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
·
A 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
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)
·
A 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.
·
A 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.
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.
·
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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