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I read a lot about this virus lately, and it looks like the mortality rate depends a lot on the availability of intensive care. If that's the case, slowing down

I read a lot about this virus lately, and it looks like the mortality rate depends a lot on the availability of intensive care. If that's the case, slowing down the diffusion of the infection could be really important in keeping down the total number of deaths.

wonderwonder 7y ago
I noticed the same thing. As numbers continue to grow, we run the real risk of even top of the line health care systems being overwhelmed and people passing from lack of access to care. Couple numbers that jump out for me are China with ~3% mortality rate but also rumors of these numbers being vastly unreported. Iran with a 19% mortality rate (on a small scale)! Also the mortality rate appears to be 3.2% where for a while it was in the low 2s. https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries If this grows into a true pandemic, it will to the best of my knowledge be the first stress test of our Just-In-Time style of inventory management at grocery stores.
- mytailorisrich 7y ago
  In Iran I suspect that either the actual number of cases is much higher than currently reported/known or that the people infected were mostly elderly, or both.
- rossdavidh 7y ago
  China also reports about 8 recovered for every 1 death, so even if their numbers are accurately reported, there are a lot more who have done neither as of yet, and about 11% of them will die. Which would be a lot more deaths.
  - znpy 7y ago
    China also has a relatively old population, due to their one child policy. And age is a risk factor for covid-19. Italy on the other hand... Oh, nevermind.
- nicolapede 7y ago
  Given that it can take N weeks to die, wouldn't it make sense to calculate the mortality rate at a given time t as the number of deaths at time t divided by the number of reported infected people at time t-Nweeks ? (I am using N =3 for my back-of-the-envelope calculations).
  - SpicyLemonZest 7y ago
    No, since not everyone who dies will have had a confirmed case 3 weeks back - both because the actual time the disease takes is (almost surely) variable and because detection isn't perfect. The mortality rate in Iran is infinity by that metric, for example.
- makomk 7y ago
  Iran's mortality rate is almost certainly much lower than 19%, since there's reason to believe the total infection rate is much higher than they're claiming. We wouldn't expect nearly so many travellers from Iran to be infected if coronavirus was as rare there as their figures make it out to be.
asiachick 7y ago
Dumb question but what intensive care? Do people need to be on respirators? Need access to drugs only available at ICU? Just curious if any of the things done at an ICU to prevent death really need to be only at the ICU.
- daxorid 7y ago
  Yes, mechanical ventilators and in most cases, supplemental oxygen for roughly 18% of patients. We can expect CFR in the US to be fairly low (approx 2%) as long as the availability of these resources permits treatment for all who need it. After saturation, however, the CFR will move asymptotically toward approx 15%. Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. The US has about 62k mechanical ventilators, about half of which are already occupied at any given time, and half of the available ones are purpose-built for infants in NICUs. So let's assume we begin to have a real problem above (62k/4)/0.18 == 86k simultaneous US cases. I'd assume oxygen supplies should be easy to scale up. No idea about scaling up the manufacture of ventilators, or if the (much more numerous, and cheaper) CPAP machines in the US could be used as stand-ins. Perhaps someone more familiar with these devices can chime in.
  - paganel 7y ago
    > After saturation, however, the CFR will move asymptotically toward approx 15%. > Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. This would practically be a Denial of Service Attack on any health system, no matter the country in which that health system is based in. Which is why it is so important to try to contain the virus spread before we get to the "move asymptotically toward approx 15%" phase.
  - JshWright 7y ago
    CPAP is definitely a viable intervention for ARDS. Some percentage of patients will still end up needing intubation/ventilation, but CPAP is a good way to prevent that in some percentage of cases (esp if used pretty "aggressively" to support the patient while they're still able to breathe on their own, if they get to the point where they can't breathe for themselves effectively enough, then CPAP isn't going to do anything for them)

wonderwonder 7y ago

I noticed the same thing. As numbers continue to grow, we run the real risk of even top of the line health care systems being overwhelmed and people passing from lack of access to care. Couple numbers that jump out for me are China with ~3% mortality rate but also rumors of these numbers being vastly unreported. Iran with a 19% mortality rate (on a small scale)! Also the mortality rate appears to be 3.2% where for a while it was in the low 2s. https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries If this grows into a true pandemic, it will to the best of my knowledge be the first stress test of our Just-In-Time style of inventory management at grocery stores.

mytailorisrich 7y ago
In Iran I suspect that either the actual number of cases is much higher than currently reported/known or that the people infected were mostly elderly, or both.
rossdavidh 7y ago
China also reports about 8 recovered for every 1 death, so even if their numbers are accurately reported, there are a lot more who have done neither as of yet, and about 11% of them will die. Which would be a lot more deaths.
- znpy 7y ago
  China also has a relatively old population, due to their one child policy. And age is a risk factor for covid-19. Italy on the other hand... Oh, nevermind.
nicolapede 7y ago
Given that it can take N weeks to die, wouldn't it make sense to calculate the mortality rate at a given time t as the number of deaths at time t divided by the number of reported infected people at time t-Nweeks ? (I am using N =3 for my back-of-the-envelope calculations).
- SpicyLemonZest 7y ago
  No, since not everyone who dies will have had a confirmed case 3 weeks back - both because the actual time the disease takes is (almost surely) variable and because detection isn't perfect. The mortality rate in Iran is infinity by that metric, for example.
makomk 7y ago
Iran's mortality rate is almost certainly much lower than 19%, since there's reason to believe the total infection rate is much higher than they're claiming. We wouldn't expect nearly so many travellers from Iran to be infected if coronavirus was as rare there as their figures make it out to be.

asiachick 7y ago

Dumb question but what intensive care? Do people need to be on respirators? Need access to drugs only available at ICU? Just curious if any of the things done at an ICU to prevent death really need to be only at the ICU.

daxorid 7y ago
Yes, mechanical ventilators and in most cases, supplemental oxygen for roughly 18% of patients. We can expect CFR in the US to be fairly low (approx 2%) as long as the availability of these resources permits treatment for all who need it. After saturation, however, the CFR will move asymptotically toward approx 15%. Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. The US has about 62k mechanical ventilators, about half of which are already occupied at any given time, and half of the available ones are purpose-built for infants in NICUs. So let's assume we begin to have a real problem above (62k/4)/0.18 == 86k simultaneous US cases. I'd assume oxygen supplies should be easy to scale up. No idea about scaling up the manufacture of ventilators, or if the (much more numerous, and cheaper) CPAP machines in the US could be used as stand-ins. Perhaps someone more familiar with these devices can chime in.
- paganel 7y ago
  > After saturation, however, the CFR will move asymptotically toward approx 15%. > Medical system saturation is believed to be the main reason the CFR in Hubei is much worse than other provinces. This would practically be a Denial of Service Attack on any health system, no matter the country in which that health system is based in. Which is why it is so important to try to contain the virus spread before we get to the "move asymptotically toward approx 15%" phase.
- JshWright 7y ago
  CPAP is definitely a viable intervention for ARDS. Some percentage of patients will still end up needing intubation/ventilation, but CPAP is a good way to prevent that in some percentage of cases (esp if used pretty "aggressively" to support the patient while they're still able to breathe on their own, if they get to the point where they can't breathe for themselves effectively enough, then CPAP isn't going to do anything for them)