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Comment by gwd | Hacker News Reader

If you look at the breakdown of infections vs deaths in China[1], you'll see that the death rate outside of Hubei is far lower than the death rate inside. As of yesterday, Guangdong, for instance, has had 1345 confirmed cases, but only 6 deaths -- in spite of the fact that at least 800 of those had been exposed more than 2 weeks ago[2].

The most likely explanation to me is that the hospitals in Hubei have been overwhelmed. Obviously that means we should be vigilant about limiting the spread of the disease, so that hospitals elsewhere aren't overwhelmed. But catching it isn't the immediate death sentence headlines like this indicate.

[1] https://www.who.int/docs/default-source/coronaviruse/situati...

[2] https://www.who.int/docs/default-source/coronaviruse/situati...

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The scary thing about this virus, isn't the mortality rate, but the high R0 value and the potentially high proportion of infected people who are classified as severe cases.

Assuming that 20% of the US population (330 million) gets it, we're looking at about 13.2 million (20%x20%x330 million) patients who require admission to an ICU ward. Needless to say, that is enough to overwhelm the healthcare system and hospitals, and increase the overall mortality rate, when people who requires ICU are turned away due to lack of beds or equipment.

As it is, the best option would be to delay the spread as much as possible, so that the number would be spread across a time-span for as long as possible.

I don't think that number is accurate because so many people are not tested. Only people with severe infections are tested or those who have been in contact with known infected people.

With the deaths in Italy it is now also unclear if one person actually died from COVID-19 or if it was the late stage cancer they had.

Never mind that, far before you get to 20% the billing issues will destroy the system: https://www.miamiherald.com/news/health-care/article24047680...

If you charge $1,400 to each suspected person then either the testing will bankrupt the population or people are going to hide from testing. If coronavirus arrives in bulk in the US, then it's either going to be "Medicare for coughs for everyone" or a pandemic.

This is something insurance will cover, and 90% of the American population are already covered under health insurance.

https://www.cbo.gov/publication/55085

Are you sure? I couldn’t say with certainty whether any emergency service is covered by my insurance. There are no blanket statements and a relatively high co-insurance to ER services. Most policies have over $10,000 in co-insurance so stating that 90% are technically covered doesn’t actually respond to the parent’s claim. You’d have to know intimate details for how the service is billed which is apparently impossible before receiving service. If you don’t believe me call your hospital or your physician or your insurance company and ask what your out-of-pocket would be. Nobody can tell you.

What percentage of that insurance doesn't involve arcane rules about what's covered? My parents recently learned, following my dad's heart attack, that our town's ambulance was considered "out of network" and told they should have shopped around first. I had the pleasure of overhearing this conversation. Combined with the fact that many rural and suburban folk can't afford a $20 copay for a regular checkup let alone thousands of dollars for their deductibles, I put little confidence in that 90% coverage.

The article explicitly says that (a) he has insurance (b) this is out of pocket after insurance and (c) the insurance is disputing whether to cover this at all:

> Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a preexisting condition.

Also for the irony:

> Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance

Another thing to consider is that more public facing jobs like the Starbuck's barista, is also part of the population that fears doctor/hospital bills the most.

> The scary thing about this virus, isn't the mortality rate, but the high R0 value and the potentially high proportion of infected people who are classified as severe cases.

This is kinda where I'm at right now. The true mortality rate is almost certainly well below the 3% being reported now due to a high number of mild unreported cases. That said, the speed with which it is spreading combined with the potential severity is cause for concern.

If we compare this to the previous SARS and MERS events the trajectory is worrying. The SARS epidemic lasted 19 months and resulted in 8400 confirmed cases. The MERS epidemic has been ongoing since 2012 (very few cases after 2015 though) and resulted in 2500 confirmed cases. The current Coronavirus epidemic has only been going for a little over 2 months and we're already over 80,000 confirmed cases with no indication of a slowdown.

As a counterpoint though, from October through December of last year, there were 3.7 million cases of the flu in the US alone.

I'm less worried about death rate than the long term damage I might likely suffer from. The paper mentions that the onset of pulmonary fibrosis may be close to levels seen in SARS/MERS (~45%) and usually develops 3-6 months after the infection. There has also been another paper[0] indicating high chances of testicular damage.

There is an interesting thought experiment here. Hospitals are a large vector for spreading the disease. On the individual level you'd want to stay away from them as much as you can. On the collective level, that behavior is counter-productive ofc.

[0] ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...

Pulmonary fibrosis is essentially a death sentence, too. It’s important to keep that in mind.

If I understand the relevant parts of this paper correctly, then this pulmonary fibrosis is not an ongoing and worsening condition in patients recovered from SARS. They "merely" attest that there was more long-term damage to those patients lungs that took months to recover (if at all). Not in the field of medicine though, so I might be incorrect.

That is a possible explanation, but not necessarily the most likely explanation.

It's also quite plausible the Hubei numbers are being scrutinized and processed differently (perhaps with input or oversight from the central government) whereas the other provinces are relying more on local provincial officials' reporting. There is a high incentive for these officials to avoid reporting negative news, so a bias towards low numbers would not be surprising.

We should rely more on international numbers instead of Chinese ones and particularly look askew at the China ex-Hubei numbers.

Beyond hospital admissions being overwhelmed in Hubei, the rate of infection spreading probably far exceeded their ability to test everyone and as a result there were probably considerably more infections than the official numbers.

eg from Jan 26

>Prof Neil Ferguson, a public health expert at Imperial College, said his “best guess” was that there were 100,000 affected by the virus even though there are only 2,000 confirmed cases so far https://www.theguardian.com/science/2020/jan/26/coronavirus-...

We know the death rate raises with time, we have seen this before with SARS. It takes people time to die.

We are you contradicting what we know? This needs a good reason. We've even been through this stage in Hubei, it started low if you just superficially look at figures.

"In the early stages of the SARS epidemic, health officials estimated the mortality rate at less than 4%. More recently, officials have cited rates in the 6% to 7% range. Today's SARS figures from the WHO—6,903 cumulative cases and 495 deaths—point to a case-fatality ratio of 7.2%. But WHO officials note that this calculation underestimates the rate, since some currently ill patients will die of the disease."

(2003) http://www.cidrap.umn.edu/news-perspective/2003/05/estimates...

> It takes people time to die. ...We've even been through this stage in Hubei, it started low if you just superficially look at figures.

Right, that's why I used Guangdong as an example, and not (say) Korea or Japan, and compared cases 2 weeks ago vs deaths now. How long a lag time do you think is better?

Hard to say. 4 weeks at least I think. 4 weeks to start to snuff it. But it will be longer for many people. It's a good question, that's in part what the OP is trying to work out.

Look at the (ongoing) deaths on the Diamond Princess

https://www.princess.com/news/notices_and_advisories/notices...

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