Some Issues to Consider — Facts before Fear

Facts about Covid-19

Published: March 14, 2020; UpdatedApril 7, 2020
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Fully referenced facts about Covid-19, provided by experts in the field, to help our readers make a realistic risk assessment. (Updated daily, see below)

„The only means to fight the plague is honesty.“ Albert Camus, The Plague (1947)

According to the latest data of the Italian National Health Institute ISS, the average age of the positively-tested deceased in Italy is currently about 81 years. 10% of the deceased are over 90 years old. 90% of the deceased are over 70 years old.

80% of the deceased had suffered from two or more chronic diseases. 50% of the deceased had suffered from three or more chronic diseases. The chronic diseases include in particular cardiovascular problems, diabetes, respiratory problems and cancer.

Less than 1% of the deceased were healthy persons, i.e. persons without pre-existing chronic diseases. Only about 30% of the deceased are women.

The Italian Institute of Health moreover distinguishes between those who died from the coronavirus and those who died with the coronavirus. In many cases it is not yet clear whether the persons died from the virus or from their pre-existing chronic diseases or from a combination of both.

The two Italians deceased under 40 years of age (both 39 years old) were a cancer patient and a diabetes patient with additional complications. In these cases, too, the exact cause of death was not yet clear (i.e. if from the virus or from their pre-existing diseases).

The partial overloading of the hospitals is due to the general rush of patients and the increased number of patients requiring special or intensive care. In particular, the aim is to stabilize respiratory function and, in severe cases, to provide anti-viral therapies.

(Update: The Italian National Institute of Health published a statistical report on test-positive patients and deceased, confirming the above data.)

The following aspects should also be taken into account:

Northern Italy has one of the oldest populations and the worst air quality in Europe, which had already led to an increased number of respiratory diseases and deaths in the past and is likely an additional risk factor in the current epidemic.

South Korea, for instance, has experienced a much milder course than Italy and has already passed the peak of the epidemic. In South Korea, only about 70 deaths with a positive test result have been reported so far. As in Italy, those affected were mostly high-risk patients.

The few dozen test-positive Swiss deaths so far were also high-risk patients with chronic diseases, an average age of more than 80 years and a maximum age of 97 years, whose exact cause of death, i.e. from the virus or from their pre-existing diseases, is not yet known.

Furthermore, studies have shown that the internationally used virus test kits may give a false positive result in some cases. In these cases, the persons may not have contracted the new coronavirus, but presumably one of the many existing human coronaviruses that are part of the annual (and currently ongoing) common cold and flu epidemics. (1)

Thus the most important indicator for judging the danger of the disease is not the frequently reported number of positively-tested persons and deaths, but the number of persons actually and unexpectedly developing or dying from pneumonia (so-called excess mortality).

According to all current data, for the healthy general population of school and working age, a mild to moderate course of the Covid-19 disease can be expected. Senior citizens and persons with existing chronic diseases should be protected. The medical capacities should be optimally prepared.

Medical literature

(1) Patrick et al., An Outbreak of Human Coronavirus OC43 Infection and Serological Cross-reactivity with SARS Coronavirus, CJIDMM, 2006.

(2) Grasselli et al., Critical Care Utilization for the COVID-19 Outbreak in Lombardy, JAMA, March 2020.

(3) WHO, Report of the WHO-China Joint Mission on Coronavirus Disease 2019, February 2020.

Reference values

Important reference values include the number of annual flu deaths, which is up to 8,000 in Italy and up to 60,000 in the US; normal overall mortality, which in Italy is up to 2,000 deaths per day; and the average number of pneumonia cases per year, which in Italy is over 120,000.

Current all-cause mortality in Europe and in Italy is still normal or even below-average. Any excess mortality due to Covid-19 should become visible in the European monitoring charts.

Winter smog (NO2) in Northern Italy in February 2020 (ESA)

Updates

Regular updates on the situation (all sources referenced).

March 17, 2020 (I)

  • The mortality profile remains puzzling from a virological point of view because, in contrast to influenza viruses, children are spared and men are affected about twice as often as women. On the other hand, this profile corresponds to natural mortality, which is close to zero for children and almost twice as high for 75-year-old men as for women of the same age.
  • The younger test-positive deceased almost always had severe pre-existing conditions. For example, a 21-year-old Spanish soccer coach had died test-positive, making international headlines. However, the doctors diagnosed an unrecognized leukemia, whose typical complications include severe pneumonia.
  • The decisive factor in assessing the danger of the disease is therefore not the number of test-positive persons and deceased, which is often mentioned in the media, but the number of people actually and unexpectedly developing or dying from pneumonia (so-called excess mortality). So far, this value remains very low in most countries.
  • In Switzerland, some emergency units are already overloaded simply because of the large number of people who want to be tested. This points to an additional psychological and logistical component of the current situation.

March 17, 2020 (II)

  • Italian immunology professor Sergio Romagnani from the University of Florence comes to the conclusion in a study on 3000 people that 50 to 75% of the test-positive people of all ages remain completely symptom-free – significantly more than previously assumed.
  • The occupancy rate of the North Italian ICUs in the winter months is typically already 85 to 90%. Some or many of these existing patients could also be test-positive by now. However, the number of additional unexpected pneumonia cases is not yet known.
  • A hospital doctor in the Spanish city of Malaga writes on Twitter that people are currently more likely to die from panic and systemic collapse than from the virus. The hospital is being overrun by people with colds, flu and possibly Covid19 and doctors have lost control.

March 18, 2020

  • A new epidemiological study (preprint) concludes that the fatality of Covid19 even in the Chinese city of Wuhan was only 0.04% to 0.12% and thus rather lower than that of seasonal flu, which has a mortality rate of about 0.1%. As a reason for the overestimated fatality of Covid19, the researchers suspect that initially only a small number of cases were recorded in Wuhan, as the disease was probably asymptomatic or mild in many people.
  • Chinese researchers argue that extreme winter smog in the city of Wuhan may have played a causal role in the outbreak of pneumonia. In the summer of 2019, public protests were already taking place in Wuhan because of the poor air quality.
  • New satellite images show how Northern Italy has the highest levels of air pollution in Europe, and how this air pollution has been greatly reduced by the quarantine.
  • A manufacturer of the Covid19 test kit states that it should only be used for research purposes and not for diagnostic applications, as it has not yet been clinically validated.
Datasheet of Covid19 virus test kit

March 19, 2020 (I)

The Italian National Health Institute ISS has published a new report on test-positive deaths:

  • The median age is 80.5 years (79.5 for men, 83.7 for women).
  • 10% of the deceased was over 90 years old; 90% of the deceased was over 70 years old.
  • At most 0.8% of the deceased had no pre-existing chronic illnesses.
  • Approximately 75% of the deceased had two or more pre-existing conditions, 50% had three more pre-existing conditions, in particular heart disease, diabetes and cancer.
  • Five of the deceased were between 31 and 39 years old, all of them with serious pre-existing health conditions (e.g. cancer or heart disease).
  • The National Health Institute hasn’t yet determined what the patients examined ultimately died of and refers to them in general terms as Covid19-positive deaths.

March 19, 2020 (II)

  • A report in the Italian newspaper Corriere della Sera points out that Italian intensive care units already collapsed under the marked flu wave in 2017/2018. They had to postpone operations, call nurses back from holiday and ran out of blood donations.
  • German virologist Hendrik Streeck argues that Covid19 is unlikely to increase total mortality in Germany, which normally is around 2500 people per day. Streeck mentions the case of a 78-year-old man with preconditions who died of heart failure, subsequently tested positive for Covid19 and thus was included in the statistics of Covid19 deaths.
  • According to Stanford Professor John Ioannidis, the new coronavirus may be no more dangerous than some of the common coronaviruses, even in older people. Ioannidis argues that there is no reliable medical data backing the measures currently decided upon.

March 20, 2020

  • According to the latest European monitoring report, overall mortality in all countries (including Italy) and in all age groups remains within or even below the normal range so far.
  • According to the latest German statistics, the median age of test-positive deaths is about 83 years, most with pre-existing health conditions that might be a possible cause of death.
  • A 2006 Canadian study referred to by Stanford Professor John Ioannidis found that common cold coronaviruses may also cause death rates of up to 6% in risk groups such as residents of a care facility, and that virus test kits initially falsely indicated an infection with SARS coronaviruses.

March 21, 2020 (I)

  • Spain reports only three test-positive deaths under the age of 65 (out of a total of about 1000). Their pre-existing health conditions and actual cause of death are not yet known.
  • On March 20, Italy reported 627 nationwide test-positive deaths in one day. By comparison, normal overall mortality in Italy is about 1800 deaths per day. Since February 21, Italy has reported about 4000 test-positive deaths. Normal overall mortality during this time frame is up to 50,000 deaths. It is not yet known to what extent normal overall mortality has increased, or to what extent it has simply turned test-positive. Moreover, Italy and Europe have had a very mild flu season in 2019/2020 that has spared many otherwise vulnerable people.
  • According to Italian news reports, 90% of test-positive deceased in the Lombardy region have died outside of intensive care units, mostly at home or in general care sections. Their cause of death and the possible role of quarantine measures in their deaths remain unclear. Only 260 out of 2168 test-positive persons have died in ICUs.
  • Bloomberg highlights that „99% of Those Who Died From Virus Had Other Illness, Italy Says“
Italy test-positive deaths by prior illnesses (ISS / Bloomberg)

March 21, 2020 (II)

  • The Japan Times asks: Japan was expecting a coronavirus explosion. Where is it? Despite being one of the first countries getting positive test results and having imposed no lockdown, Japan is one of the least-affected nations. Quote: „Even if Japan may not be counting all those infected, hospitals aren’t being stretched thin and there has been no spike in pneumonia cases.“
  • Italian researchers argue that the extreme smog in Northern Italy, the worst in Europe, may be playing a causative role in the current pneumonia outbreak there, as in Wuhan before.
  • In a new interview, Professor Sucharit Bhakdi, a world renowned expert in medical microbiology, says blaming the new coronavirus alone for deaths is „wrong“ and „dangerously misleading“, as there are other more important factors at play, notably pre-existing health conditions and poor air quality in Chinese and Northern Italian cities. Professor Bhakdi describes the currently discussed or imposed measures as „grotesque“, „useless“, „self-destructive“ and a „collective suicide“ that will shorten the lifespan of the elderly and should not be accepted by society.

March 22, 2020 (I)

Regarding the situation in Italy: Most major media falsely report that Italy has up to 800 deaths per day from the coronavirus. In reality, the president of the Italian Civil Protection Service stresses that these are deaths „with the coronavirus and not from the coronavirus“ (minute 03:30 of the press conference). In other words, these persons died while also testing positive.

As Professors Ioannidis and Bhakdi have shown, countries like South Korea and Japan that introduced no lockdown measures have experienced near-zero excess mortality in connection with Covid-19, while the Diamond Princess cruise ship experienced an extra­polated mortality figure in the per mille range, i.e. at or below the level of the seasonal flu.

Current test-positive death figures in Italy are still less than 50% of normal daily overall mortality in Italy, which is around 1800 deaths per day. Thus it is possible, perhaps even likely, that a large part of normal daily mortality now simply counts as „Covid19“ deaths (as they test positive). This is the point stressed by the President of the Italian Civil Protection Service.

However, by now it is clear that certain regions in Northern Italy, i.e. those facing the toughest lockdown measures, are experiencing markedly increased daily mortality figures. It is also known that in the Lombardy region, 90% of test-positive deaths occur not in intensive care units, but instead mostly at home. And more than 99% have serious pre-existing health conditions.

Professor Sucharit Bhakdi has called lockdown measures „useless“, „self-destructive“ and a „collective suicide“. Thus the extremely troubling question arises as to what extent the increased mortality of these elderly, isolated, highly stressed people with multiple pre-existing health conditions may in fact be caused by the weeks-long lockdown measures still in force.

If so, it may be one of those cases where the treatment is worse than the disease. (See update below: only 12% of death certificates show the coronavirus as a cause.)

Angelo Borrelli, head of the Italian Civil Protection Service, emphasizing the difference between deaths with and from coronaviruses.

March 22, 2020 (II)

  • In Switzerland, there are currently 56 test-positive deaths, all of whom were „high risk patients“ due to their advanced age and/or pre-existing health conditions. Their actual cause of death, i.e. from or simply with the virus, has not been communicated.

To read the rest of the article, go to:    https://swprs.org/a-swiss-doctor-on-covid-19/

Pay Attention!

Corona Is Slowing Down, Humanity Will Survive, Says Biophysicist Michael Levitt

avatar by Ari Libsker / CTech

A member of a medical team wears a protective face mask, following the coronavirus outbreak, as he prepares disinfectant liquid to sanitize public places in Tehran, Iran, March 5, 2020. Photo: WANA (West Asia News Agency) / Nazanin Tabatabaee via Reuters.

CTech – Nobel laureate Michael Levitt, an American-British-Israeli biophysicist who teaches structural biology at Stanford University and spends much of his time in Tel Aviv, unexpectedly became a household name in China, offering the public reassurance during the peak of the country’s coronavirus (Covid-19) outbreak. Levitt did not discover a treatment or a cure, just did what he does best: crunched the numbers. The statistics led him to the conclusion that, contrary to the grim forecasts being branded about, the spread of the virus will come to a halt.

The calming messages Levitt sent to his friends in China were translated into Chinese and passed from person to person, making him a popular subject for interviews in the Asian nation. His forecasts turned out to be correct: the number of new cases reported each day started to fall as of February 7. A week later, the mortality rate started falling as well.

He might not be an expert in epidemiology, but Levitt understands calculations and statistics, he told Calcalist in a phone interview earlier this week.

The interview was initially scheduled to be held at the fashionable Sarona complex in Tel Aviv, where Levitt currently resides. But after he caught a cold — “not corona,” he jokingly remarked — the interview was rescheduled to be held over the phone. Even though he believes the pandemic will run its course, Levitt emphasizes his support of all the safety measures currently being taken and the need to adhere to them.

Levitt received his Nobel prize for chemistry in 2013 for “the development of multiscale models for complex chemical systems.” He did not in any way intend to be a prophet foretelling the end of a plague; it happened by accident. His wife Shoshan Brosh is a researcher of Chinese art and a curator for local photographers, meaning the couple splits their time between the US, Israel, and China.

When the pandemic broke out, Brosh wrote to friends in China to support them. “When they answered us, describing how complicated their situation was, I decided to take a deeper look at the numbers in the hope of reaching some conclusion,” Levitt explained. “The rate of infection of the virus in the Hubei province increased by 30 percent each day — that is a scary statistic. I am not an influenza expert but I can analyze numbers and that is exponential growth.” At this rate, the entire world should have been infected within 90 days, he said.

But then, the trend changed. When Levitt started analyzing the data on February 1, Hubei had 1,800 new cases each day and within six days this number reached 4,700, he said. “And then, on February 7, the number of new infections started to drop linearly and did not stop. A week later, the same happened with the number of the deaths. This dramatic change in the curve marked the median point and enabled better prediction of when the pandemic will end. Based on that, I concluded that the situation in all of China will improve within two weeks. And, indeed, now there are very few new infection cases.”

Levitt compared the situation to bank interest — if on the first day a person receives an interest rate of 30 percent on their savings, the next day of 29 percent, and so forth, “you understand that eventually, you will not earn very much.”

The messages his friends translated quickly made waves in China and people wanting to make sure he did indeed write the information attributed to him started contacting Levitt. “That is how I knew I needed to continue,” he said. “I could have said, yes, that’s what I said,’ and left it at that.”

New numbers were being reported every day by various entities, such as the World Health Organization (WHO). Levitt started sending regular reports to his Chinese friends, and their popularity led to interviews on Chinese television, for example on CNN-equivalent CGTN. Based on the diminishing number of infection cases and deaths, he said, the virus will probably disappear from China by the end of March.

Initially, Levitt said, every coronavirus patient in China infected on average 2.2 people a day — spelling exponential growth that can only lead to disaster. “But then it started dropping, and the number of new daily infections is now close to zero.” He compared it to interest rates again: “even if the interest rate keeps dropping, you still make money. The sum you invested does not lessen, it just grows more slowly. When discussing diseases, it frightens people a lot because they keep hearing about new cases every day. But the fact that the infection rate is slowing down means the end of the pandemic is near.”

There are several reasons for this, according to Levitt. “In exponential growth models, you assume that new people can be infected every day, because you keep meeting new people. But, if you consider your own social circle, you basically meet the same people every day. You can meet new people on public transportation, for example; but even on the bus, after some time most passengers will either be infected or immune.”

Another reason the infection rate has slowed has to do with the physical distance guidelines. “You don’t hug every person you meet on the street now, and you’ll avoid meeting face to face with someone that has a cold, like we did,” Levitt said. “The more you adhere, the more you can keep infection in check. So, under these circumstances, a carrier will only infect 1.5 people every three days and the rate will keep going down.”

Quarantine makes a difference, according to Levitt, but there are other factors at work. “We know China was under almost complete quarantine, people only left home to do crucial shopping and avoided contact with others. In Wuhan, which had the highest number of infection cases in the Hubei province, everyone had a chance of getting infected, but only 3 percent caught it,” he explained. “Even on the Diamond Princess (the virus-stricken cruise ship), the infection rate did not top 20 percent.” Based on these statistics, Levitt said, he concluded that many people are just naturally immune to the virus.

The explosion of cases in Italy is worrying, Levitt said, but he estimates it is a result of a higher percentage of elderly people than in China, France, or Spain. “Furthermore, Italian culture is very warm, and Italians have a very rich social life. For these reasons, it is important to keep people apart and prevent sick people from coming into contact with healthy people.”

China did great work and managed to gain complete control of the virus, Levitt said. “Currently, I am most worried about the US. It must isolate as many people as possible to buy time for preparations. Otherwise, it can end up in a situation where 20,000 infected people will descend on the nearest hospital at the same time and the healthcare system will collapse.”

Israel currently does not have enough cases to provide the data needed to make estimates, Levitt said, but from what he can tell, the Ministry of Health is dealing with the pandemic in a correct, positive way. “The more severe the defensive measures taken, the more they will buy time to prepare for needed treatment and develop a vaccine.”

Levitt avoids making global forecasts. In China, he said, the number of new infections will soon reach zero, and South Korea is past the median point and can already see the end. Regarding the rest of the world, it is still hard to tell, he said. “It will end when all those who are sick will only meet people they have already infected. The goal is not to reach the situation the cruise ship experienced.”

The Diamond Princess was the worst case scenario, according to Levitt. “If you compare the ship to a country — we are talking 250,000 people crowded into one square kilometer, which is horribly crowded. It is four times the crowding in Hong Kong. It is as if the entire Israeli population was crammed into 30 square kilometers.” Furthermore, he said, the ship had a central air conditioning and heating system and a communal dining room. “Those are extremely comfortable conditions for the virus and still, only 20 percent were infected. It is a lot, but pretty similar to the infection rate of the common flu.”

As with the flu, most of those dying as a result of coronavirus are over 70 years old, Levitt said. “It is a known fact that the flu mostly kills the elderly — around three-quarters of flu mortalities are people over 65.” To put things in proportion: “there are years when flu is raging, like in the US in 2017, when there were three times the regular number of mortalities. And still, we did not panic. That is my message: you need to think of corona like a severe flu. It is four to eight times as strong as a common flu, and yet, most people will remain healthy and humanity will survive.”

from:     https://www.algemeiner.com/2020/03/13/corona-is-slowing-down-humanity-will-survive-says-biophysicist-michael-levitt/