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I think it’s very important to be precise if you’re speaking of potential worldwide calamity. I think you may be giving OP too much credit with their use of “c

by zaroth 7y ago

I think it’s very important to be precise if you’re speaking of potential worldwide calamity. I think you may be giving OP too much credit with their use of “cases” implying hospital cases (which is the 5% ICU number, it is not 5% of infections require the ICU) I’m happy if we are agreeing and will leave it at that. > 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. You are still making too strong of a statement. In the study last week from NEJM of 1099 hospital patients around China that found that 90% plus were diagnosed with pneumonia, and 5% were admitted to the ICU. Case fatality rate was 1.4%. [1] It is absolutely not 5% of “known” cases. China turned anybody not seriously ill from the hospitals back home. So we actually do know there are a large number of uncounted mild (and even asymptomatic) cases. It is 5% of serious hospital cases going on to the ICU. This is not my claim, this is straight from the latest issue of the NEJM. Also, I didn’t say anyone couldn’t speak their mind. But I said if you do try extrapolating a sub-population percentage and multiplying by world population, it would be a serious miscalculation. That’s why I think it’s important (crucial) to clearly identify the sub-population when you state the percentage. Calling a sub-population dealing with hospital admittances the “known” cases is not clearly stating identifying the patient population. I don’t think HN commentators should play epidemiologist while making predictions of catastrophe. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032 https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

jacquesm 7y ago
> But if you extrapolating a sub-population percentage and multiplying by world population Where did that happen? In this thread or elsewhere?
- deleted 7y ago
  [deleted]
- zaroth 7y ago
  I did not say that anyone did try to extrapolate numbers using these percentages in this thread. I said, and am saying, that it’s important not to try to do that. Because it leads to fear-mongering. For example, downthread, here; https://news.ycombinator.com/item?id=22461804 https://news.ycombinator.com/item?id=22461804
  - jacquesm 7y ago
    > I did not say that anyone did try to extrapolate numbers using these percentages in this thread. But you did imply that. Look, I am all for keeping a cool head. But at the same time I'm not going to cool my head by sticking it in the sand. I think if you're going to participate in these discussions then you probably should do so by making your statements a lot clearer than you do. If you - for instance - idd not intend to suggest that someone did try to extrapolate those numbers then you did a poor job of it. You can't just make up strawmen and then suggest people shouldn't do that. The comment you linked to was properly qualified and is not fearmongering. If you think that is fearmongering then you possibly have a reading / comprehension issue. Let me help you by picking that comment apart: > The 1.4% apply to the general population. You can't really argue with that I think, > For people over 80, the fatality rate is 15%. Not exactly correct, I have it at 14.8% once infected and showing symptoms. But close enough. > There are roughly 13 million people over 80 in the US [1]. This is properly cited. > If everyone gets infected, a fatality rate of 15% means 2 million deaths in that single bracket alone. Again, this is properly qualified by the leading 'If' > With the 1.4% figure it's 4.6 million over the entire US population. Again, with the implied assumption that people are all infected, something that is unlikely to happen. > As a comparison, the number of yearly deaths in the US caused by influenza is in the 5 digits. This is correct as far as I know, between 10 and 60K cases annually ranging from very good years to very bad ones. > World war 2 killed 3% of the world population over a range of multiple years [2]. Can't argue with that. > If the coronavirus kills only 1% of the current world population, its death toll in absolute numbers will be equal to WW2. Again, properly qualified by a conditional. > I think at this point, the disease can't be contained, its spread only slowed. I don't think anybody is arguing that it can be contained still, even the WHO has moved on this, though they kept it up for longer than I personally think was responsible. > Everyone will be exposed to it sooner or later. Probably correct, similar to the flu, most people get exposed to it in their lives and usually once per year. > 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. If there is one part of this comment that I have issues with then it is this one. There are - as far as I know - no vaccine candidates that have been trialed. I'm happy to be proven wrong here so any link is welcome. > The less people have the disease at the same time, the better. And that is the key insight: the whole thing revolves around managing the capacity to deal with the people that are ill. That and effectively reducing R0 < 1 are the main tools that we have at this stage to deal with this particular virus.
tristanj 7y ago
> In the study last week from NEJM of 1099 hospital patients BTW that NJEM paper you keep referencing is very out of date. Yes it passed peer review and was published last week, but it's using data from Jan 29. It was actually written nearly a month ago; I found a preprint of that paper posted Feb 3. You'd be aware of this if you were actively following the novel coronavirus situation. There's a more up-to-date paper published by China CDC that covers 72,314 patients / 44,672 confirmed cases using data thru Feb 11. I would reference figures from that paper instead. > I think you may be giving OP too much credit with their use of “cases” implying hospital cases (which is the 5% ICU number, it is not 5% of infections require the ICU) ... It is absolutely not 5% of “known” cases. No, he's correct. Current evidence shows at least 5% of confirmed cases require ICU care. From the WHO China report, they note that 6.1% of all cases are critical. They define critical as the following: "Critical cases are defined as respiratory failure requiring mechanical ventilation, shock or other organ failure that requires intensive care." These numbers are not just a China fluke. We're seeing similar critical percentages in other countries. For example, as of today, Singapore has 106 confirmed cases of which 7 are critical (~6.6%). > I don’t think HN commentators should play epidemiologist Isn't that what you're doing? [0] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9... [1] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf https://www.who.int/docs/default-source/coronaviruse/who-chi...
- zaroth 7y ago
  Thanks for the link. One interesting data point; > In China, the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1- 10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak. So to highlight that, going forward, CFR of 0.7% of lab diagnosed cases.
  - tristanj 7y ago
    Yes, assuming access to medical care. But we see that COVID19 quickly overwhelms medical systems, as it did to Wuhan & Iran, and upcoming in Italy & South Korea. For instance, this week 4 South Koreans died while waiting to be hospitalized. An additional 600 sick are still waiting for hospital beds. They don't have enough beds! And this is in the country with the 2nd most hospital beds per person! Many of the serious, and almost all of the severe cases will perish without medical care. Once the medical system is overwhelmed, the CFR could climb past 10%. https://www.reddit.com/r/Coronavirus/comments/fbxm0s/south_korea_4_in_22_deaths_happened_while_waiting/ https://www.reddit.com/r/Coronavirus/comments/fbxm0s/south_k... https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...

by zaroth 7y ago

jacquesm 7y ago

> But if you extrapolating a sub-population percentage and multiplying by world population Where did that happen? In this thread or elsewhere?

deleted 7y ago
[deleted]
zaroth 7y ago
I did not say that anyone did try to extrapolate numbers using these percentages in this thread. I said, and am saying, that it’s important not to try to do that. Because it leads to fear-mongering. For example, downthread, here; https://news.ycombinator.com/item?id=22461804 https://news.ycombinator.com/item?id=22461804
- jacquesm 7y ago
  > I did not say that anyone did try to extrapolate numbers using these percentages in this thread. But you did imply that. Look, I am all for keeping a cool head. But at the same time I'm not going to cool my head by sticking it in the sand. I think if you're going to participate in these discussions then you probably should do so by making your statements a lot clearer than you do. If you - for instance - idd not intend to suggest that someone did try to extrapolate those numbers then you did a poor job of it. You can't just make up strawmen and then suggest people shouldn't do that. The comment you linked to was properly qualified and is not fearmongering. If you think that is fearmongering then you possibly have a reading / comprehension issue. Let me help you by picking that comment apart: > The 1.4% apply to the general population. You can't really argue with that I think, > For people over 80, the fatality rate is 15%. Not exactly correct, I have it at 14.8% once infected and showing symptoms. But close enough. > There are roughly 13 million people over 80 in the US [1]. This is properly cited. > If everyone gets infected, a fatality rate of 15% means 2 million deaths in that single bracket alone. Again, this is properly qualified by the leading 'If' > With the 1.4% figure it's 4.6 million over the entire US population. Again, with the implied assumption that people are all infected, something that is unlikely to happen. > As a comparison, the number of yearly deaths in the US caused by influenza is in the 5 digits. This is correct as far as I know, between 10 and 60K cases annually ranging from very good years to very bad ones. > World war 2 killed 3% of the world population over a range of multiple years [2]. Can't argue with that. > If the coronavirus kills only 1% of the current world population, its death toll in absolute numbers will be equal to WW2. Again, properly qualified by a conditional. > I think at this point, the disease can't be contained, its spread only slowed. I don't think anybody is arguing that it can be contained still, even the WHO has moved on this, though they kept it up for longer than I personally think was responsible. > Everyone will be exposed to it sooner or later. Probably correct, similar to the flu, most people get exposed to it in their lives and usually once per year. > 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. If there is one part of this comment that I have issues with then it is this one. There are - as far as I know - no vaccine candidates that have been trialed. I'm happy to be proven wrong here so any link is welcome. > The less people have the disease at the same time, the better. And that is the key insight: the whole thing revolves around managing the capacity to deal with the people that are ill. That and effectively reducing R0 < 1 are the main tools that we have at this stage to deal with this particular virus.

tristanj 7y ago

> In the study last week from NEJM of 1099 hospital patients BTW that NJEM paper you keep referencing is very out of date. Yes it passed peer review and was published last week, but it's using data from Jan 29. It was actually written nearly a month ago; I found a preprint of that paper posted Feb 3. You'd be aware of this if you were actively following the novel coronavirus situation. There's a more up-to-date paper published by China CDC that covers 72,314 patients / 44,672 confirmed cases using data thru Feb 11. I would reference figures from that paper instead. > I think you may be giving OP too much credit with their use of “cases” implying hospital cases (which is the 5% ICU number, it is not 5% of infections require the ICU) ... It is absolutely not 5% of “known” cases. No, he's correct. Current evidence shows at least 5% of confirmed cases require ICU care. From the WHO China report, they note that 6.1% of all cases are critical. They define critical as the following: "Critical cases are defined as respiratory failure requiring mechanical ventilation, shock or other organ failure that requires intensive care." These numbers are not just a China fluke. We're seeing similar critical percentages in other countries. For example, as of today, Singapore has 106 confirmed cases of which 7 are critical (~6.6%). > I don’t think HN commentators should play epidemiologist Isn't that what you're doing? [0] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51 http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9... [1] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf https://www.who.int/docs/default-source/coronaviruse/who-chi...

zaroth 7y ago
Thanks for the link. One interesting data point; > In China, the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1- 10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak. So to highlight that, going forward, CFR of 0.7% of lab diagnosed cases.
- tristanj 7y ago
  Yes, assuming access to medical care. But we see that COVID19 quickly overwhelms medical systems, as it did to Wuhan & Iran, and upcoming in Italy & South Korea. For instance, this week 4 South Koreans died while waiting to be hospitalized. An additional 600 sick are still waiting for hospital beds. They don't have enough beds! And this is in the country with the 2nd most hospital beds per person! Many of the serious, and almost all of the severe cases will perish without medical care. Once the medical system is overwhelmed, the CFR could climb past 10%. https://www.reddit.com/r/Coronavirus/comments/fbxm0s/south_korea_4_in_22_deaths_happened_while_waiting/ https://www.reddit.com/r/Coronavirus/comments/fbxm0s/south_k... https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...