5/n What has changed is that some of these things are now justified This is good, but not really adequate to improve the rigor of the paper
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16/n This is still a bit low - for some reason, this paper uses an incorrect IFR for the Brazilian estimate (0.3% instead 1% given by the authors) - but much more in line with the estimate from our updated meta-analysis of 0.64%https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v3 …
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17/n One thing worth noting - the paper still makes the clear error in comparing the IFR of COVID-19 to influenza This is a common mistake, so I thought I'd highlight itpic.twitter.com/Oscf9UZn4q
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18/n Here, Ioannidis is comparing the IFR of influenza used by the CDC - which is ~0.1% - to the IFR of COVID-19 inferred from seroprevalence studies These two figures, however, are not comparable
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19/n The IFR estimate for influenza generated by the CDC is the result of a complex modelling process that inflates the numerator (deaths) according to hospitalization data for pneumonia and other ICD codespic.twitter.com/YMS8AkDyh7
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20/n Why is this a problem? Well, we are not comparing apples with apples here. Numerous efforts have demonstrated that the death count of COVID-19 in many places is a significant underestimate (by 50%+)pic.twitter.com/vR5VxuCUFg
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21/n If we instead compare the IFR of influenza calculated from seroprevalence studies and official death counts to the same for COVID-19, we see a VERY different picture
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22/n The HIGHEST IFR estimate for influenza using this methodology, based on a 2014 systematic review, is 0.01% That's 18x lower than the lowest reasonable estimate of COVID-19 IFRhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/ …
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23/n More broadly, if we look at the total range, the IFR of COVID-19 calculated from seroprevalence data appears to be around 50-100x higher than the same number for influenza
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24/n This is actually a serious flaw with the paper - the author has chosen only to pursue corrections of the data that push the IFR lower. If we were to account for excess mortality attributable to COVID-19 - based on published research - the IFRs would all jump substantially
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25/n Now, there are some excellent improvements to the paper For example, much of the language in the discussion/conclusion has been correctedpic.twitter.com/KkVboq3eDO
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26/n There are still odd, emotive phrases ("blind lockdown"), but the paper no longer describes COVID-19 as common and mild, which was clearly incorrect
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27/n However, overall this paper still suffers from many of the issues I previously raised, and seems to still substantially underestimate the IFR of COVID-19
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28/n I should be clear that I am not speculating in any way about the reasoning behind these decisions. The fact that the paper underestimates IFR is a problem, but we can't really know why these decisions were made
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End of conversation
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