Comment by robocat | Hacker News Reader

Comment by robocat | Hacker News Reader

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~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...

> 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.

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...

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.

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

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.

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

> 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.

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...

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.

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 does not report resolved cases IIRC.

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.

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