terça-feira, 24 de março de 2020

The president of the Italian Civil Protection Service stresses that these are deaths “with the coronavirus and not from the coronavirus“

Published: March 14, 2020; Updated: March 24, 2020

A Swiss medical doctor provided the following information on the current situation in order to enable our readers to make a realistic risk assessment. (Daily updates below)

According to the latest data of the Italian National Health Institute ISS, the average age of the positively-tested deceased in Italy is currently about 81 years. 10% of the deceased are over 90 years old. 90% of the deceased are over 70 years old.

80% of the deceased had suffered from two or more chronic diseases. 50% of the deceased had suffered from three or more chronic diseases. The chronic diseases include in particular cardiovascular problems, diabetes, respiratory problems and cancer.

Less than 1% of the deceased were healthy persons, i.e. persons without pre-existing chronic diseases. Only about 30% of the deceased are women.

The Italian Institute of Health moreover distinguishes between those who died from the coronavirus and those who died with the coronavirus. In many cases it is not yet clear whether the persons died from the virus or from their pre-existing chronic diseases or from a combination of both.

The two Italians deceased under 40 years of age (both 39 years old) were a cancer patient and a diabetes patient with additional complications. In these cases, too, the exact cause of death was not yet clear (i.e. if from the virus or from their pre-existing diseases).

The partial overloading of the hospitals is due to the general rush of patients and the increased number of patients requiring special or intensive care. In particular, the aim is to stabilize respiratory function and, in severe cases, to provide anti-viral therapies.

(Update: The Italian National Institute of Health published a statistical report on test-positive patients and deceased, confirming the above data.)

The doctor also points out the following aspects:
Northern Italy has one of the oldest populations and the worst air quality in Europe, which has already led to an increased number of respiratory diseases and deaths in the past and is likely an additional risk factor in the current epidemic.

South Korea, for instance, has experienced a much milder course than Italy and has already passed the peak of the epidemic. In South Korea, only about 70 deaths with a positive test result have been reported so far. As in Italy, those affected were mostly high-risk patients.

The approximately twelve test-positive Swiss deaths so far were also high-risk patients with chronic diseases, an average age of 80 years and a maximum age of 90 years, whose exact cause of death, i.e. from the virus or from their pre-existing diseases, is not yet known.

Furthermore, according to a first Chinese study, the internationally used virus test kits may give a false positive result in some cases. In these cases, the persons may not have contracted the new coronavirus, but presumably one of the many existing human coronaviruses that are part of the annual (and currently ongoing) common cold and flu epidemics. (1)

Thus the most important indicator for judging the danger of the disease is not the frequently reported number of positively-tested persons and deaths, but the number of persons actually and unexpectedly developing or dying from pneumonia (so-called excess mortality).

According to all current data, for the healthy general population of school and working age, a mild to moderate course of the Covid-19 disease can be expected. Senior citizens and persons with existing chronic diseases should be protected. The medical capacities should be optimally prepared.

Medical literature
(1) Zhuang et al., Potential false-positive rate among the ‚asymptomatic infected individuals‘ in close contacts of COVID-19 patients, Chinese Medical Association Publishing House, March 2020.
(2) Grasselli et al., Critical Care Utilization for the COVID-19 Outbreak in Lombardy, JAMA, March 2020.

Reference values
Important reference values include the number of annual flu deaths, which is up to 8,000 in Italy and up to 60,000 in the US; normal overall mortality, which in Italy is up to 2,000 deaths per day; and the average number of pneumonia cases per year, which in Italy is over 120,000.
Current all-cause mortality in Europe and in Italy is still normal or even below-average. Any excess mortality due to Covid-19 should become visible in the European monitoring charts.


Updates
March 17, 2020 (I)
·         The mortality profile remains puzzling from a virological point of view because, in contrast to influenza viruses, children are spared and men are affected about twice as often as women. On the other hand, this profile corresponds to natural mortality, which is close to zero for children and almost twice as high for 75-year-old men as for women of the same age.
·         The younger test-positive deceased almost always had severe pre-existing conditions. For example, a 21-year-old Spanish soccer coach had died test-positive, making international headlines. However, the doctors diagnosed an unrecognized leukemia, whose typical complications include severe pneumonia.
·         The decisive factor in assessing the danger of the disease is therefore not the number of test-positive persons and deceased, which is often mentioned in the media, but the number of people actually and unexpectedly developing or dying from pneumonia (so-called excess mortality). So far, this value remains very low in most countries.
·         In Switzerland, some emergency units are already overloaded simply because of the large number of people who want to be tested. This points to an additional psychological and logistical component of the current situation.

March 17, 2020 (II)
·         Italian immunology professor Sergio Romagnani from the University of Florence comes to the conclusion in a study on 3000 people that 50 to 75% of the test-positive people of all ages remain completely symptom-free – significantly more than previously assumed.
·         The occupancy rate of the North Italian ICUs in the winter months is typically already 85 to 90%. Some or many of these existing patients could also be test-positive by now. However, the number of additional unexpected pneumonia cases is not yet known.
·         A hospital doctor in the Spanish city of Malaga writes on Twitter that people are currently more likely to die from panic and systemic collapse than from the virus. The hospital is being overrun by people with colds, flu and possibly Covid19 and doctors have lost control.

March 18, 2020
·         new epidemiological study (preprint) concludes that the fatality of Covid19 even in the Chinese city of Wuhan was only 0.04% to 0.12% and thus rather lower than that of seasonal flu, which has a mortality rate of about 0.1%. As a reason for the overestimated fatality of Covid19, the researchers suspect that initially only a small number of cases were recorded in Wuhan, as the disease was probably asymptomatic or mild in many people.
·         Chinese researchers argue that extreme winter smog in the city of Wuhan may have played a causal role in the outbreak of pneumonia. In the summer of 2019, public protests were already taking place in Wuhan because of the poor air quality.
·         New satellite images show how Northern Italy has the highest levels of air pollution in Europe, and how this air pollution has been greatly reduced by the quarantine.
·         A manufacturer of the Covid19 test kit states that it should only be used for research purposes and not for diagnostic applications, as it has not yet been clinically validated.

March 19, 2020 (I)
The Italian National Health Institute ISS has published a new report on test-positive deaths:
·         The median age is 80.5 years (79.5 for men, 83.7 for women).
·         10% of the deceased was over 90 years old; 90% of the deceased was over 70 years old.
·         At most 0.8% of the deceased had no pre-existing chronic illnesses.
·         Approximately 75% of the deceased had two or more pre-existing conditions, 50% had three more pre-existing conditions, in particular heart disease, diabetes and cancer.
·         Five of the deceased were between 31 and 39 years old, all of them with serious pre-existing health conditions (e.g. cancer or heart disease).
·         The National Health Institute hasn’t yet determined what the patients examined ultimately died of and refers to them in general terms as Covid19-positive deaths.

March 19, 2020 (II)
·         report in the Italian newspaper Corriere della Sera points out that Italian intensive care units already collapsed under the marked flu wave in 2017/2018. They had to postpone operations, call nurses back from holiday and ran out of blood donations.
·         German virologist Hendrik Streeck argues that Covid19 is unlikely to increase total mortality in Germany, which normally is around 2500 people per day. Streeck mentions the case of a 78-year-old man with preconditions who died of heart failure, subsequently tested positive for Covid19 and thus was included in the statistics of Covid19 deaths.
·         According to Stanford Professor John Ioannidis, the new coronavirus may be no more dangerous than some of the common coronaviruses, even in older people. Ioannidis argues that there is no reliable medical data backing the measures currently decided upon.

March 20, 2020
·         According to the latest European monitoring report, overall mortality in all countries (including Italy) and in all age groups remains within or even below the normal range so far.
·         According to the latest German statistics, the median age of test-positive deaths is about 83 years, most with pre-existing health conditions that might be a possible cause of death.
·         2006 Canadian study referred to by Stanford Professor John Ioannidis found that common cold coronaviruses may also cause death rates of up to 6% in risk groups such as residents of a care facility, and that virus test kits initially falsely indicated an infection with SARS coronaviruses.

March 21, 2020 (I)
·         Spain reports only three test-positive deaths under the age of 65 (out of a total of about 1000). Their pre-existing health conditions and actual cause of death are not yet known.
·         On March 20, Italy reported 627 nationwide test-positive deaths in one day. By comparison, normal overall mortality in Italy is about 1800 deaths per day. Since February 21, Italy has reported about 4000 test-positive deaths. Normal overall mortality during this time frame is up to 50,000 deaths. It is not yet known to what extent normal overall mortality has increased, or to what extent it has simply turned test-positive. Moreover, Italy and Europe have had a very mild flu season in 2019/2020 that has spared many otherwise vulnerable people.
·         According to Italian news reports, 90% of test-positive deceased in the Lombardy region have died outside of intensive care units, mostly at home or in general care sections. Their cause of death and the possible role of quarantine measures in their deaths remain unclear. Only 260 out of 2168 test-positive persons have died in ICUs.
·         Bloomberg highlights that „99% of Those Who Died From Virus Had Other Illness, Italy Says“

March 21, 2020 (II)
·         The Japan Times asks: Japan was expecting a coronavirus explosion. Where is it? Despite being one of the first countries getting positive test results and having imposed no lockdown, Japan is one of the least-affected nations. Quote: „Even if Japan may not be counting all those infected, hospitals aren’t being stretched thin and there has been no spike in pneumonia cases.“
·         Italian researchers argue that the extreme smog in Northern Italy, the worst in Europe, may be playing a causative role in the current pneumonia outbreak there, as in Wuhan before.
·         In a new interview, Professor Sucharit Bhakdi, a world renowned expert in medical microbiology, says blaming the new coronavirus alone for deaths is „wrong“ and „dangerously misleading“, as there are other more important factors at play, notably pre-existing health conditions and poor air quality in Chinese and Northern Italian cities. Professor Bhakdi describes the currently discussed or imposed measures as „grotesque“, „useless“, „self-destructive“ and a „collective suicide“ that will shorten the lifespan of the elderly and should not be accepted by society.

March 22, 2020 (I)
Regarding the situation in Italy: Most major media falsely report that Italy has up to 800 deaths per day from the coronavirus. In reality, the president of the Italian Civil Protection Service stresses that these are deaths “with the coronavirus and not from the coronavirus“ (minute 03:30 of the press conference). In other words, these persons died while also testing positive.

As Professors Ioannidis and Bhakdi have shown, countries like South Korea and Japan that introduced no lockdown measures have experienced near-zero excess mortality in connection with Covid-19, while the Diamond Princess cruise ship experienced an extra­polated mortality figure in the per mille range, i.e. at or below the level of the seasonal flu.

Current test-positive death figures in Italy are still less than 50% of normal daily overall mortality in Italy, which is around 1800 deaths per day. Thus it is possible, perhaps even likely, that a large part of normal daily mortality now simply counts as „Covid19“ deaths (as they test positive). This is the point stressed by the President of the Italian Civil Protection Service.

However, by now it is clear that certain regions in Northern Italy, i.e. those facing the toughest lockdown measures, are experiencing markedly increased daily mortality figures. It is also known that in the Lombardy region, 90% of test-positive deaths occur not in intensive care units, but instead mostly at home. And more than 99% have serious pre-existing health conditions.
Professor Sucharit Bhakdi has called lockdown measures „useless“, „self-destructive“ and a „collective suicide“. Thus the extremely troubling question arises as to what extent the increased mortality of these elderly, isolated, highly stressed people with multiple pre-existing health conditions may in fact be caused by the weeks-long lockdown measures still in force.
If so, it may be one of those cases where the treatment is worse than the disease. (See update below: only 12% of death certificates show the coronavirus as a cause.)

March 22, 2020 (II)
·         In Switzerland, there are currently 56 test-positive deaths, all of whom were „high risk patients“ due to their advanced age and/or pre-existing health conditions. Their actual cause of death, i.e. from or simply with the virus, has not been communicated.
·         The Swiss government claimed that the situation in southern Switzerland (next to Italy) is „dramatic“, yet local doctors denied this and said everything is normal.
·         According to press reports, oxygen bottles may become scarce. The reason, however, is not a currently higher usage, but rather hoarding due to fear of future shortages.
·         In many countries, there is already an increasing shortage of doctors and nurses. This is primarily because healthcare workers testing positive have to self-quarantine, even though in many cases they will remain fully or largely symptom-free.

March 22, 2020 (III)
·         A model from Imperial College London predicted between 250,000 and 500,000 deaths in the UK „from“ Covid-19, but the authors of the study have now conceded that many of these deaths would not be in addition to, but rather part of the normal annual mortality rate, which in the UK is about 600,000 people per year. In other words, excess mortality would remain low.
·         Dr. David Katz, founding director of the Yale University Prevention Research Center, asks in the New York Times: „Is Our Fight Against Coronavirus Worse Than the Disease? There may be more targeted ways to beat the pandemic.“
·         According to Italian Professor Walter Ricciardi„only 12% of death certificates have shown a direct causality from coronavirus“, whereas in public reports „all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus“. This means that Italian death figures reported by the media have to be reduced by at least a factor of 8 to obtain actual deaths caused by the virus. Thus one ends up with at most a few dozen deaths per day, compared to an overall daily mortality of 1800 deaths and up to 20,000 flu deaths per year.

March 23, 2020 (I)
·         A new French study in the Journal of Antimicrobial Agents, titled SARS-CoV-2: fear versus data, concludes that  „the problem of SARS-CoV-2 is probably overestimated“, since „the mortality rate for SARS-CoV-2 is not significantly different from that for common coronaviruses identified at the study hospital in France“.
·         An Italian study of August 2019 found that flu deaths in Italy were between 7,000 and 25,000 in recent years. This value is higher than in most other European countries due to the large elderly population in Italy, and much higher than anything attributed to Covid-19 so far.
·         In a new fact sheet, the World Health Organization WHO reports that Covid-19 is in fact spreading slower, not faster, than influenza by a factor of about 50%. Moreover, pre-symptomatic transmission appears to be much lower with Covid-19 than with influenza.
·         A leading Italian doctor reports that „strange cases of pneumonia“ were seen in the Lombardy region already in November 2019, raising again the question if they were caused by the new virus (which officially only appeared in Italy in February 2020), or by other factors, such as the dangerously high smog levels in Northern Italy.
·         Danish researcher Peter Gøtzsche, founder of the renowned Cochrane Medical Collaboration, writes that Corona is „an epidemic of mass panic“ and „logic was one of the first victims.“

March 23, 2020 (II)
·         Former Israeli Health Minister, Professor Yoram Lass, says that the new coronavirus is „less dangerous than the flu“ and lockdown measures „will kill more people than the virus“. He adds that „the numbers do not match the panic“ and „psychology is prevailing over science“. He also notes that „Italy is known for its enormous morbidity in respiratory problems, more than three times any other European country.“
·         Pietro Vernazza, a Swiss infectious disease specialist, argues that many of the imposed measures are not based on science and should be reversed. According to Vernazza, mass testing makes no sense because 90% of the population will see no symptoms, and lockdowns and closing schools are even „counterproductive“. He recommends protecting only risk groups while keeping the economy and society at large undisturbed.
·         The President of the World Doctors Federation, Frank Ulrich Montgomery, argues that lockdown measures as in Italy are „unreasonable“ and „counterproductive“ and should be reversed.
·         Switzerland: Despite media panic, excess mortality still at or near zero: the latest testpositive „victims“ were a 96yo in palliative care and a 97yo with pre-existing conditions.
·         The latest statistical report of the Italian National Health Institute is now available in English.

March 24, 2020
·         The UK has removed Covid19 from the official list of High Consquence Infectious Diseases (HCID), stating that mortality rates are „low overall“.
·         The director of the German National Health Institute (RKI) confirmed that they count all test-positive deaths, irrespective of the actual cause of death, as „coronavirus deaths“. The average age of the deceased is 82 years, most with serious preconditions. As in most other countries, excess mortality due Covid19 is likely to be near zero in Germany.
·         Beds in Swiss intensive care units reserved for Covid19 patients are still „mostly empty“.
·         German Professor Karin Moelling, former Chair of Medical Virology at the University of Zurich, stated in an interview that Covid19 is „no killer virus“ and that „panic must end“.
·         In Italy, overall national mortality of the 65+ age group until March 7 still remained below the level of earlier years, especially due to the rather mild winter (see red line in chart below).


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