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You may have seen a recent article published in IJID which falsely claims that a high "population burden" of Omicron is associated with mystery paediatric hepatitis cases. It is truly terrible "research", and it should not have been published.

ijidonline.com/article/S1201- 1/10

High population burden of Omicron variant (B.1.1.529) is associated with the emergence of severe...

The Omicron variant (B.1.1.529) emerged in late 2021, causing a widespread epidemic across the world, including in countries that had taken containment strategy with “zero-COVID” policy (Petersen e...

2:39 PM · May 13, 2022Twitter Web App

Replying to

The primary finding is that OECD countries with cases of the mystery hepatitis had higher omicron case counts than those with no cases of hepatitis. The problem is the Y axis. For omicron they used total counts rather than population rates! 2/10

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The fatal flaw is that countries with very large populations are more likely to have had a case of hepatitis than small countries just due to size, AND will have had more covid, also just due to size. Comparing total counts in this case is... incredibly dumb? 3/10

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For example the chance of one of these hepatitis cases popping up in the USA was much higher than Luxembourg because it's literally 500 times the size. Luxembourg will also have had about 1/500th as much covid it falsely looks like a strong association. 4/10

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This method would also show a strong association between the number of children with brainstem cancer in a country and the number of shoes sold per year in that country. Because totals of most things are larger in larger countries. That's why we use rates. 5/10

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So what happens when we compare countries with the hepatitis to those without using the RATE of covid rather than totals? The effect disappears! 22 cases per 100 people in countries with hepatitis vs 19 cases per 100 people in people without, p =0.4. 6/10

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Why the journal allowed them to completely ignore the correct number (rate) and then just keep using the totals unadjusted for population and publish this obviously spurious association is a matter of deep mystery to me. 7/10

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Side note: even using rates wouldn't make this a GOOD study, things like ascertainment bias from testing for both diseases being confounded by economic means would remain completely uncontrolled in this design. 8/10

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In short, don't use total counts when comparing comparing countries that differ in size by many hundreds of times, because everything will correlate to everything regardless of whether there is any actual link. Use rates. 9/10

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This paper should be retracted, and serious questions should be asked about how this was accepted for publication. 10/10

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@HepatologyHugh

Replying to

Wrecking ball. Paper seems to be ‘down’?

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Yes unclear what happened was there a few hours ago, still in the "articles in Press" list too but link broken.

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Matt Timberlake

Replying to

Not exactly the type of research I was expecting, and didn't realize the paper was already out as even the article only says "soon". Taking advantage of the rushed nature of it, I suppose.

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Dr. Eric Oh So Good MD

Replying to

This was my 1st impression as well.

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@therealrthorat

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and

Article link is working now - unfortunately. This is embarrassing for the authors and the journal.

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Sagebiel Markus

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@charles_consult

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This is making my brain hurt. And that is the *only* figure!

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@melbourneliver

Replying to

I really need to start putting the word covid into titles to avoid all those journal rejections

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Replying to

Hi, Your thread has been embedded on PubPeer: pubpeer.com/publications/6

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Dr CJ Houldcroft

@DrCJ_Houldcroft

Replying to

A man after your own heart

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🏴󠁧󠁢󠁥󠁮󠁧󠁿

(flag of Milan)

Replying to

really, the paper should be retracted. I can’t believe one does not normalise by population

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@H9lEnvYLVkCAGtU

Replying to

最近、IJIDに掲載された論文で、オミクロンの「人口負荷」が高いことが謎の小児肝炎患者と関連していると虚偽の主張をしているのをご覧になった方もいらっしゃると思います。本当にひどい「研究」であり、掲載されるべきではなかったと思います。

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@David_Simons_UK

Replying to

Interesting that paper was published 8 days following submission. No open peer review apparently.

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Replying to

And there’s even an applicable xkcd xkcd.com/1138/

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Replying to

They know it is insignificant when they use population rates. They say "stat significance is not essential."

Quote Tweet

Hiroshi Nishiura

@nishiurah

· May 13

Replying to @_akiraendo

haha, reads more fundamental problem than the fact we cannot distinguish between a and b from ecological correlation. the observed tendency did not completely go away even when divided by population, although not significant. but anyway I shall think more for additional analysis

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Replying to

Mr. Nishiura suddenly popped up to be famous, as an covid19 analyst on msm,he's been so weird tho.

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