The Complete Truth about COVID-19

There are many stories about COVID-19, but there are not man sources, trying to put everything in one place. This article tri to put everything in one place, with all the details, references and proof. The actual data and research is from Swiss Policy Research.

Lethality

According to the latest immunological studies, the overall infection fatality rate (IFR) of covid-19 in the general population is about 0.1% to 0.5% in most countries, which is most closely comparable to the medium influenza pandemics of 1957 and 1968.

Antibody studies

The covid-19 infection fatality rate (IFR) depends on demographics (age and risk structure), public policies (e.g. protection of nursing homes), and medical treatment quality.

Covid-19 IFRs are strongly age-dependent, with a steep increase above the age of 70. The median age of covid-related deaths in most Western countries is 78 to 86 years (see section 3 below). In most Western countries, about half of all deaths occurred in nursing homes (see section 5).

In terms of covid-19 IFRs, an important difference exists between places with and without a partial or total collapse of local health and elderly care, and between the early and late pandemic phase.

A. Places without a collapse of health and elderly care
Country Published Population IFR (%) Source
Global Oct. 7 51 locations
Below 70 years
0.20³
0.04³
Ioannidis
USA Sept. 2 Indiana (NNH) 0.265 AIM
Brazil Sept. 1
Sept. 21
Maranhao
Manaus
0.17
0.28
da Silva
Buss
Iceland Sept. 1 General population
Below 70 years
0.30
0.10
NEJM
Switzerland July 14
August 7
Geneva (NNH)
Zurich (NNH)
0.32¹
0.30¹
Perez
Aguzzi
India July 31 Delhi
Mumbai
0.07²
0.12²
India
Africa July 29
August 5
Kenya
Malawi
0.01
0.01
Uyoga
Grace
Austria June 25 Ischgl hotspot 0.26 von Laer
Sweden June 16 Stockholm (NNH)
Stockholm <70y
0.356
0.09
FOHM
Slovenia May 6 General population 0.16 GSI
Germany May 4
Nov. 5
Heinsberg hotspot
Munich (NNH)
0.364
0.488
Streeck
LMU
Iran May 1 Guilan province 0.12 Shakiba
USA7 April 30
April 24
April 21
Santa Clara County
Miami-Dade County
Los Angeles County
0.17
0.18
0.20
Bendavid
Miami
Sood
Denmark April 28 Blood donors (<70y) 0.08 Erikstrup

1) 0.64% and 0.60% including nursing homes; 2) 0.14% and 0.23% assuming 40% missing fatalities (more); 3) median values; 4) the unadjusted IFR is 0.28% (page 9); 5) general population (excl. nursing homes); 6) 0.58% including Stockholm nursing homes (about 40% of deaths, see page 23); 7) These US studies may underestimate the true IFR, as they were done early during a locally accelerating pandemic; 8) 0.76% including nursing homes (36% of deaths).

Note: The much-cited Meyerowitz-Katz meta-study claiming a global Covid-19 IFR of 0.68% is misleading because it mixes modelling studies and antibody studies, nursing homes and the general population, early and late phase IFRs, and commits several methodological mistakes.

B. Places with a partial or total collapse of health and elderly care

Overview1) Spain  2) Northern Italy  3) New York City  4) England  5) Belgium

Places with a partial or total collapse of local health and elderly care experienced significantly higher and very strongly age-dependent IFR values, especially during the early phase of the pandemic.

However, IgG antibody tests may underestimate the true prevalence of coronavirus infections and may thus overestimate the IFR to some extent (see section 2 below).

1) Spain
Country Published Population IFR (%) Source
Spain August 7 Covid confirmed
Excess deaths
Below 50 years
Below 40 years
0.82
1.07
<0.10
<0.03
Pollan

A Spanish seroprevalence study found an overall IFR between 0.82% (based on confirmed Covid-19 deaths) and 1.07% (based on excess all-cause deaths). The study didn’t include nursing homes, which accounted for about 50% of all deaths. The IFR was strongly age-dependent, with values below 0.03% until 40 and below 0.1% until 50 but reaching very high levels above 70 years.

The study found a country-wide IgG antibody seroprevalence of just 4.9% (about 12% in Madrid). However, less than 20% of symptomatic people (3+ symptoms or anosmia) had IgG antibodies. This may indicate that infections were up to five times more widespread than detected by IgG antibody tests (see section 2 below on this topic). If so, Spanish IFR values might drop below 0.5%.

Above 60 years, there was a significant difference in lethality between men and women. This might be due to e.g. genetic reasons, cardiovascular health, or certain habits like smoking.

Northern Italy
Country Published Population IFR (%) Source
Northern Italy August 6 Above 70 years
Below 70 years
Below 50 years
80+, first phase
80+, second ph.
10.5
0.43
<0.01
30.40
8.10
Poletti

An Italian study considered contacts of confirmed Covid-19 cases in the Lombardy region, which includes hotspots like Bergamo and Cremona, to determine their fatality risk and their comorbidities. They found that the overall IFR was 62% lower in the second phase of the pandemic (after March 16) compared to the first, cataclysmic phase (up to March 15).

This was particularly evident in people above 80, where the IFR dropped from 30% in the early phase to 8% in the later phase (4% for women, 16% for men). Below 50 years, IFRs were near 0%; below 70 years, IFRs were 0.43% (both phases combined). More than 80% of deaths occurred in patients with cardiovascular disease, which ist known to be a major risk factor.

Of note, among Italian people with anosmia (temporary loss of the sense of smell or taste), a very typical Covid symptom, only about 25% were found to have IgG antibodies. This could indicate that coronavirus infections are more widespread, and IFRs lower, than assumed.

Treatment

For people at high risk or high exposure, early or prophylactic treatment is essential to prevent progression of the disease. According to numerous international studies, early outpatient treatment of covid may reduce hospitalizations and deaths by about 75%.

  • Zinc inhibits RNA polymerase activity of coronaviruses and thus blocks virus replication, as first discovered by world-leading SARS virologist Ralph Baric in 2010.
  • Ivermectin (an antiparasitic drug) has strong anti-viral and anti-inflammatory properties.
  • Quercetin (a plant polyphenol) supports the cellular absorption of zinc and has additional anti-viral properties, as first discovered during the SARS-1 epidemic in 2003.
  • Bromhexine (a mucolytic cough medication) inhibits the expression of cellular TMPRSS2 protease and thus the entry of the virus into the cell, as first described in 2017.
  • Vitamin D3 supports and improves the immune system response to infections.
  • Aspirin may help prevent infection-related thrombosis and embolisms in patients at risk.
  • HCQ has known anti-thrombotic, anti-inflammatory and possibly anti-viral properties.
  • Azithromycin (an antibiotic) prevents bacterial superinfections of the lung.
  • Corticosteroids (prednisone, budesonide) reduce covid-related systemic inflammation.

References

Ivermectin

  1. Overview: A summary of international ivermectin covid studies (c19ivermectin.com)
  2. Review: Ivermectin – A Potential Global Solution to the Covid-19 Pandemic (FLCCC)
  3. Review: Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection (Andrew Hill et al., Research Square, January 2021)

Zinc

  1. Study: Low zinc levels at clinical admission associates with poor outcomes in COVID-19 (Vogel et al., medRxiv, October 2020)
  2. Study: Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients (Carlucci et al., MedRxiv, May 2020)
  3. Study: Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients (Eric Finzi, International Journal of Infectious Diseases, June 2020)
  4. Study: Zinc Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture (Velthuis et al, PLOS Path, 2010)
  5. Study: Effect of Zinc Salts on Respiratory Syncytial Virus Replication (Suara & Crowe, AAC, 2004)
  6. Study: Zinc for the common cold (Cochrane Systematic Review, 2013)
  7. Review: Zinc supplementation to improve treatment outcomes among children diagnosed with respiratory infections (WHO, Technical Report, 2011)
  8. Article: Can Zinc Lozenges Help with Coronavirus Infections? (McGill University, March 2020)

Quercetin

  1. Study: Small molecules blocking the entry of severe acute respiratory syndrome coronavirus into host cells (Ling Yi et al., Journal of Virology, 2004)
  2. Study: Zinc Ionophore Activity of Quercetin and Epigallocatechin-gallate: From Hepa 1-6 Cells to a Liposome Model (Dabbagh et al., JAFC, 2014)
  3. Study: Quercetin as an Antiviral Agent Inhibits Influenza A Virus Entry (Wu et al, Viruses, 2016)
  4. Study: Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (Biancatelli et al, Front. in Immun., June 2020)
  5. Report: EVMS Critical Care Covid-19 Management Protocol (Paul Marik, MD, June 2020)

Bromhexine

  1. Study: TMPRSS2: A potential target for treatment of influenza virus and coronavirus infections (Wen Shen et al., Biochimie Journal, 2017)
  2. Letter: Repurposing the mucolytic cough suppressant and TMPRSS2 protease inhibitor bromhexine for the prevention and management of SARS-CoV-2 infection (Maggio and CorsiniPharmacological Research, April 2020)
  3. Study: Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy? (Depfenhart et al., Internal and Emergency Medicine, May 2020)
  4. Study: Bromhexine Hydrochloride: Potential Approach to Prevent or Treat Early Stage COVID-19 (Stepanov and Lierz, Journal of Infectious Diseases and Epidemiology, June 2020)
  5. Study: TMPRSS2 inhibitors, Bromhexine, Aprotinin, Camostat and Nafamostat as potential treatments for COVID-19 (Arsalan Azimi, Drug Target Review, June 2020)
  6. TrialEffect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial (Ansarin et al., BioImpacts, July 2020)

Aspirin and heparin

  1. Study: Anticoagulant Treatment Is Associated With Decreased Mortality in Severe Coronavirus Disease 2019 Patients With Coagulopathy (Tang et al, JTH, May 2020)
  2. Study: Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 (Wichmann et al., Annals of Internal Medicine, May 2020)
  3. Review: Anticoagulation Guidance Emerging for Severe COVID-19 (Medpage Today)
  4. Study: Platelet gene expression and function in patients with COVID-19 (Manne et al., ASH Blood, September 2020)
  5. Review: Should aspirin be used for prophylaxis of COVID-19-induced coagulopathy? (Hussein et al., Medical Hypotheses, November 2020)

Age

The median age of covid deaths is over 80 years in most Western countries (but 78 in the US) and about 5% of the deceased had no serious preconditions. The age and risk profile of covid mortality is therefore comparable to normal mortality, but increases it proportionally.

Nursing homes

In many Western countries, up to two thirds of all covid deaths have occurred in nursing homes, which require targeted and humane protection. In some cases, care home residents died not from the coronavirus, but from weeks of stress and isolation.

Excess mortality

In most Western countries, the pandemic increased mortality by 5% to 15% in 2020. Up to 30% of the additional deaths were caused not by covid, but by indirect effects of the pandemic and lockdowns (e.g. fewer treatments of cancer and heart attack patients).

Antibodies

By the end of 2020, antibody seroprevalence was between 10% and 30% of the population in most Western countries. At seroprevalence levels above 30%, a significant decrease in the infection rate was observed in many regions.

Symptoms

Up to 40% of all infected persons show no symptoms. Overall, about 95% of all people develop at most mild or moderate symptoms and do not require hospitalization. Early outpatient treatment may significantly reduce hospitalizations.

Transmission

According to current knowledge, the main routes of transmission of the virus are indoor aerosols and droplets produced when speaking or coughing, while outdoor aerosols as well as most object surfaces appear to play a minor role. The coronavirus season in the northern hemisphere lasts from about November to April.

Masks

There is still little to no scientific evidence for the effectiveness of cloth face masks in the general population, and the introduction of mandatory masks couldn’t contain or slow the epidemic in most countries. If used improperly, masks may increase the risk of infection.

So far, most studies found little to no evidence for the effectiveness of cloth face masks in the general population, neither as personal protective equipment nor as a source control.

  1. A May 2020 meta-study on pandemic influenza published by the US CDC found that face masks had no effect, neither as personal protective equipment nor as a source control. (Source)
  2. Danish randomized controlled trial with 6000 participants, published in the Annals of Internal Medicine in November 2020, found no statistically significant effect of high-quality medical face masks against SARS-CoV-2 infection in a community setting. (Source)
  3. A February 2021 review by the European CDC found no significant evidence supporting the effectiveness of non-medical and medical face masks in the community. Furthermore, the European CDC advises against the use of FFP2/N95 respirators by the general public. (Source)
  4. A July 2020 review by the Oxford Centre for Evidence-Based Medicine found that there is no evidence for the effectiveness of cloth masks against virus infection or transmission. (Source)
  5. A November 2020 Cochrane review found that face masks did not reduce influenza-like illness (ILI) cases, neither in the general population nor in health care workers. (Source)
  6. A May 2020 cross-country study by the University of East Anglia (preprint) found that a mask requirement was of no benefit and could even increase the risk of infection. (Source)
  7. An April 2020 review by two US professors in respiratory and infectious disease from the University of Illinois concluded that face masks have no effect in everyday life, neither as self-protection nor to protect third parties (so-called source control). (Source)
  8. An article in the New England Journal of Medicine from May 2020 came to the conclusion that cloth face masks offer little to no protection in everyday life. (Source)
  9. A 2015 study in the British Medical Journal BMJ Open found that cloth masks were penetrated by 97% of particles and may increase infection risk by retaining moisture or repeated use. (Source)
  10. An August 2020 review by a German professor in virology, epidemiology and hygiene found that there is no evidence for the effectiveness of cloth face masks and that the improper daily use of masks by the public may in fact lead to an increase in infections. (Source)
Development of cases after mask mandates

In many states, coronavirus infections strongly increased after mask mandates had been introduced. The following charts show the typical examples of Austria, Belgium, France, Germany, Ireland, Italy, Spain, the UK, California and Hawaii. Furthermore, a direct comparison between US states with and without mask mandates indicates that mask mandates have made no difference.

Children and schools

In contrast to influenza, the risk of disease and transmission in children is rather low in the case of covid. There was and is therefore no medical reason for the closure of elementary schools or other measures specifically aimed at children.

Contact tracing

A WHO study of 2019 on measures against influenza pandemics concluded that from a medical perspective, contact tracing is “not recommended in any circumstances”. Contact tracing apps on cell phones have also proven ineffective in most countries.

PCR tests

The virus test kits used internationally may in some cases produce false positive or false negative results or react to non-infectious virus fragments from a previous infection. In this regard, the so-called cycle threshold or ct value is an important parameter.

Virus mutations

Similar to influenza viruses, mutations occur frequently in coronaviruses. Most of these mutations are insignificant, but some of them may increase the transmissibility, virulence or immune evasion of the virus to some extent.

A brief update on the new coronavirus mutations, including the ‘British’, ‘South African’ and ‘Brazilian’ variants (i.e. N501Y.V1-V3), and evidence of their properties:

  1. There is currently no evidence that new variants are more virulent or more lethal or that they produce any different symptoms. The fact that covid is generally more severe in winter than in spring and summer was to be expected (e.g. due to lower vitamin D levels).
  2. There is clear evidence that the new variants are currently about 50% more transmissible, although suspected higher viral loads have not been confirmed. However, this relative advantage in transmissibility may decrease over time, as more people get infected.
  3. There is currently no evidence that new variants preferentially infect children.
  4. There is also no evidence that measures such as lockdowns or face masks work any better or any worse against new variants. Many places affected by new variants have already seen a decrease in cases (e.g. Denmark, Portugal, the Netherlands, South Africa and the UK).
  5. Even places with a near 100% proportion of new variants, such as parts of England, managed to drive down infection rates, which speaks against an out-of-control “new pandemic”.
  6. The fact that ACE2 cell receptor affinity is higher in new variants does not mean that their virulence or infectiousness must be higher; they may as well be lower or unchanged.
  7. The fact that a new variant may replace an older variant is well known from previous Sars-Cov-2 variants (e.g. D614G and the ‘Spanish variant’) and also from seasonal influenza viruses. This effect does not necessarily require higher intrinsic contagiousness.
  8. The fact that places with a small first wave are seeing a stronger second wave (e.g. Portugal) was to be expected and does not require new variants – e.g. many Eastern European countries and some US states saw stronger second waves of the original variant.
  9. There is, however, some evidence of partial immune evasion by new variants, which is well known from influenza viruses and from other coronaviruses, and which may enable reinfections – with or without symptoms – in some people, and first infections in more people.
  10. Immune evasion may explain why some places already hit hard in spring, such as South Africa or Manaus in Brazil – both of which had an antibody seroprevalence of about 30% until summer (but not 70%, as some claimed) – are seeing a strong second wave driven by new variants.
  11. There is also clear evidence that some of the current vaccines are somewhat less protective against some of the new variants. These vaccines may require regular updates or boosters.
  12. But there is no evidence that early and prophylactic treatment is any less effective against new variants, as it targets virus replication, cell entry, or disease progression.

Lockdowns

In contrast to early border controls, lockdowns have had no significant effect on the pandemic. According to the UN, lockdowns may put the livelihood of 1.6 billion people at acute risk and may push an additional 150 million children into poverty.

Sweden

In Sweden, covid mortality in 2020, without a lockdown, was comparable to a strong influenza season and close to the EU average. About 60% of Swedish deaths occurred in nursing facilities and the median age of Swedish covid deaths was about 84 years.

Vaccines

Clinical trials showed that covid vaccines offer good protection against covid. However, little is yet known about their long-term safety and effectiveness. In some rare cases, sudden deaths or serious adverse events have been reported after covid vaccinations.

Media

The reporting of many media has been unprofessional, has increased fear and panic in the population and has led to a hundredfold overestimation of the lethality of covid. Some media even used manipulative pictures and videos to dramatize the situation.

Virus origin

The origin of the new coronavirus remains unknown, but the best evidence currently points to a covid-like pneumonia incident in a Chinese mine in 2012, whose virus samples were collected, stored and researched by the Virology Institute in Wuhan (WIV).

Surveillance

NSA whistleblower Edward Snowden warned that the coronavirus pandemic may be used to expand global surveillance. Many governments restricted fundamental rights, used drone monitoring, and announced plans to introduce digital biometric vaccine passports.

The Zero-Covid Countries

How did some countries manage to achieve a very low covid-19 prevalence?

Non-African countries with at least one million inhabitants but less than 1000 covid cases per one million inhabitants include, notably: Laos, Vietnam, Cambodia, Taiwan, Thailand, China (ex. Wuhan), New Zealand, South Korea, Cuba, Hong Kong, Australia (ex. Victoria) and Singapore (ex. migrant workers). Other major countries with a low covid prevalence include Japan, Finland and Norway.

The typical ‘reactive’ measures cannot explain this: it cannot be masks, as most of the worst affected countries have introduced mandatory masks, too; it also cannot be national lockdowns, as most of the worst affected countries have had lockdowns, too; and it cannot be mass PCR testing, as many of the worst affected countries have rather high testing rates, too.

In fact, many low-covid countries never imposed a lockdown (including Taiwan, South Korea, Japan, Australia (excluding Victoria), Laos and Cambodia), and many low-countries never performed mass PCR testing (including Taiwan, Japan, Laos, Vietnam, Cambodia and Cuba).

Instead, the single most important factor has been early border controls – as of January or February 2020 – something all low-covid countries indeed did. There are two overlapping groups of countries with successful early border controls: islands and countries neighboring China.

Border controls are easiest for islands, which most low-covid countries indeed are, including Taiwan, New Zealand, Australia, Japan, Cuba, and also, essentially, South Korea, Hong Kong and Singapore. Many other, smaller islands also did well, including Iceland, Greenland, Sri Lanka, Madagaskar, Mauritius and Haiti, but not complex island states such as Indonesia and the Philippines, which ‘despite’ extended lockdowns couldn’t contain the coronavirus.

In addition, countries neighboring China – many of which already had experience with the 2003 SARS-1 epidemic – also introduced early border controls. This group includes Thailand and Vietnam, and in extension Laos and Cambodia, plus Hong Kong, Taiwan, South Korea and Japan, and also Singapore. Thailand, in particular, appears to have been very lucky, as some Chinese tourists could enter the country until March, although requiring a ‘health certificate’ since January.

Of note, zero-covid countries like New Zealand, which already avoided the 1957 and 1968 flu pandemics, plan to keep borders closed for at least two years, until 2022.

Even with early border controls, however, a few infected people may already have entered the country. These people need to be identified and isolated very quickly. This can be done in a high-tech way (by rapid PCR testing, as in China, Taiwan and South Korea), or in a low-tech way (by batch isolation, as in Vietnam and Thailand; Vietnam isolated up to 200,000 people).

Moreover, most low-covid countries have been isolating potentially infected people not at home – where they may infect their family and neighbors –, but in dedicated isolation facilities. This is easiest for authoritarian countries (such as China, Vietnam and Thailand), but democratic low-covid countries like Australia, New Zealand and South Korea are doing this, too (using empty hotels).

Within Australia, only the state of Victoria and its capital city Melbourne failed to properly isolate infected people and, as a result of this, entered into a nightmarish months-long lockdown.

Are there (non-African) low-covid countries without early and strict border controls? No.

A few countries happened to avoid the spring wave, but got caught in the autumn wave. This group includes the Czech Republic (and most of Eastern Europe) as well as Uruguay in South America; some US states (notably in the Midwest) also belong to this group. Interestingly, in the US, the US President wanted to close borders early, but senior health experts were against it.

Germany, although located in the midst of Europe and right next to global hotspots like Belgium, the Netherlands and eastern France, managed to largely avoid the spring wave by closing borders and identifying infections just in time, but is now also facing a much stronger second wave.

The hypothesis of a ‘pre-existing immunity’ due to similar coronaviruses, e.g. in Southeast Asia, doesn’t seem to hold: while Thailand, Laos and Vietnam have few covid cases, their direct neighbors Myanmar (Burma), Indonesia, Malaysia, Bangladesh and the Philippines have many cases.

In contrast to influenza epidemics, primary schools have not been a major driver of the coronavirus pandemic. Secondary and tertiary schools are a different and more complex matter, however.

In conclusion, if you don’t want trouble with the coronavirus, don’t let the coronavirus in. Just a few weeks of delay may make all the difference, as in the cases of France vs. Germany or Norway vs. Sweden. In contrast, once the coronavirus is already widespread in a country, most of the much-discussed measures have turned out to be largely ineffective, and often destructive.

In the case of the highly infectious coronavirus, even the idea of “protecting the high-risk groups” has turned out to be very difficult, if not impossible, in a high-prevalence environment. This is shown by the fact that in many Western countries, about 50% of deaths occurred in nursing homes.

In terms of economic impact, IMF data clearly shows that the harder and longer a lockdown, the stronger the economic contraction. However, most lockdowns occurred in response to an already high infection rate due to late border control. The economic impact moreover depends on the structure of an economy (e.g. the importance of the tourism and export industries).

Once the coronavirus has become widespread in a country, the single most effective measure to reduce severe illness and deaths appears to be large-scale early and prophylactic treatment.

The question of covid prevalence is different from the question of covid mortality. The latter depends mostly on demographics and possibly on genetic, immunological and lifestyle factors.

Many Western countries and Russia show high-prevalence and high-mortality. Many African countries and India show high-prevalence but low-mortality. Countries like Vietnam and Cambodia show low-prevalence and (likely) low-mortality. Countries like Japan and Taiwan show low-prevalence but (probably) high-mortality, although likely not as high as in Western countries.


Original article found here.


 

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