4 ms·

> I suspect the true numbers are about 10x-50x the reported confirmed cases. This is good in that it means the death rate is also off by that factor, but bad in

by md224 7y ago

> I suspect the true numbers are about 10x-50x the reported confirmed cases. This is good in that it means the death rate is also off by that factor, but bad in that there will not be enough fear/incentive for the primary carriers (young adults) to adhere to adequate social distancing. If the death rate is off by 10x-50x, isn't this approaching the death rate of seasonal influenza, in which case we didn't actually need to adhere to social distancing in the first place?

pcl 7y ago
The disease also appears to spread much faster than the flu. So even if the death rate is comparable, the infection rate is likely to be far higher.
- eteos 7y ago
  This is likely because our immume system is not familliar with this virus yet.
  - Jedd 7y ago
    This doesn't add up either -- immunity per individual is expected to last 'only a few months', opening the door to multiple infections per year per person.
    - easytiger 7y ago
      > This doesn't add up either -- immunity per individual is expected to last 'only a few months', There is no evidence either way. Even if it is transient it will be enough for it to die down
      - Jedd 7y ago
        There's some very strong indicators that immunity will be ephemeral. It's possible the R naught will drop below the currently assessed 2.2 over time, but there's no evidence for that -- and if both these things stay as expected, it won't be transient enough to 'die down' naturally.
        easytiger 7y ago
        Unfortunately until we get an antigen test, we will not know for sure. But there is no reason to believe at this point that it isn't anything other than a standard immune response. It would extremely rare that it wasn't
    - bart_spoon 7y ago
      There's no indication how long the immunity is expected to last. It's just as likely that immunity, even if temporary, can last for a year or more, as is the case with the flu or some other viruses.
      - Jedd 7y ago
        On HN this morning -- news that someone in Japan is already on their second infection of this virus. So there's our first data point.
- bryanrasmussen 7y ago
  let's say there were 320,000 people without symptoms in China, which seems unlikely, that would make the total cases approximately 400000, and if we just looked at the fatalities so far out of that it would be a fatality rate of 0.8% iirc the common flu is 0.1% fatality, so if this only had 0.8% but affects 40-70% of the world (which seems to me like it would be at the 70% end if there are lots of asymptomatic people) so 40% of 7 billion and then 0.8% of that is 22,400,000 - my math is probably off here.
  - dnautics 7y ago
    > 320,000 people without symptoms in China Wuhan (the city, not even the entire province of Hubei) has 11 million people. Given what we know now about how virulently and covertly COVID-19 spreads and how (relatively late) Wuhan went into lockdown, how do you feel about that number?
    - bryanrasmussen 7y ago
      if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic. I'm not taking the exact 75% number here in the following - but close, and I will do some hasty approximations. Current total cases (maybe off by some hours) is 80,894. 80894 is 20.2% of 400000. 400000 - 80000 = 320000. So yes, given the article's premises 320000 is pretty much on the optimistic side for humanity. on edit: but once again my math is probably off somewhere so correct it if you see some glaring error in my reasoning. Also note these numbers are for China, of course.
      - dnautics 7y ago
        you're assuming everyone is capable of being infected to detectable levels.
        bryanrasmussen 7y ago
        no that is exactly what I am not doing, hence my starting off my explanation with: "if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic." then I go ahead and choose a number (400000) which is on the optimistic end of this range - 80894 is 20.2% of 400000 - I believe that is quite clear, if 80894 is 20.2% of 400000 and 80894 is the amount of total cases counted in China (no longer the case) then I am assuming 79.8% people asymptomatic that have not been counted! (although of course I did some simplifying of things around so my percentages and numbers are not exact, but I think given the linked article slightly under 320000 people being asymptomatic and 80894 being symptomatic is a very optimistic take) what number do you want to assume is not counted? millions? I assume that from your earlier post but that does not follow from the 50% to 75% cases are asymptomatic. Obviously if 50% to 75% are asymptomatic and you had 1 million people infected all together (symptomatic and asymptomatic) that would mean you needed to have at least 250000 (25% of a million) to 500000 (50% of a million) people symptomatic. But we don't have those numbers symptomatic, we have slightly under 81000.
j-pb 7y ago
That doesn't add up, if it wasn't worse than seasonal influenza, then Italys hospitals wouldn't be overwhelmed.
- easytiger 7y ago
  Italy did everything wrong. They basically turned hospitals into covid19 infection parties.
  - j-pb 7y ago
    Italys transmission rate is exactly the same exponential curve as everywhere else, chinas hospitals were overwhelmed, spanish hospitals are being overwhelmed, and its currently starting in the netherlands and germany. All year round is basically influenza infection party everywhere yet it doesn't overwhelm our medical systems.
  - bsaul 7y ago
    do you have sources for that ? i'm extremely interested in understanding why italy seems to be suffering that much compared to other countries. If it's just a matter of being the first, or if it's also something specific to them.
    - jaclaz 7y ago
      As a side note - and JFYI - Italy's situation is very nuanced, as you can see on this map (divided by region): http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h... In the North (and particularly in Lombardy) the situation is dramatic, in the center and in the south it is not (yet) that bad. Basically the lock-down (started on national level on the 10 th of March) seemingly - and for the moment - managed to work to reduce the spread of the infection in other regions. The previous lock-down (limited to some cities/provinces of the north) was only a couple days before and evidently too late to be effective.
- bsaul 7y ago
  a regular flu epidemic does between 10k to 20k over a span of two months in france alone. that's more than the total number of casualties of the covid-19 so far.My feeling so far is the problem is that most covid-19 emergencies can actually be cured if you've got a breathing machine, which requires special equipment not available at the moment. I'd say the virus isn't more dangerous than the flu, it's just requiring a very specific set of equipment which we didn't need as much previously. of course that will all depend on what the number evolves to over time.
chvid 7y ago
This is an important question and it needs to be answered. There needs to be systematic sampling of the whole population so the number of infected can be correctly measured and the policies should be based on that. This is also what WHO is saying.
khazhoux 7y ago
I expect an interesting side effect of all this is a reassessment of our tolerance for the "usual" influenza death rate. It's shockingly high. Could we save thousands of lives a year by people stopping going to work when they're sick, not going to grocery store when they're sick, etc?
- Gibbon1 7y ago
  I think that too. Basically the long long history of people of mostly old people checking out due to flu has normalized something terrible. As many people dying of flu as auto accidents. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
- carlmr 7y ago
  Just people washing their hands and not working when sick would probably help a lot with the seasonal flu. But maybe another idea would be to get more people to use the flu vaccine every year.
wongarsu 7y ago
So far the actual problem seems to be the hospitalization rate, not the death rate in ideal conditions. Most countries just don't have the spare capacity to handle COVID in addition to the normal workload. One factor in this is that a good portion of the at-risk population is vaccinating against the flu, greatly reducing the overall impact.
lostapathy 7y ago
Maybe, maybe not. Part of what makes the influenza death rate what it is is that those cases are spread over several months and hospitals can support the patients who recover. If all the influenza cases came to a head over a 3 week period, death rates would be much higher.

by md224 7y ago

pcl 7y ago

The disease also appears to spread much faster than the flu. So even if the death rate is comparable, the infection rate is likely to be far higher.

eteos 7y ago
This is likely because our immume system is not familliar with this virus yet.
- Jedd 7y ago
  This doesn't add up either -- immunity per individual is expected to last 'only a few months', opening the door to multiple infections per year per person.
  - easytiger 7y ago
    > This doesn't add up either -- immunity per individual is expected to last 'only a few months', There is no evidence either way. Even if it is transient it will be enough for it to die down
    - Jedd 7y ago
      There's some very strong indicators that immunity will be ephemeral. It's possible the R naught will drop below the currently assessed 2.2 over time, but there's no evidence for that -- and if both these things stay as expected, it won't be transient enough to 'die down' naturally.
      - easytiger 7y ago
        Unfortunately until we get an antigen test, we will not know for sure. But there is no reason to believe at this point that it isn't anything other than a standard immune response. It would extremely rare that it wasn't
  - bart_spoon 7y ago
    There's no indication how long the immunity is expected to last. It's just as likely that immunity, even if temporary, can last for a year or more, as is the case with the flu or some other viruses.
    - Jedd 7y ago
      On HN this morning -- news that someone in Japan is already on their second infection of this virus. So there's our first data point.
bryanrasmussen 7y ago
let's say there were 320,000 people without symptoms in China, which seems unlikely, that would make the total cases approximately 400000, and if we just looked at the fatalities so far out of that it would be a fatality rate of 0.8% iirc the common flu is 0.1% fatality, so if this only had 0.8% but affects 40-70% of the world (which seems to me like it would be at the 70% end if there are lots of asymptomatic people) so 40% of 7 billion and then 0.8% of that is 22,400,000 - my math is probably off here.
- dnautics 7y ago
  > 320,000 people without symptoms in China Wuhan (the city, not even the entire province of Hubei) has 11 million people. Given what we know now about how virulently and covertly COVID-19 spreads and how (relatively late) Wuhan went into lockdown, how do you feel about that number?
  - bryanrasmussen 7y ago
    if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic. I'm not taking the exact 75% number here in the following - but close, and I will do some hasty approximations. Current total cases (maybe off by some hours) is 80,894. 80894 is 20.2% of 400000. 400000 - 80000 = 320000. So yes, given the article's premises 320000 is pretty much on the optimistic side for humanity. on edit: but once again my math is probably off somewhere so correct it if you see some glaring error in my reasoning. Also note these numbers are for China, of course.
    - dnautics 7y ago
      you're assuming everyone is capable of being infected to detectable levels.
      - bryanrasmussen 7y ago
        no that is exactly what I am not doing, hence my starting off my explanation with: "if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic." then I go ahead and choose a number (400000) which is on the optimistic end of this range - 80894 is 20.2% of 400000 - I believe that is quite clear, if 80894 is 20.2% of 400000 and 80894 is the amount of total cases counted in China (no longer the case) then I am assuming 79.8% people asymptomatic that have not been counted! (although of course I did some simplifying of things around so my percentages and numbers are not exact, but I think given the linked article slightly under 320000 people being asymptomatic and 80894 being symptomatic is a very optimistic take) what number do you want to assume is not counted? millions? I assume that from your earlier post but that does not follow from the 50% to 75% cases are asymptomatic. Obviously if 50% to 75% are asymptomatic and you had 1 million people infected all together (symptomatic and asymptomatic) that would mean you needed to have at least 250000 (25% of a million) to 500000 (50% of a million) people symptomatic. But we don't have those numbers symptomatic, we have slightly under 81000.

j-pb 7y ago

That doesn't add up, if it wasn't worse than seasonal influenza, then Italys hospitals wouldn't be overwhelmed.

easytiger 7y ago
Italy did everything wrong. They basically turned hospitals into covid19 infection parties.
- j-pb 7y ago
  Italys transmission rate is exactly the same exponential curve as everywhere else, chinas hospitals were overwhelmed, spanish hospitals are being overwhelmed, and its currently starting in the netherlands and germany. All year round is basically influenza infection party everywhere yet it doesn't overwhelm our medical systems.
- bsaul 7y ago
  do you have sources for that ? i'm extremely interested in understanding why italy seems to be suffering that much compared to other countries. If it's just a matter of being the first, or if it's also something specific to them.
  - jaclaz 7y ago
    As a side note - and JFYI - Italy's situation is very nuanced, as you can see on this map (divided by region): http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h... In the North (and particularly in Lombardy) the situation is dramatic, in the center and in the south it is not (yet) that bad. Basically the lock-down (started on national level on the 10 th of March) seemingly - and for the moment - managed to work to reduce the spread of the infection in other regions. The previous lock-down (limited to some cities/provinces of the north) was only a couple days before and evidently too late to be effective.
bsaul 7y ago
a regular flu epidemic does between 10k to 20k over a span of two months in france alone. that's more than the total number of casualties of the covid-19 so far.My feeling so far is the problem is that most covid-19 emergencies can actually be cured if you've got a breathing machine, which requires special equipment not available at the moment. I'd say the virus isn't more dangerous than the flu, it's just requiring a very specific set of equipment which we didn't need as much previously. of course that will all depend on what the number evolves to over time.

chvid 7y ago

This is an important question and it needs to be answered. There needs to be systematic sampling of the whole population so the number of infected can be correctly measured and the policies should be based on that. This is also what WHO is saying.

khazhoux 7y ago

I expect an interesting side effect of all this is a reassessment of our tolerance for the "usual" influenza death rate. It's shockingly high. Could we save thousands of lives a year by people stopping going to work when they're sick, not going to grocery store when they're sick, etc?

Gibbon1 7y ago
I think that too. Basically the long long history of people of mostly old people checking out due to flu has normalized something terrible. As many people dying of flu as auto accidents. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
carlmr 7y ago
Just people washing their hands and not working when sick would probably help a lot with the seasonal flu. But maybe another idea would be to get more people to use the flu vaccine every year.

wongarsu 7y ago

So far the actual problem seems to be the hospitalization rate, not the death rate in ideal conditions. Most countries just don't have the spare capacity to handle COVID in addition to the normal workload. One factor in this is that a good portion of the at-risk population is vaccinating against the flu, greatly reducing the overall impact.

lostapathy 7y ago

Maybe, maybe not. Part of what makes the influenza death rate what it is is that those cases are spread over several months and hospitals can support the patients who recover. If all the influenza cases came to a head over a 3 week period, death rates would be much higher.