46 ms·

Preliminary test results suggest 21% of NYC residents have Covid antibodies

364 points by kgwgk 7y ago

cm2187 7y ago
Another datapoint suggesting the death rate of this virus is within 0.5%.
- Exmoor 7y ago
  Also another data point suggesting that the virus is much more contagious than the early estimates said. I personally don't see how the test, track and trace efforts that have been touted as the only way to open things up can work with a virus with these characteristics. You would need to test a huge percentage of the population each day with quick results tests and something like that is many months away from being possible assuming it ever would be possible.
  - daxfohl 7y ago
    I agree. But it seems to have worked in Korea. The math doesn't seem to reconcile somehow. Actually probably the prevalence of masks explains the difference.
    - taeric 7y ago
      The math seems to point more to there being another factor to what makes it severe, in my eye. Going by the news we have seen, elementary schools could have 80%+ infection rates and fewer deaths that NY has seen. Similarly, are there other factors besides age? (Age feels way more like a proxy.)
  - istorical 7y ago
    More contagious OR began community spread and became endemic much earlier. r0 is part of the formula for total infected at X/Y/Z date but so is date of initial infection and size of initial infected population.
  - GVIrish 7y ago
    The key is testing, contract tracing, and quarantining when the number of cases is small. That's what South Korea, New Zealand, and a few other countries did and they've all suffered relatively few fatalities. You still need a massive amount of tests to contain an outbreak, but the upside is that if you contain it early you don't need toe enact clumsy and broad measures like lockdowns.
- Spooks 7y ago
  I wonder if we did these preliminary tests with the flu if we would see a large death rate drop for influenza as well
  - nullc 7y ago
    The US's influenza mortality figures are a combined influenza and pneumonia figure because they usually don't even bother actually screening for influenza. Research attempting to determine how much of that figure is infected with influenza have found figures like 1/3rd (though with large differences year to year).
- cozzyd 7y ago
  I had the opposite conclusion. There are between 10k-15k COVID-19 associated deaths in NYC, depending on how you count (the higher rate is consistent with the excess-mortality data, I believe). That by itself produces a range of ~0.56%-0.86% if you assume 21.2 % of NYC has been infected (larger range if you allow for some error on the infection rate, obviously). Moreover, we don't know what fraction of the currently-infected who will die have already died. A reasonable guess might be 50%, which would mean that the fatality rate for NYC is somewhere between 1.1 and 1.7%. Either way, based on NYC, 0.5% might be a hard lower bound on the all-population fatality rate (of course, maybe NYC is not a representative sample for some reason)
  - rubidium 7y ago
    “ Moreover, we don't know what fraction of the currently-infected who will die have already died. A reasonable guess might be 50%” I lost you at reasonable guess. Why not ~1%?
    - vkou 7y ago
      If the mean time between infection and death is 2 weeks (Mostly true), and the virus has doubled every two weeks (True in NYC), then assuming that not a single new infection takes place starting today (Obviously not true, but this is a hypothetical), then in two weeks, you would expect to have twice the deaths that you do right now.
    - cozzyd 7y ago
      1% would imply an unrealistically high-fatality rate, so that can't be right.
    - zucker42 7y ago
      The virus takes time (2-3 weeks) to kill people, and the prevalence was presumably measured within the last week. Therefore, we have to take out the cases that occurred in the last week or two. I would suspect that 50% is on the upper end of how much the death lag could skew the results, but 20-50% doesn't seem unreasonable.
  - 7y ago
- Avamander 7y ago
  Mortality rate, case fatality rate and infection fatality rates are all different things and have different values. Infection fatality rate of the virus could be within 0.5% (because its the one that tries to take into account everyone who has been infected), mortality rate is very likely still the one WHO has published and the third, case fatality rate is ~38% in the US.
  - rimliu 7y ago
    What? 38 out of 100 infected in US die?
    - saalweachter 7y ago
      Infection fatality rate, the big number everyone is trying to figure out, best guess is somewhere around 1% right now, with a confidence interval of something like 0.3%-2.5% Case fatality rate, calculated as "number of deaths" / "number of known cases", usually something like 10% in most countries, although occasionally much lower or higher for the odd country that has really good or really bad testing. Resolved case fatality rate, calculated as "number of deaths" / "number of recoveries + number of deaths", which has been around 40% in the countries that have been hit hardest for the duration of their outbreaks. Tends to go down after the curve is bent, because it takes people longer to recover than die in most of these cases.
- vkou 7y ago
  15,000 deaths (So far) in NYC. 8.4 million people. If 20% of the population has had it, the death rate is 1%... Assuming that none of the currently infected die. Which is an unreasonable assumption (As the mean time to death from the point of infection seems to be ~2 weeks, and infections have doubled over the past 2 weeks.)
  - kgwgk 7y ago
    But those currently infected are not included in the 20% of the population that has had it. Or maybe some are, but most of those infected now who may still die, do not have antibodies yet.
- lukasm 7y ago
  Yes, but the age is a 10x factor, os CFR would be much different in Nigeria (average age is about 19) and Italy (average age 45). We have two good petri dishes: USS Theodore Roosevelt - 600 cases out of 4800. 5 sick, one dead (41 years old). which means hospitalisation is at 0.83% and CFR is 0.016% (1% dead or in hospital). Not idea what is the average age, probably around 30-35. Diamond Princess: 700 of 3711. CFR 1.1%, average age around 50. What worries me the most though is potential mutations and death rates when you are infected with Covid-19 and flu at the same time (or other pathogens). https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt-idUSKCN21Y2GB?utm_source=Nature+Briefing&utm_campaign=ff928b9a9f-briefing-dy-20200417&utm_medium=email&utm_term=0_c9dfd39373-ff928b9a9f-44762053 https://www.reuters.com/article/us-health-coronavirus-usa-mi... https://www.nature.com/articles/d41586-020-00885-w?utm_source=Nature+Briefing&utm_campaign=ff928b9a9f-briefing-dy-20200417&utm_medium=email&utm_term=0_c9dfd39373-ff928b9a9f-44762053 https://www.nature.com/articles/d41586-020-00885-w?utm_sourc...
  - rckoepke 7y ago
    Average age on an aircraft carrier appears to be 19 [0], 20 [1], and/or 24 [2] years old. 0: https://www.nytimes.com/2008/04/20/arts/television/20jens.html https://www.nytimes.com/2008/04/20/arts/television/20jens.ht... 1: https://archive.defense.gov/news/newsarticle.aspx?id=15334 https://archive.defense.gov/news/newsarticle.aspx?id=15334 2: https://mashable.com/2016/06/23/what-its-really-like-to-live-and-work-on-an-aircraft-carrier/ https://mashable.com/2016/06/23/what-its-really-like-to-live...
  - rallison 7y ago
    > which means hospitalisation is at 0.83% and CFR is 0.016% (1% dead or in hospital). 0.16%, not 0.016%.
  - greedo 7y ago
    You can't measure CFR or IFR this quickly in an isolated environment like the Roosevelt due to mortality lag. Also, the CFR for Diamond Princess is now up to 1.83%.
- grumple 7y ago
  The death rate would go up if more people had the virus at once, which is the entire reasoning behind isolating.
  - gridlockd 7y ago
    I am wondering that number, if the limiting factor is ventilators, but the CFR of people on a ventilator is close to 90% either way. Other cases may just need oxygen supplementation, which is more manageable. It is pretty clear now that Germany is not that far from from Italy in terms of CFR when controlled for age.
- gok 7y ago
  …when people are able to get treatment.
colinmegill 7y ago
Garbage news source
- CubsFan1060 7y ago
  The slides contained in it were shared by the governor. Though maybe you're calling him a garbage news source.
- ccleve 7y ago
  The Governor's press conference was covered by the major media. The slides are there, also.
JamesBarney 7y ago
> The reason the tests were randomly taken from those at grocery and big-box stores is that these were people not isolating in their homes and presumably not at work and therefore not essential workers.
- cm2187 7y ago
  I don't know what to make of that. I would expect people at work to have higher infection rate (not the least because many of these jobs involve contact with the population). It also filters out older and sick people. So intuitively I would expect to undershoot the actual rate.
  - CubsFan1060 7y ago
    I read it as people shopping, not people that work there. So folks who are out-and-about, but are not in the more likely to have it groups (healthcare workers or people working at the grocery store). You're right about older and sick people.
    - cm2187 7y ago
      No that's what I meant. People shopping and therefore not at work. Therefore intuitively I would expect the population tested to be less contaminated than the population not tested (because at work).
      - deleted 7y ago
        [deleted]
      - watwut 7y ago
        People who work also shop. People who work in stores also shop in stores. At that time, they could be randomly tested like non-workers. So workers are not excluded from study.
- deleted 7y ago
  [deleted]
guscost 7y ago
While this is great information, a few facts will still confound attempts to speculate based on this number: - The production of IgG antibodies is mostly delayed until after an infection is cleared. - This is a random sample of people who were outside, it's not representative of the total population. - Non-trivial numbers of people may never develop detectable antibodies for SARS-CoV-2: https://www.medrxiv.org/content/10.1101/2020.04.17.20061440v1 https://www.medrxiv.org/content/10.1101/2020.04.17.20061440v... https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v2 https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v...
- CubsFan1060 7y ago
  If I follow, your first and third points would indicate the number may actually be higher? Additionally, does your third point also indicate that they will never be immune, or just that we won't be able to test for it?
  - guscost 7y ago
    All three could push the true total higher, but number two easily could push it lower instead. And I'm not a microbiologist but I think lack of antibodies only means that we won't be able to test for past infection. The seronegative patients (determined by a very precise method for measuring antibodies) in the second cited paper were still able to clear their infections.
- tempsy 7y ago
  Also don’t know if people with antibodies can still spread the virus to others or whether antibody levels (not just presence) determines whether you can be reinfected.
- zucker42 7y ago
  I'm sorry, I don't know much about medicine so maybe you could clear up what those studies found. If I understand correctly, they both looked at COVID-19 patients and the first one found 83% had detectable antibodies and the second one found 163 / 173 had detectable antibodies? Or maybe I just completely don't understand it. Also it looks like they chose people with symptoms (i.e. "COVID-19 patients"). Would we expect the amount of detectable antibodies to be less, more, or the same among asymptomatic/mildly symptomatic people, or do we not know?
ccleve 7y ago
This study doesn't appear to suffer from the same methodology problems as the Stanford study of a few days ago. In that study, they recruited people through Facebook, and reported an infection rate that was low enough that it could have been caused by false positives. Here, it's closer to a random sample, but more importantly it shows really high rates. Those rates overwhelm any error due to false positives. Also, it shows numbers that are in line with our intuition. It shows higher infections in NYC, and higher infections among blacks. That reflects what the hospitals are seeing. This study may well be really good news.
- 3fe9a03ccd14ca5 7y ago
  What's weird is that the Stanford study was suggested to have exaggerated the results, since those who suspected themselves as having the virus at one time were more likely to volunteer (allegedly). However, those results were nowhere near as big as this (I think like 2%-3% versus the 20%!)
  - jdm2212 7y ago
    Roughly 1/1000 New Yorkers have died of coronavirus. At a 1% IFR, that suggests at least 10% of the state has gotten the virus. Probably more, because deaths are undercounted and many people who will die of the virus already have it but haven't died yet. In the Bay Area, almost no one has died of coronavirus so the infection rate should be next to nil.
    - brandmeyer 7y ago
      I was astonished by your 1/1000 figure and had to look it up... If anything, its too low. 15k deaths (proven+probable) in 8M people is almost 2/1000. https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page
      - jdm2212 7y ago
        I was referring to the state -- but, yeah, it's even worse in the city :( and 2/1000 people * 1% IFR => 20%
3fe9a03ccd14ca5 7y ago
At what point have we scientifically reached "herd immunity"? Is it 50%, 90%, 99%?
- deleted 7y ago
  [deleted]
- caiobegotti 7y ago
  https://en.wikipedia.org/wiki/Herd_immunity#Mechanics https://en.wikipedia.org/wiki/Herd_immunity#Mechanics
  - SpicyLemonZest 7y ago
    Although it should be noted that incomplete herd immunity will still help, by reducing the number of other containment measures which must be taken.
    - deleted 7y ago
      [deleted]
- grey-area 7y ago
  More like 50-80%, you just need spread to be impeded so that r falls below 1, but for that many people to get it would mean very high deaths, in the US 1% of 80% of 320m is > 2m deaths.
  - nullc 7y ago
    Keep in mind that if 21% of NYC residence have been infected this probably implies R0 in that population was higher than in most prior estimates of R0, which increases the threshold of immune people before R0 falls below 1.
    - votepaunchy 7y ago
      It also implies that the R0 of the already-infected population is higher than that of the not-yet-affected population.
vkou 7y ago
If this study is accurate, and is not just working on garbage data, and if these antibodies actually mean long-term immunity, this means one of two things: 1. If the lockdown is lifted, we will see another ~60,000 to 100,000 deaths in NYC, before it will hit herd immunity. 2. Or, the lockdown will continue. The accuracy of antibody studies has been called into doubt, and as far as I know, nobody has ever followed up on whether or not people with study-detected antibodies can catch the virus. The data for the latter is unlikely to be available until the second wave hits.
- grey-area 7y ago
  That would be a very useful follow up study with this same population.
- CubsFan1060 7y ago
  There is no reason why an all or none approach is necessary here, is there? By my count, 10,120/15,740 of deaths have been folks over 70. If you kept people over 70 locked down (including their caretakers), you could significantly reduce the number of deaths while increasing the percentage that have had it. In fact, only 9% of New York's population is over 70. So theoretically (though clearly not practically), you could get over the percentage required for herd immunity while reducing the deaths by 66%
- joe_maley 7y ago
  > if these antibodies actually mean long-term immunity This is the big unknown that seems to be largely ignored, thank you for bringing it up. I am frequently seeing "herd immunity" thrown around without any qualification on the durability of the associated antibodies.
- DeonPenny 7y ago
  We'd also need to make the decsision to continue a lockdown over a virus with a 99.5% survival rate or not. Seeing at the flu has a 99.9% survival rate does it make sense to destroy the economy over that.
  - 7y ago
glofish 7y ago
Well, it looks like in the end that much-criticized imperial model might be right on transmission rates but way off on the fatality rate and with that predicted deaths. It pretty much looks like none of the epidemiological models are reasonably accurate on both, case numbers and fatally rates
- guscost 7y ago
  If you're fitting a model to observations, they'll have something of an inverse (but of course non-linear) relationship. So if your virulence estimates are worse than your transmissivity estimates, or vice versa, the bad measurement is going to push the model out of whack.
- zucker42 7y ago
  Which model and what fatality rates did they predict?
- cycrutchfield 7y ago
  How are they off on fatality rates? Also note that the fatality rate is an input to the model, not a prediction of the model.
- rallison 7y ago
  If the results from this NY study hold, the numbers are basically exactly in line with the Imperial College study. That study assumed an IFR of 0.9%, and the NY results imply an IFR right around that.
sjg007 7y ago
Is this antibody test specific for covid-19 or would it be positive on other coronaviruses? That's a real concern since the other 4 coronaviruses are endemic.
- hitchhiker999 7y ago
  What's terrifying is with all these professional analysts in here, yours is the first comment I've seen that asks this obvious question.
daxfohl 7y ago
I find myself reconsidering the original proposition by England to isolate the most vulnerable for a couple months and let the virus work its course through the less vulnerable population. If death rate is substantially lower among the under 50 crowd, this could work its way through with a fairly low death toll, and result in a herd immunity within a couple months. This slow burn approach we're doing however seems possibly to be the precise worst way to handle it, leaving the virus in the population for as long as possible, reducing the ability for our vulnerable population to avoid it. Note I think the best possible solution is a complete lock down for a couple months until the virus is more or less eradicated, as Wuhan did. But I don't think it's a realistic option in our society.
- jdm2212 7y ago
  The outcomes aren't just death and recovery. There's also the possibility of long-term heart, lung, and kidney damage. And the blood thinners used to prevent coronavirus blood clots can cause brain bleeding. Those happen in younger people, too. And realistically there's no way to isolate those over 50. They generally live with, work with, or are cared for by younger people.
  - taeric 7y ago
    This feels like fear talking. As more data comes in, we are seeing more people with no affects. Not just mild, but nigh non existent. It is agreed that something gives people severe cases. Severe includes death and recovered with damage. We don't seem to have data letting you know who or what would land there.
    - eloff 7y ago
      I disagree, see my sister comment. Even without data on lingering deficiencies, we can speculate with confidence that it carries a cost.
      - taeric 7y ago
        Speculation is fine. But we need data to back it. Right now, we don't. Could hypothesize that many being found with damage surviving, had damage going in. Would neatly explain why it hit them so hard.
djrogers 7y ago
I'm starting to wonder if there aren't 2 (or more) transmission methods for this virus with differing symptoms. Aerosol transmission with 'I got a cold' type symptoms, and droplet transmission with 'I got the worst cold I've ever had' type symptoms.
- grandmczeb 7y ago
  Why would different transmission methods result in different symptoms?
  - taeric 7y ago
    Viral load, is what this typically refers to. Akin to an allergic person seeing one cat versus a room full of them. And, of course, for some people with allergies, contact where a cat has been is enough. ;) So... Complicated. Edit: was corrected down thread that this is infection dose, not viral load.
    - grandmczeb 7y ago
      There’s a very weak association between viral load and symptoms once you’re infected.
      - taeric 7y ago
        But that is what the thread was talking about, right? Would be nice to see studies. My intuition is that it is weak. But my intuition doesn't count for much here.
        grandmczeb 7y ago
        Is it? I read the original comment as saying there were significantly different symptoms based on the transmission method. Even assuming that the transmission method results in a significantly different viral load, that's not enough to explain differing symptoms since there's not a whole lot of observable difference between cases with different severities[1,2]. There are some studies that show a relationship, but nothing strong enough to explain a dramatic difference. If it's true that the transmission method makes a big difference, it's more likely due to some other reason. E.g. maybe mild strains spread more easily in the air (although as far as I know there's no evidence that's true.) [1] https://arxiv.org/ftp/arxiv/papers/2003/2003.09320.pdf https://arxiv.org/ftp/arxiv/papers/2003/2003.09320.pdf Page 3. "We did not observe significantly different viral loads in nasal swabs between symptomatic and asymptomatic." [2] https://www.medrxiv.org/content/10.1101/2020.03.15.20036707v2.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.15.20036707v... Page 4. "There was no obvious difference in viral loads across sex, age groups and disease severity"
TechBro8615 7y ago
So, at what point can we declare the lockdown to be a harmful overreaction and start opening countries up? Will we hold anyone accountable for models which proved to be pessimistic by orders of magnitude, causing implosion of economies around the world?
- deleted 7y ago
  [deleted]
- chasd00 7y ago
  has anyone modeled at one point deaths from economic collapse overtake deaths from Covid19?
  - bbarn 7y ago
    That was the first thing I said, 2 months ago, and got told I was a selfish asshole and had no clue what I'm talking about. This is going to be a real big history lesson for our grandchildren on how not to handle a situation in one way or another, unless the media rewrites the narrative. Oh, wait.
  - robocat 7y ago
    I would be very sceptical about any models produced in the US, since the issue is so partisan, and one can tweak variables to prove whatever outcome one wants from a model. I think the lost life-years of economic hardship could easily outweigh the lost life-years of Covid deaths. That is because economic hardship affects younger people, while Covid deaths primarily affect people with not many years left to live. But there are many other external costs (social costs if your grandma dies) and economic benefits to deaths (lower pension payments, home availability?). However, given current information, a lockdown for weeks to months seems to make sense, since the consensus is that economic collapse is not yet immanent, and that steps can be taken to help keep the economy spinning when lockdown restrictions start to be relaxed.
    - watwut 7y ago
      Economic hardship affects middle aged and old people too.
ineedasername 7y ago
I couldn't find any detailed write up about their selection methods for participants, only the basics of where they found them. Without that, it is very hard to determine whether or not there's some flavor of selection bias: If it is voluntary, and they do not screen out people who report having had cold/flu symptoms, then they run the risk of attracting a disproportionate number of people who volunteer because they're curious if their prior symptoms were actually coronavirus. That would make it far from a random sample. The fact that they sampled only people actually leaving their house is also a form of selection bias: these are the people more likely to be exposed and may represent a disproportionately high infection rate as well. So I await further information. That said, even if it's overall 0.6%, that is still 6x higher than flu, and higher than H1N1 which had a CFR around 0.1 for areas with adequate health care. (much higher when there was not adequate care, but that is not dissimilar to Covid.) So no matter what, no one should be walking away from this study saying "See it's no big deal! Just the Flu/Cold etc!"
- SketchySeaBeast 7y ago
  Do you have a source for the CFR of 0.1 for H1N1? I could only find this[1], which is a much smaller number. [1] http://news.bbc.co.uk/2/hi/health/8406723.stm http://news.bbc.co.uk/2/hi/health/8406723.stm
  - ineedasername 7y ago
    You may be looking at "settled" numbers when all was said & done and all facts were known. That's not an "apples to apples" comparison with current covid-19 knowledge. Here's my source [0] and the relevant quote, below. It is the CFR during the H1N1 pandemic, 10 weeks into it, which is why it is a much more appropriate (though not perfect) "apples to apples" comparison with Covid-19: >"The overall case fatality rate as of 16 July 2009 (10 weeks after the first international alert) with pandemic H1N1 influenza varied from 0.1% to 5.1% depending on the country." [0] https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
mrb 7y ago
If this study is accurate, then 1.8 million NYC resident are infected. So 15 411 deaths (as of today, including 5 121 probable deaths) suggests COVID-19 has a fatality rate of MINIMUM 0.9% which is in line with previous estimates (between 0.5 and 1.6%) and this is MINIMUM 9 times more fatal than the flu (0.1%). Edited to add "MINIMUM", as there is a lag between case detection and death (I should have known better to mention it, as I blogged about it: https://blog.zorinaq.com/case-fatality-ratio-ncov/ https://blog.zorinaq.com/case-fatality-ratio-ncov/)
- izend 7y ago
  Making it the worse pandemic in decades but no where near the Spanish Flu.
  - mmastrac 7y ago
    Hard to compare directly against the Spanish Flu as medicine has had 100 years of progress, but assuming you are talking about overall impact, agreed.
    - glofish 7y ago
      not to mention the Spanish Flu hit children just as hard as the old.
    - cozzyd 7y ago
      The age distribution was also significantly different then.
  - vladislav 7y ago
    The Spanish flu had a smaller outbreak in the Spring and came back with a vengeance the following Fall, so hold that thought. https://www.history.com/news/spanish-flu-second-wave-resurgence https://www.history.com/news/spanish-flu-second-wave-resurge...
  - rechristened 7y ago
    Or as bad as the 1957-8 "Asian Flu" that most people haven't even heard of.
duxup 7y ago
It sure would be nice to find out the virus is far more widespread / exposure is higher than expected if only that would seem to indicate that the light at the end of the tunnel is nearer than we think ... and a lot of people have been exposed and doing well.
cryptonector 7y ago
At 21% it would be time to end the shutdown. EDIT: Read the comments below.
- zucker42 7y ago
  That doesn't make sense to me. I would think you'd want to get to the point where you've reached the carrying capacity, so that "overshoot" of the equilibrium doesn't result.
  - cryptonector 7y ago
    See my other reply below. You can't overshoot 100%, and long before we get there herd immunity takes hold, and there's no question of the disease being kept from working its way through -- only a question of managing the rate at which it does. All in all the economic damage of continued shutdown does not make sense at this point (at 21% of the population exposed). We should stop now.
    - zucker42 7y ago
      Your comment doesn't address my point. See this Twitter thread, https://twitter.com/CT_Bergstrom/status/1251999295231819778 https://twitter.com/CT_Bergstrom/status/1251999295231819778 specifically this comment: https://twitter.com/CT_Bergstrom/status/1252008040376614912 https://twitter.com/CT_Bergstrom/status/1252008040376614912 for a good illustration of what I'm talking about. Keeping the rate of transmission low through the peak can definitely save lives.
- SketchySeaBeast 7y ago
  I'd think it'd be decided based upon the new cases and hospitalization and death rates, not an estimate of population with exposure.
  - cryptonector 7y ago
    Sorry, but that's dumb. If 1/5th of the population has been exposed, then you know the total strain on the healthcare system is extremely unlikely to top an additional 4x what it has been, but not only it has 1/5th the population being exposed not in fact been enough to overwhelm the healthcare system, as more of the population is exposed you begin to get herd immunity, so in fact the total strain on the healthcare system is extremely unlikely to reach a total of 5x what it has been, very likely not even half that. Give all of that, it makes no sense to continue the shutdown considering how costly the shutdown is. To those who think this is a question of saving lives, that's not so. At this point the disease will work its way through the population because there's no time to finish testing, producing, and distributing a vaccine, which means the only question is of managing the maximum load on the healthcare system. Moreover, many of the most vulnerable have been hit already, and those who haven't can be protected by measures far short of a shutdown. No, at 21% it is most definitely time to stop the shutdown. (Note: not all the measures, just the shutdown.)
SiempreZeus 7y ago
Can one buy such an antibody test online?
ummonk 7y ago
0.2% of people in NYC has died from Covid-19, so this is exactly what we would expect.
lettergram 7y ago
I’ve continuously questioned the antibody tests... My understanding (from NBC news) was that at least some of the antibody tests were derived from a couple who were on the princes cruise. They never showed symptoms, but tested positive. IMO it’s quite possible that they never had it and those tests were inaccurate (right at the start of the outbreak, no symptoms, etc). Further, these antibody tests likely weren’t fully vetted nor were the samples they derived it from. For instance how often does another coronavirus set off this antibody test? Personally, I’m just waiting to see. I actually do suspect 20% have been infected, so it fits my expectations, but that’s not validation.
aazaa 7y ago
> In his press conference today, Governor Cuomo revealed the preliminary results of a first-phase antibody test that surveyed 3,000 New Yorkers over two days in 19 counties at 40 locations that included grocery and big-box stores. The sample suggests that 13.9% of New York State residents have the antibodies, meaning they had the virus at one point and recovered. Of the regions tested–Long Island, NYC, Westchester/Rockland, and the rest of the State–New York City had the highest positive rate at 21.2%. The potential good news to come to light is that the death rate may be far lower than some estimates, at 0.5%. This still is not a random sampling. It only samples from shoppers at grocery stores and big-box retailers. Imagine doing the same study, but of people who ordered groceries online only. Would you expect to see big differences in exposure rate? I think so. The study itself isn't linked anywhere, nor have I seen it elsewhere. Science is all about the details. It's not hard to imagine half a dozen ways that the bottom line result of this study could have been skewed by decisions made by the study authors and ground team.
- t2riRXawYxLGGYb 7y ago
  This was my thought exactly. Some of my friends in the Bay area got COVID-19 (confirmed positive tests) after quarantining for over two weeks at home and taking all of the precautions. The only place they had been was the grocery store, so they suspect that they got it there.
  - usaar333 7y ago
    Are they not taking public transit? Your friends must be some of the most unlucky people ever. The Bay Area has had under 3k cases since the start of April outside group living settings (nursing homes, homeless shelters, etc.). That's ~1/2000 chance of getting covid from anywhere outside.
    - Terretta 7y ago
      Remember that’s not a count of cases. That’s a count of the under 3000 people that came up positive after permitted to take a limited availability test. Take total case deaths, divide by CFR, that’s how many likely total infected there were 3 weeks ago, and then compound daily by the daily spread rate to find how many likely today.
seemslegit 7y ago
0.5% IFR is still very high, I wonder what the antibody detection threshold is - i.e. is it possible that a lot more people have been exposed but don't have detectable antibody levels ? Would it qualify as infection in the sense that they are not susceptible for covid19 in the near term ?
IkmoIkmo 7y ago
They're trying to measure infection rates by analysing people who are more likely to go outside, and more likely to be infected. There's no adjustment for this confounder at all that I can see. Quick example: Suppose there's a 10% chance of getting infected every time someone goes outside. Suppose there's a million people of which half are type-A people who go outside once this month, and half are type-B people who go outside 10 times a month. The type-A person will have a 10% infection rate. The type-B person will have a 65% chance to be infected after a month. The average infection rate is around 42%. Yet if you randomly select someone outside, odds are 10 to 1 that it'll be a type-B person, and you'll get a far higher average of 60%, which isn't indicative of the average person, only of the average person who goes outside. Second, the article then compares the infection rate to the mortality rate. But the mortality rate does not include excess deaths. These are quite a bit higher for NYC, about 30% or so it seems than the official figures. But even this may be undercounting (or potentially, overcounting) the impact of the corona disease itself. Other deaths might be much lower (e.g. traffic, murder) or higher (e.g. untreated cancer). Then there's the lag-effect. There's 150 thousand confirmed infected, 15 thousand dead. But the vast majority of confirmed cases are still active, not recovered. They're confirmed because tens of thousands were hospitalised. Of the incubated people, 80% do not come out alive. There's lots of people fighting for their lives right now. Once those cases resolve, many will not have made it. And that's just hospitalised people. Then there's lots of cases who just got infected, and will be developing symptoms in 1-2 weeks. The way exponentials work is that lag is way more important. In the first weeks NY doubled every 2 days. That means if you have 10 thousand today infected today, in 10 days that's 320 thousand. That's when people start to get symptoms, and 10 days later people start dying from the symptoms. That means your infection count can go into the hundreds of thousands or even millions before seeing any death. But you can't conclude mortality figures from that, at all. In short, the 21% and the 0.5% conclusions are extremely premature and should not be reported like this. It's good to report the measurements, in context, but you can't draw the conclusions about the population or disease from it.
DenisM 7y ago
This might be a bit blunt but I am not jesting - an article about disease testing that does not contain the words "false positive" and "false negative" in some form is literally not worth reading. Even decent antibodies tests can have 10% false positive rates (bodysphere), and lots of those tests have dodgy provenance and 20% false positive is not out of the question. Here's a better article, thou still not great (paywall): https://www.nytimes.com/2020/04/23/nyregion/coronavirus-antibodies-test-ny.html https://www.nytimes.com/2020/04/23/nyregion/coronavirus-anti... The closest they come to discussing the errors is to acknowledge there might be some: State officials said the test had been calibrated to err on the side of producing false negatives — to miss some who may have antibodies — rather than false positives, which would suggest a person had coronavirus antibodies when they did not. Not very informative, I know. A word of caution from the NYC health officials: https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-status-of-serologic-testing.pdf https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020...
m3kw9 7y ago
For the people that thinks death rate is low is good news, it’s not when you know how contagious it is, you then need to look at numbers, not percentage to get a practical look at severity.
zyxzevn 7y ago
Good news. Herd-immunity is growing. Also, this means that the death-rate is far lower than reported. And this is nice too. Maybe we can save people by starting the society again. In other news, we see that hydroxychloroquine is actually working according to doctors. But there was a very bad study that claimed that it caused 2x as many deaths. It should have said instead that it was mainly used on patients that were close to death. Here is a good analysis of that study. https://www.youtube.com/watch?v=dLSYRqcg0wo&feature=youtu.be&t=12m13s https://www.youtube.com/watch?v=dLSYRqcg0wo&feature=youtu.be... Bad studies like this wide published one show that science is not immune to political agendas.
- baconforce 7y ago
  This video states that a randomized controlled study needs to be conducted, otherwise nobody can claim that hydroxychloroquine works or does not work.
- mantap 7y ago
  The presence of antibodies is not sufficient for herd immunity. For herd immunity you need those antibodies to stick around.
hkai 7y ago
Aha! So perhaps we shouldn't have shut down the economy and financially ruined millions of people, not to mention the hundreds of millions of people on the brink of starvation in developing countries. Perhaps we just like sharing images of coffins and feeling virtuous.
- SerLava 7y ago
  Even if the study is true, this doesn't follow. You only get to limit your response if you have the capability to do actual testing... which we didn't and still largely don't.
known 7y ago
But they can infect others
tangent-man 7y ago
To assume the infection fatality ratio(IFR)is 0.5% from this is retarded. We know that when covid-19 began to spread in South Korea at first it spread among a younger population who were ignoring or at least not following government advise so closely and taking chances the IFR was looking like about 0.7% to start with (In SK). We know this as SK kept excellent data / records to begin with. We also know that the Diamond Princess with a more generally aged population has a IFR of 13% +. We know this is a disease that adversely effects the elderly and infirm (in the developed world) If you are over 80 getting covid you might as well play Russian roulette with a Magnum .45 .These groups of people know there at risk, so if they have any sanity they are staying the hell at home. So people who are going into the Grocery store in NY city aren't representative of this population. This is why we are staying at home mostly to protect the old and infirm. That's not to say you want Covid-19 yourself either because there's about a 5% chance you will end up in the ICU (and an as yet undisclosed chance of death) even if your a member of the Hungarian Olympic Shot-Putting team. This does kill young tough people, it does happen but this is mostly killing the elderly and infirm. Why are people so fecking retarded? I can't take this anymore!! Stay the Sm3g at home! It's stopping the hospitals being overloaded.. It's buying us time to figure out new treatments / how to treat this better.
- apexalpha 7y ago
  Read an article that over half of Europe's Covid deaths might be from nursing homes...
  - tangent-man 7y ago
    Sounds plausible. Do you have a link to that article? I'm not trying to bate you, I'd genuinely like to read it.

364 points by kgwgk 7y ago

cm2187 7y ago

Another datapoint suggesting the death rate of this virus is within 0.5%.

Exmoor 7y ago
Also another data point suggesting that the virus is much more contagious than the early estimates said. I personally don't see how the test, track and trace efforts that have been touted as the only way to open things up can work with a virus with these characteristics. You would need to test a huge percentage of the population each day with quick results tests and something like that is many months away from being possible assuming it ever would be possible.
- daxfohl 7y ago
  I agree. But it seems to have worked in Korea. The math doesn't seem to reconcile somehow. Actually probably the prevalence of masks explains the difference.
  - taeric 7y ago
    The math seems to point more to there being another factor to what makes it severe, in my eye. Going by the news we have seen, elementary schools could have 80%+ infection rates and fewer deaths that NY has seen. Similarly, are there other factors besides age? (Age feels way more like a proxy.)
- istorical 7y ago
  More contagious OR began community spread and became endemic much earlier. r0 is part of the formula for total infected at X/Y/Z date but so is date of initial infection and size of initial infected population.
- GVIrish 7y ago
  The key is testing, contract tracing, and quarantining when the number of cases is small. That's what South Korea, New Zealand, and a few other countries did and they've all suffered relatively few fatalities. You still need a massive amount of tests to contain an outbreak, but the upside is that if you contain it early you don't need toe enact clumsy and broad measures like lockdowns.
Spooks 7y ago
I wonder if we did these preliminary tests with the flu if we would see a large death rate drop for influenza as well
- nullc 7y ago
  The US's influenza mortality figures are a combined influenza and pneumonia figure because they usually don't even bother actually screening for influenza. Research attempting to determine how much of that figure is infected with influenza have found figures like 1/3rd (though with large differences year to year).
cozzyd 7y ago
I had the opposite conclusion. There are between 10k-15k COVID-19 associated deaths in NYC, depending on how you count (the higher rate is consistent with the excess-mortality data, I believe). That by itself produces a range of ~0.56%-0.86% if you assume 21.2 % of NYC has been infected (larger range if you allow for some error on the infection rate, obviously). Moreover, we don't know what fraction of the currently-infected who will die have already died. A reasonable guess might be 50%, which would mean that the fatality rate for NYC is somewhere between 1.1 and 1.7%. Either way, based on NYC, 0.5% might be a hard lower bound on the all-population fatality rate (of course, maybe NYC is not a representative sample for some reason)
- rubidium 7y ago
  “ Moreover, we don't know what fraction of the currently-infected who will die have already died. A reasonable guess might be 50%” I lost you at reasonable guess. Why not ~1%?
  - vkou 7y ago
    If the mean time between infection and death is 2 weeks (Mostly true), and the virus has doubled every two weeks (True in NYC), then assuming that not a single new infection takes place starting today (Obviously not true, but this is a hypothetical), then in two weeks, you would expect to have twice the deaths that you do right now.
  - cozzyd 7y ago
    1% would imply an unrealistically high-fatality rate, so that can't be right.
  - zucker42 7y ago
    The virus takes time (2-3 weeks) to kill people, and the prevalence was presumably measured within the last week. Therefore, we have to take out the cases that occurred in the last week or two. I would suspect that 50% is on the upper end of how much the death lag could skew the results, but 20-50% doesn't seem unreasonable.
- 7y ago
Avamander 7y ago
Mortality rate, case fatality rate and infection fatality rates are all different things and have different values. Infection fatality rate of the virus could be within 0.5% (because its the one that tries to take into account everyone who has been infected), mortality rate is very likely still the one WHO has published and the third, case fatality rate is ~38% in the US.
- rimliu 7y ago
  What? 38 out of 100 infected in US die?
  - saalweachter 7y ago
    Infection fatality rate, the big number everyone is trying to figure out, best guess is somewhere around 1% right now, with a confidence interval of something like 0.3%-2.5% Case fatality rate, calculated as "number of deaths" / "number of known cases", usually something like 10% in most countries, although occasionally much lower or higher for the odd country that has really good or really bad testing. Resolved case fatality rate, calculated as "number of deaths" / "number of recoveries + number of deaths", which has been around 40% in the countries that have been hit hardest for the duration of their outbreaks. Tends to go down after the curve is bent, because it takes people longer to recover than die in most of these cases.
vkou 7y ago
15,000 deaths (So far) in NYC. 8.4 million people. If 20% of the population has had it, the death rate is 1%... Assuming that none of the currently infected die. Which is an unreasonable assumption (As the mean time to death from the point of infection seems to be ~2 weeks, and infections have doubled over the past 2 weeks.)
- kgwgk 7y ago
  But those currently infected are not included in the 20% of the population that has had it. Or maybe some are, but most of those infected now who may still die, do not have antibodies yet.
lukasm 7y ago
Yes, but the age is a 10x factor, os CFR would be much different in Nigeria (average age is about 19) and Italy (average age 45). We have two good petri dishes: USS Theodore Roosevelt - 600 cases out of 4800. 5 sick, one dead (41 years old). which means hospitalisation is at 0.83% and CFR is 0.016% (1% dead or in hospital). Not idea what is the average age, probably around 30-35. Diamond Princess: 700 of 3711. CFR 1.1%, average age around 50. What worries me the most though is potential mutations and death rates when you are infected with Covid-19 and flu at the same time (or other pathogens). https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt-idUSKCN21Y2GB?utm_source=Nature+Briefing&utm_campaign=ff928b9a9f-briefing-dy-20200417&utm_medium=email&utm_term=0_c9dfd39373-ff928b9a9f-44762053 https://www.reuters.com/article/us-health-coronavirus-usa-mi... https://www.nature.com/articles/d41586-020-00885-w?utm_source=Nature+Briefing&utm_campaign=ff928b9a9f-briefing-dy-20200417&utm_medium=email&utm_term=0_c9dfd39373-ff928b9a9f-44762053 https://www.nature.com/articles/d41586-020-00885-w?utm_sourc...
- rckoepke 7y ago
  Average age on an aircraft carrier appears to be 19 [0], 20 [1], and/or 24 [2] years old. 0: https://www.nytimes.com/2008/04/20/arts/television/20jens.html https://www.nytimes.com/2008/04/20/arts/television/20jens.ht... 1: https://archive.defense.gov/news/newsarticle.aspx?id=15334 https://archive.defense.gov/news/newsarticle.aspx?id=15334 2: https://mashable.com/2016/06/23/what-its-really-like-to-live-and-work-on-an-aircraft-carrier/ https://mashable.com/2016/06/23/what-its-really-like-to-live...
- rallison 7y ago
  > which means hospitalisation is at 0.83% and CFR is 0.016% (1% dead or in hospital). 0.16%, not 0.016%.
- greedo 7y ago
  You can't measure CFR or IFR this quickly in an isolated environment like the Roosevelt due to mortality lag. Also, the CFR for Diamond Princess is now up to 1.83%.
grumple 7y ago
The death rate would go up if more people had the virus at once, which is the entire reasoning behind isolating.
- gridlockd 7y ago
  I am wondering that number, if the limiting factor is ventilators, but the CFR of people on a ventilator is close to 90% either way. Other cases may just need oxygen supplementation, which is more manageable. It is pretty clear now that Germany is not that far from from Italy in terms of CFR when controlled for age.
gok 7y ago
…when people are able to get treatment.

colinmegill 7y ago

Garbage news source

CubsFan1060 7y ago
The slides contained in it were shared by the governor. Though maybe you're calling him a garbage news source.
ccleve 7y ago
The Governor's press conference was covered by the major media. The slides are there, also.

JamesBarney 7y ago

> The reason the tests were randomly taken from those at grocery and big-box stores is that these were people not isolating in their homes and presumably not at work and therefore not essential workers.

cm2187 7y ago
I don't know what to make of that. I would expect people at work to have higher infection rate (not the least because many of these jobs involve contact with the population). It also filters out older and sick people. So intuitively I would expect to undershoot the actual rate.
- CubsFan1060 7y ago
  I read it as people shopping, not people that work there. So folks who are out-and-about, but are not in the more likely to have it groups (healthcare workers or people working at the grocery store). You're right about older and sick people.
  - cm2187 7y ago
    No that's what I meant. People shopping and therefore not at work. Therefore intuitively I would expect the population tested to be less contaminated than the population not tested (because at work).
    - deleted 7y ago
      [deleted]
    - watwut 7y ago
      People who work also shop. People who work in stores also shop in stores. At that time, they could be randomly tested like non-workers. So workers are not excluded from study.
deleted 7y ago
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guscost 7y ago

While this is great information, a few facts will still confound attempts to speculate based on this number: - The production of IgG antibodies is mostly delayed until after an infection is cleared. - This is a random sample of people who were outside, it's not representative of the total population. - Non-trivial numbers of people may never develop detectable antibodies for SARS-CoV-2: https://www.medrxiv.org/content/10.1101/2020.04.17.20061440v1 https://www.medrxiv.org/content/10.1101/2020.04.17.20061440v... https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v2 https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v...

CubsFan1060 7y ago
If I follow, your first and third points would indicate the number may actually be higher? Additionally, does your third point also indicate that they will never be immune, or just that we won't be able to test for it?
- guscost 7y ago
  All three could push the true total higher, but number two easily could push it lower instead. And I'm not a microbiologist but I think lack of antibodies only means that we won't be able to test for past infection. The seronegative patients (determined by a very precise method for measuring antibodies) in the second cited paper were still able to clear their infections.
tempsy 7y ago
Also don’t know if people with antibodies can still spread the virus to others or whether antibody levels (not just presence) determines whether you can be reinfected.
zucker42 7y ago
I'm sorry, I don't know much about medicine so maybe you could clear up what those studies found. If I understand correctly, they both looked at COVID-19 patients and the first one found 83% had detectable antibodies and the second one found 163 / 173 had detectable antibodies? Or maybe I just completely don't understand it. Also it looks like they chose people with symptoms (i.e. "COVID-19 patients"). Would we expect the amount of detectable antibodies to be less, more, or the same among asymptomatic/mildly symptomatic people, or do we not know?

ccleve 7y ago

This study doesn't appear to suffer from the same methodology problems as the Stanford study of a few days ago. In that study, they recruited people through Facebook, and reported an infection rate that was low enough that it could have been caused by false positives. Here, it's closer to a random sample, but more importantly it shows really high rates. Those rates overwhelm any error due to false positives. Also, it shows numbers that are in line with our intuition. It shows higher infections in NYC, and higher infections among blacks. That reflects what the hospitals are seeing. This study may well be really good news.

3fe9a03ccd14ca5 7y ago
What's weird is that the Stanford study was suggested to have exaggerated the results, since those who suspected themselves as having the virus at one time were more likely to volunteer (allegedly). However, those results were nowhere near as big as this (I think like 2%-3% versus the 20%!)
- jdm2212 7y ago
  Roughly 1/1000 New Yorkers have died of coronavirus. At a 1% IFR, that suggests at least 10% of the state has gotten the virus. Probably more, because deaths are undercounted and many people who will die of the virus already have it but haven't died yet. In the Bay Area, almost no one has died of coronavirus so the infection rate should be next to nil.
  - brandmeyer 7y ago
    I was astonished by your 1/1000 figure and had to look it up... If anything, its too low. 15k deaths (proven+probable) in 8M people is almost 2/1000. https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page
    - jdm2212 7y ago
      I was referring to the state -- but, yeah, it's even worse in the city :( and 2/1000 people * 1% IFR => 20%

3fe9a03ccd14ca5 7y ago

At what point have we scientifically reached "herd immunity"? Is it 50%, 90%, 99%?

deleted 7y ago
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caiobegotti 7y ago
https://en.wikipedia.org/wiki/Herd_immunity#Mechanics https://en.wikipedia.org/wiki/Herd_immunity#Mechanics
- SpicyLemonZest 7y ago
  Although it should be noted that incomplete herd immunity will still help, by reducing the number of other containment measures which must be taken.
  - deleted 7y ago
    [deleted]
grey-area 7y ago
More like 50-80%, you just need spread to be impeded so that r falls below 1, but for that many people to get it would mean very high deaths, in the US 1% of 80% of 320m is > 2m deaths.
- nullc 7y ago
  Keep in mind that if 21% of NYC residence have been infected this probably implies R0 in that population was higher than in most prior estimates of R0, which increases the threshold of immune people before R0 falls below 1.
  - votepaunchy 7y ago
    It also implies that the R0 of the already-infected population is higher than that of the not-yet-affected population.

vkou 7y ago

If this study is accurate, and is not just working on garbage data, and if these antibodies actually mean long-term immunity, this means one of two things: 1. If the lockdown is lifted, we will see another ~60,000 to 100,000 deaths in NYC, before it will hit herd immunity. 2. Or, the lockdown will continue. The accuracy of antibody studies has been called into doubt, and as far as I know, nobody has ever followed up on whether or not people with study-detected antibodies can catch the virus. The data for the latter is unlikely to be available until the second wave hits.

grey-area 7y ago
That would be a very useful follow up study with this same population.
CubsFan1060 7y ago
There is no reason why an all or none approach is necessary here, is there? By my count, 10,120/15,740 of deaths have been folks over 70. If you kept people over 70 locked down (including their caretakers), you could significantly reduce the number of deaths while increasing the percentage that have had it. In fact, only 9% of New York's population is over 70. So theoretically (though clearly not practically), you could get over the percentage required for herd immunity while reducing the deaths by 66%
joe_maley 7y ago
> if these antibodies actually mean long-term immunity This is the big unknown that seems to be largely ignored, thank you for bringing it up. I am frequently seeing "herd immunity" thrown around without any qualification on the durability of the associated antibodies.
DeonPenny 7y ago
We'd also need to make the decsision to continue a lockdown over a virus with a 99.5% survival rate or not. Seeing at the flu has a 99.9% survival rate does it make sense to destroy the economy over that.
- 7y ago

glofish 7y ago

Well, it looks like in the end that much-criticized imperial model might be right on transmission rates but way off on the fatality rate and with that predicted deaths. It pretty much looks like none of the epidemiological models are reasonably accurate on both, case numbers and fatally rates

guscost 7y ago
If you're fitting a model to observations, they'll have something of an inverse (but of course non-linear) relationship. So if your virulence estimates are worse than your transmissivity estimates, or vice versa, the bad measurement is going to push the model out of whack.
zucker42 7y ago
Which model and what fatality rates did they predict?
cycrutchfield 7y ago
How are they off on fatality rates? Also note that the fatality rate is an input to the model, not a prediction of the model.
rallison 7y ago
If the results from this NY study hold, the numbers are basically exactly in line with the Imperial College study. That study assumed an IFR of 0.9%, and the NY results imply an IFR right around that.

sjg007 7y ago

Is this antibody test specific for covid-19 or would it be positive on other coronaviruses? That's a real concern since the other 4 coronaviruses are endemic.

hitchhiker999 7y ago
What's terrifying is with all these professional analysts in here, yours is the first comment I've seen that asks this obvious question.

daxfohl 7y ago

I find myself reconsidering the original proposition by England to isolate the most vulnerable for a couple months and let the virus work its course through the less vulnerable population. If death rate is substantially lower among the under 50 crowd, this could work its way through with a fairly low death toll, and result in a herd immunity within a couple months. This slow burn approach we're doing however seems possibly to be the precise worst way to handle it, leaving the virus in the population for as long as possible, reducing the ability for our vulnerable population to avoid it. Note I think the best possible solution is a complete lock down for a couple months until the virus is more or less eradicated, as Wuhan did. But I don't think it's a realistic option in our society.

jdm2212 7y ago
The outcomes aren't just death and recovery. There's also the possibility of long-term heart, lung, and kidney damage. And the blood thinners used to prevent coronavirus blood clots can cause brain bleeding. Those happen in younger people, too. And realistically there's no way to isolate those over 50. They generally live with, work with, or are cared for by younger people.
- taeric 7y ago
  This feels like fear talking. As more data comes in, we are seeing more people with no affects. Not just mild, but nigh non existent. It is agreed that something gives people severe cases. Severe includes death and recovered with damage. We don't seem to have data letting you know who or what would land there.
  - eloff 7y ago
    I disagree, see my sister comment. Even without data on lingering deficiencies, we can speculate with confidence that it carries a cost.
    - taeric 7y ago
      Speculation is fine. But we need data to back it. Right now, we don't. Could hypothesize that many being found with damage surviving, had damage going in. Would neatly explain why it hit them so hard.

djrogers 7y ago

I'm starting to wonder if there aren't 2 (or more) transmission methods for this virus with differing symptoms. Aerosol transmission with 'I got a cold' type symptoms, and droplet transmission with 'I got the worst cold I've ever had' type symptoms.

grandmczeb 7y ago
Why would different transmission methods result in different symptoms?
- taeric 7y ago
  Viral load, is what this typically refers to. Akin to an allergic person seeing one cat versus a room full of them. And, of course, for some people with allergies, contact where a cat has been is enough. ;) So... Complicated. Edit: was corrected down thread that this is infection dose, not viral load.
  - grandmczeb 7y ago
    There’s a very weak association between viral load and symptoms once you’re infected.
    - taeric 7y ago
      But that is what the thread was talking about, right? Would be nice to see studies. My intuition is that it is weak. But my intuition doesn't count for much here.
      - grandmczeb 7y ago
        Is it? I read the original comment as saying there were significantly different symptoms based on the transmission method. Even assuming that the transmission method results in a significantly different viral load, that's not enough to explain differing symptoms since there's not a whole lot of observable difference between cases with different severities[1,2]. There are some studies that show a relationship, but nothing strong enough to explain a dramatic difference. If it's true that the transmission method makes a big difference, it's more likely due to some other reason. E.g. maybe mild strains spread more easily in the air (although as far as I know there's no evidence that's true.) [1] https://arxiv.org/ftp/arxiv/papers/2003/2003.09320.pdf https://arxiv.org/ftp/arxiv/papers/2003/2003.09320.pdf Page 3. "We did not observe significantly different viral loads in nasal swabs between symptomatic and asymptomatic." [2] https://www.medrxiv.org/content/10.1101/2020.03.15.20036707v2.full.pdf https://www.medrxiv.org/content/10.1101/2020.03.15.20036707v... Page 4. "There was no obvious difference in viral loads across sex, age groups and disease severity"

TechBro8615 7y ago

So, at what point can we declare the lockdown to be a harmful overreaction and start opening countries up? Will we hold anyone accountable for models which proved to be pessimistic by orders of magnitude, causing implosion of economies around the world?

deleted 7y ago
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chasd00 7y ago
has anyone modeled at one point deaths from economic collapse overtake deaths from Covid19?
- bbarn 7y ago
  That was the first thing I said, 2 months ago, and got told I was a selfish asshole and had no clue what I'm talking about. This is going to be a real big history lesson for our grandchildren on how not to handle a situation in one way or another, unless the media rewrites the narrative. Oh, wait.
- robocat 7y ago
  I would be very sceptical about any models produced in the US, since the issue is so partisan, and one can tweak variables to prove whatever outcome one wants from a model. I think the lost life-years of economic hardship could easily outweigh the lost life-years of Covid deaths. That is because economic hardship affects younger people, while Covid deaths primarily affect people with not many years left to live. But there are many other external costs (social costs if your grandma dies) and economic benefits to deaths (lower pension payments, home availability?). However, given current information, a lockdown for weeks to months seems to make sense, since the consensus is that economic collapse is not yet immanent, and that steps can be taken to help keep the economy spinning when lockdown restrictions start to be relaxed.
  - watwut 7y ago
    Economic hardship affects middle aged and old people too.

ineedasername 7y ago

I couldn't find any detailed write up about their selection methods for participants, only the basics of where they found them. Without that, it is very hard to determine whether or not there's some flavor of selection bias: If it is voluntary, and they do not screen out people who report having had cold/flu symptoms, then they run the risk of attracting a disproportionate number of people who volunteer because they're curious if their prior symptoms were actually coronavirus. That would make it far from a random sample. The fact that they sampled only people actually leaving their house is also a form of selection bias: these are the people more likely to be exposed and may represent a disproportionately high infection rate as well. So I await further information. That said, even if it's overall 0.6%, that is still 6x higher than flu, and higher than H1N1 which had a CFR around 0.1 for areas with adequate health care. (much higher when there was not adequate care, but that is not dissimilar to Covid.) So no matter what, no one should be walking away from this study saying "See it's no big deal! Just the Flu/Cold etc!"

SketchySeaBeast 7y ago
Do you have a source for the CFR of 0.1 for H1N1? I could only find this[1], which is a much smaller number. [1] http://news.bbc.co.uk/2/hi/health/8406723.stm http://news.bbc.co.uk/2/hi/health/8406723.stm
- ineedasername 7y ago
  You may be looking at "settled" numbers when all was said & done and all facts were known. That's not an "apples to apples" comparison with current covid-19 knowledge. Here's my source [0] and the relevant quote, below. It is the CFR during the H1N1 pandemic, 10 weeks into it, which is why it is a much more appropriate (though not perfect) "apples to apples" comparison with Covid-19: >"The overall case fatality rate as of 16 July 2009 (10 weeks after the first international alert) with pandemic H1N1 influenza varied from 0.1% to 5.1% depending on the country." [0] https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ https://www.cebm.net/covid-19/global-covid-19-case-fatality-...

mrb 7y ago

If this study is accurate, then 1.8 million NYC resident are infected. So 15 411 deaths (as of today, including 5 121 probable deaths) suggests COVID-19 has a fatality rate of MINIMUM 0.9% which is in line with previous estimates (between 0.5 and 1.6%) and this is MINIMUM 9 times more fatal than the flu (0.1%). Edited to add "MINIMUM", as there is a lag between case detection and death (I should have known better to mention it, as I blogged about it: https://blog.zorinaq.com/case-fatality-ratio-ncov/ https://blog.zorinaq.com/case-fatality-ratio-ncov/)

izend 7y ago
Making it the worse pandemic in decades but no where near the Spanish Flu.
- mmastrac 7y ago
  Hard to compare directly against the Spanish Flu as medicine has had 100 years of progress, but assuming you are talking about overall impact, agreed.
  - glofish 7y ago
    not to mention the Spanish Flu hit children just as hard as the old.
  - cozzyd 7y ago
    The age distribution was also significantly different then.
- vladislav 7y ago
  The Spanish flu had a smaller outbreak in the Spring and came back with a vengeance the following Fall, so hold that thought. https://www.history.com/news/spanish-flu-second-wave-resurgence https://www.history.com/news/spanish-flu-second-wave-resurge...
- rechristened 7y ago
  Or as bad as the 1957-8 "Asian Flu" that most people haven't even heard of.

duxup 7y ago

It sure would be nice to find out the virus is far more widespread / exposure is higher than expected if only that would seem to indicate that the light at the end of the tunnel is nearer than we think ... and a lot of people have been exposed and doing well.

cryptonector 7y ago

At 21% it would be time to end the shutdown. EDIT: Read the comments below.

zucker42 7y ago
That doesn't make sense to me. I would think you'd want to get to the point where you've reached the carrying capacity, so that "overshoot" of the equilibrium doesn't result.
- cryptonector 7y ago
  See my other reply below. You can't overshoot 100%, and long before we get there herd immunity takes hold, and there's no question of the disease being kept from working its way through -- only a question of managing the rate at which it does. All in all the economic damage of continued shutdown does not make sense at this point (at 21% of the population exposed). We should stop now.
  - zucker42 7y ago
    Your comment doesn't address my point. See this Twitter thread, https://twitter.com/CT_Bergstrom/status/1251999295231819778 https://twitter.com/CT_Bergstrom/status/1251999295231819778 specifically this comment: https://twitter.com/CT_Bergstrom/status/1252008040376614912 https://twitter.com/CT_Bergstrom/status/1252008040376614912 for a good illustration of what I'm talking about. Keeping the rate of transmission low through the peak can definitely save lives.
SketchySeaBeast 7y ago
I'd think it'd be decided based upon the new cases and hospitalization and death rates, not an estimate of population with exposure.
- cryptonector 7y ago
  Sorry, but that's dumb. If 1/5th of the population has been exposed, then you know the total strain on the healthcare system is extremely unlikely to top an additional 4x what it has been, but not only it has 1/5th the population being exposed not in fact been enough to overwhelm the healthcare system, as more of the population is exposed you begin to get herd immunity, so in fact the total strain on the healthcare system is extremely unlikely to reach a total of 5x what it has been, very likely not even half that. Give all of that, it makes no sense to continue the shutdown considering how costly the shutdown is. To those who think this is a question of saving lives, that's not so. At this point the disease will work its way through the population because there's no time to finish testing, producing, and distributing a vaccine, which means the only question is of managing the maximum load on the healthcare system. Moreover, many of the most vulnerable have been hit already, and those who haven't can be protected by measures far short of a shutdown. No, at 21% it is most definitely time to stop the shutdown. (Note: not all the measures, just the shutdown.)

SiempreZeus 7y ago

Can one buy such an antibody test online?

ummonk 7y ago

0.2% of people in NYC has died from Covid-19, so this is exactly what we would expect.

lettergram 7y ago

I’ve continuously questioned the antibody tests... My understanding (from NBC news) was that at least some of the antibody tests were derived from a couple who were on the princes cruise. They never showed symptoms, but tested positive. IMO it’s quite possible that they never had it and those tests were inaccurate (right at the start of the outbreak, no symptoms, etc). Further, these antibody tests likely weren’t fully vetted nor were the samples they derived it from. For instance how often does another coronavirus set off this antibody test? Personally, I’m just waiting to see. I actually do suspect 20% have been infected, so it fits my expectations, but that’s not validation.

aazaa 7y ago

> In his press conference today, Governor Cuomo revealed the preliminary results of a first-phase antibody test that surveyed 3,000 New Yorkers over two days in 19 counties at 40 locations that included grocery and big-box stores. The sample suggests that 13.9% of New York State residents have the antibodies, meaning they had the virus at one point and recovered. Of the regions tested–Long Island, NYC, Westchester/Rockland, and the rest of the State–New York City had the highest positive rate at 21.2%. The potential good news to come to light is that the death rate may be far lower than some estimates, at 0.5%. This still is not a random sampling. It only samples from shoppers at grocery stores and big-box retailers. Imagine doing the same study, but of people who ordered groceries online only. Would you expect to see big differences in exposure rate? I think so. The study itself isn't linked anywhere, nor have I seen it elsewhere. Science is all about the details. It's not hard to imagine half a dozen ways that the bottom line result of this study could have been skewed by decisions made by the study authors and ground team.

t2riRXawYxLGGYb 7y ago
This was my thought exactly. Some of my friends in the Bay area got COVID-19 (confirmed positive tests) after quarantining for over two weeks at home and taking all of the precautions. The only place they had been was the grocery store, so they suspect that they got it there.
- usaar333 7y ago
  Are they not taking public transit? Your friends must be some of the most unlucky people ever. The Bay Area has had under 3k cases since the start of April outside group living settings (nursing homes, homeless shelters, etc.). That's ~1/2000 chance of getting covid from anywhere outside.
  - Terretta 7y ago
    Remember that’s not a count of cases. That’s a count of the under 3000 people that came up positive after permitted to take a limited availability test. Take total case deaths, divide by CFR, that’s how many likely total infected there were 3 weeks ago, and then compound daily by the daily spread rate to find how many likely today.

seemslegit 7y ago

0.5% IFR is still very high, I wonder what the antibody detection threshold is - i.e. is it possible that a lot more people have been exposed but don't have detectable antibody levels ? Would it qualify as infection in the sense that they are not susceptible for covid19 in the near term ?

IkmoIkmo 7y ago

They're trying to measure infection rates by analysing people who are more likely to go outside, and more likely to be infected. There's no adjustment for this confounder at all that I can see. Quick example: Suppose there's a 10% chance of getting infected every time someone goes outside. Suppose there's a million people of which half are type-A people who go outside once this month, and half are type-B people who go outside 10 times a month. The type-A person will have a 10% infection rate. The type-B person will have a 65% chance to be infected after a month. The average infection rate is around 42%. Yet if you randomly select someone outside, odds are 10 to 1 that it'll be a type-B person, and you'll get a far higher average of 60%, which isn't indicative of the average person, only of the average person who goes outside. Second, the article then compares the infection rate to the mortality rate. But the mortality rate does not include excess deaths. These are quite a bit higher for NYC, about 30% or so it seems than the official figures. But even this may be undercounting (or potentially, overcounting) the impact of the corona disease itself. Other deaths might be much lower (e.g. traffic, murder) or higher (e.g. untreated cancer). Then there's the lag-effect. There's 150 thousand confirmed infected, 15 thousand dead. But the vast majority of confirmed cases are still active, not recovered. They're confirmed because tens of thousands were hospitalised. Of the incubated people, 80% do not come out alive. There's lots of people fighting for their lives right now. Once those cases resolve, many will not have made it. And that's just hospitalised people. Then there's lots of cases who just got infected, and will be developing symptoms in 1-2 weeks. The way exponentials work is that lag is way more important. In the first weeks NY doubled every 2 days. That means if you have 10 thousand today infected today, in 10 days that's 320 thousand. That's when people start to get symptoms, and 10 days later people start dying from the symptoms. That means your infection count can go into the hundreds of thousands or even millions before seeing any death. But you can't conclude mortality figures from that, at all. In short, the 21% and the 0.5% conclusions are extremely premature and should not be reported like this. It's good to report the measurements, in context, but you can't draw the conclusions about the population or disease from it.

DenisM 7y ago

This might be a bit blunt but I am not jesting - an article about disease testing that does not contain the words "false positive" and "false negative" in some form is literally not worth reading. Even decent antibodies tests can have 10% false positive rates (bodysphere), and lots of those tests have dodgy provenance and 20% false positive is not out of the question. Here's a better article, thou still not great (paywall): https://www.nytimes.com/2020/04/23/nyregion/coronavirus-antibodies-test-ny.html https://www.nytimes.com/2020/04/23/nyregion/coronavirus-anti... The closest they come to discussing the errors is to acknowledge there might be some: State officials said the test had been calibrated to err on the side of producing false negatives — to miss some who may have antibodies — rather than false positives, which would suggest a person had coronavirus antibodies when they did not. Not very informative, I know. A word of caution from the NYC health officials: https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-status-of-serologic-testing.pdf https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020...

m3kw9 7y ago

For the people that thinks death rate is low is good news, it’s not when you know how contagious it is, you then need to look at numbers, not percentage to get a practical look at severity.

zyxzevn 7y ago

Good news. Herd-immunity is growing. Also, this means that the death-rate is far lower than reported. And this is nice too. Maybe we can save people by starting the society again. In other news, we see that hydroxychloroquine is actually working according to doctors. But there was a very bad study that claimed that it caused 2x as many deaths. It should have said instead that it was mainly used on patients that were close to death. Here is a good analysis of that study. https://www.youtube.com/watch?v=dLSYRqcg0wo&feature=youtu.be&t=12m13s https://www.youtube.com/watch?v=dLSYRqcg0wo&feature=youtu.be... Bad studies like this wide published one show that science is not immune to political agendas.

baconforce 7y ago
This video states that a randomized controlled study needs to be conducted, otherwise nobody can claim that hydroxychloroquine works or does not work.
mantap 7y ago
The presence of antibodies is not sufficient for herd immunity. For herd immunity you need those antibodies to stick around.

hkai 7y ago

Aha! So perhaps we shouldn't have shut down the economy and financially ruined millions of people, not to mention the hundreds of millions of people on the brink of starvation in developing countries. Perhaps we just like sharing images of coffins and feeling virtuous.

SerLava 7y ago
Even if the study is true, this doesn't follow. You only get to limit your response if you have the capability to do actual testing... which we didn't and still largely don't.

known 7y ago

But they can infect others

tangent-man 7y ago

To assume the infection fatality ratio(IFR)is 0.5% from this is retarded. We know that when covid-19 began to spread in South Korea at first it spread among a younger population who were ignoring or at least not following government advise so closely and taking chances the IFR was looking like about 0.7% to start with (In SK). We know this as SK kept excellent data / records to begin with. We also know that the Diamond Princess with a more generally aged population has a IFR of 13% +. We know this is a disease that adversely effects the elderly and infirm (in the developed world) If you are over 80 getting covid you might as well play Russian roulette with a Magnum .45 .These groups of people know there at risk, so if they have any sanity they are staying the hell at home. So people who are going into the Grocery store in NY city aren't representative of this population. This is why we are staying at home mostly to protect the old and infirm. That's not to say you want Covid-19 yourself either because there's about a 5% chance you will end up in the ICU (and an as yet undisclosed chance of death) even if your a member of the Hungarian Olympic Shot-Putting team. This does kill young tough people, it does happen but this is mostly killing the elderly and infirm. Why are people so fecking retarded? I can't take this anymore!! Stay the Sm3g at home! It's stopping the hospitals being overloaded.. It's buying us time to figure out new treatments / how to treat this better.

apexalpha 7y ago
Read an article that over half of Europe's Covid deaths might be from nursing homes...
- tangent-man 7y ago
  Sounds plausible. Do you have a link to that article? I'm not trying to bate you, I'd genuinely like to read it.