Comment by sciinfo | Hacker News Reader

Comment by sciinfo | Hacker News Reader

There seems to be many cases of young patients dying in Iran. Either because there are way more cases than being officially reported or (hopefully not) the virus has mutated to affect the young more, or both.

The first hypothesis is likely based on the number of infections found in international travellers who went to Iran. We still cannot rule out the second hypothesis though.

A 23-year-old woman soccer player: https://www.reddit.com/r/Coronavirus/comments/faadg4/a_23_ye...

A male nurse talking of 8 deaths in one night during his shift. 23-year-old female (same case?), 29- and 30-year-old males, 50-year-old female among them. (1-minute clip)

EDIT: It's just n=8, but 37.5% dying at age 30 or below is most likely drawn from a different distribution from 0.6% among the 70,000+ cases in the largest Chinese study (where the worldometers data comes from).

EDIT 2: Based on a link in a sibling comment, only 7 deaths among 20-29 yo and 18 deaths among 30-39 yo in the n=44,672 Chinese report.

https://twitter.com/AlinejadMasih/status/1232779487647031302

http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...

Iran said it had no cases up until the moment it announced 4 people had died. Its safe to assume that the scope of the infection in Iran is either far greater than they have been able to track, or far greater than they are willing to admit. I think its less likely that the virus is killing more young people in Iran, and more likely that there are thousands if not tens of thousands of cases in Iran that simply haven't been counted/reported.

We saw the Iranian response to the airliner being shot down recently. It’ll be just as you say.

There’s something off about Iran. According to Wikipedia [0], Spanish Flu killed a much higher percentage in Iran too, in comparison with the rest of the world:

“The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).

[...]

In Iran, the mortality was very high: according to an estimate, between 902,400 and 2,431,000, or 8% to 22% of the total population died.” — source, Wikipedia, see [0].

I wonder if it’s genetics (immune system reacts differently?), or cultural (habits - kissing on cheeks, handshaking, large religious or non-religious gatherings) or climate, or a mix.

References: [0]: https://en.wikipedia.org/wiki/Spanish_flu

Edit: admittedly, it’s too early to draw conclusions. It’ll take a few weeks to have more realistic numbers.

It's hard to find up to date records filtered by country, but they might have higher count of the ACE2 enzyme which is thought to be an entry point for coronaviruses. Asian populations have much higher count than other populations.

https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_...

Once the beds are all occupied it doesn't matter how many a country has.

Source for Asians having more? This disagrees: https://www.google.com/url?sa=t&source=web&rct=j&url=https:/...

Would that mean Covid-19 would progress faster once inside the body? I assume that could mean an infected person’s immune system could be overwhelmed, hence resulting in a more severe case and even death.

> There’s something off about Iran.

Iran is a theocratic authoritarian regime under extreme international sanctions. Might have something to do with that. Iran also only has 0.2 hospital beds per 1k people.

It's in fact 1.5 beds per 1000 capita according to World Bank data.

https://data.worldbank.org/indicator/SH.MED.BEDS.ZS

The CIA begs to differ.

https://www.cia.gov/library/publications/the-world-factbook/...

A bit off topic but Iran is mostly only under American and Israeli sanctions at this point after Trump unilaterally pulled out of the Iran nuclear deal. The rest of the world can trade with Iran though many companies are still unwilling due to the American pressure.

Due to how interconnected European and American finance and business is this effectively means that Europe cannot trade to Iran.

The Europeans cannot enforce the JCPOA without either some kind of American cooperation or a major decoupling their financial systems from the US. I believe Macron has made public musing about the latter as an option, but then again Macron says a lot of things that lack pan-european support.

Specifically, the US imposes/threatens to impose secondary sanctions ie anyone who does business with Iran is also supposed to be subject to sanctions by the US, even if they are not US companies/US parent companies. So those companies can't then themselves do business with US companies or in the US.

Last I checked that still is international as it involves 2+ nations.. Not sure why you had drag Orange Man bad into this. You come off as a bit deranged.

The Spanish Flu was a hundred years ago, I highly doubt that what happened then in Iran has much relations to what's happening now.

What's happening now has more to do with their theocratic regime that didn't take the threat seriously and doesn't care much about their people.

Wouldn't that require two unrelated explanations for higher viral-outbreak mortality rates? Isn't the explanation that doesn't require a coincidence more plausible?

> Wouldn't that require two unrelated explanations for higher viral-outbreak mortality rates?

That doesn't sound unreasonable at all when the two outbreaks are separated by a century. A lot has changed between 1920 and 2020.

I have a suspicion, and it sounds obvious when you state it, that there's a correlation between smoking and severity and both China and Iran are relatively heavy smokers.

For the first time since the revolution Friday prayers have been cancelled in Tehran. They are still on in Qom.

https://twitter.com/alihashem_tv/status/1233017138119659520

> There seems to be many cases of young patients dying in Iran. Either because there are way more cases than being officially reported or (hopefully not) the virus has mutated to affect the young more, or both.

They could easily have had an undiagnosed underlying condition that made them more susceptible to complications. This is to be expected in places like Iran with severe limitations in their healthcare system. It might be a more useful data point if it was from the US, UK, Spain, etc.

Yes, or a specific HLA type that is more prevalent in the population.

Is it just me or is your comment really insensitive? I would think that about half of world has no better healthcare system than Iran.

It's you. That half the world has no better healthcare system than Iran is a sad reflection on the state of healthcare in world, not an implication that Iran's dilapidated and overstretched healthcare system\* is a good one. Combine that with their authoritarian government with zero communications skills and no credibility due to being habitual liars, and we should place no stock in their reassurances/projections, and very little stock even in their hard-to-fuck-up stats like # of deaths.

\* I should say this is anecdata, based on comments by several Iranian friends and acquaintances.

I'm not defending Iran's healthcare system. The info I was able to dig up places it as above average, which means that more than 50% of world population will be affected just as bad or worse. Dismissing Iran's data point as not useful takes a specific viewpoint that I consider not empathic enough for my tastes, but everyone is free to disagree.

I don't see the insensitivity. This subject is not something that's very sensitive, I just see the comment as objective.

> half of world

Like he said, severe limitations.

Iran's healthcare is a lot worse than would be expected for a country of its wealth and development level because of the US embargo.

Why would you think a country under severe sanctions can have a very good health care system?

Could be many reasons: 1. Iran has more young people. 2. Iran does not have any monitoring program of significance 3. Young people in Iran are probably more mobile and more likely to contract it.

> 1. Iran has more young people.

Just wondering if that's true. It does look like that's the case:

https://www.gapminder.org/tools/#$state$entities$show$geo$/$...

Preprint paper of Iran infection estimates the number of infected around 18k. (https://www.medrxiv.org/content/10.1101/2020.02.24.20027375v...)

Dr. Li Wenliang, who warned of Covid early on, was also only 34 years old.

Doctors and nurses are exposed to a much higher viral load than most people. In Wuhan, they may also overwork and have insufficient sleep.

Good thing no younger adults in the western world are overworked and under rested ;)

> higher viral load

What is "higher viral load"? Isn't it binary - you are either infected or not?

Agree but they may also be constantly reinfected.

If you’re infected by a couple of individual viruses, it’ll take a while before it starts spreading throughout your body, which will have more time to prove an immune response. Compared to essentially bathing yourself in it for days at a time.

afaik viral infections increase at an exponential rate. If the initial load is higher, the peak infection before your immune system can get things under control will be much higher/dangerous.

Ex: 3^10 v.s. 30^10

Exposure to a virus doesn't ensure infection - there is some probability involved, depending at least partially on the number of virus particles that you are exposed to, over what period of time.

Viral load is literally a numerical expression of the quantity of virus in a given volume. It is often expressed as viral particles, or infectious particles per mL depending on the type of assay. And a higher viral load often correlates with the severity of an active viral infection.

No, your symptoms are affected by the number of viruses in your system. The virus is constantly replicating and your immune system is constantly destroying them. If the rate of increase is greater than the rate of decrease, you will not recover.

Iran is an outlier because it has an extremely poor healthcare system for a country of its size or GDP.

Same goes for their high death rate. Either they're lying about infections (which seems to be the current shared assumption of everyone else) or their version of the virus grew some really nasty teeth.

Citing individual deaths is sort of meaningless without an idea of how many people are sick. I suspect it’s in the many thousands in Iran already.

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