Covid-19: the harms of exaggerated information and non‐evidence‐based measures | Hacker News Reader

Covid-19: the harms of exaggerated information and non‐evidence‐based measures

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249 pointstomerico436 comments

Firstly, there is 10 weeks of evidence on what other countries have done to avoid transmission. Taiwan, Vietnam, South Korea, China, and Japan all show a variety of strategies and have some successes under their belts. Sure, it’s messy social data, and they have systematic differences from other countries, but it’s real data about what is working.

Ioannidis says: “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”

The Diamond Princess data shows deaths with a functioning health system. From WaPo: “a doctor at Papa Giovanni XXIII Hospital in Bergamo, where he said there are 500 patients in need of intensive care and just 100 ICU beds”. The deaths in Italy are often due to an overloaded health system, which can easily double the number of deaths. Why ignore that? Italy has 6000 deaths already with 1/5th the population of the US: you need some powerful evidence to assume the US should expect to have a different path to end up with a total of 10k (by say the end of the year).

I think John has good reason to desire evidence based decisions, but sometimes you have to make decisions without enough data and change your game as it develops e.g. look at what effective entrepreneurs do in uncertain times?

> “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”

Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's? Where does the idea of 1% come from? Both of those numbers sound ridiculously optimistic to me. Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors?

>Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's?

because everyone on the diamond princess was tested. So we know for sure how many cases we are dealing within the sample.

~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK. Italy sits at 9%. So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. I find the latter less likely than the former.

Bruce Aylward's visit to China made it sound like they were testing everyone too.

Germany is at 0.42 and South Korea is at 1.24 now that more diagnosed people have had time to die.

China outside of Hubei has a CFR under 1%, actually. And they sure as hell didn't test everyone or even 10% of those infected in Hubei.

They tested every single person in the country who showed up to a doctor with a fever.

No, they absolutely have not anywhere closed to the peak in Hubei. People with grave respiratory difficulties were given Kelatra and sent home.

Outside of Hubei and after the peak, sure.

The unanswered question of the GP is why you'd expect only 1% of the US population to be infect?

I can't see the slightest basis for such an assumption. This an extremely infectious, quickly spreading disease. 30% of the US population seem like a more likely estimate.

SK has a 1.3% fatality rate at the end but that was with a functioning health case system. If even 1% of the US population get infect, the health system won't be function and you'll have a higher fatality rate.

>The unanswered question of the GP is why you'd expect only 1% of the US population to be infect?

Ioannidis addresses this in the article. Extensive community spread is actually unlikely to be the case for this virus, epidemic development is hard to discern from simply increasing rates in testing and sensitive populations seeking testing, and maybe most importantly there is little evidence that lockdowns and other extreme measures have significant impact on reducing this sort of respiratory infection, he cites this paper. [1]

" The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children.[...]Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure."

[1]https://www.ncbi.nlm.nih.gov/pubmed/21735402

But talk about lack of data. This is looking at the spread of a different virus - a virus that certainly does not have the infectiousness of the Covid virus. So the this pure speculation.

It's a meta-study looking at over 67 papers that address the question of the spread of respiratory viruses. Obviously, every virus is a new virus, that is always a problem.

The question remains however why we ought to treat concerns about data about the virus different than concerns about data about the response to the virus. Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years?

It seems ironic that people critize Ioannidis for a sort of first-order error in thinking by not considering uncertainty. Yet causing damage and applying first-order thinking to disruption of global supply chains that likely will drive entire nations into deep recession and instability is apparently adequate.

It's a meta-study looking at over 67 papers that address the question of the spread of respiratory viruses. Obviously, every virus is a new virus, that is always a problem.

Yeah, and if any of those other viruses caused a world wide pandemic, I missed it. The article is a specious disaster.

Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years?

An extreme provokes an extreme response? Of course?

Human lives are more important than economies. And economies can't function with massive loss of life anyway. Even more, this is a massive exogenous shock. Once it's done, the various players can pick up the pieces. Until then, it should be treated like a war. Society trumps economics (hopefully, otherwise both are headed for disaster, 1 million deaths+ was the Imperial College Report estimate for what happens if the US does nothing).

>Yeah, and if any of those other viruses caused a world wide pandemic, I missed it.

They do actually. Several of the outbreaks studied among the papers were influenza pandemics, coronavirus pandemics, and SARS. (page ~110-120)

This rhetoric you're starting here about bringing out the war drums to fight invisible enemies is exactly what Ioannidis is afraid of. It is not scientific, it is not based on evidence, and it does not, weigh the tail risk of a global economic breakdown. Which may, in fact, be literal war in some places.

There is a trade-off between the economic effects and response to the virus. It is not a binary question.

Doesn’t influenzas cause a pandemic every year?

I’ve read from various sources influenza cause multiple hundred-thousand deaths every year.

That's broadly correct, although most definitions of "pandemic" jump through some hoop or another to make seasonal flu not count.

Yes, influenza causes over 250,000 deaths worldwide each year.

https://www.pbs.org/newshour/health/cdc-says-more-people-die...

This rhetoric you're starting here about bringing out the war drums to fight invisible enemies is exactly what Ioannidis is afraid of. It is not scientific, it is not based on evidence, and it does not, weigh the tail risk of a global economic breakdown.

Science is a means of discovering the most likely state of things and an always uncertain one. Other human institutions have to come into play when it is necessary to act. Those institutions make the trade-off rather simply calculating them. In the current context, the institution of a war is appropriate (more appropriate than all the semi-wars we've had over the last 50 years in fact, better than "war on drugs" or "war on terror"). We confronted by tiny semi-living creature that happens to be very good at killing us. We should band together and engage in unified, determined action to protect ourselves.

As far the economy goes - the economy is a phenomena of society. The productive machinery should kept going as much as practical and the entire process managed by the government, essentially a machinery akin to WWII needs to be in place for the duration of this. Such war measures kept things running at that time and there's little reason to think they wouldn't work today. Now, as far as lots of people losing their investment. Well, sorry, investments aren't life. This, in a sense, very quick trip from 1929 to 1948 for y'all.

But the government isn't aiming to keep the productive machinery going as much as possible. They're doing precisely the opposite, shutting down productive machinery as much as possible.

Bogus wars against viruses would've been totally unnecessary if leaders had prepared for this eventuality and not shutting down long-term preparedness. Look at this as payback with interest to that debt. Waiting for evidence would lead to worse handling, and shut everything down during panic time instead. Ensuring even worse outcomes.

His own numbers predict fewer deaths in Italy than it's already reported.

The lockdown in Italy has, thankfully, seemed to limit the virus to sublinear growth, using the very small sample of the past three days.

Infected != Ill != death

Once the hospitals run out of ventilators and supplies and once the doctors are all sick themselves. Then sick-with-serious-viral-pneumonia = dead, for a large portion of the sick. Infected != sick, no doubt but we know the ratio of infected to sick over time, despite Ioannidis' disgraceful efforts to cast doubt here.

that's not what the WHO says

~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK.

Fine numbers in the presence of a health system that is not overloaded, or a country that has managed to make effective changes to prevent transmission (how did they do that without science huh?)

By John’s numbers (0.3% die and 1% of population) Italy should get a total of 1800 deaths. Yet Italy is at 6000 and rapidly rising - using real numbers his assumptions are already wrong for a first world country that is a few weeks ahead of the rest of the world.

And why the fuck does he assume 1%? Because some actions have been taken? What actions can be taken since by his own words we lack evidence to make decisions...

Edit: by my calculations the US has 800000 cases at the moment (compared to ~40000 tested positive). 500 deaths with a 0.5% death rate, so three weeks ago there were 100000 cases, but it will have doubled 4 times in 21 days so there is now 800000 cases (already 0.2% of population). Three more doublings (easily realistic) beats John’s 1% within weeks. Ironically, going with his low mortality rate (0.025%) would mean US has 2% infected already...

Many cases in SK and Germany have not resolved yet. I don’t think you can use those numbers so definitively.

Actually South Korea is a perfect place to look for a nation which kept it under control.

Germany just lost control last week, so I expect a lot more death starting next week.

Hopefully Germany's plan of isolation will reduce the spread enough, but we will see...

German here. Could you elaborate how we lost control last week? At least in Bavaria everything seems to be ok - considering the circumstances...

Isn't it the circumstances that are being considered, that are the problem? Germany "lost control" of the pandemic. (Germany didn't actually lose control last week, it's just the numbers stopped growing fast in the "ho hum" range and started growing fast in the "I'm scared" range. This is how exponential growth works. Germany lost control when they decided to do nothing for two weeks after noticing community spread.)

Germany didn't lose control last week. A few days after they realised what happened at the Gangelt carnival, they gave up - that's when they lost control. The spread of cases took a couple weeks to be shockingly high, but this was locked in already in the first week of March.

We must stop confusing the outbreak of diagnoses with the outbreak of cases. That's the mistake every government agency in the West has made, and it's why it spreads faster and better in the west than in South Korea or Taiwan.

I think SK's numbers are becoming more reliable by the day though. The new case rate has stabilised to a small number in the range of 50 to 150 per day and the active case count is dropping at a rate of over 200 per day. The daily death rate has been below 10 the whole time I believe. If that trend continues then SK's CFR will be well known soon and I would guess not dissimilar to current estimates. Though it's always possible a false sense of security will set in and people will relax their habits and send it higher again.

Compare to Germany: weeks behind SK but already more than three times as many cases, new case rate in the last few days of 2500-4500 (SK's max: 851), daily deaths in the last few days 10-29 and heading north. Actually the death rate must reflect an amazing health care system given 30k cases, but it's early days for Germany. Their pipeline is very full, agreed I wouldn't want to make a prediction there.

EDIT: sensitivity.

OK, SK's new case rate is stabilizing, but they still have 5400 active cases. If even 1% of those active cases die (which is possible, since these longer-lasting cases are likely more severe), that's a total CFR of 2%. And this is for a country that everybody claims has been doing contact-tracing and testing asymptomatic people.

> Their pipeline is very full, agreed I wouldn't want to make a prediction there.

German here. I assume the recent hard lockdowns will work out pretty much for us... I'm more worried about the US, this is gonna be a mass die-off, and the Trump government's handling of the issue is... let's say abysmal.

German resident here. Why do you assume the recent hard lockdowns will work out? I have discovered in my time here that the German reputation for orderliness and rule following is exaggerated.

South Korea coped with the outbreak by having a test early, test often strategy, but the German strategy seems to be test eventually, test perfectly. That means that there isn't any process to flag essential workers and others as needing a good proper test. Korea's showed it's better to do a test with a high false positive and even a significant false negative many times a day and get the person out of circulation awaiting an accurate test, than to wait for them to find the symptoms concerning and ask for a proper test.

China coped with the outbreak by having actual curfews. Major lockdowns. The sort we couldn't reasonably expect. When I went to do my weekly/fortnightly shopping yesterday, I saw several police officers looking around into restaurants and on the local town square. Not hard to hide from. No-one cared what my business was.

Italy still hasn't really peaked. They did this test-free lock down strategy that Germany is doing. Apparently the amount of intercourse required for viral transmission is ridiculously low.

There's already tens of thousands of sick people here, and the government was very lethargic in their response. The peak will be huge. As I mentioned before, they gave up after Gangelt and seemed to act as if the whole thing would be minor. It took weeks after discovering a major problem existed that needed hard work before German authorities actually agreed to do hard work.

Learning lessons seems to be really hard for authorities at the moment, and I'm genuinely worried. It's like even ideas are subject to the European protectionism - better import a bad idea from Italy than an effective one from South Korea. My goal is to not get ill before there's space in the hospitals again, because any other goal seems unrealistic.

I find it interesting that SK is always brought up in these discussion about CFR and how now action is required. Actually SK is the prime example of a country acting quickly and early (also showing that general lockdown is not necessary in that case). They would have been even better off had it not been for patient 31.

One of the main effect of that action (apart from slowing down spread) was that they managed to keep the virus away from the most vulnerable parts of the population. Look at the age distribution in SK: https://www.statista.com/statistics/1102730/south-korea-coro... and compare that to Italy: https://www.statista.com/statistics/1103023/coronavirus-case...

Significant evidence that 50%+ of cases are asymptomatic or very mild and those people are not being tested at all. In the Uk even quite bad cases don't get a test

Germany does not report resolved cases IIRC.

> By John’s numbers (0.3% die and 1% of population) Italy should get a total of 1800 deaths. Yet Italy is at 6000 and rapidly rising - using real numbers his assumptions are already wrong for a first world country that is a few weeks ahead of the rest of the world.

Just highlighting this bit of the parent’s post. If you want hard evidence that COVID-19 is quantitatively and qualitatively different from other coronaviruses that, as John puts it in his article, “actually infect millions of people every year”… Italy is it.

It's also possible that Italy is vastly unlucky for some generic reason, considering most of the deaths are in a particular region of the country and among an age bracket that is less cosmopolitan and more likely to reflect limited geographic genetic dispersion.

I suppose central China, northern Italy, Iran, Spain, the rest of Italy, and soon enough France, Germany, New York City, Israel, followed by plenty of other places just happen to be vastly unlucky for “some generic reason”.

It turns out the generic reason was being human

No, the generic reason is age. This is presumably the oldest we've been on average as a species, let alone in certain countries.

While age is probably a factor in Italy, it's less of a factor in China, Iran and Spain, which also have high death rates (though the Chinese high death rate was mostly in the early stages). What these cases have in common is a very large surge which overwhelmed local health services.

If it was entirely based on age, you'd expect higher rates of death in Japan and Germany (both very elderly populations), lower in China (less elderly population) and much lower in Iran (young population).

The cfr in those areas is not even close. It seems NYC has one of the lowest cfrs in the us.

It typically takes 2.5–3 weeks after the start of symptoms for hospitalized patients to die. It only takes a few days to a week for a positive test result to come back.

Up until recently people hospitalized in NYC has had access to doctors and equipment, but NYC hospitals are already on the verge of being overwhelmed, and the crisis is just starting there. 2–3 weeks ago the “CFR” (i.e. deaths to date divided by known positive cases) was also very low in Lombardy.

The mass social distancing interventions they have undertaken in NYC should hopefully start kicking in, and we can all hope that the situation doesn’t get as bad as Lombardy, but in the mean time there are going to be thousands if not tens of thousands of deaths there, and it looks like doctors may soon end up facing choices about who to put on ventilators.

Italian here. The most probable cause for that is that these areas started being affected earlier, so the virus had more time to spread before the lockdown.

I've seen the claim that northern Italy's manufacturing industry is more integrated with China, so there was more cross traffic. I don't know how true this is.

For sure it’s more integrated than southern Italy, but I don’t know and can’t speak about other EU countries. It’s entirely possible the higher traffic brought in the first asymptomatic cases earlier than in other regions.

That doesn't affect cfr, which was higher even before the hospitals got overwhelmed. I suppose it's possible that Italian doctors are just generally bad, but I doubt that.

CFR is affected by the methodology with which you count the positive cases. Italy is badly underestimating the number of affected people (the head of the Civil Protection service says that we could have 10 times more cases than those accounted for).

In Italian:

https://tg24.sky.it/cronaca/2020/03/24/coronavirus-borrelli-...

https://www.globalist.it/science/2020/03/22/crisanti-epidemi...

It takes ~2 weeks for a person to die after they get infected. So when you are looking at numbers from Germany, you should look at current death count / number of infected somewhere around 10-14 days ago.

While virus is actively spreading, taking "current death count / current total infected", can easily underestimate mortality rate by 5-10x because it takes quite a while from infection -> death.

I am speculating, but it might be because Italy tested some (many) people after they died. That would skew the fatality statistics.

That's a false dichotomy. The situation could also be that access to treatment is a huge factor in mortality, and that Italy and Wuhan faced a large enough caseload that people were unable to get healthcare, which drove up mortality significantly.

This is a much more likely factor than the idea that Germany and South Korea are somehow 10x-30x more effective in testing their population than Italy.

I'm not sure about Germany, but South Korea was and is extremely effective at testing their population. They also did and are doing a fantastic job tracing infections (although part of this is due to being able to mostly focus on a single super-spreader rather than many simultaneous outbreaks. I think that South Korea probably confirmed 70-80% of their actual number of cases, while Italy probably has at least 2-3 actual cases for each confirmed case. Testing and tracing en masse is really, really hard, and is basically impossible if you don't catch it soon enough. I think that hospital overloading is definitely able to double or triple the death rate, though.

John's analysis is cherry picking in many ways. Death rate in Diamond Princess is 1.1% today and 2% is listed as severe. Assuming 50% of severe make it, final fatality rate for the ship may end up closer to 2%. John then adds a 50% discount factor but it is not clear how he picked that number. Also, the 1% of population infected seems to be another number pulled out of a hat. If we are basing our figures based only on the ship with no other assumptions, we have to go with 20% infection rate. Thus, one reasonable estimate of risk from the ship data is 20%x2%x330M = 1.3M deaths if we wait for "evidence" and did nothing. Clearly, this argues for doing something!

Edit: Also, Germany does not test dead folks for coronavirus while Italy does. Further, SK death rate has gone up to 1.3% (0.9% is an old number) and many more are in severe category. Thus, the sub 1% numbers seem more like the outliers than the above 1% numbers.

The Diamond Princess is also likely not a random sample of the population - they are healthy enough to be fit for travel.

You don't need to be particularly fit or healthy to go on a cruise. Yes, sure, you can't be on life support, but generally 'healthy enough' to travel on a cruise is exactly what I'd expect from any random sample of the overall population.

You may not understand what "random sample of the overall population" means if you would expect every single person in the sample to be healthy enough to travel on a cruise. Almost 1% of the population in the US has Alzheimer disease or other dementias, for example.

I noted exactly that in my comment. Yes, not all the population can go on a cruise. No, it's not like it's only the healthiest 20% of the population that can. If I randomly sampled the population I'd expect the majority to be capable of a cruise. What do you think cruises are like?

If you agree that they are not a random sample of the population - they are healthy enough to be fit for travel (like the majority of the population) you are not trying to contradict ant6n's comment as I thought. I misunderstood, my apologies.

and it's not a small travel (e.g. the British tourists that went on board the Diamond Princess).

If you are not in good health at the beginning, you don't adventure yourself 10 hours+ from your home. So this group is likely in better shape than average population.

It's been hitting those in assisted living facilities rather hard, and those people would likely not be able to take a cruise.

The problem is the disease is mostly killing off the least heathy. Exclude only 5% of the population and deaths might easily drop by 1+%. Further the Dimond Princess was evacuated specifically because they could not contain the spread. Suggesting their rate of infection is indicative of anything would mean we had somewhere to be evacuated to.

Isn't the average age on a cruise ship far older than in the general population? I would've thought the people on board would on average be far more vulnerable.

It’s a narrow band excluding the young and oldest so, the average is older but the maximum is younger. With a very sharp decline in their 80’s, which is when things really get bad.

Considering how quickly the numbers get worse with age and ill heath many countries are at higher risk.

Why 20%?

That also seems wildly optimistic. 80% seems like a more reasonable assumption than 20%.

Also - 99.9% of those patients (pulled out of a hat) wouldn't have access to health care because the capacity was already overwhelmed, so the death rate will jump markedly.

Because 712 out of the 3711 passengers and crew were infected, and 713÷3713 ≈ 19.2%. So that gives us some sort of vague idea how much of the population from which the ship was drawn will become infected if exposed.

The Dimond Princess was evacuated. It’s passengers where unusually healthy for their age range, and while older than the general population had few people over 85 which is the most at risk population. Further, these people got world class care from experts and whatever minimal care an overworked heath system could provide.

Given all that they still had 9 deaths out of 712 infected with many still in critical condition.

> It’s passengers where unusually healthy for their age range

based on what?

Based on going on cruise. People who are bedridden or who can barely walk don't usually do that.

You don't have to be bedridden to have lungs that are one cold away from death.

People with advanced COPD etc are everywhere but can walk short distances etc and prefer cruises to schlepping through airports and whatnot.

Knowing people who go on large long cruises they tell me they've never been on one where they didn't have at least one death. Indeed I know people with serious health issues who go on these knowing there is good on site medical care at hand.

Large ships have a lot of passengers. In the US Men hit a 2% chance of death at 68, which jumps to 3.6% at 75. At 85 that jumps to 9.6%, and by 95 your at 26% and the numbers keep increasing.

This means you can’t simply look at the average age to estimate risk factors. Still a 2% risk of death per year x 3000 people = 1.15 deaths per week ignoring crew. In other words what you’re describing is still a fairly heathy population.

I don't know what your are trying to achieve here but the demographics of the cruise ships in absolutely no way represents society

I am pointing out curse ship populations are actually at lower risk than society for this specific disease. The crew is all young and it’s mostly irrelevant if someone is 4 or 40 relative to people being a heathy 80 or sick 90.

That's just not true. It's pretty much impossible to be 80 years old and not be more susceptible to infection generally. Statistically the people dying have an average of 2.7 comorbiditities.

the average age on the ship was 62. In what world is the average 62 year old bedridden or too sick to go on a cruise?

Average is meaningless in this context. US Men hit a 2% chance of death at 68, which jumps to 3.6% at 75. At 85 that jumps to 9.6%, and by 95 your at 26% and the numbers keep increasing. A 50:50 mix of 85 year old men and 38 year old men have vastly higher risk of death than a group of just 62 year olds.

Except those higher odds of death are strongly associated with major heath issues. So, simply excluding the sickest 5% of the population makes a huge difference in survival rates.

Diamond Princess was largely elderly people.

> So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere.

There is a third possibility. False positive tests: Germany and South Korea may have less cases than they think they do.

Prof. Drosten who developed the test says that cannot happen in practice. One would get a false positive result with SARS-1 (de facto extinct) and related coronavirus strains in Asian bats (that have not crossed into humans).

Source: https://www.ndr.de/nachrichten/info/coronaskript132.pdf#3

> Prof. Drosten who developed the test says that cannot happen in practice.

Obviously not true

False positives are always possible in practice even if they aren't possible in theory

Get a bunch of tired lab techs running tests 24/7 and one of them will accidentally write down the wrong result at some point

I would not consider that a false positive in the test, maybe in the procedure, but that's quite different.

Moreover it is statistically irrelevant, that would maybe account for 1%, but only if they would only note false positives.

And the fourth: there were claims that only 12% Italy's COVID-19 deaths can be directly attributed to COVID-19.

interesting. this sounds reasonable given its "deaths of people who tested +ve for cv19" and not "deaths of people from complications caused by cv19"

Have you got a source?

Telegraph is reporting it: https://www.telegraph.co.uk/global-health/science-and-diseas...

Thanks

How many HIV deaths can be directly attributed to the virus? Italy’s way of counting may be preferable to the method in other countries (which I assume will be revised at some point when the full history of covid-19 is studied). And even Italy is undercounting!

Go check South Korea's numbers again. As their cases have resolved, death rate has steadily increased, and it's now at 1.33%. It will continue to rise. Same with Germany, it just takes time to die. South Korea had already found majority of their current cases 2-3 weeks ago, but deaths are only now picking up.

Edit: now 1.37%, up again since I checked a couple hours ago.

The same rise in death rate was observed way back when SARS happened. At first people estimated death rate at 2-3%, and it was continually revised upwards as cases resolved.

The opposite happened with H1N1 (swine flu) in 2009, though. The CFR was estimated to be significantly higher during the pandemic but afterwards was estimated at 0.02% with 60M American cases. [0]

Policymakers should use conservative estimates to be careful, but we still just don't know how deadly COVID-19 is.

[0] https://www.eurosurveillance.org/content/10.2807/ese.14.33.1...

That's a difference between IFR and CFR.

Unless they have a test that determines whether fully recovered people had it at some point, they are never going to get an accurate CFR.

Or Italy’s hospital system got overrun and people with survivable cases died for lack of treatment.

> Italy sits at 9%. So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. I find the latter less likely than the former.

Both could be true. For example, Germany doesn't systematically test dead old and/or hospitalized people for Coronavirus infections while Italy apparently does. Germany has more resources to test potentially infected people than Italy, where all resources are needed for treatment of the hospitalized cases.

In reality, both Italy and Germany will have infections in the 100.000s, most of them with mild or no symptoms.

0.3% & 0.9% are optimistic.

South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases = ~1.3% today, gradually going up from ~0.5-0.6% a few weeks ago. Why? People in a functioning healthcare system take time to die and these people were infected during an expansion phase of spread which rapidly increases #cases (denominator).

SK's cohort CFR is even higher. More properly, we should use the infection number from 3 weeks ago because it takes 3-4+ weeks from exposure to death: 120 deaths/4335 cases = ~2.8%

Germany's current naive CFR at 0.4% will also rise in a similar manner for the same reasons. (You can bookmark this.)

https://www.worldometers.info/coronavirus/country/south-kore... https://www.worldometers.info/coronavirus/country/germany/

South Korea has the 2nd highest number of hospital beds per capita in the world and 4 times the US number. Germany: 4th and almost 3 times.

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

South Korea's and Germany's hospitals were never overwhelmed in the same manner as Italy's. A major reason Italy's fatality number is so high is because doctors there cannot save everyone anymore.

>South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases

But the denominator in this formula strongly depends on who and how often you test. In other words: You don't know the number of cases.

Obviously, people who are severely affected are tested more often. People with mild or no symptoms might never be tested, even if they want to (I'm not sure about South Korea but for sure this is happening in Germany).

Based on people in the German parliament and the German soccer league, you can currently guestimate that 1% of the population is already infected (1% of the parliament and 1% of the premier league players are infected. I suspect that they are tested more often and even without symptoms. Maybe they have more contact to other people - maybe not).

Yes, this is a wild guess, but much better than taking the confirmed cases which are heavily biased towards people where the infection causes problems.

Yes, all my figures above are Case Fatality Rate (CFR) and not Infection Fatality Rate (IFR), which includes people with mild or no symptoms. It's much harder to estimate the latter unless one conducts antibody tests on a sufficient sample of a population. South Korea's extensive testing program should bring their two figures closer than those of other countries.

Credible estimates of IFR from noted epidemiologists I've seen are around 1%, assuming that the healthcare system still functions, and much higher otherwise.

COVID-19's CFR & IFR might not even be the biggest problem. High rate of hospitalization and broken healthcare system, with all their ramifications, could be considered even worse.

IFR early estimates from Wuhan are at 0.04-0.12%:

https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v...

There is no real consensus regarding IFR yet. I think the best data we have is from Diamond Princess, which is at least 10/712 or ~1.4% and may go up a bit from unresolved 15 serious/critical cases and 100 more active cases. The population there is older, but also have good care.

If the Diamond Princess age group represents just 20% of a population (they are not all elderly), population IFR must be >= 1.4%/5 = 0.28% and likely higher. 0.28% is above the IFR upper range from the paper in your comment.

“Estimated fatality ratio for infections 1%

Estimated CFR for travellers outside mainland China (mix severe & milder cases) 1%-5%

Estimated CFR for detected cases in Hubei (severe cases) 18%”

By the MRC center at Imperial College: https://twitter.com/MRC_Outbreak/status/1226765905306234881?...

For what it's worth, South Korea has 9k confirmed cases after performing 349k tests.

Super interesting. So, 2.5% of the tests are positive. I heard (it think somewhere else here) that in Germany it is 3%.

Has Germany performed one million tests already?

If you have the raw data you can easily estimate CFR even though the number of infected are increasing by doing a culminate graph over "death share vs time since symptom onset or diagnosis" for the cases.

> it takes 3-4+ weeks from exposure to death

Up to 8 weeks though I haven't found typical distribution/median. The increase in deaths might exponentially grow for a while after new patient load stabilizes.

Italy is a very elderly population. If, as seems to be the case, death rate ramps up dramatically over 70 and especially over 80, then this may explain part of it (though clearly testing in Germany and SK has been more effective than in Italy, too).

Deaths are not instantaneous, add exponential growth and it taking up to 9 weeks from infection to death and it’s really deceptive. All deaths tell you is how many people where infected weeks ago.

Just look at the lag in China’s rate of infections vs deaths. They had 22 deaths on March 8th and 40 new infections. Further, new cases drops off vastly faster than infections with the sickest talking longer to get better and staying at risk of death for weeks.

I know this may sound ridiculous, but Kimchi and Sauerkraut? Are any other countries with a high consumption of low pH fermented foods also showing a lower CFR?

> Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors?

Exactly: why all this focus on deaths, when sickness rates are massive and are sure to have horrific long terms outcomes for more people than those that die. Intensive care strongly implies bad things are happening.

John Ioannidis has been a fabulous force for good fighting scientific fraud and misinformation. But clearly he doesn’t know what effective decision making looks like. It usually doesn’t look very academic in my experience! edit: I mean decision making in an emergency (we did have two months to be proactive, but now we have a reactive emergency).

There is nothing "sure" about "horrific long terms outcomes".

I heard that in US if somebody dies and had pre-existing conditions the pre-existing condition is usually the official cause of death. So the person is not count.

This has to be even more true with flu. If somebody had lung problems and the flu season makes things worse and she ends up dying, the doctors are not normally going to test for flu. And the cause of death is not going to be "flu".

What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested.

I have been trying to understand for a few days how the numbers are really counted for COVID-19. And again, it pretty clear that we do not have the real data for a "normal" flu either.

So for now my understanding of how bad COVID-19 is compared to "standard" flu has been largely inconclusive.

One thing though started getting clearer. COVID-19 is a virus with no vaccine. I have largely underestimate the importance of immunizations and being in a good health. Now I started to picture more and more that without a way to keep our immune system alert against the viruses, we will be greatly screwed almost every year because the demographic at risk would inondate the health care system in a way that they cannot cope.

> What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested.

In this case now, you don't need that: the hospitals in Italy know for years how many new cases they get. Now it's like 50 times more cases that need hospital, and 50 times more dead.

It can't be anything but something completely new. If it's not a new virus X it must be a new virus Y as dangerous as X. But we know there is a new virus X. Old viruses simply had totally different need for hospitals:

https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...

In Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. The same with a need for the beds in the intensive care units.

One possible outcome for survivors is losing up to 30% of their lung capacity.

Keep in mind this number is just as certain as saying 5% at this time.

From the CDC As of 24-Mar there have been 589 deaths of 46292 tested which is 1.27% Mortality Rate. Not 3% or 4% as was initially reported. The more we test, as the days go on, we see this is not nearly as deadly as we thought. This will continue to decline as we test more and probably be around Germany and Korea's < 0.5%

Not having great data to go by is part of the definition of a crisis. If we had perfect data then its unlikely we'd be in a crisis.

Also, if 1% of the population becomes infected, and you continue economic activity, then 67% will be infected in a matter of months... This is a virus with R0 around 3 people. Suppression is the only strategy.

> but sometimes you have to make decisions without enough data and change your game

How orgs mess up handling complex problems, which they are not prepared for, or have the capacities, or time to handle has been studied ever since the second world war scientifically.

And science comes up with the concept of Bounded Rationality.

Which says if an org doesnt have the mental capacities, time, resources or the problem falls in a certain class of complex problems then whatever solution the org comes up with will be half baked.

And half baked solutions create their own issues and the cycle repeats creating a cascade.

Secondly when orgs Choose or are Forced to do something about problems above their capacities and naturally fail, they get blamed, they get defensive and react causing counter reactions which again produce a cascade of issues.

What gets lost in that blame game trap is everyone forgets that no one can solve the problem.

Bounded Rationality and more modern iterations of such theories suggest a simple solution - Pick simpler problems.

> Bounded Rationality and more modern iterations of such theories suggest a simple solution - Pick simpler problems.

Reality and emergent behaviour throws us complex problemS (like a novel virus), so how does that advice help?

With more data and info flowing its getting more and more obvious how bad we are at handling complexity. That evidence is going to keep accumulating.

How people deal with that fact (or dont) is important.

The current response/reaction to that, is to blame/replace leaders/find false messiahs/feel good narratives/distractions etc but all that doesn't reduce complexity.

It doesn't require everyone to agree on what our collective and individual limitations are but just to focus on limitations of those we don't like.

Its a trap and what the theory says is it wont matter what people do in response to crisis when they are stuck in that trap.

Orgs do a bunch of things to create conditions where groups/factions don't get carried away by blindness to their own limitations. If you are interested in the subject start with Herbert Simon's books.

Ioannidis even questions if ventilators are helping. He basically says without evidence to the contrary, they may be a placebo (the part about ICU beds).

And all the low CFRs he cherry picked have now increased dramatically.

That's not exactly a ridiculous hypothesis. A ventilator is life support; you're put on it when you're in the process of dying in hopes that something will happen before you finish.

Your lungs are filling up with fluid and your blood oxygen level is going below livable. Drain it and and ventilate which usually works much better than not doing so with pneumonia in general, or just who knows, no good empirical studies in ventilating with pneumonia related to this specific respiratory virus?

"As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."

https://www.bmj.com/content/327/7429/1459

For those who want some indicative data of what happens in a few weeks if you don't act early, together with Italy, take a look at Spain. The health system in Madrid is already overwhelmed because the growth was incredibly fast.

> a total of 10k (by say the end of the year)

Two weeks ago Italy had 463 deaths, and it now has 6000. I'm not convinced the US containment measures have been quick enough or effective enough to be significantly better than Italy, so I'd expect 10k deaths in under 3 weeks.

> Ioannidis says: “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”

For anyone wondering, this quote is from [1] and doesn't appear in the linked article. I think the linked article is better worded and more nuanced.

> I think John has good reason to desire evidence based decisions, but sometimes you have to make decisions without enough data and change your game as it develops e.g. look at what effective entrepreneurs do in uncertain times?

I think comparing the measures that governments take with what effective entrepreneurs do is misleading for two reasons. First, for a country there is no single bottom line: a good balance has to be found between low mortality, good quality of life for those that do not die, and economy (which can be tied into the latter, or it can be independent if the government prioritises the wealth of a minority). Success of a company is mostly measured financially, or perhaps by visibility.

And second, the stakes are a lot higher for governments. They cannot fail and disappear if the measures are not a success. If they fail, human consequences are massive, but the country still exists. If entrepreneurs fail, the company might go into bankruptcy and disappear, but the impact is mostly financial. On the one hand this means that the risks can be acceptable if the consequences are only financial, and on the other hand this leads to a certain selection bias -- the successful entrepreneurs you see are ones that take risks and act decisively, and were lucky enough that their risks paid off.

1. https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...

In the article Ioannidis says: "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have."

How does he know that this is not happening? It's been published for Sweden that they now moved to use "Sentinel tests" to track the spread of the virus (https://www.thelocal.se/20200320/fact-check-has-sweden-stopp...). This might explain the reason why the Swedish government is still quite relaxed. However, I would be very surprised if other governments would not be doing the same. Maybe this is the reason why governments really increased the response, because they are acting on this data.

[edit typo]

What makes it very likely that the US will not see a situation similar to the one in Italy is the following:

  * Lower amount of population with High blood pressure.
  * Lower median age.
  * Not having the same one big family model as in Italy.
  * Seeing how bad it can get in Italy and having a better response as a result.

It will still get quite bad in the US, but not like in Italy due to the above factors.

The title is funny, since Ioannidis is actually the one proposing measures ("do nothing") based on no evidence and exaggeration. Basically every number in the paper is tainted by him cherry-picking the most optimistic number possible, and then trying to twist it further into something even better.

Like his argument for the R0 being near 1.3 is just that it's "probably" the case.

At some point we need to be able to call the data we have good enough for making decisions.

Um. He doesn't advocate do nothing. He specifically says the opposite. Read the paper. WTF?

Sure he recommends researching vaccines faster, giving people flu vaccines since the flu is more serious than Covid, admitting fewer Covid patients into hospital care, and doing more research so that we're better prepared next time when something actually serious happens. Or if this is serious, doing more research so that the data is the most accurate possible.

I think calling that doing nothing is pretty generous. Since you disagree, what measure that he's proposing did you have in mind?

he seems to advocate individual hygiene and avoiding the public when sick, which also btw seems to be the response that countries like Japan, Taiwan and Singapore have taken, where complete lockdowns or closures have largely been avoided. Together with tracing they seem to have handled the situation just fine.

Taiwan is doing more than public service announcements. Singapore too. Japan closed all schools in Feb. Tracing won’t work without first getting the number manageable.

> together with tracing

This is key — these countries were able to avoid lockdown by testing and tracing early, before the case load became unmanageable. In the US, we’ve missed that opportunity

But US still needs to develop that capacity as quickly as it can, because once quarantine brings the virus under approximate control, testing and contact-tracing are what can eliminate it.

Completely agreed!

South Korea, with one-sixth the population of the US, peaked at 10,000 cases. We haven't passed that per capita case load - and even if we do, lower population density should make it easier to get the virus under control in the US (except in NYC).

We're still a long way from Korea's testing capability. Mass use of surgical masks in public probably also helps.

On Friday, March 20, The Atlantic said over 100,000 people in the US have been tested.[1] More recently, Mike Pence said 250,000 people have been tested.

We're a few days away from Korea's testing capability, if we haven't already matched it.

I think southeast Asia in general handles pandemics better. The people know how to respond and do so more quickly than Americans. Wearing masks, not going on spring break, etc.

1: https://www.theatlantic.com/health/archive/2020/03/how-many-...

300 tests per million people is much, much better than we were a week before that.. But South Korea is at 6,000.

https://ourworldindata.org/grapher/covid19-tests-per-million...

Those are old numbers. Roche alone is sending out 400k test kits per week (over 1000 per million people).[1]

According to [2], more than 290,000 Americans have been tested for the coronavirus (close to 1000 per million people) and in Washington and New York, over 3000 people per million have been tested.

What is South Korea's testing capability (tests per week)? They've had several weeks to get a lead in absolute number of tests performed, but if they've only done 6000 per million people in all that time, we've probably matched them in testing capability.

1: https://diagnostics.roche.com/us/en/news-listing/2020/roche-...

2: https://www.msn.com/en-us/news/us/one-map-shows-how-many-cor...

He seems to recommend the protection of the high-risk slices of populations and campaigns to increase awareness regarding the importance of hygiene. Also figuring out the real incubation period since, he claims, the original patient that was found contagious was already symptomatic, but researchers did not ask.

Weirdly enough, just yesterday I took all available sequence data currently on GISAID, used it to estimate R0, and got ... 1.3.

Intersting. Can you post what you did maybe on a Jupyter notebook?

The imperial college had it estimated 2.1 - 3.3 before "stay at home" measures. Obligatory influenza is 1.5.

If that were true then how can you possibly explain how rapidly the pandemic is spreading?

Long time to spread.

It's curiously spreading at the exact same rate that tests are being administered. Curious indeed..

Maybe you got the terminology mixed up like I had? `* 1.3` is just about the growth rate per day, which isn't R0.

R0 is at the initial onset, without any immunity and any preventive measures. If the virus had R0 of 1.3 it would be easily containable. The reality is that it has an R0 of 2-6 and an effective R > 1 in most except Asian countries.

A R0 of 1.3 with an incubation time of 1 week would not lead to the doubling of cases in 4 days. The whole thing is a crime against math.

I saw the videos from Wuhan hospitals 2 months ago and it was clear that the severity of this was off the charts. You can pretty much scale up the situation from a single hospital, because it tells you that it's impacting locally more than the hospital can respond.

You don't need "evidence" of how many are actually infected or what is the correct R or CFR or which way it spreads. Just look how it's impacting the local health care system. If it exceeds the capacity by X % that's how big a problem it is.

CFR can give you an indication of how long its going to last. If its low and you're getting smashed, that tells you that significant portions of the population are getting infected and it will run out of steam sooner. Higher CFR tells you that the exceeded capacity will last for longer. That will impact the strategies you use.

Spot on. Too many comments are see-sawing on details of parameters and trade offs but just talk to a doctor in NYC, they are out of room in ICUs and terrified about triaging that will start taking place.

Mt. Sinai in NYC is not currently reporting shortages of any kind. They are preparing for shortages, but are not currently experiencing them:

https://www.westsiderag.com/2020/03/23/mt-sinai-setting-up-o...

Perhaps you want to reconsider your news sources.

Hospitals in Italy are currently reporting dramatic shortages of many kinds.

> Just look how it's impacting the local health care system. If it exceeds the capacity by X % that's how big a problem it is.

Ok, let's look. There are 1175 serious/critical cases in the US [0]. I assume all of them are hospitalized, and mild cases are asked to stay home. There are 900k plus total hospital beds in the US, and 132K ICU beds [1], resulting in the current COVID demand from hospitals to be between 0.1% to 1% depending on how many of them need ICU beds. What am I missing? Before I am accused of not understanding exponentiation, I am all for prepping, but much alarm is about how we are already running out of capacity.

[0] https://www.worldometers.info/coronavirus/country/us/ [1] https://www.aha.org/statistics/fast-facts-us-hospitals

Say it's 1% and doubles every 3 days, that's 7 doublings away from over capacity or 21 days or 3 weeks time. Keep in mind bed to patient distribution is non uniform so we'll see shortage before then. Lockdowns take 12 days or so to see effect (from what Italy is seeing). So really, we have about 9 days to do a national lockdown.

It’s much easier to quantify the harms of allowing business as usual and letting the infection spread (namely # of deaths) than it is quantifying the cascading repercussions of a massive global economic meltdown.

Accordingly, world leaders are being judged based on their ability to contain the spread rather than prevent economic devastation.

As a society we are faced with navigating the delicate balance between how many lives we put to risk vs how much economic turmoil we can tolerate.

With so little data on the latter (economic crashes absolutely can lead to deaths as well), it feels like we aren’t equipped to make educated policy decisions on how far we should go to limit the spread.

I hope after all this we can create a more cohesive playbook for navigating these tradeoffs in the future. Many of these public health orders feel like knee jerk reactions lacking evidence.

Better to err on the side of caution I suppose.

If 10% of the population needs ICU and dies because they cant get it, then there is no business as usual.

You make a valid point.

At the same time, economic problems affect everyone while it seems that covid-19 harm scales with age.

No easy solutions to be sure, but I have hope more data becomes available soon so we can implement more nuanced policies to achieve similar containment while preventing massive unemployment. Testing random samples of the general population would be a good first step.

That's an "if" though.

In Italy, median age of people who have died of Corona is 83 for women and 79 for men [1]. Normal life expectancy is lower than that in the United States [2]. Lockdown measures will have severe impact on GDP, and GDP is correlated with life expectancy [3].

It can easily happen that by killing economy in order to save lives, we may actually be doing the opposite in the long term.

[1] https://www.iss.it/web/guest//comunicati-stampa/-/asset_publ...

[2] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

[3] https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...

The US might not be the best country to benchmark other developed countries against, so.

Personnaly, I have issues with people using economic data, read money, to define the value of other peoples lives.

Normal life expectancy is lower than that in the United States

I read on your link that average life expectancy in Italy is 83.4, about 4 years more than US (at 78.9). So I don't get your point unless you are speaking about the age structure: https://en.m.wikipedia.org/wiki/List_of_countries_by_age_str...

It's not just 83 year olds on the ventilator. What's the economy going to be like with millions 'working from hospital?'

An economy is not something that one should have to shovels lives into to keep going. And in any case, if we sacrifice all the lives this virus could take to the economy, it won't help the economy at all - the massive dislocation involved in the deaths will certainly be far worse than the shutdown, if you really want to think that way.

All that said, part of the collapse of things like the stock market comes through the financial system having been built up into finely tuned but extremely fragile edifice - end QE created an environment of limitless leverage and short-term thinking. This environment created the situation of not having future resources, of jury rigging everything to work in a super-efficient but fragile fashion (the 737Max being a perfect product of this paradigm).

Covid shock is logical result - in another, a more far seeing society might have made preparations beforehand, had an epidemic team in place, etc.

So a lot of things are collapsing because they weren't built to last to begin with, not because of the virus.

I definitely agree with you, but I want to see more data. Without broad testing it’s difficult to ascertain the true death rate of the virus (many infected are asymptomatic).

But my hope is we can come up with similarly effective measures (e.g. require n95 masks in public, keeping the elderly at home, offer voluntary isolated infection to low-risk individuals to increase herd immunity, etc) that can achieve both.

South Korea did extensive testing when they successfully eradicated the virus. As user rramach points out, Ioannidis cherry picks the data in many ways, including ignoring the extensive data of South Korea. Not did was Koreans' testing program extensively documented (by Korean scientific institutions, The Western press, and etc), we know they found most or the larger portion of cases because they were able to bring new infections and deaths down to zero.

(e.g. require n95 masks in public, keeping the elderly at home, offer voluntary isolated infection to low-risk individuals to increase herd immunity, etc)

These "get the economy going" measures are totally nuts. You know 10-20% of even fairly healthy people get pneumonia and require hospitalization for virus. Most young people survive but many of those surviving suffer permanent lung damage.

Further, people between 50 and 65 make a huge contribution to the economy and taking them out for an extended period would be highly costly like all this is highly costly (but quarantine should eliminate the virus so could be even quick). Just much, quarantining just some people would require moving a vast number of people from place. IE, what happen with young people living with old people (as happens a lot). The movement of people from place to place would naturally ... spread the virus extensively. More over, where do you get the extra places for either the young living or the old leaving? The UK talked about plans, true but abandoned quickly when infection began because they are obviously impractical fantasies.

Quarantining everyone is extremely simple and just requires doing what South Korea did but on a large scale.

But see, this is the kind of exaggerated information Ioannidis is concerned about. South Korea has not brought new infections and deaths down to zero.

”Most young people survive but many of those surviving suffer permanent lung damage.”

This is not true. You are repeating misinformation.

For the record, in March 2018, 58 000 people died in Italy. We will see how many died this March 2020 :

http://demo.istat.it/index_e.html (see green section on the right, By Month)

Also the following study from August 2019 (before covid19) shows that Italy has more deaths due to influenza every year than any other EU country :

https://www.sciencedirect.com/science/article/pii/S120197121...

> shows that Italy has more deaths due to influenza every year than any other EU country

I’ve read that if an elderly person dies in Italy while they have the flu or coronavirus, then that is recorded as the cause of death.

Some other countries put down other reasons like diabetes complications, or heart failure. Possibly due to pressure from insurance, or avoiding liability for iatrogenic diseases, or avoiding KPIs targeting lower death rates for infections in hospitals.

You are jumping to conclusions based on a few numbers, without understanding the background of where those numbers come from or how to validly compare them between countries.

What proves me that you understand them better than I do?

Nothing. But you are the one making conclusions based on some data series. If Italy is an outlier, are there papers about it?

The economy is someways equivalent to poverty which is highly correlated with mortality rates. Some caution with your reasoning should be warranted.

> An economy is not something that one should have to shovels lives into to keep going.

I think this is almost the literal definition of the economy. I've been shoveling my entire life and eventually I will die.

>> An economy is not something that one should have to shovels lives into to keep going.

I mean I want to agree in principle, but this is just an incorrect statement. It's a matter of what is a good-enough tradeoff of risk and reward. If you make people drive to work, some will die. If you want to mine lithium, some people will die in industrial accidents that wouldn't have died if you never built a lithium mine. If you are only willing to accept 0.000% risk, then we have to respond with a full economic shutdown whenever there is a flu outbreak, or even a common cold outbreak, because people will die if we don't stop the spread. All economic activity leads to deaths, most of the time the deaths are less obviously linked, and at a much lower rate, so we don't connect the fact that people commute to work in trains, and so the economic activity they are commuting into work to engage in directly causes their death in the form of the flu, train crashes, pedestrian accidents, and so on.

There is also a question of net lives lost, or harm minimization. Economic activity also leads to resources which can be used to tend for the sick and elderly, or better nutrition, or education, and to sum up everything that isn't eating acorns you can find on the ground (except even that is a form of economic activity). I would assume that just letting covid run free would be dramatically worse than shutting down the economy for a few weeks, but then what the endgame is I'm not sure, it really does depend on the death rate in an ICU vs with limited medical support, and the amount of economic harm this causes.

However, I think we can learn a lot from this outbreak. I was very, very embarrassed to wear my filter mask when I went to the store, so I only wore work gloves up until yesterday. Now I'm sitting in bed with a fever wondering whether I'm about to start coughing up blood (probably not, it's still more likely to be the flu). Next flu season (or, sadly, next covid season) I think I will wear my mask, though.

If people start wearing fashionable masks and gloves in the winter, we can virtually eliminate lots of communicable diseases.

> It's a matter of what is a good-enough tradeoff of risk and reward.

This also sounds very short-sighted. Yes, people die in a lithium mine, but in most countries, I'm the one taking the risk to become a miner or not. Understandably, the situation isn't that easy: in some countries, you may indirectly or directly be forced to risk your life for the economy. Yet often, I don't see the physical risk-takers being particularly rewarded for their risk-taking either, with few exceptions. Miners are definitely not one of them. Its a difference between who is taking the risk and who's life is on the line: I don't mind risking my own life. I do mind the government toying with it while a prime minister is sipping tea in his comfy seat.

Reality is, the current economy is maintained through exploitation in one way or another, and its fragile balance is now attacked by a force that doesn't care about our economy. Every time people bring up the economy as an argument, its abundantly clear the people in trouble either can't make a buffer, or don't have the discipline to make a buffer. It wasn't that long ago we were forced to go through harsh winters using the harvest of a possibly failed summer and autumn. Yet today, the economy is in jeopardy if a quarter of all activity is told to shut down temporarily. Why can't make people a buffer? Why aren't people making a buffer? Why aren't governments prepared for this?

Something unexpected can always happen, we're not gods nor do we have crystal balls. In a competent software industry, you'd be summoned for making a fragile software system where traffic stops coming through. Yet now we tolerate the same in regards to our economy. It really is time we take a step back and go on the defense rather than looking no further than 3 months.

> It wasn't that long ago we were forced to go through harsh winters using the harvest of a possibly failed summer and autumn.

Well, not really. Lots of people would fail to prepare and rely on their community, and during times the community couldn't afford to help them, they would starve to death. Lots and lots and lots of people just starved to death. They didn't prepare enough, and then they slowly and painfully died from not eating anything. Lots of rich people said "they should have prepared", but it's hard to imagine what it's like to have to decide whether your children will have to be barefoot all winter, or just not go to school at all this year if you don't decide to sell a few extra potatoes instead of saving them.

There is no trade-off. Exponential functions are pretty binary. We contain this (R0<1) or we let this kill 3.6% of the population, and likely permanently harm the lungs of many more.

A core problem is that we're not looking at how to mitigate damage to the economy. We can handle a month or two of the economy shutting down, no problem. You'll get your new car 2 months later.

Most of the damage is auxiliary: businesses going bankrupt, people defaulting on mortgages, etc. All of that can be mitigated with the right measures.

https://docs.google.com/document/d/1YbtJGn7ida2IYNgwCFk3Sjhs...

The economic harm of losing 2 months of production -- or even a year of production -- is much smaller than the economic harm of supporting people disabled by coronavirus for the rest of their lives. That is assuming we mitigate the economic fall.

>> The economic harm of losing 2 months of production -- or even a year of production -- is much smaller than the economic harm of supporting people disabled by coronavirus for the rest of their lives.

That is a tradeoff? I don't understand how you are disagreeing with what I said. You are literally spelling out what we are trading off, the fact that its a very good trade (in your opinion, which is based on expert advise and almost certainly correct, but there are no guarantees) doesn't make it stop being a trade. In fact, that is how all tradeoffs work, one option is better than the other so you pick it.

> Accordingly, world leaders are being judged based on their ability to contain the spread rather than prevent economic devastation.

Actually I am judging countries by their ability to face facts, act proactively Over the last few months, act responsibly by making sensible decisions that are effective in controlling their outbreaks, while keeping their economy functioning.

A++ for Taiwan (they started acting on Dec 31st, and they had preplanned what to do if faced with a virus outbreak). Very few infections, under control, economy working at 100%.

A+ for South Korea, Vietnam, Singapore, Japan and South Korea. Fast actions, effective tracing, economies running.

D- for US: little pro-activity, rampant community transmission, head of state in the sand, focusing on not spooking economy while ignoring downside risks to same, extremely poor planning with poor medical stocks. Health system of many states likely to fail. Now headless chickening, with every state left to act for itself (except for some negative interference from GOP). Meanwhile democrats dropped ball on opportunity of a lifetime to act well and help before the shit hit the fan.

B for China: first to have to act, zero pre warning. China acted and seem to have done better than many other countries that had plenty more warning (yes, China did downplay, but that seems to have been internal and not aimed at other countries. Either way, other countries had enough information from the 31st December or at latest mid-January but didn’t act).

C- for New Zealand: some late actions, tried to protect tourism industry and now the whole economy is paying price with shutdown. Extremely poor communication with population (trying not to worry everyone?). Mostly wasted months with inactivity, lack of planning (from my POV watching what info was given to a nurse), lack of emergency medical equipment. However expect that we’ll now respond well given shock treatment of shutdown of whole country,

If South Korea deserves two A+ maybe you could award them an A++ :-)

Japan?

What do you like about their approach?

Would you (or anyone) care to add some countries in Europe for comparison?

Context for the author: https://en.wikipedia.org/wiki/John_Ioannidis

He wrote a column a couple days before this paper. Linking the response as well.

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...

https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...

It's kind of a shame that he's wound-up writing an article like this. It certainly discredits him in my eyes and it seems utterly opposed to stated principles of evidence based medicine.

As others have noted here, the article calls for action based on very little data and lots of ad-hoc speculation. It also cheery picks its and falsely claims we don't have enough data.

I wonder if thinking all research is false too much lets jump to the idea you dream any opinion that's convenient.

Moreover, Ioannidιs has absolutely jumped into advocating this position from a partisan political position, with his positions picked up by partisan political sites such as the dailywire.com; Headline: "Stanford Professor: Data Indicates We’re Severely Overreacting To Coronavirus" https://www.dailywire.com/news/stanford-professor-data-indic...

What Ioannidis is advocating is to do nothing until we have scientific certainty of what the correct decision should be, and only then act. What he's not taking into account is that the situation is unfolding right now, and if "do nothing" turns out not to have been the correct decision then you can't go back and change that. If we overreact and cause 20% unemployment for the next year, then a harm has been caused, but if we underreact and 20 million people die, then another harm would have been caused. In the face of this alternative, with not enough data to know the probability of outcome #2, but with enough to know that it can happen, then I think it is rational to choose the route that most surely avoids it.

> if we under-react and 20 million people die, then another harm would have been caused

And it's worth noting if anything on the order of millions of people die, then there going to be economic impacts -- that's a hell of a demand crater and productivity shock.

Worst case. Instead of quickly developing herd immunity, the US ends up with persistent low level outbreaks over two to three years like the 1918 flu. If that happens the rest of the world will quarantine us.

What are you trying to say? If the rest of the world would develop hard immunity, they would have no need to quarantine you.

Assume they don't, assume they manage to stop community spread of the disease instead. Then they don't have herd immunity.

Let's check back on this piece in...2 weeks, say, when there are 10,000+ Corona deaths in the US. Well see how it ages then.

Source: https://www.nytimes.com/interactive/2020/03/21/upshot/corona...

427× 16 =11102

China quarantined 700 million of its citizens for fun and it still killed thousands. I'm sure that they regret the policies they implemented right now as they've finally gotten a hold of the outbreak.

Edit: I was being sarcastic here. China messed up the initial response but their draconian tactics worked well.

Why would they regret it? I don’t follow your reasoning. They got a hold of the outbreak precisely because they ramped up quarantining

I was being sarcastic.... it never translates well over text.

I must have have a naturally sarcastic inner monologue, because your sarcasm came through loud and clear to me.

I thought it was so outlandish that no one could actually believe it. Then I thought about my crazy uncle who still thinks this is a bioweapon released by the Chinese on its own citizens.

Yes, only thousands. The point of the quarantine was to avoid deaths of millions. China has flattened thoer curve, no one else has.

South Korea has. It's still going up but it's flatter than it was: https://coronavirus.jhu.edu/map.html

The number of coronavirus deaths is already over 10,000:

https://coronavirus.jhu.edu/map.html

Updated: comment was only for US since John is based at Stanford.

That rate is highly unlikely to hold. There's enough stay in place restrictions in effect to drive it down after about a week or so.

FWIW, at this point, it looks like NYC is going to take a huge hit and the other outbreaks (Seattle, California) will look mild comparitively.

Washington state doesn't have a statewide lockdown, I don't know if even Seattle has a lockdown. California is doing the best but there are still crowds defying the lockdown at beaches and parks. Just as much, grocery stores are open as usual and even with most people trying to do social distancing, I'm doubtful you're clamping that hard on the infection, unfortunately.

I think the best is that when fatalities spike here in California, we're in better shape to intensify the lockdown.

Washington does as of 5:00 pm PDT today.

I've dug through everything I can find. I'm feeling really stupid at the moment, but I cannot find a confirmation of that 5pm start time, though it does appear to start today and "immediately." It runs through April 6, but could be extended.

Tweet is from 6:50pm: https://twitter.com/GovInslee/status/1242267557295321090

https://medium.com/wagovernor/inslee-announces-stay-home-sta...

https://www.governor.wa.gov/sites/default/files/proclamation...

That’s when the announcement of it was broadcast, which is why I used that time.

Thanks.

The measures that have in place in both states have drastically clamped down on infection rates - the growth in WA is barely above linear at this point (and remember you are always looking 10 days backward). CA is also sub-exponential. Look at the data (in the presence of high testing):

https://covid-19.direct/state/WA

If you look at thermometer data (less accurate, but a good predictor), there's little problem going forward in either state. (but serious problems in the NY metro area):

https://healthweather.us/

To my eyes, California just looks slower exponential and Washington is ambiguous. A few days of non-growth can be randomness or reporting problems.

But I hope you're right! We all need to do our parts.

I'd also note that things are getting "hot" in other states and each has it's problems.

At least some of WA's lower numbers recently were due to fewer tests performed.

Deaths lag measures by more than that. We might see Washington’s measures kicking in strong by then but NY will probably be some time.

Yes, death lags and testing is inaccurate. We're flying blind.

I wonder. Willing to admit incorrect if parent prediction proves true? Or pivot if not to a new supposition and declare victory? (I'd say 3.5 weeks myself.)

> There's enough stay in place restrictions in effect to drive it down after about a week or so.

Why do you think that?

I have no strong opinion but I really hope that the fact that the US is not dense, and people are not very tactile, compared to European cities will help us.

I fear we will be well past 10,000 deaths in the US in 2 weeks.

Well deaths in the US only for flu were 50,000 last year. Still 5x less.

Corvid 19 deaths are doubling every 3 days in US and a few other countries. Do the extrapolation.

Trillions will die.

You can only extrapolate so far.

People seem like computers these days: they only think in logarithms, they "forget" to add some common sense.

Even in Italy, the National Health Institute said that 88% of the declared "dead by covid19" had in fact at least 1 or 2 other pre-morbidities.

If a 80 years old dies from heart attack and is tested positive by covid19, it will count as "dead by covid19".

The numbers we see in the news of "CFR" for the covid19 are, in my opinion, inaccurate. The number only shows the spread of the infection, not its actual fatality rate.

CFR is a death rate of the population with particular medical conditions by definition. It is a correct usage.

CFR doesn't translate to the additional death rate, but it does contribute to the death rate by unspecified amount. In particular high enough CFR directly translates to the additional death rate when it exceeds the original crude death rate.

In anything Italy is undercounting covid-19 deaths:

The mayor of Bergamo, a city in northern Italy devastated by coronavirus, said on Monday that the actual death toll from the pandemic is likely several times higher than official count.

Giorgio Gori told NBC News on Monday that the total deaths in Bergamo are three to four times higher than during an average year, signaling that the virus is killing many more people than medical authorities have reported.

"We [have] evidence now in our territories that many people are unfortunately dying in their homes or in the residence for [seniors]," Gori said via Skype. "They are not officially tested because the test is only for people that go to the hospital with serious symptoms."

Doctors are also reporting that patients who seem to be improving are suddenly arresting due to the virus. So counting those victims as "dead by covid19" seems to be correct.

In 47 days, twice the population of the Earth will be dead.

Of humans or crows?

Epidemiology is not putting numbers in excel and running a formula to generate a chart. Which seems like what half the world is doing now. US has already the same number of cases that Italy had one week ago when it had 4000 deaths (only 500 for US at this point). So some data is wrong and you can't model every country in the world based on data that is just plain misleading (Italy). Median age of tested people in Italy is 13.3 years higher than the general population median age, in Germany, the difference is just 0.7. Stop treating Italy as being the only point of truth and other countries (like Germany) like the anomaly.

I think people should be allowed to express a different opinion.

We should criticize and point out mistakes, but let's not demonize.

The world is complex and interdependent, overreacting can be just as bad as not doing anything, what we need to find is the right balance between the two approaches.

If we check back and he was right then what? You, like everyone else, will be elated.

Completely dismissing certain observations early on as 100% wrong is not the right approach. One has to navigate the path balancing the tradeoffs.

Imagine this. Your driving down the freeway at 60 mph, accelerating at 30%. The car in front of you puts on the breaks. Before you react, you first gather your speed gun, check the deceleration rate of the car in front, then calculate based on your speed when you should put your breaks on. I'm all for the scientific approach, but in this particular instance, our survival instincts need to take precedence. Please, we need to stop peddling evidence based approaches for an exponential situation.

Stepping on the breaks perfectly align with what we know scientifically. People think of science as something very narrow – but it's also evidence and rationality. What China and South Korea have done works. What other alternatives do we have?

Except China and South Korea did different things.

Which is consistent with what I wrote.

What all the western countries have done. A half arsed lockdown, not like China's, without testing-and-tracing, not like South Korea's. There's still no evidence that a half arsed lockdown is unsuccessful and good reason to believe they generally aren't.

Except for every time you hit the brakes, they heat up and stop working after some time.

There are significant economic impacts of the measures countries are taking, and the reality is people will only put up with quarantine so long. I think it makes sense to spend some time looking at the evidence because shutting everything down has significant negative impacts, both economically, and potentially with the spread of the virus if people give up on quarantine too soon. Given the evidence I have seen current measures make sense (at least in Ontario) but saying that we should just follow our survival instincts seems wrong, especially when everything is so distorted by the media.

It's an interesting analogy. Instinctual human response is in a way letting nature take over, and suspending analytical thinking. Govt policy making and intervention is more akin to latter, wouldn't you say?

"And yet it moves" Galileo Galilei https://en.m.wikipedia.org/wiki/And_yet_it_moves?wprov=sfla1 . I agree that in many axpects the situation is exagerated, in primis by general panic. But If the Covid is not much worse than flu why in Italy we have military trucks convoy that transport death to southern regions because the wait line for crematory in North is becomed too long?

In normal times Italy has a death rate of 10 deaths/1000 people. Which translates to ~1500 daily for a population of 60 millions. What were they doing previously with the dead?

They buried or cremated them. Unsurprisingly, the system can't handle a sudden one-of-a-kind spike.

Those people haven't stopped dying. As a comparison, 700 people have been dying every day for covid-19 in Italy. Also deaths are not (yet) evenly distributed but greatly concentated in the north.

You are building the world around your arguments. You have no proof but still talk, talk, talk.

You didn’t refute him/her.

What does that even mean? The world is what it is. Italy is seeing huge increases in background death rates at the moment, owing solely to COVID-19 (while at the same time seeing diminished deaths from things like traffic accidents, though not remotely enough to make up for all the extra COVID-19 deaths).

What is your argument exactly? It's a fact that Italy is running at a higher overall mortality rate owing to COVID-19.

> Those people haven't stopped dying

Right... they're dying from covid-19.

Covid-19 deaths are not spread out over the country. There are places where people is dying at four times the usual rate.

Non-Mobile Link: https://en.wikipedia.org/wiki/And_yet_it_moves

http://www.euromomo.eu/

Mortality across Europe has drastically declined in the past few months. Seems like everyone sitting at home is saving a ton of lives. Fewer accidents, fewer sicknesses, maybe even people eating a bit healthier.

Why stop locking yourselves indoors when so many lives are being saved by not leaving home?

It kinda proves the point that covid19 alone is less deadly than many other causes

I don't see how you've come to that conclusion.

Did you look at the charts? If you didn't know there is a global epidemic, would you have been able to see it on these curves?

In France and Italy, there were between 50000 and 60000 deaths per month in 2018 and 2019. If most of those people died because of 2 or 3 accumulated factors, covid19 would be just one more factor. But maybe those people would have died one month later anyway without covid19

I don't understand people like you who can look at the current numbers and say "Oh, it's not so bad" while also conveniently ignoring that the numbers are growing exponentially. People that are raising the alarm are not talking about the numbers now, they are talking about the numbers in the future if nothing is done to address it.

This is a new virus, _no one_ knows about the future. Data we have now could be biased toward an hidden variable we didn't figure out yet.

Well, why don't we just wait around and sit on our hands until hundreds of thousands are dead and this hidden variable makes its presence known? Sounds like a winning strategy to me.

One can predict the future with bounded error bars though. Weeks of observation yielded some numbers including R0 around 2 and CFR around one digit percent (yes, we still don't know if it's around 1% or 2%, but it is certainly not 0.1% [1] or 10%), so 0.1---5% of the total population will die somehow due to COVID-19 if absolutely nothing is done. For the reference, less than 1% of the total population dies each year in developed countries. Enough reason to be alerted.

[1] CFR is a function of age (notably among others) and more careful analysis would involve demographics. Still, the rough order of magnitude doesn't change.

The numbers are growing exponentially until they don't. You can argue that they would have, had extreme measures not been put in place, and there are reasonable arguments for that. But you have to keep track of the fact that it is an argument you're making and not an observation directly from the data. Otherwise you won't update properly on new information.

For example, one thing I've seen people worry about is that there could be huge numbers of undetected infections; one guy quoted me 1.5 million for the US's 40k known cases. This would be wonderful news if true - death rates and hospitalization rates are 37 times smaller than believed, and the theoretical peak is nearer than we'd thought? But I've universally seen people present these scenarios as bad news, because they've internalized "numbers going to grow exponentially" as an observed fact rather than a contingent conclusion.

In every country where we have seen case load sigmoid out, there have been heavy mitigation and suppression efforts put in place that preceded it by several weeks. Thus far, many European countries and the US have only just started to get serious about this. Therefore I am fairly confident that we will be in the exponential growth phase for a while longer.

The website itself says they have several weeks of delay in reporting and outbreaks are focal in nature

Europe was not sitting at home for months. Few weeks basically, including most of Itally.

Mortality _always_ falls at this time of year. As you can clearly see on the chart.

From your own link:

> Pooled estimates of all-cause mortality show normal expected levels of mortality in the participating countries.

The issue isn't that COVID is killing a lot of people right now on a continental level; in the scheme of things it's a statistical blip. The issue is the _potential_ deaths if it gets broadly out of control. If all Europe had rates similar to Northern Italy, this graph would look very, very different.

It's easy to point at others for imperfect data and imperfect science when the situation is evolving so fast and data is so hard to come by. It seems to me that papers being retracted due to inaccurate evidence is not a sign of sensationalism but of sound science. Once can argue that more diligence should be practiced in the review process, but I assume everyone is trying their best to get the information out there ASAP.

In any case, policies need to be enacted now (or rather two weeks ago) in any but the best case scenarios. There is no time to wait for more accurate information. If one argues that exaggeration is rampant and we should learn more before making hasty decisions, then that's essentially arguing for inaction. Even if that was the right action I suspect the induced panic in the society will be even greater.

The author also seems to be implicitly weighing the dire consequences of a pandemic (maybe millions more people dying) against the supposed reputation damage to science, which is bizarre to say the least.

The response will have it consequences too, lost lives, destroyed businesses, ruined families, lost requirement savings.

And a runaway global pandemic will kill more people than Mao, Hitler and Stalin combined. Pick your poison.

That's not an argument for letting this disease burn through our entire population. That's an argument for the government to step up and assist people during this time.

Edit: and who gives a shit about your retirement account.

People who for whatever reason are utterly dependent on support from the state might well give a shit about the state's decreased capacity to provide aid thanks to additional demand on the part of those whose retirement funds (which allowed them to be self-sufficient) have been destroyed.

Still not a valid reason to just let grandma and grandpa die.

At least in my country a big chunk of grandma and grandpa's retirement is subsidized by government programs, if not directly provided by government programs. The same way we provide disability coverage for people who end up out of work through no mistake of their own due to on-the-job injury, etc. You might have your own 401k you deposited salary into or have extra private disability insurance but a big chunk of your safety net here is a government program that you pay into while you're able-bodied and working and then draw out of when you're disabled and/or retired.

It's not as if a disease mitigation shutdown is the only thing that's going to crater grandpa's 401k. His stock holdings took a big hit during the 2008 crash too (as did mine).

Acting to preserve the economy first and foremost will not help those people. You have to keep them alive first while coming up with effective strategies to look after them later in the event that their retirement funds somehow evaporated. What good is protecting their retirement funds if the retiree isn't around to spend them?

What ruins families more, a breadwinner losing their job due to a shutdown or spending a month in the hospital?

P.S. You're probably not getting paid wages during that month in the hospital. Have fun paying off those ICU medical bills when you get back if you still have a job somehow and weren't replaced by someone who wasn't on a ventilator.

Unemployed parents are at least around to look after the kids. A parent sick in the hospital with COVID-19 isn't working or looking after anyone.

And that's assuming that you're at 100% when discharged from the ICU. We still don't know all of the long term issues with internal organ damage from COVID-19 survivors.

I don't believe it being bizarre, nor it being weighing. There's reasonable evidence that there isn't good evidence, with the exception of the cost of being cautious, which has its own life and mortality cost. And if science can't provide good guidance...

The answer seems so obvious. Do a hard, air tight quarantine of people of advanced age. People who are borderline or sick are told to stay inside. Encourage the rest of society to go about business as usual. Provide government support for all of it. Some people will die but probably less than if we have to do this over and over again without ever gaining herd immunity. And few enough to massively ease the burden on hospitals. And it’s the best way to avoid Great Depression 2020.

...keep in mind, that it may be the case that we're being lied to when we're told that young and healthy people have nothing to fear. The following article seems to suggest otherwise: https://www.propublica.org/article/a-medical-worker-describe...

Another data point: The following source gives additional detail on the kind of thing that is meant by "preexisting condition" when they say "people without preexisting conditions have nothing to fear". One of them is high blood pressure. Who doesn't have high blood pressure, these days.

https://www.cebm.net/global-covid-19-case-fatality-rates/

As frightening as they are, these appear to be outlier cases.

Those most at risk are those requiring care. An 80+ person with some illness with typical assistance at home might meet 20+ working age people in a week. That can probably be scaled down in the name of caution to say 5, but it's unlikely to be the same 5 every week because of staff turnover, illness.

It's the same whether you receive care at home or in an assisted living facility.

Even without such care, a lot of these people regularly need hospital care for things that aren't covid. Many have regular scheduled visits to doctors for blood pressure medication tweaks and similar. You could isolate the healthy 70 year olds quite well, but not the sick 80 year olds.

But prove that this matters. How many people are in that group? Is it not possible to quarantine the workers?

Prove that what matters? That they meet tons of working age people?

As you say you can expand the circle of isolation. All the at-risk patients (Say people over 65 and all adults with preexisting conditions). Then you isolate those people that they have to interact with. For example all staff at all nursing homes where any such person lives. But you quickly end up where you started. All the people who work in all the nursing homes have kids and spouses. They can't see those people when they aren't working, and then return to work with the risk group. They'd need to take their kids out of school for example (remember the point of all this is to make the rest of society work normally, schools are open). It's hard.

It's probably easier then to designate people as high risk "patients" and treat them with full protective clothing, move them to special homes where care can be given with more protection and so on. But that also requires 3 things: lots of staff, lots of protective gear, lots of time to set up. I don't think there is a surplus of any of those things. It might be something to consider for the long term.

Then test the caregivers too. That's still far less difficult than quarantining everyone.

When tests are cheap, available and provide results in hours, that might be possible. You’ll have thousands of people who need testing every day.

Ioannidis continues to push this evidence-based approach, but I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. They argue that one doesn't need raw evidence to act if the statistical evidence shows that the risks are catastrophic. They published a paper on January 26th which lays out arguments for why conventional risk management approaches are inadequate in these situations. [1]

This paper was met with disregard on HN [2], but the persistent reach of Ioannidis shows why Taleb's arguments have value.

Some on Twitter argue that the WHO statement on January 14th shows where Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action.

[1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog...

[2] https://news.ycombinator.com/item?id=22154333

[3] https://twitter.com/WHO/status/1217043229427761152

It's weird because I'm just as afraid of a black swan of unforeseen, runaway financial collapse due to pandemic countermeasures. People seem awfully glib about how many will die from the pursuant depression.

I'm becoming considerably more afraid of the social and economic consequences from the pandemic countermeasures than of the virus itself.

My main fears:

1. They find it does effect kids, it just takes longer

2. They find reinfection is common

Do not fear.

1. All evidence shows children have very low risk of severe illness. It can happen but is very very unlikely.

2. Immunity for corona viruses lasts months or years. Why should it be different for this one? Opposing news stories are mixtures of early discharges from hospitals and false negatives test results.

Studies that test also asymptotic cases from Italy and Heinsberg (Germany) (e.g. https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...) indicate a R0 much higher than 2 or 3 (more between 5 and 10). We do not know infected people(!!!). We just know cases. My belief and hope is that virus is so infectious live can return to normal in weeks not months because almost everybody already has or had it (in areas with community spreading). Don't panic. Distance and wait.

We had our chance to get this together years beforehand. We even had a chance to have lower impact interventions be effective 2-3 months ago.

There are no chances for light economic impacts now. Use lighter mitigation methods and productivity and demand will get hit by the illness and death itself, both the first order effects that hit those infected (which would be wider), and the second order effects as people improvise their own rightly fearful responses. The main difference you can count on is that the timing would move closer to the peak. AFAICT nobody has a clear model of whether it would be better or worse.

You do realise that, given no countermeasures, there will be deaths of millions of people, plus half the country I'll. It will collapse the economy.

Tou cant save money by ignoring the disease.

> I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam.

Is that even necessary? Taleb's school argues that empiricism has fundamental shortcomings because it must be "incomplete" in a world of imperfect (read: statistical) evidence. I agree it's a big problem, one that we are not likely to solve. But they go on to say "therefore, we must apply the precautionary principle to XYZ" which is frankly nonsense. Instinct might be important in Taleb's world of non-ergodic black swans, but that absolutely does not prove that his instinct is better than mine or yours!

Taleb's point is that high uncertainties which can result in catastrophic loss are worth of spending money to protect against.

In our present case, the real nonsense is US allocating funds for a 1.5 trillion dollar plane, but totally avoiding investing in the response of pandemics... before it can be too late.

https://www.newyorker.com/news/news-desk/how-long-will-it-ta...

"science can meet the challenges, but there is lots of attrition” before any vaccine gets to the point of licensure. The problem is twofold. First, there may never be a market for a vaccine at the end of the development process, because the epidemic is contained, or never comes to pass. Then, traditionally, if there is an epidemic, it may take hold in a developing country where the costs of research and development cannot be recouped. “The resources and expertise sit in biotech and pharma, and they’ve got their business model,” Grant said. “They’re not charities. They can’t do this stuff for free."

Were there early enough proper funding (surely insignificant compared to 1.5 trillion dollar) this pandemic could have been avoided and, additionally, in the case it couldn't have, the vaccine produced faster. (Bill and Melinda Gates tried to motivate others to do something about that, for years).

Once the virus spreads, it is totally irrelevant where it started.

Edit: and to answer to the message below: I don't have to prove anything. The exponential spread will do its work, independently of all of us. That exponential spread is not something that happens just with coronavirus, it was for decades a known fact. That's the nature of pandemics. The humans in charge ignored the fact at the humanity's peril. There's nothing that can disappear because your political beliefs are different. Even more directly, we're where we are exactly because the political beliefs resulted in the ignorance of the facts.

Surely you must see that now we're having a moral/ethical/political/religious argument, very far removed from anything resembling science?

This is exactly my point. You may believe that you have identified all of "the real nonsense" perfectly well, and your suggestions might be better or worse than mine. But good luck becoming any more certain than you are right now, or proving your case to anyone else.

Put another way: If you believe that X is a "serious enough" risk and I do not, but I believe that Y is a "serious enough" risk and you do not, how do we resolve that disagreement? Who gets the money?

> Put another way: If you believe that X is a "serious enough" risk and I do not, but I believe that Y is a "serious enough" risk and you do not, how do we resolve that disagreement? Who gets the money?

Worst possible outcome for overreacting could be severe economic hardship and domestic unrest.

Worst possible outcome for under-reacting could be millions dead, leading to severe economic hardship and domestic unrest.

If the evidence isn't beyond all doubt I would hope the choice is clear which worst outcome is worth paying to avoid.

EDIT: "paying to avoid" not "paying for"

Let's not be naive here, the worst possible consequence of overreaction is a war.

In that case, why wouldn't the same hold for underreaction?

It would. But the correct choice is not obvious anymore, don't you see? Both worst-case outcomes lead to millions of deaths, and you're not able to prove which is more likely.

I don't buy that. Judging from the actions of governments around the world, many of which made drastic course corrections based on recent findings, the consensus is that the risk of millions of deaths due to underreaction is far greater than the risk of millions of deaths due to overreaction. Of course, it will be important to continuously reassess the situation and make course corrections in either direction based on new findings. In the meantime, governments should do everything they can to mitigate financial hardship and keep the economy alive. Unfortunately, there is no way out of this that won't cause significant pain.

Pascal's Wager

Non-ergodic means the virus isn’t randomly bouncing around with the same parameters on the way down. It has very different dynamics on the way down than on the way up, due to contact tracing and more, as seen in China and S Korea etc.

The UK was using a model that said after suppression it would just immediately rise, as if other measures wouldn’t be taken to hold it down.

Risk management is the correct way to go when uncertainty is high. Containment was the correct approach at the time.

When evidence starts coming in, then you can start applying evidence based approaches.

> Mortality rate: Mortality and morbidity rates are also downward biased, due to the lag between identified cases, deaths and reporting of those deaths [1]

> Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8) . . . As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years) [2].

Based on the second source, who can still seriously believe that the naive death rate is too conservative, because all the people in intensive care just have not died yet?

Look at the deaths/recoveries in Singapore and Hong Kong for more evidence [3][4].

Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more.

[1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog...

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm...

[3] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_H...

[4] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

Right, so do the math. 5% of positives required intensive care. If 197 million Americans get this, That means 10 million people go to intensive care. There are 60,000 ICU beds in the U.S. If 10 million people need the ICU, effectively none get a ventilator and they all die.

Now it's true that the cruise ship passengers skewed significantly older, but on the other hand, they were all ambulatory and healthy enough to be taking a cruise. There are populations that are at significantly higher risk than the cruise ship passengers.

Also, Chinese experience was that about half of the people admitted to the ICU eventually died.

>Now it's true that the cruise ship passengers skewed significantly older, but on the other hand, they were all ambulatory and healthy enough to be taking a cruise.

While yes this is true technically, I'm not sure the bar for "healthy enough" is as high as you're making out it is. In my experience (apologies for the anecdote), significantly obese people are quite capable of going on a cruise almost always.

I'm talking about people in nursing homes, people in hospitals, people on immunosuppressants, for example, after a transplant (who wouldn't go on a cruise because of norovirus etc), people with other immune diseases, etc. There are a lot of these people out there, and these people would be very hard hit if we just let COVID run through the population.

But on the other other hand, they were all traveling, eating cruise ship food, and probably drinking, all of which could weaken their immune systems. We can add speculative adjustments all day long, but there's no way we're going to get a randomized double-blind study out of it.

Also you can't conclude much of anything based on a linear extrapolation, even if you have good data.

What do you need a randomized double blind study for? You're not sure the people on the ship died of COVID?

As for adjustment factors, if you just adjusted for age, you'd get about 50% less mortality if the ship had the same age distribution as the country. So that's 5 million dead. However there are over a million people in the U.S. that are medically compromised and would have a very high fatality rate with COVID.

I also don't see what the problem with a linear extrapolation is.

Finally, I only accounted for deaths due to lack of ventilators. There also wouldn't be enough hospital beds, and that would lead to millions more deaths.

There is simply no reasonable alternative to suppressing the disease. We're talking more deaths than the Holocaust here.

> What do you need a randomized double blind study for? You're not sure the people on the ship died of COVID?

Er, you're not trying to figure out how the ship victims already died, you're trying to predict how many other people might die of the same cause. To do that kind of thing well, you need a hypothesis, and then you need to test it properly.

> As for adjustment factors, if you just adjusted for age, you'd get about 50% less mortality if the ship had the same age distribution as the country.

You can't "just adjust for age" or "just adjust for" anything, you're going to miss something! That's why people do clinical trials.

> I also don't see what the problem with a linear extrapolation is.

Basically, an epidemic is not a linear system, so you can't model it with linear functions. Look into the "SIR model" for a standard way to do that kind of thing. I'm not trained in this field so I'd look for a medical/science forum if you have questions.

https://mathworld.wolfram.com/SIRModel.html

> Er, you're not trying to figure out how the ship victims already died, you're trying to predict how many other people might die of the same cause. To do that kind of thing well, you need a hypothesis, and then you need to test it properly.

What would be the randomized double blind trial that you would run, and what information would it give us?

> Basically, an epidemic is not a linear system, so you can't model it with linear functions. Look into the "SIR model" for a standard way to do that kind of thing. I'm not trained in this field so I'd look for a medical/science forum if you have questions.

I'm familiar with the SIR model. What you'll find is that if R0>1, the SIR model converges to a state where S=1/R0, I=0, and R=1-1/R0. In this epidemic, R0 is approximately 2.5, of course depending on conditions. That means in the U.S. population, 60% will end in state R, which means 60% of people will get the virus. That's the 198 million number from above. It's actually a little worse than that because the SIR model doesn't have a "Dead" state, so more than 60% of the population has to get the virus in order for 60% of the end state population to have recovered.

> What would be the randomized double blind trial that you would run, and what information would it give us?

I have absolutely no idea how to design or run a clinical study.

> 60% of people will get the virus.

All at the same time?? Your extrapolation comparing total critical cases with the number of ICU beds seemed to assume that. Try this interactive model, which plots infections over time and takes into account how long each patient will occupy a bed: https://neherlab.org/covid19/

> All at the same time??

No, but it doesn't matter. If 10,000,000 people need to use 60,000 beds, and they each use one for three weeks, that's 500 weeks, almost ten years. Even if you could get a ventilator for all of them, Chinese experience is that about half of the vented patients die.

Hopefully in a year and a half or so we'll have a vaccine. Until then we need to keep the case counts low, first by sequestering ourselves to get the numbers down, and then by other, less draconian means once the case counts are in single/double digits.

South Korea has 1% fatality rate at the end of their epidemic, they showed .5% in the middle of this. Germany has .2% rate but it has crept up to .4% and I suspect it will continue to creep to 1%, and if they get overwhelmed it could go higher. China has a less than 1% rate outside of Wuhan, since outside that area, the health care system wasn't overwhelmed [1]. The extra deaths in Wuhan could be attributed to the health care system getting overwhelmed rather than under counting - 20 or 10% of those infected require intensive care. You quote 10% of the infected on the Diamond Princess as requiring hospitalization. With an overwhelmed health care system, that might be the death rate.

Which is to say that we have more evidence but that evidence seems to point to a desperate need for containment.

[1] You can compare all the statistics at: https://covid19info.live

> You quote 10% of the infected on the Diamond Princess as requiring hospitalization.

10% of symptomatic cases, not all cases, and definitely not all infected.

I find Taleb's argument specious. The risk inherent in a reaction can be pretty catastrophic as well; for example we are now seeing some project 20%+ unemployment in the next quarter.

In addition, we do have data on the possible harms from Coronovirus, since we have more CFR data at this point. This puts bounds on possible harms. For more detail see John's other article in statnews. The results of the Diamond Princess cruise ship also are telling [1].

It looks like Iceland has about 1% of its people infected [2]. This didn't happen overnight, and Iceland is doing OK.

[1] https://twitter.com/maximlott/status/1241718453700038658?s=2...

[2] https://www.government.is/news/article/2020/03/15/Large-scal...

Well, consider if we reacted late January when he wrote that article it would have been very cheap to contain...

Then the immediate question is, the next time we react early and it turns out we overreacted, is that something you're going to register as well? In particular in authoritarian countries like China which actually have a history of vast overreaction based on a 'security-first' mindset.

Ioannidis actually points to one other example in the article. There are several corona strains already in circulation with fatality rates as high as 8% among the elderly. If this reaction is rational, are we irrational not locking down everything every winter?

Maybe we can just lock things down when we sport extremely dangerous new viruses. It doesn’t seem that tricky to me. I was following this from late December, and it was clear it was a potentially huge risk.

Iceland’s serology will be interesting to follow.

If you are driving along the coast and you hear on the radio some report of a earthquake by the ocean, do you wait until you know how big the tsunami will be or do you just do your best to get the fuck out of there?

Also, how hard is it to understand that if Taleb's argument was turned into action on January 26th (57 days ago!) the number of people being impacted would be an much smaller fraction of what it is today?

Also, today we have a virus that is "only" killing 1% of its people, and you seem to be okay with it. What about the next ones? Do you think we should take a "wait-and-see" attitude for the next epidemic that might turn out to kill 5% of the infected? What if it turns out to kill 10%?

Diamond Princess (pop. 3,711) was stationed right next to Japan (pop. 126M) and could use its full medical resource. That's not a good model for an actual country hit with the virus.

> It looks like Iceland has about 1% of its people infected.

Apologies if I've misunderstood something but your link says 473 cases, which is more like 0.1% of the population.

fro the article:

"deCode has published the results of a total of 5 571 tests. Those have yielded 48 positive results (0.86%)"

'deCode' is the new series that will test everyone.

Sorry, I just saw this now. Misunderstanding I was. Thank you.

Taleb's note was probably more relevant back when it was published. It's clear that current measures are measures devised against epidemics, and not "conventional risk-management approaches" for everyday business, which he seems to be criticizing. There's a lot to criticize about the note [1] but its conclusion was appropriate in that a response tailored to the particular epidemic based on conventional risk-assessment can't properly evaluate the harm of an epidemic until it is too late.

But today, governments are responding in the typical fashion of responding to pandemics. Closing borders and quarantines are precisely the measure that dampens the more frequent so-called "superspreader" events, and social distancing is the exaggerated response that decimates the potential impact of these "superspreader" events.

It's obvious and unfortunate that the authors didn't do their research on public health policy, since public health advisors and experts actually already knows the right measures to take; it's a matter of convincing the decision-makers that this is the right way to respond to a new pandemic rather than the risk-assessment models that were tailored to more frequent events.

> Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action.

I don't think this is the right conclusion. I think many flu strains occasionally transmit from animal to humans, but fail to spread from human to human, and imposing drastic measures upon this is too much of an overreaction, since they aren't usually much worse in public health impact than the seasonal flu. On the other hand, as soon as there is a spike of cases in a local area, that is enough evidence to be wary. That tweet just reads like a poor excuse by Chinese officials that doesn't make sense, something that the rest of the world have come to expect from them.

You also have a misreading of what Ioannidis is trying to push for. He isn't advocating against taking action before good evidence comes out. Rather, he is highlighting that our current lack of good evidence about the epidemic is necessitating a greater reaction than may actually be necessary if we had better evidence. He is advocating for better evidence to be published with higher standards, so that if this pandemic is actually less dangerous than it actually is, decision-makers would continue to trust the public health experts to make decisions should a worse pandemic come about.

[1]

e.g.

> Standard individual-scale policy approaches such as isolation, contact tracing and monitoring are rapidly (computationally) overwhelmed

Computationally ???

/You also have a misreading of what Ioannidis is trying to push for. He isn't advocating against taking action before good evidence comes out. Rather, he is highlighting that our current lack of good evidence about the epidemic is necessitating a greater reaction than may actually be necessary if we had better evidence./

This is kinda the core problem, though: We don't have access to the full evidence (yet) and things already look somewhere between very very bad and mildly catastrophic. (I'll reserve full catastrophe for Giant Asteroid.) If you don't plan for the 'catastrophic' case and it's on the table, you look pretty bad if the error tends in that direction. By the time you KNOW you're in the catastrophic case, it's too late to deal with it.

I've seen the Ioniaddis pieces showing up in a couple places, and he really comes off as a bit of a crank, more concerned about his Stanford-supported stock portfolio than considering the Actually Available evidence. I don't give a fsck about the initial wrong reports in China... Italy's got overflowing hospitals and a very exponential-looking death curve right now. Not enough testing means we're getting better numbers, leading to a sharp spike... but the numbers are still reflecting mostly the worst cases, coz that's who tests are available to. And the numbers of deaths and very bad cases are climbing very, very fast.

Here's a model you can tweak, with plots of available data and estimates of available hospital beds, etc... Just looking at the death curves (can't hide a body, amirite) the 'Fast/North' scenario looks like it fits well for the US. Moderate-to-no mitigation is then modeled at O(3MM) deaths, and strong mitigation drops to O(1MM). So, the error bars that we're playing with are measured in millions of lives.

https://neherlab.org/covid19/

Read that quote more closely. I'm of the impression that the article acknowledges that until better evidence comes in, "taking [drastic] action" is the right decision. But researchers should gather evidence quickly to see if the drastic action is an overreaction, and loosen measures once there is evidence that it is safe to do so.

You need to know if you’re walking through a two way door or a one way door. A two way door you can course correct. A one way door you can not which requires a different risk strategy. Evidence suggests a one way door.

Common sense needs to prevail over mania, numbers over hyperbole and science over conjecture. But even then, this is hard if our data is collected poorly and then poorly disseminated.

So what is the answer then? Maybe a strengthening of resolve against all forms of panic?

Is there a single event in history has been solved by panic?

What we need is more data. What is the % of Covid-19 cases that require hospitalization (and are people actually going to hospitals when they don't need to?) ? Is it 20x that of flu or 2x? We need random testing throughout the population to know true mortality rate and herd immunity.

We have the data we need. We know how fast it grows, we know how bad it is. It's at least order of magnitude (as in, surely ten times) worse than flu:

https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...

As shown, in Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. And it continues to grow.

> are people actually going to hospitals when they don't need to?

Surely no. In Italy, it is known that even the people who should go to hospitals can't be all admitted because the number of cases grows exponentially and fast, when uncontrolled. No limited resources could handle that.

People already die because the hospitals are too full.

Additionally, all people who are checked but than estimated to be able to survive without the hospital are advised to stay at home. But some of those still get sicker and die at home. That happens, infrequently for now, even in other European countries.

The reason people are admitted to hospitals is that they have so big problems breathing that they either immediately or at least soon have to be connected to the breathing machines. Which nobody would ever do to a healthy enough person, it's to save the life.

That's what are ICU on the graph above "intensive care units" -- the number of beds in typically small parts of hospitals where typically small number of people has to be connected to the machines to help them survive. Now the demand for those is huge.

And even 30-year old doctors get to have to be treated so:

https://www.thesun.co.uk/news/11226440/three-junior-doctors-...

Consider this, if the news reported "Old people with pre-existing conditions should quarantine themselves because a deadly virus may kill them", that would be rational advice based on data.

Instead, the entire economy has been shut down, and the solution? Test everyone regardless of risk or value of testing. This is not rational, and many scientists and doctors are saying this.

Doctors and nurses should be tested regularly as they are more susceptible to contraction do to proximity, and the elderly or those in contact with areas of high infection or high risk of fatality.

Poorly reported sensationalism in the news needs a proper counter balance. And society needs something to overcome their power to induce irrational panic so easily.

What harm is there in testing everyone?

If it can be done cheaply and easily while preventing additional infections, no harm at all. In fact, testing as many people as possible to isolate carriers is, I believe, the single best way to handle this crisis. It's not doable at this point, although hopefully we'll get there.

> Instead, the entire economy has been shut down, and the solution?

The hospitals are being overrun.

Your whole comments just reads like you're upset that you can't go out with your friends anymore. "Why should I have to stay at home, its the old people that are in danger, they should have to stay home."

The hospitals are being overrun. That means that if left unchecked the virus overwhelms healthcare. Just yesterday we've hospitalized people in their 30s and 40s here. It's not just the old people who need intensive care. It seems to be its the old people who die even with intensive care.

They are being overrun with panic of the citizenry in the U.S. so far - not with people needing hospital care. At least so says my E.R. doctor sister.

At the moment, but the spread is exponential, and the U.S. in not an exception. It's just a matter of N days, where N is not a too big number. Everybody can do his own math, provided he understands the math enough.

But be aware of anybody who hasn't done the math. He simply doesn't know what he talks about.

>The hospitals are being overrun.

Which hospitals in the US are being overrun by Covid cases? Close friend works at a large hospital just north of Sacramento (near the first Covid death in California)... not a single Covid patient in their hospital. Heard a guy from NYU Lagone on the radio earlier - said they're nowhere near capacity. I'm not saying this isn't serious, but a lot of the rhetoric is alarmism with no basis in fact at this point.

"Were not overwhelmed yet so its fine"

Cases are still growing exponentially. The hospitals in Italy are being overrun. They were being overrun in China.

We do not have all the data we need. Just for starters, we don't know why the situation is so much worse in Italy than in Japan.

> we don't know why the situation is so much worse in Italy than in Japan.

So... because we don't know why just Asian countries are better than Western in controlling the outbreak, the Western countries should just... do nothing to control the outbreak?

In spite already being in disadvantage?

And having the examples that we know worked?

Seriously?

What is panic and why do you think this is a panic? If anything, the lack of concern by policy makers and the public has turned this into a catastrophe. If they had “panicked” three months ago, we wouldn’t be in this situation now.

Unfortunately, if we had panicked 3 months ago and prevented all of this, we'd never know it. People would just look and say, "see it was no big deal, we panicked for nothing".

The craziest stat I heard today was on my local news, and it was about COVID19 in the county, Davidson County (Nashville, TN,) they said of all the active cases in the county only 2 had been hospitalized. That's out of 163. The others were sent home to be quarantined and medicated. I was floored. Why are stats like that not shared? That seems like very valuable information. Hospitalization rates should be one of the main stats being shared, imo.

It doesn't seem like hospitalization rates are being as consistently tracked. Or if they are, not disseminated. My state's official page tracks changes daily, but doesn't include hospitalizations.

There are countries that do report:

"17 March: the total number of cases was 1705, of which 314 patients had been admitted to the hospital"

That was week ago, now it's 1230 people in the hospital, or 4 times more. So I expect 5000 at the end of the next week in the Netherlands. The growth of the infection by the novel virus is exponential, until strong enough measures start to work, and the Netherlands wasn't (due to the politicians) ready to seriously enforce them.

So it's around 20%, once one has more than a few cases. And that's far from being a small percentage.

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

hospitalization rates are being shared. IIRC, they are generally around 20% of confirmed cases, but the testing rate is low here so hard to know the true numbers

The testing rate is low almost everywhere. The mass testing done in the Italian town Vò suggests that 50-75% of infections are asymptomatic (but still contagious). This matches the findings from the cruise ship "Diamond Princess".

Also note that the populations of both the cruise ship and Vò skew quite a bit older than the world average, and younger people are more likely to be asymptomatic (AFAIK we still don't know how more likely)

> Why are stats like that not shared? That seems like very valuable information. Hospitalization rates should be one of the main stats being shared, imo.

Because it’s in the neighborhood of 15% worst case needing hospitalization. You’ve already got enough people blowing off quarantine measures, so no one is terribly eager to share that of the people who DO get the virus, 85% don’t require hospitalization. I get the reasoning from a public policy perspective, but I agree that information should be made a bit more easily accessible.

> Why are stats like that not shared? That seems like very valuable information.

Because it's only 163, and data of an unknown quality.

In Iowa the Department of Health is reporting over 2100 negative tests (we are currently only testing patients who come into the hospital or already admitted) and 105 confirmed cases. Obviously a much smaller population size than other areas.

Sure but most of those are new cases. Do you have any idea what happened with those cases two weeks later or even if it's been two or three weeks for the cases? You'd only expect that 16-32 would require hospitalization in any case. But on the other hand, you can expect 326 visible or invisible cases the next week and gradually things get difficult, if the trend that's been documented continues.

I can see that, but I also can see that this could give us insight into the virus as it spreads throughout the population. Like, what if it is mutating, becoming weaker/stronger, hospitalization rates would give us insight into that.

Hospitalization rate is a function of age; if the 163 infected are young, you would expect a hospitalization rate of near zero.

> Why are stats like that not shared?

They are being shared daily.

That doesn't seem abnormal? The majority of cases don't need hospitalisation. Some countries have hospitalised most cases while numbers are small, but mostly as a precaution, and they'll be kicked out once numbers rise. I thought that was fairly well known.

So far. How many of those will need hospital care in the next few weeks?

Some historians attribute the French Revolution at least partly to a mass hysteria of the idea that aristocrats were planning on starving the populace during a grain shortage. And feudalism was abolished as a result.

Other countries managed to abolish feudalism without quite so many mass executions or consequent authoritarian strongmen plunging their continents into devastating series of wars.

... often just because rulers were so scared by the French experience, that they caved at the first demand for better forms of government.

In a similar way, a lot of worker rights gained in the XX century were introduced only because elites were utterly scared by the Soviet experience.

Sometimes it helps to have a reference, so to speak.

Speaking of which, before the revolution in which Soviets came to power, we had serfdom in russia - basically our version of a feudal system

Serfdom was abolished in Russia in 1861.

Eh... _kind of_. It was abolished in such a way that in practice it kept more or less functioning for a very long time afterwards.

If you mean that peasants still had to rely on the land owned by somebody else to survive, then yes. But this had been the case in every country that had serfdom and abolished it, usually until industrialization funneled all those peasants into the cities.

But serfdom is a lot more than that - it's literally treating people as slaves, selling them etc. That part was decisively abolished.

By 1917, when the Revolution happened, peasants' primary concern was access to and control of the land, not personal freedom.

As I understand it, many emancipated serfs and their descendants were still paying off a substantial tax intended to compensate landowners into the 20th century, often by working for the same landowners. It was clearly an improvement over serfdom, but likely a worse situation than contemporary peasants elsewhere.

But didn't the French revolution have highly intellectual leaders that sought to create an entirely new government?

I doubt they decided their rules of law while feeling panic. It was likely done over a long period of time with careful thought and consideration.

That ‘careful thought and consideration’ let to the Reign of Terror.

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

The road to hell, & etc.

This "Reign of Terror" (La Terreur) is becoming highly controversial amongst academic historians. Don't believe everything on wikipedia, even if it fits your views.

Furret and Soboul are most likely the cause of those, but better, or at least more descriptivist/scientific historians like https://fr.wikipedia.org/wiki/Michel_Biard or https://fr.wikipedia.org/wiki/Jean-Cl%C3%A9ment_Martin are probably closer to the truth.

I'm not saying that Furret is a bad historian: he is the reason why we can be closer to the truth, now. By disproving some of the marxist interpretation claims and advancing his own interpretation, he allowed younger historian to do the same to his own, finding proofs through legislative archives that some "French revolution facts" were not really facts, and especially, the legend about the assembly: "La Terreur est a l'ordre du jour".

French textbook still have not been updated, and neither was wikipedia :/

Sorry, i'm an history nerd.

What do you mean by “common sense”?

>Is there a single event in history has been solved by panic?

Surely there's a historical figure who at some point fled in panic. Having survived, they then changed the world.

If you're having an asthma attack, running outside in a panic might get you away from the airborne allergen.

All the training I learned in boy scouts, heard from survivalist, people who have survived outrageous circumstances by their own choosing and actions did not attribute their success to panic, but the opposite, keeping a clear head.

It's likely we can find stories of people panicing and surviving, sure. But can a paniced person (one overwhelmed with intoxicating fear) help others? No.

A drowning person will also drown their own lifeguard to attempt to save themselves. This is a well established fact that all trained lifeguards know.

Panic causes irrational and often self destructive choices. And often hurt others.

I absolutely agree that panic has only narrow uses.

> Is there a single event in history has been solved by panic?

What does that mean? "Panic" is not a strategy, it's an instinctive response to fear.

Does 'panic' mean 'reacting to a problem with a severity of response that is proportionate to how big of a problem it will be in the future, rather than how big of a problem it is now'?

Probably many problems have been solved by this.

Bah, proper statistics on Chinese data showed this was going to be really bad in January. Nobody lifted a finger then other than quarantine, which already was known to be insufficient based on initial Chinese epidemiology.

(When the curve was way past SARS-CoV-1 outbreak.)

Correct data-driven measures have been taken somewhat too late.

The definition of panic is: "A sudden, overpowering feeling of fear, often affecting many people at once. synonym: fear."

The reason we don't panic about the number 1 killer of Americans is because we are rational about it. We've researched and considered the cause and results carefully.

The solution to something that causes fear is not more fear is it?

This line of thinking is backwards. Usually the problems that we don't solve are the ones where we should have taken stronger measures (i.e, "panicked") earlier instead of waiting for evidence of a threat.

We did listen to the ones crying (i.e, "panicking") over Y2K bug and a lot of money was spent on it before January 1st, 2000, so that got solved swiftly. On the other hand:

- Had we listened to the ones crying (i.e, "panicking") over the excess of the dot-com era, we wouldn't have pets.com and WebVan.

- Had we listened to the ones crying (i.e, "panicking") about the mortgage crisis, we wouldn't have gone through the 2008 recession.

- Had we listened to the ones warning about the need of controlling flights to China in January (i.e, "panicking"), half of Europe wouldn't be in lockdown.

Italy was one of the first countries to ban flights from China. Fat lot of good it did. But I agree that there should have been a stronger reaction, in terms of testing / tracing / isolating.

It did after it was already infected, by then they should've reduced the mobility of the people, close the football games, etc - which they didn't and led to people from Valencia going to Milan for the match, getting infected and spreading the thing faster still in Spain.

No "panic" enough.

Every circumstance you mentioned was not "solved" with panic, but was solved with thoughtful and persitant action.

If you are proposing the only way to "thoughtful and persistent action" is by being induced by panic. Then I would appreciate your evidence of this.

For example the 2038 problem is more serious that Y2k. My actions today (as soon as I found out about it) was to alter all current and future systems and plan to alter all current systems in place in the near future.

No panic needed to take this action.

Do you believe the only way to motivate people is to panic them? Do you not see a long term down side to this approach?

That's not the point being made. Panic was not what was done or suggested, it was the dismissive tone that such concerns were met with by Critics. GP's point was that the claims it was panic were wrong and harmful, not the quote unquote "panic".

Yes, and not just the dismissive tone. Even worse is the fact that the "we need more data" crowd mistakes Absence of Evidence for Evidence of Absence - as in "I will only wear the seat-belt after I witness a car-crash in front of me".

My point is that what you call "panic" is not really panic.

It is not panic to leave a building as fast as you can when a fire alarm rings - even if we don't know what caused the alarm to ring in the first place. I don't care about "numbers over hyperbole" or "science vs conjecture", I leave the building and assume that I am at risk by staying inside.

Likewise, it is not "panic" to propose that we err on the side of precaution and take measures that could contain an epidemic of uncertain risk and dangers, instead of adopting a "wait-and-see" attitude that might be fatal. Chinese doctors wanted to ring the alarm in November and were silenced by the Communist Party. When we got to December/early January and even the Party couldn't hide it anymore, we should've taken that more seriously and started to look for the "way out of the building", even if we didn't know yet how big is the fire/what caused it/who started it/etc.

Another example that people seem to have basically forgotten about is the ozone hole. That could have been extremely nasty, had action not been taken.

Epidemiologists were producing numbers, papers, estimates from the december and continue to produce them. But somehow these don't count?

The acid test for this article will take place towards the end of this week and into next according to the Surgeon General.

Honestly, we're all holding our collective breath and waiting to see whether or not the U.S. begins to approach the same values associated with the Diamond Princess.

So far, the mortality rate of those testing positive, asymptomatic and symtomatic, published by the CDC today, is 0.0119 compared to the DP's 0.013.

The mortality rate as a percentage of all passengers and crew aboard the DP is 0.002 (9/3711).

The infection rate as a percentage of all passengers and crew aboard the DP is 0.192 (712/3711).

Dr. Deborah Brix indicated during today's WH presser that it's possible 70% of the U.S. population will be "exposed" to the virus by the end of 2021.

(327,000,000 * 0.70) * 0.19 = 43,491,000 potential positives if the DP number is used.

To date in the U.S., the reported percentage testing positive of the total number tested is 0.115. I'm not sure where this number keeps coming from.

At the moment, the Diamond Princess represents the best set of data for comparison.

Why do we expect to get better mortality data in the US than other countries?

Social distancing and hygiene hopefully contribute to fewer exposures and therefore fewer fatalities. Especially those 65+ with underlying conditions such as hypertension and diabetes.

Ah yes, the United States, where our incidence of hypertension, diabetes, obesity, and heart disease are so low.

I don't think many people knowing the facts are expecting that. It's that people, including me, dread the moments when the facts become manifest. This will prove us right but I will take no comfort in that confirmation. On the off chance that these (implausible sounding) arguments turn out right, well, woohoo, great.

Finishing the math on this is very sobering which is why I was intrigued by the original post.

I truly hope John Ioannidis is correct and SARS-CoV-2 is not as virulent. We are about to see in the next week or so.

The big thing is he's making a big assumption that there's some natural limit to the total infection rate that can be achieved by the virus - less than 100% and less than the 30% of the cruise ship. That seems plausible but it's essentially based on zero evidence. Diseases have wiped out societies so there's no rule I can saying Covid couldn't achieve a disastrous 30% penetration of the population. No country has had the guts just say "let's see how far this can go" and fortunately so.

An extreme worst case would be maybe 3% of the population dying. The Syrian civil war killed 2% of the Syrian population over several years, so this sounds bad. But US regular death rate is about 0.88% you could fudge and claim people would barely notice. But Covids is a very messy death and would destroy the health care system, which people would notice.

>So far, the mortality rate of those testing positive, asymptomatic and symtomatic, published by the CDC today, is 0.0119 compared to the DP's 0.013.

This is completely meaningless. Fatalities lag the start of cases by several weeks. Many people from the existing set of active cases will die in the next few weeks. You really should not use this number to draw any conclusions.

Not drawing any conclusions. Just watching the CDC's number approach the DP's number as a point of comparison.

The DP provides an accurate percentage of asymptomatic positives based upon real testing.

Can we revisit this now that it's clear how wrong John was? The US already has 6000 deaths from only 250k confirmed cases. It is assured we will cross the 10kthreshold,and likely the 100k one.

It's important to hold people accountable for their (massive, scary, indefensible) assertions.

I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill.

When people realise that their earnings have been slashed, they have been burdened with years of increased taxes, the economy has plunged, and swathes of businesses have gone bust, for the sake of people who were going to die soon anyway...

Realism is good. But it is easy to 'evidence' biased anti-vulnerable feeling with 'realism'. I'm not convinced that if most people understood the realistic risk to themselves, they would do what's necessary to protect the people at much greater risk. The last week of the 'let's be realistic' zeitgeist on the news comment thread I visit.

As usual with such pessimism, I really hope I'm wrong.

>I am worried there is a fine line between 'realism' and a backlash against care for the elderly and chronically ill.

I guarantee you that if we don't target our lockdowns on the at-risk population (elderly being the most numerous in that group), whatever backlash there is will be worse when the general population realizes they aren't at any significant personal risk.

> ... when the general population realizes they aren't at any significant personal risk

With 15-20% of confirmed cases needing intensive care and symptoms developing at roughly the same rate, it becomes a perfect storm. So deaths may begin with only the elderly or immune compromised, it likely won't stop there as the younger folks need care they can't get. Perhaps they survive anyway, but an unknown number with permanent lung damage and lower quality of life.

General population may come to any number of realizations. The underlying reality may never become entirely clear to any of us. Y2K probably could have been much worse. Yet the media coverage around the aftermath gave the impression it was no big thing.

Collecting stats on the progression from clinical presentation of the patient all the way to death seems to me a bit tedious, since death is altogether somewhat rare and when it does occur it's a lot of factors playing together.

But the following article really put the fear of god in me, as it's the first source I've discovered that gives you an idea of the rate at which patients progress from clinical presentation to "going severe". Here a doctor gives details on the criteria they use for separating patients which are not altogether that restrictive, basically just saying that the patient must test positive or have been in contact with someone who did: "We have an observation unit in the hospital, and we have been admitting patients that had tested positive or are presumptive positive; these are patients that had been in contact with people who were positive." Elsewhere in the article there is mention of the rate at which these patients progress to going severe: "About a third have ended up on ventilators."

https://www.propublica.org/article/a-medical-worker-describe...

My guess is that the clinical point of view around Covid-19 is currently probably a well-kept secret among clinicians and that Ioannidis probably doesn't have access to that kind of "inside information".

This didn't get enough attention the first time around.

We know enough now to act decisively against Covid-19. Social distancing is a good place to start - Marc Lipsitch reponding to John Ioannidis.

Previous conversation https://news.ycombinator.com/item?id=22620283

Link to the paper itself (which I can’t find anywhere on the abstract page);

https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.13222

I published a paper on outbreaks in a hospital setting and the problem is there is not a single RCT on methods to stop outbreaks. The problem is no organization is willing to approve a trial where you don't follow your protocols and commonly accepted methods to control the spread (ex. closing common areas, isolating patients, cohorting staff, enhanced cleaning). There is a good blog post about 'Riding the Wave' that basically says that perhaps the outbreak would have ended itself and we simply just take credit saying "what we did worked" but in reality we'll never know.

South Korea got their infections down and their economy isn’t in the toilet. Compare to Italy’s reactive policy and subsequent failure.

Or look to Taiwan and Japan with economies running and infection rates under control (at present).

Your “perhaps the outbreak would have ended itself” will be shown to be false in multiple countries that lack the resources to manage their infection transmission rates... We have heard of Iran, but wait until we find out what happens in other poor countries...

I’m really worried about India. So far it’s not a huge outbreak there yet, but they are hitting the beginning stages of the steep curve.

That comment about outbreak ending itself was specific to small outbreaks contained to hospital inpatient units.

A discourse vacuum was produced by lack of proper channels. I myself wouldn't have been so engaged in reading those papers and sifting through videos from obscure sources had I felt that the officials were not sleep at the wheel.

I'm still dumbfounded that China is let off the hook for delaying information a whole month, but even after declaring mass quarantines the west's officials took more than a month to take notice.

One thing that seems really important is that we get testing right. Here is a paper stating up to 80% of false positives: https://pubmed.ncbi.nlm.nih.gov/32133832/ If that was true it would make all the stats nearly useless. I have also heard that the so called 'quick tests' are even worse.

The group at Charité Berlin which developed the WHO test claims they had no false positives in hundreds of trials.

What if corona is already very widespread and not especially lethal? The increase in cases may be a function of test coverage.

There's a tonne of speculation about CFR still at this time. Maybe I'm hyperbolic, but there are still ~1,500 serious/critical cases in China which is 1/3rd of all active cases. I have a feeling like the 4% CFR is high here because many of the COVID cases became clinical diagnoses instead of rtPCR; in other words, the Chinese physicians started using CT scans and clinical presentation to diagnose COVID instead of testing. Normal viral pneumonia diagnostic criteria is a chest radiograph and clinically compatible features (e.g. fever, cough, dyspnea, etc.). My take away is that they probably ran out of test kits and therefore many asymptomatic patients are out there.

As time progresses I have a feeling that the official CFR in China is going to spike soon when they start deciding to take people of ventilators, unless the CCP decides to pour massive resources into keeping these patients alive. Regardless, I have a feeling like the number of deaths/resolved is significantly lower than what it actually is and I wanted to nerd out here for a second because I love talking about medicine.

Edit: I want to say that I still think that we should be taking this entire pandemic seriously and am in no way commenting on this article's suggestion that we are in anyway over/underreacting. I'm making a comment on CFR.

I found this bit from the paper interesting.

  A Google search with “coronavirus” yielded 3,550,000,000 results on March 3 and 
  9,440,000,000 results on March 14. Conversely, “influenza” attracted 30- to 60-fold less 
  attention although this season it has caused so far about 100-fold more deaths globally 
  than coronavirus.

First off, I am not sure how to comprehend those numbers. Back in the day a "result" was a page. What is that today? Are there really $9bn+ pages of useful content that mentions coronavirus? The number seems a bit arbitrary...

Second, the major issue with comparing flu deaths and coronavirus deaths is time. We have only known about covid-19 for a handful of months. The flu in all its forms has been with us for millennia. You simply cannot compare the two. For me this bit throws the credibility of the paper out the window.

If this is exaggerated, then surely there have been other epidemics that have gone through the world and had similar effects numbers wise (with cfr for example), and he would be able to refer to them as par for the course.

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

The virus mostly kills old people and people with comorbidities who would die anyway. Economic crisis come every ~10 years so it would come anyway. See what I did there?

This sounds more like an opinion paper than a study.

Someone ought to research out the number of cell phone accounts that have been terminated in China in the last three months. I saw a video last night claiming it was on the order of 2.1 million.

If you didn't know, the Chinese government tracks their citizens movement, social activities and pretty much everything through their phones. If you don't have a phone in China, you are a non-person, or perhaps you've died.

How was this peer reviewed?

Is this paper basically saying China and Italy's troubles with COVID-19 "ain't no big deal", and that New York and Washington are not struggling?

>"Leaving the well-known and highly lethal SARS and MERS coronaviruses aside, other coronaviruses probably have infected millions of people and have killed thousands"

This is not cited, and seems like potentially exaggerated non-evidence based information.

There's some research out there on this, and apparently at least some of the human coronaviruses have fairly impressive case fatality rates in older people. Still probably under half of what this one is estimated at, but substantial nonetheless. That's just not newsworthy because it's just a cold.

For what it's worth, the US CDC has said this about (H1N1)pdm09. I'm not sure if H1N1 is a coronavirus though and I don't know if there's any published research supporting this. But the author's statement seems reasonable enough given it was qualified with "probably".

> From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.

https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemi...

Nope - MERS and SARS were the only large Coronavirus outbreaks. H1N1 is an Influenza A strain (similar to the so-called Spanish Flu).

Spanish flu and swine flu, you mean. H1N1 is the agent responsible for both.

That is untrue. There are coronavirus outbreaks all the time. What makes MERS and SARS special is that they are the only known human coronviruses with high mortality.

> ,New York and Washington are not struggling

Completely different worlds. New York is in some serious trouble. No one is going to even remember Washington has an outbreak in a week's time - it's probably already past peak new cases.

Compare cases per million residents and reconsider.

in what way? King County, WA is at 605 and growth has flatlined (without an SIP in place). Manhattan is 2.5x that at 1500+ and probably growing much faster (very high testing rate true positives compared to WA). Westchester is the worst in the country at 3k. (realistically, well over 1% of the population has been infected).

The Bay Area (known to be an outbreak) is a blip comparatively - around 200 with sub-exponential growth.

Where are you getting your numbers from? King County has 1277[1] confirmed cases. Whatever you were looking at 9 hours ago must be out of date.

1. https://www.seattletimes.com/seattle-news/health/coronavirus...

605 per million, not absolutely. King County has 2.2 million people.

That makes more sense. I still would not say that "No one is going to even remember Washington has an outbreak in a week's time".

It's ongoing, shelter in place has been enacted. People will still be dealing with it next week, and its impact on rural areas could also be devastating.

> An argument in favor of lockdowns is that postponing the epidemic wave (“flattening the curve”) gains time to develop vaccines and reduces strain on the health system. However, vaccines take many months (or years) to develop and test properly.

It's not only about vaccines but about treatments in general. There is a good chance that we'll have a drug that significantly improves outcomes long before we have a vaccine. I don't understand how a peer-reviewed paper can overlook this.

Sadly, my takeaway/tl:dr Everything you've heard or read is fake news, we know almost nothing. Ironically uses 'gone viral' when he crits a fellow doc (cite 12) on the mask 'issue', and clearly we can't even get these experienced pros on this very topic to agree on much of anything, but will print regardless.

I'm also in this camp. I feel like it is the rational position too.

So much margin for error in about 300 different facets.

Based on my comment's downvotes, and no feedback, I have to assume I've either 1) Misread the article, 2) Misinterpreted the article, 3) Didn't clarify my position sufficiently.

This recent HN post has a pretty good summary of where I think we all are on the given 'mask issue' topic:

https://news.ycombinator.com/item?id=22673242

Suffice it to say, these clap-back articles among the medical elite in supposed positions of authority don't clarify the facts any better than the sketchy policies being made on nebulous data. But I guess we are in a state of 'real-time' peer review, and everyone left guessing the outcomes.

I will go out on a limb here (I'm hardly a domain expert) and make the following prediction: In retrospect this will be seen as the moment when peer perception of Ioannidis fell from major scientific figure to reckless (or worse!) fraud.

The problems with what he writes seem to me to be so severe, I cannot fathom how it ever made peer-review.

His original article assumed, with no measures taken, a peak infection rate in the US of 1% of the population. For that to be true, R0 would need to be around 1.01 (herd immunity to restrict further spread is achieved at around 1-1/R0). This is totally insane, there is literally no way covid-19 could have spread internationally as fast as it does with this R0 (you can work out R0 quite well from the growth rates, the main problem is reporting quality, but death figures are presumably fairly accurate).

He also gave a plausible lower bound of CFR of around half of seasonal influenza, 0.05%. For comparison the Italian CFR currently skews closer to 9%! Even accounting for immense underreporting, there is no way to reconcile these discrepancies (a factor of 200x). He upwards adjusts a tiny bit in this article, but it is still extremely hard to reconcile the situation on the ground in Italy with what he is writing.

All the countless additional severe problems with his argument (cost asymmetries, health care capacity, ...) pale in comparison to these two.

There are two pretty simple and detailed arguments above why what Ionnidis wrote is preposterous, if you disagree, why not engage with them?

Is this a case of Frequentist vs Bayesian?

There was a comment on HN a few days ago basically saying, "what's wrong with panic, maybe we should be panicking" and I just found that comment frightening. We mock all the "idiots" buying up the toilet paper, but panic clouds the clear thinking of even the "intelligent". It can absolutely effect our leaders and medical professionals.

Reading that comment charitably, I guess they meant something about fear sometimes being a productive motivating emotion. In my view, panic is fear strong enough to override rationality. Cool-headed fear might be a good thing, but panic usually isn't.

Right, panic is pure emotion, fight or flight, hard be rational in that state. Covid19 is "sobering". 100 years since the 1918 flu and we still aren't ready. Even with the billions we spend on health care.

Depends on what people define as panic and the degree of it. I started stocking up food a couple of things a time in January and many people told me I was panicking. If a lot more people had panicked like me shopping would be easier.

As it turns out I didn't panic enough either, I should have had more toilet paper and pasta to get through the panic from other people.

Mitigation is not "panicking". The earlier you do it, the less costly.

So.... was this sponsored by the airlines or by the hotels chains?

EDIT: After what happened in Spain and Italy, countries where the initial reaction was "let's not overreact", I don't believe any scientist can speak on those terms without a hidden agenda.

Whatever the numbers say, it is hardly the case that anybody has underreacted. Everywhere, we've always been at least three weeks behind the curve, which is an eternity when dealing with this virus.

Do you mean overreacted where you have written underreacted?

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