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John Ioannidis, a professor of medicine, epidemiology, and population health at Stanford University, says he's "perfectly happy" to be under virtual lockdown in California due to the COVID-19 pandemic.
And he readily acknowledges the importance of sensitizing the public to following instructions to shelter in place to curb the spread of the novel coronavirus.
In addition, Ioannidis recognizes that a large number of people may die from COVID-19.
But in a video posted on YouTube, the codirector of the Meta-Research Innovation Center at Stanford said he worries that media outlets are "falling into a trap of sensationalism".
And he suggested that this is making the situation worse for people.
"We don't want to get them into panic," Ioannidis said. "This doesn't really help."
As of today, there are more than 100,000 deaths that have been attributed to the novel coronavirus. Leading the list is Italy at 18,849, followed by the United States at 18,016.
Ioannidis is the lead author of an unrefereed preprint of an article evaluating the relative risk of COVID-19 among people under 65 years old. It was posted on medRxiv, relying on data compiled up to April 4.
It looked at eight countries (Belgium, Germany, Italy, Netherlands, Portugal, Spain, Sweden, and Switzerland), three states (Louisiana, Michigan, and Washington), and one city (New York) with at least 250 COVID-19 deaths and where there was an age breakdown.
In the European countries studied, Ioannidis and his two fellow researchers reported that those under 65 years of age had a 34-fold to 73-fold lower risk of dying of COVID-19 than those 65 years and older.
However, there was only a 13-fold to 15-fold lower risk for those under 65 years of age in New York City, Louisiana, and Michigan.
Those under 65 accounted for five to nine percent of all COVID-19 deaths in the eight European countries.
However, nearly 30 percent of COVID-19 deaths involved people under 65 in three of the U.S. hotbeds.
In Germany, the absolute risk of COVID-19 was 1.7 per million. That contrasted with 79 per million in New York City, which is threatening to overrun the city's health-care system.
"The COVID-19 death risk in people <65 years old during the period of fatalities from the epidemic was equivalent to the death risk from driving between 9 miles per day (Germany) and 415 miles per day (New York City)," the paper states.
But for those 80 years and older in Germany, the COVID-19 fatality rate rose to one in 6,000. In Spain, the risk of death was one in 420 for those 80 years and older.
World Health Organization may have missed the mark
In the YouTube video above, Ioannidis pointed out that his research focuses on appraising evidence and understanding the strengths and weaknesses of data.
He stated that because this pandemic is new, most of the information about it "is not reliable".
In addition, Ioannidis said there are "major gaps" in understanding the following key features of the pandemic:
* how lethal is the virus?
* how many people has it infected?
* how many will it infect?
* what is the likely eventual impact and how effective are different measures that are being applied?
As an example, he cited a World Health Organization estimate in March that the case-fatality rate was 3.4 percent.
That was based on the number of confirmed COVID-19 deaths being divided by the number of confirmed positive test results.
Ioannidis questioned the accuracy of the WHO estimate, based on a variety of reasons.
He noted that the fatality rate was much lower on the Diamond Princess cruise ship, where 19 percent of passengers were infected.
"Among those who were infected, as of now, one percent had died," Ioannidis said. "One percent is a figure that pertains to a population of mostly elderly people.
"The mean age of the passengers and crew was 58 years old and the median, I believe, was close to 65," he continued. "And we know now that there is a very strong age gradient. People who are older have a higher risk. People who are young have a much lower risk."
Based on this data, Ioannidis estimated that in a country like the United States, the fatality rate from COVID-19 would more likely be between 0.05 to one percent of those infected.
"As we discussed, many of the features of this pandemic, of course, are serious," he emphasized. "But I think that the estimates are exaggerated. And I think that there is a risk of really making some fundamental decisions about the structure of our civilization, of our society, of our future, that may not be appropriate."
As an example, he cited the risks of constructing a society over the longer term around where everything is done at a distance.
"Flattening the curve to avoid overwhelming the health system is conceptually sound—in theory," he wrote in a paper in March. "A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment.
"Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated," he continued. "If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse:
"Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity."
What went wrong in Italy?
Ioannidis said in the YouTube video that he's collaborating with scientists "leading the Italian response" to the pandemic.
He proposed multiple explanations for the large number of fatalities in that country.
First is demographics: Italy has the oldest population in Europe. The average age of death from COVID-19 in Italy is 81.
"Also, most of these people have lots of other underlying diseases," Ioannidis said in the video. "Italy is a country with a very strong history of smoking.
"It has very high rates, therefore, of chronic obstructive pulmonary disease. It has very high rates of coronary heart disease. And these are very strong risk factors for having a bad outcome in this infection."
Ioannidis then delivered this provocative statement: "It still remains to be decided how many of these infections are deaths with SARS-CoV-2 versus deaths by SARS-CoV-2."
Next, he noted that Italy has a "relatively low number" of intensive-care beds per population, only about one-third per population of the number in the United States.
The Italian health-care system runs at near full capacity in most winters.
According to Ioannidis, this means that if a little bit more capacity is added, "it can very easily collapse."
These weren't the only factors.
He also pointed out in the video that Italy was the first European country to be hit hard by the novel coronavirus.
It was an "exotic pathogen" and everyone wanted to do their best to contain the outbreak.
"So, they said 'we need to admit these people to the hospital even if they had modest or not so severe symptoms'. This resulted in a very bad decision-making," Ioannidis observed. "And I think that this is something that every other setting that is hit by an epidemic wave needs to avoid.
"By admitting these mild or moderate cases very quickly, they became saturated," he continued. "And when they started getting the severe cases, they just had no room for them."
Not only that, but hospitals became "heavily colonized" by a new virus that remained on surfaces.
"Many of their medical personnel got infected in that heavily infested environment," he added. "So there's a lot of factors that created like the perfect storm."
Ioannidis said about 60 million people die per year on Earth.
But COVID-19 may be the only disease that has a website meter counting every single fatality. And he believes that's fuelling the public's alarm.
He also worries that those with financial or other conflicts of interest may try to exploit this situation and "kind of take over the entire agenda", which could put many more lives at risk.
"It should be something we should all be united about—saving lives, getting the best outcome, and really knowing what are the next steps about what we do with this epidemic," Ionnadis concluded, "and what we do with our world at large."More