Extra history is fantastic, thanks for sharing.

The problem here isn't with the mortality per se, it's with the strain on healthcare resources. We just don't have the capacity to deal with an influx of cases requiring hospitalization. Currently about 10%+ of COVID-19 require that. We don't have the beds, the oxygen support, the ventilators, and generally the ability to keep these people from infecting others. That leads to scenes like in Wuhan where people get turned away from hospitals, where they end up dying at home, where bodies require mass cremation, etc. This could happen anywhere. The US healthcare system is not prepared for this. (I don't believe for a second in the assertion that it's the best in the world. Perhaps quality of care is good, but the system that pays for it is a joke. But it's also hugely variable, with some great hospitals attached to university research centers, and a ton of terrible underfunded ones.)

There was article yesterday that one of cruise passenger coming back to USA felt weak and had fewer, but Miami Hospital told him it will cost $3,700 to test his blood. He went home without testing and 3 days later came back with positive result for cornv-19. so much for “best healthcare” if you can’t afford it.

What a joke. Sometimes I am just amazed America still exists.

Wuhan later realized the problem that you cannot build ICU rooms as fast. But what is actually need is isolation. They turned stadiums into huge hospitals for those mid-age non-urgent positives. At least they are not spreading viruses to family members. So far it worked pretty well and I just don't see a better way.

This is a war. Been in US for several years, I would say US medical system is not designed for scalability and I have huge doubt if it would work.

So far this proved to be working.

The reason that the Spanish Flu evolved into a more deadly strain was because WWI was going on. The mild cases stayed at the front lines while the severe ones went home and spread the severe strain around.

This won't happen here because the severe strain will die out. Viruses generally become less lethal as they spread.

> This won't happen here because the severe strain will die out.

Can you please elaborate why this is the case? What if mild cases stay home while patients with severe cases go out looking for medical care, spreading it around? I know nothing about epidemiology, virology, etc. so I would appreciate a little hand-holding.

Viruses are trying to replicate, not necessarily kill the host. Hence selection pressures will skew it towards “Antibody resistant, lower fatality”. The common-cold is the most successfully virus for a reason. It’s constantly being spread...which is all the virus ultimately “cares” about. (I know viruses / dna don’t have desires, I’m just using shorthand to discuss the selection pressures). Viruses that kill their host ultimately are losing a means of transmission.

OK, I understand all this.

> Hence selection pressures will skew it towards “Antibody resistant, lower fatality”

But that's my question: Will it in this case? If those with severe symptoms are more likely to go out and spread the disease, wouldn't the more severe version be positively selected?

People stay home when they feel like crap. I bet parent comment is right that severe symptoms are selected against.

> Hence selection pressures will skew it towards “Antibody resistant, lower fatality”

That is pressure on the humans. All the humans that will die easily will die and all the survivors will be the more resistant ones.

The virus itself does not behave strategically. Species, other than humans, have no particular ability to plan how they evolve. The only pressures on the virus itself are for longer incubation times, faster ability to spread and the ability to reinfect people. Even if it could strategise there is no particular pressure on the virus whether it kills its host or not as long as it gets passed on to a few people in excess of the original host.

Not really true. The selective advantage is to viruses which can spread to more new hosts. The longer you keep the host arrive, the more new hosts are colonised. If it kills without spreading it’s not going to survive.

> Hence selection pressures will skew it towards “Antibody resistant, lower fatality”

Those selection pressures don't appear until the exponential growth slows down. From the virus perspective right now and in the near term it's super successful, so there's no need to adapt.

Viruses undergo natural selection too. A virus that's less lethal has the host as a virus factory for longer. A virus with less overt symptoms is more readily spread to new hosts.

The counterexample to this line of thinking is a lethal virus with a lengthy incubation period that can transmit while the host is asymptomatic.

That's the history of syphilis if i understand correctly. It started out as a serious plague that covered its host in oozing sores and killed them in a couple months, now its symptoms are much less severe and it kills in a matter of decades.

You just described HIV.

> American's aren't super worried about it because we have a great healthcare system

Good joke. You may have great healthcare if you are very rich. Otherwise...

??? You don't need to be very rich to have great healthcare.

If you are poor you get free healthcare, if you have a bit more money you get great healthcare by buying insurance, usually your employer offers it.

The worst you can say is that most people have a several thousand dollar deductible, which isn't great, but it's also not bank breaking.

> a several thousand dollar deductible, which isn't great, but it's also not bank breaking.

40% of Americans couldn’t come up with $400 for an unexpected expense.[0]

[0] https://www.cnbc.com/2019/07/20/heres-why-so-many-americans-...

Considering the vast majority of Americans do not have jobs that provide good insurance nor have thousands of dollars in savings, I would say you are agreeing that no, the vast majority does not have "great healthcare".

Which is precisely what was claimed.

The situation is not good but not quite as dire as you claim. Roughly half of Americans get healthcare from their employer. And while “good insurance” is subjective, it looks like 75% of those people have deductibles under $2000. So not great, but not quite as horrible as “vast majority” imo.

https://www.nytimes.com/2019/09/25/health/employer-health-in...

Let's sink that in: 2/3 of the population from your own numbers do not have insurance or an insurance they can pay the deductible for.

Alright, it is not a vast majority numerically. It is still a catastrophe waiting to happen in comparison with other countries.

Not sure how you came up with 2/3rds. A significant portion of the half of Americans who don’t get healthcare from their employer get it from Medicare, Medicaid, or other government programs.

About the US healthcare system, I was reading this article about a guy who had to pay to be tested. I don't know if this is representative, but it seems quite worrying.

https://www.independent.co.uk/news/world/americas/coronaviru...

Not as bad as the Spanish flu isn't really assuring:

> The global death toll was inconceivable: according to the most recent estimates, between 50 million and 100 million people worldwide perished in the three pandemic waves between the spring of 1918 and the winter of 1919. Adjusting for population growth, that is equivalent to between 200 million and 425 million today.

If 8-20% of cases go critical/ ICU the insurance cost will end a ton of peoples lifes long term.

> American's aren't super worried about it because we have a great healthcare system,

I am sorry, have you ever been to a hospital? I cannot read that with a straight face at all.

In our culture, providers are more interested with how they get paid than providing care.

People tend to avoid care completely just to avoid the hassle.