Almost one in five Americans may have been infected with Covid-19
economist.com
economist.com
While the vast majority of asymptomatic just stayed out of the system during the spring and summer.
Also, slightly off topic, but the recent spike in Turkey shows how mind-blowingly fast it can shutdown your country, they went from obscurity to 4th place in daily counts after US, India, and Brazil within a month, despite much lower population levels:
https://i.imgur.com/busPOrn.png
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
You'd expect that to decrease positivity rates (by getting a wider pool of people to get tested), but instead the positivity rates --- the percentage of tests that are positive --- have been increasing.
But as I mentioned in another comment my pharmacist said she has barely sold any cough/cold syrup at all this year when by this time of the year they'd be flying off the shelves. The lockdown may have helped stopped common cold / flu spread as well. So my proposition may be insignificant.
My area is "minimal" in flu activity in the flu surveillance systems, but has increased COVID positivity rates from 3.3% to 5.4% in the past couple weeks, despite increased testing (and increased testing, in general, can be expected to push positivity rates down).
The people seeking tests were mainly two groups: people particularly concerned about COVID-- because of known exposure or COVID-specific symptoms, or people who occupationally are being tested because of surveillance.
If you water that down with people with the flu, you'd expect the positivity rate to go down: not that influenza carriers are even more likely to have COVID than those previous groups.
Influenza surveillance is showing "minimal" activity in my area, but a huge explosion in positivity rates for COVID-19 (3.3% to 5.4% in the past couple of weeks).
I don't know a good national set of equivalent graphs, but in California the hospitalizations are tracking the case counts with some delay, as are the deaths (though those are even more delayed), so I highly doubt you're just seeing additional asymptomatic cases.
The curve of the ICU cases vs overall hospitalized cases is interesting - it's lower, so potentially that could be good news like we're better at treating it now, or bad news that capacity is already low enough (<%10 in some counties) that it's harder to get an ICU bed than it used to be.
I've long want to pull in some data locally and do so some data science on it.
Like ranking countries by cases vs population ratios.
I don't have a lot of evidence only this and some articles I read last year about it being dead as soon as masks and social distancing came about
https://www.fox4news.com/news/cooks-childrens-hospital-repor...
They seemed to expect to see fewer, too, but have observed the opposite.
https://www.cdc.gov/flu/weekly/index.htm
While not dead as GP expressed, there are notably fewer infections so far this year.
It just sounds like even doctors expected flu to be almost non-existent, but instead it seems ... oddly normal.
> Flu activity is unusually low at this time but may increase in the coming months.
How did you even get the flu.
I don't think that can be the explanation, because deaths have also spiked.
If that were the case, you wouldn’t see the hospitalization, ICU, and death rates surging at the usual delay behind the general case rates, but you do, which suggests that, no, the surge in COVID cases isn’t inflated significantly by finding COVID-asymptomatic cases with a concurrent symptomatic common cold.
ICUs routinely run at 90% capacity during the winter. Right now, most states are below this.
https://mobile.twitter.com/justin_hart/status/13277409970783...
https://protect-public.hhs.gov/pages/hospital-capacity
You have to cherry-pick individual hospitals to create the narrative that “hospitals are overwhelmed”....which is exactly what the news media has been doing.
You made an extremely similar argument months ago, about how ICU capacity was actually not high and that the media was blowing this out of proportion. That you're still trying to downplay all of this as 3,000 Americans die every day is pretty surprising even to me.
ICU capacity wasn’t abnormal months ago. I just provided you with evidence of that. It isn’t abnormal now, either.
Stop it with the hysteria about raw death counts. Do you even know what percentage of those “3,000 people a day” are dying with Covid as a secondary or tertiary cause?
(hint: most of them.)
Here’s another inconvenient fact: did you know that we’ve had over 100,000 excess deaths in 2020 that have nothing to do with Covid? Over 37,000 of them were from Alzheimer disease and dementia, alone.
Golly...that’s...2,000 deaths a week! Or about 1/3rd of all excess deaths this year.
https://cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
(click “Total number above average by cause”, and update the dashboard)
It saddens me to see so many people such as yourself fighting on the side of COVID-19 against humanity.
> you resort to insults and mockery
> But sure, go be “sad” about people sharing documented facts, instead. It’s much easier than critical thought, and it lets you feel morally superior. I can see why you prefer it.
Practice what you preach.
A reasonable person might then ask your question, but look for answers that involve something a little more intellectually rigorous than morally scolding strangers. For example: it’s seeming quite likely that our extreme, panicked reaction to this illness has killed a huge number of people.
How many more will die due to postponed cancer screenings, surgeries, and so on? How many children will be set back in their education, permanently? How many minority and low-income families will be carelessly tossed into generational poverty? How does that number weigh against the people who have died from this virus? Have you even given it a second thought?
But sure, go be “sad” about people sharing documented facts, instead. It’s much easier than critical thought, and it lets you feel morally superior. I can see why you prefer it.
That's not really relevant to what I'm talking about, though. COVID-19 hospitalizations and ICU utilization (and deaths) are surging with the expected lag behind new cases, which wouldn't be expected if the new case surge was an illusion from, e.g., symptomatic colds leading people to get tested and discovering what would otherwise have passed as asymptomatic COVID-19 cases.
Whether the overall hospital or ICU utilization is seasonally high is a different issue.
People go in to the ER for a broken leg, have a positive covid test, and get counted as a covid admission. This isn’t fiction: multiple state health departments have admitted it is happening. It’s too difficult to try to determine if Covid is “the reason” for an admission, so nobody tries.
Therefore, the only important question is: how are hospitals faring relative to any other year? And so far, the answer is that it looks like a moderately bad flu season. To hype the narrative that “hospitals are overwhelmed”, the news media routinely cherry-picks one or two hospitals, fixates on them for a week, then moves on to the next.
https://mobile.twitter.com/justin_hart/status/13277409970783...
They were eventually shamed into being more forthcoming about the situation.
Maybe just Palemoon, but the archived copy’s a bit glitchy for me: https://ibb.co/3vK1zwv
"Reality has a way of asserting itself."
https://nymag.com/intelligencer/2020/12/moderna-covid-19-vac...
Attempts at creating vaccines for SARS-CoV-1 (previously known as just SARS) and MERS apparently made significant headway, more than what I was lead to believe by the literature I read in the Spring. What I read in the Spring was that research money and interest had dwindled not long after MERS, and that the few labs still hammering away at the problem weren't making much progress. Unless it was just sheer luck, it seems what SARS-CoV-2 and COVID-19 provided was a proving ground for already well developed methodologies.
Flu immunity, including natural immunity, tends to last a very long time.
So you'd waste those million people, and you'd still have COVID hovering around like farts around Giuliani.
This logic seems faulty. During the first wave, there were an awful lot of concerns from medical professionals that case rates for other serious, life-threatening issues dropped dramatically, presumably because people were avoiding ERs and the medical system in general. I recall heart attacks being an especially serious concern. (Intuitively, trauma rates also dropped, but heart attacks aren’t as dependent on people getting out of their houses.) That presumably led conditions that might normally be treatable to become even more deadly. At this time, this seemed to be a widespread concern, although it’s fallen by the wayside lately.
We also have other issues that surely impact death rates: people are out of work; some are ending up on the streets. 2020 has been a stressful year, to say the least. It’s reasonable to assume that these circumstances cost lives.
I would still blame COVID-19 for these deaths, but I would not say that these cases were SARS-CoV-2-positive. That leaves us with the question: what portion of the excess deaths this year were a direct result of someone contracting SARS-CoV-2? How do we actually determine with even an iota of accuracy how many people have contracted SARS-CoV-2 at some point?
PSA: Unlike the rest of this comment, this is an opinion. I’ve heard an awful lot of arguments against getting tested. “By the time you’re positive, it’s too late.” “You should just stay home; that’s the lowest-risk option.” “Negative results give people a false sense of safety.” You’re an HN reader; you’re pretty smart, right? We need data. The more data we have, the better. If you’re in a position to get tested, even if you have no symptoms, you should do so. In the grand scheme of things, does your individual test matter? Probably not, especially if you’re negative. But neither does an individual vote, and we still do that.
It depends on the efficacy of the vaccine and the transmission rate, but the numbers can be higher than 90% vaccination rate to achieve heard immunity.
There's a breakdown of the math behind determining this here:
https://www.reddit.com/r/askscience/comments/k9tcv1/if_23_of...
It does cause one to wonder if we should try to concentrate the vaccine doses on the people who haven't already had it, so as to save the most lives with the limited supply available. Sure, it may be possible to catch it twice in a few cases, but the rate of that is far, far less than the rate of catching it if you _haven't_ already had it.
"In contrast, in a typical high income country, with a greater concentration of elderly individuals, we estimate the overall IFR to be 1.15%" from https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...
In my (admittedly naive) thinking, if R0 was 2, say, then if 50% of the people got it (and were therefore not able to get it again, and therefore not able to spread it), then the effective R0 would be 1.
Isn't the R0 for "no restrictions" something like 15? So I'd guess we'd need 93%? But I also have seen figures from 50 to 95% quoted for herd immunity so who knows?
Anyone with real numbers, feel free to supply them...
The word you are looking for is endemic, i.e. never goes away and cannot be effectively eradicated.
Congratulations on adding another biological landmine to modern existence.
1) 3.4% of people who catch it die every year, and life changes
2) It mutates, and gets worse. Unlikely, but not impossible. Or it leads to long-term disability which we don't know about yet (not unlikely). Etc.
3) Kids get it early, acquire partial immunity as it passes, and it becomes another variant of the common cold/flu.
Most of the time, #3 is the outcome. It's worth taking seriously because #1 and #2 will eventually happen if we ignore these, but....
Why do you think the IFR will increase by a factor of almost 7?
I'm now seeing WHO is estimating 0.5-1.0%, which is possible too.
I don't think we'll know for some time. One of the problems is people who have yet to die... You can't get a good estimate until long after a pandemic, to catch all the stragglers.
I believe Massachusetts comes as close to capturing 100% of infections as anyone at this point, although that wasn't always the case. There is a lot of test infrastructure.
CFR can overestimate or underestimate IFR. In most past pandemics, CFR significantly UNDERestimated IFR during the pandemic, because the raw numbers include a lot of people who are sick, but haven't died YET.
There is a tendency to take CFR, apply very liberal corrections, sometimes multiple times, and get artificially low IFR numbers. Those aren't really plausible, even looking at scenarios where we could catalog all cases (e.g. the cruises had an IFR just over 2%, with state-of-the-art medical).
My general impression, looking at data, is that the IFR was around 3-ish percent early on, and got better, potentially due to mutations making the virus less fatal, lower initial viral loads due to precautions, and/or better treatment.
So it does not capture 100%.
> CFR can overestimate or underestimate IFR.
Incorrect. CFR cannot be higher than IFR. The number of deaths per confirmed infection obviously isn't higher than the number of deaths per infection (confirmed or unconfirmed).
I'll continue to believe epidemiologists who actually have a clue what they are doing over your "general impression".
If you want, an exert from an epidemiology text:
"A CFR can only be considered final when all the cases have been resolved (either died or recovered). The preliminary CFR, for example, during an outbreak with a high daily increase and long resolution time would be substantially lower than the final CFR."
The cited numbers are preliminary CFR, not final CFR. The key question is final IFR. Final IFR can be lower or higher than preliminary CFR.
I'm done here.
I would be cautious about estimating countries that are only now having their first major outbreak (for example Czechia) for exactly the reason that you cite, but not every country is in that state.
Put another way, we are no longer living with preliminary data in much of the world.
* Last death of Diamond Princess occurred after more than 2 months.
* Over the past two months, the number of known cases in the US roughly doubled from 8 million to 16 million.
This means there are a lot of people who haven't died yet, and dividing deaths by cases is an underestimate of CFR by up to a factor of 2.
That doesn't mean we don't have the data. We could e.g. take the infections from June and look at how many of those resulted in death as a final CFR estimate. However, the number I gave (deaths over cases) didn't do that. It's a preliminary CFR without that sort of correction, and a correction to final IFR can go up (people who haven't died yet) or down (unidentified cases).
anoncake argued this was an overestimate by definition, and anyone who said otherwise didn't have a clue. anoncake was wrong.
Dead people / Recovered people and that is around 3 percent, down from 5 to 7 percent a few months ago.
Infections / deaths is not accurate as cases in progress are added to those with definitive outcomes.
That can also be seen as a best case, given nobody currently infected does not die.
A worst case can be seen assuming everyone infected will die.
But if we want to know the percentage of people who get sick and die, we have to compute that percentage with the people who got sick and did not die and their case ran its course to a definitive outcome.
Infections lead to outcomes.
Outcomes are where the dead vs not dead become known.
Everyone infected will eventually arrive at an outcome.
Divide dead people by recovered people to assess true risk of death from COVID.
Dividing dead people by infected people represents a best case, overly optimistic risk due to the fact that cases that ran their full course to a definitive outcome are mixed together with cases in progress. Doing that biases the risk perception down below actual risk and can be dangerous.
I know one person who died, who did not have to, and they died because they made choices after having evaluated risk incorrectly.
They have their reasons for that metric. That too doesn't make (dead/recovered) wrong.
There are dead people in my life, with whom I had this discussion. "Calculated risk" = optimistic.
The IFR combines futures with actual and does not represent an outcome based risk assessment.
Nature however, will definitely take you, or any of us, to an outcome, should we become infected.
That said, I know a few people online who have had it, one of whom has died - but I guess that’s the cross-community nature of things.
but the last month, I am hearing of more and more getting infected. It's getting worse, anecdotally.
I know two dead people, one more struggling in the hospital. (They have been there long enough it looks grim too.)
I do not currently know anyone else that has it!
The whole thing is weird. Some places seem like war zones, others tranquil, as if the whole thing is made up psyops.
The shear between experiences is particularly acute when I speak with people from both extremes in the same day!
People being confused is no real surprise now though it was earlier on.
We should be expecting to experience this as members of a large, functionally diverse population (and within HN, a technically literate sub group) in a civilization that is blindly groping its way towards post-scarcity but the future is still Gibsonian unevenly distributed. In a less-powerful civilization, this would have been a much more disruptive pandemic. Many people are still navigating with sentience ("monkey brains") that are conditioned to expect physical calamity before taking significant action, instead of navigating with intelligence which takes abundantly more energy to engage.
This is a real-time, mass experiment in operating trust and science at scale.
See Peter Watts' Blindsight for more on this sentience/intelligence divide [1].
I live in NYC and know about 25 people who had covid, myself included, from pretty much every community.
I'm not downplaying this, I'm not saying it's not a real thing, or that my experience is universal or any other implication that this isn't a real and pressing crisis. I'm simply saying that for a variety of reasons, it's entirely possible to not be in the middle of nowhere and still not have COVID invade your usual social sphere, though such experiences will quickly become extremely rare at the current rate of infection.
It isn't the most impressive of plagues.
It really is though. If it were more deadly like Ebola, people would be taking it far more seriously and it would burn itself out quicker. If it were less deadly, akin to the flu, we wouldn't have too many deaths regardless. It seems to sit right in the sweet spot of just deadly enough to cause mass casualties while being benign enough that a large portion of people don't take it seriously, and thus contribute to it's uncontrollable spread. This will easily end up killing more Americans than the 1918 flu by the end of next year.
* Normalized by population though, you would be looking at today's equivalent of ~2.15 million deaths in the US from the 1918 flu.
also:
"Previous studies reported that viral shedding can begin before the appearance of COVID-19 symptoms (8,9), and evidence of transmission from presymptomatic and asymptomatic persons has been reported in epidemiologic studies of SARS-CoV-2 (5,10,11). Because KCDC performed strong infection control procedures during boarding; the medical staff and crew members were trained in infection control; all passengers, medical staff, and crew members were tested twice for SARS-CoV-2; and a precise epidemiologic investigation was conducted, the most plausible explanation for the transmission of SARS-CoV-2 to a passenger on the aircraft is that she became infected by an asymptomatic but infected passenger while using an onboard toilet. Other, less likely, explanations for the transmission are previous SARS-CoV-2 exposure, longer incubation period, and other unevaluated situations. "
https://wwwnc.cdc.gov/eid/article/26/11/20-3353_article#r1
asymptomatic transmission is not FUD it is very real. what has not been expounded clearly enough is that the virus is inducing second order effects that are latent to incubation and transmission. the reproductive process of the virus is minimally damaging, with respect to the immuno sequelae
when it comes to the chase this is not about asymptomatic transmission, this is about presymptomatic transmission.
Actually it really does matter. Just like the anecdotes of people becoming re-infected. These things often get presented in the media as if they are common but turn out to be rare. I don't know if that's the case regarding asymptomatic transmission or not but there is an ongoing debate about it.
you seem to be hung up on the idea that some people go through the entire disease and recovery process with no reported symptoms. that is the uncommon occurance. I am not talking about media anecdotes, i am talking about the reality that has been observed by numerous independent instance of professional observation and documentation.
to wit: 3 to 7 days incubation symptom free while being contagious during that time, and onward through the course of the disease. it dosnt matter how uncommon or common asyptomatic transmission is, the progression of transmission, is exponential when no mitigations are made.
> As the COVID-19 epidemic continues to ravage the American public, an unsurprising story emerges: Poor communities are hot spots for COVID transmission. The death rate from COVID-19 appears to be staggeringly high among African Americans compared to whites. The Washington Post reports, for example, that while 14% of the Michigan population is black, 40% of COVID-19 deaths are among blacks.
> The link between poverty and infectious disease is well-documented. Influenza-related hospitalizations in low-income neighborhoods are nearly twice that of high-income neighborhoods. Pediatric hospitalizations from bacterial pneumonia are significantly higher in low-income neighborhoods compared to high-income neighborhoods. The same is largely true of tuberculosis in the U.S. where active transmission of TB is ongoing in poor neighborhoods – patterns that are not simply due to more people living in these areas.
Reference: https://theconversation.com/covid-19-is-hitting-black-and-po...