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Gordo

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

Covid-19 Vaccine Survey  

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1 hour ago, Dean Pomerleau said:

An important wrinkle is that it is almost guaranteed that many more will die if we attempt to get it over with fast due to healthcare system overwhelm than if we attempt to slow the spread with continued (but somewhat more relaxed) social distancing measures like Sibiriak suggests.

I'm with Sibiriak that a middle ground seems the only viable path forward, although your point about allowing more infections over the (northern hemisphere) summer is well taken. It could be worse if we try too hard to slow the spread between now and the fall, only to have a tsunami of cases rip through a more covid-naive population in the fall/winter.

The problem with relaxing over the summer one I mentioned on the call yesterday - once we loosen restrictions I think it will be very hard to tighten them again, especially given the resistance to such measures we're already seeing around the country. 

Like it or not, it seems inevitable we're going to see people starting to mingle more over the coming summer months due to defiance and/or necessity, triggering an increase in infections and deaths.

--Dean

You and Sibiriak make great points about the middle ground seeming to be the only viable path forward. Like the 'middle-way' suggested by the Buddha. In terms of loosening restrictions, I think you've hit the nail on the head that once they are relaxed, there will be enormous uproar if they have to be tightened up again. Hopefully, government officials have thought of that and aren't too reactive. In regards to your last point on people starting to mingle over the summer months who are defying public orders, there will certainly be some who will defy orders. Having said that, for me personally there would be a tremendous social and professional cost to doing so. My social circle would be angry to know that I had actively defied orders (both family and friends) and I would be in a position that my employment could be threatened. And on an ethical level, if I defied orders and transmitted this to someone who became critically ill, I could not live with myself. Thus, I'm happy to follow whatever restrictions health officials deem fit for my area. 

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Peer Review of “COVID-19 Antibody Seroprevalence in Santa Clara County, California” (April 18)

 

Quote

4. Conclusion

To summarize, there are three broad reasons why I am skeptical of this study’s claims.

  1. First, the false positive rate may be high enough to generate many of the reported 50 positives out of 3330 samples. Or put another way, we don’t have high confidence in a very low false positive rate, as the 95% confidence interval for the false positive rate is roughly [0%, >1.2%] and the reported positive rate is ~1.5%.
  2. Second, the study may have enriched for COVID-19 cases by (a) serving as a test-of-last-resort for symptomatic or exposed people who couldn’t get tests elsewhere in the Bay Area and/or (b) allowing said people to recruit other COVID-19 cases to the study in private groups. These mechanisms could also account for a significant chunk of the 50 positives in 3330 samples.
  3. Third, in order to produce the visible excess mortality numbers that COVID-19 is already piling up in Europe and NYC, the study would imply that COVID-19 is spreading significantly faster than past pandemics like H1N1, many of which had multiple waves and took more than a year to run their course.

These points may be mistaken. If so, I welcome corrections. And it would be wonderful news as it would imply we were much closer to herd immunity at a lower cost than people thought.

Alternatively, if these points are correct, we should try to do a second round of serosurveys that (a) aggressively reduces the false positive rate with many controls and possibly multiple independent tests and (b) that uses some form of unbiased recruitment for the serosurvey, potentially similar to jury duty.

 

Edited by Sibiriak

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1 hour ago, Sibiriak said:

Or put another way, we don’t have high confidence in a very low false positive rate, as the 95% confidence interval for the false positive rate is roughly [0%, >1.2%] and the reported positive rate is ~1.5%.

Great find Sibiriak,

That was exactly my point in this post. The reported rate of positives in the Santa Clara study (~1.5%) is much too close to the false positive rate for the serology test they used for the data to be trusted.

The Chelsea Massachusetts serology test result is much more trustworthy IMO, despite the smaller sample size. Chelsea was hit so hard by the virus that a relative large fraction of the population (~30%) had contracted it, so the false positive rate on the serology test the researchers used would add a small amount of noise around that 30% number.

--Dean

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Coronavirus' Long Mortality Tail

In this post I argued that the number of deaths in Chelsea Massachusetts should be approximately doubled from where it is today in mortality rate calculations to account for current patients who will eventually die. But that doubling was a guess as to how many more of those initially diagnosed sick people in Chelsea would eventually die.

We can get a better handle on the tail of the mortality curve by looking at data from South Korea (SK). As you probably recall, SK had a big bolus of cases resulting from a large gathering of church members in mid-February. In the weeks after that fateful event, SK's daily new cases climbed dramatically peaking around March 2nd as you can see in this graph:

Screenshot_20200419-134612_Chrome.jpg

Since then SK has done a pretty amazing job of bringing new cases down quickly with just a few new case per day for the last several weeks. This success is reflected in SK's active cases graph, showing a peak on March 11th, 9 days after the peak in daily new cases and a steady decline since then:

Screenshot_20200419-135108_Chrome.jpg

Notice that despite many weeks of very low daily additions to new cases, the active case count in SK is still lingering pretty high at around 2500, about 1/3rd its peak of around 7500.

This already shows that covid-19 isn't a disease that everyone either recovers from or dies from quickly. People, especially very sick people, linger with the disease for a long time.

This is especially apparent in the mortality graph:

Screenshot_20200419-135700_Chrome.jpg

Notice that on March 11th, at the peak of the active cases in SK and at a time when the rate of daily new cases was already very low, the cumulative death toll in SK was only 60 people. Subsequent to that date, as very few new cases were added in SK, the death toll continued to climb steadily for more than month, as sick people from that initial bolus of cases continued to die.

As of today, the death count is SK is 234, nearly 4x the number of deaths they had at the time of their peak in active cases. And the total deaths is still going up by a few every day as more of those sick people clinging to life from that initial bolus die in SK.

That's a very troubling observation for us here in the US, Italy and other places around the world where actives cases haven't yet peaked or have peaked recently. Here is the graph of actives cases in the US:

Screenshot_20200419-140321_Chrome.jpg

Our active cases clearly haven't peaked yet and by my eyeball it looks like the US won't peak for another 7-10 days at least. Today's US total death toll is about 40K and we are adding (very optimistically) 1500 new deaths per day (probably more). Therefore in 7-10 days when we reach our peak in active cases, we'll likely be around 50-55K total deaths. 

If resolving those active cases on the downward portion of the curve goes like it has in SK, the eventual death toll will be in the neighborhood of 4-5 times the number of dead at the peak of active cases, meaning ~200K-275K deaths in the US.

And unfortunately, even that seems optimistic, since unlike SK which quashed its new daily cases quite effectively after its peak with very rigorous contract tracing and isolation, the US is very likely to be adding substantial numbers of new cases long after we reach our peak in active cases, pushing our total death count still higher when those additional cases are eventually resolved (i.e. the mortality tail will almost certainly be even longer and with a more gradual decline for the US than SK).

In short, this analysis suggests we are likely to see at least quarter million deaths in this initial wave even if we continue with the level of social distancing measures we're practicing now. Interestingly, this is in pretty close agreement with the 200K+ estimate of total US deaths in this first wave I arrived at using a very different methodology to estimate the mortality tail here.

This is far higher than the IHME model, which paradoxically was recently revised downward from 68K to 60K US deaths in this first wave (assuming continued social distancing), despite the clear evidence from the US, Italy, Spain and France that the daily death toll is lingering high (i.e. plateauing) when the IHME model is saying it should be dropping quickly as all these countries pass their peak in daily deaths.

Oddly, at the same time it revised the US death toll downward, the IHME raised Italy's total death toll projection by almost 25%, from 21K to 26K, when the trend of lingering high daily deaths in Italy and therefore the error in the IHME model's projections became so egregious it was impossible to ignore.

Once again time will tell, and all bets are off if states in the US start relaxing social distancing measures soon. But I'm becoming more convinced that the US death toll will be substantially higher than current projections suggest, even assuming we continue social distancing.

Finally, if someone spots an error in this analysis please speak up. I'd be more than happy to be proven wrong.

--Dean

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1 hour ago, Dean Pomerleau said:

Finally, if someone spots an error in this analysis please speak up. I'd be more than happy to be proven wrong.

Unfortunately, the gist of your analysis seems to describe reasonably well the situation in some of the most infected countries.

In Italy, for example, the trend of daily deaths is declining but very, very slowly, notwithstanding the restrictions which we may define almost extreme.

 

image.png.c805a683096d8e3c6d460199cae13c3c.png

 

Edited by mccoy

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5 hours ago, Dean Pomerleau said:

I'm with Sibiriak that a middle ground seems the only viable path forward, although your point about allowing more infections over the (northern hemisphere) summer is well taken. It could be worse if we try too hard to slow the spread between now and the fall, only to have a tsunami of cases rip through a more covid-naive population in the fall/winter.

The problem with relaxing over the summer one I mentioned on the call yesterday - once we loosen restrictions I think it will be very hard to tighten them again, especially given the resistance to such measures we're already seeing around the country.

I don't think it will pan out quite the way you guys think.  My expectation at this point is already that the timid plans to "reopen the economy" will roll out as announced, politicians will make a big deal about the economy being "open again", and in the grand scheme of things, none of that will make a whole lot of difference with regard to ending the recession.
Gallup revealed that more than 80% of Americans will wait to return to normal activities after restrictions are lifted. Of that, 71% will wait to see what happens with the virus, while 10% will wait indefinitely.

Furthermore:
JPMorgan Chase Stops Accepting HELOC Applications Due to Coronavirus Uncertainty, changes mortgage loan requirements to 700 FICO plus 20% down payment for new purchase mortgage applicants -- a dramatic tightening

If most banks tighten lending standards like JP Morgan just did, the housing market will likely crater. It will be interesting to see if the government actually takes over the mortgage lending market.  The economic pain is really just getting started.  I expect high unemployment and deleveraging for at least a year, probably two.

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I have to agree with Gordo. Like I've been saying for a long time - they'll have to reopen the economy regardless of what the virus is doing, otherwise you'll start getting banking failures at some point, which woud be a full-on catastrophy because of the FDIC - there is no money, and you can't print indefinitely. So it simply *must* be avoided. Ergo, reopen, whatever the cost in lives. I think that pretty much sums up the reasoning of the powers that be, and I suspect that's what's going to happen.

Where I disagree with Gordo a bit is that the housing market will crater. No, it will not. Reason: lack of supply. Housing starts are at an all time low. So no new home supply. Meanwhile of the existing stock, it is not coming on market. Nobody wants to show homes in this pandemic. Prices may take a small hit, because there will always be motivated sellers who just have no choice and are desperate to sell, but there are plenty of buyers just waiting for opportunities, so that will get snapped up. Bottom line - the real estate *industry* will take a hit, agents, contractors, lawyers, mortgage financiers etc. - with low activity they'll be wiped out. Commercial real estate will take a hit - businesses don't want to take out long term leases in times such as these, and tons of retail spaces will be going begging (stores, restaurants etc.). But the *housing* market will be just fine - but locked up a bit, few buyers, few sellers, Mexican standoff. YMMV.

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22 hours ago, Dean Pomerleau said:

I've come to realize many of my fellow Americans are just nuts. Look at these scenes from today/yesterday showing a protest in Texas and beach goers in Florida....

Dean, have you ever even considered that you might be wrong? I am looking at your lengthy graphs in your post above and all I see is “garbage in, garbage out.” And a certain self-righteous smugness in the open insults hurled at those who disagree. Yet, all your dire predictions so far have been so, so wrong.

Italy and New York are clear outliers, presenting data which is, at least in part, politically influenced, which may explain the dramatically inflated mortality numbers compared to most other locales.
 

15 hours ago, Sibiriak said:

For those who haven’t found the time to watch “Professor”  Knut Wittkowski's widely viewed video, which is being promoted by Ron Put and many others, I’ve made a brief outline of it. ... (In my considered opinion,  Wittkowski is a nut and his theory is rubbish.  YMMV.)

Sibiriak, after you assured us that Russia only wants peace and prosperity for its neighbors and the EU, you have moved on to liberal dolops of Covid-19 FUD in your posts (not unlike Sputnik), from anecdotal tabloid stories, to personal attacks against the likes of Prof. Wittkowski. I am curious, why the quotation marks around “Professor?” And while you certainly made a great effort, I fail to see anything "considered" in your opinion that Wittkowski is a "nut."

Note that Wittkowski's school children exposure argument is being followed by many around the world, with Sweden's neighbor Denmark sending it's grade school and kindergarten kids back to school last week.

6 hours ago, Dean Pomerleau said:

An important wrinkle is that it is almost guaranteed that many more will die if we attempt to get it over with fast due to healthcare system overwhelm than if we attempt to slow the spread with continued (but somewhat more relaxed) social distancing measures like Sibiriak suggests.

I'm with Sibiriak that a middle ground seems the only viable path forward....

Dean, the US healthcare system has generally not been overwhelmed. New York had similar issues at some hospitals in 2018 (and for what it's worth, Cuomo declined to do anything about it). In fact, emergency rooms are emptier than normal and the fear is likely causing people to delay emergency visits,.

The "middle ground" was the reasonable social distancing advised before the California and New York economic shutdowns. The same moderate distancing as implemented by Sweden. Now that we have ruined the two largest state economies, it's too late for that.

It’s ironic how those who clearly offered false data, like “3.4% mortality rate,” “Covid-19 is NOT as contagious as the flu,” “500,000 to over a million dead in the US,” or "200,000 deaths in the UK" are being hailed by you and many others as the sole “truth bearers” and the only “experts” worth listening to. 

But anyone who points out that tremendous societal damage was inflicted by “leaders” who relied on obviously bad data, or who disagrees with the narrative promoted by WHO, China and the Western political groupthink which coalesced around all this bad data, is being personally attacked and their reputation is being actively undermined.

Yet, evidence is emerging that, just like with a flu pandemic, the number of infected within the population is 10% to 30%, lock down or not. And the mortality rate will shape to be close to that of a flu pandemic, and not a really bad one, like the 1957-58 season.

Actually, let’s look at the 1957-58 influenza pandemic, also known as the Asian flu: It killed between 70,000 and 116,000 in the US alone, and over 1,000,000 people worldwide. Note that at the time the US population was less than half of what it is today, about 170 million, and the world population was barely 40% of today’s.

Yet, there was no US or world economic shutdown in 1957. 

Now, here is something for the more hysterical here to ponder:

Total U.S. death rate is below average, CDC says

"The new weekly COVID-19 report shows that the percentage of all U.S. deaths caused by pneumonia and influenza spiked to epidemic levels in the week ending March 28 — the last week in the pneumonia and influenza chart.

But, even at the end of March, the percentage of all deaths recorded as being caused by pneumonia or influenza was still below the level recorded in late 2017.

A set of tables linked to that chart shows that states first began reporting a significant number of deaths caused by COVID-19 during the week ending March 21.  The percentage of all deaths classified as being caused by COVID-19 increased to 11 percent during the week ending April 11, from 1percent  during the week ending March 21.

The death count totals for the weeks ending April 4 and April 11 are still incomplete. The CDC death count tables for earlier weeks show that, from the week ending Feb. 1 through the week ending March 28, the average number of deaths was about 6 percent below the three-year average."

Edited by Ron Put

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2 hours ago, TomBAvoider said:

I have to agree with Gordo. Like I've been saying for a long time - they'll have to reopen the economy regardless of what the virus is doing, otherwise you'll start getting banking failures at some point, etc.

I think you guys are reading too much into my analysis, i.e. interpreting it as a recommendation to stay in lockdown. I've mostly been providing reasons that the powers that be are underestimating the human carnage that will result even if we stay in lockdown.

I too think relaxing the social distancing measure to some degree is inevitable regardless of how much extra human life will be lost. And like Gordo I don't believe what the politicians call reopening will be anything like getting back to normal, both because the politicians will leave many restrictions in place and because even if they didn't, a good fraction of the population (the rational ones) will still take steps to limit their personal exposure until it is clear the risk is much lower than it is right now for themselves or people they care about.

--Dean

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On a lighter note, today is Orthodox Easter, so I friend sent me the morning briefing by Luzhkov (Moscow's mayor):

"Good morning! Overnight, there were:

101 new infections; 
3 deaths.
1 resurrection.

Any questions?"

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3 hours ago, Ron Put said:

On a lighter note, today is Orthodox Easter

It also happens to be Bicycle Day! So there's that...

In other news, I'm hearing more and more skepticism about a vaccine...

We've never made a successful vaccine for a coronavirus before. This is why it's so difficult

And even if they do create one, it may only be effective for a short time (weeks or months at most) from what I'm reading.  

Edited by Gordo

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4 hours ago, Dean Pomerleau said:

Finally, if someone spots an error in this analysis please speak up. I'd be more than happy to be proven wrong.

I think you have raised important points and in general express appropriate uncertainty and are in the ballpark of what looks to me a likely scenario.  But I have a minor quibble:

4 hours ago, Dean Pomerleau said:

Therefore in 7-10 days when we reach our peak in active cases, we'll likely be around 50-55K total deaths. 

I think it would be better to say "a peak" as opposed to "our peak".  If we peak there is no guarantee it is the peak of the first wave unless one defines any further peaks as additional waves. 

On worldometer's world graph of active cases we had a peak on 2/17 of 58,747 due to China.  A US peak due to NYC might likewise not be our last peak.  If we peak because of actions to reduce the spread as opposed to reaching herd immunity there is no guarantee that a change of actions won't change the results.  Approaching herd immunity might be slowing the spread in the hardest hit locales such as parts of NYC responsible for the majority of cases.   But most of the nation has seen far fewer cases and deaths per capita and is unlikely to be approaching NYC's degree of infection induced immunity.  The spread of this virus is affected by what people do and what people will do is hard to predict.  There still isn't much testing of the asymptomatic and because there is significant lag between policy changes and the rate people progress to seeking care relaxing restrictions will likely lead to outbreaks catching us by surprise. 

With 40527 deaths so far NY is currently at 933 deaths per million and the rest of the US is at 122.  If we eventually go with the herd immunity solution, we could reasonably expect the rest of the nation at least catches up with where NY is today.  Suggesting at least 40527 * 933 / 122 = 309,932 deaths.   But I'd bet the hardest hit areas have a lot more than NY's average of 933 deaths per million and as you have pointed out there will be more deaths among the active case counts so this is a very conservative estimate and recalculating it day by day has shown rapid growth.  It will be some time before we have a solid upper limit for the number of people per million this might kill.

Also there are potential wildcard factors.  Perhaps tomorrow Donald Trump will announce a beautiful new cure more amazingly perfect than hydroxychloroquine.  Or maybe there will be some sort of systemic breakdown either regionally or nationally that increases mortality.

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From the article Gordo just posted. Something to think about for those of us who are considering volunteering for the vaccine development human challenge trials.

Quote

"So that immunisation with SARS corona vaccine caused, in animals, inflammation in the lungs which wouldn't otherwise have been there if the vaccine hadn't been given."

In Dr. Greger's webinar on the pandemic he mentioned we have never made a vaccine against a coronavirus, and we don't know if one is even possible. Maybe it won't be. If that is the case, I'm not really sure how this ends. Maybe the virus will mutate enough to become less deadly, or maybe it will just be a new fact of life. Maybe dying from the coronavirus will become one of the leading causes of death year after year and that many of us will die from it eventually when we reach old age.

At the same time the difficulty of creating a vaccine like this, together with the sheer number of incredibly smart people working on this with massive funding directed towards this task could lead to so major leaps forward in medical science. Who knows, we might just end up with a new method that finally gives us a cure to the common cold!

Or maybe a vaccine is just not going to work at all, but a very rigorous testing and contact tracing could create a kind of social cure. If we knew every human and animal that is currently infected and could successfully isolate them for several weeks, the pandemic ends. We are a long way off from that now, but if a vaccine isn't possible after years of trying and wave after wave of outbreak keeps happening, we might just get good enough at it to make a serious attempt. We could do the same thing with HIV and other viruses. There are all kinds of obstacles to this approach, including social, political, financial and ethical ones. But I rather like the idea of coming up with a solution that not a vaccine at all. A solution that comes out of left field.

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I can’t believe oil just hit $12, we should have <$1gas soon:

 

12oil.png.a969e30b814aa09c1d9b32d4d60e4fe1.png

Banks are screwed.

Edited by Gordo

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12 hours ago, Ron Put said:

I am curious, why the quotation marks around “Professor?”

He's a professor of what?  Where?

Edited by Sibiriak

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I can’t believe oil just hit $15, we should have <$1gas soon[...]

You would think so, but nah, at least not in California. We can barely get below $3 here in LA, you have to count taxes and fees into the price also. The issue is refineries and stock. There is little refining going on, because the producers anticipate little demand. They're drawing down stock, so there's no pressure from the supply side. Lack of urgency to sell (supply) and lack of urgency to buy (demand), means little in the way of price movement. At least that's the situation here in CA. Elsewhere the situation is somewhat different (more refineries production), so there the price might fall, but there's always a lag between crude prices and the final gasoline product, it'll take some time, and everyone will need to be sure that the prices are staying at this level more or less, before the price for the consumer moves. Meanwhile demand will spike up the moment the economy is unlocked, which might happen faster than the time lag between crude prices and the consumer product, so there'll never be time for a big price movement. I suspect that there'll be some buying of crude futures very soon and bigger stocks in anticipation of the crude price moving up as the economy gets going. Bottom line, I don't expect to see below $1 gas prices, certainly not in CA. YMMV.

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8 hours ago, Todd Allen said:

I think it would be better to say "a peak" as opposed to "our peak".  If we peak there is no guarantee it is the peak of the first wave unless one defines any further peaks as additional waves

Fair point. I do try to make it clear I'm referring to the first wave, but there could definitely be multiple peaks even in the first wave. 

9 hours ago, Todd Allen said:

With 40527 deaths so far NY is currently at 933 deaths per million and the rest of the US is at 122.  If we eventually go with the herd immunity solution, we could reasonably expect the rest of the nation at least catches up with where NY is today.  Suggesting at least 40527 * 933 / 122 = 309,932 deaths.   But I'd bet the hardest hit areas have a lot more than NY's average of 933 deaths per million and as you have pointed out there will be more deaths among the active case counts so this is a very conservative estimate and recalculating it day by day has shown rapid growth

Even your very conservative analysis of 310k deaths to attain herd immunity seems to be assuming NYC has achieved herd immunity which seems very unlikely to me. Chelsea MA has seen 975 deaths per million (similar to NYC) and the serology testing there suggests only 30% of residents have been infected, which is still a long way from herd immunity. 

--Dean 

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Not much social distancing going on at the Pennsylvania anti-shutdown protest rally:

 

 

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Total collapse of the oil market!  Now at $4/barrel,  lowest price in our lifetime!  Biggest one day crash ever possibly?  Down 73% right now.

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Quote

Buyers in Texas are offering as little as $2 a barrel for some oil streams, raising the possibility that producers may soon have to pay to have crude taken off their hands.

 

 

 

Edited by Sibiriak

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So, despite the media hysteria, the preliminary excess mortality in the US hasn't exceeded even 2017-2018 (it's in fact lower so far than the last 3-year average).

I looked up the weekly excess mortality graphs for Europe and it looks not all that different than previous years -- as you can see the spike is commensurate with the spikes for earlier flu seasons, except that the current spike is within a narrower time span (less excess deaths).  One explanation for the high mortality in Italy was that the flu season was extraordinarily mild there, resulting in close to 50% less flu deaths than usual, which means that an excess of vulnerable people survived the flu and were left susceptible to Covid-19. The much lower mortality earlier in this season is clearly seen in the graphs:


875225849_ScreenShot2020-04-20at10_54_08.thumb.png.f62472ea739883a824c55c0da537e5e7.png

http://www.euromomo.eu/

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