Swedish epidemiologist wonders Lithuania’s fight against coronavirus: no scientific support and evidence

According to the researcher, the European Center for Disease Prevention and Control (ECDC) proposes to set the indicator by evaluating other factors. However, the representatives of the Ministry of Health (SAM) justify the calculation of the indicator based on the ECDC recommendations.

We present Delphi sent to the editorial staff by epidemiologist dr. The letter sent by A. Kavaliūnas:

“Lithuania compiles the list of affected countries on the basis of the total 14-day morbidity rate of 100 thousand, as mentioned in the order of the Minister of Health. Population. The basis on which the thresholds are entered and modified for 25, 16 and 25 cases is completely confusing! But the first thing to start with is the misuse of the concept of morbidity as an indicator, since it has long been clear that some of those who test positive do not experience any symptoms. For example According to a preliminary study in Italy, 74% of people in the age group under 60 had laboratory-confirmed COVID-19. They had no symptoms (note: these are preliminary results that are currently being evaluated by independent experts). Since when can the absence of symptoms be considered a disease, and since when has laboratory test data become morbid?

It would be more logical to call this indicator, as its authors call it, the European Center for Disease Prevention and Control, that is, the 14-day notification rate of new cases of COVID-19. But the biggest problem is that the Ministry of Health does not see, does not want to see or has not yet learned English to read what the European Center for Disease Prevention and Control says, and that this indicator should be used to assess the epidemiological situation from the country. other factors, including testing strategy, scope of tests performed, their positivity rate, rates of hospitalization and admission to intensive care units, excess mortality.

If the European polite tone is still very incomprehensible, let me translate it into the “short and clear” option, an indicator that is not suitable for political decisions, much less for a list of countries. And yet, have you ever heard that decisions of this magnitude are made based on a single absolutely “naked” number, when experts warn that it is not rational? The explanation that Estonians and Latvians do the same because they agree is not an argument, because again it is not clear on what basis. It is just a fight or imitation based on science and evidence, and the discrediting of epidemiology and, at the same time, of Europe. “

Delphi When asked to comment on the incidence of the countries affected by the coronavirus, the list of “most countries affected by coronavir” is based on number data in each country. “

When asked why the incidence indicator included non-asymptomatic cases and did not include a broader list of factors, such as test volumes, their positivity rate, hospitalization and admission rates, excess mortality, etc., the ministry responded : “The importance of asymptomatic cases of coronavirus infection for the spread of coronavirus in the community has been demonstrated, and any identified case of COVID-19, with or without symptoms of the disease, is considered a potential source of infection.

Publications from the European Center for Disease Prevention and Control state that asymptomatic infection has been laboratory confirmed and, in some of these cases, certain symptoms have occurred at a later stage of infection. In the last review, the proportion of positive cases that remained asymptomatic was estimated at 16%, with a range of 6%. up to 41 percent. There have also been reports of asymptomatic cases in which the laboratory has confirmed the release of virus in the respiratory tract and in gastrointestinal samples. Non-peer-reviewed mathematical modeling studies have shown that asymptomatic individuals may be the main drivers of growth in a COVID-19 pandemic.

We would like to point out that the other “broader factors” mentioned in the question, such as test volumes, the proportion of positive tests, hospitalization rates, etc., are other indicators not related to the calculation of the infection rate by coronavirus “.