Ask HN: Covid-19 panic – what am I missing? | Hacker News Reader

Ask HN: Covid-19 panic – what am I missing?

1 pointdoitLP5 comments

Major news outlets are still asserting a mortality rate of 3-4%. This figure is obtained by dividing number of deaths by number of infected.

Weeks ago the WTO pointed out what any first year medical student knows - a true accounting of mortality is dependent upon an accurate denominator.

And that denominator was expected to be much larger than appreciated - as early as January there were reports from Wuhan that many people had mild symptoms, and by February it was clear many were also without any symptoms.

We finally have some substantial data from South Korea. 20k tests are being done daily, picking up many asymptomatic or mild cases. They report a death rate of 0.7% [1]

The CDC estimates that regular flu has resulted in 9 million to 45 million illnesses, 140,000 – 810,000 hospitalizations and 12,000 – 61,000 deaths every year in the US alone since 2010. [2]

There are many measures being taken by companies and countries that seem very extreme. There is no toilet paper at the store. The breathless media is milking this for everything it's worth. Why are the lives this is claiming worth shutting down the world, instead of all the other, far more preventable deaths that occur on a daily basis.

This is nuts. What am I missing?

[1] https://www.bbc.com/news/world-asia-51836898 [2] https://www.cdc.gov/flu/about/burden/index.html

Postscript: I'm hoping however this wakes everyone to the real danger of much more lethal engineered pandemics and force some preparedness.

Disclaimer: these are my own opinions, I am not going to link for supporting evidence. I am just shooting off the cuff and I have no real expertise in the matter:

1. from most reports this is spreading much faster than other diseases, such as the flu. Because of this it has a higher chance to overwhelm a countries healthcare services. Once that happens, mortality will spike.

2. it has a higher mortality rate, especially for elderly.

And most importantly:

3. it is still new and it is harder to predict the outcomes and people are scared of the unknown.

What you also have to keep in mind, the reaction isn't about the deaths that have already occurred. It is about trying to slow the exponential progression so that the demand for medical services are spread out over a longer time period, thus avoiding the overwhelming of our medical services.

Good summaries:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

https://www.youtube.com/watch?v=cZFhjMQrVts

https://www.worldometers.info/coronavirus/#countries

Key points: People are spreading the virus before they start to show symptoms. Real number of cases is 10 times known cases. So if you think there are 100 cases in the country there are actually 1000, and, with a doubling time of 6 days, in a month's time there will be about 20 000, and on it goes.

Kids, in particular, fail to show symptoms and are infecting their elders.

This is one of the real dilemmas. Do we send them home from school, to reduce the kid-to-kid infection rate? Also, they need to stay away from their grandparents. But that will then require nurses with kids to be home to look after them. Who will then do the required testing and nursing in the health system?

We all have to practise infection control:

"The current scientific consensus is that this virus can be spread within 2 meters (6 feet) if somebody coughs. Otherwise, the droplets fall to the ground and don’t infect you.

The worst infection then becomes through surfaces: The virus survives for up to 9 days on different surfaces such as metal, ceramics and plastics. That means things like doorknobs, tables, or elevator buttons can be terrible infection vectors.

The only way to truly reduce that is with social distancing: Keeping people home as much as possible, for as long as possible until this recedes."

Soap, hand sanitiser and bleach destroy viruses.

One thing I heard, which may or not be true as I have not heard the Big media stations talking about it.

There are atleast two strains of Wuhan fever, "Type S" and "Type L".

Aperantly South Korea had the milder of these and the care home in the Seattle area had the deadlier one.

Like I said that is what I heard but maybe it's not true, or maybe thats something your missing, or something that being covered up by the media for some reason, that we are all missing.

Even at a 0.7% mortality rate, you’re talking about a small percentage of a very big number. Up to 70% of the world’s population may become infected. [0] In that case, a 0.7% death rate converts into 37 MILLION deaths.

The runs on toilet paper are the irrational panic of humans. I saw some comments on the internet early on in the outbreak telling people to buy anything they can’t live without for two weeks, with particular emphasis on toilet rolls, so that’s probably where that came from.

With regards to the extreme measures, my understanding is that this is primarily to try to prevent health care systems collapsing.

Around 20% [1] of people with COVID-19 are sick enough to need hospitalisation, and 1/4 of those (5% of total cases) require intensive care. The number of hospital beds is finite, and the number of ICU beds even smaller. Most health care systems already run near maximum capacity, and right now we’re barely past the peak of flu season [2], so there is very little buffer.

The rate for new infections is dictated by the number of people exposed to an infected person and the probability of each exposure becoming an infection [3]. As such, the primary lever we have to try to “flatten the curve” is to reduce the number of people exposed to an infected person, and the way to do that from the top-down is to ban as many congregations of people as possible. Again, since this is exponential growth we’re talking about, even a tiny downward shift in the number of exposures results in an unintuitively large reduction in total cases.

The rate of infection today is still exponential—doubling every 6 days in most places—and there are enough infections already that just a few more case doublings in many areas will overwhelm hospital systems, leading to situations equal or worse to what we are seeing already in Italy [4].

Once hospitals are full, it will be impossible for every person who needs hospital care to receive it. People with treatable injuries and illnesses will die simply because there is no more capacity—and this is every person, not just those infected with COVID-19.

In the state where I live, which has a population of ~5.6 million, we’ve got about 500 free hospital beds right now. Without these extreme measures to reduce the infection rate, it’s obvious that we’re headed toward catastrophe. We lost the luxury of using a light touch approach because the case numbers are already too high to gently steer the ship away from the iceberg. We’re going to hit it anyway, but more people will survive if we don’t crash into it full steam ahead. [5]

[0] https://www.cbsnews.com/news/coronavirus-infection-outbreak-...

[1] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...

[2] https://www.cdc.gov/flu/weekly/weeklyarchives2019-2020/image...

[3] https://www.youtube.com/watch?v=Kas0tIxDvrg

[4] https://www.theatlantic.com/ideas/archive/2020/03/who-gets-h...

[5] https://www.flattenthecurve.com/

Approximately 10% of cases get bad enough to require hospitalization, and 1% become critically ill and require intubation.

South Korea has more hospital beds per capita than any country in the world other than Japan[1] at 12.27 per 1000 people. They are better equipped to handle the critically ill cases and save them. Italy has a much better health care system than the US, but at last count (2017) they had 3.18 beds per 1000 and I'm guessing their respirators on hand are far fewer than what South Korea has. The US at last count only had 2.77 per 1000.

Also worth noting that these counts are not open beds, so the real available capacity in the US is more likely to be just over one bed per 1000 people, and the number of available ventilators likely are also inferior to Italy and South Korea.

While the US population is younger than Italy[2][3] it has a higher rate of diabetes (nearly double Italy's rate, at 9.4% vs 5.3% for diabetes) and obesity[4][5][6] which can be complicating factors.

So a less healthy population, with an inferior health care system, and other factors being equal, mean that Italy's experience with Coronavirus is likely to be a preview of what can happen here. Best guesses I'm hearing is it's about 10x the regular flu season.

On top of the health care system being overrun with patients affected by the outbreak, this likely means that other emergencies, which could've been treatable, will not be. Heart attacks, strokes, cancer treatments will all be affected.

I think raising fears of engineered pandemics at this time is getting into conspiracy theory territory, feeds xenophobia, and is not helpful. Nature, on its own, is more than inventive enough of an adversary and the human population is a monoculture that has a gigantic attack surface for garden-variety wild viruses.

[1] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...

[2] https://www.populationpyramid.net/italy/2020/

[3] https://www.populationpyramid.net/united-states-of-america/2...

[4] https://www.cdc.gov/media/releases/2017/p0718-diabetes-repor...

[5] https://www.istat.it/en/archivio/202712

[6] https://www.oecd.org/els/health-systems/Obesity-Update-2017....

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