This virus is much more transmissible than the viruses we usually deal with in humans.
If a virus has a low fatality rate, but is extremely contagious and prevalent, hospitals will get overwhelmed. A small percentage of a big enough number is itself a big number.
The subway and high-utilization of buses are likely factors in NYC vs. LA. LA is much more representative of the typical US city.
Frankly, I'm not sure why so many on HN are surprised by this. The scientific data on asymptomatic carriers coming out of Italy, Germany, South Korea, and Iceland has been very clear on a majority asymptomatic frame for this virus. I think that maybe authorities and responsible people are concerned that this information could lead to people flouting lockdowns more.
https://www.cebm.net/covid-19/covid-19-what-proportion-are-a...
"Setting: Diamond Princess cruise ship, Yokohama, Japan (n=-634 tested positive).
Proportion: 18%"
Also:
"23 Residents of a Long-Term Care Nursing Facility King County, Washington
10 (43%) had symptoms, and 13 (57%) were asymptomatic."
But then:
"Seven days after testing, 10 of 13 asymptomatics developed symptoms"
That means that just 3 of 23 remained asymptomatic there too, i.e. 13%.
It is estimated that the people mostly spread this virus exactly in the phase where they still haven't developed symptoms, and the virus can be detected. But that doesn't mean they will remain without the symptoms.
Like you said, probably only 10% to 15% truly asymptomatic.
Especially as we know the disease affects these demographics up to 100X more than the young.
For instance consider: "Emerging evidence suggests many more people are infected than tested. In Vo Italy, at the time the first symptomatic case was diagnosed, about 3%, had already been infected – most were completely asymptomatic." [1]
[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
Not a covid-19 symptom.
EDIT: I'm wrong, sorry. Thank you to kgwgk for the correction.
The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, NASAL CONGESTION, runny nose, sore throat or diarrhea.
The optimistic take on this is: that means soon enough will be exposed that their immunity will stop the spread.
The pessimistic take on this is: we also don't have strong evidence that the previously exposed are immune, ie, have a strong enough immune response to stop the virus.
I don't know if there is a "right" policy answer on what to do with something like that.
As someone else said, the lockdowns are probably illegal, you can't just throw away freedom of association over the flu. But if we didn't have them, we might have seen another 100k dead..
Where did you study constutional law? Rights granted in the constitution are subject to many restrictions. There is no explicit "freedom of association" in the Constitution, although it has been held to be implicit in freedom of speech. Free speech doctrine includes a "time, place, and manner" test that's applied to restrictions on speech when the government has a "significant interest" in the restriction[1] (e.g., national emergency for a viral pandemic). I don't know how the lockdowns (which are mostly not full lockdowns) would fare if Supreme Court were to apply the time, place, manner test, but I wouldn't presume to offer an offhand opinion that they're "probably illegal".
[1] https://en.wikipedia.org/wiki/Freedom_of_speech_in_the_Unite...
A law has to exist that gives states and the federal government the ability to do what they are doing and that law needs to not violate special protections built into the Bill of Rights.
With a state of emergency declared, some things can temporarily be enacted that under normal circumstances would not be legal.
I don’t know if all the lock down rules are legal, but I wouldn’t be surprised to find out that governments have overstepped their bounds.
A) Everything is illegal for a citizen unless granted as legal by a state or federal govt.
B) The fed govt. can do anything it wants. The only things it cannot do are things that are expressly forbidden.
C) A state can do anything it wants unless a law prevents it.
D) A state of emergency does not expand the powers of the the state or fed govt.
Those are the reverse of what I said I remember and none of those sound right.
(for C/D, ignoring the supremacy clause)
Because people on here panicked without thinking and don't want to admit it.
No one wants to say "Oh yeah, I ignored second year calculus and never bothered plotting logistic growth curves with the full spread of expected fatalities. Because of this I supported legislation that's started the next Great Depression. But I meant well!"
I can't speak for the original commenter, but I think the evidence increasingly suggests that we would benefit from allowing people to visit small groups of friends and run non-essential businesses.
So either everyone in New York City was infected, or most probably 200-400k infected in LA is an order of magnitude of wishful thinking (e.g. ~2% false positive test rate.)
EG this from UK https://twitter.com/ONS/status/1252518098047041536
California local and state government being ahead of NY in issuing shelter-in-place orders even though NY was being harder hit even before the divergent response also makes a difference. But, yeah, the hyperdensity of the NYC metro area is a big factor.
Previous studies suggested that the strain circulating in NYC is of European origin, whereas the California strain, arriving earlier, was of Asian origin.
It's always possible that the NYC one is more fatal. We don't have data, but it is possible.
Thing is, though, at the peak, NYC was seeing a 60% positive rate on tests and is still seeing something near 30%. That pretty much guaranteed that the vast, vast majority of NY cases were not detected, and still probably are not.
(Italy is back around 5-6% again, for example)
It must be the case that a dramatic percentage of NYC is infected. Certainly not more than 100% as some oversimplified maths suggest, and likely not 80%+ that would be very comforting -- but quite likely between 30% and 45%, given the Stanford and LA studies, and the NYC testing data.
But also, NYC is considerably more dense, so diseases spread far more rapidly. Especially so considering heavy public transit use versus, what I would say is, extreme overuse of personal vehicles.
I love it when people have strong opinions about a complex, constantly changing piece of difficult science.
As I've mentioned before, using CFR to determine fatality rate of the disease is like trying to determine the fatality rate of skydiving by measuring the ratio of people who go to hospital with skydiving injuries over those who recover. Obviously you'd think skydiving kills basically everyone who does it, but it just doesn't.
It's starting to become clear that the infection fatality rate of COVID is in the lower quartile of the range 0.25-1%.
And yeah, a huge portion of New York likely has it. It's super contagious.
The article says 221,000 infected at a 2.8% rate, in "early April". So they're assuming a 7,892,857 population. Currently, we have 601 Deaths total in LA[1], which we can assume are a result of early april event on April 20. So a 0.002% "fatality rate" relative to total exposures, "Woohoo" (NOTE, this is an optimistic figure implied by this study, the standard 2% [edited] previously claim but still not equivalent to the flu, which has 0.2% [edited] relative people who get sick). Now, with weekly doubling: 221,0008 = 1,768,000 infection now = 22.4% - > 4808 deaths. However, past 10%, we can ask whether we start reaching saturation/diminishing returns. But that is a key question.
-- Let's look at NYC. There we have 14,500 Death. Using the article's implied figure, 14,500/ 0.002 = 7,250,000 infected on April 1, out of 8,398,748. So this implies an infection rate of 7,250,000/8,398,748 = 86.32239%, which, in fact, seems very implausible and which implies; a higher death rate among "vulnerable people". Maybe we're about to hit full saturation with NYC and see an immediate decline.
Now, the other bad* scenario is the possibility that a lot of sickness and death NOW is being driven by reinfection, that exposure isn't giving much immunity at all and instead of the unexposed dying, what we're seeing is the re-exposed dying and with this dynamic, the death rate settle into a steady and unacceptably high level. Note that Italy, which has seen a high death rate, hasn't a strong drop-off at all, just gradual plateauing. IE, guess what, one possibility is "herd immunity" just doesn't exist for this virus.
Anyway, time will tell, literally a week will tell if NYC has enough fatalities to make this 0.002 exposure-to-death rate numerically impossible.
[1] covid-19.live
Edit: corrected conversion ratio to percentages.
Italy has had 24114 deaths. If take those as being in Northern Italy with a 27,000,000 population, that's 0.8931 % of the entire population. Even adjusting for age, that can't squared with 0.002% death rate [wrong wrong, it's 0.08931%, which is possible but with a huge infection rate, which maybe].
For example:
> So a 0.002% "fatality rate" relative to total exposures,
You appear to be deriving this from the computation 601/221000. That gives .27%, not 0.002%.
> Italy has had 24114 deaths. If take those as being in Northern Italy with a 27,000,000 population, that's 0.8931% of the entire population
No it's not. 1% of 27M is 270k, not 27k.
Yeah, 0.08931% of the population of Italy experienced fatality.
If we assume .2% fatality rate, that implies 50% of the population was infected (which might make sense with an extremely contagious virus but that's more than even the cruise ships).
Florida has 20% of it's population over 65 and it's 21 million people might similarly be rather hard hit.
It's totally despicable, and it's not my position.
I propose we do what the UK proposed, and what Sweden is doing: keep all vulnerable folks inside, provide them with services such as groceries and any healthcare they may need on-site, and release the low risk to build a protective barrier of herd immunity around them. That should have been evident when I said "old people were hundreds of times worse off."
That's totally orthogonal to my point, which is that you can't project the mortality rate of a population that's overwhelmingly disproportionately affected, scale it linearly onto the world population and assume that'll be at all representative of the reality on the ground.
And yes, Florida may be affected very badly, and the plan may need to be adjusted accordingly.
This would explain: NYC vs LA vs Italy. Why isn't this theory brought up more?
"Wang, whose full name has not been disclosed for privacy reasons, is one of more than 100 reported cases of Chinese patients who have been released from hospitals as survivors of the new coronavirus — only to test positive for it a second time in the bewildering math of this mysterious illness."
https://www.latimes.com/world-nation/story/2020-03-13/china-...
Because if reinfection so close to recovery were possible, it would make this virus really unique, and it doesn't really fit the available data very well. It makes much more sense that the virus takes a long time to clear after symptoms abate, and the tests have a really lousy false negative rate.
Moreover, if a lot of Covid infections are in the area and the virus is mutating quickly, a person might be exposed to a different strain soon after recovery and wind up infected, if the SAR-COV-19 is similar to the common cold. This would be hard to notice, since it would tend to happen as the virus was spreading rapidly anyway. It would become a problem only if people expected the virus to abate once everyone had been exposed.
See: https://www.technologynetworks.com/immunology/news/why-dont-...
This kind of speculation is relevant to the more irresponsible approaches; "developing herd immunity" and "immunity certificates" but it mostly should be a reminder to "don't do that because you really don't know what you're getting into".
Regional differences? Lombardy's death rate is less than half of peak
It seems weird to think the body can clear an infection but have no ability to fight it later.
There's been only a very few cases globally where a person who previously tested negative later tested positive, for which a test giving a false negative is a much more likely explanation - especially as these cases were early on when tests were more unreliable. Otherwise - everybody else who tests negative does so consistently.
The virus is very similar to the original SARS (genome about 80% the same which is huge). It is a relatively stable by virus standards not mutating massively. In fact, if you had SARS your are likely immune from covid19: https://marlin-prod.literatumonline.com/pb-assets/journals/r...
So the general scientific consensus I have seen is that there's no evidence to suggest covid19 is some sort of supervirus that will reinfect people and defeat your immune system.
There's also been some animal testing on reinfection : https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1
I add this point because most of speculative arguments are used to claim allowing the virus infect a large portion of population won't cause much harm.
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-d...
[1] https://fee.org/articles/sweden-s-top-epidemiologist-covid-1...
[2] https://aatishb.com/covidtrends/?location=Canada&location=Sw...
The First Amendment very clearly binds only Congress in its literal reading: it begins "Congress shall make no law..." And there is no literal text in any subsequent amendment that might cause incorporation to the states--the Fourteenth Amendment only literally incorporates the Fifth Amendment, and that by literal repetition of the text.
Biological and nuclear weapons should not fall in the scope of the 2nd amendment. They're useless for guaranteeing your liberties against a tyrannical government, and the consequences for storing them improperly are severe.
Depends on who's attacking and what might deter them.
> They're useless for guaranteeing your liberties against a tyrannical government
Which is only part of "the security of a free State", not all of it. The militia was also for repelling foreign invasions.
Given our current modern world, I would agree that weapons of mass destruction (nuclear, biological, and chemical) shouldn't be available to anyone who wants them; but the correct legal way to make that happen in the U.S. would be to amend the Constitution to explicitly add that exception to the Second Amendment. As the Second Amendment is currently written, it does not admit of any exceptions. As I noted in another comment upthread, privately owned warships were significant at the time the Second Amendment was passed, and the framers of the Amendment did not exempt them from the category of "arms".
No, it isn't. In the time period in which the Second Amendment was passed, privately owned warships of similar capability to the ones in national navies were common enough to play a pivotal role in two wars (the American Revolution and the War of 1812).
However, the colloquial use at the time of the phrase "arms" almost certainly referred to small arms, but would have included knives and swords (State v. Kessler 1980[1]) which are paradoxically much more heavily regulated than firearms in most states. See also "To Bear Arms"[2], by which the modifier "to bear" suggests arms that could be carried.
Perhaps one counter argument to this point was the desire by the framers to include a conscientious objector clause obviating military service for people who had specific objections, which may support the view that "arms" was anything in use by the military of the day, but the clause was stricken from the constitution for fear that the second amendment may be interpreted by later generations as a right that could not be enjoyed by the people and was intended to encompass military service.
There is also the argument that the framers opposed the idea of a standing army, which would support your viewpoint, and there is an excellent essay[3] that makes a fair and reasonable argument to this end.
My personal opinion is that this isn't clear, but it is obvious that--at a minimum--the interpretation of "to bear arms" would suggest that the 1986 ban is unconstitutional, as is the 1934 NFA tax act that required registration. I'm not convinced "to bear arms" includes other weapons that could not be "beared," such as warships, but perhaps this will clarify my thought process for you.
[1] https://law.justia.com/cases/oregon/supreme-court/1980/289-o...
[2] https://guncite.com/gc2ndmea.html
[3] https://tenthamendmentcenter.com/2016/06/30/what-does-the-wo...
Perhaps it did, but whether it did or not, I don't think its use in the Constitution can be reasonably described as "colloquial". Since no specific restrictions were set out by the framers, I think they intended a broad right, not one restricted to small arms. Of course my opinion is an extreme outlier given current jurisprudence on this topic, to say the least. :-)
> it is obvious that--at a minimum--the interpretation of "to bear arms" would suggest that the 1986 ban is unconstitutional, as is the 1934 NFA tax act that required registration.
I agree.
> I'm not convinced "to bear arms" includes other weapons that could not be "beared," such as warships
Currently that question is moot in a practical sense, since nobody appears to be in the market for privately owned warships. And I will cheerfully admit that if we could get to a point where it was generally accepted that people had a right to bear small arms, and the arguments were over other categories, I think that in itself would be huge progress from where we are today. If that happened, I wouldn't spend a lot of time complaining that everyone recognized my right to keep and bear an AR-15 but I was being given grief about wanting to buy an aircraft carrier or a nuclear submarine. :-)
"Arms" was used in colloquial speech and legal use at the time which converged on approximately the same definition. It's late, but there are some resources on guncite that support this argument. They're all worth reading beyond this reason, mind you, and there are plenty of arguments there that disagree with mine.
Either way, it makes for good reading should you find a topic there you're not already familiar with, and even if you are, there are some interesting twists. I don't necessarily agree with all of them.
> Of course my opinion is an extreme outlier given current jurisprudence on this topic, to say the least.
Suffice it to say that I understand where you're coming from, but in my definition a broad application of "military small arms" is probably more accurate according to my understanding of what was intended. The problem is that I don't know, nor will we ever know for certain, since the militia (rather, the people) were to act as the nascent US' standing army. I rather wish this point were discussed in civics classes, but it's not. So, the younger generations are woefully unaware of history, much to no one's surprise...
Anyway, while I also wish we could undo some of the impingement on our rights by legal challenges made in the 20th century, I'm afraid that would be an uphill battle (as you also allude) given how panicked the general public is on loosening firearms restrictions thanks in large part to the unnecessarily excessive coverage of mass shootings that seem focused primarily on stoking fear.
But, if you allowed me, I'd probably rant all night about this subject which wouldn't do either of us much good by the sounds of it, other than reaching continued agreement and probably upsetting other readers.
> since nobody appears to be in the market for privately owned warships
...admittedly a shame!
> I think that in itself would be huge progress from where we are today.
Agreed. Somewhat surprised to have this conversation on HN of all places, TBH.
> ...that everyone recognized my right to keep and bear an AR-15
I live in an open carry state and sometimes exercise that right, particularly since I live in an area sometimes subject to wild animals. But while I would love to do the same with an AR, I suspect that would probably get me called in to the local sheriff's office. Not that they would care, but I would be disappointed if someone thought it apropos to waste their time.
The coronavirus bans on public gathering are fairly clearly permissible under SCOTUS precedent.
So no.
Just because a majority of people do sensible things doesn't matter. The actions of the irresponsible and sociopathic minority still create the epidemic.
Absent the data from widespread testing, the spread of the disease was consistent with two epidemiological models -- low-contagion/high-mortality and high-contagion/low-mortality. In the latter model, there's not much to be done to stop the disease from infecting the population at large, and not that much that needs to be done, since the vast majority of people will emerge unscathed. But in the former model, it matters tremendously -- doing nothing will slowly but surely result in vast loss of life but quarantines can stop the disease dead in its tracks.
Therefore the most cautious course of action, from a public health perspective, was to assume the former and proceed with a regime of extreme social distancing. Unfortunately doing so had dire economic consequences.
- The way deaths are counted in each state
- Daily Temperature
- Comorbidity percentage difference for residents - https://covid19tracker.health.ny.gov/views/NYS-COVID19-Track...
it's been unseasonably cool in socal for the duration of this so i doubt it's that.
Sweden has about 23 active cases for each one recovered. The US is about 10:1, Europe overall is about 2:1, so is Italy, and Spain is close to 1:1. Asia as a whole is about 1:1.
[edit] I misread, disregard, but preserving for posterity.
Now, 11/100 blood givers in Stockholm who has not been sick in the last two weeks have antibodies according to researchers.
That gives you a naive mortality rate of 0,4% per infection, assuming the spread among bloodgivers is the same as the population in general and just dividing the death count by 11% of the population. It is a high eastimate as I guess many wont get traceable antobodies and mostly asymptotic people give blood.
[1] (Swedish) https://www.folkhalsomyndigheten.se/publicerat-material/publ...
The worst flu season we saw in a decade killed (~80k / 300M) = .02% of the US population. NYC has seen ~14000 deaths, or .18% (~14k / ~8M) death rate for the entire population, and while the absolute worst may be over, people are still dying at a high rate in NYC.
The only way I can make sense of this is that you're somehow mixing figures relating to deaths in healthy populations (COVID) vs. overall death rates in flu (including older/unhealthy populations).
If we don't develop herd immunity ASAP, and instead pursue a course of lockdowns, as soon as we lift the lockdowns (either voluntarily or because people just walk out -- see the midwest), we'll immediately start playing rolling lockdown whack-a-mole as China is. The first contagious person who flies in from a foreign country (or domestically) without perfect lockdowns will re-ignite the wildfire.
We should do exactly what Sweden is doing and what the UK proposed: isolate and provide support services to those who are at risk, and let out those who aren't. I think it speaks volumes that Sweden's new infection rate stabilized at the same time as the rest of the world but without lockdowns.
It's really the only path forward. Is it perfect? Of course not. People will die. However, there's no world in which about 70% of the population won't get the disease before the vaccine arrives, so we need to control who gets it, when, and in what order, to minimize harm.
While I agree mostly with your assessment, it's worth mentioning that the lack of official lockdown in Sweden doesn't mean there isn't a lockdown. According to Google's mobility data for Sweden, their lockdown activity looks pretty similar to what we see in the US. People are voluntarily staying home.
Since Sweden doesn't have a lockdown, this statement is meaningless. A major objection to lockdowns is their involuntary nature. In general, there is a big difference between choosing to stay home, and being coerced (with the threat of force) to do so. One is "choosing to do what you believe is best", the other is "prison".
In the meantime, the coastal town that I live in is getting swarmed with out of town visitors every weekend. This is in violation of the shelter-in-place orders. Other towns have stepped up enforcement to combat this type of behavior, but our police department is small and does not have the resources. We shut down the parking lots, but now they just park in the neighborhoods. And to add insult to injury, we have a large senior housing complex at the entrance point to my neighborhood.
I have little faith that the US could achieve the type of distancing and isolation necessary on a voluntary basis. There is a sharp vein of individualism that runs through our society that works strongly against us in these types of situations.
It's by no means a "hope and pray it goes away" or a "lets wait it out until a vaccine" -- it's a "let's get everyone not in a risk category infected as fast as possible so long as the healthcare system retains some excess capacity."
> healthcare facilities remain un-saturated
You can't simply look at the current burden on the health care system to guide the process. The virus has a 2-3 week lag time between when an infection cluster breaks out, and when the health care system starts to feel the impact. Without wide scale testing, we are just going to end up back in a lock down once the infection numbers start climbing again. And I can't think of a worse scenario for our economy than having to shut things down every other month because our government is to incompetent to implement a tracing program that multiple countries already have up and running.
It's a creative interpretation of the facts.
One important note: it's impossible that NYC is overestimating cases by 100x. Close to 2% of NYC has confirmed cases.
This has included a couple lf suicides of folks who had respiratory illness prior to death, and one person who got in an auto accident and died of head trauma -- but he had tested COVID-positive.
Yes, most people right now who get a respiratory illness and then die probably did have COVID -- and it is possible that some folks are dying of COVID and being uncounted to offset some of the overcounting -- but with death numbers counted so loosely, it is hard to know the real story, and impossible to do simple maths using rates from one place at one time to compute rates at other times or other places.
I tend to think that NYC must be approaching saturation, and that the true new-case numbers must be falling there, but it's impossible to answer with certainty using only the numbers we have here on the internets.
No, this isn't what's happening.
Doctors who are sure to the best of their knowledge and experience that the deceased had covid-19 will put covid-19 on the death certificate, and they will also say if they think it contributed to death.
That's not the same as "anyone who dies with covid-19 is being described as killed by covid-19".
In some countries they absolutely do count anyone who dies while in the possession of COVID as a COVID death, for instance Italy. " Italy’s death rate might also be higher because of how fatalities are recorded. In Italy, all those who die in hospitals with Coronavirus are included in the death counts."
“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88% patients who have died have at least one pre-morbidity – many had two or three.” [1]
In New York they're counting speculative COVID deaths of anyone with respiratory illness even if they've never tested positive [2].
"A subtler issue is what to do when the patient has other serious medical conditions. If the person suffered from chronic lung disease, then became infected with the virus and died of pneumonia, the immediate or primary cause would be pneumonia as a result of COVID-19. The lung disease would be listed as a contributing condition, said Sally S. Aiken, president of the National Association of Medical Examiners." [3]
The CDC has guidance on this but it's fair to say its interpretation will vary from place to place. "COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death" -- that's pretty broad. [4]
Sorry, Dan, this is looking like it's not the Ebola infection you're making it out to be.
[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
[2] https://www.cnbc.com/2020/04/15/coronavirus-new-york-city-st...
[3] https://www.inquirer.com/health/coronavirus/coronavirus-covi...
[4] https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-I...
The problem here is that you don't know what "COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death" means.
Here's one for the UK: https://twitter.com/ONS/status/1252518098047041536
On the other hand, there's one very specific way that considering NYC gives us data we can't (yet) get elsewhere. While it's possible that we're underestimating disease prevalence by 50x elsewhere, it's basically impossible in NYC (almost 2% of people already have tested positive, with less than 10% of the population being tested).
Depends on whether mortality rates can be variant on environmental conditions, such as viral load, population density, access to healthcare/ICUs, population socio-demographic profile, etc.
What I would still say is that it's reasonable to say "NYC has .18% of its population dead. It's extremely implausible that this disease is no more lethal than the flu is, when that's 10x the overall death rate from the flu. If you present me evidence suggesting that from elsewhere, it's going to have to be quite strong to overcome the evidence from NYC."
edit: it shouldn't be controversial to say that a thing that kills 30-80k per year with active measures of mitigation already something that would be more deadly without a vaccine. seriously reflect on that. the corona virus is something we need to take 100% seriously but also acknowledge that the flu is also very deadly... even more so without any mitigation (thankfully we have for the common flu)
The flu as-is causes 45,000,000 sicknesses every year in the US alone.
If people there stopped all preventative measures, yes it would get much worse than 3x.
So it seems like there should be no possible way to frame it as less severe than the flu, even only comparing to when the flu is at its worst and even assuming 100% of the population has covid or whatever other extreme things you want.
If we assume that COVID is spreading like wildfire (it is), and that we're front-loading the cases (we probably are), and that immunity will be built up as one-off instead of like having the disease mutate substantially every year like the flu, over a few years, it could easily be better.
I'm not saying it is or isn't, just that there is a path.
If we compare this with complete shutdown of all public activity on the other end of the spectrum, we can see there are things we could be doing that are on neither ends. Maybe distancing but not shutdown, or avoiding some mass gathering but still being ok with individual meetings, or having places like restaurants operating at reduced capacity to ensure people aren't too close to each other, or ask people to wear masks when they enter stores, etc. And strict lockdown for places like nursing homes, but more relaxed for places like college, or having people of high-risk groups to work from home, but people with lower risk be allowed to work in the office. I'm not saying it's the right way to do right now, but it's a possibility, there are options.
So if this is e.g. 50 times worse than the flu, then trying any of the above may be too risky. But if it's kinda sorta like the flu, maybe somewhat worse but not 50x worse - then it may be prudent to consider measured response, given that for the flu we basically have no response at all and we're ok with that.
None of us know for sure, but isn't it plausible on the face of it that something 10x worse that could easily become 100x or 1000x worse warrants the lockdowns? I don't know if this is common sense, but in an alternate universe it could be.
At about 10 weeks into the H1N1 influenza pandemic, we had a CFR of between 0.1 and 5.1% depending on the country as compared to 0.07 to 14.93% for COVID. H1N1 ended up with an actual IFR of 0.02% or one fifth of the low end of the CFR range.
Honestly, it's probably a maximum of three times as bad as H1N1, especially when you consider Italy later admitted of its 13.22% CFR, 88% of that number was "people who happened to die while COVID positive" instead of "likely died of COVID". [1] Huge deltas in CFR are likely attributable to mess-ups along the way and how COVID deaths are counted.
10X as bad is likely on the very highest end as Sweden hasn't locked down anyone, suggesting common sense instead, and their new case rate flattened out right alongside the rest of the world. 1000X is totally out of proportion with the data. [2]
I suppose we don't know for sure but we do have two and a half million data points which is enough to make a pretty good guess.
It's kinda starting us in the face that it's kinda like a bad flu except worse for old people, who we should lock down and look after as we build herd immunity.
[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
[2] https://aatishb.com/covidtrends/?location=Canada&location=Sw...
That seems impossible. CDC estimates 61k flu deaths in 2017-2018 and 34k in 2019-2020: https://www.cdc.gov/flu/about/burden/index.html
That is nowhere near 1.3k per day.
And this report relies on figures that diverge dramatically from the COVID death tolls. It lists the current total report as around 15k, when we're close to 3x.
Here's some more data. What I'm saying (that it's approximately the same as the flu for the young, with some early evidence pointing to it being better) isn't particularly controversial and well supported by evidence [1] (also older, April 14th). CDC as of late March "... no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups." [2] In Italy nobody under 30 died, and only 5 people between 30 and 39, as of April 19th -- yes in spite of a CFR of what, 13.22%? [3, 4]
More data as of April 20th from Oxford [4]. Scroll through all the data the world has to offer, I'm not wrong on this. I repeat, the facts you're arguing with me over, without citing data to support your case are not controversial. Surprising maybe, but not controvercial.
Especially when you consider (an albeit bad flu): the overall case fatality rate as of 16 July 2009 (10 weeks after the first international alert) with pandemic H1N1 influenza varied from 0.1% to 5.1% depending on the country. [4] The flu can absolutely be very bad is the take away there. And yeah this is worse than the flu, by around 3X on both ends of that range. Not bad, not great.
> It lists the current total report as around 15k, when we're close to 3x.
They actually address that critique, that it takes a few weeks for case data to be finalized and reported upwards, so the CDC data can be up to a few weeks behind. It's not divergent, it's delayed. This is a live list updated and maintained by the CDC. Make of that what you will.
[1] https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-d...
[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
[3] https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho...
[4] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
There are 400 covid-19 deaths reported so far in the 18-44 age group in NYC. There are 3.5 mn people in that age group in NYC. That's over 11 per 100'000.
The mortality per 100'000 for the 18-49 group in the US estimated by the CDC was in the last nine flu seasons: 1.8, 2, 1, 1.2, 0.7, 2.5, 1.5, 0.5, 3.9.
It's a stretch to say they are approximately the same and definitely 11 is not better than 0.5-3.9.
Not to mention, flu deaths are attenuated by flu shots, and pre-existing immunity. It's totally plausible that there are many more COVID cases than flu cases in that age group -- and of course those flu deaths will happen year after year while COVID is a very stable virus, and if you get it once, you probably won't get it again.
Certainly not enough data to conclude it's way out of line with the flu for this age group, in this season let alone if you factor in a few seasons end on end.
Lastly, with H1N1, the numbers are quite different, too.
The infection fatality rate for seasonal flu [edit: in the slightly older 18-49 group] is around 0.2% considering symptomatic cases, and probably there are as many asymptomatic cases which give 0.1%.
So yes, it's not impossible for the infection fatality rate to be similar. With some strong assumptions including that it's five times as contagious. So yes, it's not impossible for the acumulated lethality over five years to be similar. And if you extend the period the common flu will be much more dangerous, specially as this young people became older.
7 under 30 and 40 between 30 and 39. One order of magnitude more.
https://www.epicentro.iss.it/en/coronavirus/bollettino/Repor...
I wonder if you can back that up with a reference.
"The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.
"On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three," he says.
"Other experts have also expressed scepticism about the available data."
"Report from the Italian National Institute of Health: analysed 355 fatalities and found only three patients (0.8%) had no prior medical conditions. See Table 1 in the paper; (99% who died had one pre-existing health condition): 49% had three or more health conditions; 26% had two other ‘pathologies’, and 25% had one." [2]
(For what it's worth in my reply I called it out as "[4] from the parent post" which is [1] here -- sorry for the confusion -- all I meant was that the Italian data skews very high, both because it's the oldest region [Lombardy] in the oldest country in Europe [Italy] -- and because they were very generous in how they ascribed cause of death).
[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
[2] https://www.stuff.co.nz/national/health/coronavirus/12044372...
Actually the official number is grossly under-reporting COVID-19 deaths:
"We estimate that the number of COVID-19 deaths in Italy is 52,000 ± 2000 as of April 18 2020, more than a factor of 2 higher than the official number."
https://www.medrxiv.org/content/10.1101/2020.04.15.20067074v...
Less than 9000 COVID-19 deaths were reported in Lombardia by that time. If you think they are too generous classifying deaths as being caused by the infection, what would you say that caused the death of more than twice the usual number of people during the period?
That's a whole lot of people left out of your number. A quick google suggests that 1/3 of Americans have hypertension and 9% have diabetes. It seems like probably the majority of the US has at least one of these underlying illnesses.
As compared to the IFR: "The term infection fatality rate (IFR) also applies to infectious disease outbreaks, and represents the proportion of deaths among all the infected individuals. It is closely related to the CFR, but attempts to additionally account for all asymptomatic and undiagnosed infections." [1]
One's the risk that given you show up at a hospital, you die. The other is the risk given that you get infected, you die.
One factor could be the nature of transmission. Regions where transmission occurs with high viral loads entering at the point of infection (for example, hospital-acquired infections) could see more severe disease progression. You would therefore expect a high hospitalization rate relative to prevalence. It's possible in other regions, including CA, hospitalization rate as a function of prevalence is lower because acquisition is largely at lower viral loads resulting in less rapid and severe disease progression. This is, of course, a hypothesis and very likely not correct. Time will tell.
Other important factors include age distribution of infection, as well as weather conditions and prevalence of pre-existing conditions.
I can't tell you how many people ride the subway every day, but it's certainly less than half of the number of rides per day.
One way to explain the hospital surge in NYC is that a small percentage of people have had a highly fatal disease. Another plausible explanation is that a much larger number of people have had a less-fatal disease.
To date, we've had very poor estimates for fatality rates and prevalence. It wouldn't be shocking at all to find out that we're off by a factor of 10-, 20-, or even 50-fold.
That isn't impossible at all, given that the population of NYC is around 8.8M people. It would mean that the city is approaching herd immunity.
(I don't personally think the ratio will be as high in NYC as in LA, but that's just a hunch based on the higher testing rate.)
Basically, you're just saying that you don't want to believe what they're saying, therefore it's hard to believe. But there's nothing illogical or impossible about it in the slightest.
I am willing to bet the farm that it won't.
Also, having antibodies and being hospitalized is a very different thing. If a lot of the cases are asymptomatic or very light you won't see hospitalizations and you'd never know the person had an encounter with the particular virus until you do mass testing. And NY is quite different from LA, as far as I know, in terms of how dense population can be and how much people use mass-transportation and other high-risk scenarios, and the probability of being hospitalized may also depend on that (in other words, it may matter not only whether you had any contact with the virus, but in which circumstances and how much of the contact you had).
That doesn't prove the study is true of course, but I don't see anything from comparison with NY that makes it implausible on its face.
[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...
15.6% of pregnant woman at a given hospital were PCR confirmed over 2 weeks. I haven't seen strong arguments this wouldn't be broadly characteristic of the overall population. Worse (or better depending on how you look at it), there's significant false negatives with PCR testing.
It's credible NYC could be at 30% by April 4 and given that confirmed cases doubled since then, could be at 50%+ by now.
Everyone is eager for these results, because there’s a good chance that the true case count is higher by anywhere from 2x to 100x. If it is, then proportionally fewer people are expected to die as the virus eventually does churn through the whole population.
It’s probably still too early to tell, but this is promising.
But just from a logical perspective it follows clearly from this data, and there's nothing fundamental about the situation that makes it particularly unlikely.
Of course it's quite possible that the LA data isn't really applicable for any number of reasons. But the idea that COVID will run through dense populations mercilessly, but quickly, and then sort of peter out is completely within the range of possible and non-shocking outcomes.
It's the natural outcome of an extremely communicable disease with a large prevalence of asymptomatic transmission and there's plenty of corroborating evidence for the idea that this is one of those.
It's also quite likely that the false-positive rate with this test is super high. Who knows.
The tobacco smoking rate in New York is 14.1%; it's 11.3% in California. Some difference, yes, but far less difference than you see between either and some rural southern states where the numbers can be roughly double that.
The people are probably healthier too.