Quite funny, but the stats don't lie[0]. The number of new cases in Italy has grown at an exponential rate. This is a developed economy. Similar rates are being seen in France, the UK and Switzerland. The same will happen in the US. We're all going to get this, and most of us will be fine, but if you take the midpoint of experts' forecast of 40-80% of people being infected and multiply that for a conservative 1% death rate (the WHO has mentioned 3.4% and 2% is also often thrown around), that yields
7.8 billion * 0.6 * 0.01 = 46.8 million dead
At an 80% infection rate and an 3.4% mortality rate (worst case scenario), you get 212.2 million dead.
That's a once-in-a-century, catastrophic black swan event.
[0] https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_I... – see the chart below the table for the unbelievable exponential rate
[1] https://twitter.com/EricTopol/status/1236321986122375168
[2] https://twitter.com/NBCNews/status/1235956761015783427
Not a doctor, but I suspect 3.4% is the upper end of the case fatality ratio (i.e. death among people tested positive) as opposed to the infection fatility ratio (i.e. death among estimate of people infected).
Problem is, given the current numbers, the projected total number of people who will require hospitalization, and of those that will require ICU, significantly exceed availability. So if it spreads too fast, and all these people get sick at the same time, we won't have enough beds to go around - and that will cause the mortality rate to spike again.
One of the issues working against this scenario is the fact that the worst-affected regions are also the ones with the best health services. The other regions might struggle to respond as efficiently as the "pioneers", although they will benefit from the accumulated experience.
The whole point of locking down Wuhan/Hubei and then northern Italy and now the whole country and other places and cancelling large public gatherings and events is that local, regional, and national authorities start seeing the numbers soaring and initiate extreme mitigation strategies.
We don't know how successful these strategies will be individually/collectively in the long run but if China is anything to go by it can severely retard the spread of the virus.
To show I'm not spouting out of my derriere compare the logarithmic infection and death rates of China[1] and Italy[2]
So you have to modify your formula: `7.8 billion * 0.6 * 0.03 * mitigation_factor = ?` We just don't know what the mitigation_factor is yet and because the spread is exponential any dent in the rate of spread brings the fatality number tumbling down[3].
I happen to believe this virus is a very serious global threat and I assure you that I am not one given to alarmism. But I also have never seen governments respond to the onset of an epidemic like this before and I'm nearly fifty and my mother says she can't remember anything like this in her lifetime. So yes, tens of millions absolutely could die but I'm willing to bet that between lock-downs and modern medicine tens of millions won't and I pray to, you know, $deity I am not wrong.
[1] https://www.worldometers.info/coronavirus/country/china/
[2] https://www.worldometers.info/coronavirus/country/italy/
[3] https://www.youtube.com/watch?v=Kas0tIxDvrg [Exponential growth and epidemics]
Here are my calculations based on current data[1]:
Country tot. deaths pop. (1m) tot. deaths/1m pop.
Italy 463 62 7.46
Iran 237 83 2.85
China 3120 1384 2.25
South Korea 53 51 1.03
Spain 30 49 0.61
France 30 67 0.44
USA 26 329 0.08
With any luck we'll have a vaccine in 18 to 24 months. The flu season is halted by warmer weather. We can change our behaviour for a few years until we get it under control.
China has 1.4 billion people, and they've had ~3,000 deaths (let's assume it's several times higher in reality). But we'll see tens of millions dead globally? No we will not. If you killed every person that has been infected in China, and extrapolated that event globally, we would not see tens of millions dead. So that premise is absurd, to an extreme.
I consider this to be a very serious situation, however, it's not very serious as a great mass mortality threat (unless it mutates and becomes far more deadly and we prove unable to slow it down or vaccinate against it). It's a serious threat for massive disruption to our daily lives, including severely harming the global economy. It's a serious threat to swamping our healthcare systems due to ICU demands and diverting our resources to managing the ongoing crisis (instead of routine, normal productive work).
Assuming this isn't going to burn out come Spring & Summer, the next step is to rush to vaccine, at any cost. That will end this thing globally. Maybe we'll need to vaccinate against it annually, maybe it won't come back after this year, who knows of course.
Tens of millions will not die. Tens of thousands might die in the plausible worst case scenario, before we get a vaccine ready. We can rush to vaccine at greater patient risk and financial cost, as necessary.
We might ballpark the number of global deaths – in the optimistic case† at between 20,000 and 30,000 souls. Not a global tragedy, on a scale of the recent Ebola outbreak, but warranting much more drastic action.
There's a huge sense of urgency. We could have a vaccine before the next flu season in the northern hemisphere.
† assuming not every country acts quickly when the time comes nor acts as effectively as China
That's quite unlikely. We're looking at 12-18 months if everything goes perfectly according to plan and we get it right on the first try.
> nor acts as effectively as China
Only if you take China's numbers at face value, which nobody really seems keen on doing.
1. We don't know the actual reality of what's happening on the ground in China. Hubei and Italy have approximately the same population, yet Italy is suffering more proportionally. I think the obvious explanation is drastic underreporting of cases and fatalities in China. When all is said and done I think China probably has underreported by at least a magnitude if not double that.
2. Most Western countries won't impose the type of strategies that China undertook; they simply can't. When things get too bad to impose draconian quarantines, it'll be too late. Even Italy's efforts in quarantining the nation are not enough.
3. Most of the world doesn't have good healthcare. I'm talking about Africa, Southwest Asia, South America. There simply aren't enough ICU beds and ventilators to go around. Even in the US, I've read reports of only 100K ventilators nationwide. If the pandemic keeps growing exponentially with a doubling period of 4 days, the US alone will have 1M cases by mid-April.
4. Simple math. World population outside of China is 6.5B. If 10% are infected (very conservative imho) we're looking at 650M cases world wide. If the CFR drops to 1%, then we're in the neighborhood of 6.5m fatalities. And the survivors? Roughly 81% of those infected survive with no serious side effects. The remainder have serious health issues even after the disease runs its course. That's 117M casualties. This is world altering.
To address (1.) You and others are going to have to provide sources for why you think that China "probably has under-reported by at least a magnitude if not double that". I've seen the ill feeling and distrust towards China increase on HN and elsewhere in the last 5 years and this fits the bill.
You can explain the differences between Hubei and Italy by the differences in responses. As has been pointed out, China built two make-shift hospitals in ~ 10 days and quarantined 100s of millions in cities. Have you not seen the pictures coming out of China. Now that Italy is taking drastic steps we'll see the outcome in a few weeks and it will tell us if it is an effective strategy. If any of the reported numbers is suspect it is the total number of cases that the USA is reporting: https://www.worldometers.info/coronavirus/ It's completely out of whack with every other country. This implies the US has been under-testing, something which we have lots of evidence for. On the other hand we have no evidence China is under-reporting.
To address (2.) "Most Western countries won't impose the type of strategies that China undertook; they simply can't." Why not? Why can't they?
To address (3.) "Most of the world doesn't have good healthcare." But most of the world has soap, most of the world understands what it means to self-isolate, most of the world can implement quarantining. "If the pandemic keeps growing exponentially with a doubling period of 4 days," Looks like mitigation strategies slow the doubling period to three weeks, why pick the worst case scenario?
To address (4.) "Simple math." Yes! Times an unknown mitigation factor of ? This outbreak is scary because it's exponential (highly lethal and highly infectious), but the total fatalities is also highly susceptible to interventions exactly for the same reason.
I have no ill feeling towards China other than the fact that they have a repressive, authoritarian government. Those types of government necessarily try to control and spin the news to maintain their authority. If a country is willing to censor Winnie the Pooh to make their leader feel better, than they'll naturally minimize the effect of SARS-Cov2.
I also agree that the US is underreporting due to inadequate testing. Estimates in the US should be closer to 9-10K. I think that we'll see a large spike in cases as soon as testing approaches levels in other countries.
My inclination regarding quarantine controls in Western countries stems from the willingness of these societies to restrict freedoms. Italy's quarantine is very basic, a 1 on a 1-10 level. Compared to what China implemented, it's not even close.
Soap isn't the ability to treat cases; it's a way of trying to mitigate the spread.
- The US plays along. We are likely a hotspot now, whether we go the “undertest and live in ignorance” route, or not.
- We have an effective plan for rebooting out of the lockdown. Which, until we have an effective treatment or vaccine, to me means temperature scanning in most public places imaginable, continued vigilance around disinfecting, continued limits on public gatherings, and more.
(The # of deaths for Germany is suspiciously low, as is the # of deaths for S. Korea.) I actually think the Chinese data is fairly accurate. the Iranian data, well, who knows. I'd like to think the European data is reliable, but again, who knows.
If the USA becomes a hot-spot then other countries will undoubtedly institute a travel ban to/from there like is happening with parts of China, S. Korea, Italy, Iran, and so on.
(chance of contracting virus) * (chance of contracting disease from virus) * (chance of fatality from disease).
The first is dependent on containment efforts. The second is not 100%. The third is also partly dependent on containment efforts, as fatality goes up if hospitals get overwhelmed.
I don't see how you get "we're all going to get this" when China and South Korea are already reporting decreases in daily cases.
It's a catastrphic event but I don't see any reason it won't happen again in the coming years / decades. The virus itself could even have worse characteristics in terms of transmissibility and mortality. Our transportation network is so great and modern society so dependent on it there is no hope stopping these outbreaks going global, only slowing them down.
In fact it should probably be fairly easy for a malicious actor to engineer a worse virus. Longer incubation period, truly airborne, super lethal. Whatever the final death toll is, I don't think it'll be the last or the worst of the 21st century.
Granted, she was not the only one publishing them on Twitter, but she was the one I was following the most. Also to add, news organisations like the FT or the BBC were only publishing news that could be taken for a political spin, like in the case of Li Wenliang, they were not publishing news about people committing suicide on their home as not to infect their loved ones or desperate phone calls made by people who were trying to get their loved ones into an hospital (which were already full by that point).
Also, many of the hospital scenes I was seeing on Twitter on her account are similar to what now surfaces from hospitals located in Northern Italy.
[1] https://twitter.com/nytimes/status/1236484352965521408
[2] https://twitter.com/nytimes/status/1236479276586807296
I mean the events happened are similar, but the point of reporting is totally different.
https://www.thedailybeast.com/six-inmates-dead-scores-escape...
In that case (https://news.ycombinator.com/item?id=22274728) also, the article wasn't in English, which makes it off topic here (we deeply respect other languages, but HN is an English-language site).
The question is to which one we are closer? That's what I think no one knows. Like how reddit says "2 million will die in the US" and some people say "it's just a flu" the truth maybe between the two half way there or so