'Finally, a virus got me’: Scientist who fought Ebola and HIV reflects | Hacker News Reader

'Finally, a virus got me’: Scientist who fought Ebola and HIV reflects

sciencemag.org

196 pointsakeck227 comments

"Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives."

There have also been reports of people in China with significantly reduced lung capacity even months after recovery. Still so many scary questions about the long-term effects of this virus, possibly the biggest ones being about the post-recovery immunity. How long does the immunity last and how encompassing is it?

There is so much we donot know about the long-term effects. It shocks me to Silicon Valley icons like Elon Musk, Paul Graham, and Justin Kan pushing to reopen and spreading conspiracy theories over building tools to understand the long term effects.

> It shocks me to Silicon Valley icons like Elon Musk, Paul Graham, and Justin Kan pushing to reopen...

In fairness, they might be pushing to reopen to make the governments do better than rely on lockdown indefinitely. After all, necessity necessitates invention. One way to reopen and still be on top of the epidemic is accurate, fast, and cheap testing [0] at scale, so that, not only could people be tested repeatedly to curb the spread but also get a good overall data on the spread itself. Contact tracing, social distancing, and quarantine remains essential till a vaccine, or a prophylactic / therapeutic treatment is discovered.

[0] Grant Sanderson, Simulating an Epidemic, https://www.youtube-nocookie.com/embed/gxAaO2rsdIs

Have you been tested?[1] I'd rather not get tested multiple times a month for months on end, thanks.

1.https://youtu.be/ssApeG-FBCU?t=1m37s

I've had many nose and throat swabs over the years, it's nothing

Yes if that’s what it takes I’ll do it. The US eradicated Polio by mandating a painful vaccination. We have a long history of public health improvements by collective action. The only difference is that many people now assume bad faith on the part of the government despite the overwhelming majority of us complying with government orders.

See: https://news.ycombinator.com/item?id=22857384

The efficacies are worlds apart.

> necessity necessitates invention

No, it merely prompts it.

If you toss an 8-year-old into the deep end of a pool, does it force him to swim? No. Drowning is an option.

>does it force him to swim?

This is more or less how how most animals learn to swim or how birds learn to fly.

>This is more or less how how most animals learn to swim or how birds learn to fly.

yeah, and they have the losses to show for it.

some birds have losses of up to 41% due to falls and premature flight/parental following.[0]

[0]: https://repository.si.edu/bitstream/handle/10088/5389/SCtZ-0...

This is the most absurd (in the best possible sense) use of sources to win an argument I’ve seen in a while!

Is there an alternative which works better for birds?

For some reason, this works better for younger children than older children.

Paul Graham pushing "conspiracy theories"? Source please.

Please be accurate. I just went to @paulg ‘s twitter feed and just 5 days ago he retweeted a @DrEricDing tweet that “Bifurcation. Reopening is not going to go well...” showing rising cases outside of NY.

Elon Musk, on the other hand, has been wrong on this from the get-go - he took a denialist stance in January and has repeatedly predicted things that have been proven false and keeps shifting the goalposts to try to support his original stance of ignoring the virus.

what did he predict and how has it been proven false?

>what did he predict and how has it been proven false?

First example that comes to mind is Mar 19:

"Based on current trends, probably close to zero new cases in US too by end of April"

https://twitter.com/elonmusk/status/1240754657263144960

Musk has became indistinguishable from the paper clip maximizer AI...

More like erratic PR maximizer AI

We know for sure that if we force Americans to stay at home, tens of thousands will kill themselves or be the victims of domestic violence as a result. An untold number of people will go hungry or become homeless. These are certainties. If you want to make a real cost benefit analysis (as opposed to a fear-motivated choice to stay inside), then provide some good data about the long term effects of covid19. Sorry, but saying "it could have terrible effects 5 years after you get infected" isn't good enough. Try again.

That's simply false. If we force people to stay home without providing them with compensation, then yes, people will go hungry and homeless. We have enough wealth to provide for people to make sure that doesn't happen, though. Whether the government will step up is an open question, but this doesn't have to go the way you are suggesting.

This is much like saying "No one will go homeless if we institute universal basic income". You're completely correct but you're missing the point. I don't see any indication whatsoever that the US will realistically give people enough compensation to stay at home or can afford to do so.

> I don't see any indication whatsoever that the US will realistically give people enough compensation to stay at home or can afford to do so.

It seems to me that is the problem that people should focus on, instead of arguing for lifting measures aimed at protecting people.

South Korea, Taiwan and Hong Kong controlled the virus without imprisoning everyone at home.

More forced sacrifice and pain does not equal better policy.

Worth adding that keeping asymptomatic people at home, which an indiscriminate blanket house containment does, prevents the virus from mutating to become less deadly, which is the typical evolution of viruses.

The opposite, of sick soldiers being transferred to hospitals where they spread their viral infection, and asymptomatic soldiers remaining in trenches where they couldn't spread their less deadly strain, led to the second wave of the Spanish flu being far more deadly than the first.

> South Korea, Taiwan and Hong Kong controlled the virus without imprisoning everyone at home.

South Korea imposes far more intrusive and arguably totalitarian measures such as tracking each and everyone's every movement and impose compulsive tests on anyone suspected of contacting suspected cases.

If you were genuinely concerned about restrictions on individual freedom then you would never even dare mention those cases as examples of desirae practices.

Even then, looking at the practicality of your cherry picked examples, those approaches are only possible if you already have all the people tracking infrastructure and testing services in place. Well, you really don't, do you? So what other options are on the table? Only social distancing, isn't it?

So please stop abusing cherry-picked half truths to spread your disinformation. Results are due to processes, and you're complaining about the lesser of all evils while at the same time desiring a specific outcome while disingenuously omitting what was trampled to be able to get to them.

>>South Korea imposes far more intrusive and arguably totalitarian measures such as tracking each and everyone's every movement and impose compulsive tests on anyone suspected of contacting suspected cases.

South Korea's measures are far less draconian than imprisoning everyone at home.

Banning people from engaging in communal economic and social activity without complying with surveillance and safety measures, and having mandatory testing != less authoritarian than banning people from engaging in communal economic and social under all circumstances, or even leaving their homes.

Granted that under house imprisonment, you get more location privacy, with no phone tracking, but everything else is more restricted, and on par with house arrest, and the tracking privacy is irrelevant, since the authorities know you're home anyway.

>>Even then, looking at the practicality of your cherry picked examples, those approaches are only possible if you already have all the people tracking infrastructure and testing services in place.

You wrote above:

>>It seems to me that is the problem that people should focus on, instead of arguing for lifting measures aimed at protecting people.

This was in reference to not having a massive social welfare safety net that costs hundreds of billions of dollars a year, necessitates income tax rates of over 50%, and requires an extensive bureaucracy to administer, that typically decades to set up.

It seems to me overcoming the challenges of imposing South Korea or Hong Kong's hygiene rules for being outside the home, mandatory testing and phone tracking, is the problem that people should focus on, instead of arguing for creating vast forcible income redistribution schemes or keeping millions imprisoned at home in the name of protecting them.

>>So please stop abusing cherry-picked half truths to spread your disinformation

>>those approaches are only possible if you already have all the people tracking infrastructure and testing services in place.

Please stop some promoting mass-house-imprisonment, which means giving the state the power to imprison innocent people for months in the name of the public good, and your social welfare agenda, which includes imposing 50% income rates indefinitely, under the guise of fighting the virus.

People in some places, including where I am now, have been under house arrest for over two months now. And there are people like you advocating that it continue, while brushing aside alternative ways to stop viral transmission with hardly any critical analysis.

Meanwhile, you characterize my comments as 'disinformation', merely because they disagree with your house imprisonment policy.

You're disingenuously implying that it's less challenging to setup a $500 billion / year welfare bureaucracy, than an infrastructure for phone location tracking, and that phone tracking and mandatory testing are more restrictive than forcing everyone to shut everything down and stay imprisoned in their house.

For short term (say month or two) that may work. But any wealth redistribution cannot work without wealth production. And uncertainty about government restrictions already starts to disrupt food production in Europe, as farmers may not sew vegetables if they do not know whether they can get enough workers for harvest.

We have tools to address poverty and domestic violence if we have the political will to do so. We have damned few to address a global pandemic.

That’s why I’d rather see us be cautious about re-opening, but we seem to have decided that rather than find a different way forward to protect everyone, we’re going to just go back to the old economy and hope the sky doesn’t come crashing down on us.

I'm all for proper cost benefit analysis of a lockdown, but the fact that you're asking for good data on the long term effects of a disease that is six months old shows me that you are not interested in it.

Any decision has to be made considering uncertainties. You either accept the risk or you don't.

BTW, this is what we know for sure can happen when you risk normalcy:

https://twitter.com/jburnmurdoch/status/1258031434981392389

What is the risk of recovered patients developing a life-threatening or disabling condition over 6 months after recovering? Do you have any estimate for this risk? 5%? 10%? 50%? 100%?

Why ask a question you know cannot be answered? The disease is barely six months old, if that, so this data doesn't exist. They say there are no stupid questions but they're wrong.

> Why ask a question you know cannot be answered?

One value in doing this is to highlight the importance of problems.

While the exact long term effects are obviously unknowable, we can make some reasonable predictions by looking at patients who survived similar viruses such as SARS and MERS.

No, you cannot. Regular colds are also caused by weaker coronaviruses, and leave no serious long-term consequences.

I don’t know if you caught this, but I think that’s exactly what the parent comment was driving at.

We know that in the vast majority of cases, the body clears the virus, and there's protection against re-infection for at least some time.

We know the infection fatality rate is well below 1%.

We know that people under 65 are at far lower risk of suffering severe symptoms and death.

And we know it's a virus, so will spread and evolve according to the same evolutionary principles as other viruses.

There are of course unknowns, but everything in the world has unknowns. We have to make educated guesses, and decide on a strategy based on them.

> We know the infection fatality rate is well below 1%.

No, we don't. It seems to be at ~1%.

If it were well below 1%, it would be a nothing-burger, and would not have spiked NYC's weekly death rate by a factor of 6.

>If it were well below 1%, it would be a nothing-burger,

No, it wouldn't. The other important value is the reproduction rate of the virus. If that value is high, then our healthcare system is going to be overwhelmed just through the sheer number of people that will be infected.

So yes, it is looking like the infection fatality rate is well below 1% (as suggested by preliminary studies from NYC, Cali, Germany, and the Netherlands), but because the reproduction rate is so high, and the fact we have no herd immunity, still means thousands (or hundreds of thousands of people) will end up in the ICU. This seems like what happened in NYC and Italy. There was a massive spike in untracked infections in Feb/March. The vast majority of those people cleared the infection, but the tiny percentage of people who had complications, still overwhelmed the availability of ICU beds.

The term 'reopen' is ambiguous. I haven't seen anybody serious argue for a pre-COVID reopening. There is an implicit and explicit understanding that re-opening means "re-opening with social distancing, PPE availability and continual sheltering-in-place of at-risk groups". Even the re-openings in states like Georgia are re-openings with major strings attached that place a lot of restrictions on businesses. All that to me makes sense given that coronavirus pandemic is the new normal for the next year or two - a period of time in which we cannot simply shelter-in-place under a lockdown.

I have noticed, however, a tendency to vilify those that even suggest an alternative to the current lockdown and a distortion of their positions (such as suggesting that those people care more about money than people, or that they are minimizing the severity of this pandemic).

This virus is terrible and is taking a terrible toll on a lot of people as well as national healthcare systems and economies, but there are also people that purposely want to magnify the risks beyond what the data shows. That's not helping anyone either.

It should be noted that these reports weren't a surprise - reduced lung capacity months after recovery is common for all kinds of pneumonia.

This. There is so much fear-mongering going on by "the news" it sickens me.

Fear-mongering, or reporting the facts? Plenty of people wouldn’t know about that aspect of the disease, I’m quite happy the media isn’t trying to cover it up.

Straw man. No one thinks the media should "cover it up". However, It would be more responsible for the media to not present the public with so much obvious misinformation about the virus.

You've been making big assertions about “misinformation”, “fear-mongering”, etc. but you haven't provided any evidence or analysis supporting those claims. Since you're taking a position which is contrary to what medical experts are saying you really need to substantially back it up.

From the start of epidemic in Europe, all media (that i read or listened) constantly mentioned ~5 % fatality rate (based on case reports). While WHO report from 2020-02 already reported IFR estimations 0.3% - 1.0%.

CFR, or crude fatality rate is deaths/known infections. It is known to run high, but early on is the best we've got.

That said I'm not aware of the WHO saying the IFR was .1-.3%, I've consistently seen estimates of .5-1.5%.

That said, in Italy the CFR is 15%, and reasonable estimates for the IFR wouldn't be below 2%, with 5% being completely reasonable.

The other poster already pointed out that there is a difference between CFR and IFR (and initially CFR was reported because we did not have good estimates of CFR) The IFR for the flu is 0.1% in the bad years, and we have estimates of the IFR which are more in line with 0.9 to 1.5% (based on the antibody tests in NYC for example). That's 10 times higher, I don't know about you, but an order of magnitude is pretty significant in my book.

Not only that, even common sense observations confirm at least 3 times higher fatality rate compared to the worst flu: Every years approx. 45000 people die from flu in US. Within 1.5 months since the surge number of deaths reached 80000. According to various estimates number of deaths in US will reach 150 thousands. So already, with all the precautions it is 3 times deadlier. Without precautions we'd have 2-3 times higher rate.

> The other poster already pointed out that there is a difference between CFR and IFR

I know the difference between CFR and IFR. But i doubt journalists who wrote about covid-19 fatality knew that, such details are too technical for mainstream media. The idea conveyed by media was simply 'most people would get it as there is no immunity, and there is ~5% fatality rate'.

In that time we already have order of magnitude lower IFR estimates from WHO (e.g. from covid-19 situation report 30).

> we have estimates of the IFR which are more in line with 0.9 to 1.5% (based on the antibody tests in NYC for example).

In different areas it seems to be different. NYC was hit particularly bad, so it is not a good idea to generalize data from that. In Heinsberg (Germany) study, the IFR is estimated to be 0.37, although Heinsberg was also hit hard.

> The IFR for the flu is 0.1% in the bad year ... That's 10 times higher, I don't know about you, but an order of magnitude is pretty significant in my book.

I did not compare covid-19 to flu. It is true that covid-19 is order of magnitue worse than seasonal flu. My point was that it is order of magnitude better than media image of covid-19.

If it’s true, it’s not misinformation.

The articles I’ve seen talking about this usually explain that other severe illnesses can cause such symptoms.

The unusual thing about the coronavirus is that it causes severe illness in so many - resulting in not only an extraordinary number of deaths but also of other damage to the body.

For it to be informative, you need to provide the adequate context that explains it. "New evidence shows that coronavirus can cause long term breathing problems" suggests that this is something unique or unexpected about this, when it's really par for the course for any upper respiratory infection that takes a turn for the worse.

>> suggests that this is something unique or unexpected about this, when it's really par for the course for any upper respiratory infection that takes a turn for the worse.

I wonder why they report the number of deaths and infections. After all it's all known that viruses spread and people die from respiratory infections, right?

Framing is important.

In many places the annual flu is more deadly. And all the articles about running out of space at morgues, etc. are common in winter in Europe.

We've had SARS and MERS before (MERS is way more deadly, yet we didn't enter a global panic). There is something specific about this panic, and it's not the virus; it's a variant of something we've seen before.

That the media played fear mongering is a given, that's what they always do; I suspect the new factor is social media, which has probably amplified that factor even more.

> We've had SARS and MERS before (MERS is way more deadly, yet we didn't enter a global panic). There is something specific about this panic, and it's not the virus; it's a variant of something we've seen before.

Can I suggest some basic reasoning as to why? Do you know which countries MERS spread to and how many people died as a result of MERS since it was first identified?

MERS was first identified in 2012. In 8 years, it has killed about 866 people worldwide.

SARS was first identified in 2002. In 2 years, it has killed 774 people and then disappeared.

SARS-Cov-2, the novel coronavirus, first appeared only 6 months ago in China. Since then, it has killed 100,000s.

How can you suggest that there isn’t more cause for concern over SARS-Cov-2, considering deaths are already at over 100x the other two viruses you mention in far less time, and that this death count comes despite an incredible, unprecedented international campaign to slow the virus?

Granted, this one is tougher, but not that much tougher than a bad strain of influenza.

Again, I'm not saying we shouldn't be doing anything. The catastrophe movie, Hollywood-like global mass hysteria was totally over the top and unwarranted, though.

We have ways to deal with epidemics that don't involve completely changing the rules, talking about "being at war" and so on.

> Granted, this one is tougher, but not that much tougher than a bad strain of influenza.

This is simply outright wrong.

https://www.livescience.com/new-coronavirus-compare-with-flu...

Please stop spreading misinformation.

Get lost, seriously.

We all have the same voice here, and I'm "spreading" whatever the heck I want. It's not "misinformation" just because you happen to have a different appreciation of the facts. I don't have to answer to the nerd police, here or elsewhere.

> We all have the same voice here

We have the same access to a website, sure, but you don't have the right to freely outright lie, specially when confronted with the facts.

Again, don't spread misinformation.

Stop spreading misinformation.

>>Granted, this one is tougher, but not that much tougher than a bad strain of influenza.

Covid is more contagious and more deadly than what we had so far when both factors are considered. In Italy hospitals were pretty much overwhelmed this year due covid with the number of people dying and the sheer number of infections. Did that happen last year or the year before due influenta/flue season as well?

> Framing is important.

> In many places the annual flu is more deadly. And all the articles about running out of space at morgues, etc. are common in winter in Europe.

This is false and you are spreading misinformation. The estimated IFR you can calculate from e.g. the antibody test done in NYC is between 0.8 and 1.5% that's 10times higher than the flu. Moreover, the percentage of patients requiring intensive care is comparatively even higher (it really is not about the death rate primarily). Also please show some evidence for you assertion that morgues running out of space in Europe is common.

The reason why MERS and SARS did not cause this response is because they spread much slower. There are lots of diseases which are more deadly than covid19, the difference is how they spread. For example a disease that spreads through blood transfusions could have 99% fatility rate but would never be as dangerous to public health as covid 19 is.

> That the media played fear mongering is a given, that's what they always do; I suspect the new factor is social media, which has probably amplified that factor even more.

Actually the new thing is "experts" popping up all over social media talking about how everything is just overblown and we should not trust the real experts. This stories are pushed very clearly from political corners with a very specific agenda, it's all about discrediting science, evidence based decision making and our institutions (it all started with cigarettes then global warming and now covid19) . That's the irony all the conspiracy followers don't realise that they are part of the biggest misinformation campaign orchestrated by groups with very strong economic interests (you might even call them elites)

I said that it is more deadly in many places, and you're talking about a single place (NYC). Let me remind you that it's not actually the centre of the world.

And I think you're reading a bit too much into my post. I don't think I'm a conspiracy theorist or whatever (and may I suggest you take your condescending tone and shove it deep down where the Coronavirus won't reach it?)

Now, I'm actually following the advice of scientists. I'm not more an "expert" than you are an "expert", of course, that is correct. I'm French, and our foremost (actual) expert on the issue, Professor Didier Raoult, whose advice I'm listening to, has been saying that it's just another respiratory disease epidemic, like we have regularly. He's not advising to do nothing; quite the opposite, for many years he's been asking the government to do more to fight seasonal flu. Now, the irony is that he finds himself in the camp of people urging the government to calm down a bit...

As for my evidence regarding morgues:

One (French) article from 2017: http://www.leparisien.fr/archives/une-grippe-meurtriere-13-0...

"FACT OF THE DAY. The number of deaths largely exceeds the seasonal average. Like emergency rooms, funeral services are overflowing"

This happens every other winter here, and it's generally worse in Italy due to their older population. It's bad, we need to manage those epidemics, but not start shooting a catastrophe movie every time that happens.

Cannot say much about Paris, but there was not a year, when NYC hospitals had to use refrigerator trailers to store the dead (from flu, for example), and just the death toll in 2 months reached yearly flu death rate in the whole US, from previous years.

I am well aware that NYC is not the centre of the world. I'm European myself, so much for your assumptions.

The reason why I used NYC was because we have reasonably good data from the recent antibody tests which found about 20% population infection. Based on those numbers, the population of NYC and the dead we end up with an IFR of 0.8%-1.5% depending if we use confirmed deaths, suspected deaths or excess deaths (note the actual value would be higher because of the lag between infection and death).

Now for some non US numbers just have a look at the Euromono data https://euromomo.eu/graphs-and-maps/ You can see the excess death spike which is considerably (for some countries by a lot) larger than the flu epidemic from 2017. So in most countries in Europe it has been significantly more deadly than the flu.

And considering your comment on overflowing hospital, tell me when was the last time they were flying many flu patients per day from Paris hospitals to relief hospitals by helicopter. I know people living close to one and they had almost constant flight noise.

Didier Raoult definitely warrants some background reading

Rabies, for example are nearly 100% deadly, yet not that contagious.

There has been quite a lot of “It’s like the flu“ messaging, including here on HN. In that light, and considering people’s idea of the flu is often closer to the common cold than the actual flu, I do believe most people would be surprised to learn of chronic health issues persisting after even mild courses of COVID.

Paul Graham, the owner of this site, actually was spreading this idea of Covid being a flu. That might explain this rate of denialism.

That's because bad news sells, and no news doesn't.

"But 87 years ago, on 18 April 1930, the BBC's news announcer had nothing to communicate. "There is no news," was the script of the 20:45 news bulletin, before piano music was played for the rest of the 15-minute segment."

https://www.bbc.co.uk/news/entertainment-arts-39633603

I can still remember, on an evening back in the 1980s, newscaster Gerrick Utley commenting on “this particularly slow news day.” Even as a dumb kid, I understood that to be a good thing. But I couldn’t have guessed how much I’d pine for another one like it the way I do now.

Eh, there was plenty of news that day, there just wasnt a global communications network to deliver it in a timely fashion.

Fear is the right response to pneumonia.

If you haven’t had it you won’t understand. I can’t swim but if you’re a swimmer you might understand a parallel - it’s like not being able to swim - your head bobbing on water surface, sometimes you can breathe other times you are just gasping. If you’re in water the people will see you’re drowning and a life guard will pull you out.

Pneumonia is this “almost drowning” for weeks!and then bring barely able to breathe for months.

Again: fear is exactly the right response to pneumonia!

The vast vast majority of the cases are mild if you are strong and healthy.

How many people are strong and healthy?

Ok here is a random stat, by definition itself 10% of people will be in bottom 10 percentile of the health risk profile and at huge risk.

I am not countering you but the parent. Old age itself is a pre-existing condition and then we develop more for each day we live (obesity, heart attacks, diabetes). I know the numbers of true risk may be different but can we manage 5-15% of people falling extremely sick?

Strictly, this isn't right. You can have more than ten percent of a population below the tenth percentile of a measure. Consider how this stat squares the percentage of people with less than (or more than) the tenth percentile of finger count.

The US has an enormous population of elderly, obese, and diabetics. Trying to pick a random risk factor doesn't really work.

In most countries, most people. Problems with obesity and chronic health conditions are relatively recent in the history of mankind.

Almost 80% of people in the US are overweight as of 2015, with 35% suffering from obesity and 5% from extreme obesity.

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

Hence why I said most countries.

“People in another country who are less fat will be fine” might be technically true, but it’s less than helpful when you’re trying to decide what to do right here and right now.

And you're still incorrect. https://ourworldindata.org/grapher/share-of-adults-who-are-o...

It is interesting to consider what the death toll from exporting American food culture worldwide is. I think it would really help put the death toll from corona virus in perspective.

Why are people obsessed with turning disease into a chance to pass moral judgment?

I guess it can help with coping with one's own fear and helplessness. Those people brought it on themselves, so I'm good because I didn't do the bad things they did, and it's less of a problem if they suffer, because again they brought it on themselves. Something like that maybe. I don't really get it either.

See: "Illness as Metaphor" (1978) by Susan Sontag

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

> Fear is the right response to pneumonia

Yes, but not so much fear that you ride out your stroke or heart attack at home because you think venturing out of your house and into the ER is wading into certain death via pneumonia.

That is the level of fear that the media has induced in some people and it's even more dangerous (at the individual level) than too little fear.

The media? Or social media? Or random blogs and forums? It’s easy to accuse a general “media” but we get bombarded by so much content that it’s hard to really pinpoint who’s doing the fear mongering. Anecdata, I found the coverage in my city (Toronto) being much more accurate by the traditional large media than the random crap I’ve been reading on twitter / local reddit / click-baity blogs. And I wouldn’t put the 24 hours cable news channel in the same category as the newspaper either. “Medias” can mean so many things.

What about the people who have the symptoms of COVID-19, where it's not severe enough for them to be hospitalized for that, so the messaging is for them to self-quarantine; but then they also get struck with some other problem (such as a heart attack)? I feel like I've heard no clear messaging on what such people are supposed to do, even from the most rational/level-headed medical authorities.

I imagine being in those shoes feels a lot like it would have to need surgery when you're HIV positive, back when HIV was an eventual death sentence: you'd feel guilt/shame for exposing your doctors to this coincidental problem you have, that might get them sick.

And so these people don't go, and end up dying of these other problems, likely at a much higher level than the people who are just staying indoors out of paranoia.

If you have a heart attack you call 911. There hasn’t been much messaging about that because, frankly, it’s assumed to be obvious.

People tend to call 911 while they're having a heart attack; but a first heart attack doesn't tend to kill people, so if they live through it, they tend to think it isn't an urgent problem in need of calling 911, and instead just go to the hospital at their earliest convenience. The problem here guilt/shame delaying "earliest convenience."

Washing your hands and covering your mouth while you cough is obvious too; that doesn't mean the messaging is unnecessary.

It isn't obvious, unless you happen to suffer from hypochondria.

So far COVID-19 has killed 0.25% of NYC, with that number continuing to rise. The idea that fear is more dangerous than that is facile.

Edit: Updated fatality percentage from 0.16% to 0.25%, to reflect the latest numbers.

No it's absolutely not. Your risk of dying, or of having life altering chronic illness, from not immediately seeking medical attention if you are having a heart attack or stroke is far higher than your risk from COVID, and those people aren't showing up at hospital right now.

Update: updated the stat to 0.25%, based on the official fatality count of 21,045 and a population of 8.4mil.

In 2018, NYC’s premature death rate was 189 per 100,000, or 0.189% of the population. In a single quarter COVID-19 has already surpassed all causes of premature death combined. And that’s before the epidemic is done, and before we’ve had a chance to re-test earlier deaths to adjust the numbers properly.

You’re not wrong that some people will die from otherwise treatable heart attacks, and that’s tragic. But to assert that more will die from staying home than not requires some pretty extraordinary evidence.

This is a terrible take.

Assuming you have a heart attack, your chance of dying is 20%. Higher if you don't get treatment.

That's as high or higher than your chance of dying from covid-19 assuming you're in the highest risk group.

A conservative estimate of likelihood to catch covid if you go to a hospital at this point is 5%. In reality it's probably lower.

These end up mostly cancelling out, so if you the I the chance you're suffering from a heart attack is higher than the chance of catching covid you should go to the hospital. (And this is me still fudging the numbers to make covid look comparatively more dangerous than it really is).

People will needlessly sir if we collectively overstate tht dangers of covid. That's without a doubt true. People will also die if we understate them and don't take reasonable precautions.

> A conservative estimate of likelihood to catch covid if you go to a hospital at this point is 5%.

Really? Where is this number form?

The fact that hospitals aren't pouring new Covid patients out of their ears. Major hospitals are handling lots of cases, and have many more than one hundred employees. They're not hotbeds of transmission, from what I've seen.

You're certainly at more risk in a hospital than at home, but it's not that crazy. Since it seems like you're in the bay area, consider that for the chance to even be 5%, something like most new Covid cases in the bay would need to come from hospital employees or patients. I don't think that's happening.

Haha, no, I am from the Central Asia. All you you just said are handwavey arguments, "I think", "I believe". I think for example, that chances of catching Covid in hospitals in US, at the peak of the epidemic were way above 20%. How is this an argument?

Data backed arguments and your imaginings aren't the same.

What is the definition of premature death?

I live in Ontario where ~250 people get diagnosed with malignant tumors on an average day vs. 500 people getting diagnosed with COVID at the peak of the pandemic (now ~350).

Months after the lockdown started and the surge was successfully averted, we're still not doing cancer surgeries and diagnostics. I don't understand how this level of fear and conservatism is saving more people than it's hurting. COVID is nowhere near as dangerous as a malignant tumor.

There is a middle ground of appropriate fear that we've blown past.

What if Ontario was like new York State? Then Ontario with a pop of 14M vs 19.5M would have lost around 15,000 people not 1600 as current.

There is also this assumption that people will haplessly get infected as if they were livestock. Which they are not. The will stop going up, stop spending money, avoiding work if they can. That's baked in and not something the government imposes. Except to impose order on the process. An orderly early lockdown is better than a late chaotic panicked one.

I can understand. I had it and got tested positive for antibodies recently.

I had symptoms but it honestly was more like a mild flu.

So please stop your fear mongering and holier than thou attitude, just because you had it and it was bad doesn't mean that everyone will be the same. In fact serological studies prove that the overwhelming majority barely have any symptoms, and of those who do even fewer develop into a severe illness.

> So please stop your fear mongering and holier than thou attitude, just because you had it and it was bad doesn't mean that everyone will be the same.

I'm not sure you fully understand the problem you're trying to discuss. The problem is not just about ourselves catching it. The main problem is us acting as transmission vectors to anyone and everyone around us.

You may believe you are magically enchanted to not have any lasting consequences from a covid19 infection, but I'm quite sure that you come across people who may fall within one of the risk cohorts. Thus you crossing their path might very well be a death sentence to them. But that shouldn't bother you, right?

During the height of the HIV epidemic, I was a teenager. A close family friend, and one of my middle school teachers died of pneumonia. The virus compromised their immune systems, that is, AIDS, and that condition led to their susceptibility to pneumonia.

We've largely addressed HIV through various treatments and education (what you might call "fear-mongering" about shared needles and unprotected sex). HIV doesn't cause an obvious symptomatic response -- much like many people's experience with the novel coronavirus. But it weakens the immune system and other, otherwise harmless, infections take root and can cause significant harm.

The content of this 'news article' is an interview with a virologist with years of experience and a strong reputation among his peers. His understanding of the seriousness and his first-hand experience seem to be in pretty strong opposition to your position. How is that fear mongering by 'the news'? I don't disagree that the general news media has been as sensational as they can be (that's worked for them with all the other 'news' ) but it seems to be really dangerous to use that to downplay the actual seriousness of this pandemic.

ok, but is there any other kind of pneumonia that can spread to the whole humanity in months? sincere question

Influenza B. It’s been spreading for decades. That being said we mostly have a partial immunity to it.

I had influenza B in early January and had pneumonia. 105 fever for a week, difficult to breath, the whole thing.

During that time I actually looked up and found out about COVID-19. I tested positive for influenza B, but the information actually let my family prepare by stocking up in January. Lucky in a sense.

Yes. Hundreds of millions of people get pneumonia every year. (But most causes of pneumonia have effective treatments or vaccines, while covid-19 does not.)

But we hear the covid-19 triggers issues in most tissues (respiratory, cardiovascular, digestive, even brain). So what causes more damage, the virus or the usual colateral pneumonia ?

The pneumonia, for sure. It’s easy to get lost looking at rare symptoms and forget that we have millions of examples of what the disease typically looks like.

> even brain

This is not a peculiarity of SARS-CoV-2. Other coronaviruses can also invade the central nervous system.

China is a big place. Imagine any possible negative health complications, we can safely assume that at least one person in China has developed it. The question is, what fraction of people have developed these complications? We don't even know what fraction of people developed the disease, or what fraction outright died...

People are reading too much into aberrations from the norm, which happens with any disease, leading them to conclude the novel coronavirus is something extraordinary, when none of the evidence supports that at all.

It is of course unique, like all viruses, and has its own distinctive pathophysiology, but nothing about it stands out as exceptional. Influenza can also cause all kinds of deadly complications in rare cases, and in fact is significantly more deadly for the under 65 population than the coronavirus.

There is some research [0] that immunity to SARS ”v1.0” lasts around 1-3 years for those who had it. It would seem reasonable that Immunity against Covid19 lasts about the same period of time.

We are now at about 6 months into people being infected en masse. So hopefully in about another 6 months people in Wuhan and elsewhere wont start getting sick again!

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/

We don’t know, obviously, but immunity to some other coronaviruses only lasts a few years.

The question about why some viral infections confer lifelong immunity while others don’t is still an open question, I believe.

How are people catching COVID-19?

It would be good to hear plausible scenarios of how people still catch it despite of masks and social distancing. There is something to learn from each story. And I see a distinct lack of focus on anecdotal stories of how people think they caught it. How the fuck are people catching this disease?

I expect mostly poor hygiene when it comes to touching contaminated things and faces. I basically can't go out in public without seeing someone with their mask pulled down to talk/eat/smoke. You should be sanitizing your hands every single time you don or doff a mask.

There have been studies of influenza that suggest nearly 100% of all transmission occurs through coughing & sneezing and inhaling the output. To a close approximation, handwashing does exactly zero to stop it from spreading. Scientists seem to think the same is likely true for SC2.

Which isn't to say you shouldn't wash your hands, because there are other things you get on your hand which can make you ill. It means keep the damn mask on, and don't take it off until you're well out of range of other people.

This has been nagging me. Feels like we are dangerously close to many taking "precautions" as a signaling move more than being cautious. :(

If you're going to say hand washing doesn't affect transmission rates please at the very least post sources.

If that turns out to be misinformation it could be extremely dangerous advice.

> I basically can't go out in public without seeing someone with their mask pulled down to talk/eat/smoke.

Many countries that have lifted their lockdowns and are now requiring masks in the post-lockdown stage, require those masks to be worn only on public transportation or in shops. Overall, public-health authorities do not believe that people pulling down their mask in the open air to eat or talk on their phone, will significantly change the infection curve for the worst.

Let us remember that the public-health goal here is not to prohibit any and all behavior that could potentially, under very ideal circumstances, result in transmission. Rather, the goal is to institute a few general rules that will flatten the curve to the point where contact tracing is effective. People should heed their local authorities on what to do, but I am troubled by the moral panic where posters such the above are insisting on even more stringent behavior than required by the public-health authorities.

With regard to hand-washing, touching things is now seen as so relatively unlikely a form of transmission, that some countries which initially required supermarkets to provide gloves and hand sanitizer, have decided to lift that requirement (while keeping the mask requirement). Of course hand washing in general is a good thing, but authorities in many countries do not think that obsessively doing so will make a real impact on COVID-19 transmission rates across society.

> Overall, public-health authorities do not believe that people pulling down their mask in the open air to eat or talk on their phone, will significantly change the infection curve for the worst.

No. "Public health authorities" are all really clear: if you're going to wear PPE you need to do it properly. DIY cloth masks are not PPE, they're theatre, so it doesn't really matter whether you wear it or not.

> With regard to hand-washing, touching things is now seen as so relatively unlikely a form of transmission

This is untrue. Some people on HN are fixated on droplets and aerosols, but we know that fomites are a significant risk.

https://www.nejm.org/doi/full/10.1056/NEJMra032498

> The primary mode of transmission appears to be through direct or indirect contact of mucous membrane (eyes, nose, or mouth) with infectious respiratory droplets or fomites.3,26,27 The use of aerosol-generating procedures (such as endotracheal intubation, bronchoscopy, and treatment with aerosolized medication) in hospitals may amplify the transmission of SARS-CoV, and outbreaks have involved more than 100 patients on occasion.3,26-28 SARS-CoV survives for many days when dried on surfaces and in feces at an alkaline pH.33 Although data from direct comparisons are not yet available, a review of previously published data suggests that SARS-CoV may be far more stable than other human respiratory viruses, such as respiratory syncytial virus. The role of fecal–oral transmission is unknown but may be important, given that profuse watery diarrhea is a common feature of the disease and that SARS-CoV is shed in large quantities in stool.

> "Public health authorities" are all really clear: if you're going to wear PPE you need to do it properly.

You are confusing two things here. For preventing certain people in certain contexts from being infected, PPE is important. For preventing the average person walking around from infecting others to the point of upsetting curve-flattening efforts, any kind of face covering (even if it be a scarf or a Buff) will satisfy the requirement in most countries now.

Indeed, the public health authorities – at least in Europe which is presently my main concern – are very clear here: the authorities overall are calling for masks to be required only in shops or on public transportation. Countries like Poland and the Czech Republic which require masks to be worn at all times in public are outliers. (And I expect their rules to soon be harmonized with the less strict countries. De facto in Poland the outdoor requirement is not even being strictly enforced outside the major cities).

> No. "Public health authorities" are all really clear: if you're going to wear PPE you need to do it properly. DIY cloth masks are not PPE, they're theatre, so it doesn't really matter whether you wear it or not.

Even the CDC is now promoting cloth masks:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-si...

There's some evidence that countries which chose to promote or mandate masks early have low infection rates. Although there are a lot of confounding variables. https://www.thelocal.com/20200405/coronavirus-and-face-masks...

> People should heed their local authorities on what to do, but I am troubled by the moral panic where posters such the above are insisting on even more stringent behavior than required by the public-health authorities.

My public health authority does say you must wash hands before putting on, before taking off, and after taking off a non-medical face mask.

While your local authorities may have voiced such a recommendation for people to follow, as far as I know, no country which has mandated mask usage, is requiring specific behavior around the donning and doffing of that mask. (Please point to specific legislation if this really is the case where you are.) If there is no requirement and enforcement mechanism around a certain behaviour, then IMHO it is excessive for any of us here to complain that the general public is not observing that behaviour.

We can only expect the general public to observe any restrictions to the least possible degree; only if there is a hard rule that is being enforced will society overall heed it. Public-health authorities generally know this, and so if they are not pushing for certain behavior to be actively enforced, then that behavior likely matters less to curve-flattening efforts than you might assume.

Oh, there's no mandated use here, but the official guidance on how to wear masks is pretty clear: "you must wash your hands immediately before putting it on, before taking it off, and immediately after taking it off"

I wasn't really complaining, I was positing a mechanism for the OP's question of "How are people catching COVID-19 [despite masks and social distancing]?"

I've read very few reports of actual infection scenarios.

This is one https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article Image https://i.insider.com/5ea01ef938bf2357b9756173?width=750&for...

As we are two months into this, we really should be getting regular updates on infection events.

This article summarizes some different case studies and scenarios: https://www.erinbromage.com/post/the-risks-know-them-avoid-t...

That page keeps crashing in my phone. :(

I got to toilette hypothesis, so don't know if the rest had data. That said, this still sounded like speculation. Are the rest more backed with data?

TL.DR. from that page: It's airbone. The less air, more people and longer exposition in an environment, the higher the risk.

Surfaces play a significant but minor role, outside exposure (a lot of air) is almost irrelevant as long as people don't stay long close to each other.

Most people out there have “essential” jobs and can’t work from home. How could they not still catch it? All it takes is one eye rub, forgetting to sanitize your hands before you eat, etc.

> It would be good to hear plausible scenarios of how people still catch it despite of masks and social distancing.

One of the issues is that not everyone is wearing masks or properly social distancing. If you have any opportunity to go out and safely observe from a distance any groups, you'll notice a sizable fraction not wearing masks and many not properly distancing themselves.

All it takes is some percentage of those who are not mask wearing or distancing also being asymptomatic spreaders to keep the spread going.

This still doesn't answer the question.

If wearing a mask keeps you from spreading it, the question is how did you get it?

With the reasoning you are giving, a single case of this will have to spread to lethal numbers quickly. But the more we learn, the more it seems it was here for a while before it broke into long term care facilities and deaths started spiking.

I don't know what you find so hard to believe. Many people are not wearing masks. Many people are not distancing. Those people, and their family members, are getting it. People who work with one of these people and then touch their face get it, etc.

This is flat against your first point. You are now relying on folks not being in a mask having more of a chance of getting it. Not of spreading it.

So, again, what is the actual vector here. How are folks getting it?

I confess I believe the general idea. But it has been pushed with a ton of heavy handed bs from folks saying how much they protect you. And then completely neglect to account for the scores of folks in masks that are still getting it. How?

It's the same as any virus - how do you catch a cold? Its the virus gets in somehow, you touch it on a surface, then touch your face, scratch yourself. This one seems to need a lot of touches which is why you need to be in close proximity to others who have it for a while.

Claiming it needs a lot of touches seems counter to the evidence if how fast it spreads. Or to the claims of how fast it spreads.

I'm ok with "we don't fully know." To that end, take my question to be as much "how could we figure out how folks are actually getting it?"

As things stand, I'm mainly seeing ridiculous reaches by folks to sanitize all things into their houses, with no logic to why they is what they should do. Feels more like managers that want you busy, without focusing on what you are busy doing.

> I'm mainly seeing ridiculous reaches by folks to sanitize all things into their houses, with no logic to why they is what they should do

Yah, people - that's why Gwyneth Paltrow is rich

Here's some facts, seems to be the best summary I can find - https://www.health.qld.gov.au/news-events/news/novel-coronav...

edit: here's another one https://www.abc.net.au/news/health/2020-03-28/is-coronavirus...

Being overly cautious about a virus we don't 100% understand yet seems like a good idea.

What is against my point? Wearing a mask reduces the chance of getting the virus and of spreading the virus. It doesn't eliminate the risk. Masks are not impenetrable. You can touch your face even with a mask on. You can touch your face after you take a mask off. The only way to prevent getting the virus completely is to live alone, stay home, and have enough food to prevent going out.

At my local grocery store, they carefully arrange hard cheeses like Parmesan so that the price tag is hidden from view. If you comparison shop, that means you'll be touching several packets before making your final selection. And when you bring it home, it's coming along with the fingerprints of perhaps a half-dozen other customers. If it's shrink-wrapped plastic, you can wash it (do you?) -- if it's wrapped in clingfilm, you can't wash it without harming the cheese, so you need to somehow remove it from its packaging without carrying over the contamination. That's just a piece of cheese.

One of the difficulties in disease modeling is how very many transmission vectors that aren't accounted for.

You're assuming people are following protocol. Humans undergo lapses in judgement multiple times a day and are just as forgetful. Just the other day, I found myself having scratched my face under the mask while at the supermarket, something I only realised after the fact.

Many people don't realise how much contact spread can occur in just half an hour as well, as seen [0]. This was modelling the spread inside of a dining hall of a cruise ship, but you can imagine similar behaviour in other public spaces.

[0] https://youtu.be/9cZTfUAYrF8

It reminds me of a buddy telling me about his MOPP training in the Air Force. He said if there was ever a large scale biological/chemical attack, trying to decontaminate and drink water through a tube in your gas mask was going to get overwhelming real quick. It just takes one bad drink. The gas mask strapped to your leg was just a security blanket.

https://www.airforcemag.com/goldfein-time-to-dust-off-the-mo...

a) masks and social distancing only reduce the risk of transmission substantially, they do not eliminate it. Especially in the case of essential workers and stuff like grocery shopping

b) not everyone is socially distancing to the same degree.

1. Many people don’t have masks. Cloth masks aren’t as effective as N95s anyway and we don’t have nearly enough N95s. New York serology survey shows FEWER health care workers have caught the virus than general population - because only health care workers have access to and training in how to use N95s, face shields, gowns and goggles.

2. Many people are still working in industries where they aren’t social distancing, e.g. all the meat packing plant outbreaks where sick employees were ordered to continue working in close proximity to their coworkers and nearly every employee in the plant got infected.

3. Positive cases are being sent home to quarantine in the same residence as their uninfected family members, who then catch the virus. Some other countries are either quarantining sick cases in the hospital, in hotels, or in monitored quarantine sites, but we haven’t been doing that in most cases and so we send home a positive case and they then infect everyone else in their home. This is worst in nursing homes but is happening in multigenerational households and other households as well. https://www.nydailynews.com/coronavirus/ny-coronavirus-cuomo...

People are still going to grocery stores, pharmacies. Lots of people break quarantine and visit others. In some areas stores and places of worship are still open. And we don’t isolate people outside the home, so people spread to family/roommates.

Further, the virus can take 5-14 days to show symptoms, and people don’t go for a test immediately. So confirmed cases lag actual infections.

I find the Korean call center paper pretty interesting [1]. In early March, this building had 97 infections: 89 on one half of one floor, 5 on the other half of the floor, and 3 on other floors. The two halves of the floor were separated by doors but shared the elevators, bathrooms, etc. It seems clear from this that almost all of the infections were from being in a shared space with someone infected. (There's a nice diagram of the infections [2].)

The other thing I got from the article is that South Korea is on a whole different level of testing than the US. When infection was detected, they tested everyone who was in the building or had visited: 1143 people tested with results in 12-24 hours. Everyone positive was isolated and everyone negative was quarantined and re-tested for 14 days. They also texted 16,628 people who had been near the building for more than 5 minutes (from cell data), telling them to avoid contact with others and get tested. This level of testing and tracing got South Korea (51 million people) to the point that it is now averaging just 10 new cases per day.

[1] https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article [2] https://wwwnc.cdc.gov/eid/article/26/8/20-1274-f2

> South Korea is on a whole different level of testing than the US

According to [1] and [2], the US has performed twice as many tests per capita as South Korea. Roughly:

The US has performed 8.9 million tests for a population of 330 million (27 tests per thousand people).

South Korea has performed 660 thousand tests for a population of 50 million (13 tests per thousand people).

1: https://www.realclearpolitics.com/coronavirus/

2: https://ourworldindata.org/coronavirus-testing#how-many-tota...

> According to [1] and [2], the US has performed twice as many tests per capita as South Korea.

That's probably because South Korea managed to quickly contain the spread by starting large-scale testing much much earlier. And its number of new daily cases of COVID-19 reached the peak on February 29.

Not to mention, thanks to contact tracing, South Korea's tests are more targeted.

Yes, they were on a different level in February, because the first batch of tests from the CDC was defective. Not now.

maybe the difference is who they are testing. I mean, US started testing later, and is not doing testing based on who came in contact with positives. So, people continue to spread until they get sick, IF they get symptomatic.

Or government response isn't the reason for the difference.

Japan's government didn't respond quickly to COVID-19 (some have even said they actively tried to downplay it to protect the Olympics) and yet Japan has very few cases.

Perhaps the difference is cultural, or geographic, or travel patterns, or something else entirely.

I think that you are considerably underestimating how small and numerous viruses are, and how difficult one like this is to stop once it's spreading in a community. They've evolved for billions of years to do exactly this, and they are very good at it.

There's so much conflicting information out there right now that I'm not even listening to it. I'm wearing masks and avoiding people, because my wife has bad lungs and I have a 6 month old. Until there's more facts that are rock solid, all anyone is doing is speculating. The real issue here is lack of consistency and leadership from the top levels of government (USA here). If we had a consistent message from the experts and politicians together, then there would be less speculation, less fighting over lockdowns, less misinformation, and less grasping at straws guessing what the virus is doing. Instead, we (Americans in aggregate) have lost trust in both the experts and politicians, which is resulting in major issues. The deadliness of the virus isn't the major issue, it's the infighting that's preventing us from fixing it that's the issue now and will result in more dead.

When you walk around outside, are you also carrying an umbrella? Because cloth masks aren't that effective at protecting the wearer and I don't see how else you can prevent someone else from getting close to you.

I had n95 masks saved from the fires around me in previous years, but i generally don't run into people where i live so i can skip the mask when outdoors. People generally stay away from each other where i live, too. I don't live in a big city, so it's easier for me.

But like i said before, I don't care about what people say about the efficacy of masks, i will wear one anyways. Your comment had no bearing on my plan to keep doing so, because, like i said, i don't trust any "facts" about this virus right now, so i default to the most safe choice: wearing a mask.

oh sure. And good that you aren't finding it hard to keep distance.

Stay healthy fellow human.

Transmission risks are pretty low outside based on several studies. Especially if you keep distant, which isn’t too hard in most places if you can cross the street. (I live in a city, am never close to people outside).

cloth masks are not nearly as much about protecting the wearer as protecting everyone else from your germs. if you cough or exhale powerfully or suddenly, you're pushing your germs all over the place, unless you have a cloth mask on. that's why it's important for everyone to wear them.

it's like washing your hands after going to the bathroom. yeah, it's gross not to, but the primary thing is to protect others from germs in your feces.

Right, masks are not primarily about protecting the wearer. So if you want to protect yourself from droplets, what tool do you reach for?

Well, a cloth mask will provide about 65% protection to the wearer, so its better than nothing.

If others are wearing cloth masks, then the protection is pretty good.

If you need real droplet protection, as in you're extubating a covid patient, then you need a face guard, n95 mask, gown, and a bunch of other stuff.

This link provides more info:

https://www.newyorker.com/news/news-desk/keeping-the-coronav...

Compared to umbrellas, masks incur much lower extra costs and inconveniences. Even more importantly, we can almost perfectly predict if it will rain or not, within a day or two, and especially in US, there is no much need for umbrellas anyway - get a plastic bag and run to your car. Masks are also culturally acceptable right now.

The German hospital Universitätsklinikum Hamburg Eppendorf (UKE) performed more than 190 autopsies of patients who died with COVID-19. In a study (where they covered the first 12 cases) they found an unusually high number of of thromboembolic events. Therfore they are now recommending a prophylactic heparin treatment (a commonly uses blood thinner to prevent thrombosis), even for ambulantory care.

Here is the study: https://annals.org/aim/fullarticle/2765934/autopsy-findings-...

And for those who speak German, here is their press conference: https://www.youtube.com/watch?v=VvH3mG-v0Ms

Interesting, natural sunlight is also a strong blood thinner - can it be used as a treatment?

I had never heard that about sunlight before, but if true, it seems impractical to roll out ICU beds into the sun. (Not sure if patients outside of hospital would need blood thinning of course.) Edit: read too quick when typing "outside of hospital", ambulantory care has nothing to do with ambulances.

> It turned out I had severe oxygen deficiency, although I still wasn’t short of breath.

I've read about this pitfall before. It might be an idea to have a blood oxygen saturation meter at home to keep an eye on this.

They to be about $25 and now they’re about 70, Thanks to price gouging

What's the difference between price gouging and price increases due to shortages?

Price gouging means you took stock on hand and re-priced it to gouge the desperate with no increase in cost to the seller. It also covers people who buy out the retail stock in 4 states to "corner" the supply, and then try to extort high prices for necessary goods due to an emergency.

A price increase due to shortage is legitimate if it is new stock or production, brought online or made possible by a higher price that is now sought to satisfy demand.

I also believe a price increase to prevent shortage is legitimate (or actually good). If demand goes up prices shd go up so the buyer themselves can prioritise (if desinfect prices hiked immediately (some ppl would call it price gouging) buyers might not empty the shelves or at least more ppl had the chance to get something. But this needs to be done with stock on hand.

That's still price gouging, it merely re-allocates the supply from those that need it to those that can pay exorbitantly.

It's not as though the wealthy have more legitimate need for the products.

It doesnt merely do that. If like one liter of desinfectant costs 200US, still everybody can afford it, but everybody will think twice (actually not thinks twice, but dismiss the idea) of buying more than one bottle.

IANAL (or economist), but I'd say price gouging is when hoarders raise prices to profit from artificial shortages that they created.

As a people, we did not run low on hand sanitizer. As a free market, we ran low on hand sanitizer because a small minority decided they needed 10,000 bottles in their garage.

When there exists plenty of product for everyone, and there are distribution networks by which we can get it to everyone who needs it, and yet opportunists insert themselves in the middle for no purpose other than to make a quick buck, I call that price gouging.

I’m pretty sure we actually did run low on hand sanitizer.

Yes, there were some hoarders, but people also started buying and using a lot more sanitizer, the supply chain was overwhelmed. Companies didn’t have huge excess warehouses of the stuff ready to ship when demand suddenly spiked over the period of a few days.

I think he's referring to the feedback loop that hoarding causes.

If you're confident you'll be able to buy the good in the future, you'll buy less now. If a hoarder clears out the supermarket, that means that everyone that shops at that supermarket and doesn't get what they want is more liable to make a larger purchase when do find it at another store. This chain reaction leads to shortages. It's impossible to prove the direct amount of causation (and of course organic demand spiked), but the relationship is clearly there.

I think he's specifically referring to the hoarders being the cause of the price increase in the first place and profiting off of their hoarding (correct me if I'm wrong).

But that's definitely not the case with most shortages of things like PPE and alcohol. Most people are calling any price increase gouging, to the point where sites like eBay have simply banned anyone from selling masks at marked up prices. However they grandfathered some pre-existing sellers.

Ironically this created a monopoly situation that has constrained supply which by definition means ebay is price gouging (since they make a percentage based fee on sales).

If they simply let new sellers "price gouge", it would flood the supply and naturally lower prices for things like masks on eBay.

Sure, but people also just used up what they had.

I had a box of mini hand sanitizer in the closet i purchased 2-3 years ago, I brought it out at the beginning of march and began to use it. I ran out and there was no more to be found in any store. Still have only seen it once or twice in a store, behind the counter now 2 months later.

Even if we had all just tried to buy 1 bottle of hand sanitizer each that would have been 330 million bottles, I don’t think store shelves had that many in march.

(Edit: It’s the same thing as happened to stuff like toilet paper - we usually make just enough toilet paper for everyone, between commercial and retail toilet paper sales. Suddenly commercial toilet paper became unsaleable with industries shuttering their doors, and the existing supply of home toilet paper wasn’t enough anymore since now all the bum-wiping that would have been done with commercial toilet paper needed to be done with the different rolls that are sold to home goods buyers)

Wrong. Demand for hand sanitizer increased because people thought the world was ending and hand sanitizer would save their lives. Hand sanitizer went from a tool that marginally increased your health to a tool that many believed would save their lives. If you can't call this a genuine rise in demand, I'm not sure what you could call a rise in demand. I haven't seen any real data that the effect of middlemen was anything but tertiary. Hospitals and governments buying up truckloads of hand sanitizer had a greater effect on the market than middlemen.

> IANAL (or economist)

And true to form, your following statement was not what lawyers or economists would call price gouging.

As with most things, there is the colloquialism, and then there is the law. Price gouging laws are almost impossible to run afoul of, because thats not how this country is run. There are limited temporary state-controlled market disruptions, activated by a State of Emergency declaration.

State-level State of Emergency declarations activate "price gouging" statutes, which have almost no way of including a pulse oximeter. The price gouging statutes are often codified to last 30 days, because if the state of emergency lasts longer than 30 days then something much much bigger must be occurring, something far outside the capabilities of that state. It looks like the legislatures were accurate.

There is no reason to pay attention to any price gouging idea or statute anymore. There is a market price and that's it.

If the state really wants to disrupt a market to alleviate cost pressures on their consumers, then they can subsidize over a particular price if it wishes.

There is no interstate price gouging statute so basically any online merchant can conform any price around a different state's price gouging statute. When you see the Federal Government saying they are investigating price gouging, it doesn't mean anything, the Feds just extend enforcement resources to help a state enforce state level laws, which often don't apply to anything that's actually happening.

When the state of emergency lasts forever you just have a market.

That's quite a moderate price increase compared to face masks. In January the price for a single surgical mask was about 6 Eurocents. Now you will pay about a Euro, if you are lucky.

If you're in the US, check eBay. There's a bunch being sold on there for only about $30. I got one for $25 off there about a month ago and it seems to work fine.

Same with us.

You can find them for ~$30 on Amazon.

Good! This will reduce waste and allow firms to manufacture more at a greater marginal production cost.

$34.99 at Walmart: https://www.walmart.com/ip/Heart-Pcs-Waterproof-Film-Large-B...

The Samsung Health app on their Galaxy phones has a Stress Tracker that measures your blood oxygen saturation. You put your finger on the sensor and it shines light to measure your pulse and O2.

The caveat there is that it is reputed to be quite inaccurate, so it may be useful as an indicator, but it may also cause unnecessary distress.

https://www.cebm.net/covid-19/question-should-smartphone-app...

> It therefore requires the measurement of light transmission or reflection from a body segment such as a finger at two different wavelengths (usually in the red and infra-red).

> The Samsung Galaxy series of phones had a red light emitting diode (LED) built into the phone in addition to the flash light and camera. There were no details released by the company of how its app used the LED to estimate oxygen saturation, but it appears from publicity material on YouTube that it worked via a single-wavelength measurement (albeit with a monochromatic light source, the LED) and therefore that oxygen saturation could not be accurately derived from it.

> For the few patients whose oxygen saturation measurements were between 85% and 93%, the difference between the smartphone estimate and the ABG device varied between -5.5% and +2.5%. In other words, the readings become less accurate as the patient becomes more hypoxic.

That's accurate enough to tell whether you have serious Covid in many cases, especially if your baseline reading is 99% like mine. "No evidence" has killed a lot of people in this pandemic by discouraging practices that work but haven't been RCT'd. "Should not be trusted" because something has error bars, even when they're smaller than the dangerous range, could kill even more.

It's good to have the information out there that this is an inferior way to check, but I already assumed that was true just because it was only a phone app. "Possibly-inaccurate and free" is the choice I want to make with my health. I have low risk and it leaves more oximeters for others.

huawei honor band 5 has an SpO2 sensor, about $30. Your oxygen saturation should be 95-100%

I think the overall reason for that effect might be that CO2 can still be transported out properly (which is what your body uses to measure how much breath it's got) but not enough O2 in, which you don't notice happening at all other than oxygen deprivation symptoms.

I sent out blood-ox monitors to all my family members after a discussion on COVID hypoxia with a MD friend.

It’s never my favorite source, but in the US there are a number of Chinese companies with US shipping on EBay.

I purchased 7 devices from “ConTec” at ~$26/each. All arrived and at least my unit read the same as a retail unit from Walgreens.

Not trying to shill, there are a number of other sources with thousands of positive reviews.

> That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair.

Do viral epidemiologists have much insight about the effects of economic depression, combined with all-but-unprecedented fear and social isolation, on public health? Do they have any at all? This comes across as incredibly arrogant, and just as unfair.

There's a huge difference between criticizing the people/science and criticizing the decision. We collectively need to have a real conversation about the pros/cons/risks of reopening parts of society. However, we're stuck in this rut of just calling the science bad (it's not) in order to avoid talking about the harsh reality of increased death rate.

In Slovenia we did random sample testing. Out of this we concluded that 3% of population had covid-19. This is 60000 people of which ~100 people die. This gives death rate around 0.17. Majority were people in elderly homes with many other diseases.

Serology testing is incredibly inaccurate, and has a ~2-3% false positive rate.

I agree that tests have a high false positive rate, but still how would you interpret results we got?

NYC has population fatality ratio of 0.17% to 0.23%. 8.4 million people and 14,753 confirmed COVID-19 deaths [0]. They have also 5,178 probable COVID-19 deaths. In other words, around 1 person per 500 overall died due COVID-19. Serology tests shows that only one in 5 people had the disease [1]. So the population fatality rate could still go up to 1 in 200. Imagine a wedding party, then imagine one person dead and 5 hospitalized, that's how bad it can get. There are very similar statistics in Bergamo, Italy and on board of Diamond Princess. Well, Diamond Process has infection fatality rate of 1.8% - 13 people out of 712 infected died.

[0] https://www1.nyc.gov/site/doh/covid/covid-19-data.page [1] https://www.nytimes.com/2020/04/23/nyregion/coronavirus-anti...

I am just pointing this out because severe seasonal flu that appears in some years has reportingly ~0.1 fatality rate. Then my explanation would be that those two are comparable. Except covid spreads faster and therefore we see more death in shorter period?

Please poke holes in my theory:) I would like to se poking holes in my theory:)

I'm on the edge of what I know here but. I think the flu is innately self limiting because the virus only infects cells in the respiratory system, and generally only the upper part. It tends to kill people who are frail.

Covid19 most of the time mimics the flu. But because the receptors it uses are wide spread in the body it can an does cause systemic illness. In particular I see more and more comments from doctors about clotting and vascular issues.

Consider strep. You have step throat. And then you have scarlet fever. Covid19 is similar, presents at a mild respiratory disease mostly, or as a serious one with pnumonia, or deadly systemic.

They are sort of comparable. Indeed, 0.1% IFR for seasonal flu is more of an upper bound. For example, Swine Flu that cause 2009 pandemic had infection fatality rate of 0.03% [0]. COVID-19 infection fatality rate is probably around 0.8% (0.5-1 95% Confidence Interval) [1]. So, COVID-19 upper bound would be 1% IFR.

So, COVID-19 appears at least 5 to 10 times more deadly than flu.

But we have vaccines for flu and susceptible population is maybe around 30%. For COVID-19 susceptible population appears to be at least 60% based on Bergamo, Italy, probably close to 100%.

[0] http://news.bbc.co.uk/2/hi/health/8406723.stm

[1] https://miro.medium.com/max/1400/1*G6ql9WUz114Mdwktyp53Mg.pn...

I’m so, so sad.

“Let’s be clear: Without a coronavirus vaccine, we will never be able to live normally again. The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide.”

Worldwide? It is fair to expect this will take years.

In the mean time what does normalcy look like? Sweden?

Yes, unless something important changes. Many places have published their pre-vaccine plan, and the restrictions have been pretty similar to what Sweden has.

This is interesting and I wonder if we could use it on our most vulnerable until a vaccine is ready (part of focusing on cutting the mortality rate further):

"Sorrento Therapeutics and Mount Sinai Health System in New York City have joined forces to develop an antibody cocktail they hope will shield against Covid-19 infection for up to two months. The treatment, called COVI-SHIELD, is designed to be administered as often as necessary, with each dose expected to provide antiviral protection for health care and other essential workers."

https://www.cnbc.com/2020/05/08/sorrento-therapeutics-mount-...

Theres a risk of antibody dependent enhancement (antibodies backfire and lead to worse disease) with coronavirus antibody cocktails based on what we know about SARS. There are efforts to develop monoclonal antibodies that are selected to avoid ADE if that turns out to be a problem, so maybe a passive vaccine like that could be viable

With the death rate is so slow for large portions of the population, the vaccine will have basically no margin for error. How do you convince parents to vaccinate kids for a disease that has say a .001% fatality rate for those under 17 unless the vaccine is even safer?

The same way you convince them to get a flu or chickenpox vaccine. Most people won't mind, and "most people" is enough for effective containment of diseases less contagious than measles.

Their kids likely have grandparents.

I think it's safe to say that most people won't need to be convinced.

The complete details on the pathophysiology of the disease are far from known yet. For instance "The death of a five-year-old boy in New York of inflammatory complications possibly linked to Covid-19 has prompted Andrew Cuomo, the state’s governor, to warn of “an entirely different chapter” of a disease that had been believed to cause only mild symptoms in children."

"Cuomo later tweeted that there have been 73 reported cases in New York of children falling severely ill with a toxic shock-like reaction that displays symptoms similar to Kawasaki disease."

https://www.theguardian.com/world/2020/may/09/children-coron...

In the same hospital?

Here in new Zealand we are embarked on a total eradication path. Just yesterday a friend was espousing that even if we succeed, sooner or later we'll have to join Sweden anyway (unless a vaccine arrives) as the only alternative is to keep our borders entirely shut. Personally I don't have a problem with that, as I have several elderly relatives, but it's amazing to contemplate the decisions that await us all in these strange times.

For an isolated country like New Zealand it's possible to secure the borders, and institute a mandatory 2 week quarantine and testing of visitors. They may be able to relax that quarantine for travelers from countries with very low infection rates.

NZ could quarantine travelers who come in and use extensive testing, temperature checks, etc. to keep it from coming back. Or yes, it could give up on the amazing progress already made in eradicating the virus, open everything up, and not give it a second thought like Sweden. Can't imagine the people in charge would be that stupid, however, to give up all they achieved and let people die unnecessarily.

What about fast, easy-to-administer, inexpensive and accurate tests becoming available, allowing procedures to be set up to test people at airports before departing?

What about them? Do they exist yet? How long until we know they're accurate?

That is one path. You'd probably need to require daily covid tests afterward though for a few days. PCR has a 100% false negative rate the day of infection.

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