There is now strong evidence that obesity and vitamin D deficiency are serious risk factors for COVID-19.

https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13128

https://cardiologyres.org/index.php/Cardiologyres/article/vi...

https://www.mdpi.com/2072-6643/12/9/2757

This doesn't pan out when children have developed severe inflammatory responses, young adults have died, and not all people with comorbidities have had severe reactions. You can't just say it's fat and/or old people who are having severe symptoms or dying.

We have to look at the bigger statistics. Some young children die of many things that the vast majority of them easily survive, but that doesn't mean we need to lock down every flu season.

Flu is harder to transmit and there is vaccine infrastructure available every year, despite that, it can still be very severe. Let's add a coronavirus with potentially greater severity than a flu, which has no vaccine, and has easier transmission, with a severe flu season this year and just watch the bodies pile up.

> with a severe flu season this year and just watch the bodies pile up.

There is no evidence of this and you are continually creating worst-case scenarios.

Please stop.

Do you know that this year will not be a difficult flu season? Do you know the ramifications of combined flu and COVID-19 infection?

If the flu season is severe, then it could be quite catastrophic when combined with COVID-19. We should definitely be preparing for worst-case scenarios, and not downplaying potential severity because it's inconvenient.

Influenza and Noro/Calicivirus (Winter vomiting disease) stats for Sweden this year. Social distancing and increased hygiene measures implemented mid March, about week 11, killed them off much earlier than usual.

Influenza: https://www.folkhalsomyndigheten.se/globalassets/statistik-u...

Calicivirus (Vinter vomiting disease): https://www.folkhalsomyndigheten.se/contentassets/0ad710ef37...

Technically that was "last flu season", not the upcoming flu season, and it was relatively mild. It is hard to predict if 2020-2021 will be similar, or 2017 levels, or 2009 levels. At minimum it will add more strain to medical services.

It shows that "okay" measures against COVID are strong enough to push the R_eff value for those viruses well below 1, unless something extraordinary happens. I.e. no extra strain for medical services.

As said, this hinges on social distancing and hygiene measures being kept enforced. If you open a country fully again and get two simultaneous peaks then you are in for a bad time.

I think we're on the same page here. My catastrophic scenario involved no mitigation steps and removal of lockdown. The goal was to dissuade people from thinking since things are "fine/better" right now, lockdown/mitigation is not needed anymore. We still need to get through this winter, and on to a vaccine.

"The southern hemisphere skipped flu season in 2020, Efforts to stop covid-19 have had at least one welcome side-effect"

https://www.economist.com/graphic-detail/2020/09/12/the-sout...

My point to jaywalk was that combined COVID-19 + severe flu w/o mitigations like a lockdown, could be catastrophic. Their post was anti-lockdown comparing COVID-19 to flu.

I am not surprised that measures to avoid COVID-19 also reduces the spread of flu.

I wonder whether skipping flu season is alike fire suppression in forests. When, not if, it eventually burns, it'll be that much more devastating.

>This doesn't pan out when children have developed severe inflammatory responses, young adults have died, and not all people with comorbidities have had severe reactions

How many millions has covid infected thus far? It would be concerning if it hadn't killed a couple healthy kids and not killed a couple obese old people.

It's not "a couple", there's been about 105 child deaths, and 4600 child hospitalizations. It's not as bad as adults, but you can't say little Johnny is magically immune, nor can you say that Brad the football star at the local college is either. I don't think it's currently clear why some apparently healthy people develop severe reactions.

Do you feel we should restrict billions from gathering with and hugging their family so that we can save 105 children?

Can you help us understand the thinking you use to make that tradeoff?

The point of the 105 dead children was to show children can be severely affected and don't have magic immunity. 500K children have been diagnosed with COVID, with varying symptom levels. We have 200,000 dead overall in the USA, so it's not just a matter of 105 dead children justifying lockdown, it's all those other dead people you seem to have forgotten about.

Also FYI, you can't hug your family member anymore once they're dead.

They don't, but they are far more susceptible to Measles. In 2018 140,000 children died from measles -- a disease we actually have a well known vaccine that's been proven safe!

Well we've yet to develop a COVID-19 vaccine that ditzy parents can ignore/avoid. Stupidity isn't an excuse for more stupidity.

What’s the median age of those that have sadly passed and the percentage with comorbidities?

Do you really mean "sadly" when trying to make the point that old people or people with pre-existing conditions are acceptable deaths?

He is Just Asking Questions

https://rationalwiki.org/wiki/Just_asking_questions

Am I. Which part of the question is leading? Which part is not Socratic?

Well that would be an extremely unpleasant attempt at putting words in somebody's mouth that makes me wonder whether you are actually engaging honestly here.

Did you honestly not know the answer? What was your point?

This is emotional manipulation that we can all engage in. The 105 children are not the only victims.

I have bad asthma and my wife is ill I don't appreciate you gathering and hugging your family and killing mine.

Did that advance the discussion? Was it manipulation? No and you bet!

It's small enough that it's not a concern and not something we should spend much effort worrying about. 105 is absolutely nothing compared to nearly 200k deaths in the US.

It's also a HUGE distraction to the real concern: We don't fully understand how contagious children are.

Go here: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Filter by 'Weekly Number of Deaths by Age' and you will see that it is literally the safest time ever for children and young adults because they are not allowed to go outside and do dumb stuff. Yes, some of them have died because of COVID, but the number is staggeringly small.

Maybe fewer have died of covid because of lockdown?

Sweden didn't close schools, 1 person under 20 has died out of about 2 million.

How many people do people under 20 infect?

How many of those secondary infections die? How many of them stay sick for months?

There was a case right before schools opened in Georgia, I believe, of a kid who caught COVID at football practice. He's fine, but both of his parents died in a week.

Fortunately, he now no longer needs to worry about COVID. Unfortunately, he's now an orphan.

And he's still proof that "few children get sick" from this.

I did not realize that the sole metric that our society should optimize for, to the exclusion of all else is 'how many children get sick and die from COVID'.

(It's a very convenient optimization metric, though, because it requires us to do quite literally nothing.)

Lots of people argue that children aren't dying because they were more locked down. For example the person I responded to. That is wrong, children aren't dying since covid doesn't hit them very hard. Children being vectors infecting others wasn't a part of this discussion.

Children get sick, few have got sick enough to have died from it.

It mostly does. Those cases you mention are quite rare.

>Factor in a glut of people who're living into advanced age, due to the progress of medical technology, so naturally in a precarious place against any infection

Then why does the annual flu not wipe out this population? Immunity lasts about 3 years so every such person who is exposed to the flu should be dying in one 3 year cycle.

Immunity lasts longer than 3 years:

>According to our study, it appears they can last the entire lifespan of the human organism — 90 years plus.

>n our study we were looking for antibodies to the 1918 flu. This flu virus was reconstructed a number of years ago in the lab, so we were able to test to see if 90 years later we could still find antibodies. I recruited survivors, people who were born in 1915 or earlier and thus presumably survived the 1918 flu. We found that virtually all the people born in 1915 or earlier — about 90% of them — had good "titers" to the 1918 flu, which means they still had reasonably high concentrations of the antibodies in their blood, whereas among controls, people who were born in 1926 or later, it was only about 10%. That was really quite a remarkable finding.

http://content.time.com/time/health/article/0,8599,1835907,0...

Wouldn't annual re-exposure to a similar virus "renew" the immunity?

It does, in recent years, the flu death tolls have been below average mortality - Levitt's been looking at EuroMOMO for this.

Flu vaccination is pretty prevalent among seniors.

Which reinforces the need to have vaccines to get to herd immunity, not just herd immunity except for seniors who will die a lot.

No. "Obesity" and "vitamin-d deficiency" can't explain what happened in Italy (a lot of sun), and also can't explain what happened in the Nordic countries (much less sun), including Germany and Sweden (the later having order of magnitude more deaths than the former, measured as the percentage of the population). Sweden is particularly bad, having the deaths per capita even worse than the U.S. the last time I've checked.

What we see is that countries that were lucky enough to do strong enough prevention actions early enough had order of magnitude less deaths than those who didn't do them (and Sweden is in the latter camp, even if they did have more response than most admit -- they did close all universities, for example). The scale of deaths seen in New York would have never happened, had the use of masks been common early enough.

Eidt: Regarding "vulnerable populations" Italy and Germany have similar number of "vulnerable" and it seems Sweden would be better than Germany then:

https://commons.wikimedia.org/wiki/File:Population_pyramid_o...

https://commons.wikimedia.org/wiki/File:Population_pyramid_o...

https://commons.wikimedia.org/wiki/File:Sweden_population_py...

It is worth noting that living in a sunny country does not guarantee the larger population receiving adequate Vitamin D through sun exposure, as many such populations somewhat paradoxically avoid sun exposure, as there are legitimate health reasons for doing so (extreme heat, concerns about skin cancer, etc.).

India being the case in point where exposed skin is culturally unacceptable

To support that you'd have to show that Italians have order of magnitudes higher deficiency than most of Nordic countries, and I don't think it is possible.

Another country with equivalent sun exposure to Italy is Greece, again orders of magnitude less deaths (like Germany). They also had strong lockdowns and early enough.

It's the measures. Analyzing what happened in Europe (and still happens) can't be explained with anything else.

Compare it with fires. Small fires are easy to extinguish. Pretending "it will go away" will simply result in a big fires. Eventually there won't be anything to burn. With people, eventually everybody who can and "feels the heat" will try to protect themselves.

A lot of older people in Sweden stay in their homes and take care not to be infected. Masks are common in the supermarkets, etc.

> Masks are common in the supermarkets, etc.

Not sure where you got this information - masks are not commonly worn at all in Sweden. I see perhaps 1 mask per week, unless I go into the city center, then I might see 10 in a day.

The Swedish public health authorities are not currently recommending general usage of face masks, citing mainly the lack of evidence of the effectiveness of general mask usage (wearing a mask can cause you to get lulled into a false sense of security, for example).

See https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utb...

(in Swedish, unfortunately)

> To support that you'd have to show that Italians have order of magnitudes higher deficiency than most of Nordic countries, and I don't think it is possible.

Sweden adds vitamin D to food items so I wouldn't be surprised if Sweden has less vitamin D deficiency than many southern countries.

https://www.nutraingredients.com/Article/2015/05/28/Sweden-t...

Can we find order of magnitude difference among darker skinned people? We've all heard about the disparity there.

> Masks are common in the supermarkets, etc.

This is outright false. I've been to a big supermarket twice this week and didn't see a single mask as far as I can recall.

yes, masks are marginal at best, and as long as you're not spending a lot of time breathing another's direct exhaust, even indoors, you're at negligibly low risk of transmission.

i get super frustrated with the random corona rules at supermarkets in the US (like one-way only aisles, exit only doors), especially trader joe's, which is as draconian as it is arbitrary. for a while they weren't allowing you to take in your reusable grocery bags. later they relented and switched to just bagging your own groceries outdoors, leading to an awkward triple handling of your purchased items for what amounts to nothing other than safety theater.

for 6 months i've worn the same useless surgical mask to play my part in that misguided spectacle, when required. folks are slowly starting to realize their lack of utility, but have nothing else to latch onto because the obvious solution of modest distancing seems so mundanely unbelievable (and lacking obvious and spectacular conformance).

For reference, see this article in the Lancet:

https://www.thelancet.com/journals/landia/article/PIIS2213-8...

It's just an argument that the actual deficiency could cause worse outcome. But that article in Lancet doesn't claim that Italy had Vitamin D deficient population. The number of deaths per capita due to Covid-19 was however orders of magnitude higher in Italy and Sweden than in Germany. I don't think that there's anywhere any evidence that Germans are less Vitamin D deficient than Italians and Germans.

Vitamin D doesn't explain anything related to Covid-19 deaths in Europe, whereas the existence or lack of measures do, almost perfectly. Whoever can look at the curves of number of deaths since the begin of the epidemics, check the times of partial lockdowns or the introduction of some measures, can see that exactly around three weeks after these the curves stop going up and begin going down.

Italy as the first country seriously hit in Europe had the curve raising exponentially up until the measures started to work (there's a delay -- for people to stop dying the spread of infection has to turn first etc). Sweden also had the curve raising comparably to Italy, even if they had a negative example from Italy -- because there was a decision of targeting the "herd immunity". Germany's curve remained very low, as they had low prevalence at the time their measures started to be applied.

It's all about the measures and the adherence of the people to them.

Many countries have Vitamin D deficient populations, including Italy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986426/

In Italy, it gets worse the older the population gets.

It is also an issue in Germany: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499202/

I make no claims other than: 1) there is a very strong correlation between vitamin D insufficiency/deficiency and poor outcomes for COVID-19, and 2) many populations, including those in sunny countries, suffer from widespread vitamin D insufficiency.

I for one have been taking 1,000 IUs of vitamin D every day since March, and trying to get sun exposure mid-day whenever I can.

Look at the graph, it has obviously nothing to do with any deficiencies, and everything to do with the measures:

https://ourworldindata.org/coronavirus-data-explorer?zoomToS...

The comparison is possible because it’s per million. See Italy and Spain hit before they were aware what is going on., then introducing lockdowns.

See Sweden’s and the US denial, then limiting the initial outbreaks but continuing just not doing enough.

See Greece and Germany doing early enough good enough measures, and still doing it.

It’s that simple. The US not being aware how wrong they are doing is a crime to their own people. It’s historical failure.

You claim: “there is a very strong correlation between vitamin D insufficiency/deficiency and poor outcomes for COVID-19“ — show me that on the graph above. It’s obviously a red herring talking about Vitamin D once one sees it.

> Sweden is particularly bad, having the deaths per capita even worse than the U.S. the last time I've checked.

No. USA: 608 per million. Sweden: 580. [1]

But the current trajectory is also important. In Sweden, the last day with more than 0.6 deaths/million was July 21 (according to actual date of death, not the date when death was reported), while the US currently is about 2-3 deaths/million/day.

[1] https://www.worldometers.info/coronavirus/

People really see what they want to see. As a Swede this whole pandemic has been truly enlightening regarding peoples propensity for confirmation bias. It has been truly shocking how prevalent it is throughout entire societies and ideologies.

Here in Sweden the right-wing folks want to lock everything down and the left-wing want to keep deferring it to the experts. In the rest of the world it seems to be the other way around.

Can you provide some articles/material regarding right wingers wanting to lock things down in Sweden? I'm not familiar with Swedish politics and would be interested in reading more.

The debate is pretty calm compared to USA, most politicians agree with the general strategy so the opposition mostly criticize the execution.

https://www.thelocal.se/20200530/swedish-opposition-demands-...

I wish this complete upside-down debate would get more attention in international media but it's truly the reverse of what's happening in the US.

While the official stance for all parties is that they support the strategy (the most right-wing party being the exception who is heavily criticizing it), it's more telling in social media.

Hanif Bali, one of the most prominent right-wing figures in social media, has really been pushing for lockdowns/masks and is cheered on by his tail of alt-right followers. Meanwhile the left is mocking him, lockdowns and masks in general.

Throughout the pandemic the (neo-)Liberal (right-wing by Swedish standards) newspaper Dagens Nyheter (Today's News, dn.se) have led a campaign criticising the Swedish lax approach. The news site is paywalled however.

The leader of the Swedish Democrats, the most right-wing in the Swedish parliament, called for the state epidemiologist, Anders Tegnells, to take responsibility and resign immediately: https://www.expressen.se/nyheter/jimmie-akesson-tegnell-mast...

Interesting enough it's also the same kind of fringe-right that are protesting in against restrictions in Germany that is calling our approach genocidal here:

"Tegnell is a danger to society" https://projektsanning.com/2020/03/12/coronaviruset-statsepi...

"Tegnell reported to the Police due to the mass death among elderly" https://www.friatider.se/tegnell-polisanmald-massdoden-bland...

Another way of looking at it: the left-wing people everywhere want to defer to the experts. It's just that the experts in different places are saying different things.

Sweden has 5x deaths of Germany. Not quite an order of magnitude. And as someone else pointed out, the US has more deaths per capita than Sweden.

5x is order of magnitude larger. Quote:

Generally, the order of magnitude of a number is the smallest power of 10 used to represent that number.[2] To work out the order of magnitude of a number N, the number is first expressed in the following form:

    N = a × 10^b

where 1/sqrt(10) ≤ a < sqrt(10) . Then, b represents the order of magnitude of the number.

https://en.wikipedia.org/wiki/Order_of_magnitude

> the US has more deaths per capita than Sweden

Nothing to be proud about for either of them. Anyway, until e.g. month ago Sweden had the lead.

Just checked: it seems the last day the U.S. was better than Sweden in deaths per capita was 11. September, so just 8 days ago. And, when the trends continue, in a week the U.S. will be worse than the U.K. too. The only countries in Europe with more Covid-19 deaths per million then will be Belgium and Spain.

If I recall correctly the US passed Sweden in excess mortality sometime in June/July. So they have probably passed some of the other European countries already. I couldn't find a good up to date source, but Belgium seems to have lower excess than US. Comparing death statistics is not trivial.

Anyways, I don't think comparing the US to most countries in Europe really makes sense, considering the size and population differences.

> If I recall correctly the US passed Sweden in excess mortality sometime in June/July.

According to ourworldindata, in reported Covid-19 deaths per million, on Sept 12:

https://ourworldindata.org/coronavirus-data-explorer?zoomToS...

> I don't think comparing the US to most countries in Europe really makes sense

You are missing "per million" which is what I used. Comparing absolute numbers has of course no sense. When comparing relative numbers ("per million"), the big country spread across big area, like U.S. is, would be expected have huge advantages compared to any country in Europe (due to slower spread over the distances, much less dependency on public transportation). Moreover, the countries worst hit in Europe were only those where the spread happened first -- others took note and introduced measures early enough. Not the U.S. which totally botched its response even ignoring the initial hit in NY. Compare the slopes of all other European countries for months, v.s. what's going on in the U.S. The response in the U.S. is criminally bad, and continues to be so -- and not looking at the "cases" but simply and tragically, deaths. Those that are reported.

I admit that comparing some other estimates of "excess deaths" could give some other numbers, but I don't see any way in which U.S. can look good, especially as it was Italy being hit the first and everybody else having the time to react somehow.

Also see daily average of deaths per million, to get the idea how bad it is still:

https://ourworldindata.org/grapher/daily-covid-deaths-per-mi...

I said the interplay of chronic disease, vitamin-d and vulnerable populations.