6 ms·

I haven't been shouting from the rooftops because I'm not an epidemiologist and don't really want to get into an argument, but none of the low/medium/high death

by ohazi 7y ago

I haven't been shouting from the rooftops because I'm not an epidemiologist and don't really want to get into an argument, but none of the low/medium/high death estimates that I've seen have seemed plausible to me. The back-of-the-envelope math that I've been doing would put most of them about half an order of magnitude too low. From what I can tell, the best-case death estimate in the US should be around 1-2 million, and the worst case should be around 5-10 million. Does this seem wildly off? This is based on the varying death rates in other countries that have had controlled/mild/manageable outbreaks (e.g. South Korea, Singapore) vs. severe outbreaks (e.g. Italy, Iran). The overall death numbers also seem to change depending on how overrun the hospitals are (going from, e.g. 0.9% to ~3%+), national demographics, etc. I'm also assuming an eventual population infection rate of 40% - 70%. I'd obviously be thrilled to be proven wrong, but I honestly don't understand how people are coming up with numbers that are so much more optimistic.

save_ferris 7y ago
Agreed, I so wish one of the networks or YouTube would give someone like Fauci an hour or two to walk through their methodology in detail instead of just answering topical questions on projections from pundits. We’re not getting a whole lot of context right now that would be useful and engaging.
- bluena 7y ago
  There's a 15 min interview on YouTube with Fauci being interviewed by Trevor Noah today. Strongly recommended: https://youtu.be/8A3jiM2FNR8 https://youtu.be/8A3jiM2FNR8
  - kennywinker 7y ago
    frustratingly not available in my region
  - fortytwo79 7y ago
    That's what our media has to offer? An interview by a comedian? I agree we need Fauci to walk us through it. I'd like a panel interview conducted by a reputable interviewer.
jdavis703 7y ago
A best case scenario might be to look at the number of confirmed CV-19 deaths in China as a percent of total China population. This of course assumes competent public health policy, but we’re assuming what the best case could be.
sub7 7y ago
Your worst case is correct but % population infected drops dramatically with lock down. The countries with better infrastructure (richer, Western) will likely see ~1-2% of their population infected and a death rate under 1%
- deleted 7y ago
  [deleted]
throwaway8291 7y ago
Nobody knows what is coming, but I'm in the 1M+ camp as well. US is so ill-equipped plus administration is very aware, how devastating the economic consequences are even now (2T stimulus and infinite FED liquidity are already in effect today). Let this spread for two more weeks and the administration might loose their countenance and will declare: "we cannot save both the infected and our country, so we will save our country".
- deleted 7y ago
  [deleted]
Leary 7y ago
There's no reason why 40-70% of people will inevitably get infected. California daily new cases already plateued
- kennywinker 7y ago
  I think that number might be coming from the idea that at that level of infection you'd get herd immunity - i.e. this thing is going to keep going around until we hit herd immunity.
  - Leary 7y ago
    Reaching herd immunity level is a possibility but not inevitable
    - ska 7y ago
      Agree it's not inevitable, but seems plausibly to be the highest probability path at this point.
    - kennywinker 7y ago
      With the current tools we have, it seems inevitable to me. Look at china or hong kong... lockdown led to getting local infections under control, which leads to an easing of restrictions, which lead to new infections from outside of the region. So by that logic, life doesn't get to go back to "normal" until either herd immunity is reached, or new tools come online.
  - threatofrain 7y ago
    That assumes that this virus doesn't mutate quickly, mitigating the effectiveness of herd immunity and vaccination.
    - kennywinker 7y ago
      Totally true. Obviously nobody knows right now if that will happen or not, but that question was posed on a recent episode of This Week in Virology (great podcast, btw) and they seemed to be saying that the mutated seasonal variant is a fairly unique characteristic of the flu virus, and it would not be _likely_ to happen with COVID-19.
kennywinker 7y ago
Nobody knows the asymptomatic infection rate. Without that, differences in mortality numbers between countries are meaningless, because testing rates are all over the place. Explaining the differences by overrun hospitals is jumping the gun I think.
- Ozzie_osman 7y ago
  Exactly. Fatality rates are mostly just a function of a country's testing (how much testing they're doing, and how biased the sample is). If you're only testing a small # of people with severe symptoms, obviously the fatality rate will look really high. If you're testing a much wider section of the population, and testing people who aren't severely sick, the number will look lower. Some examples: - Iceland randomly tested people in the general population (no symptoms), they found ~1% of people tested positive, and half of those had no symptoms (and so probably wouldn't be tested). [1] - Italy tested an entire village (the village had a cluster of cases), 3% tested positive, of which half had no symptoms. - One professor used the Diamond Princess cruise ship as a baseline, and estimated anywhere from 0.025%-0.625% [2] - China had a fatality rate of 17% initially, which went down to 0.7% if you only consider symptom onset _after_ Feb 1st. [3] Of course, there are a lot of other factors, and it's possible that the rates end up in fact being really high, but there's an argument that we just don't know how many people are infected and fatality ends up being a lot lower then just dividing # of deaths by # of confirmed cases would have you believe. Just to be clear: even the lower case scenarios are really serious and worrying, and I'm definitely not in the "this is just another flu" camp. But there's a huge range of uncertainty here. [1] https://www.government.is/news/article/?newsid=f96a270c-66e8-11ea-945f-005056bc4d74 https://www.government.is/news/article/?newsid=f96a270c-66e8... [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... [3] https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
- cashsterling 7y ago
  I can't stress enough how important this factor is... without widespread randomized testing of the population, we have no idea what the true infection rate is or how widespread the virus really is. Our current stats have a huge selection bias problem. This is why it is so important that we take social distancing, self hygiene, and shelter-in-place measures really seriously in order to protect those among us who may be more susceptible to severe infection. The silver lining: the more widespread the virus, and hence the number of asymptomatic cases... lower the actual the severity statistics are. i.e. we know "number of deaths", "number of hospitalizations", and "number of positive cases". Right now, when we calculate our various severity rates, we are putting "number of positive cases" in the denominator because we don't know the number of actual infections. There is an unknown multiplier (>= 1) relating positive cases to infections. All our severity statistics need to be divided by this unknown multiplier. But right now, since we don't know what it is... the responsible thing to do for reporting and policy decisions is assume it is 1 (worst case). It is not 1... it is greater than 1... we all know that. But how much is a tough question to answer properly without proper statistical sampling of the population. There are modelling studies and estimates that suggest value ranges for the multiplier, but I don't want to spread potentially false information on a public forum.
streetcat1 7y ago
No. It all depends on mass testing. If mass testing is adopted, it would surface the asymptomatic carriers. In addition, it would allow the creation of "clean" zones (.e.g on flights/buses) where you would need to prove that you are clean. So, once the virus cannot "hide", and R0 is bought down to below 1, you would actually see the rate of infection crash to zero (I.e. the exponential rate works both ways). To sum up, as long as there is no vaccine, it all depend on mass testing.
deleted 7y ago
[deleted]
voisin 7y ago
Can you share your math for the various situations for those of us not as clear on the differing rates in those countries? Has anyone built a calculator that shows how it could play out in different countries based on the experience we have seen in countries so far?
ac29 7y ago
The question to me, aside from assumptions about infection rate, is: are the people that are getting hospitalized and/or dying today just unlucky, or are they more susceptible to the virus or its effects? If they are just unlucky, the death rate may hold. If, however, its just the highest risk population having the worst outcomes, the death rate will plummet as they die off. In order for the US to hit 1M+ deaths, you have to assume that people getting infected in 3 or 6 or 12 months from now are just as likely to die as those dying today.

by ohazi 7y ago

save_ferris 7y ago

Agreed, I so wish one of the networks or YouTube would give someone like Fauci an hour or two to walk through their methodology in detail instead of just answering topical questions on projections from pundits. We’re not getting a whole lot of context right now that would be useful and engaging.

bluena 7y ago
There's a 15 min interview on YouTube with Fauci being interviewed by Trevor Noah today. Strongly recommended: https://youtu.be/8A3jiM2FNR8 https://youtu.be/8A3jiM2FNR8
- kennywinker 7y ago
  frustratingly not available in my region
- fortytwo79 7y ago
  That's what our media has to offer? An interview by a comedian? I agree we need Fauci to walk us through it. I'd like a panel interview conducted by a reputable interviewer.

jdavis703 7y ago

A best case scenario might be to look at the number of confirmed CV-19 deaths in China as a percent of total China population. This of course assumes competent public health policy, but we’re assuming what the best case could be.

sub7 7y ago

Your worst case is correct but % population infected drops dramatically with lock down. The countries with better infrastructure (richer, Western) will likely see ~1-2% of their population infected and a death rate under 1%

deleted 7y ago
[deleted]

throwaway8291 7y ago

Nobody knows what is coming, but I'm in the 1M+ camp as well. US is so ill-equipped plus administration is very aware, how devastating the economic consequences are even now (2T stimulus and infinite FED liquidity are already in effect today). Let this spread for two more weeks and the administration might loose their countenance and will declare: "we cannot save both the infected and our country, so we will save our country".

deleted 7y ago
[deleted]

Leary 7y ago

There's no reason why 40-70% of people will inevitably get infected. California daily new cases already plateued

kennywinker 7y ago
I think that number might be coming from the idea that at that level of infection you'd get herd immunity - i.e. this thing is going to keep going around until we hit herd immunity.
- Leary 7y ago
  Reaching herd immunity level is a possibility but not inevitable
  - ska 7y ago
    Agree it's not inevitable, but seems plausibly to be the highest probability path at this point.
  - kennywinker 7y ago
    With the current tools we have, it seems inevitable to me. Look at china or hong kong... lockdown led to getting local infections under control, which leads to an easing of restrictions, which lead to new infections from outside of the region. So by that logic, life doesn't get to go back to "normal" until either herd immunity is reached, or new tools come online.
- threatofrain 7y ago
  That assumes that this virus doesn't mutate quickly, mitigating the effectiveness of herd immunity and vaccination.
  - kennywinker 7y ago
    Totally true. Obviously nobody knows right now if that will happen or not, but that question was posed on a recent episode of This Week in Virology (great podcast, btw) and they seemed to be saying that the mutated seasonal variant is a fairly unique characteristic of the flu virus, and it would not be _likely_ to happen with COVID-19.

kennywinker 7y ago

Nobody knows the asymptomatic infection rate. Without that, differences in mortality numbers between countries are meaningless, because testing rates are all over the place. Explaining the differences by overrun hospitals is jumping the gun I think.

Ozzie_osman 7y ago
Exactly. Fatality rates are mostly just a function of a country's testing (how much testing they're doing, and how biased the sample is). If you're only testing a small # of people with severe symptoms, obviously the fatality rate will look really high. If you're testing a much wider section of the population, and testing people who aren't severely sick, the number will look lower. Some examples: - Iceland randomly tested people in the general population (no symptoms), they found ~1% of people tested positive, and half of those had no symptoms (and so probably wouldn't be tested). [1] - Italy tested an entire village (the village had a cluster of cases), 3% tested positive, of which half had no symptoms. - One professor used the Diamond Princess cruise ship as a baseline, and estimated anywhere from 0.025%-0.625% [2] - China had a fatality rate of 17% initially, which went down to 0.7% if you only consider symptom onset _after_ Feb 1st. [3] Of course, there are a lot of other factors, and it's possible that the rates end up in fact being really high, but there's an argument that we just don't know how many people are infected and fatality ends up being a lot lower then just dividing # of deaths by # of confirmed cases would have you believe. Just to be clear: even the lower case scenarios are really serious and worrying, and I'm definitely not in the "this is just another flu" camp. But there's a huge range of uncertainty here. [1] https://www.government.is/news/article/?newsid=f96a270c-66e8-11ea-945f-005056bc4d74 https://www.government.is/news/article/?newsid=f96a270c-66e8... [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... [3] https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
cashsterling 7y ago
I can't stress enough how important this factor is... without widespread randomized testing of the population, we have no idea what the true infection rate is or how widespread the virus really is. Our current stats have a huge selection bias problem. This is why it is so important that we take social distancing, self hygiene, and shelter-in-place measures really seriously in order to protect those among us who may be more susceptible to severe infection. The silver lining: the more widespread the virus, and hence the number of asymptomatic cases... lower the actual the severity statistics are. i.e. we know "number of deaths", "number of hospitalizations", and "number of positive cases". Right now, when we calculate our various severity rates, we are putting "number of positive cases" in the denominator because we don't know the number of actual infections. There is an unknown multiplier (>= 1) relating positive cases to infections. All our severity statistics need to be divided by this unknown multiplier. But right now, since we don't know what it is... the responsible thing to do for reporting and policy decisions is assume it is 1 (worst case). It is not 1... it is greater than 1... we all know that. But how much is a tough question to answer properly without proper statistical sampling of the population. There are modelling studies and estimates that suggest value ranges for the multiplier, but I don't want to spread potentially false information on a public forum.

streetcat1 7y ago

No. It all depends on mass testing. If mass testing is adopted, it would surface the asymptomatic carriers. In addition, it would allow the creation of "clean" zones (.e.g on flights/buses) where you would need to prove that you are clean. So, once the virus cannot "hide", and R0 is bought down to below 1, you would actually see the rate of infection crash to zero (I.e. the exponential rate works both ways). To sum up, as long as there is no vaccine, it all depend on mass testing.

deleted 7y ago

[deleted]

voisin 7y ago

Can you share your math for the various situations for those of us not as clear on the differing rates in those countries? Has anyone built a calculator that shows how it could play out in different countries based on the experience we have seen in countries so far?

ac29 7y ago

The question to me, aside from assumptions about infection rate, is: are the people that are getting hospitalized and/or dying today just unlucky, or are they more susceptible to the virus or its effects? If they are just unlucky, the death rate may hold. If, however, its just the highest risk population having the worst outcomes, the death rate will plummet as they die off. In order for the US to hit 1M+ deaths, you have to assume that people getting infected in 3 or 6 or 12 months from now are just as likely to die as those dying today.