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> “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

by 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.
- defen 7y ago
  Bruce Aylward's visit to China made it sound like they were testing everyone too. Germany is at 0.42 and South Korea is at 1.24 now that more diagnosed people have had time to die.
  - sudosysgen 7y ago
    China outside of Hubei has a CFR under 1%, actually. And they sure as hell didn't test everyone or even 10% of those infected in Hubei.
    - user_50123890 7y ago
      They tested every single person in the country who showed up to a doctor with a fever.
      - sudosysgen 7y ago
        No, they absolutely have not anywhere closed to the peak in Hubei. People with grave respiratory difficulties were given Kelatra and sent home. Outside of Hubei and after the peak, sure.
- joe_the_user 7y ago
  The unanswered question of the GP is why you'd expect only 1% of the US population to be infect? I can't see the slightest basis for such an assumption. This an extremely infectious, quickly spreading disease. 30% of the US population seem like a more likely estimate. SK has a 1.3% fatality rate at the end but that was with a functioning health case system. If even 1% of the US population get infect, the health system won't be function and you'll have a higher fatality rate.
  - Barrin92 7y ago
    >The unanswered question of the GP is why you'd expect only 1% of the US population to be infect? Ioannidis addresses this in the article. Extensive community spread is actually unlikely to be the case for this virus, epidemic development is hard to discern from simply increasing rates in testing and sensitive populations seeking testing, and maybe most importantly there is little evidence that lockdowns and other extreme measures have significant impact on reducing this sort of respiratory infection, he cites this paper. [1] " The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children.[...]Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure." [1]https://www.ncbi.nlm.nih.gov/pubmed/21735402 https://www.ncbi.nlm.nih.gov/pubmed/21735402
    - joe_the_user 7y ago
      But talk about lack of data. This is looking at the spread of a different virus - a virus that certainly does not have the infectiousness of the Covid virus. So the this pure speculation.
      - Barrin92 7y ago
        It's a meta-study looking at over 67 papers that address the question of the spread of respiratory viruses. Obviously, every virus is a new virus, that is always a problem. The question remains however why we ought to treat concerns about data about the virus different than concerns about data about the response to the virus. Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years? It seems ironic that people critize Ioannidis for a sort of first-order error in thinking by not considering uncertainty. Yet causing damage and applying first-order thinking to disruption of global supply chains that likely will drive entire nations into deep recession and instability is apparently adequate.
- robocat 7y ago
  ~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK. Fine numbers in the presence of a health system that is not overloaded, or a country that has managed to make effective changes to prevent transmission (how did they do that without science huh?) By John’s numbers (0.3% die and 1% of population) Italy should get a total of 1800 deaths. Yet Italy is at 6000 and rapidly rising - using real numbers his assumptions are already wrong for a first world country that is a few weeks ahead of the rest of the world. And why the fuck does he assume 1%? Because some actions have been taken? What actions can be taken since by his own words we lack evidence to make decisions... Edit: by my calculations the US has 800000 cases at the moment (compared to ~40000 tested positive). 500 deaths with a 0.5% death rate, so three weeks ago there were 100000 cases, but it will have doubled 4 times in 21 days so there is now 800000 cases (already 0.2% of population). Three more doublings (easily realistic) beats John’s 1% within weeks. Ironically, going with his low mortality rate (0.025%) would mean US has 2% infected already...
  - cycrutchfield 7y ago
    Many cases in SK and Germany have not resolved yet. I don’t think you can use those numbers so definitively.
    - 411111111111111 7y ago
      Actually South Korea is a perfect place to look for a nation which kept it under control. Germany just lost control last week, so I expect a lot more death starting next week. Hopefully Germany's plan of isolation will reduce the spread enough, but we will see...
      - lankin 7y ago
        German here. Could you elaborate how we lost control last week? At least in Bavaria everything seems to be ok - considering the circumstances...
        gindely 7y ago
- abiogenesis 7y ago
  I am speculating, but it might be because Italy tested some (many) people after they died. That would skew the fatality statistics.
- scarmig 7y ago
  That's a false dichotomy. The situation could also be that access to treatment is a huge factor in mortality, and that Italy and Wuhan faced a large enough caseload that people were unable to get healthcare, which drove up mortality significantly. This is a much more likely factor than the idea that Germany and South Korea are somehow 10x-30x more effective in testing their population than Italy.
  - sacred_numbers 7y ago
    I'm not sure about Germany, but South Korea was and is extremely effective at testing their population. They also did and are doing a fantastic job tracing infections (although part of this is due to being able to mostly focus on a single super-spreader rather than many simultaneous outbreaks. I think that South Korea probably confirmed 70-80% of their actual number of cases, while Italy probably has at least 2-3 actual cases for each confirmed case. Testing and tracing en masse is really, really hard, and is basically impossible if you don't catch it soon enough. I think that hospital overloading is definitely able to double or triple the death rate, though.
- rramach 7y ago
  John's analysis is cherry picking in many ways. Death rate in Diamond Princess is 1.1% today and 2% is listed as severe. Assuming 50% of severe make it, final fatality rate for the ship may end up closer to 2%. John then adds a 50% discount factor but it is not clear how he picked that number. Also, the 1% of population infected seems to be another number pulled out of a hat. If we are basing our figures based only on the ship with no other assumptions, we have to go with 20% infection rate. Thus, one reasonable estimate of risk from the ship data is 20%x2%x330M = 1.3M deaths if we wait for "evidence" and did nothing. Clearly, this argues for doing something! Edit: Also, Germany does not test dead folks for coronavirus while Italy does. Further, SK death rate has gone up to 1.3% (0.9% is an old number) and many more are in severe category. Thus, the sub 1% numbers seem more like the outliers than the above 1% numbers.
  - ant6n 7y ago
    The Diamond Princess is also likely not a random sample of the population - they are healthy enough to be fit for travel.
    - giantDinosaur 7y ago
      You don't need to be particularly fit or healthy to go on a cruise. Yes, sure, you can't be on life support, but generally 'healthy enough' to travel on a cruise is exactly what I'd expect from any random sample of the overall population.
      - kgwgk 7y ago
        You may not understand what "random sample of the overall population" means if you would expect every single person in the sample to be healthy enough to travel on a cruise. Almost 1% of the population in the US has Alzheimer disease or other dementias, for example.
        giantDinosaur 7y ago
        I noted exactly that in my comment. Yes, not all the population can go on a cruise. No, it's not like it's only the healthiest 20% of the population that can. If I randomly sampled the population I'd expect the majority to be capable of a cruise. What do you think cruises are like?
- im3w1l 7y ago
  > So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. There is a third possibility. False positive tests: Germany and South Korea may have less cases than they think they do.
  - bmn__ 7y ago
    Prof. Drosten who developed the test says that cannot happen in practice. One would get a false positive result with SARS-1 (de facto extinct) and related coronavirus strains in Asian bats (that have not crossed into humans). Source: https://www.ndr.de/nachrichten/info/coronaskript132.pdf#3 https://www.ndr.de/nachrichten/info/coronaskript132.pdf#3
    - shawabawa3 7y ago
      > Prof. Drosten who developed the test says that cannot happen in practice. Obviously not true False positives are always possible in practice even if they aren't possible in theory Get a bunch of tired lab techs running tests 24/7 and one of them will accidentally write down the wrong result at some point
      - cycomanic 7y ago
        I would not consider that a false positive in the test, maybe in the procedure, but that's quite different. Moreover it is statistically irrelevant, that would maybe account for 1%, but only if they would only note false positives.
  - rimliu 7y ago
    And the fourth: there were claims that only 12% Italy's COVID-19 deaths can be directly attributed to COVID-19.
    - easytiger 7y ago
      interesting. this sounds reasonable given its "deaths of people who tested +ve for cv19" and not "deaths of people from complications caused by cv19" Have you got a source?
- bugzz 7y ago
  Go check South Korea's numbers again. As their cases have resolved, death rate has steadily increased, and it's now at 1.33%. It will continue to rise. Same with Germany, it just takes time to die. South Korea had already found majority of their current cases 2-3 weeks ago, but deaths are only now picking up. Edit: now 1.37%, up again since I checked a couple hours ago. The same rise in death rate was observed way back when SARS happened. At first people estimated death rate at 2-3%, and it was continually revised upwards as cases resolved.
  - nkohari 7y ago
    The opposite happened with H1N1 (swine flu) in 2009, though. The CFR was estimated to be significantly higher during the pandemic but afterwards was estimated at 0.02% with 60M American cases. [0] Policymakers should use conservative estimates to be careful, but we still just don't know how deadly COVID-19 is. [0] https://www.eurosurveillance.org/content/10.2807/ese.14.33.19309-en https://www.eurosurveillance.org/content/10.2807/ese.14.33.1...
    - jtbayly 7y ago
      That's a difference between IFR and CFR.
  - marknutter 7y ago
    Unless they have a test that determines whether fully recovered people had it at some point, they are never going to get an accurate CFR.
- philwelch 7y ago
  Or Italy’s hospital system got overrun and people with survivable cases died for lack of treatment.
- lazyjones 7y ago
  > 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. Both could be true. For example, Germany doesn't systematically test dead old and/or hospitalized people for Coronavirus infections while Italy apparently does. Germany has more resources to test potentially infected people than Italy, where all resources are needed for treatment of the hospitalized cases. In reality, both Italy and Germany will have infections in the 100.000s, most of them with mild or no symptoms.
- nopinsight 7y ago
  0.3% & 0.9% are optimistic. South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases = ~1.3% today, gradually going up from ~0.5-0.6% a few weeks ago. Why? People in a functioning healthcare system take time to die and these people were infected during an expansion phase of spread which rapidly increases #cases (denominator). SK's cohort CFR is even higher. More properly, we should use the infection number from 3 weeks ago because it takes 3-4+ weeks from exposure to death: 120 deaths/4335 cases = ~2.8% Germany's current naive CFR at 0.4% will also rise in a similar manner for the same reasons. (You can bookmark this.) https://www.worldometers.info/coronavirus/country/south-korea/ https://www.worldometers.info/coronavirus/country/south-kore... https://www.worldometers.info/coronavirus/country/germany/ https://www.worldometers.info/coronavirus/country/germany/ South Korea has the 2nd highest number of hospital beds per capita in the world and 4 times the US number. Germany: 4th and almost 3 times. https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_countries_by_hospital_... South Korea's and Germany's hospitals were never overwhelmed in the same manner as Italy's. A major reason Italy's fatality number is so high is because doctors there cannot save everyone anymore.
  - seppel 7y ago
    >South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases But the denominator in this formula strongly depends on who and how often you test. In other words: You don't know the number of cases. Obviously, people who are severely affected are tested more often. People with mild or no symptoms might never be tested, even if they want to (I'm not sure about South Korea but for sure this is happening in Germany). Based on people in the German parliament and the German soccer league, you can currently guestimate that 1% of the population is already infected (1% of the parliament and 1% of the premier league players are infected. I suspect that they are tested more often and even without symptoms. Maybe they have more contact to other people - maybe not). Yes, this is a wild guess, but much better than taking the confirmed cases which are heavily biased towards people where the infection causes problems.
    - nopinsight 7y ago
      Yes, all my figures above are Case Fatality Rate (CFR) and not Infection Fatality Rate (IFR), which includes people with mild or no symptoms. It's much harder to estimate the latter unless one conducts antibody tests on a sufficient sample of a population. South Korea's extensive testing program should bring their two figures closer than those of other countries. Credible estimates of IFR from noted epidemiologists I've seen are around 1%, assuming that the healthcare system still functions, and much higher otherwise. COVID-19's CFR & IFR might not even be the biggest problem. High rate of hospitalization and broken healthcare system, with all their ramifications, could be considered even worse.
- rsynnott 7y ago
  Italy is a very elderly population. If, as seems to be the case, death rate ramps up dramatically over 70 and especially over 80, then this may explain part of it (though clearly testing in Germany and SK has been more effective than in Italy, too).
- Retric 7y ago
  Deaths are not instantaneous, add exponential growth and it taking up to 9 weeks from infection to death and it’s really deceptive. All deaths tell you is how many people where infected weeks ago. Just look at the lag in China’s rate of infections vs deaths. They had 22 deaths on March 8th and 40 new infections. Further, new cases drops off vastly faster than infections with the sickest talking longer to get better and staying at risk of death for weeks.
- 34679 7y ago
  I know this may sound ridiculous, but Kimchi and Sauerkraut? Are any other countries with a high consumption of low pH fermented foods also showing a lower CFR?
robocat 7y ago
> Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors? Exactly: why all this focus on deaths, when sickness rates are massive and are sure to have horrific long terms outcomes for more people than those that die. Intensive care strongly implies bad things are happening. John Ioannidis has been a fabulous force for good fighting scientific fraud and misinformation. But clearly he doesn’t know what effective decision making looks like. It usually doesn’t look very academic in my experience! edit: I mean decision making in an emergency (we did have two months to be proactive, but now we have a reactive emergency).
- rimliu 7y ago
  There is nothing "sure" about "horrific long terms outcomes".
ChrisCinelli 7y ago
I heard that in US if somebody dies and had pre-existing conditions the pre-existing condition is usually the official cause of death. So the person is not count. This has to be even more true with flu. If somebody had lung problems and the flu season makes things worse and she ends up dying, the doctors are not normally going to test for flu. And the cause of death is not going to be "flu". What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested. I have been trying to understand for a few days how the numbers are really counted for COVID-19. And again, it pretty clear that we do not have the real data for a "normal" flu either. So for now my understanding of how bad COVID-19 is compared to "standard" flu has been largely inconclusive. One thing though started getting clearer. COVID-19 is a virus with no vaccine. I have largely underestimate the importance of immunizations and being in a good health. Now I started to picture more and more that without a way to keep our immune system alert against the viruses, we will be greatly screwed almost every year because the demographic at risk would inondate the health care system in a way that they cannot cope.
- acqq 7y ago
  > What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested. In this case now, you don't need that: the hospitals in Italy know for years how many new cases they get. Now it's like 50 times more cases that need hospital, and 50 times more dead. It can't be anything but something completely new. If it's not a new virus X it must be a new virus Y as dangerous as X. But we know there is a new virus X. Old viruses simply had totally different need for hospitals: https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F_ENG.png https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F... In Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. The same with a need for the beds in the intensive care units.
deleted 7y ago
[deleted]
Kye 7y ago
One possible outcome for survivors is losing up to 30% of their lung capacity.
- sharken 7y ago
  Keep in mind this number is just as certain as saying 5% at this time.
DiffEq 7y ago
From the CDC As of 24-Mar there have been 589 deaths of 46292 tested which is 1.27% Mortality Rate. Not 3% or 4% as was initially reported. The more we test, as the days go on, we see this is not nearly as deadly as we thought. This will continue to decline as we test more and probably be around Germany and Korea's < 0.5%

by defen 7y ago

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.

defen 7y ago
Bruce Aylward's visit to China made it sound like they were testing everyone too. Germany is at 0.42 and South Korea is at 1.24 now that more diagnosed people have had time to die.
- sudosysgen 7y ago
  China outside of Hubei has a CFR under 1%, actually. And they sure as hell didn't test everyone or even 10% of those infected in Hubei.
  - user_50123890 7y ago
    They tested every single person in the country who showed up to a doctor with a fever.
    - sudosysgen 7y ago
      No, they absolutely have not anywhere closed to the peak in Hubei. People with grave respiratory difficulties were given Kelatra and sent home. Outside of Hubei and after the peak, sure.
joe_the_user 7y ago
The unanswered question of the GP is why you'd expect only 1% of the US population to be infect? I can't see the slightest basis for such an assumption. This an extremely infectious, quickly spreading disease. 30% of the US population seem like a more likely estimate. SK has a 1.3% fatality rate at the end but that was with a functioning health case system. If even 1% of the US population get infect, the health system won't be function and you'll have a higher fatality rate.
- Barrin92 7y ago
  >The unanswered question of the GP is why you'd expect only 1% of the US population to be infect? Ioannidis addresses this in the article. Extensive community spread is actually unlikely to be the case for this virus, epidemic development is hard to discern from simply increasing rates in testing and sensitive populations seeking testing, and maybe most importantly there is little evidence that lockdowns and other extreme measures have significant impact on reducing this sort of respiratory infection, he cites this paper. [1] " The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children.[...]Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure." [1]https://www.ncbi.nlm.nih.gov/pubmed/21735402 https://www.ncbi.nlm.nih.gov/pubmed/21735402
  - joe_the_user 7y ago
    But talk about lack of data. This is looking at the spread of a different virus - a virus that certainly does not have the infectiousness of the Covid virus. So the this pure speculation.
    - Barrin92 7y ago
      It's a meta-study looking at over 67 papers that address the question of the spread of respiratory viruses. Obviously, every virus is a new virus, that is always a problem. The question remains however why we ought to treat concerns about data about the virus different than concerns about data about the response to the virus. Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years? It seems ironic that people critize Ioannidis for a sort of first-order error in thinking by not considering uncertainty. Yet causing damage and applying first-order thinking to disruption of global supply chains that likely will drive entire nations into deep recession and instability is apparently adequate.
robocat 7y ago
~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK. Fine numbers in the presence of a health system that is not overloaded, or a country that has managed to make effective changes to prevent transmission (how did they do that without science huh?) By John’s numbers (0.3% die and 1% of population) Italy should get a total of 1800 deaths. Yet Italy is at 6000 and rapidly rising - using real numbers his assumptions are already wrong for a first world country that is a few weeks ahead of the rest of the world. And why the fuck does he assume 1%? Because some actions have been taken? What actions can be taken since by his own words we lack evidence to make decisions... Edit: by my calculations the US has 800000 cases at the moment (compared to ~40000 tested positive). 500 deaths with a 0.5% death rate, so three weeks ago there were 100000 cases, but it will have doubled 4 times in 21 days so there is now 800000 cases (already 0.2% of population). Three more doublings (easily realistic) beats John’s 1% within weeks. Ironically, going with his low mortality rate (0.025%) would mean US has 2% infected already...
- cycrutchfield 7y ago
  Many cases in SK and Germany have not resolved yet. I don’t think you can use those numbers so definitively.
  - 411111111111111 7y ago
    Actually South Korea is a perfect place to look for a nation which kept it under control. Germany just lost control last week, so I expect a lot more death starting next week. Hopefully Germany's plan of isolation will reduce the spread enough, but we will see...
    - lankin 7y ago
      German here. Could you elaborate how we lost control last week? At least in Bavaria everything seems to be ok - considering the circumstances...
      - gindely 7y ago
abiogenesis 7y ago
I am speculating, but it might be because Italy tested some (many) people after they died. That would skew the fatality statistics.
scarmig 7y ago
That's a false dichotomy. The situation could also be that access to treatment is a huge factor in mortality, and that Italy and Wuhan faced a large enough caseload that people were unable to get healthcare, which drove up mortality significantly. This is a much more likely factor than the idea that Germany and South Korea are somehow 10x-30x more effective in testing their population than Italy.
- sacred_numbers 7y ago
  I'm not sure about Germany, but South Korea was and is extremely effective at testing their population. They also did and are doing a fantastic job tracing infections (although part of this is due to being able to mostly focus on a single super-spreader rather than many simultaneous outbreaks. I think that South Korea probably confirmed 70-80% of their actual number of cases, while Italy probably has at least 2-3 actual cases for each confirmed case. Testing and tracing en masse is really, really hard, and is basically impossible if you don't catch it soon enough. I think that hospital overloading is definitely able to double or triple the death rate, though.
rramach 7y ago
John's analysis is cherry picking in many ways. Death rate in Diamond Princess is 1.1% today and 2% is listed as severe. Assuming 50% of severe make it, final fatality rate for the ship may end up closer to 2%. John then adds a 50% discount factor but it is not clear how he picked that number. Also, the 1% of population infected seems to be another number pulled out of a hat. If we are basing our figures based only on the ship with no other assumptions, we have to go with 20% infection rate. Thus, one reasonable estimate of risk from the ship data is 20%x2%x330M = 1.3M deaths if we wait for "evidence" and did nothing. Clearly, this argues for doing something! Edit: Also, Germany does not test dead folks for coronavirus while Italy does. Further, SK death rate has gone up to 1.3% (0.9% is an old number) and many more are in severe category. Thus, the sub 1% numbers seem more like the outliers than the above 1% numbers.
- ant6n 7y ago
  The Diamond Princess is also likely not a random sample of the population - they are healthy enough to be fit for travel.
  - giantDinosaur 7y ago
    You don't need to be particularly fit or healthy to go on a cruise. Yes, sure, you can't be on life support, but generally 'healthy enough' to travel on a cruise is exactly what I'd expect from any random sample of the overall population.
    - kgwgk 7y ago
      You may not understand what "random sample of the overall population" means if you would expect every single person in the sample to be healthy enough to travel on a cruise. Almost 1% of the population in the US has Alzheimer disease or other dementias, for example.
      - giantDinosaur 7y ago
        I noted exactly that in my comment. Yes, not all the population can go on a cruise. No, it's not like it's only the healthiest 20% of the population that can. If I randomly sampled the population I'd expect the majority to be capable of a cruise. What do you think cruises are like?
im3w1l 7y ago
> So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. There is a third possibility. False positive tests: Germany and South Korea may have less cases than they think they do.
- bmn__ 7y ago
  Prof. Drosten who developed the test says that cannot happen in practice. One would get a false positive result with SARS-1 (de facto extinct) and related coronavirus strains in Asian bats (that have not crossed into humans). Source: https://www.ndr.de/nachrichten/info/coronaskript132.pdf#3 https://www.ndr.de/nachrichten/info/coronaskript132.pdf#3
  - shawabawa3 7y ago
    > Prof. Drosten who developed the test says that cannot happen in practice. Obviously not true False positives are always possible in practice even if they aren't possible in theory Get a bunch of tired lab techs running tests 24/7 and one of them will accidentally write down the wrong result at some point
    - cycomanic 7y ago
      I would not consider that a false positive in the test, maybe in the procedure, but that's quite different. Moreover it is statistically irrelevant, that would maybe account for 1%, but only if they would only note false positives.
- rimliu 7y ago
  And the fourth: there were claims that only 12% Italy's COVID-19 deaths can be directly attributed to COVID-19.
  - easytiger 7y ago
    interesting. this sounds reasonable given its "deaths of people who tested +ve for cv19" and not "deaths of people from complications caused by cv19" Have you got a source?
bugzz 7y ago
Go check South Korea's numbers again. As their cases have resolved, death rate has steadily increased, and it's now at 1.33%. It will continue to rise. Same with Germany, it just takes time to die. South Korea had already found majority of their current cases 2-3 weeks ago, but deaths are only now picking up. Edit: now 1.37%, up again since I checked a couple hours ago. The same rise in death rate was observed way back when SARS happened. At first people estimated death rate at 2-3%, and it was continually revised upwards as cases resolved.
- nkohari 7y ago
  The opposite happened with H1N1 (swine flu) in 2009, though. The CFR was estimated to be significantly higher during the pandemic but afterwards was estimated at 0.02% with 60M American cases. [0] Policymakers should use conservative estimates to be careful, but we still just don't know how deadly COVID-19 is. [0] https://www.eurosurveillance.org/content/10.2807/ese.14.33.19309-en https://www.eurosurveillance.org/content/10.2807/ese.14.33.1...
  - jtbayly 7y ago
    That's a difference between IFR and CFR.
- marknutter 7y ago
  Unless they have a test that determines whether fully recovered people had it at some point, they are never going to get an accurate CFR.
philwelch 7y ago
Or Italy’s hospital system got overrun and people with survivable cases died for lack of treatment.
lazyjones 7y ago
> 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. Both could be true. For example, Germany doesn't systematically test dead old and/or hospitalized people for Coronavirus infections while Italy apparently does. Germany has more resources to test potentially infected people than Italy, where all resources are needed for treatment of the hospitalized cases. In reality, both Italy and Germany will have infections in the 100.000s, most of them with mild or no symptoms.
nopinsight 7y ago
0.3% & 0.9% are optimistic. South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases = ~1.3% today, gradually going up from ~0.5-0.6% a few weeks ago. Why? People in a functioning healthcare system take time to die and these people were infected during an expansion phase of spread which rapidly increases #cases (denominator). SK's cohort CFR is even higher. More properly, we should use the infection number from 3 weeks ago because it takes 3-4+ weeks from exposure to death: 120 deaths/4335 cases = ~2.8% Germany's current naive CFR at 0.4% will also rise in a similar manner for the same reasons. (You can bookmark this.) https://www.worldometers.info/coronavirus/country/south-korea/ https://www.worldometers.info/coronavirus/country/south-kore... https://www.worldometers.info/coronavirus/country/germany/ https://www.worldometers.info/coronavirus/country/germany/ South Korea has the 2nd highest number of hospital beds per capita in the world and 4 times the US number. Germany: 4th and almost 3 times. https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_countries_by_hospital_... South Korea's and Germany's hospitals were never overwhelmed in the same manner as Italy's. A major reason Italy's fatality number is so high is because doctors there cannot save everyone anymore.
- seppel 7y ago
  >South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases But the denominator in this formula strongly depends on who and how often you test. In other words: You don't know the number of cases. Obviously, people who are severely affected are tested more often. People with mild or no symptoms might never be tested, even if they want to (I'm not sure about South Korea but for sure this is happening in Germany). Based on people in the German parliament and the German soccer league, you can currently guestimate that 1% of the population is already infected (1% of the parliament and 1% of the premier league players are infected. I suspect that they are tested more often and even without symptoms. Maybe they have more contact to other people - maybe not). Yes, this is a wild guess, but much better than taking the confirmed cases which are heavily biased towards people where the infection causes problems.
  - nopinsight 7y ago
    Yes, all my figures above are Case Fatality Rate (CFR) and not Infection Fatality Rate (IFR), which includes people with mild or no symptoms. It's much harder to estimate the latter unless one conducts antibody tests on a sufficient sample of a population. South Korea's extensive testing program should bring their two figures closer than those of other countries. Credible estimates of IFR from noted epidemiologists I've seen are around 1%, assuming that the healthcare system still functions, and much higher otherwise. COVID-19's CFR & IFR might not even be the biggest problem. High rate of hospitalization and broken healthcare system, with all their ramifications, could be considered even worse.
rsynnott 7y ago
Italy is a very elderly population. If, as seems to be the case, death rate ramps up dramatically over 70 and especially over 80, then this may explain part of it (though clearly testing in Germany and SK has been more effective than in Italy, too).
Retric 7y ago
Deaths are not instantaneous, add exponential growth and it taking up to 9 weeks from infection to death and it’s really deceptive. All deaths tell you is how many people where infected weeks ago. Just look at the lag in China’s rate of infections vs deaths. They had 22 deaths on March 8th and 40 new infections. Further, new cases drops off vastly faster than infections with the sickest talking longer to get better and staying at risk of death for weeks.
34679 7y ago
I know this may sound ridiculous, but Kimchi and Sauerkraut? Are any other countries with a high consumption of low pH fermented foods also showing a lower CFR?

robocat 7y ago

> Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors? Exactly: why all this focus on deaths, when sickness rates are massive and are sure to have horrific long terms outcomes for more people than those that die. Intensive care strongly implies bad things are happening. John Ioannidis has been a fabulous force for good fighting scientific fraud and misinformation. But clearly he doesn’t know what effective decision making looks like. It usually doesn’t look very academic in my experience! edit: I mean decision making in an emergency (we did have two months to be proactive, but now we have a reactive emergency).

rimliu 7y ago
There is nothing "sure" about "horrific long terms outcomes".

ChrisCinelli 7y ago

I heard that in US if somebody dies and had pre-existing conditions the pre-existing condition is usually the official cause of death. So the person is not count. This has to be even more true with flu. If somebody had lung problems and the flu season makes things worse and she ends up dying, the doctors are not normally going to test for flu. And the cause of death is not going to be "flu". What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested. I have been trying to understand for a few days how the numbers are really counted for COVID-19. And again, it pretty clear that we do not have the real data for a "normal" flu either. So for now my understanding of how bad COVID-19 is compared to "standard" flu has been largely inconclusive. One thing though started getting clearer. COVID-19 is a virus with no vaccine. I have largely underestimate the importance of immunizations and being in a good health. Now I started to picture more and more that without a way to keep our immune system alert against the viruses, we will be greatly screwed almost every year because the demographic at risk would inondate the health care system in a way that they cannot cope.

acqq 7y ago
> What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested. In this case now, you don't need that: the hospitals in Italy know for years how many new cases they get. Now it's like 50 times more cases that need hospital, and 50 times more dead. It can't be anything but something completely new. If it's not a new virus X it must be a new virus Y as dangerous as X. But we know there is a new virus X. Old viruses simply had totally different need for hospitals: https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F_ENG.png https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F... In Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. The same with a need for the beds in the intensive care units.

deleted 7y ago

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Kye 7y ago

One possible outcome for survivors is losing up to 30% of their lung capacity.

sharken 7y ago
Keep in mind this number is just as certain as saying 5% at this time.

DiffEq 7y ago

From the CDC As of 24-Mar there have been 589 deaths of 46292 tested which is 1.27% Mortality Rate. Not 3% or 4% as was initially reported. The more we test, as the days go on, we see this is not nearly as deadly as we thought. This will continue to decline as we test more and probably be around Germany and Korea's < 0.5%