identity politics talking point and excuse for rage/violence and social remodeling. White people don’t riot when they are ki!lled by police.

          • “White people don’t riot when they are ki!lled by police.”

            Yes, and a lot more white people are killed by the police than black people.

          • “The answer to preventing riots, is to stop your police from murdering black people.”

            We do stop the police from murdering black people. Two of the police who murdered George Floyd have been charged with murder, and the other two soon to follow, I imagine. That’s the way we stop police from killing anyone illegally.

            It is impossible to stop a mentally ill person from committing an act of violence. But we can punish that individual after the fact, and we can send a message to others out there that this is what they are going to get if they do violence.

            You can’t expect anything more. We are not mindreaders. We have to wait unitl the insane show themselves, and then we can act against them.

          • Chief Justice John Roberts played politics with that decision. His siding with the Libs shows he is scared the Democrats will pack the Supreme Court with 4 more Justices to dilute the Rule of Law and Constitutional law. He took the cheap way out of giving the Dems justification for court packing. He did the same thing in 2012 with his pretzel logic ruling to save ObamaCare’s clearly unconstitutional individual mandate and thus the ACA law itself.

          • I need to make a correction to one of my posts: I said that a second police officer had been charged in the George Floyd murder case, but that is not correct. As of a few minutes ago, none of the other three officers have been charged. I do expect all of them to be charged in the near future.

          • “Chief Justice John Roberts played politics with that decision. His siding with the Libs shows he is scared the Democrats will pack the Supreme Court with 4 more Justices to dilute the Rule of Law and Constitutional law.”

            It definitely shows he can’t be counted on to uphold the U.S. Constitution, which is clear when it comes to restricting religious practices. The U.S. Constitution says you can’t restrict religion. Congress shall make NO law doing such a thing. But the Chief Justice says otherwise.

            Maybe during Trump’s second term we can get enough real conservatives on the Court to negate Robert’s vote.

          • His siding with the Libs shows he is scared the Democrats will pack the Supreme Court with 4 more Justices to dilute the Rule of Law and Constitutional law.

            Err . . . huh???

          • The U.S. Constitution says you can’t restrict religion. Congress shall make NO law doing such a thing. But the Chief Justice says otherwise.

            Doh. I mean emphatically, “DOH!”

            Are you even remotely reviewing the same decision I read?

            (That question is rhetorical. Please don’t answer.)

  9. they can’t predict the curve of a flu season … ever …one of the most “studied” viruses we see annually … all of these models are just academic exercises in nazel gazing all science uped with buzz words like R(naught), etc … useless nonsense … the “experts” are nothing of the sort … just like the cures for cancer research … we have wasted billions on these experts …

  10. Yes the business of herd immunity .
    “It is becoming evident that, in addition to individuals’ general resistance to infection varying, around half the population may well have pre-existing partial immunity to COVID-19 due to previous encounters with other coronaviruses.[5] [6] [7] Variation in susceptibility related to resistance to COVID-19 infection is therefore an important factor.”
    That so many people are asymptomatic when infected with this virus, indicates this is not a new disease for which the “Herd” has zero immunity.?
    All the panic and pandemic projections started off advising us this was new and deadly.
    Visions of the Black Plague and the european diseases sweeping through the “New World”
    Time has proven those fears overblown.
    When does this stop being an emergency?
    Funny how our forefathers could deal with pestilence and mass deaths,yet we, even with all our earth moving equipment, are having the vapours over burying the ,as yet undead,Covid 19 victims.
    The “save the healthcare” campaign was quite an eye opener,our current emergency system is unfit for the purpose as it cannot handle a junior pandemic,what will happen in a real disaster?

    The real lesson here appears to be “trust not your government”.
    All the experts were wrong and unprepared,the lack of basic equipment and planning is pitiful.
    The one job they had,being prepared for a outbreak of pestilence,they failed.

    And the amazing divergence of points of view,between those put out of work and those who are paid from the taxes those out of work people.
    The host is near death,but the parasites feast on.
    Though it beggars my imagination what the “helpers” will live on without the productive members of society producing..

    • Our forefathers dealt with it, by building & using isolation units. That varied from nailing the infected up in their own homes, to “Fever” hospitals & sanitoriums. These closed when antibiotics & vaccinations became widely available.
      They also had “Seekers” who would examine bodies, to try & determine if they’d died from plague & then forcibly isolate their families.
      One of the major mistakes in how we’re treating these outbreaks, is the patients are being put into hospitals, spreading the infection to people in high risk of death groups. Then once infected, they were being discharged into care homes.
      The UK government, has just released a batch of SAGE (An ad-hoc committee of experts used to advise on technical problems) minutes, one of these held on 14th April, noted that transmission had slowed in in the community, while there was “significant transmission in hospitals” which “may have been masking the decline in cases in the community”.
      We also had “Nightingale Units” opened in arenas. However, rather than using these to treat any Covid-19 patients needing hospital admission, they were used as overflow facilities & it was deemed a “success” when they were closed, after treating a handful of patients.
      The success of antibiotics, vaccines & food safety laws, has lead to the dismantling of the local Environmental Health services, so our abilities to conduct contact tracing is markedly reduced.
      What’s possibly the biggest problem, is treating the Covid-19 pandemic, as a uniform & universal infection. It’s not. Because contact testing, tracing & isolation hasn’t been performed, the initial foci of infection, have been allowed to spread.
      For the major centres of infection, it’s too late, we’ll just have to let the infection run its course. If effective test, trace & isolate measures are put in place, then localities with lower levels of infection, could be opened up & allowed to resume more normal lifestyles.

      • “One of the major mistakes in how we’re treating these outbreaks, is the patients are being put into hospitals, spreading the infection to people in high risk of death groups.”

        Not just nosocomial infections, but more importantly, doctors actually creating the disease. A very large part of the mortality likely has been due to the treatments received in hospitals, such as early high-PEEP intubation and experimental use of toxic antivirals. Just like it was during SARS with their aggressive treatments using ribavirin, early corticosteroids and invasive intubation.

        Dr. Paul Mayo, perhaps New York City’s most illustrious critical care doctor expressed the risks [of ventilators] pithily: putting a person on a ventilator creates a disease known as being on a ventilator.

        The surest way to increase #COVID19 mortality is liberal use of intubation and mechanical ventilation.

        https://twitter.com/drjohnm/status/1250037261024059394

  11. This is an analysis in the correct direction so that countries and the WHO acquire a know-how and tools that were missing. The past semester has been an observational experiment the world over, and let’s hope that a good response to high rate epidemics is mapped out.

    The countries proceeded by trial and error, some governments putting emphasis on lives and some on the economy, until their failing health systems forced them to regulate deaths.

    In hind site it is easy to see that lock-downs should be selective, but the horror induced by the Lombardy horror videos, of patients effectively euthanized, dying in the corridors and army trucks carrying coffins, made some governments take early measures, as happened in Greece . The fear of the economy made other governments go with the herd immunity slogan, until their health system was overwhelmed ( see UK,…) and they came late to lock-downs, as an afterthought.

    1) The slogan “vulnerable people will die anyway”, go for herd immunity, was seen to be wrong, because the collapse of the health system made many more deaths, of people who would have survived for years if they could get emergency care.

    2)The slogan the economy would have survived if there were no lock downs has to be checked against reality: Was the economy in Lombardy working when the coffins were piling up and people were dying in the corridors? It would be a good Master thesis subject. My intuitive answer is it would be in shambles anyway because of the fear induced by the hospital and funeral failure . But it has to be studied.

    Hind site shows that selective lock-downs would work better. In the end they were used in Greece in specific regions that developed a high number of cases, and the system is prepared to use them again if flare ups come during the relaxed period that started two weeks ago.

    In hind site, it might have been better to use localized lockdowns, but that is what hind site means , that you were ignorant before and were learning on the way.

    Maybe the world should consider itself lucky to be given this exercise, with a virus of flue like mortality, to show us that rapidity of infection transfer is very important in twentieth century societies, so as to be prepared for a virus that might be more deadly next time.

    • Anna
      Fair comment
      Governments needed to act as they saw fit.
      But the Diamond Princess experiment was more than two months ago.
      It combined with early aged care facility deaths in Washington state, is enough trial and error.

  12. Macromolecular Studies in Łódź, the Polish Academy of Sciences (PL: CBMiM PAN) composed of M. Turek MA, dr. E. Różycka-Sokołowska, prof. M. Makowska-Janusik, dr. M. Koprowski and dr. K. Owsianik under the direction of prof. P. Bałczewski developed a two-component drug that can be used not only in the treatment of COVID-19 disease caused by SARS-CoV-2 infection, but also as the prevention of its development and a way of strengthening the immune response directed against SARS-CoV-2. The invention was filed with the Polish Patent Office (- patent application of 29.04.2020, P.433749).

    The main component of the developed drug is the active substance used so far to treat hypertension, affecting the ACE2 (angiotensin-converting enzyme 2), which is also a receptor of SARS-CoV-2, with the help of which the virus penetrates into the cell. By blocking this receptor, the active substance can prevent the development of acute respiratory failure syndrome, which is the main cause of death of patients infected with SARS-CoV-2. What is more, it also increases the Ang-(1–7) production. Currently, worldwide in less than 2 months, 38 active clinical trials have already been recorded on the effects of this active substance and other drugs in this group on SARS-CoV-2. An additional beneficial effect of the developed formulation is provided by the second component (a nutraceutical), which is a key compound that allows the strengthening of the immune response, mainly in viral infections, and also prevents ventilator-induced lung injury, which is especially vital in treating COVID-19. Importantly, the main component of the developed drug is characterised by poor solubility, which results in its low bioavailability. The developed co-amorphisation methodology, which allows for a dual-track drug system, has led to a stable pharmaceutical form, characterised by up to 24 times higher solubility of the starting component and proportionally greater bioavailability.

    The carried out research was funded from the National Science Centre Preludium project (M. Turek) No UMO-2019/33/N/ST5/01602 and the statutory research subsidy of the Division of Organic Chemistry of the Centre of Molecular and Macromolecular Studies in Łódź, the Polish Academy of Sciences (PL: CBMiM PAN) No. 500-02.
    http://www.en.ujd.edu.pl/news/view/drug-formulation-for-treating-covid-19-patients-developed-by-researchers-of-jdu-and-centre-of-molecular-macromolecular-studies

  13. The simple truth is: The leaderboard of infections of the Johns-Hopkins-University is now a leaderboard of the nations with the most populist presidents. And America is first, exactly as Mr. Trump promised you.
    Sorry for my poor English.

    • The nations that you called out are also the leaderboard of pretty much the most number of highly accurate tests. Huh, maybe that has something to do with the numbers. More tests, more positives. Duh!

      • Leaderboard of Infections is irrelevant. The countries on the leaderboard of deaths are those with the most aggressive treatments.

    • well Brazils rising count just buggered that theory for you;-)))
      and africas been a slow start but rampingup as well

    • “And America is first, exactly as Mr. Trump promised you.
      Sorry for my poor English.”

      Your english is good enough to convey your insult.

      Perhaps you should check out the death rate per one million population for all those nations. If you do you will find the U.S. has the second lowest death rate, with Germany having the lowest. Trump does make America First, well, second, in this case. But don’t count him out, he may make it to first by the time it’s all over.

  14. Nic – Thank you, this is great stuff!

    Consider this though: the ‘R’ value is not a basic attribute of the disease. It is a compound of the number of interactions of each individual with the probability of infection at each interaction.

    So, consider the KissoGram guy. He has hundreds of intimate interactions in a week. He is almost certain to catch the disease quickly, and to spread it to hundreds. He is one of your super-spreaders, and contributes to raising the apparent R.

    But in a second outbreak, he has already had the disease and is immune.

    My contention would be that the effective R value should naturally fall, and that subsequent outbreaks will have a much lower apparent R than the first.

    Does your model account for the differential removal of ‘super spreaders’ from the susceptible population?

    • Russell
      You are correct.
      Additionally even a mild or voluntary lockdown will help with super spreaders.
      They know who they are.
      They can change their habits and significantly reduce their R0

    • Russell robles-thome

      “…the ‘R’ value is not a basic attribute of the disease” I agree with you.

      Weeks ago when we where introduced the concept, that was the impression I got – R was an attribute of the disease: Coronavirus R=3, measles R=13. But it would seem to me that it is not only an attribute of the disease, and a function of the behavior of the individual with the disease (as you suggest), but also a function of the effectiveness of the public health measures used against the disease.

      If R represents the number of persons a contagious person infects, then it would seem to me to be affected by all three variables: the disease, the individual behavior, and the public actions taken to contain the disease. Thus, it now appears to me that much on the modeling for a HIT is just an academic exercise.

      We are not doomed to a HIT based solely on the characteristics of the disease. We can, and are, finding ways to limit the spread of the disease by getting people to modify their behavior and providing physical barriers to it’s spread.

      It would help if politics were not the determining factor in the actions taken. If the Republican President says taking a certain drug might help, the Democrats say it’s poison. If the liberal community suggests that masks might help, the ultra-conservatives yell ” you can force me wear a mask- its unconstitutional.” How about we do what works, if doesn’t destroy our economy, regardless of where the suggestion comes from.

  15. I went out tonight in Edmonton, Canada, and the bars are open. Lots of young people sitting across from each other, talking into other people’s faces. Because, in spite of the aggressive campaign to alarm them, they now know that they are at very low risk of suffering harms from infection with the novel coronavirus.

    Now our leaders, after telling everyone for the last ten weeks that everyone is at risk of dying from COVID-19, have to say never mind. It’s safe now, even though nothing about the virus or how it is spread has changed. That’s could be a delicate point to make.

    It is going to turn out that the mortality of COVID-19 in people younger than 60 is less than the mortality for the flu. In fact, the premier of Alberta has now said this out loud, formally and publicly, in the legislature, in a bid to restart our economy. Watch other media outlets ignore him, or deride him as an agent of dangerous public complacency.

  16. Well, so there you have it. Wonky data, wonky conjectures and even wonkier theories. All viral outbreaks suffer from so serious flaws as to make even the best modelers flat out wrong and certainly are not as certain as the modeler states.

    The actual take home lesson is to read all the modelers models as the epilogue to Alice in Wonderland.

  17. From the article: “Government intervention at an early stage appears to have been designed mainly to avoid health systems being overwhelmed, but the subsequent paths of the epidemics show that in most cases it was unnecessarily strong for that purpose.”

    Yes, but we didn’t know it was unnecessarily strong when the Wuhan virus first appeared. So at the time, the intervention was not unnecessarily strong. Or at least, not know to be.

    Had the Wuhan virus been as lethal as the Ebola virus, there wouldn’t be any criticism of government intervention, and you wouldn’t be saying the intervention was unnecessarily strong. Instead, you might be questioning whether it was strong enough.

  18. For 2020 the USA has an “excess death” rate about 5.5% (50,331) higher than the previous 4 year average for weeks 1 to 16. As a comparison I checked the first 16 weeks of 2018 compared to the previous 4 year average and it was 7.2% (63,260).

    The script and all related files are here if you want to kick the tires:
    https://www.dropbox.com/sh/fh9x5fngmfbeiiu/AAAH-OtOMqiY_R9qqG6YccCRa?dl=0

    Recently Yoram Lass (formerly director-general of Israel’s Ministry of Health) gave an interview and said “total deaths” was the only way to look at it. I’d already done the script up before that but nice to get his view.

    https://www.spiked-online.com/2020/05/22/nothing-can-justify-this-destruction-of-peoples-lives/

    “The only real number is the total number of deaths – all causes of death, not just coronavirus.”

  19. Taiwan, situated on the doorstep of China, has recorded 442 CV19 cases resulting in 7 deaths. Next to no economic impact. They set the gold standard in pandemic control.

    Anyone justifying any other approach is just being silly. Herd immunity is a silly concept in the context of a known deadly virus in the human population. The vast majority of Swedes did not need to be told to stay in their homes; they were already doing that. But they are paying the cost in lives for seeking herd immunity by not undertaking contact tracing. Although they have belatedly locked down nursing homes resulting in lower death rate despite daily cases being steady around 600.

    US has demonstrated its low social capital and the cost is counted in lost lives for very little benefit. The current riots will increase the rate of spread. The daily cases has flatlined above 20k. California rate of infection is still accelerating. US has a long way to go; with very high risk of increasing rate of infection.

    Greece has opened its borders to visitors from 29 countries considered low risk for spreading the virus:
    Albania, Australia, Austria, North Macedonia, Bulgaria, Germany, Denmark, Switzerland, Estonia, Japan, Israel, China, Croatia, Cyprus, Latvia, Lebanon, Lithuania Malta, Montenegro, New Zealand, Norway, South Korea, Hungary, Romania, Serbia, Slovakia, Slovenia, Czech Republic, Finland.

    These countries are out the other side of the virus risk and it had nothing to do with herd immunity. If anyone wants to understand what works in controlling the virus then look closely at what these countries did – the notion of herd immunity does not even figure in their response.

  20. I’m no scientist and have no claims of academic prowess In this area but I’ve been perplexed at the worlds response to the virus. Very early on the policy way was really clear because this virus had a massive bias . It almost exclusively was serious for the elderly and those with serious preconditions. It was so rare for anyone under 30 to die that every time one Did it became headlines as if to justify locking everyone up. If one did social distancing ,quarantined for 2 weeks those that test positive ,and protected the elderly and sick life could’ve been pretty normal. Around half the cases have been in aged care residences and facilities. What’s more bizarre is you get Cuomo in New York sending Covid positive elderly patient away from hospitals back into aged care homes, and it’s all Trumps fault.
    It’s clear that the lockdowns without any proper plans to get back to work would cause maximum economic damage and because policies weren’t thought through too well probably didn’t do much better on the death count. If one wants to look at how it should be handled look at Singapore . They’ve been illustrated as the example of beware of the second wave. But this fear is highly exaggerated. Yes there cases in early April started to shoot up with a rapid rise in infections from returning foreign workerS. The number went from around 900 to over 30,000 but the deaths have barely doubled from 11 to 23 . I haven’t been able to find any articles that explain this low death rate phenomena but I suspect that 1. Most of those active cases are probably younger ie of working age or less.2. That Singapore had always been very active in having adequate tracing capability. 3. Singapore had adequate hospital facilities to meet any demand. 4. Singapore may have had different standard of care ( maybe they used hydroxychloroquin ). 5. Weather may have helped. 6. They will have had proper quarantine of positive cases 7. They must’ve protected the elderly and vulnerable.
    Whatever the reason it highlights what I think is most important. The number of cases and spread is irrelevant ( subject to hospital capacity). What really matters are deaths and it is possible to have things operating normally whilst keeping the virus manageable.
    The only number that really matters is the deaths per million of population and the record on lockdowns is so variable that there is no statistical evidence to link lockdowns to more or less deaths. There are huge anomalies and I think that the economic avalanche that occurred was ( in hindsight) unnecessary. Surely after quickly working out what was happening policies that were less damaging could’ve been implemented.
    And finally just a query does anyone understand why Belgium has easily the highest number of deaths per million of population and why the media allows them to fly under the radar while have apoplexy about USA , UK, Sweden and Brazil’s Covid responses.

    • Belgium is counting not only hospital deaths, but also deaths in retirement homes and in the community. More than half of the deaths counted are in retirement homes and, of those, only 4% are confirmed by testing as covid-19 deaths with the other 96% only being suspected of involving covid-19.

      • Thanks David for your response. The different definitions of Covid deaths does make it difficult to analyse numbers. My understanding is that there are factors in the US for instance which suggest that Covid numbers are both overstated and understated at the same time. When you incentivise and encourage health officials to designate the cause of death as Covid means that it will overstate figures whilst politically in some countries it may be considered preferable to understate figures and many “ at home “ deaths will be stated as due to other factors. I think the fact that the WHO has an official estimate last years influenza figures at between 350,000 and 600,000 ( you could drive a truck through those figures) tells you how difficult it is to determine whether people have really succumbed to a virus or that death was in fact caused by other factors.

  21. Years ago I was taught that respiratory diseases are the norm in temperate climates while intestinal and parasitic diseases were the norm in tropical climates.

    Maybe it is as simple as hot and cold. In cold months in temperate climates, everyone lives inside breathing the same air. In the tropics there is no cold weather to kill off the pathogens.

  22. It might be informative to see if there is any correlation between riots and lockdowns. I read a may 21 article in Forbes that appeared to predict the riots as a consequence of normal human reaction to lockdowns.

    History – And Psychology – Predict Riots And Protests Amid Coronavirus Pandemic Lockdowns

    • “It might be informative to see if there is any correlation between riots and lockdowns.”

      I think there would certainly be some correlation. Stressed out emotions.

      It appears that most of the “rioting” is actually planned anarchy. Antifa and other radical groups appear to be the ones causing all the violence and damage and burning and looting and they are not from the cities they are destroying, they are from other states and are getting together to cause mayhem.

      Attorney General Barr said today that people who travel from other states and engage in violence and arson are in violation of federal laws, and he is going to throw the book at any of them caught in this situation.

      They need to start slapping federal charges on the Antifa thugs and all the rest of them. It’s time to get tough with these people who are actively trying to destroy our cities and our way of life. You can’t reason with such people, you have to force them to comply.

      I think tonight is going to be different in Minnesota.

  23. It seems intuitive to me that a mild flu winter would be followed by a spring with excess “all cause” mortality, in relation to the average. A proportion of the elderly who might otherwise have been taken by the flu are still around to succumb to heart failure and other age related morbidities. Similarly, following a severe winter flu season there ought to be reduced “all cause” mortality in the following spring. If this supposition were true, this would imply that it is wrong to attribute all of the excess mortality in spring 2020 to the coronavirus. Does anyone know what the data actually says ?

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