Exhibit of shoddy analysis masquerading as insight. Plenty of reasons why Case Fatality Rates (CFR) may be low in new outbreak States, which has nothing to do with #COVID19 being "FAR LESS deadly." 1/4
Early US epidemic (eg, in NY,NJ,CT), testing capacity was limited resulting in fewer cases and was restricted to mostly hospitalized pts late in disease progression. Less precautions and limited knowhow / preparedness for disease management. All contributed to higher CFR.
With testing ramp, we are now detecting cases in community and sampling broader population (including younger people). Much improved knowhow about the virus, disease management, and precautionary measures. Some mitigation efforts still in place. All contribute to lower CFR.
Correlating mitigation policy onset/lifting w/ #coronavirus transmission leads to misleading conclusions if underlying consumer behavior & societal changes aren't considered. Where's the "second wave" some like to ask? Let's take Georgia as an example:
🧵 1/ 👇
Testing has been a fiasco (one of the States mixing PCR & AB results: theatlantic.com/health/archive…). Even then, as testing ramped, new cases finding has increased and positive rate has at best stayed flat recently. 2/
The increase in new cases is happening despite depressed mobility even after shelter-in-place orders were lifted. Workplace, retail & recreation, transit stations activities still not back at pre-epidemic baseline. % at home also remains elevated. 3/
Discussions about #COVID19 focus on binary outcomes: Death & Recovery. But we know #coronavirus undertakes “ferocious rampage through the body, from brain to toes” (sciencemag.org/news/2020/04/h…). This has dramatic implication for the Quality of Life of those not fully recovered. 1/
We can think of the total number of people infected with #coronavirus being distributed on a health-related Quality of Life scale (0 = Death & 1 = Fully recovered). Significant majority fully recover. 2/
However, what’s the number of people in the in-between compromised health state? How high is that number? It’ll be sometime before the full extent of this disease burden will become evident. In the interim, one shouldn’t forget this invisible damage exists. 3/3
2/ "common denominator for everything that I was doing was that I was very interested in the methods—not necessarily the results but how exactly you do that, how exactly you try to avoid bias, how you avoid error.”
How ironic! buzzfeednews.com/amphtml/stepha…
3/ That news report is about shoddy, questionable, and unethical participant recruitment for the same study Dr. Ioannidis proudly stands by. Perhaps example of "biases that are trying to generate significant, spectacular, fascinating, extraordinary results”?
1/ What does #FlattenTheCurve mean for #NewYork.
3 likely scenarios for new #COVID19 cases finding:
a) Declines sharply (high containment)
b) Gradual decline (medium containment)
c) Flares up forming a bigger wave before declining (low containment)
2) a) Means beyond flattening, quashing the curve. Requires aggressive testing, tracing, and isolation of cases to arrest #coronavirus spread (like #SouthKorea). Highly unlikely given testing capacity/resources limitation & rampant community transmission.
3) b) Means mitigation works in keeping new cases increase controlled. While curve stays flat, days/wks of high new cases finding, followed by gradual decrease. Requires keeping mitigation measures in place for extended time given limitation in testing/tracing/isolation.