COVID19 update, May 6, 2020: Dr. Hansen on what we learn from autopsies of COVID19 patients; infection fatality rate; Neil Ferguson’s downfall

(1) In a previous episode, I partly translated an interview with a German pathoogy professor and his assistant about what they learned from autopsies on COVID19 patients pathology professor discusses what can be learned about COVID19 from autopsies

Now Mike Hansen MD discusses the same in English

Blood clots, endothelial inflammation, and in general the immune system trying to kill you in order to save you. The blood clots account for much if not all of the damage to all sorts of organs. If only we could reliably stop this from happening, COVID19 would be a nuisance, not an emergency.

And Roger Seheult MD just posted this video on the exact same subject.

The rule of thumb is that 80-85% of symptomatic cases get the mild version that affects the upper respiratory tract but not the lower lungs. These patients, seemingly without exception, get better on their own — it’s the remaining 15-20% that get lower pneumonia who may be fighting for their lives against bad odds. The sooner such cases are recognized, the better to start administering oxygen and anticoagulants, and perhaps remdesivir if available.

(2) But is this “80% rule” constant across all age brackets? A breakdown of case fatality rates by age cohort makes this seem quite implausible. The figures below are taken from the daily report of the Korean CDC for South Korea, from the RKI’s daily report for Germany, and from an informally shared report for Israel.

Age groupIsraelSouth KoreaGermany
Average1.462.364.18
80+13.023.918.4 average 70+
70-796.310.3
60-691.82.61.65 average 30-69
50-590.50.8
40-490.10.2
30-390.10.2
20-290.1nil0.01
10-19nilnil0.01
0-9nilnil0.01
case fatality rates (%) per age bracket

It is pretty obvious with the low mortalities in the lower age brackets that severe cases cannot account for 15-20% of the age bracket. (I would love to lay my grubby hands on statistics of ICU admissions in Germany as a proxy for severe cases.)

Note also, by the way, that Israel’s mortality seems to be lower across the board than South Korea’s and especially Germany’s. While Israel’s medical system punches above its weight, it would be silly to claim it is that much better than Germany’s or South Korea’s. I also can’t think of any genetic reason, and in terms of vaccination schedules, Israel is similar to the other two countries. Now it is quite possible that despite pretty aggressive testing, Germany’s denominator is too low; South Korea had meticulous test & tracking from the beginning (one reason why they were able to weather the storm without hard lockdowns). Adjusting for population pyramid (Israel’s is by far the youngest of the three) accounts for much of the difference between Israel and South Korea. What remains with Germany?

It couldn’t possibly have anything to do with this fireball in the sky, 150 million kilometer away, could it? Israel of course enjoys a much warmer and sunnier climate — its largest population centers are near the 32nd parallel, compared to the 52nd parallel for Berlin. Lots of sun means more vitamin D and a stronger immune system; warmer and especially sunnier weather means virus survives less time on surfaces, clothes,…

(3) And as long as we’re crunching numbers:

German virologist Prof Hendrik Streeck, from community-wide testing in Gangelt in North Rhine-Westphalia, derives 0.36% as the infection fatality rate, but allows it might be as low as 0.24%. He suggests the ratio between his IFR estimate and the official CFR as an estimate for the Dunkelziffer or stealth infection rate.

The small country that tested the highest percentage of it s population is, of course, Iceland, which according to  http://www.covid.is/data now has tested over 14% of their entire population (of about 360K). With ten (10) dead out of 1,799 confirmed infections, this suggests an upper limit of 0.56% to the infection fatality rate (IFR). German virologist Prof. Hendrik Streeck derived 0.36% from nearly whole-population testing of a single hard-hit village (Gangelt), but in an interview on Unherd I’m now watching, he allows it might be overestimated and be closer to 0.24%.

(Streeck also talks about the initial outbreak in Gangelt through mass spreading at a carnival celebration: packed indoors, loud singing, loud shouting over the “music”, traditional kissing on the mouth [UGH],… None of this is representative of going about regular business of life in a country where people keep each other at arm’s length, like the US.)

The infamous “two million will die” prediction of Neil Ferguson was based, among other assumption we now know to be incorrect, on an IFR of 0.9% Swedish epidemiologist Johan Giesecke [sp?] speaks of 0.1%, a number similar to what some of the community testing studies in California imply. I am leaning toward 0.3±0.2% as a rule of thumb.

(4) Speaking of Neil Ferguson: despite his vocal advocacy of social distancing and lockdown, he was forced to resign after being caught meeting with his lover , a younger woman in an allegedly “open” marriage to someone else. Toby Young in the Spectator cannot suppress a degree of Schadenfreude.

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