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Comment by FlorianRappl | Hacker News Reader

Germany is still missing out on some very basic things that have been done right in countries like South Korea: Namely: constant cleanup, constant testing, identification and information about potential hot spots. The government reacted really slow (we had the first case ~mid of February and nothing happened for another 3 weeks) it now does a lot of actions but mostly destructive ones like shutting down the economy.

Yes, social distancing is good, and yes we need to flatten the curve, but there are other possibilities, too? Protecting people above 65 (i.e., retired) and with medical conditions would have been easier. Now there is fear everywhere. Still, I hear from a lot of people that they indeed show (mild) symptoms, but are not tested - even upon request. How can that work?

I was riding the subway here in Munich last Friday. Quite empty - still very dirty. No where anyone with sanitizing spray or anything.

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Do you have any evidence that cleaning subways is an effective way of preventing infection? From everything I have read the main vector of infection is by direct droplet infection during personal contact with an infected person. Sure, maybe if you disinfect surfaces everywhere you may decrease the spread a tiny little bit, but everyone's resources are probably better spent elsewhere right now.

You also can't just protect people above 65 and let the virus spread amongst young people. Have a look at the Imperial College study published a few days ago, where they modeled the effect of different interventions in the UK and US. Even if you could perfectly isolate all old people (and ignoring the mental health cost of that) the young people needing medical attention would still vastly overwhelm the health system.

And I agree that widespread testing would be great, but there are simply only so many tests you can do with the resources available. It's easy to say "you should test everyone" but nobody ever has an answer for how.

It has been shown that this virus can survive on surfaces for 3 days.

Virus fragments. The ability of the virus to infect decreases quickly.

Honestly curious, do you by chance have a source for this ability to infect decreasing quickly? I would love to share it becasue many people are getting paranoid about how long a tabletop or doorknob could infect them after being touched.

That doesn't mean much without also accounting for how easily an infected person actually spreads the virus into their environment, as well as how likely copies of the virus left in the environment are to actually infect someone.

I would suspect that as long as people don't sneeze/cough without a tissue they are not actually spreading that much copies of the virus on surfaces. And similarly I would also expect that if you wash your hands before eating or touching your face, you are not that likely to get infected even if you had touched a surface with viral particles on it.

But of course I have no evidence for any of this since the studies have clearly not been done yet.

"Even if you could perfectly isolate all old people (and ignoring the mental health cost of that) the young people needing medical attention would still vastly overwhelm the health system."

I am willing to stipulate that this is correct.

However, I feel that we've slowly developed (over the past few decades) an underlying assumption that "flu-like symptoms" automatically warrant a trip to the hospital.

During normal times, if you went to an emergency room in rich, well-educated American cities, you would see many, many rich, well-educated people who had taken their children to the ER (or urgent care center) for flu-like symptoms and had asked for and been given antibiotics, wastefully, for a condition caused by a virus.

This was, of course, irksome and disappointing, but now it is a matter of tremendous import for public health: what would our options look like if we did not assume every person exhibiting flu-like symptoms needed medical services ?

What would our options look like if people understood that there is no such thing as cold "medicine" or flu "medicine" and that the doctor can do nothing for your not-critically-sick child other than prescribe rest and good nutrition ?

Instead, we desire to be consumers of health-care because it is a modern imperative.

I believe these were wrong-headed attitudes and we are now paying the price for them.

There are medicines for flu: oseltamivir and zanamivir to name two. None for the cold as far as I'm aware.

I don't think the desire for a cure is unreasonable on the part of patients though, but it's the job of public health and experts to temper those expectations. By now any doctor prescribing antibiotics for a virus or to placate a patient should be facing professional sanctions.

Are you implying that the reason the hospitals are overwhelmed is that they are admitting people that could just "ride it out at home"? Because that is certainly not the problem. Many COVID patients need to be on 24/7 ventilation in the ICU to stay alive, including young and healthy ones. Way more than the hospitals can cope with.

This is not about people's attitudes towards healthcare, this is about thousands and soon millions of people suddenly requiring emergency medical treatment, way beyond what the health system can cope with.

> including young and healthy ones

I'd be interested to see the stats on this. I also hear that the success rate for patients who have to be ventilated for COVID19 is pretty low. Given that the vast majority of deaths are 70+, one of these statements isn't correct. Either ventilation is pretty successful after all, or many young and healthy patients who are hospitalized for COVID19 are not vented.

I haven't seen any young and HEALTHY folks needing ICU care. Can you share any cases? Or any stats indicating this is the case?

https://www.statnews.com/2020/03/18/coronavirus-new-age-anal...

And of course the case everybody should know about:

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

I read that statnews article. Nothing in there actually indicates that young and HEALTHY people are at a high risk. What it does say is that 2-4% of the 20-44 age group needed ICU treatment. No indication is made to the risk profile or previous issues that group has. That being said there is a 0.1-0.2% risk for people within the age range of 20-44.

The example of the hero doctor frankly stands out as an outlier. We aren't actually sure he was healthy, and even if we were, what we know is he was exposed to a high viral load very rapidly. Beyond that he was under tremendous stress from being a front line worker, meaning he might have been exposed to multiple infections and under stress from an authoritarian government trying to silence him with questionable means. Stress has a very real effect on our immune systems that has been empirically shown to make it very challenging for the body to recover from infections.

I want us to be incredibly careful about how we share information and our interpretations of it. I have yet to see anything that clearly indicates that young people age 20-44 are at a high risk if they are HEALTHY. Healthy here means not currently battling any other severe infections, and in a general state of good health. The percentage within this demographic is clearly stated as 0.1-0.2% and this includes immunocomprised people.

Please help spread accurate information, as this panic is getting absurd. I was at a grocery store today and people were fighting for supplies that there is not actual shortage of, and being generally rude to each other.

People are losing their livelihoods and our economy is crashing. A recent bloomberg article is stating that we should expect a 30% unemployment rate. https://www.bloomberg.com/news/articles/2020-03-22/fed-s-bul...

This would be a devastating outcome which will be substantially worse than this virus has been, especially in a country like the USA with no universal health care and no clear indication that will ever happen. Have you ever tried being poor in the US? It's not fun or easy.

Unfortunately our leadership is not equipped to handle this correctly. Corrupt congresspeople are profiting off of this. The sitting president is showing signs of mental instability. The alternative probably isn't much better. Beyond that, sentiment on social media now seems to have people favoring authoritarian measures enacted to force people to stay home.

This virus is serious, but our reaction to it is much more serious. We cannot sustain this type of quarantine for the long run. We may end up finding ourselves under authoritarian rule that won't disappear anytime soon.

The only solutions we have are that we accept this virus as a real part of life, we attempt herd immunity through a more targeted type of quarantine, or we wait for the miracle of a vaccine to be developed. Referring back to the statnews article, they come to a similar conclusion and say that the demographics of a country should dictate the measures taken to prevent the most at risk populations from contracting this virus.

On top of what you said there is also the naked assertion that this virus is in “exponential growth phase” when the truth is we aren’t testing the right population to prove or disprove it.

And before you downvote this comment... consider all the “exponential growth” you see on those stat counters could correlate to number of tests administered.

> I read that statnews article. Nothing in there actually indicates that young and HEALTHY people are at a high risk.

That's not what I responded to. This is:

> I haven't seen any young and HEALTHY folks needing ICU care.

The linked articles says "up to one-fifth of infected people ages 20-44 have been hospitalized, including 2%-4% who required treatment in an intensive care unit."

Unless you wish to claim that 1/5 people ages 20-44 are not HEALTHY (your capitalization, maybe there is some intended meaning I'm missing there), you have now seen what you were asking for.

> That being said there is a 0.1-0.2% risk for people within the age range of 20-44.

Let's go with the lower number, 0.1%, and see what that implies. In 2018, there were about 109 million people aged 20 to 44 in the US [1]; 0.1% of that is 109000, more than all ICU beds in the US [2]. And that's just counting those who would die if given intensive care. If we go with 2% of the same age group needing ICU treatment (again, the lower end of the quoted range, 2-4%), that's 2.2 million people.

With only 100000 ICU beds available, that means 2.1 million people aged 20-44 die, even if we deny everybody else intensive care.

[1] https://www.statista.com/statistics/241488/population-of-the...

[2] https://eu.usatoday.com/story/news/health/2020/03/18/coronav...

"Are you implying that the reason the hospitals are overwhelmed is that they are admitting people that could just "ride it out at home"?"

No. As of this writing, on March 22, no hospitals in California are, as yet, overwhelmed.

I am saying that we are taking steps to avoid hospitals being overwhelmed, with the assumption that anyone with flu-like symptoms will be utilizing professional medical care.

If, instead, we assumed that only critical cases (as you say, those needing, for instance, ventilation) need to avail themselves of medical care, then the potential for overwhelm drops significantly.

"This is not about people's attitudes towards healthcare ..."

I think it is. We set a symptomatic bar, above which we seek professional care and consume medical resources. In 2020 America, I think that bar is too low.

There's actually evidence that there's tissue damage in the longs (read, potentially permanent damaged lung capacity) even prior to symptoms, and of course, even after recovery, in young people too. This thing is no joke. There's good reason to believe even many young people who get infected will have permanent damage and for given the correlations between lifespan and organ health, it's not unlikely that this damage to the lungs results in years of lifespan cut decades down the line.

That's just a little tidbit on people who don't even show any symptoms. Then there's many people hospitalised who're literally in a state of feeling like they can't breath for weeks, it's absolutely agonising. If you want more, just look up the pictures of coffins laid out in Italy and the military trucks transporting out dead bodies. These aren't hoax images or videos (although some do circulate). I don't see how the comparison to flu is apt.

What would be your sources for this, and in reference to the claim that people being hospitalized and feeling like they can't breathe for weeks, are you referring to those who number among the roughly 5% of critical cases?

Who goes to the ER for flu like symptoms? Even with insurance the costs would make this a fairly expensive trip, and the wait times can involve hours. I mean I’m sure there are some but it’s hard to imagine that this a choice that lots of people would make.

If you want something prescribed the local urgent care center is a much quicker and much cheaper option. For children you can also generally get same day appointments at most pediatric clinics.

It would require a pretty severe case to justify a trip to the ER.

You missed the point entirely. If we could magically isolate everyone over 50 and let everybody else get infected it would still overwhelm hospitals with people that really need ICU care.

I don't claim that not cleaning spreads the virus, nor do I have any evidence that cleaning helps. For me its just an indicator that the cities / government do not work carefully. In South Korea pretty much all subways (at least from what I hear in Seoul and Daegu) and public buildings are cleaned very frequently during the pandemic. Look at their numbers / curve to see how well they handled this.

The assumption regarding the health system is based on the official number, which is way too low. The official number right now is ~25k cases in Germany. The real number may be closer to 250k cases. Most people get mild or no symptoms at all. Also of these 25k cases - most people do not require intensive medical care. Yes, the deaths are tragic, but influenza death count is above 2k this year alone. In comparison each year we have 33k kills caused by superbugs in Europe. Do we act here (in some countries there are active measurements - not so in Germany)? So while flatten the curve is definitely important its all about the balance here. And I think the balance is way off ...

Yes, I am aware that Germany has only 25k breathing machines (80% already taken) and would not be equipped for a full outburst - but that would not happen with general sanity, too (e.g., basic hygienic measures). For instance, in South Korea (sorry to use this example again) every citizen gets 2 facial masks per week. I know that these masks are not for your protection, but for protecting others - but that's exactly it. If everyone wears them (by order of the government) then the infection risk is drastically reduced.

Again I don't want to claim all would be good, but claiming that now everything is good is certainly wrong, too. Without basic testing and other essential measures the spread will continue. If you need some evidence here then look at Italy. First country to act with such strong restrictions, still right now the one that has the most problems.

Honestly I don't have time to pick apart this entire comment, but just to address the most egregious assumption you make:

You compare death numbers from the flu to COVID.

COVID is a pandemic that is in its exponential growth phase, with zero existing immunity and no existing treatment. The flu is a well-known, well-studied disease for which we have a vaccine, to which many people will have some level of immunity and for which we actually have a treatment. The flu is also at the end of the season right now. COVID is only getting started.

Even if we instituted perfect social distancing and prevented all further spread we can expect COVID deaths to double every few days for the next few weeks because of the incubation period. I am willing to bet good money that the 2k influenza deaths this year will dwindle in comparison to the number of COVID deaths when everything is said and done.

Before you reason about somebody's assumption you should first think about your interpretation. Next time please read it more carefully before you compare apples and oranges.

I think "ignoring the mental health cost of that" is exactly what most governments have been doing up until now.

I am in mainland China (outside Hubei) where we had about 4 weeks of strict lockdown and then 4 weeks of shops slowly reopening but still fences and checkpoints and restrictions on where people are allowed to go... It's been devastating to my mental health, and that of many others. The schools still aren't open and parents are on their last thread.

If there is a strategy for getting on top of this outbreak where less people have to go through the stress of lockdown, I think that would be worth investigating.

> Still, I hear from a lot of people that they indeed show (mild) symptoms, but are not tested - even upon request. How can that work?

Why would you test everyone with mild symptoms? 90% or more of those people are going to have the flu or a common cold. And they’d use a test that can be used on someone where it makes a difference: someone admitted to hospital, or someone working at a hospital.

Everyone else with symptoms can just act as if it is covid and isolate for 14 days.

When you have exponential growing, testing capability can never keep up.

Given the long incubation period, as well as the fact that many people who are carriers are completely asymptomatic, blanket testing has been tentatively shown to be an effective way to halt the spread of the virus. See: the whole of South Korea's approach, as well as https://www.independent.co.uk/news/world/europe/coronavirus-...

My point wasn’t that fewer than possible should be tested, my point was that given the constraints (staff, equipment, time) it’s best to test people that it makes a difference for, such as those who must be in contact with people - in healthcare.

If you could test everyone with symptoms (or everyone full stop) then go for it. That’s not possible though.

> That’s not possible though

With less foot-dragging it can be. Germany tests 20,000 people a day, Korea tests 15,000 a day, the US (4-6x more populous) only test a few thousand...

The tests have an approx 20% false negative rate.

You test someone who has symptoms. The test returns negative. What do you tell them to do, given that you know the false negative rate?

This doctor says it better than me.

https://twitter.com/keirshiels/status/1241042696560619523?s=...

You tell them the same thing regardless of the outcome of the test.

The 80% of the time it returns positive, you tell the epidemiologist, and they prevent a few further infections by investigating close personal contacts.

>blanket testing has been tentatively shown to be an effective way to halt the spread of the virus.

Testing does not halt the virus. A test is just an indicator to see if you have it or not. Even if you could test for Corona as easily as you can for drunk driving, it'd still do us no good if you don't actually take some concrete steps to halt the virus.

If you have mild symptoms, you don't need a test. You need to stay the fuck home. No symptoms? Avoid going out if you don't need to.

I saw a paper that said 80% of positive tests in a Chinese population sample of people without symptoms were false positives. Is there some reason that wouldn't happen anywhere else?

Berlin for instance tested over 20.000 people last week alone. Less than 3% results were positive.

> Berlin for instance tested over 20.000 people last week alone.

20000 per week seems to be an absurdly low number to me.

> Less than 3% results were positive.

Given high number of VIPs that are already infected (members of the parliament, professional soccer, actors), I suspect that 0.5% to 1% of the population is already infected.

Edit to add numbers: The German parliament of size 709 had 4 member already infected last weekend. On March 19 we were at 6.

If 3% test positive and 0.5% are infected, then most of the positives are false, right?

But they test only 20000 per week(!).

We assume you at least have temporary immunity so testing everybody with symptoms will make their anxiety less and a lot of more people could be mobile and working.

Because if you're tested and it's positive you can tell everyone you came into contact that they need to isolate themselves too.

Having people wear masks in public so that they don't spread the virus by droplets is the biggest thing missing in all western countries. Lack of masks seems to be the primary reason.

I went out to a supermarket last night, I was the only person there wearing a mask and disposable gloves.

People only need to wear masks currently when they are infected

Yes, but some people are infected and don't know it yet. And some people have symptoms but don't think it's worth wearing a mask, maybe because of the social stigma of wearing one in western countries. I think if everyone was wearing a mask, that would solve both problems. (of course, we know that many countries don't have enough masks).

I was saying the same thing as you two weeks ago (even in HN comments). Now I'm confined and can't leave my home without risking a fine. There may not be sufficient scientific evidence yet, but I'm starting to believe that we wouldn't be in this situation if everybody started to wear a mask in public places at the very start of the epidemics.

Than you are describing human fallacy.

Even when you only think you are infected or there is a good chance => wear a mask

I strongly disagree.

1. Heaps of people have the virus without showing symptoms

2. No-one wants to be treated like a leper, so everyone needs to wear masks. If only the sick wear them, then self-deception and avoiding social opprobrium will cause people to avoid wearing masks, and the selfish will not wear masks

3. If home-made masks help even 20%, that would make a massive difference to infection rates over time due to exponential growth (think compounding interest).

4. Everyone in smart Asian countries wears them for a reason.

5. There is a reasonable chance that the reason Japan has low infection rates is due to masks. Everyone should be jumping on whatever actions that have a percentage chance of working (so long as they don’t carry significant risk).

Other example is Taiwan. Everybody wears a mask there since the first cases. We don't know for sure it's the reason why they have so few cases but there are good reasons to believe so. I had friends there and thought I was smart telling them it was useless to wear a mask without symptoms (which was actually WHO recommendations)... Maybe WHO recommendations took into account the fact that masks weren't in sufficient quantities. For this strategy to work, you need enough mask for everybody, otherwise people would start hoarding masks. Maybe this will be the strategy post-confinement.

Taiwan were preprepared for an outbreak, and started acting on the 31st December: https://jamanetwork.com/journals/jama/fullarticle/2762689

They are using many overlapping layers of solutions to contain the virus.

Everyone using masks is surely a great help in reducing the R0, but it is the breadth of multiple solutions that is protecting Taiwan so far.

I imagine the first is because there's no masks which to wear. I only have face mask (well, two masks) because I have a pollen allergy.

Haven't heard really anyone talking about disposable gloves, so I'm not exactly surprised that people are not wearing them.

I happen to have a couple of protective masks but they're specifically intended for non-toxic dust, like sawdust or whatever, so I'm not sure if they would serve any purpose.

You may be interested in this webpage about materials for DIY masks: https://smartairfilters.com/en/blog/best-materials-make-diy-...

> Still, I hear from a lot of people that they indeed show (mild) symptoms, but are not tested - even upon request. How can that work?

The sad truth is that we're low on reagents to test if people are infected. If the general advise is to stay home and self-isolate anyways, then we can stretch the supply for healthcare workers (nurses, doctors,...).

I might be wrong but I think this is the reasoning to prioritize and ration testing for certain critical people in the health supply chain of things.

edit: "low on reagents" was meant relative. I just wanted to convey we need to be smart how we use this limited supply.

Add to that mandatory (includign self made) mask wearing in public space. This is really not hard to do, cheap & can help a lot to prevent infected people from infecting others in public.

The official opinion on mask wearing is absolutely pathetic in Germany. The should declare that there is a shortage, medical staff must have priority, others should use DIY masks.

Exactly this. Looking at South Korea every citizen got 2 facial masks per week. That's how it should be done - they are only effective if everyone wears them.

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