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It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here? - Around 200 million Americans

It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here? - Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. - Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe. - All we can do is alter the timetable to keep the hospitals functioning, which has been done successfully in many places throughout the world albeit at great cost. There's both good news and terrible news in those facts but none of it really seems to be in the consciousness of the public or of leaders, whereas "oh no you can maybe get it 8 hours after a guy sneezed in a lobby" is everywhere. Along with "everyone who stays at home is a hero" as we set ourselves up for a second Depression.

digitaltrees 6y ago
It’s not 0.5% it’s closer to 2%. You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.
- eightysixfour 6y ago
  And that also assumes everyone can get medical care, if all of the cases are happening at the same time, the mortality rate would increase as resource constraints force medical providers to pick who gets care.
- apatters 6y ago
  What's your source for 2%? A recent study which was featured on Hacker News estimated the infection fatality rate at 0.66%. [1] I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2] Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one). In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it. [1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext https://www.thelancet.com/journals/laninf/article/PIIS1473-3... [2] https://en.wikipedia.org/wiki/Case_fatality_rate https://en.wikipedia.org/wiki/Case_fatality_rate [3] https://news.ycombinator.com/item?id=22828691 https://news.ycombinator.com/item?id=22828691
  - khuey 6y ago
    The CFR in Italy is nearly 13%. Even if you make incredibly generous assumptions that there are no unreported deaths and they're only catching 10% of cases that still leaves the infection fatality rate at twice the number you propose
    - apatters 6y ago
      With an older population, a problematic medical system, and being caught totally unprepared, isn't Italy the worst case scenario? I don't think it would be representative of what's going to happen in other countries from here on out.
      - khuey 6y ago
        I don't know where this meme came from that Italy has a "problematic medical system" but that's certainly not true in Lombardy.
      - ModernMech 6y ago
        The US has a population riddled with comorbitities (obesity, heart disease, diabetes, etc.), a problematic medical system, and was caught totally unprepared. Isn't the US the worst case scenario, with the most deaths and most infections in the world?
      - Mountain_Skies 6y ago
        >Isn't the US the worst case scenario, with the most deaths and most infections in the world? Adjust your numbers for population. Per capita numbers for the US are far from the worse case scenario.
      - girvo 6y ago
        You pretty much just described the US.
    - marcell 6y ago
      That's almost certainly untrue. Recent studies have show that as many as 38% of the Italian population has been infected at this point [1]. That gives a fatality rate 0.03%. Let's say the official death count is 10x undercounting, you're still left with 0.3%. [1] https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early_results_from_the_italian_biolab_meleam/ https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early...
- throwawaysea 6y ago
  No, 2% is the case fatality rate. The true overall mortality is far lower. Germany did a randomized test recently of a town and calculated that 2% of the population is actively infected, 14% possess antibodies indicative of a current/prior infection, and overall 15% have been infected at some point. Once this broader testing was completed, the overal mortality was found to only be 0.37%. For comparison, a typical flu season is 0.1%. https://www.tagesschau.de/regional/nordrheinwestfalen/corona-studie-heinsberg-101.html https://www.tagesschau.de/regional/nordrheinwestfalen/corona...
  - morsch 6y ago
    For comparison, a typical flu season is 0.1%. That is incorrect. The worst flu wave to hit Germany in the last 20 years, 2017/2018, killed appoximately 25000 people (excess mortality). That's 0.03%, and it's not typical. Often, the number is much lower. Note also that the results from the Gangelt study you're referring to are preliminary; there's a press release but no paper yet, not even in preprint. https://edoc.rki.de/handle/176904/6253 https://edoc.rki.de/handle/176904/6253
    - throwaway237683 6y ago
      > That's 0.03%, and it's not typical. Often, the number is much lower. 0.03% or 0.1% or 0.66%, the number is low enough to be perceived as not too dangerous by general populace. Contrast that with 13% mortality rate for Italy that was widely spun a month ago. Now _that_ was scary!
azakai 6y ago
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc. > Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe. Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.
saalweachter 6y ago
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. "Significantly less than 200 million Americans catching it" is still on the table. "Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily. This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs. This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed. It isn't hopeless. > Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe. We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.
- apatters 6y ago
  This is a great comment, thanks. So isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease? For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine. I think we need to explore alternatives to lockdowns because I believe the economics of lockdowns will make them impossible to continue for very long. At the moment people see this as a "be heroic and do the right thing" issues, but most people don't yet understand the severity of the economic impact and haven't yet been personally affected by it. Lockdowns will probably become politically untenable by May or June whether anyone today likes that fact or not.
marcinzm 6y ago
The death rate is 0.5% IF there's really good medical treatment. If there isn't then not only does the death rate from the covid go up but so do death rates for every other condition requiring medical treatment. And not only during the pandemic but for a some time afterwards as the health system recovers. That's not counting those who survive but have some form of permanent damage. The way to avoid that is to at least spread out the impact over time. Telling people it'll be okay leads to no one listening and the health system collapsing. That's human nature. Telling people it's the apocalypse means most listen and the health system survives. Welcome to humanity.
- SpicyLemonZest 6y ago
  I'm just very skeptical of this kind of noble lie. If authorities are known to tell people what's convenient for them to believe rather than what's true, is anyone going to end up listening to them in the end?
  - JamisonM 6y ago
    It is not a noble lie to tell people it won't be ok if it really won't be ok. Really, if every jurisdiction in the world overwhelms their hospital capacity it won't be ok.
    - SpicyLemonZest 6y ago
      Agreed, it'd be wrong to tell people it's okay. It's not okay, a lot of people are going to die, and even more people would have died if we didn't take costly measures to stop it. This has been and will be the worst experience of a lot of people's lives, and it'd just be a lie in another direction to pretend that's not so. What seems to be a noble lie is the apocalyptic mindset, where the coronavirus is literally the only thing that matters and we must never ask if a particular mitigation is worth the cost. Many authority figures are promoting this idea, even though they clearly don't believe it themselves and couldn't formulate effective policy if they did.
      - 6y ago
cameldrv 6y ago
Based on Italian serological and all cause mortality data I have seen, the death toll would more likely be about 1.4%. 0.5 IMO is quite optimistic. 0.1% of New York's population has already died. This also discounts the unknown possibility of disability, reinfection, and limited time immunity.
- DuskStar 6y ago
  I was under the impression that NYC had a confirmed infection rate of ~1%. Have they really had a tenth of confirmed cases die already?
  - irq11 6y ago
    No. Currently >200k confirmed, <11k deaths in New York State. NY population is 18.8M. 0.05% of the population has died.
    - Ankaios 6y ago
      New York City's population is around 8.5 M, and more then 10,000 people there have died from from the virus so far (https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus-deaths.html https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...). That puts the toll over 0.1 %.
      - irq11 6y ago
        I cited the correct, current numbers for the entire state. You’re citing numbers released by the city where they haven’t confirmed cases, so it doesn’t answer the OP’s question.
        alexbanks 6y ago
        Can you cite them, rather than saying that you cited them?
marcell 6y ago
Just in support of your argument, new data is showing that the fatality rate is lower then previously estimated, due to a large number of undetected cases. Just one example, tests of pregnant women coming into labor in New York show that 1/6 of them are positive for nCov, but 85% are asymptomatic or presymptomatic. (https://twitter.com/CT_Bergstrom/status/1249836446569181186 https://twitter.com/CT_Bergstrom/status/1249836446569181186) Another example, Denmark is finding potentially as high as 30-80x undercounting of cases, which would bring the fatality rate down to 0.1-0.2% (like a bad flu season) [https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_denmark_status_entering_week_6_of_the/ https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_...] I've seen a few more of these data points coming out, and nothing is 100% conclusive, all the new data points are showing that it's less bad than mainstream thinking suggests.
ScottBurson 6y ago
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. This doesn't seem right to me. With social distancing now, and testing and tracing once we have enough tests available, it seems to me that we should be able to keep the total number of infected people well below 200M, even if a vaccine takes the expected 18-24 months. If there's a solid argument that this is not the case, I'd like to hear it.
- redis_mlc 6y ago
  1) SARS-2 is highly contagious. 2) Testing and tracing is working fairly well in S. Korea because they're treating it like a war, and they've been orgainzed since fairly early on. The US is not organized. What most people, including HN, miss is that passing a test today means nothing about tomorrow.
altcognito 6y ago
I discount any comments that argue IFR as the sole basis for how quickly we can let the disease spread to save jobs on a short term basis. Hospitalization is a more important factor as it the death count goes up dramatically without intensive care. These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.

digitaltrees 6y ago

It’s not 0.5% it’s closer to 2%. You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.

eightysixfour 6y ago
And that also assumes everyone can get medical care, if all of the cases are happening at the same time, the mortality rate would increase as resource constraints force medical providers to pick who gets care.
apatters 6y ago
What's your source for 2%? A recent study which was featured on Hacker News estimated the infection fatality rate at 0.66%. [1] I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2] Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one). In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it. [1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext https://www.thelancet.com/journals/laninf/article/PIIS1473-3... [2] https://en.wikipedia.org/wiki/Case_fatality_rate https://en.wikipedia.org/wiki/Case_fatality_rate [3] https://news.ycombinator.com/item?id=22828691 https://news.ycombinator.com/item?id=22828691
- khuey 6y ago
  The CFR in Italy is nearly 13%. Even if you make incredibly generous assumptions that there are no unreported deaths and they're only catching 10% of cases that still leaves the infection fatality rate at twice the number you propose
  - apatters 6y ago
    With an older population, a problematic medical system, and being caught totally unprepared, isn't Italy the worst case scenario? I don't think it would be representative of what's going to happen in other countries from here on out.
    - khuey 6y ago
      I don't know where this meme came from that Italy has a "problematic medical system" but that's certainly not true in Lombardy.
    - ModernMech 6y ago
      The US has a population riddled with comorbitities (obesity, heart disease, diabetes, etc.), a problematic medical system, and was caught totally unprepared. Isn't the US the worst case scenario, with the most deaths and most infections in the world?
    - Mountain_Skies 6y ago
      >Isn't the US the worst case scenario, with the most deaths and most infections in the world? Adjust your numbers for population. Per capita numbers for the US are far from the worse case scenario.
    - girvo 6y ago
      You pretty much just described the US.
  - marcell 6y ago
    That's almost certainly untrue. Recent studies have show that as many as 38% of the Italian population has been infected at this point [1]. That gives a fatality rate 0.03%. Let's say the official death count is 10x undercounting, you're still left with 0.3%. [1] https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early_results_from_the_italian_biolab_meleam/ https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early...
throwawaysea 6y ago
No, 2% is the case fatality rate. The true overall mortality is far lower. Germany did a randomized test recently of a town and calculated that 2% of the population is actively infected, 14% possess antibodies indicative of a current/prior infection, and overall 15% have been infected at some point. Once this broader testing was completed, the overal mortality was found to only be 0.37%. For comparison, a typical flu season is 0.1%. https://www.tagesschau.de/regional/nordrheinwestfalen/corona-studie-heinsberg-101.html https://www.tagesschau.de/regional/nordrheinwestfalen/corona...
- morsch 6y ago
  For comparison, a typical flu season is 0.1%. That is incorrect. The worst flu wave to hit Germany in the last 20 years, 2017/2018, killed appoximately 25000 people (excess mortality). That's 0.03%, and it's not typical. Often, the number is much lower. Note also that the results from the Gangelt study you're referring to are preliminary; there's a press release but no paper yet, not even in preprint. https://edoc.rki.de/handle/176904/6253 https://edoc.rki.de/handle/176904/6253
  - throwaway237683 6y ago
    > That's 0.03%, and it's not typical. Often, the number is much lower. 0.03% or 0.1% or 0.66%, the number is low enough to be perceived as not too dangerous by general populace. Contrast that with 13% mortality rate for Italy that was widely spun a month ago. Now _that_ was scary!

azakai 6y ago

> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc. > Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe. Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.

saalweachter 6y ago

> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. "Significantly less than 200 million Americans catching it" is still on the table. "Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily. This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs. This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed. It isn't hopeless. > Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe. We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.

apatters 6y ago
This is a great comment, thanks. So isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease? For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine. I think we need to explore alternatives to lockdowns because I believe the economics of lockdowns will make them impossible to continue for very long. At the moment people see this as a "be heroic and do the right thing" issues, but most people don't yet understand the severity of the economic impact and haven't yet been personally affected by it. Lockdowns will probably become politically untenable by May or June whether anyone today likes that fact or not.

marcinzm 6y ago

The death rate is 0.5% IF there's really good medical treatment. If there isn't then not only does the death rate from the covid go up but so do death rates for every other condition requiring medical treatment. And not only during the pandemic but for a some time afterwards as the health system recovers. That's not counting those who survive but have some form of permanent damage. The way to avoid that is to at least spread out the impact over time. Telling people it'll be okay leads to no one listening and the health system collapsing. That's human nature. Telling people it's the apocalypse means most listen and the health system survives. Welcome to humanity.

SpicyLemonZest 6y ago
I'm just very skeptical of this kind of noble lie. If authorities are known to tell people what's convenient for them to believe rather than what's true, is anyone going to end up listening to them in the end?
- JamisonM 6y ago
  It is not a noble lie to tell people it won't be ok if it really won't be ok. Really, if every jurisdiction in the world overwhelms their hospital capacity it won't be ok.
  - SpicyLemonZest 6y ago
    Agreed, it'd be wrong to tell people it's okay. It's not okay, a lot of people are going to die, and even more people would have died if we didn't take costly measures to stop it. This has been and will be the worst experience of a lot of people's lives, and it'd just be a lie in another direction to pretend that's not so. What seems to be a noble lie is the apocalyptic mindset, where the coronavirus is literally the only thing that matters and we must never ask if a particular mitigation is worth the cost. Many authority figures are promoting this idea, even though they clearly don't believe it themselves and couldn't formulate effective policy if they did.
    - 6y ago

cameldrv 6y ago

Based on Italian serological and all cause mortality data I have seen, the death toll would more likely be about 1.4%. 0.5 IMO is quite optimistic. 0.1% of New York's population has already died. This also discounts the unknown possibility of disability, reinfection, and limited time immunity.

DuskStar 6y ago
I was under the impression that NYC had a confirmed infection rate of ~1%. Have they really had a tenth of confirmed cases die already?
- irq11 6y ago
  No. Currently >200k confirmed, <11k deaths in New York State. NY population is 18.8M. 0.05% of the population has died.
  - Ankaios 6y ago
    New York City's population is around 8.5 M, and more then 10,000 people there have died from from the virus so far (https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus-deaths.html https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...). That puts the toll over 0.1 %.
    - irq11 6y ago
      I cited the correct, current numbers for the entire state. You’re citing numbers released by the city where they haven’t confirmed cases, so it doesn’t answer the OP’s question.
      - alexbanks 6y ago
        Can you cite them, rather than saying that you cited them?

marcell 6y ago

Just in support of your argument, new data is showing that the fatality rate is lower then previously estimated, due to a large number of undetected cases. Just one example, tests of pregnant women coming into labor in New York show that 1/6 of them are positive for nCov, but 85% are asymptomatic or presymptomatic. (https://twitter.com/CT_Bergstrom/status/1249836446569181186 https://twitter.com/CT_Bergstrom/status/1249836446569181186) Another example, Denmark is finding potentially as high as 30-80x undercounting of cases, which would bring the fatality rate down to 0.1-0.2% (like a bad flu season) [https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_denmark_status_entering_week_6_of_the/ https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_...] I've seen a few more of these data points coming out, and nothing is 100% conclusive, all the new data points are showing that it's less bad than mainstream thinking suggests.

ScottBurson 6y ago

> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. This doesn't seem right to me. With social distancing now, and testing and tracing once we have enough tests available, it seems to me that we should be able to keep the total number of infected people well below 200M, even if a vaccine takes the expected 18-24 months. If there's a solid argument that this is not the case, I'd like to hear it.

redis_mlc 6y ago
1) SARS-2 is highly contagious. 2) Testing and tracing is working fairly well in S. Korea because they're treating it like a war, and they've been orgainzed since fairly early on. The US is not organized. What most people, including HN, miss is that passing a test today means nothing about tomorrow.

altcognito 6y ago

I discount any comments that argue IFR as the sole basis for how quickly we can let the disease spread to save jobs on a short term basis. Hospitalization is a more important factor as it the death count goes up dramatically without intensive care. These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.