9 ms·

What we can learn from the 1918 flu pandemic

123 points by jkuria 7y ago

melling 7y ago
I was watching this clip of Michael Osterholm on Joe Rogen: https://youtu.be/B6IgMdsZHbM https://youtu.be/B6IgMdsZHbM He said the covid-19 would eventually slow once enough people get it then we’ll have sufficient immunity that it won’t spread. Of course, he also said a lot of people are going to get it and we’re at the very beginning of a multi-year problem.
- ajross 7y ago
  Yes, realistically the world will be playing whack-a-mole over the coming months as city after city experiences an outbreak that saturates its health care facilities and has to lock down. It will seem endless. But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity. But it's going to be a rough road to get there, and we'll all suffer on some level. This isn't going to be "over" for quite some time.
  - melling 7y ago
    It doesn’t affect each age group uniformly. If you’re under 30 without any other health issues, you should be fine? Might not realize you have it? I wonder if it would be easier to create a low dosage vaccine for younger people, thus creating a bit of a firewall so it doesn’t spread as rapidly. I know nothing about medicine so this may be silly.
    - rogerkirkness 7y ago
      Generally speaking, all vaccines are low dosage. Everyone having the vaccine would be better, starting with those most at risk. If we had a vaccine, we would give it to 80 year olds first, then go down the chain.
      - Retric 7y ago
        You generally start with healthcare workers, then high risk populations, then the general public.
      - deleted 7y ago
        [deleted]
      - paulmd 7y ago
        Dr Anthony Fauci has been estimating it'll take about 12-18 months to get a vaccine through trials. Human testing starts in a month or two. https://www.nytimes.com/2020/03/08/health/fauci-coronavirus.html https://www.nytimes.com/2020/03/08/health/fauci-coronavirus.... We have a ways to go before a vaccine is available. iirc he reiterated this to congress this morning before hearings were terminated to allow Trump to hold a press conference. Witnesses were told to stop their testimony and leave immediately. > “This morning we were informed that President Trump and Vice President Pence have called our witnesses to an emergency meeting at the White House,” Maloney said. “We don't know the details, just that it is extremely urgent.” > At about 11:30 a.m., she ended questioning from lawmakers, saying she received notice from the White House that the witnesses needed to leave “now.” https://thehill.com/homenews/house/487014-trump-officials-cut-testimony-short-at-coronavirus-hearing https://thehill.com/homenews/house/487014-trump-officials-cu...
    - mhb 7y ago
      It's not silly. Though I'd be interested in the comparison of under-30 without any health issues to over-50 without any health issues.
    - maxerickson 7y ago
      The current goal is to create any vaccine that is safe and effective. If you have that, you give it to everybody you can. I guess deciding what safe enough is can be a problem (for many people the bar will be "getting the vaccine has better odds for a good outcome than getting the infection", but that is sort of a minimum).
    - supercanuck 7y ago
      >without any other health issue I think people are underestimating what an over-capacity, health care system looks like and the increase in risk of other infections can have.
      - bryanrasmussen 7y ago
        right, as I understand the information from Italy right now emergency services are basically shut down because system overburdened. So as a healthy 30 year old, don't go do any of those healthy sports you like because you might get an injury and that's it then. Also patient 1 in Italy was a healthy marathon runner who at least ended up in intensive care, not sure if dead yet or not.
        giovan-ni 7y ago
        he is breathing on is own since yesterday, still hospitalized
        bryanrasmussen 7y ago
        thanks for the info!
        lultimouomo 7y ago
        In Lombardy, the only region where the situation is critical at the moment, emergency service have NOT shut down. Non urgent procedures are suspended, both to spare doctors and nurses and to avoid creating new emergencies in case those procedures go wrong. ERs are not overwhelmed, ICUs are. You basically get in real trouble if you need a respirator - they're pretty much out of those and they have to assess your chance of survival to decide if they can tube you. Interestingly ERs are seeing much less load because people have stopped going there for stupid reasons, because they are afraid of catching COVID-19. All medical stuff is still busting their ass if course, a lot of them have been lended to ICUs, rooms have been repurposed, etc. This is not to say that the situation isn't bad. It's really bad. And if you think that your country has such a good health care system that it will hold better, you should know that Lombardy hospitals are top notch. Whatever your age, stop traveling. If there's been a single case in your region, stop risky behaviors now: don't go shopping, have it delivered. Work from home. Don't use public transit. Teach your parents how to shop online and force them to stay home. Don't shake hands and wash them often.
    - williamDafoe 7y ago
      Not completely true. It can apparently spread to a lower respiratory problem in ANYONE (where it is VERY deadly, 50% mortality rate) it just tends not to do it very often in persons 10-30 yrs old.
      - hybrid_cluster 7y ago
        Source?
      - gnulinux 7y ago
        I've never seen this 50% figure, looking at people in critical condition data, even that's not 50%, more like 20% mortality. Please provide a source, or delete your comment.
    - fock 7y ago
      yeah, I agree that this is no problem if hospitals stop taking anyone over 40 with respiratory issues and leave them to die at home. Letality might approach 10-20% then (from all we know), but hey, we are young!
      - andybak 7y ago
        I'm 49. I wish you'd said "Over 50".
    - JamesBarney 7y ago
      Im 34 so I'll be fine, and I probably won't lose any friends. But I may lose a parent and I'll definitely have a friend who loses a parent. And that seems pretty awful especially considering how preventable this all was.
      - jamesrcole 7y ago
        > so I’ll be fine I hope so, but - it will kill some number of younger people, even healthy ones. - it’s also worth considering that we don’t (AFAIK) have a clear picture about potential long-term complications (eg lung damage). We should not simply assume there won’t be these. I’m saying this to emphasize the seriousness of the situation.
      - gambiting 7y ago
        >>Im 34 so I'll be fine I'm sorry, but that's a stupid assumption to make. I'm "only" 29 and last year I managed to catch a parvovirus B19 from someone - it's a virus that's relatively common in children, but has very mild symptoms - it's almost unheard of in adults, mostly because you either already have immunity, or there are no symptoms/the symptoms are no worse than a mild cold/flu. Well, except that in about 10% of adults it causes severe response with a high fever that last weeks, with arthretic swelling of joints - and in 10% of those the joint issues don't go away for years. Well, it's been nearly a year now and my knees and other joints are still fucked from the virus, I'm constantly on steroids just to control the inflammation. So no, this has changed my "I'm young so I'll be fine" outlook on this - the chances are not always in your favour.
        krageon 7y ago
        You're being overly dramatic. While in general you might be correct, in this specific case you are not and your fear mongering isn't helping anyone.
        brigandish 7y ago
        Sorry to hear that. I wish the insight you have could spread further (what a sorrowful irony) but it seems wisdom is rarely won without painful experience, the blasé attitude of some is not helping right now. I hope you get better soon.
    - teambayleaf 7y ago
      The mortality rate of COVID-19 is estimated to be around ~0.1% for young people, which is five times higher than seasonal flu. > the risk of death among young adults would be smaller than that of older adults, e.g., at most 0.1%–0.2%. Whether to perceive this estimate as severe or moderate is a matter for discussion, but we consider 0.1%–0.2% among young adults to be unusually high. > https://www.mdpi.com/2077-0383/9/2/580 https://www.mdpi.com/2077-0383/9/2/580 So although it is not as deadly as SARS (which had 20% fatality rate), you definitely don't want to catch it.
      - lixtra 7y ago
        > we consider 0.1-0.2% ... high To put that into perspective that’s the mortality rate of measles [1] and our grandparents were still going to measls parties. [1] https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
        ajross 7y ago
        But measles wasn't a pandemic! Everyone keeps thinking this is about individual risk and trying to downplay things, and it's not like that. Our grandparents went to measles parties because they knew that they'd eventually be exposed and wanted to do it under controlled conditions where they knew treatment was available and had a plan for early detection of symptoms. The situation with COVID-19 is that people who get sick are going to do so in an environment where they and their government are surprised as "how fast it grew" and where all the hospital beds (and oxygen masks, and ventilators, and intubation kits, and doctors, and nurses, and...) are going to be filled by other sick people. And a lot of them are going to die, who didn't need to if we had just taken this seriously and not told people "it's just like measles".
        lixtra 7y ago
        My reading of melling was to actually infect young and healthy people under controlled circumstances such that herd immunity builds. To that teambayleaf pointed out that it comes at high individual risk. But in the past this was done for measles at similar risk.
    - lllr_finger 7y ago
      An otherwise healthy thirtysomething in Minnesota is in critical condition right now - it's not time to panic but you probably want to avoid getting this if you can.
  - qznc 7y ago
    That would be the good scenario because then we can move the critical ICU equipment from outbreak to outbreak. The bad scenario is if it becomes too much. China sending equipment to Italy now is a good sign.
  - saiya-jin 7y ago
    > But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity. Last time I checked there are at least 3 or 4 different strains circulating now. That's why some folks who got cured got it again. So don't have such naive hopes that all will be rosy on its own soon. If the story will be similar to flu, we're pretty much fucked - every year the strain is so different that prior vaccinations/immunity doesn't work on them. I certainly hope that's not the case, too early to tell.
    - op00to 7y ago
      Two strains. Stop spreading rumors.
      - animal531 7y ago
        I'm looking at: https://nextstrain.org/ncov https://nextstrain.org/ncov What defines a strain? I know about the L/S sub-types, but there have been a great number of splits.
        saiya-jin 7y ago
        Exactly. Anyway, the topic is that simply getting through the infection doesn't grant immunity so one doesn't have to care about covid-19 anymore. Plus thinking that when we have few (even if 2) variants of the virus within first 3 months there won't be any more mutations is a bit naive IMHO.
      - ajross 7y ago
        Realistically it's more than that, though. Viruses mutate rapidly and this one is into the hundreds of thousands of human transmissions now and still picking up steam. We just don't have the PCR bandwith available to sequence them as fast as they're spreading. Pretty much any direct pronouncement on the "kinds" of SARS-CoV-2 is going to be speculation, so it's all "rumors". But strains don't correlate perfectly to immune respnse, so the upthread point about reinfection risk remains speculation. We just don't know yet. But all endemic viruses eventually reach equilibrium with the population immune response (and vaccination regime), even if it requires regular updates a-la the yearly change in flu shots.
- the6threplicant 7y ago
  In other words it's following a logistics curve. This is what every pandemic does: the problem is that we can't know when the inflection point is. Sometimes it's quite early on, and sometimes it isn't. Plan for the latter, hope for the former.
  - jmkni 7y ago
    What do you mean by inflection point, and why is it better if it's early?
    - ryukafalz 7y ago
      3Blue1Brown has a recent video on this that explains it really well: https://youtu.be/Kas0tIxDvrg https://youtu.be/Kas0tIxDvrg
      - jmkni 7y ago
        Thanks!
      - plemer 7y ago
        3Blue1Brown is just exceptional. I don’t know anyone else’s combination of animation and explanation that comes close.
    - usrusr 7y ago
      Early can mean "at a low percentage" (which would be good) and not just "reached fast" (which would be very bad, unless also at low percentage). The percentage is directly depending on R0 (which apparently isn't easy to get below 1 even with China-grade measures).
    - tibu 7y ago
      The inflection point here means that the speed of the spreading of virus gets slower, so less people get infected then previous day. If this point is earlier in time, this means that the virus won't infect so many people after a time. I think the big question is the cause of the inflection point. Is it because of the nature of the virus or because of the different action like quarantine
- usrusr 7y ago
  If official numbers are less than 90% off even Wuhan hasn't reached anything close to saturation yet.
  - jeromegv 7y ago
    That's because they took measures to stop it, same as South Korea, where the USA has not.
    - kerabatsos 7y ago
      It will be difficult to convince the 40% of the population that measures need to be taken when that 40% thinks everything of consequence is a hoax, fake news, etc - being incited and reinforced by their Dear Leader. It's the result of a decades long undervaluing, underfunded, ignored education system.
- omarhaneef 7y ago
  Does this mean it is better to get it very early before the health system stresses out (might be too late for that and this is a selfish sort of thing anyway), or medium early before you are so old that your immune system is crap, or very late when they have effective vaccines. Anytime but right now, basically.
  - tpfour 7y ago
    If you are part of a high mortality rate demographic, you are better to get it first in your demographic to have a better access to resources (or very late when the resources are back under control). The issue is not really the virus per se, but its effect on the healthcare systems. That is something health systems work with _every year_ with flu season, nothing new under the sun. What's different is _nobody_ has immunity to this virus, and a lot of people initially dismissed the virus, or are still dismissing the risks.
    - eveningcoffee 7y ago
      I think it is like with everything else - it depends. If you are in the high mortality rate demographic and your recovery is not fast enough then you may still have the risk of being "phased out" when the medical system comes crashing down with the load of new cases happening during your recovery. The best is to not get the infection.
LilBytes 7y ago
Link around the paywall: http://apkmetro.com/what-we-can-learn-from-the-20th-centurys-deadliest-pandemic/ http://apkmetro.com/what-we-can-learn-from-the-20th-centurys...
- war1025 7y ago
  That's a very odd link. It's mostly the same but has many transcription errors. Maybe to ward off automated takedown notices or something?
  - aaron695 7y ago
    I assume they run it through a translator and back. Other ideas? It's just to wash it for copyright. It's actually a good business case for GANs (In the underground)
neonate 7y ago
https://archive.md/BzVSx https://archive.md/BzVSx
- politelemon 7y ago
  Thank you
burlesona 7y ago
This is a really good article, and the contrast in the outcomes between Philadelphia and St. Louis is such a clear example why aggressive social distancing is so crucial right now. Thanks for sharing!
alex_young 7y ago
I know about archive.org etc, but it’s really striking to see public health reporting behind a paywall.
- o_____________o 7y ago
  Yeah, and FTA: > In the face of highly variable responses from public officials, the media served as an essential ally of the public health community in fighting the pandemic.
  - CaptArmchair 7y ago
    This can be true in this particular context. However, the difference between private media outlets, such as WSJ, and the public health administration is that the latter is being paid for by taxes. Your taxes. The only "free" media are public media such as public broadcasters. Even so, those aren't "free" as in "free beer", they are part of a fiscal budget and the only reason why you can consume them with little restrictions is because that's foundational to public policy. It's perfectly acceptable for private ventures, such as WSJ, NYT or WaPo, to put their articles behind a paywall. Put differently, even during the 1918 pandemic, you would still pay the paperboy on the corner of the street a few nickles to get a copy of the daily. If you think that the WSJ or NYT are mere outlets for public health administration, you're very much mistaken. The "independence" of the Press serves one goal in particular: to critically assert public governance. That independence is a constitutional right, but it's not a guarantee nor an entitlement. Good journalism needs to be paid for. The digital age didn't suddenly deprecate the expense associated with doing research and writing a good piece. So, the statement needs to be amended: > the media served as an essential ally of the public health community in fighting the pandemic, but it can only do so if the audience is willing to pay for the efforts. Yes, I understand that in modern economics, particular outlets are part of larger corporations. A newspaper can be a losing proposition if the costs can be covered through other income channels. The downside of that is the reduction of quality as media channels devolve in sheer revenue machines (ads, subscriptions,...) or heavily biased outlets. Hence why I feel that supporting journalist organisations, who aren't "brands" bought by larger corporations, is where audiences can really make a difference if we hope to let a true "free and independent" press survive. TL;DR: The "free" in "free press" doesn't mean free lunch.
aaron695 7y ago
The Spanish Flu was previous to really having cars or dual incomes. I'm not sure you can learn the same lessons. I don't shop in the same stores as any of my friends for instance. I only occasionally see acquaintances at the shops. H1N1 case study in Texas is interesting. Italian Grandparents Step in as Schools Close Amid COVID https://time.com/5797637/italian-grandparents-coronavirus-babysitters/ https://time.com/5797637/italian-grandparents-coronavirus-ba...
- squarefoot 7y ago
  About the grandparents caring for the children: it's true that this could pose a risk, however it also keeps the risk confined to a single family circle, which wouldn't be the case with a nanny who could then potentially spread the infection to her own family or other families kids.
baby 7y ago
Paywall
allovernow 7y ago
I've been extremely pessimistic since early January when I started following this obsessively - and I still think it's going to get far worse before it gets better. But there is a silver lining here. This is probably the first time in history that a disease will have this much attention from so many researchers. There's a good chance someone will find a cure or prophylactic relatively soon, even if a vaccine is unlikely. Also any potential drug will be put on rush evaluation so things should move quickly - there's Hope yet.
- nkozyra 7y ago
  I agree. And yet there are swarms of people complaining the media attention is alarmist or that this is no big deal. Pretty sure public response so far, at least stateside.
  - smolder 7y ago
    It's my anecdotal observation that there are more people hysterical over the hysteria than there are people legitimately hysterical over the virus. But that's probably not representative. I hope.
- mellavora 7y ago
  2020: Covid-19 1918: Spanish Flu 1820: First Cholera Pandemic 1720 is not as clearcut but you could cherry-pick some candidates. Likewise 1620 https://en.wikipedia.org/wiki/List_of_epidemics https://en.wikipedia.org/wiki/List_of_epidemics So, have we a 100-year event ??
  - k4runa 7y ago
    Astrologically it happens with Saturn / Pluto conjunctions which are the two malefic planets. That happened in the middle of January this year, it also happened when HIV was discovered in 1983, and in 1914 it happened again, also in January 1820 for the Cholera pandemic, and in 1713, and 1616. So the next big one is 2053...
    - 7y ago
ktr 7y ago
For a fascinating, in-depth look at the Spanish flu of 1918 check out John Barry’s “The Great Influenza” [1]. The book was amazing and gives you a real sense of what one of the worst pandemics in history must have been like. [1] The Great Influenza: The Story of the Deadliest Pandemic in History https://www.amazon.com/dp/0143036491 https://www.amazon.com/dp/0143036491.
- francisofascii 7y ago
  FWIW, I recently ordered a Spanish Flu book by Gina Kolata, and it took more than a week to arrive instead of the normal two days. Kindle version might be a better bet.
Stevvo 7y ago
If it spreads to infect a large proportion of the world's population, it way be beneficial to get it now, before the healthcare services are overwhelmed.
- sigstoat 7y ago
  might've been an option a month and a half ago. but: exponential growth. most western countries are _days_ behind italy. if you're destined to downturn, it'll take you a week or more to need the ventilator, and you'd be on it for some time.
- sten 7y ago
  Only for the first few people who do it and it will come at a great cost to everyone else. Classic collective action problem at work and down right dangerous thinking. If even a fraction of the population acts on this idea the rate of transmission will increase and the overall outcome of the event will be worse. Flatten the curve. Reduce the rate of spread. Buy time to keep the strain on the health care industry as low as possible. Increase the probability that vaccinations can be produced in time to assist. And stop spreading this ridiculous idea.

123 points by jkuria 7y ago

I was watching this clip of Michael Osterholm on Joe Rogen: https://youtu.be/B6IgMdsZHbM https://youtu.be/B6IgMdsZHbM He said the covid-19 would eventually slow once enough people get it then we’ll have sufficient immunity that it won’t spread. Of course, he also said a lot of people are going to get it and we’re at the very beginning of a multi-year problem.

ajross 7y ago
Yes, realistically the world will be playing whack-a-mole over the coming months as city after city experiences an outbreak that saturates its health care facilities and has to lock down. It will seem endless. But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity. But it's going to be a rough road to get there, and we'll all suffer on some level. This isn't going to be "over" for quite some time.
- melling 7y ago
  It doesn’t affect each age group uniformly. If you’re under 30 without any other health issues, you should be fine? Might not realize you have it? I wonder if it would be easier to create a low dosage vaccine for younger people, thus creating a bit of a firewall so it doesn’t spread as rapidly. I know nothing about medicine so this may be silly.
  - rogerkirkness 7y ago
    Generally speaking, all vaccines are low dosage. Everyone having the vaccine would be better, starting with those most at risk. If we had a vaccine, we would give it to 80 year olds first, then go down the chain.
    - Retric 7y ago
      You generally start with healthcare workers, then high risk populations, then the general public.
    - deleted 7y ago
      [deleted]
    - paulmd 7y ago
      Dr Anthony Fauci has been estimating it'll take about 12-18 months to get a vaccine through trials. Human testing starts in a month or two. https://www.nytimes.com/2020/03/08/health/fauci-coronavirus.html https://www.nytimes.com/2020/03/08/health/fauci-coronavirus.... We have a ways to go before a vaccine is available. iirc he reiterated this to congress this morning before hearings were terminated to allow Trump to hold a press conference. Witnesses were told to stop their testimony and leave immediately. > “This morning we were informed that President Trump and Vice President Pence have called our witnesses to an emergency meeting at the White House,” Maloney said. “We don't know the details, just that it is extremely urgent.” > At about 11:30 a.m., she ended questioning from lawmakers, saying she received notice from the White House that the witnesses needed to leave “now.” https://thehill.com/homenews/house/487014-trump-officials-cut-testimony-short-at-coronavirus-hearing https://thehill.com/homenews/house/487014-trump-officials-cu...
  - mhb 7y ago
    It's not silly. Though I'd be interested in the comparison of under-30 without any health issues to over-50 without any health issues.
  - maxerickson 7y ago
    The current goal is to create any vaccine that is safe and effective. If you have that, you give it to everybody you can. I guess deciding what safe enough is can be a problem (for many people the bar will be "getting the vaccine has better odds for a good outcome than getting the infection", but that is sort of a minimum).
  - supercanuck 7y ago
    >without any other health issue I think people are underestimating what an over-capacity, health care system looks like and the increase in risk of other infections can have.
    - bryanrasmussen 7y ago
      right, as I understand the information from Italy right now emergency services are basically shut down because system overburdened. So as a healthy 30 year old, don't go do any of those healthy sports you like because you might get an injury and that's it then. Also patient 1 in Italy was a healthy marathon runner who at least ended up in intensive care, not sure if dead yet or not.
      - giovan-ni 7y ago
        he is breathing on is own since yesterday, still hospitalized
        bryanrasmussen 7y ago
        thanks for the info!
      - lultimouomo 7y ago
        In Lombardy, the only region where the situation is critical at the moment, emergency service have NOT shut down. Non urgent procedures are suspended, both to spare doctors and nurses and to avoid creating new emergencies in case those procedures go wrong. ERs are not overwhelmed, ICUs are. You basically get in real trouble if you need a respirator - they're pretty much out of those and they have to assess your chance of survival to decide if they can tube you. Interestingly ERs are seeing much less load because people have stopped going there for stupid reasons, because they are afraid of catching COVID-19. All medical stuff is still busting their ass if course, a lot of them have been lended to ICUs, rooms have been repurposed, etc. This is not to say that the situation isn't bad. It's really bad. And if you think that your country has such a good health care system that it will hold better, you should know that Lombardy hospitals are top notch. Whatever your age, stop traveling. If there's been a single case in your region, stop risky behaviors now: don't go shopping, have it delivered. Work from home. Don't use public transit. Teach your parents how to shop online and force them to stay home. Don't shake hands and wash them often.
  - williamDafoe 7y ago
    Not completely true. It can apparently spread to a lower respiratory problem in ANYONE (where it is VERY deadly, 50% mortality rate) it just tends not to do it very often in persons 10-30 yrs old.
    - hybrid_cluster 7y ago
      Source?
    - gnulinux 7y ago
      I've never seen this 50% figure, looking at people in critical condition data, even that's not 50%, more like 20% mortality. Please provide a source, or delete your comment.
  - fock 7y ago
    yeah, I agree that this is no problem if hospitals stop taking anyone over 40 with respiratory issues and leave them to die at home. Letality might approach 10-20% then (from all we know), but hey, we are young!
    - andybak 7y ago
      I'm 49. I wish you'd said "Over 50".
  - JamesBarney 7y ago
    Im 34 so I'll be fine, and I probably won't lose any friends. But I may lose a parent and I'll definitely have a friend who loses a parent. And that seems pretty awful especially considering how preventable this all was.
    - jamesrcole 7y ago
      > so I’ll be fine I hope so, but - it will kill some number of younger people, even healthy ones. - it’s also worth considering that we don’t (AFAIK) have a clear picture about potential long-term complications (eg lung damage). We should not simply assume there won’t be these. I’m saying this to emphasize the seriousness of the situation.
    - gambiting 7y ago
      >>Im 34 so I'll be fine I'm sorry, but that's a stupid assumption to make. I'm "only" 29 and last year I managed to catch a parvovirus B19 from someone - it's a virus that's relatively common in children, but has very mild symptoms - it's almost unheard of in adults, mostly because you either already have immunity, or there are no symptoms/the symptoms are no worse than a mild cold/flu. Well, except that in about 10% of adults it causes severe response with a high fever that last weeks, with arthretic swelling of joints - and in 10% of those the joint issues don't go away for years. Well, it's been nearly a year now and my knees and other joints are still fucked from the virus, I'm constantly on steroids just to control the inflammation. So no, this has changed my "I'm young so I'll be fine" outlook on this - the chances are not always in your favour.
      - krageon 7y ago
        You're being overly dramatic. While in general you might be correct, in this specific case you are not and your fear mongering isn't helping anyone.
      - brigandish 7y ago
        Sorry to hear that. I wish the insight you have could spread further (what a sorrowful irony) but it seems wisdom is rarely won without painful experience, the blasé attitude of some is not helping right now. I hope you get better soon.
  - teambayleaf 7y ago
    The mortality rate of COVID-19 is estimated to be around ~0.1% for young people, which is five times higher than seasonal flu. > the risk of death among young adults would be smaller than that of older adults, e.g., at most 0.1%–0.2%. Whether to perceive this estimate as severe or moderate is a matter for discussion, but we consider 0.1%–0.2% among young adults to be unusually high. > https://www.mdpi.com/2077-0383/9/2/580 https://www.mdpi.com/2077-0383/9/2/580 So although it is not as deadly as SARS (which had 20% fatality rate), you definitely don't want to catch it.
    - lixtra 7y ago
      > we consider 0.1-0.2% ... high To put that into perspective that’s the mortality rate of measles [1] and our grandparents were still going to measls parties. [1] https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
      - ajross 7y ago
        But measles wasn't a pandemic! Everyone keeps thinking this is about individual risk and trying to downplay things, and it's not like that. Our grandparents went to measles parties because they knew that they'd eventually be exposed and wanted to do it under controlled conditions where they knew treatment was available and had a plan for early detection of symptoms. The situation with COVID-19 is that people who get sick are going to do so in an environment where they and their government are surprised as "how fast it grew" and where all the hospital beds (and oxygen masks, and ventilators, and intubation kits, and doctors, and nurses, and...) are going to be filled by other sick people. And a lot of them are going to die, who didn't need to if we had just taken this seriously and not told people "it's just like measles".
        lixtra 7y ago
        My reading of melling was to actually infect young and healthy people under controlled circumstances such that herd immunity builds. To that teambayleaf pointed out that it comes at high individual risk. But in the past this was done for measles at similar risk.
  - lllr_finger 7y ago
    An otherwise healthy thirtysomething in Minnesota is in critical condition right now - it's not time to panic but you probably want to avoid getting this if you can.
- qznc 7y ago
  That would be the good scenario because then we can move the critical ICU equipment from outbreak to outbreak. The bad scenario is if it becomes too much. China sending equipment to Italy now is a good sign.
- saiya-jin 7y ago
  > But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity. Last time I checked there are at least 3 or 4 different strains circulating now. That's why some folks who got cured got it again. So don't have such naive hopes that all will be rosy on its own soon. If the story will be similar to flu, we're pretty much fucked - every year the strain is so different that prior vaccinations/immunity doesn't work on them. I certainly hope that's not the case, too early to tell.
  - op00to 7y ago
    Two strains. Stop spreading rumors.
    - animal531 7y ago
      I'm looking at: https://nextstrain.org/ncov https://nextstrain.org/ncov What defines a strain? I know about the L/S sub-types, but there have been a great number of splits.
      - saiya-jin 7y ago
        Exactly. Anyway, the topic is that simply getting through the infection doesn't grant immunity so one doesn't have to care about covid-19 anymore. Plus thinking that when we have few (even if 2) variants of the virus within first 3 months there won't be any more mutations is a bit naive IMHO.
    - ajross 7y ago
      Realistically it's more than that, though. Viruses mutate rapidly and this one is into the hundreds of thousands of human transmissions now and still picking up steam. We just don't have the PCR bandwith available to sequence them as fast as they're spreading. Pretty much any direct pronouncement on the "kinds" of SARS-CoV-2 is going to be speculation, so it's all "rumors". But strains don't correlate perfectly to immune respnse, so the upthread point about reinfection risk remains speculation. We just don't know yet. But all endemic viruses eventually reach equilibrium with the population immune response (and vaccination regime), even if it requires regular updates a-la the yearly change in flu shots.
the6threplicant 7y ago
In other words it's following a logistics curve. This is what every pandemic does: the problem is that we can't know when the inflection point is. Sometimes it's quite early on, and sometimes it isn't. Plan for the latter, hope for the former.
- jmkni 7y ago
  What do you mean by inflection point, and why is it better if it's early?
  - ryukafalz 7y ago
    3Blue1Brown has a recent video on this that explains it really well: https://youtu.be/Kas0tIxDvrg https://youtu.be/Kas0tIxDvrg
    - jmkni 7y ago
      Thanks!
    - plemer 7y ago
      3Blue1Brown is just exceptional. I don’t know anyone else’s combination of animation and explanation that comes close.
  - usrusr 7y ago
    Early can mean "at a low percentage" (which would be good) and not just "reached fast" (which would be very bad, unless also at low percentage). The percentage is directly depending on R0 (which apparently isn't easy to get below 1 even with China-grade measures).
  - tibu 7y ago
    The inflection point here means that the speed of the spreading of virus gets slower, so less people get infected then previous day. If this point is earlier in time, this means that the virus won't infect so many people after a time. I think the big question is the cause of the inflection point. Is it because of the nature of the virus or because of the different action like quarantine
usrusr 7y ago
If official numbers are less than 90% off even Wuhan hasn't reached anything close to saturation yet.
- jeromegv 7y ago
  That's because they took measures to stop it, same as South Korea, where the USA has not.
  - kerabatsos 7y ago
    It will be difficult to convince the 40% of the population that measures need to be taken when that 40% thinks everything of consequence is a hoax, fake news, etc - being incited and reinforced by their Dear Leader. It's the result of a decades long undervaluing, underfunded, ignored education system.
omarhaneef 7y ago
Does this mean it is better to get it very early before the health system stresses out (might be too late for that and this is a selfish sort of thing anyway), or medium early before you are so old that your immune system is crap, or very late when they have effective vaccines. Anytime but right now, basically.
- tpfour 7y ago
  If you are part of a high mortality rate demographic, you are better to get it first in your demographic to have a better access to resources (or very late when the resources are back under control). The issue is not really the virus per se, but its effect on the healthcare systems. That is something health systems work with _every year_ with flu season, nothing new under the sun. What's different is _nobody_ has immunity to this virus, and a lot of people initially dismissed the virus, or are still dismissing the risks.
  - eveningcoffee 7y ago
    I think it is like with everything else - it depends. If you are in the high mortality rate demographic and your recovery is not fast enough then you may still have the risk of being "phased out" when the medical system comes crashing down with the load of new cases happening during your recovery. The best is to not get the infection.

LilBytes 7y ago

Link around the paywall: http://apkmetro.com/what-we-can-learn-from-the-20th-centurys-deadliest-pandemic/ http://apkmetro.com/what-we-can-learn-from-the-20th-centurys...

war1025 7y ago
That's a very odd link. It's mostly the same but has many transcription errors. Maybe to ward off automated takedown notices or something?
- aaron695 7y ago
  I assume they run it through a translator and back. Other ideas? It's just to wash it for copyright. It's actually a good business case for GANs (In the underground)

neonate 7y ago

https://archive.md/BzVSx https://archive.md/BzVSx

politelemon 7y ago
Thank you

burlesona 7y ago

This is a really good article, and the contrast in the outcomes between Philadelphia and St. Louis is such a clear example why aggressive social distancing is so crucial right now. Thanks for sharing!

alex_young 7y ago

I know about archive.org etc, but it’s really striking to see public health reporting behind a paywall.

o_____________o 7y ago
Yeah, and FTA: > In the face of highly variable responses from public officials, the media served as an essential ally of the public health community in fighting the pandemic.
- CaptArmchair 7y ago
  This can be true in this particular context. However, the difference between private media outlets, such as WSJ, and the public health administration is that the latter is being paid for by taxes. Your taxes. The only "free" media are public media such as public broadcasters. Even so, those aren't "free" as in "free beer", they are part of a fiscal budget and the only reason why you can consume them with little restrictions is because that's foundational to public policy. It's perfectly acceptable for private ventures, such as WSJ, NYT or WaPo, to put their articles behind a paywall. Put differently, even during the 1918 pandemic, you would still pay the paperboy on the corner of the street a few nickles to get a copy of the daily. If you think that the WSJ or NYT are mere outlets for public health administration, you're very much mistaken. The "independence" of the Press serves one goal in particular: to critically assert public governance. That independence is a constitutional right, but it's not a guarantee nor an entitlement. Good journalism needs to be paid for. The digital age didn't suddenly deprecate the expense associated with doing research and writing a good piece. So, the statement needs to be amended: > the media served as an essential ally of the public health community in fighting the pandemic, but it can only do so if the audience is willing to pay for the efforts. Yes, I understand that in modern economics, particular outlets are part of larger corporations. A newspaper can be a losing proposition if the costs can be covered through other income channels. The downside of that is the reduction of quality as media channels devolve in sheer revenue machines (ads, subscriptions,...) or heavily biased outlets. Hence why I feel that supporting journalist organisations, who aren't "brands" bought by larger corporations, is where audiences can really make a difference if we hope to let a true "free and independent" press survive. TL;DR: The "free" in "free press" doesn't mean free lunch.

aaron695 7y ago

The Spanish Flu was previous to really having cars or dual incomes. I'm not sure you can learn the same lessons. I don't shop in the same stores as any of my friends for instance. I only occasionally see acquaintances at the shops. H1N1 case study in Texas is interesting. Italian Grandparents Step in as Schools Close Amid COVID https://time.com/5797637/italian-grandparents-coronavirus-babysitters/ https://time.com/5797637/italian-grandparents-coronavirus-ba...

squarefoot 7y ago
About the grandparents caring for the children: it's true that this could pose a risk, however it also keeps the risk confined to a single family circle, which wouldn't be the case with a nanny who could then potentially spread the infection to her own family or other families kids.

baby 7y ago

Paywall

allovernow 7y ago

I've been extremely pessimistic since early January when I started following this obsessively - and I still think it's going to get far worse before it gets better. But there is a silver lining here. This is probably the first time in history that a disease will have this much attention from so many researchers. There's a good chance someone will find a cure or prophylactic relatively soon, even if a vaccine is unlikely. Also any potential drug will be put on rush evaluation so things should move quickly - there's Hope yet.

nkozyra 7y ago
I agree. And yet there are swarms of people complaining the media attention is alarmist or that this is no big deal. Pretty sure public response so far, at least stateside.
- smolder 7y ago
  It's my anecdotal observation that there are more people hysterical over the hysteria than there are people legitimately hysterical over the virus. But that's probably not representative. I hope.
mellavora 7y ago
2020: Covid-19 1918: Spanish Flu 1820: First Cholera Pandemic 1720 is not as clearcut but you could cherry-pick some candidates. Likewise 1620 https://en.wikipedia.org/wiki/List_of_epidemics https://en.wikipedia.org/wiki/List_of_epidemics So, have we a 100-year event ??
- k4runa 7y ago
  Astrologically it happens with Saturn / Pluto conjunctions which are the two malefic planets. That happened in the middle of January this year, it also happened when HIV was discovered in 1983, and in 1914 it happened again, also in January 1820 for the Cholera pandemic, and in 1713, and 1616. So the next big one is 2053...
  - 7y ago

ktr 7y ago

For a fascinating, in-depth look at the Spanish flu of 1918 check out John Barry’s “The Great Influenza” [1]. The book was amazing and gives you a real sense of what one of the worst pandemics in history must have been like. [1] The Great Influenza: The Story of the Deadliest Pandemic in History https://www.amazon.com/dp/0143036491 https://www.amazon.com/dp/0143036491.

francisofascii 7y ago
FWIW, I recently ordered a Spanish Flu book by Gina Kolata, and it took more than a week to arrive instead of the normal two days. Kindle version might be a better bet.

Stevvo 7y ago

If it spreads to infect a large proportion of the world's population, it way be beneficial to get it now, before the healthcare services are overwhelmed.

sigstoat 7y ago
might've been an option a month and a half ago. but: exponential growth. most western countries are _days_ behind italy. if you're destined to downturn, it'll take you a week or more to need the ventilator, and you'd be on it for some time.
sten 7y ago
Only for the first few people who do it and it will come at a great cost to everyone else. Classic collective action problem at work and down right dangerous thinking. If even a fraction of the population acts on this idea the rate of transmission will increase and the overall outcome of the event will be worse. Flatten the curve. Reduce the rate of spread. Buy time to keep the strain on the health care industry as low as possible. Increase the probability that vaccinations can be produced in time to assist. And stop spreading this ridiculous idea.