Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought?
In the field it appears many/most of the less severe cases don’t exhibit the initial set they had defined, so patients experienced illness written off as not COVID-19.
From what I’ve heard from the field, a careful patient history finds there was typically a bout of unusual “but it can’t be COVID” illness with a set of the expanded set of symptoms in almost every “asymptomatic” patient.
It’s further speculated these variations may have to do with level of exposure and path of infection, along with the earlier noted lung health and comorbidities.
https://www.santafenewmexican.com/news/local_news/what-happe...
https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-p...
Virus aside, when are they not?
A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. It could also be there are bad and not-so-bad strains. Or it could be bad down-the-line.
Until we do have proof, I'm advocating being conservative. In 2 weeks, we'll know if people are turning up in ERs or in morgues. In a few months, we'll know about lung damage, immune system damage, strokes, or a lot of the other potential consequences. In a year, we'll know about vaccine and long-term immunity.
I think the key problem here is failure to understand risk management. I can believe one think, but act another way just in case I'm wrong. Or I can be unsure. And so on. That nuance is lost in the right/wrong discussions.
I think at this point we know enough to say:
1) For most of the population, the virus is not that serious
2) For a subset of the population the virus is seriously deadly. For example, ~20% of NY state coronavirus deaths were from nursing homes, ~37% are 80 or older. By contrast, there were 2 people under the age of 10 at the time of this post. [0]
> I think the key problem here is failure to understand risk management
I think another key problem is a failure to be frank about the cost-benefit of our actions. I have had to make stronger cases about changing the color of a button or optimizing a backend call than I've seen presented by authorities who are shutting down or reopening or anywhere in between.
[0] https://covid19tracker.health.ny.gov/views/NYS-COVID19-Track...
Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy. Second order effects include reduced vehicle deaths, reduced deaths from pollution, etc. IE, my discussions has felt agenda driven because it considers first order effects only.
If we're going to compare apples-to-apples, I'm willing to have that conversation. If the conversation is limited to "people die during recessions", it's a pretty clear signal that agenda is driving and would not be a productive use of my time.
The deaths in New York are quite telling for who is at risk, see https://www.statista.com/statistics/1109867/coronavirus-deat....
Over 90% of the dead so far are old with comorbidites such as Hypertension and Diabetes, see https://www.bloomberg.com/news/articles/2020-03-25/most-nyc-....
So i agree that "not serious" is an accurate statement.
There remains a required link to why this isn't serious for young people. And from there, an argument that this situation is better than the other scenarios (including 2nd order effects from other scenarios).
See https://www.statnews.com/2020/03/30/what-explains-coronaviru...
That could explain why Monaco and Japan have not seen a lot of deaths, while Italy and Spain for example have.
In the US it would help immensely i think, if obesity and hypertension became a focus area when this crisis is over.
Deaths are telling for who is dead, not for who is at risk of lung damage, compromised immune system, or other consequences.
Africa have registered 1,297 deaths with a population of 1.2 billion (https://www.africanews.com/2020/04/24/coronavirus-in-africa-...).
Given the fact that 8.8 million die yearly, i'd say that for Africa this disease can be classified as 'not serious'.
If I break both of your legs, that's serious. You're not dead.
If you catch AIDS, that's pretty serious. You're also not dead for a pretty long time.
If I poke your eyes out, that's serious. You're also not dead.
You've redefined a serious medical problem at one which kills you. COVID19 disables far more people than it kills. We don't know how many more, and we won't know for quite a while. With lung damage, most doctors believe the damage is permanent, but some believe people will recover in a decade or two. With other organ damage, we're just speculating.
What's your definition of "old"?
I looked at your statista.com link and about 2/3 of deaths in NY are from people aged 75 and up. That leaves a non-trivial number of deaths for "middle-aged" people (and maybe younger).
Also, I don't know many middle-agers without some co-morbid condition, so I'm not sure we can just ascribe the deaths exclusively to "old sick people" because an enormous portion of the US population is "sick" with a morbid condition.
That being said, I will admit that there are many conflicting pieces of data flying about.
Are the PCR and antibody tests reliable enough to base our lock-down decisions?
Do we already have "herd immunity" and we're just too stupid/reluctant/lack-the-testing-capacity to realize it?
It would be "nice" to have an AMA from an epidemiologist with expertise in this area to cut through the noise.
Coronary Heart Disease, Lung cancer and Hypertension can all be mitigated by a healthy life and the numbers seem to suggest that Corona has made these illnesses even more serious than before.
An AMA would be great and i can certainly see that being middle-aged with a co-morbid condition has gotten a lot more serious.
Death rates, hospitalization rates, etc.
As mentioned before, 20% of NY deaths are nursing home patients. 37% are 80 or older.
I'm on mobile and a bit lazy, but check out death rates for the flu in younger populations and compare them to this virus. The virus has a higher mortality rate but not enough to be worth worrying about in younger populations.
>Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy.
While keeping the benefits in mind is an important part of this analysis, the fact is the pre-quarantine deaths were already accepted as "worth it" given that there was no political will to reduce them.
But yes, we should tally the reduction in deaths, pollution, etc.
Comparison to the flu could indicate that we underindex on all these other causes of death. It doesn't make those death numbers some magical line where now it's worth it, because Coronavirus deaths in 2 months equal annual flu deaths.
If it were just 3.6% of the US population dying, I would understand the economic versus public health argument. It comes down to values at that point: how much is a human life worth?
But that changes completely when you consider how many people we'll either need to support for decades, or who will have lower economic output. Those costs get astronomical, and at least by my ballpark estimates, align public health with economic outcomes completely.
If you can't, then perhaps it might be a good idea to reconsider advocating for reopening the economy. Because for all we know, this could end up being another Chickenpox situation leading to something similar to Shingles. We don't know enough about the virus to make reckless remarks such as yours.
If you think things are bad now, do you honestly think things would get better if we had to go through this again because we decided to stop early? Though given you seem to be peddling the idea that this is all a conspiracy by activists to keep us at home forever, I'm willing to bet you're not going to engage this point with any sort of good faith.
I do not have that information either. Until we (and 'we' as in medical professionals) figure out the best way to deal with the virus and any potential effects in the long term then yes, we should stay at home. Because there's still a lot of unknowns.
Can you prove that coronavirus didn't give me protection from some other more severe illness a la cowpox and smallpox?
No?
We can both come up with creative scenarios.
We are severely impacting the quality of life of hundreds of millions of people. We should have a reason to do so grounded in fact and educated guesses.
What reason do we have to suspect your scenario? What are the odds that it will occur? What are the odds it's going to be severe? What's the anticipated quality of life impact and with what confidence intervals?
Also: even if it did create this situation, and we know it for sure, what can we do about it?
We don't have a vaccine. We don't have effective treatments. Those are potentially years away, if they ever materialize at all.
How long, and how severe, should a lockdown be to prevent a hypothetical scenario? What are the impacts of a quarantine that's long enough to guarantee a vaccine with, say, 90% confidence?
As I've mentioned in other posts here, we're remarkably lucky that COVID-19 isn't something currently far more threatening. Considering attitudes such as yours would easily lead to mass extinction as we strive to save an imaginary economy rather than the people.
As for how long and how severe a lockdown should be, I leave that up to the medical community. You and I are not part of that community and are not nearly educated to make that decision for them, so trying to argue that the economy must be opened up now is an argument made from ignorance.
What we should be doing is mitigating damage to those hundreds of millions of people. That's a lot easier to do than just about anything else in this equation.
We've redefined "serious" to mean in an ICU, on a ventilator, within a few weeks of catching it (or in some cases, we've defined "serious" to mean dead within a few weeks). By that definition, AIDS isn't serious for most of the population.
There is a distinct lack of ROI calculations, but my ROI calculations lean towards a much stricter shutdown than we have in place right now, together with thoughtful actions to protect the economy.
The estimate of 1% mortality is with medical intervention. The estimate of hospitalization rates ranges from 5% to 15% (sometimes higher). If you get a disease serious enough to require hospitalization, and there are no hospital beds/nurses/ventilators etc. available, then it is very likely you will die.
But of course it's worse then that: because hospital resources are generally somewhat fungible - at least for ICU/surgical treatment. So not only does your mortality shoot up to ~5% at least, literally every other treatable but potentially life endangering condition (say appendicitis - which occurs at a rate 1.1 per 1000 people per year, or an estimate of 300,000ish cases yearly in the US) has now become, quite likely, untreatable - and thus lethal (appendicitis will definitely kill you, untreated).
Lots of people seem really latched onto that 1% number or whatever they imagine it to be, without any actual consideration of the context of what that figure is actually all about, or you know, an explanation things are "not that bad" yet hospitals can't get PPE, and ventilator triage is in progress, and local morgue capacity has been overwhelmed.
Presumably in two weeks, when we know whether more of these thousands of people go on to develop symptoms or not.
Is anybody following up on stories like this? Do we have any from two weeks ago?
1) that the asymptomatic rate for this Coronavirus is much higher than other Coronaviruses.
2) but at the same time, it's more deadly than most Coronaviruses.
3) and it's also the R0 is much higher than other Coronaviruses.
Isn't it more likely there's a testing issue? This seems a lot like a person that runs a SQL query that overturns all established data at a business, and instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong.
I'm not saying the tests are inaccurate. I'm saying when you get highly conflicting data that has critical implications, you shouldn't jump to conclusions. And you should prepare for the worst case, not assume the best.
R0 depends on the population you measure. In a high contact, crowded place, the R0 could be very high. In a population staying at home, the R0 could be very low.
All those 3 numbers you cite are taken from the same small set of models where the rate of asymptomatic cases is an input. So, no, that's not right.
The best follow-up we have is from the cruise ship, where at the time of testing more than half of those who tested positive were asymptomatic, but ultimately something like 80% of the confirmed infected ended up with symptoms.
I probably saw that factoid hyped up in multiple media stories which misconstrued the original paper.
If anyone knows of more reliable recent sources about this, it would be great to clear it up.
Also lots of information in the comments.
https://www.medrxiv.org/content/10.1101/2020.03.18.20038125v...
In particular, that CDC report I linked above citing 46.5% is from late March (early release on March 23, published on March 27th).
That report cites a website by the Japanese Ministry of Health, Labour and Welfare [1], which itself confirms that 46.5% (331/712) is up-to-date as of March 26th.
I'm not very knowledgeable about stats, to be perfect honest, but I think your paper must've turned out to be a red herring. Maybe they got unlucky with their sample?
[1] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/newpage_000...
That won't be what the public policy decisions will be based around if the asymptomatic and already exposed rate is so high.
We don't know enough to make that decision yet, but testing more broadly was the first step.
Remaining steps:
- Do they get sick in two weeks?
- Skip testing for current sickness, and test for antibodies instead.
- Get a better antibody test that is more accurate
- Understand how well antibodies work, and for how long
and then we can make decisions, even if they are as simple as "this is a systemwide over the air update, some people will get bricked"
it's becoming clear that we might end up with a society where the average BMI is under 24.9 simply due to the lower oxygen and resource requirements to support those body systems.
How would you do that without locking down the rest of the population? You're going to isolate all nursing home workers?
Confining people to their own home, and locking them in their workspace are markedly different.
I'm not sure there's a better solution; financial incentives and let the workers decide if they want to do it? Care home workers have their own families and dependents too, but that could make it possible for many of them without having to lock them up against their will.
Which is a large part of my point/question. Would it have been more effective than what we have been doing?
This is frustrating with a lot of news coming out that it had been spreading longer and faster than thought. Conceivable that much of the peak in deaths is the highest risk crowd having hit a saturation.
Its the plan for making a plan.
This certainly adds another data point, but I wouldn’t throw conventional wisdom out the window yet.
First, there's not much secrecy involved. It isn't a secret at all that, Hollywood, the American mainstream media, and the political left are all on the same side. It's been obvious for 30 years now.
What we are currently living through is a left-authoritarian consolidation of power. Like other similar consolidations in the 20th century.
That is why, within 24 hours of the first house-arrest orders, propaganda about how our old lives of freedom are gone forever because they were "irresponsible", and how we must all get used to "the new normal" began.
Dr. Fauci says that physical human contact is a thing of the past ("nobody will ever shake hands ever again"), governors, especially those of "blue states" have all acted to either make their house-arrest orders indefinite (like in CA) or to declare that they will continue for multiple years (as VA announced yesterday, for example).
Enforcement is gradually increased everywhere, and citizens are increasingly encouraged to snitch.
Political protests are banned. Even organizing them online is being locked down, with states pressuring Facebook and Google into deleting people's accounts if they even mention the existence of a protest.
The thing is, it takes time to take a society used to freedom and fully consolidate it.
The house arrest orders are the start -- now, when the government eventually let's people out of their houses, but only on conditions (like wearing a tacking wristband, showing your papers to any government official, having to have "a legitimate purpose"), people will be so desperate to leave home that they'll agree.
With "contact tracing" apps and "mandatory isolation", the government will be able to declare any person they need to silence as "contaminated", and they go back to imprisonment, with no recourse, no due process, no burden of proof. Even better, having communicated with a "contaminated" person automatically adds you to the list of the unpersoned.
The economic disruption has already made 1 in 4 Americans dependent upon government handouts to survive. Every week, another 4-5% join them. An authoritarian government needs it's people to be dependent for survival, in order to ensure cooperation.
Meanwhile, the food supply is being turned off. We already have a third of our food production offline, and are most of the way toward driving all independent farmers and ranchers into bankruptcy. We are pretty much guaranteed to have widespread hunger by the fall. This will leave the way for a government takeover of food production.
But, in order for the consolidation to work, they have to keep us all imprisoned willingly until they finish consolidating enough power to make it permanent, or we will all just go back to our lives as free people, the economy will recover, and people won't be dependent upon the would-be dictators for their continued survival.
The next 3-6 months are critical to breaking the back of the capitalist system and soften everyone up to accept the new freedomless world. It will take that long to drive enough people to poverty, hunger, and desperation for them to be willing to go to the authoritarians and beg to be ruled.
This isn't a secret, and it isn't really new. It's more or less how every current left-authoritarian state was formed -- only with more technology and fewer guns.
Narratives drive how we see the world. In concrete, objective, measurable terms -- what do you mean by a "left-authoritarian consolidation of power"? From my perspective, the right is the one really good at consolidating and protecting their power, while the left is a little ADD about what they care about. (And are thus less effective at being in charge, even if more Americans profess those beliefs.)
You don't need the presidency when you can make the presidency meaningless. Look at Trump -- every time he tries to take any position at all, he gets wrecked and ultimately loses. The media destroy him, the tech companies disband any gatherings of his followers.
Besides, unlike the left, the right and Republicans are a fractious, disunited lot. They can't hardly agree on anything -- too many incompatible viewpoints -- so they're almost completely ineffective anyway.
In 10 seconds, it would be a crime to disagree with the left -- just like they've succeeded in doing online and in places like Europe.
These days, each election is potentially the last one.
I do share your confusion about why the media would say such things, but they are.
Like Dr Fauci said, the virus decides the timetable, not us. Nobody knows when it will be safe to reopen.
Many businesses are simply not safe for people to mingle in. Many people don't want to understand or take the distancing guidelines seriously, if they're even adequate.
As far as whether they're worth the cost, there's plenty of room for speculation about that. I do think that reducing a potential overload on hospitals is a wise plan.
I'm against Trump too, for various reasons - for example, I don't like his authoritarian mindset, his stance on torture, his stance on surveillance, and his foreign policy towards Iran - but I'm not a fan of the constant hysterics of the anti-Trump media either. Some of those people would claim that Trump was somehow being deceitful and evil even if he just said that 2 + 2 = 4.
There are, I'm sure, other sources of media bias on this matter as well, but this is the one that immediately comes to my mind.
It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
I feel that it was idiotic propaganda.
>It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
The problem as I see it is too many Trump haters go beyond the many valid reasons to hate him and instead, due to conscious or subconscious bias, start to do things like take things he says out of context, or read more into those things than is necessarily justifiable, or try to paint him as a uniquely evil figure even though we have had presidents in recent memory who literally supported death squads in third world countries... etc.
When at least one large studied group has an outcome (symptomatic recovered, asymptomatic recovered, or dead). So for this group I guess a few more weeks.
For example, they've been finding that the virus can trigger strokes in otherwise healthy individuals. That's individuals that either exhibit no symptoms or minor symptoms. So while they may otherwise be asymptomatic, we can't know unless we do a full extensive test to see if they're also suffering from unseen clotting issues.