I am not getting it either.

"It infected 500 million people around the world,[2] or about 27% of the then world population of between 1.8 and 1.9 billion, including people on isolated Pacific islands and in the Arctic. The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history"

500 million infected, 40-50 million deaths. Isn't that 10% death rate?

Perhaps it was 2% for people who were treated in hospitals.

2% of 2 billion is 40 million. So perhaps it was 2% of the whole population.

2% would be over 6 million Americans. I don't understand why that percentage is often reported as insignificant.

that's legit -- the percentage is not insignificant -- but it does look like you're calculating 2% of all Americans (approx 327M). the 2% number is _case_ fatality rate, i.e., how many cases are fatal. so to get from there to actual deaths, you have to apply it to _cases_. so you need to combine that with the attack rate, or attack ratio.

the only number I've heard for the attack rate is 30%, from the virologist Ian Mackay, who caveated it as a guess:

https://twitter.com/MackayIM/status/1233511899083530240

it could probably never be anything but a guess, until after the fact.

anyway, it would not be 2% of the US population. it would be 2% of 30% of the US population, which is approximately two million people. with the caveat that all of these numbers are early estimates based on limited data.

2M people is still a lot of deaths.

but it's not just how many people are killed. the rate of hospitalization is 15-25%. approx 10% of patients in Italy right now are in intensive care. the disease expresses as severe pneumonia, so severe that survivors have experienced _organ failure_. you could be hooked to a ventilator for a month.

in the United States, if you survive a medical problem that serious, it still ruins your life. probably this country will see not just a significant number of deaths, but also a spike in medical bankruptcies -- which are already a huge problem here.

So the question according to those numbers is, are we prepared to hospitalize 10% of the 30% of people who may get infected in the United States? In particular, do we have enough ventilation beds, the isolation infrastructure, the staffing? During a crisis you’d want daily briefings where questions like these could be asked.

I’ve said in other threads: it feels like the US is sleepwalking through this. If the CDC believes, as they said last week, that this will spread inevitably — what exactly are we waiting for? We have two cases of unknown origin in Santa Clara county, yet schools are still open as of now. Wouldn’t it make sense to close them for two weeks now to hopefully slow the spread and give us additional time to ramp up our medical response?

we definitely do not have enough hospital beds.

as for the CDC, the Trump administration gutted the CDC in 2018. they fired its leadership and dramatically reduced its budget.

they went to Congress last week or so for an emergency $2.5B, which is better than nothing, but $25B would have been a more realistic number. House leaders were basically complaining like "you should have asked us for more money."

Trump et al also put Mike Pence in charge of the situation last week. Trump said, when announcing that Pence would be in charge, that "he's got a talent for this." however, as governor of Indiana, Pence prioritized ideology over public health, and the state experienced an HIV outbreak due to his leadership (a subsequent Yale study found the outbreak was entirely preventable).

long story short: yes, the Federal government's response is extremely inadequate. it will probably continue to be inadequate throughout the crisis.

Of course a small percentage of a huge number is a big number...

The point is to reassure people and to prevent panic. For the vast majority of cases this virus is not a big deal so people should be vigilant but not be overly scared for themselves.

Another way to see it is that "panic" could save a million lives (eg through the use of quarentines). Is it worth it then? I'm not saying that it's an obvious answer (panic causes its own problems), but it is a trade-off worth considering.

It could also reduce the number of people that go get voluntary checkups if they believe to be infected. People tend to want to avoid quarantines.

Panic is never productive. Saving lives requires a reasoned and reasonable approach.

The trade-off between the options is being considered and quarantine is being used.

Panic can very much be more productive than inaction. It’s not the optimal choice, but sometimes doing something right now is better than doing something even better a little later.

Panic is not helpful (it should go without saying, but apparently not...). There is a huge gap between inaction and panic. There is no inaction at the moment, whether more actions should be taken is another issue.

Yeah. The part that should freak people out is this looks multiples more infectious to boot.

And I think its important to note that 2% is the mortality rate in a hospital where they have respirators, etc. The mortality rate outside of a hospital (e.g. in a quarantine wharehouse) is something like 20%. (I wish I could remember the source for this, will look and edit but it may have been The Atlantic).

It also seems like some survivors come out of this with pretty severe damage to their organs, especially lungs, because the persons immune system goes overboard and attacks healthy tissue. So, some fraction of people will live, but be disabled.

A 20% death rate is highly unlikely.The Italian researchers who sequenced the Italian strain believe that the virus has been circulating widely in Italy since January, even before Italy banned direct air flight to China. This seems to be confirmed by the fact that almost all the new cases in Europe are originating from big Italian cities. If the death rate was 20% we should start to see a lot of death in Italy and it doesn't seem to be the case. Iran and Egypt also seems to be largely hit, as many tourist back from Egypt have been infected. Now getting the real death rate is going to be a very complicated game, especially if many infected patient remain without symptom. I tend to believe the virus is already highly circulating in a high number of place of the planet where the health system is bad, and lacking testing capabilities. We are even starting to see untraceable cases in the USA.

Caveat: some of the "untraceable" cases are kind of "semi-traceable" in practice. The American government (against the advice of its own CDC) flew back American patients who had been on the Japanese cruise ship, infected and uninfected alike, and sent in HHS employees to interact with them, with inadequate training and hazard protections (i.e., no bunny suits).

This heightened infection risk for the uninfected cruise ship patients and the HHS employees, as well as anybody who knew them.

This plane landed at Travis Air Force Base in Solano County, California. Which is where the first "untraceable" case in the United States occurred.

You're mixing up two different evacuations. The whistleblower complaint about HHS employees with inadequate training processing evacuees was about the Wuhan evacuation, not the Diamond Princess one. Only about three of the Wuhan evacuees ever ended up testing positive for the virus, there's no reason to believe they were even infectious when flown back and none of the staff involved have shown signs of COVID-19. It's certainly possible that one of the people involved in the quarantine didn't follow precautions and was infected, even with full training, but I don't think there's any evidence tying the California case to it.

OK — I did conflate Wuhan and Diamond Princess, so thanks for correcting me there, but according to both Time and the Washington Post, HHS employees were sent (without proper training or protection) to meet with evacuees in each case:

https://www.washingtonpost.com/health/2020/02/27/us-workers-...

https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...

I keep hearing about this- is there a source for this? Or drumf is inolved so must be true?

If a large population of infected people never show symptoms, you'd see a lot more untraceable cases in Singapore, who are doing tracing very well.

But if you look at their reports there are practically no untraceable cases. That suggests to me that there are not many cases without symptoms.

As long as you have enough intensive care units with a lung ventilator that 1-2 % might be correct. But 10% develop pneumonia and require ventilation. If only about 10% of the population gets infected the health system would be overwhelmed. After that, even a simple flu might become a live threating experience.

The 2% mortality rate of the coronavirus is likely greatly overestimated [1]. Early mortality rates of diseases are generally estimated to be too high because only severe cases are tested. The exact same happened with H1N1 (Swine Flu): initial studies showed a 2-3% case fatality rate, but afterwards it was found to have an actual mortality rate of around 0.15% [2], close to that of the flu at 0.1%.

[1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea...

[2] https://en.wikipedia.org/wiki/2009_flu_pandemic

So, should we even care if the actual rate is merely 50% above your regular flu? Is this 0.15% one winter/year or across several seasons?

It is still speculated to be more contagious than the flu, and the flu itself is no joke. Many people will die if the coronavirus gets out of control. However, it is certainly not the end of the world others are claiming either. Being aware of it and taking certain precautions (e.g. washing your hands more often and staying home if you feel sick) is a good idea.

It should also be noted that they did not have antibiotics back then. The Spanish flu today would have most likely a lower fatality rate than it had then.

Obviously those diseases are viral. But it seems that they can be helped by bacteria and certainly bacterial pneumonia is a common serious complication, and I believe that patients hospitalised for COVID-19 are given antibiotics for these reasons.

The spanish flu would probably have been much less severe if it didn't happen right after WWI. Basic supplies for food and soap were not yet at their pre WWI levels and the population was still weaker and physically recovering from the war.

WWI started 10 months after the Spanish flu.

Press censorship did also contribute to its spread.

Huh, what? WWI started on 28-07-1914 and ended 11-11-1918 while the spanish flu started around january 1918.

That's an additional aspect, yes.

20 percent? Where? Most people are not even tested and in China where they have the largest hospital facilities for treating patients the number is far lower than 20 percents.

That comment was about the 1918 influenza pandemic.

On numbers from https://news.ycombinator.com/item?id=22432358 (and those numbers are not necessarily accurate for lots of reasons) the death rate is below 0.4% for all age groups below 49. Then it increases exponentially. I'm curious what the comparative age breakdown of the 1918 flu was, particularly given that a lot of people would have been malnourished due to the war, and health care was not as advanced as now.

The Spanish influenza affected young adults more than the elderly/weak because it caused the immune system to attack the body. The stronger the immune system, the more damaging the individuals illness.

There are some graphs broken down by age for the Spanish flu https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/

Wikipedia is inconsistent for 1918 flu pandemic: https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid...

"The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).[51]"

"The unusually severe disease killed up to 20% of those infected, as opposed to the usual flu epidemic mortality rate of 0.1%.[2][54]"

2% is very huge, it is every 50th person!

Context matters. We had almost no medicine back in 1918. That changes everything.

The death rate was "small" but the reach was large. 1/4 of the world's population got it so the total death toll was large.

2% means 1 in 50 people. How many people do you know? How about people who are a friend of a friend? What is that number divided by 50?

In all likelihood, within a year, several people you know will die of covid-19.

(Also note that the effects will be different around the world and in different social strata; in poorer areas, the death rate will be much higher, and in rich areas much lower.)