COVID-19/Dan Polansky

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My research on COVID-19 has so far been at B:User:Dan_Polansky/COVID-19. A lot of it is not necessarily "original research" since it heavily traces to sources.

What follows is more questions than answers.

Highlighted sources:

  • Mortality monitoring in Europe, euromomo.eu - has graphs going up to 2020 for some countries, up to week 16
  • Excess Deaths Associated with COVID-19, www.cdc.gov - has blue-bar all-cause death graphs for the whole U.S. and also for U.S. states via "Select a jurisdiction" and also specifically for New York City, assuming dashboard Weekly Excess Deaths was selected

I am experimenting with journal or mini-article like posts at Talk:COVID-19/Dan Polansky.

Test coverage and trace-and-isolate[edit | edit source]

One may try to ensure high test coverage to implement a trace-and-isolate mitigation strategy. If so, it is probably essential to test also asymptomatic cases: if you perfectly track and isolate symptomatic cases but you completele ignore asymptomatic cases, you will still have a considerable leak in the system: the asymptomatics are going to be leaking the infection around them.

Research questions:

  • 1) What percent of Covid infected people are asymptomatic (completely free of symptoms)?
  • 2) What percept of Covid infected people have only very mild symptoms, with bodily temperature not exceeding 37 deg?
  • 3) What countries excel in testing completely covid-asymptomatic people via random screening, if any?
  • 4) What websites provide Javascript simulations of infection spread in a population, where population members are shown as circles hitting one another and gaining colors?

Links:

Portion of asymptomatic cases[edit | edit source]

Research questions:

  • What portion of infected people are asymptomatic, showing no symptoms?

Observations:

  • Asymptomatic cases need to be distinguished from presymtomatic ones.

Links:

Containment and mitigation measures[edit | edit source]

Research questions:

  • What measures or interventions did regions take or can take to stop or slow down the covid spread?

Tentative answer:

  • Air travel limitation, either as for specific regions or more comprehensive.
  • Trace-and-isolate: Case tracing, including contact-tracing and putting infected people and people in contact with them at isolation.
  • School closures, either all schools or some levels of schools.
  • Recommendation for businesses to support home office as much as possible.
  • Recommendation for people to reduce non-essential travel.
  • Mandatory or recommended wearing of face coverage, whether a face mask or an analog.
  • Nation-wide lockdown:
    • Limited going outside of homes. U.K. has a specific rule for distance from home.
    • Closure of non-essential businesses: keeping groceries, pharmacies and the like.
  • Increased safety requirements for operating businesses, such as keeping distance between people and mandating face coverage.
  • Criminalizing dissent and spread of what some authority deems to be misinformation.

Links:

Non-disruptive interventions[edit | edit source]

Many countries are implementing multiple interventions that disrupt the economy, causing significant adverse economic impact. That matters when you only care about economy and not at all about people, but it matters also when you care about people since negative economic impact, e.g. layoffs, can statistically result in deaths as well. Gaps in tax collection can impact ability of social systems to provide services, at least in principle.

Research questions:

  • 1) Would relatively non-disruptive interventions be able to flatten the curve to an interesting degree? For instance, would border checks, expansive testing and isolation, and requirement for everyone to have covered nose and mouth whenever outside their home have significant flattening effect even without school closures, pub closures and prohibition of entry of foreign nationals?
  • 2) Would it be feasible to preventively perfectly isolate only the most vulnerable portion of the population by age, assuming that the remaining vulnerables are not going to overwhelm the healthcare?
    • 2.1) A crazy idea: take all the old people to an island with great recreational facilities and govern the island in a highly tightly regulated manner. If the beast starts leaking on the island, lock down the island in a massive way, but since most of the inhabitans are not economically active (old age), the lockdown is not going to disrupt the economy. Could an analogue of this work? Has anything like that ever been tried and with what results?
    • 2.2) A variant: order all old people or other group of vulnerables selected by a simple rule to stay home. Let food and medicines be delivered to the vulnerables by designated delivery squad of young and healthy people. Let the squad be massively tested on Covid, with high frequency, and let those infected by isolated. Let the delivery squad be subject to more restrictive regime than the rest of the population. The delivery squad can consist of volunteers but also be taken from the army or other suitable employees of the state. Since you do not test the whole population, you have enough test kits for the delivery squad and for the vulnerables. Could this work? If not, why not? (Comment: Interestingly, this variant violates Mill's principle--by restricting individuals for their own good--while more widely-sweeping variants don't. Is it really so unforgivable a violation of the principle?)
      • 2.2.1) A: What do you do with nursing homes? Old people living alone can isolate themselves, but how do you isolate old people in nursing homes from the relatively young care-taking personnel that can bring infection from the outside? Q: As a somewhat wild idea, use robots for some of the caretaking if you can. As another wild idea, only allow personnel in that is then going to stay in the nursing home and not leave it.

Sustainable mitigation[edit | edit source]

Research questions:

  • What are the objectives of mitigation as contrasted to containment?
  • What contrast can be drawn between sustainable mitigation and unsustainable mitigation? ("Sustainable" not in the environmentalist sense but rather in the generic sense of "such as can be sustained for an extended period of time".)

Links:

Regions in lockdown[edit | edit source]

Research questions:

  • What are the regions that implemented significant lockdown in response to the covid?

Links:

Health consequences of lockdown[edit | edit source]

Research questions:

  • What are the possible adverse health consequences of a lockdown and economic depression?

Tentative answers:

  • Suicides.
  • Reduced physical activity may lead to worsening of health.
  • Reduced face-to-face human contact can adversely impact health in certain medical conditions.
  • Increased lockdown-induced stress can adversely impact health in certain medical conditions.
  • Worsened supplies of medicines can have an adverse impact.
  • Reduced access to healthcare preventively reserved for covid patients can have an adverse impact.
  • Financial difficulties of healthcare facilities resulting from preventively cancelled medical interventions may lead to reduced healthcare capacity in near future.

Links:

Case fatality rate[edit | edit source]

Research questions:

  • 1) What are the best estimates for the case fatality rate (CFR) of the covid in various regions?
  • 2) What are the limitations of these estimates?
  • 3) What is the CFR for common flu?
  • 4) If the reported CFR for common flu is 0.1% and common flu often goes undiagnosed, could it be that the real CFR for common flu is 0.01% If not, why not?
  • 5) What factors affect the CFR of the covid? Hint: Age, underlying medical condition, age structure of the country, medical capacity. What other factors come into play? What are some of the best sources online covering the factors?

Links:

General death statistics[edit | edit source]

Research questions:

  • What are general death statistics (in absolute numbers and per capita) in various countries and regions?
  • What are death statistics for deaths associated with respiratory diseases (in absolute numbers and per capita) in various countries and regions?
  • What are the year-to-year changes in total deaths per capita in the countries and regions worst stricken by the covid, on a month parity basis (e.g. Feb 2019 vs. Feb 2020, or Mar 2019 vs. Mar 2020)?
  • What are the suicide rates associates with economic depression?

Average all-cause daily death counts for selected countries for 2017, got by summing deaths per cause from ourworldindata.org and dividing them by 365:

  • China: 28036
  • Czechia: 298
  • France: 1507
  • Germany: 2527
  • Italy: 1667
  • Spain: 1107
  • Sweden: 241
  • U.S.: 7567

Above via: awk -F, "(/France/&&$3==2017) {for(i=5; i<=NF; i++) {s+=$i}}END{print s/365.0}" annual-number-of-deaths-by-cause.csv

Links:

Deaths with covid vs. by covid[edit | edit source]

Research questions:

  • Which countries properly distinguish deaths with covid vs. deaths by covid in their statistics, that is, covid-colored deaths vs. covid-caused deaths, that is, deaths where covid was present but had no or little contribution to the death and deaths where covid has a significant contribution to the death?

Observation:

  • The graphs in all-cause death reports for 2020 week 15 for UK[1] and 2020 week 14 for Switzerland[2] strongly suggest that the covid is a significant contributor to death. These graphs do not suffer from the problem of with-vs-by distinction. One objection could be that the additional deaths are due to the lockdown (additional stress, missed healthcare interventions) rather than the covid; I don't know and tend to disbelieve that.

Links:

Case counts[edit | edit source]

Research questions:

  • What are the limitations of the confirmed case counts and their development in time?
  • What is the relationship between the base of the exponential growth of confirmed cases and the base of the exponential growth of the real cases?
  • How does the exponential growth of test counts affect the confirmed case development in time?

Links:

Test count per day[edit | edit source]

Research questions:

  • What are the time series of test counts (test count per day) in various regions?
  • Why is knowing the test count per day important?

Links:

Ratio of cases to tests[edit | edit source]

Research questions:

  • What are the daily ratios of daily confirmed case count to daily test count in various regions?

Links:

Figures per capita[edit | edit source]

Research questions:

  • Which sources provide covid-related figures per capita, whether per million pop or 100,000 pop?

Links:

ICU beds[edit | edit source]

Research questions:

  • 1) What are the counts of ICU beds available in various countries in the world?
  • 2) How do the counts of ICU beds per million people in Hubei (China) and Italy compare to, say, Germany and U.K.?
  • 3) How do the loads of ICU beds develop in time in various regions?

Some answers are at B:User:Dan Polansky/COVID-19#ICU beds and ventilators.

Links:

Healthcare overload in media in recent years[edit | edit source]

Research questions:

  • What is the recent history of reports of overload of healthcare in mainstream media?

Credits: The links found via off-guardian.org.

Links:

Air pollution[edit | edit source]

Research questions:

  • What is the role of air polution in bringing about covid-positive pneumonias and covid-positive deaths?
  • How does the air pollution of various regions differ, e.g. Wuhan and Italy vs. Germany and Spain?

Links:

Comparison to influenza[edit | edit source]

Research questions:

  • 1) Some sources report the CFR for influenza to be 0.1% for the U.S. To which properly academic resource can this rate be traced?
  • 2) To what extent does the CFR of 0.1% misrepresent the true CFR for influenza? How much do the true influenza cases exceed the confirmed influenza cases? Twice? 10 times?
  • 3) Do the RTG images of lungs of covid-induced pneumonia differ from RTG images of influenza-induced pneumonia? If so, what does the difference tell us about the severity?

Anecdotal evidence[edit | edit source]

Research questions:

  • 1) In research of drugs (pharmaceuticals), anecdotal evidence is important to point to potential problems with drug safety, per Ben Goldacre's Bad Pharma. That is to say, individual reports of drugs being associated with adverse effects should not be dismissed as anectodal evidence not being a systematic clinial trial. What is the epistemic role of anecdotal evidence in the form of stories of overwhelmed healthcare from Hubei (China) and Italy, given that the systematic numbers including total confirmed counts and total confirmed deaths suffer from considerable measurement incompleteness?
    Answer: One has to be careful. Both China and Italy have low number of ICU beds and ventilators per million people. One has to carefully look at numbers and analyze possible causes and differentiators.

Epidemic curve[edit | edit source]

Research questions:

  • How do epidemic curves look like?
  • Can the knowledge of epidemic curves be used to validate (check on plausibility) data published from various sources?

Links:

Test market[edit | edit source]

Research questions:

  • 1) What are the prices for which covid tests can be bought on the global market?
  • 2) Are the tests freely available on the international market? If not, why not?
  • 3) What are the restrictions that countries or international organizations have put on the covid test market, if any?
  • 4) Is the price mechanism allowed to regulate the supply and demand for covid tests, with increasing prices creating increasing stimulus for private enterprise to meet the increasing demand?

Civil liberties[edit | edit source]

Research questions on limiting civil liberties on account of the coronavirus:

  • 1) Which civil liberties is the state justified to temporarily abolish to mitigate the coronavirus?
  • 2) Is the state justified in preventing citizens from leaving the country and why? (Entering the country we can see, but leaving the country?)
  • 3) Is the state justified in limiting freedom of assembly and why?
  • 4) Under what conditions and why is the state justified in prohibiting private laboratories from doing coronavirus testing, where the private laboratories are expanding the insufficient state testing capability?
    • 4.1) What is the ethical justification for Czechia to prohibit Tilia Laboratories from performing coronavirus testing, if any? (Refers to an actual occurrence.)
  • 5) Is the state justified in confiscating valuable medical material from businesses rather than buying it at the market price and why? (Refers to a real occurrence in Czechia.)
  • 6) Which interventions violate Mill's principle and why?

Links:

China figures[edit | edit source]

Research questions:

  • How reliable are the covid-related figures coming from China, given the censorious nature of the Chinese regime, and the history of misreporting on adverse events by communist regimes other than China?

Links:

China conduct[edit | edit source]

Research questions:

  • How did China conduct itself during the covid outbreak?

Links:

Behavior of political actors[edit | edit source]

Research questions:

  • Which of the two behaviors by political actors are more likely?
    1) "We have shown a gross negligence in planning our medical capacities for sudden increases of demand; we failed to provide sufficient free capacities. We apologize."
    2) "There is a deadly dangerous virus. Our healthcare is very good."

WHO conduct[edit | edit source]

Research questions concerning World Health Organization (WHO) conduct:

  • At what point did WHO inform the world about the pandemic, whether as an outbreak or a pandemic?
  • How did WHO assess the severity of the pandemic at various points of time?
  • What measures did WHO recommend at what time and what measures did WHO recommend against?
  • What were the WHO recommendations concerning travel bans?
  • When did WHO declare the covid to become a pandemic?
  • What are the expert qualifications of key public WHO persons?
  • Which countries did WHO praise, which countries did WHO ignore, and which regions did WHO pretend don't exist?

Links:

Media misconduct[edit | edit source]

Research questions:

  • What are examples of media misleading the public about the covid?

Links:

  • Coronavirus: Why You Must Act Now by Tomas Pueyo, Mar 10, medium.com
    The article treats confirmed case growth speed as if it were a good estimator of the real case growth speed. It does not account for test count growth.
  • Coronavirus: US overtakes Italy as country with most deaths, Apr 11, theguardian.com
    The article does not mention deaths per capita, helping to create the wrong impression in the reader that the U.S. situation was worse than Italy, which it was not on a per capita basis on Apr 11 and still was not on Apr 26. By absolute death numbers, San Marino would be perfectly fine, and yet it was not as was obvious from the per capita figures. Presenting absolute numbers without relating them to population or other similar figure is information presentation misconduct.

Country data pages[edit | edit source]

Research questions:

  • What are covid-covering data web pages that various countries provide on their own accord, providing case counts, death counts, test counts and other figures?

Links:

Countries to immitate[edit | edit source]

Research questions:

  • Which countries were given in the media as role models, as examples to follow?
  • Which countries are successful at containing the covid or limiting its health impact?
  • What are the metrics by which the success is measured? Which metrics are unreliable and which metrics are reliable?
  • How do the successful countries differ in measures taken?
  • Which of the successful countries are more likely to report accurate covid-related data?

Links:

Worldometers links:

Sweden[edit | edit source]

Research questions:

  • What measures did Sweden take to contain or mitigate the covid?
  • How do Swedish measures differ from some other European countries?
  • How do the online media report on what Sweden is doing?
  • How do the covid-relating figures develop in Sweden?
  • How do the covid-relating figures per million inhabitants in Sweden compare to other European countries?
  • What are the healthcare capacities (ICU beds, ventilators, personnel) per million inhabitants in Sweden?
  • In Sweden, what is the population density and what are the urban centers with higher density?

Links:

Experthood[edit | edit source]

Research questions:

  • What are the kinds of experts whose expertise is relevant to covid-related questions? Epidemiologists, microbiologists, virologists, physicians, statisticians, mathematical modelling experts? If some of them are not, why not? Who else?
  • What is the history of performance of mathematical models in epidemiology? How well did past mathematical models predict development of past epidemies?
  • How well did particular experts perform in the past as for making predictions using models?

Skeptics[edit | edit source]

Research questions:

  • What journalists and experts are skeptical about the covid or consider the measures taken in Europe and the U.S. excessive?
  • What are some of their best arguments?
  • What are the rebuttals of their arguments and claims, if any?

Some skeptical experts (found with the help of off-guardian.org):

  • Dr John Ioannidis: Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences.[3][youtube]
  • Dr Peter Goetzsche: Professor of Clinical Research Design and Analysis at the University of Copenhagen and founder of the Cochrane Medical Collaboration.[4][5]
  • Johan Giesecke, an epidemiologist and an advisor to Swedish government; "written a textbook on infectious disease epidemiology, and now teaches on this subject as a professor emeritus at the Karolinska Institute Medical University in StockholmL[WHO Biography]
  • Michael Levitt, a biophysicist and a professor of structural biology at Stanford University, a co-recipient of the 2013 Nobel Prize in Chemistry[6]

Links:

Czech links:

Lessons learned[edit | edit source]

Research questions:

  • What are the lessons learned from the covid pandemic?

Tentative answers:

  • You have to get a reliable case fatality rate (CFR) figure as soon as possible, by properly randomized testing taking samples from the whole population.
    • This is utterly critical since the draconian measures have huge impacts and should only be applied if the real CFR is high.
    • If you suspect there are too few infected cases to obtain statistically valid numbers, you must compensate for it by making a larger number of tests. If the testing is expensive, you do it anyway since it is much less expensive than the draconian measures.
  • You have to present data in a way that mitigates the failure to distinguish covid-caused vs. covid-positive entities:
    • If you are going to give us daily death counts, you must also give us daily all-cause death counts or at least weekly all-cause death counts. If you do not have fresh data, you must at least present some past year's averages.
    • The same for beds: if you provide covid-positive hospitalizations, also provide daily or weekly all-cause hospitalizations.
    • The same for ICU beds: if you provide covid-positive ICU beds, also provide daily or weekly all-cause ICU beds.
    • The same for ventilators: if you provide covid-positive ventilators, also provide daily or weekly all-cause ventilators.
  • If you are going to give us daily case counts, you must also give us daily test counts.
  • Any plot that plots daily case counts must also show daily test counts in the same plot.
  • We are fallible. We know nothing or close to nothing. There are too many experts who make pretentious claims to knowledge. We need to have a critical attitude. Experts are not to be disregarded but they must not be blindly trusted either.
  • Influenza is a significant contributor to deaths, not as the sole cause but as an auxiliary cause in a death case. People should not feel free to caugh into their hands in public transport and thereby contribute to influenza spread.
  • Nursing homes are the Achilles' heel (point of vulnerability) of mitigation strategies, and require special attention and dedicated effort.