5 ms·

The most recent data I have seen (yesterday in the NEJM) indicates 1.4% fatality in lab diagnosed cases. This of course will only include more serious symptomat

by zaroth 7y ago

The most recent data I have seen (yesterday in the NEJM) indicates 1.4% fatality in lab diagnosed cases. This of course will only include more serious symptomatic patients, as mild or asymptomatic patients are told to stay home and are not getting tested. No one wants to stand up and call hysteria for what it is. It’s easier to go with the flow and cancel events out of an “abundance of caution.”

_bxg1 7y ago
I think cancelling events is still a good idea. There's still a wide radius of unknown and none of these "events" are of any life-and-death importance to anybody. Hysteria is bad, but for other reasons.
altcognito 7y ago
R0 value is roughly 4-7. Upwards of 5% of the cases require the ICU, 15% require support breathing. Medical personnel are coming down with it frequently, and Italy is trying to bring in newly graduated nurses and retired nurses to fill the gap. This is NOT hysteria. While it isn't a death sentence for most, it is imperative to slow this thing down.
- zaroth 7y ago
  Please understand that every single one of those percentages is wrong as you have stated them. You forgot the most important qualifier, which is that the denominator is some fraction (potentially small fraction) of the total number infected. So when you say “upwards” of 5% of cases require the ICU, this is potentially very misleading. Stating that upwards of 5% of hospital cases require the ICU may be true, but now you must not try to extrapolate that value any further until you can tell me definitively what percentage of infections result in hospitalization? 1 in 5? 1 in 20? I won’t get into debating R0 values because they are nearly impossible not to misuse. For example, COVID-19 does not have just one R0 value. R0 changes radically based on actual conditions on the ground, often day to day. The R0 value of COVID in a cult church in South Korea may be actually 1,000 while the R0 globally over the entire course of this news cycle might be 1.2.
  - jacquesm 7y ago
    > Please understand that every single one of those percentages is wrong as you have stated them. No, they are accurate as far as I know and I've been following this thing with some dedication since before it was discussed in the media because of relatively close ties to China. > You forgot the most important qualifier, which is that the denominator is some fraction (potentially small fraction) of the total number infected. You are misrepresenting the OP's words. He said 'of cases', that is the denominator right there. That we don't know all cases is something that everybody takes as a given. But just like we don't know all cases we also don't know all of the dead. The same happened with the swine flu, with SARS and with every other epidemic so far. Only afterwards, sometimes more than a year later do we have all the numbers. And sometimes those end up substantially higher than the original estimate both for the number of infected people as well as for the number of people that end up dead. > So when you say “upwards” of 5% of cases require the ICU, this is potentially very misleading. Upwards of 5% of the known cases. But that's assumed, if we don't know someone is infected then they by definition won't require ICU level care. > Stating that upwards of 5% of hospital cases require the ICU may be true, but now you must not try to extrapolate that value any further until you can tell me definitively what percentage of infections result in hospitalization? 1 in 5? 1 in 20? They don't need to tell you anything 'definitely' to be allowed to speak their mind. And as far as I'm informed that 5% rate is on the money. So, instead, the onus is on you to prove that less than 5% of the people infected that require care require ICU care. I don't think you are able to do that but I will happily take good news at this point if properly sourced. > I won’t get into debating R0 values because they are nearly impossible not to misuse. Agreed. > For example, COVID-19 does not have just one R0 value. R0 changes radically based on actual conditions on the ground, often day to day. > The R0 value of COVID in a cult church in South Korea may be actually 1,000 while the R0 globally over the entire course of this news cycle might be 1.2. True, but there are averages and even the WHO seems to place the number at > 3 at this point in time. That is already a pretty high number, even when taking all the care in the world to ensure it doesn't spread. Of course the criminals in Korea that hope to bring about the end times in some kind of warped self fulfilling religious prophesy are going to skew that number upwards. But in Iran and Italy there was no such cult, and their numbers are very much in line with the development in Korea. And since we're mentioning Iran now, there are lots of informal reports that the situation there is much worse then officially reported, with the number of high officials there infected this - unfortunately - isn't hard to believe at all.
- pergadad 7y ago
  Also >80% of the world population does not have access to great quality healthcare....
jacquesm 7y ago
Yes, like in Spain, where they have a 1 million strong 18 day long party going down right now. That gives just enough time for a third round of infections. [1] Shall we agree that if it ends up being bad there that you'll print out this comment and eat it? There is no downside from an 'abundance of caution' but there is a severe downside from not being cautious enough. Or do we really have to re-enact each and every mistake made by the Chinese early on in this drama? [1] https://www.visitvalencia.com/en/events-valencia/festivities/the-fallas https://www.visitvalencia.com/en/events-valencia/festivities...
- zaroth 7y ago
  I will unhappily eat my words if it turns out to be worse than a bad flu year. Will the people discussing 5-7% general population fatality rates over the last week agree to eat theirs if it turns out to be less harmful than last year’s flu? Of course there are serious downsides to hysteria and doomsday prophecies. The market lost $3.4 trillion in value last week, for starters. But also real world economic impact which causes actual harm to everyday people. This has to be scientifically justified and not just political expedience.
  - jacquesm 7y ago
    > Will the people discussing 5-7% general population fatality rates over the last week agree to eat theirs if it turns out to be less harmful than last year’s flu? I'm sure they will be very happy to do that, but I haven't seen anybody discussing 5-7% general population fatality rates, especially not on here. Link? My own comments - and I stand by those - consistently list 2-3% of those infected. That's still plenty bad and if it ends up to be less harmful than last years flu then we all have a reason for a celebration. > Of course there are serious downsides to hysteria and doomsday prophecies. The market lost $3.4 trillion in value last week, for starters. The market can will recover just as fast if it turns out to be a 'false alarm'. But right now there are no indications that it is and the only thing propping the markets up this Monday is the promise of money injected into the markets. Also, dead people typically do not recover as well as markets do. > But also real world economic impact which causes actual harm to everyday people. Yes it does. > This has to be scientifically justified and not just political expedience. I would start with my own comments if I were you. You fairly consistently mis-represent the numbers and have been called out on that before.
est31 7y ago
The 1.4% apply to the general population. For people over 80, the fatality rate is 15%. There are roughly 13 million people over 80 in the US [1]. If everyone gets infected, a fatality rate of 15% means 2 million deaths in that single bracket alone. With the 1.4% figure it's 4.6 million over the entire US population. As a comparison, the number of yearly deaths in the US caused by influenza is in the 5 digits. World war 2 killed 3% of the world population over a range of multiple years [2]. If the coronavirus kills only 1% of the current world population, its death toll in absolute numbers will be equal to WW2. I think at this point, the disease can't be contained, its spread only slowed. Everyone will be exposed to it sooner or later. Fortunately though there are treatments, and there are already candidates for vaccines. The question is only how quickly and how well those treatments can be deployed. The less people have the disease at the same time, the better. [1]: https://www.populationpyramid.net/united-states-of-america/2019/ https://www.populationpyramid.net/united-states-of-america/2... [2]: https://en.wikipedia.org/wiki/World_War_II_casualties https://en.wikipedia.org/wiki/World_War_II_casualties
- zaroth 7y ago
  This is badly misinterpreting the data. You cannot extrapolate the fatality rate of lab-confirmed infections to the general population. This is especially true in scenarios where the infection is predominantly mild. This is also especially true in scenarios where diagnostic testing bandwidth was being stressed. Both are true in this case. I fully expect the general population fatality rate for COVID will be on the order of 0.1% or less of all infected. Keeping in mind the true denominator will never actually be known. At risk of belaboring the point... you state that the fatality rate for people over 80 is 15%. This is false. Maybe it is accurate to say that the fatality rate is 15% for people over 80 who go to the hospital. That is a massively important qualifier to the statement. The fatality rate for all infected people over 80 is not known. The closest you can get is looking at Diamond Princess, where everyone was exposed and as of right now 6 of 3700 died, and that’s in a population skewing elderly.
  - est31 7y ago
    > you state that the fatality rate for people over 80 is 15%. This is false. Check this study, it contains that number: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9... Yes, most people studied were symptomatic, so asymptomatic people weren't checked. > The closest you can get is looking at Diamond Princess, where everyone was exposed and as of right now 6 of 3700 died, and that’s in a population skewing elderly. First, we can't be sure that everyone was exposed to the disease. Even if we assume that everyone was exposed, then I still interpret the numbers differently from you: first, patients on Diamond Princess were subject to medical attention so they likely saved many lives, and second, A total number of 705 of 3700 people became ill enough to be able to confirm the disease on them, the same category of people the 1.4% or the 15% were calculated on. So assume for a moment that 1 out of 5 people exposed become confirmably ill. Even if you divide the number of deaths by 5, it's still a large number and larger than influenza or other diseases.

by zaroth 7y ago

_bxg1 7y ago

I think cancelling events is still a good idea. There's still a wide radius of unknown and none of these "events" are of any life-and-death importance to anybody. Hysteria is bad, but for other reasons.

altcognito 7y ago

R0 value is roughly 4-7. Upwards of 5% of the cases require the ICU, 15% require support breathing. Medical personnel are coming down with it frequently, and Italy is trying to bring in newly graduated nurses and retired nurses to fill the gap. This is NOT hysteria. While it isn't a death sentence for most, it is imperative to slow this thing down.

zaroth 7y ago
Please understand that every single one of those percentages is wrong as you have stated them. You forgot the most important qualifier, which is that the denominator is some fraction (potentially small fraction) of the total number infected. So when you say “upwards” of 5% of cases require the ICU, this is potentially very misleading. Stating that upwards of 5% of hospital cases require the ICU may be true, but now you must not try to extrapolate that value any further until you can tell me definitively what percentage of infections result in hospitalization? 1 in 5? 1 in 20? I won’t get into debating R0 values because they are nearly impossible not to misuse. For example, COVID-19 does not have just one R0 value. R0 changes radically based on actual conditions on the ground, often day to day. The R0 value of COVID in a cult church in South Korea may be actually 1,000 while the R0 globally over the entire course of this news cycle might be 1.2.
- jacquesm 7y ago
  > Please understand that every single one of those percentages is wrong as you have stated them. No, they are accurate as far as I know and I've been following this thing with some dedication since before it was discussed in the media because of relatively close ties to China. > You forgot the most important qualifier, which is that the denominator is some fraction (potentially small fraction) of the total number infected. You are misrepresenting the OP's words. He said 'of cases', that is the denominator right there. That we don't know all cases is something that everybody takes as a given. But just like we don't know all cases we also don't know all of the dead. The same happened with the swine flu, with SARS and with every other epidemic so far. Only afterwards, sometimes more than a year later do we have all the numbers. And sometimes those end up substantially higher than the original estimate both for the number of infected people as well as for the number of people that end up dead. > So when you say “upwards” of 5% of cases require the ICU, this is potentially very misleading. Upwards of 5% of the known cases. But that's assumed, if we don't know someone is infected then they by definition won't require ICU level care. > Stating that upwards of 5% of hospital cases require the ICU may be true, but now you must not try to extrapolate that value any further until you can tell me definitively what percentage of infections result in hospitalization? 1 in 5? 1 in 20? They don't need to tell you anything 'definitely' to be allowed to speak their mind. And as far as I'm informed that 5% rate is on the money. So, instead, the onus is on you to prove that less than 5% of the people infected that require care require ICU care. I don't think you are able to do that but I will happily take good news at this point if properly sourced. > I won’t get into debating R0 values because they are nearly impossible not to misuse. Agreed. > For example, COVID-19 does not have just one R0 value. R0 changes radically based on actual conditions on the ground, often day to day. > The R0 value of COVID in a cult church in South Korea may be actually 1,000 while the R0 globally over the entire course of this news cycle might be 1.2. True, but there are averages and even the WHO seems to place the number at > 3 at this point in time. That is already a pretty high number, even when taking all the care in the world to ensure it doesn't spread. Of course the criminals in Korea that hope to bring about the end times in some kind of warped self fulfilling religious prophesy are going to skew that number upwards. But in Iran and Italy there was no such cult, and their numbers are very much in line with the development in Korea. And since we're mentioning Iran now, there are lots of informal reports that the situation there is much worse then officially reported, with the number of high officials there infected this - unfortunately - isn't hard to believe at all.
pergadad 7y ago
Also >80% of the world population does not have access to great quality healthcare....

jacquesm 7y ago

Yes, like in Spain, where they have a 1 million strong 18 day long party going down right now. That gives just enough time for a third round of infections. [1] Shall we agree that if it ends up being bad there that you'll print out this comment and eat it? There is no downside from an 'abundance of caution' but there is a severe downside from not being cautious enough. Or do we really have to re-enact each and every mistake made by the Chinese early on in this drama? [1] https://www.visitvalencia.com/en/events-valencia/festivities/the-fallas https://www.visitvalencia.com/en/events-valencia/festivities...

zaroth 7y ago
I will unhappily eat my words if it turns out to be worse than a bad flu year. Will the people discussing 5-7% general population fatality rates over the last week agree to eat theirs if it turns out to be less harmful than last year’s flu? Of course there are serious downsides to hysteria and doomsday prophecies. The market lost $3.4 trillion in value last week, for starters. But also real world economic impact which causes actual harm to everyday people. This has to be scientifically justified and not just political expedience.
- jacquesm 7y ago
  > Will the people discussing 5-7% general population fatality rates over the last week agree to eat theirs if it turns out to be less harmful than last year’s flu? I'm sure they will be very happy to do that, but I haven't seen anybody discussing 5-7% general population fatality rates, especially not on here. Link? My own comments - and I stand by those - consistently list 2-3% of those infected. That's still plenty bad and if it ends up to be less harmful than last years flu then we all have a reason for a celebration. > Of course there are serious downsides to hysteria and doomsday prophecies. The market lost $3.4 trillion in value last week, for starters. The market can will recover just as fast if it turns out to be a 'false alarm'. But right now there are no indications that it is and the only thing propping the markets up this Monday is the promise of money injected into the markets. Also, dead people typically do not recover as well as markets do. > But also real world economic impact which causes actual harm to everyday people. Yes it does. > This has to be scientifically justified and not just political expedience. I would start with my own comments if I were you. You fairly consistently mis-represent the numbers and have been called out on that before.

est31 7y ago

The 1.4% apply to the general population. For people over 80, the fatality rate is 15%. There are roughly 13 million people over 80 in the US [1]. If everyone gets infected, a fatality rate of 15% means 2 million deaths in that single bracket alone. With the 1.4% figure it's 4.6 million over the entire US population. As a comparison, the number of yearly deaths in the US caused by influenza is in the 5 digits. World war 2 killed 3% of the world population over a range of multiple years [2]. If the coronavirus kills only 1% of the current world population, its death toll in absolute numbers will be equal to WW2. I think at this point, the disease can't be contained, its spread only slowed. Everyone will be exposed to it sooner or later. Fortunately though there are treatments, and there are already candidates for vaccines. The question is only how quickly and how well those treatments can be deployed. The less people have the disease at the same time, the better. [1]: https://www.populationpyramid.net/united-states-of-america/2019/ https://www.populationpyramid.net/united-states-of-america/2... [2]: https://en.wikipedia.org/wiki/World_War_II_casualties https://en.wikipedia.org/wiki/World_War_II_casualties

zaroth 7y ago
This is badly misinterpreting the data. You cannot extrapolate the fatality rate of lab-confirmed infections to the general population. This is especially true in scenarios where the infection is predominantly mild. This is also especially true in scenarios where diagnostic testing bandwidth was being stressed. Both are true in this case. I fully expect the general population fatality rate for COVID will be on the order of 0.1% or less of all infected. Keeping in mind the true denominator will never actually be known. At risk of belaboring the point... you state that the fatality rate for people over 80 is 15%. This is false. Maybe it is accurate to say that the fatality rate is 15% for people over 80 who go to the hospital. That is a massively important qualifier to the statement. The fatality rate for all infected people over 80 is not known. The closest you can get is looking at Diamond Princess, where everyone was exposed and as of right now 6 of 3700 died, and that’s in a population skewing elderly.
- est31 7y ago
  > you state that the fatality rate for people over 80 is 15%. This is false. Check this study, it contains that number: http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9... Yes, most people studied were symptomatic, so asymptomatic people weren't checked. > The closest you can get is looking at Diamond Princess, where everyone was exposed and as of right now 6 of 3700 died, and that’s in a population skewing elderly. First, we can't be sure that everyone was exposed to the disease. Even if we assume that everyone was exposed, then I still interpret the numbers differently from you: first, patients on Diamond Princess were subject to medical attention so they likely saved many lives, and second, A total number of 705 of 3700 people became ill enough to be able to confirm the disease on them, the same category of people the 1.4% or the 15% were calculated on. So assume for a moment that 1 out of 5 people exposed become confirmably ill. Even if you divide the number of deaths by 5, it's still a large number and larger than influenza or other diseases.