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GidMK's profile
Health Nerd
Health Nerd
Health Nerd
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@GidMK

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Health NerdVerified account

@GidMK

Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him

Sydney, New South Wales
theguardian.com/profile/gideon…
Joined November 2015

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    1. Health Nerd‏Verified account @GidMK 19 May 2020

      Today, this new preprint from John Ioannidis (of "Most Published Research Findings Are False" fame) went online Already up to Altmetric of 541 Let's do a rapid peer-review on twitter 1/npic.twitter.com/aNth3I59Xa

      78 replies 935 retweets 2,292 likes
      Show this thread
    2. Health Nerd‏Verified account @GidMK 19 May 2020

      2/n The paper is here, if you want to have a gander:https://www.medrxiv.org/content/10.1101/2020.05.13.20101253v1.article-metrics …

      3 replies 21 retweets 151 likes
      Show this thread
    3. Health Nerd‏Verified account @GidMK 19 May 2020

      3/n What did the study consist of? Well, the aim is to estimate the infection-fatality rate (IFR) of #COVID19 using seroprevalence (antibody test) studies The methodology here is not ideal at first glancepic.twitter.com/9d9V7qmTys

      6 replies 18 retweets 148 likes
      Show this thread
    4. Health Nerd‏Verified account @GidMK 19 May 2020

      4/n What's the issue? Well, if you want to estimate a number like this from published data you want your search and appraisal methods to be SYSTEMATIC Hence, systematic review

      2 replies 15 retweets 221 likes
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    5. Health Nerd‏Verified account @GidMK 19 May 2020

      5/n Instead, what we appear to have here is an opaque search methodology, little information on how inclusion/exclusion criteria were applied (and no real justification for those criteria)pic.twitter.com/35EYmKMBFE

      2 replies 22 retweets 224 likes
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    6. Health Nerd‏Verified account @GidMK 19 May 2020

      6/n For example, seroprevalence studies including healthcare workers were excluded, because the samples are biased, but studies including blood donors were not, even though these are arguably even more biased That's a strange inconsistency

      5 replies 23 retweets 305 likes
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    7. Health Nerd‏Verified account @GidMK 19 May 2020

      7/n Studies only described in the media were excluded, but this appears to have included government reports as well Again, there's no justification for this and it is REALLY WEIRD to exclude government reports (they're doing most of the testing!)

      3 replies 17 retweets 260 likes
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    8. Health Nerd‏Verified account @GidMK 19 May 2020

      8/n Moving on, the study then calculated an inferred IFR, if the authors hadn't already done so. The calculation is crude, but not entirely wrong However, there's an issue - the estimates were then 'adjusted'

      1 reply 10 retweets 139 likes
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    9. Health Nerd‏Verified account @GidMK 19 May 2020

      9/n Spefically, the IFR estimates were cut by 10-20% depending on whether they included different antibody tests or not I had a look at the reference here, and it definitely doesn't support such a blanket judgementpic.twitter.com/AYzDRR5suk

      1 reply 15 retweets 173 likes
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    10. Health Nerd‏Verified account @GidMK 19 May 2020

      10/n Ok, so, on to the results This table is basically the crux of the review. 12 included studies, with "corrected" IFR ranging from 0.02-0.4% MUCH lower than most published estimatespic.twitter.com/hDyd9YQgOL

      3 replies 17 retweets 150 likes
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      Health Nerd‏Verified account @GidMK 19 May 2020

      11/n A colleague and I did a systematic review and meta-analysis of published estimates of IFR and came to an aggregated estimate of 0.74% (0.51-0.97%) so this is a bit of a surprise to me https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v2.article-metrics … What's happening here?

      8:59 PM - 19 May 2020
      • 82 Retweets
      • 351 Likes
      • 🔴🔴🔴kwippo 💉 Tom Hansen - social distancing now 😷 Davi Sidarta-Oliveira Denken, dann tweeten Mark Germaine Thatcher Ulrich Laura Drew, PhD, MPH (she/her/hers) Dinocaridid Γιώργος Κυλάφας 💉💉
      7 replies 82 retweets 351 likes
        1. New conversation
        2. Health Nerd‏Verified account @GidMK 19 May 2020

          12/n Looking at this table, there are some things that immediately spring out Firstly, three of these studies are of blood donorspic.twitter.com/5wyn4wPbXD

          5 replies 15 retweets 188 likes
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        3. Health Nerd‏Verified account @GidMK 19 May 2020

          13/n It is pretty easy to see why these studies aren't actually estimates of IFR - blood donors are by definition healthy, young etc, and so any IFR calculated from these populations is going to be MUCH lower than the true figurepic.twitter.com/EaJZlygIRc

          19 replies 21 retweets 259 likes
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        4. Health Nerd‏Verified account @GidMK 19 May 2020

          14/n But if we look at the other included studies, this problem is repeated. The French and Japanese studies both used highly-selected patient populations, both of which likely would lead to a biased (low) estimate of IFRpic.twitter.com/imYkR1aEyN

          4 replies 15 retweets 187 likes
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        5. Health Nerd‏Verified account @GidMK 19 May 2020

          15/n (The same concern has been raised about the Santa Clara study at the bottom, but for now let's ignore that and move on)

          1 reply 9 retweets 121 likes
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        6. Health Nerd‏Verified account @GidMK 19 May 2020

          16/n Remember when I said that the calculation of individual IFRs was reasonable? Well, there's a problem here. When Ioaniddis calculated IFRs, he did a decent job. However, some of the INCLUDED STUDIES didn't

          2 replies 9 retweets 128 likes
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        7. Health Nerd‏Verified account @GidMK 19 May 2020

          17/n For example, the Iran, Kobe, and Brazilian studies made no attempt to account for right-censoring That's an issue, as I describe here https://twitter.com/GidMK/status/1262563856456445952?s=20 …pic.twitter.com/dSoRieF29E

          5 replies 12 retweets 147 likes
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        8. Health Nerd‏Verified account @GidMK 19 May 2020

          18/n In addition, the Iranian study uses the official figure for deaths, and as has been pointed out this number may be a significant underestimatepic.twitter.com/AQBSIirjRF

          8 replies 11 retweets 142 likes
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        9. Health Nerd‏Verified account @GidMK 19 May 2020

          19/n So, a problem The red-outlined studies are clearly not estimates of population IFR - they look at specific, selected individuals and can't be extrapolated The orange-outlined studies are likely underestimates due to methodologypic.twitter.com/b4bZBslEpN

          2 replies 20 retweets 133 likes
          Show this thread
        10. Health Nerd‏Verified account @GidMK 19 May 2020

          20/n If we exclude these potentially misleading numbers, the lowest IFR estimate immediately jumps from 0.04% to 0.18% Coincidentally, that 0.18% is Ioannidis' own researchpic.twitter.com/PlaOSJ1AbB

          1 reply 15 retweets 139 likes
          Show this thread
        11. Health Nerd‏Verified account @GidMK 19 May 2020

          21/n To me, a low estimate of 0.18% makes MUCH more sense than a minimum of 0.02% for IFR Why? Well, take New York. ~16,000 deaths in a city of 8.4 million means that if every single person has been infected the IFR would be 0.19%pic.twitter.com/pmA8oM4nSm

          10 replies 38 retweets 234 likes
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        12. Health Nerd‏Verified account @GidMK 19 May 2020

          22/n Now, everyone calls NYC an outlier, and perhaps it is, but if you repeat this calculation for other places in the States, the same chilling thing happens: Massachusetts: 0.9% New Jersey: 0.12% Connecticut: 0.1%

          10 replies 19 retweets 162 likes
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        13. Health Nerd‏Verified account @GidMK 19 May 2020

          23/n The same is true of other places overseas - Lombardy has a total death toll of 0.16%, Madrid is around the same, even London is above 0.1% dead due to COVID-19 It seems INCREDIBLY unlikely, at this point, for the IFR to be below 0.1%

          6 replies 32 retweets 241 likes
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        14. Health Nerd‏Verified account @GidMK 19 May 2020

          24/n Now, this is noted in the preprint, but basically dismissed as the deaths of old and poor people That's...not a great perspective imopic.twitter.com/2Zd2se4CyT

          2 replies 23 retweets 216 likes
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        15. Health Nerd‏Verified account @GidMK 19 May 2020

          25/n In particular, Ioannidis argues that places with lots of elderly and disadvantaged individuals are "very uncommon in the global landscape" This is trivially incorrect. Most of the world is far worse off than people in NEW YORK CITYpic.twitter.com/HzmUcBdq0V

          12 replies 32 retweets 281 likes
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        16. Health Nerd‏Verified account @GidMK 19 May 2020

          26/n There's also some discussion of the obviously underestimated studies, which begs the question why they were included in the first place? They are clearly not realistic numberspic.twitter.com/PFpfWbNTZk

          3 replies 9 retweets 118 likes
          Show this thread
        17. Health Nerd‏Verified account @GidMK 19 May 2020

          27/n ...and then a paragraph about Iran that contradicts the earlier points raised about why NYC has seen so many deathspic.twitter.com/u70mD8SEWH

          3 replies 8 retweets 103 likes
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        18. Health Nerd‏Verified account @GidMK 19 May 2020

          28/n Some discussion about press release science (we are agreed that it isn't good) but no mention of government reports This is a HUGE gap to the study

          2 replies 9 retweets 128 likes
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        19. Health Nerd‏Verified account @GidMK 19 May 2020

          29/n For example, why wasn't this Spanish seroprevalence study included? It is the biggest in the world, and estimates IFR to be ~1-1.3% - triple the highest estimate in this review!pic.twitter.com/VUxKFVNO2O

          14 replies 47 retweets 297 likes
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        20. Health Nerd‏Verified account @GidMK 19 May 2020

          30/n On the other hand, why were clearly biased estimates included? Why was 500 arbitrarily the minimum size considered for included research (if you choose 1,000, the IFRs are suddenly much higher)

          2 replies 12 retweets 178 likes
          Show this thread
        21. Health Nerd‏Verified account @GidMK 19 May 2020

          31/n Which brings us to this conclusion, which is, frankly, a bit astonishing Is it a fact? That's certainly not shown in this review, and most evidence seems to contradict this statementpic.twitter.com/V9LKRjHKHv

          10 replies 30 retweets 299 likes
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        22. Health Nerd‏Verified account @GidMK 19 May 2020

          32/n The final thoughts here may make this a bit more understandable It seems the author is not a fan of lockdowns. Perhaps this has driven his decisions for his review?pic.twitter.com/BcvRv1XooZ

          5 replies 29 retweets 206 likes
          Show this thread
        23. Health Nerd‏Verified account @GidMK 19 May 2020

          33/n Ultimately, it's hard to know the why, but what we can say is that this review appears to have very significantly underestimated the infection-fatality rate of COVID-19

          2 replies 19 retweets 160 likes
          Show this thread
        24. Health Nerd‏Verified account @GidMK 19 May 2020

          34/n Moreover, the methodology is quite clearly inadequate to estimate the IFR of COVID-19, and thus the study fails to achieve its own primary objective

          7 replies 16 retweets 170 likes
          Show this thread
        25. Health Nerd‏Verified account @GidMK 19 May 2020

          Health Nerd Retweeted

          35/n Something that people are pointing out - another weakness of this study is that the author appears to have taken the LOWEST POSSIBLE IFR estimate from each study For example, the Gangelt authors posited an IFR of 0.37-.46%, this paper cites 0.28% https://twitter.com/FreisinnigeZtg/status/1262983934549397511?s=20 …

          Health Nerd added,

          This Tweet is unavailable.
          7 replies 16 retweets 167 likes
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        26. Health Nerd‏Verified account @GidMK 19 May 2020

          36/n I should note - this paper is currently a PREPRINT This gives us a great opportunity. We can correct the record in real time, and put up a study that actually achieves its aims Let's hope it happens

          4 replies 12 retweets 184 likes
          Show this thread
        27. Health Nerd‏Verified account @GidMK 19 May 2020

          37/n I think it's also worth pointing out that I personally WISH that the IFR of COVID-19 was 0.02%. It would solve so many of our problems - unfortunately, it seems extremely unlikely

          16 replies 15 retweets 217 likes
          Show this thread
        28. Health Nerd‏Verified account @GidMK 20 May 2020

          38/n Another good critique of the study is here: https://quomodocumque.wordpress.com/2020/05/19/pandemic-blog-23-why-one-published-research-finding-is-misleading/ … It appears that for the Netherlands study, the number provided in this review is roughly 6x lower than the true IFR

          4 replies 9 retweets 78 likes
          Show this thread
        29. End of conversation

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