4 ms·

We might be lucky to have a low mortality rate but why does it require a miracle? All new evidence seems to suggest a <0.5% fatility rate and a large number of

by cm2187 7y ago

We might be lucky to have a low mortality rate but why does it require a miracle? All new evidence seems to suggest a <0.5% fatility rate and a large number of infected people with mild or no symptoms.

ericmay 7y ago
I think initial concerns were the mortality rate would be much, much higher without the sometimes draconian shelter in place measures. It may be lower now because we are able to devote more intense resources (ventilators) to those who are sick. Burry seems to overlook that without implementing social distancing policies we may have had a huge surge in sick people all at once, which would have left many without access to potentially life saving equipment. Cases where a ventilator or other resources save someone and lower the overall mortality rate would have resulted in more deaths because you’ve simply got far too many sick people. With that being said, I’m sympathetic toward the concerns about the economic cost, and think that we need to really focus on a reopen plan in May or June. Workers who can WFH should probably continue to do so, but if we’ve been able to flatten the curve it’s probably time to go back outside and see what happens. I’ll also say with respect to Burry that although he is a trained physician, it doesn’t make him an expert in epidemiology, so, frankly, I don’t really care for his opinion on the subject any more than anyone else who is moderately educated.
- cm2187 7y ago
  I agree directionally, but the numbers matter as well. Depending on what study we look at, the survival rate of covid19 patients that require a ventilator is anywhere between 0% and 50%. For the sake of argument let’s assume the other patients can be treated in field hospitals that scale reasonably well, it means running out of ventilators would “only” double the mortality rate. But double a rate that is <0.5% may still be <0.5%.
- travisoneill1 7y ago
  Only 1/3 of people with COVID who require ventilation survive, so lack of ventilators will raise mortality, but only by 50%.
  - DanBC 7y ago
    Ventilators are also used by people who don't have covid-19, so lack of access to ICU is going to affect more than just covid-19 patients.
    - cm2187 7y ago
      Fine. Assume all ventilators used for non covid19 patients. The maths stay the same.
      - DanBC 7y ago
        You haven't counted length of stay before death or transfer to a different ward (covid-19 patients stay in ICU longer before they die or recover), nor iatrogenic harm caused by non-intensivist doctors and nurses suddenly being pulled into ICU work.
- amalter 7y ago
  Additionally, COVID-19 is a new disease and we have no data about the long term effects. This is true anecdotal, but I’m following a cohort of 5 MD friends who all experienced “walking COVID” (aka reached the loss of smell symptom, but required no hospitalization). This cohort is 35-45 and all previously highly athletic. They are between +20 and +45 days from being “symptom free”. Not one of them can perform cardiac challenged activities. I’ve heard things like “I get winded carrying groceries up the stairs” to “I cannot perform even a single push-up”. So before we take this big risk of letting the virus “burn” through the population, shouldn’t we understand just a bit more? Sure, maybe we’ll get lucky and the IFR will just be 2-10x flu. But there are worrying signs of permanent heart, lung and kidney damage. These costs will also stay with us long term. Mortality isn’t the concern when dealing with an unknown virus.
  - gremlinsinc 7y ago
    I wonder how this plays out with the NBA, since Rudy Gobert and many other players have tested positive and experienced those same kind of symptoms.
flohofwoe 7y ago
As far as I understand it, fatality rate is only low as this as long as the health care system isn't overwhelmed, so that people in serious conditions can be treated (and the number of serious cases is a lot higher than 0.5%). As soon as hospitals are at their capacity, a lot more people will die which otherwise had survived (and this will also affect people which are in critical conditions for entirely different reasons).
- rumanator 7y ago
  This. I don't understand how the whole point of flattening the curve was already forgotten. The whole point of the lockdown is not to act as a magic wand to make the pandemic vanish. The whole point is that, as it stands, emergency services are already operating beyond capacity. This means that your friends and loved ones risk needlessly dying for no reason just because they weren't able to have medical treatment, including from non-covid19 issues.
  - gremlinsinc 7y ago
    Also, if you're high risk (I may be - obesity) this is a scary disease, and honestly the longer you wait to get infected the better your chances. More local medical doctors will have experience treating it, there will be more studies on drugs, more help available etc. Your chances go up astronomically on a long enough time scale. So why rush it? I have the luxury of being a freelancer working from home, so this is mostly my normal, but I know it hurts a lot of people, but so does being dead - or having lung issues for life or neurological ones. Some broadway actor lost his leg over the weekend because of this. TLDR; It definitely helps w/ hospitals so they can still function it also gives time to find and create better treatments.
- bob33212 7y ago
  We don't know yet how much of a difference that makes. For example how many infected 80 year olds without medical treatment die compared to those that do get medical treatment. Medical treatment is certainly going to have a better mortality rate but not 100%.
kgwgk 7y ago
Where do you get that <0.5% fatality rate from? It seems to have caused already the death of between 0.1% (lab-confirmed) and 0.2% (excess deaths) of the population of NYC.
- cm2187 7y ago
  Now that we start doing anti-body tests, there seems to be multiple studies surfacing all pointing to a much higher than anticipated number of people infected. A few sources pointing in that direction: https://mobile.twitter.com/AmeshAA/status/1249446561010106370 https://mobile.twitter.com/AmeshAA/status/124944656101010637... https://mobile.twitter.com/AmeshAA/status/1249020677551796224 https://mobile.twitter.com/AmeshAA/status/124902067755179622... https://www.youtube.com/watch?v=_LG-so-8qwg https://www.youtube.com/watch?v=_LG-so-8qwg
  - kgwgk 7y ago
    What would you say that the number of infected people in NYC may be? If 20% of them are infected, the infection fatality rate observed is already in the 0.5%-1% range.
    - cm2187 7y ago
      I did that calculation for a similar objection a few days ago: https://news.ycombinator.com/item?id=22881103 https://news.ycombinator.com/item?id=22881103
      - kgwgk 7y ago
        Ok. If we take the observed data (0.15% mortality rate in the overall population) we can make hypothesis like “infection rate is 30%” and “infection fatality rate is 0.5%”. But being consistent and plausible doesn’t make them true. 15% and 1% are also plausible, as far as I know.

by cm2187 7y ago

ericmay 7y ago

I think initial concerns were the mortality rate would be much, much higher without the sometimes draconian shelter in place measures. It may be lower now because we are able to devote more intense resources (ventilators) to those who are sick. Burry seems to overlook that without implementing social distancing policies we may have had a huge surge in sick people all at once, which would have left many without access to potentially life saving equipment. Cases where a ventilator or other resources save someone and lower the overall mortality rate would have resulted in more deaths because you’ve simply got far too many sick people. With that being said, I’m sympathetic toward the concerns about the economic cost, and think that we need to really focus on a reopen plan in May or June. Workers who can WFH should probably continue to do so, but if we’ve been able to flatten the curve it’s probably time to go back outside and see what happens. I’ll also say with respect to Burry that although he is a trained physician, it doesn’t make him an expert in epidemiology, so, frankly, I don’t really care for his opinion on the subject any more than anyone else who is moderately educated.

cm2187 7y ago
I agree directionally, but the numbers matter as well. Depending on what study we look at, the survival rate of covid19 patients that require a ventilator is anywhere between 0% and 50%. For the sake of argument let’s assume the other patients can be treated in field hospitals that scale reasonably well, it means running out of ventilators would “only” double the mortality rate. But double a rate that is <0.5% may still be <0.5%.
travisoneill1 7y ago
Only 1/3 of people with COVID who require ventilation survive, so lack of ventilators will raise mortality, but only by 50%.
- DanBC 7y ago
  Ventilators are also used by people who don't have covid-19, so lack of access to ICU is going to affect more than just covid-19 patients.
  - cm2187 7y ago
    Fine. Assume all ventilators used for non covid19 patients. The maths stay the same.
    - DanBC 7y ago
      You haven't counted length of stay before death or transfer to a different ward (covid-19 patients stay in ICU longer before they die or recover), nor iatrogenic harm caused by non-intensivist doctors and nurses suddenly being pulled into ICU work.
amalter 7y ago
Additionally, COVID-19 is a new disease and we have no data about the long term effects. This is true anecdotal, but I’m following a cohort of 5 MD friends who all experienced “walking COVID” (aka reached the loss of smell symptom, but required no hospitalization). This cohort is 35-45 and all previously highly athletic. They are between +20 and +45 days from being “symptom free”. Not one of them can perform cardiac challenged activities. I’ve heard things like “I get winded carrying groceries up the stairs” to “I cannot perform even a single push-up”. So before we take this big risk of letting the virus “burn” through the population, shouldn’t we understand just a bit more? Sure, maybe we’ll get lucky and the IFR will just be 2-10x flu. But there are worrying signs of permanent heart, lung and kidney damage. These costs will also stay with us long term. Mortality isn’t the concern when dealing with an unknown virus.
- gremlinsinc 7y ago
  I wonder how this plays out with the NBA, since Rudy Gobert and many other players have tested positive and experienced those same kind of symptoms.

flohofwoe 7y ago

As far as I understand it, fatality rate is only low as this as long as the health care system isn't overwhelmed, so that people in serious conditions can be treated (and the number of serious cases is a lot higher than 0.5%). As soon as hospitals are at their capacity, a lot more people will die which otherwise had survived (and this will also affect people which are in critical conditions for entirely different reasons).

rumanator 7y ago
This. I don't understand how the whole point of flattening the curve was already forgotten. The whole point of the lockdown is not to act as a magic wand to make the pandemic vanish. The whole point is that, as it stands, emergency services are already operating beyond capacity. This means that your friends and loved ones risk needlessly dying for no reason just because they weren't able to have medical treatment, including from non-covid19 issues.
- gremlinsinc 7y ago
  Also, if you're high risk (I may be - obesity) this is a scary disease, and honestly the longer you wait to get infected the better your chances. More local medical doctors will have experience treating it, there will be more studies on drugs, more help available etc. Your chances go up astronomically on a long enough time scale. So why rush it? I have the luxury of being a freelancer working from home, so this is mostly my normal, but I know it hurts a lot of people, but so does being dead - or having lung issues for life or neurological ones. Some broadway actor lost his leg over the weekend because of this. TLDR; It definitely helps w/ hospitals so they can still function it also gives time to find and create better treatments.
bob33212 7y ago
We don't know yet how much of a difference that makes. For example how many infected 80 year olds without medical treatment die compared to those that do get medical treatment. Medical treatment is certainly going to have a better mortality rate but not 100%.

kgwgk 7y ago

Where do you get that <0.5% fatality rate from? It seems to have caused already the death of between 0.1% (lab-confirmed) and 0.2% (excess deaths) of the population of NYC.

cm2187 7y ago
Now that we start doing anti-body tests, there seems to be multiple studies surfacing all pointing to a much higher than anticipated number of people infected. A few sources pointing in that direction: https://mobile.twitter.com/AmeshAA/status/1249446561010106370 https://mobile.twitter.com/AmeshAA/status/124944656101010637... https://mobile.twitter.com/AmeshAA/status/1249020677551796224 https://mobile.twitter.com/AmeshAA/status/124902067755179622... https://www.youtube.com/watch?v=_LG-so-8qwg https://www.youtube.com/watch?v=_LG-so-8qwg
- kgwgk 7y ago
  What would you say that the number of infected people in NYC may be? If 20% of them are infected, the infection fatality rate observed is already in the 0.5%-1% range.
  - cm2187 7y ago
    I did that calculation for a similar objection a few days ago: https://news.ycombinator.com/item?id=22881103 https://news.ycombinator.com/item?id=22881103
    - kgwgk 7y ago
      Ok. If we take the observed data (0.15% mortality rate in the overall population) we can make hypothesis like “infection rate is 30%” and “infection fatality rate is 0.5%”. But being consistent and plausible doesn’t make them true. 15% and 1% are also plausible, as far as I know.