Coronavirus patients start to overwhelm US hospitals | Hacker News Reader

Coronavirus patients start to overwhelm US hospitals

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146 pointsericdanielski331 comments

As an Italian (albeit one living abroad) I was expecting this, and hoping to be wrong. So much advantage, squandered.

I am seeing a lot of comments on this story complaining that it is anecdotal or that New York is extraordinary and thus this is implicitly less important to people outside New York.

I live in the city of New York and I think it's important that everyone nationally absorb what is happening right now and the "anecdotes" are important. By anecdotes, I mean, in particular the New York Times story and video published last night about Elmhurst Hospital in Queens (a very hard hit borough)(https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-...).

People are dying of Covid at this hospital in chairs or on floors ("Some have died inside the emergency room while waiting for a bed"). People are dying without their loved ones allowed or able to be present (https://www.nytimes.com/2020/03/24/opinion/coronavirus-hospi...) (<--link is about Boston but Elmurst story above makes clear this is happening in NYC too, very much so). In his briefing yesterday the governor of New York discussed people sharing venilators (already happening per the Elmurst story) and bringing back retired doctors (horrifying given the risk to the old -- in China older working doctors were often kept off Covid wards).

The morgues are filling up and they are building outfoor refrigerators to hold the bodies (this is in the Elmhurst story). People with babies due are giving birth alone without their partners (https://www.nytimes.com/2020/03/24/parenting/coronavirus-lab...). People (including one in Elmhurst story with fever) are waiting multiple days outdoors (including rain) for a test and being turned away day after day after waiting all day.

Why talk about this? Is it for clickbait? To be dramatic? Because we're certain the NYC scale problems will spread to less dense areas?

No. It is because many many people in this country are continuing to not take this situation seriously. Many people (including relatives of mine on Facebook) think this is completely overblow, like the flu, not worth keeping people at home for given economic cost.

Many of these people have already ignored the hard evidence, the numbers, the consequences. Talking about terrible things that are starting to happen -- "anecdotes" -- may help shake some of these people out of their denial. And if they are prepared, and IF anything approaching NYC scale problems happens in their area, there is a better chance they will help rather than hinder efforts to flatten the curve.

Please don't dismiss what is happening here as anecdote or irrelevant. Believe me, I'm no better than you, I did this too, when this was "just" in Wuhan, or "just" in China, or "just" in Italy. I took a trip at the end of February in the U.S. on an airplane. I look back -- what was I thinking?! Now I'm locked in my apartment going on three weeks. My wife had a fever for 6 hours a little over a week ago, she's been coughing. Probably we're ok. But it's in the back of your head: What if I get sick, and she gets worse, who will take care of our kids? What if they close the stores and we can't get groceries?

I wish some of the anecdotes had reached me earlier. I hope some of these anecdotes reach others.

Here's my anecdote - I had to drive my wife to the emergency department yesterday because she was having trouble breathing, and the ambulance service was busy. She's been sick for 2 weeks. 47 years of age. Only for the fact my sister-in-law is staying with us since the lockdown began I'd have had to leave my 2 panicked kids (14 and 11) alone in the house

Wife didn't need to be ventilated, and is home and seems to be improving. We're all still pretty on edge though. We live in Ireland FWIW

I am glad to hear your wife seems to be improving. I'm sorry you had to go through that. Take care.

It already looks like New Orleans and Atlanta are also on the brink of overwhelming their hospitals as well. What's happening in NYC is just a preview of what many US cities are going to be dealing with very soon.

Judging from the comments, explaining the severity of the epidemic is now politically charged.

Epidemiologists and the medical field have made it clear we are _under_ reacting. But apparently some politicians want to down play the problem and their obfuscation is echoed in every corner of the web with great zeal and again drowning out reality.

It's like the climate change denial phenomenon but at high speed.

It's exactly like high speed climate change, from lacking the infrastructure and political will to do anything about it to missing our grace periods to act.

The fact that we're more likely to listen to a politician (or a media figure) rather than someone who has spent the better portion of four decades studying a topic is one of the most existential threats we face.

We need to figure out a way to get through the tribal mentality. Right now, a significant plurality (if not an actual majority) of people are more concerned about their side winning points than about effectively dealing with a crisis.

Seriously, what is the analogous computer science problem to this? Why is it that a lifetime of experiences, and I still draw blanks every time I try to figure out what to do about this stuff. I mean... everything minus scenarios which include massive amounts of death. Surely there's a better way though.

I don't think there is an analogy in computer science; that deals with data, and this deals with emotion.

This is driven, as far as I understand it, by evolutionary psychology. It was an advantage to be "right enough, and unified" as opposed to "completely right, but divided", and an advantage to take care of "us" before taking care of "them." As a result, we are hard-wired toward tribalism.

Smart people are able to set this aside and deal with the facts as they are, but we still have to overcome the initial, emotional surge that takes offense whenever something we hold true is challenged.

One of the big issues is that people don't see immediate fallout from this sort of behavior on the national level. They vote for people who cut taxes for the rich and gut worker protections, but never connect that to their own financial ruin. The effect follows too far after, and too far from, the cause.

Politics, as a result, is treated like football: root for your team, because the other team sucks.

We might see some of that change as the bodies start piling up from COVID-19, but I doubt that there will be a larger societal change.

There are a few analogous situations you'll find in computer science and the development world: brand worship and celebrity worship.

We'll quickly adopt patterns and opinions given by well known individuals without judging the output on its own merit. We'll follow tools, frameworks and trends that emerge from organizations without assessing its suitability for ourselves. In fact we will even twist our world view in order to accommodate someone else's reality, at detriment to ourselves. I specifically don't want to give examples, but you can come up with a few of you think about it.

It's a matter of course in our industry however so we don't really consider it to be analogous to the above problem, simply because we are inside the system. We see nothing wrong with what we're doing and are quick to judge outside groups on the same behaviours... Which makes it even more analogous!

You can't do anything about this stuff without a lot of power. It's a very deep-rooted problem in US society. One aspect of this that I was thinking about yesterday is that everyone can spout all kinds of hogwash and opinion without fear of repercussion, because this is socially tolerated in US society more than some others.

But with today's amazing communication technology this means that strong opinions without evidence in support of ideological action for causes and reasons not grounded in reality gets broadcasted; low-quality opinion masquerading as facts.

But I think it may be possible to "hack" this lack of repercussion by a platform/institution where reporters/publishers can artificially promise repercussions for themselves that so-and-so statement is true. e.g. betting that a claim is true, and allowing anyone to challenge your claim with contrary evidence by posting a higher stake, that if the challenge meets some platform/institution-wide threshold for rules of evidence, allows the challenger to pocket up to half of the prior claim's stake (the remaining becomes the stake for the new claim), else the challenger loses their stake and the prior claim stands. Of course, the evidence needs to meet a certain standard.

The hope is that non-bogus rules of evidence end up supporting only a theory of very sane and reasonable facts, whereas bogus rules of evidence end up allowing a lot of bogus claims to stand unchallenged that are not falsifiable, or that claims are too easily contradicted, so that it becomes easy for people to tell real information from ideological polemic, and also invites challenge from fact-checkers and competing interests.

It's a tricky problem. People listen to politicians and media figures (if they are different) because those entities are listenable and provide a constant standard flow of communication--that is their expert area. In contrast the veteran epidemiologist or any other expert is primarily an expert in that domain and not an expert in reaching a broad audience.

If the collective "we" (if there is such a coherent thing) were to listen primarily to experts, we would need to constantly shift which expert to which we are listening, depending on the problem of the day. Additionally, each of those experts would have to take time out of their expert practice area to become a highly skilled communicator.

Is the Surgeon General an expert or politician/media figure? Is the WHO reflective of experts all the time or is it an institution with political and media concerns?

> But apparently some politicians want to down play the problem and their obfuscation is echoed in every corner of the web with great zeal and again drowning out reality.

Yes obviously they take the main blame.

but also others.

From Jan,

https://www.nytimes.com/2020/01/29/opinion/coronavirus-panic...

> China’s response appears to be driven by political considerations more than epidemiological ones. The government has imposed a travel lockdown on more than 35 million people, which experts say is a quarantine of unprecedented size and scale, yet it may not even turn out to be very effective.

what about the nameless experts media has been quoting to float their conspiracy theories. Will these ppl take some of the blame for eroding people's trust in experts?

"We don't know how well a large-scale quarantine of an entire heavily populated region will work" isn't a conspiracy theory. It turned out to work, but that wasn't a certainty back then. (You're also linking an op-ed piece.)

> China’s response appears to be driven by political considerations more than epidemiological ones.

I was referring to this.

Author isn't interpreting it as "we don't know".

Epidemiologists know a lot about epidemics, but they're not necessarily as good at figuring out the total effect of pandemic in the long term (for example, how economic effects could kill large numbers via suicide and general want). It's very important to have people looking at the total picture.

Beyond that, even the politics is not falling in predictable lines. There was a report this morning that the mayor of New York wants to reopen the schools in a few weeks.

But trends in suicide including economic causes are handled by epidemiology[1]

It is great that attention is now being paid to this subject. Although the overall suicide rate has continued to _rise_ in spite of 11 years of a rising DOW, the suicide rate among those approaching retirement has risen significantly in the last decades. From past trends we know this is directly related to social security[2]. I sincerely hope the attention continues and solutions are pursued and deeply hope that, as some think, it is not a cynical ploy.

Likewise, I hope the sudden concern for food security among the vulnerable poor continues.

[1] https://en.wikipedia.org/wiki/Epidemiology_of_suicide

[2] https://books.google.com/books?id=ESSEHA5TyoIC&pg=PA360&lpg=...

No doubt, but we need more than just epidemiologists to project how complex changes in the world economy will affect suicide. For example, how can the various interventions possible by the US Fed affect the economic well-being of the poor? Etc. We need all of our experts on this, including the political ones, who have a good sense of what will fly and what won't.

No doubt social security (Social Security?) does affect those of us who are older. I can personally attest, though, that there are a lot of other factors that also come into play (and in my opinion may be more important).

In principle that makes perfect sense. And it is important to note that there is another choice other than the two we are given: the one the Europeans have chosen: employee protection/compensation along with any corporate bailouts.

If for political reasons we refuse the European approach then the concern is not that fatality counts and epidemiologist will be balanced by economist but that epidemiologist and economists will be balanced by lobbyists.

As if to underscore this point, the order for 80,000 ventilators[1] was stopped yesterday on grounds that it was too expensive[2]. The cost at 1 billion is equivalent to 1/4 to 1/12 of 1% of the total F-35 order at 428 to 1196 billion [3] And the f-35 order is already controversial to begin with.

[1] https://twitter.com/realdonaldtrump/status/12417326813664829...

[2] https://www.nytimes.com/2020/03/26/us/politics/coronavirus-v...

[3] https://en.wikipedia.org/wiki/Lockheed_Martin_F-35_Lightning...

I do think that employees should be taken care of. I have no idea of the best way to do that. It sounds like a job for economists and politicians.

Re the ventilators, the most obvious standard would be not the F-35 cost, but rather what we pay to support a statistical life under other circumstances (e.g., medicaid, EMS services, etc.) No idea what the right balance is, but we don't want people to needlessly die because we overshot on the ventilators.

Everything is political in the US. Can't you tell? A scientific fact such as global warming has been political for decades now. It's not surprising a global pandemic can be politicized as well.

An expert tends to weight their needs heavier without being aware of the other problems. Where, if we are optimistic, the politician might be balancing this against the economic, military, climate, geo-political, etc needs.

It's weird, it's almost like this is following the exponential growth that literally everyone said it would.

Not literally everyone. There were a few people writing it off as a 'scare' and a 'hoax'.

For example, the president of the United States.

https://www.youtube.com/watch?v=G5TZ6fTYrsE "we lost nobody"

Our current political process follows a simple loop:

1. Experts describe the likely outcome of a course of action.

2. Those experts are declared to be frauds, their views labeled a hoax or fake news.

3. We implement the policy the experts were trying to warn us about.

4. The experts' warnings come to pass.

5. We learn nothing, and repeat the whole cycle with the next issue.

From 'Yes, Prime Minister,' a comedy show in the UK in the 80s:

https://www.youtube.com/watch?v=nSXIetP5iak

Judging by the history of most pandemics, I am currently more worried about the capacity of morgues than hospitals. Maybe this one will be different though.

That's probably a little more easily solved. When things get ugly enough, humans have a tendency to skip all the polite rituals and start using mass graves.

In the case of morgue's they are already solving this by having air conditioned semi trailers parked by the hospital where store bodies until they can be moved.

And ice skating rinks

Madrid already has already converted it's largest ice skating rink into a morgue...

https://english.elpais.com/society/2020-03-24/madrid-starts-...

There are potential options. Spain recently converted an ice rink into a temporary morgue. Decent cooling.

Coolstores and refrigerated containers make ok morgues - first world countries don’t have troubles keeping sanitation standards.

Really? You're more worried about lifeless atoms piling up than actual humans dying?

I see a morgue at capacity and I think about the thousands of family members who aren't able to properly grieve for, manage, and bury their deceaseds.

I wouldn't jump to accusations of callousness on the part of the GP quite so fast.

Improper corpse disposal can itself help spread disease.

Yes. Because heaps of those lifeless atoms decomposing in the streets become vectors of many awful diseases. That was the case with most pandemics we've had to deal with so far.

The 2017-2018 flu season also overwhelmed US hospitals:

https://time.com/5107984/hospitals-handling-burden-flu-patie...

https://www.cdc.gov/flu/about/season/flu-season-2017-2018.ht...

My point isn't that we should take Coronavirus any less seriously this year. Healthcare workers have no vaccine for it. It's on top of the flu. Etc.

My point is that we should take the flu more seriously every year. Everyone gets their flu shot, right?

I agree, this event has also opened my eyes to how important the flu shot is

What about this event makes the flu shot more important than otherwise?

It has always been important.

If you have taken your flu shot and get flu like symptoms there is now a larger chance that you are experiencing a mild Coronavirus. For you it's not that important a statistic, but if everyone had flu shots it would be beneficial.

Flu is so common that people don't realise simple things like washing your hands and getting the shot would reduce the cost massively.

With Covid19 we can all see the cost, upfront and at the same time.

I'm wondering if we could actually kill the flu by sitting still for a bit. Say we stopped the world, which apparently is a possibility now. Would that get rid of it? And if it would, would it be worth it?

Interesting thought. My understanding is rather that the converse is true: we're headed for a world where both flu and SARS-CoV-2 are endemic.

I'm no epidemiologist, but I doubt it. It just takes one infected person at the end of the global quarantine to get the ball rolling again.

More importantly, though, the flu (just like SARS-CoV-2) is zoonotic, meaning that it can jump from animals to humans. Even if every human was flu-free, influenza type A still lives on in birds for example, and there's an everpresent risk of it jumping to human beings.

“All of humanity's problems stem from man's inability to sit quietly in a room alone.”

― Blaise Pascal, Pensées

Where I live it has been public policy to only recommend the flu shot to at risk groups.

Never really gave it much thought before. Now I strongly disagree with the policy

It's always important. People are learning a bit more about intensive care and the poor outcomes for people in ITUs. They're learning a bit more about respiratory illness and the impact it can have even if you don't die. They're also learning that flu isn't a trivial illness for quite a few people.

(EDIT: I didn't downvote you, and I don't think an honest question deserves downvotes.)

Thank you. Too often this comparison is made to establish the ridiculous inverse argument: We don't take the flu very seriously, so we shouldn't take Corona very seriously.

Why Covid-19 is worse than the flu, in one chart https://www.vox.com/science-and-health/2020/3/18/21184992/co...

He isn't saying Covid-19 isn't worse than the flu, he is saying that many people consider the flu not important, which meant that they would just as easily consider Covid-19 as unimportant, because the flu was the closest reference they had.

Got my flu shot last year, still ended up with severe flu in February. The flu shot is not completely effective.

True, but if everyone that _could_ get their shot did, it would be a lot less impactful to everyone.

Nobody is saying it is completely effective.

It doesn't need to be completely effective on an individual level if enough people get it on a societal level.

Wonder what it would have been like _without_ the shot.

There are different strains of the flu and doctors sort of guess each year which strain to vaccinate for, seems like they guessed wrong in your case.

Literally nobody said it's completely effective.

In fact, if you read the experts, you'll see the the flu shot is generally a cocktail against the most prevalent strains. Since strains are left out, it's absolutely known that the flu shot will not protect you against all influenza strains.

See this page for information on how strains are selected: https://www.cdc.gov/flu/prevent/vaccine-selection.htm

The flu shot is not a magical guarantee that you personally won't get the flu. What it does do is lower the rate of transmission for the flu significantly, by improving the herd immunity.

People need to understand that getting the flu shot is less about helping yourself, and more about helping your community. Think of it like giving blood. It's an altruistic action that you can take to help others around you.

Maybe you didn't get the flu. Flu like symptoms are very common in a huge variety of ailments.

Vaccinations are very effective protective measures. Just not at protecting against stuff that isn't in their narrow scope.

Vaccinations are very much like a blacklist (or signature-based anti-virus). They are generally highly effective against what's on the list, but they don't interact with stuff that isn't on it. Of course, some vaccines work better than others. Additionally, most vaccinations, and all the common ones, are very safe. So even though e.g. the flu shot is not 100 % effective in preventing the flu², it is practically 100 % safe, which means your expected outcome can only improve by taking it.

² I believe the actual numbers are something like 80 % for the flu: people vaccinated against flu strain X only contract it at 20 % the rate of unvaccinated people, or numbers to that effect

The flu shot doesn't protect you from all / any flu.

Without some serious testing you're not likely to know what you got.

But even if we assume you did catch the flu, there have been long term effects that show that regular flu shots over a few years lessens the severity, occurrences of serious problems with the flu. So the benefits seem to go beyond a given vaccine.

With flu vaccines there seems to be both a specific benefit, but also more general benefit longer term.

AFAIK, the flu vaccine doesn't prevent against all strains, because the virus mutates so rapidly year by year. They prepare it every year based on the worst/most common strains that were seen in opposite hemisphere's flu season. It does help limit the spread though, and is still really important to get.

Its about 40% effective. Probably helped you not get the flu twice. So worth it?

> Got my flu shot last year, still ended up with severe flu in February. The flu shot is not completely effective.

My understanding is that the 'flu shot' changes every year, in anticipation of the strains predicted to be the most prevalent that year.

In other words, flu shot producers say "we think flu strains A, B, and C will spread this year" and strains B, C, and D may be what actually spread.

It's still worth getting because even if you catch strain D, your immune system still easily defeated B and C when exposed and you didn't even notice.

Its effectiveness has on average been less than 50% in the past decades, sometimes far lower. There's just too many strains and to much seasonal variability.

But they usually also decrease the severity of the symptoms, even when they don't completely block them. This is almost as important as the full effectiveness as helps decreases death and hospital time.

Yes, I do. Helps that I live with a Nurse Practitioner. However, the number of people I know who are convinced that getting the flu shot makes them sick or gives them the flu and thus refuse to get the shot is shocking.

Some things I've actually heard:

"I get sick every time!" No, you don't.

"It's a LIVE VIRUS! Everybody knows this!" No, it's not. You're just an idiot hanging around with idiots.

> "I get sick every time!" No, you don't.

This is possible theoretically . yes?

There is no guarantee that you get lucky from flu shot at-least once.

As it's been explained to me, you don't get the flu from the flu shot, but the vaccine forces a reaction from your immune system to prepare it to fight the real thing. The way your body reacts can make you feel sick, but you're not actually sick. And the way you feel is much more mild than what the real thing would do to you.

oh makes sense. I didn't reliase that comment meant "i get sick every time" ( from flu shot). I thought it meant "i get sick every time" regardless of flu shot.

Then you were very unlucky in that you caught a different flu than the strains you were vaccinated against - there are 3-4 strains in a typical shot, but many more can come up during the flu season. Alternativey, you didn't have a real flu but a bad cold, which can be quite nasty in some cases.

Speaking for myself, I definitely do "get sick" when I get the vaccine, and it has a new strain in it. Sometimes flu shots don't change from year to year, and this year's doesn't actually have anything new in it. When there's nothing new I basically notice nothing.

However, "get sick" is a very vague term. In my case, to be specific, about 3 through 9 hours after the shot with a new strain in it, the shot site is tender and I run a small, but noticeable, fever kind of thing, barely worthy of the term but definitely a bit of an elevated temperature. Then it subsides. It is basically a minor inconvenience. By contrast, while I don't get the flu every year, it can hang with me for two weeks and knock me out cold for a good three or four days in the middle. And the shot generally covers more than one flu.

So yeah, both things may be "get sick" in some sense, but just because they both fit into the phrase "get sick" does not mean they are particularly comparable.

(Incidentally, over the past 10 years I've managed to do a lot of improvement to my immune system for various reasons. When I got the shot with a less-strong immune system, I generally didn't notice any symptoms from a flu shot at all. Everyone's different, but I'd suggest you generally should notice some symptoms from an effectual shot.)

Well now hang on...

The flu shot you get every year in USA and Europe is the vaccine for the most common flu that was seen in Asia and Australia the 6 months previous. And vice versa.

It’s a guess. If there are two common flus that went around, they pick one to vaccine for. Sometimes they get it wrong and the shot you get has nothing to do with the flu that ends up being common in your area.

It’s very possible to get the shot every year and still get sick.

There is a little bit of art in this science, a lot of people don’t get that.

> It’s very possible to get the shot every year and still get sick.

haha so I wasn't the only one who interpreted it wrong. comment means "I get sick everytime from flu shot"

Ohh... well, it should be the dead version of the virus, but the whole point is you develop an immune response. Do some people experience that as being sick-actual? I suppose there is some per person variance possible?

Normally there's at least 2 strains the vaccinate against. They've had flu shots with three strains before (around the time of swine flu)

I have usually skipped the flu shot for entirely selfish reasons -- that it's a hassle going to get it, needles are scary, and if I got the flu it's never that big of a deal. And I rationalized it to myself under the pretense that the shot sometimes doesn't work, etc.

I'll be more vigilant in getting it in the future.

Not sure if you are in the US and what your insurance situation is, but I got mine at some random CVS when I was passing the time, and I was in and our in less than 10 minutes.

People are probably referring to the immune response. The flu shot does trigger an immune response and other side effects, so having a fever, muscle aches, etc. is not made up. I too have a far more severe reaction every time I get a flu shot than I've ever had from actual flu.

Same here. I got flu shots twice In my life and both times felt worse than any flu I have had without.

Same question to you: The last time you had "the flu", did you get tested for Influenza? Are you sure it was Influenza and not a common cold, for which there is no vaccine anyway?

Taking to some nurse friends they say a lot of people think they have the flu when it's a bad cold. And some people just appear to not be very susceptible. Friends that have gotten the flu appear to be laid out flat for week or more.

Based on that I think I've never had the flu.

I didn’t get the flu until well into my 20s. Never got vaccinated, either. Ditto strep throat and sinus infections. Get all of them now. My diet and lifestyle are vastly healthier now than then and I have less exposure, so I guess HGH and massive amounts of testosterone are just a hell of a drug.

> laid out flat for week or more

That sounds about right. I did not really appreciate the distinction between a bad cold and the flu until I finally got the flu. I gained a real appreciation for why it kills weaker people.

It doesn't matter. The point still stands. So far he's been worse off when getting the shot than when not. But who's to say what would have happened those two years without the shot? Perhaps it saved him from a severe flu case or even death.

> It doesn't matter.

It does matter. The claim here is basically "for certain people (me), the flu shot has been worse than the flu". If that person never experienced an actual Influenza infection, then that claim was made in error.

The claim has not been made in error. If he has never experienced the flu, but has experienced symptoms from the flu shot, then the statement "the flu shot has been worse than the flu" is 100% true.

I am not claiming I had the flu. What I am saying is that the flu shots made me more miserable than any cold/flu I ever had. I am very reluctant to intentionally make myself sick for a few days every year.

That's an important distinction. You may never have had the flu in the first place.

In that case, it would be like saying "my reaction to the vaccine was worse than any infection I never had".

That is equivalent to "my reaction to the vaccine was worse than my reaction to nothing", or more simply "I had a negative reaction to the vaccine". Fair enough, there's no questioning that.

Now, if you had ever had an actual Influenza infection, my guess would be that you would prefer the vaccine. If you react that strongly to just the vaccine, why should you react less strongly to the actual virus? To be on the safer side, why not just assume that the actual virus would completely overwhelm you?

> I am very reluctant to intentionally make myself sick for a few days every year.

That's the tradeoff. Feel miserable for a few days per year versus taking the risk of contracting a severe infection and potentially being dead for the remaining years of your life.

To complicate the matter, flu vaccines are only about 50% effective, though I'm told they help even with actual infections.

I'm not telling you what to do, except to re-evaluate your thinking on the matter.

So, you had a flu shot and you were confined to bed for over a week?

Maybe 3-4 days. I have never been confined to bed for longer with or without flu shot. In terms of headache and other pain the flu shot times were among the worst.

This is interesting. I suspect you may never have had “the flu.” Many people think or have felt like they’ve had the flu, but people rarely get tested. Also, and I could be wrong, but if you’re immune response to the vaccine is so strong wouldn’t your immune response to the actual virus be much worse? What component of the vaccines you have had do you believe caused your adverse reactions?

The real virus isn't directly injected into your body tissue, it has to find a way in through mucus membranes when the immune system may be strong enough to fight it off before full on body aches.

Last time my wife and I came down with what we're reasonably sure was the flu she was bed-ridden and rarely conscious for two weeks, and I was barely mobile basically only out of necessity (someone had to get out of bed to feed us and let the dogs out).

I felt worse than I'd ever felt in my life. Everything hurt when I moved or when I didn't. My head was killing me. I never stopped coughing. It woke me up at all hours of the night and took me hours to get back to sleep. I was drinking cough syrup like it was candy just to get some barely passable naps during the night. It eventually devolved into pneumonia.

By the time I recovered and came back to work, I'd coughed so much I no longer had any voice.

I'd thought I'd had the flu before, but like many other people are saying it was pretty quickly apparent that it had always just been colds. I got the flu the first time when I was almost 30. I too would be extremely surprised if your reaction to the flu shot was anywhere near as bad as a flu.

my wife and I noticed this last year's shot was more painful - she especially had soreness in her arm for close to a week - in the past years it's typically been a day or two. Now... we're both getting older, which may account for some of it, but it can hurt for a while. And perhaps some people react other ways, which perpetuates the "I won't get one cause it makes me sick" scenarios.

> I too have a far more severe reaction every time I get a flu shot than I've ever had from actual flu.

Are you sure you ever had an actual Influenza infection? It's not like a common cold.

Even then, let's say you do get Influenza, there's a solid chance you'll get pneumonia, even as an otherwise healthy person.

Most diseases to vaccinate against have are mild in the majority of cases. You're vaccinating because of the fraction of cases that are severe.

I have been diagnosed by a doctor as probably having flu, but they don't always test, and I have had pneumonia, albeit not from influenza. But please understand you're preaching to the choir on vaccinations. I'm just saying that telling people something they actually experienced just isn't real just because it's not infectious is equally incorrect and counterproductive.

Don't get me wrong, I'm not ruling out that reactions to flu shots can be more severe than actual (mild) infections.

It just strikes me as unlikely. It's more likely that people don't understand the difference between a flu and a cold.

That's why I'm asking for clarification.

>> I too have a far more severe reaction every time I get a flu shot than I've ever had from actual flu.

Then why bother?

Some years I don't depending on my circumstances. But it's the same thing as COVID-19: it's not just about me getting it, I'm in a relatively low-risk demographic. It's about not spreading it if I will associate with high-risk demographics a lot. Herd immunity.

Also the immune response can suck, but I would think the risk for complications is still actually lower than genuine infection. I would see the flu shot as taking one for the team.

I've received the flu shot three times in my life. I've been hospitalized for influenza three times in my life.

Please tell me more about how I've deceived myself.

Just as the MMR vaccine is less about you contracting measles and more about your spreading measles to more vulnerable populations that are unable to get the vaccine, the flu shot is identical in that regard. Sure, it helps you not get sick and/or to lessen the effects, but there is the fact that some portion of the population is unable to get the shot for various health reasons.

Edit: Instead of downvoting please tell me how my experiences are wrong. I'm very much aware of evidence and studies stating that its "impossible" to get the actual flu from the flu shot, yet I am walking proof of contrary evidence. I'm also aware of how batshit emotional people can get with regards to vaccines, and I want to be clear I am absolutely NOT advocating that anyone forgo getting a flu shot every year. When everyone else gets the shot, I'm safer. When I get the shot, my body reacts violently and I will contract the virus.

> I've received the flu shot three times in my life. I've been hospitalized for influenza three times in my life.

> Please tell me more about how I've deceived myself.

Here you go: https://en.wikipedia.org/wiki/Confirmation_bias

Nope. Like I just stated in my edit, I'm not advocating that anyone forgo the flu shot, but that the flu shot is not 100% effective or 100% side effect free.

It's not bias. It's a fact. My GP is the one that has specifically told me to avoid the shot because I have a history of complications with it.

If you're capable, I'd love for you to diagnose me with some other mental disorder or logical fallacy, but please look at my medical history before you start dismissing my experiences as idiotic.

Your edit says:

> I'm very much aware of evidence and studies stating that its "impossible" to get the actual flu from the flu shot, yet I am walking proof of contrary evidence.

This is the famous "anti-tiger rock" argument from the Simpsons. (https://en.wikipedia.org/wiki/Much_Apu_About_Nothing)

You have evidence you got the flu.

You do NOT have evidence you got it from the shot.

> My GP is the one that has specifically told me to avoid the shot.

Anti-vaccine cranks exist even amongst medical professionals. Hell, the whole movement was started by one: https://en.wikipedia.org/wiki/Andrew_Wakefield

> the flu shot is not 100% effective or 100% side effect free

This is a strawman. Vaccine proponents agree with these specific statements. It's well known that the effectiveness varies from year to year, and that side effects are possible.

ceejayoz, I generally respect most everything you write on this site, but I'm amazed how dismissive you are of this.

Can you point me to a study stating that the flu vaccine is 100% safe and effective? Not mostly effective, or mostly safe, but 100% honest-to-god safe for 100% of the population to get?

edit: really? calling my GP an anti vaccine crank? fuck you.

> Can you point me to a study stating that the flu vaccine is 100% safe and effective?

No, because that's a totally different claim.

The flu shot can't give you the flu.

The flu shot can have side effects, and no one with any knowledge claims it's 100% effective.

> edit: really? calling my GP an anti vaccine crank? fuck you.

I'm saying "my GP says so" isn't sufficient to contest the wealth of scientific evidence we have on the safety and efficacy of the flu shot.

edit: You've since edited it to say he recommended due to complications, which is fine, but doesn't sound like the same claim you made originally. There are absolutely people who can't take the shot for various reasons (egg allergies, for example!) and depend on herd immunity as a result. I simply contested the claim that you can get flu from the shot, as every bit of scientific data we have disputes that particular claim.

Please stop.

Assuming that this is true, then even moreso you should advocate others get the flu shot to help protect you.

And yes, the flu shot isn't 100% effective. And yes some have bad reactions to certain vaccines. However, I find it extremely unlikely that you got it from the vaccine and instead that you were just very very unlucky at getting influenza. It's a bit of a sharpshooter fallacy to me.

And for those who are vulnerable, then their only protection is herd immunity where everyone else around them is immunized by vaccines.

Yes. This is my position.

> Just as the MMR vaccine is less about you contracting measles and more about your spreading measles to more vulnerable populations that are unable to get the vaccine

No, this is false. The MMR vaccine is very much about stopping individual people who get the vaccine from getting measles. Herd immunity follows, and is important, but the primary aim of the vaccination is to prevent measles in the people who are vaccinated.

To be clear - some people can feel a bit rough after the flu shot for a day or so. Still much MUCH better than getting flu

It makes me feel like I'm sick for about 4 days after a shot. I STILL get it because I remember getting the Flu as a kid and hope to never get it again if I can help it...

It IS a live virus in many cases:

"A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins."

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

I have nothing against vaccines, but my understanding is that you CAN get sick from it.

The definition of "sick" matters here.

A dead-virus vaccine like the flu shot cannot give you the flu. It can cause "sick" side-effects (for example: https://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_sy..., or the fairly common aches and pains from the immune response), but not the flu.

A live-virus vaccine like the flu nasal spray can give you the flu, especially if you're immune suppressed or something along those lines.

I don't understand the point of contention - a lot of vaccines have historically included a live virus that has been stored for a while, often in a frozen and/or dried out form.

Are you saying that a lot of vaccines are NOT weakened versions of the actual virus which can give you the sickness if your immune system is weak?

Or are you saying that the commonly used flu vaccine in the US does not utilize a live form of the virus?

If you are talking about the specifics of the latter, you could be right, I am not an expert.

The latter.

https://www.cdc.gov/flu/prevent/misconceptions.htm

> No, flu vaccines cannot cause flu illness. Flu vaccines given with a needle (i.e., flu shots) are currently made in two ways: the vaccine is made either with a) flu viruses that have been ‘inactivated’ (killed) and that therefore are not infectious, or b) using only a single gene from a flu virus (as opposed to the full virus) in order to produce an immune response without causing infection. This is the case for recombinant influenza vaccines.

Fair enough. Though I do think people need to understand that OTHER vaccines do use live viruses, and that's where the confusion comes from.

I used to skip the flu shot because getting a week home from work every 3-6 years was nice. This year I got

I meant to say this year I got the flu and it was very bad. I realized that since I work from home now the week home is not worth it. I'm going to start getting flu shots.

If there is a silver lining out of SARS-CoV-2, hopefully it's that we become more careful in general about infectious diseases, and we don't quickly just revert to the previous behavior.

There are so many axis (axes) on which we can improve.

Rethink doors with pull handles and common surfaces in trafficked areas (Union Station in Toronto has these all over the place. Hundreds of thousands of people and you're pulling common surfaces constantly).

People wearing masks when they aren't feeling well or even if just that they're a bit worried, without it being a social wrong. Despite the social pressure on masks, I have noticed a huge uptick in people wearing masks here in Ontario.

People staying home when they're sick. People having appropriate behavior when they are (even with a "cold").

And most contentious, we as a people just don't need to travel nearly as much. Aside from the environmental cost, many Western countries are particularly susceptible to these outbreaks because everyone is travelling everywhere constantly. For that meeting that could as easily have been an email. Etc.

I’m definitely getting all the doors in our office re-fitted with low touch handles and anti microbial surfaces. Everyone should be investing in some low tech stuff to reduce disease transmission. It’s not hard.

Automatic doors seem miraculous right now.

I'd love a more comprehensive discussion about the flu shot, because I've only used anecdotal evidence, and I suspect a lot of other people do the same. The first two years I got the flu shot from my employer at the time was 2007-2008, and I got a violent flu both years. Didn't get one after that for years, until last Feb, when I felt like I was going to die. Eventually went to urgent care, where I got fluids and sheepishly acknowledged to the nurse that I skipped my flu shot. She kinda shrugged it off and said, "Eh, it's about 50/50 whether it will work anyway."

We have lots of actual scientific evidence on this.

The flu shot can't give you the flu. (The nasal spray can! Your doc will recommend against it if you're in certain categories, like being immune suppressed.)

The efficacy varies from year to year, because they have to make an educated guess at which strains will be most prominent each year.

https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates...

50/50 is fine, for the same reason even imperfect handwashing and social distancing are better than nothing.

Since we are speaking anecdotally, I have had the flu shot every single year since 1994, which was the last time I got influenza. I have three kids and all of them get the shot every year too. They have never had influenza either. It works.

I think Freakonomics did a fantastic piece on the flu shot and the low vaccination rate. This answers a lot of the questions being tossed around in this thread:

https://freakonomics.com/podcast/why-doesnt-everyone-get-the...

The flu shot is not just about you but also community at large. People mistakenly assume that the flu shot didn't work but it did the strain you got the shot for did not spread because a large part population was immune to it. As a result the strain people were not immune for got the chance to spread.

The problem with anecdotes around the flu shot is there's a clear bias involved. If you get the shot and end up getting the flu its because the shot didn't work. If you get the shot and don't end up getting the flu it might be because the flu shot was effective, or it could also be because you just didn't come in contact with the virus. You always get a reminder of when it doesn't work and you (almost) never get a reminder of when it does work.

Just to throw my anecdote in there, I'll always get the flu shot if its convenient, but won't usually go out of my way to get it. This year I didn't get it, but my pregnant wife and daughter did as part of their regular visits. I ended up getting the flu and was violently sick, and my wife and daughter who almost certainly came in contact with the virus from me had no symptoms at all.

> getting the flu and was violently sick

That's what it took for me. Now I always get the flu shot, even if inconvenient. The last time I had the flu, it hurt so bad that I swore I'd never miss the flu shot again. Haven't got the flu since, which is part luck and part shot, but still, I'll take whatever protection I can get.

The CDC has all your answers about flu shots:

https://www.cdc.gov/flu/prevent/misconceptions.htm

We have decent coverage for the the Flu shot. 45% of the population over 18 received the shot.

https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.ht...

That's a good point, but from a response perspective the only thing they have in common is they are transmissible respiratory diseases.

COVID-19 is 1-2 orders of magnitude more fatal, has a longer convalescence, is more severe in severe cases, multiple orders more infectious, and has no vaccine.

Yeah, get your flu shot, be better prepared, but frankly I think since this is just very early in the crisis people are trying to compare this to previous experience when it is not comparable. Hundreds of thousands of people that might otherwise survive are about to be left to die for lack of capacity to save them. Possibly millions. At this point, it's too late to prevent it. Further, the US administration knew about it in time to take protective measures and did not. Nothing like this has ever happened in any of our lifetimes in the US.

Stop comparing the Coronavirus to the flu. It’s the mistake that brought us to the current situation and which will bring us into much darker times than now if we don’t start to take things seriously.

But that's precisely the point. If the hospitals get overwhelmed with the flu regularly, how can we expect to cope with the current virus which is way worse?

The 2017/18 flu season was the worst in decades. Here in Germany it increased overall mortality rate by about 40% in March 2018. Italy has a similar increase due to COVID-19 right now, but in the most affected regions mortality is a lot higher. And this is with serious measures in place that were not done in 2017/18.

That's so weirdly American: a top-voted post about flu shots. On EU forums literally nobody brings this up somehow.

Because everyone gets the flu shot in EU, or because nobody cares?

No unless you're at risk (old person or with medical issues) you usually don't get the flu shot. The reason is to actually to build the so-called "herd immunity" I think. Same thing with antibiotics (no need to give evolutionary "ammunition" to virus and bacteria if we don't need to).

>The reason is to actually to build the so-called "herd immunity" I think. Same thing with antibiotics (no need to give evolutionary "ammunition" to virus and bacteria if we don't need to).

I don't think that's the right comparison. Herd immunity refers to stopping a disease by spreading by making enough of the population immune so it can't spread. It doesn't have anything to do with evolutionary pressures or superbugs, like what you're alluding to with your second sentence.

There's a misunderstanding here. Vaccine confers immunity to an individual. Herd immunity means that an infection cannot get a foothold in a community if a certain portion of the members are immune.

Widespread vaccination is important exactly because it produces herd immunity.

It's not that nobody cares. I think it's more encouraged for the elderly or other "at risk" groups whatever that might be but it's not really being pushed for anyone else. I'm in my 30s and have lived in the EU my entire life and I have literally never had one, for example.

Unfortunately (in my eyes), only a part of the population regularly gets flu shots. A bit better ratio in the endangered part of the population, but it would help, if not so many of the low-risk population would get and transmit the flu. Just a few weeks ago, some schools nearby Munich had to close for a few days due to high flu numbers amongst the pupils.

In the US, health authorities encourage the entire population to get an annual flu shot. My understanding is that most European health authorities are more skeptical.

I made sure to get my flu shot very early last year. I only wished the shot cover every possible viruses.

Hopefully people who skip the flu shot because it makes them a little sore realize that increasing herd immunity SAVES THE LIVES OF OTHERS. I'll take a day of sore arm to save a life.

>> Everyone gets their flu shot, right?

No, and that's ok. There is a lot of stuff written - even in science papers - that indicate differing things about those vaccines effectiveness.

There is no universal "right" answer to your question. I'm assuming you thought it was rhetorical.

Can you provide a source of these "science papers"? Please only provide the peer reviewed repeated studies, not those agenda driven ones.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850385/

> Loyola University Health System in Chicago—which set a hospital flu-activity record of 190 confirmed cases between January 7 and 13

It's not even close to what we saw just this week from coronavirus. Stop making a comparison where there isn't one to be made, this is much worse than the flu.

Coronavirus is serious. Also, get your flu shot. I don't understand why this is even remotely controversial.

I suppose his point is that the coronavirus overwhelms hospitals much, much more seriously than the flu does.

All the more reason to get your flu shot to reduce the chance that you end up in the hospital using valuable space needed for Coronavirus patients.

I'm not minimizing Coronavirus. I'm trying to leverage the attention people are paying to it to emphasize the importance of vaccination.

I agree, getting the flu shot is very important. My whole family gets it every season.

> this is much worse than the flu.

The CDC estimates that up to 710,000 Americans have been hospitalised by the flu in the past six months out of 54 million infected.

Up to 59,000 of them died. IN SIX MONTHS. In the USA alone.

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

Stop trivialising influenza.

> This coronavirus hasn't even approached those levels globally in five months.

Three months, and yes, that's how exponential growth works. It's pretty small at the beginning. You'd think a community of (largely) computer scientists would appreciate the power of exponential growth.

Edit: ah, looks like you're editing your post.

It's hard to take you seriously when you take a range given by the CDC (38,000,000 – 54,000,000) and cherry-pick it as a specific figure that makes your position look stronger. You're arguing in bad faith.

Even according to the figures you've given from the CDC, the flu has a 0.1% death rate, which is nowhere near the 1.4% death rate COVID-19 currently has in the US.

No one is trivializing the flu, but it's silly to say we should relax w.r.t. COVID-19 because we're used to the flu. At a minimum it kills TEN TIMES as many infected people as the regular flu, even without considering vaccines.

Influenza is chump change compared to COVID-19.

> 1.4% death rate

We don't know that. At all. In the past these kinds of on-the-fly estimates during the spread of an infection have turned out to be overestimates. Sometimes by an order of magnitude.

Source?

59k deaths out of 54 million infections is a 0.1% fatality rate. While the average fatality rate for COVID19 using global statistics is around 4%, let's use South Korea as an example because they have been testing much more frequently than other countries. The South Korea fatality rate is about 1%, so we'd see 540k fatalities in the US for similar infection rates.

Also, initial R0 transmission statistics for COVID19 look to be in the 2.5 range, where the R0 for seasonal flu is around 1.3.

So COVID19 is 2x as transmissible, and 10x as deadly. I don't think the conversation is around dismissing the seriousness of the flu, and more around emphasizing the risk of COVID19.

> using global statistics

Let's keep it real, the flu infection rate given by the CDC is hindsight knowledge. The real time "global statistics" for COVID19 are with vastly restricted testing. There's not really a valid comparison to be made at this point.

Exactly everyone who is quoting numbers for flu deaths needs to realise these are estimates based on the statistics of how deaths vary year to year, i. e. looking at how many more people died in a flu year compared to other years (simplified). Most people actually don't die of the flu itself but secondary infections (the number of deaths linked directlybto the flu are orders of magnitude lower). Corona directly kills people.

The other thing to remember is the lag in the calculations, the people dying now are the ones who were admitted to hospital a week ago.

"Corona directly kills people"

I'm not so sure about that. Covid may grease the skids, but the vast majority of people dying have health complications already. Kids aren't dying. Teens aren't dying. 20s and 30s aren't dying in numbers. If Covid were directly killing, we'd see kids dying.

That does not follow. Yes the majority of people have preexisting health conditions, but they die directly of the pneumonia that is a result of COVID-19. For the flu, people typically die of secondary infections, e.g. bacterial pneumonia. Someone younger without pre-existing conditions is just much stronger to fight off the infection.

Regarding children, this is actually one of the many questions that is not fully understood, why do children not get so severe symptoms (initial thoughts were they might not even get infected, but this has been disproven by recent studies).

If you want to know fatality rates you need a controlled population. South Korea isn't that, its level of testing isn't even much higher than Switzerlands at this point.

There are only two known populations in which everyone was forced to be tested and their movement was limited, which thus makes up a controlled study: the Diamond Princess and the town of Vo in Italy. In both cases the fatality rate is much less than 1%. In fact in Vo it was zero.

https://www.theguardian.com/commentisfree/2020/mar/20/eradic...

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

In prior pandemics like this one the final fatality rate ended up being much lower than the initial reports: like an order of magnitude lower. So we would expect to see the same this time.

0.1% or less is well within the bounds of possibility, as the essay by Ioannadis explains.

The Diamond Princess’s population is also small, extremely poorly represents the general population, and happened in a setting unrepresentative of the rest of the world. Passenger age is just about the only factor that would drive the mortality and infection rates up, everything else lowers it. As a model the Diamond Princess should probably be treated more as the floor rather than anything representing the average.

everything else lowers it

What are these everything else’s? By far the best predictor of patient mortality has been age. What else is it about the Diamond Princess population that would come even close, even in sum, to the predictive power of their age?

Quality of care after the fact is the obvious one. The patients of the cruise ship weren’t being treated by a flooded hospital system. Quarantine on the ship is less than perfect, but it’s still better than the efforts made by many governments which was to do nothing until things got out of hand.

> In fact in Vo it was zero.

Isn't it a bit disingenuous to use a city with 89 cases as being statistically significant?

Vo has 3000 inhabitants, it's not a city, that's why they could completely isolate it and test every single inhabitant. It gives a 'random' sample, unlike other testing regimens.

The population size isn't that big indeed, but it's still multiple times larger than the cruise ship.

>The population size isn't that big indeed, but it's still multiple times larger than the cruise ship.

Which cruise ship? Diamond Princess had ~3600 occupants (passengers and crew).

> Vo has 3000 inhabitants,

How can you consider the fatality rate over an uninfected population? A year ago 8 billion peoples were not infected and 0 died! I have no idea why we worry. /s

What's matter for the fatality rate is the 89 persons infected, which isn't statistically significant.

What a disappointing reply. We're trying to express that this is much worse than flu. Nobody is trivializing flu; flu is bad enough, the entire point is this is WORSE than flu, so our reaction should be more comprehensive than flu.

This comparison is invalid and dangerous. You can't compare some absolute numbers against the unknown. Just look at fatalities rate in Italy. This virus can turn your lungs into dust within days under unknown conditions

It's bad here in NYC. I have multiple friends symptomatic after contact with confirmed infected. One knows he was in contact with confirmed infected because the one of their group that went back to Canada was tested there and came back positive. Of all of sick friends with confirmed exposure, only a single one has been tested and it's because he's currently in the hospital under quarantine on oxygen with a tentative pneumonia diagnosis. We just don't have test kits.

My partner and I are both sick and self isolating. My friends who are nurses are saying it's bad where they are and they're running out of supplies. And we're not due to hit the height of hospitalizations for another 3 weeks. 911 in NYC is already at Sept 11th levels.

Stay home, stay safe. Only call 911 in an emergency. Ignore the president, listen to epidemiologists and medical professionals. "anybody that needs a test gets a test. They’re there. And the tests are beautiful" - Trump, March 6

What kind of amazes me about this is it was obvious this would happen if the US didn't test as many people as possible early on to catch the virus. Yet the CDC banned most labs from testing and when a researcher in Seattle tested against permission and found the virus spreading tried to cover it up. Why? Wasn't it obvious that that would result in the present mess? Why couldn't they have just said yeah, test whatever?

Because apparently even non evasive medial test are bound in ridiculous amounts of regulatory red tape and pointless bureaucracy by the FDA.

Is there any data on how many people died which had no pre-existing medical conditions?

You probably need a "socialist" country to find someone collecting that data. e.g. : https://www.icnarc.org/

Note that preexisting conditions include high blood pressure and diabetes. Turns out quite a lot of people have them.

This twitter thread had some good info from NYC:

https://twitter.com/ArmstrongDrew/status/1242648015959187456

> Another common trend -- 95% of people who have died so far had an underlying health condition ... BUT

> Keep in mind those underlying health conditions include things like diabetes -- which affects about 10% of the U.S. population. Oh, and hypertension -- 29% of adults. And cancer, heart disease, kidney diseae, etc. That's a LOT of people. Not some tiny, sick fragment.

-e- Direct Source ("Daily Syndromic and Case Data Update"): https://www1.nyc.gov/site/doh/covid/covid-19-main.page

It was easy to see the future: you just look up on the wiki the evolution of numbers of confirmed cases in the EU countries.

Given that the US is now neck and neck with Italy to be the first country to have more cases than China, we have been wildly exceeding any estimates based on EU countries.

To be fair the US has a population more similar in scale to that of Europe than to that of any single European country.

Wouldn’t cases per capita be more important than cases total? And don’t cases recognized under back to testing? As in does anyone really believe Russia has zeros cases?

Bigger population means more movement and more points of entry so the absolute numbers are proportionally bigger.

Growth percentages looked scary for several days. So probably there were indeed some differences in the ramping up of testing.

The US's rate per capita is still only about 20% Italy's. For now.

If America was willing to learn lessons based on data from Europe, we'd all have universal health care by now.

Actually the EU is a great preview of where the US is headed in the next weeks: As of today so far (March 26th) the EU has about 237,000 positives and about 14,200 deaths with over 1,000 deaths in the last 24 hours so far. The numbers for France and Italy haven't been reported yet for the 26th of March so it's likely the totals by the end of the day will be somewhere around 250,000 positive cases and roughly 15,000 total deaths with close to 2,000 deaths in a single 24 hour period. It is not hard at all to see the US having similar numbers in the coming weeks.

Pages with links to reliable sources, fact-checking:

- "COVID-19 Resources for Reporters": https://www.sciline.org/covid

- "More COVID-19 Resources for Journalists": https://www.sciline.org/covid/resources

On Twitter have been following:

- @AdamJKucharski - Mathematician/epidemiologist at @LSHTM https://twitter.com/AdamJKucharski

- Kai Kupferschmidt - science journalist & molecular biologist reporting on COVID-19 for Science Magazine https://twitter.com/kakape

How often do our hospitals get overwhelmed by endemics?

another question i have is are positive tests being sent to icu even if the symptoms are not bad?

Not here in Rochester, NY. Our ICUs aren't full yet, and the county is giving "number hospitalized" and "number in ICU" distinct numbers. Ours are about 50% ICU right now.

https://twitter.com/CountyExecBello/status/12431834845097861...

no.

"To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."

Historically, when sexually transmitted disease outbreaks occurred in the US, social workers would ask for the names of everyone you had slept with if you were infected and they would contact them and screen them and treat them. This was effective in stopping outbreaks.

We largely abandoned this approach after AIDS became a thing. In the US, AIDS was mostly a disease of IV drug users and gay men, both of whom were highly stigmatized populations. They understandably did not wish to give up the names of people they had slept with (or shared needles with).

Although I think we got a lot of human rights gains out of the battle to protect those populations, the downside is that we largely abandoned a proven method for putting a stop to disease outbreaks. Instead, we now default to trying to find drugs and vaccines rather than trying to stop the spread via "social" means (for lack of a better word).

There is a book called The Hot Zone that similarly describes non-medical/social interventions that helped stop the spread of Ebola. Among other things, tribal elders in Africa blockaded the roads so outsiders couldn't come in, they told their people "Don't go to the white man's hospital" because you go with a broken leg and die of Ebola and they began quarantining the sick.

You were forbidden from leaving your hut. They would leave food on your front doorstep for you to provide for you. If it sat there for three days in a row untouched, they burned the hut down without going in to check if you were still alive.

We are currently focusing a lot on ventilators. I've seen numerous articles on ventilators on HN and there are numerous projects trying to develop open source ventilators. Meanwhile, we are apparently largely overlooking noninvasive lung clearance techniques that can help with less extreme cases and may help prevent them from becoming such.

In human history, epidemics tend to mostly get stopped with non-medical interventions. Yes, I know, there are states under lock down. I'm in one of them.

But I feel I am seeing inadequate emphasis on prevention, changes in lifestyle, promotion of remote work as a solution, non-medical home care options so fewer people end up at the overwhelmed hospitals where care is getting rationed etc.

I have been saying for some days now that high use of ventilators will promote a rash of antibiotic resistant secondary infections. There has been at least one article posted to HN that suggested that antibiotic resistant infections may be a factor in the high death rate in Italy.

I think we can do better. I think that's not going to happen as long as we continue to worship medical intervention as the answer here.

I think lifestyle and procedural changes are needed. An ounce of prevention is worth a pound of cure and prevention doesn't require you to see a medical professional or get prescribed anything, yet everyone acts like either that's not going to be effective or it is too objectionable to embrace or making suggestions of that sort amounts to practicing medicine without a license.

-----

Previous comment about the history of AIDS in the US: https://news.ycombinator.com/item?id=22658583

PDF version of The Hot Zone: http://projectavalon.net/THE_HOT_ZONE_Richard_Preston.pdf

Previous comments by me about about air clearance techniques and ventilators: https://news.ycombinator.com/item?id=22651884

To the people inclined to harass me and threaten to sic the mods on me for commenting here, the mods appear to be well aware of my comments and have already asked someone to please cease and desist harassing me: https://news.ycombinator.com/item?id=22660362

Interesting points (not sure why you're getting downvotes here). I also wonder if it would help if the medical "establishment" encouraged people to stay home even if they get symptoms, and only seek medical care for serious shortness of breath or if you have co-morbidities that are life-threatening. There is not effective treatment yet, so what is the point of standing in line at the ER? It would also have the effect of freeing up healthcare capacity.

NY Times yesterday had an article about people standing in line outside at the ER for hours. If you can stand in a line outside for hours, you probably don't need admission to the hospital and should leave that capacity for those that really need it.

The medical establishment is already encouraging people to stay home and not seek medical care if it isn't overly severe. This is making people very upset, and understandably so, because it boils down to a big fat "fuck you."

What we actually need is a list of medically approved home care options to empower people to deal with this on their own to some degree. We mostly aren't getting that.

If you don't give people actual solutions for how to cope effectively without seeing a doctor, then everyone wants to see a doctor because it's their only hope. Duh.

People outside of the healthcare system don't realize that even in non-pandemic times, ERs and hospitals are some of the most dangerous places to spend your time. Doctors won't say that publicly, but the ones I worked with all had that sentiment.

Yes, hospitals actively breed antibiotic resistant infections. They are a primary source.

This is another point I have made in prior discussions that people didn't like hearing.

Thank you for this detailed and insightful comment!

In Europe (or at least in my country), health authorities have been saying for several weeks that we need to stop people from needing ventilators, rather than get more ventilators. I think most people here get it, and overall the population has been compliant even with the quite drastic measures that have been taken in most places.

this is a really good point. much easier to do than mass testing.

And much more effective. We need things that get results with fewer resources. We simply don't have the resources to do it the way a lot of people would like to do it.

not sure why you get the downvotes. this is really good and extremely actionable

There have been a few people following me around and harassing me.

I'm not a doctor. Much of what I know about managing serious lung issues is because I have serious lung issues. That is being used as an excuse to say I have no right to talk about what I know because it's medical in nature and I don't have a medical degree.

I'm also a woman and that often goes weird places in online discussions. People have different expectations for women than for men.

There's also a pandemic on. People are cranky and scared and looking for a proverbial dog to kick.

Downvotes or other negative reactions can beget more of such. People can just react based on social signaling, especially if it is a touchy subject or they have personal baggage or are upset for some reason.

Etc.

Hopefully it will settle down soon and people will engage more in the future with the actual points I'm trying to make and focus less on what they feel are my personal deficiencies or whatever.

We aren't really supposed to talk about downvotes. I usually try to abide by that guideline. I'm leaving this comment because it's really meta commentary on how panic and such works in a crisis. Hopefully it will be enlightening for a few people and help them more effectively navigate the current online social climate generally.

Wow, they followed you all the way down this thread to downvote it. Some weird, obsessive people.

Thank you. This was a very informative comment and I am especially grateful for The Hot Zone PDF.

It was difficult to follow your chain of comments to find the information on air clearance techniques separate from ventilators. This is the relevant thread for anyone interested - https://news.ycombinator.com/item?id=22624959

All the emergency managers did a great job posting videos and FAQs, which are completely useless now. We should have been building massive free clinics in every city starting two weeks ago. This is a failure of imagination.

More like two months ago.

More like shortly after 9/11. Or after the 1918 flu. Or...

I would say it is a failure of communication, or coordination. There were plenty of observers recognizing the threat by the new year, but not enough to crystallize into a shared awareness and coherent re-prioritization of resources. In light of that, I think it is misguided to trash-talk any attempts at communication and outreach by people tasked to protect the public and who lacked the power to actually commit the nation to drastic course changes.

As a layperson in academia, I certainly recognized the potential threat just from the news trickling out of China in late 2019. Meanwhile, I had colleagues who went ahead with business travel to Italy towards the end of February! There is mind-boggling inertia in the capacity for the public at large to internalize disruptive facts and ideas, and this inertia connects back through the body politic into representative leadership, who can be pinned down like Gulliver even if they are aware that action is required.

A relative of mine works in security and risk mitigation for a large school district in CA. They were being briefed on the COVID-19 risk by their federal contacts in late January. They were scrambling to revise and organize appropriate disaster plans. Even with that, they struggled to steer the whole ship around to school closures in mid-March.

Now, imagine that every large organization had to do similarly in the same timeframe, drawing mostly on extant resources. They could not all hire new staff, bring in specialists, or procure large supplies that were not already part of their general war-chest for unknown emergencies.

Like most other for-profit enterprises, there is little incentive to maintain capacity greater than what is needed needed to handle the "average" demand. So when something exceptional happens, of course the capacity is inadequate.

You can also (likely successfully) argue that this will also happen in a government run healthcare system, but the situation has certainly not been improved by capitalism as implemented in the US.

Oh, it definitely happens in government-run healthcare systems. Remember how proponents of single-payer government healthcare in the US used to point to the amount of money that the UK spends on the NHS and argue that the US would save money by switching? One of the ways the NHS keeps costs down is by not maintaining excess capacity, meaning that even a moderately bad flu season is a major struggle.

Doesn't that apply to for-profit hospitals as well? In both cases, there is an incentive to avoid paying for excess capacity.

The cost advantage of a single-payer system is in larger negotiation. A single person has no leverage at all in negotiating with a hospital. An insurance network has some leverage when negotiating with hospitals, but results in user-complexity trying to navigate the in-network and out-of-network agreements. A single-payer has a large amount of leverage when negotiating with hospitals, and can avoid price gouging from manufacturers.

What data we have indicates that the US is going to have by far the largest outbreak of COVID-19 in the world, larger even than in China, a country with something like four times our population. So the unique way we do healthcare here is not looking particularly good.

”The state is home to more than 6% of the world's confirmed cases so far”

World population: 7½ billion. 6% of that: 450 million. Population of New York State: 20 million.

⇒ overrepresentation factor: 22½.

Open question: how much of that is due to more testing being done in New York State, compared to, say, India or Pakistan (large, less wealthy countries that may skew the statistics)

Uhmm confirmed cases.. I don't know why you're calculating population.

They're trying to calculate overrepresentation of US patients.

They claim 6% of confirmed cases not 6% of the world's population.

Yes, so 6%/22.5 is the percentage of cases NY should have, given a uniform distribution. They're overrepresented by 22.5x.

While I'm not questioning the truth of these accounts, what annoys me about all these reports is that they seem to be anecdotes rather than hard data. It's really difficult to understand what's actually going on because the data sucks. It's hard to assess just how full hospitals are, which hospitals are at capacity, how many patients are actually testing positive vs. showing up at the hospital because they feel a bit off that day, how many require hospitalization, how these cases are affecting other patients, and a whole lot of other things.

I'm still kind of on the fence about this whole situation. The panic is undoubtedly real and serious, but the seriousness of the virus itself seems questionable. I don't think we'll really know what's actually going on for a few more weeks or months.

I agree with your main point. That said, if we're okay with subjecting ourselves to propaganda that reduces the spread of covid19, these anecdotes might serve a useful role.

They are useful to know, but they have one fundamental problem: they erode trust. Though it is up for debate on how much trust in the political system and mass media there is left in the US.

Can you elaborate on how they (the anecdotes, I assume) erode trust?

Simply: by telling lies. If we tell people 3 in 100 will die, and after the fact it turns out that 3 in 1000 died, next time, when it will be more serious nobody will believe.

So you are proposing the solution to not do anything so the projections become true, so next time you will take it serious?

The problem with your way of arguing is that one can not win. If they say "if we don't do anything there will be 3 in 100 people dying" and they do something, you say they lied. If they don't do anything, you will ask "why have they not done anything! They are incompetent or malicious"

I think part of the problem is that these sorts of anecdotes have been reported in previous bad flu years. That's perhaps a part of why people think it's just a bad flu. You can easily find reports (see above) where doctors describe their hospitals as "like the third world", needing tent wards, like war time, overloaded, people on beds in corridors etc from prior years. They sounded like a disaster had struck at the time too, because the media highlights the most dramatic anecdotes.

A bit like audio compression - if everything is compressed to the same volume then it gets really hard to tell how loud things are relative to each other.

Another problem is people encounter stories where there are anecdotes in the other direction e.g. today I read stories about Ticino, Japan, Germany where hospitals are waiting for an influx, but it doesn't seem to be growing in the expected way. Why? Unclear. These stories of course get less attention.

> They are useful to know, but they have one fundamental problem: they erode trust. Though it is up for debate on how much trust in the political system and mass media there is left in the US.

Clickbait-style "everyone in New York is dead!" bad-faith hysteria would erode my trust.

"We saw a terrible situation, and communicated the situation as clearly as we could at the time, even though our information was incomplete. Since then we have more facts, and are striving to communicate them to you" enhances my trust, not erodes it.

It's kinda hard to get "hard data" in the middle of a shitshow. This comment sounds like someone watching a school shooting live and asking "yeah but what's the % of kids that got shot".

Show some humanity dude.

This.

There's no reason that state health departments shouldn't be reporting hospitalization to the best of their ability. Hospitals already send information to them on a daily basis.

I think that's a bit of an overreaction. The way I read that comment was very similar to your response to it: it's hard to get hard data in the middle of a crisis. The difference is that the commenter was also expressing the very natural, human response of frustration at this fact. A lot of people are feeling that way.

The serious problem with the comment is that it's saying these reports are annoying, however it is not the job of the providers of these reports to provide hard statistics, it's not as if any of them have the option to do that themselves instead. So it's basically just saying, shut up. I don't want to hear your annoying report of actual effects on human beings.

A more charitable reading of the comment would be an annoyance of anecdotes without underlying prevalence data to contextualize the info.

It would be all too easy for the media to pick a healthy senior with a mild case and tout “it sucks but it’s not so bad” or find cases of healthy 18yo dying in horrific conditions to fit their overall narrative.

Data by itself doesn't cut it. That nurse in London didn't commit suicide because of data. She did is because she couldn't face the reality of treating so many patients dying in agony.

I’m not arguing for just data, I’m arguing for both. I would be equally “annoyed” if it were just data.

Just data wouldn’t give me sympathy/empathy and not being a medical professional I’m not familiar with diagnostic or clinical language. Data won’t properly convey the suffering unless you’ve seen it.

I’m weary of just anecdotes because it is impossible for me to be able to allocate my limit resources efficiently. I’m not saying this isn’t important or can only be validated when enough people are devastated.

Thanks, that was well put.

I'm sure we all recognize the tragedy. That deserves to stand in a paragraph alone; it's tragic and my heart goes out to the medical professionals and patients who have to deal with it.

But it's not an isolated tragedy like a school shooting. If the proposed response to school shootings were indefinite social isolation, I would definitely want to know the percentage of kids that got shot and I would be intensely suspicious of a narrative that it's rude or dangerous to ask the question.

81 people died of the virus in NYC yesterday. I think the large number approach of pandemics can almost sanitize the numbers of their humanity.

Imagine 81 people died in a bus accident, or a fire, or a mass shooting. This is very serious and we're still at the beginning of it.

Looking at yesterday misses the point. Look at tomorrow!

Don't look at the lit fuse. Look at the bomb it leads to.

NYC death numbers double in under 2 days now.

I wrote a comment elsewhere about death rates in the US. 81 people per day is not an astronomical number for the most densely populated part of the country, in fact it's well within the normal number of deaths according to CDC data. In fact, just compared to heart disease alone, it might be slightly on the lower end.

But of course heart disease isn't contagious and rapidly increasing. I think if it were, it would be far more concerning, wouldn't you agree?

The problem is, as bad as the current numbers are, without significant changes, they are inevitably going to get considerably worse quickly, as you can see from the graphs.

Imagine what'll happen if 60% of the US population gets this quickly (over the next 3 months say) and then 2% of those people die with another 8% in hospital...

With the current rate it’s going to be 2500 death per day in 10 days.

A stable 80 deaths per day isn't that many, it's only 29,200 people per year.

But with covid-19 the numbers of people dying is doubling every 3 days.

80, 160, 320, 640, 1280, 2560, 5120, 10,240, 20,480

Potentially Covid-19 would hit that 29200 figure in about 25 days from today.

Keep extrapolating and you'll find 2.5 trillion people will be dead just a week after that.

Look at Italy; look at Spain. These are not unreasonable extrapolations.

Neither of them have exponential growth. The rate of growth has steadily decreased after the first initial spike of cases.

The growth seems to be tapering off after extreme lockdown measures have been taken.

Of deaths? Here's Spain. They implemented lockdown on about the 7th of March.

https://www.ft.com/coronavirus-latest

https://www.worldometers.info/coronavirus/country/spain/

   8th   17 deaths
  11th   55 
  14th  196 
  17th  533
  20th 1093
  23rd 2311
  26th 4365

This is absurd.

You can use the same argument for flu deaths, heart disease deaths, diabetes deaths, etc. The numbers that you pay attention to are dependent on what is popular right now.

The difference is the rate of those aren't doubling every three days.

This is true and conceded, but that wasn't my argument.

Hmm. This comment got me curious.

Using CDC's FluView app I looked at the 2017/2018 flu season to see what the doubling time was. It's not 3 days indeed. It varied quite significantly during the outbreak, but there were periods where it was doubling approximately every week. Potentially faster I suppose depending on how closely people were looking for it (not that close if I understand correctly for most flus).

Viruses can grow pretty fast.

It isn't the virus that is sanitizing people of their humanity. They lost their humanity a long time ago, and the virus is simply revealing their nature.

The only hard data we have are death numbers. They're awful enough: https://www.ft.com/coronavirus-latest

Other hard data takes time to collect and will only be reliable once the disaster has swept through.

They're bad, but if you put it into the context of normal daily life it's not that crazy. Check out the CDC stats[1] yourself. On average there are about ~1700 deaths per day from heart disease alone in the US, according to the CDC data.

[1]: https://www.cdc.gov/nchs/fastats/deaths.htm

None of those other numbers are doubling every three days.

If heart disease deaths were contagious and increasing by 33% daily, that'd be a great point.

If the number of heart disease deaths doubled every 3 days I would take heart disease much more seriously than I do now.

And now that number is going to go up because medical care is less available.

https://xkcd.com/2278/

Those numbers are going to go up if your hospitals are overwhelmed.

Additionally, a very large percentage of health care workers will catch the virus, this will further reduce the amount of capacity.

Loss of health care workers could be a long term issue as well given the CFR in a place like Italy.

Even the death numbers are going to be off. Lot of deaths either were attributed to the ultimate cause (i.e. heart attack) or happened at home and haven't been attributed to covid as of yet.

No, it's the other way around. Normally deaths would be specifically linked to e.g. the flu, but in this case, all deaths are being tested for COVID-19 and mostly assigned with that as the 'cause' even if there were other causes like heart failure.

There was an article in the Spectator today where a doctor made that point: that this disease has been made a 'notifiable disease' whereas a normal flu wouldn't be, meaning each death gets tested and reported up to the government if positive, whereas for other types of coronavirus the death would just be marked as pneumonia, for example. The data isn't being treated consistently.

You can look at pictures on twitter

The hard data we have may be incomplete.

https://www.buzzfeednews.com/article/nidhiprakash/coronaviru...

> And two of the hardest-hit areas in the nation — New York City and Los Angeles County — released guidance earlier this week encouraging doctors not to test patients unless they think the test will significantly change their course of treatment. That means that potentially more people in both places could be admitted to hospitals with severe respiratory symptoms and recover — or die — and not be registered as a coronavirus case.

In Bergamo and surrounding areas the death rate is 5-10x higher than it was at this time last year.

> the seriousness of the virus itself seems questionable.

Half of the world’s population are or have been under some kind if restriction due to this virus. I don’t governments do that if they are uncertain.

> I don't think we'll really know what's actually going on for a few more weeks or months

I don’t think it is going to happen, but if the US does what Trump wants and ”lets it rip”, that will answer the question about the seriousness.

Even scientists are uncertain, how can governments be?

Unfounded certainty is a byproduct of abject stupidity

https://www.worldometers.info/coronavirus/

Exponential growth of cases and deaths translate into many horrible anecdotes.

It would be interesting to see geographic case density vs. geographic ventilator capacity.

One of the huge failures of the government is that we still don't have any push for ubiquitous testing. South Korea's aggressive testing for the virus is a key factor in their success in suppressing the epidemic.

Assuming you're talking about the US, I think this situation exposes a not well known fact that the federal government doesn't really control the inside of the country. The response has to come at the state and local level, which it is, slowly. e.g. : https://www.theatlantic.com/science/archive/2020/03/coronavi...

Here in our county in rural Montana (based on info from the local medical establishment, who I know fairly well), we have been conducting much more testing than you'd expect based on reports from around the country, and we have never had a shortage of tests, and our small hospital lab will shortly have in-house testing deployed.

Actually that's not true in this case. I believe it was the CDC who said only use our test. I'm not from the States but I believe the CDC is a federal agency isn't it?

FDA actually, but I'm not addressing the existence of the test but rather decisions on whether to perform widespread testing like SK.

> The response has to come at the state and local level, which it is, slowly

I don't think this makes sense. If this is actually true then the US is just completely broken. Coronavirus is a global pandemic - are you arguing that each individual local jurisdiction should develop and manage it's own tests? That's horribly inefficient and slow.

The initially hit states were depending on the CDC and FDA to provide tests (or at least approve tests):

https://www.newyorker.com/news/news-desk/what-went-wrong-wit...

Unfortunately under the current administration the CDC and FDA are understaffed and being run extremely poorly, which greatly hampered initial testing. If your argument is that local jurisdictions should be responsible for pandemic testing, that makes very little sense to me. It is far more efficient for a single organization to coordinate pandemic response at the national level.

My comment was responding to parent's "push for testing", not the development of a test. Having a test exist is one thing. Deciding how many people to test is a different thing, and is decided at the local level in the USA.

Even if you are on the fence I hope you're taking measures now and having older relatives isolate. If you're not, a couple of weeks from now you will look back and regret being on the fence. Look after yourself.

Well in the hypernetworked hive mind that is society these days, American News Media plays the role of brain cancer.

Randomly infecting cells to over broadcast, attack each other, focus on noise, unfocus signal etc etc.

Basic prediction about them, whether on the left or right or podcasting from a garage is that they don't contribute to good outcomes and the bad outcomes are not their fault.

Then one year down the road they hand each other Pulitzers for "unravelling" what actually happened.

“If you need to be right before you move, you never win. Perfect is the enemy of what is right when it comes to emergency management. Speed trumps perfection.” - WHO Executive Director Dr. Michael Ryan

https://twitter.com/JIMrichards1010/status/12391407105589698...

Individually the danger is not so big but the fact that a lot of people are ill simultaneously is unmanageable for hospitals. The number off people who have the virus simultaneously is enough to see there is a big problem.

Well, that’s some fear mongering.

The article is all anecdotes. Most of the nurses and doctors they talked to are anonymous sources.

According to the AHA[1], there are 6,146 hospitals in the US. There are 68,000 confirmed covid-19 cases in the US, and 33,000 of those cases are all in New York—almost 10x more than the next states (4.4k NJ, 3.2k CA)[2].

I don’t know the rate of hospitalization for the infected, but symptoms are mild enough for home recovery for at least 80%.

So this is bad in NY. But even the next most affected state, NJ, we’re looking at a worst case of ~880 covid-19 patients across 70+ hospitals[3].

Bad situation in NY. No need to say it’s like that across the whole US.

[1] https://www.aha.org/statistics/fast-facts-us-hospitals

[2] https://www.theguardian.com/world/ng-interactive/2020/mar/26...

[3] http://www.njha.com/media/316774/2014EconomicImpactReportFIN...

Doubling every 3 days.

Remember the US is short on tests, so I would assume a greater than 20% hospitalization rate because only the most severe cases are being reported.

Mild cases aren't being reported either because none of them qualify for testing and couldn't get one anyway due to low availability.

According to data from the COVID Tracking project, the hospitalization rate nationwide is a bit under 10%[1], with NY at about 13%[2]. No doubt they are missing some cases, since theirs is an exercise in piecing together multiple, manually-curated sources. It seems to be a good ballpark estimate, though.

[1] https://covidtracking.com/us-daily/

[2] https://covidtracking.com/data/#NY

That's not a worst case, it's just the current situation today. The worst case is when we reach peak concurrent infections, whenever that is and however many it is.

My wife is a nurse at a London hospital here in the UK. They're overwhelmed, whole hospitals have been converted to Covid-19 only. A nurse at another hospital here recently committed suicide because she couldn't face treating so many patients dying in agony every day. My wife's ward had some patients with other conditions transferred from one of them, but half of those patients subsequently showed symptoms soon after and now it's going through her hospital like widldfire.

She's currently living in a Premier Inn near her hospital, because her parents live with us. They're high risk and she doesn't want to bring it back with her. She's going to be working shifts over the weekend and I don't know when I'll see her again. She has asthma. Sorry if this is all too anecdotal for you.

This isn't fear-mongering. This is reality.

My dad is a practicing internist in Miami. He told me last night that every ICU in the area is already filled with patients. I doubt every single one of those patients has been tested and is counting towards these official numbers.

This is key. We're still not testing in large enough numbers to know the extent of this.

Seriously? We've watched this thing spread over the past three months. Every single nation and state saw exponential growth of confirmed cases once community spread started happening — often doubling every 2-4 days. The growth continued until serious mitigations (like shutdowns and lockdowns) were put in place.

Why do you think the rest of the US is going to be different? They're just a few doublings (some days) behind.

What did South Korea do to mitigate?

South Korea stockpiled enough supplies to do mass testing and contact tracing right out of the gate. And they have a functional government and a public that knows when to obey.

doesnt sound like what the OP was proposing

also, sk only tested people with significant ailments

There's a difference in timeframe and scope here. You can get away with testing and individual quarantines if you start early.

Now, 1 in 3 (!!) tests are coming back positive in NY. Too many people have it at this point for it to be effective.

Far as I understand sk tested and quarantined contacts ill or not.

Extensive — super extensive — testing, contact tracing, and strong quarantining of suspected and confirmed positives. From the get-go.

yes that all seems like things we could easily do in the US. i dont know why the gov doesnt push this, vs mass ineffective lockdowns

We don't have enough tests to do it. The testing backlog is getting worse — not better. The current backlog is estimated at 7-14 days in some areas.

where did sk get all their tests? they didnt know about cov2 before the outbreak. seems we could fast track test production, or do whatever they did

We absolutely could have... two months ago. There were a number of missteps that cost us very important time:

* WHO developed its protocol based on a German solution and open-sourced it mid-Jan

* The CDC decided to develop its own protocol and finalized it by end of Jan. They told local and private labs that they'd handle all of the testing and thus the FDA did not grant authorization for local and private labs to begin standing up their own testing protocol.

* By early Feb, it was becoming obvious that the CDC tests had manufacturing troubles.

* In mid-Feb the FDA re-iterated its guidance to labs to not stand up their own tests

* On Feb 29, the FDA finally allowed local labs to develop their own tests

* Two weeks later, those other tests finally started rolling in

https://www.nytimes.com/aponline/2020/03/23/us/politics/ap-u...

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...

acted before things got bad, developed a test fast ,massive amount of testing , trace and track , aggressively quarantining people who test positive, providing financial support for people who test + and stop working

That's not fear mongering at all. It's the truth in several areas that were infected early. Spread is exponential and ICU is at the median 14 days from exposure. You would expect the highest density and earliest sites to see overwhelmed ICUs there. That's going to happen everywhere in the next few weeks and months.

The idea you are discounting anonymous sources is ill-founded given this is realtime in healthcare (in which being on record as a source could be an employment risk) and agrees with every analysis, including the briefings from the military and intelligence community given to the president in January and February. It also agrees with analyses of this specific situation, which almost exactly the archetype of the type of pandemic people were concerned about.

I suspect Florida and Louisiana are next. You are also incorrectly aggregating data and not looking at local demographic and healthcare coverage. Beds and ICUs are not evenly distributed. There was a rural healthcare crisis before COVID-19 and the demographics were older with more CFR associated comorbities, too. VA outside of NoVA, WVa, AL, KY, southern OH, MO, AK, AR... it's just a matter of time.

I hope you can make the same comment in two weeks. I think you are way too optimistic about situation.

How are we this far into this crisis and there are still people who don't understand what "exponential growth" and "doubling every 3 days" means? This comment is going to look ridiculous in two weeks' time.

You're only fooling yourself. Everyone except medical professionals in my country were too saying it's not going to be so bad, most people do not require hospitalization etc. etc.

We are now in complete lockdown to avoid full blown meltdown of the health care system. Not as bad as Italy and Spain, but still bad.

What concerns me in the US:

* The spring breakers. Massive number of college students are currently traveling and partying around the country and then returning home to their parents. These are young people without symptoms who are carrying the virus across the country and state borders. You're going to see a massive spike in cases in about a week I am afraid.

* Generally low regard of authorities, and a "culture of individualism". Many people are just going to say it's another scare tactic, "big government", mainstream media, some conspiracy etc. People - up to the president - really think they know better than scientist who have devoted their lives to studying contagious diseases.

* Patch work approach to public health. Each state has its own regulations and measures. This is not good when you need to act fast. I except federal martial law to override states could come to effect (in my country it already is - the government is currently decreeing through martial law and temporarily suppressing basic freedoms like freedom of movement protected in our constitution).

* Culture of working while sick. Many low income earners in US have no access to sick pay so they are forced to work even if sick. I understand this was however being addressed by temporarily introducing federal sick pay? If not, I'd hurry the f-ck up with that. NOW.

Remember that the virus takes effect after a delay of up to 14 days. If you're seeing ICUs filling up today and not taking measures to stop the spread, you're going to require military scale hospitals next week.

The amount of intensive care units (and their type) and their location is more important than the total number of hospitals.

If we applied this reasoning a week or 10 days ago, when there were ~4000 cases in the United States ("we're looking at a worst case of 800 people across all the hospitals in the country"), would we not reach this conclusion:

"Bad situation in Italy. No need to say it's like that in the United States."

And should that not make us concerned about this thought process?

After the hospitals in Wuhan were quickly overwhelmed, we apparently thought it wouldn't happen outside China. After the hospitals in Lombardy were overwhelmed, apparently lots of people in the US thought it couldn't happen in New York like it happened in Italy. So I don't think the argument "It can't happen in NJ the way it is happening in NY" is a convincing one, it's just wishful thinking.

The tragic thing is that neither I nor anyone else needs to argue against this ridiculous "worst case" of 880 hospitalizations (that apparently assumes no growth beyond 4402 cases on March 25): all we need to do is wait until later today when the new numbers come out.

If you're looking for on-the-record sources, every ICU bed in Atlanta is full, according to the mayor of Atlanta.

https://thehill.com/homenews/state-watch/489374-atlanta-mayo...

That's with 1,387 confirmed cases Wednesday, up from 1,097 confirmed cases Tuesday.

And now it's later today, and the increase in confirmed NJ cases is 2,492, or 56% in a single day.

https://www.nj.com/coronavirus/2020/03/nj-coronavirus-outbre...

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