Your math doesn't check out. 5% of people that get it (among a wide range of ages) require serious medical care for weeks. And if we send 5% of any population to the hospital in a given month the death rate for ALL diseases goes way up.
It still sends as many people to the hospitals as it sends to the hospitals, weak epidemiological data or no. If that's more than the hospitals can handle, people start dying who otherwise wouldn't. That, too, is not an indicator subject to measurement bias imposed by lousy testing regimes. It's also a thing that is happening. We will see more of it before we see less.
> 5% of people that get it (among a wide range of ages) require serious medical care for weeks
Just based on the experience in other countries, GP seems quite spot on in terms of who is impacted, who dies, and the percentage of the population. Your comment seems speculative and substantial number of non-70+ year olds dying has not been borne out by the data at all.
There are far more deaths in Italy and France then statistics show...
> On Tuesday night, the health authority in the Grand Est region said two-thirds of its 620 old people’s homes had been affected by the coronavirus pandemic and 570 residents had died.
> Those 570 people are not recorded in France’s official coronavirus death toll, which reached 4,032 on April 1, but so far counts only those who have died in hospital.
> In an Italian retirement home in Mediglia, outside Milan, 52 of the 152 elderly staying there had died from Covid-19 infection by last week.
> In the province of Bergamo, 2,060 deaths were attributed to the virus in March. However L’Eco di Bergamo, a local newspaper, found that a total of 5,400 deaths occurred in the province in March, up from just 900 in the same month in 2019.
I was under the impression that Italy did test for covid also post-mortem? there were claims here couple days back that this was the case (and a claim that apparently Germany didn't). if that's the case then how could the numbers be different?
People also die now for example because of a heart attack that cant be treated due to overwhelmed hospitals. Not saying that is the case for the numbers, I dont know.
In London someone died of malaria last week because it took 9 hours for an ambulance to show up.
It kills 1% if ICU care is available. It kills a lot more if the healthcare system is overwhelmed. Look at Spain or Italy. Case fatality rate is around 10%.
Letting it run its course it needs to infect 60-70% of the population before herd immunity kicks in. 1% of 60% of the population of the US is 2 million people. World-wide you're looking at 45 million people for a very optimistic scenario. The numbers could easily be 5 or 10 times larger. If we're lucky and the number of asymptomatic cases is very high, the numbers could also be lower. At this stage we really don't know, but I don't think it's ethical to take that risk.
Spain and Italy have fatality rates of 10% because the infection exploded far before they could ramp up testing capacity, so they were only testing the people who were in serious medical distress.
This is obvious if you compare the numbers between different countries versus their relative level of hospital capacity.
The comment you're replying to referred to "1% of the people who get it", which has basically nothing to do with CFR. Getting the virus is necessary but far from sufficient to become a case.
Not quite. 1% of people who get it don't survive when healthcare resources are not strained. But when ICUs fill up, that number starts to skyrocket, because people who need intensive care cannot get it.
You're really missing my point. CFR is not the percentage of "people who get it" that don't survive. It's the percentage of "people who get it, get tested, test positive and are thus confirmed as a case" that don't survive. The actual mortality rate, whether ICUs are working or not (they mostly are), isn't known.
That was a prediction CDC made in early Feb for broader China. More recent CDC reports for United States (https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6912e2-H.pdf) say mortality is somewhere between 1% (lower bound) and ~30% (depending on age) based on calculations they did w/ cases having "known outcomes". The CDC says they only have 44 such samples at this time, and that ICU status data is missing or unknown for the several thousand or so other cases. So we really just don't know the facts yet.
I know. But we don't know the true fatality rate yet and we won't know it before it's way too late to act. I don't think it's okay to literally risk millions of lives on the off chance that we missed 95% of the cases with our testing.
That is a reasonable line of thought, but incomplete. How many lives are we risking by tanking the global economy? That seems like it should be a more quantifiable risk. It becomes a trade-off between the amount of lives we can calculate will be lost via our pandemic-prevention measures (and to what degree of certainty) and the number that might be lost without them (and to what degree of certainty).
The trade-off is between loss of lives one way versus loss of lives another way.
Okay, but you have to look at both sides of it. How many people aren't dying in road traffic accidents that don't happen because of isolation? How many people aren't dying of diseases they won't develop because reduced economic output has also reduced the output of carcinogens and toxins produced by manufacturing that's not being done? And like that - those are just the first two examples off the top of my head; there are more.
I don't see much mention of this among the "back to work at any cost" crowd, and I wonder why. It seems like a pretty obvious consideration.
Exactly this! The WHO estimates that air pollution kills 7M people annually[0]. A really big range of estimates suggest 20-50% decrease in airborne pollutants since the start of the pandemic. Even a 10% decrease, sustained, could save 700k lives/year.
Yes, bad economies harm people. But they also reduce harm. Pointing simply at directionality due to a bad economy is disingenuous.
A natural outcome when you have 30% unemployment in the worlds largest economies. Who knows, maybe we will get lucky and it will only be civil wars in China and India with only hundreds of millions dead.
It is quantifiable, however it appears that periods of economic decline are strongly associated with decreased mortality rates, at least according to the best evidence I can find from Nature.
In Italy you see 10% mortality because Italy tests only (really) sick people. It's really likely that millions of italians have covid. This is not really demonstrable at the moment, but still https://www.wantedinrome.com/news/coronavirus-report-six-mil...
Italy is treating every single patient with high standard healthcare. They did not reach the "0 free ICUs" moment yet.
What we can say as of today is that the high number of deaths do not depend on overwhelmed hospitals, but likely just because there are A LOT of covid patients. Also a greater average age and the fact that older people are much more integrated in the society played a role affecting mortality, but still those are only theories and we can't say how much they affected the total.
The US media reporting has also been terrible. CNN even noticed that a lack of testing was correlated with a higher reported percentage of deaths... and then went and concluded that the reason for this was that more testing caused fewer people to be infected, even though this wouldn't directly affect the mortality rate and there was other evidence indicating that the lack of testing had screwed with the denominator in the calculation.
sick of hearing this silliness: https://www.ecodibergamo.it/stories/bergamo-citta/coronaviru... so yeah, they barely test half the dead people (which are still double the normal deaths...). And A LOT of covid patients means a lot of deaths as well, bc. at 1.3% (Diamond Princess, where people are still not through it/dying) to 5% letality, the thing IS BAD.
But again, what was the age group on Diamond Princes? Because it matters, the death rate goes up with age. 5% says the average age was something like 50.
with emphasis on "should". Most people started to argue with the low number of deaths, when there were 5. Now there are at least 10 and about 100 people unaccounted in statistics...
Hm - 10 as of a few weeks or so ago, I doubt we will see any more and certainly not 2-3x more. That 10/800 = 1.2% and the cruise ship skewed older. 100 people entirely unaccounted for would only impact spread rates, not CFR, unless the unaccounted people are more likely to have died than those from the ship writ large.
I don't see where people are getting 5% from. 1% is already 10x worse or so than the flu, I don't see the need to exaggerate the facts.
There was an 11th death Apr 1, and 113 of the 712 are still active, not recovered. Didn't find from a quick search how critical or mild they are, but it is concerning that it's been this long...
That doesn't appear to be entirely correct - from my research, it appears to actually have been about 12 deaths (the last on March 28th from https://www.mhlw.go.jp/stf/newpage_10599.html) but there appear to be multiple sources on this.
Regardless, I'll admit that I was wrong - there are still people dying. Regardless, we'd have to get about 3-4x the number of deaths we've had so far to reach 5% - and from the sources I can find most of those remaining cases are non-critical (though there could be even a doubling).
What do you feel is stupid about the response to this? 1% is a lot of people. The whole point of social distancing and staying at home is to not overwhelm the healthcare system and to give more time to develop proper care procedures.
Playing devil's advocate for a moment, 1% would be approximately the same number of deaths we get in a typical year. Slightly more, yes, but some number of the COVID deaths are probably people that had a high likelihood of dying this year anyway, so it seems like an okay estimate.
In that case we are doubling our deaths for a year. Very significant, but in the grand scheme of things it poses no real danger to the species. I haven't decided if I agree with the position that collapsing the economy is worse than letting those deaths happen, but I understand how someone could feel that way. Ask me again after I lose my cushy software job because it's a luxury companies can no longer afford with nobody buying anything.
And yet you did not address the issue that the health care systems will collapse. Why are you (and many others) ignoring that outcome?
Everyone seems to get tied up in the % of fatalities. Debating those numbers are a waste of energy, everyone is just cherry-picking numbers that support their own arguments. But we know for a fact that without containment measures (and even with them), this virus can result in the health care system getting overwhelmed and possibly collapsing.
This has a number of impacts, 1) Health care workers will die at a much higher rate than normal. This will have lasting impacts. 2) Anyone who needs health care for any reason will be in trouble (cancer patients, diabetes patients, pregnant women, accidents, etc...). I read somewhere that ~30% of home births require emergency hospitalization. How would our economy do if ~30% of pregnant mothers died during child birth? 3). Even without government mandated shut-downs, people will reduce economic activity to avoid the risk of getting COVID or getting into an accident that would require a hospital visit. Many companies were cancelling events and implementing WFH policies before local governments required it.
This isn't really an either/or option. The economy is going to take a massive hit regardless of the actions we take. But by implementing shut-downs we can save lives and also potentially get back to normal business faster than we would otherwise.
I'm in the fashion industry right now, I get the layoff worries. But, okay, worst case, I get laid off and then I get a less cushy job in an industry that's less affected. Maybe I draw down my savings for a couple of months before I find one. It's not the end of the world. That's a major benefit of having a skillset as portable as ours.
I'd definitely rather risk that than risk a couple million people dying over the course of a few months - 1% of 70% of 320M, and that's just in the US. What effect on the economy do you expect would come of that?
> What effect on the economy do you expect would come of that?
On the economy? Very little. Most of the people dying are not in the job market any more nor are they big consumers. It might even reduce the load slightly on Social Security and Medicare.
No, the risk of letting a couple million extra people die this year is a social/moral one, not an economic one IMO.
Even in countries with no lockdown in place, economic activity is way down.
For instance in Sweden, at least when I read about it a few days ago, restaurants and everything were still open.
If I remember correctly, they had between 10-20% of the usual activity.
Even if it's not mandated, people don't want to take the risk, either for others or for themselves.
All of this to say: I don't think the options are between close the economy to save people (at least short term), and don't close the economy and bear the hit.
The latest one is not an option, the economy will mostly shut down by itself
>I'd definitely rather risk that than risk a couple million people dying over the course of a few months - 1% of 70% of 320M, and that's just in the US. What effect on the economy do you expect would come of that?
A hugely positive one because the deaths are for people who no longer work and generally are net drains on the economy, with either multiple diseases, old age or some other disability.
The effect of wealth transfer between generations alone would be amazing, with 20-40 year olds inheriting housing for the first time since the 90s in large numbers.
> I haven't decided if I agree with the position that collapsing the economy is worse than letting those deaths happen
Have you considered the position that a collapsed economy is inevitable due to deaths? Or that it would lead to less pollution, saving lives (although who knows what the net-net would be)?
7M people die annually from air pollution, according to the WHO. Early estimates of pollution reduction are in the 20-50% range; even a sustained 5% reduction is 350k lives saved/year.
You should check the numbers coming out of Italy. It’s not 1% if the medical system is overwhelmed. Moreover, you do realize that’s 3 million dead in the US alone?
It's also not the reported number in Italy. The sources of error in the data are enough to make the data fairly meaningless.
1. We have no idea how many people were infected
2. We have no idea how many people who have died died from Covid 19
3. The population pyramid in Italy is extremely disparate from the rest of the world.
The medical system being overwhelmed is a portion of the contribution, and what it means to be 'overwhelmed' is about as clear as what it means to have an error in your application. Are you overwhelmed due to lack of beds? Lack of ventilator access? Lack of doctors? What are the numbers for these in the remainder of the world?
Treating any modeling we have of the impact of Covid 19 as reliable is an exercise in insanity.
EDIT: To be clear this isn't to say that the responses are unwarranted. It's just to say that they are conservative and acting on knowingly incorrect information. If they were the right decisions remains to be seen. The impact of global financial collapse isn't just 'stocks down', but has tangible impacts on life expectancy, healthcare quality, and quality of life globally. Time will tell.
> Treating any modeling we have of the impact of Covid 19 as reliable is an exercise in insanity.
In detail, yes. In general, you can still make some good back-of-an-envelope calculations.
Conservative estimates are that the coronavirus has a CFR of about 1% given adequate medical care (South Korea's statistics, where testing has been comprehensive enough that we should have identified any wide pool of asymptomatic cases), and another low estimate of its R0 factor is 2. Left unsuppressed, this implies that the disease would spread to infect about half of the population, and it would kill 1% of those infected.
For the United States, that implies that a "flattened curve" -- where mitigation prevents medical resources from being overwhelmed but does not fully suppress the disease's spread -- will kill about 1.6 million people.
Beyond that, we know that the disease requires intensive care at some multiple of the death rate (say 2x) and hospitalization at another multiple (say a further 3x). These estimates are reasonably consistent with New York's numbers (https://nymag.com/intelligencer/article/new-york-coronavirus...). Testing shortfalls could make these multiples worse, if there are hospitalized or ICU patients positive for the virus but not included in these totals.
Given overwhelmed medical services, we can presume that a large fraction (say half?) of ICU patients would die for want of care, and a smaller but still significant fraction of hospitalized patients would do the same (1/8?).
This implies that an un-flattened curve would have roughly triple the death rate, with the excess caused by inadequate care. With a 3% inadequate-care CFR, if left to run its course the disease would then kill about 4.8 million Americans.
> It's just to say that they are conservative and acting on knowingly incorrect information.
If policymakers are acting on "knowingly incorrect information," it's because their assumptions are too benign rather than too severe. I believe that my estimates above should be uncontroversial, and to the extent they err I've tried to err on the less-deadly, less-contagious side.
Various models and data sets put asymptomatic cases at between 20% and 50%. Those are fully asymptomatic - i.e. total end-to-end progression with either very mild symptoms indistinguishable from a minor cold, or no symptoms at all.
It's almost impossible to estimate expected population mortality with limited and noisy data, but I've seen estimates from 1.5% to 0.05%.
The only thing that can be said with certainty is that social distancing, testing, and tracking all do a lot to prevent initial infection, and good access to ICU hugely improves chances of survival after infection.
The rest is guesswork at this point. Having said that - my current hand-wavy estimate of deaths in the UK is high five, low six figures. Multiply by five or so for the US.
> Various models and data sets put asymptomatic cases at between 20% and 50%. Those are fully asymptomatic - i.e. total end-to-end progression with either very mild symptoms indistinguishable from a minor cold, or no symptoms at all.
That's why I use South Korea as a model. They've tested enough that they should have found the majority of asymptomatic cases, and they still have CFR above 1% (1.7% as of this writing).
That also puts a bound on reasonable levels of occult spread. We can support maybe 50% of cases being totally asymptomatic and undetected, but if that is significantly greater then we'd see contact-tracing (again, SK-style) entirely fail as a control measure.
So it seems like an absolute best-case CFR is 0.5%, if it would be 1% among symptomatic cases and there again that many that never notice / are diagnosed with the disease. For the UK, that would give an optimistic projection of (66e6 * 50% * 0.5% =) 165k deaths in a "herd immunity" outcome with a "flat curve", so this is consistent with the range of your "hand-wavy estimate."
We will not know how effective testing has been until we have serological tests. There are a few assumptions being made regarding the efficacy of testing, and contact tracing will certainly miss pockets of asymptomatic people.
The financial probelms are a given. Joining some political death cult to sacrifice the weak and elderly portion of our population to feed the COVID-19 Volcano isn't going to make the virus end any sooner, and you'll have even fewer consumers left after it's all over if governments choose to go that route. The virus doesn't care, and as far as I'm concerned any economic system that isn't capable of protecting the vulnerable isn't worth reviving.
”Joining some political death cult to sacrifice the weak and elderly portion of our population...isn't going to make the virus end any sooner”
Barring the development of a vaccine (which is far from guaranteed, and a year or more away, in the best case), letting the virus sweep through the population is pretty much the only thing that would bring this to an end quickly. We could achieve herd immunity in a few months and have it behind us.
This situation is a direct tradeoff of time (and money) for lives.
Letting it sweep through uncontrollably quickly by pretending it's business-as-normal out there will lead to many times more deaths due to hospital overutilization.
Our current actions are focused on the goal of leveling the curve, not putting up a wall. There aren't armed guards outside our homes preventing us from leaving. The grocery stores are open. We can come into contact with others to order just about all goods we've always been able to order. We can go to parks and trails and beaches. This will cause more infections, and we all know it; but thanks to these measures, ER visits in our city are down over 20%, allowing healthcare some capacity to deal with the influx infected people, and our daily growth of infections doesn't look exponential anymore.
This thing hospitalizes many young (under 40 years of age) people as well, and in our state that has been on lockdown for longer than many others, medical fellows and residents from unrelated specialties are being asked to help with COVID-19 cases. In a week or two at most it's expected they'll be required to help. If our government wasn't taking these defensive measures, we'd already need more space to store the bodies.
Yeah, I get it. It was implicit in the point I was making: we’re explicitly trading time for lives.
Literally the fastest way to get this over with is to let it sweep through the population. More people might die if we did that, but it would get it over with quickly.
Remember, it's a ratio. What matters isn't the raw number of missed cases, it's the ratio of missed-to-detected cases versus uncounted-to-counted deaths.
If Italy has missed half of its deaths but also half of its total cases, the fatality ratio would remain the same. To bring its CFR down to the level of South Korea, you'd have to make the implausible assumption that Italy has caught nearly all of its deaths but missed more than 85% of its total cases.
Yes, I know it’s a ratio. That’s why I used the term “numerator” and “denominator”.
It’s not at all implausible that Italy has missed the vast majority of it’s cases, because they’re barely testing, and they’re not testing minor cases. It’s essentially guaranteed that they’re missing a huge number of cases.
A reasonable estimate is that they’re missing 10 cases for every one they actually detect. The error in the denominator is much larger than the error in the numerator.
It's universally true that the people eager to feed the olds (and a bunch of non-olds, too) into the wood chipper never seem to have their, and their parents', do-not-treat orders signed.
We don't like to think about it explicitly, but human life has a market or dollar value. You can figure it out by how much we spend on things like safety measures and court settlements and judgments for deaths. As it turns out, it runs about $7 million per person in the United States.
That does make some sense. None of us picked the circumstances of our birth, but we have billions of people because of the economy, because we don't all grow our own food, because some people specialize in scientific research, etc. Now, we have billions of people that depend on a functioning economy, and if it doesn't function, people will die that way as well.
So what if it's 1%. It's life. Nothing else matters.
Should we shut down the country and quarantine ourselves during every flu season? In an average year the flu kills about 0.01% of the population, and nothing else matters but trying to save those tens of thousands of people, right?
