Thread by @AtomsksSanakan

1/T

As we get closer to the end of the pandemic, it's worthwhile to look back on false claims that helped make the pandemic worse.

One of these claims was:
COVID-19 is not much of a danger to people outside of nursing homes + other institutions.

2/T

John Ioannidis is a proponent of this claim.

He argued that relatively few SARS-CoV-2-infected people died of the disease COVID-19, outside of nursing homes.

In other words: the infection fatality rate, or IFR, was low outside of nursing homes.

institutefordiseasemodeling.github.io/nCoV-public/an…

3/T

He defended this idea since at least early May 2020. And he continued to defend it in his most recent work:

"in Europe and the Americas (~0.2% among community-dwelling non-institutionalized people)"
onlinelibrary.wiley.com/doi/10.1111/ec…

medrxiv.org/content/10.110…
sciencedirect.com/science/articl…

4/T

Ioannidis' idea then led to the "focused protection" strategy of the Great Barrington Declaration:

Protect 'vulnerable' people in nursing homes and elsewhere. But impose almost no restrictions on the general population of less 'vulnerable' people.

5/T

So a lot hinges on the idea that IFR is low (≤~0.2%) in the Americas and Europe, outside of nursing homes.

If IFR is higher, then letting many people get infected in the general population would lead to a huge pandemic with many COVID-19 deaths.

6/T

Unfortunately, IFR was ≥0.2% in the Americas + Europe, outside of nursing homes:

0.2% - 0.4%: medrxiv.org/content/10.110…
0.3%: ncbi.nlm.nih.gov/pmc/articles/P… []
0.3%: thelancet.com/journals/lanin… (appendix)

{blue shade: 0.79% (0.68–0.92%)}
nature.com/articles/s4158…

7/T

Re: "IFR was ≥0.2% in the Americas + Europe, outside of nursing homes"

0.5%: ncbi.nlm.nih.gov/pmc/articles/P…
0.6%: ncbi.nlm.nih.gov/pmc/articles/P…
0.8%: ncbi.nlm.nih.gov/pmc/articles/P…
0.9%: nature.com/articles/s4146…
1.0%: ncbi.nlm.nih.gov/pmc/articles/P…

1.4%:
medrxiv.org/content/10.110…

8/T

Re: "IFR was ≥0.2%"

Parts 6/T + 7/T focused on studies that use representative/randomized sampling.



But even studies with non-representative sampling debunk Ioannidis' idea:

0.6%: medrxiv.org/content/10.110…

0.8%:
medrxiv.org/content/10.110…

9/T

Ioannidis also performed a misleading comparison of:
- influenza IFR, *including nursing home deaths*
- SARS-CoV-2 IFR, *without nursing home deaths*



That doesn't correct for influenza killing older people in nursing homes.

cdc.gov/flu/about/burd…

10/T

So Ioannidis' position, + that of the Great Barrington Declaration, still rests on:

- under-estimating the risk COVID-19 poses to the general population, including outside nursing homes
- misleading comparisons to influenza