Worse than flu?

From time to time, I hear an argument that the COVID-19 pandemic is actually not as bad as the politicians and scientists try to argue. One argument goes along the lines that the mortality in 2020/21 is actually similar to what happens in other years from seasonal flu, other diseases, or other causes like car accidents.

Many news outlets produce daily reports on COVID-19 death numbers. These data, while very useful for monitoring the current state of the outbreak, need to be properly interpreted. Firstly, they usually represent ‘death by reporting date’, i.e. how many deaths are reported by authorities on that day. There are of course delays with reporting and so the current value might be significantly lower than the actual number (Sweden is notorious for long delays of death reporting). Of course, the numbers will eventually catch up but might create a (temporary) impression that the pandemic is dying out.

Secondly, the reports concentrate on deaths labelled as COVID-related. There are again problems with the process of assigning deaths to COVID and different countries use different (and changing) criteria. The procedure is often criticised for attributing to COVID deaths that are caused by other diseases.

The ‘excess death’ record is a measure that is not that easy to question, as it looks at death records, without any attribution to COVID. In this approach, we compare the total number of deaths in 2020/21 season to values in previous years. I used the deaths records in one of my early posts on COVID, back in April 2019. We now have much more data to look at and I am going to make use of them here.

Deaths in the US since 2015. Different coloured lines show years 2015-19 (black is 2015, light blue is 2018 and pink is 2019) and red shows years 2020 and 2021. The horizontal line shows the maximum pre-2015 value.

In the graphs above, weekly US death notifications are shown for 2020 and 2021, with different coloured lines showing values from individual years 2015-21.

Looking first at the general trends before 2020, roughly 54,000 people die each week in the population of about 330 million; 2.8 million deaths a year from all causes, or about 0.85% of the population. The numbers vary over the year and typically are higher in winter and lower in summer. Some years, particularly when the seasonal flu is bad, have higher mortality in winter months, November to February. In the period 2015-2019, the highest point was in the second week of January 2018, with 67,661 deaths that week. Finally, the overall number of deaths increases slightly over years, reflecting mainly the increase in the population, but also the declining general health.

Compared to this, the highest level of deaths in 2020/21 was in the last week of 2020, with 82,255 deaths recorded. There were two periods when the weekly number of deaths exceeded even the highest value observed in winter 2018: Spring 2020 and Winter 2020-2021. Summer 2020, when in other years the deaths are much lower, got nearly to the same level.

Even more striking are the total yearly numbers for the period of March of one year to February next (to compare with 2020-21). In the ‘bad flu’ year 2017-2018, 2,839,711 deaths were recorded. In the last year before COVID, 2019-20, the number was 2,860,458.

In the COVID year, 3,447,015 died, an excess of 586,557 people, of about 20% of “typical” death numbers.

Now, these are all deaths, so include not only those who died of COVID, but also those who died because of COVID. People who did not have COVID but died because of lack of medical access are included, and those who died because of economic hardship.

It will take, I am sure, a long and detailed study to disentangle the different causes of COVID-related and unrelated deaths, but it suffices here to note that the highest excess deaths have occurred not in periods of the strictest lockdown measures (as reflected in the Google mobility data below) but when there was the highest number of reported COVID cases. This makes the case that the majority of deaths are not COVID-related outrageous.

US mobility data from Google. The graph shows the reduction to the baseline at the beginning of the COVID outbreak.

In summary, COVID-19 is not like flu but – for the US and for many countries in the world – a disaster that is causing immeasurable suffering and deaths.

Społeczeństwo i pandemia w Polsce – Society and pandemic in Poland (and elsewhere)

Patrzę z wielkim niepokojem na to co się w Polsce dzieje, i nie widzę tego bardzo optymistycznie. Naprawdę szkoda zaprzepaszczonego potencjału po pierwszej fali.

Reakcja społeczeństwa na pandemię: Myślę, ze przynajmniej w większości krajów większość ludzi zachowywała by się sama z siebie rozsądnie. Niektóre społeczeństwa pewnie mniej (Polska), niektóre więcej (UK).

Problemem nie jest społeczeństwo, ale to, że rządy nieumiejętnie działają. Są tu myślę dwa mechanizmy. Po pierwsze, rządy tego nie mówią, ale ciągle stosują zasady “flatten the curve” (“spłaszczyć krzywą”) i “herd immunity” (“odporność stadna”).

Tzn. ważniejsze są inne rzeczy (polityka, wybory, gospodarka), a zdrowie dopiero wtedy kiedy system opieki zdrowotnej się zaczyna sypać. Ale wtedy jest za późno i wchodzimy w nowy cykl.

A “odporność stadna” to nadzieja, że nawet jak nic nie będziemy robić to problem sam się w końcu rozwiąże (jak wystarczająco dużo osób się przechoruje).

Efektem więc jest to miotanie się miedzy skrajnościami – to pozwalamy na wszystkie rzeczy, to wszystko blokujemy, ale jak blokujemy, to ludzie się buntują, więc zaraz odkręcamy, itd itp. A wartość R jest ciągle bliska 1.

Ja już o tym pisałem rok temu po tym jak Trump najpierw nic nie robił, a potem nagle zablokował wszystkie loty, a potem znowu kompletnie nic nie robił.

A poza tym, rząd polski (i nie tylko) jakoś nie może się zdobyć na szczerość i otwartość – przykładem ciągłe podkreślanie, że to już koniec epidemii i to myśmy ją zwalczyli.

Efektem jest to, ze przekaz jest nieszczery, społeczeństwo (słusznie) przestaje wierzyć, i następuje kompletne rozejście się rządu i społeczeństwa. Czym to grozi, to można zobaczyć w Brazylii.

Porównanie: Wlk. Brytania: ścisły lockdown od przed Świąt; Izrael: ponad 50% zaszczepionych; Polska: ?

On testing again

Testing has been covered on this blog several times, for example here on true and false positives, and here on interpreting data, and here on a statement by a former US president. As the cases generally fall down in many places in the world, we start worrying about false positives and false negatives.

I have just written another piece for The Conversation, explaining why – as the numbers drop – we might be seeing more false positive test results than true positive ones. This is a normal thing – and not a reflection on the quality of the tests (and nothing to do with PCR “cycle” numbers).

Also, pointing out that with 50% sensitivity we are likely to see a lot of false negatives, each one of which might trigger an outbreak. This is potentially more worrying and shows why we need to be very cautious to build the whole strategy of school reopening on Lateral Flow Tests.

This is not to denigrate the importance of testing, but more to explain why the test results need to be interpreted cautiously. Tests, together with tracing – and support for those self-isolating – are a key to #ZeroCovid strategy.

But, as with every strategy, we need to use them carefully and Reverend Bayes clearly has a lesson for us in this respect (pity I could not mention him in the piece for lack of space).