
Coronavirus: an email to my family - harrylove
https://www.julianagrant.com/blog/2020/2/29/coronavirus
======
nostromo
This seems to be overstating things.

> COVID-19 seems to be most severe in older adults.

The median age of deaths is 75. I guess that’s technically “older adults” but
I think “elderly” would be a better description.

[https://www.nytimes.com/2020/01/23/world/asia/coronavirus-
vi...](https://www.nytimes.com/2020/01/23/world/asia/coronavirus-victims-
wuhan.html)

> there are a number of indications that it will be very much like the 1918
> Flu Pandemic

The New England Journal of Medicine has a different take:

[https://www.nejm.org/doi/full/10.1056/NEJMe2002387](https://www.nejm.org/doi/full/10.1056/NEJMe2002387)

It sounds increasingly likely that the fatality rate is less than 1%,
potentially a lot less, as were now hearing that 80% of people don’t even get
sick enough to seek medical attention, and many have no signs of illness at
all — which means the denominator in the death rate is likely much higher than
is accounted for in the common 2% metric from the first data.

> Expect people you know to die.

Aside from this likely being inaccurate, is this language even remotely
helpful?

~~~
azinman2
That number will vary greatly by region and the quality of healthcare, as well
as the functioning ability of governments to handle it. The infection rate is
such that it’s exponentially growing, which means it’s showing no signs of
slowing down. If 1% of the world dies from it, that’s hundreds of millions of
people dying from something in addition to everything else already killing
people. This is really bad.

~~~
allendoerfer
The death rate seems so low, that I could imagine many of the elderly people
dieing from it, would also have been killed from many other viruses that would
have possibly come along shortly after.

~~~
elif
It's both. When a virus like this taxes your immune system, the risk of
secondary infections becomes far greater.

------
remarkEon
> For those of you who don’t know me well, I am a preventive medicine
> physician and infectious disease epidemiologist. I graduated from the CDC’s
> Epidemic Intelligence Service and have over 17 years of experience in the
> field, most of that with CDC.

For those here expressing skepticism of the author's (admittedly dire)
predictions, what set of credentials should someone have before you take what
they say seriously? Not trying to be snarky. Perhaps I simply wish to
understand more of what people find convincing in situations like this and
why.

~~~
miked85
I am not sure there is any set of credentials which would make me trust
someone's predictions.

~~~
koheripbal
Really? That doesn't seem rational. If a doctor diagnosed you with pancreatic
cancer and told you that you had 6 months to live - you would not trust his
prediction?

~~~
miked85
I would get a second and third opinion, and then decide. I guess my point was
that I am not going to trust any one individual based off of their
credentials.

------
samvher
I think a lot of the comments in this discussion risk understating the
potential impact of the virus. Yes, there are many unknowns, and we might not
encounter the worst-case scenario. But many experts have basis for being
worried, e.g. listen to these interviews [1,2]. It will take a while before
the virus really spreads in the US/Europe but it seems pretty clear that it's
not contained anymore. Remarks about the fatality rate cut both ways: if it's
lower than reported it means that the virus is spreading faster than we think
(more mild cases), if it's higher than reported there are going to be many
more fatalities still. There are arguments to be made for both (lower: many
mild cases go undetected, higher: reported fatality rates often seem to be
calculated from active cases, not complete cases). Either way it's clear that
in China the rate of infection was well beyond what hospitals could handle
which seems to indicate that we might encounter similar issues.

Let's just be careful and be prepared, there really seems to be too little
info to get comfortable with this at this point.

[1] [https://www.stitcher.com/podcast/deep-background-with-
noah-f...](https://www.stitcher.com/podcast/deep-background-with-noah-
feldman/e/67663436)

[2] [https://www.nytimes.com/2020/02/27/podcasts/the-
daily/corona...](https://www.nytimes.com/2020/02/27/podcasts/the-
daily/coronavirus.html)

~~~
remarkEon
>Either way it's clear that in China the rate of infection was well beyond
what hospitals could handle which seems to indicate that we might encounter
similar issues.

What's more concerning about what happened in China is that it overwhelmed
their healthcare infrastructure even after they implemented what would
otherwise be called martial law throughout the country for a period of time.

------
demosito666
Honest question: how one can ditinguish coronavirus from other "pandemics" of
recent years like svine flu or bird flu or whatnot? Those happened primarily
on TV news, and the informational background was about the same: apocalyptic
pictures of empty airport, packed hospitals, etc. Why should an average Joe
care more this time?

~~~
koheripbal
I don't believe any of those had packed hospitals nor piles of bodies, as
we've seen for this one.

There are some major differences.

------
enchiridion
I am seeing some harsh comments here out of fear. I dealt with the same
reaction from family members.

The U.S. is doing very little to prevent this. A lot of people, especially
elderly people, will likely die.

It will also likely have a severe impact on the market. The sooner we can all
accept this and prepare the better.

~~~
dosethree
"The U.S. is doing very little to prevent this. A lot of people, especially
elderly people, will likely die."

At this point, what realistically could the US do to prevent this? It will
continue to spread in other countries, and there's nothing the US can do about
that. We can implement more severe travel restrictions, but that has its own
issues and it's not recommended by the WHO. That will only be effective for a
period of time in the beginning of the virus spread, and they are basically
doing that afaik

Im no expert, but besides providing financial or medical aid to to the
countries fighting the virus, and helping developing a vaccine/cure, I'm not
sure what the US should be doing prevention wise

~~~
koheripbal
There is considerable value in SLOWING the virus.

1\. You smooth out the cases that end up in hospitals and ICUs

2\. You give more time for a vaccine to be developed and deployed.

3\. You reduce the economic impact.

~~~
enchiridion
Exactly #1. From what I've seen, in a best case scenario we have 30k extra
ventilators. Reportedly, 6% of cases require ventilation. Some quick math
shows that only .16% of the population needs to be infected at the same time
for our ventilator supply to runs out.

------
clumsysmurf
Just FYI: Reddit /r/coronavirus is having an AMA with a panel of experts from
WebMD on Wednesday, March 4 at 12pm EST

/r/covid19 is an interesting scientific discussion of the topic.

------
gmoore
Much conjecture, not supporting data. Much of what he predicts is not
supported by the CDC which he starts off saying you should listen to first....

------
gentleman11
Is Juliana Grant a noteworthy expert or something?

~~~
tessierashpool
_For those of you who don’t know me well, I am a preventive medicine physician
and infectious disease epidemiologist. I graduated from the CDC’s Epidemic
Intelligence Service and have over 17 years of experience in the field, most
of that with CDC._

------
pbourke
What is wrong with this god-damned site? Seriously, this post was #25 on the
front page, I check again and it's buried 4 pages deep literally 10 minutes
later.

Some people in this community are in really deep denial and do not understand
the concept of asymmetric risk.

This is a clearly written piece that can be shared widely with your network,
especially for people who may not be clued in to the situation. Please share
this.

~~~
samvher
I don't get this either - the front page has many posts with fewer points over
a longer period. Maybe downvotes are treated differently from upvotes in the
sorting algorithm?

------
ganafagol
> COVID-19 seems to be most severe in older adults. Children and young adults
> generally have mild infections. We are grateful for this.

I'm sorry to ask this .. why are we grateful for this?

~~~
thombat
When I bury my father, I will be very sad.

If I should have to bury my daughter, I would be devastated.

~~~
foxrob92
There are few things that feel utterly "against nature" than a parent
outliving a child.

------
m0zg
>> It’s possible that COVID-19 will be similar to a bad flu year but there are
a number of indications that it will be very much like the 1918 Flu Pandemic.

This, right here, is horseshit. There is no way whatsoever it will be like the
1918 Flu Pandemic, unless we've utterly failed as a society and did not invent
anything in the last 102 years. In 1918 we didn't yet have _penicillin_, let
alone antiviral drugs.

More accurate prediction: this will be only slightly worse than the seasonal
flu we endure every year. In fact, it's quite possible that this year in the
US more people will die of the complications of the flu, than of COVID19.

~~~
cycrutchfield
5-10x more deadly than influenza is “only slightly worse”?

~~~
m0zg
Nobody knows if it's 5-10x more deadly because nobody knows the denominator -
the _total_ number of cases, including the cases which are mild (which most of
them are), and for which people are unlikely to seek treatment. Also, even
allowing hypothetically that it's 5x as deadly in China, that doesn't mean its
CFR is the same in the developed world.

~~~
mrb
The denominator was estimated by multiple teams:
[https://news.ycombinator.com/item?id=22405204](https://news.ycombinator.com/item?id=22405204)
That's why we are fairly confident in the approximative CFR range of 0.5%-1.6%
See more details in all the studies I link to in my post at:
[https://blog.zorinaq.com/case-fatality-ratio-
ncov/#updates--...](https://blog.zorinaq.com/case-fatality-ratio-ncov/#updates
--validation)

~~~
m0zg
Sounds about right. But that's not "we're all gonna die" estimate of 5x-10x.

~~~
mrb
Yes it is. 0.5-1.6% means the coronavirus is 5x-16x deadlier than the flu
(0.1%)

So the fatality, at the upper end of the range, would be _comparable_ to the
1918 pandemic flu (estimated at 2.04%:
[https://institutefordiseasemodeling.github.io/nCoV-
public/an...](https://institutefordiseasemodeling.github.io/nCoV-
public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-
preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html))

