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This article[1] states that our best natural experiment for COVID-19 is the Diamond Princess cruise ship and its quarantine passengers. From that he estimates t

This article[1] states that our best natural experiment for COVID-19 is the Diamond Princess cruise ship and its quarantine passengers. From that he estimates the the mortality rate is between 0.05% and 1%. That is, we don't really know what the rate is. The WHO giving a number with two significant digits implying some reasonable certainty about the number, is very deceiving and very likely just plain wrong. [1]https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/ https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a... By:John P.A. Ioannidis professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.

epistasis 7y ago
I don't know a single scientist that thinks that Ioannidis is on the right track there. He's known for being a contrarian, which can be a useful thing. But it certainly doesn't make him right, in fact he's quite likely wrong. And he's absolutely wrong, as he's not managing risk, but looking to make the minimum deviance from normal activity. Ie a very foolish take. It's sad that Stat News publishes that in this time. But at least they published this the next day: https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...
- wahern 7y ago
  He can't be wrong because he deftly avoids making any conclusions. All he's expressing is doubt and uncertainty, which is 2/3rds of FUD. I think it goes without saying that the numbers we have (whichever ones you choose) are wrong, even to an order of magnitude or more. But the responsible, constructive way during an emergency to express a contrarian opinion is by identifying facts and crafting reasoned conclusions. That includes doing enough due diligence to have some reasonable confidence that you understand the premises behind the public authorities' responses. For example, the clean data he wants to see might not even exist. Telling a blind man that he's blind isn't helpful; he knows that and is presumably (hopefully) making decisions accordingly, such as keeping a wide berth to any potential hazards. Here's a small handful of what we do know, independent of the cold, hard, vanilla statistics on SARS-CoV-2 that we'd all like to have: Italy is experiencing a public health crisis, whether justified by the number of deaths or not; two national lawmakers in Iran have died (how many die annually of seasonal flu?); Wuhan was no joke; initial outbreak in the U.S. so far seems to align with its evolution elsewhere. All these things are also evidence that can and should be part of drafting early responses. These aren't population mortality rates, r0, infection fatality rates, or the like, but evidence nonetheless; evidence that should be heeded in the absence of more concrete quantitative evidence.
- jdminhbg 7y ago
  > And he's absolutely wrong, as he's not managing risk, but looking to make the minimum deviance from normal activity. Disease is not the only risk here. People will die from a severe recession. It's important to realize that there are tradeoffs, and to be sure we're making the right ones.
ejstronge 7y ago
Readers may also be interested in this forceful reply by a well-known research at Harvard's School of Public Health who studies the dynamics of infectious disease, Mark Lipsitch (1). While the document linked in the parent highlights the many uncertainties we have, the response focuses on datasets from countries where we do have more data. 1. https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...
deleted 7y ago
[deleted]
bugzz 7y ago
0.05% is just ridiculous. That's half the death rate of the flu, so the only way he can justify a number like that is if he believes we are missing the VAST majority of all cases (due to them being mild) and only seeing the severe ones / deaths. But there's a simple check to this - how many deaths does Italy have per day in a bad flu season vs how many Covid-19 deaths per day are they having now? Worst flu year on record I could find for Italy was 25,000 deaths (average year ~15,000 deaths). Spread those over 3 months for flu season, and that's 277 deaths per day. Italy had 475 deaths yesterday from Covid-19. Even if you assumed EVERY Italian has contracted Covid-19, death rate would have to be at least 2x the flu. Now, think about how the majority (80%?) of deaths in Italy are in the Lombardy region, which has maybe 1/4 the population, and thus 1/4 the flu deaths per year. Now it's clear Covid-19 must have fatality rate at least 5-6 times worse than the flu, even assuming every Italian has it... Edit: Flu mortality stats for Italy: https://www.sciencedirect.com/science/article/pii/S1201971219303285 https://www.sciencedirect.com/science/article/pii/S120197121... Covid-19 deaths per day in Italy: https://www.worldometers.info/coronavirus/country/italy/ https://www.worldometers.info/coronavirus/country/italy/
- CGamesPlay 7y ago
  Can you drop sources for your numbers? Thanks!
- 609venezia 7y ago
  I think Ioannidis included that very low number as an example of how ridiculous the statistics can look when using the Diamond Princess as a sample and factoring in the relevant sources of uncertainty. <<Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.>> Mainly I think he wants more testing, but people are cherry picking his argument to try to downplay the risk. His key point from the overall piece is something like "we need more testing, including randomly sampled data. Let's not give up on testing while we ratchet up the countermeasures." Evidence: Second graph- <<At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.>> in the middle- <<The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.>> concluding graph- <<If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.>> --- Coming from a different angle, the latest estimate from Wuhan is 1.4% (.9-2.1) https://www.nature.com/articles/s41591-020-0822-7?mod=article_inline https://www.nature.com/articles/s41591-020-0822-7?mod=articl...
jMyles 7y ago
> From that he estimates the the mortality rate is between 0.05% and 1%. No. He estimated the case fatality rate is that low. The mortality rate is much, much lower.
beaunative 7y ago
He's discrediting all other statistics from large dataset, and making a point from the stats of a single cruise ship. Of course, he is aware of that and made it clear in the article. We should not take a passage out of context, which would certainly confuse the crowd.
- beaunative 7y ago
  and of course, those who on a cruise ship are generally middle-class if not wealthy no-need-to-work people, so projecting that population onto the american population will tend to error, as wealthier people tend to have better medical care and thus less "pre-existing" conditions. On the other hand, for people suffering from chronical or critical disease, it wouldn't make sense for them to take on a cruise trip, where they won't have access to sufficient medical services. Yet, that's quite possible for many of us. Thus the population on the cruise is already healthier than the general population of the same age.

epistasis 7y ago

I don't know a single scientist that thinks that Ioannidis is on the right track there. He's known for being a contrarian, which can be a useful thing. But it certainly doesn't make him right, in fact he's quite likely wrong. And he's absolutely wrong, as he's not managing risk, but looking to make the minimum deviance from normal activity. Ie a very foolish take. It's sad that Stat News publishes that in this time. But at least they published this the next day: https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...

wahern 7y ago
He can't be wrong because he deftly avoids making any conclusions. All he's expressing is doubt and uncertainty, which is 2/3rds of FUD. I think it goes without saying that the numbers we have (whichever ones you choose) are wrong, even to an order of magnitude or more. But the responsible, constructive way during an emergency to express a contrarian opinion is by identifying facts and crafting reasoned conclusions. That includes doing enough due diligence to have some reasonable confidence that you understand the premises behind the public authorities' responses. For example, the clean data he wants to see might not even exist. Telling a blind man that he's blind isn't helpful; he knows that and is presumably (hopefully) making decisions accordingly, such as keeping a wide berth to any potential hazards. Here's a small handful of what we do know, independent of the cold, hard, vanilla statistics on SARS-CoV-2 that we'd all like to have: Italy is experiencing a public health crisis, whether justified by the number of deaths or not; two national lawmakers in Iran have died (how many die annually of seasonal flu?); Wuhan was no joke; initial outbreak in the U.S. so far seems to align with its evolution elsewhere. All these things are also evidence that can and should be part of drafting early responses. These aren't population mortality rates, r0, infection fatality rates, or the like, but evidence nonetheless; evidence that should be heeded in the absence of more concrete quantitative evidence.
jdminhbg 7y ago
> And he's absolutely wrong, as he's not managing risk, but looking to make the minimum deviance from normal activity. Disease is not the only risk here. People will die from a severe recession. It's important to realize that there are tradeoffs, and to be sure we're making the right ones.

ejstronge 7y ago

Readers may also be interested in this forceful reply by a well-known research at Harvard's School of Public Health who studies the dynamics of infectious disease, Mark Lipsitch (1). While the document linked in the parent highlights the many uncertainties we have, the response focuses on datasets from countries where we do have more data. 1. https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...

deleted 7y ago

[deleted]

bugzz 7y ago

0.05% is just ridiculous. That's half the death rate of the flu, so the only way he can justify a number like that is if he believes we are missing the VAST majority of all cases (due to them being mild) and only seeing the severe ones / deaths. But there's a simple check to this - how many deaths does Italy have per day in a bad flu season vs how many Covid-19 deaths per day are they having now? Worst flu year on record I could find for Italy was 25,000 deaths (average year ~15,000 deaths). Spread those over 3 months for flu season, and that's 277 deaths per day. Italy had 475 deaths yesterday from Covid-19. Even if you assumed EVERY Italian has contracted Covid-19, death rate would have to be at least 2x the flu. Now, think about how the majority (80%?) of deaths in Italy are in the Lombardy region, which has maybe 1/4 the population, and thus 1/4 the flu deaths per year. Now it's clear Covid-19 must have fatality rate at least 5-6 times worse than the flu, even assuming every Italian has it... Edit: Flu mortality stats for Italy: https://www.sciencedirect.com/science/article/pii/S1201971219303285 https://www.sciencedirect.com/science/article/pii/S120197121... Covid-19 deaths per day in Italy: https://www.worldometers.info/coronavirus/country/italy/ https://www.worldometers.info/coronavirus/country/italy/

CGamesPlay 7y ago
Can you drop sources for your numbers? Thanks!
609venezia 7y ago
I think Ioannidis included that very low number as an example of how ridiculous the statistics can look when using the Diamond Princess as a sample and factoring in the relevant sources of uncertainty. <<Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.>> Mainly I think he wants more testing, but people are cherry picking his argument to try to downplay the risk. His key point from the overall piece is something like "we need more testing, including randomly sampled data. Let's not give up on testing while we ratchet up the countermeasures." Evidence: Second graph- <<At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.>> in the middle- <<The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.>> concluding graph- <<If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.>> --- Coming from a different angle, the latest estimate from Wuhan is 1.4% (.9-2.1) https://www.nature.com/articles/s41591-020-0822-7?mod=article_inline https://www.nature.com/articles/s41591-020-0822-7?mod=articl...

jMyles 7y ago

> From that he estimates the the mortality rate is between 0.05% and 1%. No. He estimated the case fatality rate is that low. The mortality rate is much, much lower.

beaunative 7y ago

He's discrediting all other statistics from large dataset, and making a point from the stats of a single cruise ship. Of course, he is aware of that and made it clear in the article. We should not take a passage out of context, which would certainly confuse the crowd.

beaunative 7y ago
and of course, those who on a cruise ship are generally middle-class if not wealthy no-need-to-work people, so projecting that population onto the american population will tend to error, as wealthier people tend to have better medical care and thus less "pre-existing" conditions. On the other hand, for people suffering from chronical or critical disease, it wouldn't make sense for them to take on a cruise trip, where they won't have access to sufficient medical services. Yet, that's quite possible for many of us. Thus the population on the cruise is already healthier than the general population of the same age.