Italien 712 nya dödsfall enligt worldometer. Men tegnell och statsmedia. Glömde även Sveavägen 68 att flockimmunitet fungerar? De hävdade även att Italiens peak var förra helgen.
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Går alt, som forskerne håber, kan danske covid-19-patienter behandles med lægemidlet allerede i næste uge - som de første i verden.
- Forskere i Tyskland og Japan har været langt fremme med forskning i det her, men vi har handlet ekstremt hurtigt og fået det her sat i værk. Det har vi kunnet, fordi vi har alle de rigtige kompetencer til at kunne udføre det her ganske hurtigt, siger Mads Fuglsang Kjølby, der en af forskerne bag projektet.
Behandlingen skal vise, om lægemidlet faktisk har den effekt, forskerne håber på.
Håbet er færre patienter på intensiv
Det japanske lægemiddel hedder camostat mesylate og er for flere år siden udviklet til behandling af halsbrand og betændelse i bugspytkirtlen.
Men lektorerne Mads Fuglsang Kjølby og Ole Schmeltz Søgaard fra henholdsvis Klinisk Farmakologisk afdeling og Infektionsmedicinsk afdeling på Aarhus Universitetshospital, håber på, at midlet også kan bruges til at bremse coronavirusset.”
If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.
Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.
The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.
Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.
Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.
In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.
The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.
How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.
The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.
This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.
If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.
A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.
Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford
Onekligen intressant artikel, har du länk till originalet?
Hela coronagrejen har blivit så absurd, man vet knappt vad man ska tro längre. Stater går all in med karantän och åtgärder, sen läser man en sån här artikel.
Att viruset är luftburet, att det smittar på flera meters avstånd, att det överlever på kalla ytor i dagar, att man inte blir immun om man överlevt det, att viruset smittar innan man själv har symptom, att IVA-personal troligen dör efter ett par månaders intensivt coronaarbete, att vi troligen inte kommer att ha råd med vaccin på många år, att man får nedsatt lungkapacitet, att Sverige är sämre rustat än de flesta EU-länder, att långt fler kommer att dö här än i andra länder, att det borde vara utegångsförbud, arbetsförbud, inrese- och utreseförbud och att detta kommer att pågå i flera år?
Skulle han säga sanningen skulle mången vårdpersonalen gå hem. Men vi kan fortfarande rädda samhället från att gå sönder totalt. Ska vi offra folket för att rädda vårdpersonalen? De vet nog att många av dem kommer att dö. Han menar gissningsvis att med fullgod utrustning är det inte farligt. Och måhända riktar han sig även till den delen av vårdpersonalen som bedriver vanlig vård. Annan akut vård måste fortsätta. Vårdpersonal är också människor och blir rädda. Anders Tegnell intervjuas non stop hela dagarna. Han är extremt tillgänglig, kör nästan dygnet runt. Det är inte han, utan politiker, som slarvat med lagren. Någon formulering i farten blir väl fel. Hans huvudsakliga budskap är att undvika sociala kontakter, undvika äldre, att arbeta hemma om det går, att inte resa samt att tvätta händerna ofta och noga. Det är bra råd tycker jag. Jag skulle inte vilja byta med Anders Tegnell. Och vi vet inte mycket om det här viruset. Viruset finns dessutom i ett par varianter, L och S. Många lever i samma familj som coronasmittade men blir inte själv smittade.
Det går så klart att ha en complete lockdown och alltid gå ut med förinspelade regisserade felfria uttalanden från Tegnell. Men hur länge? Det finns ett pris i andra änden. 50 % arbetslöshet, depression, banker i konkurs, utraderade pensioner, staten i konkurs, anarki och våld på gator.
Visst, uttalandet var inte helt bra av Tegnell, men det får vi ha överseende med.
Och du tror inte något av detta kommer bli verklighet i alla fall? Om det visar sig att Sverige klarar sig sämst osv så är samtliga inblandade i detta körda, de kan aldrig visa sig i Sverige igen.
Hur länge ska man hålla på med detta då?
1 år?
10 år?
Ja, det är den stora frågan.
Om man nu tänker sig att man gör motsatsen, förklarar för ambulanspersonalen att de bara får ta med sig patienter som inte hostar eller har misstänkt lunginflammation till sjukhusen, hur tror du att medborgarna reagerar då?
Någon som vet varför inte Sverige sätts i Karantän i 3-4 veckor? Då borde viruset försvinna och de som har det hinna tillfriskna?
Det har ingen effekt på smittspridningen. Eller väldigt marginell effekt. Efter 4 veckor skulle vi troligen börja om hela skiten igen. När folk tar in det i Sverige igen. Flockimmunitet och vaccin är det enda. Om vi inte vill låsa gränserna helt till ett vaccin finns. Sverige skulle gå under med fler döda av lösningen än av viruset.
