WHO Director-General: “We may only be seeing the tip of the iceberg” | Hacker News Reader

WHO Director-General: “We may only be seeing the tip of the iceberg”

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97 pointselectriclove74 comments

Dr. Tedros has faced a lot of criticism for strongly praising China's handling of the epidemic over the past few months.

There is now growing belief that China is under-reporting. Primary evidence for this is that the stats fit too neatly to a curve extrapolated from previous releases. Would actual deaths occur so tidily? Secondary evidence is that China's response seems significantly larger than expected based on the statistics they are releasing. Judge by actions not words, and all that jazz.

This doesn't conclusively prove tampering, but at minimum suggests there is some rate-limiting factor influencing the figures. Shortage of test kits or test lab throughput, perhaps.

Either way, if China is under-reporting it puts the rest of the world at a disadvantage information-wise, and that leads to inadequate preparation and response.

Assuming this is true, Dr. Tedros is in a political pickle. True transmission and mortality rates will become apparent once the virus spreads in countries that can't or won't falsify figures.

On the basis of all of the above, which I admit is by no means conclusively proven, this Tweet makes a lot of sense. It provides a stepping-stone in messaging from fawning over the CCP to providing more aligned-with-reality messaging on the developing pandemic. When the dust settles, I wouldn't be surprised if any stats differences between China and what we see in the rest of the world is pinned on 'mutation'.

A more generous take is that Dr. Tedros had to gush about China to avoid non-cooperation, but is now trying to move past that and back into a messaging space where the WHO can best prepare the rest of the world to respond appropriately.

Disclaimer: I'm not an expert and I spend far too much time in the sewers of the Internet to have an objective opinion. This is just a summary of the more plausible speculation I'm seeing.

there's no other way he could get china to cooperate. it was the correct play.

Yes, and on top of that there's not cooperating and there's not cooperating. He still has to walk that tightrope even if he knows China will never fully cooperate.

China's still not cooperating. It didn't work.

this twitter thread was also about getting WHO feet on the ground as he literally waved them off a couple posts earlier. it's a win in my book.

It was a terrible move that has jeopardized the lives of millions and further corroded the WHO's reputation. The very trustworthiness of the organization is being questioned so much so that people are dismissing official communiques as outright lies.

orthogonal. terrible but still correct. alternatives were worse.

China defined what the meaning for each of the reported stats. Infected means it's tested positive under a RNA ptpcrt test. I don't think at this point, china is fudging the number. But because of this definition a lot of cases are not being tested because of a lack of medical resources especially in wuhan. So the real cases in the public is far greater than 40000. They also released information on what they learned medically about the virus and the real situation in wuhan. I seen the videos posted on FB and Twitter and I think the government is not hiding the "the bad news" so just following these source already paints a virus that is highly contagious and difficult to diagnose. Their actions are formed based on a lot of information not captured by the reported numbers and actions are more forward looking as they are trying to anticipate how the virus will develop. The numbers are laggards. So I believe we should all look at the actions instead of the number. If the situation does not warrent lock down on travel and public gathering in many cities, which destroys the economy, why would they do it? Now the situational assessment is two parts, one is the dangerous of the virus, second the societal conditions in China that encourage the virus spreading. It might be that for the same virus it might not be as transmittable in other countries. So other countries shouldnt copy Chinese response directly.

>>Dr. Tedros has faced a lot of criticism for strongly praising China's handling of the epidemic over the past few months.

What doesn't work for day to day life (dictatorship), works great in such cases. Complain about quarantines if you dare.

China is the one really affected so whatever they're doing, so they have every incentive to do it right. I see falsifying as a possible way not to spread panic but that's white /gray lie, all countries should prepare for the worst.

yeah except it doesn't because people run away screaming from the hospital when they get diagnosed for fear of quarantine facilities and conditions therein. (reports from HK hospitals, don't have source at hand, sorry)

Let me preface by saying I'm not an expert at all.

But as an outside observer just watching the stats, here's my biggest reason for being suspicious regarding the number. Right now there's five other provinces (Guangdong, Zhejiang, Henan, Hunan, and Anhui) with more than 800 confirmed cases.

For context that's the level Hubei (Wuhan) was at three weeks ago. To contextualize when Wuhan had O(1000) cases, before full quarantine, the infection was growing at a rate of 50-100% per day. In contrast all of the aforementioned provinces are now currently keeping growth below the target of 10% per day.

Now obviously, the infection control process will improve over time as we learn more about transmission. But none of those other provinces are in full quarantine like Wuhan. And yet, every single one of them is doing a remarkably better job than Wuhan was at the comparative point in the infection. In fact they're all doing even better than Wuhan did after it locked down to full quarantine.

That kind of rapid improvement in disease transmission control over the span of a few weeks is hard to believe. Every single province seems to be hitting their targets on every single day. Compared to a few weeks ago, the public health improvements are almost too large to be believable. Most likely, I'm being paranoid, but it does smell a little fishy.

I'm not exactly sure what you're hinting at here:

Is it that China is underreporting new infections for the neighboring provinces now, or that they mis-reported stats of Hubei before?

Anyways, I must say I find it a little disconcerting to see such a statement (which I can only describe as fear-mongering) from the director of the WHO on a public plattform. Does he not have the means to contact officials directly and tell them what they should prepare for? His "call for calm" is 3 tweets in ffs

He's suggesting the other provinces are getting underreported.

You are not alone - users on reddit and weibo have also accused China of falsifying figures.

One reddit user fit a quadratic curve to the infection rate some time ago and used it to predict the number of infections.

https://old.reddit.com/r/bestof/comments/f0anox/uantimonic_a...

Could this be attributed to increased public awareness/paranoia? Perhaps people, scared of the disease, are now acting more diligent about avoiding unnecessary social contact, washing their hands frequently, etc.

I was thinking about that too - and all the articles about the Chinese ghost towns. Few people are going out most places where the epidemic is raging - society basically came to a stop. My guess is that that would indeed modify the function that dictates infection rates.

Now granted, the articles are anecdotal and not statistically representative, so there is some extrapolation in these assumptions. The actual numbers are probably somewhere in between.

> To contextualize when Wuhan had O(1000) cases, before full quarantine, the infection was growing at a rate of 50-100% per day. In contrast all of the aforementioned provinces are now currently keeping growth below the target of 10% per day.

This is how the figures have grown for confirmed cases, i.e. number of positive test results that came back. Not "actual real number of cases", which I'm sure the healthcare professionals and politicians in China are all aware of, as everyone else should be. It's already been clearly recognised that Wuhan/Hubei botched the early part of managing the epidemic, so the discrepancy you point out is pretty expected.

WHO needs to somehow convince China to release real number of deaths for the past 12 months in Wuhan. This would get the ball rolling.

Are we then going to start talking about how the 2009 H1N1 flu outbreaks were massively under-reported?

https://en.wikipedia.org/wiki/2009_flu_pandemic#Comparisons_...

https://pubmed.ncbi.nlm.nih.gov/22738893-estimated-global-mo...

I don't see any of the scares or complaints of under-reporting from back then. So what's the difference here, the fact that the disease originated from China? Seems pretty racist to me.

Criticism of the Chinese government is not racism. They have a history of controlling the flow of information both in and out of the country; any suggestion they are controlling the flow of information about this virus is rooted in established historical facts.

I find people saying things like "criticism of the Chinese government is not racism" is akin to things like "I am not racist because I have black friends".

Anywho, I gave you an actual link of a pubmed article about the H1N1 2009 outbreak being under-reported, yet the criticism is once again about China controlling information flow. Where is the criticism of under-reporting from the US and Mexico H1N1 outbreak from 2009 and 2010 and controlling the information flow? I don't remember any of that, do you?

What we are in danger of witnessing, is a priority inversion - when we should just have two measures of 'global panic'.

The priority is, of course, to stop a 21st century plague from happening. When/if such an event occurs, it will have a vast effect on the daily life of millions and millions of people, whether they are infected or in danger, or not.

Social fallout from mass panic is almost as dangerous as an actual viral plague could be. They've happened in the past, because people weren't prepared - so sure, we should not be lying about it.

There is responsibility to have a survivable world, after such events occur - governments plan for recovery too, not just prevention and control - so the panic of the global populace, at scale, is one thing that can have a massive effect on whether there is a society to rebuild 'after the cure is found'.

The point is that folks should be observant that there are two massively dangerous potential events occurring here: 1. Coronavirus, and 2. Agitprop/Counterprop being used to re-shuffle the world economic scene, prematurely as it seems in some cases, but preparedly in other cases, too.

Its remarkable to me that in WWII the British plan for post-apocalyptic recovery was, to put up signs that read "Keep calm and carry on". Which, because it was Britain, would very probably have worked.

Is someone able to properly translate this graph? https://img1.dxycdn.com/2020/0210/392/3395802964777411656-13....

Seems like someone is estimating 250k "potential" cases? Google Translate isn't very clear here.

I wonder what would happen if the virus arrives in a densely and arguably less developed nation like India. That would probably a disaster. Apparently not many travel from China to India.

One saving grace is that coronaviruses (like the common cold or SARS) do much worse in the heat because they denature easily. Which is why SARS died off once summer came -- and which would help reduce the spread and severity of a pandemic in India or sub-saharan Africa.

So, I just copied the data from WHO sitreps and the total-cases diff of diffs has been increasingly negative for three of the last four days. So it's still getting worse, but the second derivative might be negative.

And those are WHO numbers, so he surely knew that when he put the tweet out (it's enough that you can just see it in the scatterplot).

So I wonder if he's saying that to stay out ahead. What he would really want now is for people to not let up. Keep people on alert, and clamp down on the respiratory human-to-human transmission. Keep that second derivative negative!

> So, I just copied the data from WHO sitreps and the total-cases diff of diffs has been increasingly negative for three of the last four days. So it's still getting worse, but the second derivative might be negative.

Could you explain what this means in layman's terms?

The rate at which new people get infected is going down.

Only if we assume that the published rates of new infection reflect reality.

The statistics refer to diagnosis of 2019-nCov based on conclusive test results. They do not include diagnosis solely made on symptoms - if somebody in China had flu-like symptoms and died from pneumonia, that's not considered a diagnosis of 2019-nCov infection and thus it's not an 2019-nCov death unless proper tests were performed.

Even if we assume that all the test results are reported, we know that large quantities of suspected cases in Wuhan are not tested - hospitals report there's an insufficient quantity of RNA test kits available, there are some reports that outpatients aren't tested, and bed capacity is limited, so anybody who does not have space in the hospital system is not tested. And if they die, they're excluded from statistics of 2019-nCov patients because they were not tested.

So if you have a system that's capable to test X people per day, even if you report all the test results perfectly honestly, you're not going to see more than X new infections per day... no matter how many new infections you actually have. If it's nontrivial for Japan to test 3600 people quarantined on a ship, how would it be possible to test everyone who's sneezing from 11 million people quarantined in a city?

The second derivative is the acceleration. If it's negative it can still be getting worse (positive first derivative), but it's slowing down.

The second derivative is the rate at which the rate of change is changing.

Sounds about right.

This will get worse before it gets better.

This is an interesting chart to new map the new daily infection rate.

https://twitter.com/Tom_Fowdy/status/1226659915160117248

The daily count of new cases is going down. China’s containment effort might be successful.

However, this may not account for everything.

* They have limited daily testing kits. Especially in the early days of this crisis.

* There may be people who had died, but they didn’t get tested, so they won’t be counted in this statistic. The moral dilemma is: Do you burn a precious test kit on a dead corpse to verify that they had the virus, or do you save it for someone still living?

* The city and the province’s medical system is under severe strain, and there are not enough supplies to go around. They may not even be able to account for everything or everyone, because their medical system is suffering from a massive denial of service attack right now.

* They may have ramped up test kit production this weekend to 10k/day, so this may skew the numbers higher, as they are able to test more people.

* There are reports that the testing is not fully accurate, if you’re in the early stage, where the virus hasn’t generated enough markers to be detected yet. So, this is a false negative, where you are actually infected, but the test says that you are not. This might be why they will only clear you, if you get two negative tests in a row.

Yes, but likely at a predictable and slowing rate. Some graphs I've seen look something like a bell curve.

if a virus would wipe out say 50% or 75% of humanity, it would be terrible for us but wouldn't be that bad for mother nature. It may provide a couple of decades (if not centuries) in which nature is able to recover from us.

I think thanks to global warming, there will be many more diseases coming our way. Things that our immune system has never previously had to fight against and for which there is no cure.

Might be a alit more if some of our nuclear reactors arnt shut down properly

From the perspective of mother nature, Chernobyl is just a wildlife preserve already now; if our reactors explode, that would be bad for us but no big deal for ecosystems after some reasonable timeframe e.g. 10000 years - long term for us, but short term for evolution. From the perspective of Earth, a few millenia of active humanity is just a tiny spike that's inducing lots of rapid change, but very short.

Chernobyl was controlled if the firefighters didn't sacrarice their lives most of Europe would have been irradiated and that was just caesium . Uranium would have been a nightmare

I think your comment hits the nail on the head. Statistics about viruses are based on tests and test kits are limited, personnel to test are limited, lab capacity is limited. The results we see may be heavily influenced by testing capacity.

Like in any other epidemic as well. So that in itself is nothing special or something to worry about.

WHO daily situation report data (global) charted and updated each day: https://w.wiki/Gk4

The numbers from Wuhan are simply wrong and we have no idea how many people there are infected or how many have died. So you should discard all data from Wuhan at least before doing your analysis.

The whole city is under quarantine, people may not be able to get to a hospital. Even if they do, hospitals are overloaded and beyond capacity. If people there die before being tested their death won't be counted as being from coronavirus. If they have mild symptoms but are not in a serious condition they would be stupid to go to a hospital and get tested (and risk getting infected). And China is a communist country so the numbers should be taken with a large grain of salt anyway.

People have really strong reaction here. Outside of popular news, we know how to deal with incomplete data and biased numbers. This probably should be told more often when reporting the cases on the TV, but I expect anyone actually having impact on the issue understands that any actual counts we get are a lower bound, that testing resources and travel regulation affects the reports, and how to take into account other reporting biases. This is not a new idea.

I was replying to this: "I just copied the data from WHO sitreps and the total-cases diff of diffs has been increasingly negative for three of the last four days."

In any case I disagree that the data from Wuhan contains any information. Even if you can magically model away all the problems in the data, the Chinese government is still a disreputable source. Chinese state media is notorious for only showing the CCP in a good light. When you see the words 'Xinhua News', what comes to mind? Propaganda right?

I don't understand why people think that China is publishing the truth now, when China is in crisis and freedom of speech is trending on Weibo. Surely this is the time to turn propaganda up to 11.

These numbers are the most powerful tool that the Chinese government has for propaganda right now. And given their penchant for it, the baseline assumption should be that they are being massaged into the narrative that Beijing wants to tell.

We know how to deal with random noise in the data and random omissions in the data. However, if data is completly fabricated with no input from reality, then it's not possible to tell anything about reality from that data, only parameters of the (fictional) model used to generate that data. We can determine the assumptions about the disease which were encoded in that model, we can't validate whether these assumptions match reality.

the problem with official data is that it fits a quadratic curve so well it's hard to believe it's true.

https://www.reddit.com/r/dataisbeautiful/comments/ez13dv/oc_...

"Hey Xi, what's going on, this latest batch of infected is enormous! Is there something going on? We need to get on this now!"

"Oh whoops, we accidentally sent you next week's numbers."

Oh my WTF, they plonked the numbers into a quadratic and have so far predicted 5 days of deaths accurately.

Couldn't it just be that the virus, and the epidemic, simply behave like the are supposed to?

i'm not sure if we know how the novel coronavirus 2019 is supposed to behave.

because there are already Coronaviruses out in the wild. AFAIK causing quite a lot of colds every year. Then we know a lot about SARS and MERS. And the new Corona virus is having the shit anlyzed out of it. Plus We know a lot about epidemics in general.

So no, we don't have to reinvent the last couple of centuries regarding epidimiology research, everytime a new disease springs its head somewhere, and every "data scientist" on the internet tries to fit it in some kind of model without the necessary domain knowledge.

I think each day the infected count increases 2000 to 3000. It indicates a capacity limits at the health care system to diagnose and confirm an infected case.

"3.6 Roentgen not great but also not terrible"

To me the new infection numbers hovering around 3000 means they don't have capacity to test more or faster. Thats the biggest problem in Wuhan that the healthcare systems got overwhelmed so they are still trying to catch up. Where as rest of the cities got enough of a warning to maybe curtail the spread. With people themselves isolating themselves so that they don't catch the virus I personally feel the virus won't spread as fast in other places.

Indeed, I'm most worried about other asian and african countries where they can't muster the money, manpower or the coordination that the chinese gov't has done in order to contain the spread.

If this virus is like sars, it doesn't seem to transmit well in hot environments (which is why sars just went away during summer) at least it will not transmit as well in Africa.

Haven’t there been multiple local transmissions in Singapore, which is pretty warm right now?

Yes, but one would assume there is a lot of AC in Singapore.

Likely blasting full power in every large building. (It's really pretty much the case in every hotel / conference room) Which helps the air to mix where people meet.

A Chinese team of doctors working with the Chinese CDC released this paper on the characteristics of patients.

https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v...

(By the way I wish the mainstream media can report on more papers like this. I heard there are a number of papers released on the scientific information about the virus and patients)

“So what looks like a horrific disease may be the horrific tip of a very large iceberg”

https://www.sciencemag.org/news/2020/02/beast-moving-very-fa...

The sars outbreak of 2002 is also linked to bats. I wonder if when this outbreak is over if they go back to eating bats because "our traditions and culture". It's not a staple food like chicken or pigs.

As was the case with SARS, it's believed that the virus made the jump from bats to humans through another animal intermediary.

It was determined to be civets for SARS and I heard it was believed it might be pangolins for the new virus (but don't quote me on this).

AFAIK, it shouldn't be possible for the bats viruses we know to make the jump directly to humans.

So eating bats wasn't the cause of the outbreak in SARS and isn't the cause either for the new virus.

Pretty sure there was a story from a few years ago of a person dying from a then unknown virus after contact with a fruit bat in Queensland.

Edit. Here’s a link but not sure if this was the one https://www.abc.net.au/news/2013-02-22/queensland-boy-dies-o...

Oh, that's entirely possible.

I just heard that for this particular virus (the bat virus believed to be the ancestor of 2019-nCov), transmission to human without an intermediary was very unlikely since the bat version used a receptor that doesn't have an equivalent in human to infect cells.

Any animal, wild or domestic, can theoretically transmit diseases to humans if the conditions are right.

Ironically researchers from the Wuhan Institute of Virology demonstrated in 2013 "intermediate hosts may not be necessary for direct human infection by some bat like corona viruses"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389864/

Also, the lancet publication found that the first diagnoses on December 1st had no link to the seafood market

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Furthermore, university of Toronto just published a model showing likely start of the outbreak was November, which aligns with first reported diagnoses in December.

https://www.utoronto.ca/news/model-built-u-t-researchers-sug...

On that basis we should at the very least be cautious of the bat soup intermediary theory, and the media should stop reporting it as a fact that it was the source of the outbreak.

There are more than one Corona virus in the wild already. Usually they cause a simple cold. Also, did you know there are recurring outbreaks, albeit very limited ones, of Hanta in the western world? And the plague in India? And Ebola in Africa, right now?

Seriously, the press is notoriously bad at reporting stuff like that, like all complex potetialy scary things. I just thought that a community like HN would be wiser than falling for Dunning-Kruger about the own competency when it comes to diseases, and to go down the twitter / Youtube / "dark corners of the internet" hole.

The current claim in the media is that intermediate hosts are the vector for the virus. It is clear from published research an intermediate vector is not required.

These are all peer reviewed journals. There are no links to twitter / youtube / dark corners of the internet here. You assume that commenters on HN don't have experience working in this field.

I feel like this comment has been made without an insight into a biosafety lab's day to day workings or reading those papers from an informed perspective - so assuming a Dunning-Kruger effect through a lack of understanding of the person submitting the comments on HN. I believe this would be classed as a relativist-fallacy.

Then please explain this.

https://www.npr.org/sections/itsallpolitics/2012/08/07/15822...

This is a business in Florida that serves smoked fruit bats.

You know.. it’s the exact same type of bat that’s being linked to the coronavirus in China.

Explain it? It's a silly comparison.

That's a singular business (in an article from 2012), not hundreds of dangerous, wet markets that presently exist all across China serving tens of millions of people.

Show me the figures on the number of people in the US eating bats, versus China. Bat is not considered a common delicacy in the US. It's considered an extremely bizarre thing to eat bat in the US.

In fact bats are so rarely consumed in the US, it's difficult to find information on it:

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

https://www.tripadvisor.com/Restaurant_Review-g34407-d388919...

Seems to have gone out of business. Doesn't exactly seem like serving bats was popular enough for them to stay afloat.

The bat video you've seen is a Chinese tourism TV show eating it in the Pacific..

It's equivalent to an American TV person eating fried cricket on a stick in Thailand, or fermented fish in Iceland..

>It's not a staple food like chicken or pigs

You forgot to add "in western culture"

It's not a staple in China either. Chicken and pigs are.

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