6 ms·
> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll prob
by marcell 6y ago
> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead
I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1]
The coronavirus infection fatality is likely around 0.5-1%, but it's heavily skewed towards older individuals. Younger people do die from it, but a very low rates. And young people die from other causes as well, the annual mortality rates for a 20-something is around 0.1%. Getting coronavirus for a 20-something or 30-something is roughly equivalent to the mortality rate of a few months of life.
Death is sad and terrible, but we don't shut down society because people die.
[1] https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp https://www.mdch.state.mi.us/osr/deaths/ageadjdxARS.asp
- johnnyo 6y agoThe things that generally kill Americans (heart disease, cancer, car crashes, diabetes, etc) aren’t contagious, so this is a bad analogy.
- marcell 6y agoNo analogy is perfect, but people need context to understand fatality rates, and see what risk is acceptable. Society doesn't have a goal of 0% death rates. We all accept some risk of death as a cost of continued existence. New data is showing that the fatality rate from covid-19 is more like existing risk we were all previously exposed to in the course of our existence, and not like a second version of smallpox.
- johnnyo 6y agoAs you said, you gotta die of something. If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing. That’s assuming no second order effects like a shortage of medical care making things worse.
- beagle3 6y ago> If the covid rate equals the regular rate, then the US death rate would effectively double if we simply did nothing. For one year (or however long it takes to reach herd immunity -- and if longer, then death rates wouldn't double but increase much less). Assuming recovery confers significantly long lasting immunity, which I agree is not a trivial assumption (and one we don't know yet how reasonable). Definitely not trivial, but -- in context -- means a reduction of life expectancy by less than one year. The US already lags Japan by 6; there's a lot that can be done to improve it by a year, with costs much lower than those currently spent to avoid reducing it by a year.
- scott_s 6y agoCorrect, Covid-19 is not as bad as smallpox. But it's still bad. Focusing on fatality rates misses the infection rate. Two diseases with the same case fatality rate can kill widely different number of people if one is more infectious than the other. We have learned that SARS-CoV-2 is way more infectious than the flu, meaning that way more people are getting it. With way more cases, we have way more deaths. (And, of course, way more strain on the medical system.)
- dekhn 6y agoThis more or less sums up my position. Thank you for stating it. I think the news media played a big role in amplifying the risk in a very uncertain early period that made people treat this differently from other risks that affect us and many of the arguments right now are happening because some poeple believe the goal of society is to reach 0% death rates. An important thing to recognize is that the disease itself is not an existential threat (even smallpox wasn't; even the plague wasn't!), but our response to it skirts creating one.
- evross 6y agoThe graphs on this page shows the situation for NY. It is clear that the risk can't be compared with 2009's H1N1. It's sobering. https://www.nytimes.com/interactive/2020/04/10/upshot/coronavirus-deaths-new-york-city.html https://www.nytimes.com/interactive/2020/04/10/upshot/corona... We need to give the scientists and medical professionals and industry more time to figure out how best to prevent this. There are many reports of 40-50 day illnesses in young people due to not clearing the virus. And the poorly named 'mild' case can be rough. It's (badly imo) defined as when a patient doesn't require hospital. It should be called moderate I think. [1] [1] https://www.businessinsider.com/what-coronavirus-mild-symptoms-are-fever-2020-3?op=1&r=US&IR=T https://www.businessinsider.com/what-coronavirus-mild-sympto...
- gus_massa 6y agoThe numbers from Wikipedia are very different, many death are due to contagious illness https://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate https://en.wikipedia.org/wiki/List_of_causes_of_death_by_rat... Cardiovascular diseases 29.34% Infectious and parasitic diseases 23.04% Malignant neoplasms (cancers) 12.49% Respiratory diseases 6.49% Unintentional injuries * 6.23% Perinatal conditions 4.32% Digestive diseases 3.45% Intentional injuries + 2.84% Neuropsychiatric disorders 1.95% Diabetes mellitus 1.73% Diseases of the genitourinary system 1.49% * includes car accidents + suicide, violence, war, etc.
- johnnyo 6y agoThose are world rates, not US rates. In the US, it’s largely the things I listed.
- beagle3 6y agoThis is not an analogy. It's just math - the risk of dying from COVID19 if you got it is comparable to the risk of dying this year all things other than COVID19 considered. (approx 0.1% in your twenties, approx 15% in your eighties). If getting it confers lifelong immunity (a question that does not yet have a definite answer), that means getting it means you compressed the overall risks of two years into one[0], or reduced your life expectancy by one year. Now, one year is a lot. But the difference in life expectancy between the US (78) and Japan (84) is already six times as much, so the lockdown in that context is about 6 times more expensive (per day, per person) than moving to Japan[1] would have been before COVID19, and no one would have preached the latter. Here's a conundrum: you can (a) lock yourself at home for 6 months, likely losing your job, potentially keeping in touch through the internet; then come back to "normal" life. (b) give up 6 months of your life expectancy, but go back to your normal life tomorrow. That is, w.r.t life expectancy, you can pause for 6 months and keep those 6 months; or fast forward those 6 months (and thus lose them). Almost everyone I know would pick (b) if there aren't any exception circumstances such as terminal disease. But the western world at large chose (a). [0] That's not exactly true - depending on some other model parameters; reduction of life expectancy by 6-9 months is more accurate. [1] It's not guaranteed that moving to Japan would grant you Japanese life expectancy. It is also not guaranteed that the lockdown as practiced really buys you more than a year either.
- JoeAltmaier 6y agoThat's a terrible analysis, for reasons well-covered all over HN and elsewhere. This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.
- centimeter 6y ago> for reasons well-covered all over HN and elsewhere. I've yet to see a compelling argument that LY or QALY analysis is the wrong approach. > This is a whole different thing from 'another flu'. We have to address it head-on It sounds like you're not actually offering any relevant response to the parent comment, but just repeating the taglines we all saw in the article. > Throwing people (a million people?) under the bus is not going to fly, not politically and not morally. Every political action has victims and beneficiaries. At the moment, we're hurting billions of people (almost the entire world population) to buy (on average) a few expected life-months for a very small section of the population. Your model of "people dying is bad" is true but not sufficient to make rational decisions.
- JoeAltmaier 6y agoBecause, its well-covered all over HN and elsewhere. I suggest reading and thinking, before posting throw-away pseudo-analyses.
- marcell 6y agoEvery year around 3 or 4 million people die in America from a variety of causes. This is sad, but at some point, everyone has to die. Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality. [1] https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_antibody_study_of_blood_donors_reveals_3/ https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
- johnnyo 6y ago
- rguzman 6y agothe CFR is only as low as 0.5-1% when there is adequate medical care and the population is otherwise healthy. in NYC the CFR for the 18-45 cohort is ~5%[1]. [1]: https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/ https://www.worldometers.info/coronavirus/coronavirus-age-se...
- centimeter 6y agoCFR is a terrible metric - you should be using IFR. CFR is of course going to be much higher than the IFR, probably orders of magnitude higher. IFR data hasn't been available until recently because you need A) randomized sampling and B) antibody tests, which have only just been rolled out. The most up-to-date IFR data suggests that "0.5%" is actually an astoundingly high overestimate for any reasonable metric of "number of people who die from this", and that's before adjusting for the fact that the people who die were usually going to die soon anyway.
- chockablock 6y ago> astoundingly high overestimate for any reasonable metric 12k deaths in NYC gives a pretty hard lower bound on IFR of 0.14%. The IFR will end up higher than 0.5% if incidence in city is any lower than 27%, which seems very reasonably likely.
- arcticbull 6y agoUsing CFR to determine fatality rate of COVID is as effective as it would be for skydiving. If you only count people who go to hospital (because they're frightfully sick -- or splatted out of an aircraft) and compare that to those who walk out of hospital you're exhibiting massive adverse selection bias. For H1N1 swine flu, CFR was between 0.1% and 5.1% depending on the country. The IFR was 0.02%. For COVID it's between 0.07% and 15%. The IFR is probably in the lower quartile of the 0.1%-1% range. [1] [1] http://cebm.net/oxford-covid-19-evidence-service/ http://cebm.net/oxford-covid-19-evidence-service/
- astrophysician 6y ago> Death is sad and terrible, but we don't shut down society because people die. Yea, but COVID has the potential to kill a lot of people, quickly -- are you suggesting it's a bad idea to "shut down society" to keep our hospitals functioning? I get the point that the economic cost is severe and also comes with its own share of human cost, but we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it...
- aianus 6y ago> Several trillion dollars is still worth it $2 trillion is 10% of GDP or the losses in ~6 months of a lockdown resulting in 80% productivity (with the assumption that everything goes back to normal immediately after the shutdown, which it won't) So it seems like a ~6 month lockdown is warranted if you crassly value saving a life from COVID at $1 million. That's not long enough for a vaccine. Alternatively, working backwards, you need to value a life saved at $3-$4m each to make a 18-24 month lockdown worth it.
- johnnyo 6y agoWe’ve already got a “Value of Statistical Life” in the US, and it’s higher than that. So you could justify lockdown on that alone EPA recommends that the central estimate of $7.4 million ($2006), updated to the year of the analysis, be used in all benefits analyses that seek to quantify mortality risk reduction benefits regardless of the age, income, or other population characteristics of the affected population https://www.epa.gov/environmental-economics/mortality-risk-valuation#means https://www.epa.gov/environmental-economics/mortality-risk-v...
- astrophysician 6y ago6 month lockdown doesn’t seem necessary, but a lockdown until it’s possible to do contact tracing and containment does seem necessary, either way this is something that easily warrants a drastic response because the potential cost is so high.
- beagle3 6y ago> we're talking about saving ~1-2 million people in the US alone by doing this. Several trillion dollars is still worth it... No, we're not. 88% of people on ventilators in NYC don't survive (in a predictable pattern - 97.2% over age 65 don't for example). You might remember that just a couple of weeks ago, everyone was calling for more ventilators and every company with a workshop started building one -- because it was assumed (a) they would be needed, and (b) they would be very useful; neither is considered self evident truth (or truth at all) three weeks later. There is no vaccine yet, and no medicine yet, and either may take a year or twenty (TTBOMK, no successful vaccine for the corona family was ever made, and not for lack of trying). Unless you assume a miracle, the assumption is everyone will get it -- and so far, our ability to significantly "save" people has not been demonstrated. The only reasonable assumption right now is that everyone will get it, and while keeping the hospital system function is important in general, it makes little difference to those who get COVID19. A more reasonable model is that we're avoiding a 6-8 month reduction in life expectancy, at a cost of (so far) 2 months of normal life. Whether it is worth it or not is not for me or you to decide and obviously depends on your point of view -- but it is clearly not self evident one way or another. [0] https://www.washingtonpost.com/health/2020/04/22/coronavirus-ventilators-survival/ https://www.washingtonpost.com/health/2020/04/22/coronavirus... edit: someone is systematically downvoting all my posts on this thread. Whoeveer that is, I am not advocating for or against a course of action - I'm addressing the math. It is your right to downvote without explanation, but if you think I'm wrong, I would appreciate an explanation.
- fzeroracer 6y agoSo would you be willing to roll the dice then for the sake of opening up society? In fact, are you willing to die for it? If given the choice between dying of COVID-19 or shutting down society, you're saying that you personally would choose to die? I'm bringing this up because the difference between this and other causes of death is that not only is this transmissible, but it also has knock-on effects that we currently have no clue about (see: blood clotting). If we don't do what we can to prevent this, it could become far worse than what we originally thought.
- marcell 6y ago> If given the choice between dying of COVID-19 or shutting down society Obviously shut down society, but that's not the choice that exists. The choice in reality is an acceptable risk of death, or shut down society. Between those I pick the acceptable risk of death. We all make the same choice for many, many other situations.
- fzeroracer 6y agoNo, what I'm directly asking you is: Are you willing to die to reopen society? I'm not asking you to to take an acceptable risk. The reason why I bring this up is because when you argue for reopening society based on 'acceptable risk', you're not just risking your own life. You're asking other people who are at risk (ie people with asthma or other issues) to die for you.