[set fair]

In a trial in Spain, of 76 covid patients admitted to hospital, all treated the same except 50 were given calcifediol (25-hydroxyvitamin D3) 26 were not (radomly) results:-

Vitamin D group 1 admitted to ICU, 0 died
No vitamin D group 13 admitteg to ICU, 2 died

https://www.sciencedirect.com/science/article/pii/S0960076020302764

[alancalverd]

Several fundamental aspects were considered when evaluating admission to the ICU: Presence of comorbidities,....

How strange that only one of the active group had significant comorbidities compared with 50% of the untreated controls.

the randomization did not achieve a homogeneous distribution of all the variables investigated between the two comparison groups (with and without calcifediol (Table2). A statistically significant difference was identified for the variable hypertension (26 had a history of hypertension of which 11 (42%) received Calcifediol [11/50 = 22%] and 15 (58%)[15/26 =58%]  not (CI: −0.58 to −0.13; p: 0.002) and close to statistical significance for diabetes 3 (6%) versus 5 (19% ).

an honest admission that the VitD result is inconclusive but, if you do the maths correctly (my figures in red) hypertension and diabetes are significant comorbidities.
Which we already knew.

[set fair]

How strange that only one of the active group had significant comorbidities compared with 50% of the untreated controls.

The 1 v 50% was the number admitted to the ICU - an outcome not the starting point.

[alancalverd]

But read the next paragraph - "randomisation" was very far from  random, and the strongest correlation seems to be with pre-existing hypertension and/or diabetes, as expected from observations elsewhere. 

there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression [2], which were more frequent in patients not treated with calcifediol.

we did not collect the BMI, which would have allowed us to add obesity

Serum 25OHD concentrations at baseline or during treatment are not available

In other words the study proved nothing beyond what was already known, ignored the known most important risk factor, and does not demonstrate the efficacy of VitD in treatment for COVID. Pity, because a cheap and simple treatment is always desirable, but false hope can be damaging.

[set fair]

But read the next paragraph - "randomisation" was very far from  random, and the strongest correlation seems to be with pre-existing hypertension and/or diabetes, as expected from observations elsewhere. 

there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression [2], which were more frequent in patients not treated with calcifediol.

we did not collect the BMI, which would have allowed us to add obesity

Serum 25OHD concentrations at baseline or during treatment are not available

In other words the study proved nothing beyond what was already known, ignored the known most important risk factor, and does not demonstrate the efficacy of VitD in treatment for COVID. Pity, because a cheap and simple treatment is always desirable, but false hope can be damaging.

Of course there will be differences between the groups, that's what happens when you randomise patients. They are taken into account -

Therefore, a multivariate logistic regression analysis was performed to adjust the model by possible confounding variables such as hypertension and type 2 diabetes

This is all standard stuff.

This is a science forum and you're a moderator Alan, I would have expected you to know this.

[alancalverd]

The maths fell apart in the previous sentence, and

 

The dependent variable considered was the need to be treated or not in ICU

Now since the "control" group had roughly 3 times the incidence of hypertension and/or diabetes, it is hardly surprising that a greater proportion were deemed to require ICU admission - the implication being that this was precautionary, not reactive, and therefore a matter of opinion, not fact.

It is interesting that the control group had a mean D-dimer of twice the active group, with a range up to 4 times that value*, so at least some of the control group were indeed in a very serious cardiopulmonary condition on entry, whilst the active group were all in the normal range. But this was not considered a prognostic bad risk factor.

Yes, it is all standard stuff, which makes it surprising that anyone would take the result as indicative of VitD benefit. I have no doubt that the intention was sincere, but whether by bad luck or skewed judgement, the trial turned out to be of dubious value. There's always a risk of spurious findings with small numbers and it always pays to look at the small print, and asking what have they not recorded (BMI) or recorded and ignored (D-dimer).

And like it or not, the essence of science is disproof. If, of the zillion available molecules, you choose to test the effect of A on B, it means that you hope it will produce a desirable effect. With the best will in the world, and particularly when dealing with life and death, it is very difficult to avoid bias in favor of your hypothesis. 

Unlike drinking Lysol, frying yourself with ultraviolet, or participating in a mass pray-in, adding a bit of vitamin D to your diet won't do much harm, but neither will chicken soup, and I remain to be convinced that either will lessen the impact of COVID. 

* Whilst 650.92 +/- 405.61 is just credible  for the active group, how do we interpret 1333.54 +/- 2570.50 in the  control group? Can anyone actually have a negative D-dimer score? Or do we not understand statistics? The minimum implication of these figures is that at least one of the control group scored over 3900 which would suggest a pre-existing pulmonary embolism or serious inflammation whereas all the active group were in the range of normal for age. Remember that most COVID-related deaths are due to inflammation or cardiovascular insufficiency.

[alancalverd]

As for the original question, both Oz (3 persons per sq km) and NZ (19) have much lower population densities than the UK (280) and far less regular travel between conurbations. The worry is that USA (34) is doing almost as badly as the UK, despite having pretty much the same ethnic mix and overall standard of living as the others.   

[Bored chemist]

If a journal contains 20 reports of positive findings at  the p=0.95 level, it's quite likely that at least one of them is wrong.

[Bored chemist]

As for the original question, both Oz (3 persons per sq km) and NZ (19) have much lower population densities than the UK (280) and far less regular travel between conurbations. The worry is that USA (34) is doing almost as badly as the UK, despite having pretty much the same ethnic mix and overall standard of living as the others.   

Japan has a population density (347/km^2) rather higher than the UK.
The UK has 612 death per million of population
Japan had 11 deaths per million of population.

It's hard to escape the conclusion that incompetent government is a major factor.
(So is poverty, which is a lot harder to fix).

[alancalverd]

I've not visited Japan but the impression I get from colleagues who have, and from Japanese colleagues I've met elsewhere, is also of social norms and compliance that make British "reserve" look positively savage in comparison.

Ben Elton put it succinctly in a novel, where an American enters a British burger joint and discovers that however much you train a British teenager and put him in a uniform, "Have a nice day" still sounds like "F**k off".

[Bored chemist]

This also supports the "having a liar in charge" hypothesis.
https://god.dailydot.com/trump-covid-19-interviews/?fbclid=IwAR13tZHb8PUY0Tl2b6Uk2CFpMxzzAyDv6DwJOVzic4r1PC7w8-Z2TOdHy6s

[alancalverd]

What surprises me is that anyone took any notice of what Trump said, when plenty of people who know what they are talking about were telling the truth and reporting it for all to see. Blame surely lies with journalists and broadcasters who give airtime and print space to the ignorant ramblings of politicians.   

[Bored chemist]

A journalist can hardly not report what the president said.
However, a good one can add editorial comment.

Unfortunately, that system breaks down if the President only ever talks to people who will support him.

[alancalverd]

I disagree. A free press can report or ignore anything it chooses to. The public (apart from Daily Mail readers) expects to learn what has happened and what is going to happen. What a politician thinks or says is of no significance to anyone unless he is announcing a forthcoming action or passing on actual intelligence that has previously been an official secret (Tony B Liar please note - a PhD thesis is not an official secret or credible intelligence. House of Commons please note: you are elected to hold the executive to account, not to cheer the prime minister on to an election victory).

Editorial opinion is no more valid than that of the politician, though pointing out inconsistencies and probable consequences of announced policy  may be considered due diligence.

The president can talk to whoever he likes, but Goebbels was only quoting a historical fact when he pointed out that a lie repeated becomes a truth, and any journalist who knowingly broadcasts a lie or treats politics as an arm of entertainment  is doing Goebbels' work.  Party propaganda should be paid for by the party, not the viewer. 

UK coverage of the last US presidential election campaign was at least 80% about Trump, so the fact that the electorate still rejected him came as a bit of a surprise, but balance was restored by the electoral college which treated the popular vote as irrelevant.

[Bored chemist]

What a politician thinks or says is of no significance to anyone unless he is announcing a forthcoming action

Saying "covid isn't a real threat " is announcing a plan of action; a plan to ignore the virus (and a plan to tell further lies etc).
People need to be made aware of that policy.

If they think it's a stupid policy then they can vote for someone else next time. (by which time it's too late).

[alancalverd]

Saying "covid isn't a real threat " is announcing a plan of action; a plan to ignore the virus (and a plan to tell further lies etc).

It's an announcement of personal belief and non-action. Why anyone would choose to broadcast it is beyond comprehension, particularly when the facts are freely available.

Broadcasters and newspaper editors run their staff and freelance reports through fact check and legal before publication, so why not apply the same standards to political speeches and simply reject anything that doesn't stack up?   

[Bored chemist]

It's an announcement of personal belief and non-action. Why anyone would choose to broadcast it is beyond comprehension,

Because it's important to know what the President is doing.

so why not apply the same standards to political speeches and simply reject anything that doesn't stack up?   

great idea.
How do you anticipate getting it through parliament or congress?

I see there's a big song and dance at the moment about Boris and his latest impossible idea. Loads of testing daily for everyone by Xmas.
They say it would cost £100 B
Yes, £10^11
But that's not actually the problem. The govt can write (and honour) a cheque for that. The problem is to whom can you make it payable?

It's equivalent to roughly £ 300 B per year
If you pay people £30,000 per year that's ten million people
Where are they going to find 10 million people with the sorts of skills needed?
It's plausible that there are that many scientists, and technicians inteh world but it's not as if they are currently fly-fishing.

So, it's obvious that Boris is lying.

Yet his supporters still think he's doing well.
And that's not so much because they are fools, but because the media are not telling the truth.

[alancalverd]

Because it's important to know what the President is doing.

In this case, nothing. No news is not news.

from: alancalverd on Today at 14:58:41]
so why not apply the same standards to political speeches and simply reject anything that doesn't stack up?   

great idea.
How do you anticipate getting it through parliament or congress?

No need. Editorial policy is decided by editors, not government, in a free country. Which, for the next 8 weeks, includes the USA.

They say it would cost £100 B
Yes, £10^11
But that's not actually the problem. The govt can write (and honour) a cheque for that. The problem is to whom can you make it payable?

That's almost enough to cover the consultancy fees for 100 miles of railway that nobody needs. Cheque payable to Party supporters, spouses of personal friends, and whoever has the PM's balls in his hand, as usual. It's your money, so he can spend it any way he likes.

The test doesn't actually have to work anyway. All it tells you is that you may have or may have had a disease, which you may or may not know anyway. It doesn't stop you getting it or dying from it, which is what you want.

[Bored chemist]

No need. Editorial policy is decided by editors, not government, in a free country. Which, for the next 8 weeks, includes the USA.

If Boris makes a speech then the only relevant editor is Cummings.

There is a difference between reporting
"We have a world leading track + trace system"
and reporting
" Boris said ' We have a world leading track + trace system'"

An editor is only responsible for misleading the readers in the first case.
As you said

Editorial opinion is no more valid than that of the politician

The problem arises when the BBC decides to make Farage the most frequent Question Time "guest" in history.
That's when it turns into propaganda.

[Bored chemist]

The test doesn't actually have to work anyway. All it tells you is that you may have or may have had a disease, which you may or may not know anyway. It doesn't stop you getting it or dying from it, which is what you want.

It may stop you spreading it- which would be rather useful.