Coronavirus: A third of hospital patients develop dangerous blood clots
bbc.com
bbc.com
There is one line that quotes a doctor stating, "He believes the number of critically ill coronavirus patients developing blood clots could be significantly higher than the published data in Europe of up to 30%." No mention of the percentage of cases that require hospitalizations in the first place, let alone any non-anecdotal evidence to back his claim.
I wish we would stop sharing articles that are not backed by any scent of a scientific study or peer review. It leads to fear, like others have pointed out.
From news article:
> Up to 30% of patients who are seriously ill with coronavirus are developing dangerous blood clots, according to medical experts.
(One doctor anecdotally thinks its higher)
From journal article https://www.nature.com/articles/d41586-020-01403-8
> Studies from the Netherlands and France suggest that clots arise in 20–30% of critically ill COVID-19 patients. 1,2
But yes, rounding "20-30%" up to "one third" is a bit odd. The news article seems to leave the reader to do their own discovery of sources. So you're not wrong to be skeptical, but you're not right that it's wrong :)
fear is evolutionarily contagious. you see it most obviously in herding animals, but in people too.
fearful people share their fear with others for validation (my fear is real since others fear too), esteem (i'm helping others and that feels good) and group cohesion (we're together and i'm in). it's useful in context and when used judiciously. it's harmful generally (stress, anxiety, resource diversion, etc.), but the rare instance where it's actually helpful, the positive outcome is outsized, or at least perceived to be so. as a result, we over-attribute usefulness to fear, and then over-prescribe it.
brashness, disregarding even rational fear to accumulate resources during diminished competition, can be a dampening counterforce. it also has harmful effects (death, aggression, corruption, etc.) so is a poor general strategy.
what's dismaying is that the intellect, literally designed to predict the future, is overwhelmed and failing it's job. the brain constantly assesses the likelihood and magnitude of danger, rationalizing away the remote, and that generally checks our instinctual fear, our overreaction to it, and its spread. but our brains are overcome by massive, relentless, and fast-spreading fear, in forms that seem reasonable or even unreasonable, abetted by the marvel (and it is marvelous) of the internet.
the hopeful, eventual upside is that we develop some individual and societal resilience against overwrought fear.
Given that extreme events tend to belong to these sorts of difficult to predict distributions and have a high chance of ruin, fear is far more rational than pretending you can apply empirical methods that work for mundane phenomenon.
This is the study of extreme value theory and estimators for heavy tailed distributions. A well known popularizer of these mathematics with applications to events like pandemics is Nassim Taleb. His style is very brash and arrogant but his mastery of probability theory in this domain is very solid.
The appropriate reaction to a highly unpredictable event with potential widespread impact will look like overreaction to a naive rationalist post hoc. Don't fall into that sophistic trap. Your lizard brain knows a lot more than you give it credit for and you debase your intelligence by innapropriately elevating your rational brain.
i bought black swan way back when, because it was popular and a couple people i knew recommended it. boy was that a mistake. i can overlook arrogance if it comes with insight, but that book was all incoherence and convolution, no meat. couldn't even finish, it was so bad. his fund backed by that strategy has underperformed. so appealing to taleb's authority is not a winning argument.
> "The appropriate reaction to a highly unpredictable event with potential widespread impact will look like overreaction to a naive rationalist post hoc."
the appropriate reaction to an unpredictable event is no reaction at all, since by definition, you can't predict what it is, much less when it will happen.
> "Your lizard brain knows a lot more than you give it credit for..."
your lizard brain is designed to handle futures on the order of seconds and minutes, not months and years, and certainly not decades and centuries. it's really good at predicting (and avoiding) the path of a bird for example, but not so good at predicting (and avoiding) drought.
edit: also, fat-tailed typically means a tiny bit fatter than a guassian tail, not some wavy, unknownably fat "tail". otherwise, we'd have enough known events from which to draw reasonable predictions, making it not extreme and unpredictable, nor even a tail at all.
I don't think his fund is structured to beat the market. If his fund is structured for extraordinary events then I would expect it to underperform strategies that are optimized for typical conditions. I would expect his fund to be used as a hedge in a more diversified strategy and IIRC there was publicity that it did exactly what it was intended to do for its clients when COVID-19 became a pandemic.
> your lizard brain is designed to handle futures on the order of seconds and minutes, not months and years, and certainly not decades and centuries.
I guess I should eat my words for using an imprecise phrase like lizard brain but I'm talking about the limbic system which is most assuredly involved in decisions involving fear and ignorance and long term behavior, not snap decisions. Fear in ignorance is good if the possibility space you're ignorant of contains catastrophic consequences. If you have to make a decision that is beyond your intellectual capacity, you should be cautious. We evolved from very stupid creatures that needed to survive phenomena they did not understand. We have not transcended that need. Rationality is also knowing the limits of your rationality.
> the appropriate reaction to an unpredictable event is no reaction at all, since by definition, you can't predict what it is, much less when it will happen.
I'm sorry but this is collective suicide in the face of a pandemic. In the face of an exponentially self-propagating phenomenon that has a wide possibility of effects including: death, permanent injury and the collapse of the healthcare system, waiting around to get more information just means it would be too late if action was needed. Even if it turns out we could have gotten away without it this time, that doesn't mean we overreacted.
> edit: also, fat-tailed typically means a tiny bit fatter than a guassian tail, not some wavy, unknownably fat "tail". otherwise, we'd have enough known events from which to draw reasonable predictions, making it not extreme and unpredictable, nor even a tail at all.
Is this a philosophical point? Are you saying that if I cannot draw enough samples to approximate it that the population distribution doesn't exist?
I'm arguing that there are limits to empirical methods in the face of extraordinary events and I'm making that claim somewhat more concrete by appealing to the divergence in behavior between the population and sample statistics of heavy-tailed, e.g. something with power law decaying tails like a pareto distribution.
Is it ridiculous to conclude that in the face of extraordinary events that cannot be reasonably predicted empirically whose outcomes would be A) widespread, basically affecting everyone and B) potentially catastrophic, we have to be cautious? I don't see how.
> "Fear in ignorance is good if the possibility space you're ignorant of contains catastrophic consequences."
sure, a fear of the unknown is baked into the limbic system, but herein is the crux of our disagreement: what fear is and is not, what's catastrophic and what's not, and the magnitude of "contains" relative to preparation and response.
fear is a cascading physiological process that triggers our fight-or-flight response (lizard brain), causing physical and emotional degradation, and shutting down our rational brains. fear retards our ability to think and act appropriately. unless the threat is something imminently immediate, like an oncoming car, fear can easily overwhelm our response with misjudgment (hoarding, for example).
concern and caution--cousins of fear--are frontal, intellectual processes built atop the limbic. these, along with diversity of thought and appropriate communication, can lead to reasonable responses to non-imminent threats. this is what we should lean into, not fear.
the mistake with covid (and 9/11, etc.) is not recognizing the difference.
covid is trending toward 5% of yearly US deaths. certainly concerning and worthy of serious response, but not civilization destroying. that's the right context to couch our reactions.
I really dislike HN's habit to label controversial or incorrect articles as "misleading" - and then offer "corrections" that would radically alter an article's point.
The article's main claim is that around 30% of all serious ly ill COVID-19 patients develop blood clots - and the headline conveys that quite correctly.
Now that claim is quite likely incorrect or at least not the majority opinion - so you're very justified to criticize it. However to be able to do that we must at least acknowledge what the article was saying in the first place and not pretend it was saying something completely different.
On the other hand, I find that the style of reporting contributes to the irrational panic and fear around COVID-19.
Only a tiny fraction of those with COVID-19 are admitted to the hospital, a third of those develop blood clots (assuming the reporting is accurate), and, presumably, in some unknown fraction of those cases, the blood clots cause death or permanent injury.
However, people will focus on this "1/3 of people get blood clots!" number, and their intuition about the risk of themselves or people they care about being maimed or killed by COVID-19 will increase irrationally.
I think it’s a cause for concern, yes — and the current reaction is miles beyond what can reasonably be described as “concern”.
I think heart disease — the #2 cause of death in the US — is serious too, but I still don’t think sensationalism and panic about it is helpful.
We shouldn't panic, we should make decisive decisions based on the best information we have, and we should seek to reject fear-driven reactions just because something's new and scary.
R_0 really isn't relevant, we're all in all of these together.
Even if after the fact it looks like the pandemic didn't have catastrophic long term effects, it was still rational to be extremely cautious.
Car accidents don't have the potential to collapse society. A car crash has a chance to cause other crashes but that correlation dies off exponentially fast over relatively small time and distance scales. A pandemic in our modern connected world is basically scale invariant without mitigations.
With exponential phenomena, if you wait for evidence of extreme downside it'll already be too late. The absence of evidence is not evidence of absence. You can't wait, you have to act on your ignorance. This is not "panic".
Rationality is not just about reasoning about what you know, it's about reasoning about what you don't know as well. In typical, mundane processes you can act on ignorance by collecting evidence. In extreme, self-propagating processes, one needs to apply the rationality of ignorance: extreme value theory and the statistics of extreme distributions.
Your comment compares apples to oranges. Heart disease has no way to grow exponentially. COVID deaths can.
Marking cardiac arrest as cause of death is like filling in the blank with “died by not living anymore”.
Therefore it is not a meaningful stat to say the heart disease is the #1 or #2 cause of death. I cringe when that is used by fitness gurus to justify their videos or when scientific discussions are derailed by making the comparison.
Panic isn't helpful and you can't sustain it.
Disregard is just plain stupid - it's a lethal disease that messes up a lot of young and healthy people pretty seriously.
What definitions of “a lot” (using actual numbers, not anecdotes) and “messes up” are you using here?
We just spent two decades being terrified of terrorism, giving up hard won civil rights and spending trillions on needless wars. Terrorism never even approached the damage caused by a damn bat virus. 9/11 killed about 2000 people and caused a tiny fraction of the economic damage, and that was by orders of magnitude the largest terror attack.
Same goes for random mass shootings, serial killers, most drugs (except maybe fentanyl), street crime, and so on.
It makes more sense to be alarmed about this than any of those things, yet many of the same voices that were in utter panic over that stuff are dismissive of this.
Ultimately it seems to be about what fits the government's narrative, more than anything else. Whatever they can use to spread fear is something they perceive as good - it deflects from real issues at home, and can be used to justify otherwise dubious actions (e.g. having a populace scared of terrorism was the perfect situation for invading Iraq).
Another classic example: Few people fear dying in a car accident, but many people fear dying a plane crash, despite the relative probabilities being skewed entirely in the other direction. This irrationality is not part of any government narrative, it is simply fueled by fear.
Humans are terrible at rationally evaluating risks and, especially when trained by the media they consume, fear the dumbest things (dying in a mass shooting vs. dying in a police shooting, plane crashes vs. car crashes, immigrants vs. other community members, brain-eating amoebas vs. swimming pools, etc. etc.).
The fact that a lot of people are hypocrites for being dismissive of COVID-19 is true, but completely unrelated to whether being dismissive of it is rationally warranted.
Conservatives who thought starting wars because of terrorism was justified and liberals who think shutting down civilization for months because of a moderately lethal viral pandemic is justified might both be wrong.
Not a reasonable description of stay at home orders with electricity, running water and (for many anyway) grocery deliveries.
Sorry for not making it clear that what I was saying wasn’t intended to be applicable internationally.
Any potential source of division in the US gets seized upon by the utterly massive partisan propaganda machinery (of both parties) and turned into a fault line with which to segment the electorate. Nothing is immune, and the process is advanced, scientific, industrial scale, and highly effective.
The reason billions are spent to do this to us is that elections are largely decided by whose base is most fired up to actually bother to vote. That means it's less about debating issues or convincing anyone and more about firing up the base with fear, hate, or other base emotions that tend to translate easily to action.
What is your definition of tiny?
My country is running an antibody study. Preliminary results are around 1-2% fatality rate. I wouldn't call that tiny, and the hospital admission rate is obviously higher.
For younger people, the risk of death is quite low. In NYC, for example, IFR from ages 0-17 is 0, and for 18-44 is 0.019%. The hospitalization rates for those two age brackets are 0.02% and 0.2%, respectively.
Source? Your link only has CFR (and >10%).
In my country's (CFR ~15%) antibody study (reminder: preliminary data) the IFR is ~1.5%. Both pretty close to initial estimates.
> heavily skewed to the oldest members of the population
And?
Either way: the huge influx of patients completely collapsed the healthcare system, which made it harder to treat everyone else.
That said, I think the natural next step for this argument is targeted testing at younger populations to see what their IFR is. With stronger (read: expensive) measures to isolate long term care facilities. Occupants, care givers, cooks, cleaners, all. (If the immunity antibody story plays out, work on ways to get antibody positive people in those positions.)
And I will again point out. I'm a random internet poster. No, nobody should do something just because I think it makes sense. :)
The link I provided has IFR, and is where I got the NYC numbers I quoted. They’re in the bar graph, expressed as rates per 100k.
The best reference I know of for a global, age-adjusted IFR as of early April is here (their estimate is 0.66%):
https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099...
However, more recent papers have come out, suggesting much lower values. For example, this paper estimates a a value of 0.08% for patients under 70, using antibody data in blood donors in Denmark:
https://www.medrxiv.org/content/10.1101/2020.04.24.20075291v...
My stated estimate is conservative. If anything we are continually reducing the number as we gather more data on prevalence. Regardless, a range of 0.5-1% is a safe bound for the highest quality estimates of IFR. The values cited by the OP (>>1.5%) are far too high, and based on severity-biased samples were gathered early in the pandemic.
AFAICT that's per 100k total population, not per 100k infected (which amounts to 0.2% total FR citywide, not even IFR).
Or am I missing the graph you mean?
> The values cited by the OP (>>1.5%) are far too high, and based on severity-biased samples were gathered early in the pandemic.
I am OP. They're based on an antibody study currently ongoing in my country so... no, they're not far too high nor severity-biased. (I'm trying to find links in English, but no luck so far).
Note I am not pushing for just letting go. But I do feel efforts could be made that are more targeted to the vulnerable population.
Numbers like 0.5% sound small as an abstract concept, but 0.5% of the US population is still 1.6M ppl. That’s a lot!
The other is peoples social networks tend to skew towards their own age group. But not exclusively. So older people have networks with lots of other old people. Which reminds me I showed up in San Francisco in the mid 90's. I missed the HIV carnage of the 80's. But I have gay friends who are my friends because HIV killed most of their friends and they had to start over.
I challenge you to quote the portion of my comment where I said anything resembling this.
I stated facts about IFR and its strong age-dependence. I made no judgments about what policies we should pursue based on these facts.
At the same time the risk of hemorraging events was the same as the non-anticoagulant group.
Their findings are similar. In the first 12 cases they found thrombosis in 7 cases[1]
They recommend prophylactic treatment with Heparin, even in ambulantory care.
https://www.hopkinsmedicine.org/Press_releases/2003/10_17_03...
My calculations for the Coronavirus death rate:
<5 0%
5-14 0%
15-24 0%
25-34 .04%
35-44 .12%
45-54 .37%
55-64 .9%
65-74 2.1%
75-84 5.5%
85+ 16.9%
Based on this data I think the lockdown is an absurdly heavy handed approach. Subjective opinion increases -> It's about older voters. In Eric Weinstein's words "they are hoarding well-being on every front" to the point that they will gladly screw over the younger generations.
We need to end this nonsense ASAP.
If politicians want to do testing and tracing for nursing home and hospital staff, fine. Otherwise, end the lockdown.
edit: OK I got one downvote instead of an answer. Wasn't the question gentle enough?
The death rate for my age is .37%, it seems that the death rate for your age may be not important at all -correct ?
I'm in the 35-44 range.
A lot of people are making arguments without keeping things in perspective. First, people die. That is a fact of life. Our attempt to smooth out nature will be smyted in time. It will snap back. We are spending too much money. We are creating a fear-driven easily controlled society. We are encouraging censorship.
All of this stuff is very bad. Do you agree with that?
Given the risk level, on an average basis, the question seems to be, "Are you willing to kill off either yourself, or more likely someone you know, so that we can all enjoy the ability to go stand in stores?"
A large percentage of the population (doesn't even have to be anywhere near a majority) is going to answer "No" to that question. Regardless of lockdowns, regardless of what the government says they are allowed to do. People will maintain their own personal "shutdowns" regardless of how the government (or those who assess the risk differently) tell them to feel.
This is an absurd appeal to emotion — it implies that you should treat COVID-19 as something you will deterministically die from.
The correct framing is “what _probability_ of increased death for yourself or someone you know would you accept in order for the lockdown to be over?”
Well, “someone you know” is extremely vague, but just speaking for myself, I’d probably accept a 10% risk of my own death to end the lockdown (which is many orders of magnitude higher than the actual risk).
No I don’t think my grandma dying is worth all this being over. I do think some small risk of people dying is worth it, though. Everyone thinks that way about everything, even if it’s hard to admit. If they didn’t, they would never have gone outside even before COVID-19 was discovered.
It's not an appeal to emotion at all. If we allow the virus to run unabated through the population, it's a statistical likelihood that someone you know will die from it. I think "someone you know" is generally understood to mean friends, acquaintances, near and extended family members.
Of course, we're only talking about probabilities and at the end of the day there would be people who would end up having no one they know die, and others who would see half their families wiped out.
> I’d probably accept a 10% risk of my own death to end the lockdown
Accepting a 10% risk of death to "end a lockdown", of all things, so that people can go stand in stores, is completely incomprehensible to me, which just goes to show that not everyone's risk tolerance is the same.
You can't dictate to others how they feel on this topic.
It is not about wanting to stand in stores. It is about avoiding long-term damage to the material conditions of millions, maybe billions, of people.
Do you not think the lockdown will cause a huge increase in poverty, homelessness, and starvation?
Perhaps. But that's something that should be quantified and included as part of the risk assessment so that rational decisions can be made. It's also something that can be planned for and mitigated.
It also plays into the idea that the economy is "shutdown" or that there is a universal "lockdown" happening or that the economy needs to be "reopened" because it is no longer producing anything at all. Large parts of the economy didn't have to (and did not) shut down and they have continued full-steam ahead.
If you gave people a complete understanding of the scenario, that "stay inside until the risk is gone" means "stay inside until at least 2021, maybe longer, while the rest of the world gets to stand in stores and eat at restaurants again", I doubt any significant number of people would sign up for it.
People are being asked to make the temporary sacrifice of practicing physical distancing. That's what it boils down to in terms of "freedoms lost".
And because, frankly, we have been utterly unprepared to deal with this completely predictable viral outbreak, much of our society is unprepared to conduct business in a way that allows or supports physical distancing. So people are scrambling.
Yes, there will be severe economic hardship for many people. No one denies that. But as I said, for many people they are making an extremely difficult choice between economic hardship or what they perceive to be the health and wellbeing of family and loved ones.
Do you agree? How many quality-adjusted life years do you think it's worth paying to keep the kids in school? The answer can't be zero, since just driving them there costs something. This isn't a pleasant question, but it's one that society has to answer.
I really don't like the binary argument about "lockdowns". It creates the impression that the pro side wants no one leaving the house except for food, and the anti side wants to resume status quo ante corona. The real answer is of course in between--that some measures, like masks and not standing too close are clearly worth it, while others, like banning all outdoor exercise, are not. Perhaps some people arguing for or against "lockdowns" really are at those extremes, but I doubt most are.
But, and this speaks to your point about binary arguments, why are our only options presented to us "open schools as we normally would" or "keep them closed"?
It seems to me that there are many ways that education systems could be re-tooled by the time school opens in the fall to enable education while substantially reducing risk of infection. To me the question is if there is a will to make those changes and compromises. It really seems to me like there isn't, and I think that is the part that distresses me the most among all of this.
And while I'm here, I think the proposals to move university education entirely or mostly remote are insane. College students are themselves at very low risk from this, and they live mostly with college students. We should take measures to protect those at risk (help students living with their parents to instead live with classmates, let older professors lecture remotely while TAs run the class, etc.), but the cost of moving that online-only again seems huge to me.
> I'm in the 35-44 range.
Me too. Leaving aside the danger to older people, let's selfishly consider our risk.
My baseline fatality rate is something like 1 in 1,000. That's not odds I'm absolutely wild about - I wouldn't be keen on getting on an aeroplane with a 1 in 1,000 chance of crashing - but not something I'd worry too much about.
What's considerably scarier and what you don't seem to be considering is the hospitalisation rate. This could be in the region of 3-5% for our age group. A case requiring hospital treatment could easily be lethal if you have an overwhelmed health system. Even if you survive, you may then be facing serious long-term health problems.
Odds of a bad outcome approaching 1 in 20 are a lot more thought-provoking than 1 in 1,000.
> We are creating a fear-driven
Fear is a good thing in general, providing it doesn't stop you thinking rationally. It keeps people alive.
https://www.cbsnews.com/news/kawasaki-disease-coronavirus-il...
A _novel_ virus means we don't know what it does to everyone yet. At a minimum, closing the schools globally probably has saved millions of children from this "new polio"... for now.
Perhaps also maybe grandparents would like to live long enough to see their _healthy_ grandchildren again.
Worse, it has a shaky basis with everything else we do know about the virus. Which is that it is highly contagious and the earliest community spread cases we knew of in WA included a student. Which is to say it remains to be proven that we did keep the kids from getting it.
Again, I'm not against caution. And I am not pushing for reopening the schools. I am pushing for testing the students to see if that ship sailed or not. If it had, I would actually push for more expensive measures on older populations.
The school closure was criticized basing on current evidence in an editorial[1] on Disease and Childhood (sister publication of the British Medical Journal). They also go over the reports of Kawasaki disease saying that there needs to be more evidence to support the claim.
Also a limited test in two schools in New Wales, where contact tracing was used, there was one reported infection of a student by another out of 853 recorded contacts. There are indications that a. grave effects are rare in children (rare does not mean zero) and b. children aren't as good "spreaders" of this disease as adults.
[1] https://adc.bmj.com/content/early/2020/05/05/archdischild-20...
Actually I don't think we don't know the infection rate among children[0]. Keeping them isolated among adults 24 hours a day could be having the opposite effect.
[0] Although one Icelandic study claimed 0 (zero) known transmissions between children.
There's a widespread lack of reagents, and the government is pretty slow at procuring them.
The only reliable data there is ICU admissions, and yes, they're going down.
But don't call reporting as accurate: it's not even close (although testing capacity has increased a lot in the past weeks), and not even the testing is widespread (many are calling for increased testing regimes).
Life is irreversible. I’m curious to know what the plans are if lockdown ends asap.
On the other hand, I also feel that the commitments and policies in this society are more about protecting the elderly and their way of living (their wealth, single family homes, less sustainability, car-based city planning). Some may be debatable. But isn’t protecting each other part of humanity? I hope we are not in a stage where we have to decide which groups to sacrifice. If US is a still free country, is freedom-from-danger also a form of freedom as well?
so I think your numbers are a bit low but order of magnitude correct. Also of note, S. Korea fatality rate is like 2.4%, in spite of the fact that 20 year olds were dramatically over represented in infections and none of them died - though, because of korea's older demographics, if you extrapolate to the US you get a 1.4% fatality rate (though I think it could be a bit higher because americans are fatter)
Estimates of the IFR come either from isolated populations that were fully tested by PCR (often ships, like the Diamond Princess) or tests for antibodies in a random sample of the population. The antibody studies are tricky when the incidence of antibodies in the population is low, since the tests have some nonzero false positive rate, but much easier in a place like NYC (with ~20% infected).
ETA: But any single IFR is misleading--this disease really is no more lethal than the flu for children (which doesn't mean no one dies, just that very few do), but is >10x worse for the elderly. To ignore that promotes both needless panic in the young and dangerous complacency among the old.
Life isn't binary. Life isn't just life or death.
Do you want to end up in an ICU? Intubated for weeks? Not being able to properly function afterward?
It's so silly to look at a binary dead/alive statistic when this virus can make you damn sick.
We are ending this nonsense, but step by cautious step, and in such a way that people will feel safe outside their homes.
No news here, just normal life, everything has consequences, unfit people die earlier, that’s how nature works in general.
EDIT: Just to clarify, not saying that any death is less tragic, just that this is really not news worthy. It’s pretty well understood that blood clots can happen when people are ill and even when they are not ill, and the fatter one is the higher the chance of this happening. Journalists really scrape for any BS to write about recently.