Global perspective of COVID‐19 epidemiology for a full‐cycle pandemic

Ioannidis, John P. A.

doi:10.1111/eci.13423

Cited by 150 publications

(156 citation statements)

References 66 publications

(87 reference statements)

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“…Using the age distribution of deaths and comorbidities, in the UK the average person who died due to COVID-19 had 3-5 healthy years left to live; that is, 3-5 QALY, or 18-30 WELLBY. 95,144,147 This number was even lower in Italy. 144 We can calculate that lockdowns 'saved': 50% infected to herd immunity X 0.3% IFR X 7.8 Billion people X 5 QALY lost per death = 11.7 million deaths, 58.5 million QALY, or 360 million WELLBY.…”

Section: Cost-benefit Analysismentioning

confidence: 91%

“…94 The destabilizing effects may lead to chaotic events (e.g., riots, wars, revolutions). 95,96 In high-income countries, the collateral damage has also been staggering (Table 3), affecting visits to emergency departments and primary care for acute (e.g., myocardial infarction, stroke) and 'nonurgent' ('elective' surgery, and cancer diagnosis and treatment) conditions, intimate partner violence, deaths of despair, and mental health. 12,[97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] Of excess deaths occurring during the pandemic in highincome countries, 20-50% are not due to COVID-19.…”

Section: Iatrogenic Collateral Harms: Lockdown As a 'Drug' With Dangementioning

confidence: 99%

“…95 Unequal structural determinants of health meant that disadvantaged minorities have experienced a greater toll from the COVID-19 "Great Lockdown", 117 with contributors including lower income (e.g., economic and job insecurity), homelessness or crowding at home (and in transportation), worse health care (and preexisting health disparities), and inability to work from home (e.g., for essential, manual, and temporary workers). 45,95,118,119 COVID-19 policing has involved "racial profiling and violence, crippling punishments for those living in poverty, and criminalization of mental health." 120 Refugees are particularly vulnerable, undertaking "arguably the most essential form of travel… with little access to water, space or health care."…”

Section: Iatrogenic Collateral Harms: Lockdown As a 'Drug' With Dangementioning

confidence: 99%

“…If only 10% of the high-risk population are infected, COVID-19 will account for 0.6% of global deaths over 5-years. 95 Some causes of death in the world are given in Table 5; COVID-19 deaths (~3500/day up to September 4, 2020) are also shown. [131][132][133][134][135][136][137][138][139][140][141][142][143] For example, there are an estimated 4110 deaths/day from Tuberculosis, 133 3699 deaths/day from motor vehicle collisions, 131 21,918 deaths/day due to use of tobacco, 132 >3400 deaths/day from Under 5 cases of pneumonia or diarrhea, 137,138 and 30,137 deaths per day from dietary risk factors.…”

Section: Numbers In Contextmentioning

confidence: 99%

“…Some of these costs include that the lockdown: "will decrease national income… and this will have a measurable effect on the length of the average lifespan", "[has] disrupted normal health services… estimated an increase in cancer deaths over the next 12 months of 20%", [and will cause] future suicides by the unemployed and others whose lives have been ruined." Urge for "a cost-benefit analysis, including lives saved versus lives lost, both directly and consequentially… [and] weekly or daily non-epidemic death figures should be posted as well as deaths from the epidemic…" Ioannidis, JPA 95,[215][216][217][218][219] Called for evidence to guide policy, noting many of the collateral and recession effects discussed above. "Shutdowns are an extreme measure.…”

Section: Referencementioning

confidence: 99%

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COVID-19: Rethinking the Lockdown Groupthink

Joffe

2020

Preprint

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The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population’s movements, work, education, gatherings, and general activities in attempt to ‘flatten the curve’ of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. First, I explain how the initial modeling predictions induced fear and crowd-effects [i.e., groupthink]. Second, I summarize important information that has emerged relevant to the modeling, including about infection fatality rate, high-risk groups, herd immunity thresholds, and exit strategies. Third, I describe how reality started sinking in, with information on significant collateral damage due to the response to the pandemic, and information placing the number of deaths in context and perspective. Fourth, I present a cost-benefit analysis of the response to COVID-19 that finds lockdowns are far more harmful to public health than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. I close with some suggestions for moving forward.

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Section: Cost-benefit Analysismentioning

confidence: 91%

Section: Iatrogenic Collateral Harms: Lockdown As a 'Drug' With Dangementioning

confidence: 99%

Section: Iatrogenic Collateral Harms: Lockdown As a 'Drug' With Dangementioning

confidence: 99%

Section: Numbers In Contextmentioning

confidence: 99%

Section: Referencementioning

confidence: 99%

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COVID-19: Rethinking the Lockdown Groupthink

Joffe

2020

Preprint

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Serum calprotectin can indicate current and future severity ofCOVID‐19

Shokri-Afra

Moradi

Musavi

et al. 2022

Clinical Laboratory Analysis

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Background Predictive and prognostic biomarkers to guide 2019 novel coronavirus disease (COVID‐19) are critically evolving. Dysregulated immune responses are the pivotal cause of severity mainly mediated by neutrophil activation. Thus, we evaluated the association of calprotectin, neutrophil secretory protein, and other mediators of inflammation with the severity and outcomes of COVID‐19. Methods This two‐center prospective study focused on PCR‐proven COVID‐19 patients (n = 76) with different clinical presentations and SARS‐CoV‐2 negative control subjects (n = 24). Serum calprotectin (SC) was compared with IL‐6 and other laboratory parameters. Results Median levels of SC were significantly higher in COVID‐19 patients in comparison to the control group (3760 vs. 2100 ng/ml, p < 0.0001). Elevated SC was significantly respective of disease severity (3760 ng/ml in mild up to 5700 ng/ml in severe cases, p < 0.0001). Moreover, the significant positive and negative correlations of SC with disease severity and oxygenation status indicated disease progression and respiratory worsening, respectively. It was found that SC was high in severe patients during hospitalization and significantly declined to normal after recovery. The logistic analysis identified the independent predictive power of SC for respiratory status or clinical severity. Indeed, SC behaved as a better discriminator for both outcomes, as it exhibited the largest area under the curve (receiver operating curve analysis), with the highest specificity and sensitivity when the predictive value of inflammatory biomarkers was compared. Conclusion Calprotectin can be used as a reliable prognostic tool to predict the poor clinical outcomes of COVID‐19 patients.

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The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

et al. 2022

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Background The healthcare industry's efforts to immunize the global community against severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) have been unprecedented. Given the fast‐tracking of the novel vaccine, its short‐ and long‐term medical implications remain largely to‐be‐determined in most patient populations. This study aims to analyze 90‐day post‐operative outcomes in microsurgical patients, who have received or not received SARS‐CoV‐2‐vaccination, using a continuously updated federated electronic medical record network (TriNetX Inc, Cambridge, MA). Methods After screening 70 million de‐identified records, 16,799 microsurgery patients aged 18–99 meeting medical coding criteria were allocated into two cohorts. Cohort One received SARS‐CoV‐2‐vaccination prior to undergoing microsurgery whereas Cohort Two did not. Two equally sized cohorts, totaling 818 patients were created after propensity score matching for characteristics including: age, race, ethnicity, smoking, hypertension, heart disease, diabetes, obesity, chronic obstructive pulmonary disease, and history of SARS‐CoV‐2 exposure. Postoperative outcomes within 30‐, 60‐, and 90‐days of microsurgery were analyzed. Results Patients who were SARS‐CoV‐2‐immunized experienced significantly lower ( p < .01) surgical site infections (Absolute Risk Reduction (ARR)[95%CI]) = (3.79%–5.36% [0.84–8.54]) ICU admission (9.47%–9.82%[5.45–13.88]), generalized infections (7.68%–9.92%[3.15–14.64]), and hospitalizations (28.48%–32.57%[20.99–40.13]) within 30‐, 60‐, and 90‐days of microsurgery. Additionally, SARS‐CoV‐2‐vaccinated patients also experienced significantly less flap failure (2.49%[0.97–4.02]) and death (2.46%[0.96–3.97]) within 30‐ and 60‐days post‐operatively. Conclusion Our analysis examines the potential protective effect of SARS‐CoV‐2‐vaccination in microsurgical patients. Limitations include the retrospective nature of this analysis and the inherent reliance on medical coding. Future prospective studies are warranted to better understand if in fact pre‐operative SARS‐CoV‐2‐vaccination has the potential to protect against post‐operative microsurgery outcomes.

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Global perspective of COVID‐19 epidemiology for a full‐cycle pandemic

Cited by 150 publications

References 66 publications

COVID-19: Rethinking the Lockdown Groupthink

COVID-19: Rethinking the Lockdown Groupthink

Serum calprotectin can indicate current and future severity ofCOVID‐19

The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

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