
Coronavirus may have spread undetected for weeks in U.S. - onetimemanytime
https://www.boston.com/news/health/2020/03/01/coronavirus-may-have-spread-undetected-for-weeks-in-u-s
======
wuwuno
I created a throwaway account because, well you'll see why.

My wife just told me that two of her co-workers were in Wuhan in Late November
visiting a factory and they both got the flu in Wuhan.

One guy A, tested negative for the flu, he was sick for 6 weeks, he would
start to feel better than get sicker. His doctor told him that he had no idea
what was wrong with him. The guy A, said it was the strangest flu he ever had.
Over the 6 weeks he was sick he worked from home the entire time and was only
working part time for most of those 6 weeks because of how bad he felt.

The other guy B, I don't know if B was tested for the flu, was sicker than A,
and he was sick for 8 weeks. He also worked from home for the entire time, my
wife doesn't work closely with B, so she's not sure how much time he missed
during those 6 weeks.

~~~
oceanghost
> One guy A, tested negative for the flu, he was sick for 6 weeks, he would
> start to feel better than get sicker.

I really think there's something to this. In my part of So Cal, people have
been talking about a "recurrent flu" that keeps getting better and relapsing
at about 2-week intervals. Everybody I know has had something like that.

I think we're going to find out that we've already had covid-19, or there's
another very nasty bug out there.

~~~
fspeech
There are (at least) two strains of flus circulating this season.

~~~
oceanghost
Of course, there are, there would have to be dozens if not hundreds?

------
0xff00ffee
Seeing as how the latest percentage-du-jour claims "80% of infected people
will have no to mild symptoms"[0] I'm not surprised.

[0] [https://www.nytimes.com/2020/02/27/world/asia/coronavirus-
tr...](https://www.nytimes.com/2020/02/27/world/asia/coronavirus-treament-
recovery.html)

~~~
_bxg1
Honestly it seems like that would be a huge relief? Last I heard the fatality
rate is 1%. If that's actually 1% of the 20% who show any symptoms at all,
it's now 0.2%.

~~~
zaroth
The most recent data I have seen (yesterday in the NEJM) indicates 1.4%
fatality in lab diagnosed cases. This of course will only include more serious
symptomatic patients, as mild or asymptomatic patients are told to stay home
and are not getting tested.

No one wants to stand up and call hysteria for what it is. It’s easier to go
with the flow and cancel events out of an “abundance of caution.”

~~~
altcognito
R0 value is roughly 4-7. Upwards of 5% of the cases require the ICU, 15%
require support breathing. Medical personnel are coming down with it
frequently, and Italy is trying to bring in newly graduated nurses and retired
nurses to fill the gap. This is NOT hysteria. While it isn't a death sentence
for most, it is imperative to slow this thing down.

~~~
zaroth
Please understand that every single one of those percentages is wrong as you
have stated them. You forgot the most important qualifier, which is that the
denominator is some _fraction_ (potentially small fraction) of the total
number infected.

So when you say “upwards” of 5% of cases require the ICU, this is potentially
very misleading. Stating that upwards of 5% of _hospital cases_ require the
ICU may be true, but now you must not try to extrapolate that value any
further until you can tell me definitively what percentage of infections
result in hospitalization? 1 in 5? 1 in 20?

I won’t get into debating R0 values because they are nearly impossible not to
misuse. For example, COVID-19 does not have just one R0 value. R0 changes
radically based on actual conditions on the ground, often day to day.

The R0 value of COVID in a cult church in South Korea may be actually 1,000
while the R0 globally over the entire course of this news cycle might be 1.2.

~~~
jacquesm
> Please understand that every single one of those percentages is wrong as you
> have stated them.

No, they are accurate as far as I know and I've been following this thing with
some dedication since before it was discussed in the media because of
relatively close ties to China.

> You forgot the most important qualifier, which is that the denominator is
> some fraction (potentially small fraction) of the total number infected.

You are misrepresenting the OP's words. He said 'of cases', that is the
denominator right there. That we don't know all cases is something that
everybody takes as a given. But just like we don't know all cases we also
don't know all of the dead. The same happened with the swine flu, with SARS
and with every other epidemic so far. Only afterwards, sometimes more than a
year later do we have all the numbers. And sometimes those end up
substantially higher than the original estimate _both_ for the number of
infected people as well as for the number of people that end up dead.

> So when you say “upwards” of 5% of cases require the ICU, this is
> potentially very misleading.

Upwards of 5% of the known cases. But that's assumed, if we don't know someone
is infected then they by definition won't require ICU level care.

> Stating that upwards of 5% of hospital cases require the ICU may be true,
> but now you must not try to extrapolate that value any further until you can
> tell me definitively what percentage of infections result in
> hospitalization? 1 in 5? 1 in 20?

They don't need to tell you anything 'definitely' to be allowed to speak their
mind. And as far as I'm informed that 5% rate is on the money. So, instead,
the onus is on you to prove that _less_ than 5% of the people infected that
require care require ICU care. I don't think you are able to do that but I
will happily take good news at this point if properly sourced.

> I won’t get into debating R0 values because they are nearly impossible not
> to misuse.

Agreed.

> For example, COVID-19 does not have just one R0 value. R0 changes radically
> based on actual conditions on the ground, often day to day.

> The R0 value of COVID in a cult church in South Korea may be actually 1,000
> while the R0 globally over the entire course of this news cycle might be
> 1.2.

True, but there are averages and even the WHO seems to place the number at > 3
at this point in time. That is already a pretty high number, even when taking
all the care in the world to ensure it doesn't spread. Of course the criminals
in Korea that hope to bring about the end times in some kind of warped self
fulfilling religious prophesy are going to skew that number upwards. But in
Iran and Italy there was no such cult, and their numbers are very much in line
with the development in Korea. And since we're mentioning Iran now, there are
lots of informal reports that the situation there is much worse then
officially reported, with the number of high officials there infected this -
unfortunately - isn't hard to believe at all.

~~~
zaroth
I think it’s very important to be precise if you’re speaking of potential
worldwide calamity.

I think you may be giving OP too much credit with their use of “cases”
implying _hospital_ cases (which is the 5% ICU number, it is not 5% of
infections require the ICU) I’m happy if we are agreeing and will leave it at
that.

> _Upwards of 5% of the known cases. But that 's assumed, if we don't know
> someone is infected then they by definition won't require ICU level care._

You are still making too strong of a statement. In the study last week from
NEJM of 1099 hospital patients around China that found that 90% plus were
diagnosed with pneumonia, and 5% were admitted to the ICU. Case fatality rate
was 1.4%. [1]

It is absolutely not 5% of “known” cases. China turned anybody not seriously
ill from the hospitals back home. So we actually do know there are a large
number of uncounted mild (and even asymptomatic) cases.

It is 5% of serious hospital cases going on to the ICU. This is not my claim,
this is straight from the latest issue of the NEJM.

Also, I didn’t say anyone couldn’t speak their mind. But I said if you do try
extrapolating a sub-population percentage and multiplying by world population,
it would be a serious miscalculation. That’s _why_ I think it’s important
(crucial) to clearly identify the sub-population when you state the
percentage. Calling a sub-population dealing with hospital admittances the
“known” cases is not clearly stating identifying the patient population.

I don’t think HN commentators should play epidemiologist while making
predictions of catastrophe.

[https://www.nejm.org/doi/full/10.1056/NEJMoa2002032](https://www.nejm.org/doi/full/10.1056/NEJMoa2002032)

~~~
jacquesm
> But if you extrapolating a sub-population percentage and multiplying by
> world population

Where did that happen? In this thread or elsewhere?

~~~
zaroth
I did not say that anyone _did_ try to extrapolate numbers using these
percentages in this thread. I said, and am saying, that it’s important not to
try to do that.

Because it leads to fear-mongering. For example, downthread, here;

[https://news.ycombinator.com/item?id=22461804](https://news.ycombinator.com/item?id=22461804)

~~~
jacquesm
> I did not say that anyone did try to extrapolate numbers using these
> percentages in this thread.

But you did imply that. Look, I am all for keeping a cool head. But at the
same time I'm not going to cool my head by sticking it in the sand. I think if
you're going to participate in these discussions then you probably should do
so by making your statements a lot clearer than you do.

If you - for instance - idd not intend to suggest that someone did try to
extrapolate those numbers then you did a poor job of it. You can't just make
up strawmen and then suggest people shouldn't do that.

The comment you linked to was properly qualified and is not fearmongering. If
you think that is fearmongering then you possibly have a reading /
comprehension issue.

Let me help you by picking that comment apart:

> The 1.4% apply to the general population.

You can't really argue with that I think,

> For people over 80, the fatality rate is 15%.

Not exactly correct, I have it at 14.8% _once infected and showing symptoms_.
But close enough.

> There are roughly 13 million people over 80 in the US [1].

This is properly cited.

> If everyone gets infected, a fatality rate of 15% means 2 million deaths in
> that single bracket alone.

Again, this is properly qualified by the leading 'If'

> With the 1.4% figure it's 4.6 million over the entire US population.

Again, with the implied assumption that people are all infected, something
that is unlikely to happen.

> As a comparison, the number of yearly deaths in the US caused by influenza
> is in the 5 digits.

This is correct as far as I know, between 10 and 60K cases annually ranging
from very good years to very bad ones.

> World war 2 killed 3% of the world population over a range of multiple years
> [2].

Can't argue with that.

> If the coronavirus kills only 1% of the current world population, its death
> toll in absolute numbers will be equal to WW2.

Again, properly qualified by a conditional.

> I think at this point, the disease can't be contained, its spread only
> slowed.

I don't think anybody is arguing that it can be contained still, even the WHO
has moved on this, though they kept it up for longer than I personally think
was responsible.

> Everyone will be exposed to it sooner or later.

Probably correct, similar to the flu, most people get exposed to it in their
lives and usually once per year.

> Fortunately though there are treatments, and there are already candidates
> for vaccines. The question is only how quickly and how well those treatments
> can be deployed.

If there is one part of this comment that I have issues with then it is this
one. There are - as far as I know - no vaccine candidates that have been
trialed. I'm happy to be proven wrong here so any link is welcome.

> The less people have the disease at the same time, the better.

And that is the key insight: the whole thing revolves around managing the
capacity to deal with the people that are ill. That and effectively reducing
R0 < 1 are the main tools that we have at this stage to deal with this
particular virus.

~~~
zaroth
You asked for an extrapolation example, I gave that one. OK, so we agree
people are extrapolating with these numbers.

Now, you want to keep playing that game.

To extrapolate over the general population with the 1.4% case fatality of
serious hospital cases, _would be wrong_ and would be fear mongering. The
general population does not have a infection rate of 100% nor a case fatality
rate of 1.4%.

So the premise is wrong, the assumptions are wrong, and the result are wrong.

>> If everyone gets infected, a fatality rate of 15% means 2 million deaths in
that single bracket alone.

> Again, this is properly qualified by the leading 'If'

Qualifying a statement ending with _”means 2 million deaths in that single
bracket alone.”_ with a qualifier that is false is what I would call
fearmongering.

>> With the 1.4% figure it's 4.6 million over the entire US population.

> Again, with the implied assumption that people are all infected, something
> that is unlikely to happen.

No, it’s not an “implied assumption” it’s faulty epidemiology. First, it is
faulty to assume that everyone who is exposed will be infected. Second, it is
faulty to apply the 1.4% case fatality rate of _serious hospital infections_
to the entire US population.

The assumptions are wrong. The figures are wrong. The result is wrong. It is
putting false information based on poor understanding of the facts into the
discussion and it’s gone totally off the rails. Please, you should seriously
reconsider why you are supporting this.

~~~
jacquesm
> Now, you want to keep playing that game.

I am not playing games. This stuff is _far_ too serious to play games over.

> To extrapolate over the general population with the 1.4% case fatality of
> serious hospital cases, would be wrong and would be fear mongering. The
> general population does not have a infection rate of 100% nor a case
> fatality rate of 1.4%.

No, but the Spanish Flu for instance had an infection rate of about 25%, and
the general _infected_ population could very well be above that 1.4% (in fact,
there is every indication so far that it will end up somewhere between 2 and
3%).

> So the premise is wrong, the assumptions are wrong, and the result are
> wrong.

The premises isn't nearly as faulty as you make it out to be, it might be off
by a factor of four, hopefully much less than that. But so far - taking Wuhan
as our baseline - unchecked this thing will spread very fast and kill lots of
people. The only reason the onslaught was halted is because the Chinese took a
bunch of draconian counter measures, the likes of which very few countries in
the world will be able to copy.

> Qualifying a statement ending with ”means 2 million deaths in that single
> bracket alone.” with a qualifier that is false is what I would call
> fearmongering.

That's fine by me. But it isn't. As a whole it isn't and in the details it
isn't either. We actually have precedent for this whole situation, it is the
1918 pandemic and the world apparently hasn't learned its lesson fully. Which
may mean we are about to re-learn it the hard way. Maybe this time it will
stick. But then - as now - there were plenty of people like you who were
willfully - given the way this conversation is progressing I am assuming you
are doing this on purpose - ignoring the cold hard facts. And that made the
pandemic _much_ worse than it had to be.

Large events were not called off and led to the disease spreading much further
than it had to.

Absent an effective anti-dote to this virus and with an overwhelmed health
care system (note the qualifiers!) we might as well be in 1918.

> No, it’s not an “implied assumption” it’s faulty epidemiology.

Not as far as I can see. People talk about hypotheticals all the time. You
can't really come out like this against a pretty clear comment and at the same
time make up stuff you rail against that never happened in the first place.
Fix your own issues first.

> First, it is faulty to assume that everyone who is exposed will be infected.

Agreed, so let's divide the number by 4 and call it a day. That's the worst
this could possibly get. Right? Or do you think that given a sample of '1' the
1918 flu might not be the best guideline for precision and that it might be
better _or_ worse? We don't actually know the answer to that.

> Second, it is faulty to apply the 1.4% case fatality rate of serious
> hospital infections to the entire US population.

That's true. But for all the same money we end up with a higher case fatality
rate. So that may end up affecting the equation in a negative way.

But assuming 10% of the country becomes infected and 5% of those end up with
symptoms serious enough to warrant ICU care there is a serious problem.

And that 10% could very well be low. So as far as I'm concerned you should
start taking this a bit more serious instead of trying to shout down the
discussion. Stay dispassionate and try to argue your case with actual numbers
rather than nay-saying. That way you can contribute rather than just irritate.
Think of it as an opportunity to educate, and you just might learn a thing or
two yourself.

~~~
zaroth
Look, I appreciate the discussion, and I’m about to sign off.

I just want to say, it’s easy to take the wrong numbers, multiply together,
and see 100 ways that _millions of people die_. That’s fear mongering.

What I believe is that it’s incumbent on anyone who wants to participant in
predictive discussions to do so responsibly and using only the best numbers
that we have on hand.

Anything could happen. And this is always true, whether it’s the Ebola
discussion from a while back, or SARS, or MERS, or COVID today.

You still seem to insist on claiming that we could see pervasive worldwide
infection, 5% ICU admits, and 1.4%+ general population fatality. I hope you
will soon realize that is not actually representative of what we are facing,
where in fact, the vast majority of cases are mild or even asymptomatic. I
expect this will be clear even to the most avid doomers by mid-April.

Lastly, I don’t want to go back and forth on little things, but this;

> _at the same time make up stuff you rail against that never happened in the
> first place. Fix your own issues first._

I think you need to re-read what I originally wrote. I never strawmaned.

I said the numbers were all wrong _as they were stated_ due to lack of proper
context. I could have used the word “useless” or “misleading” instead of
“wrong” and that might have been better.

I then followed up by saying it’s imperative not to try to use those numbers
to extrapolate in the general population. I could have said “one must not”. I
was not accusing Op of doing this.

I was trying to say that the _danger_ of not properly qualifying the context
of a percentage like case fatality is that people will misuse it by improperly
extrapolating.

Then we found an example down thread which does exactly that... and you defend
it anyway. Which is fine, but I stand my ground on the argument (same as the
NEJM doctors) that it’s improper to extrapolate the hospital case fatality to
the general population.

If one “assumes that the number of asymptomatic or minimally symptomatic cases
is several times as high as the number of reported cases, the case fatality
rate may be considerably less than 1%.” (NEJM)

~~~
jacquesm
> using only the best numbers that we have on hand.

But you yourself are not doing that. You quote data that has been long ago
overrun by the reality on the ground.

> You still seem to insist on claiming that we could see pervasive worldwide
> infection, 5% ICU admits, and 1.4%+ general population fatality.

We could. We also could not. Let's hope for the best and plan for the worst.
That way we can all laugh at this a year from now.

> I hope you will soon realize that is not actually representative of what we
> are facing, where in fact, the vast majority of cases are mild or even
> asymptomatic.

I do not doubt that at all. But that does not rule out that the numbers could
still be quite bad.

10% infected and 1.4% CFR would be _very_ bad news.

> I expect this will be clear even to the most avid doomers by mid-April.

Maybe those 'avid doomers' aren't the doomers. The doomers are the cultists
and the 'we're all going to die' people. We're not all going to die. But
unless we take substantial countermeasures a lot more people will die than
need to. Look at Iran for a taste of that. And that's the message that should
go out: reduce the opportunity for the virus to spread so that we get to R0 <
1 as soon as possible and then mop up from there. Anything less and it will
just get worse and worse.

------
soonnow
That is scary, not for the actual health risk implications but for the
implication when it comes to the supply chain. (Unless you are a member of a
risk group). I'm not trying to panic or fear monger at all, but I think it is
a good time to point to this scientific american blog post that suggest to
have food and water on hand for two weeks
[https://blogs.scientificamerican.com/observations/preparing-...](https://blogs.scientificamerican.com/observations/preparing-
for-coronavirus-to-strike-the-u-s/)

That doesnt mean you need to stock up on ammunition and night vision googles,
just have some food safety even just to not overload the supply chain

~~~
adrr
Why do we need to stock up on water? Even the CDC is recommending it. How does
the virus put our water supply at risk? I have two weeks worth of water
already stockpiled in case of an earthquake which could cause infrastructure
damage to our water supply. Everyone should have that.

~~~
mherdeg
Jeez, you stock 14 gallons of water per person in your house? Where do you
keep it? Do you periodically re-freshen it or what?

~~~
almost_usual
Do you have a hot water heater? Common knowledge among SFFD to have some
bottled water and access the hot water heater when that runs out.

~~~
mherdeg
Interesting, our hot water heater is "tankless" and it hadn't occurred to me
until this thread that this makes emergency prep a little more complicated.

------
rawfan
Fun story: a friend of mine works as an engineer in critical infrastructure
(for a large utility in Germany). He wanted to spend his vacation in northern
Italy (which currently has a COVID19 outbreak). When his employer got wind of
it they offered to pay him extra to choose a different destination. If he
went, they told him, he couldn't come back to work for another 2 weeks after
his vacation (unpaid leave).

------
29athrowaway
I have read reports saying that the CDC won't test you unless you have fever,
shortness of breath and chest pain. By the time you get to that point you
already passed the virus to a bunch of people.

~~~
SpicyLemonZest
Fever and shortness of breath are the symptoms of the disease - how else would
they figure out who to test?

~~~
29athrowaway
What are your thoughts on this story:

[https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_stor...](https://www.reddit.com/r/nyc/comments/fayko1/my_covid19_story_brooklyn/)

------
zaroth
There’s almost nothing new in this article, for what it’s worth. A genetic
analysis of two infections show a mostly identical genome.

This does not definitively tell you anything about how those two people were
infected.

Everything else is speculation wrapped in clickbait.

For the vast majority of people, an infection of this coronavirus would be
more mild than catching the flu.

A reasoned analysis (such as what was provided yesterday in the New England
Journal of Medicine) puts the fatality rate of COVID-19 on the same order of
magnitude as the flu.

It is new and very sensationalized. I think it’s absolutely imperative to try
to maintain a rational stance of the actual relative impact of this
coronavirus versus a typical flu season.

~~~
triangleman
Reading this article actually had the effect of reducing my level of alarm,
because it introduced the possibility that some of my household has already
caught this bug in the last 6 weeks and we got through it.

~~~
pbourke
I wouldn't feel too sure about that. They estimate 150 - 1500 total infected
right now. There would be substantially fewer even 1 week ago (R0 of 2,
roughly 1/2 last week. R0 of 3, roughly 1/3, etc).

It's possible the number of infected in the region only broke triple digits a
couple of weeks ago. But exponential processes being exponential, there could
be many thousands in 1-2 weeks.

Edit: Stated another way, from what we know of the course of the disease
(14-21 days from infection till fatality) the critical and fatal patients
identified this weekend likely entered the disease process 2-3 weeks ago when
the total number of infections was small.

Edit 2: another confounding factor is that these numbers seem assume that all
of the current infected are traceable to the index patient. I think it's very
possible that there are other "trees" of infections spreading at the same time
from different unidentified index patients. I'm guessing that's true because
studies show that airport screening misses >50% of cases. Additional sequences
on WA patients will be hugely informative.

------
ackbar03
Yea I'm pretty sure it's out and about in the US now. Your patient numbers are
always 0 if you don't test for it

------
rawfan
1\. Don't panic, COVID19 won't harm you. 2\. No wonder it spreads undetected,
with the messed up US medical system, I wouldn't go to the hospital either if
I had to fear a huge medical bill [1].

[1] [https://www.nytimes.com/2020/02/29/upshot/coronavirus-
surpri...](https://www.nytimes.com/2020/02/29/upshot/coronavirus-surprise-
medical-bills.html)

