
Coronavirus: South Korea’s aggressive testing gives clues to true fatality rate - ryannevius
https://www.scmp.com/week-asia/health-environment/article/3065187/coronavirus-south-koreas-aggressive-testing-gives
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DataDrivenMD
I caution against reading too much into the South Korean fatality rates
because many of the patients are younger and generally healthy
([http://www.koreaherald.com/view.php?ud=20200303000714](http://www.koreaherald.com/view.php?ud=20200303000714)).

Whatever the global mortality rate shakes out to be in the long-run, it’s
impossible to ignore the fact that this virus killed nearly a dozen nursing
home residents in the span of 2 weeks. There’s a lot we don’t understand about
COVID-19, certainly more than a single metric can tell us.

Based on what we’re seeing in the state of Washington and around the world,
it’s safe to say that older patients are at higher risk for developing
respiratory failure. Beyond that, it’s simply way too early to draw
conclusions.

~~~
xbmcuser
Rumors of a few young people discharged after they have recovered and testing
negative have later died with the virus coming back. I agree we have too many
stories with even stories of 2 different strains one being deadlier than the
other and people being infected by both at the same time. Actual mortality
rate we will find out after 1-2 years only even that only if they have a test
where can check if a healthy person ever contracted the infection in the past
then test a few thousand people randomly. Btw China numbers show that people
either survived or died in the third or fourth week after their symptoms got
worse in 14-20 days after infection. So Korean mortality rate might even go up
as it is still too early to tell .

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KarlKemp
Don’t spread “rumors”.

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krzyk
Isn't it that there are two main strains, one (30% of cases) is less lethal
(and this one is predominant in South Korea) and the other (70% cases) is e.g.
in Italy?

Two strains source: [https://www.newscientist.com/article/2236544-coronavirus-
are...](https://www.newscientist.com/article/2236544-coronavirus-are-there-
two-strains-and-is-one-more-deadly/)

~~~
mlang23
What speaks against this theory is that in austria, which is north of italy,
the cases so far have been pretty mild.

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koheripbal
Those infections are still recent. The virus takes weeks to kill you.

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nraynaud
I was watching a conference, they were saying the cruise ship was the best
data, because everybody got exposed, tested and had a follow-up.

~~~
arno_app
The cruise ship has a massive age bias. Most passengers were 60+

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dogma1138
The cruise ship also didn’t had proper medical facilities.

This is somewhat the problem with these epidemics the mortality rate is highly
dependent on the available level of care.

If the healthcare services get overwhelmed the mortality rate can easily
spike.

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patrec
Does anyone know of any good, publicly accessible case data (for any country)?

E.g. for each case,

    
    
       date of detection, age of patient, ongoing|recovery date|date of death

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akg_67
Try This page from Hokkaido government in Japan. You should be able to extract
relevant data from the table and pdf using a translator.

[http://www.pref.hokkaido.lg.jp/hf/kth/kak/hasseijoukyou.htm](http://www.pref.hokkaido.lg.jp/hf/kth/kak/hasseijoukyou.htm)

Table shows quite a bit of data about each case including age, gender,
location, any link discovered to other patients and status. The pdf shows
additional data on when they had fever and other symptoms, when they went to
different medical facilities and when they were confirmed as infected.

~~~
patrec
The data is great, thanks! Unfortunately (or fortunately for Japan so far)
it's a very small sample.

~~~
akg_67
Give it time, list is growing. You can get similar data for Japan nationwide.

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mytailorisrich
This corroborates Chinese numbers. China has also been very aggressively
testing and mortality outside Wuhan is no more than 1% (according to Dr
Aylward, following the WHO fact finding mission to China).

This implies very serious efforts, though, which I'm not sure we're seeing in
the West.

~~~
jmnicolas
Yes the WHO report is very clear : mortality in Wuhan is 6% because they were
overwhelmed by the number of cases.

The lack of decisiveness in the west worries me. It's like they wait for the
hospitals to be full before they decide quarantine might be in order.

~~~
n0rbwah
I can't speak for all western countries but in my country (France) if the
government tried to impose quarantine on the same level as China, I'd expect
riots.

People here aren't as docile as Chinese people and don't fear their
government. If a city was quarantined like Wuhan with the situation turning to
shit, many people would take to the street to protest instead of staying
nicely confined at home.

And if the government's repression got too harsh there, you'd get protests all
around the country in support.

That's why I haven't heard anything from my government about potential large-
scale quarantine. They know that here it probably would make the situation
worse.

~~~
mytailorisrich
> _People here aren 't as docile as Chinese people and don't fear their
> government_

Don't underestimate the sense of doing what's good for the community and the
patriotism of the Chinese people (and I'm sure many others).

I think they understood what was at stake and what had to be done, and did it
but not because they are "docile" or because they "fear their government".

~~~
n0rbwah
Yes, people here aren't that eager to make sacrifices for the greater good.
Unless it's other people doing the sacrificing.

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mirekrusin
Uh, just looked at map and Pyongyang/North Korea is holding great on stats -
zero infections. Does anyone know if it's becase a) almost nobody travels
there, or b) there's no outgoing information or both?

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MarkSanghee
I saw a couple of articles written in Korean - those stated, in North Korea,
there are only limited people, in a novel class, are able to travel outside
the country. Also, unbelievable point was, North Korean government executed
one inspected person immediately after finding out.

~~~
solveit
Two people were executed. One for smuggling(The regime was figuring out how he
had contracted the virus _after_ NK barred Chinese people from entering the
country and they found out that he was meeting Chinese smugglers), and the
other for breaking quarantine and going to a public bath.

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scarmig
My theory on the coronavirus. I've managed to convince myself to have moderate
levels of confidence in it; please tear it apart.

1) The Diamond Princess is our best source of data. Every person who got
infected on it was identified (~700), and those who were infected got the best
medical care possible. This led to a ~1% mortality rate (6/700) and a ~5%
ventilator support rate (35/700). 6/700 is subject to significant error in
both directions, but let's go with it.

2) Their average age was in the upper 40s, so assuming younger people don't
suffer the most serious ill effects from it, a guess for the general
population might be a 0.5% base mortality rate and 2.5% ventilator support.
This is a rough order of magnitude estimate: obviously expected mortality
should be adjusted for actual age distributions.

3) South Korea's mortality rate is 0.6%. Cases outside of Wuhan but within
China have a reported mortality rate of 0.4%. Singapore (at ~100 cases) is 0%.
These are all consistent with the estimated mortality rate I extrapolated from
the DP.

4) All of the areas mentioned in 3) have very aggressive testing protocols. No
evidence has come up suggesting widespread infection among the broader
community. This includes China randomly sampling some areas and not finding
meaningful unknown pockets of infection.

5) But what about Wuhan? It has a much higher mortality rate (>3%). The
reports on the ground suggested that it was the medical system being
overwhelmed that drove the mortality through the roof. If we assume everyone
who needs a ventilator but doesn't get one dies, that explains in one fell
swoop Wuhan's elevated mortality rate.

6) What about Italy? Its mortality rate is ~3.5%. But, compare the number of
hospital beds in Italy and SK. It's ~3/1k vs ~10/1k. SK is already running
into issues with hospital bed availability, so it stands to reason that the
situation is much worse in Italy. Italy also has a significantly older
population than SK. So it's starting to run into the same nightmare scenario
as Wuhan. Of note, the US has a younger population than Italy, but fewer
hospital beds.

7) What about Iran? It has ridiculous mortality rates. My best explanation is
that testing constraints probably lead to more undercounting of infections in
the hardest hit areas, so Hubei, Italy, and Iran probably all have artifically
elevated mortalities, while the reality for all of them is much closer to
2.5%.

8) There's no need for weird hypotheses about Asians having different proteins
in their lungs, there being multiple strains that act radically differently
from each other, China running secret death camps for the infected, etc.

9) Policy-wise, we need to keep the rate of infection low enough such that the
medical system is not overloaded. This is possible, as it's been done in
multiple countries, and that's the difference between a severe-but-normal flu
season and over a million dead in the USA. We also have to start taking
decisive action yesterday, with today being a second best option.

~~~
samvher
Something to keep in mind is that you can't properly calculate the mortality
rate if the cases haven't "completed" yet. Yes, a certain number of people
died from the Diamond Princess spread (I read it's more than 6 though -
apparently some of the fatalities get their death counted with their country
of origin rather than in the Diamond Princess stats). But there are still 34
or so people in very poor condition in hospitals, who might still die.

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Grue3
South Korea already has huge experience with SARS _and_ MERS. Most other
countries don't, so "true fatality rate" would be higher. The demographics(age
distribution) is also different in other countries.

~~~
archseer
The response to MERS was a total shitshow (no laws against breaking
quarantine, quarantined patients playing golf, flying to China, etc.) and we
were lucky the virus didn't spread too easily. But they seem to have learned
from that and are handling things really well this time:
[https://edition.cnn.com/2020/03/02/asia/coronavirus-drive-
th...](https://edition.cnn.com/2020/03/02/asia/coronavirus-drive-through-
south-korea-hnk-intl/index.html)

