4 ms·

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.
      - jamesrcole 7y ago
        Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
    - jamesrcole 7y ago
      Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
  - jtbayly 7y ago
    I'd like to see more discussion around this point. I don't care where you got the numbers from. It's been clear from a glance that 3 weeks of cancelled school isn't going to do anything. So now we're looking at 8 weeks. Umm.... According to what? Which is more likely, 8 weeks or 2 years? I don't know, but I'm guessing 8 weeks isn't nearly long enough.
    - jamesrcole 7y ago
      Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
  - jamesrcole 7y ago
    Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
  - dragonwriter 7y ago
    > What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s... People are talking about it, that talk is driving policy, and the answer is “with some local adjustments possible based on caseload, until there is an effective vaccine developed and deployed, which will probably be 18+ months”, and the alternative is a truly catastrophic number of fatalities.
    - AncientTree 7y ago
      By my estimate, we would need to shutdown 10 years worth of life in order to save 1 year of life from Coronavirus. And those shutdown years are in the peak working years, whereas the years saved are in the twilight years. The suppression strategy is hugely economically destructive. We should not accept it. Politicians need to isolate the elderly and prepare the public to accept hundreds of thousands of deaths within the elderly population - ie. doing their job and making hard decisions for the good of us all, instead of just pushing all of the cost to businesses and individuals.
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%

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.
    - jamesrcole 7y ago
      Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
  - jamesrcole 7y ago
    Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
- jtbayly 7y ago
  I'd like to see more discussion around this point. I don't care where you got the numbers from. It's been clear from a glance that 3 weeks of cancelled school isn't going to do anything. So now we're looking at 8 weeks. Umm.... According to what? Which is more likely, 8 weeks or 2 years? I don't know, but I'm guessing 8 weeks isn't nearly long enough.
  - jamesrcole 7y ago
    Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
- jamesrcole 7y ago
  Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
- dragonwriter 7y ago
  > What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s... People are talking about it, that talk is driving policy, and the answer is “with some local adjustments possible based on caseload, until there is an effective vaccine developed and deployed, which will probably be 18+ months”, and the alternative is a truly catastrophic number of fatalities.
  - AncientTree 7y ago
    By my estimate, we would need to shutdown 10 years worth of life in order to save 1 year of life from Coronavirus. And those shutdown years are in the peak working years, whereas the years saved are in the twilight years. The suppression strategy is hugely economically destructive. We should not accept it. Politicians need to isolate the elderly and prepare the public to accept hundreds of thousands of deaths within the elderly population - ie. doing their job and making hard decisions for the good of us all, instead of just pushing all of the cost to businesses and individuals.

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%