Comment by ookblah | Hacker News Reader

Comment by ookblah | Hacker News Reader

my issue is how to reconcile the way different countries have handled it. i don't think this is a nothing burger, but i'm also wary of the "overreaction" by the media and then you add signaling and political issues and it becomes a mess.

- america and some european countries. we haven't tested anybody in the US and are basically treating it like it's nothing, but it's clear that this thing has been spreading already. still yet to be seen how it plays out in terms of overwhelming the system.

- contrast this to a place like korea which is aggressively testing 10k people per day, finding a low mortality rate, but still trying to balance hospital resources.

- compare that to italy and iran, where they are struggling w/ resources and people seem to be dying at an alarming rate (imagine if like 3 politicians just dropped dead from this thing).

- now compare that to china, where they literally quarantined tens of millions (and still are), had to build extra hospitals in a matter of days, and are still implementing draconian measures to manage it. they basically had to shut down their production briefly. and even then the actual numbers might not be clear.

if someone could help enlighten me with an explanation that would fit all these cases that would be much appreciated. right now it's too black and white, that this is some world ender or "just the flu, bro".

This article helped me answer those questions. This will probably become another cold/flu in addition to the current cold/flu seasons-as a better possible outcome:

https://slate.com/technology/2020/03/coronavirus-covid19-pan...

China is the first to handle it, had no idea about how deadly this virus is, and might have freaked out due to its SARS experience.

Korea is next door to China, so it's alerted early on.

Tiny countries like Singapore cannot survive a quarantine. So containment is not an option, they have to work out an effective mitigation plan.

Different countries also have different demographics, population density, and confidence about their healthcare system.

What confuses me is how China had Chernobyl-style liquidators spraying down the insides of malls and outdoor public areas, supposedly with bleach. Contrast that with America's relatively tame "don't touch your face, do wash your hands for 20 seconds" advice.

As long we don't touch our face we should be okay according to officials in charge https://www.youtube.com/watch?v=sscoRb11wDw

This is a very serious disease for many of the infected when left untreated: it causes pneumonia (inflammation of the lungs/airways) which makes people’s respiratory system less effective, leading their blood oxygen levels to drop and potentially leading to death, especially in the elderly and people with pre-existing conditions like cardiovascular problems, obesity, diabetes, compromised immune systems, asthma, other chronic respiratory issues, ....

A significant proportion of people over 60, a non-negligible proportion of people ages 40–60, and still some proportion of people aged 20–40 need to be hospitalized and put on supplemental oxygen. In severe cases people need support from a mechanical respirator. In the WHO report from China 20% of positive cases needed hospitalization. This might be a substantial overestimate if there are many mild cases not caught by tests, but even if that estimate is off by a factor of 5 or 10, if there are many cases this can overwhelm hospital capacity.

When treated aggressively by a capable healthcare system (caught early before severe symptoms start, treated with antiviral meds, patients put on supplemental oxygen as soon as blood oxygen starts to dip, hospitals have enough respirators for severely affected patients) so that people don’t die while waiting for their immune systems to fight the virus off, many fatalities can be avoided, as is happening in Singapore or some wealthier provinces in China. But this depends on social distancing in the community, widespread testing, aggressive isolation and contact tracing of infected people, and efficient triage of cases.

If cases are not caught early and treated aggressively or if medical systems get overwhelmed, it is bad news. If this virus is not checked and spreads throughout the world quickly, the death toll could be in the millions.

Beyond being very dangerous to a substantial proportion of infected people, it is also extremely contagious, and has been spreading very rapidly. It is contagious even among pre-symptomatic or asymptomatic people. Perhaps most dangerously, its early symptoms are close enough to ordinary cold/flu symptoms (and some of the infected seem to not advance to the more serious stage) that people who are shedding the virus continue to go about their everyday lives without realizing they are infected with novel coronavirus instead of a typical cold or flu.

To be clear, at this time we only the “CFR” - known case fatality rate. Likewise, we only know the known case hospitalization rate.

What we do not know, and can only estimate, is the “IFR” or the overall infection fatality rate, and the overall infection hospitalization rate.

Imagine the flu was a brand new virus which we didn’t have any test for. In 3 months we would see 100,000 hospitalizations and 10,000 deaths from this new virus.

Only after testing became inexpensive and widespread would we come to realize that actually 32 million people were infected with this virus, but only 200,000 per year went to the hospital, about 20,000 of which end up dying.

My point is, we do not know the infection hospitalization rate, nor the infection fatality rate of COVID-19, but its upper bound is the CFR and it’s reasonable to suspect the actual value is at least an order of magnitude lower than the current CFR data might indicate.

It’s not reasonable to state anything definitively about the overall hospitalization rate of COVID at this time without the qualifier that it’s based on only known cases and therefore overstated by some unknown amount.

You may find this letter (written March 4th) from doctors specializing in Emergency Medicine more compelling than my own summary:

https://www.bmj.com/content/368/bmj.m606/rr-5

Edit: I was basing my comment on a 2018 newspaper story, but thanks for tracking down a peer-reviewed model estimate. I deleted my comment as it didn’t make a grounded comparison.

We can only wait and see how many people die from ncov-19 in Italy or anywhere else.

> “We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly.”

> “In the winter seasons from 2013/14 to 2016/17, an estimated average of 5,290,000 ILI cases occurred in Italy, corresponding to an incidence of 9%. More than 68,000 deaths attributable to flu epidemics were estimated in the study period.”

(Edited) The wording here is confusing. It’s an average of 5.2 million cases per year for 4 years resulting in a total of 68,000 deaths over 4 years. Meaning an average of 0.325% IFR due to Flu (ILI - “influenza-like illness” in Italy.

That’s a high confidence IFR based on a well established surveillance network and widespread testing. Meaning it is likely not being overstated. Versus COVID’s know case fatality rate, which is an upper bound on the IFR and known to be missing a significant number of mild cases in the general population from the denominator.

I agree that it remains to be seen how bad this will be in Italy and elsewhere, but putting it in perspective to the flu (which we do not generally “fear”) is useful.

[1] - https://www.sciencedirect.com/science/article/pii/S120197121...

Consider the chain of reasoning in https://threadreaderapp.com/thread/1236095180459003909.html

This is just dark fiction, not science.

If any of this were true, China would already be totally overrun. Instead they are reported fewer than 150 new cases per day and closing their temporary hospitals.

My prediction is that we will see the same thing happening in Italy and South Korea in two/three weeks time.

The counter-prediction is irresponsible wishful thinking. China just did the most extreme and largest-scale social shutdown in modern history.

I sincerely hope you are right though.

My hyperbole: It’s known that preexisting conditions contribute to deaths: if we presumptuously view atmosphere in a Chinese city as a condition, then the Wuhan death toll makes some sense.

Also for “just the flu”: it’s a coronavirus. A cousin of common cold. So it gets you like common cold, you usually don’t know when or where or how you got it. Most effective prevention, not vaccination, not facemasks or spacesuits, but washing hands often, facing away from people when sneezing, eating more vegetables, getting good nights’ sleep, those mom of 5-year-old kid items. There are not many effective meds save for NyQuils and lab experiment Ebola shots. I think “just the common cold” is a technically accurate description regardless of whether it’s world ending or not.

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