I had a trip booked to Italy starting on March 20 so have been following the news very closely since at least mid February... I Ask HN'd how people were tracking the virus, and the answers I got were "I'm not tracking it in any way, shape or form and I hope it reciprocates the courtesy."

Quite funny, but the stats don't lie[0]. The number of new cases in Italy has grown at an exponential rate. This is a developed economy. Similar rates are being seen in France, the UK and Switzerland. The same will happen in the US. We're all going to get this, and most of us will be fine, but if you take the midpoint of experts' forecast of 40-80% of people being infected and multiply that for a conservative 1% death rate (the WHO has mentioned 3.4% and 2% is also often thrown around), that yields

7.8 billion * 0.6 * 0.01 = 46.8 million dead

At an 80% infection rate and an 3.4% mortality rate (worst case scenario), you get 212.2 million dead.

That's a once-in-a-century, catastrophic black swan event.

[0] https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_I... – see the chart below the table for the unbelievable exponential rate

The range of mortality I see is rather 0.3-1% [1] [2]

[1] https://twitter.com/EricTopol/status/1236321986122375168

[2] https://twitter.com/NBCNews/status/1235956761015783427

Not a doctor, but I suspect 3.4% is the upper end of the case fatality ratio (i.e. death among people tested positive) as opposed to the infection fatility ratio (i.e. death among estimate of people infected).

Mortality rates are low because hospitals are working. Intensive care beds in Italy are projected to be full in less than 10 days. You’ll see the rate grow by then.

Areas that were locked down exactly 15 days ago, now seem to have seen a significant decrease in infection rates in the last few days. So there is hope that the system will fire on all cylinders and hold the line just long enough to weather the storm. Also, Southern Italy is significantly drier and warmer than Northern Italy, which might (might) help.

One of the issues working against this scenario is the fact that the worst-affected regions are also the ones with the best health services. The other regions might struggle to respond as efficiently as the "pioneers", although they will benefit from the accumulated experience.

The range varies a lot depending on the quality of the treatment. The early initial estimates were based on data from Wuhan, where hospitals were overwhelmed early. The later, lower numbers were from areas where all new cases had hospital beds and ICUs available if they needed them.

Problem is, given the current numbers, the projected total number of people who will require hospitalization, and of those that will require ICU, significantly exceed availability. So if it spreads too fast, and all these people get sick at the same time, we won't have enough beds to go around - and that will cause the mortality rate to spike again.

You have to have number for each of:

(chance of contracting virus) * (chance of contracting disease from virus) * (chance of fatality from disease).

The first is dependent on containment efforts. The second is not 100%. The third is also partly dependent on containment efforts, as fatality goes up if hospitals get overwhelmed.

I don't see how you get "we're all going to get this" when China and South Korea are already reporting decreases in daily cases.

> That's a once-in-a-century, catastrophic black swan event.

It's a catastrphic event but I don't see any reason it won't happen again in the coming years / decades. The virus itself could even have worse characteristics in terms of transmissibility and mortality. Our transportation network is so great and modern society so dependent on it there is no hope stopping these outbreaks going global, only slowing them down.

In fact it should probably be fairly easy for a malicious actor to engineer a worse virus. Longer incubation period, truly airborne, super lethal. Whatever the final death toll is, I don't think it'll be the last or the worst of the 21st century.

People keep extrapolating that tens of millions will die, and I don't doubt that tens of millions surely would _if_ there were no lock-downs! (The subject of this article!)

The whole point of locking down Wuhan/Hubei and then northern Italy and now the whole country and other places and cancelling large public gatherings and events is that local, regional, and national authorities start seeing the numbers soaring and initiate extreme mitigation strategies.

We don't know how successful these strategies will be individually/collectively in the long run but if China is anything to go by it can severely retard the spread of the virus.

To show I'm not spouting out of my derriere compare the logarithmic infection and death rates of China[1] and Italy[2]

So you have to modify your formula: `7.8 billion * 0.6 * 0.03 * mitigation_factor = ?` We just don't know what the mitigation_factor is yet and because the spread is exponential any dent in the rate of spread brings the fatality number tumbling down[3].

I happen to believe this virus is a very serious global threat and I assure you that I am not one given to alarmism. But I also have never seen governments respond to the onset of an epidemic like this before and I'm nearly fifty and my mother says she can't remember anything like this in her lifetime. So yes, tens of millions absolutely could die but I'm willing to bet that between lock-downs and modern medicine tens of millions won't and I pray to, you know, $deity I am not wrong.

[1] https://www.worldometers.info/coronavirus/country/china/

[2] https://www.worldometers.info/coronavirus/country/italy/

[3] https://www.youtube.com/watch?v=Kas0tIxDvrg [Exponential growth and epidemics]

There is cause for optimism in the numbers out of South Korea and China. Even assuming China has lied about their numbers (population ratios with Italy and South Korea vs China make that plainly clear, they lied to a large degree on the numbers), if China has managed to bring it under control through their extreme quarantine measures, then we can prevent it from killing tens of millions. South Korea seems to have considerably slowed it there. Japan has done a good job of limiting its spread.

China has 1.4 billion people, and they've had ~3,000 deaths (let's assume it's several times higher in reality). But we'll see tens of millions dead globally? No we will not. If you killed every person that has been infected in China, and extrapolated that event globally, we would not see tens of millions dead. So that premise is absurd, to an extreme.

I consider this to be a very serious situation, however, it's not very serious as a great mass mortality threat (unless it mutates and becomes far more deadly and we prove unable to slow it down or vaccinate against it). It's a serious threat for massive disruption to our daily lives, including severely harming the global economy. It's a serious threat to swamping our healthcare systems due to ICU demands and diverting our resources to managing the ongoing crisis (instead of routine, normal productive work).

Assuming this isn't going to burn out come Spring & Summer, the next step is to rush to vaccine, at any cost. That will end this thing globally. Maybe we'll need to vaccinate against it annually, maybe it won't come back after this year, who knows of course.

Tens of millions will not die. Tens of thousands might die in the plausible worst case scenario, before we get a vaccine ready. We can rush to vaccine at greater patient risk and financial cost, as necessary.

I think this is far too optimistic.

1. We don't know the actual reality of what's happening on the ground in China. Hubei and Italy have approximately the same population, yet Italy is suffering more proportionally. I think the obvious explanation is drastic underreporting of cases and fatalities in China. When all is said and done I think China probably has underreported by at least a magnitude if not double that.

2. Most Western countries won't impose the type of strategies that China undertook; they simply can't. When things get too bad to impose draconian quarantines, it'll be too late. Even Italy's efforts in quarantining the nation are not enough.

3. Most of the world doesn't have good healthcare. I'm talking about Africa, Southwest Asia, South America. There simply aren't enough ICU beds and ventilators to go around. Even in the US, I've read reports of only 100K ventilators nationwide. If the pandemic keeps growing exponentially with a doubling period of 4 days, the US alone will have 1M cases by mid-April.

4. Simple math. World population outside of China is 6.5B. If 10% are infected (very conservative imho) we're looking at 650M cases world wide. If the CFR drops to 1%, then we're in the neighborhood of 6.5m fatalities. And the survivors? Roughly 81% of those infected survive with no serious side effects. The remainder have serious health issues even after the disease runs its course. That's 117M casualties. This is world altering.

https://ourworldindata.org/coronavirus

And I think your assessment is too pessimistic.

To address (1.) You and others are going to have to provide sources for why you think that China "probably has under-reported by at least a magnitude if not double that". I've seen the ill feeling and distrust towards China increase on HN and elsewhere in the last 5 years and this fits the bill.

You can explain the differences between Hubei and Italy by the differences in responses. As has been pointed out, China built two make-shift hospitals in ~ 10 days and quarantined 100s of millions in cities. Have you not seen the pictures coming out of China. Now that Italy is taking drastic steps we'll see the outcome in a few weeks and it will tell us if it is an effective strategy. If any of the reported numbers is suspect it is the total number of cases that the USA is reporting: https://www.worldometers.info/coronavirus/ It's completely out of whack with every other country. This implies the US has been under-testing, something which we have lots of evidence for. On the other hand we have no evidence China is under-reporting.

To address (2.) "Most Western countries won't impose the type of strategies that China undertook; they simply can't." Why not? Why can't they?

To address (3.) "Most of the world doesn't have good healthcare." But most of the world has soap, most of the world understands what it means to self-isolate, most of the world can implement quarantining. "If the pandemic keeps growing exponentially with a doubling period of 4 days," Looks like mitigation strategies slow the doubling period to three weeks, why pick the worst case scenario?

To address (4.) "Simple math." Yes! Times an unknown mitigation factor of ? This outbreak is scary because it's exponential (highly lethal and highly infectious), but the total fatalities is also highly susceptible to interventions exactly for the same reason.

Chinese underreporting is currently underestimated by a factor of 20:(https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v...)

I have no ill feeling towards China other than the fact that they have a repressive, authoritarian government. Those types of government necessarily try to control and spin the news to maintain their authority. If a country is willing to censor Winnie the Pooh to make their leader feel better, than they'll naturally minimize the effect of SARS-Cov2.

I also agree that the US is underreporting due to inadequate testing. Estimates in the US should be closer to 9-10K. I think that we'll see a large spike in cases as soon as testing approaches levels in other countries.

My inclination regarding quarantine controls in Western countries stems from the willingness of these societies to restrict freedoms. Italy's quarantine is very basic, a 1 on a 1-10 level. Compared to what China implemented, it's not even close.

Soap isn't the ability to treat cases; it's a way of trying to mitigate the spread.

The region in Italy has something like 3x more elderly, proportionately, than Wuhan.

Thoughtful and level-headed response. :)

We might ballpark the number of global deaths – in the optimistic case† at between 20,000 and 30,000 souls. Not a global tragedy, on a scale of the recent Ebola outbreak, but warranting much more drastic action.

There's a huge sense of urgency. We could have a vaccine before the next flu season in the northern hemisphere.

† assuming not every country acts quickly when the time comes nor acts as effectively as China

> We could have a vaccine before the next flu season in the northern hemisphere.

That's quite unlikely. We're looking at 12-18 months if everything goes perfectly according to plan and we get it right on the first try.

> nor acts as effectively as China

Only if you take China's numbers at face value, which nobody really seems keen on doing.

I’m not sure about the overall efficacy of lockdowns unless:

- The US plays along. We are likely a hotspot now, whether we go the “undertest and live in ignorance” route, or not.

- We have an effective plan for rebooting out of the lockdown. Which, until we have an effective treatment or vaccine, to me means temperature scanning in most public places imaginable, continued vigilance around disinfecting, continued limits on public gatherings, and more.

From what the numbers are saying it looks like the USA is both under-testing and over-reporting simultaneously. Very odd state of affairs. I'm ignoring the total cases number from the USA at present because it is a clear outlier. The # of deaths is much more reliable but that number will lag as tests are performed.

(The # of deaths for Germany is suspiciously low, as is the # of deaths for S. Korea.) I actually think the Chinese data is fairly accurate. the Iranian data, well, who knows. I'd like to think the European data is reliable, but again, who knows.

If the USA becomes a hot-spot then other countries will undoubtedly institute a travel ban to/from there like is happening with parts of China, S. Korea, Italy, Iran, and so on.

This is impossible to contain. The purpose of the lockdown isn't to contain, it's just to spread out the infections over a larger period of time so that hospitals don't get overwhelmed. But there's likely not a plausible scenario at this point where we globally jump on this and only a few million or even tens of millions are infected. All we can do is slow it down.

China has demonstrated that it is in fact possible to contain the spread. Please use the links I provided to review the data. Do remember that the Chinese built two make-shift hospitals in something like 10 days. Once a couple of weeks pass we'll see if Italy is able to replicate what China did.

Here are my calculations based on current data[1]:

   Country     tot. deaths    pop. (1m)   tot. deaths/1m pop.
   Italy        463             62        7.46
   Iran         237             83        2.85
   China       3120           1384        2.25
   South Korea   53             51        1.03
   Spain         30             49        0.61
   France        30             67        0.44
   USA           26            329        0.08

Italy has blown past China which is why they've locked down the country. Iran will surely do so next if they are not already doing so unless they want a national calamity. South Korea reacted quicker. Spain, France, will have to act next, possibly next week or the week after, the USA will have to act in about 3 or 4 weeks assuming things remain the same but by that time it'll be early April and the weather will be getting warmer so who knows.

[1] https://www.worldometers.info/coronavirus/

China’s current status is impressive but it’s come at enormous cost which is unsustainable in the long run. And it’s unclear what’s going to happen in the long run as China opens up workplaces and public gatherings, and as international travel and commerce resumes. It may very well explode again. Some countries will get a handle on this for now, but many won’t, and it will continue to spread globally. It might take months, it might take years, but it’s not going away.

People can do great things when needed. Who says it is unsustainable? Can we not change our habits? Can we not provide the equipment and supplies (respirators, medicines, masks, disinfectant and sanitizers) that need providing?

With any luck we'll have a vaccine in 18 to 24 months. The flu season is halted by warmer weather. We can change our behaviour for a few years until we get it under control.

I really want to know if the people who appeared to catch it after recovering simply had the disease in remission or what, because being unable to develop an immunity screws up all the numbers until there is a workable vaccine.

I feel like it's less a matter of normalcy bias, and more that people reasonably distrust a Falun Gong newspaper written in a language they can't read.

For a while this Falun gong member [1] was one of the few persons who was publishing real news and videos of what was happening in Wuhan and in China as a whole.

[1] https://twitter.com/jenniferatntd

How do you know that the news and videos she was publishing were real?

Because news organisations like the FT or the BBC published the same news that she had published two or three days before.

Granted, she was not the only one publishing them on Twitter, but she was the one I was following the most. Also to add, news organisations like the FT or the BBC were only publishing news that could be taken for a political spin, like in the case of Li Wenliang, they were not publishing news about people committing suicide on their home as not to infect their loved ones or desperate phone calls made by people who were trying to get their loved ones into an hospital (which were already full by that point).

Also, many of the hospital scenes I was seeing on Twitter on her account are similar to what now surfaces from hospitals located in Northern Italy.

But you see the obvious concern, right? If news organizations publish some but not all of the same news she's reporting, that could mean that they're selectively skipping news to push a political angle - or it could mean that she's selectively adding fake news for her own political motivations. My inclinations are not to break the tie in favor of the person posting about a mystical connection between coronavirus and the shape of the Wuhan train station.

This is not surprising, even very common. The media can easily guide the direction of public opinion. After all, there are not many people who think independently (Fortunately, most of the people on the HN were able to make their own judgments). Look at these two tweets from NYT, just separated by 20 minutes:

[1] https://twitter.com/nytimes/status/1236484352965521408

[2] https://twitter.com/nytimes/status/1236479276586807296

I mean the events happened are similar, but the point of reporting is totally different.

TBH epochtimes.com is not a legit news source. It's run by the cult group who also produces Shen Yun.

Prison riots too:

https://www.thedailybeast.com/six-inmates-dead-scores-escape...

The biggest factor in what does or doesn't get upvotes is randomness, so you can't conclude anything from a single data point.

In that case (https://news.ycombinator.com/item?id=22274728) also, the article wasn't in English, which makes it off topic here (we deeply respect other languages, but HN is an English-language site).

>The opposite of normalcy bias is overreaction, or worst-case scenario bias, in which small deviations from normality are dealt with as signals of an impending catastrophe.

The question is to which one we are closer? That's what I think no one knows. Like how reddit says "2 million will die in the US" and some people say "it's just a flu" the truth maybe between the two half way there or so

It doesn't matter - what matters is the point when hospitals get overwhelmed. Past that points, fatality rate goes up just from lack of treatment. Societies have already proven they can put in sufficient containment practices to keep hospitals from getting overwhelmed, so it's a matter if other countries follow similarly effective practices or let themselves get overwhelmed.

I think this in and underdeveloped topic; as I see it this infection even if it is comparable to the flu in mortality require often more intense medical intervention.

I've been on this site for more than 10 years, I do not care about karma, I was using the karma number as proof that that news/story was being neglected/ignored.

Doesn't actually mean much. A submission that eventually gets 600 upvotes can be posted a dozen times only receiving 1 upvote. It's mostly a lottery.

https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...