4 ms·

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 t

by 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.
- watwut 7y ago
  Italy has over larger fatality rate over identified cases then China had.
  - m0zg 7y ago
    China "had" whatever comrade Xi allowed it to publish so that his "leadership" doesn't look too bad. I wouldn't put too much trust in that data. Edit: CCP comrades downvoting this, here's how "zero new cases" is being achieved in your country: https://www.reddit.com/r/PublicFreakout/comments/fosodi/covid19_patient_allegedly_being_escorted_out_of/ https://www.reddit.com/r/PublicFreakout/comments/fosodi/covi...
    - Stevvo 7y ago
      There is no mention of Coronavirus in that video. Someone took a random video of a dispute in a hospital and literally pulled the title out of thin air. That said, the no new cases sure does sound like bullshit.
      - m0zg 7y ago
        > no new cases sure does sound like bullshit As does 50-60 cases a day per 1.5 billion people when your test accuracy is pretty much a random number generator (as Spain has unfortunately found out when they received Chinese tests). I'd have a much easier time believing 5-7K new cases per day. For China that'd be the same as 1K per day for the US, which for us would be not an issue at all, if it kept steady.
- pessimizer 7y ago
  At the very least the fatality rate for non-coronavirus emergencies goes vastly up if the beds are filled with coronavirus sufferers.
  - downerending 7y ago
    It's complicated. I vaguely recall a study that indicated that fatalities for some condition that might normally indicate surgery fell when the doctors needed were out of town for their annual conference. Don't recall the details. And also, we should hope that proper triage will mean that the non-coronavirus emergencies that matter will indeed be allocated a bed, etc. I have little doubt that this will be awful, but the counterfactual scenarios are difficult to evaluate.
sm0ss117 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. If the medical system starts to fail it's not just COVID-19 you get to worry about, if the incapacity rate is high enough you get to start worrying about things like: how long will it take for my electricity to get fixed, how long will my heat be out for, where's the food for the local supermarket, when will my pharmacy get my prescriptions in stock, etc. Second order effects start getting noticeable quick in a society as connected and just in timed as ours.
- robocat 7y ago
  I think you are overplaying things. Most first world countries have hardened, resilient, and distributed infrastructure that takes little resources to maintain. The more your economy revolves around non-essential goods and services, the more headroom there is for dealing with failure. The second order effects of breakdowns in supply chain are real. But they are most effectively dealt with by JIT and connectivity. The US is changing significant parts of it’s economy to deal with this shock: and it looks to be effectively redeploying resources without any leadership at the top. Look historically at whole countries hit by war or disaster, and see how they managed. Imagine if tomorrow all medicines are unavailable, and all hospitals destroyed? Many people would die, but the vast majority of the economy would keep running and the vast majority of citizens would remain healthy. Sure, we all could have stocked up on some resources better, but there are heavy costs associated with over stocking and over planning.
  - sm0ss117 7y ago
    The yugoslav wars had a total death rate of < 1%, and saw most of the cities still standing. 3-4 Million ppl were displaced, ~15-20% of pre war population and there are 5-6 countries where there used to be 1. It doesn't take much to change a lot.
smallgovt 7y ago
>> Fatality rate goes up drastically if the medical system fails Based on my research, it actually seems like fatality rate will NOT skyrocket if our medical system is overwhelmed like in Italy. Here is an actual study that looks at fatality rates in Italy vs China after stratifying by age group: https://jamanetwork.com/journals/jama/fullarticle/2763667 https://jamanetwork.com/journals/jama/fullarticle/2763667 The most eye-opening graphic is the first chart. To summarize the article: 1) Italy's fatality rate for patients younger than 60 is actually better than China 2) Italy's fatality rate for patients older than 60 is less than double that of China 3) Italy may have a higher rate of pre-existing conditions which makes fatality rate look worse than it is 4) Italy is only testing symptomatic patients which makes fatality rate look worse than it is All of these results were surprising to me. The information being spread by the mainstream media suggests that if hospital systems get overwhelmed like they have in Italy, fatality rate will skyrocket. In reality, it seems like we're dealing with a classic case of Simpson's paradox (https://en.wikipedia.org/wiki/Simpson%27s_paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox). If you stratify data by age group, you find that even if hospital systems are overwhelmed (to the same degree as Italy), fatality rates will, at most, double.
- umbec 7y ago
  In Italy the hospital system has not _yet_ been overwhelmed, even if it is quite close to that point. Still, people are already dying just because it is getting harder to have a proper care/medications even when you are not covid-sick. While covid fatality rate is not affected by such cases, at national level this is definitely not negligible.
- thdrdt 7y ago
  When a hospital system is overwelmed it will also be bad for other emergencies. The amount of people that need medical care caused by this virus should also be taken into account. And that rate is high.
  - gautamnarula 7y ago
    This is a good point. How many people who got in a car accident might die when they otherwise wouldn't have because all the ICU units were taken up by COVID-19 patients? How many people will succumb to an infection they caught in the hospital because there wasn't enough PPE? While not a direct fatality of the viruses, these cases should be estimated to see its total mortality impact.
jryle70 7y ago
> 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. 3,800 patients, or 12% of case in NY were hospitalized as of today. 888 require intensive care. [0] You're right about approx 1% fatality rate though. And this is NYC the epicenter of the pandemic in the US. [0] - https://www.nytimes.com/2020/03/25/nyregion/coronavirus-new-york-update.html https://www.nytimes.com/2020/03/25/nyregion/coronavirus-new-...
emanuensis 7y ago
>So let's start testing aggressively for antibodies. Until we get that number, I'm all for extreme caution. There is no Antibody/serological/immunity test yet. Biologically it is harder even that a vaccine... Test WILL be intensive/invasive (think blood, not mucus), much more so than a simple test for presence/absence of a particular virus. https://www.reuters.com/article/us-health-coronavirus-immune-test-insigh/u-s-companies-labs-rush-to-produce-blood-test-for-coronavirus-immunity-idUSKBN21C1KK https://www.reuters.com/article/us-health-coronavirus-immune... Important though

by ekidd 7y ago

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.

watwut 7y ago
Italy has over larger fatality rate over identified cases then China had.
- m0zg 7y ago
  China "had" whatever comrade Xi allowed it to publish so that his "leadership" doesn't look too bad. I wouldn't put too much trust in that data. Edit: CCP comrades downvoting this, here's how "zero new cases" is being achieved in your country: https://www.reddit.com/r/PublicFreakout/comments/fosodi/covid19_patient_allegedly_being_escorted_out_of/ https://www.reddit.com/r/PublicFreakout/comments/fosodi/covi...
  - Stevvo 7y ago
    There is no mention of Coronavirus in that video. Someone took a random video of a dispute in a hospital and literally pulled the title out of thin air. That said, the no new cases sure does sound like bullshit.
    - m0zg 7y ago
      > no new cases sure does sound like bullshit As does 50-60 cases a day per 1.5 billion people when your test accuracy is pretty much a random number generator (as Spain has unfortunately found out when they received Chinese tests). I'd have a much easier time believing 5-7K new cases per day. For China that'd be the same as 1K per day for the US, which for us would be not an issue at all, if it kept steady.
pessimizer 7y ago
At the very least the fatality rate for non-coronavirus emergencies goes vastly up if the beds are filled with coronavirus sufferers.
- downerending 7y ago
  It's complicated. I vaguely recall a study that indicated that fatalities for some condition that might normally indicate surgery fell when the doctors needed were out of town for their annual conference. Don't recall the details. And also, we should hope that proper triage will mean that the non-coronavirus emergencies that matter will indeed be allocated a bed, etc. I have little doubt that this will be awful, but the counterfactual scenarios are difficult to evaluate.

sm0ss117 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. If the medical system starts to fail it's not just COVID-19 you get to worry about, if the incapacity rate is high enough you get to start worrying about things like: how long will it take for my electricity to get fixed, how long will my heat be out for, where's the food for the local supermarket, when will my pharmacy get my prescriptions in stock, etc. Second order effects start getting noticeable quick in a society as connected and just in timed as ours.

robocat 7y ago
I think you are overplaying things. Most first world countries have hardened, resilient, and distributed infrastructure that takes little resources to maintain. The more your economy revolves around non-essential goods and services, the more headroom there is for dealing with failure. The second order effects of breakdowns in supply chain are real. But they are most effectively dealt with by JIT and connectivity. The US is changing significant parts of it’s economy to deal with this shock: and it looks to be effectively redeploying resources without any leadership at the top. Look historically at whole countries hit by war or disaster, and see how they managed. Imagine if tomorrow all medicines are unavailable, and all hospitals destroyed? Many people would die, but the vast majority of the economy would keep running and the vast majority of citizens would remain healthy. Sure, we all could have stocked up on some resources better, but there are heavy costs associated with over stocking and over planning.
- sm0ss117 7y ago
  The yugoslav wars had a total death rate of < 1%, and saw most of the cities still standing. 3-4 Million ppl were displaced, ~15-20% of pre war population and there are 5-6 countries where there used to be 1. It doesn't take much to change a lot.

smallgovt 7y ago

>> Fatality rate goes up drastically if the medical system fails Based on my research, it actually seems like fatality rate will NOT skyrocket if our medical system is overwhelmed like in Italy. Here is an actual study that looks at fatality rates in Italy vs China after stratifying by age group: https://jamanetwork.com/journals/jama/fullarticle/2763667 https://jamanetwork.com/journals/jama/fullarticle/2763667 The most eye-opening graphic is the first chart. To summarize the article: 1) Italy's fatality rate for patients younger than 60 is actually better than China 2) Italy's fatality rate for patients older than 60 is less than double that of China 3) Italy may have a higher rate of pre-existing conditions which makes fatality rate look worse than it is 4) Italy is only testing symptomatic patients which makes fatality rate look worse than it is All of these results were surprising to me. The information being spread by the mainstream media suggests that if hospital systems get overwhelmed like they have in Italy, fatality rate will skyrocket. In reality, it seems like we're dealing with a classic case of Simpson's paradox (https://en.wikipedia.org/wiki/Simpson%27s_paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox). If you stratify data by age group, you find that even if hospital systems are overwhelmed (to the same degree as Italy), fatality rates will, at most, double.

umbec 7y ago
In Italy the hospital system has not _yet_ been overwhelmed, even if it is quite close to that point. Still, people are already dying just because it is getting harder to have a proper care/medications even when you are not covid-sick. While covid fatality rate is not affected by such cases, at national level this is definitely not negligible.
thdrdt 7y ago
When a hospital system is overwelmed it will also be bad for other emergencies. The amount of people that need medical care caused by this virus should also be taken into account. And that rate is high.
- gautamnarula 7y ago
  This is a good point. How many people who got in a car accident might die when they otherwise wouldn't have because all the ICU units were taken up by COVID-19 patients? How many people will succumb to an infection they caught in the hospital because there wasn't enough PPE? While not a direct fatality of the viruses, these cases should be estimated to see its total mortality impact.

jryle70 7y ago

> 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. 3,800 patients, or 12% of case in NY were hospitalized as of today. 888 require intensive care. [0] You're right about approx 1% fatality rate though. And this is NYC the epicenter of the pandemic in the US. [0] - https://www.nytimes.com/2020/03/25/nyregion/coronavirus-new-york-update.html https://www.nytimes.com/2020/03/25/nyregion/coronavirus-new-...

emanuensis 7y ago

>So let's start testing aggressively for antibodies. Until we get that number, I'm all for extreme caution. There is no Antibody/serological/immunity test yet. Biologically it is harder even that a vaccine... Test WILL be intensive/invasive (think blood, not mucus), much more so than a simple test for presence/absence of a particular virus. https://www.reuters.com/article/us-health-coronavirus-immune-test-insigh/u-s-companies-labs-rush-to-produce-blood-test-for-coronavirus-immunity-idUSKBN21C1KK https://www.reuters.com/article/us-health-coronavirus-immune... Important though