38 ms·

Current estimates about the Covid-19 fatality rate may be too high

84 points by nsainsbury 7y ago

ash 7y ago
Without paywall: http://archive.vn/cgCff http://archive.vn/cgCff
fl0wenol 7y ago
Not quite, but within a margin of error as described. Are you a glass half empty or half full person?
phenkdo 7y ago
There are some credible voices skeptical of the current doomsday predictions from Dr. Fauci et al, vis-a-vis the national quarantine. Unfortunately, this too has become a partisan political issue with dems for shutdown/quarantine, and republicans for opening up.
- willis936 7y ago
  It’s funny that the Republican plan involves the manslaughter of their voter base prior to the next election. https://en.wikipedia.org/wiki/Social_Darwinism https://en.wikipedia.org/wiki/Social_Darwinism
  - networkimprov 7y ago
    Unintended consequences strikes again. See also https://en.wikipedia.org/wiki/Gaia_hypothesis https://en.wikipedia.org/wiki/Gaia_hypothesis
  - smcl 7y ago
    Maybe not ha-ha funny but I agree it is really bizarre. I don't know if they believe they're immortal or if just hugely skeptical but it does seem to be flying in the face of reason to just assume it's not a big deal. If it does turn out to be devastating then those responsible won't face any consequences. When confronted with their weak response to the virus in any elections in the future the likes of Boris and Trump will counter that you're politicising the deaths of [thousands, hundreds of thousands, millions?] of citizens blah blah.
  - derekp7 7y ago
    The worst hit states are Democrat. Many of the Republican states have lower population density, therefore lower spread.
    - willis936 7y ago
      Age is a larger predictor of political party affiliation than location[1], and the CFR of covid-19 against age[2] means the deaths will disproportionately be republicans. Every elderly persons life is also worth more, on average, in terms of number of votes because the elderly vote more than the young[3]. An early end of self-isolation would be an unmitigated political disaster for the Republican party. These are statistics so simple that even politicians should be able to understand them. Edit: I would also like to add that it is very early days for covid-19. A significant percentage of the population will be infected at some point before November. How high of a percentage is inversely related to how long people self-isolate. The states that are barely hit at all today will the "worst hit states" tomorrow. 1. https://www.people-press.org/2018/03/20/1-trends-in-party-affiliation-among-demographic-groups/ https://www.people-press.org/2018/03/20/1-trends-in-party-af... 2. https://statmodeling.stat.columbia.edu/2020/03/07/coronavirus-age-specific-fatality-ratio-estimated-using-stan/ https://statmodeling.stat.columbia.edu/2020/03/07/coronaviru... 3. https://en.m.wikipedia.org/wiki/Voter_turnout_in_the_United_States_presidential_elections https://en.m.wikipedia.org/wiki/Voter_turnout_in_the_United_...
  - dang 7y ago
    Please don't take HN threads further into political or ideological flamewar. It leads to predictable, bad places. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
    - willis936 7y ago
      I genuinely disagree that this is a flamewar topic. I posted about a political party’s actions the same way I would post about any other organizations actions.
      - dang 7y ago
        I believe you, but what makes it a flamewar topic is how other people are going to react. The results will be predictably dismal. Actually you combined two flamewar topics there: a partisan one and an ideological one. This is a moderation issue because such flamewars aren't only off topic, but destroy the intellectual curiosity that HN exists for.
- hannob 7y ago
  The closest thing to a credible voice with a somewhat contrarian view I've seen is John Ioannidis [1]. His comment was a bit provocative, but ultimately the main thing he was asking for was proper studies to have better numbers for the real mortality rate. Which would be a study with a random sample of the population where you test everyone and then follow up for a while to see how they do. But asking for such a study is far away from the people asking to just let a few % of the population die because "it's for the economy". [1] 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...
- cycrutchfield 7y ago
  Name some of these "credible" voices. Thus far, most of the skeptical analyses seem to come from non-specialists and/or make some ridiculous assumptions that do not hold water.
  - phenkdo 7y ago
    The authors of the above article for example. Are you more qualified than them to dismiss them as "ridiculous"?
jkh1 7y ago
Related pieces by John PA Ioannidis: - Coronavirus disease 2019: the harms of exaggerated information and non‐evidence‐based measures[1] - A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data[2] There are two ways of getting the answer to the question: get relevant data to make reliable predictions (e.g. test for prevalence in the population) or run the experiment (which some governments seem prepared to do) 1- https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222 https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222 2- 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...
- fsh 7y ago
  One problem with this is that in the early stages of the spread you would have to run hundreds of thousands of tests daily in order to get statistically significant results. This is clearly impossible with the available lab infrastructure. And this is ignoring the possibility of getting false positives. Maybe it will be possible to get quantitative results with fast antibody tests in later stages, but at that point it is probably much too late to act.
- skat20phys 7y ago
  I have a lot of respect for Ioannidis's work, and kind of lean toward his perspective in some respects, but I think he's misrepresenting certain data and missing certain points. He's right to point to the Diamond Princess Cruise ship for example, but his statistics are already out of date. As of yesterday, 8/712 infected had died; if you expand this to the Grand Princesss, it/s 10/800, which is at 1.1-1.25% CFR. This is a lot bigger than the statistics Ioannadis cites, and greater than the flu. There are some issues about how to extrapolate the cruise ship population to other populations, but that isn't straightforward (cruise ship passengers are probably older on average, but also might be healthier and/or wealthier). In any event, that number can only increase. The other issue is that regardless of CFR in the population, the experiences of various locations points to the threat. That is, we can argue with Ioannadis all he wants about CFR and so forth, but in the end, if places are crumbling under the weight of hospital visits, it doesn't matter. As someone else pointed out, fatality rates are only part of the picture, and in this case it's important. At some level, it's not the the fatalities per se that are the sole problem, it's the much greater percent of cases that require hospital care. It's not like CFR is a fixed statistic that applies everywhere all the time anyway; it will depend on resources and other things. Finally, there's been a lot of discussion by Ioannadis and others about costs of restrictions and so forth but little data about that that's pointed to (even though it's available). For example, if you look into data about the Great Depression and Great Recession, it appears that overall there was a decrease in mortality that followed. Data on health effects of recessions is actually pretty clear: although there tends to be an increase in suicide and mental-health related deaths (e.g., drug overdoses), there's a much bigger decrease in deaths due to things like motor vehicle accidents, cardiovascular events, work-related deaths, and so forth. So this benefit-cost mortality analysis, as morbid as it is, doesn't necessarily play out in the way Ioannadis assumes.
justinclift 7y ago
> So if 100 million Americans ultimately get the disease, two million to four million could die. Seems to miss any mention that people who get sick - but don't die - seem to be having pretty severe (sometimes permanent looking) damage. Aka, they're only counting "deaths", when they should also be including other very serious negative consequences too. :(
- justinclift 7y ago
  On the other hand, and from a completely immoral point of view... would a lot of people with _long term_ illness from this provide a potentially significant extra revenue source for US drug makers?
  - deleted 7y ago
    [deleted]
  - H8crilA 7y ago
    Maybe, and also be a drag on the overall economy (by being unproductive). Why would you ever think that harming people could potentially be good for the economy? It makes absolutely no sense.
    - justinclift 7y ago
      Sorry, bad wording on my part. There is no way I'd ever think harming people could be good. For the economy, or otherwise. I'm just pointing out that some people over the years have presented a very cynical view of US drug company leadership, and the way they influence things for their personal benefit regardless of human cost. :( eg: Purdue Pharma (apparently owned by the "Sackler" family)" https://en.wikipedia.org/wiki/Purdue_Pharma#Controversy https://en.wikipedia.org/wiki/Purdue_Pharma#Controversy https://en.wikipedia.org/wiki/Sackler_family https://en.wikipedia.org/wiki/Sackler_family
- networkimprov 7y ago
  The numbers from Italy imply that <25% of the population is susceptible. They've done almost 300K tests as of this writing. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...
KaoruAoiShiho 7y ago
There's insufficient data to say whether the death rate is actually low or not. But this will be interesting to see play out politically, if the Republicans agree to open up and there is mass deaths as a result this could sink the party for decades.
- erikstarck 7y ago
  That will sink the _country_ for decades.
- meddlepal 7y ago
  It cuts both ways... if we open up and the death rate is tolerable then Democrats are going to be framed as panic raisers in an attempt to tank the economy for political gain. That could end the parties viability in a number of swing States where the battle is for working moderates.
  - KaoruAoiShiho 7y ago
    Don't agree, the political risk for dems is much lower. The deaths will still be substantial even if "tolerable".
    - tathougies 7y ago
      What number of deaths is substantial for a pandemic? In orders of magnitude? one thousand, ten thousand, a hundred thousand?
    - watwut 7y ago
      The more I watch American politics and how it plays out in relation to pandemic, actual outcome does not matter. People are willing to believe and hope for things that were already disproven in other coutries. Facts won't matter at all.
- benmmurphy 7y ago
  Even if opening up leads to massive deaths it can still be the correct thing to do. Here in the UK the NHS uses a system called QALYs which is approximately years of life saved to evaluate the effectiveness of NHS interventions. The NHS generally will only introduce new interventions if they $s per a QALY is low enough. The spectrum of options for dealing with the pandemic are a trade off and if the damage to the economy is high enough then even a high death rate might not justify a strong intervention. During the NHS's normal operations there are a bunch of interventions that NHS is not pursuing because the cost is higher than the marginal cost they are willing to spend for a QALY. The NHS is killing large numbers of people right now by not pursuing these interventions but everything is a tradeoff and stopping death is not an absolute.
rancidhell 7y ago
at this point who cares? we know that older people are at risk and do we really want to risk our parents/grandparents/neighbours health? it's not worth it. isolate yourself, clean your hands and face, and help fellow humans.
kator 7y ago
FTA "But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million." Meanwhile, https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/ shows Deaths: 19,603 I'm not an epidemiologist but how can we barely at the mid-point of the spread and say things like the above, while the hard facts already show we're at 20k deaths? While I agree the actual rates are hard to know until we have robust antibody assay in larger populations, it seems a bit hand-wavy to say "oh it's just not that bad, here look at these random samples we looked at it and it'll be ok."
- brobdingnagians 7y ago
  I believe they are talking about numbers in the context of the US population and arguing about magnitude of deaths in those terms. I agree that there is room to disagree, but it is best to interpret the argument in the context in which they are making it. Part of the reason they are doing it in the context of the US is because of the political and economic nature of the current measures, which are drawn along national lines, even though the total magnitude on the world ignores national lines.
- dredmorbius 7y ago
  The US alone could concievably see over 1 million deaths before the end of April: https://joindiaspora.com/posts/6b0f5a00507f013830be002590d8e506 https://joindiaspora.com/posts/6b0f5a00507f013830be002590d8e... The specific number based on a projection from 11 days' data on March 6 would exceed all deaths in all wars in all US history. The deaths projection specifically has run high (by about six days), though case counts remain surprisingly consistent with reported data. There are plenty of reasons to be cautious about the data and trends. And there's no necessary reason this possibility must come to pass. But if the US continues down the path it's chosen to date, that is what is in store.
  - H8crilA 7y ago
    I'm not sure why you're being downvoted, but the hard facts are that the volatility of the situation is very high - by that I mean that a large range of outcomes is possible. And the long tail is both possible and daunting.
sytelus 7y ago
TLDR; the article argues that the actual fatality rate is possibly 0.06% as opposed to 1-6% touted in media. The reasoning is based on estimating actual cases given confirmed cases. For example, in Italian town Vò, the entire population was tested to find a prevalence rate of 2.7%. Apply this to the whole province to estimate actual cases and then divide that by confirmed deaths. So assuming that unconfirmed cases mostly recovered without an event, the actual fatality rate goes down to 0.06%. Arguably, the author doesn't have a lot of other strong data to back this up. Also, this would imply that a large part of the infected population simply recovered without needing to possibly sick treatment. If this is true, however, it would mean we just had a 2 trillion dollar party :).
- vmilner 7y ago
  0.06% is hard to reconcile with 10 out of 712 cases on the Diamond Princess liner proving fatal.
  - sytelus 7y ago
    The cruise ship with a higher level of density and socialization than New York City is not really comparable with regular townships. Also, the cruise ship population is very biased towards the old population.
    - nutjob2 7y ago
      Density only affects the speed of spread. It largely[1] doesn't affect how many people will die. Over time everyone will get infected unless the virus is wiped out. [1] there is speculation that greater exposure to the virus may make some people sicker
  - whb07 7y ago
    I don't understand how the whole age thing doesn't make you think for a second your conclusion is a bit misguided. Can you elaborate how you think a population of average age ~60 handles any disease? For reference, a 70 yo has a 1.9% mortality. A 80 yo has 6% mortality rate according to actuarial tables.
wcoenen 7y ago
> Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. If we'd let this thing run its course, wouldn't almost all corona patients have to be refused in hospitals and instead die at home? Normal "triage" doesn't cut it. You'd basically paralyze normal health care for months, which would come with an additional death toll. This is already happening even with the lockdowns.
- jonathanstrange 7y ago
  Isn't normal triage designed to optimize the number of patients cured or some similar metric? How does that not "cut it"?
  - khafra 7y ago
    I believe he's saying that "improving triage" is like tuning the engine of your Civic before you run a quarter mile against a top fuel dragster. Technically speaking, it will help, a little. But to actually measure up to the challenge you'd need to completely replace the entire thing with something vastly more capable.
  - wcoenen 7y ago
    I'll try to clarify. The article argues that the death toll from covid-19 is low enough that it doesn't justify shutting down the economy. However, we've seen that hospitals will be overrun with covid-19 cases for a while even with a lockdown, so this would likely be worse without a lockdown. My point is then that, triage or not, there will effectively be no hospital service for a certain period. So you basically have to add the death toll of having no hospitals for a certain period. Avoiding this additional death toll requires refusing corona patients, not just triage. Perhaps the article was arguing that even with covid-19 deaths plus "health care paralysis" deaths, it's still not worth shutting down the economy. In that case my point is moot.
jonathanstrange 7y ago
tl;dr The case fatality rate is usually much higher than the real mortality rate. People and health professionals have pointed that out from the start and it should be hard to find anyone who doesn't know that by now. > A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. Sure, you can use expected utility theory to calculate that. What result you get depends a lot on the monetary value you attribute to a human live, or, if you think that's better, on the value of quality-adjusted life years (QUALYs). If you're particularly sociopathic you can also reverse-engineer the simple models used in order to find the value judgments that will give you the decision result you want. Just tweak the values for QUALYs, lower the estimates here and there, and the result is that it's better to save the economy (or vice versa, depending on what you want). Call me cynic, but I'm sure plenty of people around the world are doing that right now.
- makomk 7y ago
  People should understand that, but the media reporting has been absolutely atrocious. CNN even ran an article arguing that the reason not testing as widely was correlated with a higher reported fatality rate (as a percentage of cases) was because widespread testing reduced the fatality rate by simply reducing the number of people who got it, which is... not exactly the right conclusion, shall we say. It's not like there's been a shortage of folks who happily multiply the CFR figures by 60, 70, 80% of the entire population and present this as the inevitable death toll of, generally, the actions of the political party they oppose.
  - hcknwscommenter 7y ago
    "CNN even ran an article arguing that the reason not testing as widely was correlated with a higher reported fatality rate (as a percentage of cases) was because widespread testing reduced the fatality rate by simply reducing the number of people who got it, which is... not exactly the right conclusion, shall we say." It is a factor though, and not a minor one. You test widely enough and you can track, trace, and quarantine your way to containment or at least massively flatten the curve and thereby avoid overwhelming the medical system and spiking CFR. That is exactly what S. Korea did. You didn't link to the article, so it's hard to tell if you are just a troll or not. If the article stated that as a factor, it is not wrong at all. IF the article stated that as THE reason, well it's pretty misleading. Did the media mess up here? We shall never know I guess unless you can produce a link.
davedx 7y ago
The WSJ has a history of climate change denial too. They are 100% not a publication that follows science at all. You may also not be surprised to know they're owned by News Corp.
- jonstewart 7y ago
  In particular, this is in their Opinion section. WSJ News still has a great deal of credibility and integrity, though maybe center-right pro-business. The Opinion section, however, has long been divorced from reality; the joke is that it’s simply wishful thinking salve to corporate executives.
  - ardy42 7y ago
    > WSJ News still has a great deal of credibility and integrity, though maybe center-right pro-business. The Opinion section, however, has long been divorced from reality; the joke is that it’s simply wishful thinking salve to corporate executives. I'm soon to be a non-subscriber, but I might have kept my subscription longer if the WSJ app had a setting to suppress the opinion section. It's not even interesting, and I'm far from a doctrinaire left-liberal.
- Jgrubb 7y ago
  My dad is a life long WSJ reader, it's become the print version of Fox News.
- RickJWagner 7y ago
  I like to triangulate my news from several sources. RealClearPolitics is an excellent site, it provides the opposing views on issues from the right and from the left. Otherwise, you're in danger of just feeding your confirmation bias.
deleted 7y ago
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kasperni 7y ago
> the real fatality rate could in fact be closer to 0.06% If you take a look at Diamond Princess. ~ 4000 on board * 712 cases * 10 deaths Gives a case fatality rate of 1.4%. The average age onboard was ~60 years (don't know if it includes staff) which is definitely higher than average. However, the two numbers (1.4% and 0.06%) sounds very far apart.
- 101404 7y ago
  Conditions like obesity and diabetes seem to increase risk dramatically. Not just plain age.
  - me_me_me 7y ago
    ...and smoking is a big factor too.
- yodsanklai 7y ago
  As you say, the average age is high, which makes a big difference, but some people think there were more cases than the confirmed ones on the boat. That could explain the difference.
- whb07 7y ago
  Now imagine a population that was averaged in the 30's years. What do you imagine the death rate to be then? it wouldn't be half, as it scales non linearly the younger the person gets.
- simik 7y ago
  US population median age is 39. Fatality rate for people under 40 is <0.2%. Fatality rate of people aged 60+ is >3.6% [1] So, no, 1.4% and 0.06% sound about right given the age difference. [1] https://ourworldindata.org/coronavirus https://ourworldindata.org/coronavirus
  - fsh 7y ago
    It is impossible to calculate this from just the medians. John Ioannidis estimates a range of 0.025% to 0.625% by comparing the age distributions. However, there is so little data that any small systematic error could completely invalidate this.
s9w 7y ago
Somethng else I wonder about all this: Let's look at Germany and say we have about 10000 new cases per day with the current measures, including unknown infections and some handwaving. That's a lot of days until you reach a significant portion of the polulation (~80 million).
- danialtz 7y ago
  you're right if one assumes a linear growth, but the reality is that it has an exponential growth. See https://www.youtube.com/watch?v=Kas0tIxDvrg https://www.youtube.com/watch?v=Kas0tIxDvrg for a short intro.
  - tarruda 7y ago
    It only looks exponential at the beginning: https://voxeu.org/article/it-s-not-exponential-economist-s-view-epidemiological-curve https://voxeu.org/article/it-s-not-exponential-economist-s-v...
    - cycrutchfield 7y ago
      It certainly looks exponential until mitigation/suppression measures are put in place or you reach herd immunity. Guess which of the two will result in more deaths?
      - glofish 7y ago
        the problem with that approach is that treats everyone as equally susceptible most likely those more susceptible get it first it is not clear what percentage of the population would either not get it or if they do get not get noticeably affected
        cycrutchfield 7y ago
        I think Diamond Princess is a pretty good petri dish scenario for testing that hypothesis. In fact, although there are still some ongoing cases so the data is not finalized, you can normalize by passenger/crew age and reach a final infection fatality rate estimate for the whole population. Here's a tip: it still comes out to be 5-10x higher than the seasonal flu.
yodsanklai 7y ago
> We should undertake immediate steps to evaluate the empirical basis of the current lockdowns. I think there's not enough data available to evaluate if these lockdowns are justified. Especially the cost of the lockdowns are hard to assess. We won't know until it's over. But even if the mortality rate is vastly over-estimated, it will be hard for a leader to justify that their country has twice the mortality rate as the neighbor country (even this rate is low, and even it a lockdown was avoided). Besides, most countries are imposing a lockdown anyway, so "do like everybody else" is a safe bet for our leaders. Plus, the population asks for it.
op03 7y ago
Everything feels "deadly" in the hyper connected world. The hyperconnected world is like a baby's brain which is more connected than an adult. As learning happens connections are culled [1]. To the baby every new piece of info is mesmerizing or frightening. The brain hasn't yet understood how to process things, what to filter out, what to focus on etc With this new networked world/hive mind, reactions to every new event are much like the reactions of a Baby as it blunders about discovering a new world. https://www.edge.org/conversation/alison_gopnik-a-separate-kind-of-intelligence https://www.edge.org/conversation/alison_gopnik-a-separate-k...
- H8crilA 7y ago
  Are you just ignoring the basic fact that this thing can potentially compound on a daily basis with population being the only upper limit? Because that seems pretty easy to understand.
northsentinel 7y ago
Spain just recorded 738 deaths in a single day. We will certain know within a week of monitoring Spain and Italy as to who was right and who was wrong. It isn't something I would gamble on personally. I also don't see the act of a complete shut down as being more economically-damaging then a drawn out partial shutdown. Also, the other side of the equation is said to be perfect, but as was shown the other day, a lot of elderly people are left for dead in their homes or retirement villages and not reported. Also, I don't know if all deaths in hospitals are checked for coronavirus.
- DesiLurker 7y ago
  they just wanted to delay action until we are locked on the preferred course and they got it with testing screwups. more reaction time we burn in indecision easier it is to say its too late to do much.
Dwolb 7y ago
The conclusion of the article isn’t controversial but the logic is incomplete. Of course policy-makers should continuously evaluate whether or not shutting down a whole economy is worth it. Definitely we need better testing to understand the true number of infections. But you can’t completely disregard current human responses when a) the condition can be fatal (game over, there’s no retry) and b) the virus can leave behind long-lasting damage. In this case a purely quantitative argument based on fatality statistics feels myopic. For sure agreed we need to find ways of gathering more and accurate information.
ekidd 7y ago
They have a good point about missing data, but they're glossing over the fact the fatality rate goes up drastically if the medical system fails. I 100% agree that we should be running antibody tests to see how many people have caught COVID-19 and recovered. All of our testing until recently was based on RNA tests, which may only be positive during a relatively short window. (I saw a case study claiming that even some hospitalized patients are testing negative inside 7 days.) We need to know how many people catch this and beat it quickly. That said, even in populations that have been RNA-tested early and extensively (such as the Diamond Princess and South Korea), the number of completely asymptomatic cases is less than 50%. Using the most optimistic data, I personally have less than a 0.5% chance of dying assuming I get all the medical care I need. And that's the problem. This virus hospitalizes about 20% of identified cases. They require some supplemental oxygen, and maybe an IV. With good care, probably less than 1% die. So there are really two key fatality rates: 1. How many people die if they get all the care they need, and 2. How many people die if 30+% of the population catches this at the same time? Even if we're overestimating (1) by a factor of 10, that's still enough to make (2) catastrophic. What happened in Wuhan and Lombardy can happen here, and there's absolutely no reason that it couldn't get 10x worse. Even if we're overestimating the disease. So let's start testing aggressively for antibodies. Until we get that number, I'm all for extreme caution.
- baq 7y ago
  yes that's the key thing. it doesn't matter what the IFR (infection fatality rate, usually impossible to know exactly) is. what really matters is how many people will end up in hospitals at the same time in absolute terms. after the first wave passes, it is important to know how many people are now immune to plan lockdowns and health care capacity for the second and future waves - but this again isn't related to fatality rates, but hospitalization rates and true R0 (maybe there were much more people infected who didn't even know they had it than we think).
- downerending 7y ago
  > the fact the fatality rate goes up drastically if the medical system fails We all assume that this is so (and I hope it is), but this is not completely clear. It might be that for covid-19, help from the medical system doesn't matter much, given our current state of medical knowledge and care. And iatrogenic harm cannot be discounted. Certainly we cannot ethically run the experiment. As a single anecdatum, there was a (BBC?) piece on a hospital in the worst Italian region, showing a number of people on ventilators. The narrator explained that the staff was demoralized by the fact that everyone they had put on a ventilator died anyway.
deleted 7y ago
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lukasm 7y ago
Q: how accurate are the covid19 reported deaths? My guess is that they measure immune cells from blood (cytokine storm), but they can't know for sure if covid19 was they cause of death. It means we have an upper bound of deaths.
- watwut 7y ago
  Not necessary. People who die before being tested are not tested in many places.
- hcknwscommenter 7y ago
  None of the numbers you see from CDC, hopkins, etc. are guessing on deaths. They are only counting confirmed COVID deaths. It is possible this is a lower bound, but if any number right now is trustable right now, it's deaths.
jerome-jh 7y ago
Knowing the fatality rate requires knowing the number of people infected: we all know the figures we currently have are mostly a low estimate for a number of reasons already discussed at length. We must also know the number of fatalities, and this will only be known after the epidemic once we calculate the over-mortality compared to a normal year. So the current numbers are a low estimate too. In the end we can tell nothing about the fatality rate which is the ratio of those values. Hence governments make a guess and act accordingly. Only those who test large scale and isolate only positive people act rationally.
nodamage 7y ago
A few thoughts: 1) Extrapolating from the infection rates of very specific groups (for example, evacuees) to the entire population without taking into account transmission dynamics and the time between infection and detection does not make very much sense. The authors naively multiply the infection rate among evacuees by the population of Wuhan to conclude that Wuhan must have had 178,000 infections at the end of January. By comparison, epidemiological models have estimated there were around ~20,000 infections at that time [1][2][3]. What conclusion should we draw here? If you use sloppy, back of the napkin math to over-inflate the infection count by 10x then you can correspondingly deflate the mortality rate? 2) Speculating about the mortality rate of Covid-19 based on several gigantic assumptions ("If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%") seems borderline irresponsible. Numerous researchers have been modeling this virus and have generally arrived at numbers in the range of 0.5% to 1.6% [4][5][6][7][8][9]. The authors don't present any compelling reason why we should doubt those numbers. 3) Ultimately the mortality rate is not as important a number as the hospitalization rate. The authors would have you believe this virus is no worse than the flu, but this is not congruent with the number of reports coming out of places like Italy and New York saying they're about to run out of ICU beds, or China rushing to build temporary hospitals to house all of the patients that need critical care. What the mortality rate might be under ideal circumstances where every patient receives adequate medical care might be significantly different compared to a scenario where you've run out of ICU beds and have to start rationing ventilators. [1] https://www.mdpi.com/2077-0383/9/2/419/htm https://www.mdpi.com/2077-0383/9/2/419/htm [2] https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v2.full.pdf https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v... [3] https://www.mdpi.com/2077-0383/9/2/523/htm https://www.mdpi.com/2077-0383/9/2/523/htm [4] https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-severity-10-02-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s... [5] https://institutefordiseasemodeling.github.io/nCoV-public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html https://institutefordiseasemodeling.github.io/nCoV-public/an... [6] https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html https://cmmid.github.io/topics/covid19/severity/diamond_crui... [7] https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v... [8] https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v... [9] https://www.nature.com/articles/s41591-020-0822-7 https://www.nature.com/articles/s41591-020-0822-7
hprotagonist 7y ago
for the last time it’s not the death toll it’s the massive numbers of immunologically naive people of all ages who need advanced medical care all at once.
deleted 7y ago
[deleted]
julienchastang 7y ago
Is there any explanation as to why this thread is "flagged"? It seems like the original article and the discussion here are of good quality even if some of the ultimate conclusions maybe flawed.
- dang 7y ago
  Usually when there's an ongoing divisive story, follow-up posts get flagged by a coalition of (1) users who don't like the article because they favor the opposing view, and (2) users who are just fatigued by all the articles on the topic. In most cases the first group alone isn't enough to win the tug-of-war with upvotes. Moderators sometimes turn off flags when an article is good and the discussion seems able to be substantive (enough). That's arguably the case here, so we'll try overriding the flags. (This is not an endorsement of the article.)
erikdlarson 7y ago
Let's prove it. Go, go, go! Let's beat Iceland! We can do it. https://www.cloverpop.com/blog/we-need-a-covid-19-testing-moonshot https://www.cloverpop.com/blog/we-need-a-covid-19-testing-mo...
- erikdlarson 7y ago
  Or if we're really dreaming big, let's beat the Faeroe Islands. In the whole world, there are only two places that can reasonably claim to be taking a scientific approach to those aspects of this virus at this point: Iceland and the Faeroe Islands. Both have tested about 3% of their populations (that’s about 6X better than South Korea, 12X better than Italy, and 100X better than the US). Iceland is trying to test a representative population, although their testing is still skewed towards ill and exposed people. The Danes of the Faeroe Islands are tracing almost 100% of cases. We should still do testing of sick people to support healthcare decisions as we are today. We should do more testing of exposed people for containment like in South Korea and Germany. But that doesn't help much with the broader governmental and societal decisions we need to make. We must do more. Embrace the "and." No more "or." Since everything is moving so fast, just keep it bold and simple: Race For COVID-19 Truth -- Test 30 Million People In 30 Days.
charles_f 7y ago
Something I'm wondering about all this, if you look at the current and unprecedented almost worldwide policy of self isolation and distancing through the prism of unintended consequences, cobra effect, natural selection, and Spanish flu with deadly second wave (and corresponding deadlier strain), I'm wondering: aren't we creating a perfect ground to selecting the most durable and transmissible strain of the sars-cov2?
- eternauta3k 7y ago
  Yes, in the same sense that sterilizing with bleach selects for microbes which can survive bleach. But it's so hard to survive bleach that it's not a real concern.
whb07 7y ago
Why is this flagged? Can anyone or a mod enlighten me? dang?
- dang 7y ago
  https://news.ycombinator.com/item?id=22688861 https://news.ycombinator.com/item?id=22688861
deodorel 7y ago
Hello, just an info, in my hometown, Bucharest, population approx 3mil,they just announced they will test everyone. Some good data will come out if this.
- DesiLurker 7y ago
  they dont need to do that, they just need a random sampling to identify the percentage of spread. Now if you want to quarantine everyone who had it, its another story. my problem is that asymptomatic transmission will still get you.
- smallgovt 7y ago
  That's good to hear (that 100% testing will take place). Where can we follow up on the testing results and subsequent fatality statistics?
- deleted 7y ago
  [deleted]
neonate 7y ago
https://archive.md/j8FFk https://archive.md/j8FFk
altoidaltoid 7y ago
It has been horribly fascinating watching the (coordinated?) campaign to downplay either the fatality rate or just write off a percentage off the population dying as the "cost of doing business".
- meowface 7y ago
  People should care about the facts, whatever they may be. If the fatality rate really is lower than what was previously reported, it's a disservice to the public to not report that. These are objective data and statistics, if they're accurate and put in the proper context (e.g. grouped by ages and pre-existing conditions). The exchanging deaths vs. economic health thing is a subjective policy position, which is different, and doesn't necessarily change even if the fatality rate is lower than reported. If it still appears to be more contagious and more fatal than the flu, I think most people will continue to support the lockdowns.
  - hcknwscommenter 7y ago
    "If it still appears to be more contagious and more fatal than the flu" If? The amount of magical thinking required to still have some doubt about this is undefinable. Spain is converting ice-rinks into morgues to store the freaking bodies. NYC has run out of ventilators and the federal response is something like: NY could have had some at a good price in 2015.
    - meowface 7y ago
      I'm just speaking in a neutral way. As in "if it remains the case that...". Of course, I do think it is the case, and am not doubtful at all. It seems to be incontrovertible. I'm talking about how I expect the population to react based on their perception of the situation.
- GuB-42 7y ago
  Optimist: the fatality rate is lower than expected Pessimist: there are more cases than expected They both mean the same thing. And for now, it is pure speculation.
standardUser 7y ago
I don't see why people are obsessing over this. The pandemic is just beginning so we know we don't have the data we need yet to believe in firm numbers. It's just mental masturbation.
DesiLurker 7y ago
if its really so low then why are they scrambling to pass a 2T bailout package. just let it rip through the population because 'its just a flu bro' and it will be over in a month and a half. /s as I see it this is BS propaganda from WSJ to normalize whats coming next, push to open businesses.
- traden209 7y ago
  earnest answer: because even if it had a 0% fatality rate, the sheer number of people who would be out sick for a week at the same time would decimate the economy. The bailout package is probably not going to be enough.
  - DesiLurker 7y ago
    are you saying that everyone taking a 2 week pause would irreparably damage us economy, really? more like you will see a V shaped movement in stock market. the main problem right now is that there is a lot of fear and uncertainty in everybodys mind partly because of Italy & spain. and as cases mount that fear will only harden so regardless of whether there is a lock-down or not people wont go out an shop until a sizable portion of population is infected and recovered OR we determine with american data that CFR is indeed quite low (doesn't look like from hospital testing data & they wont do widespread tests). but regardless I do agree bailout package is not gonna be enough.
  - nutjob2 7y ago
    That is a reach. Although people stop spending the delayed demand will return once the danger has gone. People will want holidays and cars that they put off buying. Demand will produce jobs. Even businesses that failed will be replaced by new ones that satisfy new demand. This is different to something like 2008 where people no longer trusted financial and other institutions.
    - Gibbon1 7y ago
      I was thinking that too. We've normalized bad responses to finance driven recessions. Where trying to make the finance sector whole results in a half decade of lost ground for the real economy. This is more like pre-1970's recessions where the central banks squeeze the money supply for a couple of months. Or WWII mobilization. In each of those cases the economy came roaring right back due to pent up demand. We will get the worst of both worlds if our response to this is to either a) let it 'run it's course' or b) try to make the finance sector whole. The US is looking at both those options and the result will be catastrophic of they come to pass.
m0zg 7y ago
Re-posting the most informative visualization I have found on this topic so far: https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/ https://www.politico.com/interactives/2020/coronavirus-testi... See dramatic ramp-up in testing, and where the number of tests administered is significant, a reasonable approximation of the infection rate can be established. So the recent blow-out in NY was actually a good thing and it does not reflect the true daily infection rate: they just didn't know how many cases they had. They still don't in fact, asymptomatic cases don't get tests, and those who had the virus and now have immunity (of which Cuomo's advisors suspect there's at least 100K) can't be tested without the new serological test currently under development. The only reliable metric of severity remains the number of deaths, and until that gets into tens of thousands (i.e. exceeds that of flu), any panic is premature. We're not Italy. We're not Spain. The current level of response to this is unprecedented.
- wool_gather 7y ago
  Thank you! I've been wanting to see exactly this: tests administered vs. positives, over time. I've just been doing it in my head for my state by checking the health authority website.
  - m0zg 7y ago
    I wonder what happened to USDS? Does it still exist? A need for an "official" version of such a thing is pretty obvious, yet the CDC website is pretty much worse than nothing at all, because people go there, and whatever data they have is not only incomplete, it's also a few days behind. They also don't update it over the weekend, as far as I can tell.
    - wool_gather 7y ago
      The situation is not great, to be sure. Check out covidtracking.com, which is aggregating data from state health department sites. I think that's the best going at the moment.
- hcknwscommenter 7y ago
haltingproblem 7y ago
There are people who build and grok models (A) and people who build epidemiological models (B) and then people who built epidemiological models of infectious diseases (C). It is a common error for folks in set A to believe that they can understand models built by folks in set C. It is a subtle but serious error for folks in set B to believe they can understand models by set C e.g. John Katz of Yale who is a doctor focusing on diets and wrote a woefully misguided article in the NY Times. Roughly, I find the confounding factors about models about the current epidemic seem to the following: 1- 1% of the population severely affected etc. (see: Diamond Princess). What they fail to appreciate is that the Diamond Princess was an enclosed environment and the outbreak was controlled and limited to the population on board. In the general population, a virus with an R0 of 3 will infect 50,000+ people in 10 infection steps. 2- What most people miss is the collision of the 1% severity with the capacity of the medical system. This second-order effect is something hard to understand. 1% of the US is 3.6 million. Even if 10% of those cases turn up at the ER in the same year and occupy the beds for 2 weeks each it will be a disaster. 3- #1 and #2 interacts with life as usual demands on the health care system – accidents, heart attacks, strokes, etc. to create third order effects – more deaths as there are no beds and no personnel to deal with them. 4- PPE running short and causing infections amongst medical personnel leading to their quarantine, hospitalization or death (Wuhan, Italy, Spain) decimates their ranks and accentuates the stress on the health care system……. 20% of lost capacity translates to some fraction more deaths and more stress on the rest of the medical population. I am sure there are factors I have missed. We have seen many contrarian viewpoints. None of these contrarian thinkers make any concrete suggestions (Ionnadis, Katz, Friedman, Gillespie, Hanson) except making ominous predictions to how wrong we are and we need more data. Meanwhile ER doctors say this is the worst they have ever seen and bodies keep piling up. These contrarian thinkers provide no simulations of how saving the economy will lead to lesser deaths. Just hand waving and finger jabbing. The contrarians seem to think that the playbook to deal with the epidemic has been improvised. Or that this is something modelers are thinking up on the fly. These playbooks have existed for decades with very good understanding of the dynamics and were used during SARs, Ebola and heck even back during the Spanish Flu. What seems to be lacking was parameters specific to Covid-19. Its R0, CFR, co-morbidities, etc. The reason Taiwan, Korea and Singapore were able to act so decisively and fast was that they just dusted of the SARs playbook and knew almost exactly what to do. Taiwan enforced the first measures in early Jan. I will take the word of the viral epidemiologists over the contrarian's armchair speculations and continue to overreact. I recommend you should too.
haltingproblem 7y ago
Both the authors of this piece are not infectious disease epidemiologists. One (https://profiles.stanford.edu/eran-bendavid https://profiles.stanford.edu/eran-bendavid) is an infectious disease doctor who focuses on the effects of economics, politics, and the environment on health. The second (https://healthpolicy.fsi.stanford.edu/people/jay_bhattacharya https://healthpolicy.fsi.stanford.edu/people/jay_bhattachary...) focuses on "the constraints that vulnerable populations face in making decisions that affect their health status, as well as the effects of government policies and programs designed to benefit vulnerable populations. " This is not the time for folks to hit the pages of the WSJ to start developing their viral infectious disease modeling muscles. Imagine if you asked a compiler writer to start developing a commercial OS. These folks fundamentally do not understand viral growth models. Their article demonstrates their lack of understanding and they keep falling back to the normal models (pun intended) of epidemiology based on the usual statistical machinery. This is a common problem in this analysis. I made a more detailed comment further down that demonstrates the pitfalls of this thinking. (edits: grammar)
earonesty 7y ago
One of the biggest reasons the rate may be too high is the method of attribution. For example, in Italy, post-mortem testing of people who were origially presumed dead of other illnesses accounted for a large portion of testing. When it turned out they had COVID-19 at the time of death, the cause was attributed to COVID-19 regardless of comorbidities: https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho... In other words, many of those who died today would have died within the year. Many were already in and out of hospitals for serious diseases. So, not only is the IFR wildly unknown without serology tests. The CFR itself is also severely biased. Currently in the U.S. you cannot get tested unless you have severe, life-threatening illnesses. The fact that the U.S. has such a low CFR speaks very well of healthcare in the U.S.... considering the majority of those tested have severe symptoms.
imtringued 7y ago
Case fatality rate (CFR) is meaningless for the general public. A case is basically any person that went to the doctor and received the permission to get tested and eventually became a patient. Knowing the CFR for a disease is therefore very valuable for doctors because they know that x% of their patients may die. However, it is very possible that the vast majority of Covid-19 cases never become patients. This doesn't mean that the quarantine is pointless. Even if covid19 is as "harmless" as influenza, having two influenza type diseases is still worse than only having one.

84 points by nsainsbury 7y ago

ash 7y ago

Without paywall: http://archive.vn/cgCff http://archive.vn/cgCff

fl0wenol 7y ago

Not quite, but within a margin of error as described. Are you a glass half empty or half full person?

phenkdo 7y ago

There are some credible voices skeptical of the current doomsday predictions from Dr. Fauci et al, vis-a-vis the national quarantine. Unfortunately, this too has become a partisan political issue with dems for shutdown/quarantine, and republicans for opening up.

willis936 7y ago
It’s funny that the Republican plan involves the manslaughter of their voter base prior to the next election. https://en.wikipedia.org/wiki/Social_Darwinism https://en.wikipedia.org/wiki/Social_Darwinism
- networkimprov 7y ago
  Unintended consequences strikes again. See also https://en.wikipedia.org/wiki/Gaia_hypothesis https://en.wikipedia.org/wiki/Gaia_hypothesis
- smcl 7y ago
  Maybe not ha-ha funny but I agree it is really bizarre. I don't know if they believe they're immortal or if just hugely skeptical but it does seem to be flying in the face of reason to just assume it's not a big deal. If it does turn out to be devastating then those responsible won't face any consequences. When confronted with their weak response to the virus in any elections in the future the likes of Boris and Trump will counter that you're politicising the deaths of [thousands, hundreds of thousands, millions?] of citizens blah blah.
- derekp7 7y ago
  The worst hit states are Democrat. Many of the Republican states have lower population density, therefore lower spread.
  - willis936 7y ago
    Age is a larger predictor of political party affiliation than location[1], and the CFR of covid-19 against age[2] means the deaths will disproportionately be republicans. Every elderly persons life is also worth more, on average, in terms of number of votes because the elderly vote more than the young[3]. An early end of self-isolation would be an unmitigated political disaster for the Republican party. These are statistics so simple that even politicians should be able to understand them. Edit: I would also like to add that it is very early days for covid-19. A significant percentage of the population will be infected at some point before November. How high of a percentage is inversely related to how long people self-isolate. The states that are barely hit at all today will the "worst hit states" tomorrow. 1. https://www.people-press.org/2018/03/20/1-trends-in-party-affiliation-among-demographic-groups/ https://www.people-press.org/2018/03/20/1-trends-in-party-af... 2. https://statmodeling.stat.columbia.edu/2020/03/07/coronavirus-age-specific-fatality-ratio-estimated-using-stan/ https://statmodeling.stat.columbia.edu/2020/03/07/coronaviru... 3. https://en.m.wikipedia.org/wiki/Voter_turnout_in_the_United_States_presidential_elections https://en.m.wikipedia.org/wiki/Voter_turnout_in_the_United_...
- dang 7y ago
  Please don't take HN threads further into political or ideological flamewar. It leads to predictable, bad places. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
  - willis936 7y ago
    I genuinely disagree that this is a flamewar topic. I posted about a political party’s actions the same way I would post about any other organizations actions.
    - dang 7y ago
      I believe you, but what makes it a flamewar topic is how other people are going to react. The results will be predictably dismal. Actually you combined two flamewar topics there: a partisan one and an ideological one. This is a moderation issue because such flamewars aren't only off topic, but destroy the intellectual curiosity that HN exists for.
hannob 7y ago
The closest thing to a credible voice with a somewhat contrarian view I've seen is John Ioannidis [1]. His comment was a bit provocative, but ultimately the main thing he was asking for was proper studies to have better numbers for the real mortality rate. Which would be a study with a random sample of the population where you test everyone and then follow up for a while to see how they do. But asking for such a study is far away from the people asking to just let a few % of the population die because "it's for the economy". [1] 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...
cycrutchfield 7y ago
Name some of these "credible" voices. Thus far, most of the skeptical analyses seem to come from non-specialists and/or make some ridiculous assumptions that do not hold water.
- phenkdo 7y ago
  The authors of the above article for example. Are you more qualified than them to dismiss them as "ridiculous"?

jkh1 7y ago

Related pieces by John PA Ioannidis: - Coronavirus disease 2019: the harms of exaggerated information and non‐evidence‐based measures[1] - A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data[2] There are two ways of getting the answer to the question: get relevant data to make reliable predictions (e.g. test for prevalence in the population) or run the experiment (which some governments seem prepared to do) 1- https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222 https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222 2- 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...

fsh 7y ago
One problem with this is that in the early stages of the spread you would have to run hundreds of thousands of tests daily in order to get statistically significant results. This is clearly impossible with the available lab infrastructure. And this is ignoring the possibility of getting false positives. Maybe it will be possible to get quantitative results with fast antibody tests in later stages, but at that point it is probably much too late to act.
skat20phys 7y ago
I have a lot of respect for Ioannidis's work, and kind of lean toward his perspective in some respects, but I think he's misrepresenting certain data and missing certain points. He's right to point to the Diamond Princess Cruise ship for example, but his statistics are already out of date. As of yesterday, 8/712 infected had died; if you expand this to the Grand Princesss, it/s 10/800, which is at 1.1-1.25% CFR. This is a lot bigger than the statistics Ioannadis cites, and greater than the flu. There are some issues about how to extrapolate the cruise ship population to other populations, but that isn't straightforward (cruise ship passengers are probably older on average, but also might be healthier and/or wealthier). In any event, that number can only increase. The other issue is that regardless of CFR in the population, the experiences of various locations points to the threat. That is, we can argue with Ioannadis all he wants about CFR and so forth, but in the end, if places are crumbling under the weight of hospital visits, it doesn't matter. As someone else pointed out, fatality rates are only part of the picture, and in this case it's important. At some level, it's not the the fatalities per se that are the sole problem, it's the much greater percent of cases that require hospital care. It's not like CFR is a fixed statistic that applies everywhere all the time anyway; it will depend on resources and other things. Finally, there's been a lot of discussion by Ioannadis and others about costs of restrictions and so forth but little data about that that's pointed to (even though it's available). For example, if you look into data about the Great Depression and Great Recession, it appears that overall there was a decrease in mortality that followed. Data on health effects of recessions is actually pretty clear: although there tends to be an increase in suicide and mental-health related deaths (e.g., drug overdoses), there's a much bigger decrease in deaths due to things like motor vehicle accidents, cardiovascular events, work-related deaths, and so forth. So this benefit-cost mortality analysis, as morbid as it is, doesn't necessarily play out in the way Ioannadis assumes.

justinclift 7y ago

> So if 100 million Americans ultimately get the disease, two million to four million could die. Seems to miss any mention that people who get sick - but don't die - seem to be having pretty severe (sometimes permanent looking) damage. Aka, they're only counting "deaths", when they should also be including other very serious negative consequences too. :(

justinclift 7y ago
On the other hand, and from a completely immoral point of view... would a lot of people with _long term_ illness from this provide a potentially significant extra revenue source for US drug makers?
- deleted 7y ago
  [deleted]
- H8crilA 7y ago
  Maybe, and also be a drag on the overall economy (by being unproductive). Why would you ever think that harming people could potentially be good for the economy? It makes absolutely no sense.
  - justinclift 7y ago
    Sorry, bad wording on my part. There is no way I'd ever think harming people could be good. For the economy, or otherwise. I'm just pointing out that some people over the years have presented a very cynical view of US drug company leadership, and the way they influence things for their personal benefit regardless of human cost. :( eg: Purdue Pharma (apparently owned by the "Sackler" family)" https://en.wikipedia.org/wiki/Purdue_Pharma#Controversy https://en.wikipedia.org/wiki/Purdue_Pharma#Controversy https://en.wikipedia.org/wiki/Sackler_family https://en.wikipedia.org/wiki/Sackler_family
networkimprov 7y ago
The numbers from Italy imply that <25% of the population is susceptible. They've done almost 300K tests as of this writing. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

KaoruAoiShiho 7y ago

There's insufficient data to say whether the death rate is actually low or not. But this will be interesting to see play out politically, if the Republicans agree to open up and there is mass deaths as a result this could sink the party for decades.

erikstarck 7y ago
That will sink the _country_ for decades.
meddlepal 7y ago
It cuts both ways... if we open up and the death rate is tolerable then Democrats are going to be framed as panic raisers in an attempt to tank the economy for political gain. That could end the parties viability in a number of swing States where the battle is for working moderates.
- KaoruAoiShiho 7y ago
  Don't agree, the political risk for dems is much lower. The deaths will still be substantial even if "tolerable".
  - tathougies 7y ago
    What number of deaths is substantial for a pandemic? In orders of magnitude? one thousand, ten thousand, a hundred thousand?
  - watwut 7y ago
    The more I watch American politics and how it plays out in relation to pandemic, actual outcome does not matter. People are willing to believe and hope for things that were already disproven in other coutries. Facts won't matter at all.
benmmurphy 7y ago
Even if opening up leads to massive deaths it can still be the correct thing to do. Here in the UK the NHS uses a system called QALYs which is approximately years of life saved to evaluate the effectiveness of NHS interventions. The NHS generally will only introduce new interventions if they $s per a QALY is low enough. The spectrum of options for dealing with the pandemic are a trade off and if the damage to the economy is high enough then even a high death rate might not justify a strong intervention. During the NHS's normal operations there are a bunch of interventions that NHS is not pursuing because the cost is higher than the marginal cost they are willing to spend for a QALY. The NHS is killing large numbers of people right now by not pursuing these interventions but everything is a tradeoff and stopping death is not an absolute.

rancidhell 7y ago

at this point who cares? we know that older people are at risk and do we really want to risk our parents/grandparents/neighbours health? it's not worth it. isolate yourself, clean your hands and face, and help fellow humans.

kator 7y ago

FTA "But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million." Meanwhile, https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/ shows Deaths: 19,603 I'm not an epidemiologist but how can we barely at the mid-point of the spread and say things like the above, while the hard facts already show we're at 20k deaths? While I agree the actual rates are hard to know until we have robust antibody assay in larger populations, it seems a bit hand-wavy to say "oh it's just not that bad, here look at these random samples we looked at it and it'll be ok."

brobdingnagians 7y ago
I believe they are talking about numbers in the context of the US population and arguing about magnitude of deaths in those terms. I agree that there is room to disagree, but it is best to interpret the argument in the context in which they are making it. Part of the reason they are doing it in the context of the US is because of the political and economic nature of the current measures, which are drawn along national lines, even though the total magnitude on the world ignores national lines.
dredmorbius 7y ago
The US alone could concievably see over 1 million deaths before the end of April: https://joindiaspora.com/posts/6b0f5a00507f013830be002590d8e506 https://joindiaspora.com/posts/6b0f5a00507f013830be002590d8e... The specific number based on a projection from 11 days' data on March 6 would exceed all deaths in all wars in all US history. The deaths projection specifically has run high (by about six days), though case counts remain surprisingly consistent with reported data. There are plenty of reasons to be cautious about the data and trends. And there's no necessary reason this possibility must come to pass. But if the US continues down the path it's chosen to date, that is what is in store.
- H8crilA 7y ago
  I'm not sure why you're being downvoted, but the hard facts are that the volatility of the situation is very high - by that I mean that a large range of outcomes is possible. And the long tail is both possible and daunting.

sytelus 7y ago

TLDR; the article argues that the actual fatality rate is possibly 0.06% as opposed to 1-6% touted in media. The reasoning is based on estimating actual cases given confirmed cases. For example, in Italian town Vò, the entire population was tested to find a prevalence rate of 2.7%. Apply this to the whole province to estimate actual cases and then divide that by confirmed deaths. So assuming that unconfirmed cases mostly recovered without an event, the actual fatality rate goes down to 0.06%. Arguably, the author doesn't have a lot of other strong data to back this up. Also, this would imply that a large part of the infected population simply recovered without needing to possibly sick treatment. If this is true, however, it would mean we just had a 2 trillion dollar party :).

vmilner 7y ago
0.06% is hard to reconcile with 10 out of 712 cases on the Diamond Princess liner proving fatal.
- sytelus 7y ago
  The cruise ship with a higher level of density and socialization than New York City is not really comparable with regular townships. Also, the cruise ship population is very biased towards the old population.
  - nutjob2 7y ago
    Density only affects the speed of spread. It largely[1] doesn't affect how many people will die. Over time everyone will get infected unless the virus is wiped out. [1] there is speculation that greater exposure to the virus may make some people sicker
- whb07 7y ago
  I don't understand how the whole age thing doesn't make you think for a second your conclusion is a bit misguided. Can you elaborate how you think a population of average age ~60 handles any disease? For reference, a 70 yo has a 1.9% mortality. A 80 yo has 6% mortality rate according to actuarial tables.

wcoenen 7y ago

> Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. If we'd let this thing run its course, wouldn't almost all corona patients have to be refused in hospitals and instead die at home? Normal "triage" doesn't cut it. You'd basically paralyze normal health care for months, which would come with an additional death toll. This is already happening even with the lockdowns.

jonathanstrange 7y ago
Isn't normal triage designed to optimize the number of patients cured or some similar metric? How does that not "cut it"?
- khafra 7y ago
  I believe he's saying that "improving triage" is like tuning the engine of your Civic before you run a quarter mile against a top fuel dragster. Technically speaking, it will help, a little. But to actually measure up to the challenge you'd need to completely replace the entire thing with something vastly more capable.
- wcoenen 7y ago
  I'll try to clarify. The article argues that the death toll from covid-19 is low enough that it doesn't justify shutting down the economy. However, we've seen that hospitals will be overrun with covid-19 cases for a while even with a lockdown, so this would likely be worse without a lockdown. My point is then that, triage or not, there will effectively be no hospital service for a certain period. So you basically have to add the death toll of having no hospitals for a certain period. Avoiding this additional death toll requires refusing corona patients, not just triage. Perhaps the article was arguing that even with covid-19 deaths plus "health care paralysis" deaths, it's still not worth shutting down the economy. In that case my point is moot.

jonathanstrange 7y ago

tl;dr The case fatality rate is usually much higher than the real mortality rate. People and health professionals have pointed that out from the start and it should be hard to find anyone who doesn't know that by now. > A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. Sure, you can use expected utility theory to calculate that. What result you get depends a lot on the monetary value you attribute to a human live, or, if you think that's better, on the value of quality-adjusted life years (QUALYs). If you're particularly sociopathic you can also reverse-engineer the simple models used in order to find the value judgments that will give you the decision result you want. Just tweak the values for QUALYs, lower the estimates here and there, and the result is that it's better to save the economy (or vice versa, depending on what you want). Call me cynic, but I'm sure plenty of people around the world are doing that right now.

makomk 7y ago
People should understand that, but the media reporting has been absolutely atrocious. CNN even ran an article arguing that the reason not testing as widely was correlated with a higher reported fatality rate (as a percentage of cases) was because widespread testing reduced the fatality rate by simply reducing the number of people who got it, which is... not exactly the right conclusion, shall we say. It's not like there's been a shortage of folks who happily multiply the CFR figures by 60, 70, 80% of the entire population and present this as the inevitable death toll of, generally, the actions of the political party they oppose.
- hcknwscommenter 7y ago
  "CNN even ran an article arguing that the reason not testing as widely was correlated with a higher reported fatality rate (as a percentage of cases) was because widespread testing reduced the fatality rate by simply reducing the number of people who got it, which is... not exactly the right conclusion, shall we say." It is a factor though, and not a minor one. You test widely enough and you can track, trace, and quarantine your way to containment or at least massively flatten the curve and thereby avoid overwhelming the medical system and spiking CFR. That is exactly what S. Korea did. You didn't link to the article, so it's hard to tell if you are just a troll or not. If the article stated that as a factor, it is not wrong at all. IF the article stated that as THE reason, well it's pretty misleading. Did the media mess up here? We shall never know I guess unless you can produce a link.

davedx 7y ago

The WSJ has a history of climate change denial too. They are 100% not a publication that follows science at all. You may also not be surprised to know they're owned by News Corp.

jonstewart 7y ago
In particular, this is in their Opinion section. WSJ News still has a great deal of credibility and integrity, though maybe center-right pro-business. The Opinion section, however, has long been divorced from reality; the joke is that it’s simply wishful thinking salve to corporate executives.
- ardy42 7y ago
  > WSJ News still has a great deal of credibility and integrity, though maybe center-right pro-business. The Opinion section, however, has long been divorced from reality; the joke is that it’s simply wishful thinking salve to corporate executives. I'm soon to be a non-subscriber, but I might have kept my subscription longer if the WSJ app had a setting to suppress the opinion section. It's not even interesting, and I'm far from a doctrinaire left-liberal.
Jgrubb 7y ago
My dad is a life long WSJ reader, it's become the print version of Fox News.
RickJWagner 7y ago
I like to triangulate my news from several sources. RealClearPolitics is an excellent site, it provides the opposing views on issues from the right and from the left. Otherwise, you're in danger of just feeding your confirmation bias.

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kasperni 7y ago

> the real fatality rate could in fact be closer to 0.06% If you take a look at Diamond Princess. ~ 4000 on board * 712 cases * 10 deaths Gives a case fatality rate of 1.4%. The average age onboard was ~60 years (don't know if it includes staff) which is definitely higher than average. However, the two numbers (1.4% and 0.06%) sounds very far apart.

101404 7y ago
Conditions like obesity and diabetes seem to increase risk dramatically. Not just plain age.
- me_me_me 7y ago
  ...and smoking is a big factor too.
yodsanklai 7y ago
As you say, the average age is high, which makes a big difference, but some people think there were more cases than the confirmed ones on the boat. That could explain the difference.
whb07 7y ago
Now imagine a population that was averaged in the 30's years. What do you imagine the death rate to be then? it wouldn't be half, as it scales non linearly the younger the person gets.
simik 7y ago
US population median age is 39. Fatality rate for people under 40 is <0.2%. Fatality rate of people aged 60+ is >3.6% [1] So, no, 1.4% and 0.06% sound about right given the age difference. [1] https://ourworldindata.org/coronavirus https://ourworldindata.org/coronavirus
- fsh 7y ago
  It is impossible to calculate this from just the medians. John Ioannidis estimates a range of 0.025% to 0.625% by comparing the age distributions. However, there is so little data that any small systematic error could completely invalidate this.

s9w 7y ago

Somethng else I wonder about all this: Let's look at Germany and say we have about 10000 new cases per day with the current measures, including unknown infections and some handwaving. That's a lot of days until you reach a significant portion of the polulation (~80 million).

danialtz 7y ago
you're right if one assumes a linear growth, but the reality is that it has an exponential growth. See https://www.youtube.com/watch?v=Kas0tIxDvrg https://www.youtube.com/watch?v=Kas0tIxDvrg for a short intro.
- tarruda 7y ago
  It only looks exponential at the beginning: https://voxeu.org/article/it-s-not-exponential-economist-s-view-epidemiological-curve https://voxeu.org/article/it-s-not-exponential-economist-s-v...
  - cycrutchfield 7y ago
    It certainly looks exponential until mitigation/suppression measures are put in place or you reach herd immunity. Guess which of the two will result in more deaths?
    - glofish 7y ago
      the problem with that approach is that treats everyone as equally susceptible most likely those more susceptible get it first it is not clear what percentage of the population would either not get it or if they do get not get noticeably affected
      - cycrutchfield 7y ago
        I think Diamond Princess is a pretty good petri dish scenario for testing that hypothesis. In fact, although there are still some ongoing cases so the data is not finalized, you can normalize by passenger/crew age and reach a final infection fatality rate estimate for the whole population. Here's a tip: it still comes out to be 5-10x higher than the seasonal flu.

yodsanklai 7y ago

> We should undertake immediate steps to evaluate the empirical basis of the current lockdowns. I think there's not enough data available to evaluate if these lockdowns are justified. Especially the cost of the lockdowns are hard to assess. We won't know until it's over. But even if the mortality rate is vastly over-estimated, it will be hard for a leader to justify that their country has twice the mortality rate as the neighbor country (even this rate is low, and even it a lockdown was avoided). Besides, most countries are imposing a lockdown anyway, so "do like everybody else" is a safe bet for our leaders. Plus, the population asks for it.

op03 7y ago

Everything feels "deadly" in the hyper connected world. The hyperconnected world is like a baby's brain which is more connected than an adult. As learning happens connections are culled [1]. To the baby every new piece of info is mesmerizing or frightening. The brain hasn't yet understood how to process things, what to filter out, what to focus on etc With this new networked world/hive mind, reactions to every new event are much like the reactions of a Baby as it blunders about discovering a new world. https://www.edge.org/conversation/alison_gopnik-a-separate-kind-of-intelligence https://www.edge.org/conversation/alison_gopnik-a-separate-k...

H8crilA 7y ago
Are you just ignoring the basic fact that this thing can potentially compound on a daily basis with population being the only upper limit? Because that seems pretty easy to understand.

northsentinel 7y ago

Spain just recorded 738 deaths in a single day. We will certain know within a week of monitoring Spain and Italy as to who was right and who was wrong. It isn't something I would gamble on personally. I also don't see the act of a complete shut down as being more economically-damaging then a drawn out partial shutdown. Also, the other side of the equation is said to be perfect, but as was shown the other day, a lot of elderly people are left for dead in their homes or retirement villages and not reported. Also, I don't know if all deaths in hospitals are checked for coronavirus.

DesiLurker 7y ago
they just wanted to delay action until we are locked on the preferred course and they got it with testing screwups. more reaction time we burn in indecision easier it is to say its too late to do much.

Dwolb 7y ago

The conclusion of the article isn’t controversial but the logic is incomplete. Of course policy-makers should continuously evaluate whether or not shutting down a whole economy is worth it. Definitely we need better testing to understand the true number of infections. But you can’t completely disregard current human responses when a) the condition can be fatal (game over, there’s no retry) and b) the virus can leave behind long-lasting damage. In this case a purely quantitative argument based on fatality statistics feels myopic. For sure agreed we need to find ways of gathering more and accurate information.

ekidd 7y ago

They have a good point about missing data, but they're glossing over the fact the fatality rate goes up drastically if the medical system fails. I 100% agree that we should be running antibody tests to see how many people have caught COVID-19 and recovered. All of our testing until recently was based on RNA tests, which may only be positive during a relatively short window. (I saw a case study claiming that even some hospitalized patients are testing negative inside 7 days.) We need to know how many people catch this and beat it quickly. That said, even in populations that have been RNA-tested early and extensively (such as the Diamond Princess and South Korea), the number of completely asymptomatic cases is less than 50%. Using the most optimistic data, I personally have less than a 0.5% chance of dying assuming I get all the medical care I need. And that's the problem. This virus hospitalizes about 20% of identified cases. They require some supplemental oxygen, and maybe an IV. With good care, probably less than 1% die. So there are really two key fatality rates: 1. How many people die if they get all the care they need, and 2. How many people die if 30+% of the population catches this at the same time? Even if we're overestimating (1) by a factor of 10, that's still enough to make (2) catastrophic. What happened in Wuhan and Lombardy can happen here, and there's absolutely no reason that it couldn't get 10x worse. Even if we're overestimating the disease. So let's start testing aggressively for antibodies. Until we get that number, I'm all for extreme caution.

baq 7y ago
yes that's the key thing. it doesn't matter what the IFR (infection fatality rate, usually impossible to know exactly) is. what really matters is how many people will end up in hospitals at the same time in absolute terms. after the first wave passes, it is important to know how many people are now immune to plan lockdowns and health care capacity for the second and future waves - but this again isn't related to fatality rates, but hospitalization rates and true R0 (maybe there were much more people infected who didn't even know they had it than we think).
downerending 7y ago
> the fact the fatality rate goes up drastically if the medical system fails We all assume that this is so (and I hope it is), but this is not completely clear. It might be that for covid-19, help from the medical system doesn't matter much, given our current state of medical knowledge and care. And iatrogenic harm cannot be discounted. Certainly we cannot ethically run the experiment. As a single anecdatum, there was a (BBC?) piece on a hospital in the worst Italian region, showing a number of people on ventilators. The narrator explained that the staff was demoralized by the fact that everyone they had put on a ventilator died anyway.

deleted 7y ago

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lukasm 7y ago

Q: how accurate are the covid19 reported deaths? My guess is that they measure immune cells from blood (cytokine storm), but they can't know for sure if covid19 was they cause of death. It means we have an upper bound of deaths.

watwut 7y ago
Not necessary. People who die before being tested are not tested in many places.
hcknwscommenter 7y ago
None of the numbers you see from CDC, hopkins, etc. are guessing on deaths. They are only counting confirmed COVID deaths. It is possible this is a lower bound, but if any number right now is trustable right now, it's deaths.

jerome-jh 7y ago

Knowing the fatality rate requires knowing the number of people infected: we all know the figures we currently have are mostly a low estimate for a number of reasons already discussed at length. We must also know the number of fatalities, and this will only be known after the epidemic once we calculate the over-mortality compared to a normal year. So the current numbers are a low estimate too. In the end we can tell nothing about the fatality rate which is the ratio of those values. Hence governments make a guess and act accordingly. Only those who test large scale and isolate only positive people act rationally.

nodamage 7y ago

A few thoughts: 1) Extrapolating from the infection rates of very specific groups (for example, evacuees) to the entire population without taking into account transmission dynamics and the time between infection and detection does not make very much sense. The authors naively multiply the infection rate among evacuees by the population of Wuhan to conclude that Wuhan must have had 178,000 infections at the end of January. By comparison, epidemiological models have estimated there were around ~20,000 infections at that time [1][2][3]. What conclusion should we draw here? If you use sloppy, back of the napkin math to over-inflate the infection count by 10x then you can correspondingly deflate the mortality rate? 2) Speculating about the mortality rate of Covid-19 based on several gigantic assumptions ("If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%") seems borderline irresponsible. Numerous researchers have been modeling this virus and have generally arrived at numbers in the range of 0.5% to 1.6% [4][5][6][7][8][9]. The authors don't present any compelling reason why we should doubt those numbers. 3) Ultimately the mortality rate is not as important a number as the hospitalization rate. The authors would have you believe this virus is no worse than the flu, but this is not congruent with the number of reports coming out of places like Italy and New York saying they're about to run out of ICU beds, or China rushing to build temporary hospitals to house all of the patients that need critical care. What the mortality rate might be under ideal circumstances where every patient receives adequate medical care might be significantly different compared to a scenario where you've run out of ICU beds and have to start rationing ventilators. [1] https://www.mdpi.com/2077-0383/9/2/419/htm https://www.mdpi.com/2077-0383/9/2/419/htm [2] https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v2.full.pdf https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v... [3] https://www.mdpi.com/2077-0383/9/2/523/htm https://www.mdpi.com/2077-0383/9/2/523/htm [4] https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-severity-10-02-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s... [5] https://institutefordiseasemodeling.github.io/nCoV-public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html https://institutefordiseasemodeling.github.io/nCoV-public/an... [6] https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html https://cmmid.github.io/topics/covid19/severity/diamond_crui... [7] https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v... [8] https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v... [9] https://www.nature.com/articles/s41591-020-0822-7 https://www.nature.com/articles/s41591-020-0822-7

hprotagonist 7y ago

for the last time it’s not the death toll it’s the massive numbers of immunologically naive people of all ages who need advanced medical care all at once.

deleted 7y ago

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julienchastang 7y ago

Is there any explanation as to why this thread is "flagged"? It seems like the original article and the discussion here are of good quality even if some of the ultimate conclusions maybe flawed.

dang 7y ago
Usually when there's an ongoing divisive story, follow-up posts get flagged by a coalition of (1) users who don't like the article because they favor the opposing view, and (2) users who are just fatigued by all the articles on the topic. In most cases the first group alone isn't enough to win the tug-of-war with upvotes. Moderators sometimes turn off flags when an article is good and the discussion seems able to be substantive (enough). That's arguably the case here, so we'll try overriding the flags. (This is not an endorsement of the article.)

erikdlarson 7y ago

Let's prove it. Go, go, go! Let's beat Iceland! We can do it. https://www.cloverpop.com/blog/we-need-a-covid-19-testing-moonshot https://www.cloverpop.com/blog/we-need-a-covid-19-testing-mo...

erikdlarson 7y ago
Or if we're really dreaming big, let's beat the Faeroe Islands. In the whole world, there are only two places that can reasonably claim to be taking a scientific approach to those aspects of this virus at this point: Iceland and the Faeroe Islands. Both have tested about 3% of their populations (that’s about 6X better than South Korea, 12X better than Italy, and 100X better than the US). Iceland is trying to test a representative population, although their testing is still skewed towards ill and exposed people. The Danes of the Faeroe Islands are tracing almost 100% of cases. We should still do testing of sick people to support healthcare decisions as we are today. We should do more testing of exposed people for containment like in South Korea and Germany. But that doesn't help much with the broader governmental and societal decisions we need to make. We must do more. Embrace the "and." No more "or." Since everything is moving so fast, just keep it bold and simple: Race For COVID-19 Truth -- Test 30 Million People In 30 Days.

charles_f 7y ago

Something I'm wondering about all this, if you look at the current and unprecedented almost worldwide policy of self isolation and distancing through the prism of unintended consequences, cobra effect, natural selection, and Spanish flu with deadly second wave (and corresponding deadlier strain), I'm wondering: aren't we creating a perfect ground to selecting the most durable and transmissible strain of the sars-cov2?

eternauta3k 7y ago
Yes, in the same sense that sterilizing with bleach selects for microbes which can survive bleach. But it's so hard to survive bleach that it's not a real concern.

whb07 7y ago

Why is this flagged? Can anyone or a mod enlighten me? dang?

dang 7y ago
https://news.ycombinator.com/item?id=22688861 https://news.ycombinator.com/item?id=22688861

deodorel 7y ago

Hello, just an info, in my hometown, Bucharest, population approx 3mil,they just announced they will test everyone. Some good data will come out if this.

DesiLurker 7y ago
they dont need to do that, they just need a random sampling to identify the percentage of spread. Now if you want to quarantine everyone who had it, its another story. my problem is that asymptomatic transmission will still get you.
smallgovt 7y ago
That's good to hear (that 100% testing will take place). Where can we follow up on the testing results and subsequent fatality statistics?
deleted 7y ago
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neonate 7y ago

https://archive.md/j8FFk https://archive.md/j8FFk

altoidaltoid 7y ago

It has been horribly fascinating watching the (coordinated?) campaign to downplay either the fatality rate or just write off a percentage off the population dying as the "cost of doing business".

meowface 7y ago
People should care about the facts, whatever they may be. If the fatality rate really is lower than what was previously reported, it's a disservice to the public to not report that. These are objective data and statistics, if they're accurate and put in the proper context (e.g. grouped by ages and pre-existing conditions). The exchanging deaths vs. economic health thing is a subjective policy position, which is different, and doesn't necessarily change even if the fatality rate is lower than reported. If it still appears to be more contagious and more fatal than the flu, I think most people will continue to support the lockdowns.
- hcknwscommenter 7y ago
  "If it still appears to be more contagious and more fatal than the flu" If? The amount of magical thinking required to still have some doubt about this is undefinable. Spain is converting ice-rinks into morgues to store the freaking bodies. NYC has run out of ventilators and the federal response is something like: NY could have had some at a good price in 2015.
  - meowface 7y ago
    I'm just speaking in a neutral way. As in "if it remains the case that...". Of course, I do think it is the case, and am not doubtful at all. It seems to be incontrovertible. I'm talking about how I expect the population to react based on their perception of the situation.
GuB-42 7y ago
Optimist: the fatality rate is lower than expected Pessimist: there are more cases than expected They both mean the same thing. And for now, it is pure speculation.

standardUser 7y ago

I don't see why people are obsessing over this. The pandemic is just beginning so we know we don't have the data we need yet to believe in firm numbers. It's just mental masturbation.

DesiLurker 7y ago

if its really so low then why are they scrambling to pass a 2T bailout package. just let it rip through the population because 'its just a flu bro' and it will be over in a month and a half. /s as I see it this is BS propaganda from WSJ to normalize whats coming next, push to open businesses.

traden209 7y ago
earnest answer: because even if it had a 0% fatality rate, the sheer number of people who would be out sick for a week at the same time would decimate the economy. The bailout package is probably not going to be enough.
- DesiLurker 7y ago
  are you saying that everyone taking a 2 week pause would irreparably damage us economy, really? more like you will see a V shaped movement in stock market. the main problem right now is that there is a lot of fear and uncertainty in everybodys mind partly because of Italy & spain. and as cases mount that fear will only harden so regardless of whether there is a lock-down or not people wont go out an shop until a sizable portion of population is infected and recovered OR we determine with american data that CFR is indeed quite low (doesn't look like from hospital testing data & they wont do widespread tests). but regardless I do agree bailout package is not gonna be enough.
- nutjob2 7y ago
  That is a reach. Although people stop spending the delayed demand will return once the danger has gone. People will want holidays and cars that they put off buying. Demand will produce jobs. Even businesses that failed will be replaced by new ones that satisfy new demand. This is different to something like 2008 where people no longer trusted financial and other institutions.
  - Gibbon1 7y ago
    I was thinking that too. We've normalized bad responses to finance driven recessions. Where trying to make the finance sector whole results in a half decade of lost ground for the real economy. This is more like pre-1970's recessions where the central banks squeeze the money supply for a couple of months. Or WWII mobilization. In each of those cases the economy came roaring right back due to pent up demand. We will get the worst of both worlds if our response to this is to either a) let it 'run it's course' or b) try to make the finance sector whole. The US is looking at both those options and the result will be catastrophic of they come to pass.

m0zg 7y ago

Re-posting the most informative visualization I have found on this topic so far: https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/ https://www.politico.com/interactives/2020/coronavirus-testi... See dramatic ramp-up in testing, and where the number of tests administered is significant, a reasonable approximation of the infection rate can be established. So the recent blow-out in NY was actually a good thing and it does not reflect the true daily infection rate: they just didn't know how many cases they had. They still don't in fact, asymptomatic cases don't get tests, and those who had the virus and now have immunity (of which Cuomo's advisors suspect there's at least 100K) can't be tested without the new serological test currently under development. The only reliable metric of severity remains the number of deaths, and until that gets into tens of thousands (i.e. exceeds that of flu), any panic is premature. We're not Italy. We're not Spain. The current level of response to this is unprecedented.

wool_gather 7y ago
Thank you! I've been wanting to see exactly this: tests administered vs. positives, over time. I've just been doing it in my head for my state by checking the health authority website.
- m0zg 7y ago
  I wonder what happened to USDS? Does it still exist? A need for an "official" version of such a thing is pretty obvious, yet the CDC website is pretty much worse than nothing at all, because people go there, and whatever data they have is not only incomplete, it's also a few days behind. They also don't update it over the weekend, as far as I can tell.
  - wool_gather 7y ago
    The situation is not great, to be sure. Check out covidtracking.com, which is aggregating data from state health department sites. I think that's the best going at the moment.
hcknwscommenter 7y ago

haltingproblem 7y ago

There are people who build and grok models (A) and people who build epidemiological models (B) and then people who built epidemiological models of infectious diseases (C). It is a common error for folks in set A to believe that they can understand models built by folks in set C. It is a subtle but serious error for folks in set B to believe they can understand models by set C e.g. John Katz of Yale who is a doctor focusing on diets and wrote a woefully misguided article in the NY Times. Roughly, I find the confounding factors about models about the current epidemic seem to the following: 1- 1% of the population severely affected etc. (see: Diamond Princess). What they fail to appreciate is that the Diamond Princess was an enclosed environment and the outbreak was controlled and limited to the population on board. In the general population, a virus with an R0 of 3 will infect 50,000+ people in 10 infection steps. 2- What most people miss is the collision of the 1% severity with the capacity of the medical system. This second-order effect is something hard to understand. 1% of the US is 3.6 million. Even if 10% of those cases turn up at the ER in the same year and occupy the beds for 2 weeks each it will be a disaster. 3- #1 and #2 interacts with life as usual demands on the health care system – accidents, heart attacks, strokes, etc. to create third order effects – more deaths as there are no beds and no personnel to deal with them. 4- PPE running short and causing infections amongst medical personnel leading to their quarantine, hospitalization or death (Wuhan, Italy, Spain) decimates their ranks and accentuates the stress on the health care system……. 20% of lost capacity translates to some fraction more deaths and more stress on the rest of the medical population. I am sure there are factors I have missed. We have seen many contrarian viewpoints. None of these contrarian thinkers make any concrete suggestions (Ionnadis, Katz, Friedman, Gillespie, Hanson) except making ominous predictions to how wrong we are and we need more data. Meanwhile ER doctors say this is the worst they have ever seen and bodies keep piling up. These contrarian thinkers provide no simulations of how saving the economy will lead to lesser deaths. Just hand waving and finger jabbing. The contrarians seem to think that the playbook to deal with the epidemic has been improvised. Or that this is something modelers are thinking up on the fly. These playbooks have existed for decades with very good understanding of the dynamics and were used during SARs, Ebola and heck even back during the Spanish Flu. What seems to be lacking was parameters specific to Covid-19. Its R0, CFR, co-morbidities, etc. The reason Taiwan, Korea and Singapore were able to act so decisively and fast was that they just dusted of the SARs playbook and knew almost exactly what to do. Taiwan enforced the first measures in early Jan. I will take the word of the viral epidemiologists over the contrarian's armchair speculations and continue to overreact. I recommend you should too.

haltingproblem 7y ago

Both the authors of this piece are not infectious disease epidemiologists. One (https://profiles.stanford.edu/eran-bendavid https://profiles.stanford.edu/eran-bendavid) is an infectious disease doctor who focuses on the effects of economics, politics, and the environment on health. The second (https://healthpolicy.fsi.stanford.edu/people/jay_bhattacharya https://healthpolicy.fsi.stanford.edu/people/jay_bhattachary...) focuses on "the constraints that vulnerable populations face in making decisions that affect their health status, as well as the effects of government policies and programs designed to benefit vulnerable populations. " This is not the time for folks to hit the pages of the WSJ to start developing their viral infectious disease modeling muscles. Imagine if you asked a compiler writer to start developing a commercial OS. These folks fundamentally do not understand viral growth models. Their article demonstrates their lack of understanding and they keep falling back to the normal models (pun intended) of epidemiology based on the usual statistical machinery. This is a common problem in this analysis. I made a more detailed comment further down that demonstrates the pitfalls of this thinking. (edits: grammar)

earonesty 7y ago

One of the biggest reasons the rate may be too high is the method of attribution. For example, in Italy, post-mortem testing of people who were origially presumed dead of other illnesses accounted for a large portion of testing. When it turned out they had COVID-19 at the time of death, the cause was attributed to COVID-19 regardless of comorbidities: https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho... In other words, many of those who died today would have died within the year. Many were already in and out of hospitals for serious diseases. So, not only is the IFR wildly unknown without serology tests. The CFR itself is also severely biased. Currently in the U.S. you cannot get tested unless you have severe, life-threatening illnesses. The fact that the U.S. has such a low CFR speaks very well of healthcare in the U.S.... considering the majority of those tested have severe symptoms.

imtringued 7y ago

Case fatality rate (CFR) is meaningless for the general public. A case is basically any person that went to the doctor and received the permission to get tested and eventually became a patient. Knowing the CFR for a disease is therefore very valuable for doctors because they know that x% of their patients may die. However, it is very possible that the vast majority of Covid-19 cases never become patients. This doesn't mean that the quarantine is pointless. Even if covid19 is as "harmless" as influenza, having two influenza type diseases is still worse than only having one.