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
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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
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
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
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
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
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
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%
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%
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
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
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
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
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
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
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)
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
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
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
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
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 …
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
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
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
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