Hacker News Reader

Comment by on_and_off | Hacker News Reader

I fear that the situation is already at that state in the USA.

There are 1600 confirmed cases but the lack of tests hides how many real infections there are.

Leaving aside the fact that here in the US tests are literally not happening on an epic scale that will be the subject of numerous investigations, hearings (, and prosecutions?) in the years to come. And forget that even if we had legit numbers, those numbers we can see are a tip of the iceberg, representing at most 20% of the actual more-serious cases.

Put that all aside.

Remember-- the numbers we see now are a look at the PAST. The infection incubates silently for a median 5 days. Then symptoms present. Then a week goes by with relatively mild illness. THEN shit gets real. THEN comes the hospital visit, the fight for a test, the time it takes for the test results to come back (if it happens). THEN the number gets added. Then you see it on wikipedia or the news.

These numbers we're seeing today are a time machine view backwards to recognize infections from 14 days ago. So infections spreading TODAY will show up AFTER the current Italy-like situation has already taken hold in the United States.

If it is possible, STAY HOME.

> Don't forget-- the numbers we see now are a look at the PAST. The infection incubates silently for a median 5 days. Then symptoms present. Then a week goes by with relatively mild illness. THEN shit gets real.

And the "shit gets real" part only occurs 20% of the time, give or take - which means the virus might spread quite a bit while showing symptoms no more severe than a common cold. That also introduces some further unpredictable lag between any social distancing behaviors being introduced and their effects on the actual numbers.

Yes, exactly. I said 14 days but again, that's the median. The US is flying blind right now.

We're using a cracked, dirty camera lens to film a small fraction of the tip of a rapidly growing iceberg.... And the photo processing time is two weeks.

It gets hospital-level serious for 20% of cases? I thought the lethality rate wasn’t even that high for the most at-risk demographics (something like 14%).

> It gets hospital-level serious for 20% of cases? I thought the lethality rate wasn’t even that high for the most at-risk demographics (something like 14%).

Well, substantially all of the cases that end up dying go to the hospital first, and many more besides that and up recovering. It shouldn't be surprising that the hospitalization rate is higher than the fatality rate.

About 15-20% require hospital care of some kind. Then depending on how prepared/overrun the health care system is, 0.6-5% cases are fatal. These numbers are ballpark and the lack of data makes it hard to know with confidence. The CFR gets more severe with age and comorbidities.

Yes, hospital-level serious for 20% of cases. 5-10% require ICU care. The ~2% fatality rate is with ICU support and ventilation. When the hospitals get overrun it increases to ~7%, which is what we saw in Wuhan and now Italy. Your chance of dying if you do need hospitalization but don't get it appears to be > 50%.

Death rates by age range also assume ICU care. It's virtually unheard of for healthy middle-aged people if they have access to good medical care, but plenty of 30- and 40-somethings can and have died from it once the hospitals are overrun.

It’s far from clear how accurate those numbers for Italy and China are. China essentially gave up on testing the general population in Wuhan and their numbers mostly represent the most serious cases. Italy’s infections seem to be mostly centered around the elderly with 40% of infections in the 70+ age range despite 65+ year olds only representing 21.53% of their population.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

https://en.wikipedia.org/wiki/Demographics_of_Italy

The WHO has verified China's numbers.

Sure, but they didn't go back in time to test more people.

The WHO has verified China's numbers.

Source?

China plainly lied about the outcomes of the SARS epidemic and reported about half the fatality rate of nearly every other country. Hell, no Chinese person I've talked with recently believes the official numbers.

The Lancet unverified those numbers quite a while ago https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I flagged this because it was published in January nearly a month earlier than the WHO's verification.

Essentially this was not in bad faith when it was published but it is now so out of date and misleading and sharing it now is dangerous in that it may cause people to ignore safety advice.

It was a nowcast. It's intended to be out of date after a while. And provide an estimation at the time. I don't understand how it is dangerous, could you explain that?... earlier action would have been better.

You are claiming that a study published in January supercedes a study in February.

Given that people are making difficult choices right now that will impact the course of the epidemic we should be very careful sharing outdated information that could lead to people becoming infected.

China's numbers are a minimum. Many people are saying online they are a maximum. I.e. claiming that there are lots of hidden mild infections when there are not.

> You are claiming that a study published in January supercedes a study in February.

No, I am no. I am saying the study supercedes numbers reported by authorities. The point of the study was to scatter information on very opaque reporting.

> China's numbers are a minimum. Many people are saying online they are a maximum. I.e. claiming that there are lots of hidden mild infections when there are not.

That doesn't parse.

A lot of people are claiming that China's death rate was under 1%. That is one of the reasons everyone is delaying action.

Death rate was under 1% outside of Wuhan and in South Korea. It's over 5% within Wuhan and in Italy.

The way I interpreted that discrepancy is that in the presence of full testing and good ICU care, the death rate from COVID-19 is about 0.7-1%. When the hospitals get overloaded, as they've been in Wuhan and Italy, the death rate skyrockets to 5-10%. This also squares roughly with the number of people who need ICU care in places where the death rate is low. If you need ICU care and don't get it, presumably you'll be dead.

Median death is 14 days after first symptoms with many cases taking significantly longer. That combined with an exponential growth curve looks significantly less deadly. A major discrepancy is the under detection of cases as full population testing has been rare outside of the cruse ships which also have an elderly population.

Populations of China and Italy are ageing and have a lot of smokers.

> If it is possible, STAY HOME.

People need to stay home, period. Unless you work in healthcare, a grocery store, or some essential service, or are going to one of the same, you need to stay home. I know there's lots of reasons people aren't staying home yet, like they don't have paid sick leave, but still, none of this overrides the sheer importance of stopping the pandemic.

So the phrasing should be "Stay home, period." Not "Stay home if possible".

I wonder if you'd be so absolute if this meant your job ceasing to exist.

Yes, it's a risk vs. benefit calculation where the risk is very very high. And not only risk to yourself but risk to others...

The risks of large portions of the economy shutting down and millions of people losing their jobs is also very significant, particularly in a country where so many live so close to the edge of disaster. It's a difficult balance, but it feels like the economic fallout is sometimes lost on the readers of HN, most of who would quite comfortably live through a period of complete lockdown.

Forget losing jobs - without a lockdown, millions of people will lose their lives. Including many of our loved ones. We already know this from Italy and Wuhan, where entire families have died one by one in their homes. The only way to save some of these lives is to flatten the curve to avoid overrunning hospitals, and reduce deaths before a cure or vaccination is widely available.

People's jobs are going to cease to exist on account of this whether they want it or not. What anyone wants or feels has nothing to do with it. This is what is going to happen, period.

Exactly - I'm tired of hearing people say "oh but the economy". How good do you think millions of dead people are going to be for our economy? Would you rather lose your job or your parents?

I'd rather my job ceased to exist than my parents or grandparents. Because that's the choice we're making now as a society.

Easy to say when you don't seriously have to face your children becoming homeless. While it certainly isn't as dramatic as a pandemic, there are severe human consequences of completely shutting down the economy. I'm sure I don't need to repeat the stats that showcase how close to the edge much of America lives - 40 million Americans don't consistently have access to enough food[1]. 1 in 6 children don't have access to enough food (which has massive effects on development and long-term health). 22 million children rely on school lunches as their primary source of nutrition[2]. Food insecurity is directly correlated with higher rates of diabetes and obesity[3]. Half of America has a negative net worth. Unemployment is correlated with alcohol and drug abuse[4].

Pretending that the only disaster we are facing is medical is blinding yourself to the reality that we are trying to navigate our way between twin catastrophes.

[1] https://www.usnews.com/news/healthiest-communities/articles/...

[2] https://www.nytimes.com/aponline/2020/03/13/us/ap-us-virus-o...

[3] https://www.feedingamerica.org/sites/default/files/2019-04/2...

[4] https://www.theatlantic.com/health/archive/2017/07/how-job-l...

And there aren't severe human consequences from millions of people dying in the next few months? Easy to say when you don't seriously have to face the possibility of your parents and grandparents dying, I guess. Remember that the mortality rate for people 80+ is 1/7, which isn't far from a game of Russian roulette.

Plus, all the school districts that have shut down so far have continued to offer meals for students AFAIK.

Source: - https://www.buzzfeednews.com/article/lamvo/coronavirus-death... - https://www.santaclarausd.org/site/default.aspx?PageType=3&D... - https://www.sfgate.com/news/article/Bay-Area-school-closures...

I actually very much do need to seriously face that possibility. And I still think complete isolation is too extreme.

This is where the government needs to step in and guarantee healthcare, paid sick leave, and improve unemployment. It's already starting to happen. We'd be in much better shape if we were already closer to European countries in this regard, though.

I initially had said simply "STAY HOME", but it's just not possible/advised for people in situations such as the ones you mention.

But your point is right. "If possible" means "unless it's absolutely essential for your survival or the survival of others".

I have been telling a lot of my friends this, but many are scheduled to work on Monday (most in public-interacting roles) and if they don't go to work, they lose their job and can't make rent next month.

This is a real issue, and I have no solutions. The only thing I've been saying to them is that all bars and restaurants will be closed here in 2-3 weeks and that their bosses will understand then. They are understandably worried that in the aftermath of all of this, there will be so many unemployed servers/bartenders/cooks/drivers that it will be difficult or impossible to get their job, or any other job, back, with no way to pay rent in April or perhaps May either.

This is not going to be over in April or May, except maybe in the worst case scenario. The point of social distancing etc is flattening the curve and spreading the load on healthcare systems over a longer time.

The only thing that might help there is if warmer weather reduces the spread. But then it could very well come back in the fall.

Like China, "the USA" is very large and probably not something that can be treated as an atomic entity. Even much-smaller Italy is probably too large for that. While there may be hot spots that develop in the US, I can tell you from personal experience that there states that have taken strong measures when there are still single-digit numbers of infected in them. The state I'm in is not in a mandatory full lockdown per se, but pretty much every vector the virus has to spread by the dozens/hundreds/thousands at a time has been eliminated; what few are still left are fading fast. I don't know what will happen, but a full on r0-2.3 (or whatever the latest number is) spread isn't going to happen here under these conditions. (I highlight those last three words.)

I live in Dallas and two of my friends who work at hospitals both have multiple corona patients. It's everywhere, the official numbers are lying.

I wish people were lying, that implies that officials know the reality and are hiding it. That is too optimistic I’m afraid.

Indeed, the reality is probably that they have no clue so there is nothing to hide. And that's a lot scarier.

'may be hot spots that develop in the US'

You're kidding right? Under what conditions that things are fine are you preposing? If you're not taking this serious, and in the US, you're definitely part of the problem. That attitude, statistics aside, is going to get people killed.

Settle down and read more carefully.

Among the things you should have derived from reading more carefully is the fact that state I'm living in is taking it quite seriously. Personally, my hatches are battened down and I'm prepared to be isolated for at least a month, maybe two. (Have to admit it's hard to tell how far my supplies will go, I've never actually had to live on them before.)

You're talking to someone who specially prepped for this about seven weeks ago, in addition to the general prep I already had on hand. If you can match that, then maybe consider start lecturing me. I actually got a bit of flak from my wife for the amount of prepping I did, because it was before she'd hardly even heard there was a new virus. Now she's glad I did, because I bought all the things that are missing in the stores around here now long before it was "hoarding".

I'm in the top tier of taking it seriously. At the same time... Don't panic. Don't advise panic. Don't fall into the cognitive trap of modeling this as a zombie apocolypse or some other thing where the virus is intelligently seeking out victims. Isolation measures will slow the virus down. It isn't possible to keep it "out of the US" but it remains possible to keep it out of your county, or your city, or your neighborhood, with sufficient steps. Total doom is not yet inevitable, and even then, how you are impacted remains significantly under your control even if your government is feckless. Or, at least, it was, if you got your prep in before the panic rush... you may be a bit more at the mercies of your government now.

The majority of spread is from small groups/gatherings, not stadiums and such. Restaurants, cafes, offices, homes, et c.

"Small groups and gatherings" have collapsed here, too. Like I said, we're not in total isolation, but most people aren't going out, restaurants are abandoned, etc., and the few foolhardy folks still doing it are fading fast.

The exposure network hasn't been trimmed to zero, but its branching factor has been radically cut down. This is going to have an effect.

> There are 1600 confirmed cases but the lack of tests hides how many real infections there are.

2,695 at the moment, per the NYT tracker

https://www.nytimes.com/interactive/2020/world/coronavirus-m...

Last official update from cdc was 1629 [0]. NYT seems to be aggregating data from state reports, and even that is out of date. NYT reports 607 in WA, but the state itself reports 642 [1] (cdc reported 457 in WA on Friday).

[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

[1] https://www.doh.wa.gov/Emergencies/Coronavirus

2969 right now at https://coronavirus.1point3acres.com/. That site aggregates from news media reports and is the most real-time of the various sites I've seen. Plus it gives county-level breakdowns and links to reports with further details.

This is the interesting case where anecdote really does become data. If there are truly only 1,600 confirmed cases then hearing a few stories from a friend of a friend that they know people are sick should still be very unlikely.

The fact that many people here and around the web are sharing stories of sick friends is are a set of anecdotes that would be nearly impossible if the reported numbers were correct.

I suspect by this coming weekend the US will feel very different. I wouldn't be surprised at all if a major update to official numbers came and completely changed the current state of where things are.

>This is the interesting case where anecdote really does become data

I still disagree with this, although I somewhat agree with your sentiment. The anecdotes I have seen range from extremely mild to nightmarish. A large fraction of those made me false, deliberately or by accident. I find the statistics still tell the most concrete story.

I think some napkin math with the number of celebrities and professional sports players, who presumably have far better access to testing than the US public (which has essentially zero access), would show that we are at least at 150k-200k infections, if not more. At least, immediately before Tom Hanks announced his infection, I saw some napkin math that showed that since no politicians, movie stars, or professional athletes were positive, the rate was less than 1/2000 in the US. Now that we have multiple infections in that group, we are in the > 1/2000 == 150k infection regime.

Does this control for the fact that celebrities and politicians do way more travel and meet way more people?

Nope! Napkin math will treat all cows as spherical. However, if they are traveling and meeting way more people, it's also likely they are spreading it far more in addition to having it at a higher rate than the more socially distant segment of the population. Also, would likely indicate vast amounts of community spread that is going completely undetected.

Canada has a population of 38 million, and only 150 confirmed cases.

But one of those cases is the Prime Minister's wife.

Do we really think there are only 150 cases?

It's obviously way, way, way higher than that.

Mme. Grégoire Trudeau seems to have contracted the novel coronavirus in the UK, so your datapoint doesn't really suggest anything about the situation in Canada.

Many people travel between UK and Canada.

There are far more than that today, the number you're quoting is the last cdc report (published mid day Friday). Current number is likely around 3000. NYT last published ~2700 from aggregating state reports, and their per state numbers were a bit lower than every state website I checked.

And this is with extremely limited testing.

What's being done to fix the lack of tests in the USA?

The CDC is headquartered in Atlanta. Where do the COVID-19 tests from them come from? Where are they manufactured, what ingredients do they require, how much do they cost to make, how long does it take to make them? What's the hold up on getting "unlimited" tests from the CDC? Do the tests even come from the CDC? How many are they producing a day? What are their blockers?

There are at least a couple of major upgrades to US testing capacity in progress from Roche[0] and Thermo Fisher[1].

[0] https://www.npr.org/2020/03/13/815522836/u-s-coronavirus-tes...

[1] https://www.statnews.com/2020/03/14/thermo-fisher-to-produce...

I'd say we are late and in the 100s of thousands of cases that are untested.

Edit: others seem to feel the same. See epistatis' comment

Reply on news.ycombinator.com