6 ms·

Imagine all 65M people in the UK caught the virus then a 10,000 case fatality number would give a rate of 0.015%. The rate itself has no time element so it tel

by yomly 7y ago

Imagine all 65M people in the UK caught the virus then a 10,000 case fatality number would give a rate of 0.015%. The rate itself has no time element so it tells you nothing about the number of people in hospital right now and hence isn't very illustrative of how hospitals can be swamped by this disease. More interestingly (for me at least) is that the mortality rate is dependent on a patient's access to a ventilator. This means if you caught the virus early in the spread of the pandemic your odds of surviving are substantially higher than if you caught it right at the peak of infection. This is impossible to reflect in a simple global mortality rate and so really paints a different picture of the virus - the death rate in South Korea vs other places really highlights this. I guess to your point, hospitals are more in this way because the virus is so infectious, rather than it being a universally dangerous disease as may be seen from a higher mortality rate. Remember, a high number of people experience little to no symptoms from catching this. This variability in symptoms doesn't seem to be as true for other lethal diseases like say malaria or dengue fever

Tepix 7y ago
> This means if you caught the virus early in the spread of the pandemic your odds of surviving are substantially higher than if you caught it right at the peak of infection. I'd say your odds are best if you catch it some time after the peak. The hospital will be better prepared to prevent infections there and have more experience on how to treat patients best. There may even be some treatment that prevents the worst symptoms. Also, if you (egoistically) try to get Covid-19 early, you may inadvertently infect others against their will.
- yomly 7y ago
  Yep you're right, your odds are best towards the tail of the pandemic
  - bluGill 7y ago
    In most cases, but the 1918 Spanish flu famously got more deadly after a mutation, if you got it early you were better off. I'm still hoping to get it late assuming better treatment (or better yet vaccine), but I recognize there is no way to know if this is correct in this case.
    - TheOtherHobbes 7y ago
      The best case with mass immunity is that R drops below 0 and the virus burns itself out. The worst case is that immunity primes the body for a massive and lethal immune system overreaction if the virus returns and/or mutates. This seems to have happened in 1918, which is why the second wave was more deadly. Generally viruses seem to become less lethal over time, so this is rare and unlikely - and we'd be very unlucky indeed if it happened now. But it isn't entirely impossible. The smart thing to do would be to have some high-quality monitoring in place to catch it if it starts happening, with high quality contingency planning for an international response.
      - vsl 7y ago
        Below 1, not 0. Below 0 would mean an infected person on average heals other infected.
cm2187 7y ago
Though my understanding is that the survival rate of a covid19 patient once he requires a ventilator is around 50%. If that's true, at worst, if we ran out of ventilators, the death rate would double. That's bad and we should avoid it but the doubling of a tiny number will still be a small number. Which is why I am still confused by the ratio of 1:10 that the White House has shown between the death toll under lockdown vs no lockdown. For the reason above, I would only expect the death rate to double. No lockdown means a lot more people get infected faster. But lockdown still requires to build herd immunity, we are only slowing it down. So the same number of people will get infected ultimately. So either they implied that the lockdown would be permanent until we get a vaccine (at best 2021 Q1), or it completely disregarded what happened after the initial few weeks of lockdown and then the numbers were at best grossly misleading.
- jpxw 7y ago
  Some 15% of people become “seriously” unwell, and require medical intervention such as oxygen. In a situation where the peak is hit unmitigated, these people will not get the medical care they need, and a lot of them will die.
  - cm2187 7y ago
    The 15% looks implausible given the fatality rates mentioned here. But I would expect a lot of the medical care to be scalable so unmitigated doesn't mean no medical care. We have been building field hospitals in the UK and US (though have barely used them so far), using hotels, etc. Providing oxygen should be fairly straightforward. I understood ventilators was the part that caused a serious scalability bottleneck.
    - yomly 7y ago
      Yes - part of the strategy of flattening the curve is to buy time to scale capacity. Dedicated covid19 hospitals also have the advantage of isolating covid19 patients from high risk non-covid19 patients (e.g immunocompromised cancer patients) As the disease is so easily transmitted hospitals are partly buckling due to contamination within hospitals. A regular 50 year old probably has a good chance of surviving coronavirus. A 50 year old who is midway through chemo, probably less so... All of this nuance is hard to express through topline death tolls and mortality rates.
chiefalchemist 7y ago
In addition, this virus tends to prey on the weak. You don't want to have a pre-existing condition around Covid-19. If you look at the top causes of deaths in the USA in recent years then match well with C19's "favorite" targets. This instance, high blood pressure, diabetes, lung disease (e.g., COPD aka smoking), etc. The last stat I heard was 40% of USA adults have a pre-existing condition. That's a significant amount of potential hospitalizations.
- nradov 7y ago
  A study of patients in New York showed that obesity was the top chronic pre-existing condition risk factor. https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1 https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v...
  - chiefalchemist 7y ago
    Right. And obesity is, in general, preventable. That is, C19 is a symptom. The underlying "disease" is how generally unhealthy the average citizen is.
nradov 7y ago
Access to ventilators has only a minor impact on mortality rate. About 80% of COVID-19 patients placed on ventilators die. (This is significantly worse than other forms of ARDS.) https://www.sfgate.com/news/medical/article/Some-doctors-moving-away-from-ventilators-for-15187546.php https://www.sfgate.com/news/medical/article/Some-doctors-mov...
moneywoes 7y ago
From what I read the mortality rate of patients on ventilators is near 80% in NY. Are they really beneficial?
- yomly 7y ago
  But what does that 80% mean? We know that New York's hospitals are overrun. We also know that in countries where the hospitals aren't at capacity the mortality rate is much lower. Look at Wuhan vs the rest of China. Or Singapore/HK/Taiwan/South Korea vs Italy, Paris, New York. So if ventilator access is low and doctors are triaging ventilators to go to the most urgent cases, is the data skewed towards severe cases and late access to ventilation support? This anecdotal account[1] seems to suggest ventilate as early as possible to maximise the chances of saving a patient. So again, a global stat could be masking a time element and context to the data https://www.bloomberg.com/news/articles/2020-03-24/covid-19-mysteries-yield-to-doctors-new-weapon-crowd-sourcing https://www.bloomberg.com/news/articles/2020-03-24/covid-19-...

by yomly 7y ago

Tepix 7y ago

> This means if you caught the virus early in the spread of the pandemic your odds of surviving are substantially higher than if you caught it right at the peak of infection. I'd say your odds are best if you catch it some time after the peak. The hospital will be better prepared to prevent infections there and have more experience on how to treat patients best. There may even be some treatment that prevents the worst symptoms. Also, if you (egoistically) try to get Covid-19 early, you may inadvertently infect others against their will.

yomly 7y ago
Yep you're right, your odds are best towards the tail of the pandemic
- bluGill 7y ago
  In most cases, but the 1918 Spanish flu famously got more deadly after a mutation, if you got it early you were better off. I'm still hoping to get it late assuming better treatment (or better yet vaccine), but I recognize there is no way to know if this is correct in this case.
  - TheOtherHobbes 7y ago
    The best case with mass immunity is that R drops below 0 and the virus burns itself out. The worst case is that immunity primes the body for a massive and lethal immune system overreaction if the virus returns and/or mutates. This seems to have happened in 1918, which is why the second wave was more deadly. Generally viruses seem to become less lethal over time, so this is rare and unlikely - and we'd be very unlucky indeed if it happened now. But it isn't entirely impossible. The smart thing to do would be to have some high-quality monitoring in place to catch it if it starts happening, with high quality contingency planning for an international response.
    - vsl 7y ago
      Below 1, not 0. Below 0 would mean an infected person on average heals other infected.

cm2187 7y ago

Though my understanding is that the survival rate of a covid19 patient once he requires a ventilator is around 50%. If that's true, at worst, if we ran out of ventilators, the death rate would double. That's bad and we should avoid it but the doubling of a tiny number will still be a small number. Which is why I am still confused by the ratio of 1:10 that the White House has shown between the death toll under lockdown vs no lockdown. For the reason above, I would only expect the death rate to double. No lockdown means a lot more people get infected faster. But lockdown still requires to build herd immunity, we are only slowing it down. So the same number of people will get infected ultimately. So either they implied that the lockdown would be permanent until we get a vaccine (at best 2021 Q1), or it completely disregarded what happened after the initial few weeks of lockdown and then the numbers were at best grossly misleading.

jpxw 7y ago
Some 15% of people become “seriously” unwell, and require medical intervention such as oxygen. In a situation where the peak is hit unmitigated, these people will not get the medical care they need, and a lot of them will die.
- cm2187 7y ago
  The 15% looks implausible given the fatality rates mentioned here. But I would expect a lot of the medical care to be scalable so unmitigated doesn't mean no medical care. We have been building field hospitals in the UK and US (though have barely used them so far), using hotels, etc. Providing oxygen should be fairly straightforward. I understood ventilators was the part that caused a serious scalability bottleneck.
  - yomly 7y ago
    Yes - part of the strategy of flattening the curve is to buy time to scale capacity. Dedicated covid19 hospitals also have the advantage of isolating covid19 patients from high risk non-covid19 patients (e.g immunocompromised cancer patients) As the disease is so easily transmitted hospitals are partly buckling due to contamination within hospitals. A regular 50 year old probably has a good chance of surviving coronavirus. A 50 year old who is midway through chemo, probably less so... All of this nuance is hard to express through topline death tolls and mortality rates.

chiefalchemist 7y ago

In addition, this virus tends to prey on the weak. You don't want to have a pre-existing condition around Covid-19. If you look at the top causes of deaths in the USA in recent years then match well with C19's "favorite" targets. This instance, high blood pressure, diabetes, lung disease (e.g., COPD aka smoking), etc. The last stat I heard was 40% of USA adults have a pre-existing condition. That's a significant amount of potential hospitalizations.

nradov 7y ago
A study of patients in New York showed that obesity was the top chronic pre-existing condition risk factor. https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1 https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v...
- chiefalchemist 7y ago
  Right. And obesity is, in general, preventable. That is, C19 is a symptom. The underlying "disease" is how generally unhealthy the average citizen is.

nradov 7y ago

Access to ventilators has only a minor impact on mortality rate. About 80% of COVID-19 patients placed on ventilators die. (This is significantly worse than other forms of ARDS.) https://www.sfgate.com/news/medical/article/Some-doctors-moving-away-from-ventilators-for-15187546.php https://www.sfgate.com/news/medical/article/Some-doctors-mov...

moneywoes 7y ago

From what I read the mortality rate of patients on ventilators is near 80% in NY. Are they really beneficial?

yomly 7y ago
But what does that 80% mean? We know that New York's hospitals are overrun. We also know that in countries where the hospitals aren't at capacity the mortality rate is much lower. Look at Wuhan vs the rest of China. Or Singapore/HK/Taiwan/South Korea vs Italy, Paris, New York. So if ventilator access is low and doctors are triaging ventilators to go to the most urgent cases, is the data skewed towards severe cases and late access to ventilation support? This anecdotal account[1] seems to suggest ventilate as early as possible to maximise the chances of saving a patient. So again, a global stat could be masking a time element and context to the data https://www.bloomberg.com/news/articles/2020-03-24/covid-19-mysteries-yield-to-doctors-new-weapon-crowd-sourcing https://www.bloomberg.com/news/articles/2020-03-24/covid-19-...