50% – 75% of cases of Covid-19 are asymptomatic | Hacker News Reader

50% – 75% of cases of Covid-19 are asymptomatic

repubblica.it

533 pointsfortran77471 comments

I live in Japan and I experience mild symptoms since last Wednesday but not sure if my symptom is due to Covid-19. In Japan, You have meet two conditions to take a CPR test.

1. the symptoms with fever of 37.5 degrees or more continue for 4 days or more (for the eldery and those with underlying disease, "4 days" becomes "2 days")

2. you have strong laxity (malaise) or breathlessness (dyspnea), or you have underlying diseases (diabetes, heart failure, respiratory diseases (such as chronic obstructive pulmonary disease))

I don't meet the first condition, so I was refused to take a test, but I still have chest tightness and consistent coughing. I wonder where the number "37.5" comes from, and 4 squeal days!? If the article in question is true, these two conditions are totally meaningless.

So why is taking a PCR test so hard in Japan? Most people believe it is due to Olympic. The Japanese prime minister, Shinzo Abe, still believes we can hold Olympic as planned at this point. To that end, they want to hide the case of infection as possible. I feel strong anger towards my government since they care more about Olympic than human lives.

At this point, Olympic will be inevitably postponed. I hope my government is smart enough to loosen the conditions and let people to take PCR tests immediately…

The symptoms you describe are very similar to those articulated by these two CoV patients who were aboard the Diamond Princess cruise ship which docked in Japan.

Here is their vlog on youtube. https://www.youtube.com/watch?v=H2E1t3yMXgE

The husband describes his experience with temperature and thermometers in the first 5 minutes. The similarity to your symptoms begins at ~ 5:00.

This whole video is worth an investment of 38 minutes. 5M+ views.

Sounds like the government is correctly rationing tests.

My sense is that the vast majority of the healthy population shouldn't get tested even if they might have the virus because the infrastructure doesn't support widespread testing (anywhere -- as far as I know). They should act as if they have the virus and stay home, rest, drink a lot of water, and take NSAIDs if the pain gets out of hand.

I've been sick since last week (much improved yesterday and today) and it could definitely be covid-19. But there's no point in trying to get tested. If I felt the symptoms were serious (significant difficulty breathing) then I'd go to an ER or call 911.

Also, 37.5 is a fairly low fever.

Note, France is warning against NSAIDs specifically for COVID-19.

https://www.theguardian.com/world/2020/mar/14/anti-inflammat...

In the Guardian article in the parent comment, the warning says that any anti-inflammatory drug may be a risk, not just NSAIDs. They include cortisone as an example of a drug to avoid, which is a non-NSAID anti-inflammatory.

Wouldn't that just leave steroids, which is generally never good idea to give when you have an infection as far as I know.

I think it's generally the case that taking pain killers isn't a fantastic idea when you have an infection. Of course, for mild infections there's little consequence, but in this case it might be best to avoid them. Just wrap up warm and stay hydrated.

current advice is: DON'T take NSAIDs (e.g. ibuprofen), which may cause complications due to interaction with immune system.

do take paracetamol

aka Tylenol (acetaminophen) in the USA. Consult your doctor. Not sure what this means for children, but this directive against NSAIDs is a really important development in treatment protocols for COVID-19.

Tylenol / acetaminophen is not an NSAID.

Grandparent was saying that paracetamol is a synonym for Tylenlol/acetaminophen

Paracetamol is the same compound as Acetaminophen, and is sold under the Tylenol brand in the US.

This is incorrect. Paracetamol, Tylenol etc are brand names for acetaminophen which is not NSAID. Ibuprofen, Naproxen, Aspirin are NSAIDs.

https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory...

Isn't it the case that most countries in the world don't have enough tests, it seems only South Korea does. I live in Switzerland and they are also restricting tests to higher risk groups, and people with worse conditions (which is a bit grim, how dead do I need to be before I can get a test?)

Either it's due to Olympics, or just logistics. Will the Olympics even happen if Japan is declared "OK" but many guest nations still have sick people?

I would guess their criteria for testing is people who could develop into a critical situation quickly because the tests are not 100 percent reliable and they are slow.

They were talking about having a televised only Olympics which might work if there were enough countries with athletes willing to fly to Japan.

It's not really about how bad your symptoms get before you can get tested. It's about WHERE you are.

Coronavirus is a virus after all, just like the flu, there is no medication. You can only treat the symptoms, but not the virus itself (as opposed to a bacterial infection where you can attack the bacteria with antibiotics).

So with these undeniable facts it's fairly simple, if your symptoms are so mild that you can cure it out at home without special medical equipment like a ventilator, then you don't need testing. You just have to self isolate yourself for two weeks, get over it and afterwards you are fine and not contagious, so no way of further transmission and therefore no need to test.

If however you develop severe symptopms and need hospitalisation, then they have to test you so they know if they need to isolate you in hospital away from other patiens and protect staff or if you can get a bed amongst everyone else. That is really the only reason.

Your treatment in or outside hospital does not change at all whether you have breathing difficulties because of COVID-19 or any other influenza.

So that is it.

Don't know why this is downvoted. Doctors can't treat the virus but only the symptoms, even for the flu.

From a public health perspective, if you have any symptoms, be it covid-19 or flu, just isolate yourself for the health of others.

It's downvoted because it's dangerous and uninformed medical advice.

You can treat flu (influenza) with osetalmivir. People with mild symptoms can still be at risk, further testing is needed [1]

Please just phone your emergency line if you suspect you may have it.

[1]https://news.ycombinator.com/item?id=22610265

Would not the influenza vaccine be better than using osetalmivir?

These serve different purposes.

If you are already infected, a vaccine is not useful.

But regardless, there is no approved treatment for COVID.

Gilead's new antiviral looks promising, and the Chloroquine/Azithromycin combo looks promising, too, but the first isn't approved for any use yet, and the second is an uncertain off-label use, so in either case, you aren't going to get those treatments unless the alternative is likely death, if you can get them them at all.

If you know you have the covid virus, then you know you have a disease that is far more dangerous than the standard flu, and so you need to take much more stringent measures to prevent others from being infected. You also need to have to health dept trace out all the people you may have infected already.

Capacity of testing is a major issue, and as cases increase, turn around goes down. Tests have to be used where they will be useful and influence management.

> but I still have chest tightness and consistent coughing

Could be hayfever. 花粉症の時期が始まったからね。

I would assume its because the number of people with similar symptoms far exceeds the capacity to test for covid-19. If the numbers in this article[1] are accurate there were around 2.23 million people who went to the doctor for flu related symptoms from January 21 to 27, 2019.

1. https://www.nippon.com/en/japan-data/h00386/japan-gripped-by...

Are you having issues with your smell/taste? A german virologist talked to symptomatic patients and found that most patients were stating that they lost smell/taste for days.

"Almost all infected people we interviewed, and this applies to a good two thirds, described a loss of smell and taste lasting several days."

https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...

I have a terrible sense of smell to begin with. I always wonder what people with good senses of smell experience on a daily basis.

But I can generally taste things, so this is good to know.

Loss of taste is caused by loss of smell, is my understanding. That is consistent with the colds that cause significant nasal congestion causing a loss of the ability to smell and therefore taste as well.

I have read that a few of the "common cold" infections are also caused by different species of "corona virus" so this is perhaps not too surprising.

I think there is a more reasonable explanation why they are not testing you. Simply because they wouldn’t do anything with that information anyway. If the test is positive they’ll send you home to quarantine telling you to call back if your fever worsens. If the test would show negative, they’d tell you, guess what; “please call back if your fever worsens, and stay in quarantine anyway”.

So the information doesn’t really matter.

In Sweden once they change tactics from trying to track each and every case, and who they might have gotten it from etc, to a a strategy more about just accepting that it’s spreading and trying to limit the spread in general, and protect the weak. Then they also stopped doing testing here.

Unless you are in a risk group, the test doesn’t really make a difference.

> So the information doesn’t really matter.

It would matter to me. If I know I have it, I would stay at home and have somebody else do shopping and leave stuff in front of the door. If I dont know that, I do shopping by myself.

Having it or not is also difference between whether one can join one of those programs where young people shop for elderly and leave stuff in front of the door. Of course the caution must be taken with everyone, but also those with confirmed case are out.

It makes difference for people who still have to go to work.

Even official expectations on people with corronavirus are different then on others.

I tend to agree with you, I would like to know as well. But consider this: if it is cold or flu - would you want to risk your health being more prone to the infection while your immune system fights another virus, or bringing more people into the same situation in circumstances like these?

If it is cold of flu, when it passed, it passed. 7 days and you are fine. Corona is can get better and become worst and take weeks. So it is still a difference.

Is it a fact that corona in general takes long to get better from? Thats not what Ive heard/read. Unless you are unlucky and get pneumonia.

I'm always wary of any strategy that is fine with having less information. Of course cost of information is never zero but in this case the actual cost of tests is relatively low.

The cost as in “COGS + markup” may be low but the opportunity cost (cost of not doing a test when it is more important) might be higher when the supply of tests and lab time is limited. While it is absolutely important to ramp up both, it is a different story.

^^^^^^^

This, right here. The entire world is struggling to get enough testing supplies. Testing somebody who's experiencing mild symptoms takes away from testing cases that are much more important - because part of what is happening right now is that everybody with a light fever is all "I GOT THE COVIDS" and wants a test.

Fact of the matter: We don't have enough tests, worldwide. We can't produce them fast enough. We need to triage.

Yes, but it is also true that the number of available tests is increasing rapidly, and also is partly in response to government demand.

If the the available number increased to the level where everyone with symptoms could be tested, would you favor doing so? and do you think that governments should push til enough tests are available to do that?

Late reply, but yes to the former, with the caveat that it's contingent on sensitivity and specificity. (I.e. false negatives/positives)

Probably yes to the latter, unless it takes away resources we need more urgently elsewhere.

But really, what we need to do is depress the count of infected people to a point where it's even feasible to test everybody with symptoms.

Even if we rolled out testing to a point where we can test 1M/day (I think it's 200K/day right now?), it'd take a year to test all of the US. If we're in flu-prevalence territory, that's only 19M, and so suddenly much more doable.

And at that level, we need the ability to both test anybody with symptoms and to conduct random samplings of asymptomatic people, because without that, we couldn't lift shelter-in-place until we have a vaccine. That's... a tad long.

So, more tests, plus suppression doing its job. And it'd be lovely if our government would push to get anything done, really. They've wasted 8 weeks by now, at least. Coordinated response is allowed to kick in any day, by my book.

Cost isn’t zero though. Have a lot of people with mild symptoms come in puts strain on health care, and increases the risk that important health care workers get the affliction.

If the test could be done yourself, at home, then I would agree with you.

If you know how much the general spread is, and how often it requires different sorts of treatment (or is asymptomatic), you can plan your mitigations and restrictions much more effectively.

You don't need to know, the immediate doctor telling you to wait and see at home doesn't need to know, but the government absolutely needs to know.

> Unless you are in a risk group, the test doesn’t really make a difference.

If the test is positive, you can self-quarantine and notify everyone you've been in contact with that they need testing. Then any one of those people that tests positive can do the same thing, etc. etc.

If you don't do any testing, you end up with a bunch of positive but asymptomatic carriers wandering around unknowingly infecting other people.

South Korea is taking this approach and they seem to be doing a lot better than most other countries.

Indeed and it probably makes much of the difference why active cases in Korea have kind of leveled off while in Europe they are growing about 25%/day. And just a reminder that's 800x a month.

Is it possible for the number of cases counted to go up simply because more testing is occurring, while the number of people with the virus has leveled off?

Jup, but they are already at their test capacity so they already need to priorize who is beeing tested.

So unless you have the lab infrastructure in place already (I don't know how it is in Japan), you can't really invent it out of thin air in the midst of a crisis.

The truth is that neoliberal ideology all around the globe did its best to make hospitals and health systems "more economic" by cutting (at the time) unneeded capacities, without any real concern about the resillience of the system as a whole. This is (aside from timing and culture) where you see the main difference between nations today. This is e.g. why Spain decided the privatization of their hospitals was a grave mistake.

Thank you!

There is a HUGE cost to "shelter-in-place". People's businesses and jobs depend on customers going out and using their services, and without customers, they won't have jobs, business will fail, and people will get hurt, and die. (Hopefully fewer now that Trump's doing a bail out.)

Shelter-in-place may be the right thing to do, now that that containment has failed, because people will get hurt and die otherwise, but containment wasn't doomed to failure from the start. It's wrong to frame it that way. It's like running for the bus. You don't have to run as fast as a bus can possibly, you only have to run fast enough to catch it before it leaves the bus stop.

Containment isn't supposed to last forever, it lasts as long as it lasts. It absolutely required far more aggressive action to be successful, and one of those was testing. Which we dropped the ball on.

You should not be giving medical advice. 3% of people with no fever who test positive end up needing ITU admission. Deterioration can be sudden after the first week.

You’re right. I’ll edit it. Edit: I cannot edit it:(

Did you even read the article? The article points out that identifying those infected and isolating them from those who are not reduces infection and also increases the number of those that get better.

The results of the individual test might have limited use to the individual.

But the idea that the information won't be used is nonsense. It's invaluable for the overall response. We have only the vaguest of ideas how many people (in the U.S.) are infected. The more information we have about cases with few or no symptoms, the more we can understand the spread and take appropriate measures (that will also be more obviously justified, countering people who claim overreaction).

More accurate information about symptoms would also help individual people:

- help them understand that they can feel fine and still be getting other people sick

- help them have an accurate picture of contracting the disease, instead of leaving it to nightmares

There's no universe where having more information about the situation would not be better.

In my experience, government/businesses/schools have been slow to close without confirmed test results. If you don't get the tests, no one is going to pull the trigger on quarantining. That is frustrating to me.

What would you change if you take the test and come positive?

Gut instinct:

- More likely to strictly adhere to the lockdown - Post recovery / quarantine period, if (big IF) you now have immunity and aren’t risking infecting others anymore, you could be more productive in the world.

- Helping others with their food/supplies/whatever. Heck, even spending more money on take out food which helps the economy.

The idea of building up a herd immunity seems to me to require knowing who has the immunity so we know when we have enough.

Get a blood test. If CRP raised and lymphopenic, likelihood of ARDS requiring ITU admission is higher. This can happen very quickly after the first week, so I'd put pressure on the doctor to keep me hospitalized.

If you're really desperate for a test go to the hospital and say you feel breathless. Dyspnoea is a subjective symptom but no doctor worth it's salt would just ignore it without investigating further.

I suspect the reason for fewer tests is, as many have pointed out, because of a lack of tests rather than overt political malfeasance. Note: Yesterday they performed 3.4k tests,[0] which is aprox 30% of the total tests to date in a single day. Tests are ramping up as supplies come online.

[0] https://covid19japan.com/

The government says they can perform around 7,500 test a day. However, the total number of tests are much lower than that. Please see the data below. https://toyokeizai.net/sp/visual/tko/covid19/en.html

3/17 is kind of an outlier, because there were too many tests for those who were in close contact with suspected carriers.

I wonder if this will be like H1N1.

At first we only identified extreme cases and we had these terrifying reported fatality rates.

Then we identify more and more mild or asymptomatic cases and the rates drop and drop.

We’ve already seen how CFR was reported as 3 or 4%. Then on the cruise ship full of people over 60 it’s 0.7%. If there are lots of mild or asymptomatic cases it will likely be much lower.

H1N1 was identified as having a scary 0.4% CFR early on and was later found to be much lower, but we didn’t know until after the fact.

An example report from 2009:

https://www.who.int/immunization/sage/1.Briand_epi_7th_July_...

In the end it may have killed over half a million people in 2009 - but for some reason people barely noticed. (Tangent: I wonder if it’s partly the changing media landscape from 2009 to 2020.)

CFR, whatever it is, isn’t the most significant detail. What is “terrifying” is its high contagiousness combined with its high hospitalisation and ICU rates.

Yeah,and the high hospitalization and ICU rates become high case fatality rates once medical infrastructure is saturated, as well as increasing the case fatality rate for every other condition that creates a critical need for inpatient care.

That's where Italy definitely is, and where it seems Iran is evn moreso (though they are less public about it.)

What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation.

I ran the numbers for Canada, and it looks like we'd need isolation measures for 2+ years.

I don't see how that's a feasible solution long-term.

So, wild speculation aside, what numbers did you use to base your model on, and what is your qualification to do anything like that?

Did you factor in an asymptomatic rate?

The numbers I ran for the UK put it at 12 years:

No. People in UK: ~66,000,000

Est. proportion of people who will get sick: 80%

Est. proportion of sick people who require intensive care: 5% (in Italy it's 10%)

So that's 60,000,0000.80.05 = 2,640,000

Number of ICU beds in the UK: ~4100 (90% occupied, but let's ignore that for now)

Length of time ICU required: at least 1 week (probably longer, but let's ignore that too)

So that's 2,640,000 / 4100 = 644 weeks or 12 years that we would need to spread the cases over in order to have enough capacity.

It's likely that we'll have a vaccine or at least some kind of treatment by the end of the year, so this should improve the prospects quite a bit.

I did a similar calculation but came back more optimistically (although still on scale of a year to two).

You only need count over 18s as very few cases in this group. It is believed by the UK experts to have a lower fatality rate of 1% and likely lower admission rate due to asymptomatic infections (estimates at 16-75%). Ventilator capacity can increase with stopping surgery and CPAP/other measures can be used in some cases. Treatments developed later should improve efficiency of treatment. Extra ventilators should be manufactured and help ease burden. I think 80% is too high, likely more 60% given an R0 of 2-3. Finally, the chronically unwel elderly are unlikely to benefit from ITU care significantly and would never qualify. With these exceptions it gets down to 1-2 years depending on assumptions.

Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

I'd like to see more discussion around this point. I don't care where you got the numbers from. It's been clear from a glance that 3 weeks of cancelled school isn't going to do anything. So now we're looking at 8 weeks. Umm.... According to what? Which is more likely, 8 weeks or 2 years? I don't know, but I'm guessing 8 weeks isn't nearly long enough.

Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

Around 18 months (until sufficient quantities of vaccine) is this group of experts’ estimate

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

> What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation.

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

People are talking about it, that talk is driving policy, and the answer is “with some local adjustments possible based on caseload, until there is an effective vaccine developed and deployed, which will probably be 18+ months”, and the alternative is a truly catastrophic number of fatalities.

But, like CFR, we don’t know how high the rates are if we have no idea how many people have or had it.

Here’s a few first hand accounts of what the illness was like. These folks aren’t even that young and they describe it as being quite mild:

https://www.nbcnews.com/video/coronavirus-patient-from-diamo...

https://www.adn.com/opinions/national-opinions/2020/03/01/i-...

https://www.msn.com/en-us/news/us/don-t-panic-says-us-woman-...

Anecdotes are not sufficient data

They are when there's little quantitative data to work with.

A lot of people's biggest questions are what the hell "COVID-19 symptoms" and apparently it means just about anything.

I'm suspicious of the 2 week long illness my family has just gotten over. Hit each of us differently. Predominantly nasal mucus, but the kids had some chest congestion, wife had a fever, and I had what felt like a sinus infection and a bit of a dry cough.

None of it particularly severe. Likely not COVID-19, but given the scattershot presentation of the disease in non-critical cases, I'm not ruling it out.

No, the symptoms are pretty clear:

Fever, dry cough, fatigue, sputum production, shortness of breath (dyspnoe), muscle/joint pain.

https://ourworldindata.org/coronavirus#the-symptoms-of-covid...

We don’t have sufficient data because we are, in our infinite wisdom, not testing every person with a pulse. Or at least testing from as random of a population subset as we can manage. At least in the US. Other countries mileage may vary.

But even then it is my understanding that there currently is no way to test if you already had it.

"But, like CFR, we don’t know how high the rates are if we have no idea how many people have or had it."

While it's true that the hospitalization / ICU / mortality rates may be lower because we don't know the full number of cases, it still seems to be an immediate and acute problem.

Regardless of the rates, the absolute number of people being hospitalized in Italy was enough over overrun their healthcare system. The same situation looks to be on track in many European countries (Spain, France, UK).

So, the worst-case scenario may be less bad than predicted (let's certainly hope this is the case!), the number of case's we're identifying and having to deal with is still dangerously high.

Whatever they are, they’re high enough to be causing major problems for hospital systems in places like Italy. They seem high enough that many countries desperately need to slow the spread of the virus or they will face dire consequences.

> These folks aren’t even that young and they describe it as being quite mild...

Take that with a grain of salt. The people for whom it's not mild aren't going to be giving interviews.

It’s literally survivorship bias.

Technically, the hospitalization rates and ICU rates would also be greatly overestimated due to the number of unidentified asymptomatic cases.

But from a perspective of absolute numbers of patients hospitalized and admitted to ICU, your point stands.

Those high rates are also dependant upon the fraction of cases detected.

We are currently seeing about a 9% hospitalization rate based on detected cases.

If we are really missing 75% of cases, then true hospitalization is only about 2.3%

I really, really hope so.

My hope is it is way more widespread than we think, and while that means it's going to be near impossible to contain, the denominator is so large that the CFR ends up being much lower than expected.

Maybe in the end the CFR will be the same as the regular flu.

The only thing that matters in the end is total population mortality rate.

That is a bad metric. The death rate could be really bad yet the overall death rate would still not change very much.

If I am the only person on the planet with a 100% deadly disease why should I force everyone else to suffer because of me?

The fear and suffering alone is enough to have a negative effect on people, so it matters.

So is shutting down the entire worlds economy. That has massive, very real impacts well beyond just money.

Ya, but the anxiety of thinking you might sick and die also has negative impacts beyond just money.

It has already proven to be far worse than the flu in its strain on healthcare systems.

Isn't that largely due to a lack of immunity? Too many people getting it at once in clusters?

If this becomes a cyclical thing, I'm sure we'll have vaccines for it like we do the flu, at which point it'll just be annoying like the flu is.

If Covid-19 does end up being a dud, then we are in real trouble if/when an actual pandemic arrives -- because by then everyone will say the CDC is Crying Wolf.

It’s already proven not to be a dud — healthcare systems stretched to beyond 200% capacity is solid evidence of something no one has seen in recent memory. When youngish healthcare workers are dying, something is going on.

Not necessarily. If it's already in a sizable portion of the population but mostly undetected, it will kill some seemingly healthy young people.

They may have some unknown underlying condition, may have the genetics to trigger a lung destroying cytokinin storm, or may just have gotten unlucky.

Here's some more information about cytokine storm syndrome treatment in COVID-19 patients.

https://www.uab.edu/news/research/item/11176-covid-19-do-not...

Where did you get that number from?

A report from Lombardy yesterday says so far everyone with any reasonable chance of recovery has been treated:

https://www.reuters.com/article/us-health-coronavirus-italy-...

As far as I can tell so far, no hospital systems have collapsed due to this, even in the most extreme hot zones. The fear is that they will, and that sounds totally reasonable. But we also are basing that fear on data that's not robust. So we don't really know yet what will happen.

This has been so widely reported, not sure where to start. Operating rooms at many Italian hospitals have been closed and turned into ICUs to handle the demand, which means that surgeries in many places are no longer possible.

You can read about this in any of hundreds of media outlets. Here's one:

https://www.dailymail.co.uk/news/article-8095835/Overwhelmed...

You don't seem to be contradicting me. I'm not saying everything is normal or other operations weren't cancelled. I'm saying that at this time, Italy is saying they have not run out of capacity to treat CV patients. And they definitely aren't 200% over capacity (for CV) as claimed.

They have not enough ICU beds.

That is pretty much the definition of running out of capacity.

OK, so I read the Daily Mail article. I think there are a couple of things going on here.

Firstly, hellofunk made a claim of "health care systems stretched to beyond 200% capacity". I asked where that number came from because it contradicted what I'd read. S/he's provided a source, which is this quote from the DM:

Another medic in northern Italy told a friend in the UK that hospitals were running at '200 per cent capacity' with operating theatres hurriedly converted into intensive care units.

So this is a snippet from a private conversation with a friend repeated on Twitter, and it grew in the telling ("at 200%" became "at over 200%"): it's not a formal claim by someone with all the data. It's a claim that's painting a picture of what it looks like inside a hospital where one person works.

Secondly the report I cited has this:

"Over three weeks, 1,135 people have needed intensive care in Lombardy, but the region has only 800 intensive care beds, according to Giacomo Grasselli ... Grasselli coordinates all the state-run intensive care units across Lombardy."

When I read this the first time I thought, OK, so then they've surely run out of beds and are turning away people they could save. Confusion followed when I read this:

Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.”

The first quote doesn't actually say they've run out of beds. That would be true if everyone needed to stay 3 weeks. If the average recovery time is 14.7 days then 1135 people could be treated with 800 ICU beds without anyone being turned away, whilst being at full capacity.

In the DM article the anonymous doctor claims Lombardy's healthcare system is one of the best in the world (sometimes this is phrased as most efficient, which isn't quite the same thing: you'd expect a highly efficient healthcare system to run out of capacity earlier than a less efficient one, I suppose). The Reuters article says:

Intubating can be taxing on the body, especially for older patients, says Grasselli ... adding that he would never intubate his 84-year old father. Before the coronavirus broke, “we more often had the luxury to try to intubate patients who were at the limit,” said Mario Riccio, head of anaesthesiology at the Oglio Po hospital near Cremona. Now that’s changed.

So some of this notion of rationing of healthcare is that before, Lombardy could afford to try extreme and risky measures to extend every life even in cases where the likely outcome was severe damage to the body from the procedure. Now they can't afford to take such measures anymore.

Medical systems don't have a hard notion of capacity. Total capacity is flexible: when under stress doctors are forced to triage more aggressively and drop the most extreme treatments. It may not make sense to talk about running out of capacity in a world where medical systems can keep otherwise terminal patients alive indefinitely; there is always triage even in quiet times. I'm not sure how best to measure it but it may be unduly alarming to say Lombardy has run out of beds.

> The first quote doesn't actually say they've run out of beds.

It does. It literally says people without much chances to live had not been treated.

If you had 25% chance of living, and are told you will be dead anyway, I am sure you would understand the quote perfectly at that moment.

And you are not even taking into account the amount of psychological stress to health professionals (and the families of victims) that have to tell people that or, worse, that they will disconnect someone even if it still had chances to live. There are nurses breaking down, and I expect a wave of PTSD cases in health professionals when this is over.

You seem to be living in a different factual world than the rest of us, where ICU cases are in hallways and surgical suites is not "over capacity", and leaving people to die of suffocation without standard lifesaving treatment is not unusual.

I'm going to be giving up on this thread in a moment because people aren't even reading what I'm reading and definitely aren't answering in good faith.

The original claim was that people over the age of 80 aren't being treated because they don't have the capacity for it. I queried if they were sure about that, because the Italian government was saying that's not true. An Italian has now replied to that same post also stating it's not true and the international media has exaggerated a comment by a single doctor.

That's the factual world.

In another thread a guy claimed the Italian system was "at over 200% capacity". This turned out to be an exaggeration of another claim by a single doctor, not a real statistic.

I've been querying these sorts of claims by directly citing detailed testimony from the guy who literally runs all of ICU in Lombardy, the worst struck place in the whole world. He is saying, as clear as can be, he doesn't believe people with a chance of recovery have been turned away due to lack of beds. This doesn't mean they haven't increased beds via drastic measures or taken other actions to increase capacity. It means that as of the time that report was made, he didn't believe they'd run out of at-present capacity and had to turn people away at the hospital entrance.

Maybe he's wrong and not living in the same factual world as the rest of us. I don't know. But I'd hope he understands the state of his own hospitals given his job.

Lombardy is not the worst hit place so far. Wuhan is.

Sorry, I meant "at the moment". Wuhan is apparently now in the tail end (if you believe the PRC). But I didn't say that. Precise communication is hard!

> reasonable chance of recovery has been treated

This is the caveat of what you said. The West, and especially Americans, doesn't take kindly to the realities of triaging. See the arguments on "death panels" regarding the Affordable Care Act.

This is my biggest concern. I don’t even think this is “the big one”

Oh, it's absolutely not "the big one", which is why I'm so frustrated at all of the panic buying. It was pretty clear early on that this isn't that deadly and that the main issue with it is filling up hospitals. We later learned that the whole process from infection to recovery (well, enough to be released from a hospital) is about 2 weeks, maybe less.

This isn't some society-collapsing event, but it does require containment so our medical infrastructure doesn't get overwhelmed. If you get it, you'll most likely live, even without medical attention.

That being said, we do need to treat it seriously. It isn't just a dress rehearsal for something worse, but it is telling in how people react. I'm worried about what will happen if something worse comes along.

What I have learned, however, is that my general strategy is always keeping 1-2 months of basic essentials on hand is a good idea, and that I need to be more vigilant about it because people overreact.

I lived in the Tampa Bay area for 7 years. Twice a year (despite the fact that TB has been very much sparred from impact) hurricane panic ramps up and the region is CLEARED out of wood, petro, water, and canned goods. Hurricane Irma results in a complete wipeout of supplies 2 weeks before landfall. The initial landfall target was Miami and all hell broke loose anyway.

So when you get 1-2 months of essentials just in case, it’s a good idea, but when other people do it, it’s panic buying and overreaction?

The trick is to already have 1-2 months of essentials before hand. The issue is when everyone tries to get 1-2 months of essentials all at the same time.

Obviously, but that doesn’t make it an overreaction for people who waited until now to buy what they need.

Hospitals in Italy are over capacity. People are prioritized based on chance of survival. Anyone unlucky is left to die because there is not enough equipment.

Yesterday the news was that anybody over 80 is not treated. They simply don't have the capacity for it, and survival chances are better for people under 80.

Are you sure?

https://www.reuters.com/article/us-health-coronavirus-italy-...

Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated.

I wonder if we're getting mixed messages here; that is, it's inevitable doctors give up on some cases and unplug them from the ICU but that is always a risk in ICU for any reason to be there.

Doctors "Give Up" on people all the time. If you have advanced pancreatic cancer, are 85 and a heavy smoker, most doctors are going to suggest you go home and spend your last few days with loved ones.

Yeah, that's what I'm getting at.

What I see at the moment on HN and elsewhere is a lot of people who seem to believe that in Italy the hospitals are already overrun and people are being turned away in large numbers because all the beds are gone already days ago.

But this doesn't match what is actually happening there, according to the Italian government. What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it.

I think this mismatch is coming from a couple of places. One is mis-interpreting doctors switching off life support for patients who can theoretically be kept alive using e.g. ECMO but for whom their lungs are destroyed and they wouldn't really have a life afterwards. That's terribly sad but isn't the same thing as patients who are in the middle of making a full recovery being switched off, or people who could be saved being denied beds because there just aren't enough. Another is a confusion between "we're about to run out of beds" and "we think we're about to run out of beds".

I'm not trying to downplay the seriousness of the situation here, but we have also have to keep our heads and double check things being claimed about that seriousness, as it's always tempting in times of crisis to lose our heads and go full sandwich-board. Maybe by tomorrow Italy will actually be there, but as of yesterday at least, it seems they aren't.

> What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it.

You wrote yourself a quote in another comment where it is claimed that has happened. I am confused...

> What they're saying is so far they've had to turn away noone; that everyone who needs treatment is getting it.

> all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated.

These two quotes from you are mutually contradictory.

They're not quotes from me. I'm directly citing the head of ICU for all of Lombardy.

I think reading the Reuters article I'm citing in full is the best way to understand what's going on. I've also tried to summarise it here:

https://news.ycombinator.com/item?id=22607485

The confusion probably comes from the definition of treatment. It's possible for simultaneously nobody to be turned away due to lack of a bed, whilst terminal cases they know they can't save are now being turned off quicker i.e. less aggressive intervention than before. That's what Grasselli is saying:

So if you have a terminal cancer and get coronavirus that means you don't get a ventilator. That's the nice part.

The next part is "living an acceptable" quality of life. This probably means anyone not brain damaged and anyone they think won't require oxygen later. Might mean people not currently on oxygen when they get covid-19.

And despite all of that he says that this system is under strain.

Read between the lines.

I don't understand what you don't understand. That quote is literally saying they are over capacity.

What are the results of the "over capacity"? Are hundreds of people who could have recovered from the virus dead today because they didn't have access to oxygen, or ICUs?

Yes, that is exactly what it means.

And what the reuters article is saying is that that's not the case at all. So, by your definition, it's not actually over capacity.

How does that quote contradict the parent? If you were a doctor, and you wanted to communicate the concept of triage without baldly stating that people are being left to die, how would you phrase it?

Not sure how, but definitely wouldn't lie about it. Plenty of 80 year-olds would have a chance of making it, so they wouldn't be turned away according to that declaration.

It's not a rule i've read on any Italian report. There was a doctor in Bergamo who said that they might have to do that in an interview and it was misreported in the international media. (I'm Italian living abroad) the Italian healthcare system is regularly listed in the top 10 in the world and Lombardy is usually number 1 in Italy. They are building a massive facility in one of the exhibition centers in Milan, it's tough but they're doing amazing work, from what I read and what I hear from people. I am much more worried for my friends in the USA..

Then i probably read the misreported quote. I'm Danish, and despite having lived in northern italy for a few years, i sadly don't speak/read italian :)

As Italy is "3 weeks" ahead of us, news from there is being monitored closely as it could signal what might happen here.

You state this as fact. However there are also plenty of other sources of facts that counter yours. Who is right? Who the hell knows.

We now live in an age where you can dig up facts to confirm whatever you want to confirm. Information overload is a real thing.

This is not a dud, and it will prime whole generations in different countries to have respect for new diseases. If the United States just delays a little longer in its response, it will also be on the list of those countries. Don't know if one should count that as a success or not.

>If the United States just delays a little longer in its response

You'd think following the trend of Italy was scary enough.

https://www.vox.com/policy-and-politics/2020/3/13/21178289/c...

I dont think thats true. Unfortunatelly I dont see mortality rates like in Seattle reported in other retirement facilities.

This is wishful thinking, and it doesn’t take much examination of the medical literature to realize this fact.

Edit: it's super fucking irresponsible to say "this is going to be like H1N1" when there is no reputable medical literature that supports that position

> it's super [] irresponsible to say "this is going to be like H1N1"

Good thing the person you responded to never said that.

that is pretty much the hypothesis in their post

I don't see in that link where it shows the CFR in the U.S. changing at all, let alone dramatically.

Here's a paper from 2013 that surveyed CFR reports for H1N1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/ After a long discussion about the varying definitions of the numerator and denominator, they had this to say:

> Given that estimates of the infection fatality risk are unlikely to be available early enough for decision-making in a pandemic, a more feasible solution may be to measure the case fatality risk among symptomatic cases. ... Such estimates based on symptomatic cases may provide timely but imprecise estimates of seriousness for risk assessment.

CFR is not population mortality, and is usually not even infection fatality rate--but, confusingly, sometimes is as there's no official definition. After COVID-19 passes I suspect and hope that the medical community will tighten down definitions. CFR should be restricted to symptomatic cases approximating the type of severity that consumes non-negligible medical resources. Early on in an outbreak it's the only possible practical definition for tactical management of medical resources. An ER doctor couldn't care less how many infected people are convalescing at home. IFR (infection fatality rate) should be explicitly broken out. It's an important numbers to have, but often impossible to pin down until late in the game, sometimes only after the epidemic has passed. And IFR is most useful combined with r0, which has it's own definitional problems--do you care about hypothetical r0, r0 with social distancing, etc. Population mortality rate is even more difficult pin down.

I'm not a doctor, but I feel like "CFR" is one of those terms which was never meant to be consumed by the public. Early on it was probably taken for granted by the medical and scientific community to be a "case" as understood by doctors, who would typically only diagnose a specific illness when a patient presented with moderate or severe symptoms that required intervention. But as the medical and scientific community grew more diverse (and lab tests grew increasingly cheaper) the implied assumptions behind "case" became less and less valid, and they completely fall away in public discourse. These types of definitional problems are familiar to those of us in the tech sphere.

That report was from summer 2009, so it was written during the outbreak. Note the early CFR from WHO was 0.4% for the US and over 1% for Mexico.

Later in the year it was found to be <0.03%.

http://news.bbc.co.uk/2/hi/health/8406723.stm

AFAICT, that 0.03% is for the U.K, not the U.S. And it doesn't say what the definition of CFR was. I've read a significant number of papers (primary materials) about SARS, MERS, H1N1, and influenza over the past few weeks. IME, CFR is usually defined as diagnosed or symptomatic cases as the denominator (which, as I've said, was until recently effectively equivalent), especially mid pandemic. But it's not always so defined. One notable exception that adds to the confusion is seasonal influenza, where U.S. annual fatality rates are calculated using post hoc modeling.

Even if we pin down CFR to be # deaths / # confirmed symptomatic, there's obviously still going to be some variability, possibly significant--quality of medical interventions, age distribution, etc. But trying to shoehorn IFR and other definitions into that number would compound such problems many fold.

Knowing the actual CFR allows us to set the right policy. The seasonal flu has a range of 0.10 and 0.015% CFR. At what point do we shut down society? 0.4% 0.6%?

And I know this will get me down=voted, but what if COVID-19 is everywhere already and it turns out the CFR to be close, or even lower than influenza?

But the enormous strain in the healthcare system is very unlike H1N1, so it’s probably not too far from the estimates. To see what’s happening in Italy, this is obviously much worse and unprecedented.

I wouldn't be surprised if it's similar. Many countries, even ones in Europe with high infection rates, still don't test people if they don't show severe symptoms because they don't have the capacity to do it on a large scale.

AFAIK, the case fatality rate is always higher than the actual mortality rate, but before reliable antibody tests are available and used on large random samples of the population speculating about it is not helpful.

The WHO predicted that 150 million people would be killed by avian flu

https://www.google.com/amp/s/amp.theguardian.com/world/2005/...

Using the same logic that had lead to the severe predictions for cv19.

For swine flu they promoted and stood by a CFR of 60%. Again turned out to be nonsense; nonsense known at the time to others

https://jech.bmj.com/content/62/6/555.abstract

When it comes to these estimates, the WHO seem to be really bad at their job.

But the reality now is that no matter what the estimated CFR is, Covid-19 guarantees that without containment there will be significantly more people in need of hospital care than there will be beds and support staff. And that will affect the final mortality rate, and push it higher than a normal flu season.

> and push it higher than a normal flu season.

last major flu season in Italy killed 24k people. We didn't immolate the global economy as a result

Why didn’t the hospital system collapse because of the flu?

It is because of the consequences of covid-19 on the lungs of some people, which needs intensive care and specialized equipment to cure them, that is rare (ventilators etc.).

People are conditioned by experience to not present to hospital with mild respiratory symptoms. As they get older it gets more common and you still apply the same rules. Often too late by then to do anything other than ventilate.

People forget that ventilator means not only the machine itself, but you also need couple of doctors - anesthesiologist in the least and nurses that have to keep watch. Person on the ventilator needs to be partly paralyzed to not interfere with the machine. I do not know how many staff on average is needed per patient but it is a significant number.

Also the length of time that people stay on it, with covid-19 it seems to be 2-3 week so bed and staff turnover is slow, which meant you need many more people that are available.

ICU "bed" is a virtual term, it not only means the physical availability of ventilator, but also staff.

Just a nitpick but a regular ventilator doctor that isn’t necessarily qualified to administer anesthesia is a Pulmonary specialist. They are generally the doctors prescribing the ventilation therapy. Below them are Respiratory Therapists who have a core of general knowledge and training for ventilation therapy. The RT is the person who administers the therapy and manages the equipment in the day to day. You don’t need to have run anesthesia ventilators to run regular ventilators. Anesthesia delivery is generally considered a different animal.

Based on the CDC's numbers for the US[1], less than 2% of seasonal flu cases require hospitalization at all. This disease is at about 20% (based on detected infections). Even if 75% of infections are really undetected and asymptomatic, we're still looking at about 3 times the number of hospitalizations as seasonal flu.

[1] https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...

This doesn't make sense.

The flu figures are statistically derived. The cv2 figure is derived from literally actual test cases only, which represent a tiny tiny tiny subset.

They cannot surely be compared, unless I'm missing something

Because the health care system is built with those estimates in mind.

It's the same with electricity infrastructure on climatologically hot days. The infrastructure is only built to handle a certain normal peak load. COVID-19 like a heat wave, is abnormal.

And COVID-19 is on track to kill way more than that in less time. So what's your point?

If we wait for new pandemics to kill more people than the flu to take them seriously, then it's too late to act.

At this rate in Italy alone it will kill more than 100k people. And the rate is increasing.

It won't

https://twitter.com/jeremycyoung/status/1239975682643357696?...

The rate is decreasing, not increasing

Note enough data to say that, the past 3 days were all twice as high as the 3 days before that, and those days looked like it was decreasing.

How would you accurately attribute that to the risk of the disease being overestimated, rather than the measures taken being effective?

Because it's becoming obvious the disease is vastly more widespread and far further ahead than the official numbers based on death rate/testing data show.

Death is usually around 20 days after first symptoms

Overestimates of the severity of the threat have much less harmful consequences than underestimates. For a start, actual casualty statistics are not independent from mitigation actions taken.

> Overestimates of the severity of the threat have much less harmful consequences than underestimates.

We didn't take the estimates for SARS and h1n1 as "seriously" as now, and they are just as if not worse than this.And look what happened.

I think Asian countries took the estimates pretty seriously. I think both would have been worse if they didn't, especially SARS.

SARS was more lethal and more infectious than COVID-19. It was however easier to contain because there wasn't much asymptomatic transmission, and the incubation period was short. Those two things are what makes COVID-19 more dangerous in practice.

Definitely agree, but at a certain point, WHO is going to be seen as crying wolf. They've already taken a large credibility hit in this crisis. They can't afford to ignore their perception in the age of populism and social media.

Don't underestimate the number of people whose lives will ultimately be shortened by the economic harm being done in panic over the virus.

The estimates in that first article seem oddly cavalier:

> “Around 40 million people died in 1918 Spanish flu outbreak," said Prof [of mathematical biology at ICL] Ferguson. "There are six times more people on the planet now so you could scale it up to around 200 million people probably."

As of 2014 the number of deaths is <500, although the Wikipedia article [1] is written as if bird flu is something that may yet turn much worse.

[1] https://en.m.wikipedia.org/wiki/Influenza_A_virus_subtype_H5...

The thing is, there's what happens if you don't contain something and what happens when you do.

Humans are a monoculture across the planet at this point. In many ways it's surprising that there aren't more pandemics.

Both links are for H5N1 avian flu

In Italy more than 300 people die every day, the overall mortality rate is between 3% and 8% this is 10 times more than 0.4%. Even if 50%-75% are asymptomatic, there is still large percentage of critical cases that need ICU treatment and currently we are not prepared for it.

For me the title should be 25% of cases require treatment in hospital and we are not able to put 25% of population into hospitals, so, very likely 3%-8% will have to die (3% - WHO estimate, 8% - real numbers we have for now).

That's assuming that all reported cases make up all ACTUAL cases. This is likely completely wrong. What if a much much larger chunk of Italy is already infected and simply not showing symptoms? You would never get permission for a test.

Estimates, I found them on Germany's top Robert Koch Institute website [1], suggest that Wuhan underreported cases by a factor between 4.5x and 11.1x (3 separate studies with different factors).

[1] https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...

I don't think anyone knowledgeable is assuming reported cases make up all or even a significant proportion of infected cases (I myself am in recovery from moderate lung inflammation which is probably COVID-19, but even with very-obviously-not-regular-flu symptoms don't figure in my country's stats because tests are reserved for those requiring hospitalisation)

Even if it was actually the case that nearly everyone in Italy had it in which case the casualty rates would be much lower than current estimates, the proportion of cases needing ventilators is sufficiently high to overload Italy's healthcare system (so the risk is similar, we're just looking at different risk factors i.e. the disease being less deadly but much more efficient at spreading than current estimates). Knowing that would make it easier to shift from containment to building more ventilators as a strategy, I guess

> I don't think anyone knowledgeable is assuming reported cases make up all or even a significant proportion of infected cases

The WHO explicitly and repeatedly asserted exactly that.

Surely the amount of symptomatic but untested people in Italy is high. If you're sick but readily able to manage the symptoms, and you're already under lockdown because the health system is overloaded, you're not going to bother going in to get tested - you're going to let the doctors work on the people who need it.

> For me the title should be 25% of cases require treatment in hospital

The opposite of "completely asymptomatic" is not requires hospital.

>Then on the cruise ship full of people over 60 it’s 0.7%. If there are lots of mild or asymptomatic cases it will likely be much lower.

Here is a comedy show lambasting Donald Trump for saying he had a hunch this was the case:

https://www.youtube.com/watch?v=yNfmTMdoao0

Donald Trump's gut probably saved thousands of Americans through closing the borders early (this is a talking point he repeats again and again and I haven't seen anyone argue with this - so I accept that if any other President had been in office that President wouldn't have closed the borders from highly hit areas so early - an unprecedented action - and hundreds, or thousands of Americans would be dead. Since it is unrefuted I accept Trump's assertion that U.S. has a huge number of tourists and ordinarily would have been harder-hit.)

However: not sure how I feel about being led by a gut rather than experts.

I debated whether to submit this but I will do this to judge for myself HN replies and voting on my comment.

I've actually been really surprised by how well he has handled this so far too. The nation-wide lockdown plus direct cash stimulus are exactly the measures I had hoped to see. Pandemics may be one of the rare situations where having authoritarian leadership can actually benefit the populace. Though I guess we have a while before it plays out completely. I have doubts about whether any non-populist president would have taken these steps any sooner.

Meh. An actual leader would clearly articulate what is going on—he hasn’t done that. An actual leader would tell people not to panic—hasn’t done that. An actual leader would take strong, very visible action against people hoarding supplies or worse reselling them for profit—toilet paper memes are funny until you run out.

And quite frankly a real smart leader would have started testing the fuck out every person with a pulse. More understanding of how many people have it is important.

I'm not really a trump fan - but at the same time, these people have to have time to do the work, they can't spend it all in press conferences.

At a practical level on the hoarding - what can the president do, declare martial law? There aren't enough police/solidiers to enforce it anyway. Far better to get to work on the source of the panic, especially if you believe it can be contained if you prioritize that.

It's clear we're behind on testing - and definitely the FDA is owed some blame. But at the same time, if the tests don't exist in quantity, they don't exist. That takes time - and be all accounts, they seem to be working hard on getting there.

They can make clear, well publicized examples of people hoarding goods for resale. They make well publicized examples of people getting arrested in stores who are loading their carts up with every hand sanitizer bottle on the shelf.

It doesn’t take more than a few very visible examples to clamp down on that kind of behavior.

That absolutely should be happening - but that needs to be done at the state or local level, or in consumer protection agencies. That's not a job for the president at times like this.

> That's not a job for the president at times like this

It is absolutely the job of a president, at least a good one anyway, to ask the populace to chill the fuck out and stop hoarding toilet paper and medial supplies.

It’s up to the states to manage hoarding and reselling, and they are.

Sure but the president’s job is to tell people to chill the fuck out. So far, he is not.

The U.S. is not under lockdown. Far from it. Any lockdowns have been entirely done at the state and local level and even those are very spotty and a far cry from the lockdowns in Italy at the moment and in China.

Direct cash stimulus is one thing I'm definitely looking forward to. The other big one is the various cash infusions into key pillars of business (e.g. airlines).

I don't think it's been an abject failure, but I think the U.S. response to the pandemic has been at best middling and full of whiplash in both rhetoric and policy pointing to a reactionary plan rather than any sort of proactive attempt to get out ahead of the curve. We didn't learn a lot of the lessons we could've from South Korea and Singapore (and at the very least why couldn't we have imported their testing).

> I've actually been really surprised by how well he has handled this so far too

No one who knows how national pandemic response works agrees with you. They know that trying to suppress testing, and criminal lack of executive management of the testing capacity was a known and must-be-fixed quantity 6 weeks ago. They know that hundreds of millions of PPE supplies should have been ordered under federal pandemic authorities 8 weeks ago. They know that emergency powers for production of ventilators should have been invoked 6-8 weeks ago, and still haven't been. It's bungled beyond belief and the only thing that will prevent something near a worst-case run of this pandemic will be some luck.

Thanks for chiming in with those examples. I suppose "well" is much too strong of a word then. I guess I just have very little faith that others would do a decent job either.

Since you seem knowledgeable, I guess my question is: While large scale testing seems a reasonable thing to do on it's face - since we already know this thing spreads like wildfire - isn't the best play to just have everyone self-quarantine regardless of health status? Why spend resources on mass testing and preparing for mass-scale treatment when it seems that a total lock-down could nip the transmission in the bud? If you're a non-severe case they tell you that you're supposed to stay away from people if you test positive. So if you're doing that already - what's the difference? Especially considering the logistics of performing large scale testing to identify non-critical cases could expose the people performing the tests if they mess up on their safety protocols. And then there's the issue of false-positives and false-negatives.

I guess I just don't see the benefit of mass testing everybody when we have the option of just shutting down everything now.

> Why spend resources on mass testing and preparing for mass-scale treatment

This is a good question, I hear it a lot. So here's an inarticulate stab at an answer.

[TLDR: After quarantine the population is still at risk and the virus will start its exponential growth again, just a few weeks down the line]

No matter how effective your mass quarantine may be, we will never "nip transmission in the bud". This thing is endemic and may well be chronic.

The purpose today of mass quarantine is just to slow down the exponential growth of the epidemic. It's only worth doing if you have something to stop the growth from starting again at the end since shutting down the economy isn't sustainable and is enormously damaging even in the short term.

What's that something? Wide-spread, universal testing. Rapid follow-up on positive tests to trace contacts and isolate them. This way you cut down the number of people each person can infect so that the growth rate is less than 1.

You have to keep this regime going until a sufficiently large proportion (in this case, 60%-70%) is immune either because they have recovered from infection or they have been vaccinated.

So, barring getting really lucky with some kind of seasonal disappearance of the virus, we will have to maintain this surveillance-tracing-isolation three legged stool until a vaccine is available.

If we had done this from the beginning we would not now have to be shutting down and destroying the economy to prevent a worst-case disaster, which is estimated that it would peak at about 40,000+ deaths per day in the US, sometime in late May, if left unchecked.

If we had done wide-scale test-trace-isolate from the beginning we could just be going about our business, albiet with this new factor in our lives. Since the criminals bungled, and are still bungling the response, we instead will have many many deaths and serious illnesses w/lifetime consequences and unprecedented economic damage.

This seems like a fairly common view to people who have come late to the topic.

If you have been paying attention for a while, the way the USA has handled this is horrifying.

Compare the outcomes in Italy to those in South Korea to see what good handling of this crisis looks like.

Even though we had the example of Italy weeks ago, we waited and waited and waited until now. Our outcomes will be similar to Italy's in a great deal of the USA.

The worst thing was the terrible, terrible failures in testing. We will never know exactly how many lives could have been saved if we ramped up testing the way South Korea did. We will be able to make some rough guesses after we get the final body count.

Trump also did enormous damage by continuously, repeatedly dismissing the new Coronavirus as no worse than the flu. Foot dragging and denial are natural anyway; having the president constantly dismiss the worst epidemic since 1918 as alarmism from whiners delayed action at the state and local levels, never mind all the action that wasn't being taken at the national level. There are still many people--maybe a majority in my area--who think this is all overblown panicking over nothing.

Here's the best I can say. The travel ban was a good idea and would have saved lives if we had not chosen to throw away the extra lead time it gave us. And most of Europe handled this just as poorly as we did, if that seems justifying to you (it does to some people).

I'll argue with this. He didn't close borders early and he didn't close them well. Here's a general link about it: https://www.factcheck.org/2020/03/the-facts-on-trumps-travel...

Specifically as to the timing of travel restrictions, the U.S. was more or less in line with other countries at the time. A wide swath of countries started banning entry to foreign nationals from China around the end of January, beginning of February. In the U.S. travel was banned to foreign nationals from China on Feb. 2nd, around the middle-low end of the pack (although not by much, just a day or two). This was less restrictive than some other countries (which banned flights altogether), but generally in line with other countries. However, the U.S. has consistently been behind the ball when it comes to quarantining U.S. nationals from China. Long after the official announcement people were getting off the plane and not even being asked let alone compelled to at least self-quarantine in their own homes for days if not the full two weeks.

Testing has been infuriatingly slow to roll out and there has been a noticeable lack of coordination between states and the federal government about how to institute protective measures. The 1.5 million tests promised by Pence has failed to materialize as of yet. The CDC stopped counting case numbers (at least publicly) and now the best available case count is one maintained by a private institution (Johns Hopkins University). More generally, Trump has consistently downplayed the threat of the virus through February in a way that medical experts repeatedly complained was far too incautious for the situation and is now doing an abrupt about-face and claiming that he has never downplayed the risk at all and in fact was more cautious than even experts.

So I guess the South Korean CFR of 0.7%, with by far the best testing, a relatively young population, and no overloading of hospitals, is "way under 1%"? And any suggestion that a higher percentage of people died in other circumstances is just a "false number"?

Or it could be like the 1918 Spanish flu - a bad first wave that was most dangerous to the elderly, and a second wave that mutated and killed mostly young adults.

I don't know why there would be any reason to believe that would be the case. Generally viruses become less deadly over time, not more. The Spanish flu was an outlier.

I'm pretty sure the Spanish flu did become less deadly over time. I'm sure the virus didn't go away after the second wave, however humanity started developing an immunity to it.

No, from what I’ve read the second wave was the deadliest by far. The first wave being mild. There is anecdotal evidence that sick soldiers spread a virus that became stronger with soldier to soldier spread and then infected more venerable people when returning home. How this would extrapolate to the current outcome I’m not sure.

Right, the swine flu pandemic of 2009 was basically a descendant of Spanish Flu. It continues to circulate, particularly in the last couple years - a majority of flu cases this last couple months have been the H1N1 strain that descends from Spanish Flu. We don't hear about it because newer and more deadly pathogens like COVID-19 have cropped up since.

I think most people in this thread are talking about 1918-1919, though, since that time period's a little more relevant for predicting what COVID-19 will do.

SARS (including this new Coronavirus) does not mutate as fast as the flu, so it's even less likely to become more deadly than the common flu.

> But SARS has a molecular proofreading system that reduces its mutation rate, and the new coronavirus’s similarity to SARS at the genomic level suggests it does, too. “That makes the mutation rate much, much lower than for flu or HIV,” Farzan said. That lowers the chance that the virus will evolve in some catastrophic way to, say, become significantly more lethal.

https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

If only optimism could kill viruses.

Humans are wired for doomsday scenarios. Our brains love to imagine the worst case scenarios.... probably how we survived as a species for so long.

Our brains have not evolved to deal with 24/7 media coupled with social media, HN, Reddit, YouTube and every other information source feeding us a nonstop stream of raw unfiltered data.

Dunno where I’m going with this but our brains latch onto stuff like this and run wild. Multiply by billions of brains doing the same thing and there is a massive social and political pressure to “do something”.

Who the fuck knows what is really happening. We have plenty of “facts” and “information” floating around but no way to make any sense of it. All we can do is imagine the worst and replay “prepare for the worst, hope for the best” or “better safe than sorry”. Except unchecked that attitude can make things worse.

And, in short, that is why I’m not in the office today and pretending to work at home just like everybody else here.

The people in the saturated hospitals know what's going on. HN or Reddit had nothing to do with that.

> saturated hospitals

citation needed.

PS: you should easily be able to cite that statement in favor or in disfavor of your statement. Both citations will be equally valid and invalid.

> An anesthesiologist at a hospital in Bergamo, one of the cities with the most cases of Covid-19, the illness caused by the new coronavirus, told the paper that the intensive care unit was already at capacity, and doctors were being forced to start making difficult triage decisions, admitting people who desperately need mechanical ventilation based on age, life expectancy, and other factors. Just like in wartime.

> The hospital in Bergamo was not the only hospital in the area dealing with a lack of capacity and rationing of care. The same day, I heard from a manager in the Lombardy health care system, among the most advanced and well-funded in Europe, that he saw anesthesiologists weeping in the hospital hallways because of the choices they are going to have to make.

https://www.bostonglobe.com/2020/03/13/opinion/coronavirus-c...

That article is five days old. Find something from today suggesting the same. And make it relevant to the entire world. Italy is not a model for how this is going down in other countries. Every region is different (and more important has different data collection methods, making it hard to compare two areas)

Again, nobody knows what the fuck is going on. Chill out, stop spreading panic and think critically about things. It’s okay to question stuff.

I am sad to say, official sources say that the Bergamo hospital ran out of intensive care units yesterday.

This is one of the articles in Italian, there are plenty if you look for the last 24h news.

https://it.notizie.yahoo.com/coronavirus-bergamo-terapia-int...

You are right that every country and region is different, but collection methods have nothing to do with the hospitals being flooded with sick people, that would be true if there were 1 or 1 million tests being administered.

> citation needed

It would be ridiculous to copy here the URL of all newspapers and TV channels in Europe. You can also easily find doctors and other personal in hospitals saying they are over capacity. You can also see how in China they had to build new hospitals.

If you need me to give you a citation to understand that this is a huge shitstorm for our health systems you are just stupid.

Perhaps this is a side effect of subscribing to unhealthy number of true crime podcasts and listening to police radio.

Not to mention if pessimism could kill viruses!

I don’t know any reason that wouldn’t be the case, and many/most experts are already predicting a second wave - we don’t know the reasons that the 1918 pandemic mutated to become more lethal, so I don’t know how someone can say that it won’t happen again. Good planning would dictate that we not write off worst case scenarios without reason.

I have heard that the reason 1918 was so bad was because, among all the soldiers in the trenches, it could be virulent and still be able to spread effectively, so it had no selection pressure to not be virulent. (If an illness is too virulent, it usually dies out before it spreads too far.)

Covid is a bit different, because it has a longer incubation time, and therefore has more time to spread before the spreader knows not to infect others, but that wasn't the issue with the 1918 influenza outbreak.

(Note well: I am not an epidemiologist.)

I’ve heard that as well and certainly hope that’s the case. But I’d think it’d be irresponsible for planners to just assume that’s what would happen, and not ask themselves what happens if the pandemic becomes worse.

Viruses generally become milder because of selective pressure to do so. If it kills the host, it doesn't get to spread as much.

Plus, of you get slightly sick, you probably continue your life and infect others. If you get horridly sick, you stay in bed and encounter no one.

WWI made the Spanish Flu have it's second wave. Mildly I'll soldiers stayed where they were. Really sick ones were sent in overcrowded trains far from the front lines back to overflowing hospitals with inadequate sanitation.

These lockdowns we are doing are encouraging a deadly second wave.

As I understand it (please correct me someone if I'm wrong), this was a freak mutation. Not to suggest it couldn't happen again. And we 100% should be prepared. But the concept of a virus leaving, mutating to be more deadly, and coming back, isn't on the 'expected' path.

And when people talking about leaving, they mean that the mass transmission stops and it continues to transmit, and mutate, among some small subset population (e.g. remote island, etc). Eventually it recurs in the main population, whether hitting people who never got it, or because it has mutated enough that prior protections don't defend against it.

Which is exactly what happens with the flu and the cold. Lots of viruses, constantly mutating. So much so that when the next season comes around it's like an entirely new virus to your body.

You're comparing a virus that early on was reported as 3-4% to one that early on was reported as 0.4%.

The cruise ship and South Korea are probably closest to the true death rate of this virus. CFR in South Korea is currently around 0.8%. A common "educated guess" I see from people that work on this is its probably around 0.5%-1% assuming you can get the care needed for it.

Currently, we have 7 total reported deaths from the cruise ship and 696 confirmed cases. Seeing that it's been a long while since the outbreak, let's assume all current cases will survive; this puts us to 1% CFR. But note that Cruise Ship had a higher average age than public, so assuming you'll receive all the medical care you need, ~1% CFR seems to be a good approximate upper-bound estimate.

IIRC all or almost all of those 7 were over 80.

I heard "all over 80" on HN and reddit multiple times as well, but could not confirm. Regardless, Italy's official average age of death is 81, so it wouldn't be surprising.

6 in the 70-79 bracket and one in 80-89, but 70-79 was also the biggest group. https://cmmid.github.io/topics/covid19/severity/diamond_crui...

The majority of people on the cruise ship were older and it's not at all representative of the real population.

That's why I said an "upper-bound" approximation. As in, CFR for general population is likely below 1%.

This reflects the opinions shared by Michael Osterholm, Amesh Adalja, and Nicholas Christakis: a final case mortality of ~0.7%. But just to highlight the point, that's on a strong assumption that critical cases receive proper medical attention. I don't think that's a safe assumption for the outbreak in the United States.

Now it's really not the time to speculate with numbers that could downplay the risks. We'll see in a few years. 0.\d+% could be someone we love. Keep safe. Prevent if you can.

I'm just quoting experts. But I agree with your point. Only one of them stated that figure with "confidence", but he also was clearly motivated to downplay the risk because he was worried about panic. My intuition is that a final case mortality < 1.5% would be towards a "best case" outcome; and we should expect worse.

"Tangent: I wonder if it’s partly the changing media landscape from 2009 to 2020."

You think that the reaction of health agencies worldwide was the result of a "changing media landscape"? This takes quite an extraordinary perspective to serious posit.

And just to be clear, there was a huge reaction to SARS (a sibling to this virus) six years before H1N1. A massive, coordinated worldwide effort, quarantines, and whole-cities going quiet.

How do you blame the media for that, or was it a "changing media landscape" between 2003 and 2009? SARS thankfully was contained through heroic efforts so it never yielded the catastrophe we have now.

Regardless, they're very different viruses. Even if we pretend that the world "barely noticed" H1N1 (hint: It saw a huge response), health agencies and their experts have rang the warning bell about this virus because of the way it accelerates and presents in an area. They aren't jerking about CFR (which is a post-facto statistic), they're noticing that it hits an area and as it spreads the need for massive intervention explodes. That is why Wuhan got so much attention early on, and why cities are taking extraordinary, historic actions.

Rather than repeat myself - https://news.ycombinator.com/item?id=22607318

Trying to casually blame the media is not useful.

> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion".

The Professor of Clinical Immunology of the University of Florence, Sergio Romagnani

> Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.

https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Clinical and epidemiological data from the Chinese CDC and regarding 72,314 case records (confirmed, suspected, diagnosed, and asymptomatic cases) were shared in the Journal of the American Medical Association (JAMA) (February 24, 2020), providing an important illustration of the epidemiologic curve of the Chinese outbreak. There were 62% confirmed cases, including 1% of cases that were asymptomatic, but were laboratory-positive (viral nucleic acid test).

https://www.ncbi.nlm.nih.gov/books/NBK554776/

Weird discrepancy on the order of 75x. I'd love to trust the experts, but who? I am leaning towards truly asymptomatic spread being rare, since you get infected by SARS-CoV-2, not COVID-19 (COVID-19 is the disease), the level of uncertainty of 25% is higher than for other reports, and the main reported mode of transmission is through symptomatic cough droplets.

The Italian number (75%) comes from testing everyone in a village of 3000 people. The Chinese number (1%) comes from testing everyone who comes to hospitals and maybe their family members. I would guess that the Chinese sample was selected for people displaying symptoms (asymptomatic people will not go to the clinic), while the Italian number biases for people early in the course of the disease. For the purposes of public health and controlling disease spread, the Italian number is more meaningful.

Note also that it is possible the virus has evolved to spread more easily, which in the context of a lot of screening and social distancing of symptomatic people would mean more asymptomatic spreading.

How are the South Korean's coming up with such few positives if the disease is presumably spreading among the 70% with no symptoms?

Early strict containment and disciplin.

Most "asymptomatic" people will show symptoms within two weeks, so aggressive cluster/contact tracing works. South Korean local goveenment staff are following the credit card use, transit use, and other daily movements (CCTV logs) for every confirmed case, then issue two week self-isolation orders to those who shared a workplace, restaurant, cafe, church, or elevator with the confirmed case. Since most cases get a short lived fever or cough within two weeks, SK has been able to stop most transmission chains. I'm actually a bit confused about the scope of SK testing. It looks like everyone with symptoms is being tested, as well as quarantined health care workers and quarantined people from high risk groups, but I'm not sure whether asymptomatic people are tested at the end of their quarantine period.

Yup. Apparent efficacy of the South Korean approach versus more generalised 'self-isolate if you have symptoms' instructions would be a point in favour of the disease being often asymptomatic [for extended periods]

They wore medical grade mask in the first place. Hygiene and cautious about it. They stopped and block visits from China ( or any where else with COVID ) very early on. Instead of acting everything is going to be great despite all the warnings, they were mindful and kept social gathering to minimal. ( Comparatively speaking ). Citizens were also proactively reporting if they were having symptoms, and government are testing every case as well as tracing where they have been and issue warning.

Medical Mask also meant even though the case broke out in a city with very high population density, the spread is far lower ( again comparatively speaking ).

Where did you get the information that they've blocked people traveling from anywhere with Covid. You can still turn up now from Europe and be let in, they just ask you to install an app and report your health status daily.

Thanks, makes sense. Iceland also did voluntary testing and then estimated 1% of their population is infected. I doubt 1% is even showing mild symptoms. Remains the significance of asymptomatic spread. If someone does not cough or sneeze, are they shedding enough to be a formidable source of contagion?

https://grapevine.is/news/2020/03/15/first-results-of-genera...

> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion"

So long as every asymptomatic person got it from someone with symptoms, they necessarily a source of contagion. Is the conclusion based on modeling, i.e. that the rate of spread is only consistent with the asymptomatic people also trasmitting the virus?

Lots of asymptomatic infected doesn't (automatically) mean lots of transmission from asymptomatic people to uninfected people.

Well they aren't testing symptomatic people. How would they know to want to be tested other than personal election to do so because they had been in contacted with someone else?

Are there countries who conduct serologic tests? PCR tests (widely used?) wouldn't catch people who got the infection, developed antibodies with no or mild symptoms, but didn't transmit the virus around at the moment test is taken.

From the article about Covid-19 serologic test development:

> The serologic tests, which are different from the ones used to diagnose active infection, would allow researchers to test the blood of people who were not confirmed cases of Covid-19 in communities where the virus spread. They would be designed to look for signs that people have mounted an immune response after being exposed to the virus.

https://www.statnews.com/2020/03/11/cdc-developing-serologic...

Another source:

> "The current PCR test only tells you whether a person has the virus at this moment," Dr Meru Sheel, an epidemiologist and research fellow at the Australian National University said.

> "What it doesn't tell you is that a person may have had the infection, has recovered and is immune or not immune."

> Dr Sheel said a serological test would help understand at population level how many people have been exposed to the disease, have recovered and if there are populations that are not immune to the virus.

https://www.abc.net.au/news/2020-03-17/coronavirus-experts-c...

> Are there countries who conduct serologic tests? PCR tests (widely used?) wouldn't catch people who got the infection, developed antibodies with no or mild symptoms, but didn't transmit the virus around at the moment test is taken.

Not that I know of. On the most recent "This Week in Virology" podcast, they mentioned that China has recently said they won't be doing serologic testing, which lead them to think that China has reason to believe the disease is far more widespread than their official numbers show. This may be in line with the idea that most infections are asymptomatic.

I'm not a confirmed case, but I'm a 90% sure case based on symptoms and symptoms of people I have been in close contact with, and so far the experience has been relatively mild, in the literal sense. The primary discomfort has likely been the anxiety of how the tightness in my chest might progress (which ironically can also cause chest tightness).

I'm in a low risk group. I had lethargy and high fever the first day of symptoms (a little over a day after high contact exposure to my suspected source), then no fever (or very mild fever, can't tell because I have no thermometer), dry eyes, consistent mild chest tightness and occasional cough for the following two days (to present). The person I believe I contracted it from is also in a low risk group and had a sore throat and persistent cough for about 5 days, and is currently asymptomatic. She had been going about her business thinking it was just a cold for the duration of her symptoms.

Testing is still difficult in my area, and many folks with mild symptoms like the aforementioned aren't even attempting to get tested, so I suspect the true numbers are about 10x-50x the reported confirmed cases. This is good in that it means the death rate is also off by that factor, but bad in that there will not be enough fear/incentive for the primary carriers (young adults) to adhere to adequate social distancing. It's an unfortunate externality when an infectious disease has discriminatory consequences.

Mean incubation period is 5.6 days (range 1-14). So while possible, it’s highly unlikely you got it 1 day after infection.

"Mean" means nothing in the context of probability distributions.

It's possible I picked it up elsewhere, and less likely that I have something else with these unique symptoms (I've never a had fever without nasal congestion or gastrointestinal symptoms before). However, I think it makes sense I would be at the lower incubation period range due to the high level of contact with said suspect and the fact that I'm an otherwise healthy young adult, which as I understand it can lead to the immune system reacting faster.

> "Mean" means nothing in the context of probability distributions.

Just wanted to boost this. With a range of 1–14 days, it's possible for close to 50% of infections to only incubate for ~1 day, and still have a mean of 5.6 days for incubation. Without knowledge of the distribution, the mean means nothing.

Just realized I understated this. It's actually possible for 64.6% of infections to only incubate for 1 day and get a mean of 5.6 days, if the other 35.4% of infections incubate for 14 days (i.e. an extremely bimodal distribution at 1 and 14 days).

“We estimated that fewer than 2.5% of infected persons will show symptoms within 2.2 days (CI, 1.8 to 2.9 days) of exposure, and symptom onset will occur within 11.5 days (CI, 8.2 to 15.6 days) for 97.5% of infected persons.”

From https://annals.org/aim/fullarticle/2762808/incubation-period...

Similarly, I'm not a confirmed case but I've been isolation since Friday just out of general precaution, and I developed a mild chest tightness while here. I was sure it wasn't covid because I didn't have a fever, but just a few hours ago I checked again and I have a borderline one (99.4). Then my girlfriend got an email that someone tested positive from the same floor in her office.

I don't qualify for a test and my doctor said don't bother coming in with my current symptoms and risk profile. Still waiting to hear back about whether my girlfriend qualifies, who has a closer connection to a case and an underlying health condition.

Last weekend we were very nearly at a small conference. We had zero symptoms. Even now I'm not sure if I have covid, a cold, or if I'm just stressing myself into seeing something that isn't there.

I would be a lot more stressed if I had gone to that conference, and given people there whatever it is I have.

Same here, persistent mild chest pressure. My girlfriend as well as myself are experiencing it. But it's so subtle that you start to question it at times. But especially when lying in bed it becomes quite annoying or frightening if I think too much about it.

The 'it feels worse when lying in bed' is something I can really identify with

Same boat--annoying overlap that anxiety causes the same symptom. Luckily I've always worked from home, so have been pretty well isolated.

Hey, here with you. I have chest tightness (and sometimes a stabby pain) and it feels like I cannot breathe as well. Going on for almost two weeks now - no other symptoms at all.

I called in with a physician and they said likely not covid, just muscular stuff. I also have allergies and thing begin to bloom...

So I am confused and worried, lots of anxiety. But it could just be allergies or something muscular from workout (had that before).

I'm also not 100% convinced that it isn't something psychosomatic. The whole situation is very tense and that reflects physically. The fact that even in Germany testing isn't an option doesn't help. I stay mostly home and and it seems that the situation is improving. I hope you'll also soon feel better!

Thank you, today it seemed better until afternoon... now its back to tight chest and all. It might very well be psychosomatic but I dont dare to go out to a physician these days.

That sounds like anxiety to me. I used to get that in my early 20s with those exact symptoms. That was before I learn to recognize my anxiety. Breathing tools were the best solution, at different times I've needed anti-anxiety medication.

Chest tightness and panicked breathing, followed by heart palpitations with no other primary symptoms (fever, cough, etc).

This is a very stressful time, especially for high-information consumers. I wouldn't be surprised if there are thousands of people right now mistaking anxiety for COVID symptoms. Over analyzing your health can lead to some crazy self-driven outcomes too.

I am inclined to believe I am in the same boat. I have had a somewhat sore throat in the morning. I am producing a slight amount of phlegm with a light cough. I don't have a thermometer and they're unreasonably expensive locally/amazon. My chest feels fairly tight.

I don't know if it's allergies or what, but every one on my office floor is coughing. We're all fairly young so I can't help but believe they're all also infected and just rolling along.

> I suspect the true numbers are about 10x-50x the reported confirmed cases. This is good in that it means the death rate is also off by that factor, but bad in that there will not be enough fear/incentive for the primary carriers (young adults) to adhere to adequate social distancing.

If the death rate is off by 10x-50x, isn't this approaching the death rate of seasonal influenza, in which case we didn't actually need to adhere to social distancing in the first place?

The disease also appears to spread much faster than the flu. So even if the death rate is comparable, the infection rate is likely to be far higher.

This is likely because our immume system is not familliar with this virus yet.

This doesn't add up either -- immunity per individual is expected to last 'only a few months', opening the door to multiple infections per year per person.

> This doesn't add up either -- immunity per individual is expected to last 'only a few months',

There is no evidence either way. Even if it is transient it will be enough for it to die down

There's some very strong indicators that immunity will be ephemeral.

It's possible the R naught will drop below the currently assessed 2.2 over time, but there's no evidence for that -- and if both these things stay as expected, it won't be transient enough to 'die down' naturally.

Unfortunately until we get an antigen test, we will not know for sure. But there is no reason to believe at this point that it isn't anything other than a standard immune response.

It would extremely rare that it wasn't

There's no indication how long the immunity is expected to last. It's just as likely that immunity, even if temporary, can last for a year or more, as is the case with the flu or some other viruses.

On HN this morning -- news that someone in Japan is already on their second infection of this virus.

So there's our first data point.

let's say there were 320,000 people without symptoms in China, which seems unlikely, that would make the total cases approximately 400000, and if we just looked at the fatalities so far out of that it would be a fatality rate of 0.8% iirc the common flu is 0.1% fatality, so if this only had 0.8% but affects 40-70% of the world (which seems to me like it would be at the 70% end if there are lots of asymptomatic people)

so 40% of 7 billion and then 0.8% of that is 22,400,000 - my math is probably off here.

> 320,000 people without symptoms in China

Wuhan (the city, not even the entire province of Hubei) has 11 million people. Given what we know now about how virulently and covertly COVID-19 spreads and how (relatively late) Wuhan went into lockdown, how do you feel about that number?

if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic.

I'm not taking the exact 75% number here in the following - but close, and I will do some hasty approximations.

Current total cases (maybe off by some hours) is 80,894.

80894 is 20.2% of 400000.

400000 - 80000 = 320000.

So yes, given the article's premises 320000 is pretty much on the optimistic side for humanity.

on edit: but once again my math is probably off somewhere so correct it if you see some glaring error in my reasoning. Also note these numbers are for China, of course.

you're assuming everyone is capable of being infected to detectable levels.

no that is exactly what I am not doing, hence my starting off my explanation with:

"if 50% to 75% of cases are asymptomatic that means 25% to 50% are symptomatic."

then I go ahead and choose a number (400000) which is on the optimistic end of this range - 80894 is 20.2% of 400000 - I believe that is quite clear, if 80894 is 20.2% of 400000 and 80894 is the amount of total cases counted in China (no longer the case) then I am assuming 79.8% people asymptomatic that have not been counted! (although of course I did some simplifying of things around so my percentages and numbers are not exact, but I think given the linked article slightly under 320000 people being asymptomatic and 80894 being symptomatic is a very optimistic take)

what number do you want to assume is not counted? millions? I assume that from your earlier post but that does not follow from the 50% to 75% cases are asymptomatic.

Obviously if 50% to 75% are asymptomatic and you had 1 million people infected all together (symptomatic and asymptomatic) that would mean you needed to have at least 250000 (25% of a million) to 500000 (50% of a million) people symptomatic. But we don't have those numbers symptomatic, we have slightly under 81000.

That doesn't add up, if it wasn't worse than seasonal influenza, then Italys hospitals wouldn't be overwhelmed.

Italy did everything wrong.

They basically turned hospitals into covid19 infection parties.

Italys transmission rate is exactly the same exponential curve as everywhere else, chinas hospitals were overwhelmed, spanish hospitals are being overwhelmed, and its currently starting in the netherlands and germany.

All year round is basically influenza infection party everywhere yet it doesn't overwhelm our medical systems.

do you have sources for that ? i'm extremely interested in understanding why italy seems to be suffering that much compared to other countries. If it's just a matter of being the first, or if it's also something specific to them.

As a side note - and JFYI - Italy's situation is very nuanced, as you can see on this map (divided by region):

http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h...

In the North (and particularly in Lombardy) the situation is dramatic, in the center and in the south it is not (yet) that bad.

Basically the lock-down (started on national level on the 10 th of March) seemingly - and for the moment - managed to work to reduce the spread of the infection in other regions.

The previous lock-down (limited to some cities/provinces of the north) was only a couple days before and evidently too late to be effective.

a regular flu epidemic does between 10k to 20k over a span of two months in france alone. that's more than the total number of casualties of the covid-19 so far.My feeling so far is the problem is that most covid-19 emergencies can actually be cured if you've got a breathing machine, which requires special equipment not available at the moment.

I'd say the virus isn't more dangerous than the flu, it's just requiring a very specific set of equipment which we didn't need as much previously.

of course that will all depend on what the number evolves to over time.

However, now hospitals have to contend with both the flu AND COVID-19

Seasonal flu already puts quite a strain on most hospital systems every year. If the rate of severe flu infection were doubled, I think a lot of health care systems would be pushed to the limit. And Covid-19 is worse than the flu, if not in terms of severity (although that is up for debate), it is in terms of contagiousness, as there is no one in the population with resistance from prior exposure, no vaccines, etc.

So it is plausible that Italy (and other countries) problems are a result of a double whammy of flu and Covid19 as it is due to the severity of Covid19 itself.

This is an important question and it needs to be answered.

There needs to be systematic sampling of the whole population so the number of infected can be correctly measured and the policies should be based on that.

This is also what WHO is saying.

I expect an interesting side effect of all this is a reassessment of our tolerance for the "usual" influenza death rate. It's shockingly high. Could we save thousands of lives a year by people stopping going to work when they're sick, not going to grocery store when they're sick, etc?

I think that too. Basically the long long history of people of mostly old people checking out due to flu has normalized something terrible. As many people dying of flu as auto accidents.

https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...

Just people washing their hands and not working when sick would probably help a lot with the seasonal flu. But maybe another idea would be to get more people to use the flu vaccine every year.

So far the actual problem seems to be the hospitalization rate, not the death rate in ideal conditions. Most countries just don't have the spare capacity to handle COVID in addition to the normal workload.

One factor in this is that a good portion of the at-risk population is vaccinating against the flu, greatly reducing the overall impact.

Maybe, maybe not. Part of what makes the influenza death rate what it is is that those cases are spread over several months and hospitals can support the patients who recover. If all the influenza cases came to a head over a 3 week period, death rates would be much higher.

Exactly the same.

Considering that antimalarial drugs have positive impact against COVID-19, do you happen to be a carrier of thalassaemia?

Those with the trait of thalassaemia happen to have a better chance not contracting malaria, hence the prevelance around the Mediterranean.

What are you saying, that thalassaemia is protective against COVID?

Thalassaemia protects against malaria because blood cells (the home of the parasite during a phase of its lifecycle) are destroyed up to 3-4x faster than in non-thalassaemia traits (where they last on average for 120 days).

Chloroquine seems to work by interfering with cellular binding and entry of SARS-CoV-2 on the ACE2 receptor (amongst other mechanisms)

This is why only people with training or understanding should speak about medical matters, there is enough rubbish out there (particularly at the moment) without you adding to the noise

(0) https://emcrit.org/ibcc/covid19/#chloroquine

Same here in London over a month ago. Though my wife and I did develop mild respiratory problems.

I've been arguing for days that the death rates are complete fantasy. People still only using tested cases / deaths when in fact no one is being tested.

In South Korea, as of the weekend only 248,000 people out of a population of 50,000,000, with 8,086 +ve cases and 72 deaths. Without statistical extrapolation that's a <1% death rate. Real rate a fraction again of that. Hospitalisation rate is high because an abundance of caution due to the publicity around this.

Regarding your fear about primary carriers, the advice in the UK is not to visit vulnerable groups. If you are asymptomatic you are also less likely to cough etc and died the disease.

In my office culture anyone who is sick is told to go home and made to feel unwelcome (in a friendly way) Had been this way for decades. We know not to visit each other.

> I suspect the true numbers are about 10x-50x the reported confirmed cases

I came to similar conclusion just looking at the openly available numbers: https://www.worldometers.info/coronavirus/#countries

If you compare the number of serious cases to the number of total cases for different countries you'll get a 10x difference. Norway tests more thoroughly then the other countries, so it has a huge number of active cases. But from those only ~2% serious. There may be different reasons for such a discrepancy but I tend to agree with your conclusion that we have a lot of asymptomatic cases around, higher then estimated R0 and lower then estimated fatality.

I made a simple site to graph the daily increase figures. It only shows infections and deaths but from that you can see very different ratios for different countries.

(http://coronanalytics.com if you’re interested.)

do you respect the time delay when calculating Case Fatality Rate?

https://smw.ch/article/doi/smw.2020.20203

I’m just using the data straight from the John Hopkins institute.

https://github.com/CSSEGISandData/COVID-19

You might try sorting the countries in your select input. They appear to be in some random order and I almost gave up looking for the country I was interested in.

This is a good shout. I’m just using them in the order the John Hopkins institute put them. A sort would be useful!

Came back from the link to leave the same comment. It's impossible to use that selector.

Sincerely curious, how do you square this with the CFR in Italy at this time? That the initial impact to primarily elderly people and a low count of cases compared to a much larger undiagnosed quantity (still mostly undiagnosed cases) are creating a high death rate statistic? Or do you think some other factors are at work there?

> dry eyes

Also no confirmed case here, but I attended a conference and later got an email that one participant tested positive. Since a few days, I also have dry eyes (thought it was because of dry heating air in our apartment first, but it didn't go away for days as it normally does, not even yesterday when we did not had the heating on because of the warm weather), dry cough and I am a little tired. 2 days ago I had an aching sore throat starting in the evening, but it went away during the night and after several very strong cups of fresh hot ginger tea. Also a runny nose. Yesterday I decided to work from home, my wife also couldn't go to work because she also developed a strong dry cough Sunday evening and she decided to better stay at home. Felt a bit tired while working yesterday (and also a bit confused), so my wife suggested I might also have a light fever, but I didn't take any measurement because I really felt fine. She herself had intermittent fever the whole day yesterday, going up to 38.7 degrees Celsius (101.7 Fahrenheit), so nothing really serious and she felt fine otherwise. Our 12 month old daughter woke us up several times two nights ago with an extremely scary cough, but it didn't seemed to bother her and she continued sleeping. Yesterday morning, though, she looked quite unhappy, was still extremely tired and then basically slept for the whole day, from the morning to the late afternoon. When she woke up, she was completely happy again, no fever, no cough.

I have no idea if we have the virus, but after reading some comments here, I think there is at least a possibility. So far it was really just a nuisance, any cold I had in the last years was much, much worse. Without the media coverage, I would've just shrugged it of and continued to go to work.

I have similar symptoms to yours. I live in Paris and the number of cases here are exploding, but so far for me the mains symptoms are an high temperature, general tiredness and a sore throat/ dry eyes. So far so good, but each day passing I feel a bit more tired. The doctor advised me to take paracetamol every 4 hours, and to stay inside. Also here in France, they are sending SMS to any suspected case with advices and to know if the symptoms are evolving towards the worse case, which is the difficulty to breath.

Dry cough and fever are the most common symptoms of Covid. Given that you display both, staying at home is definitely the correct behavior. Also get on the phone with your GP or the respective coronavirus hotline for your country to inquire about the next steps.

The dry eyes thing is crazy.

I got Lasik about two years ago and had a period of dry eyes afterwards, which abated in time. I got them again about a week ago. I also got an intermittent fever and a dry cough. The fever wasn't severe and only hit me for a short period over several days. The cough, which is still present, is like a smoker's cough and is accompanied by a feeling of reduced lung capacity.

Kind of sounds like allergies?

Note that I am not an M.D. But, consider getting a pulse oximeter. You can use it to assess your respiratory function (more) objectively. Anxiety and panic attacks can impact your oxygen saturation, but unlikely to do so to dangerous levels.

Again, I'm not an MD. Maybe someone from the field of medicine can add their thoughts here.

Your comment made me want to get an Oximeter so i hopped on amazon right now.

These were my results: https://i.imgur.com/LIta2jR.png

One of these things just doesn't belong!!!

LOL, thanks a lot for sharing! Really made my day here, and I needed that :)

I have shortness of breath, cannot go up the stairs in our house without having to stop and rest. 37 years old and otherwise quite healthy. Have underlying autoimmune disease, and am on immunomod. Coughing and light fever. I’ve had this for 5 days. When I called the hospital they told me to come in and get tested, but when I came to the hospital they did not test me.

The doctor told me, it wouldn’t make a difference anyway. No matter what the test would show he would tell me the same thing: go home, isolate yourself, and come back if your fever worsens.

Once your area reach a certain number of persons affected, there is little use to try to track each one. When they have changed to a strategy of trying to protect the weak, and just slow down the spread. Testing doesn’t really add much value or information.

I hope you get better soon.

I think your comment describes very well the economics of the pandemic when it spreads further. Basically you can treat everyone with Corona-like symptoms like a corona patient. It doesn't make much difference anymore. Isolation and monitoring of the condition.

If it's a severe common cold the advice isn't that much off, too.

It would sure be nice to know whether you’ve had it though.

If I thought I’d already recovered from a mild COVID-19 - assuming I’d then have immunity for a decent chunk of time - I might think I could now move from the sidelines and into the fight and help others.

But if I was wrong and I never did actually have it, then I’d be making things worse.

Widespread testing could obv illuminate much.

I keep hearing “masks are useless”. If every person who has any cough or any chest tightness or any sore throat, however mild, put on a mask, wouldn’t that stop the spread?

I live in Japan. It started here earlier but didn’t explode. Nothing is closed. Business as usual. everyone wears masks.

Most cases in Hokkaido. Maybe because it is much colder there and easy to overexposed and tax the immune system.

I think some of the logic behind "masks are useless" is that if people believe masks will prevent it, they'll get too reckless about going out as long as they have a mask. Sadly many people wear masks incorrectly and other people will wear masks that don't actually block viral particulates while out there acting more dangerously than otherwise, spreading disease.

IIRC anything below N95 isn't going to do much, and from experience (yay wildfires) I can say wearing N95s is very uncomfortable. Incidentally even physicians wearing proper PPE (n95 or better, etc) can still catch COVID, so it wouldn't be appropriate to say that those are good enough.

It's certainly better than nothing - I'd prefer it if everyone out and about was wearing masks - but the risk of false security leading to dangerous behavior is strong, and we already have issues with mask supplies, so it makes sense to discourage it.

> I think some of the logic behind "masks are useless" is that if people believe masks will prevent it, they'll get too reckless about going out as long as they have a mask.

Lying to people for their own good may be acceptable in some circumstances, but in the long run it's always going to have deleterious effects. It erodes trust, it disincentivizes responsible people, and if the people doing the lying are wrong ... it makes things worse.

That's very convoluted reasoning. I think the main goal of surgical masks for entire population would be to limit amount of virus floating in the air. They are also good at stopping people from touching their faces.

IMO the goverments should make masks mandatory, even if it's DYI mask made from few layers of tshirt. And start teaching people how to use them and why.

If the supply was there I'd absolutely agree. At least in the US it's very hard to get adequate masks right now (this is partly due to a failure to maintain supply, there were some news stories recently about how a local manufacturer was begging the government to invest in this so he could maintain production)

Masks prevent sneezing from reaching other people.

https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...

"Why Telling People They Don’t Need Masks Backfired"

"To help manage the shortage, the authorities sent a message that made them untrustworthy."

There is a huge shortage of masks in the west - even hospitals are running out.

And that is the only reason for the claim that masks are useless. Of course they are not useless, Chinese aren't idiots.

It's a white lie by the media. If they told the truth to the public then they fear it would deprive hospitals of masks and cause worse outcomes for society.

They're obviously not useless. They do keep spittle down. But every person in public would have to wear them in the off chance they're asymptomatic carriers.

And a virus will still penetrate most masks through the sides where air is mainly being pulled in from. So there is more nuance than just "masks are useless"

I guess you can wear them. But given the choice I'd rather have immunity. And I think we should focus more on that.

Droplet infection is only really a problem within a couple of metres - SARS-CoV-2 does not seem to be aerosol spread.

I seems Coronavirus can stay active airborne for several hours.

Not sure why you're being downvoted. Emerging research suggests that aerosolized SARS-Cov2 can stay active for hours.

Droplets (e.g. projectile saliva or mucus) fall out of the air quickly, but this is different.

Here's a source: https://www.nejm.org/doi/full/10.1056/NEJMc2004973, and an upvote.

Masks decrease R0. You don't need everybody to wear them. You just need enough people to wear them for R0 to fall below 1, combined with all the other measures. It's academic because there aren't enough masks but it's a lesson to learn for a future epidemic. Also it's high time that mask wearing becomes culturally normalised in the West as it is in east Asia.

> You just need enough people to wear them for R0 to fall below 1

This is the point I wanted to make but I went with "everyone" instead of "enough"

For what it's worth, I think you'll find here in the US at least a very pigheaded attitude towards wearing masks. And that includes myself. I just don't want to live in a world where everyone has to wear masks. It's soul crushing.

Oh come on.

A) nobody is making that claim - you are.

So don't turn this into some weird non-fact-based appeal to emotions. The claim that they are useless is because the evidence does not support them. They ARE useful in clinical settings, and heavily required there.

B) there is no evidence for their success:

1) https://www.bbc.co.uk/news/health-51205344 "implementing simple hygiene measures" was vastly more effective." "Although there is a perception that the wearing of facemasks may be beneficial, there is in fact very little evidence of widespread benefit from their use outside of these clinical setting." "routine surgical masks for the public are not an effective protection against viruses or bacteria carried in the air"

2)research study, particularly on leakage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306645/

3) efficiacy in Beijin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969371/ (again largely leakage)

4) efficacy in 22micron particulate: https://www.ncbi.nlm.nih.gov/pubmed/3470452 (again leakage. but depends on particulate size)

Nobody is making this claim? Since your nickname sounds German, you may be able to understand this text from the FAZ:

"Im Folgenden ist eine Reihe nachweislich falscher Angaben aufgelistet – etwa der Nutzen von Atemmasken gegen eine Ansteckung"

Source: https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...

What they claim is that the uselessness of face masks is proven. Not that the usefulness is unproven. That makes a big difference.

For those who don't read German:

"In what follows, a series of provably false claims are listed - such as the use of breathing masks against contagion".

(Native German speakers can correct me if my translation is inexact)

Masks are effective at preventing spread to others, but they're fairly ineffective at preventing spread to the wearer since the virus can get on any exposed skin and make it's way to your mouth (e.g. touching after washing hands) within the 3 hours or so it can survive.

Since we don't know who is contagious, and we don't have enough masks for everyone, they're essentially "useless". They're quite useful for medical professionals because they're more likely to use sufficient caution than the average person, so it makes sense to reduce panic buying for something that likely won't help the average person so more are available for those that really need it.

It's business as usual because the government refuses to increase testing. They're pretending there's no cases because they don't want to cancel the Olympics later this year. For a more realistic figure look at South Korea where mask usage is about as common as here.

I live in Japan too and just spoke with a friend who thinks government is hiding cases to keep the Olympics. Given how hard it seems to get a test (as per the press) this has some truth. People are a bit more careful than in Europe but not amazingly careful either, so the virus is probably spreading silently.

That certainly seems like something the Japanese government would do. Just look at the Fukushima nuclear issue for evidence of them hiding information to save face. I personally do not trust the Japanese government to be transparent about such things.

"...so the virus is probably spreading silently"

And harmlessly? Because the outbreaks in Iran and Italy show that the virus, if not contained, will spread rapidly and start killing hundreds every day.

Why exactly is this not occurring in Japan? How do we reconcile the idea that Japan is doing little-to-nothing about the virus with the fact that the virus is not causing nearly the same level of illness or disruption as in other countries?

It's useless in the sense that you can still contract the virus with a mask. Let's say they are using the surgeon's mask, someone can sneeze and it can get in through the side. The n95 has a better seal so that can prevent it, but what if someone sneezes and it gets into your eye. I would say some protection is better than nothing, but don't assume you will be protected from coronavirus 100%.

No! It’s bloody useless because you’re not just receiving it through your respiratory passage, but also eyes. And then you touch a surface which someone has put bodily fluids on and put your fingers in your mouth or rub your eyes.

Masks are excellent for stopping transmission for infectious patients however - because it catches particulates.

Current (and to be fair, there remains some debate but it seems it is really just the precautionary principle) evidence suggests that spread is by droplet. So a mask doesn’t help stop you receiving it. Definitely helps you stop transmitting it; definitely helps healthcare workers who are exposed to high titre loads, and will be working sick unlike the rest of the population,

But the average person can reduce both their transmission and infection by being vigilant with hand washing, masks if sneezing/coughing/isolating, not touching face/mouth/eyes

Leave the masks to the healthcare workers and the infected

If I accept your argument that a mask doesn't stop you from receiving it (which I doubt):

If it were a social norm to wear a mask during an outbreak, and 50% of the population did, it would reduce the spread of the virus greatly. Far from bloody useless. Americans are locked into individualistic thinking: "How will this benefit me?". Also consider asymptomatic transmission.

>but don't assume you will be protected from coronavirus 100%.

Washing hands does not protects you 100% so why bother?

100% protection might be important to you personally, but it does not matter on a societal scale. What does matter is to decrease as much as possible the mean number of new people infected per sick person.

If that number is above 1, the growth is logistic (exponential in early stages), if it is lower but still above 1, it is exponential but with a longer doubling time ("flattening the curve"), and if it is below 1, cases will decrease.

I was one of those people discouraging masks a while back here. I was wrong. With what we know now asymptomatic people should have masks if there is a supply available. At the present, that supply isn't available in the US and many other countries, but as soon as it becomes so we need to normalize mask wearing in public for the duration of the pandemic.

If a virus takes a week to develop symptoms, and doubles every 3.5 days, that's exactly what do you would expect: after a week 3/4 of the cases are new and too early to detect symptoms.

asymptomatic proportion sampled at a moment grows exponentially with incubation period, it means nothing about who will eventually develop symptoms.

In case this thread doesn’t gain momentum, some more (potentially interesting) discussion on Reddit [1].

Particularly this post [2]:

> I wonder if they plan to follow up and monitor... From the Diamond Princess they initially found 50% of people had no symptoms. However upon following them over the course of weeks that dropped down to about 18%. Due to the long incubation period it can take some time to determine if someone is truly asymptomatic or just not symptomatic yet.

[1] https://www.reddit.com/r/Coronavirus/comments/fjuj24/5075_of...

[2] https://www.reddit.com/r/Coronavirus/comments/fjuj24/comment...

On an unrelated note, I just noticed this entire time I've been reading "asymptomatic" as "asymptotic". I thought it was cases that happen in the limit as severity goes to zero.

Some news services have referred to asymptotic spread but it's just hyperbole.

Your obtuse reply isn't even tangentially related to the line of discussion.

No need to go ballistic over couple of lines.

I feel it's unfair that people have disrespected the trifecta you achieved here.

I feel like I’m approaching the limit of what I can take, but I doubt I’ll ever truly reach it.

This is what I was wondering when I read Donovan Mitchell from the Utah Jazz saying he felt fine. I wondered if he just hasn’t become ill yet.

I read the Diamond Princess study and the 19% figure is not based on following up with departed passengers. They're using some probability estimation based on the 50% discovered cases, I assume they're trying to account for people who had mild symptoms but not at the time they were tested. They identify flaws in the study though: the passengers were mostly old, so they are more likely to be symptomatic. They also didn't test everyone on the boat, only vulnerable, or symptomatic people, so their base numbers are missing some number of asymptomatic cases. It's not a great study really but I think you could take 19% as a low bound on the figure and in wider society 50% is plausible.

"Everyone we found to have Covid-19 had serious symptoms, so we don't want to waste money testing you if you don't!"

I feel this is a trillion dollar mistake, testing more aggressively like South Korea means that you don't have to deploy the army and quarantine people. I had mild symptoms and they refused to test me, what am I to do? Self quarantine without a notice and hence without pay? I could work from home, but most can't so they will just go to work as normal and spread it. And now it is all over the world so only drastic measures will help.

> Self quarantine without a notice and hence without pay?

If you have symptoms of _any_ illness you should always get a sick leave and stay at home. It does not matter if it's covid, seasonal flu or just a common cold - sick leave and stay at home.

Unfortunately this is not an option for many people. I don't disagree with the sentiment - avoiding the spread of disease is good - but often the reward systems in place don't optimize for the best global outcomes.

So why do we keep accepting these conditions?

> So why do we keep accepting these conditions?

Probably because the negative repercussions of that behavior are typically not very severe.

They actually cost a lot of money to businesses, but no one cares to track to show the ugly truth. Europe has a lot of data showing that going to work sick ends up costing much more than staying home, thus this is a irresponsible attitude - given you keep getting your pay of course.

Luckily we are born with "judgment" for all these cases were instincts or rewards do not point in the right direction. According to some, that's literally the reason d'etre of consciousness. I wish it worked better and I were not confined home right now.

You sound like someone that works at a company with “unlimited pto” am I right?

Right. But how often does this actually happen in the real world ? And most importantly, what are we, as a society, ready to bet on the fact that not enough will make the "wrong" judgement ?

Where are you from? Where I live - I think I am even motivated to get sick leave. If I feel ill, I can get sick leave, with no time limits I am aware of [0], and as a reward I will get 80% [1] of my salary back for essentially doing nothing. IMHO it's a win/win. I will get well and be productive as soon as possible [2]. If it's a viral illness - my employer would be happy that I will not make dozens of other people ill.

[0] I have not read the law, but I have never heard of anyone reaching that limit. You can stay ill for months and still be compensated. Of course after some long time, you'll probably be moved from sick leave to some kind of disability program, which sucks, but we are not talking about disabilities.

[1] There's a cap for sick leave compensation, but unless you are earning _a lot_ it should be enough.

[2] Personal anecdata, but personally common cold takes couple of days of rest to go away, if I try to be tough and won't rest - it may take couple of weeks before I feel well again. Better couple of days of 0 productivity, than couple of weeks of work simulation.

Wait till you hear about the health care system in the United States...

I mean, sure, if you have sick leave. The above comment is perhaps aspirational, but otherwise it is woefully ignorant of the sad, sad state of US healthcare for most of its residents.

It's a problem everywhere. Sick leave is something you take when you have high fever or need surgery, not when you start coughing. Reasons include: there's only so much sick leave you can take, employers expect sick leave to be extremely rare and will "phase you out" if it isn't, getting a sick leave involves a visit to a doctor - which, like any visit to a healthcare facility processing sick people - comes with a risk of catching something even worse than what you came with.

Every place on the planet needs to rethink how we handle infectious diseases. This requires both a cultural and legal shift, so that one can just not come to work when showing mild symptoms and not face any negative consequences. The market will not make this happen on its own. But this is a golden opportunity for the cultural shift - every society on this planet is going to be deeply scarred by SARS-CoV-2.

> getting a sick leave involves a visit to a doctor - which, like any visit to a healthcare facility processing sick people

Remote doctor visits are starting to become a thing, now! Still don't know how they'll check our temperature, or issue us the sick leave paperwork.

But hey! It's a start!

It's a huge opportunity and I hope it'll become popular everywhere.

Like e.g. someone in my family has been noticing a rash on their hands recently and was getting worried. There's no way in hell I'll let them go visit a doctor now, and this kind of consultation is something perfectly suited for doing it over the Internet.

> Sick leave is something you take when you have high fever or need surgery

No, you take it when you have a problem big enough that it impacts your ability to work OR when you have a contagious disease.

It's a lose/lose situation for a company if a single person gets half the company sick.

> there's only so much sick leave you can take, employers expect sick leave to be extremely rare and will "phase you out"

In the US sure, in Europe you can't fire someone for health reasons. In France you'll even get 66% of your salary for 3 years if you can't work at all for health related reasons.

More detailed response here: https://news.ycombinator.com/item?id=22602990.

> Europe you can't fire someone for health reasons

On some types of contracts. Probably not the most common ones in practice. Also, making the job a living hell for someone, or laying them off the first legal opportunity arises are common practice, and I think everyone outside our industry knows it (in most industries, employers have more power than employees on the job market).

Well yes of course if you're employed with a contract that doesn't represent your working conditions, which is illegal in the first place, you're fucked. What I meant is that in some countries you can come to work on day x and be asked not to come on day x+1, even with a regular contract, that's going to be very hard to pull in europe, and especially not going to happen if the reason is "took a week of because of the flu".

That's also why there is such a big thing around uber, deliveroo &c. in europe. These types of contracts weren't the norm 20 years ago and are very limiting when shit hits the fan.

In my company we just had the opposite, some dude was very obviously sick, couching for weeks, the CEO couldn't legally force him to take his sick days. So he stayed, and got a few of use sick. So brave and heroic, right ?

In England there are "n day off a year before being disciplined" clauses for many jobs.

Who can afford time off work when you're going to get fired for being ill?

It's wrong, and it does impact the whole company when someone comes in when they shouldn't, but there are several reasons why people get disciplined.

A lot of people would like to stay off work and get paid. Hangovers. Stress because of working conditions.

Just off the top of my head.

England is not a nice place to work for a lot of people.

> Every place on the planet needs to rethink how we handle infectious diseases. This requires both a cultural and legal shift, so that one can just not come to work when showing mild symptoms and not face any negative consequences

Do I live on another planet? Coming in sick even with mild symptoms is frowned upon at least for a decade where I live. As a tech worker I can easily work remotely, so on mild symptoms I inform my employer that I will work remotely and that's it. If I feel, that I am not capable to work productively - I get a sick leave from my doctor and that's it.

I am of course not from medieval US (though POTUS probably could easily call place where I live a "shithole" country) where sick leave is compensated to 80% of your salary (there's a cap, but it's high enough) and I am not aware of any time limits, if there is - it's a year or more. That's the reason I pay taxes! :)

So no "legal shift" required. There's a "cultural shift" needed for some employers though, where being unwell is a sign of weakness, though legally they cannot do anything to the employee.

All in all, I do not want my restaurant order to be handled by anyone who's is even mildly ill or have a runny nose. Same thing applies to doctors, nurses, grocery store staff, etc. All politicians, employers and people in general who cannot grasp this simple idea - belong to live in the dark middle ages.

As tech workers, we're particularly privileged. Ask your local grocery store clerk, or the person that handles your paperwork in the bank.

I too am from a highly-developed (relative to the US) European country. It's all nice on paper. But in practice, a lot of these legal protections are commonly evaded (and government attempts at fixing it get badmouthed by a population considering itself "not exploited proletariat, but temporarily embarrassed millionaires").

It's still much better than what Americans have, but nowhere near good enough in terms of biosafety.

I agree that everybody who can work remotely is a bit privileged compared to someone who cannot, and in general tech employers are richer and more liberal.

As I said in my reply above, some employers or employees need a cultural shift. Either employers put pressure on employees to not get sick leave (which is illegal and unethical), or as you say some employees think that they are "temporarily embarrassed millionaires" (or just conditioned by decades of peer pressure), but I digress.

My point is that in my whole life I was _never_ rejected a sick leave by a doctor and my doctor definitely does not check if I am grocery store employee or "privileged" tech worker. Also it's not employers business to regulate how often employee can be ill or what "pre-existing conditions" employee has. People are not robots.

I'm not talking about getting a sick note rejected. I'm asking, would you realistically go and get a sick note for a runny noise and feeling generally unwell? Would you feel secure at your job if you did that 20 times a year?

I do not see what the problem is. People with small children get sick leaves many times per year, because children get ill in kindergarten very often. I know women who will get 5-10 one to two day sick leaves per year due to menstruation cramps.

People are not robots, people get ill. I have very good employer which would never question employees job security due to illness. If you do not - search for a better one, join a union and/or inform your colleagues that their rights are protected by law.

The horror stories I hear about evil employers - usually the employers themselves would be the first to take sick leaves or have luxury long lasting holidays that the employees cannot enjoy. Such employees are conditioned to slave away and forget that their rights are protected by law.

> It's a problem everywhere. Sick leave is something you take when you have high fever or need surgery, not when you start coughing

Do you be any experience outside the USA? Your description doesn't fit my experience in the UK and Denmark, or my general understanding of the rest of Europe.

Europe will need to consider smaller changes — there are more gig economy workers than ever before, different countries have taken different approaches to closing schools etc — but I think the fundamentals are OK.

I'm in Poland. We have free public healthcare and all the other nice employee privileges Europe boasts about. On paper.

In practice, most of those are guaranteed when your contract is the regular full-time one. Which is minority of jobs in Poland. To avoid paying taxes, most employers strive to employ their workers via contracts meant for part-time or gig work, or through B2B (thus we have lots of sole proprietorships "entrepreneurs" in the country). Most protections don't kick in there.

On top of that, getting a doctor's note for a runny nose is too much of a hassle, and nobody realistically does that.

Thirdly, regardless of how much worker protection your country has, day to day nobody wants to be seen as the panicky outlier at work. That's a self-limiting move, both career-wise and socially. This normalizes coming to work with potentially infectious diseases.

> To avoid paying taxes, most employers strive to employ their workers via contracts meant for part-time or gig work, or through B2B (thus we have lots of sole proprietorships "entrepreneurs" in the country). Most protections don't kick in there.

I know that this "loop hole" exists where I live too, but AFAIK it's either used by very small companies, which can fly "under the radar" or it's not done at all, because inspecting agencies will quickly stop this.

Where I live if you work for employer like a full-time long-term employee - you are full-time long-term employee, and cannot work as a "freelancer"/sole proprietor-contractor (I do not know exact terms in English, but I think we'll understand each other). Work inspection will check this employer rather soon. Usually, because competitor or some employee will make an anonymous report.

If you agree to work on this loop hole - then it's your problem - work as a full time employee, or charge enough to compensate yourself for possible downtime during illness.

Big enterprises definitely do not use this kind of loop hole.

> I mean, sure, if you have sick leave.

Where do you live that sick leave does not exist?

I agree with you and practice that. But even in tech where work from home is an option and companies are rich enough to let people stay in bad anyway, in many companies it is treated as heroic to push through. Meaning, staying at home makes you seen as less comited and less passionate. Thus, people avoid it.

If you're working for a company where it's seen as "heroic" or "passionate" to come to work sick, you're in a toxic environment.

I've had a couple co-workers who perhaps see themselves as heroic for coming to work sick, but everyone else resents them and wishes they would just stay home.

> in many companies it is treated as heroic to push through.

I disagree, I see myself as weak for staying home an extra day or two, but I don't see others as weak for doing the same.

Today, I think the pressure to push through is mostly self-imposed. That's makes it no less real though.

Personally, I don't like sitting in an office with someone who is coughing. During the current virus out break, I doubt anyone will appreciate you pushing though :)

Those environments are created by employees themselves. If you don't tell someone with a cold to go home, you are part of the problem.

By employees and by leadership. It absolutely does matter more what management does and how management acts then what random employees do.

I'm not sure if you're quoting something or paraphrasing a position you disagree with.

If it's a paraphrase, I'm not so sure it's a fair one.

In the United States, for example, we are urging people not to be tested unless they have severe symptoms. The reason for that is not to save money, but it's for a lack of testing capacity. As a policy we would much prefer to be testing even the mild suspected cases. But we don't (currently) have the testing capacity to do so.

So I think the lack of testing of mild cases (at least in the United States, and I suspect in other countries) is more a reflection of our rationing priorities than it is a reflection of our spending priorities.

If the testing capacity becomes unconstrained and we (or other countries) still fail to test mild cases.

The lack of testing capacity was a choice.

Yes, we are 3 months late. These wasted last 3 months were critical after the December outbreak in China. I don't think it is the U.S. problem, Europeans didn't move a finger until the beginning of March either. Literally everyone watched China as if they could contain it properly. They didn't even tell people until it was very late.

Yes, absolutely. The lack of testing capacity was a total failure of the government.

After the acute phase of the crisis, we should investigate what happened in great detail.

But the advice about who should get a test is based on the testing capacity we have now. If we hadn't failed at testing capacity, we would be recommending more users get tested.

So, if the critique is: "we failed to produce adequate testing capacity", then I absolutely agree. If the critique is instead: "The recommendation of who gets a test is bad", then I disagree. The recommendation is correct given the test capacity failing.

The solution is not to recommend everyone gets tests, because they can't! Those tests are being rationed. The solution is to rapidly improve out testing capacity.

> it's for a lack of testing capacity

I feel compelled to point out that it's purely a lack of _authorized_ testing capacity, although things seem to have improved recently. The test itself is relatively trivial from a scientific perspective.

The fact that our bureaucratic apparatuses were so ill prepared for such an event I find highly concerning.

> In the United States, for example, we are urging people not to be tested unless they have severe symptoms.

They should test randomly: e.g. use a hash of the person’s name.

Otherwise there is a huge risk of missing cases that matter...

Testing randomly gets us a better picture of how widespread it is then testing to confirm severe cases. I'd much rather know that X% of the population has it with an error of Y than Z% of severe cases are due to this virus.

Yes from the research/understanding perspective but a lot of the testing is also to provide healthcare to those most in need. You test the most severe to make sure you can treat them effectively.

100% agree with you, but would also supplement "test the most severe" to be "test the most severe and healthcare workers".

Getting healthcare workers out of quarantine if they aren't infected is also super important.

Both of those come as a priority before surveillance.

How have South Korea's numbers meshed with this study? They've been testing very aggressively, surely if there was a huge asymptomatic population it would show up in their testing as well as Italy's?

System is overwhelmed, can't really blame anyone since maintaining such, ready to spring, system would cost a lot of money. In an ideal world a drone would come and take your temp and then drop food supplies etc etc.

But I'm wondering...if we all are going to get infected (40-80%) wouldn't it better to choose the time? Early on you get all the benefits, 3 weeks later you are lucky to have someone measure your temp. Of course you might escape it entirely or new knowledge might be gained in weeks ahead, but the downside is terrible https://news.sky.com/story/coronavirus-italian-doctor-says-f...

Three weeks later you will most likely still be in ICU if you have a severe case. It is better to catch it six or twelve months later when the first peak is over and treatment options may be better.

Been thinking this since January. Did not have the guts to do it.

The employer wants a doctor's note, for you to get a paid sick day? They explicitly do not trust your self-assessment?

I think this is a cultural defect. Evidence? We keep getting most everything wrong and paying more per capital to do it. The free market failures. The government failures. Their various incentives are widely considered flawed or perverse. We even fail to have effective conversations, almost immediately they get rail roaded, and we allow them to be rail roaded. The language strikes me as a lot of attachment/adoration for ideological things like "the free market" and "proper regulation" and being unable to get past our emotional attachments to these things.

Literally the entire rest of the industrialized world does this better and cheaper per capita, and somehow Americans keep defending the system using various slogans and name calling.

I think it's bad culture, like a national mental health disorder, resulting from long term cognitive dissonance. The longer it continues, it's like a perpetually recurring psychological trauma, at a national level.

Asymptomatic for the entire duration of infection? That sounds bad for reducing R but good for the health of the individual.

I would assume that asymptomatic person has a lesser concentration of virus and hence would be less contagious than the really sick ones

Unfortunately that's not necessarily the case. I don't have the reference, but I read somewhere that asymptomatic patients may have even larger amounts of the virus, compared to symptomatic people.

At least asymptomatic patients wouldn’t cough around like symptomatic ones do. They’d "only" spread through talking.

This isn't necessarily true. The big symptoms of almost any infectious disease are actually the body's response to the disease rather than being caused by the disease itself. Things like fever, cough, runny nose are usually (very very often) caused by the body to help fight the infection, rather than the infection itself causing them. This means that not having these symptoms isn't necessarily indicative of not having the disease or having less of it. Sometimes the body doesn't respond right.

If you're asymptomatic, you're not coughing droplets everywhere, which ought to make you less contagious

On the other hand, some people (e.g. myself) keep sneezing and coughing the whole winter every winter, so I definitely wouldn’t consider those symptoms without either headache, body ache, throat pain or fever...

that's also the thing I was wondering. All the people keep talking about asymptomatic spread, yet that should be relatively ineffective at spreading (unless it's super contagious and one cough can infect dozens). Somehow I think people are just not really honest with it I think...

I think that’s the reason many countries rely on harsh measures that hit everyone, not only those who are apparently ill.

The original source of the linked article is a letter by Prof. Sergio Romagnani, sent to the newspaper Corriere Fiorentino, published here on March 15:

https://corrierefiorentino.corriere.it/firenze/notizie/crona...

As follow-up, they interviewed him, published on March 17:

https://corrierefiorentino.corriere.it/firenze/notizie/crona...

Very interesting, thanks.

Translation of the follow-up article: https://translate.google.com/translate?hl=&sl=it&tl=en&u=htt...

That sounds like the perfect way for a disease to spread. Do nothing to most.

If you've ever played Plague, Inc. you will find eerie similarities.

Its cause it's completely accurate trust me I've been playing it. Also the Corrupted Blood virus from world of warcraft.

I wonder if games had more mechanics like that whether people would become more aware of how to handle a disease outbreak.

You just convinced me to move to Greenland.

Madagascar closed their ports to cruise ships a while ago.

Cruise ships have hopefully been sitting in port for a while now. At least no new ones are leaving (or people are more stupid than I thought).

The best evolutionary strategy for a virus is to not cause any disease at all.

Better still, it would make the host feel unusually social.

Toxoplasmosis.

There is a paper that showed that the flu virus makes people more socialable.

It was done with students who took flu vaccine. They found people socialised more after they had the vaccine (and thus, were a little bit infected) compared to before.

A literature review looked at the study and came up with the negative explanation - that people felt more secure or relaxed after getting the vaccine as they felt safer. Or were more nervous about needles before.

Ancedote:

I think I have covid-19 and the days before symptoms I felt unusually anxious to get outside and amongst fellow humans. I'm usually an introvert and stay inside mostly so it was notable.

Suggestion:

Online interview people with symptoms now to collect data on peoples behaviour in the days before symptoms showed, when they were infected but not showing, compared to 2 weeks before.

A vaccine does not make people "a little bit infected". Vaccines are deactivated virii, so your body develops the antibodies, without any actual infection.

That's not totally true the live Polio Vaccine used a live weak infectious virus. Which had the advantage of conferring immunity to unvaccinated people. At the expense of very rarely reverting and causing full blown disease. Far as I know it's no longer being used because of that.

The best evolutionary strategy in human viruses is probably to cause mild upper respiratory tract or gastrointestinal disease such that it increases coughing and sneezing or causes diarrhoea.

Basically, the most successful viruses—colds and Norwalk like viruses—modify our behaviour by hijacking one of our body's defence mechanisms so that they can spread more easily.

I would guess that the mildest form of disease sufficient for such behaviour changes would probably be the best strategy. This would keep the infected host active enough to circulate and spread the virus.

My layman's opinion on covid is that it will become weaker the more it spreads through the population, to the point that when most of us inevitably get it it will cause symptoms like a cold or mild flu.

It seems like the less deadly a virus is, the higher the total kill count. Ebola was so much more deadly but it killed people quickly or at least kept them in bed. Covid-19 lets people walk around for weeks without even knowing they have it.

Yes. This sounds astonishing, and really explains the expansion we see in Italy and other countries.

I live in Hungary, where health care workers don't get (enough) protective wear, the health care system is neglected since decades, and government is not willing to communicate clearly. Also, most of the people who should be tested are not tested, because of the "protocol".

I fear this, and the rate of asymptomatic cases will lead to a deadly mixture here.

Reminds me of old malware that used to destroy their host, which then evolved to dormant malware that didn't disrupt the host PC to evade detection.

Do nothing to everyone. The virus doesn't benefit from killing its host. Quite the opposite, in fact. Successful viruses keep their hosts alive. Think influenza, rhinovirus, herpes etc. Viruses that kill tend to be ones that crossed the species barrier (ie. we're not the original hosts).

Guys, don't underestimate this pandemic, wear plastic gloves, FFP3 masks and if possible protective glasses when you are going outside. Leave your shoes out of the door and wash frequently your hands.

Yet another full population study estimates: “We estimated the asymptomatic proportion at 17.9%” - https://www.medrxiv.org/content/10.1101/2020.02.20.20025866v...

I read this study and the recorded figure is around 50%. They're using some probability estimation based on the 50% discovered cases to account for people who had mild symptoms but not at the time they were tested (potentially after they left the ship). They identify flaws in the study though: the passengers were mostly old, so they are more likely to be symptomatic. They also didn't test everyone on the boat, only vulnerable, or symptomatic people, so their base numbers are missing some number of asymptomatic cases. It's not a perfect study and I think you could take 19% as a low bound on the figure and in wider society 50% is plausible.

It's a largely academic question, at least in terms of mortality and treatment. If you're asymptomatic, you're unlikely to get tested, and you'll never even know you had it. On the other hand, if you have enough symptoms to be tested, you have a higher mortality risk than asymptomatic cases by definition, so the overall mortality rate doesn't matter to you anyway.

Where it does matter (a lot) is in containment, where we should assume many more people are contagious than the reported cases, so the average individual risk of catching it is much higher.

This article on hacker news a couple of days ago could explain a lot of this. There is a possibility that a very large number of the asymptomatic positive tests are in fact false-positives. This could be good news for the world, but I'm not betting on that yet. https://www.ncbi.nlm.nih.gov/pubmed/32133832.

Wouldn't it be great news if so many are asymptomatic or mild? It might explain why China seems to have so few current cases given its population. Maybe many people have already caught it and now have some form of immunity.

I suppose you have a point there. I was thinking that it could be bad that so many are spreading without knowing it.

Also, if many are asymptomatic, and the test is creating a large number of false-positives for those that are asymptomatic, there is a chance that this crisis is not as big as we think it is. Let's hope...

Occam's Razor would imply that the "asymptomatic non-transmissive" cases are really just false positives. The only work I've seen on false positives is these guys, who estimate the FP rate for the active nucleic acid test screening at 75% chance of there being a 'false positive rate' greater than 47%.

https://pubmed.ncbi.nlm.nih.gov/32133832/?fbclid=IwAR3LHLplR...

Interesting, but it doesn't change the fact that health systems are overwhelmed.

If the rate of hospitalization is 15-10%, lockdowns seems the only realistic option.

We've known this for a while. Everyone will get it. You might have it now. Nothing will happen. Still, quarantine for a while because you'll give it to an older person or kid. This isn't about a 20-something year old getting sick. Let your anti-bodies make yourself non-contagious. We are all kindergartens and this is chickenpox basically.

I don't want to spread misinformation here, but u thought I had read several times that children are almost immune from symptoms but can still carry it.

Yeh but like babies. Or really sickly people.

Not even babies, and of thousands of small children I'm sure there have been those exposed that have all kinds of diseases such as severe asthma, diabetes, heard conditions, cystic fibrosis etc. Luckily it seems that small children either don't contract the illness at all, or do so with little to no symptoms.

Correct. Not a single child fatality worldwide.

This is very different than Spanish Flu and even the regular flu.

There is one 14 year old who sadly died, but yes, it is close to zero.

If everyone will get it as you say, the elders will too.

Yes, it isn't even about protecting the old. The sole purpose of the quarantines and self distancing is to avoid the healthcare system to collapse. Corona will become a constant companion for mankind, unless people get, one day, broadly vaxxed. But since we can't get people to vax for far worse diseases this won't happen.

Agreeing with your point: there is only one human virus thought to have been successfully totally eradicated: smallpox, which plagued humanity from ancient history until the late 1970s.

But herd immunity due to widespread (if imperfect) vaccination gets you much of the way there. Assuming flu vaccines continue to work, there probably can't be flu outbreaks that kill tens of millions of people as there have been in the past.

That means 1-2 million deaths in the US according to the latest modelling from Imperial Collage London, so it’s likely all countries will proceed to full lockdown for months at some point soon.

Any chance you could link to those models? I searched around and couldn't find them.

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined. In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.

Excellent. Thank you.

This just isnt true. Look at china. Their new cases per day have now dropped to effectively zero. Under 100,000 people got it, and deaths are around 6,000. Keep in mind this is for a population of 1.3 Billion. US population is 300 million. Please explain how 2 million people are gonna die in this country.

The paper explains how, these are not my figures but they do seem credible, this is the modelling team advising the uk gov and the gov has adjusted their strategy to suppression in response (the tactic in China), but the economic impact of that is pretty dire too, and it means tough choices.

The measures in China were draconian and long lasting (large cities on lockdown for months), and they managed to contain it because they were first hit and it had not spread far. It has already unfortunately spread widely in the UK and US.

I feel like those models take china into it. A place with high levels of smokers and pollution. When the dust settles I doubt 2 million old people will die.

I have read a couple places that there is a worry that becoming ill may not generate long-lasting immunity — possibly only for a few months.

MOST COVID19 CASES ARE ATYPICAL AND NOT REPRESENTED BY ADVERTISED SIDE EFFECTS

ATYPICAL SIDE EFFECTS: Light Fever, Severe Lightheadedness, Long Duration Headache, Sore Throat, Severe Body Aches, Tight Chest, Very Light Cough No Phlegm, Sharp Edged Flush on Cheeks with Pale Circle Surrounding Lips, Slight Runny Nose, Lethargy, Confusion, Hot Flashes, Inconsistant Diarrhoea Without Discomfort, Trouble Focusing on Conversations, Shakiness, No Issues Breathing Until Exercise, Flush After Taking Anti-Inflammatories, Very Shakey Legs on Rising, Swollen Lymph Nodes (under arms), Nervous System Issues: Anxiety, Change in Perception of Senses, Insomnia These symptoms will cycle and not present at the same time which is indicative of COVID19

YOU WILL NOT HAVE THE COUGH OR FEVER YOU EXPECT AND MOST PEOPLE BLAME IT ON STRESS,ALLERGIES,COLD,FLU,ETC.

DO NOT TAKE NAPROXEN, IBUPROFEN OR ANY ANTI-INFLAMMATORIES

Example Symptom Progression From an Interview:

“ I’ve been so tired and so winded and just kind of moody and had a constant headache for a week and hot flashes mostly at night where it felt like I had a fever but only at night, random coughing. I figured it was just the weather and stress. Then last night came to a head—terrible brain fog yesterday could barely hold a convo, would shake (like when you’re blood sugar crashes) when I’d try to get up and do something, Had the worst migraine ever last night and terrible nausea and was throwing up. Then today this is my face with a huge rash.”

Examples of Corona Rash:

https://imgur.com/a/dXz52rR

During the US coronavirus task force briefing just an hour ago, one of the heads of the HHS suggested (without outright saying) that one of the reasons (just one of them) the US is lagging on testing is because they're concerned about the efficacy of tests other countries are running. High false-positive and false-negative rates were both mentioned, in "tens of thousands of tests" distributed to other countries.

There's an underlying truth to this disease that no one has a grasp on right now, and the only way we get to it is the widespread execution of accurate tests. That doesn't happen quickly. Just think about that the next time you feel mad about our testing situation; a core doctrine of medicine (at least in our country) is First, Do No Harm. Telling someone they're infected, when they're not, is doing harm. Telling someone they're clear, when they're not, is doing harm. Enacting policy based on numbers derived from a bad test is doing harm.

And, most importantly, the single thing that represents the entire point of the doctrine: doing nothing is not doing harm.

>because they're concerned about the efficacy of tests other countries are running. That's rich. I understand that the US developed test had a lot more issues that the standard not-invented-here one.

And a lot of countries do the test twice, and only act on double positives or double negatives.

>doing nothing is not doing harm How can this be OK? People will spread it if they think they are not sick.

> And a lot of countries do the test twice, and only act on double positives or double negatives.

The false-positivity or false-negativity of a test is not independent across multiple runs. Its not like each test rolls a dice and decides if it wants to be accurate or not. Its more accurately based on the human being tested; a false-positive test for one human would increase the likelihood for a subsequent false-positive test on that same human. Double-testing helps, but its not the solution.

> How can this be OK? People will spread it if they think they are not sick.

First, do no harm. This often means the first response for doctors is to do nothing (and gather information), until they're certain enough that their actions will not result in harm. Doing nothing is not causing harm; the harm has already come to their patient. The doctor is not the cause of that harm; the world caused it. Its a core responsibility of a doctor to not make it worse accidentally.

Sure, people may spread it if they think they're not sick. But what if a doctor provides a false-negative result to an asymptomatic patient? Now, that patient has been told by a doctor "you're fine". They go back to work. Now, they're spreading it. "My doctor said I'm fine, this little cough is probably just a cold." Patient doesn't go back to get it checked out again.

What if they provide a false-positive result to an asymptomatic patient? "Wow, that's crazy. I must have just gotten lucky" the patient says. Two weeks later, they leave quarantine after getting an accurate negative result. A month later, they actually contract the disease. "But, that's impossible. I already had it! My other doctor told me so, he even gave me a Test." Can coronavirus re-infect patients? Now, we're not so sure. Panic. Research studies. The truth is obscure.

This is how doctors everywhere operate, and this is true at the FDA/CDC more than nearly every other country. Our standards for drug development, testing kit development, etc are among the most stringent in the world. It would take a disease far, far more deadly than the coronavirus to compromise them.

Let's talk about false positives: there seems to be no solid estimate regarding common Cov-19 tests. I've seen numbers from 40% to 85% in papers suggesting at least a high number, some of which will probably be sloppily classified as "asymptomatic" cases.

I read that the false positive rate is extremely low (below 1%).

False positives are not a huge problem when you are only testing people with symptoms. False positives would only become a problem when you are doing a large number of tests on people who have no symptoms (e.g. 1% of 1 million people when close to none have the virus).

I think your numbers are the detection rate: false negative rate is high (up to 40% for early tests).

Another thread about a Chinese study on this topic:

https://news.ycombinator.com/item?id=22598803

I saw a discussion of this on reddit, there was NOT info on if these individuals eventually developed symptoms, so take this with a grain of salt.

Why is this post title in English while the actual article linked is in Italian?

Shouldn’t they have to match?

The best way or reducing new positives test-results is by not allowing any new testing.

So, how do I know if I am one of those asymptomatic cases?

Assume and act as if you are.

Here’s another question: isolation... and then what?

Sit at home until 2021 when we maybe have a vaccine?

I don’t see how we make this virus disappear so while I can see how people staying at home can stop the spread, what happens when they leave? Back to square one?

Maybe UK approach is better.

Maybe we should infect young people deliberately. Here’s Netflix, some books, some video games, some virus, stay at home for 2 weeks. Build up herd immunity. Get a paper, move on.

That’s UK approach except they wait for clusters to pop up. Why not make them? Control the infection rate.

If the chances are everyone gets infected would be better to chose when!

Isolation is too slow the spread. Let the currently sick people get treated, then let the next wave of people catch the virus, once the hospitals have more capacity again. The virus is not that dangerous (under 1% fatality) as long as the healthcare system does not collapse.

It really bothers me to see comments like this get buried. The comment asks a perfectly valid, well articulated question.

How long can these lockdowns continue before their costs outweigh their befits?

It should be safe and okay to question and criticize the actions society is taking right now. Groupthink is its own form of a virus and can be just as destructive, if not more destructive than a physical virus.

Holy cow......I really need to learn Italian

How reputable is this paper?

Very. Repubblica and Corriere are the two main newspapers in Italy, and they are both quite reliable. Repubblica is left leaning, Corriere is right leaning.

Googly translation:

https://translate.googleusercontent.com/translate_c?depth=1&...

Does that mean 25-50% are severe? Is this a bimodal distribution?

Probably not, the other 25-50% get symptoms of which 80% are mild and 20% severe.

not super surprising - plenty of other diseases are similar.

Even serious things like HIV are contagious for a long time while being completely asymptomatic.

Reply on news.ycombinator.com