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Bill13 said:
An update on Sweden, so far so good
Click to expand...
To underscore the point, here are the active cases for Sweden as of today:
Screen Shot 2020-04-22 at 07.22.48.png
And the active cases for Australia:
Screen Shot 2020-04-22 at 07.22.17.png
If Australia had done what Sweden did:
  • Australia would have 4,400 dead people now, instead of the 71 it actually has
  • Australia would have 38,000 infections that are still rising, instead of the 6,600 it actually has (and that have fallen to around 20 new infections per day)
  • Australia would have an overwhelmed hospital system, meaning even more fatalities than the projected figures suggest
Sweden's approach in Australia would likely have turned Australia into another Italy or Spain.

When politics overrule science, things usually go pear-shaped. That is because denial of reality does not change reality.
 
pistachio said:
If you take a nonsensical scenario and multiply dubious numbers, you get nonsense out.
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The post is very easy to follow and the data are all public.

You can actaully omit just about any one single assumption and not alter the analysis.

eg, quantity = workforce@160million x 52 weeks a year (there is no asusmption here to challenge) = 8.3 billion test/year. You can sanity check this another way and ask "if I have 160 million people and 60 million tests/year" is that good enough?

No, not if you understand the test and the disease you are testing for.

You have to test every time there is a possible exposure, which for airborne virus is much different than virus like EBOLA or HIV where you need blood or body fluid contact. Its much easier to confirm "no body fluid contact" than it ist to confirm "no contaminated air contact" (especially once you consider asymptomatic carriers).

So you need testing on the order of magnitude of 1/week not 1/year. This means you need n=~50 PCR-test per year per worker.
 
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The Stanford (Santa Clara) and USC studies (Los Angeles County) turned out to be done by the same people. And yes, using facebook to source samples in the middle of a pandemic is about as dumb as it sounds. Although that was only the tip of the iceberg.

https://statmodeling.stat.columbia....-in-stanford-study-of-coronavirus-prevalence/
I think the authors of the above-linked paper owe us all an apology. We wasted time and effort discussing this paper whose main selling point was some numbers that were essentially the product of a statistical error.
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LMAO :upsidedownspin:

The study got attention and credibility in part because of the reputation of Stanford. Fair enough: Stanford’s a great institution. Amazing things are done at Stanford. But Stanford has also paid a small price for publicizing this work, because people will remember that “the Stanford study” was hyped but it had issues. So there is a cost here. The next study out of Stanford will have a little less of that credibility bank to borrow from. If I were a Stanford professor, I’d be kind of annoyed. So I think the authors of the study owe an apology not just to us, but to Stanford.
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Michi said:
To underscore the point, here are the active cases for Sweden as of today:
View attachment 77784
And the active cases for Australia:
View attachment 77785
If Australia had done what Sweden did:
  • Australia would have 4,400 dead people now, instead of the 71 it actually has
  • Australia would have 38,000 infections that are still rising, instead of the 6,600 it actually has (and that have fallen to around 20 new infections per day)
  • Australia would have an overwhelmed hospital system, meaning even more fatalities than the projected figures suggest
Sweden's approach in Australia would likely have turned Australia into another Italy or Spain.

When politics overrule science, things usually go pear-shaped. That is because denial of reality does not change reality.
Click to expand...


Michi said:
To underscore the point, here are the active cases for Sweden as of today:
View attachment 77784
And the active cases for Australia:
View attachment 77785
If Australia had done what Sweden did:
  • Australia would have 4,400 dead people now, instead of the 71 it actually has
  • Australia would have 38,000 infections that are still rising, instead of the 6,600 it actually has (and that have fallen to around 20 new infections per day)
  • Australia would have an overwhelmed hospital system, meaning even more fatalities than the projected figures suggest
Sweden's approach in Australia would likely have turned Australia into another Italy or Spain.

When politics overrule science, things usually go pear-shaped. That is because denial of reality does not change reality.
Click to expand...

Science is dependent on politicians for funding which makes science political. Along with the military industrial complex we can add the scientific government grant dependent complex. Eisenhower is famous for his quote about the former but he was also worried about the latter and said "we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.”

Your comparison is flawed and it's worse by many multitudes of the well known sin of cross comparing phase 3 medical trials. You are comparing an island with a population density according to the web site world population review "Australia has a very low population density of just 3 people per square kilometer, or 7 per square mile. This makes it one of the least densely populated countries in the world." to a country where from the same web site "Sweden Population density is recorded as 57.5 people per square mile (22.2 people per square kilometer)"

I recommend watching the video I posted where the Swedish scientist explains they expect to have more deaths up front but at they develop immunity they expect to be around the same as other European countries. But without destroying their economy.

But regardless can we all agree that the world would be better off if Sweden has chosen the correct course. If they are correct (which granted is unknown at this point) they will end up with about the same number of deaths at the end to comparable countries, but without giving up freedoms (like our first amendment) even if temporarily, and without causing massive unemployment, government debt, poverty, increased suicide etc. I am hoping they are correct.
 
Interesting takes on the Santa Clara study, @HRC_64. Thanks for posting. Glad we’re finally getting some expertish opinions, rather than just listening to each other talk. The problem with self-selection in the study seems like it could be a thing, given how hard it was to get tests otherwise in the Bay area. Maybe it would have been a good idea to explicitly say in the advertisement “you will not be told your results!”. Or maybe that would be irresponsible... because if you get positives I suppose you want them to take precautions? Worth it for the study? Hmm.

Anyway, looking forward to more data from similar studies, and more expert opinions. Not planning on “L-ingMFAO” at any of this. More info, more studies = better.
 
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Bill13 said:
Your comparison is flawed and it's worse by many multitudes of the well known sin of cross comparing phase 3 medical trials. You are comparing an island with a population density according to the web site world population review "Australia has a very low population density of just 3 people per square kilometer, or 7 per square mile.
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I don't think the comparison is flawed. That is because the entire interior of Australia is empty. There are effectively no people there. I imagine that Sweden has large unpopulated areas as well, so looking at the population density of Sweden overall is just as as meaningless as it is for Australia.

Population density of Melbourne in the CBD is around 20,000 people per square kilometre. Probably not that much different from any other modern city. In the suburbs, population density is lower because we have generally more land available, and because housing policy here has long favoured low-density living. Regardless, the places where people get infected, that is, shopping centres, public transport, schools, work places, etc. are very much the same as they are in any other first-world country.

I understand that comparing overall statistics is fraught with problems because that ignores too many variables. Regardless, it seems bloody obvious that Australia has managed to very effectively put the lid on the infections, and Sweden has not. It follows that, had Australia done the same as Sweden, there would have been many more infections and deaths.

But we don't need to argue about it. All we need to do is wait. I'll be watching with interest as various countries relax the restrictions. My prediction is that they'll promptly put them back on again once the numbers start to spike. Even assuming that we have detected only 1/10th of the actual number of infections, that still leaves 90% of the population susceptible. Relax social distancing, and the numbers will spike just as quickly as they did the first time.
 
ian said:
Not planning on “L-ingMFAO” at any of this. More info, more studies = better.
Click to expand...

I highly recommend you watch this video. The opening 10 minutes is pretty compelling so please give it a try. You can understand how fundamentally ad-hoc alot of science/medicine is with respect to a novel disease pathogen. Don't want to comment too much more. Just suggest anyone interestd watch this for as long as you can (its gets more technical as it goes on).

 
A VA study found that hydroxychloroquine caused more harm than benefit:

https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1
I hasten to add (as do the authors) that this was NOT a randomised controlled trial (it was a retrospective analysis).

The upshot is what we all already knew- you need to wait for actual scientifically valid studies before we can say yea or nay.
 
HRC_64 said:
I highly recommend you watch this video. The opening 10 minutes is pretty compelling so please give it a try. You can understand how fundamentally ad-hoc alot of science/medicine is with respect to a novel disease pathogen. Don't want to comment too much more. Just suggest anyone interestd watch this for as long as you can (its gets more technical as it goes on).

Click to expand...


Thanks for the link. It’s an interesting conversation, and if one wants to, one can quickly decipher most of the jargon with a google search. It’s really interesting to hear everyone talking about the different things they’re trying, and it was surprising to me how much they stressed the perils of intubation. I only watched an hour of it, though, because I have a child and that was all the time I could spare. :(

I’m not sure exactly how this video was a response to anything we were talking about above. I see people trying their best to study and treat a new disease as best they can. None of them are laughing, and neither am I.
 
I watched most of it and stopped probably about 15 minutes short. I thought it was interesting, and it also shows how much of a patient's outcome depends on the instinct and experience of the doctor. I remember an ER doctor telling me years ago that intubation was a last resort because, once someone is on a respirator (meaning they have to be unconscious and with a muscle relaxant), it can be very difficult to get them off the respirator again. And, while on the respirator, other complications can arise quite easily, such as atrophied muscles and susceptibility to other infections. (Ironically, pneumonia is one of the risks.)

I just came across this article:

Some coronavirus patients are still testing positive months later and experts are not sure why

No-one seems to have a handle on what's going on there. I'm hoping that this won't turn out to be another curve ball.
 
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Looks like the results of the VA study was caused by a very poor design, and that is being generous. My question is why was it so poorly designed and who designed it or even allowed it to go forward? Was it intentional or (hopefully) incompetence? CNN spent a fair about of time on this study. I look forward to their reporting in the future on how such a flawed study came to be. You can bet Robert Wilkie who is the head of the VA is doing so.


Dr Raoult's response to the VA trial.

"In the current period, it seems that passion dominates rigorous and balanced scientific analysis and may lead to scientific misconduct. The article by Magagnoli et al. (Magagnoli, 2020) is an absolutely spectacular example of this. Indeed, in this work, it is concluded, in the end, that hydroxychloroquine (HCQ) would double the mortality in patients with COVID with a fatality rate of 28% (versus 11% in the NoHCQ group), which is extraordinarily hard to believe. The analysis of the data shows two major biases, which show a welling to be convinced before starting the work :

The first is that lymphopenia is twice as common in the HCQ groups (25% in the HCQ, 31% in the HCQ+AZ group versus 14% in the no HCQ group, p =.02) and there is an absolute correlation between lymphopenia (<0.5G/L) and fatality rate, which is well known (Tan, 2020) and confirmed here : 28% deaths, 22% and 11% in the HCQ, HCQ+AZ and No HCQ group, respectively. Lymphopenia is the most obvious criterion of patient severity (in our cohort, lymphocytes in dead individuals (n=22, mean ± standard deviation, 0.94 ± 0.45), versus in the living (n=2405, 1.79 ± 0.84, p < .0001)). As the authors acknowledge, the severity of the patients in the different groups was very different, and their analysis can only make sense if there is a selection of patients with the same degree of severity, i.e. the same percentage of lymphopenia.

The second major bias is that in an attempt to provide meaningful data, by eliminating the initial severity at the time of treatment, two tables are shown: one table where drugs are prescribed before intubation, and which shows no significant difference in the 3 different groups (9/90 (10%) in the HCQ group, 11/101 (10. 9%) HCQ+AZ, and 15/177 (8.5%) in the group without HCQ, chi-square = 0.47, ddl = 2, p = 0.79), and one table, where it is not clear when the drugs were prescribed, where there are significant differences. These differences are most likely related to the fact that the patients had been intubated for some before receiving hydroxychloroquine in desperation. It is notable that this is unreasonable at the time of the cytokine storm, as it is unlikely that hydrochloroquine alone would be able to control patients at this stage of the disease.

Moreover, incomprehensibly, the “untreated” group actually received azithromycin in 30% of cases, without this group being analyzed in any distinct way. Azithromycin is also a proposed treatment for COVID (Gautret, 2020) with in vitro efficacy (Andreani, 2020), and to mix it with patients who are supposedly untreated is something that is closer to scientific fraud than reasonable analysis.

Altogether these 3 voluntary biases are all pushing to the idea of dangerosity of hydroxychloroquine safest drug as reported on nearly 1 million people (Lane, 2020).

All in all, this is a work that shows that, in this period, it is possible to propose things that do not stand up to any methodological analysis to try to demonstrate that one is right.
 
Bill13 said:
Looks like the results of the VA study was caused by a very poor design, and that is being generous. My question is why was it so poorly designed and who designed it or even allowed it to go forward? Was it intentional or (hopefully) incompetence? CNN spent a fair about of time on this study. I look forward to their reporting in the future on how such a flawed study came to be. You can bet Robert Wilkie who is the head of the VA is doing so.


Dr Raoult's response to the VA trial.

"In the current period, it seems that passion dominates rigorous and balanced scientific analysis and may lead to scientific misconduct. The article by Magagnoli et al. (Magagnoli, 2020) is an absolutely spectacular example of this. Indeed, in this work, it is concluded, in the end, that hydroxychloroquine (HCQ) would double the mortality in patients with COVID with a fatality rate of 28% (versus 11% in the NoHCQ group), which is extraordinarily hard to believe. The analysis of the data shows two major biases, which show a welling to be convinced before starting the work :

The first is that lymphopenia is twice as common in the HCQ groups (25% in the HCQ, 31% in the HCQ+AZ group versus 14% in the no HCQ group, p =.02) and there is an absolute correlation between lymphopenia (<0.5G/L) and fatality rate, which is well known (Tan, 2020) and confirmed here : 28% deaths, 22% and 11% in the HCQ, HCQ+AZ and No HCQ group, respectively. Lymphopenia is the most obvious criterion of patient severity (in our cohort, lymphocytes in dead individuals (n=22, mean ± standard deviation, 0.94 ± 0.45), versus in the living (n=2405, 1.79 ± 0.84, p < .0001)). As the authors acknowledge, the severity of the patients in the different groups was very different, and their analysis can only make sense if there is a selection of patients with the same degree of severity, i.e. the same percentage of lymphopenia.

The second major bias is that in an attempt to provide meaningful data, by eliminating the initial severity at the time of treatment, two tables are shown: one table where drugs are prescribed before intubation, and which shows no significant difference in the 3 different groups (9/90 (10%) in the HCQ group, 11/101 (10. 9%) HCQ+AZ, and 15/177 (8.5%) in the group without HCQ, chi-square = 0.47, ddl = 2, p = 0.79), and one table, where it is not clear when the drugs were prescribed, where there are significant differences. These differences are most likely related to the fact that the patients had been intubated for some before receiving hydroxychloroquine in desperation. It is notable that this is unreasonable at the time of the cytokine storm, as it is unlikely that hydrochloroquine alone would be able to control patients at this stage of the disease.

Moreover, incomprehensibly, the “untreated” group actually received azithromycin in 30% of cases, without this group being analyzed in any distinct way. Azithromycin is also a proposed treatment for COVID (Gautret, 2020) with in vitro efficacy (Andreani, 2020), and to mix it with patients who are supposedly untreated is something that is closer to scientific fraud than reasonable analysis.

Altogether these 3 voluntary biases are all pushing to the idea of dangerosity of hydroxychloroquine safest drug as reported on nearly 1 million people (Lane, 2020).

All in all, this is a work that shows that, in this period, it is possible to propose things that do not stand up to any methodological analysis to try to demonstrate that one is right.
Click to expand...

So, I'm not equipped to weigh in on how big these issues are that he raised. But before condemning the VA, how about we just wait for more opinions, preferably by independent doctors that haven't been plugging hydroxychloroquine for months? We can also wait for more data --- a larger study is supposed to conclude by the end of April, iirc. Presumably the NIH, etc..., are making the best decisions they can given available data, and we here at KKF certainly don't know better. In the words of Dr. Raoult,

Bill13 said:
In the current period, it seems that passion dominates rigorous and balanced scientific analysis
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Bill13 said:
All in all, this is a work that shows that, in this period, it is possible to propose things that do not stand up to any methodological analysis to try to demonstrate that one is right.
Click to expand...
I get the impression that you really wish that hydroxychloroquine would work, despite there being no clear consensus among the medicos whether that is actually the case. In the absence of a consensus, why push it? What are doctors supposed to do? Use it and hope for the best? And if it doesn't, say "oops, let's try with another patient"?

I'm quite happy to wait until we have a more definite answer either way. If it works, great, let's go for it. If it doesn't, fine, at least we checked it out with due diligence. I'm wary of ad-hoc experimentation on human subjects.
 
Michi said:
I get the impression that you really wish that hydroxychloroquine would work, despite there being no clear consensus among the medicos whether that is actually the case. In the absence of a consensus, why push it? What are doctors supposed to do? Use it and hope for the best? And if it doesn't, say "oops, let's try with another patient"?

I'm quite happy to wait until we have a more definite answer either way. If it works, great, let's go for it. If it doesn't, fine, at least we checked it out with due diligence. I'm wary of ad-hoc experimentation on human subjects.
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This has been a huge waste of time and resources vs allowing doctors to try to find solutions that make sense. No more magical solutions being pushed by people who clearly know nothing about the science...

This is a time for creative solutions but not wishful thinking and pushing the latest fox conspiracy...notice all those tv folks shut up and moved on after preaching nonsense nonstop for the past month and a half...looking forward to their next brilliant medical advice that after being pushed by the president will be another huge waste of time for doctors that don't have it.

Politicians need to stay the **** out of the science and cheerlead from the sidelines. Everyone wants a solution and sooner the better. Scientists and physicians do their best work when left alone...trust the goddamn science and we'll get there sooner w less loss of life.
 
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Michi said:
This is why this virus is so hideous. It's the silent and aggressive spread of infections while hardly anyone shows symptoms:

https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-cities.html
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The fact that hardly anyone shows symptoms is a good thing. Just means that a lot more people had it already and that it is a lot less deadly than previously thought. Also, means that some of the actions by the governments around the world were probably a panic based over reaction and not as useful as some might think. If it is as contagious as it seems to be and if it has been around for month longer, locking down countries later in the game than we thought was probably less useful than some thought. Wearing face masks and testing more people with less severe symptoms, that made sense from the very beginning and would've probably resulted in better outcome all around, but for various reasons this wasn't done.
 
Barmoley said:
If it is as contagious as it seems to be and if it has been around for month longer, locking down countries later in the game than we thought was probably less useful than some thought
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I think it's probably still quite useful to lock down a country at this point. Even the high estimates of 3% being infected, for instance, still leaves a ton of people waiting to be infected. Given that the point of the lockdown is mitigation rather than containment, it seems very useful to prevent the number of infections (and hence people needing hospitalization) from increasing too fast now that we are at capacity in many of our hospitals. Having the number of covid patients double from 1 to 2 to 4 didn't stress the system, but having it double from (capacity) to 2(capacity) is a huge problem. I'm not saying it wouldn't have been smart to shut down earlier, but let's not dismiss the current lockdown because there are more infections than we previously thought.
 
Btw, I remember arguing above that the results of the (perhaps dubious) Santa Clara study perhaps indicated earlier spread rather than higher R_0. If there actually were two deaths in Santa Clara in early Feb, as was reported I believe, maybe this could make sense? Anyway, I’m looking forward to more seroprevalence studies.
 
Yes. I meant "lockdown" that already happened. It is in progress, so this discussion is theoretical at best. Santa Clara study was highly criticized and for good reasons, but now there are more studies and more data that shows that the virus was at least in California months before we thought. It is very possible that more than 3% of people are/were infected, numbers are all over the place. It is possible and likely that the virus is a lot less deadly than first thought. Locking down economies is a very bad tool to combat this, we will see more of these viruses in the future and we need better mechanisms to deal with them than what was done this time. I think it is OK and even beneficial to question what was done and the reasons for it. We can't shut down economies every time there is a new virus. CA hospitals don't seem to be at capacity and many people are suffering because they are afraid or are told by doctors not to go to the hospitals to not get COVID and to not overburden the system that is not close to capacity. For example, wearing masks in public should've been done earlier, the reasons given for not doing that make no sense at all, yes masks are not 100% effective, but they are effective to a high degree.

My biggest issue is that policies and actions are done based on panic and using models that use incomplete and dubious data at best. It doesn't help that CDC screwed up early testing and that only people with severe symptoms are tested even today. I understand that given the mess a month and a half ago and the time pressure it was difficult to do anything else. I just hope that in the future we will do a better job of figuring out what is actually going on before running around screaming that the sky is falling. It is still not clear if locking down CA to such a degree was needed, assuming the virus was here as early as it seems.
 
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