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Excess Deaths, Excessive Predictions
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It is a bright new day, so here are some thoughts on various subjects, most of which have the same theme: deciding how bad things are depends on your frame of reference.

I had said that excess deaths was the key variable in understanding the coronavirus epidemic, and the policies being deployed against it. Once deaths are plotted out over several years then we have a base-rate against which any upward trend can be detected. Emil Kirkegaard directs me to European data, which shows deaths week by week at national level. Given the nature of the epidemic, it is the over 65 years of age group which is of particular interest.

https://www.euromomo.eu/outputs/zscore_country65.html

No evidence of excess mortality, so far, in the reporting countries, apart from Italy. Data is delayed in coming through, so we should be cautious about that for another few months. Nonetheless, so far, we are not at the excess death levels of the winter of 2016/2017.

In Europe at least, it is not killing many of us, yet, compared with previous seasonal variation in death rates. However, since most countries are isolating the population as much as possible (no stepping stone) this paucity of excess deaths may indicate that the policy of isolation is working.

All simulations have assumptions, each with their error terms, and most have projected estimates of death rates under different policy conditions. Basically, if a government gets its act together, then a mixture of test and isolate; test, isolate and trace contacts and isolate those; different degrees of lockdown; different degrees of mask wearing; different degrees of hand and home washing will result in a lower number of deaths. So, when looking at any simulation you need to look not just at their worst case, but at the predictions they make for each condition.

The Imperial predictions have, in my view, been unjustly criticised because their high estimates of death rates under the “Do Nothing” condition. That prediction led the UK Government to Do Something, and under this new condition it is appropriate to look at the predictions they made about those mitigating scenarios, which were much lower. Not a change in the model, nor an admission of error, but a confirmation that when circumstances of social interaction change, the death rate will probably go down. Note also that their model suggest that the increased demand for hospital care will be evident in late April/early May, and we are not there yet.

By the way, unless commentators are publishing their own models, they should merely state their own assumptions and make their own predictions in sufficient detail that they can be evaluated later. The best guy on this is Prof Philip Tetlock, who has doggedly tested expert prediction, and has scathing things to say about most public experts, but much better things to say about less well known, tested and validated winners of prediction competitions.

Here are super-forecaster’s predictions for the situation a year from now: more than 800,000 deaths but less than 8,000,000 worldwide, they estimate. Talk about error bands.

https://goodjudgment.io/covid/dashboard/

Here is a brief summary of Tetlock’s work:

https://www.unz.com/jthompson/the-tetlock-forecast/?highlight=tetlock

Another approach, (previously posted by Steve Sailer) is due to Aatish Bhatia with Minute Physics is to plot for all countries the log of their infection rate versus the log of their death rate, to create an interactive display in which most countries progress up the same path, but China and South Korea seem to have fallen off the routine death march into apparent safety. Unfortunately, I cannot find an actual interactive link, only a video of the simulation at work a week ago.

As a final individual point of view, here is University of Cambridge virologist Dr Jane Greatorex, who worked in Sierra Leone on the Ebola outbreak and for Public Health England during the swine flu epidemic being interviewed about various issues, particularly how long self-isolation should last for infected persons.

https://www.cambridgeindependent.co.uk/news/cambridge-virologist-explains-what-we-know-and-dont-know-about-covid-19-9104220/

The Covid-19 virus has not been in the UK for very long, so is not widespread.
Recovered people probably have immunity now, though it will take 12 before extent of immunity is clear.

I take great umbrage at the lengths of time you are meant to be infectious for because it is just not true. Nine days is nonsense. You don’t excrete a live virus that long.

Those studies are not checking for live virus, they are checking for genome. They do something called a PCR test (polymerase chain reaction), which is the test we are using to diagnose patients. It doesn’t tell you that you have live virus in your nose, it tells you have had it. For about 72 hours of a viral infection you have a live virus. In children it can last for longer – four or five days have been observed in flu.

So, there’s a big difference between how long we can detect the virus and how long they can infect someone else. With this coronavirus the only way you can say, yes, they are still shedding live virus – which is the only thing that will infect someone else, is if you take that sample from the patient and extract it and put it on tissue culture cells and then see it growing. That is done very rarely.

How long are people contagious before symptoms appear?

The likelihood is up to 48 hours before.

Is the data from China trustworthy?

Yes, there is very good data. The studies that have been done are excellent and so rapidly produced, but it is all about the context in infectious diseases. There will be some genetic differences in the way that we respond to diseases. That’s not unheard of. So I have a bit of wariness. The data that is coming out of here matters the most and Public Health England is looking at that.

Summary

Although we have to wait for more data, it is already possible to run simulations to roughly guess the impact of lockdown policies, so these predictions can be tested against the death rates reported over the next three weeks. It is possible that, far from excess deaths, all infectious diseases will be reduced.

We may become a world in which we wash our hands more frequently, wear masks in public places whenever we feel a cold coming on; nod or bow rather than shake hands, and accept that no-one flies anywhere without good cause, and a clean bill of health.

Or, that by next October, it will be business as usual again.

Your call.

 
• Category: Science • Tags: Coronavirus, Disease 
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  1. dearieme says:

    more than 800,000 deaths but less than 8,000,000 worldwide, they estimate. Talk about error bands.

    Aw, take logarithms to the base ten and they are not all that different.

    Today’s Times suggests that the government is frustrated by the uselessness of the NHS and Public Health England at producing test kits. Shades of the American CDC and FDA!

    No doubt any attempt to reform the NHS after this is all over will fail as usual. But it should not be beyond the wit of man just to abolish PHE and start a new outfit with a remit of public health in the strict sense, starting off with epidemic diseases, stockpiling equipment, and so on. Then after about 25 years it will be necessary to abolish the new outfit because by that time it will be being run entirely for the benefit of its bureaucrats not for the benefit of the nation.

    It’s tempting to suggest that the Stalinist NHS could only be reformed by Stalinist techniques but it would take a braver man than me to say so. What will happen is that the badly incentivised incompetents who run it will point at the death toll among the Poor Bloody Infantry within the NHS and expect to bask in public favour accordingly. Shitbaggery of a high order is what that is.

    • Replies: @Hypnotoad666
  2. > The Covid-19 virus has not been in the UK for very long, so is not widespread.

    The Imperial team’s latest report (March 30th)
    https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/
    estimates 2.7% on March 28, i.e. about 1.8M people. That implies an understatement of cumulative case counts by a factor of about 100.

    If true, that puts a very different perspective on the fatality rate. But instead of estimates, why aren’t we doing random testing so we know for sure?

    A prediction: the virus will turn out to be about as dangerous as Hong Kong flu or less, so not very. According to Wikipedia that flu killed about 100,000 people in the US which puts it in the range of 100,000 – 200,000 today, allowing for population increase. That number is now considered horrifying but was no big deal 50 years ago.

    A theory: pandemics recur every few decades so one was inevitable sooner or later. It would have been prudent to stockpile ventilators, masks, prefab hospitals etc. A sensible government would have done that but don’t have those, hence the scrambling. If you’re scrambling, which is the better way to present it – that you’re up against a frightful danger or that you’re struggling with the consequences of not having done your job? There is a powerful incentive to turn up the hysteria.

    • Replies: @dearieme
  3. Biff says:

    nod or bow rather than shake hands,

    I prefer that I, and others, keep their hands to themselves.

  4. dearieme says:
    @Bored Lockdownee

    A governor of California did stockpile as you recommend. Then there was a change of governor and the new chap sold off the lot.

    The sad truth is that as long as the electorate is decadent and short-sighted the politicians are likely to dance to that same tune.

    And just imagine the media: “NHS heroes asked to use respirators that are ten years old, shock, horror!”

    • Replies: @Cortes
  5. AaronInMVD says: • Website

    The Italians being exceptional in having excess deaths seems to suggest more than anything that the Italians just aren’t as good as everyone else. They’ve been living the urbanized studio apartment and single room occupancy life for millennia now.

    The more data I would like to see, but probably won’t ever see is a differential in the admissions of younger, healthier people into Italian hospitals with flu-like symptoms compared to other years. Having been told “this isn’t the flu” a lot of those young people that would have normally suffered and survived at home seem to have overwhelmed their healthcare system and hastened the deaths of their elderly.

    The hysteric element of this crisis is going to ensure that the world is poor enough that by next October that “Business as Usual” will have to mean something very different. Whether the rest of the world begins adopting Asian over reactions to all upper respiratory ailments seems far less certain to me in light of the exponential decline in attendance at 9/11 candle light vigils. We’ll probably get stuck with the security theater elements however.

  6. res says:

    Thanks for the link to Tetlock’s Good Judgment Project. Even though the explanatory text there is brief, I think it is worth highlighting this.

    percentages refer not to what portion of Superforecasters think a given bucket of outcomes is most likely, but how likely they think each bucket is to occur.

    Some things which strike me about that page.

    – If we take the current world population as 7.8 billion and the current US population as 330 million then the largest buckets represent (just multiply by 0.1 for successively smaller buckets). Current bucket distributions (%) included ordered low/high.
    World cases – 68% 1/12/54/31/2
    World deaths – 1% 1/16/60/21/2
    US cases – 70% 1/9/58/30/2
    US deaths – 1% 1/5/69/24/1
    Based on both the buckets used and the responses this implies a CFR around 1.4% (forecasters estimate a little lower).

    – Cases reported/estimated is an interesting category given how much estimation techniques might vary. Notice that the CDC H1N1 estimates give ranges over roughly a factor of 2 for 2009 H1N1 with midpoints for cases of 60 million and deaths of 12,270. There is also significant uncertainty for attribution of deaths.
    https://www.cdc.gov/h1n1flu/estimates/April_March_13.htm#Table%20Cumulative

    – I can’t decide how much of the log-normal character of the estimates is real and how much an artifact of the multiple choice format and human nature. Thoughts? I get the sense that the more severe buckets are overweighted (e.g. 23% chance of >8 million deaths worldwide) based on this look at epidemics since 1900 (world population then 1.6 billion, or about 1/5 today).
    https://towardsdatascience.com/the-few-most-severe-epidemics-caused-the-vast-majority-of-epidemic-death-d6c0c4523aef

    What do others think?

    P.S. Tetlock uses the Brier score to judge accuracy. This page might be of interest.
    https://en.wikipedia.org/wiki/Scoring_rule

    • Replies: @res
    , @Polynikes
  7. NPleeze says:

    this paucity of excess deaths may indicate that the policy of isolation is working.

    That’s exactly what they want you to think. They have needlessly (and maliciously) imposed martial law to destroy the economy (read: middle class, since the government will use what they have left to bail out the rich), and when this whole thing proves to have been a total hoax, they’ll say: “it’s because we acted quickly and decisively!”

    You can’t win when the vast majority of the population is brainless sheep. Even the Editor in Chief here, who usually is quite thoughtful, has fallen into the trap of reptilian fear-based hysteria to dispense with all reason.

    • Agree: AaronInMVD, Kratoklastes
  8. res says:
    @res

    Over in this iSteve comment:
    https://www.unz.com/isteve/masks-inbound-and-outbound-protection/#comment-3812155

    I link a CDC FluSurge based prediction for the US (1968 scenario)
    https://qventus.com/blog/predicting-the-effects-of-the-covid-pandemic-on-us-health-system-capacity/
    which estimates 6.1 million cases and 200,000 deaths. Those numbers would fall in the middle buckets of the GJP options.

  9. Cortes says:
    @dearieme

    The retired staff encouraged to “lend a hand” are almost certain to be familiar with the “primitive” bits of kit which I’m led to believe exist in quite large numbers in some NHS authorities. The newly qualified may never have been trained to use older models but ought to be able to brought up to competence fairly easily.

    • Replies: @dearieme
  10. Off topic: how do you reply to an individual comment? I see no link or button to do that. I am supposed to see such? Perhaps it requires running the Google spyware that Unz pages attempt to include?

    • Replies: @NPleeze
    , @James Thompson
  11. NPleeze says:
    @Puzzled commenter

    If you block Google lots of pages don’t work. Unfortunately Unz relies on Big Brother, this way you are sure not to be “anonymous” regardless of what the site policy claims to be.

    • Replies: @YetAnotherAnon
  12. dearieme says:
    @Cortes

    Fair enough, but would that dissuade the media from complaint? No chance.

  13. Sean says:

    No evidence of https://www.bloomberg.com/news/articles/2020-03-31/italy-s-mild-flu-season-may-solve-mystery-of-coronavirus-deathsexcess mortality, so far, in the reporting countries, apart from Italy

    Italy has a very high concentration of hard core heavy smokers, and “is known for its enormous morbidity in respiratory problems, more than three times any other European country”. Moveover, Italian homes are generally cold in winter, and the recent Italian winter was mild, leading to fewer influenza deaths in Italy than usual.

    DEATHS among those aged 65 and above during the coronavirus outbreak through March 17 had already reached the levels of the previous two flu seasons and were below the overall death total from 2016-2017.

    https://assets.bwbx.io/images/users/iqjWHBFdfxIU/iVtbKUnx60yQ/v0/800x-1.png

    It is difficult to avoid sources of infection, even when you are trying to do it conscientiously in a lockdown. If the pathogen had been here while no one knew to distance and not touch their face and so on, it would have spread like wildfire.

    The Covid-19 virus has not been in the UK for very long, so is not widespread.

    Maybe, maybe not. A British consultant I saw interviewed said the time from infection to death in a UK intensive care unit is a month, which is a few weeks longer than Imperial appears to have assumed in their calculation from the first death. If it (SARS-CoV-2 ) has been here a few weeks longer than Imperial hypothesised, then the pathogen has had time to have gone through half the UK population. For this scenario, SARS-CoV-2 would have to produce serious illness in only a tiny minority of people, with the rest being asymptomatic or suffering only the mildest of symptoms. This being one one of a couple of mutually exclusive hypotheses that the Oxford team led by Professor of Theoretical Epidemiology Gupta says are equally likely, there is no question but that extreme caution and continued isolation is the best policy under the current conditions of uncertainty.

    However, Imperial did not think the aforementioned alternative ‘half the population have had it and are now clear with no ill effects, and probable immunity from reinfection or infecting others for a few years ‘ hypothesis of Gupta’s team worth even mentioning. I don’t see why Ferguson’s Imperial paper was dogmatic, because after all the outcomes are so asymmetrical, a lockdown is only sensible. There is an antibody assay just devised that can detect whether one has eliminated the coronavirus, and thus is currently unable to be a source of infection, and probably immune from being re-infected or infecting others for a few years. Until the antibody assay is given to a random sample of the population, we do not know so continued isolation is still very much in order. And for the elderly and vulnerable continued precautions are advisable in any case.

    It will be a few weeks until we get that data one way or the other. However a BBC reporter was shown on the news at ten four five hours ago taking a new and not yet officially approved antibody assay, and although he said he has never ever had any symptoms, he was positive for exposure to the SARS-CoV-2 (the COVID-19 pathogen). I can see Fergusson may have decided scare tactics were justified, but he has sold the pass. I speak of the trust that the population, whose taxes pay for his institution, put in science; they will not be as willing to listen with total credulity next time.

    • Replies: @LondonBob
  14. The High Wire.

    DATA OR DECEIT? : THE COVID-19 PEAK

    As the U.S. shutdown continues, Americans are divided. Is the panic surrounding death rates justified, or is it blown out of proportion? The only way to answer this question is to dig into the real numbers.

  15. LondonBob says:
    @Sean

    Yes the BBC reporter having the antibody test and coming back positive was interesting. Given how infectious the virus is it would make sense, especially given his job, that he would have been infected.

    My Aunt, despite having terminal cancer, says she just felt a little tired with a bit of a cold, although given her suppressed immune system it might well progress from there.

    • Replies: @LondonBob
  16. @NPleeze

    How do you block Google stuff on any web page?

    • Replies: @Hippopotamusdrome
  17. NPleeze comment 11: thanks.

    Impressive that even among the Unz commentariat, being spied on by Google is considered just fine!

  18. @Puzzled commenter

    Does the “Reply” button not work for you?

  19. Polynikes says:
    @res

    My main thought is I wonder how the super-forecasters factor in the politics of it. The CDC complains of the difficulty in attributing deaths the H1N1, and I don’t doubt that. Yet, here we are today where any death with a positive for Covid19 seems to get added to the tally.

    Could part of the be related to the fact that we did nothing last time, so there is no impetus to make us (i.e. the CDC) look bad in hindsight by running up that tally? (I saw another estimate of 70k for the H1N1, but I’m having trouble remembering where I found that. It was a 10 year retrospective published last year.) Are we going to take the opposite approach this time and test and count every single death that occurs, in a hospital or not, for 2020? If that is the case, I can see where some super-forecasters might put a little extra probability in the “more severe” buckets. Who is counting matters.

    • Replies: @Polynikes
    , @res
  20. Polynikes says:
    @Polynikes

    Add on to this, Alex Berenson (@AlexBerenson) has been all over the initial doomsdayer models. Today he posted something from the “National Vital Statistics System.” On March 24th they sent out a letter with the new code for Covid19 deaths.

    Essentially, the recommendations for reporting Covid19 deaths are to use that designation in any case where they tested positive or the medical professional assumes they died of said disease. It also gets listed first with co-morbidities listed as contributing factors.

    This 1) could help explain the spike in deaths around March 24th, and 2) explain the vast number of deaths with co-morbidities. In essence, there is guidance directing officials to code any suspected deaths of Covid19, as such.

  21. res says:
    @Polynikes

    An excellent point. A related point is how to factor in uncertainty in things like how long countermeasures will stay in place.

    The buckets are each an order of magnitude wide though, so lots of room for uncertainty.

    One interesting thing (found after the question just occurred to me, sad that it took me so long to wonder about this) is that TGP has a special “ordered categorical scoring rule” (FAQ 6, see linked PDF for details):
    https://www.gjopen.com/faq

  22. James Thompson, comment 18: the reply button doesn’t work because it doesn’t appear in my browser. It doesn’t appear because I block requests from my browser to Google, Facebook etc (see NPleeze’s comment 11), having no wish to be part of their product.

    • Replies: @botazefa
  23. dearieme says:

    In many cases I suspect that “cause of death” is an intrinsically arbitrary notion. You know he’s dead – his heart stopped. What caused that? Take your pick: (i) pneumonia perhaps as a result of coronavirus, (ii) renal failure, (iii) …

    I doubt that there is a right answer.

  24. botazefa says:
    @Puzzled commenter

    You are stating that every time I click ‘reply’, my browser sends data to google? to facebook?

    Please provide considerably more detail on this. Do you have any code or debug traces to share? ty

    • Replies: @Hippopotamusdrome
  25. Deaths from Covid_19 haven’t shown up in Welsh mortality data yet. I plotted this year, last year and 2018 a bad year for flu for lack of other plotting. Wales contains the UK’s hottest hotspot (best described as places where infection started earliest).

    This is not unexpected. From case identifcation to death is 25 days. The first cases of community transmission in Wales date from 10 March.

  26. @dearieme

    government is frustrated by the uselessness of the NHS and Public Health England at producing test kits. Shades of the American CDC and FDA!

    The Government has certain coercive abilities that are essential in an epidemic, such as shutting down public gathering. But other than that it is just as generally incompetent as always when it comes to resource allocation and innovation.

    The CDC and FDA were worse than useless as they not only bungled the production of test kits but actively prevented anyone else from providing them.

    The private sector has to be allowed – and incentivized — to step into the breach when an emergency hits. But then everyone gets morally exercised about “profiteering” and “gouging.” For this crisis and the next, there needs to be a better mechanisms for the government to get out of the way and instead allow private enterprise to ramp up super-fast based on profit motives. It may not feel altruistic but it gets the job done..

  27. @Hypnotoad666

    Probably right. In the UK private supermarket companies responded to panic buying very quickly: they stepped up production of desired products, restricted the number that any one person could buy; stopped most of their “buy one get one free” offers; narrowed their range of products; and achieved all this in about 10 days. Virtually all these steps made their businesses more profitable. Where possible, they moved staff from non-food to food duties, to keep shelves fully stocked.

    Online delivery services faced such an increase in demand that they struggled more. However, they have all invested and taken on more staff. Things are a bit better, and once again profits are going through the roof. In the long term, it is better to have delivery of food because the density of the delivery increases, and each van trip becomes more profitable. The best advantage is that shoppers say exactly what they want to buy, and pay in advance. Food waste is reduced considerably. Profit again.

  28. dearieme says:

    An interesting metric from Cambridge:

    ” I was using the mortality rates, the infection mortality rates, published by Imperial College, which may be a bit high, but I used those. And they rise incredibly steeply with age – exponentially with age. And then I thought, you know, what else rises exponentially with age? Well, our normal risk of dying rises exponentially with age! And it’s amazing – if you draw a graph of the average risk dying at each age in the country (you can get that from government life tables), and you plot these Covid 19 risks on top of it, they go almost along the line. It’s staggering. And what this means is that, essentially if you get Covid 19, the risk of dying is very roughly equivalent to the risk you’d normally have over the whole year: it packs a year’s worth of risk into the few weeks that you’ve got the disease. And that kind of puts it in perspective, what it shows is that this is a relative risk, whatever risk you’ve got, at the moment, it ups it enormously for that short period, if it’s three or four weeks, then maybe that’s 15 times your normal risk. And so we can really understand why frail, vulnerable people are at such high risk, why it’s so dangerous for them because they’re at risk anyway and suddenly it shoots up, they get a whole year’s worth, you know, in less than a month.”

    My interpretation: so your total risk of death in the next year about doubles – the old risk plus the new one. So if you’re young and fit – few worries. If you’re old and frail, potentially Goodnight, Vienna.

    The whole thing’s worth a dekko.
    https://riskytalk.libsyn.com/transcript-of-coronavirus-understanding-the-numbers

    • Thanks: res
  29. botazefa comment 24:

    > every time I click ‘reply’, my browser sends data to google? to facebook?

    I don’t permit my browser to download scripts from Google and Facebook. Unz pages routinely attempt to do so, from both. So what the button does specifically I don’t know or much care since I won’t be using it. This is well off-topic however, so I’ll end by suggesting you look into browser add-ons such as “uBlock Origin” and “uMatrix”.

    • Thanks: botazefa
  30. @YetAnotherAnon

    Browser addons like Ghostery and Noscript.

  31. @botazefa

    You need javascript to be enabled to do that. If javascript is running it can contact other bad websites as part of the script to do ‘enterprisey’ professional web site stuff (or may not). There is a like on facebook and twitter buttons at top right. It is possible the icon images could be fetched from facebook (or could not be), but that would happen even with javascript off.

    You can get a browser addon like noscript and ghostery that selectivly blocks contact with bad sites while still allowing javascript to run.

  32. @Hypnotoad666

    The Government has certain coercive abilities that are essential in an epidemic, such as shutting down public gathering.

    Nah.They didn’t have coercive abilities to shut down gay bathhouses during AIDS epidemic.

  33. Cortes says:
    @Hypnotoad666

    The private sector may tend, as it did in Germany during WWII, to “fanny around” with profit-seeking ideal solutions like the overly-complex and mutually incompatible versions of armoured vehicles produced by Porsche. Of course they may not have considered being crushed by the Red Army to be an emergency.

    Fortunately those lessons have been learned…

  34. On the subject of false reporting of C19 deaths, this article has an image of a meme that reads ” Diabetic disabled man gets hit by car, dies of COVID19 “:

    https://www.anti-empire.com/global-covid-hysteria-uncovers-a-society-has-lost-touch-with-elementary-truths-of-human-existence/

  35. LondonBob says:
    @LondonBob

    My aunt is being released today, only a mild case and she has duly beaten off the virus.

    • Replies: @Philip Owen
  36. @LondonBob

    That is good news. Encouraging for us all.

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