5 ms·

The Netherlands has 3.3k deaths vs 29k confirmed cases, which would give a CFR of ~10% I.e. the Netherlands aren't testing much. A 10x reduction there brings

• Gibbon1 6y ago
  My current bet is younger healthy people are more likely to be asymptomatic. And older people much less so. Theodore Roosevelt with likely a young population, most are asymptomatic. Diamond Princess much older population most are symptomatic.
  • alexbanks 6y ago
    This is a thing I've been thinking about a lot. We're quick to say "We're not testing enough", but also quick to throw statistics around "disproving" the amount of asymptomatic cases. I am on the side of "It's probably orders of magnitude widespread than most countries think", and the number of totally asymptomatic cases is actually far far higher. You can't test only the old and the already sick and then accurately assess likelihood to develop symptoms. Your sample is totally wrong.
    • feral 6y ago
      Humanity's understanding of this disease is much more sophisticated than the two comments above this would imply. Researchers are not stupidly looking at Diamond Princess and getting confused because the population is old. Rather it's a powerful dataset because it enables us to quantify the asymptomatic people of all ages, because people were tested fairly exhaustively before being allowed leave, regardless of symptoms, and because we've had enough time for many of the cases to play out. The diamond princess data revealed a large number of asymptomatic cases in China, the absence of which were skewing the detected cases in China much older. Anyway, you don't need to think anything complicated about correcting for ages, etc You can just look at the data from the Netherlands where they conclude they have 3% population infection, by looking at the random serological testing, and then look at the number of confirmed deaths they have, and do the very simple math. It's very hard to do that and then say we're missing say 10x higher numbers of asymptomatic cases all over the place. This blog post I wrote a while back is Ireland specific but has figures on CFR and IFR I think are still valid, and references to the academic articles I got them from: https://medium.com/@fergal.reid/predicting-the-impact-of-coronovirus-on-ireland-bff1b6d00d6a https://medium.com/@fergal.reid/predicting-the-impact-of-cor...
      • guscost 6y ago
        Anyone who actually knows this stuff would never say that it’s a matter of “simple math”, that’s absurd. Those people have not been saying that they’re sure about anything at this point, because they’re not. There’s nothing to prove you wrong yet either, of course, but let’s see how your prediction does over the next few months: between 14,400 and 80,000 deaths in Ireland.
        • feral 6y ago
          The simple math comment was about estimating IFR, given the sampling in the Netherlands, not about the whole domain. Maybe you are saying the implied model is too crude. Perhaps, but there's a value in it's simplicity - folks can get a convincing estimate of the rough scale of the IFR, that this disease is serious, not the flu etc. > let’s see how your prediction does over the next few months: between 14,400 and 80,000 deaths in Ireland. That prediction, was based on the measures in place over a month ago (very few, which was the point). We're since in lockdown almost 3 weeks. However, I think it remains a reasonable prediction for an unmitigated epidemic. To go back to the simple math: If you believe that 3% of a random sample of the Netherlands have had covid, and that the Netherlands has had 3k deaths, then if 100% were infected they might have 100k deaths (without modeling clustering, and healthcare saturation effects). Their population is 3x Ireland's. >There’s nothing to prove you wrong yet either, of course, If the serological sampling had shown instead that their 3k deaths had come from 30% of their population being infected, that would have proved the prediction wrong. There's loads of subtlety which could improve that estimate (people take time to die, clusters, etc) but there is an increasing body of evidence that the early IFR estimates were not wrong by an order of magnitude.
          • marvin 6y ago
            It's just splendid how a lot of people will criticize an estimate of deaths assuming no mitigating measures, and then say "see? no problem!" when the outcome is much better after stopping most economic activity for a month. War-time level mitigating measures.
    • elliekelly 6y ago
      People always seem to forget half of the Diamond Princess population was young, healthy, and under 35. Let’s not forget the crew were on board and infected, too.
  • dx034 6y ago
    It might also not only be age. Sailors on the Roosevelt are likely to be less obese than average, more fit, maybe lower rates of smokers (not sure) and certainly lower rates of other pre-existing conditions. That all puts them in lower risk groups. Just the higher share of men increases risk somewhat. But overall they certainly don't represent the average US population.
  • Scarblac 6y ago
    Or it is related to initial viral load, and getting it through the air from the ventilation systems on a ship gives low viral load. Otoh, maybe asymptomatic cases also don't build up immunity so shouldn't really be counted as cases.
  • de_watcher 6y ago
    "Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free" Be fit. Be young. We've solved it boys, hit the showers.
• misun78 6y ago
  Diamond princess skewed heavily towards an older age population, as did some of the hardest hit cities in Italy like Lombardi etc. To counter your point, there isn't any evidence to infer an IFR or 0.5-1% either. We simply don't know given the lack of antibodies testing in a randomized population set that's adequately representative of the right demographics in a given location (say NYC).
  • iso947 6y ago
    Half the diamond princess people were staff - mainly under 40s.
• rocqua 6y ago
  Dutch testing policy is acknowledged by national bodies to not be representative at all. Moreover, so is our death rate. We have a lot of hidden deaths of elderly people who decide not to go through the trauma of an ICU stint and instead decide to die at home. I don't recall exact numbers but think it was estimated the true death toll is about 50 to 100 percent higher.
  • jaynetics 6y ago
    The middle part is an interesting point. A study of the first 50 hospital patients in Heinsberg (worst affected region in Germany) found that of 8 who had died, 4 had rejected ICU treatment.
    • Thlom 6y ago
      In Sandinavia we see a lot of covid-19 related deaths at elderly care homes. These are older people, often with a lot of underlying deceases in addition to their old age. Very seldom these patients are moved to a hospital, so they die at the home with only palliative care. I guess in many cases they are not in any position to decline or accept ICU at all due to dementia.
  • simonh 6y ago
    Pneumonia patients in hospital have their blood oxygen continuously monitored, with alarms if it goes too low because the symptoms of oxygen starvation are very hard to spot even by a trained nurse, but can be rapidly fatal. The most common cause of death is heart attack because the heart isn't getting enough oxygen. So these people dying at home probably think they're not at serious risk and don't want to take up a hospital bed from someone in a worse condition, so they try to tough it out but then they suddenly die.
    • rocqua 6y ago
      These are also (usually older) patients who decide they don't want to go on a ventilator because they feel their quality of life, if they were to survive, is so low as to not matter. These are decisions made in concert with the 'huisarts' (General Practitioner).
• dwd 6y ago
  Similar case with the Ruby Princess. It currently accounts for 10% of Australia's known cases (~600) and 30% of the deaths (20).