Just curious, anyone have a plan, or preps for global pandemic?

[Sibiriak]

[BrianA]

Purposely infecting volunteers with very low doses of the virus could be a useful approach, assuming the data proves out that low initial dose = less severe disease.

 

Variolation May Cut Covid19 Deaths 3-30X

http://www.overcomingbias.com/2020/03/variolation-may-cut-covid19-deaths-3-30x.html

[Gordo]

More Americans Should Probably Wear Masks for Protection

[TomBAvoider]

Here's an anecdotal report from someone who is reliable and not a rumor monger, an excerpt:

"My friend who's a doctor of emergency medicine at a Manhattan hospital is becoming more and more afraid for his own safety. Two of his colleagues are now hospitalized on ventilators and in very bad condition. He says some hospital services have totally abandoned the ER, some won't send their people even to attend to non-COVID patients. And apparently hospital admin is willing to let them get away with it. He's also been told not wear scrubs on his way home because some health workers have been accosted by people who apparently blame doctors for spreading infection".

[Gordo]

Debate Ends Over Chloroquine as France Officially Sanctions Usage

Days after beginning a large scale double blinded trial, the so called gold standard, France has now reached the conclusion chloroquine is recommended to treat corona.

out of 80 patients treated with chloroquine, 78 recovered within 5 days.

[BrianA]

Political Calculations has updated their stock market forecast based off the continued deterioration in future projected dividends... the projection in their 2nd chart looks pretty ugly. Dividend futures do of course fluctuate, so if the economy suddenly improves perhaps based off even more stimulus measures, this projection could change. Next 3 weeks will be interesting.

 

https://politicalcalculations.blogspot.com/2020/03/s-500-rises-and-falls-on-fed-stimulus.html

[Sibiriak]

Is factory farming to blame for coronavirus?

Quote

[...]“Our study does not directly shed light on the geographical origin of the virus,” says Andersen. “However, all the available evidence shows that it was inside China.”

Case closed then, and President Trump is right to call Sars-CoV-2 the “Chinese virus”. Well, no, because if you want to understand why this pandemic happened now and not, say, 20 years ago – since Chinese people’s taste for what we in the west consider exotic fare is not new – you have to include a number of other factors. “We can blame the object – the virus, the cultural practice – but causality extends out into the relationships between people and ecology,” says evolutionary biologist Rob Wallace of the Agroecology and Rural Economics Research Corps in St Paul, Minnesota.

Starting in the 1990s, as part of its economic transformation, China ramped up its food production systems to industrial scale. One side effect of this, as anthropologists Lyle Fearnley and Christos Lynteris have documented, was that smallholding farmers were undercut and pushed out of the livestock industry. Searching for a new way to earn a living, some of them turned to farming “wild” species that had previously been eaten for subsistence only. Wild food was formalised as a sector, and was increasingly branded as a luxury product. But the smallholders weren’t only pushed out economically. As industrial farming concerns took up more and more land, these small-scale farmers were pushed out geographically too – closer to uncultivable zones. Closer to the edge of the forest, that is, where bats and the viruses that infect them lurk. The density and frequency of contacts at that first interface increased, and hence, so did the risk of a spillover.

It’s true, in other words, that an expanding human population pushing into previously undisturbed ecosystems has contributed to the increasing number of zoonoses – human infections of animal origin – in recent decades. That has been documented for Ebola and HIV, for example. But behind that shift has been another, in the way food is produced. Modern models of agribusiness are contributing to the emergence of zoonoses.

Take flu, a disease that is considered to have high pandemic potential, having caused an estimated 15 pandemics in the past 500 years. “There is clearly a link between the emergence of highly pathogenic avian influenza viruses and intensified poultry production systems,” says spatial epidemiologist Marius Gilbert of the Université Libre de Bruxelles in Belgium.

The reasons, many of which were documented in Wallace’s 2016 book Big Farms Make Big Flu, include the density with which chickens, turkeys or other poultry are packed into factory farms, and the fact that the birds in a given farm tend to be near genetic clones of one another – having been selected over decades for desirable traits such as lean meat. If a virus gets introduced into such a flock, it can race through it without meeting any resistance in the form of genetic variants that prevent its spread. Both experimental manipulations and observations in the real world have demonstrated that this process can result in a ratcheting up of the virus’s virulence. If it then spills over into humans, we are potentially in trouble.

In a paper published in 2018, Gilbert’s group reviewed historical “conversion events”, as they call them – when a not-very-pathogenic avian flu strain became much more dangerous, and found that most of them had occurred in commercial poultry systems, and more frequently in wealthy countries. Europe, Australia and the US had generated more of them than China.

That doesn’t let China off the hook. Two highly pathogenic forms of avian flu – H5N1 and H7N9 – have emerged in that country in recent decades. Both infect humans, though not easily (yet). The first human cases of H7N9 were reported in 2013, and there were small annual outbreaks thereafter. But, says Gilbert, “nothing was done until the virus turned out to be pathogenic for chickens as well. Then it became an important economic issue and China started to mass-vaccinate its poultry against H7N9, and that ended the transmission to humans.”

China is one of the world’s major exporters of poultry, but its poultry industry is not wholly Chinese-owned. After the recession of 2008, for example, New York-based investment bank Goldman Sachs diversified its holdings and moved into Chinese poultry farms. So if China has its share of responsibility for spillover events, it isn’t alone. That is why Wallace insists on talking about relational geographies rather than absolute geographies, when it comes to identifying the causes of disease. Or as he puts it: “Follow the money.”

Not everybody sees a straightforward link between factory farming and new and dangerous forms of flu.  [...]

 

Quote

And we’re not just talking about birds. Gilbert believes a ratcheting up of viral virulence is happening in pig herds, too. Porcine reproductive and respiratory syndrome (PRRS), a disease of pigs that was first described in the US in the late 1980s, has since spread to herds across the world and strains detected recently in China are more virulent than the early American ones. A 2015 study carried out by Martha Nelson of the US National Institutes of Health and colleagues mapped the genetic sequences of swine flu viruses and found that Europe and the US – the largest global exporters of pigs – are also the largest exporters of swine flu.

There have been claims on social media, sometimes posted by vegans, that if we ate less meat there would have been no Covid-19. Interestingly, some of these have been blocked by mainstream news organisations as “partly false”. But the claims are also partly true. Though the links they draw are too simplistic, the evidence is now strong that the way meat is produced – and not just in China – contributed to Covid-19.

It is clear that to prevent or at least slow the emergence of new zoonoses, as Fearnley and Lynteris have argued, China’s wet markets will need to be better regulated. But we also need to look behind those markets, at how our food is produced globally [...]

 

Bat meat at a market in Indonesia.

Edited March 30, 2020 by Sibiriak

[Dean Pomerleau]

4 hours ago, Gordo said:

Days after beginning a large scale double blinded trial, the so called gold standard, France has now reached the conclusion chloroquine is recommended to treat corona.

That's a very hopeful development Gordo. Thanks for finding it. It should be noted though that the French study referenced wasn't a double blind trial. Reading the actual paper (pdf), it involved 80 patients, all of whom received hydroxychloroquine plus azithromycin. As you said, 78 of them recovered from the virus in 5 days, which the authors says is much less than the 14 day recover for usual care.

There is mention that there should also be data coming out of a trial of chloroquine/hydroxychloroquine in NY today (Monday). Hopefully that one will have a control group and show the same positive results!

--Dean

[Dean Pomerleau]

1 hour ago, Dean Pomerleau said:

Hopefully that one will have a control group and show the same positive results!

On a much less hopeful note, this small study [1] (Forbes article on it) from a few days ago out of China did have a control group and found hydroxychloroquine plus standard care was no better than standard care alone in terms of how quickly patients cleared the virus.

--Dean

------

[1] A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19)
CHEN Jun, LIU Danping, LIU Li, LIU Ping, XU Qingnian, XIA Lu, LING Yun, HUANG Dan, SONG Shuli, ZHANG Dandan, QIAN Zhiping, LI Tao, SHEN Yinzhong, LU Hongzhou
(Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan
University, Shanghai 201508, China)
Corresponding author: LU Hongzhou, E-mail: luhongzhou@fudan.edu.cn,
https://orcid.org/0000-0002-8308-5534
[Abstract] Objective: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the
treatment of patients with common coronavirus disease-19 (COVID-19). Methods:
We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed
consent at Shanghai Public Health Clinical Center. The patients were randomized 1:1 to HCQ
group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days
plus conventional treatments, while those in the control group were given conventional treatment
only. The primary endpoint was negative conversion rate of COVID-19 nucleic acid in respiratory
pharyngeal swab on days 7 after randomization. This study has been approved by the ethics
committee of Shanghai public health clinical center and registered online (NCT04261517).
Results: One patient in HCQ group developed to severe during the treatment. On day 7,
COVID-19 nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and
14 (93.3%) cases in the control group (P＞ 0.05). The median duration from hospitalization to
virus nucleic acid negative conservation was 4 (1-9) days in HCQ group, which is comparable to
that in the control group [2 (1-4) days, (U = 83.5, P ＞ 0.05)]. The median time for body
temperature normalization in HCQ group was 1 (0-2) after hospitalization, which was also
comparable to that in the control group 1 (0-3). Radiological progression was shown on CT
images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all
patients showed improvement in follow-up examination. Four cases (26.7%) of the HCQ group
and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (P＞
0.05). Conclusions: The prognosis of common COVID-19 patients is good. Larger sample size
study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent
research should determine better endpoint and fully consider the feasibility of experiments such as
sample size.

[Gordo]

3 hours ago, Dean Pomerleau said:

On a much less hopeful note, this small study [1] (Forbes article on it) from a few days ago out of China did have a control group and found hydroxychloroquine plus standard care was no better than standard care alone in terms of how quickly patients cleared the virus.

--Dean

Interesting, I also stumbled upon this critique of the original smaller french study and the famous researcher behind it.  I guess for now we still only have mostly anecdotes or questionable studies without real controls or blinding.  Along those lines, see: https://techstartups.com/2020/03/28/dr-vladimir-zelenko-now-treated-699-coronavirus-patients-100-success-using-hydroxychloroquine-sulfate-zinc-z-pak-update/?fbclid=IwAR0zUC1INTVFpYNRmuM3lSPPJVnf4yu7AaYvL5ofg30-xg7E4K8050HvaYc

"In an exclusive interview with former New York Mayor, Rudy Giuliani, Dr. Vladmir Zelenko (a board-certified family practitioner in New York) shares the results of his latest study, which showed that out of his 699 patients treated, zero patients died, zero patients intubated, and four hospitalizations.

Dr. Zelenko said the whole treatment costs only $20 over a period of 5 days with 100% success."

There are many other success stories about hydroxychloroquine across the country. Last week, Dr. William Grace, an oncologist at Lenox Hill Hospital in New York City, said they’ve not had a single death in their hospital because of  hydroxychloroquine. “Thanks to hydroxychloroquine, we have not had a death in our hospital,’ Dr. Grace said.

 

Also, in a study conducted by the National Institute of Health (NIH) also confirmed some of Dr. Zelenko’s findings. The study by NIH showed that Zinc supplementation decreases the morbidity of lower respiratory tract infection in pediatric patients in the developing world. A second study also conducted by NIH titled: “In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2),” also showed hydroxychloroquine to be more potent in killing the virus off in vitro (in the test tube and not in the body).

Below is a video of Dr. Zelenko’s latest interview explaining his treatment protocol and results. "We need to hit this infection hard and early." You can't wait 3 days for a test result to come back.  This doc emphasizes the need to combine Hydroxychloroquine (200mg twice a day for 5 days), zinc (220mg once a day for 5 days), and azithromycin (500mg once a day for 5 days). None of his patients have died.  He does not treat patients without serious symptoms, does not prescribe anything to the young and healthy (under 60 years old without preexisting conditions) unless they have shortness of breath.  This Doc exclusively practices by telemedicine by the way (does not see anyone in person). "Many doctors are coming on board and they are having similar results" ... "I really think that this is the answer, and if you scale this nationally the economy will rebound much quicker and the country will be open again"

Edited March 30, 2020 by Gordo

[TomBAvoider]

The projections for how long these lockdowns will last are all over the place. Trump after initially saying "Easter" now says "end of April", but governors are another matter:

Maryland, Virginia, D.C. issue stay-at-home orders to all residents 

Northam, governor for Virginia just issued a mandatory stay-in-place order that is supposed to last through June 10! I mean... this is close to the outer edge of what the economy can take. The country shut down can maybe be stretched to the end of June at the most and have the economy rebound sharply in the 3rd and 4th quarter like what Wall Street is pricing in. But if this lasts beyond June, then all bets are off, because there simply isn't going to be a sharp rebound - too many businesses will have gone belly up and too many consumers will be too tapped out to be able to spend for a rebound. Looking at savings, you are going to burn through too much if you go beyond June. 

I really don't know - it seems crazy that they'd be able to enforce this thing beyond June, but we live in strange times. Let's hope we don't find out what happens if they try to keep the lockdowns across the country beyond June. 

[Sibiriak]

UK coronavirus restrictions could last six months – deputy chief medical officer  Dr Jenny Harries says lifting lockdown too soon could risk second wave of infection

 

NPR's Mary Louise Kelly talks with Justin Lessler from the Johns Hopkins Bloomberg School of Public Health about President Trump's statement that the coronavirus pandemic may abate in July or August.

Quote

[Mar 17, 2020] [...]KELLY: Let's talk now with someone who has been studying the data, Justin Lessler of Johns Hopkins Bloomberg School of Public Health. [...] Help me process the president's comment there that we just heard about July or August, which is four or five months from now. Do you agree with that assessment?

LESSLER: Yeah. I mean, it's not exactly clear to me what he's referring to in terms of the timing - whether he's talking about when the epidemic will have peaked and begin declining or when we'll be out of the woods altogether. One of the interesting questions is that if we do well in mitigating or containing the epidemic, we actually slow it down, so it lasts longer. [...]As people have been saying, flatten the curve. And if we flatten the curve, it may peak in July or in August. If we don't flatten the curve, it'd probably peak much sooner but in a very unpleasant way.

 

Bill  Gates argues that extended shutdowns are necessary,  and that if they are ended before absolute numbers of infections are brought way down,  widespread fear will still stop people from returning to  normal economic activity

Short version (10:51):

https://www.youtube.com/watch?v=A71lfXrQlxU

Long version:

https://www.youtube.com/watch?v=UHLJ0DaMIIc

 

Edited March 31, 2020 by Sibiriak

[Gordo]

I think most here already know this, but...

Why You Shouldn’t Believe the 3.4% Coronavirus Death Rate

The COVID-19 Data is a Classic Example of Selection Bias

[Dean Pomerleau]

Gordo,

The article you point to is almost certainly true - the case fatality rate can tend to be overestimated during an outbreak due to a lack of widespread testing of mildly symptomatic or asymptomatic people.

But at the same time, there is evidence that pushes in the other direction. For example,  not all coronavirus deaths are being counted as such.

From this article:

And two of the hardest-hit areas in the nation — New York City and Los Angeles County — released guidance earlier this week encouraging doctors not to test patients unless they think the test will significantly change their course of treatment. That means that potentially more people in both places could be admitted to hospitals with severe respiratory symptoms and recover — or die — and not be registered as a coronavirus case.

Several other factors push towards an underestimation of the death rate, including the long tail of people who are sick with coronavirus and only die much later. That's why the death rate in South Korea (where there is lots of testing and no overwhelmed hospitals) has seen its death date drift continually higher from around 0.6% near the beginning to almost 2% now.

Another factor pushing up the death rate is obviously overwhelmed hospitals, which seem like important factors in Wuhan and Italy. Here is a graph (from here) of the death rate over time in various countries, showing just how wide the range is:

The above link has a good discussion of how the case fatality rate can be biased in either direction in the midst of an outbreak.

--Dean

[Ron Put]

On 3/28/2020 at 8:31 PM, Sibiriak said:

Following the "Chinese Model",  however,  has its detractors:

Yep. I've been away, but here is my latest rant :) Looking at the latest numbers, the mortality rate has dropped to below 0.5% and that's factoring in only confirmed cases. But since testing is limited, it is highly likely that the mortality rate will be lower yet and closer to that of a bad flu season. In Italy for instance, even if the current death toll doubles, it will still be less than the death toll from the 2017-2018 flu season. Which is not good, of course, but we don't shut down the world's developed economies during every bad flu season.

Notably, the news and the hysterical opposition haves stopped mentioning the mortality rates, shifting focus to demanding help and lining up for bailouts. In Italy, which was the first to adopt the Chinese model, Conti is now threatening the EU if they don't bail him out. Italy's Duce-wannabes on the Right shifted allegiance from Russia to become a Trojan Horse for China, with Salvini pushing through a New Silk Road deal last year, in exchange for 2.5 billion China, against strong EU objections. In the US, Cuomo, Newsom and other governors who shut down their economies are now positioning to blame the feds if they don't get what they want to bail out their states, certain that much of the media will back them up.

The headlines are still focussing on areas where the healthcare facilities are under stress, but this has happened during virtually every flu season, except that it was not covered nearly as relentlessly, and the political polarization has not been as great. When the mass hysteria is over, we are likely to face a deep recession with little room to do anything about it and populism and political turmoil and polarization are likely to increase in the liberal democracies. Putin, just like Stalin before him, fixated on the wrong "enemy" and, having being instrumental in softening and destabilising the EU, might find himself playing a vassal to a much strong China. What a mess! :(

End of rant.

[Ron Put]

23 minutes ago, Dean Pomerleau said:

And two of the hardest-hit areas in the nation — New York City and Los Angeles County — released guidance earlier this week encouraging doctors not to test patients unless they think the test will significantly change their course of treatment. That means that potentially more people in both places could be admitted to hospitals with severe respiratory symptoms and recover — or die — and not be registered as a coronavirus case.

No, it doesn't mean that at all. This is why Buzzfeed should not be used as a news source, unless one is interested in the latest about the Kardashians.

It means that only severe enough cases will be tested, generally among the vulnerable groups. Which will in fact decrease the number of those with mild symptoms tested and will cause the death rate to appear higher, just like it did initially in China and Italy.

Notably, California has been undercounting flu deaths for years, officially counting as flu-caused deaths only those deceased who were over 65.

Edited March 31, 2020 by Ron Put

[mccoy]

17 minutes ago, Ron Put said:

otably, the news and the hysterical opposition haves stopped mentioning the mortality rates, shifting focus to demanding help and lining up for bailouts. In Italy, which was the first to adopt the Chinese model, Conti is now threatening the EU if they don't bail him out. Italy's Duce-wannabes on the Right shifted allegiance from Russia to become a Trojan Horse for China, with Salvini pushing through a New Silk Road deal last year, in exchange for 2.5 billion China, against strong EU objections.

Ron, you are interested into Italian politics, but maybe you are consulting sources which are a little confused. Conte does not appear to be threatening europe, he's rather underlining that the very purpose for which Europe was borne is at risk of failure. Please note his faction so far has been a strong supporter of Europe, but it seems they are being disabused. More countries in addition to Italy and Spain are favourable to the Coronavirus bonds, whereas Germany remains reluctant. I'm not aware that the right-wingers are favouring China, sure not last year. Salvini and Meloni are rather wary of China, whereas Di Maio and his 5-star movement have been very favourable., especially so during a meeting with Xi-Jinping last year. They are strict-sense populists, wheras Salvini is nationalist, not a populist, although he can draw huge crowds.

[Dean Pomerleau]

55 minutes ago, Ron Put said:

 Looking at the latest numbers, the mortality rate has dropped to below 0.5% and that's factoring in only confirmed cases.

Ron, 

Do you realize death occurs on average about 2 weeks after diagnosis with this disease?  That means the death numbers lag the cases by ~14 days. So saying that the mortality rate is below 0.5% based to diagnosed cases and deaths to date is just silly, given the geometric growth in the number of cases in the last two weeks. 

55 minutes ago, Ron Put said:

In Italy for instance, even if the current death toll doubles, it will still be less than the death toll from the 2017-2018 flu season.

If Italy's total deaths double from here that will be around 25k deaths. I couldn't find Italy's 2017-2018 seasonal flu mortality numbers, so let's scale it to the US for comparison. We have about 5x the population of Italy, so 25k deaths in Italy would be comparable to 125k deaths in the United States, which incidently is what epidemiologists are saying is the ballpark of what we will likely see if we stick to the social distancing efforts. In bad 2017-2018 flu season, the US death toll from the seasonal flu was estimated to have been about 60k. So the coronavirus death toll would be about twice the seasonal flu. 

But what you are really missing Ron is the fact that those coronavirus death numbers are what's likely to happen in Italy and the US with the very serious mitigation efforts both countries (but especially Italy) are taking. The number of deaths would be much higher if no social distancing measures were implemented. 

There is no denying the economic and social consequences of these containment efforts will be huge. But it is disingenuous of you to say that we shouldn't be doing them based on the fact that with the extreme distancing measures fully implemented the death toll might not to more than a couple times worse than the death toll during a very bad flu season. 

--Dean 

[Ron Put]

32 minutes ago, mccoy said:

Ron, you are interested into Italian politics, but maybe you are consulting sources which are a little confused. ...

mccoy, I am actually not really interested in Italian politics and have no deep knowledge, other than what I read casually or what I hear from sources which have much deeper knowledge. On Italian politics, I'd certainly defer to you in this forum.

My impression was that Salvini, while he was a DPM, brought in a friend who was at the time living in China and who subsequently designed Italy's China policy, including setting the stage for increases in port investment and ultimately for the agreements of last year. My understanding is that Salvini distanced himself from the agreements mostly as a political gesture to Trump and to parts of his base, who were pro-Russian but leery of the increasing Chinese influence in Italy. Which in my book makes Salvini a populist :)

[mccoy]

6 minutes ago, Ron Put said:

My understanding is that Salvini distanced himself from the agreements mostly as a political gesture to Trump and to parts of his base, who were pro-Russian but leery of the increasing Chinese influence in Italy. Which in my book makes Salvini a populist 🙂

It might be, exactly one year ago Salvini did not join the other ministers in a lunch with the Chinese president, whereas Di Maio was enthusiastic about the silk road project. What I can tell you is that Salvini still supports the possibility of stronger links with Russia. Partly because Russia used to be a huge importer of Italian goods.

Definition of populist: a person, especially a politician, who strives to appeal to ordinary people who feel that their concerns are disregarded by established elite groups.

This definition might apply to Salvini, if the established elite groups are the bankers and others which presently are supported by the left-wingers. As a matter of fact, the blue-collar workers used to be leftists, whereas today most of them feel more represented by Salvini  and his right-wing (not extreme right as many journalists erroneously define him). This was the situation until a few months ago. I don't know exactly now, the situation changes very fast here.  Presently the right-wingers at the opposition are prompting the government to be quicker and more assertive in funding the unemplyed of the pandemic.

[Ron Put]

1 hour ago, Dean Pomerleau said:

Ron, 

Do you realize death occurs on average about 2 weeks after diagnosis with this disease?  That means the death numbers lag the cases by ~14 days. So saying that the mortality rate is below 0.5% based to diagnosed cases and deaths to date is just silly, given the geometric growth in the number of cases in the last two weeks. 

If Italy's total deaths double from here that will be around 25k deaths. I couldn't find Italy's 2017-2018 seasonal flu mortality numbers, so let's scale it to the US for comparison. We have about 5x the population of Italy, so 25k deaths in Italy would be comparable to 125k deaths in the United States, which incidently is what epidemiologists are saying is the ballpark of what we will likely see if we stick to the social distancing efforts. In bad 2017-2018 flu season, the US death toll from the seasonal flu was estimated to have been about 60k. So the coronavirus death toll would be about twice the seasonal flu. ...

Hi, Dean. I had seen the upper range of the 2017-2018 influenza death toll in Italy to be about 30,000. Can't look right now, but here is something I had left open in my tabs:

* In the winter seasons from 2013/14 to 2016/17, an estimated average of 5,290,000 ILI cases occurred in Italy, corresponding to an incidence of 9%.

* More than 68,000 deaths attributable to flu epidemics were estimated in the study period.

* Italy showed a higher influenza attributable excess mortality compared to other European countries. especially in the elderly.

https://www.sciencedirect.com/science/article/pii/S1201971219303285

This is over four seasons, of course, but I believe that 2017-2018 was a notable outlier, with over 1 million people dying from the flu around the world. The 25,000 to 30,000 deaths in Italy during 2017-2018 seems to jive with the above. Keep in mind that the Italians appear to be among the most rabid anti-vaxers in Europe and their flu immunization rates are generally lower than in other parts of the EU and in the US.

BTW, in the US the death toll during 2017-2018 was about 80,000 according to the CDC. This is well over double the average flu mortality rate in the US, which is between 30,000 and 35,000 annually.

I respectfully disagree about the death rates, since as you noted, Covid-19 is very contagious, it spreads before symptoms appear and in about 80% of the cases manifests as a mild cold. Which means that it is highly likely that the infection rates are much higher than the published confirmed numbers, while the same is not true with the number of dead, even if there is a lag.
 

Edited March 31, 2020 by Ron Put

[Ron Put]

50 minutes ago, mccoy said:

It might be, exactly one year ago Salvini did not join the other ministers in a lunch with the Chinese president, ...

I did a search and this seems to lend some support to my understanding:

“[W]e should not forget that the architect of Italy’s China-friendly policy shift … is Michele Geraci, a League member who was personally picked by Salvini as undersecretary for economic development,” she said. “While Salvini has adopted a tougher rhetoric on China, he has so far not done anything concrete to prevent Rome from pursuing closer political ties with Beijing.”

https://www.scmp.com/news/china/diplomacy/article/3023787/could-giuseppe-contes-exit-be-end-italys-closer-ties-china

[Dean Pomerleau]

42 minutes ago, Ron Put said:

This is over four seasons, of course, but I believe that 2017-2018 was a notable outlier, with over 1 million people dying from the flu around the world. The 25,000 to 30,000 deaths in Italy during 2017-2018 seems to jive with the above

Ron,

Suppose I grant you 25k deaths in Italy is ~1x (rather than ~2x) the number of deaths during a bad flu season. You still seem to have ignored the larger issue. It is only by implementing rather draconian social distance measures (including having to carry a filled out government form to leave your house, as mccoy has described) that Italy is (hopefully) going to keep their death toll down to the level experienced during a very bad flu season.

I'll say it again. Claiming that draconian measures are unneccessary based on the (relatively moderate) death toll that will result only if such measures are successfully implemented is a specious argument, since the death toll would be much higher if the measures were lifted (or never implemented in the first place).

--Dean

[TomBAvoider]

So how are we to interpret what Sweden is doing? I suppose it's a natural experiment, and the future will show us how well their course of action worked for them. Of course, we'll only be able to compare to other countries. Norway, Finland and Denmark (plus Iceland) all have much smaller populations compared to Sweden.

Interestingly enough, I've read that they ran all sorts of simulations, and one of the factors was the impact of economy on death rates:

"you cannot prevent it from spreading. It is already out. The purpose of measures is to limit the peak so the health system does not collapse [...] I am pretty sure they did modelling based on their ICU capacity and behavioral patterns of their population [...] They protect the vulnerable, that is the old and sick, but also take into account the potential increase in death rate because of economic collapse (depression, alcoholism worse quality of medical services in the future). [...] the Swedes ran such simulations before this pandemic had even started."

It seems to me that there's an impact from the economy, but it's hard to quantify. 

 

[AlPater]

I wonder how many people with serious underlying conditions such as end stage kidney disease, end stage heart failure, treatment resistant hypertension, etc. who are infected by the virus are described by doctors or coroners to have died from the virus versus other disease.

Re the flu -- Covid-19 comparison, I thought that information in https://www.vox.com/science-and-health/2020/3/13/21176735/covid-19-coronavirus-worse-than-flu-comparison pertained.