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It's not as simple as that. Early on, people with low blood oxygen were put on ventilators quickly, which both took a great toll on the system, and didn't help

It's not as simple as that. Early on, people with low blood oxygen were put on ventilators quickly, which both took a great toll on the system, and didn't help (or even made things worse). If you look at the graphs now (I looked at 30 countries just an hour ago), you'll see that many countries in Europe have a very visible "second wave", including Denmark, Austria, the UK, France, Spain and even Sweden - but almost no deaths; and unlike the first wave, despite more people diagnosed with SARS-COV-2, much less people need treatment, and there is no lack of beds anywhere (although there is a lot of fatigue, which is a more complicated discussion). Given you know what to do, such as prawning, vitamin D, and more (and more importantly - what not to do - no early ventilation, for example) - then, we no longer have hospital ICUs stuffed full of people with COVID19 either. A lot has changed since April, but when I look at arguments, some sides still hold the data from early April (assuming up to 5% IFR, and the Ferguson predictions), while some do not acknowledge that April happened and only look at the stats in Aug-Sep. Not surprisingly, such arguments aren't really converging and each side tends to assume the other side is an idiot or insane.

matthewmacleod 6y ago
It's not as simple as that. I don't know about that. Everything you say is reasonable and not at all an example of the effect I was talking about. It's totally fine to say "hey it looks like the CFR/IFR is declining because we have better treatment methods". This is a good-faith point, backed up by some easily observable data, and something that can evolve into a discussion about how to effectively manage the disease. It's not a point that I've heard any rational person object to. It is worth noting though – the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths. This is much better, but those numbers are increasing pretty rapidly and without careful management risks getting out of control.
- thu2111 6y ago
  "hey it looks like the CFR/IFR is declining because we have better treatment methods" It's a claim not many are making because it's not clear it's really true. Firstly, the bulk of the falling IFR is due to more widespread testing driving up numbers of known infections and sero-surveys indicating that even more people than that may have been infected. It's not primarily driven by better survival rates, although they did get better. At this point it seems clear that mass ventilation was a mistake. It was actually killing people rather than saving them because it's a last-ditch resort. COVID wasn't actually deadly enough to justify this and the large scale usage was driven more by the lack of reliable information, the somewhat unusual form of presenting pneumonia in early patients, the belief that it was an extremely deadly virus and the fact that ventilators force all air coming out of the patients lungs through high quality filters, so doctors are trained that ventilation stops infected patients pumping virus into hospitals. But doctors are smart and pretty quickly figured out that the ventilation was making things worse, that they couldn't keep the hospitals virus-free anyway, and at any rate they were about to run out of the machines so their hands were forced and they had to try something new. After that usage of ventilation went back to more normal policies, with supplemental oxygen being deemed sufficient for even quite extreme cases, because of course almost all cases need little or no hospital treatment. Meanwhile many drugs were tried and some were hailed as drugs that could help, e.g. remdesivir or hydroxychloroquine. But later on more controlled studies done under calmer conditions concluded they actually seemed to have no effect. Given this progress of events it's hard to argue that treatment methods actually got better, except in a very technical sense that most people wouldn't really mean. They got better in the sense that they returned to normal for this kind of virus and stopped making the situation worse. If there had been no mass panic at the start it's likely treatments would never have got so extreme to start with. the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths The UK has also quadrupled its testing rate since April. The numbers aren't directly comparable. without careful management it risks getting out of control I don't believe that's been proven at all. The analysis was done many times by now: every government intervention tried so far has no correlation with the course of the disease. That means attempts at management have failed and it has in fact been out of control the whole time, but, fortunately for us, our bodies are generally pretty good at fighting diseases except in the last years of our lives or when immunocompromised in some way, so that hasn't led to disaster.
  - beagle3 6y ago
    I generally agree, though do note that vitamin D and prawning do seem to make a difference - and are practiced in many places even without local study and tracking (because the risk is negligible).
nradov 6y ago
As ghoulish as it may seem, I suspect another reason behind the declining fatality rate is that the earlier waves already killed some of the most vulnerable people.
- disgruntledphd2 6y ago
  Nah, it's a statistical artefact caused by testing policies. In March, you needed multiple symptoms to get a test, which meant that conditional on having a test, your illness was much more serious. Because this isn't an issue right now, it looks like the mortality rates have dropped when it's more likely that we are capturing a larger proportion of mild cases.
  - beagle3 6y ago
    Obviously depends on where you look for this kind of reasoning, but I don’t think it is compatible with data in general. Sweden’s death graph totally looks like “inventory of likely-to-die people exhausted”, regardless of testing (they have not changed recommendations or actions). Israel had no first wave in April (it had a blip, which turns out was essentially limited to ultra orthodox religious which are about 15% of the population). In September, the official 2nd wave but really 1st wave struck the entire population - and testing capacity was already high (about 0.7% of the population tested daily). And the stats looked way too similar to other countries’ first wave. The US is a weakly connected network of hundreds of different repositories, which makes it really hard to observe similar processes - they are not visible on aggregate.
spfzero 6y ago
Certainly in my county, many fewer people are dying even though many more are testing positive. Many more people are getting tested, for job requirements, travel, etc. It results in more positives, naturally. In a county of more than 3 million, we have around 50 in ICU, lowest in many months. As positive tests grow. Two things (at least) might be at work: better treatment is one, the other is that there were far higher numbers of people infected than known, earlier in the year. I’m sure treatment now is better, but I would not be surprised if many more people have been exposed, and have recovered, from this virus than is assumed.

matthewmacleod 6y ago

It's not as simple as that. I don't know about that. Everything you say is reasonable and not at all an example of the effect I was talking about. It's totally fine to say "hey it looks like the CFR/IFR is declining because we have better treatment methods". This is a good-faith point, backed up by some easily observable data, and something that can evolve into a discussion about how to effectively manage the disease. It's not a point that I've heard any rational person object to. It is worth noting though – the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths. This is much better, but those numbers are increasing pretty rapidly and without careful management risks getting out of control.

thu2111 6y ago
"hey it looks like the CFR/IFR is declining because we have better treatment methods" It's a claim not many are making because it's not clear it's really true. Firstly, the bulk of the falling IFR is due to more widespread testing driving up numbers of known infections and sero-surveys indicating that even more people than that may have been infected. It's not primarily driven by better survival rates, although they did get better. At this point it seems clear that mass ventilation was a mistake. It was actually killing people rather than saving them because it's a last-ditch resort. COVID wasn't actually deadly enough to justify this and the large scale usage was driven more by the lack of reliable information, the somewhat unusual form of presenting pneumonia in early patients, the belief that it was an extremely deadly virus and the fact that ventilators force all air coming out of the patients lungs through high quality filters, so doctors are trained that ventilation stops infected patients pumping virus into hospitals. But doctors are smart and pretty quickly figured out that the ventilation was making things worse, that they couldn't keep the hospitals virus-free anyway, and at any rate they were about to run out of the machines so their hands were forced and they had to try something new. After that usage of ventilation went back to more normal policies, with supplemental oxygen being deemed sufficient for even quite extreme cases, because of course almost all cases need little or no hospital treatment. Meanwhile many drugs were tried and some were hailed as drugs that could help, e.g. remdesivir or hydroxychloroquine. But later on more controlled studies done under calmer conditions concluded they actually seemed to have no effect. Given this progress of events it's hard to argue that treatment methods actually got better, except in a very technical sense that most people wouldn't really mean. They got better in the sense that they returned to normal for this kind of virus and stopped making the situation worse. If there had been no mass panic at the start it's likely treatments would never have got so extreme to start with. the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths The UK has also quadrupled its testing rate since April. The numbers aren't directly comparable. without careful management it risks getting out of control I don't believe that's been proven at all. The analysis was done many times by now: every government intervention tried so far has no correlation with the course of the disease. That means attempts at management have failed and it has in fact been out of control the whole time, but, fortunately for us, our bodies are generally pretty good at fighting diseases except in the last years of our lives or when immunocompromised in some way, so that hasn't led to disaster.
- beagle3 6y ago
  I generally agree, though do note that vitamin D and prawning do seem to make a difference - and are practiced in many places even without local study and tracking (because the risk is negligible).

nradov 6y ago

As ghoulish as it may seem, I suspect another reason behind the declining fatality rate is that the earlier waves already killed some of the most vulnerable people.

disgruntledphd2 6y ago
Nah, it's a statistical artefact caused by testing policies. In March, you needed multiple symptoms to get a test, which meant that conditional on having a test, your illness was much more serious. Because this isn't an issue right now, it looks like the mortality rates have dropped when it's more likely that we are capturing a larger proportion of mild cases.
- beagle3 6y ago
  Obviously depends on where you look for this kind of reasoning, but I don’t think it is compatible with data in general. Sweden’s death graph totally looks like “inventory of likely-to-die people exhausted”, regardless of testing (they have not changed recommendations or actions). Israel had no first wave in April (it had a blip, which turns out was essentially limited to ultra orthodox religious which are about 15% of the population). In September, the official 2nd wave but really 1st wave struck the entire population - and testing capacity was already high (about 0.7% of the population tested daily). And the stats looked way too similar to other countries’ first wave. The US is a weakly connected network of hundreds of different repositories, which makes it really hard to observe similar processes - they are not visible on aggregate.

spfzero 6y ago

Certainly in my county, many fewer people are dying even though many more are testing positive. Many more people are getting tested, for job requirements, travel, etc. It results in more positives, naturally. In a county of more than 3 million, we have around 50 in ICU, lowest in many months. As positive tests grow. Two things (at least) might be at work: better treatment is one, the other is that there were far higher numbers of people infected than known, earlier in the year. I’m sure treatment now is better, but I would not be surprised if many more people have been exposed, and have recovered, from this virus than is assumed.