3 ms·

> the disease is severely underdiagnosed That's one possibility; the other is what is happening in Italy right now, i.e. initial 2 weeks of infections are done

by bitL 7y ago

> the disease is severely underdiagnosed That's one possibility; the other is what is happening in Italy right now, i.e. initial 2 weeks of infections are done and now the severe cases remain and pass away. Like in South Korea 98% cases are in progress, so the outcome is not known yet and making any stats out of those is premature (i.e. too optimistic). I'd say nobody is going to shut down whole megalopolis cities if it was just a more severe flu...

Barrin92 7y ago
we also have the cruise ship though or the death rates outside of Wuhan in China (about 0.7% so far) and they have a lot of recovered cases. Rather than everyone somehow lagging behind Italy's death rate I think it's likely that they have just lost the plot and there's a huge number of cases under the radar. >I'd say nobody is going to shut down whole megalopolis cities if it was just a more severe flu. I mean a severe flu by a factor of five or so is basically what this is, it's just that this in and of itself is really, really bad because nobody has the capacity to handle that many cases.
- bitL 7y ago
  Flu typically doesn't need breathing apparatus. I think in 1-2 months we will know much more and will have better stats. Until then I think treating it as R0 > 2 and mortality rate of 1-2% would serve us well.
  - Barrin92 7y ago
    >Flu typically doesn't need breathing apparatus. Neither does this virus, typically. However some people end up having severe complications, as do people with the flu which is why the latter causes a few ten thousand deaths each year in the US, and half a million worldwide. The issue here really is a matter of quantity. Covid-19 is not a mysterious super disease, but it is dangerous enough to overstress an unprepared healthcare system.
- claudeganon 7y ago
  The cruise ship isn’t a good test of anything because the healthcare the infected received wasn’t under strain and resource limited like it will be when widespread infection hits. I get why people cling to its example out of optimism, but look at the reality in Italy now for a better example of what things will look like further out, and what most people will face.
  - joe_the_user 7y ago
    Well, Italy is not how things have to be further out. Health system can system prepare before hand (they aren't, it seems but still). Also, if the entire population of Northern Italy was infected and mortality rate was .5%, you would be seeing 13K deaths (which isn't impossible given the situation but far from 6-700 deaths so far). Which is to say, you're right that infection on a large scale is far more problematic than infection on a small scale but I don't think infection on a large necessarily contradicts the Diamond Princess results. A lot of people can die and it is social catastrophe even with percent of the entire population.
    - fock 7y ago
      a) I think you meant 80000 deaths (northern italy has maybe 15 Mio inhabitants), b) so according to your calculation, there should be about 140000 cases closed by now?
      - joe_the_user 7y ago
        Wikipedia gives a figure of 27 million for Northern Italy[1]. But I want to be clear that nothing I said above is anything like a solid prediction, just a pure back-of-the-envelope rough comparison. There's nothing I'm going to predict here. [1] https://en.wikipedia.org/wiki/Northern_Italy https://en.wikipedia.org/wiki/Northern_Italy
joe_the_user 7y ago
That's one possibility; the other is what is happening in Italy right now, i.e. initial 2 weeks of infections are done and now the severe cases remain and pass away. Like in South Korea 98% cases are in progress, so the outcome is not known yet and making any stats out of those is premature (i.e. too optimistic) I think you're putting forward a weirdly deceptive view that the two possibilities (under-diagnosis and long-dying-process) are exclusive. It seems extremely likely both factors are involved in current statistics - nothing in one excludes the other. A nation that's systematically testing and finding all the cases will start with a lower death rate and watch it creep upward - but for the manageable number of cases they will see as they get patient quarrantine. A nation or region that's not systematically testing will have a high death and high recovery rate as they only see cases after the fact but then they'll see all cases spike, their health system overwhelmed and things in a mess (ie, Italy now, Hubei earlier). I'm heartened that the US is now finding more cases rather than just seeing more death but clearly the US slacking on testing and surveillance.
- bitL 7y ago
  Italy has one of the best healthcare systems in the world. It's more of a policy problem in their case. We will see Germany in the next 1-2 weeks when the severe cases might start developing en masse.
  - _-___________-_ 7y ago
    It really depends where you are. In much of the south the healthcare standards are not that great.
    - bitL 7y ago
      Lombardy, the most affected region, is one of the wealthiest in Europe with one of the best healthcare systems. I agree south is way worse.
joshuamorton 7y ago
My understanding is that the opposite is happening in Italy: the severe cases have been found, but it takes time for the mild cases to (and the non fatal ones) to be marked as recovered.
- _-___________-_ 7y ago
  Many of the mild infections will never be known about (and thus never be counted as a case at all). There may have been no symptoms, or the symptoms may have been minor enough that the person thought it was a cold. Because of this the case fatality rate is a terrible metric to use to try to estimate expected deaths, or your own risk if you contract the virus.

by bitL 7y ago

Barrin92 7y ago

we also have the cruise ship though or the death rates outside of Wuhan in China (about 0.7% so far) and they have a lot of recovered cases. Rather than everyone somehow lagging behind Italy's death rate I think it's likely that they have just lost the plot and there's a huge number of cases under the radar. >I'd say nobody is going to shut down whole megalopolis cities if it was just a more severe flu. I mean a severe flu by a factor of five or so is basically what this is, it's just that this in and of itself is really, really bad because nobody has the capacity to handle that many cases.

bitL 7y ago
Flu typically doesn't need breathing apparatus. I think in 1-2 months we will know much more and will have better stats. Until then I think treating it as R0 > 2 and mortality rate of 1-2% would serve us well.
- Barrin92 7y ago
  >Flu typically doesn't need breathing apparatus. Neither does this virus, typically. However some people end up having severe complications, as do people with the flu which is why the latter causes a few ten thousand deaths each year in the US, and half a million worldwide. The issue here really is a matter of quantity. Covid-19 is not a mysterious super disease, but it is dangerous enough to overstress an unprepared healthcare system.
claudeganon 7y ago
The cruise ship isn’t a good test of anything because the healthcare the infected received wasn’t under strain and resource limited like it will be when widespread infection hits. I get why people cling to its example out of optimism, but look at the reality in Italy now for a better example of what things will look like further out, and what most people will face.
- joe_the_user 7y ago
  Well, Italy is not how things have to be further out. Health system can system prepare before hand (they aren't, it seems but still). Also, if the entire population of Northern Italy was infected and mortality rate was .5%, you would be seeing 13K deaths (which isn't impossible given the situation but far from 6-700 deaths so far). Which is to say, you're right that infection on a large scale is far more problematic than infection on a small scale but I don't think infection on a large necessarily contradicts the Diamond Princess results. A lot of people can die and it is social catastrophe even with percent of the entire population.
  - fock 7y ago
    a) I think you meant 80000 deaths (northern italy has maybe 15 Mio inhabitants), b) so according to your calculation, there should be about 140000 cases closed by now?
    - joe_the_user 7y ago
      Wikipedia gives a figure of 27 million for Northern Italy[1]. But I want to be clear that nothing I said above is anything like a solid prediction, just a pure back-of-the-envelope rough comparison. There's nothing I'm going to predict here. [1] https://en.wikipedia.org/wiki/Northern_Italy https://en.wikipedia.org/wiki/Northern_Italy

joe_the_user 7y ago

That's one possibility; the other is what is happening in Italy right now, i.e. initial 2 weeks of infections are done and now the severe cases remain and pass away. Like in South Korea 98% cases are in progress, so the outcome is not known yet and making any stats out of those is premature (i.e. too optimistic) I think you're putting forward a weirdly deceptive view that the two possibilities (under-diagnosis and long-dying-process) are exclusive. It seems extremely likely both factors are involved in current statistics - nothing in one excludes the other. A nation that's systematically testing and finding all the cases will start with a lower death rate and watch it creep upward - but for the manageable number of cases they will see as they get patient quarrantine. A nation or region that's not systematically testing will have a high death and high recovery rate as they only see cases after the fact but then they'll see all cases spike, their health system overwhelmed and things in a mess (ie, Italy now, Hubei earlier). I'm heartened that the US is now finding more cases rather than just seeing more death but clearly the US slacking on testing and surveillance.

bitL 7y ago
Italy has one of the best healthcare systems in the world. It's more of a policy problem in their case. We will see Germany in the next 1-2 weeks when the severe cases might start developing en masse.
- _-___________-_ 7y ago
  It really depends where you are. In much of the south the healthcare standards are not that great.
  - bitL 7y ago
    Lombardy, the most affected region, is one of the wealthiest in Europe with one of the best healthcare systems. I agree south is way worse.

joshuamorton 7y ago

My understanding is that the opposite is happening in Italy: the severe cases have been found, but it takes time for the mild cases to (and the non fatal ones) to be marked as recovered.

_-___________-_ 7y ago
Many of the mild infections will never be known about (and thus never be counted as a case at all). There may have been no symptoms, or the symptoms may have been minor enough that the person thought it was a cold. Because of this the case fatality rate is a terrible metric to use to try to estimate expected deaths, or your own risk if you contract the virus.