16 ms·

The Doctor Who Helped Defeat Smallpox Explains What's Coming

243 points by ajaviaad 7y ago

merricksb 7y ago
Earlier discussion: https://news.ycombinator.com/item?id=22635225 https://news.ycombinator.com/item?id=22635225
- Amygaz 7y ago
  Thanks, except the discussion on this one are more relevant, to what is at stake. The other started pretty quickly on pooping the media.
  - ethbro 7y ago
    As opposed to this one, which is starting with armchair statisticians extrapolating curves without considering the nuances of the underlying data?
throwaway_pdp09 7y ago
This is bad. I've been graphing the exp curve for Italy, UK and USA and the USA curve is fearsomely steep. Italy has more cases now but the USA is growing fastest and looks like it will match Italy's on ~March 28th (looking at the most recent 10 points, see below) The rate of growth in the USA, extrapolated, is just huge. Looking at the whole curve it does not match an exponential well, I think the early part is skewing it. If we take the last 10 data points, they fall very well onto the curves for all 3 countries, and that curve for the USA is horrific. I'm not an epidemiologist nor statistican so it would be irresponsible to put my predicted figures here, but christ, if I'm right the US is going to be reeling in just a few day. Edit: @mnl below has pointed out that infection is not an exponential but on the whole a logistics curve (s-shaped curve https://en.wikipedia.org/wiki/Logistic_function https://en.wikipedia.org/wiki/Logistic_function). He is correct. However in early stages I believe an exponential MAY be a decent approximation (and I'm reading up on it now). However, the inflection in the 'S' (where new infections would start to slow down) would be expected to be at far higher figures than those I'm looking at - a few tens of thousands of reported infections per country currently - and it's not even close to that (populations of multiple millions in each country).
- Wowfunhappy 7y ago
  But how much of the US’s growth is due to us finally having some (albeit not enough) testing?
  - throwaway_pdp09 7y ago
    Good question, I don't know. If it helps, a quick search got this https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Ftesting-in-us.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/test... See table at bottom.
  - tyingq 7y ago
    That's a very good point, and the lack of tests had a secondary effect. Nobody here took it very seriously at first, because the numbers were very low.
  - simonh 7y ago
    This is key. We really can't compare countries confirmed case numbers directly because they are operating very different testing programmes. Just look at Germany. More confirmed cases than the USA, but a quarter of the deaths. Germany also has 80% as many cases as Spain, but about 5% as many deaths. All that, without a severe lockdown. Clearly something completely different is going on there than in many other countries, and it seems they have an extremely effective and well organised testing system. They're testing about 160,000 people a week. In comparison, the UK to date has only tested around 50,000 people in total so no wonder our case numbers are far lower, even though we have double the number of deaths. So Germany is an outlier, but it just goes to show even for other countries you can't just compare the curves and draw any definitive conclusions without also looking at the testing regime. This is where the experts with their detailed population models and simulation tools come in.
    - hallohallohallo 7y ago
      It is the health care system like number of ICUs, training of doctors and stuff like not being able to get antibiotics simply over the counter like in Italy. If my memory serves me right e.g. in Italy 29% have a resistance to antibiotics, in Germany only 0.4%.
Dahoon 7y ago
Most people (and most people who advice the public in the US) doesn't take this serious enough. One of the foremost experts in epidemiology in the US Michael T. Osterholm said on Joe Rogan (AFAIKR) 6-12 months for the virus to go away, up to 5 years for a vaccine and that it would return in China when people start behaving normally again. This isn't something that will go away in a few weeks or months. In "Deadliest Enemy: Our War Against Killer Germs" he also predicted a Corona virus coming from China. In a months time the US will take the place of Italy and see the healthsystem crash.
- bamboozled 7y ago
  If you read the article, Dr Brilliant [sic] says 12-18 months most likely for a vaccine?
- pfdietz 7y ago
  China is not going to wait five years to roll out a vaccine, or sell it internationally.
no_gravity 7y ago
From what I read in this article and other sources, performing more tests seems to be a very promising approach to get this pandemic under control. The number of positive tests and death rates are published every day on all channels. I wish the number of performed tests would be also published daily. What gets measured gets managed. I wonder what limits the number of tests that can be performed. How much would it cost to ramp up testing capabilities so that every person with symptoms can be tested? How much to increase it to a level that everyone can be tested?
- bamboozled 7y ago
  Which is scary because Japan seems to have had the virus for a long time and is hardly testing at all. Really makes me wonder how the Olympics will or won't look.
  - Frost1x 7y ago
    "We're virus free! Our strategy of extensively not testing has eliminated cases of the disease! Come to the 2020 Olympics, stay long, and please spend money here."
    - bamboozled 7y ago
      It’s a joke and everyone in Japan knows it too. The sooner they cancel or postpone and get on with solutions, the better.
  - nkrisc 7y ago
    Not cancelling or postponing the Olympics is massively irresponsible. That said, those who would still choose to attend are beyond help and a risk to their communities.
- Amygaz 7y ago
  It's not a question of cost at this point. It's a question of availability of reagents and consumables, materials to make those, and time it takes to ramp up. The supply chain is like a supertanker. At first we didn't have enough test, but that ramped up quickly, then we didn't have enough RNA extraction reagent, now we don't have enough swabs, and soon is the collection media that will be missing. There has been a call for more protective equipement. But as the situation gets worst, beds space, ventilator, and then staff are going to be the bottleneck. If you google you'll find stories of people helping their local hospital by 3D printing parts for for respirators, and swabs. There's nothing cost effective about that, it's not fast, but it gets the job done. If you were to scale that, you would be competing for the same materials than manufacturers using injection molding or plastic dipping are.
steipete 7y ago
Doctor Who?
yotamoron 7y ago
Corona is killing a negligible % of the population, mostly very old and very sick people (checkout the official data from the Italian health ministary - average age of dead patiences is 79.5 years, all of them with severe background illness, in a part of the country where 29% of the population is at least 60 yeard old. Those are the facts.). If anyting, what we are experiencing is not a corona pandemic but a massive, global hysteria pandemic - much more dangerous.
- DanBC 7y ago
  > all of them with severe background illness, Diabetes, high blood pressure, obesity: these aren't what people think of as "severe background illness", but all of these seriously increase risk.
  - yotamoron 7y ago
    When you are 80 years old - those are serious medical conditions.
- flyinglizard 7y ago
  That’s true only when hospitals are functioning. Corona spread saturates hospitals and then mortality goes up to near 10%, from the virus itself as well as other unrelated causes which get no ICU treatment.
  - logicchains 7y ago
    >Corona spread saturates hospitals and then mortality goes up to near 10% Some evidence of this? Hospitals were completely overrun in Wuhan initially, but the mortality rate didn't get anywhere near 10%.
    - flyinglizard 7y ago
      Italy: 47000 cases, 4000 deaths. This does not include the collapse of the ICU system, meaning people with stroke, heart attacks and other life threatening conditions do not get optimal (or any) treatment. https://www.worldometers.info/coronavirus/country/italy/ https://www.worldometers.info/coronavirus/country/italy/ I’ll respectfully disregard Wuhan numbers - no one knows for sure what’s the count other than the Chinese government.
nabla9 7y ago
Francois Balloux Computational biologist, director of Genetics Institute at UCL had interesting twitter post: https://twitter.com/BallouxFrancois/status/1238837158007447558 https://twitter.com/BallouxFrancois/status/12388371580074475... > Predictions from any model are only as good as the data that parametrised it. There are two major unknowns at this stage. (1) We don't know to what extent covid-19 transmission will be seasonal. (2) We don’t know if covid-19 infection induces long-lasting immunity. >How long immunity lasts for following covid-19 infection is the biggest unknown. Comparison with other Coronaviridae suggests it may be relatively short-lived (i.e. months). If this were to be confirmed, it would add to the challenge of managing the pandemic. >Short-lived immunisation would defeat both ‘flattening the curve’ and ‘herd immunity’ approaches. Devising an effective strategy would be even more challenging under low seasonal forcing. It would also considerably complicate effective vaccination campaigns.
- 34679 7y ago
  Why don't we know the extent of seasonal transmission? At the very least, we have data from areas that are in opposite seasons, even if we've yet to collect data on the transition from one season to another. Can't we get some insight from comparing the rate of transmission in Australia, where it's summer, to the UK, where it's winter?
  - nabla9 7y ago
    Australia is as close to equator as North Africa or Southern parts of Spain (Melbourne).
  - marcosdumay 7y ago
    This virus has spread just like you would expect it to if airplanes did not exist (probably because most flights are short range). And it started at the North Hemisphere. The southern countries are all on the initial stages, and I doubt any one has any reliable number for transmission speed, due to both test limits and low numbers overall.
yread 7y ago
165M deaths actually sounds plausible for covid19, if it overwhelms health care in India and developing world countries...
- georgeek 7y ago
  Yes: as usual with disease the poorest countries are going to be hit the hardest. If you think that Lombardy's medical facilities are bad, this will be quite the next level.
  - danmaz74 7y ago
    Lombardys health facilities are excellent, but there is only so much you can do when you're overwhelmed
- yotamoron 7y ago
  And how many deaths would a greater-then-the-great-despresison depression will cause?
  - mrfusion 7y ago
    Yes. No one is asking this question.
    - bsaul 7y ago
      That, IMHO is the point that was only implicitely made by the original article : massive testing lets you keep the economy at least partially work, because you know who can go to work safely and who can't. I really hope someone makes a deep study of the decisions that were taken regarding testing facilities in the various european countries, because i have the feeling, at least here in france, that doctors gave up a little too fast on that option (and i still don't understand why)
  - tcbawo 7y ago
    The wider this disease spreads, the more likely mutations and new strains will appear. This could very quickly spiral out of control. If you are insinuating that an economic shutdown will cause more deaths, you are probably incorrect. Although, we will never know the answer for certain.
DoreenMichele 7y ago
Is there in any way a brighter side to this? Something I talk about a fair amount: It's incredibly hard to measure what didn't happen but should have. Humans are really bad at that, and understandably so. If we had adopted a lot of the practices being advocated currently and avoided the epidemic, no one would know or believe we had accomplished anything. Having a pandemic and defeating it is the only way humanity can know and understand with confidence that we need to make a lot of changes to make life work with so many billions of people on the planet. I have a serious medical condition. I've gotten off all drugs. I know what my life is supposed to look like because I know what my condition is supposed to do. Other people have what I have. I know the typical prognosis. Yet I have no credibility. I've been mocked and attacked and dismissed online for years because other people cannot see that I've done anything and don't believe I have. Other people can't see what I see and it makes me look to them like a loon suffering hallucinations, not a visionary that people ought to listen to. I once had someone email me and tell me "I give my child the sea salt and coconut oil you've recommended, and he's in the ER less, but he's not on fewer drugs." She meant he still was on the same amount of maintenance drugs as before. She wasn't really recognizing that fewer ER visits meant fewer rounds of antibiotics, steroids and similar. The child was taking less medication, but the mother couldn't quite manage to count the drugs that weren't happening. In her mind, it would only count if her child could reduce his maintenance drugs. There are a lot of things I hope we change. But the reality is that without a pandemic, no one would believe those changes actually provide germ control and actually matter to the functioning of the world. People would just find the restrictions annoying and pointless and would rebel against it. You are only going to get compliance when enough people have been burned that change seems less onerous than not changing. That's basically how humans always handle things. It's frustrating. I wish it weren't so. But people don't change everything at great cost to avoid disaster based on predictions and models. We make those changes because we got burned in actual fact, not in theory, and we don't want to go back. And then it's no longer hypothetical. Then it's actually real and we aren't running from Boogeymen. We're problem solving and dealing with actual reality. Then you see real change.
- ComputerGuru 7y ago
  I’m sorry, you sound like you’ve been through a lot, but what does this have to do with the article, or even the sentence you excerpted?
stevespang 7y ago
Disheartened that Epidemiologist Larry Brilliant did not comment on chloroquine and hydroxychloroquine.
bg24 7y ago
Illiterate politicians can still survive if they keep competent people in their surrounding. Our president pushed out the relevant people from national security council, kept his own folks, and did not listen to anyone in January. Four years of presidency tenure has it’s downsides.

243 points by ajaviaad 7y ago

merricksb 7y ago

Earlier discussion: https://news.ycombinator.com/item?id=22635225 https://news.ycombinator.com/item?id=22635225

Amygaz 7y ago
Thanks, except the discussion on this one are more relevant, to what is at stake. The other started pretty quickly on pooping the media.
- ethbro 7y ago
  As opposed to this one, which is starting with armchair statisticians extrapolating curves without considering the nuances of the underlying data?

throwaway_pdp09 7y ago

This is bad. I've been graphing the exp curve for Italy, UK and USA and the USA curve is fearsomely steep. Italy has more cases now but the USA is growing fastest and looks like it will match Italy's on ~March 28th (looking at the most recent 10 points, see below) The rate of growth in the USA, extrapolated, is just huge. Looking at the whole curve it does not match an exponential well, I think the early part is skewing it. If we take the last 10 data points, they fall very well onto the curves for all 3 countries, and that curve for the USA is horrific. I'm not an epidemiologist nor statistican so it would be irresponsible to put my predicted figures here, but christ, if I'm right the US is going to be reeling in just a few day. Edit: @mnl below has pointed out that infection is not an exponential but on the whole a logistics curve (s-shaped curve https://en.wikipedia.org/wiki/Logistic_function https://en.wikipedia.org/wiki/Logistic_function). He is correct. However in early stages I believe an exponential MAY be a decent approximation (and I'm reading up on it now). However, the inflection in the 'S' (where new infections would start to slow down) would be expected to be at far higher figures than those I'm looking at - a few tens of thousands of reported infections per country currently - and it's not even close to that (populations of multiple millions in each country).

Wowfunhappy 7y ago
But how much of the US’s growth is due to us finally having some (albeit not enough) testing?
- throwaway_pdp09 7y ago
  Good question, I don't know. If it helps, a quick search got this https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Ftesting-in-us.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/test... See table at bottom.
- tyingq 7y ago
  That's a very good point, and the lack of tests had a secondary effect. Nobody here took it very seriously at first, because the numbers were very low.
- simonh 7y ago
  This is key. We really can't compare countries confirmed case numbers directly because they are operating very different testing programmes. Just look at Germany. More confirmed cases than the USA, but a quarter of the deaths. Germany also has 80% as many cases as Spain, but about 5% as many deaths. All that, without a severe lockdown. Clearly something completely different is going on there than in many other countries, and it seems they have an extremely effective and well organised testing system. They're testing about 160,000 people a week. In comparison, the UK to date has only tested around 50,000 people in total so no wonder our case numbers are far lower, even though we have double the number of deaths. So Germany is an outlier, but it just goes to show even for other countries you can't just compare the curves and draw any definitive conclusions without also looking at the testing regime. This is where the experts with their detailed population models and simulation tools come in.
  - hallohallohallo 7y ago
    It is the health care system like number of ICUs, training of doctors and stuff like not being able to get antibiotics simply over the counter like in Italy. If my memory serves me right e.g. in Italy 29% have a resistance to antibiotics, in Germany only 0.4%.

Dahoon 7y ago

Most people (and most people who advice the public in the US) doesn't take this serious enough. One of the foremost experts in epidemiology in the US Michael T. Osterholm said on Joe Rogan (AFAIKR) 6-12 months for the virus to go away, up to 5 years for a vaccine and that it would return in China when people start behaving normally again. This isn't something that will go away in a few weeks or months. In "Deadliest Enemy: Our War Against Killer Germs" he also predicted a Corona virus coming from China. In a months time the US will take the place of Italy and see the healthsystem crash.

bamboozled 7y ago
If you read the article, Dr Brilliant [sic] says 12-18 months most likely for a vaccine?
pfdietz 7y ago
China is not going to wait five years to roll out a vaccine, or sell it internationally.

no_gravity 7y ago

From what I read in this article and other sources, performing more tests seems to be a very promising approach to get this pandemic under control. The number of positive tests and death rates are published every day on all channels. I wish the number of performed tests would be also published daily. What gets measured gets managed. I wonder what limits the number of tests that can be performed. How much would it cost to ramp up testing capabilities so that every person with symptoms can be tested? How much to increase it to a level that everyone can be tested?

bamboozled 7y ago
Which is scary because Japan seems to have had the virus for a long time and is hardly testing at all. Really makes me wonder how the Olympics will or won't look.
- Frost1x 7y ago
  "We're virus free! Our strategy of extensively not testing has eliminated cases of the disease! Come to the 2020 Olympics, stay long, and please spend money here."
  - bamboozled 7y ago
    It’s a joke and everyone in Japan knows it too. The sooner they cancel or postpone and get on with solutions, the better.
- nkrisc 7y ago
  Not cancelling or postponing the Olympics is massively irresponsible. That said, those who would still choose to attend are beyond help and a risk to their communities.
Amygaz 7y ago
It's not a question of cost at this point. It's a question of availability of reagents and consumables, materials to make those, and time it takes to ramp up. The supply chain is like a supertanker. At first we didn't have enough test, but that ramped up quickly, then we didn't have enough RNA extraction reagent, now we don't have enough swabs, and soon is the collection media that will be missing. There has been a call for more protective equipement. But as the situation gets worst, beds space, ventilator, and then staff are going to be the bottleneck. If you google you'll find stories of people helping their local hospital by 3D printing parts for for respirators, and swabs. There's nothing cost effective about that, it's not fast, but it gets the job done. If you were to scale that, you would be competing for the same materials than manufacturers using injection molding or plastic dipping are.

steipete 7y ago

Doctor Who?

yotamoron 7y ago

Corona is killing a negligible % of the population, mostly very old and very sick people (checkout the official data from the Italian health ministary - average age of dead patiences is 79.5 years, all of them with severe background illness, in a part of the country where 29% of the population is at least 60 yeard old. Those are the facts.). If anyting, what we are experiencing is not a corona pandemic but a massive, global hysteria pandemic - much more dangerous.

DanBC 7y ago
> all of them with severe background illness, Diabetes, high blood pressure, obesity: these aren't what people think of as "severe background illness", but all of these seriously increase risk.
- yotamoron 7y ago
  When you are 80 years old - those are serious medical conditions.
flyinglizard 7y ago
That’s true only when hospitals are functioning. Corona spread saturates hospitals and then mortality goes up to near 10%, from the virus itself as well as other unrelated causes which get no ICU treatment.
- logicchains 7y ago
  >Corona spread saturates hospitals and then mortality goes up to near 10% Some evidence of this? Hospitals were completely overrun in Wuhan initially, but the mortality rate didn't get anywhere near 10%.
  - flyinglizard 7y ago
    Italy: 47000 cases, 4000 deaths. This does not include the collapse of the ICU system, meaning people with stroke, heart attacks and other life threatening conditions do not get optimal (or any) treatment. https://www.worldometers.info/coronavirus/country/italy/ https://www.worldometers.info/coronavirus/country/italy/ I’ll respectfully disregard Wuhan numbers - no one knows for sure what’s the count other than the Chinese government.

nabla9 7y ago

Francois Balloux Computational biologist, director of Genetics Institute at UCL had interesting twitter post: https://twitter.com/BallouxFrancois/status/1238837158007447558 https://twitter.com/BallouxFrancois/status/12388371580074475... > Predictions from any model are only as good as the data that parametrised it. There are two major unknowns at this stage. (1) We don't know to what extent covid-19 transmission will be seasonal. (2) We don’t know if covid-19 infection induces long-lasting immunity. >How long immunity lasts for following covid-19 infection is the biggest unknown. Comparison with other Coronaviridae suggests it may be relatively short-lived (i.e. months). If this were to be confirmed, it would add to the challenge of managing the pandemic. >Short-lived immunisation would defeat both ‘flattening the curve’ and ‘herd immunity’ approaches. Devising an effective strategy would be even more challenging under low seasonal forcing. It would also considerably complicate effective vaccination campaigns.

34679 7y ago
Why don't we know the extent of seasonal transmission? At the very least, we have data from areas that are in opposite seasons, even if we've yet to collect data on the transition from one season to another. Can't we get some insight from comparing the rate of transmission in Australia, where it's summer, to the UK, where it's winter?
- nabla9 7y ago
  Australia is as close to equator as North Africa or Southern parts of Spain (Melbourne).
- marcosdumay 7y ago
  This virus has spread just like you would expect it to if airplanes did not exist (probably because most flights are short range). And it started at the North Hemisphere. The southern countries are all on the initial stages, and I doubt any one has any reliable number for transmission speed, due to both test limits and low numbers overall.

yread 7y ago

165M deaths actually sounds plausible for covid19, if it overwhelms health care in India and developing world countries...

georgeek 7y ago
Yes: as usual with disease the poorest countries are going to be hit the hardest. If you think that Lombardy's medical facilities are bad, this will be quite the next level.
- danmaz74 7y ago
  Lombardys health facilities are excellent, but there is only so much you can do when you're overwhelmed
yotamoron 7y ago
And how many deaths would a greater-then-the-great-despresison depression will cause?
- mrfusion 7y ago
  Yes. No one is asking this question.
  - bsaul 7y ago
    That, IMHO is the point that was only implicitely made by the original article : massive testing lets you keep the economy at least partially work, because you know who can go to work safely and who can't. I really hope someone makes a deep study of the decisions that were taken regarding testing facilities in the various european countries, because i have the feeling, at least here in france, that doctors gave up a little too fast on that option (and i still don't understand why)
- tcbawo 7y ago
  The wider this disease spreads, the more likely mutations and new strains will appear. This could very quickly spiral out of control. If you are insinuating that an economic shutdown will cause more deaths, you are probably incorrect. Although, we will never know the answer for certain.

DoreenMichele 7y ago

Is there in any way a brighter side to this? Something I talk about a fair amount: It's incredibly hard to measure what didn't happen but should have. Humans are really bad at that, and understandably so. If we had adopted a lot of the practices being advocated currently and avoided the epidemic, no one would know or believe we had accomplished anything. Having a pandemic and defeating it is the only way humanity can know and understand with confidence that we need to make a lot of changes to make life work with so many billions of people on the planet. I have a serious medical condition. I've gotten off all drugs. I know what my life is supposed to look like because I know what my condition is supposed to do. Other people have what I have. I know the typical prognosis. Yet I have no credibility. I've been mocked and attacked and dismissed online for years because other people cannot see that I've done anything and don't believe I have. Other people can't see what I see and it makes me look to them like a loon suffering hallucinations, not a visionary that people ought to listen to. I once had someone email me and tell me "I give my child the sea salt and coconut oil you've recommended, and he's in the ER less, but he's not on fewer drugs." She meant he still was on the same amount of maintenance drugs as before. She wasn't really recognizing that fewer ER visits meant fewer rounds of antibiotics, steroids and similar. The child was taking less medication, but the mother couldn't quite manage to count the drugs that weren't happening. In her mind, it would only count if her child could reduce his maintenance drugs. There are a lot of things I hope we change. But the reality is that without a pandemic, no one would believe those changes actually provide germ control and actually matter to the functioning of the world. People would just find the restrictions annoying and pointless and would rebel against it. You are only going to get compliance when enough people have been burned that change seems less onerous than not changing. That's basically how humans always handle things. It's frustrating. I wish it weren't so. But people don't change everything at great cost to avoid disaster based on predictions and models. We make those changes because we got burned in actual fact, not in theory, and we don't want to go back. And then it's no longer hypothetical. Then it's actually real and we aren't running from Boogeymen. We're problem solving and dealing with actual reality. Then you see real change.

ComputerGuru 7y ago
I’m sorry, you sound like you’ve been through a lot, but what does this have to do with the article, or even the sentence you excerpted?

stevespang 7y ago

Disheartened that Epidemiologist Larry Brilliant did not comment on chloroquine and hydroxychloroquine.

bg24 7y ago

Illiterate politicians can still survive if they keep competent people in their surrounding. Our president pushed out the relevant people from national security council, kept his own folks, and did not listen to anyone in January. Four years of presidency tenure has it’s downsides.