COVID Mortality Risk

With a little perseverance
You can get things done
Without the blind adherence
That has conquered some
--Cory Hart

Another important paper by John Ioannidis and his Stanford colleagues (full paper here). The researchers analyze COVID -19 mortality data from 11 European countries, Canada, and 12 'hot spot' US states as of April 24th. The primary objective was to estimate risk of COVID-19 death using 65 as the over/under age.

Results indicate that people < 65 yrs old have very small risk of dying from COVID-19. Moreover, death for people under 65 with no underlying conditions is "remarkably uncommon." For people in many countries, risk of dying from COVID-19 roughly equates to the risk of dying from driving to and from work each day. The researchers conclude that strategies that protect the high risk elderly are prudent moving forward.

A few nuggets from their Discussion section:

The researchers suspect that the peak of the 'epidemic wave' may have already been reached in many countries by May 1. While they acknowledge the possibility of a second epidemic wave next fall or spring, they note that influenza presents similar uncertainties.

They highlight issues with death count accuracy. "Even though mortality is an unambiguous endpoint, attribution of death to a specific cause is often challenging and definitions of 'COVID-19 death' vary across countries and sometimes even change within countries over time." They note that their age-stratified data sample from Canada and the UK do not appear to include deaths that occurred outside of hospitals. They were added to the UK sample past the deadline for the paper's submission.

Moreover, "different countries and US locations differ on the threshold of including deaths at care homes." For instance Belgium reports more than half of its deaths as coming from nursing homes although > 90% have not had laboratory confirmation. "New York City and some other US locations have also started counting in more recent counts 'probable deaths' without any COVID-19 laboratory confirmation, a debatable practice at best [emphasis mine]."

The researchers also comment on outlier cases--i.e., mortality of people less than 65 with no reported underlying conditions. While such cases were observed these deaths were "remarkably uncommon." They note the possibility that these people may have had underlying comorbidities that had not been diagnosed. Nonetheless, these small number of cases do not invalidate the study's conclusion that "for healthy, non-elderly people, the risk of dying from COVID-19 this season has been infinitesimally small." Unfortunately, they note "this is in stark contrast from many news stories that focus on the demise of young people and the panic and horror that these widely reverberated stories are causing."

Personally, I find these stories despicable and indicative of journalistic malpractice.

Finally, the researchers discuss the large fraction of COVID-19 deaths coming from nursing homes. Data show 42-57% of European deaths coming from care homes. Similar evidence is surfacing in the US. The researchers note that "nursing homes and hospitalized patients (nosocomial infection) appear to account for a lion's share of COVID-19 mortality."

I increasingly suspect that this will instigate a flurry of CYA actions by policymakers in weeks ahead. As analysis of the data reveals that most COVID deaths come, not just from the elderly, but from elderly confined to care facilities, then the major policy error of widespread lockdown may become clear to a whole lot of people.