Hacker News Reader

Comment by 3fe9a03ccd14ca5 | Hacker News Reader

What's weird is that the Stanford study was suggested to have exaggerated the results, since those who suspected themselves as having the virus at one time were more likely to volunteer (allegedly). However, those results were nowhere near as big as this (I think like 2%-3% versus the 20%!)

View on HN

Roughly 1/1000 New Yorkers have died of coronavirus. At a 1% IFR, that suggests at least 10% of the state has gotten the virus. Probably more, because deaths are undercounted and many people who will die of the virus already have it but haven't died yet.

In the Bay Area, almost no one has died of coronavirus so the infection rate should be next to nil.

I was astonished by your 1/1000 figure and had to look it up... If anything, its too low. 15k deaths (proven+probable) in 8M people is almost 2/1000.

https://www1.nyc.gov/site/doh/covid/covid-19-data.page

I was referring to the state -- but, yeah, it's even worse in the city :(

and 2/1000 people * 1% IFR => 20%

that's crazy to me, what are the demographics of NYC? Is the population more susceptible to dying of Covid19 somehow? I still can't get my head around why NY has suffered so disproportionately.

There are many close-knit communities in NYC and the surrounding area where people live much more densely (i.e. large family in a single house) and congregate more often with one another than do West Coast types. Jewish communities in New York seem to be especially hit by this; not sure if this is because they did not follow social distancing guidelines, or if they're not possible to follow given unavoidable physical constraints.

Yes, if you look at Israel and Montreal, Ultra-Orthodox communities were hit very hard. Based on infections numbers, not deaths(since it's mostly very young population). Lack of communication and distrust of local authorities (only praying to G-d will help...)

> Jewish communities in New York seem to be especially hit by this

From my understanding they are not hit any harder than other groups, they are just way more visible.

It's a small state with a lot of people packed next to each other. Lots of people use public transit... subways are less than six feet apart.

If the NY subway is anything like London, people will be less than 6 inches apart at rush hour. I imagine that will have played a big part in the spread in both of those cities.

Yes, the subway is the correct answer. That's how this virus spread like wildfire in NYC. Second reason could be the elevators in the tall buildings (there are plenty of those).

A counter argument is that the same didn't happen (or hasn't happened yet) in cities that also have massive public transportation systems like Tokyo or Seoul. There is probably many confounding factors, such as mask use, no talking on the subway, etc, to make pointing to one particular factor very hard.

EDIT: typo

Those cities see more widespread use of masks generally. And specifically once COVID-19 was common knowledge, so was the use of masks.

Widespread mask usage doesn't happen in NYC, same as the rest of the U.S. It's very recent this is practiced in the U.S., whether voluntarily or by order of a handful of local governments. And in my local area where it's not mandatory I only see about 3 in 4 using masks.

And Japan has a culture of talking quietly which greatly reduces droplet transmission even beyond the practice of wearing masks.

NYC has a culture of yelling.

Do you get yelling on the subway in NYC? Passengers in London famously don't even make eye contact.

Yep, I agree with you. I was trying to make the point that massive transportation is not the only factor at play. Like you said, there are many others that should be considered.

I don't think that fully explains it. There are plenty of European cities of similar density to NYC that haven't been hit nearly as hard. Naples Italy, for example.

The most likely answer is that NYC was just a good place for it to spread which had plenty of travelers to get things started fast, but that that the death rates aren't particularly high -- everywhere that has fewer deaths has just had less of their population infected ... so far.

Germany has about as many cases in total as NY, yet less than 1/2 of the deaths. The death rate seems high in NY, maybe because hospitals could not cope?

Germany has about as many diagnosed coronavirus cases; the difference could be wholly explained by Germany testing more people. (Germany has administered 2 million tests, New York State [I didn't see a figure for the city], about 700 thousand.)

> I still can't get my head around why NY has suffered so disproportionately.

Compared to California, NY locked down much later and did it in slow, incremental steps.

In my opinion it is more likely that the main cause is that the infection got here very early, and that the mitigation and containment measures started very late in comparison with cities of similar size and density (Seoul for example).

A dense, mega-city is the worst case scenario for an infection to spread.

population density. you have the density of Asia without the propensity to wear masks.

What's interesting is if you look at the rest of NY numbers (-NYC,LI,Westchester). That has infection at 3.6%. Santa Clara was estimated to be 3% and LA county 4%. So it's in strong agreement with those areas.

But the number of deaths does not agree.

There also appears to be a difference in the strains. The NYC strain seems to mostly come from the European branch, while the CA infection comes directly from China (and likely much earlier in 2020). There appears to be some difference in virulence between the strains.

https://www.medrxiv.org/content/10.1101/2020.04.08.20056929v...

and

https://nextstrain.org/ncov/global

I’ve never looked into that (I know of the hypothesis, though) but IFR in South Korea also seems to be around 1% (or higher), not 0.1%

Can you elaborate?

Percentage of people with antibodies is similar (if you take those studies at face value).

Percentage of people dead is not.

NYC and standord are markably different scenarios. But in each case the percentage of baseline infection to deaths is similarish, even though the percent compared to total pop is quite different.

Nope, the Stanford study had a much lower prediction of the infections to deaths ratio, but that's because its analysis of the data was just wrong.

But we already know the actual infection rate is higher in NYC than CA. The main point that the antibody tests help uncover is death rate.

Exaggerated in that the California study predicted a flu like IFR (Ioannidis, one of the authors, has been pushing that as his pet theory for over a month). This shows it is more likely several times that.

it doesn't contradic Ioannidis at all. He might be right in the end, and that would be an incredibly bitter pill to many.

We are getting closer and closer to the flu fatality rate.

from 5% to 3%, then 1% now 0.5% - smart money (and common sense) would bet that the rate will continue to drop,

I would expect that people living in healthier environment than NYC will fare even better. No way NYC IFR is the upper bound for the rest of the country. You could just as well expect it to be 10x higher than other places.

the flu rate is 0.1%, thus we already hit the order of magnitude.

NYC is a younger, healthier city than the national average. NYC also has one of the best medical systems not just in America, but in the world.

Roughly 0.2% of everyone in NYC has already died of COVID-19. So 0.2% is pretty close to a hard lower bound on the IFR for COVID-19.

And I don't think anyone serious suggests every NYC resident has had COVID. I don't think anyone seriously suggests even half of NYC has had COVID.

That it's a lower bound for IFR in NYC. With how widely that changes based on age alone, it could also vary based on location. Such that NYC could conceivably have the highest value for that in the US.

NYC is younger and healthier than the US average so these are lower bounds for national average outcomes.

A datum that is hard to square when the deaths are still dominated by the older population. If you had convinced everyone over seventy to move out of NYC last year, their CFR would be a fraction of what it is now.

So the IFR will be lower in the rest of the country than in NYC because... they are going to send everyone over seventy to the Moon or something?

No. I was not claiming it would be lower. Apologies if the framing said it that way. I was just pointing out that we really don't have bounds on this anywhere else.

I'm not sure how that matters. We have a lower bound for an optimistic demographic representation of the country. If NYC is younger and healthier than average and is at 0.2%, why would the lower bound for the country as a whole be lower?

I am actually having a hard time squaring the claim that they are younger than the average. The number of people over 70 that have died in NYC is above the number of people over 40 in many cities across the nation.

That all said, my point is that we don't know the bounds. Period. It could be higher. It could be lower. That is why I said it is conceivable. Probably it is about that value in most places. I am interested in where the data falls.

NYC is on average younger than the broader US population.

And the deaths are concentrated on the older population. They do have younger people. They also have more nursing homes and assisted care. They literally have more of everything.

We're looking at per capita rates though so doesn't matter if they have more of something in absolute terms.

Could. If the agitating factor to severe cases is car exhaust, as an example. There are usually tipping points to that kind of thing.

Look, I agree that I don't know. Just trying to get that uncertainty in the counter claims, as well.

I’m talking about having more number of nursing homes because they have “more of everything”, not making an argument about density and pollution or anything like that.

Ah, yes, I misstook your argument. That said, I do suspect having more nursing homes means they have more people over 60 than most places. Which will skew them to have more deaths, period.

Consider, from all that we have seen, elementary schools could get 100% infection rate on the same population size that NYC nursing homes have and not see the number of deaths they have had. It is not controversial that the IFR is dependent on how many people over 60 you have in your population.

To drive that home some, here in WA, fully 92% of the deaths have been in people over the age of 60. It is quite ridiculous how deadly this is if you are older.

All I am saying people there breath the NYC air every single day. Can't possibly be good for them, especially in the light of some chronic pulmonary inflammation induced deaths.

The point on the lower bound of 0.2% is informative. I did not know that.

That lower-bound argument is overly simplistic.

There are huge error bars on that ratio, because "the population of NYC" is not something easily defined, and the death count (at this time) includes a lot of "excess deaths" that almost certainly have nothing to do with the virus (e.g. untreated cardiac arrest).

That's some major revisionism. No credible source was ever suggesting a 5% IFR. For example the Imperial model was using 0.9% given UK's age distribution. That looks likely to be spot on.

And Ioannidis? He was quite certain that the CFR was going to be a little higher than 0.1%. Yes. CFR, not IFR. So he's off by two orders of magnitude.

At various points in interviews and articles he used Diamond Princess, South Korea, Germany, Iceland as strong evidence of miniscule fatality rates, in every single case selectively ignoring that deaths lag symptoms which was already well known at the time. All of them had their death rates double or more after he used them, and it was easily predictable based on recent exponential growth and death lag.

In his stat article he was saying it is conceivable if we didn't know about it we wouldn't have been able to even detect it in the death numbers after it ran its course (he has since walked that back).

Even the other day after his serology preprint he was saying it doesn't seem to have a higher chance of killing you than seasonal flu for each person infected: https://www.youtube.com/watch?v=cwPqmLoZA4s&t=1h9m50s

And he claims the WHO said 3.4% of people who get infected would die:

https://www.youtube.com/watch?v=cwPqmLoZA4s&t=12m54s

But they actually said that was the case fatality rate at the time. Their actual quote was:

> Globally, about 3.4% of reported COVID-19 cases have died

His data from the Diamond Princess is completely outdated. He cited 7 deaths. We are now up to 13 with 7 more on critical condition. He has been completely wrong in each of his predictions.

I would respect him more if he just argued from am economic perspective that the economic damage is greater but his wild hypotheses about Covid being comparable to the common cold or flu have been completely refuted by all data.

> We are now up to 13 with 7 more on critical condition.

Minor note, but it appears we are up to 14 now - https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_D...

> Another Japanese man in his 70s died on 14 April, making him the fourteenth fatality.

0.1% is the flu cfr. 0.6ish% seems to be the corona ifr. these are comparing chalk and cheese. how many people who get the flu never rock up to a doctor? the ifr for flu is closer to 0.01%.

the worst case scenarios are disproven it is true - but so is the idea that it's just a flu.

let us be grateful this trial run of a deadly global pandemic was only moderately bad.

.1% is flu IFR but if I remember right the number doesn't include true asymptomatics which are estimated at up to 75% (which could bring it down to 0.025%). I'm not sure on this, that was on a CDC page I saw.

first you say 0.1% is the CFR for flu then, in the same sentence you claim that it is probably closer to 0.01% because people don't go to doctors with the flu.

Are you arguing that after all this time we still don't know what the actual CFR for flu is? And that the reported CFR is a gross overestimation? - I find that hard to believe.

To me, this feels that once this disease hits the reported flu numbers people start arguing that oh wait, the flu is actually even less dangerous ...

Oh, wait. You don't understand that the CFR and IFR are not the same thing? That explains a lot. I thought you were just being disingenous when comparing the early CFR statistics to the current IFR estimates.

The CFR is, by definition, computed from known cases. It's thus trivial to determine exactly: just divide the confirmed deaths by confirmed cases. So we definitely know the CFR of flu. The problem is, of coures, that it's highly likely to be an over-estimate.

On the other hand, the IFR is hard to determine, since we don't know which cases we missed, nor whether the unresolved cases will end up living or dying. Which is why all we have is estimates.

I'm sorry but 0.1%-0.2% directly contradicts 0.6%-0.9% (or higher because that doesn't account for the lag between infection and death). That's a 3 to 9 times higher death rate.

3.4% was never stated to be anything but the case fatality rate. The WHO's statement was:

>Globally, about 3.4% of reported COVID-19 cases have died

Ioannidis acknowledged that in his original STAT article:

>Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless.

Maybe because he had an editor. But I saw him in a recent video claim the WHO said 3.4% of people who get infected would die. A blatant lie:

https://www.youtube.com/watch?v=cwPqmLoZA4s&t=12m54s

Reply on news.ycombinator.com