Actuaries in South Africa have been and will continue to be challenged on professionalism and what it means in a world where uncertainty and the pace of change is rapidly increasing. The COVID-19 pandemic, and the ability of the Actuarial Society of South Africa to respond, exposed significant problems in this regard.

The future actuary will be required to exhibit higher order understanding and judgment skill sets in an increasingly uncertain world of rapid technological advancement, war, energy crises, macro-economic and political uncertainty.  This will require actuaries that are responsive to change but also ones who have technical rigour and professionalism.  The Society and actuaries more generally, will need to be able to step out and up to address these issues in a professional manner, contributing not just to the technical arena, but also to the public interest.

The Southern African context provides additional challenges here as actuaries need to address these challenges in the context of a developing country and continent, where education and inclusion will demand innovative solutions for our profession and also for our country.

I believe South African actuaries need to focus on this by doing the following:

1. Making sure the actuaries are making relevant contributions to emerging topics such as machine learning, AI, NHI and emerging sources of risk.  The model of the COVID-19 Actuaries Response Group may be a key approach to enable actuaries to stay responsive and relevant in the debate.  Where existing structures are there, it would also be good to encourage more timeous and relevant outputs being made while still applying appropriate levels of rigour.
2. Making sure the Society's professional standards, Code of Conduct and Disciplinary Process is up to the task of ensuring that actuaries have the guidance they need, ensuring the Society can properly and in a consistent manner address issues of misconduct timeously and appropriately, especially in areas of emerging uncertainty and risk.
3. Ensure the development of young actuaries that have these hard technical skills but also the judgement and professionalism required to make sense of this rapidly changing world.
4. This all needs to be done with a particular focus on inclusiveness within the actuarial profession. Without developing an inclusive and diverse profession, it will not stay relevant.

These challenges also require an active membership willing to vote, so as an actuary, make sure you vote in the election for Council members as well as President of the Society.  Find the email with your password and go make your vote! If you have not received the email please reach out to the Society to ensure you get it.

I feel passionate about these issues and for this reason I am standing for the Council of the Actuary Society of South Africa.  I would appreciate your support.

I have been wondering why the COVID-19 Actuaries Response Group has been so successful.  The group ensured that actuaries were part of the discourse and contributed to the debate on COVID-19, particularly in the UK.  I reckon for example that John Roberts saved lives in pointing out problems with the UK vaccine roll-out resulting in government focus on the problem.  What better way to serve the public interest is there?

I think the recipe to success involved several key ingredients which I discuss below.  The goal being to think of whether we can use similar approaches to address other issues.

Passion

I think the group was filled with people who felt that actuaries could say a lot about COVID-19 and felt that this was a situation where they could contribute to the topic and make a difference. Stuart McDonald's passion for communicating clearly and John's passion for monitoring the vaccine roll-out in the UK are two examples of that and clearly Suee Chieh Tan had great passion for actuaries to make a difference. Stuart was even awared an MBE for his efforts.

Skills

The group had great people with a good combination of skills.  Certainly, the actuarial skills (and in particular mortality experience) helped tremendously but the group also consisted of team members that had broader skills in health care and public health. This helped the group understand some of the issues and communication challenges also.  The team also sought skills in the profession and in other fields where those skills were not available within the group.

Professionalism

The groups core principle is to act with professionalism in line with the the IFoA Actuaries' Code.  All articles and text was peer reviewed and contentious viewpoints were discussed rigorously.  The group did not publish contentious viewpoints unless broad consensus was reached.

Relevance

The group tried to focus on topics where it was felt that actuaries could contribute that was being discussed.  When the vaccine roll-out plans were being discussed a short post on vaccine prioritisation clearly put across the potential effectiveness for an age-based roll-out as an example.

Responsiveness vs. Rigour

Closely related to relevance is being responsive to the developing pandemic and the discourse surrounding it.  This meant that actuaries had to speed things up significantly from the normal pace.  The group could not build complicated models (though some did anyway) but had to focus on getting simple analyses that could clearly highlight the main parameters or uncertainties involved in a particular issue.  This required balancing with rigour of professionalism.  A slow perfect answer would be irrelevant.  A decent quick answer was more valuable both in terms of the problems faced as well as supporting the need to stay relevant.

This concept is summarised on the about page as follows:

Our bulletins and blogs are necessarily often “beta versions” (or work in progress). Better and more complete studies will and can be conducted in the fullness of time. We are mindful of the trade-off between “rigour and comprehensiveness” versus “responsiveness and usefulness” and we seek to tilt our approach to the latter.

Independence

The views expressed by the group were not associated with their employers nor even strictly with the Institute and Faculty of Actuaries.  This meant the actuaries of the group had a clear independent voice.  This was useful and may even be key in other contexts.

Communication strategy

All the above would have gone to waste if the group did not focus on getting the message out.  This firstly relied on a rigour to keep the messaging and explanations clear and understandable, free from technical jargon.  The Simpson's paradox bulletin is a good example of this.

The group runs a website, and social media accounts on Twitter and LinkedIn.  The group thought actively how to ensure that messages on social media was positioned and phrased to ensure that engagement with the more detailed content on the website was maximised to ensure those seeking information were able to see it and access it quickly.  The group tracked engagement to establish what worked to ensure those successes could be repeated.  Further relationships naturally developed and were alter sought out with journalists the result of which being that the members of the group appeared in news articles, podcasts, radio and even on television (including yours truly).  This enabled the work of the group to be rapidly disseminated to a broader audience.

I strongly believe this group showed how actuarial skills can be made relevant in dealing with a tremendously challenging problem.  Actuaries stepped up, made a difference, and used their skills to further profession but, even better, serve the public interest in multiple ways.  This proved to be challenging but also incredibly rewarding work.

The question is can we apply the same recipe to other problems?  I think we can, and we need to!

The TV-series "The Wire" has a character called Omar Little .  He is a sort of Robin Hood in the series exclusively stealing from those that sell drugs and is one of the show's most memorable characters for many, and was President Obama's favourite character.  

He has a principle of only targeting people in "the game" and not harming bystanders that are not involved with the drug-trade.  Some say this "integrity" is part of what makes him such a memorable character in the series.  Omar describes it as follows:

A man gotta have a code

More on Omar below including snippets from the scene where he declares his code and challenges a police detective to follow their code (big spoiler alert if you still want to watch the series).   If you are undecided, the video is quite good and I would argue you could count it as professional CPD!

Many professions want to ensure their members behave well and with integrity and thus professional bodies tend to have codes. Like Omar, actuaries have a code although it's somewhat less violent.

As a Fellow of the Institute of Actuaries I need to follow the Actuaries' Code.  I'm also a Fellow of the Actuarial Society of South Africa (The Society) so have to follow their Code of Conduct as well.

So I have two Codes. I have spent time comparing them with a view to identifying potential areas for improvement in both.

IFoA's Actuaries' Code

The Actuaries’ Code | Institute and Faculty of Actuaries

The Actuaries’ Code (the Code) applies to all members of the Institute and Faculty of Actuaries (IFoA)

Institute and Faculty of Actuaries

The IFoA's Code applies to members in their actuarial roles but also applies to other conduct if that conduct could reflect upon the profession.

The Code has six principles:

1. Integrity – Members must act honestly and with integrity.
2. Competence and care – Members must carry out work competently and with care.
3. Impartiality – Members must ensure that their professional judgement is not compromised, and cannot reasonably be seen to be compromised, by bias, conflict of interest, or the undue influence of others.
4. Compliance – Members must comply with all relevant legal, regulatory and professional requirements.
5. Speaking up - Members should speak up if they believe, or have reasonable cause to believe, that a course of action is unethical or is unlawful.
6. Communication – Members must communicate appropriately.

The Code is simple (only 3 pages of text) and relatively straightforward and, in reality, could be applicable to any profession.  Any professional would do well to follow this code, noting that the details of competence and care for, say, an architect would be very different to those for an actuary.

The Society's Code of Conduct

PROFESSIONAL CONDUCT - The Actuarial Society of South Africa

The Actuarial Society of South Africa

The Society's Code covers both the work and the conduct of members towards their clients, their employers, regulators, the Society and its members, and includes the rendering of actuarial services.

The Society's Code can be summarised in the "Professional Promise":

1. Members are expected to render quality services to their clients through:
   a. The application of specialist and up-to-date actuarial knowledge and expertise;
   b. The demonstration of ethical behaviour, especially in doing actuarial work; and
   c. The member’s accountability to the Society for professional oversight.
2. The principles of professional conduct therefore include:
   a. Knowledge and expertise: A member shall perform only those professional services for which the member is competent and appropriately experienced.
   b. Values and behaviour: A member shall act honestly, with integrity, competence and due care, and in a manner that fulfils the profession’s responsibility to the public.
   c. Professional accountability: A member is subject to the professional requirements and oversight of the Society, and shall do nothing that brings the actuarial profession into disrepute.

Differences

What is in the IFoA's Code but not in the Society's Code?

• The IFoA Code applies when an actuary's conduct be expected to reflect upon the profession.  The Society's Code is less clear but it does speak to upholding the reputation of the profession.
• IFoA members "must show respect for others in the way they conduct themselves". The Society's Code does not mention respect to others.  Respect is mentioned where the work of another actuary is reviewed or where a difference of opinion with another actuary is encountered.  It does not extend outside the profession.  This is a weakness in my view.  Lack of respect towards people outside the profession is inappropriate.  I believe the code should be widened to include respecting colleagues and the general public, which is expressed in this way under the IFoA’s code’s integrity section.
• IFoA members "must ensure their work is appropriate to the needs and, where applicable, instructions of user(s)".  There doesn’t appear to be a similar requirement in the Society’s code.
• IFoA members must consider whether other professional/specialist advice is needed and seek this out.  The Society mentions other professions less explicitly but does encourage actuaries work with other professions for an appropriate period.
• IFoA members are encouraged to speak up to and challenge others when they are non-compliant and also report any misconduct as soon as possible.  Society members must first discuss this with the member involved to obtain clarity.  They can skip this if they do not consider such a discussion constructive, but would then need to seek further guidance.  Only if the issue persists after these steps, should a Society member report this to the Society.  Because there are more hoops to jump through as part of the Society's process, this could lead to matters not being raised soon enough or at all.
• IFoA has more details on communication in their Code compared to the Society.  For example actuaries are required to be clear when potential misunderstandings are likely to occur and to point it out in their communication.

What does the Society's Code have that's not in the IFoA's Code?

• The Society's members are encouraged to assist in and engage in public debate for the public good.
• The IFoA does not mention standards directly in the Code (though members are expected to follow them).  The Society states that standards must be met and/or deviations from standards must be documented.
• In the absence of standards the Society encourages it's members to still have the required competence but members are also encouraged to innovate.
• The Society's Code focusses more directly on the reputation of the profession.   IFoA does state that the code applies when actions may reflect on the profession but does not speak about the reputation of the profession directly.
• The Society has a clause on actuaries being able to justify content of publicity for their services.
• Society members are encouraged to be involved in the structures of the society.
• The Society has a number of detailed points that could be considered sub-points of the headings provided by the IFoA.

What can we learn?

A few important weaknesses of the Society's Code to me are:

• The IFoA approach is more generic and more principles based while the Society's Code is a collection of detailed, specific points not necessarily well structured.
• The lack of an explicit requirement to acting with respect to others in a wider sense (regardless of if they are a member of the Society or not) is problematic. This is especially problematic in the context of South Africa's history.
• There are instances where the IFoA’s code applies but where it is unclear whether the Society’s code applies. In particular this arises in situations where the conduct is not "towards" clients, employers, regulators, the Society or its members, and does not include the rendering of actuarial services. The IFoA's code applies when you are doing an actuarial role, or when conduct could be reasonably considered to reflect upon the profession.
• I believe focussing directly on the reputation of the profession is not the right way.  I would argue focussing on actions (or inactions) of actuaries is better.  In my view the profession's reputation should primarily be based on the quality of actions taken by its members.  
• I believe the requirements around reporting contraventions of the Society's Code puts a few too many hurdles in front of members.  The IFoA's principles based approach seems better as it encourages members to speakup broadly, but also compells reporting to the profession and any other relevant regulatory bodies.

The Society does encourage involvement of members in public interest as well as the Society itself which I think is a good thing.  This is missing from the IFoA's Code.

These are my views and keen to engage on others' views on this topic.  I do feel a good code is critical.  Omar Little says it best:

A man gotta have a code

This week the National Institute of Communicable Diseases (NICD) announced that they are stopping the production of daily reporting with regard to COVID-19.

This may well mean that my (mostly) daily estimates of the reproduction number of COVID-19 in South Africa may cease.  Given this I thought I'd take a look back on these calculations and how they started out.

(For the moment I will not discontinue other reports which still work.)

R estimates

These started more than two years ago when I published the first such estimates on my website (different domain back then). I've tracked down the first report that was published on the website and uploaded it here.

That was created on 12 June 2020.  It included the code generating the report which may have been useful for others wishing to follow the approach in detail but perhaps not as easy to read.

At that time the cumulative cases in SA was heading towards 100k.  The report contained the following graph by province (that included SA as a whole). This is a far cry from the 4m cases reported to date.

The actual R estimates were plotted in rather ugly charts like the one below.  Here you can see R based on cases increasing during May and remaining high until mid-June when the report was created.  Estimates based on death carried wider confidence intervals.  I should not have included those outliers early on in March.

I had been informally sharing the above calculations but started sharing them on Twitter in September I believe.  This is the earliest such thread I can find.  This one indicating that the R may be above one towards the end of September 2020.  

This proved to be a false start to the 2nd wave which would only start in November 2020.  This may have been because I was still using cases by reported date back then.

I have tried to automate much of the work as possible, so my dedication has been far less than others such as Sugan who have been doing much of the work on daily basis by hand.  Though early on I was manually capturing cases quite often but over time I managed to automate much of the work together with other people involved in this data project.

Work such as that enables the report to be update daily in a mostly automated fashion. Hopefully somewhat improved now compared to the early version mentioned above.

COVID-19 Models

Back then I was also looking at modelling COVID-19 and had uploaded the first draft version of my model on 31 May 2020 (actually predating my R estimates).  This was an early draft of a provincial model that I had based off the Imperial College of London's modelling in Italy (and later USA and Brazil).  I would update that model regularly (but certainly not daily) until the last version in July 2021.

The early version of the model was still very rough and I guess the biggest issue I have with it now is that I was using reported deaths which as we learnt was much lower than the true COVID-19 toll.  Luckily for me this early version of the model did not yet produce estimate of infections and deaths as they undoubtedly would have been wrong!

This work did however help me identify early issues in the modelling being done in South Africa.  A number of these models were applying infection fatality rates (IFRs) derived by Imperial College of London researchers inconsistently with the way the research team themselves were applying those estimates.   This resulted in underestimating of the impact of COVID-19 of these models (all other assumptions being equal).

That was a bit of a Cassandra complex moment for me.   With the correct application of those assumptions those models would have been much closer to the current death toll over 325,000 (as measured by excess deaths).

Having said all that, all the models were wrong.  Some were more useful than others though...

The other thing that has been most perplexing me the last two years is the ongoing spread of disinformation around COVID-19.  I have tried blow against the wind a bit, but it's a difficult and not exactly rewarding work.

Anyway it has been a very demanding and intellectually stimulating two years.  I've also made contact with many interesting and passionate people along the way. Clearly the world and in particular South Africa has gone through so much.  With more than 1-in-200 South Africans dying over the pandemic we all have been touched.  I hope the decision to stop reporting cases daily is not too hasty and indeed hope that we would not need to monitor things as closely going forward.

During November and December I had been quoted in various articles around the case growth in South Africa associated with Omicron.  I am learning just how volatile the process of journalism is (especially the UK ones).  I was asked for an interview for one of these but this came at a extremely busy time so I did not respond in time so an article was ran based on what I said on my tweets.  The others didn't reach out to my knowledge.

I'm just diarising these as this might be my 15 minutes, but it's maybe also a lesson in understanding how journalism works and doesn't work.

The Times (2 December 2021)

How serious is the Omicron variant? What we know as cases rise

We have three facts. There are three things that we know to be true. First, there is a new variant with troubling mutations. Second, that variant is now in many

The TimesTom Whipple, Science Editor | Rhys Blakely, Science Reporter

I was quoted as follows:

Louis Rossouw, a member of the Actuarial Society of South Africa’s Continuous Statistical Investigation Committee, calculated the reproduction rate in September — the one associated with Delta — to be 0.8. This meant that if ten people were infected they could pass it to eight: the pandemic shrunk. He calculated the R of Omicron to be above 2. Ten people were instead infecting 20.

The Telegraph (13 December 2021)

South Africa’s omicron Covid outbreaks may already be running out of steam

Country’s virus death rate now one in 200 – the lowest it has been throughout the pandemic and 10 times lower than last September

The TelegraphSarah Knapton,

I am quoted as follows:

Louis Rossouw, of the Covid-19 Actuaries Response Group in South Africa, said that although the country had surpassed the peak of previous waves some areas were beginning to see a lull.

"Case growth is steeper than last week but still has slowed down versus November," he said. "In Gauteng, cases are still levelling off. Tshwane cases are relatively flat, with a slight increase in the most recent days."

The article then highlights some of the milder severity observed in South Africa.  It should be noted though that this may well be from increased vaccination since the previous (mainly Delta) wave.  The implication is then that it's not clear to me that this would be to the benefit of the paper's UK audience who had already been vaccinated in the Delta wave.

Financial Times (10 December 2021)

Subscribe to read | Financial Times

News, analysis and comment from the Financial Times, the worldʼs leading global business publication

Financial TimesJohn Burn-Murdoch

So I wasn't really quoted in this, but I'm going to count it.  John Burn-Murdoch asked to use work I do to adjust cases before calculating R from them.  This was used in a graph in the above article and you would see me on the footnote of the graph.

Together with that John also followed and tweeted about my work to his considerable following (over 400k at the time of writing) which really exposed my work further and clearly increased my followers on Twitter tremendously.

As an example:

And also:

News24 (11 December 2021)

Kyle Cowan | Inside Omicron: Breathe, early evidence indicates variant may not be as bad as feared | News24

While work continues furiously to answer key questions over vaccine efficacy with the Omicron variant, early evidence suggests that while it still represents a threat, Omicron’s real-world impact may not be as bad as feared, writes Kyle Cowan.

news24Kyle Cowan

In this piece the mention me as follows:

The effective reproductive rate of infections in South Africa, is decreasing after a sharp increase to levels over three - which means that every infected person in theory passed the virus on to three others, according to research published online by Louis Rossouw, an actuary who is a member of the Actuaries Covid-19 Response Group. While still high, it is falling, as pointed out by demography professor, Tom Moultrie.

The share Tom's tweet:

The Express (14 December 2021 x2)

Covid relief: Omicron already ‘running out of steam’ in South Africa despite UK panic

SOUTH AFRICAN data suggests that the Omicron variant of coronavirus is already “running out of steam”, while the strain spreads rapidly in Britain.

Express.co.ukDylan Donnelly

Light at end of tunnel? South African Omicron outbreak already ‘levelling off’ – new data

SOUTH AFRICA’S Omicron wave may already have begun to “level off”, health experts in the country have reported.

Express.co.ukBill McLoughlin

They had a few issues in their piece.  The 2nd headline is not in line with reality at the time.  Cases in South Africa was climbing rather rapidly at the time and I had been showing it.  Only Gauteng appeared to be levelling off.

They write:

In Gauteng, cases have also begun cases are levelling off, Louis Rossouw, of the COVID-19 Actuaries Response Group in South Africa said.

He told The Daily Telegraph: "Case growth is steeper than last week but still has slowed down versus November.

"In Gauteng, cases are still levelling off.["]

"Tshwane cases are relatively flat, with a slight increase in the most recent days."

Note these are just tweets.  They did not speak to me.

The go on to quote Pieter Streicher that said:

"Omicron is extremely mild. The rest of the world has nothing to fear."

I clearly disagree with that and given Pieter's history as part of PANDA disinformation and anti-vax group the paper may have needed to look at that.

The Sun (14 December 2021)

Omicron map shows earliest hotspots as cases spread rapidly in weeks

A NEW map reveals some of the earliest places hit with the Omicron variant, which is now spreading rapidly in the UK. Hotspots have emerged, focused mostly in the South East and London. But it is N…

The SunVanessa Chalmers

I'm quoting along similar lines as other pieces as follows:

However, there is positive data coming from South Africa, which was first hit with the variant.

Cases in the hotspots of Gauteng province and the city of Tshwane appear to be stabilising, experts say.

"Case growth is steeper than last week but still has slowed down versus November," said Louis Rossouw, of the Covid-19 Actuaries Response Group in South Africa, according to The Telegraph.

"In Gauteng, cases are still levelling off. Tshwane cases are relatively flat, with a slight increase in the most recent days."

The Telegraph (14 December 2021):

Omicron likely to cause sharp rise in hospitalisations, warns Prof Chris Whitty

The Chief Medical Officer says there is no reliable evidence from South African scientists to show that Covid case rates have peaked

The TelegraphMaighna Nanu

In this piece CMO of UK is quoted:

Chris Whitty has warned the Cabinet to expect a “significant increase in hospitalisations” because of omicron, as he said that claims Covid-19 has peaked in South Africa were not “reliable”.

The Chief Medical Officer said it was “too early” to say if South African cases were reducing or plateauing, but cautioned that there was “no reliable evidence” from South African scientists to show that case rates had peaked.

I'm then placed in contrast to that (unbeknownst to me):

Louis Rossouw, of the Covid-19 Actuaries Response Group in South Africa, said that although the country had surpassed the peak of previous waves, some areas were beginning to see a lull.

“Case growth is steeper than last week but still has slowed down versus November,” he said.

This while cases continue growing rather rapidly outside these hotspots, and where there are data issues that could be clouding the case numbers in SA.

I actually agree with Whitty though:

But Professor Whitty argued that Britain could expect to see a “significant increase” in hospitalisations as cases of the omicron variant continued to rise.

He told the Cabinet that it was too early to say how severe omicron was, but confirmed its doubling time was two to three days.

Newsweek (15 December 2021)

Omicron COVID cases may already be peaking where outbreak first started

Shabir Madhi, professor of vaccinology, told Newsweek that the Omicron wave will likely peak quicker than previous waves because of the new variant’s increased transmissibility.

NewsweekJack Dutton

I'm quoted as follows:

Another scientist noted that the average number of new cases for the past seven days in Tshwane, one of the early epicenters in Gauteng, is now "relatively flat."

"Case growth is steeper than last week but still has slowed down versus November," Louis Rossouw, of the COVID-19 Actuaries Response Group in South Africa, told The Telegraph on Sunday. "In Gauteng, cases are still levelling off. Tshwane cases are relatively flat, with a slight increase in the most recent days."

Daily Mail (18 December 2021)

Omicron cases in South African ground zero ‘peaked on 6 December’

Three weeks after the start of the wave, cases of the variant reached their highest level in Gauteng, which was first to feel the full force of the variant.

Daily MailEmer Scully

The same piece was published in News Nation USA.

The headline of the piece is based on a tweet of mine on the same day. A screenshot of the tweet is provided in the article:

There is a bit of a mistake in the article.  You should be able to spot it below (Hint - compare with the headline):

After reaching a peak of 10,100 per day on December 7 on a seven-day moving average, cases are now around 8,000 per day, according to Louis Rossouw, who has written a scientific paper on the Omicron variant in the country.

MyBroadband (19 December 2021)

Health minister gives South Africa a lockdown-free Christmas — for now

Health minister Joe Phaahla reportedly convinced the coronavirus command council to keep South Africa on lockdown level 1.

MyBroadband LogoJan Vermeulen

This piece is mainly about the Health Minister of South Africa, Joe Phaahla's decision not implement further lockdown measures before Christmas.

It includes this:

Actuarial scientist Louis Rossouw concurred, saying that cases in Mpumalanga, Limpopo, and the North West are slowing, but are still growing in other provinces.

Rossouw’s calculations also showed that the Covid–19 reproduction number in South Africa has declined to a range of 1.13 – 1.24.

MyBroadband (23 December 2021)

Covid-19 booster shot rollout approved in South Africa — when you can get it

The Department of Health has approved the implementation of Covid-19 vaccine booster doses in South Africa.

MyBroadband LogoBradley Prior

I'm quoted as follows:

Actuarial scientist Louis Rossouw added that the 7-day moving average of Covid-19 cases peaked on 12 December at around 22,000 cases per day.

Le Monde (24 December 2021)

Covid-19 : ce que l’on sait à ce stade du variant Omicron

Très contagieux, d’une dangerosité incertaine, répondant moins aux vaccins et à la plupart des médicaments disponibles, mal suivi par les tests : le portrait-robot de ce nouveau variant commence à se préciser.

Le MondeFlorence Rosier(avec Zeliha Chaffin et Catherine Mary)

I was also interviewed for a piece in Le Monde.  I don't have the quotes as it's behind a paywall.  

BizNews (24 December 2021)

I'm not linking to this site as it provided a platform for PANDA disinformation. It is a copy-paste from the MyBroadband piece of 23 December (see above).  They reference the original article but reproduce it word for word.

Other Foreign Language Pieces

TinTuc (Vietnam)

Nouvelles de Covid: Omicron se ‘stabilise’ en Afrique du Sud - Javid émet une alerte extrême | Monde | Des nouvelles

Au milieu des informations selon lesquelles la variante infecterait 200 000 personnes par jour sur la modélisation britannique actuelle, des experts de la

Marseille NewsMarseille News

The above appears similar to the Daily Express piece?

Việt Nam bàn giao hài cốt quân nhân Mỹ mất tích trong chiến tranh; Tin ‘lạ’ ở nơi sản sinh Omicron

Tình hình thế giới ngày 14/12 có nhiều diễn biến mới đáng chú ý.

soha.vnBan Quốc tế

The Bizarre

There was a strange piece that pulled a chart from a district in SA with very few cases and called it the most infectious place in SA.  It had a number of factual errors etc.  Not linking to it.

Pandemic Data Analytics (PANDA) has recently shared a series of "infobites" that aim to "spread facts not fear".  In a series of posts I show that most of these posts are misleading, wrong and/or unsubstantiated and that these are spreading falsehoods not facts.  It feels useful to address the more subjective theme of the series around "courage" and "fear" as a way to summarise the series of posts I created.

In the series, they quote Nelson Mandela and I give the full quote as shared by the Nelson Mandela Foundation:

I learned that courage was not the absence of fear, but the triumph over it. I felt fear myself more times than I can remember, but I hid it behind a mask of boldness. The brave man is not he who does not feel afraid, but he who conquers that fear.

This is a great quote of a person that exposed himself to real personal danger in the search of equality for all people in South Africa.

PANDA in this series of "infobites" but also more generally:

1. Incorrectly downplay the risks associated with COVID-19 by understating the infection fatality rates, asymptomatic spread and stating that few are susceptible.  
2. Incorrectly downplay the effectiveness of the interventions such as lockdowns, masks and vaccines and state that only the "vulnerable" need to be protected without clearly identifying how these vulnerable can be identified and protected.
3. Incorrectly question the safety of some of these interventions.

PANDA is suggesting that the "fear" of COVID-19 is worse than the risks of the actual disease.  And that "courage" and "facts" can overcome this.

This is problematic on a number of levels:

• It's grounded in falsehoods and misleading information.  I've created a series of posts on this website to show this and link to some of them above.
• The COVID-19 pandemic has killed many people around the globe.  It is nearly 5m by official counts but likely multiples more based on excess deaths.  So this is not about managing "fear" but about trying to save people from illness and death.
• Emotional words such as "fear" and "courage" is not the right way to frame discussion around the facts of COVID-19 and how to best manage the risks around that, either on an individual, organisational or country level.

A better, and certainly more objective, word for "fear" in this context is really uncertainty.  COVID-19 has significant uncertainty attached to it.  There is the uncertainty related to the disease on a personal level around our personal risk and how we manage that but also at a higher level around what is the risk to others in our community and countries and how we manage that.  

My view is that PANDA is doing exactly the opposite to what Mandela encouraged us to do.  They are dismissing others that are being mindful of very real risks of COVID-19 as being filled with "fear" and "panic". Mandela does not go into exactly how we "conquer" these uncertainties, in this quote, but I am reasonably sure dismissing these based on falsehoods was not on his mind.

A better way may be to:

1. Objectively reviewing the data and facts as much as possible.
2. Clarifying the extent of any remaining uncertainty and considering the potential outcomes given the uncertainty.
3. Making decisions based on the facts as well as attempt to mitigate the worse potential outcomes given the uncertainty.

In my view the COVID-19 Actuaries Response Group's goals were really to focus on points 1 and 2 with an aim to assist all of us to make the right decisions.

The above approach does mean that some decisions may appear over-cautious in retrospect, when clarity emerges, but we should realise that such cautious approaches were adopted to manage the uncertainty we faced at earlier times.  It should also be noted that, given the millions that have died already, we likely have not been cautious enough.

For me an approach that is based on objective assessment of data and facts, and sensitive to the risks of getting it wrong, would be conquering the uncertain in a constructive way.  This may also assist managing some of our fears by giving us a courage to continue with our lives while not exposing ourselves and our communities to undue risk.

In a blog for the COVID-19 Actuaries Response Group I cover new research on the infection fatality rate of COVID-19 in developing countries and it's potential implications for understanding the pandemic in such countries.

The Infection Fatality Rate in Developing Countries - COVID-19 Actuaries Response Group

The COVID-19 infection fatality rate (IFR) is the proportion of people infected with the virus that die. It’s a simple ratio of deaths to infections that has been surprisingly difficult to pin down. It’s also a key to understanding the impact of the pandemic and narrowing down estimates for its futu…

COVID-19 Actuaries Response GroupLouis Rossouw

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear". Here I address these and show how they are misrepresenting facts.  Number 10/13 addresses Emergency Use Authorisation (EUA)  of COVID-19 vaccines.

Before we start off with discussing EUA the first point to note is that the first vaccines are being unconditionally approved.  Pfizer' s vaccine has been fully approved by the FDA in the US.  So, for Pfizer, the whole discussion of EUA is irrelevant.

Claim 1

PANDA claims this:

Conditions for EUA of Vaccines:
1. The disease caused by the virus is life-threatening
2. There is no treatment for the disease

The refer to a document released by the following:

• U.S. Department of Health and Human Services
• Food and Drug Administration
• Center for Biologics Evaluation and Research

These are governmental bodies in the United States and do not regulate vaccines outside the United States.  These are not relevant for the rest of the world.  Let's look at their requirements anyway.  The full version is this:

1. The chemical, biological, radiological, or nuclear (CBRN) agent referred to in the March 27, 2020 EUA declaration by the Secretary of HHS (SARS-CoV-2) can cause a serious or life-threatening disease or condition.
2. Based on the totality of scientific evidence available, including data from adequate and well-controlled trials, if available, it is reasonable to believe that the product may be effective to prevent, diagnose, or treat such serious or life-threatening disease or condition that can be caused by SARS-CoV-2.
3. The known and potential benefits of the product, when used to diagnose, prevent, or treat the identified serious or life-threatening disease or condition, outweigh the known and potential risks of the product.
4. There is no adequate, approved, and available alternative to the product for diagnosing, preventing, or treating the disease or condition.

PANDA leaves out points 2 and 3.  These points establish that the vaccines have to be evidenced to be effective and safe to receive EUA.

Claim 2

Firstly PANDA claims that:

COVID-19 has serious health consequences for a small high-risk group.

They do not provide evidence for that and as already established COVID-19 kills many people across age ranges, and in varying degree of health.  Identifying this "high-risk group" is not possible and PANDA does not identify it either. Everyone is at risk. Furthermore the disease spreads as well.  So even if you have milder COVID-19 you can still infect others.

PANDA goes on:

Life saving treatment protocols, using safe and effective drugs (eg. Ivermectin), have been available since August 2020. Unfortunately, they are being suppressed and even banned.

They refer to a paper on these protocols.  PANDA refers to this paper in other "infobites"  too but this is the first one where it may be relevant. The paper is from August 2020 (again a little dated given how rapid research is evolving).

This is not evidence for a particular treatment protocol.  From the abstract:

1. The rapid spread of the virus has "has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital".
2. "In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death."   They go on to list these principles.
3. They then state that "future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles".

I interpret the above as saying that we don' t have much data yet, so we must go on to first principles when thinking about treatment outside the hospital. Future randomised trials will give us the data we need to understand and improve upon this.  Basically this:

The paper does list various treatment including hydroxychloroquine (but not ivermectin). However, given the above framing of the paper it should be clear that once evidence is collected these treatments may need to be revised. The WHO sets out why hydroxychloroquine is not used in treatment of COVID-19 and why it was stopped in a trial:

Data from Solidarity (including the French Discovery trial data) and the recently announced results from the UK's Recovery trial both showed that hydroxychloroquine does not result in the reduction of mortality of hospitalised COVID-19 patients, when compared with standard of care.

Ivermectin has not been approved by SAHPRA (South African regulator) or the FDA (US regulator)  for treatment of COVID-19.  The FDA tweeted about it:

Much of the research behind ivermectin has been lacking with papers being withdrawn and/or the data behind the studies found to be manipulated or faked. Gideon Meyerowitz-Katz has done a brilliant 5-part series on the all the fraud he has found in ivermectin studies ( Part 1, Part 2, Part 3, Part 4, & Part 5).  Part 5 concludes that:

While it is plausible that ivermectin has some use against Covid-19, the staggering scale of the fraud has made it almost impossible to say anything for certain, except that people rarely fake trials for effective drugs.

There are proper guidelines on managing COVID-19 that are up to date.  For example this is issued by the National Institute of Health in the US or this by the NICD.  

Claim 3

PANDA then summarises:

The EUA conditions are thus not met and the vaccines do not qualify for EUA. They require further study in controlled clinical trials. The results  should be replicated by independent scientists, before the vaccines are offered to the high-risk group.

Based on the above this is clearly wrong.  

1. COVID-19 is a serious or life-threatening disease or condition.
2. Vaccines are effective at preventing severe disease and also reducing transmission.
3. Vaccines are safe with vary rare serious side-effects.
4. Prevention is still better than treatment.

You can find more in this series of posts here.

I recently wrote a post for the COVID-19 Actuaries Response Group about some of the implications of COVID-19 for the life insurance industry? How is managing a life insurer in a pandemic not akin to selling home and car insurance in the middle of a hailstorm?

Details below:

Life Insurance in a Pandemic - COVID-19 Actuaries Response Group

South Africa has seen one of the highest burdens of excess deaths globally during the COVID-19 pandemic. It is estimated (by MRC and UCT researchers) there have been more than 260,000 excess natural deaths since the start of the epidemic up to 18 September 2021. This measures the excess of all regis…

COVID-19 Actuaries Response GroupLouis Rossouw

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear". Here I address these and show how they are misrepresenting facts.  Number 2/13 addresses mortality.  

Claim 1

PANDA claims that:

COVID-19 is dangerous for the very old,  yet, the median age of death with COVID-19 is similar to that of natural mortality in most countries.

The point of the statement is unclear.  If the median age of death is similar between COVID-19 and mortality due to other causes what it means is that it affects mortality roughly proportionally across the age range.  I.e. it affects mortality consistently across the age range and thus does not change the age distribution of deaths.  

Claim 2

PANDA then claims:

Children and young people have almost zero risk of death from COVID. 99.95% of individuals below 70 survive if infected.

The 99.95% of individuals below 70 survive (or 0.05% die)  is kind of difficult to fathom.  They source it from a paper by Ioannidis (dated September 2020).  In this paper he states:

In people younger than 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%.

Several commentators have been pointing out problems with Ioannidis work on COVID-19.  This review provides  a good overview of his work and the many problems encountered with it.

However, PANDA's own linked source in this paper points out that median age of death in South Africa is 62.  That means half of all deaths are below 62.  South Africa also has an excess death rate 0.44% of the population.  The researchers behind that number believe the vast majority of those deaths to be due to COVID-19.  So a bear minimum average COVID-19 fatality rate should be roughly 0.40%. South Africa has a pretty young population 96% of our population is under 70.  There is no way mathematically for the median age of death to be 62 and the probability of survival under 70 to be 99.95%.  The median age of death ties up to the data, so clearly the 99.95% is wrong.

If we use studies like Levin et al. (2020) and South Africa's age distribution the fatality rate is probably 0.13% under 70, but these estimates are probably too low still.  A more recent preprint by Levin et al. (2021) puts that number even 1.3x to 2.5x higher.

Claim 3

PANDA then claims that

Survival is even higher for healthy individuals. 95% of deaths occur with one or more serious health problems.

They cite this article that points out that 94.9% of people that were hospitalised had at least one co-morbidity.  These were classified by codes found in the data (and not necessarily by severity).  The paper goes on to state that:

The percentage of the US adult population known to have 2 or more underlying medical conditions ranges from approximately 38% to 64% by state

So it's hardly a small sub-sample of the population.  How do you protect such a large portion of the population?

Claims 4

PANDA goes on to state that:

Lockdowns failed to protect the vulnerable and caused immense collateral damage, particularly  to the young and the poor. Resources should be focused on protecting ONLY the high-risk group (mostly people above 50, with other health problems). The rest can live normally.

Now they do not give any references for any of that apart from pointers to generic information on their own website and another website similar to this.  

I do think there has been impact on the economy and brought about by COVID-19 and the measures to control it, but, the authors don't show that it cost more lives than otherwise would have been lost to the disease.  It is also not clear how (or why) they want to focus resources on people above 50 with other health problems.  Many countries including South Africa have multigenerational households.  How are we supposed to protect those individuals while the other "live normally".  It's simply impossible.

You can find more in this series of posts here.

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear".  Here I address these and show how they are misrepresenting facts.  Number 7/13 addresses masks.

Claim 1

PANDA starts off by saying that:

Numerous conflicting messages about masks were issued to the public by health authorities.

I tend to agree with them here but only early in the pandemic.  Early in 2020 Fauci did not think everyone needed to wear masks but he walked that back.  He is quoted as saying:

We were not aware that 40 to 45% of people were asymptomatic, nor were we aware that a substantial proportion of people who get infected get infected from people who are without symptoms. That makes it overwhelmingly important for everyone to wear a mask.

In 2021 it should be very clear that mask wearing is useful in reducing COVID-19 transmission.

Claim 2

PANDA then says:

The CDC published a meta-analysis in May 2020 stating, “We did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission”.

1. This is an article in a journal (Emerging Infectious Diseases) published by the CDC.  It's not the opinion of CDC but that of the authors Xiao et al. (2020).  This confuses PANDA to no end.
2. The researchers are not even investigating COVID-19 but flu.  

Claim 3

PANDA then claims:

The WHO published Interim guidance in June 2020 stating “At present, there is no direct evidence on the effectiveness of universal masking of healthy people in the community”.

The quote is paraphrased but broadly accurate in the source.  The exact quote is this:

At present, there is no direct evidence (from studies on COVID19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19

What's wrong is that the quote is not the interim guidance.  The WHO guidance on masking for the healthy is this:

However, taking into account the available studies evaluating pre- and asymptomatic transmission, a growing compendium of observational evidence on the use of masks by the general public in several countries, individual values and preferences, as well as the difficulty of physical distancing in many contexts, WHO has updated its guidance to advise that to prevent COVID-19 transmission effectively in areas of community transmission, governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission.

So the source quoted by PANDA actually recommends masking in areas of community transmission.  They also recommend for people with COVID-19 or those taking care of people with COVID-19.

Claim 4

PANDA quotes Dr. Fauci

The typical mask you buy in the drug store is not really effective in keeping out virus, which is small enough to pass through the material.

AP did a fact check on this that explains it.  Essentially they conclude that the quote is from February 2020 from a released email of Dr. Fauci.  So it comes from a time where very little was known.  They then show that:

In February and March 2020, Fauci advised the public against wearing masks, but later updated his position, noting masks are essential to help curb the outbreak.

So he updated his views as more data became available.

Claim 5

PANDA then claims:

The data shows mask mandates don’t reduce viral spread.

The data in this case is a single preprint paper based on observational data.  The paper appears to be published now so we refer to that.

The conclusion is:

We did not observe association between mask mandates or use and reduced COVID-19 spread in US states. COVID-19 mitigation requires further research and use of existing efficacious strategies, most notably vaccination.

This study didn't find an observed association.  It's not clear that they controlled for all confounders.  We also have several other studies that find the opposite:

Cheng et al. (2021) conclude that:

On the basis of direct measurements of SARS-CoV-2 in air samples and population-level infection probabilities, we find that the virus abundance in most environments is sufficiently low for masks to be effective in reducing airborne transmission.

Abaluck et al. (2021) (preprint) in a large randomised trial establishes:

A randomized-trial of community-level mask promotion in rural Bangladesh during COVID-19 shows that the intervention tripled mask usage and reduced symptomatic SARS-CoV-2 infections, demonstrating that promoting community mask-wearing can improve public health.

In a review Howard et. al (2021) find that:

The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts.

Brooks and Butler (2021) also review the work out there an conclude:

An increasing number of ecological studies have also provided persuasive evidence that universal mandatory mask wearing policies have been associated with reductions in the number or rate of infections and deaths .

PANDA is wrong again.

You can find more in this series of posts here.

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear".  Here I address these and show how they are misrepresenting facts.  Number 11/13 addresses COVID-19 Vaccines.

Claim 1

PANDA state that:

COVID-19 vaccines may be offered to high-risk individuals (mostly people above 50, with other health problems) who are not recovered from COVID only when the benefits of the vaccines clearly outweigh their risks for the individual. Their informed consent is essential.

This statement is strange as the article they link to does not identify high risk groups.  The second article is just another PANDA opinion piece so somewhat self-referential.  

There is no material provided that identifies clearly for which individuals PANDA feels the risks outweigh the benefits.  If they have such data (which I doubt), they should reference it with this infographic. Given that COVID-19 can lead to serious disease and death at all ages and perhaps because of the well established safety of vaccines this evidence is not easy to find...

Claim 2

PANDA then claim that:

There is an alarming signal in the adverse events reporting systems around the world of serious adverse events, following COVID-19 vaccination, particularly myocarditis in the young. Immediate action must be taken to prevent greater harm.

They link to reporting based on VAERS data.  Vaccine Adverse Event Reporting System (VAERS) is a US system to report vaccine related adverse events.

On the official VAERS website they state:

A report to VAERS generally does not prove that the identified vaccine(s) caused the adverse event described. It only confirms that the reported event occurred sometime after vaccine was given. No proof that the event was caused by the vaccine is required in order for VAERS to accept the report. VAERS accepts all reports without judging whether the event was caused by the vaccine.

So VAERS reporting does not indicate causation and is not verified. This twitter account shares some of the VAERS reporting that illustrates this point:

Any work based on VAERS reporting needs lots of review of the cases to separate them out.   Most alarmist reviews, such as those shared on the site PANDA links to, do not review the data in any detail and thus counts reports such as the above in their adverse outcomes, massively overstating the risks.

It is a little strange because PANDA actually links to CDC page that clarifies all of the above but they fail to reflect that on their infographic.  The article they link to contains the following information:

- COVID-19 vaccines are safe and effective.
- Millions of people in the United States have received COVID-19 vaccines under the most intense safety monitoring in U.S. history.
- CDC recommends everyone 12 years and older get vaccinated as soon as possible to help protect against COVID-19 and the related, potentially severe complications that can occur.
...
- VAERS accepts reports of any adverse event following any vaccination.
- Reports of adverse events to VAERS following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem.

They go on to state that:

• Anaphylaxis after COVID-19 vaccination is rare.
• Thrombosis with thrombocytopenia syndrome (TTS) after Johnson & Johnson’s Janssen (J&J/Janssen) COVID-19 vaccination is rare.
• The mention rare cases of Guillain-Barré Syndrome.
• Myocarditis and pericarditis after COVID-19 vaccination are rare.

On deaths they state that:

Reports of death after COVID-19 vaccination are rare. More than 403 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through October 6, 2021. During this time, VAERS received 8,638 reports of death (0.0021%) among people who received a COVID-19 vaccine. FDA requires healthcare providers to report any death after COVID-19 vaccination to VAERS, even if it’s unclear whether the vaccine was the cause. Reports of adverse events to VAERS following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem. A review of available clinical information, including death certificates, autopsy, and medical records, has not established a causal link to COVID-19 vaccines. However, recent reports indicate a plausible causal relationship between the J&J/Janssen COVID-19 Vaccine and TTS, a rare and serious adverse event—blood clots with low platelets—which has caused deaths.

The linked report mentions 3 deaths.

In the CDC report PANDA links to on myocarditis in the young the CDC concludes that:

CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older given the risk of COVID-19 illness and related, possibly severe complications, such as long-term health problems, hospitalization, and even death.

Claim 3

PANDA then goes on to state that:

For the following low-risk groups, the vaccine risks outweigh their benefits- vaccinating these groups will increase total harm

They then list these groups:

1. Children & young people
2. Individuals with past SARS-CoV-2 infection (including asymptomatic infection)
3. Individuals below 60 with no existing health problems
4. Risk to the foetus and breastfeeding infant from the vaccination of their mother cannot be determined yet.

They do not provide any evidence of the fact that risks outweigh the harm.  In fact the evidence they do link to under previous claim explicitly supports continued vaccination due to the rare risks of the vaccines and the severe impact of having COVID-19 could have..

In South Africa roughly half of deaths occurs below 60 as was pointed out by PANDA linked sources. It would seem to be ignoring the risks of COVID-19 to use 60 as a cut-off then?  There have also been deaths in South Africa in children.

Studies on vaccines in children over 12 show they are safe and effective.

This article also summarises the benefits of getting vaccinated even if one were previously infected.  It comes down to:

• Vaccination offers a boost to your immunity from infection.
• Vaccination offers a more consistent antibody response that does not vary as much as natural immunity varies from person to person.

CDC recommends women who are pregnant get vaccinated due to the increased risk COVID-19 presents to pregnant women and because vaccines have been found safe and effective for pregnant women.  They also do so for those that are breastfeeding and refer to reports that antibodies may get passed along the child and thus also protect the child.

You can find more in this series of posts here.

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear". Here I address these and show how they are misrepresenting facts.  Number 4/13 addresses asymptomatic spread of the virus.

Claim 1

PANDA quote Dr. Fauci:

In all the history of respiratory-born viruses of any type, asymptomatic transmission has never been the driver of outbreaks. The driver of outbreaks is always a symptomatic person.

They point to a source that essentially just has that quote but a source that gives the context is more useful.  It starts at 43:58.  He says firstly they'd like to see data that confirm asymptomatic transmission and then goes on to state the quote above.

Dr. Fauci later updates his estimates.  In August 2020 he is quoted as saying:

Whereas when you have community spread, it's insidious. There are people who are spreading it who have no symptoms at all, and we know that definitely occurs. It's difficult to identify it, and it's difficult to do identification, isolation and contact tracing.

So clearly there had been updated information, but, PANDA insist on quoting Fauci's comments from January 2020. So technically they are correct, but this is very misleading as Fauci had updated his assessment as more information became available.  

Claim 2

PANDA then says:

A systematic review and meta-analysis from 2020 showed that  asymptomatic spread is not a key driver of disease. Asymptomatic ‘cases’ transmit a very low viral load, facilitating population inoculation, which is protective, rather than causing severe disease.

They refer to this article which states that:

Estimated mean household secondary attack rate from symptomatic index cases (18.0%; 95% CI, 14.2%-22.1%) was significantly higher than from asymptomatic or presymptomatic index cases (0.7%; 95% CI, 0%-4.9%; P < .001), although there were few studies in the latter group. These findings are consistent with other household studies^28,70 reporting asymptomatic index cases as having limited role in household transmission.

A later study from January 2021 concluded that:

In this decision analytical model of multiple scenarios of proportions of asymptomatic individuals with COVID-19 and infectious periods, transmission from asymptomatic individuals was estimated to account for more than half of all transmissions.

This piece summarises multiple studies as follows:

All of these studies agree that AIC transmit SARS-COV2 to contacts, although to a somewhat lesser extent than SIC.

Not clear what a key driver would be but definitely important enough for many to study it.

The article referenced by PANDA does not support the statement that "asymptomatic ‘cases’ transmit a very low viral load, facilitating population inoculation, which is protective, rather than causing severe disease." They need to reference that if they believe it to be true.

Claim 3

PANDA then claims:

Testing and quarantining healthy people and preventing them from working or travelling is unscientific and must end.

This is clearly not supported by the evidence.  It makes sense that testing and quarantining those that are infected (even without symptoms) can protect others because they can transmit the virus as confirmed by:

• Dr. Fauci himself.
• The article linked to by PANDA.
• And other studies.

You can find more in this series of posts here.

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear".

Here I address these and show how they are misrepresenting facts.  Number 2/13 addresses fatality rates.

Claim 1

PANDA quotes Dr. Fauci as saying the following:

The consequences of COVID-19 may ultimately be more akin to those of a severe seasonal influenza

The quote is not 100% accurate, and is taken out of context (and unreferenced).  It comes from this article (from back in March 2020).  The article heading is "Covid-19 — Navigating the Uncharted" and is about the uncertainty surrounding COVID-19 at that early stage.  The full quote is this:

If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.

Note the "If one assumes".  At this stage much was uncertain about COVID-19 and the articles only expresses the view that it could be as mild as influenza if one assumes that there are many asymptomatic or mild cases.  And it's from March 2020, so very out of date.

So PANDA are taking this out of context and presenting it as a certain statement though it clearly was an early comment during a time of great uncertainty (and appropriately commented as such).  

Claim 2

PANDA claims that:

In March 2020, the WHO claimed mortality from COVID-19 = 3.4%. This represents deaths among cases, which then included only high-risk individuals in hospitals, with a higher risk of death than most.

They refer to a March 2020 (why with all the old articles?) speech by the WHO Director-General.

He says:

The second major difference is that COVID-19 causes more severe disease than seasonal influenza.

And goes on to say this:

Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected.

We cannot really compare the case fatality rate (3.4%) with the infection fatality rate of fewer than 1% but at this stage very early on data.  However the general point remains correct.  COVID-19 is more severe (see below) than influenza.

Claim 3

PANDA claims that:

Yet, if infected, the average mortality with COVID is similar to the flu at around 0.15%, globally.

They referenced an article by Ioannidis.  This article is dated March 2021.  And was published in European Journal of Clinical Investigation.  Ioannidis is the previous editor of that journal.  Note also Ioannidis does not state that the infection fatality rate of COVID-19 is similar to flu.

It's quite difficult to come up with global infection fatality rate as deaths in many countries are underreported (including South Africa).  Similarly infections are not reported and there are limited seroprevalence studies.

Additionally other researchers have estimated far higher infection fatality rates than this piece for example, Verity et al. (2020) and Levin et al. (2020).  

Indeed Ioannidis makes some attacks on the authors of the Levin et al. piece in his paper.

A recent preprint by Levin et al. (2021) also points out that in developing countries the infection fatality rate is even higher.

In South Africa we have an excess death rate 0.44% of the population.  The researchers behind that number believe the vast majority of those deaths to be due to COVID-19.  So, even if we assume everyone in South Africa had been infected we should get a infection fatality rate of close to 0.44% in South Africa.  In reality it's unlikely that everyone has been infected so the infection fatality rate in South Africa is probably higher.

So Ioannidis estimates appear to be problematic.  He has been underestimating the impact of COVID-19 since early in the pandemic (when he estimated that only 10,000 deaths may occur in the US, similar to PANDA's estimate of only 10,000 deaths in South Africa).

Several commentators have been commenting on this bias but this review provides  a good overview of Ioannidis work during the pandemic and the many problems encountered with it.

So clearly claim 3 is also wrong...

Though a single infection of COVID-19 is clearly not as severe as that of Ebola, COVID-19 has spread around the world and has resulted in many many deaths.

You can find more in this series of posts here.

Recently Pandemic Data Analysis (PANDA) has started spreading "infobites" under the heading "Facts Not Fear".

Here I address these and show how they are misrepresenting facts.

Lets start with 1/13:

The image does not provide references to these claims, but at least their website has a bit more details about what they are referring to.

Claim 1

For the first claim they refer to to work done by Imperial College of London Researchers in March 2020 and later published in Science.

Now we all know there are issues with modelling and we cannot accurately predict the course of the pandemic but what the researchers say is this:

We estimate that in the absence of interventions, COVID-19 would have resulted in 7.0 billion infections and 40 million deaths globally this year.

Note the bit I made bold: "in the absence of interventions". The modelling done is assuming we don't have interventions (e.g. lockdowns, masks, social distancing etc.) and people continue behaving as is.  Thus it is a somewhat theoretical model as even if no laws were past, it would seem likely that behaviour would change if lots of people start dying in various countries.

These models were also then "wrong" about the ultimate outcome because countries chose to implement measures to reduce the death toll.

But, if you look at the projections made in this report for South Africa under the "no mitigation" scenario they predicted 216,000 deaths.  Excess deaths in South Africa now are at over 260,000.  The researchers estimating excess deaths expect 85%-95% of these deaths to be due to COVID-19.  So the model is actually correct for South Africa and, strangely we suspect the following prediction seems then somewhat prophetic.

Mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population) could reduce this burden by half, saving 20 million lives, but we predict that even in this scenario, health systems in all countries will be quickly overwhelmed. This effect is likely to be most severe in lower income settings where capacity is lowest: our mitigated scenarios lead to peak demand for critical care beds in a typical low-income setting outstripping supply by a factor of 25, in contrast to a typical high-income setting where this factor is 7. As a result, we anticipate that the true burden in low income settings pursuing mitigation strategies could be substantially higher than reflected in these estimates.

These models were clearly not perfect, but they provided a useful framework for decision making as opposed the PANDA "models" predicting 10,000 deaths in South Africa with no assumptions or details.

The Economist also estimates that worldwide excess deaths during the pandemic are between 10m and 19m (as at 16 October 2021) with the pandemic still continuing perhaps given some credence to the 40m estimate too.

Claim 2

PANDA claims that:

Up to 80% of people have prior immunity from exposure to closely-related coronaviruses, protecting them from serious illness.

They reference this preprint (unreviewed paper) posted in April 2021.  Given that the paper has since been published in Science we will refer to the published paper as opposed to the preprint.  We'd suggest PANDA do the same.

First we need to define "immunity" because it doesn't technically mean what we think it means.  I found this article to be useful in understanding a about how immunologists think about immunity.  This paragraph explains:

Even the word immunity creates confusion. When immunologists use it, they simply mean that the immune system has responded to a pathogen—for example, by producing antibodies or mustering defensive cells. When everyone else uses the term, they mean (and hope) that they are protected from infection—that they are immune. But, annoyingly, an immune response doesn’t necessarily provide immunity in this colloquial sense. It all depends on how effective, numerous, and durable those antibodies and cells are.

The 80% quoted appears in the text of the paper and refers to the prevalence of T-cells that were reactive to a particular coronaviruses (pre-dating SARS-CoV-2)

The paper then concludes that:

Preexisting cross-reactive CD4+ T cells enhance immune responses in SARS-CoV-2 infection and BNT162b2 vaccination. Because these cells are greatly diminished in the elderly, our results suggest that their decrease may contribute to the increased susceptibility of this population to severe COVID-19. Preexisting cross-reactive immunity may be responsible for the unexpectedly rapid induction of protective immunity after primary SARS-CoV-2 immunization and the high rate of asymptomatic and mild COVID-19 disease courses.

In this context this says is that exposure to other coronaviruses would allow our immune system to respond quicker to infection from SARS-CoV-2 virus or indeed a vaccine.  It may explain some of the milder/asymptomatic disease of COVID-19.

So technically PANDA is stating it correctly but immunity here doesn't mean not at risk of infection.  It just means your system can respond to the disease quicker and may have less severe outcome.  

The paper just explains the variation between individuals and makes not statement about the risk of COVID-19 to people in general.

Claim 3

PANDA claims:

In March 2020, the Diamond Princess ship data showed that only a small section of the population is at risk of serious illness from SARS-CoV-2.

The article referenced describes the outbreak on the Diamond Princess, one of the cruise ships that struggled with COVID-19 outbreak early in the pandemic.  So the first point is that the information being used here dates from March 2020 and clearly our understanding of COVID-19 has moved on since then.

Nevertheless, the article shows that 5.9% of passengers and 1.9% of crew tested positive.  This sounds low, but we should note the following:

• Passengers were older than the crew and the article notes that increasing percentage of people tested positive at older ages.
• The symptoms for the first known case started 22 January 2020.
• From 5 February 2020 passengers and crew were isolated in their cabins.  The article notes that "on this date, all passengers were also isolated in their cabins and internal air re-circulation was stopped to reduce the possible risk of airborne transmission."
• The paper only considered confirmed cases up to 9 February 2020.

To use this as an example of how many people in a general population would be at risk is therefore clearly wrong.  It would only be useful if you were able to confine the whole population of a country to their "cabins" and stop "air re-circulation". I.e. the ship went into full lockdown and stopped the spread of cases.  So we cannot tell what proportion of the people onboard were susceptible.  Even if we could it would seem unlikely that the experience on a cruise ship could be extrapolated to the population of South Africa for example.

Also it seems likely that not all cases were picked up by the researchers as more people could ultimately be infected.

Thus the study shows that lockdown on a ship worked.  Somewhat contrary to the general claims being made by PANDA in other pieces.

You can find more in this series of posts here.