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The trouble with an article like this is that it mixes well reasoned arguments with nonsense. The economic cost of closing schools and shutting borders is real

The trouble with an article like this is that it mixes well reasoned arguments with nonsense. The economic cost of closing schools and shutting borders is real, especially as the epidemic continues for months. The trouble is that the article downplays the seriousness of covid-19. A mortality rate of 0.6% means nearly one million deaths if covid-19 spreads to half all Americans. The article points to South Korea as an example of a success story in the fight against covid-19. South Korea immediately began widespread testing for covid-19 as soon as infections were detected. They trace cases and isolate people suspected of having become infected. South Korea has universal healthcare, ranking first among OECD countries for access. All of this is pretty much the opposite of we've been doing in the US, which is why a lot of people here are worried about what's going to happen in the next few months. It's reasonable to ask whether school closings or shutting borders are the right policies. But we should be discussing alternative means of containing the virus and we need to be clear what we're up against.

guscost 7y ago
On the other hand, the problem with your argument is that there is absolutely no way to be sure, today, that the mortality rate is even within an order of magnitude of 0.6%. And as more evidence comes out that this thing is spreading faster and more stealthily than expected, one consequence is that the true mortality rate may be much lower than those estimates.
- notacoward 7y ago
  > even within an order of magnitude of 0.6% Have previous estimates for other diseases been off by that much? A whole order of magnitude, at this level of study? Citations please. Yes, the number is probably not perfectly accurate, but it's also converging toward what is very likely to be a correct figure. Also, how much does it have to change to affect the broader point? A hundred thousand deaths (i.e. one order of magnitude) is still nothing to take lightly. Such aggressive minimization of danger is still a worse problem than the "hysteria" the OP is supposedly trying to address.
  - guscost 7y ago
    In most parts of the world, we have absolutely no idea how far the infection spread from about the end of October to at least February, so we can’t conclusively rule out that kind of error until we can test lots of people for antibodies (this is the only way to confirm a case in a person who has already recovered). It would require the infection to be very contagious, and it probably would require us to have been pretty unlucky with the timing, but as far as I know none of that is contradicted by the available evidence.
- Analemma_ 7y ago
  As of right now, Italy’s fatality rate is almost 9% [0], so saying “it might not be within an order of magnitude of 0.6%!” is optimistic to the point of delusional. [0]: https://mobile.twitter.com/ARanganathan72/status/1241411686742941696 https://mobile.twitter.com/ARanganathan72/status/12414116867...
  - guscost 7y ago
    Italy is looking like a “perfect storm” tragedy no matter what. The older population, combined with rapid, widespread transmission, to the point where critical cases completely overwhelm the health infrastructure, is absolutely a recipe for horrible CFR numbers like that. The fear that healthcare infrastructure elsewhere could be overwhelmed by another sudden outbreak is really the only reason experts are freaking out, as far as I know. Also just reported today, apparently over 99% of fatalities in Italy were folks who had existing medical conditions, but I have no idea what that really tells us. Anyway, you could be right too, maybe it’s unreasonable to guess that true IFR is an order of magnitude lower.
    - qwytw 7y ago
      The fatality rate and the total number of cases reported by Italy don't really mean much if anything at this point. Because their health system is overwhelmed they are mainly only testing people who already have severe symptoms which inflates the fatality rate as most mild cases are never identified. While it's reasonable to assume that's it's higher there than in places like South Korea or Germany it's very likely that it's still considerable less than anything close to 9%.
    - ascorbic 7y ago
      > Also just reported today, apparently over 99% of fatalities in Italy were folks who had existing medical conditions, but I have no idea what that really tells us. Not a lot, without knowing the number with existing medical conditions among the infected population. How many over-70s don't have any existing medeical condition?
- jsnell 7y ago
  The South Korean testing has been quite extensive, and not just limited to the people with the most obvious symptoms unlike in the west. Given they appears to have contained the virus without resorting to a full lockdown, it seems unlikely they would have missed a large number of cases. If they had, those asymptomatic or mild cases should be constantly restarting the chain of transmission. 1.1% of their cases have died, and an additional 0.8% are in serious or critical condition. And they're a best case scenario: the health care system was not overloaded, and their diagnosed cases are skewing disproportionately young. The Diamond Princess also has had a fatality rate so far of 1.1%. In that case we know with absolute certainty that there is no massive hidden iceberg of infected but undiagnosed people. There might be a hidden iceberg of unreported fatalities though, since once they were off the ship, the cases stopped being tracked as Diamond Princess cases. On the plus side, the demographics obviously skewed very old. Anyway, there's very good reason to believe that the IFR is at least 0.6%. Suggesting that it's actually <0.06% seems just ludicrous. Is there any evidence at all supporting that, or are you just arbitrarily demanding "absolute certainty" in a time-critical situation?
  - guscost 7y ago
    > If [South Korea] had [missed a large number of cases], those asymptomatic or mild cases should be constantly restarting the chain of transmission. If enough people have already recovered from mild or asymptomatic cases (it would have to be a pretty hefty percentage, granted) then that, combined with not-total-lockdown conditions, could bring down the R0 value enough to cause the same result. Do you think it’s much more likely that the virus has been totally contained? > The Diamond Princess also has had a fatality rate so far of 1.1%. In that case we know with absolute certainty that there is no massive hidden iceberg of infected but undiagnosed people. This might be the strongest evidence against the “mild and everywhere” theory. However, there are still something like five out of six passengers who tested negative but could have recovered before they were tested. Even if they’re not a great representative sample, testing them all for antibodies might be a good move.
    - jsnell 7y ago
      > If enough people have already recovered from mild or asymptomatic cases (it would have to be a pretty hefty percentage, granted) then that, combined with not-total-lockdown conditions, could bring down the R0 value enough to cause the same result. They're reporting basically no new cases at this point. For that to happen naturally, they'd need to have gotten like 2/3rds of the population infected. And it's quite hard to see how that could be true. Korea had the most comprehensive testing (320k tests, available to basically anyone with even mild symptoms). They have so far confirmed infections in 0.02% of the population, and only got positive results in less than 3% of the tests. It's hard to believe that 60-70% of the population got infected, but even in the skewed sample of people who got tested only 3% being positive. Compare that with something like Switzerland where the number of confirmed cases is at 0.08% of the population despite worse test coverage (basically only get tested if your symptoms warrant hospitalization), and there's no sign of it slowing down yet. Or Spain which has 3x the cases of Korea on a similar population, has a health care system that's melting down, and where more than 55% of the tests are positive. If herd immunity provided by all the undetected cases protected Korea, why is it not kicking in anywhere else even once their infection rates are obviously higher? > Do you think it’s much more likely that the virus has been totally contained? "Totally contained" is an exaggeration, since they are still finding new cases. But given how long the infection rate has been stable, it does look like they've managed to reach a R0 of almost exactly 1 with the aggressive testing + tracing strategy. The only alternative that's at all plausible is that the Korean numbers are being fudged somehow, and they actually have a lot more cases than are being reported. But then why aren't the hospitals in a crisis unlike in other affected regions?

guscost 7y ago

On the other hand, the problem with your argument is that there is absolutely no way to be sure, today, that the mortality rate is even within an order of magnitude of 0.6%. And as more evidence comes out that this thing is spreading faster and more stealthily than expected, one consequence is that the true mortality rate may be much lower than those estimates.

notacoward 7y ago
> even within an order of magnitude of 0.6% Have previous estimates for other diseases been off by that much? A whole order of magnitude, at this level of study? Citations please. Yes, the number is probably not perfectly accurate, but it's also converging toward what is very likely to be a correct figure. Also, how much does it have to change to affect the broader point? A hundred thousand deaths (i.e. one order of magnitude) is still nothing to take lightly. Such aggressive minimization of danger is still a worse problem than the "hysteria" the OP is supposedly trying to address.
- guscost 7y ago
  In most parts of the world, we have absolutely no idea how far the infection spread from about the end of October to at least February, so we can’t conclusively rule out that kind of error until we can test lots of people for antibodies (this is the only way to confirm a case in a person who has already recovered). It would require the infection to be very contagious, and it probably would require us to have been pretty unlucky with the timing, but as far as I know none of that is contradicted by the available evidence.
Analemma_ 7y ago
As of right now, Italy’s fatality rate is almost 9% [0], so saying “it might not be within an order of magnitude of 0.6%!” is optimistic to the point of delusional. [0]: https://mobile.twitter.com/ARanganathan72/status/1241411686742941696 https://mobile.twitter.com/ARanganathan72/status/12414116867...
- guscost 7y ago
  Italy is looking like a “perfect storm” tragedy no matter what. The older population, combined with rapid, widespread transmission, to the point where critical cases completely overwhelm the health infrastructure, is absolutely a recipe for horrible CFR numbers like that. The fear that healthcare infrastructure elsewhere could be overwhelmed by another sudden outbreak is really the only reason experts are freaking out, as far as I know. Also just reported today, apparently over 99% of fatalities in Italy were folks who had existing medical conditions, but I have no idea what that really tells us. Anyway, you could be right too, maybe it’s unreasonable to guess that true IFR is an order of magnitude lower.
  - qwytw 7y ago
    The fatality rate and the total number of cases reported by Italy don't really mean much if anything at this point. Because their health system is overwhelmed they are mainly only testing people who already have severe symptoms which inflates the fatality rate as most mild cases are never identified. While it's reasonable to assume that's it's higher there than in places like South Korea or Germany it's very likely that it's still considerable less than anything close to 9%.
  - ascorbic 7y ago
    > Also just reported today, apparently over 99% of fatalities in Italy were folks who had existing medical conditions, but I have no idea what that really tells us. Not a lot, without knowing the number with existing medical conditions among the infected population. How many over-70s don't have any existing medeical condition?
jsnell 7y ago
The South Korean testing has been quite extensive, and not just limited to the people with the most obvious symptoms unlike in the west. Given they appears to have contained the virus without resorting to a full lockdown, it seems unlikely they would have missed a large number of cases. If they had, those asymptomatic or mild cases should be constantly restarting the chain of transmission. 1.1% of their cases have died, and an additional 0.8% are in serious or critical condition. And they're a best case scenario: the health care system was not overloaded, and their diagnosed cases are skewing disproportionately young. The Diamond Princess also has had a fatality rate so far of 1.1%. In that case we know with absolute certainty that there is no massive hidden iceberg of infected but undiagnosed people. There might be a hidden iceberg of unreported fatalities though, since once they were off the ship, the cases stopped being tracked as Diamond Princess cases. On the plus side, the demographics obviously skewed very old. Anyway, there's very good reason to believe that the IFR is at least 0.6%. Suggesting that it's actually <0.06% seems just ludicrous. Is there any evidence at all supporting that, or are you just arbitrarily demanding "absolute certainty" in a time-critical situation?
- guscost 7y ago
  > If [South Korea] had [missed a large number of cases], those asymptomatic or mild cases should be constantly restarting the chain of transmission. If enough people have already recovered from mild or asymptomatic cases (it would have to be a pretty hefty percentage, granted) then that, combined with not-total-lockdown conditions, could bring down the R0 value enough to cause the same result. Do you think it’s much more likely that the virus has been totally contained? > The Diamond Princess also has had a fatality rate so far of 1.1%. In that case we know with absolute certainty that there is no massive hidden iceberg of infected but undiagnosed people. This might be the strongest evidence against the “mild and everywhere” theory. However, there are still something like five out of six passengers who tested negative but could have recovered before they were tested. Even if they’re not a great representative sample, testing them all for antibodies might be a good move.
  - jsnell 7y ago
    > If enough people have already recovered from mild or asymptomatic cases (it would have to be a pretty hefty percentage, granted) then that, combined with not-total-lockdown conditions, could bring down the R0 value enough to cause the same result. They're reporting basically no new cases at this point. For that to happen naturally, they'd need to have gotten like 2/3rds of the population infected. And it's quite hard to see how that could be true. Korea had the most comprehensive testing (320k tests, available to basically anyone with even mild symptoms). They have so far confirmed infections in 0.02% of the population, and only got positive results in less than 3% of the tests. It's hard to believe that 60-70% of the population got infected, but even in the skewed sample of people who got tested only 3% being positive. Compare that with something like Switzerland where the number of confirmed cases is at 0.08% of the population despite worse test coverage (basically only get tested if your symptoms warrant hospitalization), and there's no sign of it slowing down yet. Or Spain which has 3x the cases of Korea on a similar population, has a health care system that's melting down, and where more than 55% of the tests are positive. If herd immunity provided by all the undetected cases protected Korea, why is it not kicking in anywhere else even once their infection rates are obviously higher? > Do you think it’s much more likely that the virus has been totally contained? "Totally contained" is an exaggeration, since they are still finding new cases. But given how long the infection rate has been stable, it does look like they've managed to reach a R0 of almost exactly 1 with the aggressive testing + tracing strategy. The only alternative that's at all plausible is that the Korean numbers are being fudged somehow, and they actually have a lot more cases than are being reported. But then why aren't the hospitals in a crisis unlike in other affected regions?