I watched last week’s interview with Johan Giesecke and Freddie Sayers with interest — it is still a rare thing to see a conversation about Covid devoid of the usual agenda. However, I felt that there were some important issues missed by my fellow Swede and epidemiological colleague.
- Country Comparisons:
It is popular to compare the disease outcomes of different countries and attribute their differences to the pandemic strategy employed. It is important to realise though that there is often major geographical variation within countries that is not explained by different strategies since the strategy was uniform.
For example, all parts of Sweden had the same strategy, but the Covid-19 cumulative mortality in Stockholm is almost three times higher than in my own northern home region of Västerbotten. While there are regional differences unrelated to strategy, Giesecke was essentially right a year ago when he thought that differences between countries would even out over time, even though the final number will obviously differ.
For example, a year ago, the media praised Czechia for their successful lockdown measures, but now they report the highest cumulative Covid-19 mortality in the world. Their low rates a year ago was not due to pandemic strategy. Rather, Covid-19 arrived later in Czechia than in many other parts of Europe, and the rates were held down by seasonality before the disease had time to get a strong foothold.
- The “accuracy” of the Imperial College Model:
On March 16, 2020, Neil Ferguson and his colleagues at Imperial College predicted that around 500,000 in Great Britain would die from Covid-19 under a do nothing let-it-rip strategy. A significant factor in their model was their assumed overall infection fatality rate (IFR) of 0.9%. While that was one plausible estimate at the time, it would have been more scientifically appropriate to present multiple plausible values, as did the Oxford group led by Sunetra Gupta. More recent IFR estimates are about a third to half of the Imperial College model assumption. With these later numbers, the Imperial College model would instead have predicted somewhere between 165,000 and 250,000 deaths under a let-it-rip strategy.
While not part of their research report, in an email from Ferguson dated March 29, 2020, he reported on a scenario that his group ran using the Imperial College model for an “age-based cocooning” strategy, with focused protection of older high-risk people, as advocated by the Great Barrington Declaration. “Making realistic assumptions about effectiveness,” they predicted 50-60% fewer deaths relative to a let-it-rip strategy. Together with the lower IFR estimates, that would have meant somewhere between 70,000 and 125,000 total Covid-19 deaths. We can compare this to the actual April 19 cumulative UK death count of 127,524 from the implemented lockdown strategy.
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