Stanford U Study: covid19 Prevalence 50-85x known cases

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Zobel
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In reply to NASAg03 • 10:48p, 4/17/20
AG
Bias isn't nefarious. It just means they're predisposed to think a certain way. That "hunch" is their bias as much as if you have a "hunch" it's more severe than reported.

They publish op-eds because they're humans and they want fame and notoriety. The real way to "prove" something like this is by testing it - which is why I'm glad they did this. Writing an op ed doesn't do jack.

Why are you so intent white knighting for them? I don't disagree with them or their findings, but you accuse me of bias? Bleh.
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NASAg03
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In reply to Zobel • 12:33a, 4/18/20
Not sure why i'm even responding. You don't even know what white knight means.

You de-rail every thread with the same shtick as a self proclaimed pandemic expect, and have yet to provide any basis of your experience or why your opinion should carry any more weight than the rest of us.

When people call you on it, you backpedal or downplay what you said to seem agreeable.

Why do I trust the Stanford professors? Because the other world experts are constantly changing the narrative, moving goalposts, downplaying case studies and hyping up general panic. And they benefit much more than accomplished professors.

Predicting worst case and recommending excessive safety measures is a win-win for them. They appeal to people's emotional side and "win" every time.

Yet there are experts, still involved in actual science and testing, that disagree based on logic and experience, not emotion. These are the people that prove gravity is based on mass, the earth is round, and revolves around sun. They doubt the common narrative, not because they want fame, but because they believe in truth and the scientific method.

Within a few weeks of writing an op ed, which said "We are making significant decisions that could impact many lives both directions, we need more data, this is dangerous", they gathered money, put together a study, obtained results, made conclusions, and i'm sure are doing more.

That's the leadership and voice of reason I have confidence in, not Fauci and WHO directors.

I trust accomplished professors with experience in studying epidemics, public heath and economics over political heath directors any day.
Mike Shaw - Class of '03
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Zobel
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In reply to NASAg03 • 12:45a, 4/18/20
AG
If there's no point in responding why'd you get all hot and bothered about it?

I never said my opinion should carry any value. If you disagree with me, feel free to point out any error I've made. I haven't backpedaled or downplayed anything. Instead of attacking me, why don't you offer something substantive to the conversation?

You seem really upset that I note the authors have a bias toward finding this is less severe than most people think. Kinda strange given the fact that they went through efforts not only to publicly state this, but then to organize a study to try to prove it.

You shouldnt trust anyone based on what they say. You should read their studies, understand the limitations, and try to have an informed opinion.

Please, show me where I've criticized their work, said it was bad, that I disagreed with their conclusions, or think it isn't useful or valuable?

Quote:
I trust accomplished professors with experience in studying epidemics, public heath and economics over political heath directors any day.
LOL. But only the people who study epidemics who publish findings you like?
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RGLAG85
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In reply to Zobel • 12:57a, 4/18/20
AG
k2aggie07 said:
If there's no point in responding why'd you get all hot and bothered about it?

I never said my opinion should carry any value. If you disagree with me, feel free to point out any error I've made. I haven't backpedaled or downplayed anything. Instead of attacking me, why don't you offer something substantive to the conversation?

You seem really upset that I note the authors have a bias toward finding this is less severe than most people think. Kinda strange given the fact that they went through efforts not only to publicly state this, but then to organize a study to try to prove it.

You shouldnt trust anyone based on what they say. You should read their studies, understand the limitations, and try to have an informed opinion.

Please, show me where I've criticized their work, said it was bad, that I disagreed with their conclusions, or think it isn't useful or valuable?

Quote:
I trust accomplished professors with experience in studying epidemics, public heath and economics over political heath directors any day.
LOL. But only the people who study epidemics who publish findings you like?
This is rich Tommy! That one sentence does just that. Speaking of confirmation bias.
Thomas Jefferson: "When governments fear the people, there is liberty. When the people fear the government, there is tyranny. The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government." "I prefer dangerous freedom over peaceful slavery."
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Zobel
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In reply to Stymied • 1:01a, 4/18/20
AG
AeroAg2003 said:
Exactly. Attack the science not the people. If you don't like their result and your first statement is to call out their motive, how can I trust your intent?

It wasn't an attack. It was an observation.

I am disappointed with their result. Been waiting for this study for a while, and basically they have some confounding in the sample due to recruitment method and a test with low specificity. I wish it were iron-clad and that the infection rate were much higher. I'm sure they do too. Much better to get a bombshell paper published in nature or science than an op ed in the WSJ.

The note of bias can also be taken as - they likely wanted or expected this to be significantly more impactful. Ionnadis speculated about a 0.05% IFR in his editorial. Bendavid and Bhattcharya talked about 0.01%. This result is kinda middlin, Doesn't blow anyone's socks off or put egg on their face. which means it's pretty interesting.
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Zobel
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In reply to RGLAG85 • 1:03a, 4/18/20
AG
I've shared papers that suggest 86% asymptomatic rate and the report I posted from Rystad estimates 3% of the US population has been infected. Higher than this study says.

When everyone is mad at you, probably means you're not leaning to any side.
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RGLAG85
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In reply to Zobel • 1:12a, 4/18/20
AG
k2aggie07 said:
I've shared papers that suggest 86% asymptomatic rate and the report I posted from Rystad estimates 3% of the US population has been infected. Higher than this study says.

When everyone is mad at you, probably means you're not leaning to any side.
Don't worry, you can still get to where you want to go backpedaling.
Thomas Jefferson: "When governments fear the people, there is liberty. When the people fear the government, there is tyranny. The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government." "I prefer dangerous freedom over peaceful slavery."
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littledude
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In reply to Zobel • 1:14a, 4/18/20
AG
I think a lack of scientific literacy leads to a great deal of discord on this board. We're taught to critically evaluate all scientific manuscripts. To look for bias, weaknesses in study design, application to our actual patient population. We understand the limitations of the statistics, the concept of error bars and confidence intervals and that almost none of these are intrinsically good or bad. They're just qualities that exist that the reader should consider.

Some media and some politicians take the scientific papers and use the extremes for sensational headlines and the general public aren't capable enough to scrutinize it for themselves.

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Zobel
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In reply to RGLAG85 • 1:24a, 4/18/20
AG
Where have I backpedaled? This personal thing is kind of tiresome.
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dermdoc
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In reply to Zobel • 7:25a, 4/18/20
AG
k2aggie07 said:
Where have I backpedaled? This personal thing is kind of tiresome.
Agree.

I just have a real hard time believing that with a respiratory spread virus that only 2-3% of the population are seropositive.

And I do not think you can explain California and Washington numbers by social distancing.
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The_Fox
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8:10a, 4/18/20
https://www.dailymail.co.uk/news/article-8226683/One-forty-six-homeless-NO-symptoms-test-positive-COVID-19-Boston-shelter.html
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Ranger222
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8:37a, 4/18/20
AG
Seeing a lot of criticism of this study this morning







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Stymied
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In reply to Ranger222 • 8:51a, 4/18/20
AG
Ranger222 said:
Seeing a lot of criticism of this study this morning

Not a bit of bias there... #GetToZero

With that said, there appears to be some truth to the confidence interval points.

On the flip side, there are a lot of studies coming out showing large amounts asymptomatic carriers. I think there is a pretty good chance that the overall fatality rate is <1%, if not well under 1%.
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Complete Idiot
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9:50a, 4/18/20
I'd caution everyone to read the "XX number of those tested positive were asymptomatic" articles very carefully. Many, if not most, mean asymptomatic at the time of the test. For example, a link to a homeless study was shared in another thread and the title just said "all 146 were asymptomatic" or something. But if you read further into the article there is a vague snippet about how one later got hospitalized but that "many" remained asymptomatic, implying others did not. We are interested in both - people who test positive and who are contagious but asymptomatic at the time as well as those that test positive and NEVER show symptoms, but right now I am MOST interested in the latter.

I got really excited about the study and it's findings yesterday - but after thinking about it longer I've lost some of that thrill. I still think it's a great study and that the findings seem to have merit, but I just need to see more studies like it. It's a study with some extrapolated conclusions - still somewhat theoretical - and I have to balance that with the real world impact of the disease. Not just the deaths but it's still a serious illness for many, even those who recover, as told by first hand accounts here on Texags. Still, if not as deadly as once thought and just a serious illness one can live through at home then public perception of the situation changes. Additional antibody tests will confirm the findings in this study I hope.

Let's get additional studies like this conducted across America.
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Complete Idiot
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In reply to Zobel • 10:02a, 4/18/20
k2aggie07 said:
No, they wrote them generally against the WHO estimate of 3.4% IFR. The imperial study used an IFR of 0.66%.
There has always been a misunderstanding of the 3.4% statement from the WHO director. It was not an estimate, it was a real number calculated by deaths/confirmed positive tests at the time. He did not say the knew what the denominator would be for a true estimate of a mortality rate, he was just reporting known numbers but many ran with that number as your true chance of dying if you caught the disease. Very unfortunate, and much of it due to media reporting (and I think it was unintentional misleading, but same impact).
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SirLurksALot
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In reply to Complete Idiot • 10:03a, 4/18/20
Complete Idiot said:
It's a study with some extrapolated conclusions - still somewhat theoretical - and I have to balance that with the real world impact of the disease. Not just the deaths but it's still a serious illness for most, even those who recover, as told by first hand accounts here on Texags.


I don't have a problem with most of what you said, except for this sentence. It's pretty obvious that this is not a serious illness for "most". First hand accounts, even if they are accurate, only tell a tiny fraction of the story.
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goodAg80
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10:09a, 4/18/20
AG
I have found k2aggie's analyses to be reasoned and factual. We still have too much uncertainty about the spread and we desperately need to do random sampling, but almost any scheme you come up with isn't truly random.

If the sampling is truly random the sample size can be smaller, but since truly random is not going to happen we need to increase the sample size radically.


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Complete Idiot
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In reply to SirLurksALot • 10:14a, 4/18/20
SirLurksALot said:
Complete Idiot said:
It's a study with some extrapolated conclusions - still somewhat theoretical - and I have to balance that with the real world impact of the disease. Not just the deaths but it's still a serious illness for most, even those who recover, as told by first hand accounts here on Texags.


I don't have a problem with most of what you said, except for this sentence. It's pretty obvious that this is not a serious illness for "most". First hand accounts, even if they are accurate, only tell a tiny fraction of the story.
I edited since I don't believe personally believe it is most, just a typo I guess - thanks for catching. CHanged to "many". Implying there is a number of people with serious symptoms, but I don't feel it's the majority.
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JP_Losman
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10:19a, 4/18/20
AG
Hypothetical:

IF we get enough data to overwhelmingly show 0.1% fatality rate... what are the implications?


Back to work and school full time? Back to normal? Not back to normal?
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Zobel
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In reply to goodAg80 • 10:24a, 4/18/20
AG
I think their sampling was probably fine, I mean what else can you do? At least they got a decent size, and they tried to control for over representations. Their demographic adjustment nearly doubled their raw prevalence - that's something to consider.

Then they applied the uncertainty of their test to the demographic adjusted prevalence, not the actual test raw prevalence. Also something to consider.

Third issue is their test sensitivity is sketchy (no fault of their own, it's a manufacturer supplied test) and the numbers are hugely sensitive to the specificity, meaning within their confidence interval all of their positives could have been false positives.

Fourth is they don't know if there's cross-reactivity to other antibodies from coronaviruses in their positives. I don't think they even mention that in the paper, but it could be true.

Good paper. More study needed.
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ETFan
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In reply to JP_Losman • 10:30a, 4/18/20
JP_Losman said:
Hypothetical:

IF we get enough data to overwhelmingly show 0.1% fatality rate... what are the implications?


Back to work and school full time? Back to normal? Not back to normal?

Am I goofing on my math/logic or would this imply, statistically, almost everyone in NY has/had it?

NY population: 19.4mil
Dead: 17,131

17131/.001 = 17.1mil infected.

Edited: I thought my google search for NY state pop seemed low..
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JP_Losman
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10:46a, 4/18/20
AG
0.1% would be the average for the entire country obviously.

Certain areas would be way more afflicted than others.
Average together California, NY, Texas for example and it brings the average down
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dermdoc
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In reply to goodAg80 • 10:46a, 4/18/20
AG
goodAg80 said:
I have found k2aggie's analyses to be reasoned and factual. We still have too much uncertainty about the spread and we desperately need to do random sampling, but almost any scheme you come up with isn't truly random.

If the sampling is truly random the sample size can be smaller, but since truly random is not going to happen we need to increase the sample size radically.


Agree.
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DTP02
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10:57a, 4/18/20
AG
Very interesting phenomenon I'm seeing here. There have been a couple of things posted on this thread that were clearly posted to minimize the significance of the Stanford study.

But they actually support the significance of the study much more than it might appear.

Two examples:

The tweet from former FDA chief Gottleib. By his own estimate he thinks the mortality rate could be .2%. Yes, there is a decimal before the 2.

Another is the tweet from Trevor something above, where he's calling the significance of the study into serious question while stating that he thinks the mortality rate could be .26%. Another decimal.

Are we just all going to pretend that .2% is the mortality number we've been talking about all along?
I mean, we could go to the way back (to 4-6 weeks ago) machine if we need to, but there has been some very big (trigger warning) moving of goal posts and it doesn't really seem like it's being acknowledged.



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Zobel
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In reply to DTP02 • 11:03a, 4/18/20
AG
The epidemiologists have consistently been below the rate being pushed in the media. Way back on March 10 the Imperial college put a preprint out a study by Verity with an IFR of 0.66%. When that same paper was published in the Lancet in April, it was taken as a revelation and ... perhaps unsurprisingly... used as ammunition against the same prediction it informed.

I believe InfectionAg has been talking about 0.5% for a while now. I think that's probably a reasonable number to use. The truth is we don't have any better picture today than we did a month ago, because antibody tests is what we need, and we're just starting to get results back on that.
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SirLurksALot
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In reply to JP_Losman • 11:03a, 4/18/20
JP_Losman said:
Hypothetical:

IF we get enough data to overwhelmingly show 0.1% fatality rate... what are the implications?


Back to work and school full time? Back to normal? Not back to normal?


I think you'd have to go back to mostly a full normal. How are you going to justify major impacts to daily life if the fatality rate is similar to the flu? Even with this virus being more contagious, I don't think the public at large will accept anything else.

I think you could get away with keeping schools closed, because the year is almost over anyway. You could also keep the hygiene advisories in place. Other than that I don't believe there would be widespread compliance with any other measures.
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Pasquale Liucci
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In reply to dermdoc • 11:08a, 4/18/20
AG
That being said, there seems to be a several small studies that confirm what we have all suspected: the case count is off by at least an order of magnitude.

Even if it isn't off by the 50-85x the Stanford study calls out, if it is even off by 10-20x that is substantial as far as what it entails for a) progress towards herd immunity and b) severity of this disease
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Pasquale Liucci
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In reply to SirLurksALot • 11:09a, 4/18/20
AG
Agreed
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dermdoc
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In reply to Pasquale Liucci • 11:24a, 4/18/20
AG
Lester Freamon said:
That being said, there seems to be a several small studies that confirm what we have all suspected: the case count is off by at least an order of magnitude.

Even if it isn't off by the 50-85x the Stanford study calls out, if it is even off by 10-20x that is substantial as far as what it entails for a) progress towards herd immunity and b) severity of this disease
I agree with you. If you read my posts from over a month ago, I predicted 0.3-0.6% mortality rate. And posted it would probably be even lower than that after this Stanford study.

I do not agree with K2's takes all the time as I am generally much more optimistic. But his thoughts are well reasoned and not inflammatory. That is what I was agreeing with.

Plus we are brothers in Christ that have met in real life.
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pocketrockets06
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In reply to DTP02 • 11:31a, 4/18/20
AG
Most of the serious epidemiology people have been estimating between 0.5% and 1.5% for IFR. The higher numbers you are remembering are typically CFR which is based on confirmed cases. Keep in mind that at 1% IFR and 60% infected to get to herd immunity that is still 2 million dead in the US.

Even at .25% you're still talking 500,000 dead. That's worth some level of policy response more than wash your hands posters.

A couple of other notes, some of the harder hit areas in the US (New Orleans and NYC) have already had roughly 0.1% of their population die. That kinda puts a floor on the IFR no matter what you believe about percent asymptomatic. In Italy, there are some smaller villages that lost 1% of their population. Maybe they skew older but still...

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Pasquale Liucci
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In reply to dermdoc • 11:34a, 4/18/20
AG
For sure, I know you've been consistently reasonable/optimistic throughout this. I was mainly saying that for the fearmongers who are using the statistical uncertainty in this study to dunk on anyone who dares take an optimistic viewpoint
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DTP02
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In reply to pocketrockets06 • 11:39a, 4/18/20
AG
pocketrockets06 said:
Most of the serious epidemiology people have been estimating between 0.5% and 1.5% for IFR. The higher numbers you are remembering are typically CFR which is based on confirmed cases. Keep in mind that at 1% IFR and 60% infected to get to herd immunity that is still 2 million dead in the US.

Even at .25% you're still talking 500,000 dead. That's worth some level of policy response more than wash your hands posters.

A couple of other notes, some of the harder hit areas in the US (New Orleans and NYC) have already had roughly 0.1% of their population die. That kinda puts a floor on the IFR no matter what you believe about percent asymptomatic. In Italy, there are some smaller villages that lost 1% of their population. Maybe they skew older but still...



You're serving as another example here by citing up to a 1.5% mortality rate and thinking .2%, as estimated by people who are being put forth to minimize the significance of the Stanford study, isn't really a big deal.

I mean, the Stanford study being overstated by twice as much makes it pretty much worthless, apparently, but the the mortality rate being overstated by up to 7 times as much? Not really noteworthy.

And then there's this:

Quote:
Even at .25% you're still talking 500,000 dead. That's worth some level of policy response more than wash your hands posters.


I'm just going to leave that there because it kind of encapsulates the whole point I'm making.
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SirLurksALot
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In reply to pocketrockets06 • 11:42a, 4/18/20
pocketrockets06 said:


Even at .25% you're still talking 500,000 dead. That's worth some level of policy response more than wash your hands posters.



Is it? 500,000 deaths would only be an increase of 17% of our total annual deaths, and that's assuming all the deaths came in one year. Also considering that the vast majority of death are occurring in people 70 or older it's reasonable to say that a large portion of those deaths would've happened this year anyways. It wouldn't be a net addition of 500,000 new deaths. I personally don't think this response was worth it if all we're doing is prolonging the lives of 0.1% of the population most of whom will probably be dead from other natural causes by the time we recover economically.
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Zobel
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In reply to dermdoc • 11:53a, 4/18/20
AG
I don't know if I've been optimistic or pessimistic. To be honest I don't have any feel for any of this, which is why I've contented myself with a huge range of outcomes based on studies. I can't tell you where in the range it will fall, but I have said I think it's probably going to be on the high end or the low, with a low probability middle outcome. People are getting excited about this Stanford study, and that's good, it's good to have a low IFR. But a low IFR at this point has a higher R0 by necessity. If 50% of the population is infected and the IFR is only 0.1% thats 160,000 deaths Over the course of the epidemic. Unfortunately it seems like my original best case estimate is no longer likely, because that was based on a low attack rate (~30%) and I don't think studies like this are showing that to be likely.
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dermdoc
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In reply to Zobel • 11:57a, 4/18/20
AG
k2aggie07 said:
I don't know if I've been optimistic or pessimistic. To be honest I don't have any feel for any of this, which is why I've contented myself with a huge range of outcomes based on studies. I can't tell you where in the range it will fall, but I have said I think it's probably going to be on the high end or the low, with a low probability middle outcome. People are getting excited about this Stanford study, and that's good, it's good to have a low IFR. But a low IFR at this point has a higher R0 by necessity. If 50% of the population is infected and the IFR is only 0.1% thats 160,000 deaths Over the course of the epidemic. Unfortunately it seems like my original best case estimate is no longer likely, because that was based on a low attack rate (~30%) and I don't think studies like this are showing that to be likely.


And that is why you are an engineer and I am a clinician. We see the same facts and our brains interpret them differently. And that is a good thing. And like me, you can admit you could be wrong.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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