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Comment by the_af | Hacker News Reader

I see a lot of panicky comments, both in real life and in this very thread.

I know COVID19 is different from a regular flu, but is it more serious? "Regular" flu is very contagious and kills lots of people every year. It's ok to study coronavirus and to try to find ways to effectively manage it, combat it or prevent the disease -- but why are we panicking? Nobody panics about the flu and it's proven to be fatal for a lot of people every year. Why the panic with coronavirus, why are people in this very thread worrying about "the death toll"? Is there any projection that the death toll is going to be higher than usual for a flu?

For what it's worth, my doctor told me "it's like a flu, don't worry". A doctor friend of mine told me the same.

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A single individual getting coronavirus isn't a big deal. Chances are they will be fine.

The problem is that it's very infectious, R0 could be 6+ where the flu is about 1-2. That means it's 3-6 times more contagious than the flu, so it spreads very very quickly.

At the same time, it causes severe symptoms in 15-20% of cases. When these people have access to medical care, they will likely survive. But if they don't get access to timely health care, they might die, which is what happened in China.

The problem with both the above is that you will get many, many people infected all at the same time, and you might get a few hundred people with severe symptoms in a small city. That's enough to overrun several hospitals all at the same time. The US has about 2.5 hospital beds for 10,000 citizens, which is 31st in the world. Japan and Korea have over 12 per 10,000 citizens. the top 2 in the world. And the patients that get severe need ventilators which are even less than this.

Once the hospital beds are filled, people start dying, which causes panic. Then economies will start to suffer because no one will eat at restaurants, people will panic at Costco like we've seen, businesses will go out of business.

People forget that this is simple math. Coronavirus will spread very quickly in the US and across the world. And many people will die and all hospitals will get overrun. What we need is at-home treatment and to somehow get people to avoid getting severe symptoms. If warm summer weather decreases the R0, then we might be able to avoid it, but some parts of the Northern Hemisphere are still in winter and won't be warm for at least 2 months.

where are you getting the info to say only 15-20% percent of the cases show symptoms?

I believe reading that 14% of cases are severe, so it sounds roughly accurate. I think a lot more show symptoms, though, even if they're mild.

15-20% show severe symptoms, not just "symptoms". 80%+ show mild symptoms or are asymptomatic.

I believe the only thing a hospital can offer is a ventilator -- in the worst cases, the disease slashes your lung capacity and a ventilator will keep you oxygenated.

Hospitals will only help if you feel like you can't breathe (and we do not have anywhere near the amount of ventilators that we'll need for this), so the vast majority of people should self-quarantine, take pain killers for fever and wait for it to pass.

Why do people say that warm weather will help, when there are many cases in tropical countries now?

The death rate of COVID-19 is at about 3.4% on average. In comparison, the death rate of seasonal flu is about 0.1% in the US. No, it is not "like" the flu.

https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-r...

Thanks for the reply. So my doctor is wrong then? (It wouldn't be the first time...)

"Globally, about 3.4% of reported COVID-19 cases have died"

The keyword here is reported. We don't know how many unreported cases there are, it could be 10x the reported ones. In the US it's much more than that, given that almost nobody has been tested. We have 9 deaths so far and probably thousands of infected people.

https://en.wikipedia.org/wiki/2019–20_coronavirus_outbreak#/...

Also, the death rate is 1.6% outside of China

* https://en.wikipedia.org/wiki/2019–20_coronavirus_outbreak#D...

I think most doctors make it a point to instill calm in their patients. And, the nature of their work is that they have likely dealt with emergency situations and dying patients, so they have seen the worst and have to have a way to handle these things. So they are coming from a different position than you, perhaps (maybe, maybe not).

Symptom-wise, as far as I can tell, COVID-19 can be similar to the flu. Especially for most people, who may not have much in the way of symptoms. So your doctor isn't wrong per se. But yes, the deadliness of the virus is much higher, unfortunately. So it is not quite similar in intensity, and it is a serious thing.

To be clear, the article says "Globally, about 3.4% of reported COVID-19 cases have died." The issue is with reporting (the denominator). The bar for "reporting" COVID-19 positive is very high relative to the flu, especially as some countries (ahem USA) don't / didn't even permit testing of all symptomatic patients.

So yes maybe it is orders of magnitude more deadly than the flu but it doesn't seem clear at all that we have sufficient information to say that it is 3.4%

Not just the US. Crucially, Wuhan and I think also the rest of Hubei pretty much only tested patients who showed lung abnormalities on CT scans, so only the more severe cases were diagnosed. The WHO knows this. In fact, they've been appearing in the pages of the New York Times and anywhere else that'll have them and gushing about how great this Chinese testing methodology is and how everyone should copy it.

They test much more widely but only those with pneumonia are counted as confirmed. But this is a viral pneumonia. So the undercounting is not that much.

It was 1% in diamond princess, and cruises are known to be full of retirees so it should be a lot lower than that in the general population. I believe the reason it looks so high is severe lack of testing.

it wasn't anything in the diamond princess. The diamond princess is ongoing, and the rate of hospitalization is more important if the infection rate becomes too large.

3.4% of reported cases have died. That doesn’t mean the actual IFR is 3.4%.

Data modeling suggests it’s closer to 0.98%. It’s also important to note that age plays a significant factor. The IFR is about 0.2% for young healthy people, while it is quite dangerous for people over 60 with existing conditions.

https://institutefordiseasemodeling.github.io/nCoV-public/an...

Thanks! That's interesting. I suspected there's a methodological flaw in assuming actual death rates from the sample of detected cases who died.

We need this voice of reason. Otherwise we're just panicking.

Just curious, what is the mortality rate of the regular flu for young healthy people?

For US adults ages 18-49, it varies (depending on the severity of flu strains) between .01% and .02%.

https://www.cdc.gov/flu/about/burden/2016-2017.html

0.98% seems to assume your medical system doesn't get overloaded:

> evidence to date points toward 2019-nCoV having the potential to have comparable severity to the 1918 flu pandemic in the absence of effective control and treatment, when averaged across all ages.

Early detection and isolation is key. Much of the world seems to be doing a poor job of it, and that is what is causing people to be concerned.

.2% if you are 30, .2% is greater than your cumulative risk from driving. It's a huge risk.

It's still a very small number.

BTW most of the deaths caused by the flu are not direct deaths.

It kills about 10 thousands of people a year in Italy (58 millions residents) while covid-19 has killed only 59 people and recovery rate is very high

Meanwhile pneumonia alone in Italy kills 13 thousands people/year

The real difference?

With the regular flu people stay home and die there, with this one they are being taken to the hospitals, even if there are no symptoms, and the healthcare system is under a lot of pressure for that

Draconian measure are just for that: avoiding a total crash of the healthcare system

The coronavirus is a magnitude deadlier than the flu, according to all studies I know of that attempt to estimate the Infection Fatality Ratio. The IFR is estimated between 0.5% and 1.6% which is between 5x and 16x deadlier than the flu (0.1%): see links to the 4 studies at https://blog.zorinaq.com/case-fatality-ratio-ncov/#updates--... Given that the flu kills half a million per year, I'll let you image how many could be killed by a disease a magnitude deadlier... But of course the death toll will depend on how the world reacts to the outbreak. If every country implements measures as severe as China by locking down most major cities worldwide, we may limit damages.

Incidentally, the upper end of this range makes COVID19 comparable to the 1918 Spanish Flu (IFR ~2%) according to experts (for example see https://institutefordiseasemodeling.github.io/nCoV-public/an...). And keep in mind the IFR, unlike the CFR (Case Fatility Ratio), is the metric that takes into account undetected mild or asymptomatic cases.

Something to consider: even if it was "just like a flu" (which it isn't, enough commenters already pointed out the differences, but let's just for the sake of my argument assume that it was), it is a matter of fact that this would then be a "second flu" going around at a time at which doctors and hospitals are already well-loaded with caring for patients that have more serious trouble with the "real flu" that happens to be at the peak of its activity just at the same time.

The "real flu" is relatively non-deadly for most people (even though it still kills a lot of people in absolute numbers) precisely because the healthcare system is capable of providing care to those requiring it because of the flu. It can do this because the flu is a relatively well-understood phenomenon, it comes every year, and although the exact mutations of the virus differ between the years, the overall characteristics of the outbreak are relatively well-known in advance. There are also vaccines against the flu (these are a big thing in allowing the personnel in the healthcare sector to do their work, which of course exposes them to flu patients) and there is medication available that's able to quicken the recovery. Nevertheless, the flu still puts a lot of strain on the system, and having a "second flu" of entirely unknown characteristics going around, possibly even infecting the same patients, for which there is no vaccination and no medication at all is not exactly a thing to take light-hearted.

I would not be surprised at all if the "real flu" would later be found to be much more deadly this year than in the years before, not because the virus was any different than before, but because the additional strain due to COVID-19 negatively impacted care for flu patients.

Thanks. The overloading of the healthcare system, which you and others mentioned, is something I had not considered. It makes sense that two flu-like[1] virulent diseases at the same time can overload it and that it would be a very serious matter. I still think panicking is not the answer, but I'm now convinced it's a more serious matter than I first thought.

[1] for the sake of argument, even if coronavirus is not actually similar to any flu strand. I'm not a specialist and I cannot tell the actual differences.

Apparently it's quite a bit more infectious. This coronavirus is something like 1:2.5, whereas the typical flu is about 1:1.

People do worry about the flu, too. This past flu season in Australia was particularly rough, and it was all over the media. It came up in day-to-day conversation.

Part of the reaction is political, too, ostensibly to appear to be actively doing something, e.g., Los Angeles declaring an emergency for 9 infections.

It's 1-2 orders of magnitude more deadly than the flu. Some estimates are between 2 and 4% fatality rate for the Covid-19. Flu is 0.1%.

That fatality rate average masks that it is far deadlier for the elderly and high risk patients, with as much as 10-20% fatality rate for that demographic.

Thanks for the reply. What is the fatality rate among the elderly and high risk patients for seasonal flu? (say, in the US if there are no worldwide statistics).

I understand the real problem with any flu-like disease is precisely with the elderly and high risk patients. Usually, of course there are always cases of healthy people who die from a flu.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

These are worldwide statistics. Breakdown is by age, but I don't recall if there's other categories.

Somewhere around 1%. The 10x multiplier on fatality rate seems to be fairly consistent across age groups. Note that the CFR for this virus is still largely unknown, and is vastly different in different regions.

https://www.cdc.gov/flu/about/burden/2018-2019.html

you are getting that number by dividing reported infections by reported deaths.

The reported infections number is not accurate. Its a major underestimate of the actual number of infected

1. It is both more contagious and lethal than flu. There were estimates that 40% to 70% of the world population will eventually get infected. Depending on how the world responds to this - millions might die.

2. This isn't flu. The same amount of people will die from flu this year as last year. COVID-19 deaths are additional deaths on top of that. Saying that we shouldn't worry about it because every year many of people die of flu, is like saying that we shouldn't make a big deal of the 2004 Indian tsunami because many people die of drowning anyway.

To be clear, I'm not saying we shouldn't worry. We should worry about the flu too. And if COVID19 is more dangerous, we should definitely look into it.

I'm just questioning the panic-mongering. We should be scientific about this, not panic like those guys in the media.

The real danger here is that far fewer people will have immunity to this because it is novel. This means that if we aren't careful the infections could snowball and serious cases could overwhelm healthcare infrastructure. This would lead to the tragedy of people dying not just because they were basically bound to but because there wasn't enough care to go around. 1,000,000 people infected over 3 months looks a lot different than 1,000,000 people infected over 18 months.

Spanish flu was also "just a flu" and killed between 17 and 50million people world wide

Covid19 is more contagious and more deadly than "regular flu"

But that's what I'm saying. The flu is already a serious deal and nobody panics.

In any case, surely there are some differences between the 1918 world of the Spanish flu and the current world, both in actual medicine and what we learned about how to manage contagious diseases? Maybe the Spanish flu today (I mean, if it started today and hadn't happened before) wouldn't have as many victims.

On the flip side, we're traveling farther in greater numbers than in 1918.

1918 was the height of ww1 btw.

Seasonal flu has an R0 value of ~1.2 [1] while the estimate for COVID-19 was estimated at 2.2 [2]. This can be interpreted as each person infecting 2.2 other people vs. 1.2, the spread of the virus will probably be exponentially faster.

1: https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471...

2: https://www.ncbi.nlm.nih.gov/pubmed/32097725

Available data points to it being more dangerous than the flu, especially to the elderly and immunocompromised. Your doctor might have been talking about the danger to you in particular, which is very low, similar to the flu, if you're young and healthy.

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