51 ms·

Covid-19: the harms of exaggerated information and non‐evidence‐based measures

• dannykwells 7y ago
  Let's check back on this piece in...2 weeks, say, when there are 10,000+ Corona deaths in the US. Well see how it ages then. Source: https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-deaths-by-country.html https://www.nytimes.com/interactive/2020/03/21/upshot/corona... 427× 16 =11102
  • Medicalidiot 7y ago
    China quarantined 700 million of its citizens for fun and it still killed thousands. I'm sure that they regret the policies they implemented right now as they've finally gotten a hold of the outbreak. Edit: I was being sarcastic here. China messed up the initial response but their draconian tactics worked well.
    • treyfitty 7y ago
      Why would they regret it? I don’t follow your reasoning. They got a hold of the outbreak precisely because they ramped up quarantining
      • Medicalidiot 7y ago
        I was being sarcastic.... it never translates well over text.
        • nate_meurer 7y ago
          I must have have a naturally sarcastic inner monologue, because your sarcasm came through loud and clear to me.
          • Medicalidiot 7y ago
            I thought it was so outlandish that no one could actually believe it. Then I thought about my crazy uncle who still thinks this is a bioweapon released by the Chinese on its own citizens.
    • dannykwells 7y ago
      Yes, only thousands. The point of the quarantine was to avoid deaths of millions. China has flattened thoer curve, no one else has.
      • clouddrover 7y ago
        South Korea has. It's still going up but it's flatter than it was: https://coronavirus.jhu.edu/map.html https://coronavirus.jhu.edu/map.html
  • clouddrover 7y ago
    The number of coronavirus deaths is already over 10,000: https://coronavirus.jhu.edu/map.html https://coronavirus.jhu.edu/map.html
    • dannykwells 7y ago
      Updated: comment was only for US since John is based at Stanford.
  • usaar333 7y ago
    That rate is highly unlikely to hold. There's enough stay in place restrictions in effect to drive it down after about a week or so. FWIW, at this point, it looks like NYC is going to take a huge hit and the other outbreaks (Seattle, California) will look mild comparitively.
    • joe_the_user 7y ago
      Washington state doesn't have a statewide lockdown, I don't know if even Seattle has a lockdown. California is doing the best but there are still crowds defying the lockdown at beaches and parks. Just as much, grocery stores are open as usual and even with most people trying to do social distancing, I'm doubtful you're clamping that hard on the infection, unfortunately. I think the best is that when fatalities spike here in California, we're in better shape to intensify the lockdown.
      • rbritton 7y ago
        Washington does as of 5:00 pm PDT today.
        • deleted 7y ago
          [deleted]
        • DoreenMichele 7y ago
          I've dug through everything I can find. I'm feeling really stupid at the moment, but I cannot find a confirmation of that 5pm start time, though it does appear to start today and "immediately." It runs through April 6, but could be extended. Tweet is from 6:50pm: https://twitter.com/GovInslee/status/1242267557295321090 https://twitter.com/GovInslee/status/1242267557295321090 https://medium.com/wagovernor/inslee-announces-stay-home-stay-healthy-order-4891a7511f5e https://medium.com/wagovernor/inslee-announces-stay-home-sta... https://www.governor.wa.gov/sites/default/files/proclamations/20-25%20Coronovirus%20Stay%20Safe-Stay%20Healthy%20%28tmp%29%20%28002%29.pdf https://www.governor.wa.gov/sites/default/files/proclamation...
          • 7y ago
  • Buttons840 7y ago
    I fear we will be well past 10,000 deaths in the US in 2 weeks.
  • hartator 7y ago
    Well deaths in the US only for flu were 50,000 last year. Still 5x less.
    • ClumsyPilot 7y ago
      Corvid 19 deaths are doubling every 3 days in US and a few other countries. Do the extrapolation.
      • Dylan16807 7y ago
        Trillions will die. You can only extrapolate so far.
        • listsfrin 7y ago
          People seem like computers these days: they only think in logarithms, they "forget" to add some common sense.
      • antpls 7y ago
        Even in Italy, the National Health Institute said that 88% of the declared "dead by covid19" had in fact at least 1 or 2 other pre-morbidities. If a 80 years old dies from heart attack and is tested positive by covid19, it will count as "dead by covid19". The numbers we see in the news of "CFR" for the covid19 are, in my opinion, inaccurate. The number only shows the spread of the infection, not its actual fatality rate.
        • deleted 7y ago
          [deleted]
        • lifthrasiir 7y ago
          CFR is a death rate of the population with particular medical conditions by definition. It is a correct usage. CFR doesn't translate to the additional death rate, but it does contribute to the death rate by unspecified amount. In particular high enough CFR directly translates to the additional death rate when it exceeds the original crude death rate.
  • mns 7y ago
    Epidemiology is not putting numbers in excel and running a formula to generate a chart. Which seems like what half the world is doing now. US has already the same number of cases that Italy had one week ago when it had 4000 deaths (only 500 for US at this point). So some data is wrong and you can't model every country in the world based on data that is just plain misleading (Italy). Median age of tested people in Italy is 13.3 years higher than the general population median age, in Germany, the difference is just 0.7. Stop treating Italy as being the only point of truth and other countries (like Germany) like the anomaly.
  • glofish 7y ago
    I think people should be allowed to express a different opinion. We should criticize and point out mistakes, but let's not demonize. The world is complex and interdependent, overreacting can be just as bad as not doing anything, what we need to find is the right balance between the two approaches. If we check back and he was right then what? You, like everyone else, will be elated. Completely dismissing certain observations early on as 100% wrong is not the right approach. One has to navigate the path balancing the tradeoffs.
• lubesGordi 7y ago
  If this is exaggerated, then surely there have been other epidemics that have gone through the world and had similar effects numbers wise (with cfr for example), and he would be able to refer to them as par for the course.
  • guscost 7y ago
    https://en.wikipedia.org/wiki/Epidemiology_of_pneumonia https://en.wikipedia.org/wiki/Epidemiology_of_pneumonia
• sago 7y ago
  I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill. When people realise that their earnings have been slashed, they have been burdened with years of increased taxes, the economy has plunged, and swathes of businesses have gone bust, for the sake of people who were going to die soon anyway... Realism is good. But it is easy to 'evidence' biased anti-vulnerable feeling with 'realism'. I'm not convinced that if most people understood the realistic risk to themselves, they would do what's necessary to protect the people at much greater risk. The last week of the 'let's be realistic' zeitgeist on the news comment thread I visit. As usual with such pessimism, I really hope I'm wrong.
  • CriticalCathed 7y ago
    >I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill. I guarantee you that if we don't target our lockdowns on the at-risk population (elderly being the most numerous in that group), whatever backlash there is will be worse when the general population realizes they aren't at any significant personal risk.
    • paulryanrogers 7y ago
      > ... when the general population realizes they aren't at any significant personal risk With 15-20% of confirmed cases needing intensive care and symptoms developing at roughly the same rate, it becomes a perfect storm. So deaths may begin with only the elderly or immune compromised, it likely won't stop there as the younger folks need care they can't get. Perhaps they survive anyway, but an unknown number with permanent lung damage and lower quality of life. General population may come to any number of realizations. The underlying reality may never become entirely clear to any of us. Y2K probably could have been much worse. Yet the media coverage around the aftermath gave the impression it was no big thing.
• RobertRoberts 7y ago
  Common sense needs to prevail over mania, numbers over hyperbole and science over conjecture. But even then, this is hard if our data is collected poorly and then poorly disseminated. So what is the answer then? Maybe a strengthening of resolve against all forms of panic? Is there a single event in history has been solved by panic?
  • brlewis 7y ago
    >Is there a single event in history has been solved by panic? Surely there's a historical figure who at some point fled in panic. Having survived, they then changed the world. If you're having an asthma attack, running outside in a panic might get you away from the airborne allergen.
    • RobertRoberts 7y ago
      All the training I learned in boy scouts, heard from survivalist, people who have survived outrageous circumstances by their own choosing and actions did not attribute their success to panic, but the opposite, keeping a clear head. It's likely we can find stories of people panicing and surviving, sure. But can a paniced person (one overwhelmed with intoxicating fear) help others? No. A drowning person will also drown their own lifeguard to attempt to save themselves. This is a well established fact that all trained lifeguards know. Panic causes irrational and often self destructive choices. And often hurt others.
      • brlewis 7y ago
        I absolutely agree that panic has only narrow uses.
  • root_axis 7y ago
    > Is there a single event in history has been solved by panic? What does that mean? "Panic" is not a strategy, it's an instinctive response to fear.
  • rglullis 7y ago
    This line of thinking is backwards. Usually the problems that we don't solve are the ones where we should have taken stronger measures (i.e, "panicked") earlier instead of waiting for evidence of a threat. We did listen to the ones crying (i.e, "panicking") over Y2K bug and a lot of money was spent on it before January 1st, 2000, so that got solved swiftly. On the other hand: - Had we listened to the ones crying (i.e, "panicking") over the excess of the dot-com era, we wouldn't have pets.com and WebVan. - Had we listened to the ones crying (i.e, "panicking") about the mortgage crisis, we wouldn't have gone through the 2008 recession. - Had we listened to the ones warning about the need of controlling flights to China in January (i.e, "panicking"), half of Europe wouldn't be in lockdown.
• jp_sc 7y ago
  So.... was this sponsored by the airlines or by the hotels chains? EDIT: After what happened in Spain and Italy, countries where the initial reaction was "let's not overreact", I don't believe any scientist can speak on those terms without a hidden agenda.
  • markcmyers 7y ago
    Whatever the numbers say, it is hardly the case that anybody has underreacted. Everywhere, we've always been at least three weeks behind the curve, which is an eternity when dealing with this virus.
    • maxerickson 7y ago
      Do you mean overreacted where you have written underreacted?
• Klinky 7y ago
  Is this paper basically saying China and Italy's troubles with COVID-19 "ain't no big deal", and that New York and Washington are not struggling? >"Leaving the well-known and highly lethal SARS and MERS coronaviruses aside, other coronaviruses probably have infected millions of people and have killed thousands" This is not cited, and seems like potentially exaggerated non-evidence based information.
  • makomk 7y ago
    There's some research out there on this, and apparently at least some of the human coronaviruses have fairly impressive case fatality rates in older people. Still probably under half of what this one is estimated at, but substantial nonetheless. That's just not newsworthy because it's just a cold.
  • tobyjsullivan 7y ago
    For what it's worth, the US CDC has said this about (H1N1)pdm09. I'm not sure if H1N1 is a coronavirus though and I don't know if there's any published research supporting this. But the author's statement seems reasonable enough given it was qualified with "probably". > From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus. https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemi...
    • mikeyouse 7y ago
      Nope - MERS and SARS were the only large Coronavirus outbreaks. H1N1 is an Influenza A strain (similar to the so-called Spanish Flu).
      • anticensor 7y ago
        Spanish flu and swine flu, you mean. H1N1 is the agent responsible for both.
      • 7y ago
• ExtremePopcorn 7y ago
  Context for the author: https://en.wikipedia.org/wiki/John_Ioannidis https://en.wikipedia.org/wiki/John_Ioannidis He wrote a column a couple days before this paper. Linking the response as well. https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/ https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a... https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...
  • joe_the_user 7y ago
    It's kind of a shame that he's wound-up writing an article like this. It certainly discredits him in my eyes and it seems utterly opposed to stated principles of evidence based medicine. As others have noted here, the article calls for action based on very little data and lots of ad-hoc speculation. It also cheery picks its and falsely claims we don't have enough data. I wonder if thinking all research is false too much lets jump to the idea you dream any opinion that's convenient. Moreover, Ioannidιs has absolutely jumped into advocating this position from a partisan political position, with his positions picked up by partisan political sites such as the dailywire.com; Headline: "Stanford Professor: Data Indicates We’re Severely Overreacting To Coronavirus" https://www.dailywire.com/news/stanford-professor-data-indicates-were-overreacting-to-coronavirus https://www.dailywire.com/news/stanford-professor-data-indic...
• Medicalidiot 7y ago
  There's a tonne of speculation about CFR still at this time. Maybe I'm hyperbolic, but there are still ~1,500 serious/critical cases in China which is 1/3rd of all active cases. I have a feeling like the 4% CFR is high here because many of the COVID cases became clinical diagnoses instead of rtPCR; in other words, the Chinese physicians started using CT scans and clinical presentation to diagnose COVID instead of testing. Normal viral pneumonia diagnostic criteria is a chest radiograph and clinically compatible features (e.g. fever, cough, dyspnea, etc.). My take away is that they probably ran out of test kits and therefore many asymptomatic patients are out there. As time progresses I have a feeling that the official CFR in China is going to spike soon when they start deciding to take people of ventilators, unless the CCP decides to pour massive resources into keeping these patients alive. Regardless, I have a feeling like the number of deaths/resolved is significantly lower than what it actually is and I wanted to nerd out here for a second because I love talking about medicine. Edit: I want to say that I still think that we should be taking this entire pandemic seriously and am in no way commenting on this article's suggestion that we are in anyway over/underreacting. I'm making a comment on CFR.
• deleted 7y ago
  [deleted]
• jtsnow 7y ago
  Ioannidis continues to push this evidence-based approach, but I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. They argue that one doesn't need raw evidence to act if the statistical evidence shows that the risks are catastrophic. They published a paper on January 26th which lays out arguments for why conventional risk management approaches are inadequate in these situations. [1] This paper was met with disregard on HN [2], but the persistent reach of Ioannidis shows why Taleb's arguments have value. Some on Twitter argue that the WHO statement on January 14th shows where Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action. [1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavirus-a-note https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog... [2] https://news.ycombinator.com/item?id=22154333 https://news.ycombinator.com/item?id=22154333 [3] https://twitter.com/WHO/status/1217043229427761152 https://twitter.com/WHO/status/1217043229427761152
  • ellyagg 7y ago
    It's weird because I'm just as afraid of a black swan of unforeseen, runaway financial collapse due to pandemic countermeasures. People seem awfully glib about how many will die from the pursuant depression.
    • rootusrootus 7y ago
      I'm becoming considerably more afraid of the social and economic consequences from the pandemic countermeasures than of the virus itself.
      • amiga_500 7y ago
        My main fears: 1. They find it does effect kids, it just takes longer 2. They find reinfection is common
        • rapidslowness 7y ago
• wideasleep1 7y ago
  Sadly, my takeaway/tl:dr Everything you've heard or read is fake news, we know almost nothing. Ironically uses 'gone viral' when he crits a fellow doc (cite 12) on the mask 'issue', and clearly we can't even get these experienced pros on this very topic to agree on much of anything, but will print regardless.
  • thomasfromcdnjs 7y ago
    I'm also in this camp. I feel like it is the rational position too. So much margin for error in about 300 different facets.
    • wideasleep1 7y ago
      Based on my comment's downvotes, and no feedback, I have to assume I've either 1) Misread the article, 2) Misinterpreted the article, 3) Didn't clarify my position sufficiently. This recent HN post has a pretty good summary of where I think we all are on the given 'mask issue' topic: https://news.ycombinator.com/item?id=22673242 https://news.ycombinator.com/item?id=22673242 Suffice it to say, these clap-back articles among the medical elite in supposed positions of authority don't clarify the facts any better than the sketchy policies being made on nebulous data. But I guess we are in a state of 'real-time' peer review, and everyone left guessing the outcomes.
• ropiwqefjnpoa 7y ago
  There was a comment on HN a few days ago basically saying, "what's wrong with panic, maybe we should be panicking" and I just found that comment frightening. We mock all the "idiots" buying up the toilet paper, but panic clouds the clear thinking of even the "intelligent". It can absolutely effect our leaders and medical professionals.
  • catalogia 7y ago
    Reading that comment charitably, I guess they meant something about fear sometimes being a productive motivating emotion. In my view, panic is fear strong enough to override rationality. Cool-headed fear might be a good thing, but panic usually isn't.
    • ropiwqefjnpoa 7y ago
      Right, panic is pure emotion, fight or flight, hard be rational in that state. Covid19 is "sobering". 100 years since the 1918 flu and we still aren't ready. Even with the billions we spend on health care.
  • flukus 7y ago
    Depends on what people define as panic and the degree of it. I started stocking up food a couple of things a time in January and many people told me I was panicking. If a lot more people had panicked like me shopping would be easier. As it turns out I didn't panic enough either, I should have had more toilet paper and pasta to get through the panic from other people.
  • loopz 7y ago
    Mitigation is not "panicking". The earlier you do it, the less costly.
• jsnell 7y ago
  The title is funny, since Ioannidis is actually the one proposing measures ("do nothing") based on no evidence and exaggeration. Basically every number in the paper is tainted by him cherry-picking the most optimistic number possible, and then trying to twist it further into something even better. Like his argument for the R0 being near 1.3 is just that it's "probably" the case. At some point we need to be able to call the data we have good enough for making decisions.
  • CriticalCathed 7y ago
    Um. He doesn't advocate do nothing. He specifically says the opposite. Read the paper. WTF?
    • jsnell 7y ago
      Sure he recommends researching vaccines faster, giving people flu vaccines since the flu is more serious than Covid, admitting fewer Covid patients into hospital care, and doing more research so that we're better prepared next time when something actually serious happens. Or if this is serious, doing more research so that the data is the most accurate possible. I think calling that doing nothing is pretty generous. Since you disagree, what measure that he's proposing did you have in mind?
      • Barrin92 7y ago
        he seems to advocate individual hygiene and avoiding the public when sick, which also btw seems to be the response that countries like Japan, Taiwan and Singapore have taken, where complete lockdowns or closures have largely been avoided. Together with tracing they seem to have handled the situation just fine.
        • cma 7y ago
          Taiwan is doing more than public service announcements. Singapore too. Japan closed all schools in Feb. Tracing won’t work without first getting the number manageable.
• giarc 7y ago
  I published a paper on outbreaks in a hospital setting and the problem is there is not a single RCT on methods to stop outbreaks. The problem is no organization is willing to approve a trial where you don't follow your protocols and commonly accepted methods to control the spread (ex. closing common areas, isolating patients, cohorting staff, enhanced cleaning). There is a good blog post about 'Riding the Wave' that basically says that perhaps the outbreak would have ended itself and we simply just take credit saying "what we did worked" but in reality we'll never know.
  • robocat 7y ago
    South Korea got their infections down and their economy isn’t in the toilet. Compare to Italy’s reactive policy and subsequent failure. Or look to Taiwan and Japan with economies running and infection rates under control (at present). Your “perhaps the outbreak would have ended itself” will be shown to be false in multiple countries that lack the resources to manage their infection transmission rates... We have heard of Iran, but wait until we find out what happens in other poor countries...
    • yibg 7y ago
      I’m really worried about India. So far it’s not a huge outbreak there yet, but they are hitting the beginning stages of the steep curve.
    • giarc 7y ago
      That comment about outbreak ending itself was specific to small outbreaks contained to hospital inpatient units.
• yurlungur 7y ago
  It's easy to point at others for imperfect data and imperfect science when the situation is evolving so fast and data is so hard to come by. It seems to me that papers being retracted due to inaccurate evidence is not a sign of sensationalism but of sound science. Once can argue that more diligence should be practiced in the review process, but I assume everyone is trying their best to get the information out there ASAP. In any case, policies need to be enacted now (or rather two weeks ago) in any but the best case scenarios. There is no time to wait for more accurate information. If one argues that exaggeration is rampant and we should learn more before making hasty decisions, then that's essentially arguing for inaction. Even if that was the right action I suspect the induced panic in the society will be even greater. The author also seems to be implicitly weighing the dire consequences of a pandemic (maybe millions more people dying) against the supposed reputation damage to science, which is bizarre to say the least.
  • ropiwqefjnpoa 7y ago
    The response will have it consequences too, lost lives, destroyed businesses, ruined families, lost requirement savings.
    • ClumsyPilot 7y ago
      And a runaway global pandemic will kill more people than Mao, Hitler and Stalin combined. Pick your poison.
    • cycrutchfield 7y ago
      That's not an argument for letting this disease burn through our entire population. That's an argument for the government to step up and assist people during this time. Edit: and who gives a shit about your retirement account.
      • vixen99 7y ago
        People who for whatever reason are utterly dependent on support from the state might well give a shit about the state's decreased capacity to provide aid thanks to additional demand on the part of those whose retirement funds (which allowed them to be self-sufficient) have been destroyed.
• rdlecler1 7y ago
  You need to know if you’re walking through a two way door or a one way door. A two way door you can course correct. A one way door you can not which requires a different risk strategy. Evidence suggests a one way door.
• Geee 7y ago
  I saw the videos from Wuhan hospitals 2 months ago and it was clear that the severity of this was off the charts. You can pretty much scale up the situation from a single hospital, because it tells you that it's impacting locally more than the hospital can respond. You don't need "evidence" of how many are actually infected or what is the correct R or CFR or which way it spreads. Just look how it's impacting the local health care system. If it exceeds the capacity by X % that's how big a problem it is.
  • jbc1 7y ago
    CFR can give you an indication of how long its going to last. If its low and you're getting smashed, that tells you that significant portions of the population are getting infected and it will run out of steam sooner. Higher CFR tells you that the exceeded capacity will last for longer. That will impact the strategies you use.
  • amykyta 7y ago
    Spot on. Too many comments are see-sawing on details of parameters and trade offs but just talk to a doctor in NYC, they are out of room in ICUs and terrified about triaging that will start taking place.
    • irq11 7y ago
      Mt. Sinai in NYC is not currently reporting shortages of any kind. They are preparing for shortages, but are not currently experiencing them: https://www.westsiderag.com/2020/03/23/mt-sinai-setting-up-outdoor-tents-to-extend-emergency-rooms-hopeful-comments-on-supplies https://www.westsiderag.com/2020/03/23/mt-sinai-setting-up-o... Perhaps you want to reconsider your news sources.
      • fcurts 7y ago
        Hospitals in Italy are currently reporting dramatic shortages of many kinds.
  • kajumix 7y ago
• deleted 7y ago
  [deleted]
• ajnin 7y ago
  What Ioannidis is advocating is to do nothing until we have scientific certainty of what the correct decision should be, and only then act. What he's not taking into account is that the situation is unfolding right now, and if "do nothing" turns out not to have been the correct decision then you can't go back and change that. If we overreact and cause 20% unemployment for the next year, then a harm has been caused, but if we underreact and 20 million people die, then another harm would have been caused. In the face of this alternative, with not enough data to know the probability of outcome #2, but with enough to know that it can happen, then I think it is rational to choose the route that most surely avoids it.
  • wwweston 7y ago
    > if we under-react and 20 million people die, then another harm would have been caused And it's worth noting if anything on the order of millions of people die, then there going to be economic impacts -- that's a hell of a demand crater and productivity shock.
    • Gibbon1 7y ago
      Worst case. Instead of quickly developing herd immunity, the US ends up with persistent low level outbreaks over two to three years like the 1918 flu. If that happens the rest of the world will quarantine us.
      • ClumsyPilot 7y ago
        What are you trying to say? If the rest of the world would develop hard immunity, they would have no need to quarantine you.
        • Gibbon1 7y ago
          Assume they don't, assume they manage to stop community spread of the disease instead. Then they don't have herd immunity.
• robocat 7y ago
  Firstly, there is 10 weeks of evidence on what other countries have done to avoid transmission. Taiwan, Vietnam, South Korea, China, and Japan all show a variety of strategies and have some successes under their belts. Sure, it’s messy social data, and they have systematic differences from other countries, but it’s real data about what is working. Ioannidis says: “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.” The Diamond Princess data shows deaths with a functioning health system. From WaPo: “a doctor at Papa Giovanni XXIII Hospital in Bergamo, where he said there are 500 patients in need of intensive care and just 100 ICU beds”. The deaths in Italy are often due to an overloaded health system, which can easily double the number of deaths. Why ignore that? Italy has 6000 deaths already with 1/5th the population of the US: you need some powerful evidence to assume the US should expect to have a different path to end up with a total of 10k (by say the end of the year). I think John has good reason to desire evidence based decisions, but sometimes you have to make decisions without enough data and change your game as it develops e.g. look at what effective entrepreneurs do in uncertain times?
  • defen 7y ago
    > “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.” Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's? Where does the idea of 1% come from? Both of those numbers sound ridiculously optimistic to me. Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors?
    • Barrin92 7y ago
      >Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's? because everyone on the diamond princess was tested. So we know for sure how many cases we are dealing within the sample. ~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK. Italy sits at 9%. So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. I find the latter less likely than the former.
• didibus 7y ago
  Is this a case of Frequentist vs Bayesian?
• jamilbk 7y ago
  It’s much easier to quantify the harms of allowing business as usual and letting the infection spread (namely # of deaths) than it is quantifying the cascading repercussions of a massive global economic meltdown. Accordingly, world leaders are being judged based on their ability to contain the spread rather than prevent economic devastation. As a society we are faced with navigating the delicate balance between how many lives we put to risk vs how much economic turmoil we can tolerate. With so little data on the latter (economic crashes absolutely can lead to deaths as well), it feels like we aren’t equipped to make educated policy decisions on how far we should go to limit the spread. I hope after all this we can create a more cohesive playbook for navigating these tradeoffs in the future. Many of these public health orders feel like knee jerk reactions lacking evidence. Better to err on the side of caution I suppose.
  • ClumsyPilot 7y ago
    If 10% of the population needs ICU and dies because they cant get it, then there is no business as usual.
    • jamilbk 7y ago
      You make a valid point. At the same time, economic problems affect everyone while it seems that covid-19 harm scales with age. No easy solutions to be sure, but I have hope more data becomes available soon so we can implement more nuanced policies to achieve similar containment while preventing massive unemployment. Testing random samples of the general population would be a good first step.
    • tflinton 7y ago
      That's an "if" though.
    • drno123 7y ago
      In Italy, median age of people who have died of Corona is 83 for women and 79 for men [1]. Normal life expectancy is lower than that in the United States [2]. Lockdown measures will have severe impact on GDP, and GDP is correlated with life expectancy [3]. It can easily happen that by killing economy in order to save lives, we may actually be doing the opposite in the long term. [1] https://www.iss.it/web/guest//comunicati-stampa/-/asset_publisher/fjTKmjJgSgdK/content/id/5286166 https://www.iss.it/web/guest//comunicati-stampa/-/asset_publ... [2] https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe... [3] https://ourworldindata.org/grapher/life-expectancy-vs-gdp-per-capita https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
• johnohara 7y ago
  The acid test for this article will take place towards the end of this week and into next according to the Surgeon General. Honestly, we're all holding our collective breath and waiting to see whether or not the U.S. begins to approach the same values associated with the Diamond Princess. So far, the mortality rate of those testing positive, asymptomatic and symtomatic, published by the CDC today, is 0.0119 compared to the DP's 0.013. The mortality rate as a percentage of all passengers and crew aboard the DP is 0.002 (9/3711). The infection rate as a percentage of all passengers and crew aboard the DP is 0.192 (712/3711). Dr. Deborah Brix indicated during today's WH presser that it's possible 70% of the U.S. population will be "exposed" to the virus by the end of 2021. (327,000,000 * 0.70) * 0.19 = 43,491,000 potential positives if the DP number is used. To date in the U.S., the reported percentage testing positive of the total number tested is 0.115. I'm not sure where this number keeps coming from. At the moment, the Diamond Princess represents the best set of data for comparison.
  • tlrobinson 7y ago
    Why do we expect to get better mortality data in the US than other countries?
    • johnohara 7y ago
      Social distancing and hygiene hopefully contribute to fewer exposures and therefore fewer fatalities. Especially those 65+ with underlying conditions such as hypertension and diabetes.
      • cycrutchfield 7y ago
        Ah yes, the United States, where our incidence of hypertension, diabetes, obesity, and heart disease are so low.
    • joe_the_user 7y ago
      I don't think many people knowing the facts are expecting that. It's that people, including me, dread the moments when the facts become manifest. This will prove us right but I will take no comfort in that confirmation. On the off chance that these (implausible sounding) arguments turn out right, well, woohoo, great.
• postalrat 7y ago
  http://www.euromomo.eu/ http://www.euromomo.eu/ Mortality across Europe has drastically declined in the past few months. Seems like everyone sitting at home is saving a ton of lives. Fewer accidents, fewer sicknesses, maybe even people eating a bit healthier. Why stop locking yourselves indoors when so many lives are being saved by not leaving home?
  • antpls 7y ago
    It kinda proves the point that covid19 alone is less deadly than many other causes
    • cycrutchfield 7y ago
      I don't see how you've come to that conclusion.
      • antpls 7y ago
        Did you look at the charts? If you didn't know there is a global epidemic, would you have been able to see it on these curves? In France and Italy, there were between 50000 and 60000 deaths per month in 2018 and 2019. If most of those people died because of 2 or 3 accumulated factors, covid19 would be just one more factor. But maybe those people would have died one month later anyway without covid19
        • cycrutchfield 7y ago
          I don't understand people like you who can look at the current numbers and say "Oh, it's not so bad" while also conveniently ignoring that the numbers are growing exponentially. People that are raising the alarm are not talking about the numbers now, they are talking about the numbers in the future if nothing is done to address it.
          • antpls 7y ago
            This is a new virus, _no one_ knows about the future. Data we have now could be biased toward an hidden variable we didn't figure out yet.
• anonu 7y ago
  I found this bit from the paper interesting. A Google search with “coronavirus” yielded 3,550,000,000 results on March 3 and 9,440,000,000 results on March 14. Conversely, “influenza” attracted 30- to 60-fold less attention although this season it has caused so far about 100-fold more deaths globally than coronavirus. First off, I am not sure how to comprehend those numbers. Back in the day a "result" was a page. What is that today? Are there really $9bn+ pages of useful content that mentions coronavirus? The number seems a bit arbitrary... Second, the major issue with comparing flu deaths and coronavirus deaths is time. We have only known about covid-19 for a handful of months. The flu in all its forms has been with us for millennia. You simply cannot compare the two. For me this bit throws the credibility of the paper out the window.
• beardedman 7y ago
  Of course majority of HN readers will proceed to set up straw-men, disregard references & argue for legitimising the populist alarmist rhetoric.
  • dang 7y ago
    Maybe, but please don't post unsubstantive comments here. I realize it's frustrating when others are wrong on the internet, but the only valid moves are to (1) patiently provide correct information, or (2) let go and not post. Snark and/or venting just makes things worse. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
• cmurf 7y ago
  This didn't get enough attention the first time around. We know enough now to act decisively against Covid-19. Social distancing is a good place to start - Marc Lipsitch reponding to John Ioannidis. Previous conversation https://news.ycombinator.com/item?id=22620283 https://news.ycombinator.com/item?id=22620283
• fbn79 7y ago
  "And yet it moves" Galileo Galilei https://en.m.wikipedia.org/wiki/And_yet_it_moves?wprov=sfla1 https://en.m.wikipedia.org/wiki/And_yet_it_moves?wprov=sfla1 . I agree that in many axpects the situation is exagerated, in primis by general panic. But If the Covid is not much worse than flu why in Italy we have military trucks convoy that transport death to southern regions because the wait line for crematory in North is becomed too long?
  • listsfrin 7y ago
    In normal times Italy has a death rate of 10 deaths/1000 people. Which translates to ~1500 daily for a population of 60 millions. What were they doing previously with the dead?
    • fcurts 7y ago
      They buried or cremated them. Unsurprisingly, the system can't handle a sudden one-of-a-kind spike.
    • gpderetta 7y ago
      Those people haven't stopped dying. As a comparison, 700 people have been dying every day for covid-19 in Italy. Also deaths are not (yet) evenly distributed but greatly concentated in the north.
      • listsfrin 7y ago
        You are building the world around your arguments. You have no proof but still talk, talk, talk.
        • Gigablah 7y ago
          You didn’t refute him/her.
        • CydeWeys 7y ago
          What does that even mean? The world is what it is. Italy is seeing huge increases in background death rates at the moment, owing solely to COVID-19 (while at the same time seeing diminished deaths from things like traffic accidents, though not remotely enough to make up for all the extra COVID-19 deaths). What is your argument exactly? It's a fact that Italy is running at a higher overall mortality rate owing to COVID-19.
• fcurts 7y ago
  > An argument in favor of lockdowns is that postponing the epidemic wave (“flattening the curve”) gains time to develop vaccines and reduces strain on the health system. However, vaccines take many months (or years) to develop and test properly. It's not only about vaccines but about treatments in general. There is a good chance that we'll have a drug that significantly improves outcomes long before we have a vaccine. I don't understand how a peer-reviewed paper can overlook this.
• zby 7y ago
  One thing that seems really important is that we get testing right. Here is a paper stating up to 80% of false positives: https://pubmed.ncbi.nlm.nih.gov/32133832/ https://pubmed.ncbi.nlm.nih.gov/32133832/ If that was true it would make all the stats nearly useless. I have also heard that the so called 'quick tests' are even worse.
  • fsh 7y ago
    The group at Charité Berlin which developed the WHO test claims they had no false positives in hundreds of trials.
• gyulai 7y ago
  Collecting stats on the progression from clinical presentation of the patient all the way to death seems to me a bit tedious, since death is altogether somewhat rare and when it does occur it's a lot of factors playing together. But the following article really put the fear of god in me, as it's the first source I've discovered that gives you an idea of the rate at which patients progress from clinical presentation to "going severe". Here a doctor gives details on the criteria they use for separating patients which are not altogether that restrictive, basically just saying that the patient must test positive or have been in contact with someone who did: "We have an observation unit in the hospital, and we have been admitting patients that had tested positive or are presumptive positive; these are patients that had been in contact with people who were positive." Elsewhere in the article there is mention of the rate at which these patients progress to going severe: "About a third have ended up on ventilators." https://www.propublica.org/article/a-medical-worker-describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients https://www.propublica.org/article/a-medical-worker-describe... My guess is that the clinical point of view around Covid-19 is currently probably a well-kept secret among clinicians and that Ioannidis probably doesn't have access to that kind of "inside information".
• 2008guy 7y ago
  The answer seems so obvious. Do a hard, air tight quarantine of people of advanced age. People who are borderline or sick are told to stay inside. Encourage the rest of society to go about business as usual. Provide government support for all of it. Some people will die but probably less than if we have to do this over and over again without ever gaining herd immunity. And few enough to massively ease the burden on hospitals. And it’s the best way to avoid Great Depression 2020.
  • gyulai 7y ago
    ...keep in mind, that it may be the case that we're being lied to when we're told that young and healthy people have nothing to fear. The following article seems to suggest otherwise: https://www.propublica.org/article/a-medical-worker-describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients https://www.propublica.org/article/a-medical-worker-describe...
    • gyulai 7y ago
      Another data point: The following source gives additional detail on the kind of thing that is meant by "preexisting condition" when they say "people without preexisting conditions have nothing to fear". One of them is high blood pressure. Who doesn't have high blood pressure, these days. https://www.cebm.net/global-covid-19-case-fatality-rates/ https://www.cebm.net/global-covid-19-case-fatality-rates/
    • marknutter 7y ago
      As frightening as they are, these appear to be outlier cases.
  • alkonaut 7y ago
    Those most at risk are those requiring care. An 80+ person with some illness with typical assistance at home might meet 20+ working age people in a week. That can probably be scaled down in the name of caution to say 5, but it's unlikely to be the same 5 every week because of staff turnover, illness. It's the same whether you receive care at home or in an assisted living facility. Even without such care, a lot of these people regularly need hospital care for things that aren't covid. Many have regular scheduled visits to doctors for blood pressure medication tweaks and similar. You could isolate the healthy 70 year olds quite well, but not the sick 80 year olds.
• yread 7y ago
  The virus mostly kills old people and people with comorbidities who would die anyway. Economic crisis come every ~10 years so it would come anyway. See what I did there?
• f0ok 7y ago
  This sounds more like an opinion paper than a study.
• EmilioMartinez 7y ago
  A discourse vacuum was produced by lack of proper channels. I myself wouldn't have been so engaged in reading those papers and sifting through videos from obscure sources had I felt that the officials were not sleep at the wheel. I'm still dumbfounded that China is let off the hook for delaying information a whole month, but even after declaring mass quarantines the west's officials took more than a month to take notice.
• cxhandley 7y ago
  Imagine this. Your driving down the freeway at 60 mph, accelerating at 30%. The car in front of you puts on the breaks. Before you react, you first gather your speed gun, check the deceleration rate of the car in front, then calculate based on your speed when you should put your breaks on. I'm all for the scientific approach, but in this particular instance, our survival instincts need to take precedence. Please, we need to stop peddling evidence based approaches for an exponential situation.
  • deleted 7y ago
    [deleted]
  • klmadfejno 7y ago
    This is a terrible analogy, because you know for a fact that hitting the breaks will cause the car to slow down. The evidence gathering is also just confirming the obvious. It's just... not relevant. If you're in an airplane and the pilot is dead, do you just start smashing buttons to land the plane? Instincts won't help you there. Instincts won't help you magic out a novel viral cure either.
  • michaelmcmillan 7y ago
    Stepping on the breaks perfectly align with what we know scientifically. People think of science as something very narrow – but it's also evidence and rationality. What China and South Korea have done works. What other alternatives do we have?
    • rimliu 7y ago
      Except China and South Korea did different things.
      • michaelmcmillan 7y ago
        Which is consistent with what I wrote.
    • gindely 7y ago
      What all the western countries have done. A half arsed lockdown, not like China's, without testing-and-tracing, not like South Korea's. There's still no evidence that a half arsed lockdown is unsuccessful and good reason to believe they generally aren't.
• patrec 7y ago
  I will go out on a limb here (I'm hardly a domain expert) and make the following prediction: In retrospect this will be seen as the moment when peer perception of Ioannidis fell from major scientific figure to reckless (or worse!) fraud. The problems with what he writes seem to me to be so severe, I cannot fathom how it ever made peer-review. His original article assumed, with no measures taken, a peak infection rate in the US of 1% of the population. For that to be true, R0 would need to be around 1.01 (herd immunity to restrict further spread is achieved at around 1-1/R0). This is totally insane, there is literally no way covid-19 could have spread internationally as fast as it does with this R0 (you can work out R0 quite well from the growth rates, the main problem is reporting quality, but death figures are presumably fairly accurate). He also gave a plausible lower bound of CFR of around half of seasonal influenza, 0.05%. For comparison the Italian CFR currently skews closer to 9%! Even accounting for immense underreporting, there is no way to reconcile these discrepancies (a factor of 200x). He upwards adjusts a tiny bit in this article, but it is still extremely hard to reconcile the situation on the ground in Italy with what he is writing. All the countless additional severe problems with his argument (cost asymmetries, health care capacity, ...) pale in comparison to these two.
  • patrec 7y ago
    There are two pretty simple and detailed arguments above why what Ionnidis wrote is preposterous, if you disagree, why not engage with them?
• js2 7y ago
  Link to the paper itself (which I can’t find anywhere on the abstract page); https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.13222 https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.13222
• stevespang 7y ago
  Warning: "This article has NOT undergone full peer review" . . .
• yters 7y ago
  What if corona is already very widespread and not especially lethal? The increase in cases may be a function of test coverage.
• Fjolsvith 7y ago
  Someone ought to research out the number of cell phone accounts that have been terminated in China in the last three months. I saw a video last night claiming it was on the order of 2.1 million. If you didn't know, the Chinese government tracks their citizens movement, social activities and pretty much everything through their phones. If you don't have a phone in China, you are a non-person, or perhaps you've died.
• alexk307 7y ago
  How was this peer reviewed?
• dannykwells 7y ago
  Can we revisit this now that it's clear how wrong John was? The US already has 6000 deaths from only 250k confirmed cases. It is assured we will cross the 10kthreshold,and likely the 100k one. It's important to hold people accountable for their (massive, scary, indefensible) assertions.