Andrew M. Fischer Profile picture
Apr 19, 2020 5 tweets 2 min read Read on X
#Belgium is in the US press crosshairs after yesterday’s #TrumpPressConference w #DrBirx on #COVID19

So, I must repeat: Belgian numbers incl suspected untested cases, mostly in care homes, which acct for ~1/2 deaths (2/3 yesterday). The other countries on the list do not. 1/n
So you would need to maybe double the numbers of the others to make comparable.

It is in fact a reflection of strength of the Belgian health system, not an indictment of it, that these cases are reported and that the system is also transparent and honest about them. 2/n
As noted here, Belgium is not overestimating deaths, but the other countries are underestimating:
plus.lesoir.be/295071/article…

More generally, this is a classic stat reporting bias with better functioning systems, that report more because they are functioning well. 3/n
A well functioning universal health system tends to report more deaths because it is more effective at keeping track of infection and mortality, etc, vs weaker systems that miss a lot of deaths because of lack of capacity, fragmentation, lack of coverage and access, etc. 4/n
It is similar to abortions: more reported in countries that legalise abortion, not bc there are less where they are criminalised, but bc reporting is suppressed. Or more suicides reported where less shame is assoc'd w suicide vs eg Catholic countries, where reporting repressed.

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More from @AndrewM_Fischer

Jun 15, 2020
#race & #COVID19

"the avg county-lvl death rate from Covid-19 is 12/100,000 people. Counties with a Black pop above 85% had a rate up to 10x higher. For every 10% pt increase in a county’s Black population, its Covid-19 death rate roughly doubles.”

statnews.com/2020/06/15/who…
"The reason why [Black people] face higher death rates is not bc they have higher rates of uninsured, poverty, diabetes, or these other factors.” … [or not explained by age, sex, comorbidities, and income]

That leaves other factors: systemic racism.
“Systemic racism that affects the quality of insurance African Americans have and the quality of the health care they receive.

...The correlation between death rate and driving to work suggests that just being at work, no matter how you get there, increases your risk of dying”
Read 6 tweets
Jun 2, 2020
"Black people make up the majority of low-wage workers who remain on the frontlines in positions that don’t permit them.. to work from hom.. paid sick leave, or.. PPE."

Covid-19 meets racism meets the killing of a Black American by police statnews.com/2020/06/02/my-… via @statnews
@statnews Thanks to a history of redlining and race-based residential segregation, many of these low-wage workers are living in close, cramped housing that makes social distancing all but impossible. On top of this...
@statnews a dearth of federal- and state-level racial and ethnic data on Covid-19 cases and deaths continues to devalue the humanity of Black Americans and leave us in the dark about the true impacts of this pandemic on our communities — all while...
Read 5 tweets
Apr 18, 2020
Some tentatively +ve news, but how much will a treatment cost?

Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment statnews.com/2020/04/16/ear… via @statnews
@statnews @MSF says price of remdesivir is unknown. "However, as the drug entered clinical trials in China for Covid-19 in Feb, it was estd that Gilead may charge $260/treatment-course in the country. Prices may be as high as $1,000/treatment-course in the US.”
economictimes.indiatimes.com/https://econom…
@statnews @MSF This earlier report estimated that #Remdesivir treatment-course cost might be in the range of $50-100.
ccn.com/coronavirus-dr…
Read 6 tweets
Apr 12, 2020
It is perturbing that Belgium has a gd quality health system, w ICU that is well < capacity, no dramatic shortages of PPE, and yet we still have 3rd highest fatalities per cap in the world, trailing just behind Italy and Spain by a few days...

brusselstimes.com/all-news/belgi…
Of course, this is partly because Belgium is much more transparent with reporting non-hospital deaths, unlike eg Netherlands. Only 54% of deaths were in hospital, so this leads to very significant diffs in reporting. Belgian testing is also 50% > Netherlands; 70% > UK.
Wallonian/Flemish diffs also interesting. Wallonia and Brussels much quicker with reporting non-hospital deaths, whereas some of the big jumps in recent days have been bc of accumulated lagged reporting of deaths from Flemish care homes, which have been much slower w reporting.
Read 4 tweets
Mar 30, 2020
My mother, an MD in her 90s who saw some of the last polio cases in #Canada as an intern in the 50s, notes that many compare #COVID19 to #SpanishFlu but not to polio epidemics before/after WW2, eg she remembers a lockdown in ’37. I googled and found this:
cpha.ca/story-polio
Ofc, it is because #COVID19 is a flu-like infection, but other relevant similarities. Also very infectious, most #polio cases were minor gastrointestinal illness, whereas minority more serious. Higher CFR, e.g. peak in ’53 in Canada had 9000 cases and 500 deaths, CFR = 5.6%. 2/3
And then there was the devastating paralysis, eg "estimated 11,000 people in Canada were left paralyzed by polio between 1949 and 1954… The last major polio epidemic in Canada occurred in 1959, with nearly 2,000 paralytic cases.” 3/3
Read 4 tweets
Mar 27, 2020
Such sad news. He has been such a massive inspiration for me, for his immense wisdom and his exemplary humility. I never took a course with him, but he was my teacher in the truest sense. Journey well and may we meet again.
So good that we managed to publish this interview with @tmkandawire in @DevandChg last year, before he passed, interviewed by Kate Meagher, a friend and colleague of his.
I forgot to add the link. Here it is:
onlinelibrary.wiley.com/doi/10.1111/de…

Soon to be made open access. Watch this space.
Read 4 tweets

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