15 ms·

I wonder if this will be like H1N1. At first we only identified extreme cases and we had these terrifying reported fatality rates. Then we identify more and m

• jamesrcole 7y ago
  CFR, whatever it is, isn’t the most significant detail. What is “terrifying” is its high contagiousness combined with its high hospitalisation and ICU rates.
  • dragonwriter 7y ago
    Yeah,and the high hospitalization and ICU rates become high case fatality rates once medical infrastructure is saturated, as well as increasing the case fatality rate for every other condition that creates a critical need for inpatient care. That's where Italy definitely is, and where it seems Iran is evn moreso (though they are less public about it.)
    • 12elephant 7y ago
      What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation. I ran the numbers for Canada, and it looks like we'd need isolation measures for 2+ years. I don't see how that's a feasible solution long-term.
      • Loughla 7y ago
        So, wild speculation aside, what numbers did you use to base your model on, and what is your qualification to do anything like that?
      • garmaine 7y ago
        Did you factor in an asymptomatic rate?
      • nicoburns 7y ago
        The numbers I ran for the UK put it at 12 years: No. People in UK: ~66,000,000 Est. proportion of people who will get sick: 80% Est. proportion of sick people who require intensive care: 5% (in Italy it's 10%) So that's 60,000,0000.80.05 = 2,640,000 Number of ICU beds in the UK: ~4100 (90% occupied, but let's ignore that for now) Length of time ICU required: at least 1 week (probably longer, but let's ignore that too) So that's 2,640,000 / 4100 = 644 weeks or 12 years that we would need to spread the cases over in order to have enough capacity.
        • blobster 7y ago
          It's likely that we'll have a vaccine or at least some kind of treatment by the end of the year, so this should improve the prospects quite a bit.
        • Engineering-MD 7y ago
          I did a similar calculation but came back more optimistically (although still on scale of a year to two). You only need count over 18s as very few cases in this group. It is believed by the UK experts to have a lower fatality rate of 1% and likely lower admission rate due to asymptomatic infections (estimates at 16-75%). Ventilator capacity can increase with stopping surgery and CPAP/other measures can be used in some cases. Treatments developed later should improve efficiency of treatment. Extra ventilators should be manufactured and help ease burden. I think 80% is too high, likely more 60% given an R0 of 2-3. Finally, the chronically unwel elderly are unlikely to benefit from ITU care significantly and would never qualify. With these exceptions it gets down to 1-2 years depending on assumptions.
  • nostromo 7y ago
    But, like CFR, we don’t know how high the rates are if we have no idea how many people have or had it. Here’s a few first hand accounts of what the illness was like. These folks aren’t even that young and they describe it as being quite mild: https://www.nbcnews.com/video/coronavirus-patient-from-diamond-princess-explains-what-the-illness-feels-like-80075845933 https://www.nbcnews.com/video/coronavirus-patient-from-diamo... https://www.adn.com/opinions/national-opinions/2020/03/01/i-have-the-coronavirus-so-far-it-isnt-that-bad/ https://www.adn.com/opinions/national-opinions/2020/03/01/i-... https://www.msn.com/en-us/news/us/don-t-panic-says-us-woman-who-recovered-from-coronavirus/ar-BB114R0C?ocid=msedgntp https://www.msn.com/en-us/news/us/don-t-panic-says-us-woman-...
    • cycrutchfield 7y ago
      Anecdotes are not sufficient data
      • huffmsa 7y ago
        They are when there's little quantitative data to work with. A lot of people's biggest questions are what the hell "COVID-19 symptoms" and apparently it means just about anything. I'm suspicious of the 2 week long illness my family has just gotten over. Hit each of us differently. Predominantly nasal mucus, but the kids had some chest congestion, wife had a fever, and I had what felt like a sinus infection and a bit of a dry cough. None of it particularly severe. Likely not COVID-19, but given the scattershot presentation of the disease in non-critical cases, I'm not ruling it out.
        • greedo 7y ago
          No, the symptoms are pretty clear: Fever, dry cough, fatigue, sputum production, shortness of breath (dyspnoe), muscle/joint pain. https://ourworldindata.org/coronavirus#the-symptoms-of-covid-19 https://ourworldindata.org/coronavirus#the-symptoms-of-covid...
      • spookthesunset 7y ago
        We don’t have sufficient data because we are, in our infinite wisdom, not testing every person with a pulse. Or at least testing from as random of a population subset as we can manage. At least in the US. Other countries mileage may vary. But even then it is my understanding that there currently is no way to test if you already had it.
  • bart_spoon 7y ago
    Technically, the hospitalization rates and ICU rates would also be greatly overestimated due to the number of unidentified asymptomatic cases. But from a perspective of absolute numbers of patients hospitalized and admitted to ICU, your point stands.
  • vanniv 7y ago
    Those high rates are also dependant upon the fraction of cases detected. We are currently seeing about a 9% hospitalization rate based on detected cases. If we are really missing 75% of cases, then true hospitalization is only about 2.3%
• Ozzie_osman 7y ago
  I really, really hope so. My hope is it is way more widespread than we think, and while that means it's going to be near impossible to contain, the denominator is so large that the CFR ends up being much lower than expected.
  • alexanderhorl 7y ago
    Maybe in the end the CFR will be the same as the regular flu.
    • dnautics 7y ago
      The only thing that matters in the end is total population mortality rate.
      • seanmcdirmid 7y ago
        That is a bad metric. The death rate could be really bad yet the overall death rate would still not change very much.
        • imtringued 7y ago
          If I am the only person on the planet with a 100% deadly disease why should I force everyone else to suffer because of me?
          • seanmcdirmid 7y ago
            The fear and suffering alone is enough to have a negative effect on people, so it matters.
            • spookthesunset 7y ago
              So is shutting down the entire worlds economy. That has massive, very real impacts well beyond just money.
• cycrutchfield 7y ago
  This is wishful thinking, and it doesn’t take much examination of the medical literature to realize this fact. Edit: it's super fucking irresponsible to say "this is going to be like H1N1" when there is no reputable medical literature that supports that position
  • ailideex 7y ago
    > it's super [] irresponsible to say "this is going to be like H1N1" Good thing the person you responded to never said that.
    • cycrutchfield 7y ago
      that is pretty much the hypothesis in their post
• wahern 7y ago
  I don't see in that link where it shows the CFR in the U.S. changing at all, let alone dramatically. Here's a paper from 2013 that surveyed CFR reports for H1N1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/ After a long discussion about the varying definitions of the numerator and denominator, they had this to say: > Given that estimates of the infection fatality risk are unlikely to be available early enough for decision-making in a pandemic, a more feasible solution may be to measure the case fatality risk among symptomatic cases. ... Such estimates based on symptomatic cases may provide timely but imprecise estimates of seriousness for risk assessment. CFR is not population mortality, and is usually not even infection fatality rate--but, confusingly, sometimes is as there's no official definition. After COVID-19 passes I suspect and hope that the medical community will tighten down definitions. CFR should be restricted to symptomatic cases approximating the type of severity that consumes non-negligible medical resources. Early on in an outbreak it's the only possible practical definition for tactical management of medical resources. An ER doctor couldn't care less how many infected people are convalescing at home. IFR (infection fatality rate) should be explicitly broken out. It's an important numbers to have, but often impossible to pin down until late in the game, sometimes only after the epidemic has passed. And IFR is most useful combined with r0, which has it's own definitional problems--do you care about hypothetical r0, r0 with social distancing, etc. Population mortality rate is even more difficult pin down. I'm not a doctor, but I feel like "CFR" is one of those terms which was never meant to be consumed by the public. Early on it was probably taken for granted by the medical and scientific community to be a "case" as understood by doctors, who would typically only diagnose a specific illness when a patient presented with moderate or severe symptoms that required intervention. But as the medical and scientific community grew more diverse (and lab tests grew increasingly cheaper) the implied assumptions behind "case" became less and less valid, and they completely fall away in public discourse. These types of definitional problems are familiar to those of us in the tech sphere.
  • nostromo 7y ago
    That report was from summer 2009, so it was written during the outbreak. Note the early CFR from WHO was 0.4% for the US and over 1% for Mexico. Later in the year it was found to be <0.03%. http://news.bbc.co.uk/2/hi/health/8406723.stm http://news.bbc.co.uk/2/hi/health/8406723.stm
• hellofunk 7y ago
  But the enormous strain in the healthcare system is very unlike H1N1, so it’s probably not too far from the estimates. To see what’s happening in Italy, this is obviously much worse and unprecedented.
• kayoone 7y ago
  I wouldn't be surprised if it's similar. Many countries, even ones in Europe with high infection rates, still don't test people if they don't show severe symptoms because they don't have the capacity to do it on a large scale.
• jonathanstrange 7y ago
  AFAIK, the case fatality rate is always higher than the actual mortality rate, but before reliable antibody tests are available and used on large random samples of the population speculating about it is not helpful.
• easytiger 7y ago
  The WHO predicted that 150 million people would be killed by avian flu https://www.google.com/amp/s/amp.theguardian.com/world/2005/sep/30/birdflu.jamessturcke https://www.google.com/amp/s/amp.theguardian.com/world/2005/... Using the same logic that had lead to the severe predictions for cv19. For swine flu they promoted and stood by a CFR of 60%. Again turned out to be nonsense; nonsense known at the time to others https://jech.bmj.com/content/62/6/555.abstract https://jech.bmj.com/content/62/6/555.abstract
  • TheOtherHobbes 7y ago
    When it comes to these estimates, the WHO seem to be really bad at their job. But the reality now is that no matter what the estimated CFR is, Covid-19 guarantees that without containment there will be significantly more people in need of hospital care than there will be beds and support staff. And that will affect the final mortality rate, and push it higher than a normal flu season.
    • easytiger 7y ago
      > and push it higher than a normal flu season. last major flu season in Italy killed 24k people. We didn't immolate the global economy as a result
      • woah 7y ago
        Why didn’t the hospital system collapse because of the flu?
        • jojo2000 7y ago
          It is because of the consequences of covid-19 on the lungs of some people, which needs intensive care and specialized equipment to cure them, that is rare (ventilators etc.).
          • easytiger 7y ago
• piokoch 7y ago
  In Italy more than 300 people die every day, the overall mortality rate is between 3% and 8% this is 10 times more than 0.4%. Even if 50%-75% are asymptomatic, there is still large percentage of critical cases that need ICU treatment and currently we are not prepared for it. For me the title should be 25% of cases require treatment in hospital and we are not able to put 25% of population into hospitals, so, very likely 3%-8% will have to die (3% - WHO estimate, 8% - real numbers we have for now).
  • neuronic 7y ago
    That's assuming that all reported cases make up all ACTUAL cases. This is likely completely wrong. What if a much much larger chunk of Italy is already infected and simply not showing symptoms? You would never get permission for a test. Estimates, I found them on Germany's top Robert Koch Institute website [1], suggest that Wuhan underreported cases by a factor between 4.5x and 11.1x (3 separate studies with different factors). [1] https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html#doc13776792bodyText7 https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...
    • notahacker 7y ago
      I don't think anyone knowledgeable is assuming reported cases make up all or even a significant proportion of infected cases (I myself am in recovery from moderate lung inflammation which is probably COVID-19, but even with very-obviously-not-regular-flu symptoms don't figure in my country's stats because tests are reserved for those requiring hospitalisation) Even if it was actually the case that nearly everyone in Italy had it in which case the casualty rates would be much lower than current estimates, the proportion of cases needing ventilators is sufficiently high to overload Italy's healthcare system (so the risk is similar, we're just looking at different risk factors i.e. the disease being less deadly but much more efficient at spreading than current estimates). Knowing that would make it easier to shift from containment to building more ventilators as a strategy, I guess
      • WalterSear 7y ago
• logicallee 7y ago
  >Then on the cruise ship full of people over 60 it’s 0.7%. If there are lots of mild or asymptomatic cases it will likely be much lower. Here is a comedy show lambasting Donald Trump for saying he had a hunch this was the case: https://www.youtube.com/watch?v=yNfmTMdoao0 https://www.youtube.com/watch?v=yNfmTMdoao0 Donald Trump's gut probably saved thousands of Americans through closing the borders early (this is a talking point he repeats again and again and I haven't seen anyone argue with this - so I accept that if any other President had been in office that President wouldn't have closed the borders from highly hit areas so early - an unprecedented action - and hundreds, or thousands of Americans would be dead. Since it is unrefuted I accept Trump's assertion that U.S. has a huge number of tourists and ordinarily would have been harder-hit.) However: not sure how I feel about being led by a gut rather than experts. I debated whether to submit this but I will do this to judge for myself HN replies and voting on my comment.
  • sudosteph 7y ago
    I've actually been really surprised by how well he has handled this so far too. The nation-wide lockdown plus direct cash stimulus are exactly the measures I had hoped to see. Pandemics may be one of the rare situations where having authoritarian leadership can actually benefit the populace. Though I guess we have a while before it plays out completely. I have doubts about whether any non-populist president would have taken these steps any sooner.
    • spookthesunset 7y ago
      Meh. An actual leader would clearly articulate what is going on—he hasn’t done that. An actual leader would tell people not to panic—hasn’t done that. An actual leader would take strong, very visible action against people hoarding supplies or worse reselling them for profit—toilet paper memes are funny until you run out. And quite frankly a real smart leader would have started testing the fuck out every person with a pulse. More understanding of how many people have it is important.
      • lostapathy 7y ago
• travmatt 7y ago
  Or it could be like the 1918 Spanish flu - a bad first wave that was most dangerous to the elderly, and a second wave that mutated and killed mostly young adults.
  • bart_spoon 7y ago
    I don't know why there would be any reason to believe that would be the case. Generally viruses become less deadly over time, not more. The Spanish flu was an outlier.
    • mateo411 7y ago
      I'm pretty sure the Spanish flu did become less deadly over time. I'm sure the virus didn't go away after the second wave, however humanity started developing an immunity to it.
      • egfx 7y ago
        No, from what I’ve read the second wave was the deadliest by far. The first wave being mild. There is anecdotal evidence that sick soldiers spread a virus that became stronger with soldier to soldier spread and then infected more venerable people when returning home. How this would extrapolate to the current outcome I’m not sure.
      • nostrademons 7y ago
        Right, the swine flu pandemic of 2009 was basically a descendant of Spanish Flu. It continues to circulate, particularly in the last couple years - a majority of flu cases this last couple months have been the H1N1 strain that descends from Spanish Flu. We don't hear about it because newer and more deadly pathogens like COVID-19 have cropped up since. I think most people in this thread are talking about 1918-1919, though, since that time period's a little more relevant for predicting what COVID-19 will do.
      • nostromo 7y ago
        SARS (including this new Coronavirus) does not mutate as fast as the flu, so it's even less likely to become more deadly than the common flu. > But SARS has a molecular proofreading system that reduces its mutation rate, and the new coronavirus’s similarity to SARS at the genomic level suggests it does, too. “That makes the mutation rate much, much lower than for flu or HIV,” Farzan said. That lowers the chance that the virus will evolve in some catastrophic way to, say, become significantly more lethal. https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/ https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...
• bcrosby95 7y ago
  You're comparing a virus that early on was reported as 3-4% to one that early on was reported as 0.4%. The cruise ship and South Korea are probably closest to the true death rate of this virus. CFR in South Korea is currently around 0.8%. A common "educated guess" I see from people that work on this is its probably around 0.5%-1% assuming you can get the care needed for it.
  • rojobuffalo 7y ago
    This reflects the opinions shared by Michael Osterholm, Amesh Adalja, and Nicholas Christakis: a final case mortality of ~0.7%. But just to highlight the point, that's on a strong assumption that critical cases receive proper medical attention. I don't think that's a safe assumption for the outbreak in the United States.
    • petre 7y ago
      Now it's really not the time to speculate with numbers that could downplay the risks. We'll see in a few years. 0.\d+% could be someone we love. Keep safe. Prevent if you can.
      • rojobuffalo 7y ago
        I'm just quoting experts. But I agree with your point. Only one of them stated that figure with "confidence", but he also was clearly motivated to downplay the risk because he was worried about panic. My intuition is that a final case mortality < 1.5% would be towards a "best case" outcome; and we should expect worse.
  • gnulinux 7y ago
    Currently, we have 7 total reported deaths from the cruise ship and 696 confirmed cases. Seeing that it's been a long while since the outbreak, let's assume all current cases will survive; this puts us to 1% CFR. But note that Cruise Ship had a higher average age than public, so assuming you'll receive all the medical care you need, ~1% CFR seems to be a good approximate upper-bound estimate.
• endorphone 7y ago
  "Tangent: I wonder if it’s partly the changing media landscape from 2009 to 2020." You think that the reaction of health agencies worldwide was the result of a "changing media landscape"? This takes quite an extraordinary perspective to serious posit. And just to be clear, there was a huge reaction to SARS (a sibling to this virus) six years before H1N1. A massive, coordinated worldwide effort, quarantines, and whole-cities going quiet. How do you blame the media for that, or was it a "changing media landscape" between 2003 and 2009? SARS thankfully was contained through heroic efforts so it never yielded the catastrophe we have now. Regardless, they're very different viruses. Even if we pretend that the world "barely noticed" H1N1 (hint: It saw a huge response), health agencies and their experts have rang the warning bell about this virus because of the way it accelerates and presents in an area. They aren't jerking about CFR (which is a post-facto statistic), they're noticing that it hits an area and as it spreads the need for massive intervention explodes. That is why Wuhan got so much attention early on, and why cities are taking extraordinary, historic actions. Rather than repeat myself - https://news.ycombinator.com/item?id=22607318 https://news.ycombinator.com/item?id=22607318 Trying to casually blame the media is not useful.