To be or not to be… free?

To be or not to be… free? That is the question! In these times of  lock-downs.

Here is a smart, balanced solution for all! By our duo of Medical Doctor and Health Research Agent.

 

Instead of quasi total confinement and self-isolation of the total population… We show why and how to ease out some age groups of  low risk (as low as usual) and to isolate home only selected risk groups.

The solution we suggest aim to help saving first people lives! As well as the health system and the economy. It is based on scientific studies and common sense. 

During this unprecedented coronavirus crisis blocking the world, there are two main camps. The one is for a forced  confinement of everybody. The other one is for the free movement of everybody. People from one camp think this coronavirus (SarsCov2) causing Covid19 (SARS2) is super dangerous. The other people do not think… they neglect the danger! Well, both sides are right and wrong. Right to some point and wrong to some point. How come?

THE KEY IS THAT A NUMBER OF SCIENTIFIC STUDIES ALREADY PROVED THIS VIRUS ATTACKS SEVERELY ONLY SELECTED RISK GROUPS!

For all the other people it is as mild as a seasonal flu in terms of hospitalizations and death rates. Yes Covid19 is not a flu, but you can still make valid comparisons of risk rates (if you have solid data, knowledge and clear brain). Covid and Influenza are both contagious respiratory diseases. You can compare both as you can compare relative risks of cars and airplanes accidents and deaths – both are modes of transport.

To sum up, the people with relatively high risk of hospitalization and death are people of certain age and certain health conditions.

Let’s focus on the well proven age factor. Different age groups have different risk levels to come to a need of hospital beds, especially in intensive care units, as well as  death beds.

See a quote of a new report (out of more than 70 000 cases studied), published March 30, of The Lancet Infectious Diseases medical journal. Study co-author Azra Gahni mentions in a news release, source (usnews.com/news/health-news/articles/2020-03-30/odds-of-hospitalization-death-with-covid-19-rise-steadily-with-age-study):

“Our analysis very clearly shows that at age 50 and over, hospitalization is much more likely (than in those under 50) and a greater proportion of cases are likely to be fatal,”

“Our estimates can be applied to any country to inform decisions around the best containment policies for COVID-19,”

From the same source:

“By decade, the risk of hospitalization from infection with the new coronavirus is: (Practically) Zero for kids under 10; 0.1% for kids 10 to 19; 1% for people aged 20 to 29; 3.4% for people aged 30 to 39; 4.3% for people in their 40s; 8.2% for those in their 50s; 11.8% for people aged 60 to 69; 16.6% for those in their 70s; and 18.4% for those in their 80s or above.

As for the death rate, the risk was near zero for people under 40; crept up to 0.2% for people 40 to 49; to 0.6% for 50-somethings; just under 2% for people in their 60s; 4.3% for those in their 70s; and 7.8% for those in their 80s, the findings showed.”

As you can see from the above study link, up to the age of 50, even up to 60, both risks of hospitalization and death are comparable to the levels of flu. Moreover even the overall death rate (for all groups) is 0.66% as calculated by the British researchers (again in the range of flu levels).

There is also the study of the passengers of Diamond Princess cruise ship:

Nobody died, under the age of 70 y.o! Out of the 712 infected passengers on board (Almost all recovered).

See the age numbers in the table3 via the link below. There are a few columns. For simplicity, what matters is on the left the age range,  on the right observed deaths:

(https://www.eurosurveillance.org/content/table/10.2807/1560-7917.ES.2020.25.12.2000256.t2?fmt=ahah&fullscreen=true)

 

Attention the said studies are for ALREADY PASSED outbreaks, thus the death rates are reliable. Remember DURING an outbreak it is extremely difficult to give valid estimations of death rates. I do not want to write too long with  too many technical details. But in the media there is so much chaos causing panic with different numbers of mortality… So it is essential for you to know more than a bit about it!

The reason there are so large ranges of mortality percentages is that there are TOO MANY UNKNOWN VARIABLES DURING AN OUTBREAK. Too many different methodologies. Too many different outputs to measure. Too many different contexts. Too many different terms of deaths rates, etc.

Mortality for example can be in terms of:

  • Case Fatality Ratio (aka Case Fatality Risk or Case Fatality Rate). This  is the ratio of cases of deaths out of total infected cases (but only the cases tested positive or even only the hospitalized cases by symptoms).  This usually gives false high death rates, especially during the outbreak! As usually the first diagnosed and or tested are ill people at highly risk groups. But even after the outbreak it can be misleading as you don’t know the true number of infected persons in given area or country.  Which leads us to a more important number below.
  • Infection Fatality ratio: the deaths vs the true total infected cases in a population. You know the positive tests are just a small part of the true total infected persons in your country!. The tricky part is again to find the true number of infections. This ratio would give you an accurate number only if you had the true number of the infected people. Yes this is  tricky to estimate, especially during the outbreak. The first rule of thumb is: the more tests you do, the closer you get to the true number of infected people and the true fatalities percentage. The second rule is: count the dead and live chickens at the end. The third rule: the more epidemic time passes – the more the death rate slows down. But for those that can’t wait the time there is the…
  • Crude case fatality rate: The most misleading rate usually.  You  obtain it by dividing the ongoing number of deaths vs number of infected people. This is  an unreliable estimation! This rate paradoxically gives you very high false numbers or very low false number! Which logically shows you practically always a wrong death percentage. Mainly because of the time lag between the moment one case is diagnosed and the end point (recovery or fatality). In Covid case the cases stay crude for relatively long time. The usual recovery is up to a couple of weeks. But in some cases you have to wait for  several weeks, even couple of months, to end death or alive.

 

Now you know something about epidemiology deaths that even some journalists may not know.  Unfortunately  most media just throw numbers in the air. It leads to chaos and panic. Even the WHO World Health Organisation Director General gave such a misleading number on 3rd of March during an official speech to media: “Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected”. As he mentioned: “There is now a total of 90,893 reported cases of COVID-19 globally, and 3110 deaths”. See the link to the official source (who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020).

As you already have the three different fatalities ratio above… can you guess which death percentage the WHO chief used?

That’s right he referred to the crude case fatality rate… a misleading one!

Let’s not jump to false conclusions or to false accusations of the leader for bad intentions. I understand it was just a speech and the WHO Director General wanted to emphasize the overall gravity of the situation. So that the people to take the danger seriously. This urged actions and saved lives.

The question is does the general public understand the death percentage are inaccurate? As we can see obviously even majority of journalists do not understand it’s misleading! I’ll explain to you about this in another article.

For now just to prove the golden rule in epidemiology… You count the gold at the end. Let me give you the example of another giant mass hysteria that is a dwarf compared to the current hysteria. It is about the swine flu that attacked the people in the last Pandemics, in 2009. You can see according to the study below:

The death risk was miscalculated DURING the outbreak up to 500 times higher than the real risk of only 0.02% proved later!

 

Case fatality risk of influenza A(H1N1pdm09): a systematic review

Frankly it is co

Here below is the most important quote to remember from this study:

“The estimates based on confirmed cases were up to 500 times higher than those based on symptomatic cases or infections (Figure 3). The consequent uncertainty about the case fatality risk — and hence about the severity of H1N1pdm09 — was problematic for risk assessment and risk communication during the period when many decisions about control and mitigation measures were being made.”

 

Now you see me? I mean my point. You can  have  accurate fatalities rates only after the epidemics is over. Not in advance, not during the outbreak. Sometimes not even after.

To cut the long story short. About the governments confinement measures up to now. I think, considering  the unknown dangers of this novel Coronavirus, the leaders were right in general… up to now. They have been taking necessary steps. They did slow down the spread of death. They saved lives.  Of course ideally the world leaders should have prevented the spread much earlier from the very beginning. A great example is South Korea, but that’s another story.

Anyway we do not live in an ideal world. The devil is out of the bottle. He may be dangerous to some people… but inoffensive to the large majority. So we must adapt smartly to the evolving epidemics situation.

Yes. Now, having all the confirmed data about the real danger to the risk groups vs. the banal risk to the big majority of the population… It is the time to adapt our approach. Especially the governments!

This virus is selective. Our approach must be smart, nuanced and selective too.

Specifically, we must protect and isolate only the vulnerable groups in the country. In plus, to let the overall healthy population work and live the normal life safely. Step by step. This will save peoples lives and the economy. The world must go on.

In order to protect the people lives, especially the persons at risk as well as the health system and normal life of the society. INSTEAD OF TOTAL CONFINEMENT, we must one way or another use SELECTIVE CONFINEMENT RISKY GROUPS.  Let some FREE  SELECTIVE HEALTHY GROUPS.

The selected healthy group with free movement can even be divided to specific sub-groups. For example people aged 20 to 30 or 20 to 40 living alone or in couples and families with members of risk groups. The scenario of a gradual selective group ease out are various. Did you see my page Tricks  how to save out the elephant in the snake keeping a life both and the whole jungle

Every country leaders must evaluate their specific situation. In order to ease the practically total lock-downs. The sooner the better. The evaluation is not that complicated as they claim! Here is a simple formula.

You have the latest data of death and hospitalizations risks by AGE GROUPS. You  estimate the numbers of people that may need hospitalizations by DIFFERENT AGE GROUPS. You know your hospital beds available capacity. Then you decide WHICH GROUPS TO CONFINE AND WHICH GROUPS TO LET FREE. In order to be able to manage well your health system capacity. So that to save first maximum people and the health system, but also to save  as much as possible the social life and economy, even the whole country.

For the moment fellow people, I ask you please to follow the established governments confinement and protection measures. It’s important! Let’s give the political leaders the time to analyse the evolving situation and to adapt accordingly. Just let them know that there may be better solutions than the current ones. Now. Not somewhere in the future.

Some of you may say, why don’t we use the model of South Korea that solved the Covid19 crisis without special restrictive confinements of the whole population^ Yes they did not use the western governments containment policies, they let the population work and have relatively normal life. But they were extremely proactive in the early phase of the epidemics! They contained the virus community spread quite early with really clever measures. That must be a good lesson for the world before the possible next waves of Coronavirus. The current reality for us is, we are in a community transmission phase, it’s late for the early South Korean measures.

What about the examples of Sweden and Netherlands of practically all peoples in free movement of near normal social and economic life? It may work, but it’s a gamble! The true, for every country facing Covid-19, must be somewhere in the middle. In the balance between full lock down and full free life. For each country and each context and time it’s different and specific.

In any case ff we do not adapt now, we may need to stay all of us confined for months  till the Covid Wave passes. What about the next wave after?…  The South Korean model? In any case we can’t stay all confined for a year or so till we develop a reliable vaccine. We can’t just wait for all the population to be tested (with current rates it would take years). Even if you are tested negative today, you can’t know if you are not infected tomorrow… you can’t test everyday. The only “guarantee” would be to test everybody once for anti-bodies (when you recover from the infection you get anti-bodies and acquired natural immunity forever (or at least for some good time). But currently we can’t proceed with such anti-bodies tests in mass. There is a hope to be able to proceed soon. But how soon? How many anti-body tests per day. No one knows yet.

We must adapt now with the selective ease out as well as selective confinement by selective groups. This should lead in a gradual, controlled way to the acquisition of natural immunity of the majority within the free population. The scientific term is “herd immunity”. Attention, I repeat uncontrolled free movement of people to aim for ‘herd immunity” as proposed initially by England as well as in execution in Netherlands and Sweden, is a gamble move full of risks! It may solve sooner the crisis, but may be a disaster for the population and the health system! The solution we offer is ‘selective herd immunity” or ”controlled herd immunity”‘. Which is step by step exposure of the population by selective confinement of groups of risk as well as by selective healthy free groups. Thus to acquire Selective herd immunity by selective confinement and selective groups.  After a large portion of the population in the range of 60 to 90 % gets a natural immunity… then the spread of the virus should stop as it will have no new hosts to transmit (or if it evolves it would become most probably a banal virus).

Finally there is the chance this pandemics of Coronavirus Sars CoV2 to end for good by this summer.

In any case during the Pandemics all governments must find a smart and balanced way between the two extremities of full lock-down and full free movement.

That’s it for the moment. Again, please follow all current official measures.

Jordan

04.04.2020

P.S. I wrote this serious article seriously instead of the funny presentations of Doc Dog. To know more about us, see the page About

To see the easy extra protection measures presented in a funny way, see the page Hot

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