15 ms·

Given the correlation between cases and deaths, isn't one of the big arguments against the early community spread theory that we would have seen death rates inc

Given the correlation between cases and deaths, isn't one of the big arguments against the early community spread theory that we would have seen death rates increase earlier on than they actually did?

redis_mlc 6y ago
No, because the mortality rate is very, very low outside nursing homes. And cause of death in the early days won't be listed as corona, since it was an unknown disease. The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)
- taeric 6y ago
  I have been beating this drum for a while. I feel like I'm shouting aliens. The CFR for sixty plus is staggering. Below sixty? Still crappy, but not shut down the world. Below twenty? We wouldn't even notice. The problem is not whether this is more or less scary than the flu (or anything else), it is both. With no solutions aimed at buffering nursing homes/elderly. Am I just insane? This narrative seems completely absent in all of the coverage.
  - JshWright 6y ago
    What narrative... that COVID-19 is most deadly for those over 60? That's literally the only fact that most people know about it. If you think that has been absent in all the coverage, I have no idea what coverage you have been paying attention to.
    - taeric 6y ago
      It is and it isn't. This thread is predicated on an IFR that is a flat 5 or so percent on the population. We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus. Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations. (Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
      - philwelch 6y ago
        This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages. There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
        taeric 6y ago
        That was reported as full on no shut down. Just crap reporting? Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population. Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
        philwelch 6y ago
        Sorry about the edit. The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.) Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions. What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions. Over time you could even allow travel between green zones.
  - Jabbles 6y ago
    You're not insane, but you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients. Also reducing death is not the only target, we are reasonably sure that many patients will have long-lasting damage to their lungs. There is of course some trade off between number of deaths avoided and amount of money we should be prepared to throw at the problem. Where on this spectrum are you?
    - taeric 6y ago
      I'm on a different angle, I think. My specific point is that people need to stop looking at a single IFR/CFR stat. It does no good. We look to be getting safer numbers there by simply increasing testing. (Of note, NYC has a strict lower bound on its numbers with how many in its population has died. But, do note they have more people over sixty than most cities do people. Such that most places will not be comparable.) And that is the problem. The virus has not gotten safer as we get more data. Our understanding is just not focusing on helping the elderly. We seem to be taking a crap shot that everyone can stay home and we can out sit the virus. I would wager we could have setup hotels and strict access controls on supplies into and out of at risk communities cheaper than what we have done. Certainly if you count on all of the job loss.
    - djsumdog 6y ago
      > you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients This is the narrative we keep getting fed over and over again, but it doesn't seem to be working out. There are a lot of people who were afraid to go to doctors for minor issues, a lot of important surgeries canceled for being elective, etc. On top of that, 80% of people who need a ventilator who are older or have other health issues, will die on them[0]. For the younger patients, it's almost a coin toss. Some hospital systems are overwhelmed, but some are totally empty. Treating a region as large as the US as one unified geographical region, even with our unrestricted travel, didn't seem sound. The devastation to peoples jobs, lives, savings, homes .. everything ... we keep saying Lives > Economy, but unless our leaders address how to deal with reconstruction (no one seems to be talking about this), there could be a lot of consequences worse than covid down the line. 0: https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows#1 https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
  - redis_mlc 6y ago
    No, you're correct. We know from the high rate of corona infection in SF with low mortality that corona stats are being improperly analyzed.
    - joshuamorton 6y ago
      Can you elaborate? On what are you basing the high rate of corona infection?
      - macintux 6y ago
        I’m fairly confident the Stanford study will never die, no matter how many stakes are driven through its heart.
  - loblollyboy 6y ago
    No, most people are just illogical. The numbers show that this is <1% fatal and probably <0.1% but all it takes is one story of some 30 year old dying on the news and everybody loses their minds. Granted, I was very scared myself before we had numbers, but I don’t know how many people are willing to actually take a look at them now that this has become sort of political. It’s like how a school shooting will get a lot of coverage, but nobody talks about how way more people are shooting themselves in the head. Emotions over facts.
    - chimprich 6y ago
      > The numbers show that this is <1% fatal and probably <0.1% In New York City about 0.15% of the entire population of the city have already died from the virus, putting a lower limit on the IFR. Estimates of the IFR have been consistently between about 0.5% to 1% by most authorities I have confidence in.
      - taeric 6y ago
        That is a lower limit on the IFR in NYC. They also have more people over sixty two than city of Seattle has people. So, much more dense, with about 13% of the population an at risk group. And calculate that IFR per age band. Running WA numbers in https://news.ycombinator.com/item?id=23080035 https://news.ycombinator.com/item?id=23080035 shows that the IFR here ranges from .7% to 15%(!) if you do that.
  - deleted 6y ago
    [deleted]
  - nodamage 6y ago
    Can you provide specific numbers?
    - taeric 6y ago
      Sure. Per yesterday's paper, there have been 15185 cases and 834 deaths in WA. That would be a CFR of about 5%. Now, it says the cases are 33% above sixty, and the deaths are 91% above sixty. So that would be a CFR of 758/5011, 15%. Contrast with below sixty. Which comes to a CFR of about .7%. If I go with just under twenty, the paper doesn't give me enough data to calculate. They are 4% of the cases, but don't even get listed in the deaths breakdown. Under forty, the rate is about 1.5%. And note that more testing can drive down these numbers. But it's unlikely to do so for the elderly.
- JshWright 6y ago
  That doesn't address the the question. We have seen a significant increase in deaths that correlates with our best understanding of when widespread community spread started. If it was "actually" circulating earlier than that, why did the deaths lag significantly?
  - redis_mlc 6y ago
    > why did the deaths lag significantly? Because nursing home patients don't travel, so they lag in catching it, then die.
    - JshWright 6y ago
      We have seen significant numbers of deaths in populations outside nursing homes. Why didn't those deaths show up when the disease started spreading?
      - gbhn 6y ago
        I think the theory is "there are few enough we didn't notice." There's other weird effects going on -- some countries that look really really similar have vastly different experiences with the virus. (Canonical example is DR and Haiti, although the situation is dynamic enough no-one knows if that'll last.) My takeaway from the difficulty in measuring this thing is that there is pretty high variance in transmission. Some carriers spread it REALLY well. Some carriers spread it poorly. With a lot of variance it matters a ton to figure out what is the deal with high-transmission situations. My take so far is we have some clues but no certainty. (Seems to spread in public transit and healthcare environments more rapidly, but slower than you'd expect in schools and prisons.) It'd clearly be a gigantic win in terms of intervention policy to understand this better, and we simply cannot do that without extensive contact tracing so we know what's going on. They're doing a pretty good job of this in China, HK, Taiwan, South Korea. As nearly as I can tell we're doing a dismally poor job in the US and Europe. You read papers that have diagrams of restaurant tables and bus seating charts from China. In the US it's hard to get stats on aggregate nursing home vs non-nursing home fatality rates. Maybe it takes some time for these papers to come out, but I don't see evidence that high-quality pre-pub contact tracing data is being relied on to develop policy responses.
- joshuamorton 6y ago
  > The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.) I think you're confusing Covid with pneumonic plague: https://www.nytimes.com/2019/11/13/world/asia/plague-china-pneumonic.html https://www.nytimes.com/2019/11/13/world/asia/plague-china-p.... There's apparently evidence based on mutation rates that COVID-19 can't be older than late October, and it wouldn't have been detected until mid-late November, which matches official timelines.
- lsllc 6y ago
  In the US, Massachusetts, with 6.5M total population has been hit fairly hard (outside of NY/NJ). Today's MA DoH numbers [0] show that of the 4090 deaths to date, the average age of the dead is 82 and just about 60% of them were in long term care homes. If you look towards the end of the report, it lists LTC facility after LTC facility with >30% residents infected, it's quite tragic really. FWIW, in MA the average age of hospitalized C19 patients is 69, average age of positive tested is 53 -- Interestingly over the last 2 weeks the average ages for deaths and hospitalizations has been creeping up and the average age for a positive test creeping down. In all, 1% of the MA population has tested positive (out of 4.67% the total pop. tested). [0] https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/download https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/downl... [1] Graphs of today's MA numbers (courtesy of /u/oldgrimalkin on reddit) https://i.redd.it/bpb0884w7tw41.png https://i.redd.it/bpb0884w7tw41.png
SpicyLemonZest 6y ago
If all countries had early community spread, then our knowledge of when death rates "should" measurably increase would be similarly delayed.
- aquadrop 6y ago
  We're talking about all deaths here. https://www.euromomo.eu/graphs-and-maps https://www.euromomo.eu/graphs-and-maps clearly shows when all deaths started to grow .
  - elliekelly 6y ago
    Are the spikes in prior year Q4 from the flu? And if so was this year’s flu much more mild? It seems prior to coronavirus the number of excess deaths was quite low compared to past years.
    - aquadrop 6y ago
      Yes, that's how flu looks every year.
wirrbel 6y ago
Yes and no. At the start of an epidemic the excess mortality is not yet measurable, its within the variation of normal deaths, and the "official" numbers of corona deaths (people who die after having been tested positive) are not yet observed because there is no testing. CDC estimates the basic reproduction number to be 6, German Robert-Koch-Institut IIRC around 3. Maybe the presence of earlier, undetected cases have lead to an overestimation of R0.

redis_mlc 6y ago

No, because the mortality rate is very, very low outside nursing homes. And cause of death in the early days won't be listed as corona, since it was an unknown disease. The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)

taeric 6y ago
I have been beating this drum for a while. I feel like I'm shouting aliens. The CFR for sixty plus is staggering. Below sixty? Still crappy, but not shut down the world. Below twenty? We wouldn't even notice. The problem is not whether this is more or less scary than the flu (or anything else), it is both. With no solutions aimed at buffering nursing homes/elderly. Am I just insane? This narrative seems completely absent in all of the coverage.
- JshWright 6y ago
  What narrative... that COVID-19 is most deadly for those over 60? That's literally the only fact that most people know about it. If you think that has been absent in all the coverage, I have no idea what coverage you have been paying attention to.
  - taeric 6y ago
    It is and it isn't. This thread is predicated on an IFR that is a flat 5 or so percent on the population. We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus. Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations. (Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
    - philwelch 6y ago
      This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages. There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
      - taeric 6y ago
        That was reported as full on no shut down. Just crap reporting? Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population. Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
        philwelch 6y ago
        Sorry about the edit. The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.) Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions. What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions. Over time you could even allow travel between green zones.
- Jabbles 6y ago
  You're not insane, but you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients. Also reducing death is not the only target, we are reasonably sure that many patients will have long-lasting damage to their lungs. There is of course some trade off between number of deaths avoided and amount of money we should be prepared to throw at the problem. Where on this spectrum are you?
  - taeric 6y ago
    I'm on a different angle, I think. My specific point is that people need to stop looking at a single IFR/CFR stat. It does no good. We look to be getting safer numbers there by simply increasing testing. (Of note, NYC has a strict lower bound on its numbers with how many in its population has died. But, do note they have more people over sixty than most cities do people. Such that most places will not be comparable.) And that is the problem. The virus has not gotten safer as we get more data. Our understanding is just not focusing on helping the elderly. We seem to be taking a crap shot that everyone can stay home and we can out sit the virus. I would wager we could have setup hotels and strict access controls on supplies into and out of at risk communities cheaper than what we have done. Certainly if you count on all of the job loss.
  - djsumdog 6y ago
    > you need to take into account that the CFR would be higher if the healthcare system were overwhelmed with patients This is the narrative we keep getting fed over and over again, but it doesn't seem to be working out. There are a lot of people who were afraid to go to doctors for minor issues, a lot of important surgeries canceled for being elective, etc. On top of that, 80% of people who need a ventilator who are older or have other health issues, will die on them[0]. For the younger patients, it's almost a coin toss. Some hospital systems are overwhelmed, but some are totally empty. Treating a region as large as the US as one unified geographical region, even with our unrestricted travel, didn't seem sound. The devastation to peoples jobs, lives, savings, homes .. everything ... we keep saying Lives > Economy, but unless our leaders address how to deal with reconstruction (no one seems to be talking about this), there could be a lot of consequences worse than covid down the line. 0: https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows#1 https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
- redis_mlc 6y ago
  No, you're correct. We know from the high rate of corona infection in SF with low mortality that corona stats are being improperly analyzed.
  - joshuamorton 6y ago
    Can you elaborate? On what are you basing the high rate of corona infection?
    - macintux 6y ago
      I’m fairly confident the Stanford study will never die, no matter how many stakes are driven through its heart.
- loblollyboy 6y ago
  No, most people are just illogical. The numbers show that this is <1% fatal and probably <0.1% but all it takes is one story of some 30 year old dying on the news and everybody loses their minds. Granted, I was very scared myself before we had numbers, but I don’t know how many people are willing to actually take a look at them now that this has become sort of political. It’s like how a school shooting will get a lot of coverage, but nobody talks about how way more people are shooting themselves in the head. Emotions over facts.
  - chimprich 6y ago
    > The numbers show that this is <1% fatal and probably <0.1% In New York City about 0.15% of the entire population of the city have already died from the virus, putting a lower limit on the IFR. Estimates of the IFR have been consistently between about 0.5% to 1% by most authorities I have confidence in.
    - taeric 6y ago
      That is a lower limit on the IFR in NYC. They also have more people over sixty two than city of Seattle has people. So, much more dense, with about 13% of the population an at risk group. And calculate that IFR per age band. Running WA numbers in https://news.ycombinator.com/item?id=23080035 https://news.ycombinator.com/item?id=23080035 shows that the IFR here ranges from .7% to 15%(!) if you do that.
- deleted 6y ago
  [deleted]
- nodamage 6y ago
  Can you provide specific numbers?
  - taeric 6y ago
    Sure. Per yesterday's paper, there have been 15185 cases and 834 deaths in WA. That would be a CFR of about 5%. Now, it says the cases are 33% above sixty, and the deaths are 91% above sixty. So that would be a CFR of 758/5011, 15%. Contrast with below sixty. Which comes to a CFR of about .7%. If I go with just under twenty, the paper doesn't give me enough data to calculate. They are 4% of the cases, but don't even get listed in the deaths breakdown. Under forty, the rate is about 1.5%. And note that more testing can drive down these numbers. But it's unlikely to do so for the elderly.
JshWright 6y ago
That doesn't address the the question. We have seen a significant increase in deaths that correlates with our best understanding of when widespread community spread started. If it was "actually" circulating earlier than that, why did the deaths lag significantly?
- redis_mlc 6y ago
  > why did the deaths lag significantly? Because nursing home patients don't travel, so they lag in catching it, then die.
  - JshWright 6y ago
    We have seen significant numbers of deaths in populations outside nursing homes. Why didn't those deaths show up when the disease started spreading?
    - gbhn 6y ago
      I think the theory is "there are few enough we didn't notice." There's other weird effects going on -- some countries that look really really similar have vastly different experiences with the virus. (Canonical example is DR and Haiti, although the situation is dynamic enough no-one knows if that'll last.) My takeaway from the difficulty in measuring this thing is that there is pretty high variance in transmission. Some carriers spread it REALLY well. Some carriers spread it poorly. With a lot of variance it matters a ton to figure out what is the deal with high-transmission situations. My take so far is we have some clues but no certainty. (Seems to spread in public transit and healthcare environments more rapidly, but slower than you'd expect in schools and prisons.) It'd clearly be a gigantic win in terms of intervention policy to understand this better, and we simply cannot do that without extensive contact tracing so we know what's going on. They're doing a pretty good job of this in China, HK, Taiwan, South Korea. As nearly as I can tell we're doing a dismally poor job in the US and Europe. You read papers that have diagrams of restaurant tables and bus seating charts from China. In the US it's hard to get stats on aggregate nursing home vs non-nursing home fatality rates. Maybe it takes some time for these papers to come out, but I don't see evidence that high-quality pre-pub contact tracing data is being relied on to develop policy responses.
joshuamorton 6y ago
> The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.) I think you're confusing Covid with pneumonic plague: https://www.nytimes.com/2019/11/13/world/asia/plague-china-pneumonic.html https://www.nytimes.com/2019/11/13/world/asia/plague-china-p.... There's apparently evidence based on mutation rates that COVID-19 can't be older than late October, and it wouldn't have been detected until mid-late November, which matches official timelines.
lsllc 6y ago
In the US, Massachusetts, with 6.5M total population has been hit fairly hard (outside of NY/NJ). Today's MA DoH numbers [0] show that of the 4090 deaths to date, the average age of the dead is 82 and just about 60% of them were in long term care homes. If you look towards the end of the report, it lists LTC facility after LTC facility with >30% residents infected, it's quite tragic really. FWIW, in MA the average age of hospitalized C19 patients is 69, average age of positive tested is 53 -- Interestingly over the last 2 weeks the average ages for deaths and hospitalizations has been creeping up and the average age for a positive test creeping down. In all, 1% of the MA population has tested positive (out of 4.67% the total pop. tested). [0] https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/download https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/downl... [1] Graphs of today's MA numbers (courtesy of /u/oldgrimalkin on reddit) https://i.redd.it/bpb0884w7tw41.png https://i.redd.it/bpb0884w7tw41.png

SpicyLemonZest 6y ago

If all countries had early community spread, then our knowledge of when death rates "should" measurably increase would be similarly delayed.

aquadrop 6y ago
We're talking about all deaths here. https://www.euromomo.eu/graphs-and-maps https://www.euromomo.eu/graphs-and-maps clearly shows when all deaths started to grow .
- elliekelly 6y ago
  Are the spikes in prior year Q4 from the flu? And if so was this year’s flu much more mild? It seems prior to coronavirus the number of excess deaths was quite low compared to past years.
  - aquadrop 6y ago
    Yes, that's how flu looks every year.

wirrbel 6y ago

Yes and no. At the start of an epidemic the excess mortality is not yet measurable, its within the variation of normal deaths, and the "official" numbers of corona deaths (people who die after having been tested positive) are not yet observed because there is no testing. CDC estimates the basic reproduction number to be 6, German Robert-Koch-Institut IIRC around 3. Maybe the presence of earlier, undetected cases have lead to an overestimation of R0.