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>We project a true count of over 500,000 infections, including more than 5,000 severe cases, and a breakdown in provision of care (“overshoot”) in Nagoya, Osaka

>We project a true count of over 500,000 infections, including more than 5,000 severe cases, and a breakdown in provision of care (“overshoot”) in Nagoya, Osaka, and Tokyo, before the end of April. The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight, from 741 to 338 yesterday. So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society. Japan's response seems commensurate with the problem, and this reads to me like an excessively verbose illustration of how one can spin even pre-registered falsifiable claims whichever way you want regardless of outcome. 'See? We were mostly right'. Maybe that's too harsh.

waffle_ss 7y ago
It's not too harsh. It seems pretty clear to me the blasé conclusion that essentially "things are gonna get much worse in a month" (no duh) was loosely backfilled with numbers after the conclusion was already made. Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic. For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout. I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing. [^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.
akavi 7y ago
Yeah, I'm withholding judgement till "the end of April", but given Japan's doubling time is roughly 10 days, you'd expect there to be ~2.5k severe cases right now. Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"? Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?
- ceejayoz 7y ago
  > Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"? Yes. That fits data out thus far. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm > Although the majority of reported COVID-19 cases in China were mild (81%) Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
  - akavi 7y ago
    Is "mild" vs. "severe" dichotomous? I feel like I've usually seen the trichotomy of "mild" => not needing hospitalization, "moderate" => needing hospitalization, "severe" => needing ICU treatment.
    - ceejayoz 7y ago
      https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guida... > The largest cohort of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical38: > * Mild to moderate (mild symptoms up to mild pneumonia): 81% > * Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14% > * Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
Loughla 7y ago
Maybe I read that wrong, but wasn't the point that Japan wasn't acting appropriately, and that white paper, along with other research, forced (for lack of a better word) them to own up to the scale of what they were seeing? Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true? Did I miss the point of this entirely?
- kspacewalk2 7y ago
  Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point? I read the "pre-registered" part. It was wrong on a bunch of points, both numbers and impact. I strongly doubt a major world economy of 126 million people with many world-class epidemiologists and doctors and generally non-disastrous political leadership was 'forced' into anything by this. The hubris of this guy is quite off-putting.
  - wolco 7y ago
    You would be surprised by how doctors are forced to agree with medicial associations or lose their licease.
    - kspacewalk2 7y ago
      Can your point be made more explicitly? I fail to see a connection between my comment and your reply to it.
  - barry-cotter 7y ago
    > The hubris of this guy is quite off-putting. You’re not a certified expert. Shut up and listen to your betters. If there were actually the reserves of competence you and others like you believe in; if the authorities actually deserved our trust almost everywhere would have done as well as Taiwan or at least Korea. In the world we actually live in the CDC stopped the Seattle Flu Study from testing for COVID-19 and banned private labs from testing for more than two weeks after fucking up its own tests. In the world we actually live in the prestige media spent most of February making fun of people who thought this was a real problem that would spread outside China, and later Italy. They didn’t act like they were taking it seriously. They followed the lead of the WHO, which should have been setting the alarm and instead was telling people that the real enemy was prejudice. Many countries with well credentialed experts failed. You wouldn’t accuse them of hubris. But they failed.
ekianjo 7y ago
You forgot that test capacity in Japan is still close to nil.
panarky 7y ago
One might argue that a "true count of infections" is not falsifiable -- people aren't getting tested, causes of deaths aren't properly attributed, officials are juking the stats. A more falsifiable claim is "a breakdown of provision of care in Nagoya, Osaka, and Tokyo, before the end of April". If patients are in parking lots or bodies are in refrigerated trucks and mass graves, that evidence is harder to hide. There are 10 days left in April, but at this point, is there any evidence of "a breakdown in the provision of care"?
- barry-cotter 7y ago
  Refusing to test, secret testing locations, over two hours on hold on the COVID hotline. Things aren’t looking great. https://www.facebook.com/groups/524159784940511/permalink/529891921033964/ https://www.facebook.com/groups/524159784940511/permalink/52... > 4/17 Friday: At noon my friend wakes up and asks if I can call her ward's 保健所 and make a PCR test appointment for her. I call them at 12:30. > It took 2 HOURS to set up a PCR test. > As I expected, the staff was INCREDIBLY resistant to offer a test, and spent 2 hours asking me 100 questions about her symptoms, what treatment she had received so far, what hospital she went to the night before, name of the doctor who recommended her a test etc. I'm put on hold for an extra hour as they sort their things out. They finally call me back and tell me all of the information for her test. But here's the kicker. It's a secret location. It's a medical facility that's currently closed, but is being used as a corona testing site on the downlow. To enter the building, she'll have to walk through the parking lot and use the staff entrance. The woman on the phone makes me promise not to tell ANYONE other than my friend the name of the place where she is being tested. Because if people knew they were doing testing there it would "cause a commotion." I really wish I was making that last part up. It's absolutely horrific how much they are trying to cover this up and keep the official numbers low. I am currently waiting for them to call again with her test results. Getting her tested required 1 ambulance ride, two visits to the hospital and 5+ hours on the phone. This is ridiculous and something needs to change."
  - pilom 7y ago
    This seems like exactly the measures I would institute if I just plain didn't have enough tests to test everyone who wants one (i.e. almost all humans). The secrecy sounds perfectly normal if the goal is to not be swarmed by masses of people who likely just need to stay home.
ForHackernews 7y ago
Yeah, I don't understand at all what the purpose of publishing this hash was supposed to be. Is it just to be able to say "I told you so!" (or in this case, I didn't tell you so, but I really did think this) at some later date? > In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk. Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic. Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.
- nico_h 7y ago
  The point of the hash is a marker to force yourself to come to terms with your idea. You make it public and then act on it. The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
  - ForHackernews 7y ago
    But...posting a hash doesn't force you to do anything. All it does is help you be cryptographically-verifiably smug after the fact.
    - tptacek 7y ago
      No, it demonstrates that you're not backtesting whatever your model was to fit the current reality.
    - nico_h 7y ago
      But if you didn't act on it then you're just a shmuck that knew something and didn't help their neighbors, if you did act, you can justifiably _be_ smug because you did something about it. Posting it and acting on it build a "track record" that is harder to dismiss.
- HackOfAllTrades 7y ago
  "I don't understand at all what the purpose of publishing this hash.." The author was explicit: "sending up a flare", hoping "someone would read between the lines".
whycombagator 7y ago
> The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well. Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline. > So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society. Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested. As the US has learned, once you start to ramp up testing the case count ramps up too. Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population. [0] https://ourworldindata.org/grapher/full-list-covid-19-tests-per-day?country=Japan%2C%20tests%20performed https://ourworldindata.org/grapher/full-list-covid-19-tests-... [1] https://ourworldindata.org/grapher/full-list-total-tests-for-covid-19?time=2020-02-26..&country=JPN+Japan%2C%20tests%20performed https://ourworldindata.org/grapher/full-list-total-tests-for...
barry-cotter 7y ago
Looks like the breakdown in provision of care will happen before the end of April after all. https://twitter.com/patio11/status/1252836409406152709?s=21 https://twitter.com/patio11/status/1252836409406152709?s=21 > NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa. > Experts threshold of concern for imminent impact on medical care is 30%, again per NHK. > The 28 prefectures which are above that threshold will not fit in this tweet. > NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space. >!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.

waffle_ss 7y ago

It's not too harsh. It seems pretty clear to me the blasé conclusion that essentially "things are gonna get much worse in a month" (no duh) was loosely backfilled with numbers after the conclusion was already made. Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic. For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout. I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing. [^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.

akavi 7y ago

Yeah, I'm withholding judgement till "the end of April", but given Japan's doubling time is roughly 10 days, you'd expect there to be ~2.5k severe cases right now. Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"? Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?

ceejayoz 7y ago
> Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"? Yes. That fits data out thus far. https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm > Although the majority of reported COVID-19 cases in China were mild (81%) Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
- akavi 7y ago
  Is "mild" vs. "severe" dichotomous? I feel like I've usually seen the trichotomy of "mild" => not needing hospitalization, "moderate" => needing hospitalization, "severe" => needing ICU treatment.
  - ceejayoz 7y ago
    https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guida... > The largest cohort of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical38: > * Mild to moderate (mild symptoms up to mild pneumonia): 81% > * Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14% > * Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%

Loughla 7y ago

Maybe I read that wrong, but wasn't the point that Japan wasn't acting appropriately, and that white paper, along with other research, forced (for lack of a better word) them to own up to the scale of what they were seeing? Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true? Did I miss the point of this entirely?

kspacewalk2 7y ago
Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point? I read the "pre-registered" part. It was wrong on a bunch of points, both numbers and impact. I strongly doubt a major world economy of 126 million people with many world-class epidemiologists and doctors and generally non-disastrous political leadership was 'forced' into anything by this. The hubris of this guy is quite off-putting.
- wolco 7y ago
  You would be surprised by how doctors are forced to agree with medicial associations or lose their licease.
  - kspacewalk2 7y ago
    Can your point be made more explicitly? I fail to see a connection between my comment and your reply to it.
- barry-cotter 7y ago
  > The hubris of this guy is quite off-putting. You’re not a certified expert. Shut up and listen to your betters. If there were actually the reserves of competence you and others like you believe in; if the authorities actually deserved our trust almost everywhere would have done as well as Taiwan or at least Korea. In the world we actually live in the CDC stopped the Seattle Flu Study from testing for COVID-19 and banned private labs from testing for more than two weeks after fucking up its own tests. In the world we actually live in the prestige media spent most of February making fun of people who thought this was a real problem that would spread outside China, and later Italy. They didn’t act like they were taking it seriously. They followed the lead of the WHO, which should have been setting the alarm and instead was telling people that the real enemy was prejudice. Many countries with well credentialed experts failed. You wouldn’t accuse them of hubris. But they failed.

ekianjo 7y ago

You forgot that test capacity in Japan is still close to nil.

panarky 7y ago

One might argue that a "true count of infections" is not falsifiable -- people aren't getting tested, causes of deaths aren't properly attributed, officials are juking the stats. A more falsifiable claim is "a breakdown of provision of care in Nagoya, Osaka, and Tokyo, before the end of April". If patients are in parking lots or bodies are in refrigerated trucks and mass graves, that evidence is harder to hide. There are 10 days left in April, but at this point, is there any evidence of "a breakdown in the provision of care"?

barry-cotter 7y ago
Refusing to test, secret testing locations, over two hours on hold on the COVID hotline. Things aren’t looking great. https://www.facebook.com/groups/524159784940511/permalink/529891921033964/ https://www.facebook.com/groups/524159784940511/permalink/52... > 4/17 Friday: At noon my friend wakes up and asks if I can call her ward's 保健所 and make a PCR test appointment for her. I call them at 12:30. > It took 2 HOURS to set up a PCR test. > As I expected, the staff was INCREDIBLY resistant to offer a test, and spent 2 hours asking me 100 questions about her symptoms, what treatment she had received so far, what hospital she went to the night before, name of the doctor who recommended her a test etc. I'm put on hold for an extra hour as they sort their things out. They finally call me back and tell me all of the information for her test. But here's the kicker. It's a secret location. It's a medical facility that's currently closed, but is being used as a corona testing site on the downlow. To enter the building, she'll have to walk through the parking lot and use the staff entrance. The woman on the phone makes me promise not to tell ANYONE other than my friend the name of the place where she is being tested. Because if people knew they were doing testing there it would "cause a commotion." I really wish I was making that last part up. It's absolutely horrific how much they are trying to cover this up and keep the official numbers low. I am currently waiting for them to call again with her test results. Getting her tested required 1 ambulance ride, two visits to the hospital and 5+ hours on the phone. This is ridiculous and something needs to change."
- pilom 7y ago
  This seems like exactly the measures I would institute if I just plain didn't have enough tests to test everyone who wants one (i.e. almost all humans). The secrecy sounds perfectly normal if the goal is to not be swarmed by masses of people who likely just need to stay home.

ForHackernews 7y ago

Yeah, I don't understand at all what the purpose of publishing this hash was supposed to be. Is it just to be able to say "I told you so!" (or in this case, I didn't tell you so, but I really did think this) at some later date? > In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk. Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic. Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.

nico_h 7y ago
The point of the hash is a marker to force yourself to come to terms with your idea. You make it public and then act on it. The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
- ForHackernews 7y ago
  But...posting a hash doesn't force you to do anything. All it does is help you be cryptographically-verifiably smug after the fact.
  - tptacek 7y ago
    No, it demonstrates that you're not backtesting whatever your model was to fit the current reality.
  - nico_h 7y ago
    But if you didn't act on it then you're just a shmuck that knew something and didn't help their neighbors, if you did act, you can justifiably _be_ smug because you did something about it. Posting it and acting on it build a "track record" that is harder to dismiss.
HackOfAllTrades 7y ago
"I don't understand at all what the purpose of publishing this hash.." The author was explicit: "sending up a flare", hoping "someone would read between the lines".

whycombagator 7y ago

> The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well. Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline. > So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society. Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested. As the US has learned, once you start to ramp up testing the case count ramps up too. Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population. [0] https://ourworldindata.org/grapher/full-list-covid-19-tests-per-day?country=Japan%2C%20tests%20performed https://ourworldindata.org/grapher/full-list-covid-19-tests-... [1] https://ourworldindata.org/grapher/full-list-total-tests-for-covid-19?time=2020-02-26..&country=JPN+Japan%2C%20tests%20performed https://ourworldindata.org/grapher/full-list-total-tests-for...

barry-cotter 7y ago

Looks like the breakdown in provision of care will happen before the end of April after all. https://twitter.com/patio11/status/1252836409406152709?s=21 https://twitter.com/patio11/status/1252836409406152709?s=21 > NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa. > Experts threshold of concern for imminent impact on medical care is 30%, again per NHK. > The 28 prefectures which are above that threshold will not fit in this tweet. > NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space. >!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.