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      Correlation and Causality: a Covid Conundrum

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      Publication date (Electronic):
      Journal: The European Respiratory Journal
      Publisher: European Respiratory Society

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          Abstract

          I read with interest the two contributions by James Chalmers et al. to the 1st July edition of the Journal. In a reply to correspondence [1] concerning the ICS withdrawal controversy they suggest [2] that Alvar Agusti succumbs to the fallacy of post hoc, ergo, proctor hoc i.e. A occurred, then B occurred: Therefore, A caused B. However, as we know, correlation is not causality.

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          Wrong but Useful — What Covid-19 Epidemiologic Models Can and Cannot Tell Us

          Inga Holmdahl, Caroline Buckee (2020)
          Article 0 comments Cited 173 times – based on 0 reviews     Review now
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            Coronavirus infections: Epidemiological, clinical and immunological features and hypotheses

            Didier Raoult, Alimuddin Zumla, Franco Locatelli … (2020)
            Coronaviruses (CoVs) are a large family of enveloped, positive-strand RNA viruses. Four human CoVs (HCoVs), the non-severe acute respiratory syndrome (SARS)-like HCoVs (namely HCoV 229E, NL63, OC43, and HKU1), are globally endemic and account for a substantial fraction of upper respiratory tract infections. Non-SARS-like CoV can occasionally produce severe diseases in frail subjects but do not cause any major (fatal) epidemics. In contrast, SARS like CoVs (namely SARS-CoV and Middle-East respiratory syndrome coronavirus, MERS-CoV) can cause intense short-lived fatal outbreaks. The current epidemic caused by the highly contagious SARS-CoV-2 and its rapid spread globally is of major concern. There is scanty knowledge on the actual pandemic potential of this new SARS-like virus. It might be speculated that SARS-CoV-2 epidemic is grossly underdiagnosed and that the infection is silently spreading across the globe with two consequences: (i) clusters of severe infections among frail subjects could haphazardly occur linked to unrecognized index cases; (ii) the current epidemic could naturally fall into a low-level endemic phase when a significant number of subjects will have developed immunity. Understanding the role of paucisymptomatic subjects and stratifying patients according to the risk of developing severe clinical presentations is pivotal for implementing reasonable measures to contain the infection and to reduce its mortality. Whilst the future evolution of this epidemic remains unpredictable, classic public health strategies must follow rational patterns. The emergence of yet another global epidemic underscores the permanent challenges that infectious diseases pose and underscores the need for global cooperation and preparedness, even during inter-epidemic periods.
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              Estimates of the ongoing need for social distancing and control measures post-“lockdown” from trajectories of COVID-19 cases and mortality

              Mike Lonergan, James Chalmers (2020)
              By 21st May 2020, SARS-CoV-2 had caused more than 5 million cases of COVID-19 across more than 200 countries. Most countries with significant outbreaks have introduced social distancing or “lockdown” measures to reduce viral transmission. So the key question now is when, how, and to what extent, these measures can be lifted. Publically available data, on daily numbers of newly-confirmed cases and mortality, were used to fit regression models estimating trajectories, doubling times and the reproduction number (R0) of the disease, before and under the control measures. These data ran up to 21st May 2020, and were sufficient for analysis in 89 countries. The estimates of R0, before lockdown, based on these data were broadly consistent with those previously published: between 2.0 and 3.7 in the countries with the largest number of cases available for analysis (USA, Italy, Spain, France and UK). There was little evidence to suggest that the restrictions had reduced R far below 1 in many places, with France having the most rapid reductions – R0 0.76 (95%CI 0.72–0.82), based on cases and 0.77 (95%CI 0.73–0.80) based on mortality. Intermittent lockdown has been proposed as a means of controlling the outbreak while allowing periods of increase freedom and economic activity. These data suggest that few countries could have even 1 week per month unrestricted without seeing resurgence of the epidemic. Similarly, restoring 20% of the activity that has been prevented by the lockdowns looks difficult to reconcile with preventing the resurgence of the disease in most countries.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Respir J
                Journal ID (iso-abbrev): Eur. Respir. J
                Journal ID (publisher-id): ERJ
                Journal ID (hwp): erj
                Title: The European Respiratory Journal
                Publisher: European Respiratory Society
                ISSN (Print): 0903-1936
                ISSN (Electronic): 1399-3003
                Publication date (Electronic): 28 August 2020
                Electronic Location Identifier: 2003174
                Affiliations
                Hull York Medical School, University of Hull
                Author notes
                Castle Hill Hospital, Cottingham, E Yorkshire HU16 5JQ, UK. E-mail: a.h.morice@ 123456hull.ac.uk
                Article
                Publisher ID: ERJ-03174-2020
                DOI: 10.1183/13993003.03174-2020
                PMC ID: 7453735
                PubMed ID: 32859679
                SO-VID: 2a48d3e2-bdca-45be-97db-5696df0eb054
                Copyright © Copyright ©ERS 2020
                License:

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 17 August 2020
                Categories
                Subject: Correspondence

                ScienceOpen disciplines: Respiratory medicine
                Data availability:
                ScienceOpen disciplines: Respiratory medicine

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