After further reflection, I have made some modifications to the iceberg image in an attempt to make it slightly more representative of the situation.
1/3 Image
I learned today that asymptomatic (+) PCR are generally not counted under cases, as both symptoms and a PCR (+) are required for a diagnosis.
Above is a more simplified version. 2/3
In the more detailed image, cases should be what appears above the water so there is a misrepresentation in the initial image. Here’s the updated version: 3/3 Image

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More from @abirballan

17 Sep
We must understand the enemy to counteract its tactics.
We are at war with an invisible enemy and It is NOT COVID19!

Media logic as “a form of communication, and the process
through which media transmit and communicate information”
1/n
“…what people know and believe to be true about the world is constructed or created and reinforced and supported as people interact with one another over time in specific social settings” 2/n
The COVID 19 reality was carefully constructed, reinforced and supported.
a) Constructed: “we are at war with an invisible killer” “We need rapid-fire instruments to tackle the crisis”
3/n

aromatumbleweed.blogspot.com/2020/05/while-…
Read 32 tweets
12 Sep
If you ain’t sick, you ain’t sick.

“most diseases, however, are defined by the cluster of symptoms and signs, in addition to test results. A recent review found that a single symptom or sign could not accurately diagnose COVID-19.” 1/n
“The PCR test positivity counts should include a standardized threshold level of detection, and at a minimum, the recording of the presence or absence of symptoms.” 2/n
“As a disease, the C19 case definition should constitute a disorder that produces a specific set of symptoms and signs.” 3/n
Read 10 tweets
10 Sep
Should guidelines be evidence-based?
The PCR test works by duplicating the genetic material in a sample to a point where a specific genetic sequence is detected.

Ct is the cycle threshold. It is the number of amplification cycles needed ...
1/n
..to see the fluorescent color which indicates the presence of the genetic sequence.

The higher the Ct it is set on, the more likely it is to detect a lower viral load. 2/n
So if a person has recovered and has a minute amount of viral debris still in his body:
by setting the Ct on 30, the viral debris won't be detected => giving a (-) test result
by setting the Ct on 40, the viral debris will be detected
=> giving a False (+) test result 3/n
Read 12 tweets
6 Sep
CFR, IFR, CMR & one more R:
Reality check.

I was deeply disturbed yesterday to hear a friend of mine claiming that the mortality from C19 is 5%.
Well, it is NOT!
Let me show you... 1/n
There are 3 ways to calculate mortality from a disease.
Each gives us a different set of information.
1.CFR- The Case Fatality Rate
2.IFR - The Infection Fatality Rate
3.CMR- The Crude Mortality Rate
2/n
1. CFR tells us how many people died out of the diagnosed cases with a (+) PCR test. There are so many infections hiding below the surface, CFR is a highly exaggerated mortality rate. It tends to decrease over time as the disease progresses and more cases are counted in. 3/n
Read 18 tweets
26 Aug
@gummibear737 I was against the lockdown when the epidemic started.
Any one with a background in public health could’ve known back in March the following: 1/n
1. In March, WHO said: 80% of infections are mild or asymptomatic... (not more dangerous than other respiratory viruses).. This was concluded from the cases they were seeing in primary care and hospitals. Many more cases never reach the hospital because they are too mild.. 2/n
so one could expect it to be milder than this in the end.

2.Cases of a respiratory infectious disease are always a small percentage of real infections. To calculate total illness of the flu, they use a multiplier of hospitalizations cdc.gov/flu/about/burd…
3/n
Read 24 tweets
24 Aug
Professor Raj Bhopal- Prof Em. of Public Health at the Univ of Edinburgh, Scotland- advocating for controlled herd immunity:
Protect the elderly
Let the young get C19
The vaccine might not to be here in 2, 5 or 10 years.
“We need to tell people the truth”
@PanData19 @AlistairHaimes @stacey_rudin @FatEmperor @CoronaPogue @HaraldofW @ElonBachman @boriquagato @MLevitt_NP2013 @freddiesayers

Although I am thankful that Professor Bhopal is speaking out now 6 months into the pandemic, I can’t help but feel disappointed that... 1/n
..his approach is being positioned as a new strategy when it is really just good old traditional public health science.
Dr David Katz talked about this in May
Sweden followed this approach in March. 2/n
Read 10 tweets

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