5 ms·

That is certainly alarming that it is so much more widespread than expected - it really highlights the failure of our controls against the virus and the importa

That is certainly alarming that it is so much more widespread than expected - it really highlights the failure of our controls against the virus and the importance of early testing. It I'd good news that this implies the death rate is less severe. However, a caveat is that antibody tests might have high rates of false positives, which would be a particularly large problem when very few people are actually positive. So read this with a grain of salt. The paper isn't peer reviewed yet etc.

oldgradstudent 7y ago
On the contrary, this is not alarming at all. It would point out that actual Covid-19 mortality could be close to that of seasonal flu, as it tells us the number of people infected is 50X-85X than the number of confirmed cases. Assuming the data is reliable, of course.
- buboard 7y ago
  the authors infer an IFR of 0.12 - 0.2% which is smaller than other antibody studies (like the one in germany which inferred 0.37% IIRC). While it s indeed small, it reflects the current situation, not what will happen 2 weeks down the road, plus the sensitivity of their antibody testing is not precisely known yet.
makomk 7y ago
Most signs so far suggest that the virus is basically uncontainable, short of everyone on the planet taking aggressive measures to stop it escaping China back in January or December.
- zaroth 7y ago
  That was back when China was claiming it didn’t transmit between humans, and ordering labs to destroy their samples. https://www.nationalreview.com/the-morning-jolt/chinas-devastating-lies/ https://www.nationalreview.com/the-morning-jolt/chinas-devas...
  - SpicyLemonZest 7y ago
    Right, that's why people say the Chinese government's lies (and the WHO's acceptance of them) are at fault. The rest of the world certainly should have reacted sooner, ramping up PPE production and researching treatments and trying to slow it down. But the idea of complete containment, forming widespread green zones where the virus is not merely suppressed but eradicated, probably became impossible as early as February. (Some island or basically-island countries appear to be making it work, but it's not clear what their long-term plan is - are they just going to enact sakoku for the next 18 months?)
    - zaroth 7y ago
      Well and I say this not even to indite China. Maybe they really and truly believed at the time there wasn’t human transmission. Maybe a virus originating in France or the US would have played out mostly the same way. (I doubt it, but that’s irrelevant) My point was just that with the information we had in December, there was no way politically to enact the extraordinary (and extraordinarily damaging) measures that would have been required to prevent an epidemic. Not only was it politically untenable (Trump was only acquitted on February 5th!) but it was simply scientifically unsupported and unjustifiable at that time. IMO even with hindsight being 20/20 I can’t say given the information we had on January 1 that we could or should have done any differently than the travel ban on January 31st, which itself was extraordinary. Everything post January 31st however is an absolute boondoggle of the highest degree. As far as PPE and testing capacity, I believe those are both systemic issues which needed to be dealt with years ago. Good luck with the US trying to procure a billion masks from China right at the onset of their own health crisis — imagine how that would play out with 1,000s of deaths in Wuhan and 0 known cases in the US. We would have been accused of hoarding and causing the spread in China. The testing issue was mainly an easily foreseeable and preventable regulatory problem at the FDA which has existed for some time. It took too long to remove the regulatory hurdles, but that there was not already a pandemic regulatory response framework ready to activate is totally inexcusable since we already went through this in 2009.
      - redis_mlc 7y ago
- fspeech 7y ago
  How do you square that with the fact that there is no outbreak in any overseas Chinese community? Not Taiwan or Hongkong or Macau, nor in the epicenter of Italy (https://www.reuters.com/article/us-health-coronavirus-italy-chinese/from-zero-to-hero-italys-chinese-help-beat-coronavirus-idUSKBN21I3I8 https://www.reuters.com/article/us-health-coronavirus-italy-...), nor San Francisco Chinatown (https://www.nytimes.com/2020/04/17/us/san-francisco-coronavirus-chinese-hospital.html https://www.nytimes.com/2020/04/17/us/san-francisco-coronavi...)? All of these communities have far more ties to mainland China.
  - guscost 7y ago
    It could have already passed through all of those communities basically unnoticed, and/or confused with other ILIs. There's no way to rule out that possibility, and when you consider how rare cardiovascular diseases (the most common comorbidity) are in those communities, you have to conclude that it's not vanishingly unlikely: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=49 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=4... Obviously mitigation efforts still play some part in limiting the spread, but I would not bet that all of those communities were able to suppress such a contagious disease before a big chunk of the population was exposed to it.
    - fspeech 7y ago
      Maybe Chinese emigrants in Italy are young so they didn't notice the wave. But Taiwan/Hongkong/Macau? They are testing and tracing. When their recent travelers to Europe and America came back, a lot of them were infected and caused a spike in cases. https://www.nytimes.com/interactive/2020/04/09/world/asia/coronavirus-hong-kong-singapore-taiwan.html https://www.nytimes.com/interactive/2020/04/09/world/asia/co...
tshadley 7y ago
Note coauthor name "John Ioannidis". That gives the paper a healthy boost in my view.
- projektfu 7y ago
  Careful, though, because just being a critic doesn't mean he isn't susceptible to the same sorts of biases and issues that cause a lot of other medical papers to fail. I'm hoping he's on the paper because they ran it by him for a thumbs-up before submitting it.
  - danieltillett 7y ago
    I hope he is not on the paper for that reason as this is basically honorary authorship. If he just reviewed the paper before submission then he should be in the acknowledgements.

oldgradstudent 7y ago

On the contrary, this is not alarming at all. It would point out that actual Covid-19 mortality could be close to that of seasonal flu, as it tells us the number of people infected is 50X-85X than the number of confirmed cases. Assuming the data is reliable, of course.

buboard 7y ago
the authors infer an IFR of 0.12 - 0.2% which is smaller than other antibody studies (like the one in germany which inferred 0.37% IIRC). While it s indeed small, it reflects the current situation, not what will happen 2 weeks down the road, plus the sensitivity of their antibody testing is not precisely known yet.

makomk 7y ago

Most signs so far suggest that the virus is basically uncontainable, short of everyone on the planet taking aggressive measures to stop it escaping China back in January or December.

zaroth 7y ago
That was back when China was claiming it didn’t transmit between humans, and ordering labs to destroy their samples. https://www.nationalreview.com/the-morning-jolt/chinas-devastating-lies/ https://www.nationalreview.com/the-morning-jolt/chinas-devas...
- SpicyLemonZest 7y ago
  Right, that's why people say the Chinese government's lies (and the WHO's acceptance of them) are at fault. The rest of the world certainly should have reacted sooner, ramping up PPE production and researching treatments and trying to slow it down. But the idea of complete containment, forming widespread green zones where the virus is not merely suppressed but eradicated, probably became impossible as early as February. (Some island or basically-island countries appear to be making it work, but it's not clear what their long-term plan is - are they just going to enact sakoku for the next 18 months?)
  - zaroth 7y ago
    Well and I say this not even to indite China. Maybe they really and truly believed at the time there wasn’t human transmission. Maybe a virus originating in France or the US would have played out mostly the same way. (I doubt it, but that’s irrelevant) My point was just that with the information we had in December, there was no way politically to enact the extraordinary (and extraordinarily damaging) measures that would have been required to prevent an epidemic. Not only was it politically untenable (Trump was only acquitted on February 5th!) but it was simply scientifically unsupported and unjustifiable at that time. IMO even with hindsight being 20/20 I can’t say given the information we had on January 1 that we could or should have done any differently than the travel ban on January 31st, which itself was extraordinary. Everything post January 31st however is an absolute boondoggle of the highest degree. As far as PPE and testing capacity, I believe those are both systemic issues which needed to be dealt with years ago. Good luck with the US trying to procure a billion masks from China right at the onset of their own health crisis — imagine how that would play out with 1,000s of deaths in Wuhan and 0 known cases in the US. We would have been accused of hoarding and causing the spread in China. The testing issue was mainly an easily foreseeable and preventable regulatory problem at the FDA which has existed for some time. It took too long to remove the regulatory hurdles, but that there was not already a pandemic regulatory response framework ready to activate is totally inexcusable since we already went through this in 2009.
    - redis_mlc 7y ago
fspeech 7y ago
How do you square that with the fact that there is no outbreak in any overseas Chinese community? Not Taiwan or Hongkong or Macau, nor in the epicenter of Italy (https://www.reuters.com/article/us-health-coronavirus-italy-chinese/from-zero-to-hero-italys-chinese-help-beat-coronavirus-idUSKBN21I3I8 https://www.reuters.com/article/us-health-coronavirus-italy-...), nor San Francisco Chinatown (https://www.nytimes.com/2020/04/17/us/san-francisco-coronavirus-chinese-hospital.html https://www.nytimes.com/2020/04/17/us/san-francisco-coronavi...)? All of these communities have far more ties to mainland China.
- guscost 7y ago
  It could have already passed through all of those communities basically unnoticed, and/or confused with other ILIs. There's no way to rule out that possibility, and when you consider how rare cardiovascular diseases (the most common comorbidity) are in those communities, you have to conclude that it's not vanishingly unlikely: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=49 https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=4... Obviously mitigation efforts still play some part in limiting the spread, but I would not bet that all of those communities were able to suppress such a contagious disease before a big chunk of the population was exposed to it.
  - fspeech 7y ago
    Maybe Chinese emigrants in Italy are young so they didn't notice the wave. But Taiwan/Hongkong/Macau? They are testing and tracing. When their recent travelers to Europe and America came back, a lot of them were infected and caused a spike in cases. https://www.nytimes.com/interactive/2020/04/09/world/asia/coronavirus-hong-kong-singapore-taiwan.html https://www.nytimes.com/interactive/2020/04/09/world/asia/co...

tshadley 7y ago

Note coauthor name "John Ioannidis". That gives the paper a healthy boost in my view.

projektfu 7y ago
Careful, though, because just being a critic doesn't mean he isn't susceptible to the same sorts of biases and issues that cause a lot of other medical papers to fail. I'm hoping he's on the paper because they ran it by him for a thumbs-up before submitting it.
- danieltillett 7y ago
  I hope he is not on the paper for that reason as this is basically honorary authorship. If he just reviewed the paper before submission then he should be in the acknowledgements.