Hacker News Reader

Go check out the case fatality rate and estimated r0 for the Spanish Flu of 1918-the deadliest pandemic of the past several centuries. You'll note that its characteristics are fairly similar to what we know of Covid-19. The only break we get is that young adults don't seem nearly as susceptible to Covid-19 as they were to Spanish Flu. But everything else points to the possibility of a pandemic along the lines of Spanish Flu. That's why we are so concerned.

Media aside, the CDC isn't prime to exaggeration, and China isn't prone to completely shutting down the economy of entire provinces of millions of people without dire need.

And there's every reason to believe we will have a similar experience to China's.

Everything else doesn’t point to that. Media FUD points to that.

If we have a similar experience to that of China it seems like it won’t be a big deal.

In 2018-2019 80,000 people died from the flu in the United States. 80,000. No one really cared.

The death rate for the current coronavirus seems to be about 2%, but it’s likely even lower than that since so many cases are going unreported since the symptoms are so mild in most people.

I see this whole thing as some kind of bizarre media externality. The disease here is a social one. It’s like the media has evolved in such a way that FUD has manifested into something that is almost tangible.

It’s not the coronavirus you need be worried about, but the meta-coronavirus. It’s making people crazy.

> The death rate for the current coronavirus seems to be about 2%

The United States has about 2.7 hospital beds per thousand people. Hospitalization and attentive care is the biggest contributor to survival rates for COVID-19 patients.

This is why medical professionals are concerned that is spreads effectively without presenting symptoms. One day you are going to wake up and every primary care facility will be overwhelmed.

I’ll start to worry after the first 80,000 people die.

The US has shit medical care for most people. People will get sick and die before thinking about going to the hospital. I wouldn’t worry about them being overwhelmed.

Then people will die at home.

> I’ll start to worry after the first 80,000 people die.

Flu's already horrible. You'll take it seriously only when it's proven that it's going to be much, much worse than flu?

I'm glad that most people take measures before calamity.

Agree with you 100%. I have a family member that specializes in communicable disease - she's got 25+ years of experience working on the front lines specializing in responding to disease outbreaks like this. She literally writes the policies and training material for professionals in this area. She's absolutely livid at the way the media and politicians are dealing with this. The CDC and WHO are being forced to respond the way they are because of the political and social pressure. They're trying to keep people from panicking but they just get accused of trying to cover up 'the truth' if they try to downplay the media driven frenzy.

Can you ask your family member why she thinks China is destroying their economy over this?

I've never really been worried about disease outbreaks in the past but this is different.

> she's got 25+ years of experience working on the front lines specializing in responding to disease outbreaks like this. She literally writes the policies and training material for professionals in this area.

This isn't the right set of qualifications when it comes to understanding the total impact. Aside from the front line staff often not having a high-level understanding of epidemiology, I also don't think she understands the economic costs of containment.

Early on, there was a huge amount of complacency because we've been successful in the past and nothing like this ever came to pass. Expertise in some narrow field can only go so far - unless they are familiar with this particular case, how different it is from other pathogens they have experience and sufficiently mathematically inclined to be able to extrapolate beyond the existing data. We have a once-in-a-life type of pathogen IMO and 25-years of experience may not matter much if they are merely looking back in their experience to find similar situations.

> She's absolutely livid at the way the media and politicians are dealing with this. The CDC and WHO are being forced to respond the way they are because of the political and social pressure. They're trying to keep people from panicking but they just get accused of trying to cover up 'the truth' if they try to downplay the media driven frenzy.

How people tend to respond to events like this is part of the reality of the situation. You can't simply hand-wave away the social, political and economic consequences of the expected responses and how that affects the disease-fighting efforts.

This reminds me of the financial crisis - if you did a top-down analysis, it pointed to an unprecedented situation and it was easy to see how the market actors would response in a way that would compound the crisis but but most experts had never seen something like this, didn't have a comprehensive understanding of how things work, had never seen true panic and had some flawed models telling them that in some perfect world, things are fine and some of the earlier market movements were irrational overreactions.

> symptoms are so mild...

I have to confess that im not following the entire situation but your statement brings me some hope so I'm asking- can one get affected and still not get sick at all?

I'm also hearing that people can get and ARE getting reinfected.

The majority of cases are mild or don’t have any symptoms. It’s 10 times deadlier than the flu, but that just means 4 out of 1000 40 year olds will die from it compared to 4 out of 10,000 for the flu. 95% of people under 18 have no symptoms. There are no reported deaths of children.

But if you have heart disease or diabetes or other health issues, or are over 70, you’ve got a 1 in ten chance of dying or worse.

> The only break we get is that young adults don't seem nearly as susceptible to Covid-19 as they were to Spanish Flu.

The suspicion was that Spanish Flu set off cytokine storms in young people with robust immune systems.

This doesn't seem to be happening with Covid-19.

Yes, instead it’s setting off cytokine storms in older people.

Actually it didn't at first. The Spanish Flu went through 3 waves.

The first wave was very similar to the standard flu. Fairly mild, primarily killed the elderly and sick. It first appeared around January.

The 2nd wave is what killed young people. It didn't show up until August.

More people died from the Spanish Flu than from combat in WW1 and WW2 combined. That was the first global pandemic due to soldiers traveling around the world. What's a modern version going to look like in an era of airplane travel?

25x more people died from the flu in 2018 in the United States alone then have died from COVID-19 globally.

... so far.

Even this year… 16,000 people have died from the flu so far, and this is a particularly mild year, save for the high amount of childhood deaths.

COVID-19 seems to be almost completely manufactured hysteria based on fuzzy math which includes using very low estimates of the number of infected to artificially increase the fatality rate.

When all of the top epidemiologists, public health officials, and physicians from around the globe are sounding the alarm to take something seriously - it's probably a good idea to take it seriously. If it turns out that Covid-19 is a dud in terms of impact, it will be because of not in spite of the substantial steps people are taking to be prepared.

All the headlines seem menacing but then I look at the data and stand back and say WTF.

It already is a dud. Relatively speaking, very few people die from this. 80%+ of confirmed cases are so mild you have to wonder why they were even tested. It seems to not spread as fast as the flu. No children have died.

Basically, it’s been three month and 2,000 people over 70 have died globally.

More people died from the flu LAST WEEK IN THE US ALONE.

Yes more people have died from the flu so far, but Covid-19 was only officially identified last month and is growing exponentially. Based on the studies we have seen so far, it is more contagious than the flu (R0 of 2.2 vs 1.3), and significantly more deadly (fatality rate of 2.3% vs 0.1%). We're still in the early stages of this and it is continuing to spread.

It is not growing exponentially.

Think about what exponents are and what an exponential curve looks like.

Look at the ex-China infected graph here, and click the "logarithmic scale" toggle. Looks pretty close to a straight line to me. https://www.coronaviruschart.com/

China's growth in case count has slowed down. Whether that's because of massive control efforts (literally welding people in homes, etc), or because of inaccurate reporting / missed cases, or both-- is unknown.

Looking only at the total numbers paints a misleading picture.

It is no longer growing exponentially in China because they have quarantined millions of people. It was growing exponentially prior to the quarantine.

It is growing exponentially in other countries with recent outbreaks. Look at the growth charts for South Korea, Italy, and Iran.

While it is good news that the growth can be contained via quarantine, it is incredibly misleading to claim "this is just like the flu". The flu doesn't require the government to force people to stay locked up in their homes in order to prevent outbreaks.

You are correct in that it’s not just like the flu. It’s much less severe and not as trendy. You can’t sell the flu. This you can sell.

It's maybe ten times more lethal than flu, and there's no vaccine for it at the moment.

There is little evidence of that other than people manipulating the numbers to favor that outcome.

Even within China, Outside of Hubei the fatality rate is just 0.4%.

This 10x nonsense is so utterly bogus. People literally can not think for themselves anymore. Just read and regurgitate FUD.

You seem really hung up on the fact that the flu has killed more people. But based on all the studies we've seen so far, this virus is more contagious than the flu, and more deadly as well. If it infects the same number of people as the flu does every year, a lot more people will die.

Multiply those flu numbers times ten and that’s where we’ll be in a year.

If I sold you a car for $1.00 the first day, $2.00 the first day, $4.00 the third day, ... It would look like a pretty good bargain the first few days compared to what people typically pay for cars. Eventually, on day 14, you start to reconsider how good the deal is when you make a $16,384 payment and face making a $32,768 one tomorrow.

If COVID-19 spreads exponentially, it will result in basically everyone getting it. Yes, it will take a little while (and maybe spring/summer will do enough to put on the brakes to let us have more treatment options). The fatality percentage, means if everyone gets it, it will be like several years of flu concentrated over a year or two.

Besides that, it's likely to overwhelm public health systems and have societal/economic consequences from the amount of sickness and attempts to contain the virus.

If major world governments started saying they were about to nuke one another it would not be valid to say "Why are you so worried about nukes? Car accidents killed a million people last year and nobody died due to nuclear weapons."

A pandemic from a novel virus is a black swan event that is not well represented by looking at recent statistics. The risk is not the recent past, but the possible future where this infects a significant percentage of the world's population, overwhelms our healthcare system, and kills millions if not more.

The Chinese Flu.

People died from the Spanish flu because they were malnourished and because the general conditions were bad. The Spanish flu would be nothing like that if it happened today ... In Europe at least.

Some interesting read: https://www.frontiersin.org/articles/10.3389/fcimb.2018.0034...

Famously, the disease hit soldiers in basic training hard before they were deployed. These were not malnourished people. It's entirely likely that malnourished populations suffered greatly under Spanish Flu, but it's clear that completely healthy young adults were highly vulnerable to dying from the disease.

Who was healthy 1918? Aristocrats and generals maybe. There was still a World War going on when it started.

That article doesn't seem to support "because they were malnourished" at all... it correctly points out that the 1918 pandemic was unique in having high mortality among the young (under 30) due to "Lack of pre-existing virus-specific and/or cross-reactive antibodies and cellular immunity in children and young adults" which doesn't seem to be the case with the current virus which seems to affect mainly the elderly.

It's down the list/text. But please keep in mind: this happened 1918.

Diamond Princess cruise ship shows that it’s not even close to Spanish flu in mortality. Because the symptoms are mild for 80% of people, the reported cases are severely underreported. Only when a whole populace is tested do we see the true infection rate.

OK, you've mentioned two different measurements: infection rate (I'm guessing you're referring to R0) and mortality (do you mean mortality rate or case fatality rate, because I was referring to the latter one).

The cruise ship had a strict room-based quarantine, so that would not infect the R0 of a general community-based outbreak, unless we institute similar measures (confining people to their houses, which is likely not feasible).

If you're referring to case fatality rate, I'm really interested in that data. Do you have a link? The case fatality rate from the cruise ship is a very small sample, and a very specific population, so it's susceptible to all kinds of bias. It's unlikely to be an accurate reflection of case fatality rate in the general population. Still, I'm interested in those numbers. I've not been able to find them online. Did they test all the people on the cruise ship?

Diamond Princess cruise ship shows nothing yet. Most those who got sick are still sick. You cannot do the mortality math until people are either dead or cured.

>every reason to believe we will have a similar experience to China's.

With a bit of luck you may have an experience more like Singapore, the UK or Vietnam (30 active cases, 72 recovered, 15 active, 8 recovered, and 0 active, 16 recovered respectively)

China got off to a bad start due to the thing starting there and being unexpected.

Singapore has tested thousands of people, and meticulously traced every single contact.

In the US, we are far far worse off with cases popping up everywhere of unknown origin and almost zero testing.

> I really don't get why people get so worried about this. Especially on a science oriented forum like HN.

Because of the death rate.

We're basing what we know on China, but can we really trust their numbers? We'll soon have more reliable figures from Japan, Korea, and Italy.

Iran has reported a death rate of up to 17%.

Healthy people are dying too. Young people.

And if the medical system gets overwhelmed, those that develop pneumonia will be fucked.

(I'll chase down citations and edit my post to include them.)

But what about selection bias? The mortality rate is an upper limit at the moment. Is it just wishful thinking that maybe in reality 100 times more people are infected but show no to very little symptoms? The number of people that can be tested is very limited, so only the cases are tested which are above a certain threshold in severity.

Every person infected on the Diamond Princess was identified (~800 people, older cohort than the general population), and 6 people have died so far, with optimal care. That's a strong indicator that it's much worse than the usual flu, though hardly Captain Trips.

Valid point! This is indeed already much higher, and only sets a lower bound. So we should keep an eye on this well controlled sample.

So we have a lower bound of somewhere around 1% and an upper bound of somewhere around 7% ( https://www.worldometers.info/coronavirus/ ) at the moment. Not very reassuring.

I just finally read the The Stand a couple months ago. Not the best timing in retrospect. Also had just started playing Pandemic Legacy, but I had to stop when the cover image of the game started looking the same as the front page of the newspaper.

I'm extremely skeptical of a 17% case fatality rate (likely not death rate, which is different). That's almost certainly high due to under-reporting of cases. Iran's public health surveillance system is likely not as good as China, and they've not acted with the alacrity that the Chinese have.

But it doesn't have to be a 17% CFR rate to be a disaster. The Spanish Flu of 1918 just had around a 2-3% CFR, but it was easier to transmit than the common flu, so it spread quickly and lots of people died. Covid-19 appears to share the relatively high r0 of Spanish Flu. So there's ample reason to be concerned.

> Iran has reported a death rate of up to 17%.

Apparently Iran also had a high death rate for spanish flu.

From wikipedia:

> 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.[67]

> -- https://en.wikipedia.org/wiki/Spanish_flu

Iran was also at the tail end of 4-year, 3-sided war that killed around 2M people. The very fact that there's 1.5M people (!) leeway in the numbers tells you something about the state the country was in, and how difficult it is to attribute those deaths specifically to one thing like the flu.

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

There’s no reason to believe the Iranian number is anywhere near accurate. On the contrary, it’s likely that the cases confirmed number is too low everywhere except maybe the diamond princess. Quoting 17% as the possible death rate is just inciting panic. It’s likely much lower. Which is not to say you should not worry; I think it’ll reach most people and end up killing millions.

2,900 deaths in a country of 1.39B. 2 deaths per million people.

If the same things happens in the US, that's 800 people dead in the US.

Almost 3,000 Americans die each month in traffic accidents.

Keep things in perspective.

2,900 deaths after shutting down the economy for a quarter or more.

2900 deaths in a few months, with more people getting sick every day. The process of viral expansion isn't linear...

> 2,900 deaths in a country of 1.39B. 2 deaths per million people.

1. You have no guarantee that it's not going to get worse.

2. And this was after a draconian quarantine, and nation-wide mobilization to prevent the spread.

How about 2,200 deaths in Wuhan of 10m people, only because it’s sealed off just in time so it’s not replicated in other cities across China?

This is a very silly post, especially for one claiming to be focused on being "science-oriented." Do you not understand incubation periods and exponents?

> what is currently the probability of catching the virus

Yes, that is the sudden cause for concern: we don't know. The incubation period is as long as 2 weeks before showing any symptoms, and there are now cases that have lost any connection to known vectors. To suggest that there isn't at least cause for worry is a bit ridiculous. We don't know how those people got it, we don't know how many other people got it, and we won't know for some time.

Some spread is thought to be possible before any symptoms manifest, which paired with a long incubation period with no symptoms, and the exponential way in which people interact is potential cause for concern...

From the CDC:

> The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

> This is a very silly post

For the sake of example, suppose I live in a country with 100 millions inhabitants, with 100 reported cases. Suppose that there are currently 100 times more cases. What do you think is the probability to get close enough to one of these cases to get infected? how does it compare with something like having a car accident, or getting complications for the common seasonal flu?

This virus is going to be a concern. A rough estimation tells us that number of cases increases tenfold every 10 to 15 days, depending on containment measures. It could peak at 10-20% of the population. We also expect the mortality rate to be something between 0.5% and 1%. So yes, there will be causalities, and we'll need to be especially vigilant in the near future, especially April and May. But right now, the probability to be infected if virtually zero. There is also not much we can do besides following CDC recommendations. The virus is going to spread no matter what.

Car accidents don't increase in incidence exponentially in a matter of weeks.

The chances of being infected right now are kind of irrelevant to this discussion; I don't see very many people panicking that they're necessarily concerned about this very moment, so I think you're arguing against a strawman. People are simply extrapolating a bit, and the trajectory is giving some cause for concern.

Bill Gates wrote a fairly cogent op-end explaining why we should be taking this seriously:

https://www.nejm.org/doi/full/10.1056/NEJMp2003762

The short answer is the combination of a high transmission rate and the ability to transmit the virus while asymptomatic means the number of infected people will grow exponentially. The Spanish flu had a transmission rate lower than Covid-19 and ultimately ended up infecting a third of the world's population, and that was before mass air travel was a thing. If Covid-19 reaches anywhere near that level there will be millions of deaths.

It is true that if you are young and healthy the mortality rate is low, but a 15% mortality rate in 80+ year olds and 8% in 70-80 year olds is pretty serious.

It's extremely unlikely for an individual, perhaps, and I'm honestly not particularly afraid for my life. (If anything, I'm worried about my convenience, whether I get sick or just people in my area.) However in aggregate if we act in a conscientious manner, we can slow or stop the spread in our own areas, and/or head off a run on supplies by doing some shopping early. I agree we need to be measured. I'm not changing my behavior much yet since community spread hasn't hit my area. Once it does I might try to reduce my time in public. Even now I may consider staying away from conferences that bring travelers, etc.

> I really don't get why people get so worried about this.

The virus has overwhelmed the healthcare system in multiple places (Hubei, Iran). Hospitals operate at or near capacity (empty beds don't make money), and do not have the resources to handle a 4-5x uptick in flu patients.

The mortality rate is strikingly different with and without quality medical care. You can see there is a stark difference in the mortality rate within Hubei (previously 4-5%) vs rest of China (0.4%). The mortality rate in Hubei has gone down in recent weeks (to 2.9%) as China has moved thousands of doctors/medical staff to the area and built tens of thousands of patient beds.

> Besides, symptoms are mild for most people.

This is an extremely deceptive talking point the media has been promoting. The WHO reports 80+% of cases have been mild or asymptomatic, but 14% have been serious and 5% severe [1]. As the virus is projected to infect billions of people this year, that would lead to tens of millions of serious cases, of which many would die due to lack of medical resources.

I would strongly recommend reading this article by an Australian professor explaining why the Australian medical system will be overwhelmed in the coming pandemic. It applies to most other western countries as well. https://www.theguardian.com/world/2020/feb/28/australian-doc...

[1] https://www.nytimes.com/2020/02/27/world/asia/coronavirus-tr...

Given the long incubation period for this disease, and the fact that it has a—give or take—3 percent lethality (though less for the young, but more for the old), then IMHO people should take it very seriously.

Some people even report a total of 3.4 percent lethality. To put that in perspective; that's one in about thirty people(!). No, it's not "Ebola," but it's still contageous and deadly. In that regard, the media is actually helping. If it's perhaps making some people more anxious than they really need to be, then it's a price worth paying.

As for how serious people take hygiene, IDK, man. I'm taking it very seriously myself, and so should you. If you see people caughing or sneezing without covering themselves, I'd politely ask them if they can please use the bent elbow in instead.

It depends on the kind of care you can get. With early detection and ample care it is likely 1% or lower. Chance for serious pneumonia (meaning having oxygen issues) is around 14% for the current mix of patients. In an overwhelmed medical system mortality rate will be higher than even what Wuhan experienced.

> I really don't get why people get so worried about this. Especially on a science oriented forum like HN.

That is downright obnoxious. Consider the following facts:

1. As another poster pointed out, millions of people in the US don't have health insurance. If they get a mild flu-like illness there is no chance they are getting tested. They'll pass it on to others in their community.

2. Millions in the US also have no paid sick leave, which is why I just roll my eyes when I hear the "stay at home when showing symptoms" advice you give. It's the ultimate oblivious "just let them eat cake" response to the dishwasher who won't be able to make their rent payment if they don't come in to work.

3. The death rate of those over 70 is in the high single to low double digits range. My parents are in their 70s, and otherwise in great health. I would be devastated if they were killed by coronavirus. Equating the significant possibility of them dying if they contracted the disease, something thousands of times higher than them dying in a random accident, to me shows that your line of thought is "Well, I'm in my 20s, 30s or 40s, so I'll be fine."

People are rightfully concerned because they are able to see the future impact the disease will have on others besides themselves.

I'm not personally worried, but today I cancelled my hotel reservation for RubyKaigi in April. Do I think I am going to get Corona Virus? No. It's very unlikely. Do I think I am going to catch Corona Virus at the conference? No. It's very unlikely. However large numbers means that the chance it happens to someone at some conference is incredibly likely. Indeed, there were just 8 cases in Hokkaido that seems to have originated from a trade conference.

There is no real need for me to go to a conference. I can wait until next year. If we avoid unnecessary interactions in large numbers then it will make a difference. Some people need to meet, but I certainly don't need to get together with a whole bunch of strangers in a remote location to talk about Ruby, so I'm not going to.

> This is not followed by most people in Europe

So why aren't you worried? My worry is that I'm hearing we're weighing the economic loss versus the health of people. The disease is spreading MAINLY because of air travel, and I don't see countries really doing thorough checks, or at least discouraging air travel for now, or keeping a list of people who returned from those countries.

Spreading fear in the media at least has the cheap virtue of encouraging people to wash their hands, avoid going to those countries, without the government spending money. The drawback is that people view this as fear-mongering.