I am really surprised how often I have seen "it is just the flu" type rhetoric upvoted on HN. I thought this was an intelligent, technological, scientific, and logical community. I don't see how anyone can square the idea that it is just the flu with evidence like what you posted above. COVID-19 has already accumulated a higher death toll in the US than any flu in over 40 years (I'm sure it is longer, but that is as far back as I can find data on with a quick Google search). That is all with basically the entire country under stay at home orders. There would be hundreds of thousands if not millions of deaths if we treated this like the flu.

Let me provoke some more: I predict that, by the end of this year, the number of total deaths in people over 85 will be about the same as last year.

I'm using the fact that most deaths from this virus occur in people who are already ill from other conditions. Frail old people are much more vulnerable to succumbing to infections.

Last year, about 13.5% of people over age 85 in the USA died [1]. That high death rate means that, at some point in the year, 13.5% of those people fell very ill, and had only months to live. This year, without the pandemic, a similar proportion of people would be close to death. If they caught the virus that causes covid-19, their death would be hastened. However, they would have died anyway, this year.

I know it's callous to say "they would have died anyway," since death is a terrible thing. However, humans have a limited lifespan, for some mysterious reason, and at some point our bodies start to betray us: we develop heart disease or cancer, and our immune systems become less effective. It's as if our bodies are lowering their defenses, almost inviting death. Often, along comes a flu, to finish the job. This year's angel of death is a different respiratory virus, not influenza.

1. https://www.cdc.gov/nchs/products/databriefs/db355.htm

[1] - https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

CDC data puts the US flu fatality rate at 0.1% (up to 20-60,000 deaths for 45,000,000 annual infections ~= 0.1%) and serology studies are putting COVID at around 0.3% -- not adjusting for comorbidities. So it's worse than the flu overall, but massively skewed older so for young and especially young and healthy people it's not materially different than the flu. For kids, its better than the flu -- which kills both the young and the old.

And yeah, the flu kills seemingly young and healthy people, too, we just don't really talk about it.

For old folks, it's much worse. We need to keep them safe, but that doesn't mean we need to freak out about children catching it when they're gonna be just fine. [1] Remember 99.2% of the folks who died in Italy averaged 80.5 years old with an average of 3 comorbidities. Zero health professionals under the age of 49 died in Italy despite constant and repeated exposure. [2]

Not everyone is equally affected by COVID and for the overwhelming majority (99.7% of all people), it's by no means a death sentence.

I strongly suggest you read [2] for perspective. I know all the breathless screaming on television has colored your perspective on all this, and yeah, it's not great. However, allow data to be your guide. We're gonna be just fine.

[1] https://www.wsj.com/articles/consensus-is-emerging-that-chil...

[2] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...

Also the 0.3% number you are referencing is being questioned as other serology studies have shown it to be 2x-3x higher. The reality of the situation is that we don't know the exact fatality rate of COVID-19. What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly. We also know that the coronavirus is much more infectious than the flu. Like previously mentioned, we have already passed the worst flu numbers even while most of us are under a stay at home order. It seems like no matter how you look at the data, the only way in which COVID-19 is not worse than the flu is how it impact the very young. COVID is more deadly in basically every other way. I honestly don't see what people gain from continuing to downplay this disease in relation to the flu.

That's fair, although age matters way, way more, so we can elide the bit for future re-readings.

> Also the 0.3% number you are referencing is being questioned as other serology studies have shown it to be 2x-3x higher. The reality of the situation is that we don't know the exact fatality rate of COVID-19. What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly.

I'm not just referencing the Gangelt data, but also the Vo data, and the Santa Clara data (which is very much in question now). That was also approximately the IFR for the Diamond Princess (0.85%) but of course Diamond Princess skewed much older so likely that IFR represents an upper bound. There are precious few population studies for us to reference, but they're far more valuable for making public health decisions than the ratio of people who go into a hospital as compared to come out. That only defines the numerator, without defining the denominator.

I'm also basing it on the estimates during the pandemic that H1N1 had a CFR of 0.1-5.1% from country to country, and landed on an IFR of 0.02%, or one-fifth the lowest estimate. [1]

> What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly.

Not for all demographics. It's demonstrably less fatal for children, which the flu does not spare, and approximately the same for folks under 49.

> Like previously mentioned, we have already passed the worst flu numbers even while most of us are under a stay at home order. It seems like no matter how you look at the data, the only way in which COVID-19 is not worse than the flu is how it impact the very young. COVID is more deadly in basically every other way.

There's reasons you shouldn't compare COVID's current numbers to an average flu season. One being that COVID's new so none of us have immunity. It's also more virulent. It's affecting a similar size population but just all at once instead of spread out, so it's impact is concentrated in time. That makes it not particularly meaningful to project out. Not to mention that flu number is after a vaccine and after a lifetime of exposures, so likely doesn't represent an apples to apples comparison. If the flu vaccine is 10-60% effective, you should probably multiply the number of expected flu cases by up to 2 - or more. Think of it more like the first time someone caught the flu.

Further, the flu changes regularly, and comes back at us repeatedly, and COVID may well not -- early indications are promising in that regard.

I'm not trying to downplay anything, I'm trying to synthesize the data we do know and not fall into the panic that is dominating the discourse. We shouldn't make big decisions while scared senseless, we should allow the data to dictate as much as possible.

Saying this disease is a "death sentence" for an asthmatic 20 year old is panic. It's just not that. 17% of hospitalizations involved asthmatics in the month of March [2] while 8% of the US population has asthma. So I guess your risk is doubled. From 0.3% to 0.6% without adjusting for age. That is not a death sentence.

[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm#T1_down

You are not being consistent in your arguments. You are criticizing me for not making an apples to apples comparison and in the same paragraph you are doing exactly that by talking about all the preventive measures that reduce flu deaths while ignoring that the country is currently shutdown to prevent COVID deaths.

You are cherry picking statistics to support your point while ignoring data that conflicts with it. For example the data coming out of New York suggests a higher fatality rate and the numbers you are using from the Diamond Princess are either out of date or flat wrong.

You are both putting words in my mouth and pretending I didn't say things that I did. No one here ever said "this disease is a "death sentence" for an asthmatic 20 year old". I already admitted that the only group that has less to fear from COVID than the flu is the very young, yet you are still bringing up that point when I am talking about overall fatality rates.

Apologies, what I was trying to say is that comparing COVID now to an average flu isn't an apples to apples comparison even if the numbers land where they are now, for all those reasons, some of which are non linear. This is including the ones you mention. The flu has a vaccine, and plenty of past exposures. COVID has the shut-down -- though it also has huge virulence and asymptomatic transmissions that appear to be ongoing.

> You are cherry picking statistics to support your point while ignoring data that conflicts with it. For example the data coming out of New York suggests a higher fatality rate and the numbers you are using from the Diamond Princess are either out of date or flat wrong.

Indeed the Diamond Princess number was out of date. I'm suggesting that there's a broad spectrum of CFR estimates (0.08% to 15%) and there's reasons neither is representative.

> You are both putting words in my mouth and pretending I didn't say things that I did. No one here ever said "this disease is a "death sentence" for an asthmatic 20 year old".

GP, who I realize now is not you said: "If asthma or hypertension have suddenly become a death sentence, that is a very big deal;..."

It'll be interesting to see where the dust settles.

Time will tell. Not saying one way or the other just that the worst case you've illustrated is far from a foregone conclusion.

This is a unfair way to respond to [alejo's] comment. The fact that you have responded in this way to this thoughtful response suggests to me that the problem may lie in the way you are reading, understanding, and internally labeling other people's views.

Honestly, I think we don't do nearly enough comparisons between disease mortality and other causes of mortality. A "War On Cancer" would have done us far more good than the wars we declared in the 2000s would have.

I'm not saying that wars on "terror" are a good thing. It's just that cancer is a very tough problem.

the more accurate exapolation would be relative to the first 4 months of every other studied emerging disease, considering the estimated errors of each of the important variables. you'd fit the various current studies on corona/covid, considering the high uncertainty as (large) estimated error, and providing a range of future outcomes with probabilities on them.

instead, you're asserting your worst possible scenario as the most likely outcome.

~~~~~~~~~~~~

now on the idea that we're entirely too blasé about preventable mortality in general, i agree. if we rigorously and intelligently attacked auto accidents, if we addressed cardiopulmonary diseases caused by pollution and poor habits, and if we regularly shut down the economy for the past decades because we want to reduce the hundreds of thousands of contagious disease fatalities every year and had the socioeconomic safety nets in place for that all along, then the current actions would seem more reasonable.

instead, the response is out of proportion with our own past actions because of panic and fear. it happened with 9/11, mass shootings, fukushima, and everything else. the herd is not good at reasoning about rare and novel mortality events.

That's not generous, or not generous, it's just a ballpark guess based on the best (conflicting) data we have so far. You're also discounting the fact that with every individual to gain immunity, the transmission rate is reduced. You're also extrapolating from what may be the worst possible phase of this virus. As time passes we develop better treatments and medications, we have more necessary equipment where it needs to be, we have better early detection and so on.

"...you're looking at mortality rate that swamps that of all wars, terrorist attacks, and natural disaster"

Lots of things swamp those numbers. For example, the flu.

I haven't looked it up, but 55,000 flu/pneumonia deaths a year is about 153 a day, compared to COVID-19 running near 2,000 a day:

https://public.flourish.studio/visualisation/1727839/

This visualization is from before the acknowledgement that COVID-19 deaths were only counting confirmed positive / presumed positives from the earlier set of CDC symptoms, not the 3x larger set of symptoms revised last week.

Also doesn't account for second order deaths such as those with other health problems not seeking treatment from an overloaded system, or providers in the system committing suicide from PTSD.

Taking into account the lack of all immunity to and lack of vaccine for COVID to date, and just how much more virulent COVID is (therefore front loading the disease burden) in the full course of time the flu is almost certainly going to take a much, much larger toll.

It's killed 600,000 people per year, each and every year you've been alive worldwide. So far, COVID is at 1/3 of a year's worth of flu deaths -- let alone a lifetimes -- and are approaching 25%+ of the population of some high profile cities infected. Once it gets to 70% or so, it's most likely going to burn itself out due to herd immunity.

"It's killed 20-60K people per year, each and every year you've been alive in the US. So far, COVID is at about a year's worth of a bad flu deaths in the US -- let alone a lifetimes -- and are approaching 25%+ of the population of some high profile cities infected. Once it gets to 70% or so, it's most likely going to burn itself out due to herd immunity."

You calculate herd immunity % from R0, and it's odd to decide 70% is not generous and ballpark guess because you think the data "conflicts" - there's no "conflicting" between values in a range, go ahead and cherry-pick the lowest R0 you've seen and find out what the herd immunity % required is based on that (higher than 70%)

Won't even touch you trying to pretend this is the same as the flu, plenty of other threads address that.

I've made it clear already, but just to reiterate, this is one of the worst comments I've seen on HN in a while.

Er, yes.

Project those C19 stats out across the whole population, and assume (generously) herd immunity effects at 70% that halt the progression, and you're looking at (a) mortality rate that swamps that of all wars, terrorist attacks, and natural disasters faced by the US for the last 50 years, right?

Yes. "Flattening the curve" just means keeping the hospitalization rate below what the medical system can handle. The curve stays flat near the peak rate. See the curves at [1]. The Financial Times has been updating those daily since early March. Some countries show a decline, but other than China and South Korea, which did heavy testing and lockdown, most countries peak and decline a bit, then level out above 50% of peak.

That continues until "herd immunity", either via vaccine or exhaustion of uninfected people. That's somewhere around 70-80% for this.

The vaccine situation is looking up. At least two vaccines are already beginning clinical testing for effectiveness. One from Oxford, one from Germany.

[1] https://www.ft.com/coronavirus-latest

https://blogs.sciencemag.org/pipeline/archives/2020/04/23/a-...

It includes additional promising candidates.

As I understand it, and I'd be happy for expert correction: lockdown has additional benefits beyond curve flattening; it also accounts for decreased transmission, which can get us to a point where we can track and suppress outbreaks individually while opening up the economy. That's essentially what seems to have happened in South Korea.

Influenza has a lower R0 than SARS2, and it absolutely kills people. Worth destroying our economy over, all by itself? Ehhhh... I mean, we could have done this at any time, and we didn't, so no.

Nice side effect that translates directly to lives saved? Absolutely.

Does it offset other probable side effects, such as increased heart attack mortality from patients being unwilling to go to the hospital, or increased suicide risk from sudden business failures and unemployment?

No idea, like, none. Biostatisticians are going to be crunching 2020 for the rest of the decade.

So then: if you're going to take on a massive economic hit just from altered consumer behavior, does it make sense to get the worst of both possible worlds by also relaxing regulatory constraints that are demonstrably saving lives?

It's not my stance. This is more narrowly-focused than that: we could end the flu season early, every year, by imposing lockdown from January 1st to February 15th.

But we don't, and this isn't the flu, it's a novel disease which kills many more people by even the most conservative estimate.

Still, as a side effect of the eminently rational (and economically painful) precautions which we've taken against it, ending the flu season a couple months early is a nice bonus.