Hacker News Reader

Comment by edgefield0 | Hacker News Reader

1% death rate assumes reasonable medical care. If you let everyone get infected, you'll have people dying on the streets. I bet this % jumps to 5% or more. We'd easily see 15m+ deaths.

View on HN

Exactly. Death rate in Italy is over 5% I believe. Allowing it to spread unchecked would be an unmitigated catastrophe, and the deaths certainly wouldn't be limited to the elderly. What we need to do is massively expand testing so that the lockdowns and distancing measures can be ended without allowing the virus to go back to spreading through the community.

Keep in mind, the number you are talking about is known deaths / known cases.

Neither of these is a final or accurate number: many of the current cases will progress to death, and many who have been (or are) infected have not been tested (e.g. because they were asymptomatic or had only minor symptoms).

Here’s a more careful attempt to determine the numbers for Wuhan (published today) which results in numbers substantially lower (though still scary) than those suggested by the WHO previously https://www.nature.com/articles/s41591-020-0822-7

For sure, to have an accurate number you need to wait until all cases resolved AND you need to have thorough testing to know what the total number of cases were. Good to see that it may not have been quite as bad as thought in Wuhan. That said, they did enact pretty strict quarantine measures there and massively surged hospital capacity, so it's not like that number represents total healthcare collapse either. Regardless, to me it seems to great to just say it's outweighed by the costs of control measures, especially since there is another path to take.

That seems far worse than any statistics reported so far. What is the basis for that number?

Italy's current mortality rate is 8% (3,405 deaths, 41,035 confirmed cases). Of course their lack of testing is probably influencing the numbers somewhat, but still.

Source: https://www.wsj.com/articles/italys-virus-death-toll-on-the-...

According to a recent study from Columbia University up to 86% cases are undetected based on pre-lockdown Chinese data. That would bring this number down to ~1.1%. That is in the oldest-skewing population out there, barely any containment (assuming 14 days infection to death), and with overwhelmed healthcare capacity. Frankly I didn't even expect it to be this low, I thought it was supposed to be closer to 2.5-3% after healthcare collapse and 0.5% before.

Please be careful with every study you read or be talked about in the news: there's over one thousand studies on Covid19 so far, with a big discrepancy in results. Cherry-picking the one we want to hear is pretty dangerous if it gives us a false sense of security.

For the record, on the Diamond Princess (with everybody tested) the number of asymptomatic case was 60% with more than 1% death rate with Japanese healthcare (not overloaded). You can't generalize on these figures either for many reasons but thats's still a strong warning.

Well, tbh, to beat the WW2 death count, you'd have to infect 8.5B people

There is no scenario in which we see 15 million deaths. I would like to see a single real academic you can find saying anything like that.

Agreed, because that's unthinkable, so lockdowns would be enacted instead. Without any measures taken to limit spread though, that would be the expected result.

Again, based on what? I have seen nowhere near that level of estimate assuming peak hospital overload and unmitigated spread.

Stats from Italy are going to be heavily skewed towards fatalities for a number of reasons that have been documented by epidemiologists.

Based on the death rates in Wuhan and in Italy where this actually happened.

Careful with those death rates, my guess is that they likely exclude a ton of mildly or asymptomatic patients who never got tested (skewing the death rate upwards).

Sure. And yes, Italy's population is more elderly as well. So I agree it's possible the death rate will be less than 5%. (Although I believe they're currently at ~8%, so we don't know that.) But those are the closest parallels we've seen so far as to what happens when a modern heathcare system gets overwhelmed by this, so they're the best estimates we have to work from.

And regardless, it would be very, very bad. If it's only 5M people instead of 15M, that's still catastrophic. Also while the hospitals are completely overwhelmed with COVID-19, people will die of other things that would normally be survivable.

And finally, we have an alternative: keep employing distancing and, where necessary, lockdown measures while scaling up testing. These lockdowns will get the cases under control, but they would flare back up as soon as they're ended. However, with the expanded testing, we can instead perform sufficient testing across the entire population to catch outbreaks before they start. With sufficient testing, things can go back to normal while remaining confident that we're not spreading the virus undetected and seeding a new outbreak. It needs to be orders of magnitude more than we have now, but it's entirely possible.

15 million in the US seems like a big stretch. But more than a million is plausible if no action is taken and people go about their everyday lives as usual.

Agreed, and as many as 2.2 million.

No need to make already awful numbers into lies by multiplying by 7.

Personally I think 2.2 million is extremely optimistic if we're talking about a worst case where no one reacts to mitigate the spread. But ultimately it seems like we agree that it would be really bad, whether it's 2M bad or 10M bad, so no need to argue about it really.

Have a calculator?

# Italian deaths / Italian cases = percentage dead [1]

2_978 / 35_713 = 0.0833870019

# USA population * percentage dead = USA death scenario [2]

329_414_824 * 0.0833870019 = 27_468_914

It's prob not gonna get that bad, but Italy didn't see a scenario where people would die at a rate over 8%. So there's a scenario. Don't panic, but also don't dismiss scenarios you'd rather not believe. Americans who get laid off lose access to cheap healthcare, and many as already don't have it. Lack of healthcare doesn't sound like a great a situation.

[1] Source: Coronavirus disease (COVID-2019) situation reports # 59 for March 19

[2] https://www.census.gov/popclock/

So the 24% of the US population aged 0-18 is just as likely to die as the "confirmed" cases of COVID-19 in Italy? If anyone does anything but dismiss this stupid ass math, they should panic.

We don't really know the death rate in Italy. We shouldn't get too deep in to back-of-napkin math when the data changes every day.

That's confirmed cases. I doubt Italy is testing many people with mild symptoms, just like the US is also not testing many people with mild symptoms.

Surprised that I ended up in the red on that comment, yet not a single person has given me a paper where anyone says that 15 million is a possible worst case US death toll.

Reply on news.ycombinator.com