Coronavirus: Why Everyone Was Wrong | Hacker News Reader

Coronavirus: Why Everyone Was Wrong

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15 pointshudon47 comments

> Those young and healthy people who currently walk around with a mask on their faces would be better off wearing a helmet instead, because the risk of something falling on their head is greater than that of getting a serious case of Covid-19.

I'm healthy and young and I might not die from Covid. But if I catch it I will almost certainly kill my mother.

Or she will have no symptoms at all. You have no basis to expect that it will kill her, or that she will even manifest any serious symptoms.

Remember the vast majority of people have mild symptoms, the CDC stated that the actual number of cases is about 10x of the reported ones.

It is hard to believe but 30% of nursing home residents infected with the disease were also asymptomatic. That in turn was one of the early confounding factors that made the spread in the nursing homes so hard to identify.

"Certainly" being 1%. We must have different opinions on certainty.

Baring some grand miscalculation on my part, I'd likely win the wager that you don't actually know their mother or the comorbidities she might have that lead them to that conclusion. They are likely overestimating her odds of death, but your flippant response without knowledge or her situation is more than certainly underestimating it.

Humans overvalue perspective lose to themselves, it's one of our worse traits. That said, we also presuppose knowledge we can't fathom to have. I believe both were on display just now.

And for $deity's sake, we're living through an unprecedented pandemic, this person is worried about the well-being of their family, have some compassion.

To the grandparent poster: I worry about that as well. :/

Either there's something very unusual about your personal situation, or you're using "almost certainly" to mean "well under ten percent", or your statement is simply false. Estimates of the household secondary attack rate vary but are typically low tens of percent[1][2], and the IFR even for patients >80 years old is about 8%[3]. The probability that your mother would die if you became infected is the product of those two.

To be clear, I wear a mask and I support orders requiring that, since the cost of mask-wearing seems very small to me in exchange for the possible benefit. (If anyone finds a mask uncomfortable, I'd suggest a better mask. Surgical-style masks are much easier to breathe through than fabric, and widely available near pre-pandemic prices.) We should avoid hyperbolic, misleading, or false statements in support of a noble cause, though.

1. https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

2. This is unintuitive given the close contact sharing a household and R0 = 2.5, but consistent with the theory that spread is driven by a small fraction of super-spreaders, while most infected transmit the disease to no one at all.

3. https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

You might be ignoring the fact that they know what "comorbidities" their mother has. So general population percentages might not apply to them.

I started my reply with the words "Either there's something very unusual about your personal situation...". So can you give an example of comorbidities that you wouldn't consider very unusual, and your estimate of the probability that the mother would die if the child were infected in that case? Remember that:

1. The secondary household attack rate is far less than 100%; the paper I cited found 18% for people >= 60 years old sharing the same address. So even if the child becomes infected, the mother probably wouldn't be.

2. Most eighty-year-olds have a lot of comorbidities already, so the IFR for that age group accounts for that.

Assuming only that the mother is in the oldest age category from each paper and the probabilities are independent, I get a probability that the mother dies if the child is infected of 1.4%. Comorbidities can indeed drive that higher, and maybe there's some dependence (sicker people both more likely to catch the coronavirus and more likely to die from it); but I think you'll find it very hard to build a plausible set of assumptions that would get you to "almost certainly", unless the mother is so sick that she's likely to die soon regardless. (Of course, that wouldn't mean her life is without value. But it would mean that when we decide we can't do something until a vaccine is available, we're deciding she can't do it ever again in her life. If it were my life, then I'd judge that calculation differently.)

Most discussion of probability of death feels rather ghoulish, and the above is no exception. All of us will die, though, and it's a question only of what we can do in the time before that. I'd rather plan that time using the best empirical estimates we can make than with half-informed hyperbole. Wouldn't you?

Less than 2% mortality for those under 65 years of age in developed countries. I think we should have only quarantined the elderly.

The CFR is under 2%, the IFR is way less than this for people under 67 years old who don't have other conditions.

A good ballpark number is the IFR being a tenth of the CFR. And for under 65 divide by hundred.

Let's separate the mortality rate from the actual impacts, which are multiple. The hospitals in multiple places are overwhelmed for months with cv19 cases. The mortality doesn't matter when NYC, much of Italy and Spain, and now Texas and Florida hospitals are overfull with patients being treated for cv19, and other patients are hurt because they can't be treated or are afraid to go. There is excess deaths (ie more people dying than would otherwise, more than a typical flu year).

In the us we went through a long period of shutdown and we still ended up with this happening in several places. If we only quarantined the elderly, we'd still have this happening, but it would have been much much worse. Even if the death rate ends up being low, like 2%, we'll still kill a lot of people through hospitalization overload. That's why we need to social distance and wear masks - we don't need to wear masks only if the death rate is > 2%. It's to decrease the whole impact.

Plus when this article was written it was back in the magical thinking period that somehow in the summer the incidence would go to almost 0. We now see that it's still very infectious and will be ruining people's lives for a long time.

The IFR is far below 2% for young people--a recent meta-analysis[1] got 0.7% over all ages. That study didn't break it down by age, but an older one that did[2] (and got a similar IFR over all ages) got 0.14% for <60 years old, mostly from the older end of that.

There's moderate evidence for seasonality, from studies comparing countries with different climates and trying to control for other factors, trying to regress against actual weather over weeks, etc. That's empirically not enough to bring R < 1 in the summer in the USA in combination with whatever we've been doing, but a big effect might still be there--we might just have relaxed the social distancing by enough to more than offset. If that's the case, then we're potentially in for a terrible fall and winter (and places that have built up some degree of herd immunity--whether quasi-intentionally like Sweden or accidentally like NYC--could end up better off in the end).

As to excess deaths: As far as I understand, most of those actually observed are probably unconfirmed coronavirus deaths, rather than unrelated deaths due to an overrun medical system or people afraid to seek care. I've seen speculation that the latter may occur, but no strong evidence (since even NYC barely occupied the Navy hospital ship or other temporary facilities, and since no excess deaths have been seen in areas with the lockdowns that would discourage people from seeking care but without big coronavirus prevalence).

To be clear, I'm strongly pro-mask, and pro-social-distancing. (I do think stuff like factory and school closures comes at an unacceptable social cost for the benefit to public health, though that's been reversed most places.) I just want to make the argument with the right facts.

1. https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v...

2. https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

The driving factors for lockdown was driven by the need to manage hospital resources, and had they not had a lockdown, many who would've needed hospital admission would of not got that and the mortality rate would of escalated much more with people who would of survived with intervention being cut off from that support as it was saturated. Once you get to that stage, people lose hope, panic, riot and it would of been far worse IMHO.

FWIW I worked on https://en.wikipedia.org/wiki/The_Good_Judgment_Project for the COVID project, so seen lots of data and projections.

Totally cutting off everyone over 65 from contact with everyone under 65, for months, is impractical. The UK briefly considered this before backing rapidly away.

And, er, 2% isn’t nothing.

A few good points (like the PCR detecting only RNA which does not equate to live virus) in a sea of "interesting" spin about the current data.

I really don't understand why it's "us vs them" in either camp ("doom and gloom" and "skeptics"). This makes things worse, since both camps tend to quote only evidence which support their respective claim (two examples: the Guardian saying that asymptomatic people spread more virus than the symptomatic ones, despite the study they quote saying that it can't be said, because they did not check for live virus; and some web page called "Swiss policy research" which quotes only the parts of the studies which conform to the "skeptical" narrative).

Indeed, with so much published stuff about it and still so much in the unknown and with that, our best evidence so far is what is published. then the ability to cherry pick across many sources of published data/reports and stitch together those in a way that you could make so many things appear legit, well. It really don't help as other people will just reference the sewn together published article and propagate from their. Vague news is after all, latent fake news most of the time alas.

I find it discouraging that exceptionally little is said about the outcomes for those who survive a bad case. IMNSHO, the big scare isn’t death, it’s being out of breath for the rest of a considerably shorter life, or being tied to a dialysis machine, or being perpetually foggy brained and easy to anger, etc.

The long-term damage to the country will be from damage to survivors, not from deaths.

It's funny in a sad way to read an article like this one now a month later when it has become very clear that the virus comes back with vengeance in places that have lifted restrictions summer or no summer.

Also, the semantics of whether it can be called novel or not doesn't matter one iota when the virus-caused pneumonia overwhelms medical systems in mere weaks if left to roam unchecked.

it really sounds like the youth got sick and tired of the lock-down and would rather get sick than continue with the never ending prison like conditions

it probably is the right course of action - even though ethically no official can suggest that

the paper is supported in the sense that everyone is wrong about how dangerous the disease is, and whether people should be allowed to decide what risk they are willing to take

I disagree with your last point - this is very infectious and because we can't know in many cases if we are carrying it, it's incumbent on everyone to protect others by wearing a mask. Because many don't know they have it, it's different than the flu where ordinary flu often has clear symptoms before infectiousness starts.

the "mask" is the red herring of every discussion. It is a talisman that people cling to as a way to ward off any of the ills.

I happen to be convinced that some types of masks, like the reusable cloth masks actually make you sicker.

Here is a well research piece with a randomized trial that shows how continuously worn cloth masks are worse than using them more rarely (control) (leading to 4% more infections):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/

Of course I don't expect this research to be quoted in the current hysterical environment.

But I would not be surprised if by this time next year the world will be full with publications on how cloth masks cause more trouble than worth with a strong recommendation to avoid them.

We will also find papers telling people how to sterilize.

You have misread the paper. It says that cloth masks are worse than medical masks, and worse than "standard practice" which seems to be mostly medical masks but not worn as rigorously. They didn't test against no masks, which would be insanely dangerous in a hospital.

Yeah. I saw that paper cited frequently back when the public health authorities were advising against masks, and I'm afraid their decision to characterize standard practice including medical mask wearing as the "control arm" has caused considerable confusion and harm.

If you don't think masks work, then why do you think Japan is sitting around 8 deaths per million (with no significant lockdown), while the USA is at 416?

Masks aren't the only possible explanation--it could be weather, or contact tracing (which may be unintuitively effective due to heterogeneity), or generally meticulous hygiene, or something else. They're my first guess, though.

Doing that only solidifies the transition to endemic.

Until we have meaningful treatments, living apart and doing all we can to limit the spread is the best move.

it does not say that at all, instead, perhaps we could allow some people, you know those that are willing to take the risk, to live their lives they way they want it

every single person that gets through the disease (and that is over 99.5% of them) is now immune and fully functional member of the society

we need to stop treating the disease as "dead" end, where one is you are either uninfected or "dead".

Most people suffer no ill effects and would rather get through the disease. I am like that, and for what is worth

I believe I already had the disease, yet I am not allowed to live my life as I want it.

What about 10% of the population that is estimated to have been already exposed? Where are their rights? On what basis does the rest of the population limit our rights when we are not a risk?

We need to realize we know very little and mother nature is the authority. Many of us, myself included, find it hard to come to terms with basic ignorance.

We are very ignorant about CoV19 right now. It will take a long time to get smart, have the understanding needed to live as we used to.

You don't even know you had it, or which strain. Think a little please. This is about US, not just you, or me, or "those other people."

Failure to grok that has severe consequences. Revisit these thoughts near end of year. Seriously. There is real ugly ahead.

Immunity is proving to be a thing that does not endure.

We are also finding second and third infections play out differently.

This virus won't just go away. And we are a long way from potent treatments.

Sadly, I had it too. Was a very rough month. I must be honest: scared the shit out of me. My whole fam struggled through. I came just a shade from being in the hospital too.

Worse? I am currently priced out of health care insurance. Literally everything is on the line and I am very far from alone in the US, which is going to become a very tough place to live in just a few short months.

Nobody gets to live life the way they want because everyone is impacted.

All humans are exposed, all humans are under threat, at risk, until all humans have access to remedies.

Should you get it again, say 3 to 5 months from now when whatever immune response you have going on right now fades away, your symptoms run a good chance of being much, much worse.

How we lived is over for a good long while.

And because the risks endure, escalate easily, and are serious, we are very likely to see the majority of humans enforce living differently for the common good.

I am one of them. New day. I hate it.

And I am sorry. We, as a species, could have, should have, bit flat out just didn't.

Now this thing is in the world and for now we cope and learn. One day we can live again, and ideally learn a tough, expensive lesson.

I sure hope so, because this all sucks hard.

> Should you get it again, say 3 to 5 months from now when whatever immune response you have going on right now fades away, your symptoms run a good chance of being much, much worse.

Why would it be worse if one gets it again?

First, there's no reason to expect that your immune response will fade in 3-5 months. The concentration of antibodies in the blood does decrease with time, but immunity to the original SARS lasted at least for years[1]. For a virus that was only discovered X months ago, it's impossible to demonstrate that immunity lasts longer than X months; but it seems pretty likely to me.

Second, there's no firm evidence that anyone has ever been reinfected yet[2], but there's no specific reason to believe that your symptoms would be worse the second time. Antibody-dependent enhancement was observed with some vaccine candidates for the original SARS[3], but so far the SARS-CoV-2 vaccine candidates haven't shown that. In the other direction, I've seen speculation that some modern common colds are the faint echoes of ancient pandemics, and SARS-CoV-2 would eventually end up similar if uncontrolled, with immunity acquired initially in childhood (where the IFR is not zero but extremely small, 16 per million[4]) and reinforced with mild infections throughout one's life.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/

2. The evidence for reinfection is that some people have tested positive then negative then positive by PCR, and perhaps their symptoms got worse then better then worse again too; but since the PCR test has a significant false negative rate, it might just be one long illness.

3. https://www.nature.com/articles/s41587-020-0577-1

4. https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

There is no reason to assume it will endure either.

What we need to do is be conservative and gather data and work to understand better.

Right now, our understanding is limited. We do not yet have a full cycle behind us. That's one year minimum.

Until we have a more solid basis, the risks are minimized for everyone by operating in a risk adverse way.

We are in a global scenario, rapidly moving to endemic mode.

Far too many are not reasonable and prudent and we all will pay for that.

Let me put it this way:

We want things to be true and universal.

People vary widely in their response to this virus. We do not understand why very well. A lot remains unclear. Too much.

This mode we are in could be the default for a sustained time. As we go through the year, I see that as being increasingly likely.

As people face reality as it is being shown to us, I expect large numbers of them to get on with living differently as we work on cures and hopefully vaccine.

Until we actualize those things, caution is totally warranted and indicated.

Most of the world gets that. The US doesn't yet.

There are reasons why our passports aren't much good right now. Our discussion here is one of them.

All you put here is suggestive and hopeful.

Let's hope.

In the meantime, we don't know as much as we should and caution is again, totally warranted and indicated.

Please don't take anything I wrote above as an argument to abandon caution and let the pandemic burn uncontrolled--as you'll see from my posts elsewhere on this page, I'm strongly in favor of mask use, social distancing, and other simple and relatively inexpensive interventions. I don't want to see people acting recklessly, but neither do I want to seem them in despair from an outlook more pessimistic than the best current science would support.

Fair enough.

There is a lot of want it to just go away out there.

Worries me more than pessimism does. (That is at least warranted, even if not optimal)

I, frankly, don't care about expense so much either. People are high value. Cannot be replaced.

Economic implications are not good. Nothing to look forward to at present. For me personally, I am just going to scale down.

Done right, it does not have to mean less, just differently.

I mean "inexpensive" both in dollars and in overall social cost. Closing the schools might actually save money short-term, but society will be paying for those children's interrupted education for a long time.

In any case, I agree that the virus will be with us for many months to come. I'm optimistic that with strict mask use and loose other interventions (anything involving large crowds closed, but most other facilities open, mostly prudent individual behavior) we can control the virus, as Japan seems to have. The political progress towards that has been pretty rough, but maybe it's beginning to converge.

Maybe. I am not so sure. And air percentage of us just do not want to play ball.

It has been an ongoing problem, and bow this particular scenario seems to highlight and exacerbate many of our ongoing problems.

The top reason would be our body and or immune system was impacted the first time.

Assumptions about CoV19 are unwise right now in my book.

The data is coming in real time. We know a lot less than many would prefer, or believe.

> every single person that gets through the disease (and that is over 99.5% of them) is now immune and fully functional member of the society

Except, you know, the ones with permanent lung damage, or kidney damage, or loss of taste, or brain fog.

> 10%

Citation required. No estimate I’ve seen comes anywhere near that.

It would be better if you argued using truthful facts.

Ten percent is probably an overestimate, but by a factor of less than two. In the USA, 137k are dead, which at 0.7% IFR[1] implies 20M infected, 6% of the total population.

1. https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v...

In the middle of a pandemic he suddenly realizes why everyone was wrong and now he is right. I totally believe him ... not. The long term effects of the virus are still unknown, if infected have long term immunity is unknown.

It's hard to get past this being another wrong medium article that doesn't match reality. Why does covid19 attract so many quacks who cant help but argue that it's no problem really, go on about your lives (with 130k dead in the us, 600k dead in the world). It's actually a problem. It hasn't gone away somehow, even with massive amounts of magical thinking for the past 6 months.

Edit: we're actually a week away from reaching 600k, per https://www.worldometers.info/coronavirus/#countries. Will it take 200k dead in the us before we can stop arguing it's no big deal? A million in the world?

The 1 million deaths are a big deal only because it may include rich white people or even, gasp, you and I. This is the only reason this number is quoted with such an incredulity.

Throughout history we have had and we continue to have far bigger problems than that.

Did you know that 20K people DIE every day of hunger (9 million per year)? And this has happened like so for the past twenty years? Where is the counter for that? Why aren't we locking everything down until we fix that?

I tell you why, because you and I are at zero risk of dying of hunger. Stating that 1 million deaths is a big deal sounds extremely hollow.

Thanks for posting that. More than 4 million dead already from hunger this year [1], that's an even more horrible statistic. Yes, we need to continue to fight that. I'm that typical person in the west who, might send money to international food aid charities, but doesn't know what else to do. I think increasing democracy around the world could help and fewer wars can lead to stability and improved lives. 9 or 10 million a year is such a large number it's unbeliveable. The fact that it's improved tremendously over time [2] doesn't excuse continuing to work on it to help our fellow humans. I'm mostly just fortunate to be born in a prosperous country, through no action of my own.

1. https://www.theworldcounts.com/challenges/people-and-poverty...

2. https://ourworldindata.org/uploads/2013/10/Famine-death-rate...

"Be thankful with your broccoli because there are kids starving in Africa" generally doesn't work even on a fifth grader - I honestly didn't expect to see it on HN.

At this rate, I wonder when I'd see people saying "no worries" because it's not Black Death. Or has it already started?

> no worries" because it's not Black Death.

I think mentioning the Black Death as a counterpoint weakens the argument greatly.

This disease is far-far more similar to the flu than black death, no? So we should probably deal with it as a flu not black death.

I have emails from Italy saying it is like flu.

Those same people a few weeks later?

Our grandparents and families are dying.

"no worries" because it's only seriously affecting people past 50

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