9 ms·

How to Respond to COVID-19

147 points by doppp 7y ago

JKCalhoun 7y ago
> The data so far suggests that the virus has a case fatality risk around 1%; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%). That was a little shocking to read. I had no idea the 1918 influenza pandemic was only 2%. I lost relatives to it, assumed it was a larger percentage than 2%.
- kevinthew 7y ago
  Yeah. The part that should freak people out is this looks multiples more infectious to boot.
- javajosh 7y ago
  And I think its important to note that 2% is the mortality rate in a hospital where they have respirators, etc. The mortality rate outside of a hospital (e.g. in a quarantine wharehouse) is something like 20%. (I wish I could remember the source for this, will look and edit but it may have been The Atlantic). It also seems like some survivors come out of this with pretty severe damage to their organs, especially lungs, because the persons immune system goes overboard and attacks healthy tissue. So, some fraction of people will live, but be disabled.
  - greatpatton 7y ago
    A 20% death rate is highly unlikely.The Italian researchers who sequenced the Italian strain believe that the virus has been circulating widely in Italy since January, even before Italy banned direct air flight to China. This seems to be confirmed by the fact that almost all the new cases in Europe are originating from big Italian cities. If the death rate was 20% we should start to see a lot of death in Italy and it doesn't seem to be the case. Iran and Egypt also seems to be largely hit, as many tourist back from Egypt have been infected. Now getting the real death rate is going to be a very complicated game, especially if many infected patient remain without symptom. I tend to believe the virus is already highly circulating in a high number of place of the planet where the health system is bad, and lacking testing capabilities. We are even starting to see untraceable cases in the USA.
    - tessierashpool 7y ago
      Caveat: some of the "untraceable" cases are kind of "semi-traceable" in practice. The American government (against the advice of its own CDC) flew back American patients who had been on the Japanese cruise ship, infected and uninfected alike, and sent in HHS employees to interact with them, with inadequate training and hazard protections (i.e., no bunny suits). This heightened infection risk for the uninfected cruise ship patients and the HHS employees, as well as anybody who knew them. This plane landed at Travis Air Force Base in Solano County, California. Which is where the first "untraceable" case in the United States occurred.
      - animalnewbie 7y ago
        I keep hearing about this- is there a source for this? Or drumf is inolved so must be true?
      - makomk 7y ago
        You're mixing up two different evacuations. The whistleblower complaint about HHS employees with inadequate training processing evacuees was about the Wuhan evacuation, not the Diamond Princess one. Only about three of the Wuhan evacuees ever ended up testing positive for the virus, there's no reason to believe they were even infectious when flown back and none of the staff involved have shown signs of COVID-19. It's certainly possible that one of the people involved in the quarantine didn't follow precautions and was infected, even with full training, but I don't think there's any evidence tying the California case to it.
        tessierashpool 7y ago
        OK — I did conflate Wuhan and Diamond Princess, so thanks for correcting me there, but according to both Time and the Washington Post, HHS employees were sent (without proper training or protection) to meet with evacuees in each case: https://www.washingtonpost.com/health/2020/02/27/us-workers-without-protective-gear-assisted-coronavirus-evacuees-hhs-whistleblower-says/ https://www.washingtonpost.com/health/2020/02/27/us-workers-... https://time.com/5792135/coronavirus-whistleblower-hhs-employees/ https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...
  - ekianjo 7y ago
    20 percent? Where? Most people are not even tested and in China where they have the largest hospital facilities for treating patients the number is far lower than 20 percents.
    - amf12 7y ago
      That comment was about the 1918 influenza pandemic.
  - mytherin 7y ago
    The 2% mortality rate of the coronavirus is likely greatly overestimated [1]. Early mortality rates of diseases are generally estimated to be too high because only severe cases are tested. The exact same happened with H1N1 (Swine Flu): initial studies showed a 2-3% case fatality rate, but afterwards it was found to have an actual mortality rate of around 0.15% [2], close to that of the flu at 0.1%. [1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-deaths-mortality-rate https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea... [2] https://en.wikipedia.org/wiki/2009_flu_pandemic https://en.wikipedia.org/wiki/2009_flu_pandemic
    - TomK32 7y ago
      So, should we even care if the actual rate is merely 50% above your regular flu? Is this 0.15% one winter/year or across several seasons?
      - mytherin 7y ago
        It is still speculated to be more contagious than the flu, and the flu itself is no joke. Many people will die if the coronavirus gets out of control. However, it is certainly not the end of the world others are claiming either. Being aware of it and taking certain precautions (e.g. washing your hands more often and staying home if you feel sick) is a good idea.
  - mytailorisrich 7y ago
    It should also be noted that they did not have antibiotics back then. The Spanish flu today would have most likely a lower fatality rate than it had then. Obviously those diseases are viral. But it seems that they can be helped by bacteria and certainly bacterial pneumonia is a common serious complication, and I believe that patients hospitalised for COVID-19 are given antibiotics for these reasons.
    - hyperman1 7y ago
      The spanish flu would probably have been much less severe if it didn't happen right after WWI. Basic supplies for food and soap were not yet at their pre WWI levels and the population was still weaker and physically recovering from the war.
      - mytailorisrich 7y ago
        That's an additional aspect, yes.
      - TomK32 7y ago
        WWI started 10 months after the Spanish flu. Press censorship did also contribute to its spread.
        hyperman1 7y ago
        Huh, what? WWI started on 28-07-1914 and ended 11-11-1918 while the spanish flu started around january 1918.
- brianpan 7y ago
  The death rate was "small" but the reach was large. 1/4 of the world's population got it so the total death toll was large.
- NanoWar 7y ago
  2% is very huge, it is every 50th person!
- takeda 7y ago
  2% would be over 6 million Americans. I don't understand why that percentage is often reported as insignificant.
  - tessierashpool 7y ago
    that's legit -- the percentage is not insignificant -- but it does look like you're calculating 2% of all Americans (approx 327M). the 2% number is _case_ fatality rate, i.e., how many cases are fatal. so to get from there to actual deaths, you have to apply it to _cases_. so you need to combine that with the attack rate, or attack ratio. the only number I've heard for the attack rate is 30%, from the virologist Ian Mackay, who caveated it as a guess: https://twitter.com/MackayIM/status/1233511899083530240 https://twitter.com/MackayIM/status/1233511899083530240 it could probably never be anything but a guess, until after the fact. anyway, it would not be 2% of the US population. it would be 2% of 30% of the US population, which is approximately two million people. with the caveat that all of these numbers are early estimates based on limited data. 2M people is still a lot of deaths. but it's not just how many people are killed. the rate of hospitalization is 15-25%. approx 10% of patients in Italy right now are in intensive care. the disease expresses as severe pneumonia, so severe that survivors have experienced _organ failure_. you could be hooked to a ventilator for a month. in the United States, if you survive a medical problem that serious, it still ruins your life. probably this country will see not just a significant number of deaths, but also a spike in medical bankruptcies -- which are already a huge problem here.
    - gdubs 7y ago
      So the question according to those numbers is, are we prepared to hospitalize 10% of the 30% of people who may get infected in the United States? In particular, do we have enough ventilation beds, the isolation infrastructure, the staffing? During a crisis you’d want daily briefings where questions like these could be asked. I’ve said in other threads: it feels like the US is sleepwalking through this. If the CDC believes, as they said last week, that this will spread inevitably — what exactly are we waiting for? We have two cases of unknown origin in Santa Clara county, yet schools are still open as of now. Wouldn’t it make sense to close them for two weeks now to hopefully slow the spread and give us additional time to ramp up our medical response?
- deleted 7y ago
  [deleted]
- askvictor 7y ago
  On numbers from https://news.ycombinator.com/item?id=22432358 https://news.ycombinator.com/item?id=22432358 (and those numbers are not necessarily accurate for lots of reasons) the death rate is below 0.4% for all age groups below 49. Then it increases exponentially. I'm curious what the comparative age breakdown of the 1918 flu was, particularly given that a lot of people would have been malnourished due to the war, and health care was not as advanced as now.
  - exdsq 7y ago
    The Spanish influenza affected young adults more than the elderly/weak because it caused the immune system to attack the body. The stronger the immune system, the more damaging the individuals illness.
  - E14n 7y ago
    There are some graphs broken down by age for the Spanish flu https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/
- ekianjo 7y ago
  Context matters. We had almost no medicine back in 1918. That changes everything.
- saberdancer 7y ago
  I am not getting it either. "It infected 500 million people around the world,[2] or about 27% of the then world population of between 1.8 and 1.9 billion, including people on isolated Pacific islands and in the Arctic. The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history" 500 million infected, 40-50 million deaths. Isn't that 10% death rate? Perhaps it was 2% for people who were treated in hospitals.
  - tspiteri 7y ago
    2% of 2 billion is 40 million. So perhaps it was 2% of the whole population.
- phyzome 7y ago
  2% means 1 in 50 people. How many people do you know? How about people who are a friend of a friend? What is that number divided by 50? In all likelihood, within a year, several people you know will die of covid-19. (Also note that the effects will be different around the world and in different social strata; in poorer areas, the death rate will be much higher, and in rich areas much lower.)
- qznc 7y ago
  Wikipedia is inconsistent for 1918 flu pandemic: https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid=943187983 https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid... "The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).[51]" "The unusually severe disease killed up to 20% of those infected, as opposed to the usual flu epidemic mortality rate of 0.1%.[2][54]"
javajosh 7y ago
In a perfect world, Trump would appoint Gates to lead the Department of Health and Human Services, Gates would accept, the Senate would quickly confirm, and Trump would actually listen and defer to him on this. It's interesting that this is directed to policy makers and other leaders, rather than individuals on the ground - e.g. it's about resource allocation, not personal preperation. (It was amusing to see the large-scale analogue to hoarding referred to as "lists of supplies to be stockpiled or redirected in an emergency." This presumes, of course, that governments will act as a force of mediating reason on people's irrational impulses; and we all know that sometimes it's the opposite).
- sky_rw 7y ago
  Wait I thought Gates was in on this with the Chinese and released this as population control? Have I been getting my news from the wrong source?
- animalnewbie 7y ago
  Senate would quickly confirm. There is no such world. Remember when trump closed China travel he was called an overreacting xenophobe
alien_ 7y ago
It's easy to raise the billions required to fight this. It's peanuts for governments and even larger companies hoarding tens of billions that have a lot to lose because of such pandemics.
- rm_-rf_slash 7y ago
  Raise the billions to do what though? Pay for pharmaceuticals that can’t reach sick people because there aren’t enough people to work the production lines, the docks, the ships, the trains, the trucks, and the hospitals?
mnm1 7y ago
How about investing in "low- and middle-income" Americans and providing them healthcare? In addition how about providing required paid sick leave that can be taken without fear of losing one's job? These are actual things we could do to help people respond and deal with COVID-19. Yes, working on vaccines is important but testing and avoiding spreading the virus as much as possible are even more important. Right now, we have no hope of doing either in an effective manner. People will go to work sick, including with COVID-19 because they have no choice, because our government has left them no choice. They won't be able to get tested because they have no choice due to not having health insurance--another choice removed by our ineffective policies. I don't see any coherent plan by the government at this moment to address any of these issues and given the current situation, I would not be surprised if we have one of the worst outcomes of any developed country, possibly including China. The only hope is that the virus mutates into something less contagious or harmful and that should not be something we rely on.
davidwihl 7y ago
Marc Lipsitch, a Harvard epidemiologist, estimates that 40-70% of the adult world-wide population will be infected. [0] Assuming a conservative 1% mortality rate, that would mean 30-50M deaths, a tragically huge number. [0] https://news.harvard.edu/gazette/story/2020/02/key-coronavirus-question-how-are-children-affected/ https://news.harvard.edu/gazette/story/2020/02/key-coronavir...
- ekianjo 7y ago
  Most cases with mild symptoms are not even reported or noticed by those infected so the real number is lower than 1 percent in all likelihood.
  - fab1an 7y ago
    This could swing both ways alas. The optimistic case would be how swine flu played out, where initial estimates for fatality where in the percentage range but ended up in the per mille dimension. However, for SARS 1.0, it was initially estimated to have a fatality of 2% - the final number was over 10%. It's simply too early to tell. Unfortunately, the latest WHO report suggest there isn't that big of an iceberg of undetected cases, which would sadly mean a higher CFR.
  - tristanj 7y ago
    > Most cases with mild symptoms are not even reported This is outdated. Dr. Bruce Aylward said in a WHO conference this week that the Chinese tested 320,000 samples in Guangdong and they are not seeing huge transmission beyond cases found clinically. It's at 47 mins in this video: https://youtu.be/-o0q1XMRKYM?t=2810 https://youtu.be/-o0q1XMRKYM?t=2810 > so the real number is lower than 1 percent in all likelihood. I disagree. When we calculate the SARS-CoV-2 CFR properly using CFR = deaths / (deaths + recovered) using the latest data we get 2,924 / (2,924 + 39,605) = 7% CFR That's much more in line with the original SARS CFR of around 9%.
    - learc83 7y ago
      "The claim was quickly challenged by an infectious diseases expert who serves on a committee that advises the WHO’s health emergencies program. Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, said it would be highly unusual for there not to be mild or symptom-free cases that are being missed. He pointed to the fact that outbreaks have popped up in countries far from China — including Iran and Italy — because people with mild infections were not detected and traveled to other places. 'There are mild cases that are undetected. This is why it’s spreading. Otherwise it would not be spreading because we would know where those cases are and they would be contained and that would be the end of it,' said Kobinger, who insisted that mild, undetected infections cannot be ruled out until people who haven’t been diagnosed with the illness can be tested for antibodies to the virus. 'As long as we do not have good serology data, I think that it is completely speculative to say that there are no undetected cases,' Kobinger said." What Dr. Aylward says makes no sense and reads more like a PR fluff piece designed to praise China to keep them happy, and as Kobinger points out he's probably wrong. From the same press conference he says this "If I had COVID-19, I’d want to be treated in China." Which is obviously bullshit. As the specifics of the 320,000 cases. It wasn't a serum antibody test, so it wouldn't show people with low viral loads or people who recovered. Also this is in Guangdong where the infection was potentially quickly contained, and if you'll notice the death rate is much lower in Guangdong.
nl 7y ago
Does anyone know where the 2% death rate for 1918 flu comes from? I've seen it quoted multiple times, but Wikipedia says: It infected 500 million people around the world... The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million But later The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio). It is estimated that approximately 30 million were killed by the flu, or about 1.7% of the world population died. Other estimates range from 17 to 55 million fatalities[1] [1] https://en.wikipedia.org/wiki/Spanish_flu https://en.wikipedia.org/wiki/Spanish_flu
- saberdancer 7y ago
  I'm really surprised by this as well. From what I can tell, the estimate that was named is "above 2.5%". This could be simply by calculating how many people died compared to total population in the world. If 2.5% of total world population died, assuming everyone was infected, it is at least 2.5% case fatality rate and depending on how many people were not infected case fatality rate will go down.
  - jtbayly 7y ago
    Wouldn’t case fatality rate go up the more people were not infected?
    - saberdancer 7y ago
      Yes. But if you do not have a lower bound for number of infected, you can with certainty only say "above 2.5%".
simonh 7y ago
Here in the UK we learned the hard way that health care is national defence. It’s a matter of vital national security. In WWI we were chronically short of healthy young recruits, far too many potential soldiers were too sickly or under nourished to serve. What goes for the military goes for industry too, what use is a sickly, unfit work force, especially in a crisis? This is why universal health care is not controversial in the UK. It’s why lifelong conservative voters like me support universal health care, we were faced with a clear existential threat generations ago. How could we expect the population to fight for a country that didn’t look after them in return? Loyalty has to go both ways. I accept we’re a different case from the US because we’re a much smaller country, the US can manage due to sheer numbers, but that’s a pretty poor excuse. Having a fit, healthy population matters. Now we’re faced with Covid-19. This is a matter of national and international security and defence. Health care spending is national defence spending. It’s just a different type of defence against different types of threats, some mundane, some exceptional.
- WalterBright 7y ago
  > How could we expect the population to fight for a country that didn’t look after them in return? One of the benefits of serving in the US military was free medical care for the soldier and his family.
  - forkerenok 7y ago
    I think the argument extends to potential need to draft general population in times of need. You want to draft healthy people.
    - chii 7y ago
      the argument doesn't work, because the assumption is that you have a large, but unhealthy population. But such a population is unable to sustain itself in the first place! If a country is doing fine (production wise), then there must be way more healthy, able-bodied people than sick people. The draft will just target those able-bodied people. And then there's the new style of war these days - drones, remote weapons and nukes. It either comes down to a small skirmish against brown people with little more than an AK47, or it's nuke time. i don't see war going any other direction.
lordnacho 7y ago
I wonder if there will be a more general cultural change. For instance, will it become commonplace to have disinfectant dispensers in public places, like you might have drinking fountains and public bathrooms? Will workplaces and stadiums install these? I can't judge the advice on this, but it seems to be that disinfectants work. Also, will people be told to stay home when they're even slightly ill? Currently people know that sick people spread disease, but we leave it to their own judgement as to whether to show up. What about a law that says you can't be paid as a contractor if you show up and you're ill? Could/should that happen?
- krisoft 7y ago
  “ What about a law that says you can't be paid as a contractor if you show up and you're ill?” To my european ears that’s a very strange thought. This is what paid sick leave was invented for. If we do as you proposed that strongly incentivises people to judge themselves not sick. Obviously the most intense cases will be found out, and according to your law sent home without pay, but by then the damage is done.
  - lordnacho 7y ago
    I mean contractors though. A lot of people in finance get paid per day they show up. I even have friends who will go to work while terribly ill because they get paid £1000 for it. Paid sick leave is fairly normal for people on standard employee contracts.
- blub 7y ago
  I'd be very happy of seeing everyone wash their hands after using the bathroom and sneezing in their elbows. As it is, a disturbing number of people truly are either careless or clueless.
melonkidney 7y ago
From a business perspective, be prepared for an extended period working from home, and be prepared for productivity to drop. Prioritize and set expectations accordingly. I have colleagues in China who are facing down their fifth week working from home. At the beginning, they tried to maintain their normal (and excellent) level of output. But the stress of quarantine is starting to show. Disruptions to normal routines, such as kids stuck at home and reduced/no access to childcare, are the non-newsworthy but most challenging issues for a large number of folks.
- stareatgoats 7y ago
  ... until they realized that working from home and closeness to kids and family was really a wonderful thing?
  - melonkidney 7y ago
    Right, and I must admit that was my initial reaction. I honestly hope that one positive from all of this will be that working from home (and remote work generally) becomes more widely acceptable. Unfortunately, in this instance, what I'm hearing from people on the ground is that the balance has swung a bit too far into "cabin fever" territory at this point.
  - logicchains 7y ago
    Note that in China it's common for people with kids to live with their extended family/in-laws (who look after their kids while they're working). Like anywhere else in the world, for many people spending time with their in-laws is not a pleasant experience.
  - namelosw 7y ago
    Can confirm. I'm in Beijing and it's wonderful indeed, I'm not with my family though. I already worked from home for a month as a developer, and we have confirmed we'll WFH for the next 2 weeks at least. There's no sign of productivity dropping for now according to our regular analytics. We have similar velocity as in previous months, where the estimation was done before the Chinese new year (just to clarify).
DyslexicAtheist 7y ago
who is still excited about pair programming? I think this will come to an end very abruptly. keyboards are disgusting.
- sixstringtheory 7y ago
  Only when it's done over VC. I miss ScreenHero!
- pvinis 7y ago
  I mean, it's pretty easy to do pair programming with separate keyboards or even computers..
tomohawk 7y ago
Are you legally prepared? Do you have a will, an advanced medical directive, and other important documents? If not, take this as a cue to get that done today. Pandemic or no pandemic, you should have these. Without these documents, you may very likely not receive the medical treatment you would wish to have should you become incapacitated. Also, your worldly possessions will likely not be dealt with as you would wish, and you'll be leaving a mess behind for your loved ones. So, get your affairs in order.
- JoeAltmaier 7y ago
  Some of that might work. If the pandemic is as harsh as some fear (anything like 1918) then the bodies pile up in the street. A will might not be important.
- abjKT26nO8 7y ago
  > you'll be leaving a mess behind for your loved ones. I don't have any loved ones. > advanced medical directive My country doesn't honor those. Yup, I'm about as prepared as I can be.
mhkool 7y ago
For those who are interested in how to improve your own immune system function I recommend to watch a couple of videos of Dr Bergman and Dr Axe
gdubs 7y ago
“Global health experts have been saying for years that another pandemic rivalling the speed and severity of the 1918 influenza epidemic wasn’t a matter of if but when.“ Short-term-ism is the real epidemic in America. We seem paralyzed in taking preparedness steps in a host of issues that are a matter of “not if, but when.” From Climate Change, to infectious disease. On individual level, we share some of the blame. I’ll admit that even in earthquake and fire prone California that prior to this current crisis, I’ve never kept more than a few days worth of food on hand. Even faced with a real risk, there’s inertia there — but ultimately realizing that being prepared as a household is the root of resilience for a neighborhood and community. It’s not a selfish act — it’s the responsible thing to do. But at a leadership level, we seem to be waiting for some shoe to drop in this current situation rather than take proactive steps. We seem two steps behind this thing in the US.

147 points by doppp 7y ago

> The data so far suggests that the virus has a case fatality risk around 1%; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%). That was a little shocking to read. I had no idea the 1918 influenza pandemic was only 2%. I lost relatives to it, assumed it was a larger percentage than 2%.

kevinthew 7y ago
Yeah. The part that should freak people out is this looks multiples more infectious to boot.
javajosh 7y ago
And I think its important to note that 2% is the mortality rate in a hospital where they have respirators, etc. The mortality rate outside of a hospital (e.g. in a quarantine wharehouse) is something like 20%. (I wish I could remember the source for this, will look and edit but it may have been The Atlantic). It also seems like some survivors come out of this with pretty severe damage to their organs, especially lungs, because the persons immune system goes overboard and attacks healthy tissue. So, some fraction of people will live, but be disabled.
- greatpatton 7y ago
  A 20% death rate is highly unlikely.The Italian researchers who sequenced the Italian strain believe that the virus has been circulating widely in Italy since January, even before Italy banned direct air flight to China. This seems to be confirmed by the fact that almost all the new cases in Europe are originating from big Italian cities. If the death rate was 20% we should start to see a lot of death in Italy and it doesn't seem to be the case. Iran and Egypt also seems to be largely hit, as many tourist back from Egypt have been infected. Now getting the real death rate is going to be a very complicated game, especially if many infected patient remain without symptom. I tend to believe the virus is already highly circulating in a high number of place of the planet where the health system is bad, and lacking testing capabilities. We are even starting to see untraceable cases in the USA.
  - tessierashpool 7y ago
    Caveat: some of the "untraceable" cases are kind of "semi-traceable" in practice. The American government (against the advice of its own CDC) flew back American patients who had been on the Japanese cruise ship, infected and uninfected alike, and sent in HHS employees to interact with them, with inadequate training and hazard protections (i.e., no bunny suits). This heightened infection risk for the uninfected cruise ship patients and the HHS employees, as well as anybody who knew them. This plane landed at Travis Air Force Base in Solano County, California. Which is where the first "untraceable" case in the United States occurred.
    - animalnewbie 7y ago
      I keep hearing about this- is there a source for this? Or drumf is inolved so must be true?
    - makomk 7y ago
      You're mixing up two different evacuations. The whistleblower complaint about HHS employees with inadequate training processing evacuees was about the Wuhan evacuation, not the Diamond Princess one. Only about three of the Wuhan evacuees ever ended up testing positive for the virus, there's no reason to believe they were even infectious when flown back and none of the staff involved have shown signs of COVID-19. It's certainly possible that one of the people involved in the quarantine didn't follow precautions and was infected, even with full training, but I don't think there's any evidence tying the California case to it.
      - tessierashpool 7y ago
        OK — I did conflate Wuhan and Diamond Princess, so thanks for correcting me there, but according to both Time and the Washington Post, HHS employees were sent (without proper training or protection) to meet with evacuees in each case: https://www.washingtonpost.com/health/2020/02/27/us-workers-without-protective-gear-assisted-coronavirus-evacuees-hhs-whistleblower-says/ https://www.washingtonpost.com/health/2020/02/27/us-workers-... https://time.com/5792135/coronavirus-whistleblower-hhs-employees/ https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...
- ekianjo 7y ago
  20 percent? Where? Most people are not even tested and in China where they have the largest hospital facilities for treating patients the number is far lower than 20 percents.
  - amf12 7y ago
    That comment was about the 1918 influenza pandemic.
- mytherin 7y ago
  The 2% mortality rate of the coronavirus is likely greatly overestimated [1]. Early mortality rates of diseases are generally estimated to be too high because only severe cases are tested. The exact same happened with H1N1 (Swine Flu): initial studies showed a 2-3% case fatality rate, but afterwards it was found to have an actual mortality rate of around 0.15% [2], close to that of the flu at 0.1%. [1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-deaths-mortality-rate https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea... [2] https://en.wikipedia.org/wiki/2009_flu_pandemic https://en.wikipedia.org/wiki/2009_flu_pandemic
  - TomK32 7y ago
    So, should we even care if the actual rate is merely 50% above your regular flu? Is this 0.15% one winter/year or across several seasons?
    - mytherin 7y ago
      It is still speculated to be more contagious than the flu, and the flu itself is no joke. Many people will die if the coronavirus gets out of control. However, it is certainly not the end of the world others are claiming either. Being aware of it and taking certain precautions (e.g. washing your hands more often and staying home if you feel sick) is a good idea.
- mytailorisrich 7y ago
  It should also be noted that they did not have antibiotics back then. The Spanish flu today would have most likely a lower fatality rate than it had then. Obviously those diseases are viral. But it seems that they can be helped by bacteria and certainly bacterial pneumonia is a common serious complication, and I believe that patients hospitalised for COVID-19 are given antibiotics for these reasons.
  - hyperman1 7y ago
    The spanish flu would probably have been much less severe if it didn't happen right after WWI. Basic supplies for food and soap were not yet at their pre WWI levels and the population was still weaker and physically recovering from the war.
    - mytailorisrich 7y ago
      That's an additional aspect, yes.
    - TomK32 7y ago
      WWI started 10 months after the Spanish flu. Press censorship did also contribute to its spread.
      - hyperman1 7y ago
        Huh, what? WWI started on 28-07-1914 and ended 11-11-1918 while the spanish flu started around january 1918.
brianpan 7y ago
The death rate was "small" but the reach was large. 1/4 of the world's population got it so the total death toll was large.
NanoWar 7y ago
2% is very huge, it is every 50th person!
takeda 7y ago
2% would be over 6 million Americans. I don't understand why that percentage is often reported as insignificant.
- tessierashpool 7y ago
  that's legit -- the percentage is not insignificant -- but it does look like you're calculating 2% of all Americans (approx 327M). the 2% number is _case_ fatality rate, i.e., how many cases are fatal. so to get from there to actual deaths, you have to apply it to _cases_. so you need to combine that with the attack rate, or attack ratio. the only number I've heard for the attack rate is 30%, from the virologist Ian Mackay, who caveated it as a guess: https://twitter.com/MackayIM/status/1233511899083530240 https://twitter.com/MackayIM/status/1233511899083530240 it could probably never be anything but a guess, until after the fact. anyway, it would not be 2% of the US population. it would be 2% of 30% of the US population, which is approximately two million people. with the caveat that all of these numbers are early estimates based on limited data. 2M people is still a lot of deaths. but it's not just how many people are killed. the rate of hospitalization is 15-25%. approx 10% of patients in Italy right now are in intensive care. the disease expresses as severe pneumonia, so severe that survivors have experienced _organ failure_. you could be hooked to a ventilator for a month. in the United States, if you survive a medical problem that serious, it still ruins your life. probably this country will see not just a significant number of deaths, but also a spike in medical bankruptcies -- which are already a huge problem here.
  - gdubs 7y ago
    So the question according to those numbers is, are we prepared to hospitalize 10% of the 30% of people who may get infected in the United States? In particular, do we have enough ventilation beds, the isolation infrastructure, the staffing? During a crisis you’d want daily briefings where questions like these could be asked. I’ve said in other threads: it feels like the US is sleepwalking through this. If the CDC believes, as they said last week, that this will spread inevitably — what exactly are we waiting for? We have two cases of unknown origin in Santa Clara county, yet schools are still open as of now. Wouldn’t it make sense to close them for two weeks now to hopefully slow the spread and give us additional time to ramp up our medical response?
deleted 7y ago
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askvictor 7y ago
On numbers from https://news.ycombinator.com/item?id=22432358 https://news.ycombinator.com/item?id=22432358 (and those numbers are not necessarily accurate for lots of reasons) the death rate is below 0.4% for all age groups below 49. Then it increases exponentially. I'm curious what the comparative age breakdown of the 1918 flu was, particularly given that a lot of people would have been malnourished due to the war, and health care was not as advanced as now.
- exdsq 7y ago
  The Spanish influenza affected young adults more than the elderly/weak because it caused the immune system to attack the body. The stronger the immune system, the more damaging the individuals illness.
- E14n 7y ago
  There are some graphs broken down by age for the Spanish flu https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/
ekianjo 7y ago
Context matters. We had almost no medicine back in 1918. That changes everything.
saberdancer 7y ago
I am not getting it either. "It infected 500 million people around the world,[2] or about 27% of the then world population of between 1.8 and 1.9 billion, including people on isolated Pacific islands and in the Arctic. The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history" 500 million infected, 40-50 million deaths. Isn't that 10% death rate? Perhaps it was 2% for people who were treated in hospitals.
- tspiteri 7y ago
  2% of 2 billion is 40 million. So perhaps it was 2% of the whole population.
phyzome 7y ago
2% means 1 in 50 people. How many people do you know? How about people who are a friend of a friend? What is that number divided by 50? In all likelihood, within a year, several people you know will die of covid-19. (Also note that the effects will be different around the world and in different social strata; in poorer areas, the death rate will be much higher, and in rich areas much lower.)
qznc 7y ago
Wikipedia is inconsistent for 1918 flu pandemic: https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid=943187983 https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid... "The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).[51]" "The unusually severe disease killed up to 20% of those infected, as opposed to the usual flu epidemic mortality rate of 0.1%.[2][54]"

javajosh 7y ago

In a perfect world, Trump would appoint Gates to lead the Department of Health and Human Services, Gates would accept, the Senate would quickly confirm, and Trump would actually listen and defer to him on this. It's interesting that this is directed to policy makers and other leaders, rather than individuals on the ground - e.g. it's about resource allocation, not personal preperation. (It was amusing to see the large-scale analogue to hoarding referred to as "lists of supplies to be stockpiled or redirected in an emergency." This presumes, of course, that governments will act as a force of mediating reason on people's irrational impulses; and we all know that sometimes it's the opposite).

sky_rw 7y ago
Wait I thought Gates was in on this with the Chinese and released this as population control? Have I been getting my news from the wrong source?
animalnewbie 7y ago
Senate would quickly confirm. There is no such world. Remember when trump closed China travel he was called an overreacting xenophobe

alien_ 7y ago

It's easy to raise the billions required to fight this. It's peanuts for governments and even larger companies hoarding tens of billions that have a lot to lose because of such pandemics.

rm_-rf_slash 7y ago
Raise the billions to do what though? Pay for pharmaceuticals that can’t reach sick people because there aren’t enough people to work the production lines, the docks, the ships, the trains, the trucks, and the hospitals?

mnm1 7y ago

How about investing in "low- and middle-income" Americans and providing them healthcare? In addition how about providing required paid sick leave that can be taken without fear of losing one's job? These are actual things we could do to help people respond and deal with COVID-19. Yes, working on vaccines is important but testing and avoiding spreading the virus as much as possible are even more important. Right now, we have no hope of doing either in an effective manner. People will go to work sick, including with COVID-19 because they have no choice, because our government has left them no choice. They won't be able to get tested because they have no choice due to not having health insurance--another choice removed by our ineffective policies. I don't see any coherent plan by the government at this moment to address any of these issues and given the current situation, I would not be surprised if we have one of the worst outcomes of any developed country, possibly including China. The only hope is that the virus mutates into something less contagious or harmful and that should not be something we rely on.

davidwihl 7y ago

Marc Lipsitch, a Harvard epidemiologist, estimates that 40-70% of the adult world-wide population will be infected. [0] Assuming a conservative 1% mortality rate, that would mean 30-50M deaths, a tragically huge number. [0] https://news.harvard.edu/gazette/story/2020/02/key-coronavirus-question-how-are-children-affected/ https://news.harvard.edu/gazette/story/2020/02/key-coronavir...

ekianjo 7y ago
Most cases with mild symptoms are not even reported or noticed by those infected so the real number is lower than 1 percent in all likelihood.
- fab1an 7y ago
  This could swing both ways alas. The optimistic case would be how swine flu played out, where initial estimates for fatality where in the percentage range but ended up in the per mille dimension. However, for SARS 1.0, it was initially estimated to have a fatality of 2% - the final number was over 10%. It's simply too early to tell. Unfortunately, the latest WHO report suggest there isn't that big of an iceberg of undetected cases, which would sadly mean a higher CFR.
- tristanj 7y ago
  > Most cases with mild symptoms are not even reported This is outdated. Dr. Bruce Aylward said in a WHO conference this week that the Chinese tested 320,000 samples in Guangdong and they are not seeing huge transmission beyond cases found clinically. It's at 47 mins in this video: https://youtu.be/-o0q1XMRKYM?t=2810 https://youtu.be/-o0q1XMRKYM?t=2810 > so the real number is lower than 1 percent in all likelihood. I disagree. When we calculate the SARS-CoV-2 CFR properly using CFR = deaths / (deaths + recovered) using the latest data we get 2,924 / (2,924 + 39,605) = 7% CFR That's much more in line with the original SARS CFR of around 9%.
  - learc83 7y ago
    "The claim was quickly challenged by an infectious diseases expert who serves on a committee that advises the WHO’s health emergencies program. Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, said it would be highly unusual for there not to be mild or symptom-free cases that are being missed. He pointed to the fact that outbreaks have popped up in countries far from China — including Iran and Italy — because people with mild infections were not detected and traveled to other places. 'There are mild cases that are undetected. This is why it’s spreading. Otherwise it would not be spreading because we would know where those cases are and they would be contained and that would be the end of it,' said Kobinger, who insisted that mild, undetected infections cannot be ruled out until people who haven’t been diagnosed with the illness can be tested for antibodies to the virus. 'As long as we do not have good serology data, I think that it is completely speculative to say that there are no undetected cases,' Kobinger said." What Dr. Aylward says makes no sense and reads more like a PR fluff piece designed to praise China to keep them happy, and as Kobinger points out he's probably wrong. From the same press conference he says this "If I had COVID-19, I’d want to be treated in China." Which is obviously bullshit. As the specifics of the 320,000 cases. It wasn't a serum antibody test, so it wouldn't show people with low viral loads or people who recovered. Also this is in Guangdong where the infection was potentially quickly contained, and if you'll notice the death rate is much lower in Guangdong.

nl 7y ago

Does anyone know where the 2% death rate for 1918 flu comes from? I've seen it quoted multiple times, but Wikipedia says: It infected 500 million people around the world... The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million But later The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio). It is estimated that approximately 30 million were killed by the flu, or about 1.7% of the world population died. Other estimates range from 17 to 55 million fatalities[1] [1] https://en.wikipedia.org/wiki/Spanish_flu https://en.wikipedia.org/wiki/Spanish_flu

saberdancer 7y ago
I'm really surprised by this as well. From what I can tell, the estimate that was named is "above 2.5%". This could be simply by calculating how many people died compared to total population in the world. If 2.5% of total world population died, assuming everyone was infected, it is at least 2.5% case fatality rate and depending on how many people were not infected case fatality rate will go down.
- jtbayly 7y ago
  Wouldn’t case fatality rate go up the more people were not infected?
  - saberdancer 7y ago
    Yes. But if you do not have a lower bound for number of infected, you can with certainty only say "above 2.5%".

simonh 7y ago

Here in the UK we learned the hard way that health care is national defence. It’s a matter of vital national security. In WWI we were chronically short of healthy young recruits, far too many potential soldiers were too sickly or under nourished to serve. What goes for the military goes for industry too, what use is a sickly, unfit work force, especially in a crisis? This is why universal health care is not controversial in the UK. It’s why lifelong conservative voters like me support universal health care, we were faced with a clear existential threat generations ago. How could we expect the population to fight for a country that didn’t look after them in return? Loyalty has to go both ways. I accept we’re a different case from the US because we’re a much smaller country, the US can manage due to sheer numbers, but that’s a pretty poor excuse. Having a fit, healthy population matters. Now we’re faced with Covid-19. This is a matter of national and international security and defence. Health care spending is national defence spending. It’s just a different type of defence against different types of threats, some mundane, some exceptional.

WalterBright 7y ago
> How could we expect the population to fight for a country that didn’t look after them in return? One of the benefits of serving in the US military was free medical care for the soldier and his family.
- forkerenok 7y ago
  I think the argument extends to potential need to draft general population in times of need. You want to draft healthy people.
  - chii 7y ago
    the argument doesn't work, because the assumption is that you have a large, but unhealthy population. But such a population is unable to sustain itself in the first place! If a country is doing fine (production wise), then there must be way more healthy, able-bodied people than sick people. The draft will just target those able-bodied people. And then there's the new style of war these days - drones, remote weapons and nukes. It either comes down to a small skirmish against brown people with little more than an AK47, or it's nuke time. i don't see war going any other direction.

lordnacho 7y ago

I wonder if there will be a more general cultural change. For instance, will it become commonplace to have disinfectant dispensers in public places, like you might have drinking fountains and public bathrooms? Will workplaces and stadiums install these? I can't judge the advice on this, but it seems to be that disinfectants work. Also, will people be told to stay home when they're even slightly ill? Currently people know that sick people spread disease, but we leave it to their own judgement as to whether to show up. What about a law that says you can't be paid as a contractor if you show up and you're ill? Could/should that happen?

krisoft 7y ago
“ What about a law that says you can't be paid as a contractor if you show up and you're ill?” To my european ears that’s a very strange thought. This is what paid sick leave was invented for. If we do as you proposed that strongly incentivises people to judge themselves not sick. Obviously the most intense cases will be found out, and according to your law sent home without pay, but by then the damage is done.
- lordnacho 7y ago
  I mean contractors though. A lot of people in finance get paid per day they show up. I even have friends who will go to work while terribly ill because they get paid £1000 for it. Paid sick leave is fairly normal for people on standard employee contracts.
blub 7y ago
I'd be very happy of seeing everyone wash their hands after using the bathroom and sneezing in their elbows. As it is, a disturbing number of people truly are either careless or clueless.

melonkidney 7y ago

From a business perspective, be prepared for an extended period working from home, and be prepared for productivity to drop. Prioritize and set expectations accordingly. I have colleagues in China who are facing down their fifth week working from home. At the beginning, they tried to maintain their normal (and excellent) level of output. But the stress of quarantine is starting to show. Disruptions to normal routines, such as kids stuck at home and reduced/no access to childcare, are the non-newsworthy but most challenging issues for a large number of folks.

stareatgoats 7y ago
... until they realized that working from home and closeness to kids and family was really a wonderful thing?
- melonkidney 7y ago
  Right, and I must admit that was my initial reaction. I honestly hope that one positive from all of this will be that working from home (and remote work generally) becomes more widely acceptable. Unfortunately, in this instance, what I'm hearing from people on the ground is that the balance has swung a bit too far into "cabin fever" territory at this point.
- logicchains 7y ago
  Note that in China it's common for people with kids to live with their extended family/in-laws (who look after their kids while they're working). Like anywhere else in the world, for many people spending time with their in-laws is not a pleasant experience.
- namelosw 7y ago
  Can confirm. I'm in Beijing and it's wonderful indeed, I'm not with my family though. I already worked from home for a month as a developer, and we have confirmed we'll WFH for the next 2 weeks at least. There's no sign of productivity dropping for now according to our regular analytics. We have similar velocity as in previous months, where the estimation was done before the Chinese new year (just to clarify).

DyslexicAtheist 7y ago

who is still excited about pair programming? I think this will come to an end very abruptly. keyboards are disgusting.

sixstringtheory 7y ago
Only when it's done over VC. I miss ScreenHero!
pvinis 7y ago
I mean, it's pretty easy to do pair programming with separate keyboards or even computers..

tomohawk 7y ago

Are you legally prepared? Do you have a will, an advanced medical directive, and other important documents? If not, take this as a cue to get that done today. Pandemic or no pandemic, you should have these. Without these documents, you may very likely not receive the medical treatment you would wish to have should you become incapacitated. Also, your worldly possessions will likely not be dealt with as you would wish, and you'll be leaving a mess behind for your loved ones. So, get your affairs in order.

JoeAltmaier 7y ago
Some of that might work. If the pandemic is as harsh as some fear (anything like 1918) then the bodies pile up in the street. A will might not be important.
abjKT26nO8 7y ago
> you'll be leaving a mess behind for your loved ones. I don't have any loved ones. > advanced medical directive My country doesn't honor those. Yup, I'm about as prepared as I can be.

mhkool 7y ago

For those who are interested in how to improve your own immune system function I recommend to watch a couple of videos of Dr Bergman and Dr Axe

gdubs 7y ago

“Global health experts have been saying for years that another pandemic rivalling the speed and severity of the 1918 influenza epidemic wasn’t a matter of if but when.“ Short-term-ism is the real epidemic in America. We seem paralyzed in taking preparedness steps in a host of issues that are a matter of “not if, but when.” From Climate Change, to infectious disease. On individual level, we share some of the blame. I’ll admit that even in earthquake and fire prone California that prior to this current crisis, I’ve never kept more than a few days worth of food on hand. Even faced with a real risk, there’s inertia there — but ultimately realizing that being prepared as a household is the root of resilience for a neighborhood and community. It’s not a selfish act — it’s the responsible thing to do. But at a leadership level, we seem to be waiting for some shoe to drop in this current situation rather than take proactive steps. We seem two steps behind this thing in the US.