7 ms·

Covid may be far more widespread than we thought

49 points by jrfinkel 6y ago

DevKoala 6y ago
> "I think the 3.4 percent is really a false number — and this is just my hunch — but based on a lot of conversations with a lot of people that do this, because a lot of people will have this and it's very mild, they'll get better very rapidly. They don't even see a doctor. They don't even call a doctor. You never hear about those people,..." At the time, the person who said that was called an idiot.
- troelsSteegin 6y ago
  Even an idiot is right twice a day?
  - lurquer 6y ago
    30 days ago many HN posters were saying this. I guess they were all idiots too. They don't say it much any more, though... why get downvoted? The fact that this has already spread through the US will become self-evident soon enough. ("The peak is coming in CA any day now! Just wait...")
    - ardy42 6y ago
      > 30 days ago many HN posters were saying this. I guess they were all idiots too. Quite possibly. There are all kinds.
      - lurquer 6y ago
        https://www.sfgate.com/bayarea/article/Study-investigates-if-COVID-19-came-to-Calif-in-15187085.php https://www.sfgate.com/bayarea/article/Study-investigates-if... Idiots popping up everywhere, it seems...
        pengaru 6y ago
        That article is comparing NY to CA with the expectation that they should be more similar. CA is a very car-centric state, the public transportation situation is a joke. I'd expect this alone to tamp down the spread relative to NY, considering the density of NYC and how ubiquitous public transportation is there.
        etrabroline 6y ago
        >He does not advocate lifting social distancing rules I believe the "idiots" referred to above are the people who blindly assumed without evidence the experimental hypothesis of this study simply as an excuse to avoid social distancing and self isolation.
- Gibbon1 6y ago
  Who do we believe a bullshit artist at the economist or Bob Wachter Chair, UCSF Dept of Medicine. > @Bob_Wachter > 3/ Another interesting #: @ucsf, we only test pts w/ symptoms, who all think "I have Covid.” But only ~4% of our tests are +, meaning most folks who think they have it, don’t. https://twitter.com/Bob_Wachter/status/1247722427620012032 https://twitter.com/Bob_Wachter/status/1247722427620012032
  - jrfinkel 6y ago
    I don’t think it’s that simple about the tests. They’re less accurate than people think. Here’s one article about it (if you google you can find more): https://www.wsj.com/articles/questions-about-accuracy-of-coronavirus-tests-sow-worry-11585836001 https://www.wsj.com/articles/questions-about-accuracy-of-cor... Also, if you don’t trust the WSJ either (I wouldn’t blame you) here is an article from Nature Medicine that has a comparison of nasal vs stool tests for covid, and Figure 1b really drives home the high rate of false negatives for nasal swab tests compared to stool tests (and throat swabs are even worse than nasal swabs): https://www.nature.com/articles/s41591-020-0817-4?fbclid=IwAR31EGO3WLw6LQrY5tOYUj6jPhT_fo-xU5Lb71g1azH9KtIO0ZcvosDusbA https://www.nature.com/articles/s41591-020-0817-4?fbclid=IwA...
    - dhc02 6y ago
      Yep. In fact, false negatives of current test are a function of time since the onset of symptoms: Day 1? ~7% false negative Day 10? 40% false negative Day 20? 90% false negative That's really high, and it seems anecdotally likely that a majority of tests have been administered to people who are 7-10 days or more post-symptom-onset. Here's the tweet discussing this: https://twitter.com/c0nc0rdance/status/1248094573928251398/ https://twitter.com/c0nc0rdance/status/1248094573928251398/ And here's the paper: https://t.co/aSdFeLzopH?amp=1 https://t.co/aSdFeLzopH?amp=1
- Jordrok 6y ago
  He's still an idiot. He chose to believe that not because of research or statistics or the advice of people with expertise, but because it was convenient. This was at the beginning of March when there had only been 11 deaths. He was making the argument that this is no worse than the normal seasonal flu, because he was loathe to take any drastic preventative action that might disrupt his precious stock market. Well, here we are now, thousands have died, with thousands more on the way, and the economic damage has already been done. That's what happens when you let an idiot run the country.
  - etrabroline 6y ago
    I'm loathe to defend the current US president, but almost no Western country took this seriously until the last possible minute. There is clearly a deeper ideological issue infecting the entire West.
    - mcv 6y ago
      It's absolutely true that most western countries underestimated this. East-Asian countries were better prepared and more willing to take drastic action to do what's necessary. Western countries assumed that, like SARS, Asia would solve this. Turns out it's way more contagious than SARS. Still, once the seriousness became clear, most countries did take action. Trump continued to deny and spread misinformation, even to this day.
    - ebcode 6y ago
      > There is clearly a deeper ideological issue infecting the entire West. Amen.
    - darkteflon 6y ago
      Australia and New Zealand have done a superlative job: https://www.theguardian.com/world/2020/apr/09/have-australia-new-zealand-stopped-covid-19-in-its-tracks-coronavirus https://www.theguardian.com/world/2020/apr/09/have-australia....
    - deleted 6y ago
      [deleted]
jrfinkel 6y ago
Here’s a preprint of the actual paper: https://www.medrxiv.org/content/10.1101/2020.04.01.20050542v1 https://www.medrxiv.org/content/10.1101/2020.04.01.20050542v...
amscanne 6y ago
% of visits to primary care provider is a _terrible_ metric. People have been actively advised to stay away from the Doctor’s office and hospitals for routine reasons (and reschedule for later). Obviously the % visiting because they think they have Covid is going up, even if they don’t have it!
- jrfinkel 6y ago
  One of the study authors addressed this on Twitter. It’s certainly not hard proof, but 8 million extra cases would be a whole lot of hypochondriacs. Thread is short and worth a read. https://mobile.twitter.com/inschool4life/status/1247620008349519878 https://mobile.twitter.com/inschool4life/status/124762000834...
vondur 6y ago
I was pretty sick in late February, and ended up in the urgent care at my local Kaiser. It was packed at the time too. Seemed like everyone was sick with the flu.
- chiph 6y ago
  It might actually have been the flu. At least for me (in North Carolina), this year's flu vaccine was a miss, so I ended up sick anyway.
- ceejayoz 6y ago
  My son had a nasty bout of pneumonia in late January / early February, so I'll be interested in an antibody test for him when they become available.
- ardy42 6y ago
  > I was pretty sick in late February, and ended up in the urgent care at my local Kaiser. It was packed at the time too. Seemed like everyone was sick with the flu. The 2019-2020 seasonal flu has also been relatively bad compared to many other years. https://time.com/5758953/flu-season-2019-2020/ https://time.com/5758953/flu-season-2019-2020/: 2019-2020 Flu Season on Track to Be Especially Severe, New CDC Data Suggests (Jan 4th).
- vanniv 6y ago
  I was terribly sick in early February, in CA. I went to my urgent care multiple times as I got worse. The doctor tested me for influenza, but told me that he was seeing hundreds of patients, all day every day, with "an unusual flu" where they were mildly sick for a few days, recover, and then suddenly got much worse with high fevers and chest infections -- and most of those patients were turning up with negative influenza tests. But influenza tests have a high false negative rate, so just because I was negative on the test didn't mean anything. The doc said that this year, the influenza test only seemed to show positive for folks that had a high fever the first day of their illness (which, between you and me, is very common with influenza and very uncommon for COVID) I was out of work for over a week, and only got out of bed when I had no choice the entire time. None of my doctors asked me about travel or contact with recent travelers, and nobody ever even suggested getting a coronavirus test. When I got back to work a week later, I learned that nearly 10% of my office had gotten sick either the same day as me or while I was out. Did we all have COVID-19? maybe. Maybe not. None of us were tested. None of us will turn up in the COVID statistics. But in early/mid February, there definitely was some coronavirus here -- we had a few known travel cases, and we had tons of travelers between all regions of China and all parts of CA. It is entirely possible for folks to have unknowingly brought the virus here in moderate numbers.
foton1981 6y ago
I dont understand how would such highly contagious virus suppress and contain itself if it started in CA months ago. As if Californians have no outbound travel. Impossible scenario.
- jrfinkel 6y ago
  I don’t think anyone is claiming that it suppressed and contained itself. They’re claiming it’s more widespread and more mild. There’s a good graphic in the economist article showing two different peaks that look the same early on.
alephnan 6y ago
Was this data not publicly available ? Were there not army of analysts? I thought with Machine Learning being all the rage and hype, we’d have more people and machine keeping tabs on all kinds of trends, this included. Good that we have these retroactive inspections, but the whole appeal of ML is its predictive power is it not? Or did the hedge funds just keep this knowledge to themselves?
- mr_gibbins 6y ago
  Could it be because AI is an overhyped rehash of the AI craze that swept academia and industry in the 1980s, only to collapse in the 'AI winter' as everyone realised the truth? We use AI/ML for trivial purposes right now. Multivariate statistical analysis beats AI in many domains. Covid is a real-world, grown-up problem. It isn't identifying pictures of cats, or creating obscene chatbots (remember Tay?). So AI has been shown up to be a duff non-solution.
logjammin 6y ago
This is a problem of insufficient data. We don't have a denominator, so there's no way to tell if it's more widespread than we thought. In fact there's no good way to tell how widespread it is at all. We have numerators: number of people sick enough to show to up to an ER, or number dead, or whatever, take your pick. But in every fraction we might want, we lack a denominator: total number of people infected. There's a stuningly simple way to get one: sample randomly from a population of interest in large enough numbers (say e.g. Cook County, home of Chicago, or hell, the entire US) and test everyone for the virus. Voila! You have a representative chunk of your population, an estimate of virus prevalence, and a quantifiable degree of precision about that estimate (SE's for a confidence interval, say). With enough people in your sample, you can have extremely accurate estimates of the spread of Covid in your population of interest. You repeat this process over and over, through time, to track the numbers. I'm not trivializing this kind of effort: it takes rigorous sampling designs and dozens or hundreds of field workers, among other things. It's intense but very straightforward. Political pollsters (and thousands of researchers in different fields) do it every day. No one in the US has done this, and no one with any visibility from Fauci on down has even suggested it (that I know of; please correct me). I work in public health, and this is first year, first semester of grad school stuff. This matters because the public health responses to coronavirus when there's 1% or 10% or 25% or 75% of a population infected all look very different. In short, we may be over- or underreacting to the situation with the measures we currently have in place. I've been going half crazy wondering what's happening about this for a while now. After the initial fuckup, we now have tests. We have money. We can do this. Why don't we? (Iceland has done this!)
- a9h74j 6y ago
  A Stanford MD PhD who had a recent article in the Wall St Journal was interviewed on video[1]. In the video he refers to this very denominator-related test being forthcoming. There are two things I don't understand. First, why did this have to wait for some approved(?) antibody test, rather than being tried with a presumably research-grade test to start?? Second (physicist talking here), to get a rough estimate (to within a factor) whether exposure has already silently _significantly_ spread, why not relax some rigor in the sampling design and just sample 100-1000 geographically-diverse people to get _some_ estimate that could at least speak to the "is exposure already widespread?" question? [1] https://www.youtube.com/watch?v=-UO3Wd5urg0 https://www.youtube.com/watch?v=-UO3Wd5urg0

49 points by jrfinkel 6y ago

> "I think the 3.4 percent is really a false number — and this is just my hunch — but based on a lot of conversations with a lot of people that do this, because a lot of people will have this and it's very mild, they'll get better very rapidly. They don't even see a doctor. They don't even call a doctor. You never hear about those people,..." At the time, the person who said that was called an idiot.

troelsSteegin 6y ago
Even an idiot is right twice a day?
- lurquer 6y ago
  30 days ago many HN posters were saying this. I guess they were all idiots too. They don't say it much any more, though... why get downvoted? The fact that this has already spread through the US will become self-evident soon enough. ("The peak is coming in CA any day now! Just wait...")
  - ardy42 6y ago
    > 30 days ago many HN posters were saying this. I guess they were all idiots too. Quite possibly. There are all kinds.
    - lurquer 6y ago
      https://www.sfgate.com/bayarea/article/Study-investigates-if-COVID-19-came-to-Calif-in-15187085.php https://www.sfgate.com/bayarea/article/Study-investigates-if... Idiots popping up everywhere, it seems...
      - pengaru 6y ago
        That article is comparing NY to CA with the expectation that they should be more similar. CA is a very car-centric state, the public transportation situation is a joke. I'd expect this alone to tamp down the spread relative to NY, considering the density of NYC and how ubiquitous public transportation is there.
      - etrabroline 6y ago
        >He does not advocate lifting social distancing rules I believe the "idiots" referred to above are the people who blindly assumed without evidence the experimental hypothesis of this study simply as an excuse to avoid social distancing and self isolation.
Gibbon1 6y ago
Who do we believe a bullshit artist at the economist or Bob Wachter Chair, UCSF Dept of Medicine. > @Bob_Wachter > 3/ Another interesting #: @ucsf, we only test pts w/ symptoms, who all think "I have Covid.” But only ~4% of our tests are +, meaning most folks who think they have it, don’t. https://twitter.com/Bob_Wachter/status/1247722427620012032 https://twitter.com/Bob_Wachter/status/1247722427620012032
- jrfinkel 6y ago
  I don’t think it’s that simple about the tests. They’re less accurate than people think. Here’s one article about it (if you google you can find more): https://www.wsj.com/articles/questions-about-accuracy-of-coronavirus-tests-sow-worry-11585836001 https://www.wsj.com/articles/questions-about-accuracy-of-cor... Also, if you don’t trust the WSJ either (I wouldn’t blame you) here is an article from Nature Medicine that has a comparison of nasal vs stool tests for covid, and Figure 1b really drives home the high rate of false negatives for nasal swab tests compared to stool tests (and throat swabs are even worse than nasal swabs): https://www.nature.com/articles/s41591-020-0817-4?fbclid=IwAR31EGO3WLw6LQrY5tOYUj6jPhT_fo-xU5Lb71g1azH9KtIO0ZcvosDusbA https://www.nature.com/articles/s41591-020-0817-4?fbclid=IwA...
  - dhc02 6y ago
    Yep. In fact, false negatives of current test are a function of time since the onset of symptoms: Day 1? ~7% false negative Day 10? 40% false negative Day 20? 90% false negative That's really high, and it seems anecdotally likely that a majority of tests have been administered to people who are 7-10 days or more post-symptom-onset. Here's the tweet discussing this: https://twitter.com/c0nc0rdance/status/1248094573928251398/ https://twitter.com/c0nc0rdance/status/1248094573928251398/ And here's the paper: https://t.co/aSdFeLzopH?amp=1 https://t.co/aSdFeLzopH?amp=1
Jordrok 6y ago
He's still an idiot. He chose to believe that not because of research or statistics or the advice of people with expertise, but because it was convenient. This was at the beginning of March when there had only been 11 deaths. He was making the argument that this is no worse than the normal seasonal flu, because he was loathe to take any drastic preventative action that might disrupt his precious stock market. Well, here we are now, thousands have died, with thousands more on the way, and the economic damage has already been done. That's what happens when you let an idiot run the country.
- etrabroline 6y ago
  I'm loathe to defend the current US president, but almost no Western country took this seriously until the last possible minute. There is clearly a deeper ideological issue infecting the entire West.
  - mcv 6y ago
    It's absolutely true that most western countries underestimated this. East-Asian countries were better prepared and more willing to take drastic action to do what's necessary. Western countries assumed that, like SARS, Asia would solve this. Turns out it's way more contagious than SARS. Still, once the seriousness became clear, most countries did take action. Trump continued to deny and spread misinformation, even to this day.
  - ebcode 6y ago
    > There is clearly a deeper ideological issue infecting the entire West. Amen.
  - darkteflon 6y ago
    Australia and New Zealand have done a superlative job: https://www.theguardian.com/world/2020/apr/09/have-australia-new-zealand-stopped-covid-19-in-its-tracks-coronavirus https://www.theguardian.com/world/2020/apr/09/have-australia....
  - deleted 6y ago
    [deleted]

jrfinkel 6y ago

Here’s a preprint of the actual paper: https://www.medrxiv.org/content/10.1101/2020.04.01.20050542v1 https://www.medrxiv.org/content/10.1101/2020.04.01.20050542v...

amscanne 6y ago

% of visits to primary care provider is a _terrible_ metric. People have been actively advised to stay away from the Doctor’s office and hospitals for routine reasons (and reschedule for later). Obviously the % visiting because they think they have Covid is going up, even if they don’t have it!

jrfinkel 6y ago
One of the study authors addressed this on Twitter. It’s certainly not hard proof, but 8 million extra cases would be a whole lot of hypochondriacs. Thread is short and worth a read. https://mobile.twitter.com/inschool4life/status/1247620008349519878 https://mobile.twitter.com/inschool4life/status/124762000834...

vondur 6y ago

I was pretty sick in late February, and ended up in the urgent care at my local Kaiser. It was packed at the time too. Seemed like everyone was sick with the flu.

chiph 6y ago
It might actually have been the flu. At least for me (in North Carolina), this year's flu vaccine was a miss, so I ended up sick anyway.
ceejayoz 6y ago
My son had a nasty bout of pneumonia in late January / early February, so I'll be interested in an antibody test for him when they become available.
ardy42 6y ago
> I was pretty sick in late February, and ended up in the urgent care at my local Kaiser. It was packed at the time too. Seemed like everyone was sick with the flu. The 2019-2020 seasonal flu has also been relatively bad compared to many other years. https://time.com/5758953/flu-season-2019-2020/ https://time.com/5758953/flu-season-2019-2020/: 2019-2020 Flu Season on Track to Be Especially Severe, New CDC Data Suggests (Jan 4th).
vanniv 6y ago
I was terribly sick in early February, in CA. I went to my urgent care multiple times as I got worse. The doctor tested me for influenza, but told me that he was seeing hundreds of patients, all day every day, with "an unusual flu" where they were mildly sick for a few days, recover, and then suddenly got much worse with high fevers and chest infections -- and most of those patients were turning up with negative influenza tests. But influenza tests have a high false negative rate, so just because I was negative on the test didn't mean anything. The doc said that this year, the influenza test only seemed to show positive for folks that had a high fever the first day of their illness (which, between you and me, is very common with influenza and very uncommon for COVID) I was out of work for over a week, and only got out of bed when I had no choice the entire time. None of my doctors asked me about travel or contact with recent travelers, and nobody ever even suggested getting a coronavirus test. When I got back to work a week later, I learned that nearly 10% of my office had gotten sick either the same day as me or while I was out. Did we all have COVID-19? maybe. Maybe not. None of us were tested. None of us will turn up in the COVID statistics. But in early/mid February, there definitely was some coronavirus here -- we had a few known travel cases, and we had tons of travelers between all regions of China and all parts of CA. It is entirely possible for folks to have unknowingly brought the virus here in moderate numbers.

foton1981 6y ago

I dont understand how would such highly contagious virus suppress and contain itself if it started in CA months ago. As if Californians have no outbound travel. Impossible scenario.

jrfinkel 6y ago
I don’t think anyone is claiming that it suppressed and contained itself. They’re claiming it’s more widespread and more mild. There’s a good graphic in the economist article showing two different peaks that look the same early on.

alephnan 6y ago

Was this data not publicly available ? Were there not army of analysts? I thought with Machine Learning being all the rage and hype, we’d have more people and machine keeping tabs on all kinds of trends, this included. Good that we have these retroactive inspections, but the whole appeal of ML is its predictive power is it not? Or did the hedge funds just keep this knowledge to themselves?

mr_gibbins 6y ago
Could it be because AI is an overhyped rehash of the AI craze that swept academia and industry in the 1980s, only to collapse in the 'AI winter' as everyone realised the truth? We use AI/ML for trivial purposes right now. Multivariate statistical analysis beats AI in many domains. Covid is a real-world, grown-up problem. It isn't identifying pictures of cats, or creating obscene chatbots (remember Tay?). So AI has been shown up to be a duff non-solution.

logjammin 6y ago

This is a problem of insufficient data. We don't have a denominator, so there's no way to tell if it's more widespread than we thought. In fact there's no good way to tell how widespread it is at all. We have numerators: number of people sick enough to show to up to an ER, or number dead, or whatever, take your pick. But in every fraction we might want, we lack a denominator: total number of people infected. There's a stuningly simple way to get one: sample randomly from a population of interest in large enough numbers (say e.g. Cook County, home of Chicago, or hell, the entire US) and test everyone for the virus. Voila! You have a representative chunk of your population, an estimate of virus prevalence, and a quantifiable degree of precision about that estimate (SE's for a confidence interval, say). With enough people in your sample, you can have extremely accurate estimates of the spread of Covid in your population of interest. You repeat this process over and over, through time, to track the numbers. I'm not trivializing this kind of effort: it takes rigorous sampling designs and dozens or hundreds of field workers, among other things. It's intense but very straightforward. Political pollsters (and thousands of researchers in different fields) do it every day. No one in the US has done this, and no one with any visibility from Fauci on down has even suggested it (that I know of; please correct me). I work in public health, and this is first year, first semester of grad school stuff. This matters because the public health responses to coronavirus when there's 1% or 10% or 25% or 75% of a population infected all look very different. In short, we may be over- or underreacting to the situation with the measures we currently have in place. I've been going half crazy wondering what's happening about this for a while now. After the initial fuckup, we now have tests. We have money. We can do this. Why don't we? (Iceland has done this!)

a9h74j 6y ago
A Stanford MD PhD who had a recent article in the Wall St Journal was interviewed on video[1]. In the video he refers to this very denominator-related test being forthcoming. There are two things I don't understand. First, why did this have to wait for some approved(?) antibody test, rather than being tried with a presumably research-grade test to start?? Second (physicist talking here), to get a rough estimate (to within a factor) whether exposure has already silently _significantly_ spread, why not relax some rigor in the sampling design and just sample 100-1000 geographically-diverse people to get _some_ estimate that could at least speak to the "is exposure already widespread?" question? [1] https://www.youtube.com/watch?v=-UO3Wd5urg0 https://www.youtube.com/watch?v=-UO3Wd5urg0