9 ms·

Which epidemiologist do you believe?

53 points by akbarnama 7y ago

ljf 7y ago
I think it is interesting that the discussions are only framed in measuring deaths, and also focus on deaths of the old. I'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.
- joe_the_user 7y ago
  The "how many time the flu is this" misses how damaging this is beyond it's potential casualties, how damaging to the health care system this is and so-forth. The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
  - watwut 7y ago
    I don't really think it is about economy only. I don't see the same people pushing for help for businesses nor coming up with ideas how to make economy run as much as possible under closed conditions. The push is to make it like before and act like nothing is happening. Beyond that, there is not much. It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
  - luckylion 7y ago
    > The various state could just support people for the period of the lockdown Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
    - incompatible 7y ago
      It's not really about money. Money is just bits of paper, or electronic equivalents, that can be produced in arbitrary quantities. It's about having sufficient production of food and other necessities to keep people alive, ensuring that it's distributed to everybody, and finding enough people who are willing to do enough work to keep the economy going at this level.
      - luckylion 7y ago
        Right, obviously when I say money, I don't mean "paper", I mean the equivalent value that we represent by using money. We're generating a lot less value today, while spending as if we didn't. Suggestions for the state to pay people their usual salary while locked down for the next months/years do require some idea of how to pay for it (again: with value, not with paper). Magic aside, how will that happen?
        JackFr 7y ago
        Exactly. The estimated $25 billion dollars a day the lockdown is costing the economy is real economic output not a balance in a ledger.
      - PeterStuer 7y ago
        What percentage of the 'working population' do you estimate is involved in necessities as opposed to conspicuous consumption, superfluous intermediating, red queen standoffs, speculation, empire building and active or collateral sabotage?
    - bildung 7y ago
  - StanislavPetrov 7y ago
    As someone in NY where at least 17,000 people have died of SARS2 in the last ~6 weeks including two middle aged people one older person I know personally I am absolutely certain that this is nothing, "like the flu" no matter what anyone claims. We don't get 500-1000 people dying (especially middle aged people) of the flu every day - especially when we are in virtual lockdown. There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
  - closeparen 7y ago
    I think this is generally true but with two significant complications: a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it. b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little. Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.
noizejoy 7y ago
I doubt there’s a single best way of dealing with this crisis across the entirety of our planet, given the incredible diversity in demographics, cultures, population density, wealth, health care systems and dna. EDIT: should have added politics as another differentiator
- ObscureScience 7y ago
  I absolutly agree, and it's something pretty much no reporter or goverment spokesperson mention. Also, even though it's talked about, there is absolutely risk of death and misery greater than the disease if economics are not considered.
- weddpros 7y ago
  and diversity in politics... don't forget politics Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
  - prox 7y ago
    And some countries were better prepared, especially the places that put in plans after SARS.
  - throw93232 7y ago
    North Korea already has herd immunity, zero cases :-)
  - noizejoy 7y ago
    > and diversity in politics Agreed and I amended my comment accordingly - and thanks for pointing out my oversight!
- brobdingnagians 7y ago
  I found an interesting article that argues exactly this. It points out that Africa is the youngest continent, and also loses the most from not being able to work to get food, etc. And that Africa should follow a different plan than other continents. https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-africa/ https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-af...
throw93232 7y ago
If Covid19 is 10x deadlier than flu, they both say the same thing. > it’s like a tsunami sweeping across Europe.” The real death toll, he suggested, will be in the region of a severe influenza season >UK fatality rate of Covid-19 is likely to be 0.8-0.9%,
yokaze 7y ago
How is Giesecke's approach of "so we should do what we can to slow it so the health service can cope, but let it pass" different than what is currently happening? As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.
- softwarejosh 7y ago
  most western countries
- joe_the_user 7y ago
  A few countries have eliminated the virus entirely. Most other countries are in lockdown as more or less a desperation move and effectively have no articulated plan. Maybe they'll get infection rate down and can get testing and contact tracing working enough to do elimination in heavily effected areas but in the US, certainly, all plans are vague and the authorities seem to be reacting to events rather than planning. I think WHO articulated the elimination path but again, who knows. But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
  - bsder 7y ago
    > But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit. The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.) The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now. The fact that they don't is an indictment of most of the governments of most of the countries. In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity. Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers. When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.
tapland 7y ago
Being a swede it's hard but I don't know if non-swedish epidemiologists make the same mistakes and claims. Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively. This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million. Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all. A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.
- SiempreViernes 7y ago
  Where does Giesecke propose a strategy of heard immunity? Does every set of restrictions that leave out total lockdown count as a "herd immunity" strategy?
  - ewidar 7y ago
    I only see one of these three options: 1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable 2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading 3. He does not care about the deaths, and the faster they die, the faster we can go back to normal Of course I don't think he believes in number 3, which is quite horrible in my opinion. Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis. To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.
throwaway936482 7y ago
The problem with the Giesecke approach is that it relies on 2 assumptions being true. 1) that infection brings long term immunity to the currently circulating strains. 2) that covid-19 will not mutate into a new strain with equivalent pathogenicity to which those with immunity to the current strain are no longer immune. If either of these are false then you will not get a meaningful form of immunity in the population. Currently we don't have any evidence that either assumption is true so pursuing this approach carries an increased risk for very little benefit.
- Florin_Andrei 7y ago
  To summarize - it's not an approach based on fact and solid knowledge.
- feider 7y ago
  Regarding point 2 - it is more likely that mutations would actually cause sars-cov-2 to be less pathogenic. Futher if you judge merits of approach solely by looking at death counts you miss the bigger picture: what is the total cost of the approach when you include economy and other indirect impacts, eg. mental issues caused by more severe isolation.
- aaron695 7y ago
  This is wrong. The concept Giesecke has not considered this is a little bizarre. We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months. So this is 100% untrue - "Currently we don't have any evidence that either assumption is true" "for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor. We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
- SiempreViernes 7y ago
  To clarify, the Giesecke approach is merely to use the clearer goal of keeping the case load manageable to the health services. I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.
2019-nCoV 7y ago
History won't be kind to Giesecke. Deaths are almost an order of magnitude higher in Sweden v the rest of Scandinavia: https://ourworldindata.org/grapher/covid-daily-deaths-trajectory-per-million?yScale=linear&country=NOR+SWE+FIN+DNK https://ourworldindata.org/grapher/covid-daily-deaths-trajec...
- alkonaut 7y ago
  What do you think the goal is of any strategy? Minimizing deaths from Covid-19 in the 2020 spring season? Minimizing deaths from Covid-19 overall (until the disease is "over")? Minimizing all-cause deaths this year? Minimizing some more abstract thing like "quality adjusted lives lost" over many years ahead? I'll let you know which one it isn't: the first one.
  - 2019-nCoV 7y ago
    Currently all that is certain is the Swedish gov has gambled with their citizens lives and in doing so they've done horribly in contrast with comparable countries. And the number of fatalities continues to grow. How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year?
    - alkonaut 7y ago
      > How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year? One strategy is ensuring you have some protection from immunity in the population (e.g. 20%) when the first wave is over, so that together with other measures (testing, contact tracing, quarantines) you have a chance to control the virus until a vaccine is found in say 18 months, while also allowing the economy to function. That is to say: flatten the curve but not too much. You want some percentage of immunity too. The effects on deaths from the economy will take years to manifest. What quality of cancer care can be offered in a country in 5 or 10 years can definitely depend on how this situation is managed now.
pinkfoot 7y ago
Not this bunch for sure: https://calmatters.org/health/2020/04/debunking-bakersfield-doctors-covid-spread-conclusions/ https://calmatters.org/health/2020/04/debunking-bakersfield-...
- pinkfoot 7y ago
  To which ever rational scientist downvoted me, here are the good doctors' claims from 26th [1] : "So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for COVID. So we don’t, the initial—as you guys know, the initial models were woefully inaccurate. They predicted millions of cases of death—not of prevalence or incidence—but death. That is not materializing. What is materializing is, in the state of California is 12% positives. You have a 0.03 chance of dying from COVID in the state of California." Even a child can figure out why this is not even wrong. [1] https://www.aier.org/article/open-up-society-now-say-dr-dan-erickson-and-dr-artin-massihi/ https://www.aier.org/article/open-up-society-now-say-dr-dan-...
alkonaut 7y ago
An interesting aspect is that the authority where the Swedish State Epidemologist works is the "public health agency". That is: the agency responsible for the health of the whole population. That's not irrelevant here. Their mission is always the long term health of the population. They are not in a position to recommend actions that they belive will reduce deaths from Covid if they simultaneously believe that e.g the economic effects on the healthcare system will mean it is a net negative for the public health long term. Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines. Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with. Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.
gampleman 7y ago
A lot of these discussions also sound like lockdown measures are "free". But in reality it's about balancing two unknowns. On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration. On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely. I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.
- deleted 7y ago
  [deleted]
- gizmo 7y ago
  The tail risk angle is pretty interesting. We have a pretty good idea of the upper bound of mortality of the virus, and we also know that with some basic precautions the worst case scenario can be avoided. It's worse than the flu, but not 10 times worse. On the other hand we have no clue what the end result will be of mass unemployment and food insecurity for millions who used to be middle class, on top of unprecedented central bank policy. It's pretty reckless to shut down the world economy and hope it will turn out OK.
  - 2019-nCoV 7y ago
    The disability-adjusted life year cost remains another huge uncertain tail risk that is rarely accounted for.
  - cameldrv 7y ago
    We don't know that it's not 10 times worse. Data is confusing and sketchy, but there are many datapoints that indicate that the IFR is over 1%, and maybe as high as 2%.
smitty1e 7y ago
I take the editorial stance that we should only use "believe" in a religious context, so that we tag the thought as something subjective and unprovable in the mathematical sense. Instead put a Figure of Merit against the idea. I 30% buy off that covid-19 is a nasty virus that one Does Not Want, and that precautions are in order to protect those with compromised immune systems (my wife). I 70% think that a variety of leaders on all levels and parties are not "letting a crisis go to waste" here, and purging the backlog of items that they don't care to discuss in detail.
hackeraccount 7y ago
"Whether you’re more Giesecke or Ferguson, it’s time to stop pretending that our response to this threat is simply a scientific question, or even an easy moral choice between right and wrong. It’s a question of what sort of world we want to live in, and at what cost." That right there is the thing. I think there are a lot of questions that fall into this catagory. People want them to be questions of science but they are fundamentally political questions. You can use science - in ways that are fair or unfair - but at heart science can't answer them.

53 points by akbarnama 7y ago

ljf 7y ago

I think it is interesting that the discussions are only framed in measuring deaths, and also focus on deaths of the old. I'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.

joe_the_user 7y ago
The "how many time the flu is this" misses how damaging this is beyond it's potential casualties, how damaging to the health care system this is and so-forth. The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
- watwut 7y ago
  I don't really think it is about economy only. I don't see the same people pushing for help for businesses nor coming up with ideas how to make economy run as much as possible under closed conditions. The push is to make it like before and act like nothing is happening. Beyond that, there is not much. It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
- luckylion 7y ago
  > The various state could just support people for the period of the lockdown Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
  - incompatible 7y ago
    It's not really about money. Money is just bits of paper, or electronic equivalents, that can be produced in arbitrary quantities. It's about having sufficient production of food and other necessities to keep people alive, ensuring that it's distributed to everybody, and finding enough people who are willing to do enough work to keep the economy going at this level.
    - luckylion 7y ago
      Right, obviously when I say money, I don't mean "paper", I mean the equivalent value that we represent by using money. We're generating a lot less value today, while spending as if we didn't. Suggestions for the state to pay people their usual salary while locked down for the next months/years do require some idea of how to pay for it (again: with value, not with paper). Magic aside, how will that happen?
      - JackFr 7y ago
        Exactly. The estimated $25 billion dollars a day the lockdown is costing the economy is real economic output not a balance in a ledger.
    - PeterStuer 7y ago
      What percentage of the 'working population' do you estimate is involved in necessities as opposed to conspicuous consumption, superfluous intermediating, red queen standoffs, speculation, empire building and active or collateral sabotage?
  - bildung 7y ago
- StanislavPetrov 7y ago
  As someone in NY where at least 17,000 people have died of SARS2 in the last ~6 weeks including two middle aged people one older person I know personally I am absolutely certain that this is nothing, "like the flu" no matter what anyone claims. We don't get 500-1000 people dying (especially middle aged people) of the flu every day - especially when we are in virtual lockdown. There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
- closeparen 7y ago
  I think this is generally true but with two significant complications: a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it. b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little. Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.

noizejoy 7y ago

I doubt there’s a single best way of dealing with this crisis across the entirety of our planet, given the incredible diversity in demographics, cultures, population density, wealth, health care systems and dna. EDIT: should have added politics as another differentiator

ObscureScience 7y ago
I absolutly agree, and it's something pretty much no reporter or goverment spokesperson mention. Also, even though it's talked about, there is absolutely risk of death and misery greater than the disease if economics are not considered.
weddpros 7y ago
and diversity in politics... don't forget politics Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
- prox 7y ago
  And some countries were better prepared, especially the places that put in plans after SARS.
- throw93232 7y ago
  North Korea already has herd immunity, zero cases :-)
- noizejoy 7y ago
  > and diversity in politics Agreed and I amended my comment accordingly - and thanks for pointing out my oversight!
brobdingnagians 7y ago
I found an interesting article that argues exactly this. It points out that Africa is the youngest continent, and also loses the most from not being able to work to get food, etc. And that Africa should follow a different plan than other continents. https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-africa/ https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-af...

throw93232 7y ago

If Covid19 is 10x deadlier than flu, they both say the same thing. > it’s like a tsunami sweeping across Europe.” The real death toll, he suggested, will be in the region of a severe influenza season >UK fatality rate of Covid-19 is likely to be 0.8-0.9%,

yokaze 7y ago

How is Giesecke's approach of "so we should do what we can to slow it so the health service can cope, but let it pass" different than what is currently happening? As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.

softwarejosh 7y ago
most western countries
joe_the_user 7y ago
A few countries have eliminated the virus entirely. Most other countries are in lockdown as more or less a desperation move and effectively have no articulated plan. Maybe they'll get infection rate down and can get testing and contact tracing working enough to do elimination in heavily effected areas but in the US, certainly, all plans are vague and the authorities seem to be reacting to events rather than planning. I think WHO articulated the elimination path but again, who knows. But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
- bsder 7y ago
  > But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit. The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.) The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now. The fact that they don't is an indictment of most of the governments of most of the countries. In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity. Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers. When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.

tapland 7y ago

Being a swede it's hard but I don't know if non-swedish epidemiologists make the same mistakes and claims. Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively. This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million. Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all. A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.

SiempreViernes 7y ago
Where does Giesecke propose a strategy of heard immunity? Does every set of restrictions that leave out total lockdown count as a "herd immunity" strategy?
- ewidar 7y ago
  I only see one of these three options: 1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable 2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading 3. He does not care about the deaths, and the faster they die, the faster we can go back to normal Of course I don't think he believes in number 3, which is quite horrible in my opinion. Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis. To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.

throwaway936482 7y ago

The problem with the Giesecke approach is that it relies on 2 assumptions being true. 1) that infection brings long term immunity to the currently circulating strains. 2) that covid-19 will not mutate into a new strain with equivalent pathogenicity to which those with immunity to the current strain are no longer immune. If either of these are false then you will not get a meaningful form of immunity in the population. Currently we don't have any evidence that either assumption is true so pursuing this approach carries an increased risk for very little benefit.

Florin_Andrei 7y ago
To summarize - it's not an approach based on fact and solid knowledge.
feider 7y ago
Regarding point 2 - it is more likely that mutations would actually cause sars-cov-2 to be less pathogenic. Futher if you judge merits of approach solely by looking at death counts you miss the bigger picture: what is the total cost of the approach when you include economy and other indirect impacts, eg. mental issues caused by more severe isolation.
aaron695 7y ago
This is wrong. The concept Giesecke has not considered this is a little bizarre. We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months. So this is 100% untrue - "Currently we don't have any evidence that either assumption is true" "for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor. We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
SiempreViernes 7y ago
To clarify, the Giesecke approach is merely to use the clearer goal of keeping the case load manageable to the health services. I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.

2019-nCoV 7y ago

History won't be kind to Giesecke. Deaths are almost an order of magnitude higher in Sweden v the rest of Scandinavia: https://ourworldindata.org/grapher/covid-daily-deaths-trajectory-per-million?yScale=linear&country=NOR+SWE+FIN+DNK https://ourworldindata.org/grapher/covid-daily-deaths-trajec...

alkonaut 7y ago
What do you think the goal is of any strategy? Minimizing deaths from Covid-19 in the 2020 spring season? Minimizing deaths from Covid-19 overall (until the disease is "over")? Minimizing all-cause deaths this year? Minimizing some more abstract thing like "quality adjusted lives lost" over many years ahead? I'll let you know which one it isn't: the first one.
- 2019-nCoV 7y ago
  Currently all that is certain is the Swedish gov has gambled with their citizens lives and in doing so they've done horribly in contrast with comparable countries. And the number of fatalities continues to grow. How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year?
  - alkonaut 7y ago
    > How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year? One strategy is ensuring you have some protection from immunity in the population (e.g. 20%) when the first wave is over, so that together with other measures (testing, contact tracing, quarantines) you have a chance to control the virus until a vaccine is found in say 18 months, while also allowing the economy to function. That is to say: flatten the curve but not too much. You want some percentage of immunity too. The effects on deaths from the economy will take years to manifest. What quality of cancer care can be offered in a country in 5 or 10 years can definitely depend on how this situation is managed now.

pinkfoot 7y ago

Not this bunch for sure: https://calmatters.org/health/2020/04/debunking-bakersfield-doctors-covid-spread-conclusions/ https://calmatters.org/health/2020/04/debunking-bakersfield-...

pinkfoot 7y ago
To which ever rational scientist downvoted me, here are the good doctors' claims from 26th [1] : "So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for COVID. So we don’t, the initial—as you guys know, the initial models were woefully inaccurate. They predicted millions of cases of death—not of prevalence or incidence—but death. That is not materializing. What is materializing is, in the state of California is 12% positives. You have a 0.03 chance of dying from COVID in the state of California." Even a child can figure out why this is not even wrong. [1] https://www.aier.org/article/open-up-society-now-say-dr-dan-erickson-and-dr-artin-massihi/ https://www.aier.org/article/open-up-society-now-say-dr-dan-...

alkonaut 7y ago

An interesting aspect is that the authority where the Swedish State Epidemologist works is the "public health agency". That is: the agency responsible for the health of the whole population. That's not irrelevant here. Their mission is always the long term health of the population. They are not in a position to recommend actions that they belive will reduce deaths from Covid if they simultaneously believe that e.g the economic effects on the healthcare system will mean it is a net negative for the public health long term. Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines. Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with. Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.

gampleman 7y ago

A lot of these discussions also sound like lockdown measures are "free". But in reality it's about balancing two unknowns. On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration. On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely. I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.

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gizmo 7y ago
The tail risk angle is pretty interesting. We have a pretty good idea of the upper bound of mortality of the virus, and we also know that with some basic precautions the worst case scenario can be avoided. It's worse than the flu, but not 10 times worse. On the other hand we have no clue what the end result will be of mass unemployment and food insecurity for millions who used to be middle class, on top of unprecedented central bank policy. It's pretty reckless to shut down the world economy and hope it will turn out OK.
- 2019-nCoV 7y ago
  The disability-adjusted life year cost remains another huge uncertain tail risk that is rarely accounted for.
- cameldrv 7y ago
  We don't know that it's not 10 times worse. Data is confusing and sketchy, but there are many datapoints that indicate that the IFR is over 1%, and maybe as high as 2%.

smitty1e 7y ago

I take the editorial stance that we should only use "believe" in a religious context, so that we tag the thought as something subjective and unprovable in the mathematical sense. Instead put a Figure of Merit against the idea. I 30% buy off that covid-19 is a nasty virus that one Does Not Want, and that precautions are in order to protect those with compromised immune systems (my wife). I 70% think that a variety of leaders on all levels and parties are not "letting a crisis go to waste" here, and purging the backlog of items that they don't care to discuss in detail.

hackeraccount 7y ago

"Whether you’re more Giesecke or Ferguson, it’s time to stop pretending that our response to this threat is simply a scientific question, or even an easy moral choice between right and wrong. It’s a question of what sort of world we want to live in, and at what cost." That right there is the thing. I think there are a lot of questions that fall into this catagory. People want them to be questions of science but they are fundamentally political questions. You can use science - in ways that are fair or unfair - but at heart science can't answer them.