Dr. Ioannidis: 0.05% to 1% is a reasonable range for what the data tell us now for the infection fatality rate, with a median of about 0.25%. The death rate in a given country depends a lot on the age-structure, who are the people infected, and how they are managed. For people younger than 45, the infection fatality rate is almost 0%. For 45 to 70, it is probably about 0.05-0.3%. For those above 70, it escalates substantially, to 1% or higher for those over 85. For frail, debilitated elderly people with multiple health problems who are infected in nursing homes, it can go up to 25% during major outbreaks in these facilities.
In terms of numbers of lives lost, so far the COVID-19 impact is about 1% of the 1918 influenza. In terms of quality-adjusted person-years lost, the impact of COVID-19 is about 0.1% of 1918 influenza, since the 1918 influenza killed mostly young healthy people (average age 28), while the average age of death with COVID-19 is 80 years, with several comorbidities.
The predictions of most mathematical models in terms of how many beds and how many ICU beds would be required were astronomically wrong. Indeed, the health system was not overrun in any location in the USA, although several hospitals were stressed. Conversely, the health care system was severely damaged in many places because of the measures taken.
Greek Reporter: Finally, you had stated in March that, regarding lockdowns, they may be “bearable for a time, but how can policymakers tell if they are doing more good than harm?” if they are protracted. “School closures,” you stated, ”may reduce transmission rates” but may also “diminish the chances of developing herd immunity.” Even more important, perhaps, is this point you made — “One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society and mental health.
“Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war and a meltdown of the social fabric.” Your thoughts, please, on how many of these things have indeed come to pass in this country as you had feared.
Dr. Ioannidis: I feel extremely sad that my predictions were verified. “Major consequences on the economy, society and mental health” have already occurred. I hope they are reversible, and this depends to a large extent on whether we can avoid prolonging the draconian lockdowns and manage to deal with COVID-19 in a smart, precision-risk targeted approach, rather than blindly shutting down everything. Similarly, we have already started to see the consequences of “financial crisis, unrest, and civil strife.” I hope it is not followed by “war and meltdown of the social fabric.”
Globally, the lockdown measures have increased the number of people at risk of starvation to 1.1 billion, and they are putting at risk millions of lives, with the potential resurgence of tuberculosis, childhood diseases <...>, and malaria.