If we assume that the growth chart is similar everywhere, then with our 1,000 confirmed cases in the US, we probably have around 30,000 unconfirmed dark cases.

Also a really crazy fact is that South Korea did a good job of containing 30 out of 31 of their initial cases in the early days. But then the 31st was responsible for thousands of infections.

The learning here shouldn't be that mass coronavirus death is inevitable, but that good policy that takes it seriously can contain it and make it manageable.

How about an asymptomatic case ?

Also it's not just asymptomatic cases, it's also symptomatic but not tested. Some people ignore it since it can present as a minor cold. Some people want a test but can't get one.

The media would love this term. Maybe you should try patent it.

China has 23 times the population of Italy, but only saw eight times the cases (eventually that will narrow even further). It's obviously absurd, especially given China moved slow to stop the spread in the early going. Every day that goes by we're getting confirmation that China lied aggressively about how extremely infectious the virus is, how easily it is spread, how large of a population it could infect and how quickly. That information would have helped the world a lot.

Italy's mortality rate is extreme right now, at 6.6%. Most likely they have a lot more cases than have tested positive thus far, probably at least two to three times as many are infected vs the official tally. I expect this will be a common theme almost everywhere, including in the US.

I realize the flu vaccine is not always effective, but it seems possible to me that we and many others have contracted it and already recovered.

Since testing is very rare, there would be no way of knowing until someone gets a severe enough case to go to the hospital and then qualify for testing.

Yes, highly possible, one reearcher believes it was circulating in Washington state since at least middle of January. The term of art is "cryptic transmission".

https://www.washingtonpost.com/health/coronavirus-may-have-s...

Part of the problem is that the CDC's definitions were so strict at the time that you could not be tested unless you had personally traveled to China, so all cases of domestic transmission were being discounted at that time.

Do you think this problem will be rectified in future epidemics? Or is this just the nature of testing and/or the healthcare bureaucracy at the national/international level?

The amount of times the article mentions Biogen employees getting denied testing, days before the rest of the company would find out they had reached 70, really bothers me.

I think this is such a broad question with so many factors it's not really possible to answer.

I think the fact that it was a flu-like disease contributed to an overall lax attitude towards this. If it had been Ebola, health authorities would have clamped down hard and fast.

I think the fact that it started in China was a contributing factor. China didn't want to look like a source of disease, China didn't want its reputation on the international stage damaged by criticism from CDC and WHO and so those authorities were possibly more mute than normal. And there is another potential dimension here if this ends up being a military weapon that accidentally escaped from Wuhan BSL-4 containment. That may be a reason they came down on those researchers who sounded the alarm - those researchers worked at that BSL-4 facility and may have been discussing something that was classified and the chinese government didn't want discussed. This also may have been one dimension behind the Trump administration classifying the early briefings (although more generally I think they just didn't want to spook the market).

Finally, it's also impossible to separate the response from the administration. The Trump administration cut the budget for the epidemic response teams that would have been our first defense against this, two years ago. And their overall administration has been petty at best and malicious at worst. Just like how he went after the NWS officials who corrected his (completely wrong) forecast predictions for the hurricane landfall, there has been a reluctance to countermand him or correct him even when he's doing something completely wrong lest he come back at CDC or WHO and further sabotage the response in revenge. He spent the first two months of this year arguing that it was a hoax being cooked up by the deep state CDC to damage the economy and hurt his re-election chances. Even the Bush administration would have been far more competent at responding to this, Trump's leadership is exceptionally bad. You can say that's tribalism but the reason people are so all-in on that is because it's true, the Trump administration's petty, childish behavior has significantly damaged the US response to this crisis, both actively and passively.

Most other crises eventually fade from the news. Puerto Rico still isn't rebuilt but nobody cares anymore. etc etc. He hoped it would be a tempest in a teapot that blew over and it didn't. He's reluctantly come to terms with that in the last week.

If this whole question was a trap to make me say something downvotable, oh well, so be it, but it's all factually true and that's my honest opinion.

https://www.vanityfair.com/news/2020/03/anthony-fauci-donald...

> According to Dr. Anthony Fauci, nearly everything the president has said about the coronavirus is wrong.

/shrug

Why do you think that would happen? Why would the president just contradict his subject experts with literally multiple decades of experience in this field? Why would he literally impede the state agencies from doing the testing necessary to monitor and oversee the status of the disease?

Why would he say the hurricane is going to curve into an entirely different state from where the NWS says it's going to go? Why would he then threaten to fire anyone who refuses to cook the forecasts to comply with his incorrect claims?

https://www.nytimes.com/2019/09/09/climate/hurricane-dorian-...

Dude is an actual literal child who can't stand to not be the smartest guy in the room, and if anyone corrects him they're fired. He's a nightmare boss and the only reason anyone tolerates him is because he's "on their team" Anyone who does is going to end up like Romney: "not physically safe in our presence anymore".

Can't wait for the reversal in a couple years: "nobody ever supported this guy, everyone knew he was a crazy from day 1". But that's only going to be once he's out of office.

I would like to think that I already got it, but in the end it probably doesn't matter. It is pretty unlikely that I am going to die from it, but it is pretty likely that we go into a recession and people pay less for my labor, stocks will be worth less, and food will be in short supply... so I think in the end, getting sick is just an annoyance (to me personally, I know people are dying) and the real problems come from everyone else getting sick. So either way, I'm sure it doesn't matter.

https://abcnews.go.com/Health/scientists-identified-strains-...

https://academic.oup.com/nsr/advance-article/doi/10.1093/nsr...

And, see my other post, but some researchers suspect that COVID was circulating in Washington (likely elsewhere as well) since about mid-january, so very possible.

https://news.ycombinator.com/item?id=22551360

I'd like to think you're right. It'd be nice to know that I and the people I'm in regular contact with already have some immunity.

It lasted about 5-7 days and came with a high fever, full body pain and soreness to the extent that any type of movement was difficult, delirium and confusion, difficulty eating, and vomiting for 1-2 days (which isn't typical of the flu as I understand it).

I'm 24 and generally in very good health and felt that without modern medicine and sanitation I could have easily died from this. I lost about 5% of my body weight and a lot of muscle.

The reaction to COVID-19 makes me wish we, as a society, took preventative health more seriously in general as the common diseases can be extremely nasty too.

In fact from everything I've heard about COVID-19, it sounds like it wouldn't have been nearly as bad for someone my age as the flu was for me this year.

I don't think gathering limitations can stop the spread however I believe at the very least they can slow it down.

While I am neither a tinfoil hat wearer nor have anything against China, the fact that they were silencing a Wuhan doctor who was trying to alert people and authorities to the virus all the way back in December makes me skeptical of their reported status.

Thanks for sharing, I really appreciate it.

Please correct me if I misunderstood, but the wording makes it sound like they were ordering them from China, i.e., buying, not receiving it as a donation. Which is exactly what I was afraid of. Money is money, and I can totally see some governments, especially the PRC one, prioritizing that over the actual help for their own citizens. Especially in the scenario where they know they are screwed no matter what, so might as well make some quick bucks.

That does not look like the kind of news you'd fake, or would risk doing purely for propaganda reasons.

Which is exactly how we get all those leaks and info from silenced doctors.

Read the WHO/China report. Or look at South Korea.

If they can keep it below 1, it will die out. It's possible there are many more unknown cases, but if unknown cases are increasing, confirmed cases should be too.

I understand that this is NOT the flu, but it seems like the best data we have puts the most pessimistic CFR at about 0.6% if you look at the South Korean data (who have done, by far, the best job testing en masse).

I agree that slowing the spread of the virus to help our health care workers avoid being inundated with admissions to the ICU is worth while, but I'm extremely skeptical of embracing what China has done.

Check your stats. 0.77% of South Koreans who tested positive for the virus have died already, and more of them will die in the future. The CFR is likely to be above 1%.

When those same experts see numbers coming out of Italy, they believe very strongly that the number of infected is far higher than being reported because testing is not as widespread.

But it has a key context: that's the CFR for when all patients are treated. In most of China, there were never enough infections to trigger a healthcare system collapse: that's why in all but one province, the CFR was indeed ~0.4%.

In one province, Hubei, the medical system did collapse.

Its CFR jumped to 3-4%. That is worth going to extreme measures to prevent. In the USA, that would amount to ~10M dead.

That is not a seasonal flu.

I think a superior approach for most of the world is one along the lines of Singapore, Taiwan, and South Korea: extensive testing and contact tracing and limited but real quarantine measures. But, yes, everything should be on the table to prevent the nightmare healthcare system collapse scenario.

1) But # infections were growing exponentially, we need to use numbers from the same cohort, which implies much lower # infections & higher CFR. Naive CFR will go up once infections grow more slowly. (It already is higher than 0.6%).

2) South Korean confirmed cases are much younger than their median age, mainly between 20-29 years old (perhaps because of where superspreading events happen—that church). This age group has a much lower fatality rate from Covid-19.

3) # hospital beds per capita in South Korea is second highest among OECD countries (1st is Japan) and ~4 times that of the US. They already have patients waiting for beds. Most countries will do much worse if they reach the same # infections per capita.

[0] https://www.theguardian.com/commentisfree/2020/mar/08/china-...

Like guns or not, that's the 2nd Amendment at work.

People own guns for defense. There's reason to believe that if people are being trapped in a building against their will, they may use them.

I'm not convinced yet. This would not be the first time a communist authoritarian regime lied about a bad situation - far from it, it's standard if you look at history in the Soviet Union for example. Authoritarian regimes cannot work without being respected and/or feared by the people, so they are incentivesed to lie to save face and simultaneously punish anyone who questions the lies.

Especially considering that the longer this drags on, the more likely nations and corporations alike are to pull production from China permanently.

It would require very drastic measures but would undoubtedly save a huge number of lives. Amazingly, leaders in all democratic countries seem to be too cowardly, too dumb, or too short-sighted to take the action required.

They want to exchange lives for money. And it might not even be a good trade. Letting 70% of a country get infected, even over time, might end up costing more lives and more money.

All this to say, yes, of course shut downs must occur to stop acute problems in healthcare systems and try best to protect elderly. And this should absolutely be prioritized over financial markets (though risks here still matter). But it is going to spread.

- Virus has exhausted itself with the majority of the population. - Vaccine is developed and universally available. - Virus is eradicated from quarantine (so incredibly unlikely).

I am not an epidemiologist, just writing based off of common sense.

If the quarantines last long enough, the virus will be dead. The hosts will either be dead or will have successfully fought the infection and destroyed the virus. Unless it happens to behave like some viruses that can hide in the nervous system and similar – but there's no indication that that's the case.

There's really no great alternative to attempting to contain it. We will most likely trade lives for money and then lose the money anyway. Better to just lose the money by paying a big price early on with a radical containment strategy.

really, that's the best solution to saving lives?

if you were really worried about preventable deaths, why don't you direct your fear-mongering and authoritarianism toward eradicating distracted driving, since car accidents kill a million people a year?

otherwise, wash your hands and keep a little distance from coughers/sneezers. if you get sick with (1) a high fever and (2) a dry cough, don't go out for 14 days after you feel better, unless you're so sick you need to go see a doctor.

that's it. stop with the hysteria.

You flat out do need to shut down most things to get the spread rate below 1.0. Cancel all gatherings of people, shut down non-essential businesses, etc. That's all that works.

we're apparently collectively ok with 30K americans dying of flu (or alternatively, auto accidents) every year, so it doesn't make sense to go nuts on stopping this virus that's looking more and more like it's a little worse than the yearly flu.

the point being risks need to be properly assessed and proportionately addressed, without hysteria.

the underlying question about whether we value human lives enough is another matter we certainly should continue to discuss (for the record, i think we should value human lives a little more relative to economic considerations, and the response to something like covid-19 would correspondingly be a little more proactive, but still not hasty and panicked).

You're spreading ignorance.

Every medical expert is saying it is 5-20x deadlier than the seasonal flu, because that's what the data says. They're predicting 40-70% infection rates.

A low estimate of 0.05% mortality rate with 40% infected is: 640,000 dead in the US alone. It could end up being a 1.5% mortality rate with 70% infected: 3,360,000 dead in the US alone.

Please do some reading: https://www.flattenthecurve.com

Of course, this would never happen, since we as a society would enact major policies to slow the spread long before it got anywhere near that bad, just as Italy is doing for example. It just doesn't make any sense to wait for things to get worse to start enacting policies to slow its spread; if we're going to have to do it at some point, might as well do it early and reduce the spread.

That's not really true. South Korea and China have proven that this thing can be stopped and R0 can be driven below 1. It just requires decisive action by the state (either heavy quarantining or mass testing coupled with behavioral changes by the population).

There is no country on Earth that is gonna lock up all its citizens indoors and starve them to death. Governments aren't that stupid.

And were there not videos of government agents welding bars on windows and destroying food to punish quarantine breakers recently?

I think you're dramatically oversimplifying how this all works.

First of all, you have to schedule a specific time slot to go shopping, to ensure that the store never gets too crowded. Secondly, you aren't allowed within two meters of anyone at any point. All of the store employees are wearing protective gear (gloves, masks, etc.). When you checkout, you push your cart up to them, they ring everything up, set it back down, and then you pack your bags yourself while they go away (to maintain a distance of two meters). They might be changing gloves with every checkout, too.

I have less knowledge of China, but I think it's similar. I saw a video of a ranged thermometer being used on every person before being allowed inside. Maybe Italy is doing similar. If and only if you have a fever or a confirmed infection then are you not allowed to leave your dwelling at all (unless it's to go to a hospital); that's when you get your food delivered.

With containment measures this drastic, you can definitely keep the infection rate below 1, which is all you need to stop an infection. And it's exactly these kinds of measures that need to be taken, because food is essential. You cannot have people starving to death en masse. Grocery stores are essential, and it's possible to allow grocery shipping while largely mitigating the spread of disease. Needless to say, all gatherings are banned, most stores are shut, and restaurants are to-go/delivery only (if they're even still open).

And I'm not drastically over-simplifying things, unless you somehow think that "shut down almost everything except for grocery stores and healthcare" is "over-simplified". This is working in China. They are stopping the spread of the disease while simultaneously maintaining access to food and healthcare.

The whole supply chain is guaranteed (and related companies allowed to work).

Source: I'm italian and directly affected by this

The food production aspect though is more problematic; it can involved larger groups of people and more human contact.

Economies aren't just playthings for little pieces of multicolored paper -- they're the process by which we live a life different from that of a wild animal.

Life without an economy would be smelly, brutal, and short.

Personally, I pray that the US won't try this idiocy, and further pray that people won't stand for it if they try.

At this point if you don't have at least a week's supply of rice on hand you're just being careless. It's dirt cheap and large sacks are readily available everywhere.

But in all seriousness, general guidelines are already that, even without stuff like Corona or not.

One advice from the supply chain perspective, so. If you have to stock up, do so in small quantities across multiple stores. reducing the number of stock-outs at the point-of-sale has an unbelievable efeect in stabilizing supply chains. and the last thing we want is unstable supply chains right now. As rediculous as it is, if something like th toilet paper scare happens to more life-ciritical stuff things turn a lot less funny rather quickly.

That is quite an assumption. We shall see, I hope you are right.

It's a pretty good assumption to make.

https://www.theglobeandmail.com/canada/article-first-communi...

If it survives for 12 hours on surfaces, you only need 1 person to have poor hygiene to expose a LOT of people. And "normal" hygiene levels pass infection around plenty. I wash my hands when I go to the bathroom or before I prepare food. The rest of the time I'm just passing whatever I touch to whatever else I touch. I've given up on not touching my face. I'm sure I'm not the worst in these areas.

As I understand it, you'd have this sort of infection rate with the seasonal flu if there wasn't some level of herd immunity, and you certainly have roughly this level of infection with the common cold - "Con crud" is a thing - it's just not much remarked upon as unexpected.

They're claiming you can't get it by simply breathing the same air, and saying surgical masks are sufficient.

[0] https://www.sacbee.com/news/local/health-and-medicine/articl...

They greeted each other enthusiastically, with handshakes and hugs, and then caught up over breakfast, picking from plates of pastries and the self-serve hot food bar. They were there for two days of discussions and presentations about the future of the Cambridge-based, multinational biotech firm, which develops therapies for neurological diseases. It was the kind of under-the-radar gathering that happens in this region just about every week.

Full article: https://www.bostonglobe.com/2020/03/11/nation/how-biogen-lea...