5 ms·

>There are many more infections than we know about and the CFR is not anywhere close to the actual IFR. That is the optimistic takeaway. The pessimistic takea

by slg 7y ago

>There are many more infections than we know about and the CFR is not anywhere close to the actual IFR. That is the optimistic takeaway. The pessimistic takeaway is that even the hardest hit areas are nowhere near herd immunity levels and that we are either going to be isolating until a vaccine is created or we can expect to see a lot more death once nonessential people are forced back to work.

arcticbull 7y ago
> The pessimistic takeaway is that even the hardest hit areas are nowhere near herd immunity levels and that we are either going to be isolating until a vaccine is created or we can expect to see a lot more death once nonessential people are forced back to work. The third option is, when you take into account that it's approximately as bad as the flu for folks under 40, we let out the young and keep the older folks and the vulnerable inside. This will boost our progress towards herd immunity without materially increasing the death counts.
- slg 7y ago
  I have never heard of any healthy person under 40 dying from purely the flu. COVID-19 is certainly less dangerous to the young than the old, but there are plenty examples of it killing young and otherwise healthy people.
  - TheBlight 7y ago
    See: https://www.cdc.gov/flu/about/burden/2018-2019.html https://www.cdc.gov/flu/about/burden/2018-2019.html Search for "Table 1: Estimated influenza disease burden, by age group — United States, 2018-2019 influenza season"
    - slg 7y ago
      I skimmed through that so please point it out if I missed it, but the numbers don't seem to account for comorbidities. The question was whether COVID-19 is more dangerous than the flu to healthy young people not all young people.
      - mlyle 7y ago
        Just because you've not heard about it, doesn't mean it doesn't happen. Seemingly healthy young people die from the flu each year. Since Feb 1, 204 people from 15-34 have been confirmed to have died from COVID-19 in the US. 162 people from age 15-34 have been confirmed to have died from influenza in the same period. I don't think you'll find either statistic broken down by comorbidities.
        slg 7y ago
        You mind sharing the source on those numbers because the total deaths is somewhat meaningless without the number of infections which I imagine is much higher for the flu? Even those absolute numbers show total deaths being just over 25% higher for COVID-19 than the flu.
        mlyle 7y ago
        Table 2: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm The statement you differed with is "The third option is, when you take into account that it's approximately as bad as the flu for folks under 40," You're ignoring data in order to make a wishy-washy statement that it must be much worse for people under 40 based on anecdotes you hear. I don't agree flu infections were higher for those 2 months, either. Distancing has been spectacularly effective against influenza, since it has a lower Rt in the absence of controls. Under 1% of influenza surveillance tests are positive right now, which is a level usually only seen in the middle of summer. Our best guess for overall infection fatality rate is about 0.3%, double or 3x influenza (because of the very high death rate in the elderly), but COVID-19 deaths overall have been 4x influenza in that time period, indicating that COVID-19 prevalence is higher.
        slg 7y ago
        First off, all those numbers are once again absolute deaths and not related to case numbers so my prior complaint still stands. If you look at the first chart, you will see that COVID-19 deaths didn't start becoming a problem until March. Distancing practices were not widespread until mid-March. Meanwhile flu deaths weren't dramatically cut until the most recent timeframe. So taking into consideration both the first chart and the second chart that breaks out the numbers by age range, there seems to be an implication that COVID-19 deaths are much higher for young people in recent weeks. Therefore the absolute numbers would look totally different if March 1st was the starting point. I really don't see anything here that demonstrates the flu is as dangerous as COVID-19 for young people.
- qqqwerty 7y ago
  You can't have it both ways. If IFR is low, then that means R0 is way higher than we thought, which also means isolating only the vulnerable will not work. The fact is, the number of deaths is too high in NYC to be able to cherry-pick your way to an argument that supports your view. Either R0 is really high, and we need to shutdown to prevent it from infecting the entire population in a very short time span, or the IFR is way higher than the flu and we need to shutdown to prevent it from killing a lot of people. The only sane way to open things back up at this point is to implement widespread testing and contract tracing.
  - deleted 7y ago
    [deleted]
  - mlyle 7y ago
    > If IFR is low, then that means R0 is way higher than we thought, which also means isolating only the vulnerable will not work. No. If you miss a constant percentage of cases, you get the same shape of exponential curve. That is, a virus with an R0 of 2 and 1 case doubling to 2 and 2 cases doubling to 4.... looks the same when you miss 99% of infections and see 1 of 100 infections doubling to 2 of 200 doubling to 4 of 400. This fallacy has been common in the response to this data, but it makes no sense. Large numbers of missed cases shift the curve forward and backward in time, and don't change the shape of it. All of the current findings are still consistent with R0 in the range of 2.0 to 2.5.
    - qqqwerty 7y ago
      > If you miss a constant percentage of cases We are talking about 1 serological study at a single point in time. We have no idea what percentage of cases we were missing before or after that point.
      - mlyle 7y ago
        There's no reason to interpret the serological study to think a higher R0 is implied, which is what you said. The only way that missing cases affects estimates of R0 from time series is if we're missing a much bigger proportion of cases now than we were in the past. All the evidence I've seen leans the other way-- more testing, better testing, more cases diagnosed by "presumed" criteria. So, it actually implies the opposite of what you're saying, and argues for lower R0.
CubsFan1060 7y ago
I don't think this a binary outcome. Getting closer to herd immunity also makes things better. Take NYC. Now 1 out of 5 people you see can't infect you (assuming having antibodies means immunity). The closer we get, the better it is. Having 21% "immune" leads to far different outcomes than .1%.
- badfrog 7y ago
  > The closer we get, the better it is. Having 21% "immune" leads to far different outcomes than .1%. It depends on how long the immunity lasts. If it's permanent, this is indeed great. If it lasts only a few months, this 21% won't make any difference for another wave of infections this fall.
  - __blockcipher__ 7y ago
    We use the term "immunity" but we should remember that there is a difference between the presence of active antibodies and the presence of immune "memory cells". The latter hang around long-term, even if the former disappear. So at a minimum if one does develop infection they will recover far sooner and with better outcomes. And likely will reach a far lower peak viral load which might bring down transmission.
    - maxerickson 7y ago
      That is not well established. It's likely enough, but we don't gain long term immunity to every virus that we successfully clear.
      - __blockcipher__ 7y ago
        It is well established. https://en.wikipedia.org/wiki/Memory_T_cell https://en.wikipedia.org/wiki/Memory_T_cell You are conflating active circulating antibodies with the memory T cells. Which is literally what my entire comment was about.
        7y ago
__blockcipher__ 7y ago
At this point people advocating the position you’re advocating for are in a state of denial (this is my opinion, not a matter of fact, obviously). Your assumption is that we can effectively prevent the majority of the nation from exposure via lockdown. Not only does evidence seem to point against that, but when you do the math on mortality due to suicide and overdose it’s not clear that containment would even save more lives in the long run. Here’s how you can tell people’s philosophical positions: if they talk about fear of a “second wave” they are Containers, since that implies the initial “wave” will not infect the majority; ie the virus is successfully contained (EDIT: See https://news.ycombinator.com/item?id=22961927 https://news.ycombinator.com/item?id=22961927 for the caveat here). Ironically, leaders like Fauci are verbally saying that containment is not the strategy, yet every word that he says and the IMHE model everyone is relying on are all the result of a Containment ideology. The alternative is what I would call Pareto mitigation. The vulnerable portion of the population self isolates, while the rest of us are _allowed_ to resume working and living more or less normally (still no large gatherings presumably). I'd like to take this moment to put out a brief PSA that the serological data coming out, while not 100% reliable, is all telling more or less the same story. Let's look at these IFRs (the second link is CFRs but for Italian healthcare workers who presumably are all getting tested so I'm treating it as a de-facto IFR): https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antibody_study_of_blood_donors_reveals_3/fnzkn4k/ https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib... https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_italian_progression_of_covid19/foatvgv/ https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_i... (I'm linking to the reddit comments instead of the actual study because they're really nice tables and the links are still there for anyone who wants to double check) As others have said, for those around age 45 or less, Covid is equally or less dangerous than Influenza. And particular for those under 30 the flu is an order of magnitude more deadly at least. In the general population overall, Covid is undeniably more deadly than the flu, but only about 3-5x (and I think 3x personally right now). Recall that the flu is characterized by deaths in the very young and very old, while being less harmful to those "in between", purportedly due to the "cytokine storm" which is a scorched earth reaction of the immune system. Covid is very different, it is extraordinarily deadly to the very old, extraordinarily non-deadly to the very young, and about the same as the flu to those in between. A disease with such a "spiky" (highly variable) mortality rate based on your risk factors is precisely the kind of disease that is most effectively treated with risk-informed self quarantine rather than a national lockdown. Unemployment is correlated with a 2-3x higher chance of suicide, of which perhaps half can be explained away by mental health confounds [1]. There's unique factors in play here - rampant social isolation and widespead fearmongering, propagated even by health experts and "trusted" news sources at times - that lead me to believe that the spike in suicide and overdoses will actually be much higher than predicted by just unemployment alone. We're currently at 50,000 suicides per year in the US as a base rate, it is not unimaginable that we would see at least 50,000 _extra_ suicide deaths attributable to a mixture of lockdown and the general socioemotional environment. -- I haven't even gotten to the philosophical battle of "freedom versus security". I am, ideologically, someone who drank the koolaid and really believes in freedom and civil liberties over "security" (which I view as illusory anyway), but _even just viewed through the lens of reducing mortality_, the evidence is stacking up that lockdown is going to do more harm than good. Is the evidence fully settled? Of course not. But it's shocking to me how many people seem to be operating off of the projected CFR's we had in early February, shouting from the rooftops about "1 in 20" people dying (random recent case in point: https://news.ycombinator.com/reply?id=22952764&goto=threads%3Fid%3D__blockcipher__%2322952764 https://news.ycombinator.com/reply?id=22952764&goto=threads%...). I don't know whether it's just that a large swath of the population already had clinical anxiety which is further magnified by social isolation and social media and news headlines, or whether something else is at play, but I'm very concerned about the state of discourse in the United States right now, and more broadly, the entire world. In fact, ironically I feel a bit luckier to be in the US than some of these other countries because in the US _every_ issue is partisan, which while entirely irrational means that roughly half the country will be in favor of ending the lockdown at any given time (the position I am advocating for, within reason, insofar as hospitals are not overwhelmed), as opposed to other places where you can get given a $1600 ticket for driving a car by yourself, based off of a superstition that _being outside_ causes Covid as opposed to exposure to infected respiratory droplets... -- EDIT: Lastly I should mention that in a perfect world we could have voluntary variolation; I would love to be able to expose myself to a controlled dose of SARS-CoV-2 and self isolate for several weeks to ensure that I can never pass on Covid to someone else. Unfortunately that would be very hard to make a reality due to the political environment, even though I am advocating for it to be totally voluntary. I was heartened to see this recent paper toying with a variant of that approach: https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v1 https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v... (I don't agree with an "Immunity Card" for ideological reasons but I'm glad we have a paper attempting to model it out which does show benefit of voluntary self exposure) [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v057p00594.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v05...

by slg 7y ago

arcticbull 7y ago

> The pessimistic takeaway is that even the hardest hit areas are nowhere near herd immunity levels and that we are either going to be isolating until a vaccine is created or we can expect to see a lot more death once nonessential people are forced back to work. The third option is, when you take into account that it's approximately as bad as the flu for folks under 40, we let out the young and keep the older folks and the vulnerable inside. This will boost our progress towards herd immunity without materially increasing the death counts.

slg 7y ago
I have never heard of any healthy person under 40 dying from purely the flu. COVID-19 is certainly less dangerous to the young than the old, but there are plenty examples of it killing young and otherwise healthy people.
- TheBlight 7y ago
  See: https://www.cdc.gov/flu/about/burden/2018-2019.html https://www.cdc.gov/flu/about/burden/2018-2019.html Search for "Table 1: Estimated influenza disease burden, by age group — United States, 2018-2019 influenza season"
  - slg 7y ago
    I skimmed through that so please point it out if I missed it, but the numbers don't seem to account for comorbidities. The question was whether COVID-19 is more dangerous than the flu to healthy young people not all young people.
    - mlyle 7y ago
      Just because you've not heard about it, doesn't mean it doesn't happen. Seemingly healthy young people die from the flu each year. Since Feb 1, 204 people from 15-34 have been confirmed to have died from COVID-19 in the US. 162 people from age 15-34 have been confirmed to have died from influenza in the same period. I don't think you'll find either statistic broken down by comorbidities.
      - slg 7y ago
        You mind sharing the source on those numbers because the total deaths is somewhat meaningless without the number of infections which I imagine is much higher for the flu? Even those absolute numbers show total deaths being just over 25% higher for COVID-19 than the flu.
        mlyle 7y ago
        Table 2: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm The statement you differed with is "The third option is, when you take into account that it's approximately as bad as the flu for folks under 40," You're ignoring data in order to make a wishy-washy statement that it must be much worse for people under 40 based on anecdotes you hear. I don't agree flu infections were higher for those 2 months, either. Distancing has been spectacularly effective against influenza, since it has a lower Rt in the absence of controls. Under 1% of influenza surveillance tests are positive right now, which is a level usually only seen in the middle of summer. Our best guess for overall infection fatality rate is about 0.3%, double or 3x influenza (because of the very high death rate in the elderly), but COVID-19 deaths overall have been 4x influenza in that time period, indicating that COVID-19 prevalence is higher.
        slg 7y ago
        First off, all those numbers are once again absolute deaths and not related to case numbers so my prior complaint still stands. If you look at the first chart, you will see that COVID-19 deaths didn't start becoming a problem until March. Distancing practices were not widespread until mid-March. Meanwhile flu deaths weren't dramatically cut until the most recent timeframe. So taking into consideration both the first chart and the second chart that breaks out the numbers by age range, there seems to be an implication that COVID-19 deaths are much higher for young people in recent weeks. Therefore the absolute numbers would look totally different if March 1st was the starting point. I really don't see anything here that demonstrates the flu is as dangerous as COVID-19 for young people.
qqqwerty 7y ago
You can't have it both ways. If IFR is low, then that means R0 is way higher than we thought, which also means isolating only the vulnerable will not work. The fact is, the number of deaths is too high in NYC to be able to cherry-pick your way to an argument that supports your view. Either R0 is really high, and we need to shutdown to prevent it from infecting the entire population in a very short time span, or the IFR is way higher than the flu and we need to shutdown to prevent it from killing a lot of people. The only sane way to open things back up at this point is to implement widespread testing and contract tracing.
- deleted 7y ago
  [deleted]
- mlyle 7y ago
  > If IFR is low, then that means R0 is way higher than we thought, which also means isolating only the vulnerable will not work. No. If you miss a constant percentage of cases, you get the same shape of exponential curve. That is, a virus with an R0 of 2 and 1 case doubling to 2 and 2 cases doubling to 4.... looks the same when you miss 99% of infections and see 1 of 100 infections doubling to 2 of 200 doubling to 4 of 400. This fallacy has been common in the response to this data, but it makes no sense. Large numbers of missed cases shift the curve forward and backward in time, and don't change the shape of it. All of the current findings are still consistent with R0 in the range of 2.0 to 2.5.
  - qqqwerty 7y ago
    > If you miss a constant percentage of cases We are talking about 1 serological study at a single point in time. We have no idea what percentage of cases we were missing before or after that point.
    - mlyle 7y ago
      There's no reason to interpret the serological study to think a higher R0 is implied, which is what you said. The only way that missing cases affects estimates of R0 from time series is if we're missing a much bigger proportion of cases now than we were in the past. All the evidence I've seen leans the other way-- more testing, better testing, more cases diagnosed by "presumed" criteria. So, it actually implies the opposite of what you're saying, and argues for lower R0.

CubsFan1060 7y ago

I don't think this a binary outcome. Getting closer to herd immunity also makes things better. Take NYC. Now 1 out of 5 people you see can't infect you (assuming having antibodies means immunity). The closer we get, the better it is. Having 21% "immune" leads to far different outcomes than .1%.

badfrog 7y ago
> The closer we get, the better it is. Having 21% "immune" leads to far different outcomes than .1%. It depends on how long the immunity lasts. If it's permanent, this is indeed great. If it lasts only a few months, this 21% won't make any difference for another wave of infections this fall.
- __blockcipher__ 7y ago
  We use the term "immunity" but we should remember that there is a difference between the presence of active antibodies and the presence of immune "memory cells". The latter hang around long-term, even if the former disappear. So at a minimum if one does develop infection they will recover far sooner and with better outcomes. And likely will reach a far lower peak viral load which might bring down transmission.
  - maxerickson 7y ago
    That is not well established. It's likely enough, but we don't gain long term immunity to every virus that we successfully clear.
    - __blockcipher__ 7y ago
      It is well established. https://en.wikipedia.org/wiki/Memory_T_cell https://en.wikipedia.org/wiki/Memory_T_cell You are conflating active circulating antibodies with the memory T cells. Which is literally what my entire comment was about.
      - 7y ago

__blockcipher__ 7y ago

At this point people advocating the position you’re advocating for are in a state of denial (this is my opinion, not a matter of fact, obviously). Your assumption is that we can effectively prevent the majority of the nation from exposure via lockdown. Not only does evidence seem to point against that, but when you do the math on mortality due to suicide and overdose it’s not clear that containment would even save more lives in the long run. Here’s how you can tell people’s philosophical positions: if they talk about fear of a “second wave” they are Containers, since that implies the initial “wave” will not infect the majority; ie the virus is successfully contained (EDIT: See https://news.ycombinator.com/item?id=22961927 https://news.ycombinator.com/item?id=22961927 for the caveat here). Ironically, leaders like Fauci are verbally saying that containment is not the strategy, yet every word that he says and the IMHE model everyone is relying on are all the result of a Containment ideology. The alternative is what I would call Pareto mitigation. The vulnerable portion of the population self isolates, while the rest of us are _allowed_ to resume working and living more or less normally (still no large gatherings presumably). I'd like to take this moment to put out a brief PSA that the serological data coming out, while not 100% reliable, is all telling more or less the same story. Let's look at these IFRs (the second link is CFRs but for Italian healthcare workers who presumably are all getting tested so I'm treating it as a de-facto IFR): https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antibody_study_of_blood_donors_reveals_3/fnzkn4k/ https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib... https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_italian_progression_of_covid19/foatvgv/ https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_i... (I'm linking to the reddit comments instead of the actual study because they're really nice tables and the links are still there for anyone who wants to double check) As others have said, for those around age 45 or less, Covid is equally or less dangerous than Influenza. And particular for those under 30 the flu is an order of magnitude more deadly at least. In the general population overall, Covid is undeniably more deadly than the flu, but only about 3-5x (and I think 3x personally right now). Recall that the flu is characterized by deaths in the very young and very old, while being less harmful to those "in between", purportedly due to the "cytokine storm" which is a scorched earth reaction of the immune system. Covid is very different, it is extraordinarily deadly to the very old, extraordinarily non-deadly to the very young, and about the same as the flu to those in between. A disease with such a "spiky" (highly variable) mortality rate based on your risk factors is precisely the kind of disease that is most effectively treated with risk-informed self quarantine rather than a national lockdown. Unemployment is correlated with a 2-3x higher chance of suicide, of which perhaps half can be explained away by mental health confounds [1]. There's unique factors in play here - rampant social isolation and widespead fearmongering, propagated even by health experts and "trusted" news sources at times - that lead me to believe that the spike in suicide and overdoses will actually be much higher than predicted by just unemployment alone. We're currently at 50,000 suicides per year in the US as a base rate, it is not unimaginable that we would see at least 50,000 _extra_ suicide deaths attributable to a mixture of lockdown and the general socioemotional environment. -- I haven't even gotten to the philosophical battle of "freedom versus security". I am, ideologically, someone who drank the koolaid and really believes in freedom and civil liberties over "security" (which I view as illusory anyway), but _even just viewed through the lens of reducing mortality_, the evidence is stacking up that lockdown is going to do more harm than good. Is the evidence fully settled? Of course not. But it's shocking to me how many people seem to be operating off of the projected CFR's we had in early February, shouting from the rooftops about "1 in 20" people dying (random recent case in point: https://news.ycombinator.com/reply?id=22952764&goto=threads%3Fid%3D__blockcipher__%2322952764 https://news.ycombinator.com/reply?id=22952764&goto=threads%...). I don't know whether it's just that a large swath of the population already had clinical anxiety which is further magnified by social isolation and social media and news headlines, or whether something else is at play, but I'm very concerned about the state of discourse in the United States right now, and more broadly, the entire world. In fact, ironically I feel a bit luckier to be in the US than some of these other countries because in the US _every_ issue is partisan, which while entirely irrational means that roughly half the country will be in favor of ending the lockdown at any given time (the position I am advocating for, within reason, insofar as hospitals are not overwhelmed), as opposed to other places where you can get given a $1600 ticket for driving a car by yourself, based off of a superstition that _being outside_ causes Covid as opposed to exposure to infected respiratory droplets... -- EDIT: Lastly I should mention that in a perfect world we could have voluntary variolation; I would love to be able to expose myself to a controlled dose of SARS-CoV-2 and self isolate for several weeks to ensure that I can never pass on Covid to someone else. Unfortunately that would be very hard to make a reality due to the political environment, even though I am advocating for it to be totally voluntary. I was heartened to see this recent paper toying with a variant of that approach: https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v1 https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v... (I don't agree with an "Immunity Card" for ideological reasons but I'm glad we have a paper attempting to model it out which does show benefit of voluntary self exposure) [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v057p00594.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v05...