I'm not saying that this virus is not a threat and I worry for my parents as this could be a big issue for their condition, but we've gone down the rabbit hole with the hysteria in the press and online and it's scary to see this need for a global pandemic and the urge to constantly feed the panic monster.
I live in a country with ~2mio people. If you're patient zero here, you get a comfy private room, your own bed, 5 doctors, 10 nurses, whole research teams, respirators, priority with all the tests, examinations, etc. Same for patient 1, 2, 3.
If 200k people get infected (10% of population), and only 10% of those need extra medical care, that's 20.000 people. We don't have that many hospital beds, doctors, respirators.. probably not even enough medicine (some test have shown that malaria medicine and aids medicine works on some people). You get thrown into an army tent or a school gym with many more ill people, and you get almost zero resources. Need a respirator? Sorry, only 5 available at that location, and are used on other people.. or kids.. or pregnant women... and you can just slowly suffocate.
China built a hospital in a couple of days. I don't think there's a country in EU that can do anything remotely fast as that.. we probably need 10 days just to discuss where to put the emergency tents, and even then we'd get protesters not wanting them there. Same probably in the USA.
We also don't have companies making respirators and other medical equipment. Large countries who do, are making them for their own hospitals (if they're not stuck in paperpushing hell with the government).
Basically, if there's a wide-spread epidemic, a lot of people will get really really fscked.
Lets try some other numbers. If 1% of the population gets infected, and 1% needs extra medical care, that's 200 people. If 0.1% of the population is infected and 0.1% of the population need extra medical care, that's... two people. That's not so scary, and I'm not going to slowly suffocate. (There's no need to threaten me with asphyxiation, thanks.) We don't have any reliable information, so any numbers used for "back of the envelope" math might as well be relating my birth date to star signs and be used to find my future lover, for all the basis in reality they ultimately have.
I mean, you're scared. I get it, I'm scared too. I feel powerless in the face of this epidemic and being told to wash my hands a bit more, and touch my face less only serves to reiterate my impotence. Is that where the thirst for disaster potential comes from? An addiction to the panic endorphins?
(I am genuinely curious, and am hopeful that mns' comment will stimulate commentary about the meta-topic.) (And apologies for singling you out personally, ajsnigrutin, the other sibling replies are of the same nature and yours was the comment I chose to reply to.)
If you cant limit the speed of spreading the disease, then the hospitals will miss those needed respirators and more people will die. Cause respirator is necessary if you are one of the unlucky ones.
Which is where "hysteria" around locking areas, washing hands and testing people on airports comes in. That is why locking cities, working from home and having some reasonable amount of food so that you are comfortable. The whole point is to slow down spreading, so that resources are available for sick people.
> I feel powerless in the face of this epidemic and being told to wash my hands a bit more, and touch my face less only serves to reiterate my impotence. Is that where the thirst for disaster potential comes from? An addiction to the panic endorphins?
It is not impotent to wash hands and touch face less and avoid unnecessary crowd. That done in masses is to slow down the spread. It is all actually useful.
As to whether it will become widespread, the jury is still out. China appears to have gotten it under control, but it took drastic measures to do so. The rest of the world has yet to demonstrate an ability and willingness to do the same. There is a decent chance this will spread as widely as the swine flu did, but with more than 20x the case fatality rate, we would be looking at tens of millions of deaths worldwide.
The Coronavirus isn't new. Since mid-January we knew this will be serious. Nothing has been done since to prepare.
Maybe Europeans can't build a field hospital in ten days, but we haven't even tried to start building anything in 40 days.
We wait until it hits our shores, as is now the case and then throw our hands up in the air.
"as is now the case"
I read a similar comment from someone on another forum. If you're certain this will end up a pandemic, with almost everyone eventually catching it, your best move is to catch the virus as soon as possible, ensuring you'll get the best care.
Though this assumes you can't get it a second time, after the antibodies are generated. This appears not to be the case with this virus, possibly.
No one knows if it's transmissible during the entire incubation period. It's almost certainly not given how other viruses behave. Also the possibility of transmission during asymptomatic periods doesn't mean that it's likely, or that most transmissions happen during that time.
https://www.theburningplatform.com/2020/02/15/hubei-doctors-...
Hubei’s mortality rate for literally everything at the moment would expected to be higher than anywhere else given how stretched their resources are.
The U.S. could probably build a hospital very quickly, but neither China nor the U.S. can build enough hospitals quickly enough, let alone equip them, let alone train nurses and doctors quickly enough.
If the brown stuff really hits the moving fan blades, then military tent cities it will be, and it will be more like bad hospice care than like bad hospital care.
One thing this crisis will do is highlight the need for more emergency pandemic handling capacity. That means: a) faster testing of vaccines (e.g., do double-blind testing on medical staff, since they need it most), b) faster emergency mass production of vaccines, c) faster emergency distribution of vaccines.
Creation of new treatments (new anti-virals, ...) on an emergency basis is necessarily going to lag because it's much more costly and time consuming than development of new prevention (vaccines). Manufacturing new equipment (respirators) and so on also takes time (retooling, etc.). Building hospitals takes even longer (even if you can pull together to build one very quickly, equipping it will take time). And training staff takes eons. Throw in supply chain disruptions and, really, I think only emergency development and testing of new vaccines is plausible on a timescale similar to that of a pandemic.
It's not like you can have a ton of spare capacity around: that's very costly too, and there's depreciation issues. Reaction time needs to be faster instead.
One thing I'd like to see come out of this is a treaty or agreement on cross-certification and inspection of bio labs around the world, and an agreement to not develop bioweapons, or at the very very least to not develop bioweapons that are trivially transmissible from human to human. I think it's becoming clear that SARS-covid19 was leaked accidentally from the BSL-4 lab in Wuhan, or at least that it's very plausible that it came from there, and that is rather upsetting -- this must not happen again!
I recently moved to China. The PRC has good numbers (internally) and knows more about COVID-19's severity and risk profile than anyone else. And, on the ground, the PRC is putting the entire country on what amounts to wartime footing (in a way that's unimaginable to most HN readers), to the point that it's willing to sacrifice a quarter or more worth of economic production because the alternative is potentially worse.
It's managed to be successfully contained here (it's been some time since I saw any corpses ferried out of my apartment complex), but Western countries, let alone developing countries, simply lack the state capacity to respond as decisively and effectively as China has.
I'm hoping Spring ends up curtailing the pandemic; letting warmer temperatures do their work requires slowing down the virus' spread as much as possible, and that requires significant disruptions to people's everyday lives.
If I were a CPC member, I'd be pretty happy with how this has gone. It was able to turn an initial misstep into a triumph: the people I talk to tend to take the view that China got a pop quiz and scored a B+, while all the other countries around are getting the same exam take home and flunking it.
[1] - "Welcome to Hotel California / ... / You can never leave!"
Of course, China was also probably worried about the economic and political repercussions of appearing to the world as not being strong or proactive enough in its response. So much of the global supply chain relies on China that even having the resemblance of not being in control of the situation would have produced a far greater economic bloodbath than we've seen thus far.
Also fecal matter might be part of the transmission. Gutter grease is produced from sewage waste (in many case.) https://www.bloomberg.com/news/articles/2020-02-20/fecal-tra...
Aside from the initial mishandling due to downplaying the situation and hiding information, the subsequent actions seems to have been pretty effective. Outside of Hubei the virus seems to be pretty well contained and relatively quickly at that.
I don't care about their filmographic teams. I care about whether or not the control measures are working.
Outside of just lying about case numbers...
"But by Feb. 5, the funeral parlors and crematoriums were reported to be having problems keeping up with the disposal of the dead in Wuhan. Though no data was provided to address the matter, Wuhan’s lockdown was endangering not only the lives of coronavirus-infected individuals but also those of thousands of people who required medications and occasional treatment for such things as HIV infection, kidney disease, diabetes, and hypertension. Hospitals no longer welcomed them, medicines were running out, yet there is no count of their numbers or deaths."
"As the makeshift quarantine facilities filled, questions arose about their safety, as people were stacked side by side and shared toilet facilities. There was clear evidence that the coronavirus disease could be spread via feces or the off-gassing from overused toilets and taxed plumbing."
Sounds like they've been everything but competent.
Flip it around a bit. China has taken the actions they have to contain the virus, there are some indications of success. You think it's not enough or not done correctly. What would you have done instead?
> Sounds like they've been everything but competent.
If you think that our cities are any more prepared for an epidemic of this magnitude... I don't know what to say.
I will point out, however, that the US has fewer ICU beds across the entire country (Most of which are currently occupied), than there are documented COVID-19 cases in one city in China.
If an outbreak occurs here, do you really think that we will have enough medical resources to provide quality care for everyone? If yes - what are you, and your legislators doing, to put us in that situation? Because with our current medical infrastructure, we are not in that situation.
I do not disagree with you on the point that China's response has been herculean, but we must not forget that this also comes at a hefty price, one that I am personally not willing to pay.
One that you're not ever willing to pay, regardless of what you'd get for it? Even if it saved a million lives?
Given N=1, we obviously don't currently know how effective these quarantine measures have been so far, compared to whatever platonic ideal that does not come at a 'hefty price'. [1]
I think it's more likely then not that we will have a better grasp on it in a few months, when other countries start having outbreaks, especially if they don't react seriously to them. It's becoming quite clear that travel restrictions on their own are not going to keep the virus isolated.
[1] I have no idea what exactly you mean by that, so I'm going to assume you are not a fan of the quarantine, as implemented in China.
Edit: Thank you for clarifying your point, by pointing out that your concern is for the overall context - the other repressive systems of the CPC. I am very deliberately not addressing them in this sub-thread.
I meant the human rights violations perpetrated by the regime. This is always the price we seem to have to pay for a "competent crisis handling". I would indeed rather choose a free, but impotent country.
It is ironic that personal freedoms and public health are not often compatible. Doubly important to be aware of what we are being sold.
--- As the replies to my comment indicate I have totally misunderstood the paper. And there IS in fact evidence that the temperature changes the transmission. Sorry my bad. leaving the rest as is ---
> I'm hoping Spring ends up curtailing the pandemic; letting warmer temperatures do their work requires slowing down the virus' spread as much as possible, and that requires significant disruptions to people's everyday lives.
from this paper "Temperature significant change COVID-19 Transmission in 429 cities": https://www.medrxiv.org/content/10.1101/2020.02.22.20025791v...
> There is no evidence supporting that temperature changes COVID-19 transmission. Methods: We collected the cumulative number of confirmed cases of all cities and regions affected by COVID-19 in the world from January 20 to February 4, 2020, and calculated the daily means of the average, minimum and maximum temperatures in January. ....
EDIT: I'm also very worried about this point you mention:
> the PRC is putting the entire country on what amounts to wartime footing (in a way that's unimaginable to most HN readers),
the effect of isolation/quarantine can have massive psychological damage and after-effects (especially on kids), such as PTSD, depression, ... years after the virus is gone:
"The psychological impact of quarantine and how to reduce it: rapid review of the evidence" https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
Very much underrated. There isn't enough dialogue right now with the public about what they are likely to expect.
"The study found that, to certain extent, temperature could significant change COVID-19 transmission, and there might be a best temperature for the viral transmission, which may partly explain why it first broke out in Wuhan. It is suggested that countries and regions with a lower temperature in the world adopt the strictest control measures to prevent future reversal"
fwiw trying to find evidence of this claim in studies relating to covid19 (peer reviewed or not) has so far yielded no results.
Huh? SARS is the closest studied virus there is to COVID-19. It is certainly not useless. Of course there are no/few results for COVID-19, it didn't exist until a few months ago and even then was relatively unknown until about a end of January.
The likelihood that warmer temperatures per se will have any affect on COVID-19 transmission, morbidity, or mortality is close to zero.
Historically speaking even inside China it is a pretty well known quantity (even openly spoken of in China) that local governments are hesitant to give bad news to the central government until it is too late and so on. The result usually is the central government is behind the ball dealing in broad (sometimes less than useful) strokes until things are resolved.
As far as any conclusions you can draw such as "well it must be much worse". I think that is pure speculation.
Specific speculation that isn't founded in much and IMO not helpful. The scale and wonkyness of China's efforts could be because this is a very dangerous / misunderstood disease ... or the massive efforts simply a byproduct if poor internal information / a product of the political nature of China.. panic by their leadership (historically they're very wary of any unrest of their own population), or both.
Skepticism of some information from countries with proven track records of not being forthcoming / have had issues with accurate information is reasonable. Conclusions based in nothing, not so much.
Do not mistake the above for local governments having good information to give. I'm also not sure if China is giving everything out either publicly or internationally.
Of course I'm just an outside observer with no inside knowledge making what I think are reasonable guesses.
My original post aimed at clarifying that death rates in exponentially spreading diseases that have a lag between infection and possible recovery and death is a tricky topic, and that the numbers generally reported seem to not take this nuance into account.
I think collecting accurate data in the middle of a crisis is incredibly difficult for a host of reasons, none of which need to originate from ill intent. Test kits may be missing, data may be collected differently, methodologies for evaluating "who is infected" and "who has recovered" may differ between countries, patients' records might just not be a top priority for hospital staff, ...
Sure, but we wouldn't be able to find any statistical anomaly if China was hiding something because we simply don't have enough data ourselves to determine that.
I feel like your stance may be the opposite extreme of fear-mongering, which is downplaying the potential unreliability of data that many people have good reason to speculate about (as you might've already seen in this thread SARS cases were underreported).
[1] https://www.nytimes.com/2020/01/30/podcasts/the-daily/corona...
Yes, I see the same effect skewing media and popular perception. It's an artifact of natural selection biasing human responses to perceived potential danger. It slightly enhanced survival rates to incorrectly fear every rustling bush hid a hungry tiger than correctly calculate it was almost certainly a squirrel. Hence, every historical era is overrun with politicians, pundits, journalists and activists incentivized to leverage this innate bias in service of their cause.
After a few decades of observing this in action, my best model is to assume everyone has some bias driven by their background, perspective and incentives - even if it's entirely unconscious. Then it's just a matter of determining direction and degree to apply a debiasing adjustment.
Journalists tend to sensationalize, whether overtly or merely through curation ("the bad thing isn't so bad" doesn't get clicks). Politicians either over or underplay threats depending on the context. Exaggerating the Huawei threat to support tariff policy or minimizing COVID-19 to reduce negative economic perceptions in an election year.
In my estimation, some sources, such as the CDC, are less biased not necessarily because they lack biasing incentives but often due to those incentives having opposite signs and offsetting each other. For example, the senior CDC administrators who control public statements (as opposed to the medical and science staff doing the work). Those administrators are most likely good people trying to do a very tough job as well as they can. However, they also live in a world of budget battles, congressional hearings, and the media blame-game. In the underplay direction, a public panic makes things worse and leads to post hoc blame game ("why wasn't the CDC ready?"). In the overplay direction, people not taking the threat seriously means they don't cancel large events or reduce airplane travel and it spreads faster.
People like to pretend like the world is causing their internal state, that their mood is an inevitable product of the environment they're in. I feel catastrophic, disastrous, and look at all the evidence that the world is headed for a cliff! True, we're embedded in our world, but a peaceful person doesn't spend as much time focusing on Eschatology.
Life is confirmation bias. Numbers can help, I suppose.
I'm sure you wouldn't suggest putting everybody systematically in quarantine for a flu epidemic, every year, makes a lot of sense. Yet the death rates for influenza is much higher than coronavirus atm..
edit: much lower -> much higher
Boy who cried wolf story comes to mind.
Probably true, as long as you're not one of the ones rounded up and sent to prison, er, I mean, quarantine.
It feels a bit like throwing antibiotics at everything. Sure, it's effective in the moment, but you're lowering the future effectiveness.
But I also think that it is extremely worrying that this 'HN/internet hysteria' has so rapidly become part of the national conversation. Just yesterday we (NL) had a prime-time broadcast about this.
The way I see it, it doesn't matter whether the facts align with the response. Clearly this is treated as more than just another virus, this will have effects on our global economy and compounded by a general sense of unease about there not being some big recession, it's going to have effects and they will suck.
Practically speaking, it means that I stock up on shit so at the very best I don't need to wait in line for things.
More hypothetically speaking, I'm thinking of our economy collapsing to some extent, because either it was due to anyways, or because it will because of a pandemic, or because it will because of everyone thinking there's a pandemic even when it's not that bad and <insert definition of pandemic> is not a cause for panic.
We're in panic mode, and I'm surprised and worried that this is not just an 'internet thing'.
I know that the 'severity' of the virus often refers to how severe it is once you have it, but in the context of new viruses and pandemics, IMO 'severity' should refer to overall potential impact. Covid-19 blows SARS/MERS out of the water on that front given its different transmission profile and already-established footholds.
Conspiracy theories aside.
With this I am seeing cities / countries on lockdown. I have friends that can't go home in Italy because of the lockdown. My own government (Canada) has asked us to prepare for pandemic, and we only have a handful of cases ?!?
I've been watching Canada's medical system's near-total non-reaction to this situation. Basically the measures they have taken are to caution people not to worry to much or discriminate against Chinese people. Based on that, our throughput of travellers, and the fact that asking people if they've been in Wuhan in the last two weeks is no longer good enough to rule out cases, it's obvious that it's just a matter of time before Canada has a serious outbreak.
When I crossed the US border recently, all they asked me was whether or not I've been to China.
I think it's just realistic to acknowledge that at some point we lose the containment game, and that's very likely happened already. Maybe the long term consequence is a flu season that is twice as lethal. Or maybe there will be a very effective vaccine that eraducates the virus next year. Who knows.
Well, the numbers are very wrong. That's known. There are plenty of large factors with unknown impacts pushing the numbers both ways.
But there are about as many people saying "it's not that large a problem" as there are saying "this is way worse"... What is just natural when we don't have reliable numbers.
Being somewhat of a cynic, it doesn't surprise me to see it here. HackerNews posters apparently love thinking about global catastophes and societal discontinuities. Read the breathless posts warning of dire consequences arising from the tariffs on in China 24 months or so ago. The flurry of horrific predictions arising as a result of Brexit. The neverending hysteria about CO2, ocean warming, ocean acidification, the mass-extinction insects, etc....
Most posts to hackernews come from workers who are bored... they turn to HackerNews to read interesting articles. And, there is nothing more interesting than fantasizing about some event that would give them a reason not to go work the next day. It's a normal thing to do... back in my day, it was nuclear strikes and Soviet invasions ( "wolverines!!"). Nowadays it's viruses and CO2... (a poor substitute, in my opinion, for the much cooler angst about nuclear winter and the like... but, to each their own.)
And, whatever the cause celebre may be at the time, you can always count on posters getting really ticked off at skeptics and responding along the lines of, "You just don't get it! The science is clear! This time it's different!"
The threat of nuclear war was (and is) real.
The mass reduction of insects is well-documented.
The threat of rising CO2 levels is one of the most-studied phenomena in science.
> "You just don't get it! The science is clear! This time it's different!"
Actually, it's not necessarily different. There are historical precedents for viral pandemics. The flu pandemic of 1918 killed 50–100 million people.
That doesn't mean this outbreak will be on the same scale, but it's not unreasonable to be concerned.
Quite right. Let us at HackerNews strive to be part of that group. ;)
There are plenty of other sites for the chicken-littles.
In any case, I don't expect to persuade you...
But a couple months from now, when Covid-19 is but a memory and we're off with the next impending catastrophe (Caribbean volcano? Tremors along the San Andres? Killer Bees? Whatever it may be...) perhaps you'll be so kind as to revisit this thread and give me an upvote. Likewise, if a couple months from now I'n in a crowded hospital, feverish, and on a ventilator, before I pass, I will request the nurse log me on to HackerNews so I can return here and do the same for you.
Still backing this claim, 11 days later?
Check back in 37 days.
And I hope lurquer will not find themselves in the situation they suggested above.
Lack of adequate testing is a factor, I Grant you, and a big one -- but clusters are discovered late because it now appears that people can shed virus when they're not symptomatic.
I think everyone notices it now because they all say the same thing and in the same manner. It's always, the numbers can't be trusted ( China/WHO/CDC/EU/UN/US/etc ) followed by an "anecdote" and/or their own made up numbers and without fail an intentionally misleading and false mortality/fatality rate. Every covid and even non-covid thread has the exact same fearmongering. Whatever the case, it's definitely intentional and feels a tad bit organized.
Deaths are terrible, but they are also really easy to count. Hospitalizations are terrible, but they are only marginally harder to count correctly. Most of the difficulty is that there is some evidence of undercounting at this stage, but it isn't very strong.
Non-hospitalizations of untested citizens with matching symptoms are practically impossible to count accurately.
Each step leads to more error, but these errors may actually imply reduced severity rather than greater severity. Its bad, to be sure, but seriously, there is too much public panic in the air right now.
The large part of the rest of us would love for people everywhere to continue to live and thrive.
Indeed. This calculation ignores severe underreporting of mild cases--for example, Johns Hopkins researchers (the same ones who made that map you linked to for data) estimated that only ~10% of cases in mainland China (mostly Wuhan at the time) were being reported [1]. That would put the mortality rate at under 1%, which is close to the evidence we have from elsewhere (e.g. the Diamond Princess).
dead / (recovered + dead) is only a reasonable estimate if you actually have good numbers for the recovered count. We don't, so it's irresponsible to use it.
[1] https://systems.jhu.edu/research/public-health/ncov-model-2/
Since it takes 3+ weeks to die from this illness, we're not going to know the fatality rate from the diamond princess for another month. And that's still going to be a lower bound since they'll all be getting medical care from often before they're even diagnosed.
It's not a lower bound because cruise ships skew much older than the general population. All 4 who have died so far have been in their 80s.
On the other hand, there are also a lot of infected who only have a mild version and are never checked and recorded, which swings it in the other direction.
Edit: Seems like the parent post later edited their post to mention the above.
This also should be read with the context that cruise ship passengers tend to be older.
Also, that number will climb a bit.
The biggest risk isn't the bare mortality rate when properly treated, but the actual mortality rate when the healthcare system is loaded to capacity and there are additional patients to handle. And since the worst patients end up in respirators for a week or more... Well, it makes the problem of load balancing keepalives very literal.
Yes, this doesn’t tell you what happens with less than ideal care (higher fatality rates), or under different populations (lower fatality rates) but it’s a world of difference from the 10% fatality rates being tossed around elsewhere in this thread.
4/800 = 0.5%. And if you accept the very reasonable likelihood that actually everyone on the ship was exposed, 4/3700 = 0.1%.
I agree.
I misspoke when I said very little. I was taking issue with the OPs assertion that 0.5% was a best case mortality rate. I should have said it's closer to an upper bound assuming ideal treatment, since it looks like this is much worse for the elderly.
One thing that's puzzling to me though is even though the infected rate from the diamond princess is reported at 700+, the recovery rate is still reported at 10+. So what's going on with the other 690+ people? Are they still sick in a way they could still deteriorate? It's confusing because the cfr based on dead and recovered is still pretty high.
Again, though, the diamond princess is helping to clarify things, because nonreporting and nonpresenting aren't issues for the most part.
There are around 400,000 deaths from flu globally, every year. (The numbers vary by quite a bit.) And that's after vaccination efforts.
So far I'm seeing no evidence to persuade me this is significantly deadlier. Everything that has been said about COVID-19 - the stress on healthcare, and so on - has already been happening during flu waves. For decades.
The real difference is the scale of the response. Flu's effect on the economy is a little more than a rounding error, but not by much.
Because of the measures taken, this is likely to have very significant negative economic and social effects which will last far longer than the danger of infection.
No, it makes it about 5x worse than a typical flu season (10x worse than what America is seeing this year).
Of course, within the population of old people, I would expect cruise goers to be relativly healthy; so I would expect this population to be more vulnerable then the general public, but less vulnerable then their age based demographics.
With diseases that have been better studied, we have large population studies to determine how many people have been infected for every 1 person reported.
>As is, it is mortality given that you have symptoms which is a pretty good measure to have
We don't know that because we have no idea how many people have mild to moderate symptoms and haven't been tested.
At best it's mortality given that you are severe enough to seek treatment.
It's a very bad metric to estimate the impact of an epidemics. It's way worse than useless for that, it can only lead to baseless panic.
It's a pretty good metric for many uses, just not for this one.
Very doubtful. This is a city of 11 million people. I doubt they would have the kits or lab capacity to test even 1% of the population so far.
After he said that someone else from the WHO contradicted him.
"The claim was quickly challenged by an infectious diseases expert who serves on a committee that advises the WHO’s health emergencies program.
Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, said it would be highly unusual for there not to be mild or symptom-free cases that are being missed. He pointed to the fact that outbreaks have popped up in countries far from China — including Iran and Italy — because people with mild infections were not detected and traveled to other places.
'There are mild cases that are undetected. This is why it’s spreading. Otherwise it would not be spreading because we would know where those cases are and they would be contained and that would be the end of it,' said Kobinger, who insisted that mild, undetected infections cannot be ruled out until people who haven’t been diagnosed with the illness can be tested for antibodies to the virus.
'As long as we do not have good serology data, I think that it is completely speculative to say that there are no undetected cases,' Kobinger said."
What Dr. Aylward says makes no sense and reads more like a PR fluff piece designed to praise China to keep them happy, and as Kobinger points out he's probably wrong. From the same press conference he says this "If I had COVID-19, I’d want to be treated in China."
Which is obviously bullshit.
That doesn't follow from your premise and it doesn't match what he said.
"Of 320,000 tests performed, just under 0.5% were positive for the virus at the peak of transmission there, he said — which suggests that only 1 case out of 200 was being missed."
And even based on what he said the conclusion he's drawing doesn't follow either. From other sources the 320,000 was from a community sample. Guangdong has a population of 113 million, a 0.5% infection rate is over half a million people.
Even assuming it's not a random community sample, and it's from people who self selected, so the infection rate is much higher than the general population, there is still room for an order of magnitude more mild cases than are showing up in official numbers.
For a proper estimate we should look at cases where the infection is known to have begun e.g. a month ago. Then the mortality rate should be somewhere between dead/infected and dead/(dead + recovered).
Unless I'm mistaken, that would only be true if cases that end in death are much faster than the cases that end in recovery. I have found it difficult to find detailed statistics on the topic, so I cannot tell you that it's definitely true or not, but I agree that it's an important variable that should be taken into the equation.
Bigger picture: lots of factors go into a good estimate, and epidemiologists are not new to mathematical modeling. When back-of-the-envelope math doesn't get the same prediction as the consensus models of what's going on, we shouldn't assume the epidemiologists are wrong.
We will never know for certain how many cases there are, but _of the cases we know about_ we can compute a reasonable upper bound on mortality. Were more likely not to learn of cases than were not fatal than we are of cases which are fatal as severe cases are more likely to seek treatment.
It's possible to discover an actual estimate, but it takes time and resources. Researchers may care about doing that after the crisis passes, but it's very unlikely anybody will care about this right now.
Current estimates are bad.
The princess cruise gives us a crucial piece of information which is a fully tested population.
2 things to consider:
1) population is like older due to being a princess cruise which would increase death rate.
2) not everyone is cleared yet, so more deaths could come
I must have remembered the wrong number.
4/705 = 0.5% (1/2 a percent), which is still pretty high vs the flu, but not 2% or 7.8% or whatever crazy numbers people are quoting.
This formula is still fundamentally wrong because it assumes that the time between infection and death is the same as the time between infection and recovery. I don't see why that would be true.
Of course detection also lags infection so that’s another consideration. I suspect that’s the real difference as outside of China a lot of cases where discovered before symptoms developed due to blood tests.
PS: South Korea has 1,766 confirmed cases, 13 dead, and 26 recovered. Iran has 245 confirmed cases, 26 dead, and 21 recovered. Those numbers are far enough apart to suggest underlying differences in reporting, which is I a larger issue. https://en.wikipedia.org/wiki/2019–20_coronavirus_outbreak
Also does the total number of infected not include the dead?
Btw, you made a point about exponential growth, but is that happening? The logarithmic graph on https://www.worldometers.info/coronavirus/ appears flatlined to me. Maybe (probably?) that's just about containment in China, but when we're discussing death rates that's where most of the data is.
Deaths: 26
Recovered: 49
(26 / (26 + 49)) = 34.7%
[0] https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
The diamond princess saw almost 100% exposure and only 0.5% of people died who got infected. Depending if you choose that stat, or the 2% WHO star, that suggests 15-100x more cases are in Iran than their lousy health system realizes.
- world population: 1800 million
- infected: 500 million
- dead: 50 million
I did not know it had been that bad.
1. This was sent by Jesus and is a prelude to the rapture, literally.
2. The spanish flu happened 100 years ago, and 100 is a big round number, so this is going to do the same things.
It's very strange and surreal around the home town right now. Many elderly are openly embracing what they see as their future deaths because it's God's will.
I'm very, very confused by all of this.
As for the rest of the world, I think catastrophe is a spectacle and people like to "live in interesting times". Take a NASCAR crash and multiply it by 10,000,000, you know.
This one has me concerned. There's a lot of overlap between that group and the preppers with itchy trigger fingers.
I've seen remarks from some about believing the virus is the case ("pestilence, floods") with others responding "Yes, praise God. It's time to make your peace".
My other opinion is that more so than racism and actually believing Trump would make America great again, that most of the support that pushed Trump over the edge came from wanting to burn the whole thing down.
While some of them might still have kids, or act 'irrationally' in relation to that belief, it's there, and I can't help but feel it's going to have huge effects over time as these people become politically active and vote.
To be clear, that's putting aside my beliefs on these issues. Just describing what I'm seeing.
When people online and in the news express how they just don't understand why people still support Trump, it's because they're not trying to understand. If all you care about is disrupting as much of the system as possible and pissing people off as much as possible, you're getting exactly what you wanted.
Re the higher death rates in the chinese province, I thought it was due to people not showing up to hospital when having milder symptoms, but I watched an interview of a french doctor who suggested it is rather because of the lack of medical infrastructures in that region, to which the chinese remediated by building these spectacular field hospitals.
The dead / (infected + dead) is the best-case assessment, since some of the people who have not recovered yet, will die.
A somewhat better metric would be dead / (infected X days ago) where X is the median time for the illness to fully develop.
naïve CFR = deaths / cases
resolved CFR = deaths / (deaths + recoveries)
It can be shown pretty dramatically in outbreak simulations how more accurate the resolved CFR is than the naïve CFR. See for example the chart https://blog.zorinaq.com/assets/outbreak2.svg In that specific example, the naïve CFR underestimates by 5x, while the resolved CFR is only off by ~1.3x. I ran this simulation as part of my blog post on how to estimate the Case Fatality Ratio of the coronavirus: https://blog.zorinaq.com/case-fatality-ratio-ncov/
[1]: https://www.worldometers.info/coronavirus/coronavirus-death-... "Coronavirus Mortality Rate"
I think this strongly suggests that, as one would expect, the situation is much worse if patients lack the medical resources for care. And it also shows how important quarantine and preventative measures are.
I’m legitimately confused why we’re seeing these responses make top response on hn. It’s WEIRD
On the other hand, what do you say to the claims that the real mortality rate is much lower due to people infected but with symptoms so mild they don't seek treatment?
For the same reason: How would you know the number of people who have recovered? You know the number of people who were observed and then recovered.
Not at all. For example, if I flip a fair coin, I can assign a very specific probability to the event that I get heads.
> We know it's a couple of orders of magnitude worse than the seasonal flu
Maybe one order of magnitude. Seasonal flu is about 0.1-0.2% mortality in the US. The evidence suggests that covid-19 is less than 1% mortality.
> hence the extreme quarantine measures to reduce its infectivity to essentially 0
It doesn't need a high mortality rate to justify extreme quarantine measures. The fear is that it will become a perpetual thing, another seasonal illness like the flu. Even if the mortality rate were the same as the flu it would be worth taking extreme measures to avoid that.
Nevertheless, I think all these statistics need to be taken with a grain of salt - I doubt that the numbers we are seeing are of very high quality, given the political and cultural pressures in China to underreport, the lack of test kits, corona virus deaths being attributed to other diseases, ... On the flip side, it's very likely that mild cases will never be reported, which in turn would decrease the mortality rate.
[1] https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
[2] https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
[edit: corrected the formula - thank you @anhner and @11thEarlOfMar for spotting the mistake]
[edit: indicated that there's also a chance of under-reporting mild cases - my edit coincided with @Tenoke's post - sorry for noticing this late @Tenoke]