How deadly is covid-19?

covid a deadly pandemic?

September 2020 was the least deadly month in Swedish history, in terms of number of deaths per 100,000 population. Ever. And I don’t mean the least deadly September, I mean the least deadly month. Ever. To me, this is pretty clear evidence of two things. First, that covid is not a very deadly disease. And second, that Sweden has herd immunity.

When I posted this information on my twitter feed, the response from proponents of further lockdown was that the reason September was such an un-deadly month, was because everyone has already died earlier in the pandemic. To me, that seems like a pretty self-defeating argument. Why?

Because 6,000 people have died of covid in Sweden, a country with a population of 10,000,000 people. 6,000 people is 0,06% of the population. If it is enough for that tiny a fraction of a population to die of a pandemic for the pandemic to peter out so completely that a country can have its least deadly month ever, then the pandemic was never that deadly to begin with.

In August, I wrote an article where I proposed that the mortality for covid is only 0,12%, roughly the same as influenza. That number was based on a back-of-the-envelope calculation. I figured that, since the death rate had dropped continuously for months and was at very low levels, Sweden must have reached a point where it had herd immunity. And I figured that at least 50% of the population must have been infected for herd immunity to have been reached. 50% of Sweden’s population is five million people. 6,000 / 5,000,000 = 0,12%

At the beginning of October, one of the World Health Organisation’s executive directors, Mike Ryan, said that the WHO estimated that 750 million people had so far been infected with covid. At that point, one million people had died of the disease. That gives a death rate for covid of 0,13% . So the WHO said that the death rate is 0,13% . Not too far off my earlier back-of-envelope estimation. This of course begs the question why there are continued lockdowns for a disease that is no worse than the flu.

A short while later, the WHO released an analysis by professor John Ioannidis, with his estimate of the covid death rate. This analysis was based on seroprevalance data, i.e. data on how many people were shown to have antibodies to covid in their bloodstream at different times in different countries, which was correlated with the number of deaths in those countries. Through this analysis, professor Ioannidis reached the conclusion that covid has an overall mortality rate of around 0,23% (in other words, one in 434 infected people die of the disease). For people under the age of seventy, the mortality rate was estimated at 0,05% (in other words, one in 2,000 infected people under the age of 70 die of the disease).

As I’ve discussed before, I don’t think antibody data gives a very complete picture, since there are studies showing that a lot of people don’t produce measurable antibodies in their bloodstreams, but still have immunity, either thanks to a T-cell response, or thanks to local antibody production in the respiratory tract. So I think that the fatality rate is significantly lower than what the analysis by professory Ioannidis found, and more in line with what the WHO stated earlier in October.

But even if the antibody based number is the correct number, then covid still is not a very deadly disease. For comparison, the 1918 flu pandemic is thought to have had an infection fatality rate of 2,5%, i.e. one in forty infected people died. So the 1918 flu was 11 times more deadly than covid if you go by professor Ioannidis antibody based numbers, and 19 times more deadly than covid if you go by the fatality rate provided 12 days earlier by the WHO’s Mike Ryan.

And this is missing one big point about covid. The average person who dies from covid is over 80 years old and has multiple underlying health conditions. In other words, their life expectancy is very short. The average person who died in the 1918 pandemic was in their late 20’s. So each death in the 1918 pandemic actually meant around 50 years more of life lost per person than each death in the covid pandemic. Multiply that by the fact that it had a 19 times higher death rate, and the 1918 flu was in fact 950 times more deadly than covid, in terms its capacity to shorten people’s lives.

Ok, I’ve discussed the fatality rate of the 1918 flu pandemic, and compared that to covid. But what about the fatality rate of the common cold viruses that are constantly circulating in society? How does covid compare to them?

Many people think that the common cold viruses are harmless. But in fact, among elderly people with underlying health conditions, they are frequently deadly. A study carried out in 2017 found that, among frail elderly people, rhinovirus is actually more deadly than regular influenza. In that study, the 30 day mortality for frail elderly people admitted to hospital due to a rhinovirus infection was 10% . For frail elderly people admitted to hospital due to influenza, 30 day mortality was 7% .

What is my point? If you are old and frail, and have underlying health conditions, then even that most harmless of all infections, the so called “common cold”, can be deadly. In fact, it often is. Covid-19 is not a unique disease, and does not appear to have a noticeably higher mortality rate than the so called “common cold”.

There is one final aspect to all this that needs to be discussed. And that is the effect of covid on overall mortality. If it turns out that covid has no effect on overall mortality, then that really brings in to question why we are locking down, since we’re not actually preventing any deaths. So, what is the effect of covid on overall mortality?

Let’s look at Sweden, since that is perhaps the country that has taken the most relaxed approach of any to preventing spread, and which should therefore also reasonably be expected to have had the highest impact on its overall death rate. From January to September 2020, Sweden experienced 687 deaths per 100,000 population. The last time Sweden had a deadlier year was 2015. Personally, I don’t remember any big deadly pandemic happening in 2015.

In fact, 2020 is so far one of the least deadly years in Swedish history, and is largely in line with the average for the preceding five years. To be precise, it is 2,7% higher than the average for the preceding five years, which is well within the margin of error. In 2019, mortality was 6% lower than the average, so it should be expected that 2020 would have a slightly higher mortality than average, even without covid.

What does this mean? It means that covid, a supposedly deadly viral pandemic, has not killed enough Swedes to have any noticeable impact on overall mortality.

How can this be explained, when we know that 6,000 Swedes have died of covid?

As I see it, there are two possible explanations. The first is that most people who died “of” covid actually died with covid. In other words, they had a positive covid test and were therefore characterized as covid deaths, when the actual cause of death was something else. The second is that most people who died of covid were so old, and so frail, and had so many underlying health conditions, that even without covid, they would have died by now. There are no other reasonable explanations.

I am not saying that covid is nothing, or that it doesn’t exist. I am saying that it is a virus with a marginal effect on longevity. And yet, public policy in most countries has been driven by doomsday scenarios based on completely unrealistic numbers. To put it simply, we’ve acted like we’re dealing with a global ebola outbreak, when covid is much more like the common cold.

UPDATE (26th October 2020): After SCB updated their numbers it has become clear that September 2020 was in fact the second least deadly month in Swedish history, not the least deadly month. That award goes to June 2019.

You might also enjoy reading my article about why I think Sweden has herd immunity, or enjoy watching my conversation with Ivor Cummins of Fat Emperor about covid-19.

Please provide your e-mail address below and you will get all future articles delivered straight to your inbox the moment they are released.

Join 23.9K other subscribers

145 thoughts on “How deadly is covid-19?”

  1. I’d be really interested to understand the impact of “long Covid” and also reductions in life expectancy due to lung/heart etc damage resulting from Covid. Is it years/decades before we will know about this or can anything be understood already?

    1. “Long covid” is the same thing as post-viral syndrome. It is a rare but long known condition seen in a small minority of people after respiratory viral infections. Almost everyone is fully recovered within three months.

      As to the supposed heart damage after certain MRI studies. No-one has ever looked at the hearts of asymptomatic people after other respiratory viral infections before, so there is no reference to compare to. Most likely, these “findings” mean nothing.

  2. What you say makes a great deal of sense and I look forward to your posts as a breath of sanity in a hysterical world. Thank you for taking the time to write.
    My daughter-in-law has relatives in Sweden, and she has said that they are pretty much locked down and have been told to stay at home, although it’s not the law there. Is this accurate?

    1. Hi,
      Which part of Sweden do your daughter-in-law’s relatives live in? It certainly isn’t true in Stockholm, which is where I live. Here most people are going about their lives like they were before the pandemic.

  3. Extremely interesting and indeed it does seem that Covid isn’t especially deadly. Yet perhaps different findings would have been reached if Dr Rushworth had chosen to examine northern Italy or Wuhan. Has Dr Rushworth chosen a setting that he knew would well support his conclusions rather than another one?

    Life is not simple!

    1. @Jonathan Couchman: If by your comment you are suggesting that Covid lethality depends on the setting, then it seems to me you are proving Dr. Rushworth’s point that Covid is not overly deadly per se, but that external factors play an important role. You mentioned Italy, where such an external factor may have been a long history of budget cuts in the health care system, including and outdated pandemic plan, as reported by Francesco Zambon. In fact, in Bergamo there is an ongoing investigation because of negligent epidemic.

  4. “To me, this is pretty clear evidence of two things. First, that covid is not a very deadly disease. And second, that Sweden has herd immunity.”

    Both conclusions are wrong. Covid killed about 4000 nursing home patients in Sweden. That’s why mortality is now very low (not just in Sweden). And Sweden is still far away from ‘herd immunity’, as antibody prevalence is still below 10% in much of the country (but 25% in NYC and 50% in some places in Brazil.)

    T cells may or may not contribute to mild covid, but they sure do not provide ‘immunity’ against covid. Infections in Sweden are already increasing again and will continue to do so as winter approaches.

    Also, the IFR of 0.13% is false. According to FOHM, the IFR in Stockholm is about 0.6%, or 0.35% without nursing homes. And Ryan didn’t say 10% have been infected globally, but “at most 10%” (it is much less in most places). And Ioannidis calculated a global average value, the IFR in Europe and US is much higher.

    To finish, according to surveys, 100,000 Swedes have reported long covid symptoms for more than three months.

    1. Hi Samuel,
      When you say mortality is low because 4,000 people in nursing homes died, you are proving my point that covid is not a severe disease. If it is enough for 4,000 very old and frail people to die of a disease for the country to have its lowest mortality rate ever in September, then covid is not a serious disease. 4,000 people is 0,04% of Sweden’s population!

      As to your claim that less than 10% have antibodies in Sweden, that data is over four months old. No-one knows how many people in Sweden have antibodies right now.

      T-cells certainly do provide protection, and are more important against viral infections than antibodies. That is why some of the vaccines currently being developed are only designed to activate T-cells.

      In the article I linked to, Ryan did not say 750 million at most have been infected. He said “750 million is our best guess”.

      Get your facts straight before posting a lot of nonsense. You don’t have to agree with me, but you should at least double check your facts, otherwise you are just contributing to spreading misinformation.

  5. Excellent article, many thanks!
    I wonder if all this panic is not initiated and driven by the 4 big pharmaceutics as they are the only ones who will make serious money out of the situation. We know they have enough power and lobbyists to push our science-driven situation their way. All others will lose, be it tax payers, commercial companies, education, art, or whole countries.

  6. Thank you for your informed reply, that makes the point that one can arrive at a desired conclusion by selecting the data the data that point to it. Caution seems to be advised.

  7. my fiancé had “long covid.” basically she took about 6 weeks to clear it. (for me it lasted about 2 days and I was essentially asymptomatic. I wouldn’t have known I was sick except that she was.) it was mild the whole time, but she had fatigue, stuffiness and headaches off and on for a long time. she was still going out running and exercising the whole time. people are making way too much of it, it sucks and she hated not feeling well for so long. but the way health people use it to try to scare young people is way overdone. it’s not some major public health crisis

  8. Yes, that’s accurate! Swedes follow whatever the Gov recommends. I have lived here 14 years, my husband is a Swede and he has stayed locked in since March, his mother has done the same and his entire family have done the same! Me on the other hand, I have done same too but l don’t know how much longer I can take this.. Might have to leave for a bit because everyone seems to have lost their minds! You can’t live out the rest of your life hiding from death and sickness! That’s not life!

    1. Hi Zandra, which part of Sweden do you live in? I live in Stockholm, and that is not how I nor anyone I know personally is living. There was a temporary period in March, April, and May, where people were afraid and largely avoiding contact. But now, when I sit on the tube or walk around in the centre, it is just as packed as it was before the pandemic.

  9. Great perspective to hear on how serious Covid is. I also loved to hear your observation (on a recent interview) on the low incidence and death recently from influenza-like illness since Covid arrived. I would love to hear your take on why ILI incidence is so low this year. I understand how deaths could be reduced if so many susceptible frail people already died of Covid. But, how could the number of non-lethal cases of flu also decrease? WHO has reported about the same number of tests, but with drastically lower positive rate (~98% reduction over last year I think).

    1. Hi Jeff,
      My guess is that it has to do with two things. Firstly, respiratory viruses compete with each for hosts. Like you suggest, many people who would normallt have died of flu have probably died of covid instead this year. Secondly, I think lockdown measures designed for covid have probably also hampered the spread of flu.

  10. Dr. Rushworth, though an interesting article, how would you explain the discrepancies across the UK right now? In some locations there are notably higher rates than in others. If Covid is not the killer it is often reported as being, why are so many hospitalised with it? And why are these not all elderly? Surely one would not usually expect otherwise healthy people aged 50 to be attending hospital unable to breathe? Ok so they may not die – with treatment – but they would not normally be hospitalised with flu. The lockdowns have been to prevent the hospitals becoming overwhelmed because surely then, the point is those who are unable to breathe would not be treated and then would die, hence the death rate would rise. I suspect Sweden may show different results because it is not a densely populated as many nations that have been badly hit e.g. UK, France, Spain.

    1. Hi Tom,
      I’m not an expert on the UK, but I’ve spent the entire pandemic working as a doctor in a hospital in Stockholm. During the peak in April, I saw a lot of covid patients, now I haven’t seen a single covid patient in months. Based on my personal experience, I would say that is extremely rare for otherwise healthy 50 year olds to require hospitalization for covid, and that is also borne out by the statistics. And as I understand it, in the UK, there is currently about one person requiring intensive care per hospital right now. It doesn’t sound from that like the hospitals are even close to being overwhelmed.

  11. I’ve been saying this since the first numbers started coming in. The avarage age for people dying with covid in Sweden is 83, the same as average life span. How could this be explained if this was a deadly disease? It can’t, in my mind. If it was even somewhat deadly it would at least have SOME impact on the avarage age of death.
    So, if it’s mortality is low, the around 6000 figure is just a measure on how widely spread the virus was.. As a thought experiment, if we would apply the same standards on herpes (wich about 80% of the population has, in some form) the avarage age of death with herpes would of course also be 83, but the headlines would read “72 000 people in Sweden dies of virus every year!”.Wich would be ridiculous of course, but not far from how covid is being reported now.

  12. It’s unfortunate that longhaul Covid isn’t mentioned. I see no evidence that it’s prevelent enough to warrant lockdowns but it’s an argument commonly put forth in reasoning using case numbers instead of deaths to justify lockdowns.
    Perhaps we’ll get some reliable data out of Uppsala following the recent spike in cases.

  13. A very interesting read Sebastian. I live in Victoria Australia, unfortunately we don’t have any liberties as such presently. Our Premier lacks confidence & we are in lockdown & have been for months.
    It’s very disappointing the WHO arrived at their decision way to early about the so called COVID pandemic we are experiencing.

    It is very comforting to read your articles. No doubt there are many of us world wide who reason with you & constantly ask why we are/had being led to believe what our governments have concluded.

    Keep up the great work.

    Ron Henderson

  14. Dr Rushworth,

    Thanks for your question. Dr Ioannidis did his best to adjust seroprevalence studies to incorporate for limitations in the types of antibodies measured, so that he could scale up when all three were not measured. My intuition is that while no one knows the true IFR, the disease simply is overhyped. Hopefully I am right, and hopefully we can fix things before the crazy health policies instituted all over the world cause even more harm.

  15. Hi Sebastian, I am the editor of The BFD in NZ. I am writing to request your permission to republish this article on The BFD. I would give full attribution and two links back to your site, one at the start of the article and one at the end.

  16. Thank you once again Sebastian for an excellent and evidence based, sensible article on Covid.
    This comes a day after our local news is reporting the usual panic based fear inducing headlines, like ” Sweden’s cases are skyrocketing and they got it all wrong” blah blah.
    Thanks again and keep up the good work.

  17. Your article makes so much sense, but do you have any comment on the mortality rate numbers that came out this week for the US saying something like they have over 200,000 excess deaths? To me those numbers sound out of step but I couldn’t make heads or tails of the CDC report itself. Thanks.

    1. Hi Christy,
      Well, the US has had a rising overall mortality rate year on year since 2008, likely due to its opioid epidemic. The death rate so far this year in the US is 8,9 per 1,000 people. Last year it was 8,8 per 1,000 people. The year before that it was 8,7 per 1,000 people, and the year before that it was 8,6 per 1,000 people. So there is a small increase, representing about 30,000 people (not 200,000). But that increase is in line with previous years, so it is unlikely that it is due to covid. Here’s a link to the data:

  18. Hej, This is one of the absolute best of the dozens of articles I’ve read on this matter. Tack så jette mycket. I came across a gentle Swedish Youtuber months ago (Zackleo Se Bumbar) who in March blamed the PCR test for effectively ‘creating’ the pandemic. Without getting too conspiratorial what is your view on Dr Drosten and the PCR test and whether in fact we even have a unique virus. Thanks.

    1. Hi Peter,
      I think the PCR test should only be used clinically when suspicion is high that a person has covid. It should never be used for screening, because the probability that the person is a false positive is many times bigger than the probability that it is a true positive. I’m working on an article about covid testing, which I think I’ll have ready in a week or so.

  19. Dr Rushworth – what is your interpretation and understanding of the false positives that the PCR test produces??. In conversations with other Dr’s in the UK they seem to think its a useless test. And i also find it shocking that these tests are only being confirmed by the way of CT imaging. Not a single Petri dish in sight. All so very concerning. many thanks for your article. Paul Marsh

    1. Hi Paul,
      See my reply to Peter, above 🙂
      As to CT, I agree, you can’t confirm covid with a CT, because the CT finding of ground glass opacities in the lower lobes is highly unspecific. The only way to truly confirm that someone has covid would be to do a viral culture, which is not happening clinically anywhere as far as I know.

  20. Thank you Sebastian. A very much needed article, especially for the growing number of those who despite government and mainstream media narrative beginning to have doubts.

  21. There is a link to the high cases of Cov19 in Wuhan & Bergamo Italy that has to do with those areas having high use of agricultural pesticides like Glyphosate, (Roundup in the U.S.) and other polluting chemicals, which create respiratory problems/issues in older people and people with co-morbidity issues,
    (as well as the general population).
    If you wish to know more, look up Dr. Zach Bush and COVID-19. He is a medical doctor in the U.S. and is interviewed on several podcasts where he talks about this very thing. He also can be found on his website

  22. Thank you thats very interesting. I agree with you. I just have some interrogations though.
    I am French we know some people who died in April. 2 of my parents friends and they had some health issues, but died very quickly and quite unexpectedly. And the others are 2 politicians who died – 75 yrs old – they didnt seem to have any health issue. And also some doctors died, and my friend’s boss – 40 years old. I know this also happens with the flu or other viruses so maybe as you say it is just like any other viruses. But maybe with the flu we never really hear about the deaths so thats why we tend to think it is a more dangerous virus. I just wanted your opinion on the deaths of the younger people, or those who didnt have comorbidities.
    Today I know that most people get treated – especially doctors so deaths are much fewer. Thanks

    1. Hi Agathe,
      I think you are exactly right in your analysis. For young people, flu is more deadly than covid, but the media don’t write articles when young people die of the flu, so the media narrative creates a picture of covid as a much deadlier disease.

  23. Interesting read. However, Sweden is only one observation, and one observation is not enough to prove an argument.

  24. Jonathan, a number of epidemiologists have proposed explanations for why places hit hard very early in the pandemic have higher mortality. This is not my field but my understanding from the literature I have reviewed is that relevant factors include: 1) poor management of COVID patients in hospital settings (e.g. mismanagement leading to extensive nosocomial infection amongst highly vulnerable populations); 2) the age structure of the population (e.g. northern Italy has a particularly old population); and 3) early mistakes in how COVID patients were treated whilst in hospital (e.g. suboptimal mechanical ventilation management, and poor drug/therapeutic choices may have increased mortality). I’m also pretty sure that the healthcare system in northern Italy broke down in a ways that hampered the provision of medical care to those who needed it (see – e.g. a large number of doctors and nurses got infected, leading to a loss of capacity in key hospitals, and I also read in one study (can’t recall which one) that hospitals apparently admitted too many patients with mild COVID resulting in overcrowding and too little space for critical patients.

    Some new peer-reviewed studies (discussed here also indicate that major improvement in the treatment and overall clinical management of COVID patient has dramatically reduced mortality amongst hospitalised patients. Perhaps Sweden made fewer of the early errors made elsewhere (e.g. perhaps Swedish hospitals didn’t implement the suboptimal ventilator protocols reported elsewhere)?

    Overall, what occurred in northern Italy early in the pandemic may have been, in part, a tragic instance of medical mismanagement of COVID patients leading to greater loss of loss than otherwise would have occurred,.

  25. Very interesting analysis which I do find quite persuasive except for one thing regarding your assertions about Sweden having attained herd immunity which I’d appreciate hearing your thoughts on: the rapid increase in cases being confirmed in Sweden over the past two months. According to data on the other day (October 21) Sweden confirmed/reported 1,575 new cases, which is only a bit less than the highest number reported on any single day during this pandemic (1,698 cases reported on June 24). The daily number of cases has been rising rapidly during October. This raises a question: If Sweden has attained herd immunity what is your explanation for the massive growth in cases during the fall (which may continue or increase further in the winter)? If Sweden had attained herd immunity wouldn’t this be expected to control/limit the number of new infections more than has occurred over the past couple of months?

    Regarding this recent rise in cases, state epidemiologist Anders Tegnell was reported as commenting that “I think the obvious conclusion is that the level of immunity in those cities is not at all as high as we have, as maybe some people, have believed” (from

    What are your thoughts on this?

    1. Hi Stephen,
      Thanks, you bring up an interesting point. And as to your earlier post, I think your analysis is spot on.

      I think the rise in cases seen in recent weeks is down to two things. Firstly, a huge increase in testing. Obviously the more you test, the more covid you find, and testing has increased threefold in recent weeks.

      Secondly, I think there is a true increase in incidence, which I think shows that covid, just like the other four “common cold” coronaviruses, acts in a seasonal manner. In other words, it increases in prevalence in autumn and winter, and declines in summer.

      I certainly don’t think you can call what is happening right now in Sweden a “second wave”. If you look at what happened in the spring, there was an exponential increase that peaked after one month, with over 500 people in ICU at the same time with covid. We now have a very gradual increase that’s been going on for six weeks, and currently have 45 people in ICU.

      What happened in spring was a pandemic. What is happening now is a seasonal effect. Herd immunity does not mean that there is no infection, or that there is no seasonality, it just means that there is so much existing immunity in the population that the virus spreads at a low rate.

  26. Fantastic article. I enjoy all your articles as they are logical and backed up by facts and reason. Unfortunately too many people are of the mindset “don’t confuse me with the facts my mind is already made up“. It’s like they have a mental block of some sort.

    I would love to see an article and data comparing Covid more with the flu. People understand the flu, and I think a more detailed comparison of Covid risk versus flu risk will put it more in context for people. You’ve touched on it a little bit above in the article but I would like to see a more detailed analysis. Unfortunately I have found It difficult to find the infection fatality rate for the flu especially based on age.

    Keep up the great work and writing these terrific articles. You are doing a great service for many people!

  27. Have you personally checked out this compilation of papers on HCQ? I have and I don’t understand how the “world” experts can miss such results. Indeed, they take the results of Solidarity and Recovery trials which use toxic doses late, in hospital. The Solidarity trial even said that its results do not speak to early, out of hospital use.

    The hypothesis of Dr Raoult and Dr Zelenko is early, out of hospital use, and those results are easily evident from this compilation. There are some arrows faintly on top to move the slides forward.

    It is truly strange that both the USA and Canada prohibit the use of HCQ out of hospital. HCQ has an amazingly safe history, when used off label within guidelines.

    1. Hi Ed, I haven’t looked at the observational data, just the randomized controlled trials. The highest quality RCT:s were negative. I know of a meta-analysis of these RCT’s that is awaiting peer review and which does appear to show some benefit. But it lumps infections with hospitalizations and deaths in a combined end point. If they can separate out those things, and still show a statistically significant benefit on hospitalizations or deaths then I will change my mind on HCQ.

  28. Fantastic article. I enjoy all your articles as they are logical and backed up by facts and reason. Unfortunately too many people are of the mindset “don’t confuse me with the facts my mind is already made up“. It’s like they have a mental block of some sort.

    I would love to see an article and data comparing Covid more with the flu. People understand the flu, and I think a more detailed comparison of Covid risk versus flu risk will put it more in context for people. You’ve touched on it a little bit above in the article but I would like to see a more detailed analysis. Unfortunately I have found It difficult to find the infection fatality rate for the flu especially based on age.

    Keep up the great work and writing these terrific articles. You are doing a great service for many people.

  29. The lack of RCTs is amazing, considering all the hype since China announced it as efficacious back on Feb 17th. (10 hospitals, in a RCT, HCQ offered benefit, Remdescivir did not)

    Its use was widespread back in May of this year:

    The graph of death rates for countries using it as policy show positive results.

    I recall that the AIDs cocktail has never gone through RCTs. There is the issue of ethics. Dr Zelenko of NYC offered that any physician not using his HCQ + AZ + Z is committing genocide. Maybe that comment makes it impossible to get volunteers for a RCT.

    I cannot understand why the CDC/FDA lumps HCQ and CQ together(HCQ has mush less side effects), and I cannot understand why off label use is proscribed in 44 USA states. In Canada, this proscribing is the first in Canadian history, since 1948, for off label use. In effect, doctors are being ordered to violate their Hippocratic oaths.

    I agree with Dr Zelenko, if it eventually turns out that a RCT supports the early use hypothesis, then the authorities indeed have committed genocide for prohibiting off label use. Huge lawsuits will likely result in the USA and Canada. What a mess.

  30. I’m looking forward to your opinion of the (Drosten) PCR test.

    The PCR test is at the heart of this socalled pandemic. In most (all?) countries, positive PCR tests have been driving the political decisions and measures undertaken after the initial panic.

    The paper describing the (Drosten) test was rushed through in early January (which shows up clearly), and its existence has led to a tunnel vision, to the exclusion of all other respiratory illnesses.

  31. Keep the good work, I’m eagerly waiting for that post on PCR testings, because it’s driving many (bad) decisions here in Canada.

  32. On the one side, Sweden does not receive as many tourists as other countries. On the other side, your paper and this very fact show that any country pretending to face a dangerous epidemy should start by closing borders to non-essential travel and install a visa system to reduce movement. Instead of that, lowcosts are still flying from UK/NL/FR red zones and back without anyone questioning it in the main stream media.

  33. Thank you Sebastian, a well written article bringing a little sanity to this insane world at present. Another undeniable factor in this insanity is the use of the term “cases”. In the UK it is anyone who has a positive test result. For any thing else however, you have to have signs and symptoms. Signs being something a doctor can measure, a high temperature perhaps and symptoms being something you the patient are experiencing, loss of smell, dry cough etc. So many COVID cases have non of the above therefore can it not be argued these are simply people showing resistance to the disease as opposed to being a Covid case. Quite different things.

    1. Hi Colin,
      Exactly, if you have no symptoms, you are not a case, no matter what a PCR test may show. That is why it’s important to be able to separate the case fatality ratio from the infection fatality ratio, and realize that they are two very different things.

  34. Again, very Interesting, organized and to the point article, well done.

    There are so many combining factors that now points to the conclusion that Sweden has had herd-immunity for several months by now. One factor being that if you look at the death curve itself, Sweden droped below the average line from previous years already at the end of May, secondly, all emergency rooms at the hospitals became empty around the same time, thirdly, Sweden just had it lowest number of dead people ever reported in history, and so on….

    Another point, remember when it all started. The politicians all over the world said in unison, ”we close down for 2 weeks to flaten out the curve”, well, that was over 7 months ago, hello!!
    Since an average infection from a cold or a flu last around a week, a precaution of 2 weeks make sence if you expect a really serious one, but what happened after that??
    Then you also have the fact that a virus mutate 1 or 2 times every month, that also adds to the point that 2 weeks should be the upper limit for a lockdown, because if you’ll need to extend for every new mutant of a virus, you need to stay in lockdown forever.

    Then as already pointed out by many comments, there is the problem with the PCR-test itself. The inventor Kary Mullis, the Nobel Chemistry Prise winner said ”with PCR you can find almost anything in anybody, it doesn’t tell you that you’re sick”. Mullis then went on to say that the PCR-test was invented by himself for research, and was never intended for testing if people had infections, or if anyone was sick, he actually adviced against using it for that purpose. Based on how many times you dubble the virus RNA fragment in the PCR-test, you get different results, when you pass 35 times it starts being totally unreliable with many false positives, when you pass 40 times the false positives are in majority, when you reach 60 times, 100% of the tests shows positive result, all the time. So the interesting question becomes, how many times does the Covid19 PCR-test dubble its RNA sample?
    I’ve read that it dubbles 42 times, which in that case makes it total unreliable and the Covid19 PCR-test, a perfect manipulation tool.

    Sebastian Rushworth, thank you very much for your very interesting articles, and all your excellent work.
    I’m very much looking forward to reading you next one.
    Thomas Olsson

  35. How dangerous are these cotton or linen nose caps, contaminated with f.i. pesticides. Especially to young people.

  36. Julie: That’s probably true. On the other hand, Swedes do travel a lot. Among other places many Swedes go to ski in the alps in February/March, which is where and when much of the virus first spread in the early stages.
    This small cultural difference could very well be one explanation to why the spread was higher in Sweden than neighboring countries. The Danish don’t ski and the Norwegians ski in Norway.

  37. “The highest quality RCT:s were negative.”

    Which RCT trials for HCQ are you using for your views? Can you list them?

  38. Thanks for excellent and important information!!

    Have you heard about the Great Barrington declaration written by three professors from Harvard, Stanford and Oxford uni?

    From their considered view, from a global public health and humanitarian perspective – the response to the pandemic, with forced lockdowns, contact tracing and isolation, is imposing enormous unnecessary health costs on people, and in the long run will lead to higher Covid and non-Covid mortality than would an alternative approach they call ‘Focused Protection.
    Would love to hear yr opinion, keep up the great work!

  39. Spot the reasoning flaw in this claim: “But even if the antibody based number is the correct number, then covid still is not a very deadly disease. For comparison, the 1918 flu pandemic is thought to have had an infection fatality rate of 2,5%, i.e. one in forty infected people died. So the 1918 flu was 11 times more deadly than covid if you go by professor Ioannidis antibody based numbers, and 19 times more deadly than covid if you go by the fatality rate provided 12 days earlier by the WHO’s Mike Ryan.”

    It’s pretty glaring.

  40. Nice analogy there, and yes that is exactly what would happen !
    Sebastian is doing a great job bringing some truth and facts into this information debacle the media is bombarding us with

  41. I am very glad to have found yet another soul raising his head above the cloud of fear and use that most wonderfull and powerfull tool of this cosmos – the human nervous system – to it’s full capacity.
    Thank you for standing up, and speaking out, Doctor!

    And thank you all commenting here in civil tone, curiousness and humbleness.

    Through this year I have also been very grateful for the website that has been my greatest source of information regarding this virus. Highly recomended.

    May all people rule themselves through intelligence, sober risk asessement, integrity, honour, and love of life. May all fear be disspelled! It does not serve us.


    / Myskox

    1. Dr Rushworth is a light in darkness….I’ve been reading for months…just ordered book. I had mostly given up on having any non-biased conversations with almost anyone….the degree of absolute terror and fear in the lives of perfectly logical people, people who have no desire to corroborate what they are being told….I’m left gasping. Where is curiosity and investigation on perhaps one of the most important issues of our LIFETIME? There are some…here’s my most recent find, combining docs and (I know) lawyers. Good ones.

      You can’t imagine the looming chaos in the financial systems of the world, the policy decisions are unprecedented and there are no more bullets to load the gun. The consolidation of wealth and power are extraordinary.

  42. Today [Oct 25] you received a high number of valid phrases. I’ve so many things to write about covid, politics & all…
    I restrain and, calmly, I’ll write them to you and to all interested.

  43. Excellent …. the reasons why there has been such an ‘illogical’ response still remain a mystery to me.

    The two triggers were probably because first it originated in China and the second that the Chinese vigorously repressed the information which raised Worldwide suspicion. The first point I make is pretty weak given that many of the flu viruses have supposedly originated out of that part of the World and in the past our response was ‘another seasonal flu from Asia’.

    My personal position is that the response was fuelled by the Western media and that drove the Western politicians to pick up the cause so as to wrest the lead from media. The Western medical and scientific community were also complicit in their silence. I have been amazed at how unscientific the infectious diseases community have been in their tacit position on ‘eradication’ as being a feasible strategy. Here in Australia the professional medical and scientific societies have been almost silent. If this situation did not call out for profession specific position statements what does ?

    My clearly cynical overall observation is that the only real winners out of all this are the PPE and Covid test kit manufacturers. The real losers are the Western general public who unwittingly allowed politicians into the medical decision arena and the rest of the World that fell victim to the same responses via a domino effect. Now that politicians have exercised their powers in the medical treatments area they are unlikely to leave and treatments and pharmaceuticals will now be subjected to the whims of political review.

  44. Not Swedish but visited Gothenburg recently and it was a breath of fresh air ( literally!). Everywhere packed and vibrant. Some social distancing and lots of hand sanitizing and obviously only had chance to speak to a few but def got the impression it was like that for most. It was a wonderful break from the oppression of home.

  45. I agree with your entire article except for herd Immunity. The confirmed infections in Sweden in the Worldometer data shows a huge spike. The deaths have not increased….which is great. Could you please comment.

  46. But infected people who are asymptomatic are contagious. So it is indeed relevant to count them from a epidemiological perspective.

  47. Dr Rushworth, some further brief comments and queries about some claims in your article where you assert the following: “From January to September 2020, Sweden experienced 675 deaths per 100,000 population. That is less than both 2017 and 2018”).

    I like to review relevant data and check things for myself wherever possible, so I went to to access relevant data and then did some quick calculations.

    I used the same population figures as were used by the author of the calculation you cited (i.e. the same population statistics used by and I accessed official Swedish death statistics from here:

    I then calculated the total number of deaths for Jan-Sep for each year during 2015-2020 and used these figures to calculate deaths per 100,000 people in Sweden for the Jan-Sep period for each year, which provided the following results:

    2020: 678 deaths per 100,000 people
    2019: 618 deaths per 100,000 people
    2018: 662 deaths per 100,000 people
    2017: 662 deaths per 100,000 people
    2016: 660 deaths per 100,000 people
    2015: 688 deaths per 100,000 people

    According this analysis, the mortality rate in 2020 is higher than 2017 and 2018, and the mortality rate in 2020 is 3% higher than the 2015-2019 average (which is 658 deaths per 100,000 people). The 3% increase in mortality (compared with recent years) may provide another (better?) way of estimating the epidemiological significance of the COVID-19 pandemic in Sweden?

    It might be a good idea to check the numbers yourself and see if you think these claims in your article need to be corrected.


    1. Hi Stephen,

      Thanks for your comments, and it’s great that you’re double-checking the data. I admit that I didn’t check the SCB numbers directly myself, I trusted that the numbers provided by Lars Wilderäng of the Cornucopia blog were correct. He is usually very careful to always make sure his numbers are correct. I’ve now gone through the numbers myself in the excel sheet.

      You are correct that 2020 is not less deadly than 2017 and 2018 so far, although it is less deadly than 2015. I will modify the article to reflect that. I get slightly different numbers from you though when I run the calculations, which I guess could be either due to the rounding errors if we are looking at different parts of the spreadsheet, or due to the fact that SCB has modified the numbers since you did your calculations. That might also explain why Lars Wilderäng reached still other numbers.

      Here are the numbers I get (looking at January-September):

      2020: 687 deaths per 100,000
      2019: 633 deaths per 100,000
      2018: 677 deaths per 100,000
      2017: 676 deaths per 100,000
      2016: 671 deaths per 100,000
      2015: 692 deaths per 100,000

      The average for the entire period is 673 deaths per 100,000, or 669 deaths per 100,000 if you exclude 2020. That means 2020 is 2,7% higher than the average for the preceding five years.

      I don’t think that can reasonably be called a covid effect, for two reasons. Firstly, it is within the margin of error, so I think it is completely accurate to say that 2020 is in line with recent years. Secondly, as is clear from these numbers, unusually few people died in 2019 (6% less than average), so you would expect more than average to die in 2020 even without covid.

  48. Thanks for reviewing this and doing your own calculations! Strange that we got slightly different results – the only thing I can think of is that you used different population statistics?

    I used the year-end population statistics for 2015-2019 (available from–the-whole-country/summary-of-population-statistics/), and the most recent estimate (August) for 2020 (available from–the-whole-country/preliminary-population-statistics-2020/).

    The formula I then used is: Total deaths (Jan-Sep) / Population x 100,000

    I downloaded the spreadsheet again and using this approach I get the same results as before for all years except 2020 because some additional deaths have been added to the 2020 column – I now get 679 deaths per 100,000 population (not 678).

    (NOTE: I used Table 1 in the death statistics spreadsheet and added up the deaths from January 1 – September 30).

  49. There’s lots of disagreement:

    India –
    Rathi et al. Lancet Infect. Dis. doi:10.1016/S1473-3099(20)30313-3,, Hydroxychloroquine prophylaxis for COVID-19 contacts in India, ICMR recommends chemoprophylaxis with HCQ for asymptomatic health-care workers and asymptomatic household contacts of confirmed cases, 4/17.
    Atikh Rashid,, Maharashtra expands use of hydroxychloroquine as preventive measure, 4/23.
    Ministry of Health and Family Welfare,, Advised all front line health care workers to take HCQ prophylactically, 3/28.
    Oneindia,, No COVID-19 death in Manipur, Mizoram, Nagaland, Sikkim so far: Govt, HCQ widely distributed, 6/26.
    Dr. Goldin,, Summary of HCQ usage in India from an MD in India, everyone diagnosed with COVID-19 gets HCQ, it is the standard of care country-wide. The only problem is some patients come very late, deaths are from those who wait too long before seeking medical help. Everyone at high risk, including policemen, firemen, healthcare workers, and nursing home patients, take HCQ, all contacts of positive cases also get HCQ prophylaxis. HCQ is OTC in India, so everyone else is also welcome to use it, 8/21.
    AFP,, India backs hydroxychloroquine for virus prevention, 5/27.
    AAPS,, Hydroxychloroquine Has about 90 Percent Chance of Helping COVID-19 Patients, many nations, including Turkey and India, are protecting medical workers and contacts of infected persons prophylactically, 4/28.
    The Indian Express,, Vadodara administration drive: HCQ helping in containing Covid-19 cases, say docs as analysis begins, used prophylactically in Vadora with positive results, 7/2.
    Barron’s,, Hydroxychloroquine: A Drug Dividing The World, used as preventative measure, 6/1.
    Government of India,, The caregiver and all close contacts of such cases should take HCQ prophylaxis, 7/2.
    The Australian,, India and Indonesia stand by antimalarials, 5/29.

  50. “Hi Ed, see my article about HCQ (link below). Sweden is in line with the current international consensus that hcq is ineffective.”

    Thanks.. I checked out your review.. The C19study site agrees with your first two assessments, but also it gives some relevant comments, listed below. The third study is simply declared wrong. Thus it looks like the issue is still unresolved for you. Finally, now we have this:

    #1 HC Q was significantly associated with reduction / elimination of viral load, which was enhanced with AZ. Updated 8/13: responses to this paper have raised methodological issues [1, 2, 3].

    #2 150 patients very late stage RCT showing no significant difference. Treatment very late, average 16.6 days after symptom onset.

    Data favorable to HC Q was deleted in the second version, see analysis [1].

    “[HC Q] accelerate[s] the alleviation of clinical symptoms”

    “More rapid alleviation of clinical symptoms with SOC plus HC Q than with SOC alone was observed during the second week since randomization”.

    “The efficacy of HC Q on the alleviation of symptoms, HR 8.83 [1.09-71.3], was more evident when the confounding effects of other anti-viral agents were removed”

    #3 Authors say NEGATIVE but the C19study evaluation ended up disagreeing..

    Post Exposure Prophylaxis study Source

    Boulware et al., NEJM, June 3 2020, doi:10.1056/NEJMoa2016638 (Peer Reviewed)

    A Randomized Trial of Hydroxych loroquine as Postexposure Prophylaxis for Covid-19

    COVID-19 cases are reduced by [49%, 29%, 16%] respectively when taken within ~[70, 94, 118] hours of exposure (including shipping delay). The treatment delay-response relationship is significant at p=0.002. PEP delayed treatment RCT.

    Currently this is the only study where we have evaluated the result as positive while the authors indicate it is negative. We provide a detailed explanation of why the results presented here are positive [1]. Note that author comments also differ from the published conclusion.

    6 independent analyses confirm efficacy: [2, 3, 4, 5, 6, 7, 8].

  51. You may have already addressed this elsewhere, but what can we do about this argument that we’re making other people ill even when we don’t know it that keeps going around? It seems to be a big driver of fear and guilt over here in North America and everyone says it’s backed by science and yet common sense and very little data tells me it feels bogus to a large degree. Thanks so much!

  52. As the famous Dr Fauci has said aysmptomatic people are not and never have been a major source of infection.

  53. Sweden is the perfect example of a Casedemic. Case have been climbing almost exponentially since since the beginning of September and yet the 7 day moving average on deaths is 1.

  54. Thanks for your insights! I would like your thoughts on:

    1. Excess deaths in the UK, which are reported to be significantly high.

    2. Countries like India have taken 6 months to peak, while European countries typically peaked in a month or so. Is there any difference in virus response by genetic differences in these people groups?

    3. How is China so well off even though the whole thing started there? No second wave with autumn either? Is it only a case of data manipulation?


    1. Hi Colin,
      1. I haven’t looked in detail at the UK numbers but so far there have been 45,000 covid deaths in the UK. Total annual deaths in the UK are about 600,000. That doesn’t seem vastly different from the proportion seen in Sweden.
      2. I haven’t looked at India enough to be able to comment.
      3. I don’t think we can trust any numbers coming out of China.

  55. Apparently, northern UK was not hit very hard in the Spring and therefore probably more susceptible people, lower levels of community immunity.

  56. A final query: I’m curious about data lags regarding the reporting of deaths in Sweden and, related to this, when death statistics in Sweden for a given month/year are considered to be accurate and complete. For example, the CDC in the United States caution that deaths data in recent weeks are incomplete. I also know from reviewing the death statistics released by Statistics Sweden a few times over the past week that the death statistics for September 2020 are still being updated.

    Given this, I wonder if your claim about September 2020 (being the least deadly month in Swedish history) could be premature Do you know how it will take for death statistics in September 2020 to be finalised?

    You may want to review your claim about September 2020 when the death statistics are finalised.

  57. Ivor Cummins recent YouTube video mentioned recent ideas that the vast quantities of virus including Covid are distributed by global air currents whose pattern matches the pattern of international outbreaks. This would explain why Peru which has a strict Lockdown has high infection rates and Spain that has a strict Mask mandate has high infection rates indicating these authoritarian measures have little impact on infection which will not please out authoritarian governments who will likely discourage the possibility of this infection route as much as they discourage any ‘cure’ that is not by vaccination?

  58. I don’t understand why some people didn’t see this: if a disease does not cause any symptom, then it should mean that the disease is not dangerous. Even common cold causes symptoms. Think of it….

    1. Kay, Logic was never the’s is fear and control…if you think logically, you will be seen as a loony by all, friends, family, etc. This is causing serious fractures within families….it’s unreal.
      Their train has left the station and there are many of us left in the station…..yesterday, I gained hope. Why? Some docs and lawyers have married and I am hoping we can contribute to the wedding. It may be late but if we can save the children?

  59. Hi

    Just a thought but it looks as though 2019 might have been anomalously low (significantly below average). If so, is it possible that Sweden (like UK) had a ‘soft’ flu year. This might mean that there was a far higher proportion of ‘vulnerable’ people in the population than normal.

  60. Sebastian
    In much of Europe presentations for heart attacks and strokes are well down on normal. With obvious implications re longer term adverse effects. Much of that is attributed to lockdowns and the fear of attending hospitals etc.
    what are the figures for Sweden in regard of that ?

    1. In spring we saw a similar effect. Here in Stockhol hospital admissions for heart attacks were down 40% . At present my feeling is that things are back to normal, people have realized that the danger from the virus is not greater than the danger from a heart attack.

  61. I think it’s also important to understand that immunity doesn’t necessarily mean that sterilizing immunity, ie prevents transmission. Immunity to a coronavirus may potentially mean that symptoms upon re-exposure/infection are significantly less severe or mitigated entirely, which is the cases with several other circulating coronaviruses. The vaccines also may lack sterilizing immunity, we don’t know as the clinical trial endpoints don’t address this, they were designed to determine a reduction in symptoms; in fact, the vaccine trials weren’t even necessarily designed to assess if mortality is reduced in the vaccinated group.

  62. I can’t speak for China but here in Australia extremely draconian liberty-destroying measures were employed to suppress the epidemic in Victoria, which had been running at nearly a thousand new diagnosed infections per day. The left-wing government in that state of Australia has close financial ties to the CCP and has signed up as a partner in the belt-and-road programme.

    It appears to be possible to stop transmission with tight controls over the population, including hideous police brutality and home invasions. Sad but true. It might even be possible to stop transmission completely with largely voluntary measures although that hasn’t been demonstrated anywhere yet to my knowledge.

    God bless.

  63. Thank you for this excellent, clear and easy to follow article. However, you say that Covid-19 definitely exists but do you know if anyone has actually managed to isolate it properly? As far as I have been able to establish no one appears to have done so. In this CDC document – – on page 39 under Performance Characteristics it says “Since no quantified virus isolates of the 2019-nCoV are currently available”. In the absence of isolation, which is the first required step of the Koch/Rivers postulates to establish the existence and pathogenicity of any virus, how can it be identified, or indeed identifiable, by any testing procedure with any certainty at all?

    Furthermore, they cannot have successfully proved that it causes any particular disease. In the same document on page 3 under Intended Use it says “Positive results are indicative of active infection with 2019-nCoV but do not rule out bacterial infection or co-infection with other viruses. The agent detected may not be the definite cause of disease.”

  64. In this article drawing from another CDC document it claims that they could hardly get the virus to infect Human cells at all!!! I do not pretend to understand some of the gobbledygook used in such scientific articles but perhaps you will.

    It seems to me that there is plenty of reason to doubt the certainty of claims that our current bout of illness and deaths is actually caused by this so-called new deadly virus and that it could in fact be nothing to do with it. Clearly, we have illness and deaths, and no-one is denying that, but, if it is not caused by SARSCov 2 then it must be something else and may well be any other cause of respiratory illness that we have had throughout time.

  65. Thank you for a good read. I’m sceptical about the causative correlation between the virus and the disease, even about the very existence of SARS-CoV-2 to begin with. See this:

    But out of curiosity, how would you explain the apperant increase in sick people i hospitals we had in Sweden during spring 2020? Where there really more of them or simply a mirage created by the rather questionable use of rt-PCR tests or what?!

  66. Carrying on from my last comment as it wouldn’t all fit into the box:

    In this article drawing from another CDC document it claims that they could hardly get the virus to infect Human cells at all!!! I do not pretend to understand some of the gobbledygook used in such scientific articles but perhaps you will.

    It seems to me that there is plenty of reason to doubt the certainty of claims that our current bout of illness and deaths is actually caused by this so-called new deadly virus and that it could in fact be nothing to do with it. Clearly, we have illness and deaths, and no-one is denying that, but, if it is not caused by SARSCov 2 then it must be something else and may well be any other cause of respiratory illness that we have had throughout time.

    This one in my opinion, however, has been made much worse by the unfounded claims and gullible acceptance of it being a “new deadly virus” which has exacerbated the incidence and death toll by creating fear, an extremely negative emotion that suppresses immune systems and increases the likelihood of getting ill and reduces the chances of recovery. Add to that, unwittingly inappropriate treatments being used in the form of overly toxic anti-viral drugs and excessive use of ventilators, that would never have been used had we simply treated it as a normal flu outbreak, and you have a recipe for disaster.

    As an aside, you mention the 1918 flu pandemic. I believe there is research that has suggested the flu itself was not that deadly, but the high death rate was actually caused by superbugs being generated because of the appalling conditions in which they were having to be treated, combined with excessive use of Aspirin. Also, although this may not be easily verifiable and no doubt has been debunked as a conspiracy theory, it has been suggested by some that vaccines were used at the time that may also have exacerbated the death toll.

    These may be rather more anecdotal and less acceptably scientific but nevertheless are food for thought:

    Is it true for instance that a number of vaccines were manufactured at that time and given to millions of people around the globe? Is it also true that Greece refused them and faired very much better than other countries? If so, could they be linked?

  67. As in the other post where you said Sweden has reached herd immunity, which you now said understand was incorrect (you mentioned that you did not think this was a seasonal virus). This post again boggles my mind. So once again, I ask, what is your null hypothesis?

    As an M.D., you are familiar with the multitude of independent studies that assess estimated population mortality rates above 0.50% (>0.65% in Bergamo, Italy, CEBM/OXFORD. This is an estimated value and is it of course not the infection fatality rate. In Canada the current (Nov 17) death rate for someone diagnosed with COVID by age:
    60-69 3%
    70-79 12%
    80-89 23%
    90-99 32%

    Beyond, that also an M.D. I would assume that a statement such as “that most people who died “of” covid actually died with covid” is wild. For example, you could then say that about anyone over 70 dying with cancer, “well they didn’t die of cancer, they died of old age, but they had Cancer”. In Canada, COVID is about 10-33 times more lethal than the flu. The data is available freely. The The flu also does not typically cause effects felt for months. I find it so hard to believe that you are not aware of this, or aware of the limited actual number of deaths due to influenza. Even the deaths typically discussed in the media are an estimate value as the actual influenza ‘causal’ deaths are but a fraction. Again, this data is readily available, in Sweden, Canada, UK, and many other higher quality reporting countries.

    You must also be familiar with the fact that “underlying health conditions” could mean things such as diabetes, being overweight, having heart or lung issues. These are not ‘rare’, in the US, around 40% of the population has “underlying health conditions”. I understand that Sweden may be healthier, due in some part the universal health care system (i.e. like Canada).

    So once again, I would love to know your null hypotheses on your ‘fact’: “in fact, it often is. Covid-19 is not a unique disease, and does not appear to have a noticeably higher mortality rate than the so called “common cold”.

    Actual 2018-19 Season –

    What is basis of evidence for flu related incidence, IFR and Population Fatality Rate? What % would you need to see to admit you were wrong?

    1. Hi AL,
      The data I point to is official WHO data, based on analysis of antibody prevalence. It is the highest quality data available at this time, and most likely it is an overestimate, since not everyone develops antibodies. Ioannidis has updated his estimate of infection fatality rate to 0,15-0,20% . As to flu not being able to cause long term effects, that is simply wrong. There is no evidence that covid causes more long term effects than flu.

  68. Thanks for your reply. Bit odd that no one apparently have purified the virus as of yet. And no one seems to be able to present a specific gene (genome?) sequence for it. But that’s common in virology I gather. Sorry for not using the correct terminology by the way, I’m no expert by any means.

  69. In Canada, the virus is less deadly than the flu in younger age groups.
    And the post viral syndrome is reported more frequently with flu and pneumonia than Covid at this time. However as there are more Covid symptomatic infections the gross numbers are higher.

  70. I think there is some confusion around terminology, which has been at the forefront of the challenges with much of the handing of the pandemic, as well as the public’s understanding of actual risk vs perceived risk. Beyond the issues & unprecedentedness of a positive tests being outright synonymous with a “case” in the US and other locales, regardless of presentation of symptoms or symptom severity, or where no test is conducted but instead a case is ruled probable (and likely counted, depending on local definitions/regulations) based upon presentation of symptoms, which are rather generalized and not distinct from many other disease/illnesses such as flu.
    The two other terms that direly needed clarification at the get go, especially among the media, but also by public health officials and modelers (see Imperial College’s model estimates & assumption), was CFR and IFR. That is ‘case fatality ratio’ vs ‘infection fatality ratio’ (not rate, as rate implies a time component). This difference here is quite significant and the implications of confusing these terms have been profound IMHO.
    Since “cases” are ill-defined, as I just mentioned, and since we don’t have a full picture of the true scope of infections, which the WHO has estimated to be 750M+, or more than 10x the number of “confirmed cases”, then these numbers will be different and both will be dynamic instead of static as the pandemic progresses (and as we have seen). The IFR has been estimated ~0.1-0.35%, as per Ioannidis et al and other studies, with variation across geographies and age distribution (a particularly important factor), which is a comparable IFR to a bad flu season (with quite different age distributed mortality between COVID vs flu).
    CFR is defined as the ratio of deaths of total cases; where cases are defined based upon diagnosis of a discrete, limited-time course disease; often with symptoms severe enough to necessitate treatment (as we have seen this is not how the term “cases” has been used however). On the flipside, IFR, is the ratio of deaths to all infections; including asymptomatic infections and those not diagnosed. With many SARS-COV-2 infections being asymptomatic, and also many undiagnosed, the IFR denominator is much larger (and thus the IFR value larger; by approx 10x or more in this case), giving a more complete picture of percentage of deaths resulting from SARS-COV-2 infections; and thus actual risk.
    Also, seroprevalence is known to be a poor determinant of infections or prevalence in a population, as some don’t produce Abs or high levels of detectable Abs, and Abs tend to wane with time (which is normal for infections; and thus making Ab testing time dependent) at which point cellular immunity takes over with long lived T & B cells being protective and present, providing immunological memory. Yet, testing for cellular immunity is relatively challenging logistically & technically compared to Abs.

  71. As mentioned, I would love to know your null hypotheses on your ‘fact’: “in fact, it often is. Covid-19 is not a unique disease, and does not appear to have a noticeably higher mortality rate than the so called “common cold”.

    Actual 2018-19 Season –

    WHO is one organization. There are many studies available and as a form of research, we should be mindful to include appropriate studies across multiple sources.

    Both and other data are now readily available.

    So again, what is your basis of evidence for flu related incidence, IFR and Population Fatality Rate? What % would you need to see in relation to COVID to admit you were wrong?

    1. Hi AL,
      This isn’t a number I’m pulling out of thin air, and so it isn’t something that I need to prove. It is well established that flu usually has an IFR of around 0,1%, sometimes we have a bad flu year and it goes up to 0,2 or even higher. And the article you link to at CEBM is talking about case fatality rate, which as mentioned already is distinct from infection fatality rate and usually much higher, since most infections don’t become cases.

  72. Thank you.

    So if we are to go with this notation, that the season flu has an IFR of 0.1% which is debatable – from the CEBM article “In Swine flu, the IFR ended up as 0.02%, fivefold less than the lowest estimate during the outbreak (the lowest estimate was 0.1% in the 1st ten weeks of the outbreak). In Iceland, where the most testing per capita has occurred, the IFR lies somewhere between 0.03% and 0.28%.”

    From another journal l(BMJ)l: “Research conducted in New Zealand (NZ) and internationally suggests that the IFR for COVID-19 is typically at least an order of magnitude higher than for seasonal flu. The most detailed study of seasonal influenza mortality in NZ to date estimated average annual mortality of 13.5 (95%CI 13.4, 13.6) per 100,000 population [1]. Furthermore, the proportion of the NZ population infected with influenza in a year has been measured from a seroconversion study at 35% (95%CI: 32%-38%) [2]. Combining these figures suggests an IFR for seasonal influenza of about 0.039% (ie, 13.5/35,000) in NZ. This seasonal influenza IFR is 17 times lower than that estimated for COVID-19 at 0.68% [3] and 0.65% [4], based on international data (there have been too few COVID-19 cases in NZ to produce an IFR estimate)”

    The CEBM review discusses IFR:
    Iceland – 0.3% (3x times)
    UK – 0.9% (9x times)
    Global Estimate: 0.4% (4x times)

    So ask you, what IFR for COVID would you accept to say “my fact was incorrect and was not actually a fact”?

  73. If I understand you correctly, you estimate a disease’s deadliness by IFR or CFR. IFR means how likely it is that one dies of the disease when being infected, correct? Shouldn’t then the likelihood of _becoming infected_ be another important factor? So if the virus/bacteria/whatever spreads easier and people are less immune, i.e. getting more easily infected, this makes it more dangerous in my opinion.

    Just to double-check: If you’re immune, it doesn’t count as an infection, does it? So if I am vaccinated against let’s say influenza and I acquired immunity so that getting in contact with (a significant number of) the virus does _not_ cause an infection, this would not cound as an infection in the denominator of the IFR, correct?

    To me the most worrying aspect of SARS-CoV-2 is that there is so litttle natural immunity in the population (I don’t know about influenza) and that it apparently quite easily spreads through the air. So in the large picture even a small chance of dying or getting severe symptoms is amplified by the chance of actually getting infected.

    1. Yes, like I said, the Ioannidis data is higher quality. It is normal for the IFR to seem higher at the start of an epidemic, and for the numbers to come down as new data comes in. And even though the overall IFR is 0,15-0,20, it will be higher in regions with a higher proportion of risk groups.

  74. In addition to add important emphasis: Flu IFR is also an estimate. The actual death certificate noted information for pneumonia is a faction of the estimated values.This information available by jurisdiction across dozens of countries.

    Typically those who die from the flu have other ‘underlying health conditions’ and are older. I hope to point to this to eliminate the inaccurate comparison of “people dying with COVID not from COVID” because this is the same for the flu. (CDC)

  75. At the end of WW2 Britain had very large bedded hospitals that had been built on prime city land. So it was decided to sell off these hospitals and land and instead to build smaller units on land on the edges of cities. Smaller hospitals because patients did not need to stay in hospital for long due to improvements in operations and drugs. Now we have no where near the amount of hospital beds and staff to the population. But as we all know, money comes before people. Hence corridors were piled up with trolleys full of patients and no beds. Every winter hospitals have been full to overflowing with bed stoppers. Then comes a pandemic and instead there are no beds and not enough trained nurses; so the country grinds to a halt until the backlog of bed stoppers are removed.

  76. I think you need to redo some of your calculations. Rhinovirus fatality rates:—that is for people admitted to the hospital. If someone gets admitted for rhinovirus, they are probably much more frail than someone admitted for influenza, so there is a huge selection bias.

    .05 infection fatality rate is unrealistic when almost 0.1% of the entire US has died of the disease and just under 0.3% of NYC has died of COVID. Of course if you exclude enough higher risk people and include children who have very small risk, you will get a low number.

    If you want to compare with influenza, you need to do an apples-to-apples comparison. For influenza–you need to to add asymptomatic cases (about 1/3 ) to the denominator and remove the CDC estimates of undiagnosed influenza deaths from the numerator. Furthermore, if you are going to qualify fatality rates by excluding elderly or frail from the COVID count, you must do the same with the influenza number to make the comparison.

    Finally—you must address the fact that for everyone who dies of COVID, about 20 people end up in the hospital. How many people want to end up in the hospital?

  77. UK, to mid Dec:
    c 80k deaths 0.12% of pop, 10% had antibodies, IFR = 1.2%
    In an ideal world: x 2/3 opinion based on personal network i think the 10% is a bit low, x 2/3 healthcare has been short of capacity at times, x 1/2 if nil vitamin D deficiency
    Potential IFR is 0.3%-0.4%. I can’t get to 0.2%.
    Here’s hoping the vaccines will fix things.
    Greatly appreciate the articles, thought provoking and clear even if I dont always agree.

  78. It’s interesting to re-read your articles on covid in light of what we know now.

    For example, it seems relevant to note that the latest data released on covid deaths in Sweden shows that 0.11% of Swedes have died from covid thus far during the pandemic, with around 1000 additional deaths per week (peak of second wave?).

    So, if the mortality rate for covid is “more in line with what the WHO stated earlier in October” (which you asserted is around 0.13%) this implies that close to every person in Sweden has already been infected by covid during the pandemic. What data supports this claim?

    Or if the mortality rate is, say, closer to 0.3% then around a third of the Swedish population would need to have been infected to-date (the total number of infections would be about 6x the number of confirmed cases). Does any data support this claim?

    1. Yes, in the second week of January 40% of those tested for antibodies in Sweden, and 45% of those tested for antibodies in Stockholm tested positive. Those numbers have been rising by a percentage point or two all autumn and winter, so I think they’re real, could even be an underestimate. The proportion in Stockholm with a positive PCR test was 18% two weeks ago, dropped all the way down to 12% last week (after being at around 20% for several weeks in a row). And the numbers being treated in hospital are now dropping quickly. This all points to being on the cusp of herd immunity.

  79. A related quick thought: Perhaps you ought to provide an updated commentary on Sweden (and related analysis) reflecting the fact that the winter resurgence will be just as deadly as the initial spring epidemic was (or perhaps more so)?

  80. Dr Rushworth,

    Thanks for your prompt response regarding antibody testing. Are you able to elaborate further on related data quality aspects – i.e. how close does this seroprevalence data come to a large randomised sample that could provide accurate population-wide estimate of the seroprevalence of antibodies? Any other comments on data quality considerations?

    1. It isn’t a random sample, it’s people who are deciding on their own to get the test, which could bias both up (because people test themselves after having symptoms of infection) and down (because people don’t keep re-testing themselves after they know they’ve had covid). However, that has been the case throughout, so the trend is real, and as I say, has been rising by a percentage point or two every week since the beginning of autumn. And although in the early part of a pandemic, the first factor will bias positive antibody tests up, during the late part of a pandemic, the second factor will become dominant and bias them down.

  81. Shame it’s not a random sample! I’d suggest a high level of caution is needed when interpreting such data.

    As you noted, the typical argument is that people will be more likely to seek an antibody test if they suspect they might have been exposed or infected, or perhaps if they know that they have been and wish to check their “antibody status” post-infection. That is a major validity threat. I worry about the potential for biasing the results upwards.

    Some of the other considerations you raised do weaken these concerns somewhat.

    But, given the absence of high quality data, I’d still suggest avoiding making strong claims about population-wide antibody levels.

  82. Hi Seb,
    I would love to see the official update on this article on how Sweden did with overall death from all causes.

    1. Same here.
      Do you think that your conclusions still stand? Have we learned anything over the past 7 months? Are there any corrections that should be made?

  83. Very interesting. Can you do an article on why the UK have such huge numbers of people dying of covid and why its still rising in areas.

Leave a Reply

Your email address will not be published. Required fields are marked *