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'
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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
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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
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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
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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%
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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%
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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 …
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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
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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
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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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