2/n You can find the paper here - it is a classic commentary piece, which means it is mostly the perspective of the author:https://onlinelibrary.wiley.com/doi/10.1111/eci.13423 …
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3/n Given the author's very strong public stance since early March, it is perhaps unsurprising that the main message of the piece appears to be that COVID-19 is not very bad but government actions arepic.twitter.com/u8o7KK62cR
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4/n Very broadly, the piece says: - the death toll from COVID-19 is probably low globally - government action causes lots of deaths - therefore, government action should be minimized except for protecting institutionalized elderly people
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5/n Now, as I've said before (many times), the cost-benefit of government regulation is an IMPORTANT issue that we really need to discuss more, so I applaud Prof Ioannidis for looking into the question
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6/n Unfortunately, the piece makes a large number of errors that makes the conclusion - that we should "learn to live with COVID-19" - somewhat problematicpic.twitter.com/s06efCvg31
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7/n One problem is the attribution of deaths. The author raises the point several times that COVID-19 deaths may not be caused BY the disease, but occur WITH COVID-19 and be caused by underlying comorbiditiespic.twitter.com/16C7RDjI3H
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8/n The reference to this - and indeed the most cited study in this commentary piece - is a short commentary piece written by Ioannidis back in Aprilpic.twitter.com/ROMVR2VmeV
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9/n And if you follow the references back down the chain, what we find is that the author is using an investigation done in March in Italy that found that the majority of people who died had some comorbidity to support this argument But it doesn't, reallypic.twitter.com/Ufj7d9igbd
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10/n Conversely, there is fairly good evidence that in the majority of cases COVID-19 was indeed the primary cause of death, despite comorbidities, and that the biggest issue in many places may be UNDERCOUNTING of deathshttps://www.bmj.com/content/370/bmj.m2859 …
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11/n The author then goes on to argue that while there have been excess deaths in 2020, these are most likely due to GOVERNMENT ACTION rather than the pandemicpic.twitter.com/6MKRZpRcE5
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12/n Now, while this is purely speculative anyway, I thought it worth noting that it is incorrect to argue that all disruptions to (say) TB programs are due to government measures. It is likely that much of this disruption would've occurred anyway due to, well, the pandemic
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13/n Therefore, the argument made by the author that there is harm caused by "recurrent lockdowns and other draconian measures" is not really substantiated by the evidence at hand Not great, that
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14/n (I'm not saying that there is NO harm from these measures, just that the cost-benefit of government action is quite clearly more complex than the logic presented here)
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15/n Moving on, the author basically makes the same argument about comorbidities as before, but in the framework of Years of Life Lost. Similarly, the basic argument is that people who died of COVID-19 were already very sickpic.twitter.com/zcY136e5BJ
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16/n The author then argues (again, citing himself liberally in references 3 and 41) that many deaths due to COVID-19 were "avoidable" None of this is really well-supported as far as I can tellpic.twitter.com/j1re0nfhgE
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17/n For example, the claim that "many deaths" in Lombardy were due to nosocomial (acquired though healthcare) infections is referenced back to the same April commentary as before, which itself actually suggests that hospital overcrowding was to blamepic.twitter.com/0vyrg6GCo6
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18/n It's also worth noting that the idea that nosocomial infections are AVOIDABLE in a pandemic is perhaps not entirely reasonable, given the burden that it places on the healthcare system more broadly
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19/n The author then looks at the infection-fatality rate of COVID-19, again liberally citing his (as-yet-unpublished) review on the topicpic.twitter.com/ybU8RBhny9
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20/n Rather than delving into the reasons why these numbers are likely inaccurate, I'll just link to my previous threads looking at the preprint version of this paperhttps://twitter.com/GidMK/status/1283232023402868737?s=20 …
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21/n Of note, however, the author makes a classic statistical error in dichotomizing age into two buckets We now know that the risk from age is CONTINUOUS, and so looking at the arbitrary cutoff of 70 years will lead to an erroneous resultpic.twitter.com/EBQ3MVCLXT
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22/n The author also makes the interesting claim that the WHO has estimated an infection rate of 10% of the world, referencing a recent news reportpic.twitter.com/yup98Ftm2Q
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23/n However, as
@zorinaq has pointed out, this is simply bad reporting, with the WHO arguing that LESS THAN 10% of the world is likely infected This is, perhaps, an issue with relying on headlines in a scientific paperhttps://twitter.com/zorinaq/status/1314160523613593600?s=20 …Show this thread -
24/n There are, sadly, further errors in the paper. The author repeats a common myth, that t-cells mean that the threshold for herd immunity is much lower than usually estimatedpic.twitter.com/q1sPO5voVd
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25/n Interestingly, Ioannidis here cites
@profshanecrotty, who has a great thread on why this interpretation is incorrecthttps://twitter.com/profshanecrotty/status/1313580981341712386?s=20 …
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26/n Now, I actually think that all of these errors are a real shame, because the final parts of the commentary are both interesting and worth considering
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27/n The basic idea is that, rather than thinking about the next few months, we should be designing policies based on what will likely happen over the next 5-10 YEARS This is a good point, and not made often enough!
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28/n Short-term lockdowns made sense in the early days of the pandemic, but given the months since it is perfectly reasonable to suggest that there may be better ways to manage the disease moving forward
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29/n For example, from a GLOBAL perspective, I think that there may certainly be places in which heavy long-term restrictions do not make that much sense
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30/n Nigeria, for example, has a median age of 18 years. Less than 10% of the population is over 55. Given how much lower the risk is for younger people, harsher restrictions may not make as much sensehttps://www.medrxiv.org/content/10.1101/2020.07.23.20160895v6 …
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31/n Conversely, the U.S. has a much older population, on average, and thus is at far greater risk from COVID-19 generally
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