On Thursday of last week, this hospital had their first several confirmed positive cases. Keep in mind that in the early days of this, the criteria for testing in the US has been "you are already very sick and you require hospitalization for something with similar symptoms"

On Tuesday of this week, as tests became more available, that hospital had ~20 suspected and confirmed cases.

On Wednesday they were at 22 confirmed cases and 22 suspected cases where people are sick enough to require hospitalization but test results haven't come back yet.

Last week, the hospital was dealing with normal load and on standby should this become a problem. In the space of a little over a week, they now have a floor devoted to patients who are a) sick enough to require hospitalization and b) have tested positive and another floor devoted to patients who are a) sick enough to require hospitalization and b) are presumed to have this based on symptoms presented, pending test results.

It's just one facility, but I personally cannot look at a single hospital that had zero known cases last week, which now has two floors devoted to active cases this week and comfort myself with, "It's fine, this is just the flu."

It can't touch me.

A few days ago the state of alarm began over here. Remain at home, minimal movement (just to go for groceries, pharma, the rest of retail businesses are closed now). It felt closer, but still you feel safe. You're at home, theoretically isolated.

And then you start hearing that people near you got sick and even die. One friend's father died a couple days ago. Other relative has been confirmed with covid-19 yesterday. More cases coming everyday. They are no longer points in a chart. These are your people.

We are not overreacting. We reacted late.

Take care.

Germany got hit very hard with infections, but also has a really low fatality count. Spain only got 8% more infections but over a maginitude more deaths

Edit: Spain also has only half of the population of Germany, so it's probably more like 16% more infections in relation to population.

The test, while developed quickly, isn’t likely showing lots of false positives. The nature of these tests is that they’re not too hard to quality control. You know what they’re looking for (a particular set of RNA sequences) so positive and negative controls are easy to make. In fact that’s why the CDC test was rejected initially, there was a clear issue with the controls.

For hospital beds, people don’t just randomly end up in the ICU. Italian ICU capacity is completely overwhelmed, if not this virus, why?

That said, hoarding groceries is counterproductive and an overreaction. Otherwise, absolutely not, this is a terrible virus, we need to be careful.

[1] https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...

EDIT: Typo

https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...

We all will suffer drastic economic effects from the vampires that have made our healthcare system a worldwide embarrassment.

We are LUCKY that this is a 1-4% kill rate disease. If this were a REAL deadly pandemic like smallpox or black death, we'd be totally screwed, and even more screwed due to our healthcare system actively discouraging people from using it, trusting it, or listening to it.

Otherwise, great comment!

Being a truly evil Devil's advocate for a moment:

1. Because it's not actually overwhelmed. See this discussion from 2 days ago about a Reuters report where the head of ICU for Lombardy says nobody has been turned away due to lack of beds: https://news.ycombinator.com/item?id=22605144

2. Because ICU demand expands to meet available capacity as nobody wants to switch off life support and modern medicine always gives one more intervention to try. Thus doctors are always describing their hospitals as overwhelmed the moment demand increases even a little bit.

Hospitals being described as overloaded, patients being treated in tents and doctors describing their wards as strained/at the edge of disaster/etc is not something unique to COVID-19. Here is the same thing happening in 2018 in the USA:

https://time.com/5107984/hospitals-handling-burden-flu-patie...

Here are some quotes. Remember, all this was Jan 2018 but it sounds like it could have been written yesterday.

The 2017-2018 influenza epidemic is sending people to hospitals and urgent-care centers in every state, and medical centers are responding with extraordinary measures

"We are pretty much at capacity"

Tallia says his hospital is “managing, but just barely,” at keeping up with the increased number of sick patients in the last three weeks. The hospital’s urgent-care centers have also been inundated, and its outpatient clinics have no appointments available

The story is similar in Alabama, which declared a state of emergency last week in response

In California, which has been particularly hard hit by this season’s flu, several hospitals have set up large “surge tents” outside their emergency departments to accommodate and treat flu patients

Nurses are being “pulled from all floors to care for them," ... "Many nurses have also become sick, however, so the staff is also short-handed."

"More and more patients are needing mechanical ventilation due to respiratory failure from the flu and other rampant upper respiratory infections"

https://www.dailymail.co.uk/health/article-5279685/Californi...

Flu drives hospitals into 'war zone' conditions: Tents on the street in California, 'state of emergency' in Alabama, and Boston is using GATORADE to plug shortage of IV drips

Remember - all that was in 2018. The world didn't end. The exact same terms and language are being used now.

Now, I'm not saying this case is the same as flu of 2018 in the USA. Clearly, there are critical differences and this one is much more serious. But how much more serious is being muddled by the fact that our data is all useless and so people fall back on testimony from doctors, which sounds extremely dramatic, but there's a history of describing tough flu seasons in exactly the same way.

In a way it makes sense. ICU capacity is expensive. It'd be weird to have lots sitting idle all the time, unused, whilst other people were being switched off life support.

[1] https://www.businessinsider.com/video-tour-coronavirus-icu-w...

The Business Insider article you link to is saying exactly the same things as the articles I cite about what happened in the USA in 2018: makeshift wards, extraordinary measures, more and more patients needing ventilation. That's what it looks like when a lot of patients turn up sick with pneumonia at once.

Videos are dramatic but not enough to understand what's going on by themselves. You realise that, I hope?

As of Wednesday afternoon this week, Italian hospitals were not yet at the point of turning people away:

https://www.cnbc.com/2020/03/19/italys-death-rate-reaches-re...

Medical facilities in Lombardy will “soon” be unable to help new coronavirus cases, regional Gov. Attilio Fontana said Wednesday, as he urged everyone to stay at home.

That was based on a quick search of English-language material. Perhaps there's a more recent update from the last 48 hours where things have changed - I'd love more recent info. But at the moment I'm seeing a lot of people who clearly believe hospitals are turning people away en-masse already, and yet I keep finding news stories where it's being officially denied by the relevant health authorities. Are they all oblivious, living in a fairy tale too? If so, isn't that a shocking scandal that needs to be talked about right now?

In fact, I think that this does have the potential to overwhelm the healthcare system here in the US, but I think we need to continuously re-evaluate the data and its implications. And our actions.

I also believe it's wise to err on the side of caution initially if we don't fully understand the implications of this pandemic, but it's important to always re-evaluate our reaction as a clearer picture comes in.

You're forgetting that people are being asked to self-triage on a massive scale. I've seen a ton of false information about hospital capacity on HN in the last few days. Panic is contagious so a report like "hospitals in Lombardy may soon run out of capacity" gets changed within hours to "Italy ran out of capacity days ago" despite being false. Yes, I've seen that here on HN just within the last few days, and many similar examples.

What happens if people wrongly think their hospitals can't take them? They either won't go or they'll go much later than they should have done, by which time they may require much more intensive care. If people accurately understand the state of play they can self-triage far more efficiently and safely. They can also push back against the mass hysteria that is quite visibly setting in, leading to better and more rational decisions that will end the epidemic quicker.

This was a topic of discussion in yesterday's talk [1] with Dr. Drosten, a virologist who played an important part in the development of the currently used PCR test. He said that there were extensive studies done with hundreds of samples from both flu patients and patients infected with other corona virii and none returned a positive result. The only other positive results were from corona virii that are special to certain animals (bats, some cows IIRC), but none of those are present in humans. So the accuracy of our current PCR test for SARS-CoV-2 seems to be extremely high.

[1] (transcript in German) https://www.ndr.de/nachrichten/info/16-Coronavirus-Update-Wi...

Here's a quick (and slightly condensed) translation of the relevant parts: "There was a big validation study [for the PCR test]. We tested with a big number of patient samples from patients with flu/cold diseases and other corona viruses. Not once did we get a false positive. [...] It is true though that [the current PCR test] would yield positive results against the old SARS corona virus, but that hasn't been confirmed in a human for 16 years. And theoretically, the test would give a positive result on some bat corona viruses, but they do not affect humans."

I'm confident that somewhere in his medical education the concept of false negatives came up, and I'm also certain that he doesn't word his answers in an interview for the general public to the standards of the nitpicking HN population.

Why can't we ask for more?

Right: Among the things we need, good data is a biggie.

Part of that is what I've been addressing here: Test quality, especially for test results reported by the news media.

(1) Now, in the present context, quite broadly, the testing is important.

(2) The news media reports lots of testing, e.g., from China, South Korea, Italy, the US, etc., e.g., lots of the testing from early on.

(3) IIRC in some important respects, the good tests are super tough to do: E.g., Dr. Brix mentioned in one of the White House task force presentations that the test the US is using involves amplification which likely means the PCR (polymerase chain reaction), which before 1983 by Kary Mullis, was essentially impossible and remains astounding, amazing, and non-trivial, and then analyzing the results of the amplification, likely also non-trivial.

(4) So, we have to suspect that a lot of the tests done early on were not so good. By not so good, we have to mean rates of false positives and/or false negatives too high.

(4) IRCC, Dr. Brix did mention at one of those presentations that they, the US efforts, are willing to use only "approved" tests and that some of the tests submitted had false positives of, IRCC, 60%. Here we are on the way to coin flipping range.

E.g., there is a news story about a guy offering to do tests in his college dorm room. I can't say that that is impossible, but it sounds not so good.

Also for some days, a big news media issue was essentially "Where are the tests? Why can't we all get tested? When will we all get tested? What is the big hangup on the tests? Why do the tests take so long? Where has the Administration messed up? ...."

(5) And of course, it is easy to get a rate of false positives of 0% -- just always report no virus found. Presto, bingo, 0% false positives.

(6) The media has been reporting the results of lots of tests, getting headlines, news stories, eyeballs, attention, creating anxiety, getting ad revenue, etc. -- that is, dirty stuff.

So, we all have to wonder, for a lot of those early tests from out in Wherever Land, what the heck was the quality? Were they really doing PCR? In particular, what the heck were the rates of false positives and false negatives? We just CANNOT just take for granted that the tests done had any meaningful quality. Then we have a tough time using the reported data from such questionable tests to evaluate the transmission rate, etc. of the virus and, thus, plan how and estimate when we might defeat the virus. In this context, important, quite broadly important.

(7) So, very briefly, I mentioned, as Dr. Brix did in one of the presentations, that the rate of false positives is important and even at 0% can be from a silly (technical term, trivial) test.

This mention never claimed that the medical profession is not aware of the rates of false positives and false negatives. And I'm fairly sure that the medical statistics people, some of the best statisticians there are, are quite aware of the now classic Neyman-Pearson result on how, for whatever rate of false positives specified, can get the lowest possible rate of false negatives. I have a relatively general proof from the Hahn decomposition from the Radon-Nikodym theorem (Rudin in Real and Complex Analysis gives the novel von Neumann proof).

And for such things there is a lot more, e.g., the A. Wald work on optimal sequential testing* (a stochastic optimal control problem).

Moreover I have some qualifications in the field since I published peer-reviewed original research, in Information Sciences, on anomaly detection, both multi-variate and distribution-free. And there I used the S. Ulam result tightness that even in the medical statistics community is likely not well known (it's in P. Billingsley, Convergence of Probability Measures). So, I have some technical qualifications to talk about test quality.

But here I'm not trying to address, comment on, inform, educate, or critique the medical profession. Instead:

My real point is, as Dr. Brix also seems to have had in mind, for the news media reporting we just must keep in mind test quality in particular rates of false positives and false negatives.

Simple point. Maybe some people here read in some other intentions and objected to those. Again, simple point: In this context, we have to be careful about test quality, not just within the medical profession but, now, especially for what comes from the news media. Simple point. And in the context, an important point.

It appears that some people have missed this simple point and presumed I was making some other point.

Know of anything wrong with that simple, important point?

China severely restricted travel and managed to keep the infection rate around 0.008% of their population. We're still in the early stages in the US, with about 0.00269% of the population infected.

In the US, about 8% of the population gets the seasonal flu every year on average. That's about 28 million people. Take 4% of that 28 million people and we'd be looking at 1.12 million people dying from the flu every year if it had the same 4% mortality rate that Covid19 has.

So sheltering in place to limit transmission and keep the number of cases low could save many, many lives.

None of the above estimates take into account the risk we run of running out of hospital beds and ventilators. That would increase the mortality rate.

Given the lack of availability of testing, and the fact the the available testing is (rightly) being reserved for those most in need, I don't believe we can rely on the current mortality figures as any measure of accuracy. They're probably more like 0.5% at best.

We might be seeing X deaths in china but that might not be true, due to less testing etc currently, so the mortality rate is a bit skewed.

Any idea what the mortality increase would be?

I'm sure they're working on jerryrigged work arounds like using schools and hotels, but still it's not the same as a real ICU... plus it's highly possible a lot of these people could come in with a heart attack or a car crash and get COVID19, and die from the virus when their other injuries they would've survived, or they might've even survived COVID19 by itself without the extra ailments.

Not to mention, it's possible all other patients in hospital could end up w/ it if it's not contained well, and again same thing as above.

What about immune compromised patients, like Cancer patients who need chemo... they could have to postpone treatment (not enough staff to administer) which could cause them to die..or they could show up, get infected and die within 2 weeks from COVID19 + already weakened immune system....

How many people feel safe breaking quarantine to go give blood? We're having a major blood shortage right now. They say it's safe to give, but pretty sure if someone else was there or if the blood drawers are infected you'll come home with it... There's no way they can guarantee you won't... So if the blood shortage continues to worsen, how many lives will that kill as a result...

I mean you could go further and say some might starve, but I don't think we're at that yet... but it's a possibility esp. w/ panic buying and supply chain woes... but I think not till summer. There's going to be a major issue with migratory workers who work on farms..so we might be short on crops and farm goods this year.

Also according to scientists we need to social distance for an entire year at the least... This could cause a lot of depression, anxiety, and suicide too.

The members of my community that got into a brawl over toilet paper at Costco: Yes

The members of my family who have been sending funny videos of each other because we're all stuck at home with kids: No

The members of my local gaming group that make sure to wipe down the table and wash our hands before we play: No

...

Basically, I think it is a mixed bag. Yes, we should be cautious and mindful. I agree that we don't usually put things in their proper perspective when assessing threats.

On the one hand, when dealing with the risks associated with a pandemic it is wise to error on the side of caution, but as we go through this we learn more and more how little we knew when we launched this panic campaign.

Until we have a reasonable sampling the entire population, claiming this is the doomsday virus is incredibly dangerous. Shutting down the economy is incredibly dangerous considering our lack of knowledge about this virus.

Incomplete information has spread like absolute wildfire on the internet, and closures and overreactions fell like dominos as worst case scenarios were leaked without context. It is maddening

And the worst part is, assuming it works and the epidemic curve is flattened out, people will still see this as "proof" that it wasn't necessary.

But if the only cases we consider are traditionnal approaches - confinment vs doing basically nothing, then the short answer must be no - if anything, we are underreacting (by we, I assume you mean the West - EU and US).

I've tried to be smart about the numbers, which are definitely not rock solid now, but just look at what happened in places that tried to underreact - Wuhan (not their fault), Lombardy. Have you ever seen military trucks coming into a city, during peace time, to move coffins out ? Here you go: https://twitter.com/guidosalva/status/1240555847849312256?s=...

We can argue as long as we want about age structure etc, but this kind of horror, definitely never happens unless there is something extremely unusual (and deadly) happening.

It will be hard to objectively tell if we overreacted, because the actions taken cause a lower impact than predicted.

But on the other hand, it will be pretty easy to tell if we underreacted: a catastrophe worse than projected would mean we didn't take enough action.

It's so easy to be skeptical when the data is inconsistent - but it's important to be open to new information and work to protect your community to the best of your knowledge and ability.

I'm not saying that there haven't been some good things to come out of this situation - people working from home and thereby saving gas, limiting pollution, etc.; increased awareness of basic cleanliness practices, particularly in some countries that are quite noticeably less fastidious than the US generally is; actual tests of some of our response mechanisms (I mean, you don't trust your backups unless you've used them...) - but the extraordinary response of basically shutting down Europe is so far and away over the top...

I don't pretend to understand _why_ people have freaked out like this, but I suspect it's pretty much in line with why they freak out about anything: they've been programmed to wait for the "next big thing" that is going to kill us all by news, TV, movies; the news has, as usual, plastered everything across the "front page" on a constant basis, essentially "hyping" it up; and probably that on some deep psychological level we've all gotten a little overwhelmed with technological advances and how quickly the world has become a global market that is "always on", so we were unintentionally waiting for some way to pull back and deal with ourselves for a while.

More people die of those things in a year than have died of COVID-19 so far but that's the wrong comparison. There's real science and math behind predictions of a much higher toll which would make the comparison look very different.

There's also an aspect of who has control over outcomes. People can protect themselves from various ills by eating right, exercising, not smoking, etc. There's no connection to other people's actions or outcomes. With communicable disease, the person who's not worried about their own outcome can cause the literal death of other people who had no choice about being born with certain medical conditions that made them more susceptible. You might feel you're Living Right and you're at no risk yourself, but - as has been pointed out many times but apparently not enough - It's Not Just About You. Your actions are connected to others' outcomes. There's a social responsibility to avoid becoming a vector for infection.

When economies shut down, at some point people will also start dying and suffering. Is there a quantification for that? How do we trade those lives with other lives? Do we have a morally clear picture of who we're trading for whom?

As I've already pointed out, that's a false equivalence. COVID-19 != flu. We can (and I believe should) respond differently to different things. It's so simple a child could get it.

And how many people are dying from economic damage? How does one quantify that? Does one bother to quantify that at all? Do share.

If you have a sense of moral clarity, why don't you just share it, instead of hinting that things are so obvious that a child can understand it?

They're not high enough to put strain on hospital resources, and therefore to move from a mostly-individual to a mostly-collective type of problem. Nobody else is likely to die because you didn't get a flu shot (BTW the existence of a vaccine is also a factor here) and tied up a ventilator that they also needed. That's a real concern with COVID-19.

> hinting that things are so obvious that a child can understand it?

I wasn't hinting.

How is it clear that we shouldn't organize as an entire society to deal with influenza? Because hospital resources aren't taxed? That makes it enough of "your" problem vs "our" problem, when tens of thousands die per year?

Remember, when kids go to school sick, it's not some "individual" matter. Tens of thousands of people die per year from influenza. One might say it's a kind of murder. Oh wait, it's not. They're not overtaxing the medical system, what am I thinking. This is an individual matter. It's so clear now. This is truly moral clarity for children.

Lives are at stake -- so put the numbers on the table and explain who is sacrificing for whom. How many people are going to die from economic downturn? Five?

BTW, I have actually discussed this with children, and they have no trouble understanding how the current situation is different than flu. Maybe that's because they're not obfuscating for the sake of argument itself.

Influenza kills tens of thousands per year, and people are getting sick through social contact. The fact that the medical system is having trouble doesn't change the how -- sick people getting other people sick. That's the part that makes it a social problem, the part where one person's actions potentially kills another.

The "logic" can be made pretty clear but you just prefer to respond with... "logic" instead of figures. I've asked who is paying for whom and how much. That is the uncertainty I see in the situation, and the discussion which I see lacking.

There's not even a 6-month vision for what's going to happen.

https://www.healthaffairs.org/pb-assets/documents/blog/blog_...

http://www.centerforhealthsecurity.org/resources/COVID-19/20...

Even if those patients were spread evenly over the whole year and across hospitals, which is totally unrealistic, that's tens of thousands who couldn't get the care they need and would probably die. This has already happened in Italy, which has a better ratio of resources to population than the US. BTW, that doesn't even count the people who need those resources for completely separate reasons (including the flu you pretend to care about), or those who get a bed/ventilator and die anyway, or those who never even get as far as the hospital. Add all that up and COVID-19 could exceed even heart disease as the year's #1 killer - as I already said.

By contrast, hospitals have been absorbing the congruent load related to flu, on top of the normal load from everything else, for years. "More than we can handle" vs. "less than we can handle" is a pretty basic kind of difference, and a good example of the quantitative becoming qualitative. And if you had spent half the effort looking these numbers yourself that you've spent stealth-advocating for one position by attacking its opposite (didn't see you giving chrismeller this much of a hard time for a less-supported answer) you'd be familiar with those numbers already.

> one person's actions potentially kills another

The set of actions that could potentially kill another is vast. Making that the standard without addressing likelihood or intent or anything else is solipsistic.

> I've asked who is paying for whom and how much

Ah, always with the dollars. I won't even dignify that with a detailed response. It's your turn to take an actual stand, and defend it as you demand others defend theirs. What numbers are you assuming for the economic collapse you've predicted? What rational basis is there for believing that the cure is literally worse than the disease? Can you debate with facts instead of "avoid bad things" and emotion?

You won't get an answer because they realize that putting an actual dollar amount on the lives of those who will die isn't quite acceptable yet, even on a libertarian paradise site like HN.

If 97 people have died in the US so far... you've got a _long_ way to go, even looking at an exponential growth rate, to even approach the top 10 causes of death in the US. According to the CDC 47,000 people killed themselves in 2017 [1], and that's #10. Also 100% preventable.

You also have control over your own susceptibility and spread of something like the flu or the common cold, but no one in the US ever wears a mask to prevent that (though in other countries that is a common sight).

1: https://www.cdc.gov/nchs/fastats/deaths.htm

Edit: It wasn't 8 people who have died, it was 97 according to the CDC. My bad.

Do you know how exponential growth works? The exponent matters. A lot. There's a big difference between 1% growth per week and 10% growth every day. According to the actual math and models being used by epidemiologists, over four million people could need ICU-level care for COVID-19.

https://www.healthaffairs.org/do/10.1377/hblog20200317.45791...

Since we don't have anywhere near that many ICU beds, and there's an even more acute shortage of ventilators, a high percentage of those people wouldn't get the care they need and would therefore die - eclipsing even heart disease in the list you cite. So no, measures to reduce that exponent are not unreasonable. We need to reduce both the number of contacts people have per day and the likelihood that each contact will lead to infection. Please study some math beyond what you've only partially remembered from grade school.

> You also have control over your own susceptibility and spread of something like the flu or the common cold

Those are far less likely to reach a level where they require hospitalization, let alone ICU-level care. Yes, they're preventable (not 100% BTW), but there's no danger of affecting others by increasing strain on scarce hospital resources, so it's not a very constructive comparison.

The mask culture in the US is lacking as you point out. But there is a flu vaccine. They give those out free at every corner/office in the country, pretty much. Yet the US still sees 10s of thousands of dead per year. Also of note, the flu is less fatal (case level) & less transmittable than COVID-19.

> If 97 people have died in the US so far

160[0]

Look back at 1918, 1957, 1968 flu pandemics[1]. 1918 isn't too recent, but the last two mentioned killed 100k+ in the US, and at least 1 million worldwide.

If we get less deaths from COVID-19 than we do with seasonal flu - that doesn't necessarily mean it wasn't worth reacting to.

With how easy COVID-19 spreads, the relatively high % of required hospitalization, and lack of a vaccine is exactly why Hubei/Lombardy got in the state they did. Some would prefer to "wait and see" if it gets to those levels in the US, but many would rather act now instead of later.

It will certainly be interesting to see how the COVID-19 situation pans out. For the record, I hope you end up being correct!

[0] https://www.worldometers.info/coronavirus/country/us/

[1] https://en.wikipedia.org/wiki/Influenza_pandemic#Influenza_p...

7 more doublings, which could happen as soon as 5 weeks from now (I believe the doubling rate is around ~5 days) would bring us to 1 million deaths. And there is no particular reason it would stop there.

My understanding is that it is not unlikely for something like half of the world to get infected if we can't contain it effectively. If the death rate is 1% -- which could easily be higher if the medical systems are overwhelmed -- then we are looking at 35 million dead.

Put all of that together, and a lot of our stats are stuck weeks in the past. Since the phenomenon itself is exponential and apparently has a fairly short doubling time (two to five days maybe), that delay is huge. We could be flying into the side of a mountain, and we probably wouldn't even know it.

Given that, it'd be difficult to "overreact".

-----

1) If you don't take extreme precautions (overreact), and COVID isn't worse than the flu = hospitals don't crumble, economy doesn't tank, life goes on.

2) If you don't take extreme precautions (overreact), and COVID is worse than the flu = hospitals crumble, economy is destroyed, many deaths occur, and our way of life is over.

-----

You're gambling that (1) is true. If you're right, great..... but if you're wrong, we'll end up with (2).

On the other hand, here are the scenarios for the "overreacting" gamble (what we're doing now):

-----

3) If you take extreme precautions (overreact), and COVID is worse than the flu = hospitals don't crumble, economy tanks but things eventually settle and there's a path to recovery.

4) If you take extreme precautions (overreact), and COVID isn't worse than the flu = hospitals don't crumble, economy tanks but the virus fizzles out and things eventually return to normal.

-----

This latter gamble, though expensive, provides us with a path to safety regardless of if we turn out to be right or wrong about COVID. Because we don't know enough about the virus and given the exponential spread we have to act on incomplete information, I would be in the camp of "overreacting".

That said, I do sort of understand where your sentiment comes from. It is a position reinforced by a (healthy) distrust of media sensationalism, and recognition of the widespread human suffering that results from the economy tanking. I think that's a reasonable position, and one that I'm sympathetic to. However, the cost of being wrong here is just so unspeakably high that there's just greater prudence to choosing the latter (safer) path.

The numbers look like this:

  Season - Deaths:
  2013/14 - 7,027
  2014/15 - 20,259
  2015/16 - 15,801
  2016/17 - 24,981

So while every death is tragic, the common flu is still a worse threat to the elderly and that is even though a vaccine is produced every year.

The world's leaders are stuck between a rock and a hard place here: do nothing, and be known as the leader who didn't act and caused the deaths of thousands or millions. Act with appropriately extreme measures and prevent as many deaths, and everyone will think the measures weren't warranted because the measures were successful.

Not only that, is that at what point, is current and future generations well being worth to save the population that’s largely impacted by this?

Meaning, it’s perverse to spend more resources on the elderly as opposed to the youth. This just dials up the perversion to an extreme.

There are 520 IC places in the whole of Sweden.

Even if these numbers are overstated by a factor 10 - which is possible although the SEIR-model gives even higher numbers (800.000 hospitalised, 200.000 in need of critical care) - it is clear that those in need of critical care will most likely not get the help they need leading to an increased mortality.

For a single individual the disease does not seem to be as large a threat as it is being made out to be by some. For a society unused to see people die from infectious disease it stands to be devastating. Either society will have to accept that infectious disease can and will kill people when it is allowed free reign or we'll have to do our best to make sure the limit the amount of suffering due to loss of life, loss of quality of life, loss of income, employment, economic potential and other factors as much as possible.

What is needed now is a comprehensive testing effort to find out how far the infection has spread over the country. If it turns out a sizeable part of the population already carries antibodies against SARS-CoV2 it will be clear that the disease is not as much of a threat as it seems to be. Comprehensive testing will also allow for the early isolation of infected people and will help in limiting the load on the health care system.

In the original outbreak of wuhan, there could not have been overpreparation because there was no preparation, the outbreak simply happened. So, we should look at wuhan pre-citywide-quarantine to get a feel for what it would look like if we chose to not "overreact", as originally there was no real "test" being administered, cases were diagnosed by CT scans of lungs for pneumonia, and there were not extreme imposed social distancing or population-wide quarantine.

So, any issues we might have in the west, should not apply to the original outbreak in wuhan. And in wuhan the casualties of the outbreak were on the order of 1-5% (i think estimates varied a lot for some of the reasons you list). In any case, it overloaded hospitals and a lot of people died.

If the infection reaches a broader population (the 'underreaction' scenario), it suffices to say the death rate will be a MINIMUM of 1-5%, as obviously the situation would be even worse with a large percentage of the population sick. This would continue until the population reaches herd immunity, estimated 30-60% of population infected.

Thus, we can conclude 1-5% of that 30-60% of the infected population would die, which in america ranges from about 1 million to nearly 10 million deaths. This is far far far greater than the yearly flu outbreak. And that's assuming that the rapid spread of the disease doesn't cause secondary effects through deteriorating supply chains (who staffs grocery stores if 60% of the population is home? who drives trucks to keep supply chains going? who works the amazon fulfillment center?)

Thus, I would conclude that the penalties for unabated spread of the disease are so horrific that the only reasonable response is something that looks like an overreaction: extreme social distancing, shutting down cities aside from vital functions, etc.

Because atleast our groceries stores operate and our supply chains are running.

https://www.nytimes.com/2020/03/19/health/wuhan-coronavirus-...

As of yesterday the best data suggests a 1% fatality rate amongst confirmed cases in Wuhan. Wuhan has 2169 confirmed deaths in a population of 11 million, so if we speak of the casuality rate for the population it would be 0.019%. Is that a lot? Well, it's the sort of level that's lost in the noise of regular influenza.

Thus, we can conclude 1-5% of that 30-60% of the infected population would die

No, we can't conclude that. You're taking a death rate of a very selectively chosen sample and then projecting it onto the entire population, which isn't statistically valid. People keep making basic logic errors like this one, which is what triggers questions like the OPs about possible over-reactions.

All the data we have is useless. Not a single stat has a level of accuracy that would normally be accepted for scientific use. We don't know what the infection rate is, which means we don't know how many people get sick and die, we don't know even what the mortality rate is because in fact we don't even have a globally agreed definition of COVID-19 mortality.

Italy examined their own death records and discovered that of all deaths marked as caused by CV, only 2 appeared to have no pre-existing or underlying health conditions. If that's true then SARS-CoV-2 is sort of like HIV. That makes it very hard to establish precise definitions. If someone has been battling a severe health problem for months, is very likely to die anyway, they die, and then their blood showed they got SARS-CoV-2 two days before dying - what was the cause of death? Health systems don't agree on how to answer this question which makes comparing numbers between locations very tricky. This is being floated as a possible explanation for the divergent death rates between Germany and Italy.

who staffs grocery stores if 60% of the population is home?

Here you're not using temporal reasoning. Why would 60% of the population be at home simultaneously except via forced government fiat? Even if you assume everyone has to stay at home until they get the disease (worst case scenario, not implemented anywhere) people don't all get sick instantaneously, and once recovered people can go back to work as they aren't a threat to anyone. Most people recover within a week. So, to ask a question about how many people will be out of the workforce requires discussion of timeframes and curve slopes.

Something to be aware of is that the "60-70% of the population will get it" figures are based on a form of modelling that assumes everyone in the population interacts with everyone else. That simplifies the maths but clearly isn't close to being true.

Thus, I would conclude that the penalties for unabated spread of the disease are so horrific that the only reasonable response is something that looks like an overreaction

And yet your post contains statistical and logical errors, which is why the number of people questioning that sort of conclusion is going to be non-trivial for the foreseeable future.

I think the lack of leadership and foresight will likely cause thousands to lose their lives and trillions in economic damage.

In Japan influenza rates went way down because of the threat of coronavirus. [1] It might actually save lives assuming it's contained at some point.

[1] https://www.japantimes.co.jp/news/2020/02/21/national/influe...

2. In Korea, yes. In the US, no. Other places, mostly no.

3. Unlikely. We have a bigger issue with people not going to hospitals, and therefore spreading the disease. Korea went from 30 cases to 8000 cases because of one such person. [0]

4. More likely is that flu deaths will decrease because people are taking precautions that they normally do not. We should take flu much more seriously than we do, and the same precautions we take against COVID-19 are effective against flu.

Overall, you seem to be focused on hospitals, but here in the US, that's just not something people rush to, due to expense. Here in the US, at least, we are not overreacting. It may not be possible to overreact! What I mean is: If we have exactly the right level of reaction, it will look like overreaction in hindsight, so we can't even know whether we overreacted.

[0] https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTER...

"Note that I don't subscribe to conspiracy theories so I will focus only on non-political information."

Spreads youtube Video of a guy who didn't even realize that he made an impostor his second in command leading a public health office in Germany.

Source: https://en.wikipedia.org/wiki/Gert_Postel

Article: Why Wolfgang Wodarg's Statements have little to do with science. By a well respected fact checking and investigative journalism group.

https://correctiv.org/faktencheck/hintergrund/2020/03/18/cor... ( Translate with Google Translate )

OP is a great example of how a disinformation campaign by conspiracy theorists works. They make you believe they have credible sources you can rely on they base their arguments on until you start digging and find out the stuff above and that this is the same guy who voted against a Child Predator law in Germany and is heavily politically and financially involved in spreading the bullshit he does.

What does that have to do with anything? It's really better to leave stuff like that out if you're attacking someone's credibility. Bringing in unrelated political points phrased on obviously inflammatory ways just makes it sound like you're got a partisan axe to grind and would criticise the guy no matter what he did.

In no way, form or shape did I say he voted against it because he's a child predator. It was to show that he is a politician that is frequently trying to generate controversy to push his personal "Fake Pandemic" agenda.

So of course it has to do something with the topic.

Here's what I did before submitting this:

- Saw this video on youtube, found the non-political arguments to be convincing.

- Since I've never heard about Wolfgang Wodarg before, I googled and found his wikipedia page [1], which suggested he was an expert in the field. I also considered the possibility that he had very strong political views and it may influence his judgement. For example, I never considered (or mentioned here) the parts where he talks about Chinese government.

- Googled for more articles about this guy, most of the results were in German which I didn't try to translate. The only few english results were talking about this video.

- Also looked on reddit, found many people dismissing the video without presenting any counter-arguments (which I'm still looking for).

I'm currently locked in my home with my wife and two kids, respecting the consensus that staying at home is the best way to contribute positively to this pandemic.

When I saw this video, I can't deny that it brought a bit of hope. I know that we are biased and tend to believe in things we'd like very much to be true: Emotions can cloud our judgement (something you should consider in the future when calling someone you've never met a "conspiracy theorist") .

But I left my emotions aside when I stepped through the video making notes of the relevant points and creating a summary to for Ask HN. The only reason I brought this here was to find convincing counter-arguments. I didn't read through the whole thread, but still haven't found anything.

[1] https://en.wikipedia.org/wiki/Wolfgang_Wodarg

He was an expert in what field? He's not a virologist or epidemiologist and preferably spreads his "theories" through right wing propaganda.

And if that weren't enough red flags he also had someone working as his second in command that wasn't even a doctor. He made a mailman a public health official. Please read this out loud to understand how incompetent of a doctor you have to be to make the mailman the second highest health inspection officer in the city.

What of those things qualified him the most to you as an expert to talk about pandemics, virology and epidemiology? I am interested.

With all due respect, I am not the one with the clouded judgement sir. This seems to be a common thing to pretend other people don't see the "truth" in the circles you seem to be active in.

All the relevant points of this video are bullshit. And do not benefit anyone in this crisis, but they spread dangerous misconceptions and want to portrait the gov/system as a bad actor. And by posting them so do you.

Also you got a few great answers to your questions in other comments, go read them , look them up, verify them and then make your opinion around those facts. This is all the attention you'll get from me. Have a nice day and best of health to the wife and kids and that you stay safe in this crisis.

- the fatality rate for covid is high. People make a valid point about how we don’t know the “actual” (unbiased) fatality rate, that may be hard to estimate, but at this point it’s more or less irrelevant —- we already know for a fact that it is high enough to overwhelm the healthcare system, as is already happening elsewhere. We’re not going to wake up one day and say “oh oops, the fatality rate is only 0.03%, oopsies sorry everyone go back to work”, it’s already past that point.

- because it will overwhelm our healthcare system, countries have no choice but to impose extreme measures to slow the spread, which will have huge economic effects depending on how long we can stand doing this. Ideally until there is a solution to the problem of inundated hospitals, whatever that looks like, and however long that takes.

- people hoarding resources or thinking this is the apocalypse are likely overreacting. People are panicking, which will slowly stop once people adjust to their new temporary reality, but whether people are “overreacting” has a different answer for every person.

- the impact on the economy is going to be severe, even with trillions of dollars in stimulus. The restaurant/entertainment industries are trillions of dollars in size, so this will hurt (it is already hurting) and it will put many people out of business.

So....it depends on exactly what you mean by overreacting. If people who are really ok are filling hospital beds, then once things get bad they will be sidelined in favor of serious cases. So for now I don’t see how that’s an issue but maybe it is?

In summary: panic is usually the wrong response to anything but this is incredibly serious...

They may have to take on additional debt to get started again, but there will be huge demand once restrictions are lifted.

That’s a ramble, but basically I sincerely hope your optimism is correct here, but I am much more pessimistic. I think we will get through this but at a huge economic cost.

Unfortunately, exactly in which ways we are overreacting, is trickier. It is possible for us to be overreacting, but Covid-19 still to be a serious problem.

One could also argue that, since we lose 25-60,000 people a year to flu in the U.S. alone, we were underreacting before. If we lost 25,000 people to a new threat, we would consider that appalling. It may be that we are overreacting to this because it's a new threat, but perhaps we were underreacting before?

Probably, it is some of both.

Maybe the appropriate reaction to 1,000,000 deaths is different than the appropriate reaction to 25,000 deaths.

We don't know exactly what this is, or what it may become. The infection rates are much higher than flu.

Most countries aren't as prepared as some Asian countries that've had to deal with such situations before.

After short time with exponential spread, countries will shut down anyway, and then it's too late to avoid becoming Italy.

It's prudent to stop or slow this down, until we've had time to prepare and learn more about the disease.

Nobody knows anything for sure in this situation.

We should've already prepared for this eventuality anyway.

I've read some of the literature on modeling the outbreak. In 45 days, the US will have no ICU beds available, basically no emergency healthcare available as it will be completely overwhelmed, and anywhere from 1-10 million will die over the successive pandemic waves within the next 18-24 months. Vaccine/s, prophylaxes and treatment protocols, in large numbers, are essential.

One of the largest dangers will be the premature reopening and lifting of shelter orders because the virus will not magically go away, and then people will abandon sensible precautions and cause a new pandemic wave that will kill untold thousands. Complacency and irresponsibility will kill many people.

Also, the Spring Break kids and the governor in Florida are beyond ignorant, they're reckless, selfish and liabilities to everyone else. One coastal Florida county's health department wasn't testing ILI patients to avoid coronavirus statistics, and preventing doctors from testing patients.

This isn't something to underestimate, because to do so would gamble your and your family's lives. Furthermore, young people are by far the greatest spreaders and also at risk for developing critical symptoms.

Now what would be the number of fatalities if we'd let things go? For the reasons you mentioned the fatality rate is very hard to even estimate.

Italy had 4000 deaths due to Covid-19 in 4 weeks which is bad enough. As a comparison France had 8100 death due to flu during the 2018-19 winter, and 30000 deaths in 2 weeks due to a heat wave in 2003. Would the Covid-19 overrun those figures with no containment measures. My estimation is that it would.

For Germany: it turns out the virus has currently spread between younger people, explaining the low number of fatality for now. Maybe there are more cautious as well.

https://threadreaderapp.com/thread/1239975682643357696.html

  - 25-50% infected show no symptoms
  - herd immunity is ignored
  - Non-vaccine treatments are ignored
  - Reinfection is assumed, yet we have no data yet because there havent been any reinfections yet
  - It flatly assumes full quarantine is possible at home

This guy just got scared from it, but he's just a social science historian, not a doctor or microbiologist.

What kind of study assumes capacity won't change at all in response to the sort of actions now being seen?

The mortality rate is said to be between 3 and 5%. Experts are also saying that it does not draw an accurate picture of the situation because people aren't being tested nearly as much as should be required.

So the question then becomes, why aren't we ramping up tests among the general population to get a better idea of who to prioritise ? Surely if we know who needs urgent treatment and who doesn't we don't have to freeze the whole economy and put everyone in lockdown ?

What am I missing ? Am I being too naive ?

everything below is me spitballing -- weakly held:

my thinking is that we should err on the side of caution, which means that if anything, in terms of flattening the curve, we haven't done enough, yet, but there is also that any it takes ~1-2 weeks to see the effects of any one action. once the curve is flattening, i think we ought to relax on this front as to minimize the economic damage.

in terms of structural changes to medical system (think FDA approvals), i think that we're also under-reacting, but i don't know enough to really say.

in terms of stimulating the economy, i think we've also under-reacted so far, though the latest bills look a bit promising on this front and i think if they pass they are of about the right magnitude.

"A new CDC analysis of more than 2,400 cases of COVID-19 that have occurred in the United States in the last month shows that between 1 in 7 and 1 in 5 people between the ages of 20 and 44 in the sample of those who are confirmed cases require hospitalization"

https://thehill.com/policy/healthcare/488325-cdc-data-show-c...

“The early estimates show that a fifth to a third of those between the ages of 45 and 65 who contract the disease are hospitalized.”

As for hospitals and increased infection rates, here in Seattle I've heard that people are calling ahead and arranging where to go. They are also waiting in their cars while being checked into hospitals so they don't even use public waiting areas. Pretty smart, and definitely not a panicked response!

According to the last stats I saw, 8 people have died in the US of corona so far... [2]

[1]: https://www.cdc.gov/nchs/fastats/deaths.htm [2]: https://liveupdate.world/coronavirus/m/en/

Edit: I'm not going to bother responding to all the edits, though at the moment they haven't proven anything different. Edit 2: It was pointed out that the source I used for the "8 deaths" was incorrect - it was 8 new deaths, there have been 97 total according to the CDC. My bad, but I think my point still stands regardless.

That said, "all causes ever" is ridiculous. Even worst-cases scenarios[1] put COVID-19 as the potential third cause of death in the US.

UPDATE: I think you weren't reading your own source well. There are +10 "new deaths" since an unspecified time, but that site is reporting 160 deaths overall.[2] I don't know how that's sourced, though, so I would be leery of trusting it, even though it makes a stronger case than the CDC.

[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/case...

[1] https://www.nytimes.com/interactive/2020/03/16/upshot/corona...

[2] https://liveupdate.world/coronavirus/p/en/official-corona-vi...

That said, comparing actual numbers against a "worst-case scenario" is also apples and oranges. 97 people in a country of somewhere between 325 and 330 million people... if my admittedly poor math skills are correct, that is about 0.00002%. Yes, that's in roughly a month, but even exponentially it _could_ be worse than cancer, but there is no evidence to suggest it _will_ be thus far.

Also if you check Italy, whose stats the US is currently following, death number ~infected number (t = -10days).

So I would say let's be very careful and it we see +5,000 deaths in the US in two weeks it will be a strong confirmation of how serious this is.

I guess if you are politically motivated then choosing a random non-scary disease like Flu to compare it to makes sense, but one might as well (perhaps with more justification) compare it to SARS and than panic and say "OMG it's already killed way more people than SARS!".

Rather than comparing COVID-19 to anything else, what really makes sense is to listen to the infectious disease experts (not politicians), and follow what's happening in other countries.

Should we go into full lockdown everytime there's an outbreak ? This is a very legitimate question to ask.

SARS-CV2 may not have the % kill rate of SARS-CV1, or other nasties like Ebola, etc, but it has potential to kill a LOT of people due to it's specific nature:

- Many infected people are asymptomatic, so spread it unknowingly

- It has a fairly long incubation period, so even those that will show symptoms (allowing them to be isolated) don't initially

- Symptoms may be mild and confused with those of other diseases (such as flu!), resulting in failure to diagnose, hence allowing spread

- The percentage death rate appears nothing to be complacent about. The Princess Diamond "experiment" (with 100% testing) indicates about a 1% death rate (10x that of flu), while in Italy it's running at about 10% of detected cases.

- This is a novel virus to which we have no immunity. If it's still around next year things may be better (and better yet if we have a vaccine), but this year it'll be bad if not managed

Apparently what caused Trump to eventually take this seriously was an Imperial College, UK report indicating that "do nothing" would result in a couple of million deaths in USA.

Of course it's a legitimate question to ask if the cure is worse than the disease, but it's both politically and morally impossible not to act when you know you could save millions of lives.

https://www.independent.co.uk/news/science/coronavirus-us-uk...

https://m.youtube.com/watch?v=ohO8eAwi_po

-Dr. Anthony Fauci

Are we overreacting? That depends on what your definition is on how to react to a pandemic. On one hand we don't freak out over influenza in the same way.

Let's look at it this way: Influenza('19-'20) has a projected hospitalization:death ratio between 3.2% and 15%[1].

hospitalizations: 370,000 – 670,000 deaths: 22,000 – 55,000

COVID-19: - As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States - 508 (12%) patients known to have been hospitalized[2] - 108 (21%) deaths from COVID have occurred in the US[3]

This means about 21% of those who are hospitalized in the US have died from COVID.

It's not only significant, but significantly higher than influenza.

We should be reacting to this: social distancing, monitoring symptoms and avoiding the ER and visiting doctors unless we have an emergency.

Those are things everyone can work to do although there are some folks who can't distance themselves socially(doctors, firefighters, restaurant workers, etc) and it's important the rest of us do our best to support them.

Just like some folks are allergic to vaccines, it's critical those of us that are able to get vaccines to protect those with compromised immune systems or that are unable to get the vaccine.

In short: We're not overreacting, if anything the data shows we're underreacting.

[1] - https://www.cdc.gov/flu/about/burden/preliminary-in-season-e... [2] - https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm [3] - https://www.cbsnews.com/live-updates/coronavirus-disease-cov...

In simple terms, here in the US, we only have a little data. E.g., apparently a big fraction of the data we have closely relevant to these questions is in a US CDC report

"Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020"

that is, to essentially the present and only 4 days more than a month.

Can see the report with a lot of words with actual numerical values at

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm

and, then, can see their graph of hospitalizations, ICU admissions, and deaths by age in Figure 2 at

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm#F1_down

For how many people are infected, tough to know before we test a good simple random sample with a good test. From some of what Dr. Brix said recently, our test(s) "amplifies* the genetic code and sequences that.

If I understand correctly, the amplification is via the PCR where From Google,

"Polymerase chain reaction (PCR) is a method widely used in molecular biology to rapidly make millions to billions of copies of a specific DNA sample allowing scientists to take a very small sample of DNA and amplify it to a large enough amount to study in detail. PCR was invented in 1983 by Kary Mullis."

So, the test is not trivial, is some microbiology that, say, before 1983 would have seems impossible.

Next Dr. Brix has indicated that the US is very careful about the rates of false positives and false negatives of the tests they use.

Still, for now, apparently we don't know how many people in the US are (or have been) infected.

But from the CDC data above, we have some okay data (numbers are still small for accurate statistical estimates) by age of the fraction of hospital admissions with the virus that got into an ICU and then the fraction that died.

Considering the US population over 65, how big is that?

Uh, from Google search

"US population over 65"

get

"49.2 million

In the United States, the population age 65 and over numbered 49.2 million in 2016 (the most recent year for which data are available). They represented 15.2% of the population, about one in every seven Americans."

So, the US has to try hard to stop the spread of the virus or, ballpark, the US is looking at about 50 million citizens (a) nearly all of whom would get the virus and (b) a significant fraction of whom would die if they are like the people in the data who got the virus and were admitted to a hospital.

Net, bottom line, if extrapolate from that CDC data, then the US has to be careful or a lot of people over 65 could die:

In more detail, from the reference with the words,

"This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged =85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged =19 years."

Or, it could be > 3% dead of people over 65.

So, 3% dead of 50 million would be 1.5 million. If want to use the 10% number in the CDC text, then that would be 5 million dead.

So, hurry up step #1 is to slow the spread of the virus by a lot of social distancing and hand washing.

Hurry up step #2 is look for cures by (a) trying old drugs to see if any are effective against the virus, (b) get some antibodies from some people already cured from the virus and see if those antibodies can be the basis of a cure, (c) starting with the microbiology, e.g., the molecular geometry, of part of the virus, try to construct an antibody.

Step #3 -- ASAP get a safe and effective vaccine and give nearly everyone a shot.

In case #1 to #3 happen too slowly, do #4, get hospitals ready for lots more patients.

Unlike some other diseases, some good news about this virus is that everyone who gets the virus can transmit it for only a few weeks.

So, in simple terms, if the world would be 100% effective at social distancing for a few weeks, then the world would be free of the virus! And if the world is close to 100% effective, then the world will still be free of the virus soon!

Based on everything I've read there's two schools of thought:

1. Let the virus take hold. Save the economy, let God sort out the vulnerable.

2. Quarantine and contain. Save the vulnerable, life-support the economy until the virus dies out.

US and others are doing #2.

England is doing #1.

We'll see how that plays out.

I think you were blaming Chinese people for whatever reason, even you didn't mean to.

You don't want to lose your family or friends, or suffering in economic recession.

We don't want it too.