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Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by erentz on Friday April 17, 2020 @01:58PM (#22901311)
It’s hacky and I’m happy to be told how wrong it is. But based on these recent antibody studies in Germany, Finland, and now here in CA, I’ve been assuming an actual fatality rate of about 0.4, and thus an actual infected rate of 250x our known deaths, which is a much firmer number.

This is only a small comfort since it means we may have had about 8.75 million infected and presumably now immune in the USA. Or about 2.6%. There’s still a long way to go in that case.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by Uhhrrr on Friday April 17, 2020 @04:10PM (#22902515)
This is what I've been assuming - 200 to 250x. But 250xdeaths gives you the infected number from two weeks ago.

To get current infected you then have to multiply it by communication^(days to death), something like 1.1^14, with the first term varying depending on population density and lockdown measures, and the second on how on the ball that locality is for detecting cases and keeping people alive.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by Animats on Friday April 17, 2020 @04:39PM (#22902753)
There’s still a long way to go in that case.

Yes. Stanford's recent study says 2-4% of the population of Santa Clara County has been infected. Those are probably reasonable bounds. Herd immunity is around 80% for this. So about 20 to 40 times as many people need to die before it's over.

That test needs to be repeated weekly to get the growth rate. (Preferably not with the scheme from Verity, which requires that you sign up for a Google account.[1]) Now that California hospital admissions and deaths for COVID-19 have flattened, growth should be linear for a while. But the rate of increase is still not really known.

Still, we're probably looking at a year and a million deaths in the US, within a factor of 2 either way.

[1] https://verily.com/stories/the-project-baseline-covid-19-pro...

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by danieltillett on Friday April 17, 2020 @05:20PM (#22903070)
The problem with herd immunity to this virus is how short the immunity to corona virus is - around a year. If we wait for herd immunity to build from low level natural spread then we will never get there.

There is a very major risk with extrapolating the Santa Clara data in the motivation of those being tested has not been controlled. Who is more likely to want to know they have been infected - those who have had classic COVID-19 symptoms or those who haven’t.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by Animats on Friday April 17, 2020 @08:01PM (#22904154)
How short the immunity to corona virus is - around a year.

Source? Right now, that seems unknown - too soon to tell. A few months of measuring antibody levels and we'll know more.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by danieltillett on Saturday April 18, 2020 @06:02AM (#22906612)
This is what we know from other human corona viruses. SARS-CoV-2 could be different, but without evidence I would not want to bet on long immunity.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by MiguelVieira on Friday April 17, 2020 @02:50PM (#22901736)
I've been using 0.5% for mental math, rounding down from the lower bound from this study in The Lancet:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

I would be surprised if, after this current wave of infections, the percentage of people with antibodies in the US is higher than the low single digits.

Herd immunity without a vaccine is a pipe dream. Our best bet is to massively ramp up testing and contact tracing and really start pushing the number of infections down to a point where parts of society can start functioning again.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by contravariant on Friday April 17, 2020 @03:53PM (#22902374)
Herd immunity isn't a pipe dream it is just one hell of a sacrifice. And we'd better check the immunity actually lasts before we try that. Frankly I've never been a great fan of the 'flatten the curve' explanation, sure the graphs seem nice but I reckon the peak in those graphs is drawn too low by several orders of magnitude.

In the Netherlands a fatality rate of 0.5% would mean it'd take about a year for herd immunity to kick in assuming we managed sustain the peak that occurred about 2 weeks ago (and it's somewhat dubious whether the healthcare system actually can sustain that peak).

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by Jeema101 on Saturday April 18, 2020 @11:00AM (#22908190)
One aspect that people seem to be ignoring with the whole 'healthcare capacity' argument is the mental health of the healthcare workers. The capacity everyone talks about is IMO the acute capacity, not really the chronic sustained capacity.

That's because just like in a war, it isn't realistic to expect the frontline soldiers to stay in combat for longer than weeks at a time before they start to exhibit PTSD and their effectiveness begins to drop.

Unless we have large reserves of doctors and nurses to rotate in and out I think we should be very careful not to take them for granted.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by fragmede on Friday April 17, 2020 @10:17PM (#22904813)
Let me quantify that sacrifice in a US-centric way with some napkin math to ballpark:

328.2 million (Approximate population of the US [1]) * 80% for herd immunity (based on an R0 5.7 [2]) * 1% = 2.6 million people die.

If the fatality rate is 0.5% instead, then 1.3 million people die If the fatality rate is 0.1%, we're still looking at ~260k-ish people.

That's pretty grim.

This situation is still developing so hopefully those numbers get adjusted downwards as later information becomes available.

For reference, ~1.2 million people died to heart attacks and cancer in 2017. [3]

[1] https://www.census.gov/popclock/ [2] https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article [3] https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by hcknwscommenter on Friday April 17, 2020 @03:57PM (#22902403)
It's not a pipe dream. It's just that it needs to happen in a different way. We need to massively increase number of isolation rooms, icu beds etc. (just like China did building that hospital in 10 days), massively increase number of clinicians (take every one in their last year of nursing school and med school and get them in the hospital, not making decisions but carrying out basic tasks; use a draft if you have to, just like Italy did), and massively increase testing capacity (~4x from today's capacity in US), and massively increase ventilators, add ubiquitous temperature checking (to enter any building other than your house, you need to confirm temp) and then just open up the economy and let it rip. With enough testing and enough surge healthcare capacity, we can do this.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by joe_the_user on Friday April 17, 2020 @03:47PM (#22902326)
So a 0.5% fatality rate sounds like "only" five times the rate of the flu. EXCEPT that I would bet that if you thoroughly traced all the asymptomatic but positive for the flu, it's fatality rate would decline also and it still causes significant deaths.

Total Covid deaths are already at a "mild flu season" level already after a month and continuing some level of exponential growth after social distancing.

It's sad and awful but it seems like with the current administration approach, the response of ramped up contract tracing has pretty much flown away and with these figures, we're looking 500K deaths, 250K over the next two month and another 250K over a longer period. Hide your parents...

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by wk_end on Friday April 17, 2020 @05:00PM (#22902928)
I’m not a virologist or epidemiologist, so I might be off-base here, but: the flu’s really well understood isn’t it? Medicine’s been studying it basically forever. I’d be really surprised if our fatality rate for it wasn’t pretty accurate and didn’t already have asymptomatic cases factored in.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by irq11 on Friday April 17, 2020 @04:48PM (#22902834)
Except that a huge portion of those deaths are in places that may have already reached herd immunity, if the ratio of comfirmed / actual cases is as small as this study suggests.

NYC, for example, has 123k confirmed cases. Multiply by 50, and you have 6.1M, which is close to 70% of the total population.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by JamesBarney on Friday April 17, 2020 @05:40PM (#22903239)
Where are you getting the assumption that only 1 in 50 infected are confirmed? That seems like an especially low confirmed case to infection ratio.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by irq11 on Saturday April 18, 2020 @02:18PM (#22909810)
Directly from the article. It’s the lower-bound estimate for confirmed to infected found by the study.

You should read it before commenting.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by OatMilkLatte on Friday April 17, 2020 @04:27PM (#22902645)
> Herd immunity without a vaccine is a pipe dream. Our best bet is to massively ramp up testing and contact tracing and really start pushing the number of infections down to a point where parts of society can start functioning again.

The problem is, a vaccine is also a pipe dream. So we're going to have to all get infected over some sort of timeline that doesn't cause societal collapse. Also known as flattening the curve.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by jdc on Friday April 17, 2020 @02:28PM (#22901561)
But by immune, do you mean asymptomatic and contagious?
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by erentz on Friday April 17, 2020 @02:33PM (#22901586)
Only talking about where we are in terms of progress to herd immunity. Edited it to say “presumably [now] immune” which hopefully is clearer. See my other comment below for elaboration.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by all_usernames on Friday April 17, 2020 @02:10PM (#22901407)
It's known that the vast majority infected do not experience symptoms, or have mild symptoms. I don't think you can draw the conclusion that they had prior immunity.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by tmandry on Friday April 17, 2020 @02:18PM (#22901469)
“mild” symptoms has been used to mean flu-like, i.e., not something I would call mild and certainly not the same as asympotomatic, but not requiring hospitalization.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by taeric on Friday April 17, 2020 @03:14PM (#22902020)
I think it is stranger than that. Mild has been anything from a fever for a night, to flu like for a week or so.

Really want to get a test on myself and family. We had something that near hospitalized me, but the kids barely registered being sick.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by erentz on Friday April 17, 2020 @02:14PM (#22901440)
Not concluding prior immunity but concluding that they now have immunity after having been infected. That is in progress towards herd immunity this number of people actually infected being revealed by these antibody studies is what is interesting. And based on my hacky heuristic described above that is currently around 2.6%. So we are still a long way off herd immunity. But at the same time closer than we thought we were.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by ignoramous on Friday April 17, 2020 @02:41PM (#22901657)
> So we are still a long way off herd immunity. But at the same time closer than we thought we were.

Yes and no.

A disease is endemic when R0 x S = 1 [0]. R0 for SARS-CoV-2 is estimated to be 2.5 to 3.5 and some models predicting a much higher 5.7 [1].

The herd immunity threshold is given by (1 - S)%, which implies when R0 = 2.5, 60% of the population would need to be immune; similarly 71.42% and 82.45% for R0s, 3.5 and 5.7, respectively.

[0] https://en.wikipedia.org/wiki/Endemic_(epidemiology)

[1] https://news.ycombinator.com/item?id=22817942

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by fiftyfifty on Friday April 17, 2020 @03:02PM (#22901875)
What percentage of immunity can we expect to see a slowdown in the spread of the disease? While we may need 60% or more to achieve full herd immunity surely somewhere lower than that we can expect to see a noticeable reduction in the spread?
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by ignoramous on Friday April 17, 2020 @04:02PM (#22902446)
> ...noticeable reduction in the spread?

I believe the SIR model [0] answers those questions. 3blue1brown's video on the topic is super digestible and informative [1].

In short, the discovery of a prophylactic if not a therapeutic treatment are our best immediate bets, absent which, quarantines and lockdowns will have to persist to curb the spread of a disease as infectious as covid-19 whilst we patiently wait for an effective vaccine against it [2].

[0] https://en.wikipedia.org/wiki/Compartmental_models_in_epidem...

[1] https://www.youtube.com/watch?v=gxAaO2rsdIs

[2] https://en.wikipedia.org/wiki/Vaccine_efficacy

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by tom-thistime on Friday April 17, 2020 @02:20PM (#22901488)
Most of what I've seen suggests that at time of positive test results, 40% to 70% of people have not experienced symptoms. Have you seen numbers very different from that?

[Edit: 'No symptoms experienced at time of positive test results' is intended to mean the same as 'no symptoms experienced yet at time of positive test results'.]

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by kaikai on Friday April 17, 2020 @02:59PM (#22901838)
Have not experienced symptoms yet. I haven't seen any information about testing people and then following through until a negative test, to see whether they stay asymptomatic. It's more likely that we're testing them in the window between being infected and showing symptoms.
Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by lmlsna on Friday April 17, 2020 @04:20PM (#22902591)
Confirmed population infection rate in Santa Clara is like 0.1%, and has been on a stay at home order for a month.

Highly unlikely these are all just people who have produced antibodies as part of a yet-to-be overrun immune response.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by crdrost on Friday April 17, 2020 @02:58PM (#22901821)
That can't be true for the official confirmed numbers.

Like, it was for a while impossible to get a test if you are not experiencing multiple symptoms AND can make a case that you might have been exposed via interacting with someone who has traveled. Even now I don't think they're giving the test if you don't have a fever. It's implausible that 50% of the people tested by the official pathway had no symptoms because the official pathway is not available when you have no symptoms.

But if you mean that you've seen a 50% "asymptomatic transmission" rate, in other words studies like this that purport to test a bunch of people at random and see how many of them have COVID-19, note that this definition of "asymptomatic" may include many with symptoms not severe enough to be hospitalized -- in other words they might have been feverish and coughing but not moreso than a typical cold. I myself have had a really nasty cough but it is not "dry" but "productive" and it has not come with a fever -- I would really love to be tested but right now that does not seem to be possible! Maybe I am in this above grouping of "asymptomatic" folks.

The OP article suggests that as many as 98-99% of cases might not involve hospitalization and therefore might be cases like mine (assuming I do indeed have COVID-19, maybe I don't). Now it is likely that there is some sort of selection bias in how they recruited candidates, but still it tends to push that number above your high end of 70%, suggesting maybe it's closer to 80 or 90%. On the other hand while the paper says that it did its due diligence subtracting out the test's false-positive rate, a rather small error here can have a big impact on that number because there are so few true positives right now.

In some ways the paper's claim is a bit of good news, it means that this disease has much lower mortality than we were originally told. (There may be lower bounds on mortality -- I have heard of one town in Italy where 1% of its population is gone due to COVID-19 in which case that would seem to be a good lower bound.) In other ways it is bad news, it means that this disease, still with nontrivial mortality, is going to be much less affected by quarantine countermeasures and the social distancing stuff is really the only reason it is spreading as slowly as it is, so that we need to endure the pain of isolation for much longer -- potentially until testing becomes widespread and cheap.

That may not be too much longer, as mentioned in a previous HN comment/story [1] that if you can get testing to work with the old Sanger sequencers used in the Human Genome Project you can maybe ramp up to 200,000 samples/day at first with possibilities to go up to 1M/day once you solve additional logistical problems. Before that the production of kits and sourcing of reagents may be your limit.

[1] https://news.ycombinator.com/item?id=22808208

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by tom-thistime on Friday April 17, 2020 @03:30PM (#22902179)
Ok, we can't conclude anything about the rate of symptoms from testing that was only conducted on people showing severe symptoms. I don't think we can conclude much of anything from the OP either, because its rate of positives seems compatible with the rate of false positives from the test. They could have 0% infected, they could have 5% infected.

An example where testing was conducted without requiring symptoms first: https://taskandpurpose.com/news/uss-theodore-roosevelt-sailo...

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by wool_gather on Friday April 17, 2020 @03:46PM (#22902312)
Yes, although note that it's not clear which kind of test is being used by the Navy there.

If it's the nasal swab-PCR test that most civilians are getting, then the claim of "asymptomatic" must be accompanied by a "yet". We can't really conclude anything for at least two weeks after the positive result -- after seeing whether those people ever develop symptoms.

If it's blood-antibody testing, then we can give the statement a little more weight, because a positive result would mean the infection is in a later stage or even past. I have no idea whether the Navy is using these tests.

Re:Covid-19 Antibody Seroprevalence in Santa Clara County, C... by jboy55 on Friday April 17, 2020 @03:48PM (#22902329)
Also, they weren't able to factor out a bias towards people seeking confirmation tests due to perceived COVID symptoms.

This is in the bay area, where people were very quick to self-quarantine. Most people have been working from home since early March. They were asking people to break their self-quarantine to get tested without having any symptoms?