How to Save Lives in a Covid-19 Pandemic | Hacker News Reader

How to Save Lives in a Covid-19 Pandemic

thinkglobalhealth.org

52 pointsanarbadalov21 comments

I've been following MEDCram¹ on YouTube recently. It's a medical channel for students by doctors I believe, but currently it's all about COVID-19 obviously². It often speaks to other medical practitionners.

The quality of information on such a channel (prob. not the only one, just my own serendipity) is outstanding compared to any 'mainstream' media out there — with good reason, it's not sexy to downplay mass hysteria or talk about actual RNA mechanisms with schematics.

Here's my point, using an image: when the boat is leaking, I stick with the guy who built the boat (and help him if that's the right thing to do); while the poets and dramaturges aboard make noise for the sheep, eventually the fish if we only listened to them.

Reality ≠ fiction.

Global information ≠ mainstream news (sad but true, whether medical or financial or else).

[1]: channel: https://www.youtube.com/user/MEDCRAMvideos

[2]: COVID-19 updates: https://www.youtube.com/playlist?list=PLQ_IRFkDInv-NvRRUN0aq...

What scares me the most about this coronavirus are infected people testing negative multiple days in a row only to test positive later. There are two explanations:

1. The diagnostic accuracy of the current tests is too low or

2. Some people do not clear the virus, their symptoms simply resolve, but this leaves open the potential for a flare-up later in life.

Either scenario is bad, and we simply don't have enough information about the virus yet.

Given how little is currently known about the virus, I think drastic steps including quarantining US cities are warranted. So far, only China appears to have implemented a successful quarantine. Hell, the Diamond Princess was a disaster, showing how hard it is to contain the virus. I think as a society we need to accept drastic measures to stop the spread of the virus. This will slow the spread of the virus, buying us time to develop countermeasures like vaccines.

AFAIK there are different tests with varying accuracies. Those with low accuracy tend to be ran multiple times to help. Despite having to run multiple tests, capacity for these low accuracy tests is much higher than the tests the CDC attempted to distribute, and these are the types of tests countries with a huge number already tested have tended to use.

Testing by local hospitals and universities in the USA has also been held up by FDA regulations that only recently (last week) were waived.

The USA is behind this thing by a long shot. We are thinking about stuff now that we should have thought about at least a month ago. Another example is the federal government contemplating covering tests when insurance won't. The time to contemplate this was months ago, not today. This should have been decided, at the very latest, weeks ago so it could be rolled out at the proper time.

> I think drastic steps including quarantining US cities are warranted

Do you expect whole cities, such as Seattle and San Francisco to be able to survive when people are not allowed to go to work? People such as grocery store workers, restaurant employees, Uber drivers, and so on?

Who will pay their rent?

The United States, at present, is not prepared, at all, for handling a month-long quarantine of any major city. The poor people in that city will suffer, hard, and the fall out will be worse than the 2% death rate in those cities.

I think the 2% death rate is only when your healthcare system isn't completely overwhelmed and you have enough mechanical ventilators for the ~20% of cases that need them.

I read the other day that there was a difference in virus shedding throughout the body. Orally, no virus might be shedding for an oral swab to come up positive, but the same patient might test positive with anal swabs taken the same time.

Reports have just come out that Spain has had its first death from this virus. The really significant news is that this death occurred on February 13th - before any cases were reported in Spain at all. This is very concerning.

https://www.reuters.com/article/health-coronavirus-spain-dea...

Isn't that the opposite of concerning? It shows that the virus has been in Spain for some time now without noticeable impact.

Or there hasn’t been enough to notice yet, but they’re about to explode with cases and deaths like we keep seeing.

Is there any sane information on this Covid-19 except alarmism?

Thomas Bollyky, the editor of Think Global Health and director of the global health program at the Council on Foreign Relations, is hosting an AMA on it right now! https://www.reddit.com/r/worldnews/comments/fcwnw5/im_thomas...

full disclosure: the company i work for (the MIT Press) published a book of his ("Plagues and the Paradox of Progress: Why the World Is Getting Healthier in Worrisome Ways") last year.

edit: also, i don't this article is alarmist; it's a useful and measured piece by the former director of the CDC.

Here's some solid data:

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

It's...sobering.

This Week in Virology is a very accessible podcast hosted by real academic virologists: http://www.microbe.tv/twiv/

As you can imagine, their main topic over the past few weeks has been the new coronavirus. They're very sober and rational about the new virus, but they're pretty clear that it's an extremely serious issue.

One issue that they raised in this week's podcast was that work on a SARS vaccine ended years ago. After the virus disappeared, there was no more commercial interest in developing a vaccine against it. Governments should have stepped in and continued research into coronavirus vaccines, but this sort of research is underfunded. The podcast hosts obviously have an interest in saying this, but given the current situation, I don't think anyone can really claim they're wrong!

Has it occurred that the situation is in fact alarming?

When does raising an alarm stop being "alarmist"? 5,000 dead? 10,000?

5,000 people die in New York City every month. Well over 10,000 people die from the normal seasonal flu each year in the US alone. Also in car crashes.

You didn't answer the question.

Then I will repeat myself more bluntly. Any alarm that would trigger on the annual seasonal flu or on merely the standard background death rate is a meaningless alarm and is therefore alarmist, so no, 5,000 to 10,000 deaths does not clear the threshold.

There is the WHO: https://twitter.com/WHO/status/1234871709091667969

COVID-19 is roughly 20x more lethal than the flu, and we have no therapies or vaccines.

Fortunately (contrary to my prior understanding) it does not spread as efficiently as the flu, and there are measures that can be taken to help contain the spread.

"With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19"

Would be interesting to know how it is determined that it does not spread as efficiently as the flu.

It's a much deadlier flu that nobody has an immunity to, that we can't vaccinate for, that China managed to contain at grievous economic cost, and that the United States is failing to contain.

That should be pretty alarming. I understand that a 20-something-year-old with no medical conditions may not give a damn about this sort of thing, but as a public health problem, this one is incredibly serious.

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