
Covid-19: the harms of exaggerated information and non‐evidence‐based measures - tomerico
https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222
======
robocat
Firstly, there is 10 weeks of evidence on what other countries have done to
avoid transmission. Taiwan, Vietnam, South Korea, China, and Japan all show a
variety of strategies and have some successes under their belts. Sure, it’s
messy social data, and they have systematic differences from other countries,
but it’s real data about what is working.

Ioannidis says: “If we assume that case fatality rate among individuals
infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess
from my Diamond Princess analysis — and that 1% of the U.S. population gets
infected (about 3.3 million people), this would translate to about 10,000
deaths.”

The Diamond Princess data shows deaths with a functioning health system. From
WaPo: “a doctor at Papa Giovanni XXIII Hospital in Bergamo, where he said
there are 500 patients in need of intensive care and just 100 ICU beds”. The
deaths in Italy are often due to an overloaded health system, which can easily
double the number of deaths. Why ignore that? Italy has 6000 deaths already
with 1/5th the population of the US: you need some powerful evidence to assume
the US should expect to have a different path to end up with a total of 10k
(by say the end of the year).

I think John has good reason to desire evidence based decisions, but sometimes
you have to make decisions without enough data and change your game as it
develops e.g. look at what effective entrepreneurs do in uncertain times?

~~~
defen
> “If we assume that case fatality rate among individuals infected by SARS-
> CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond
> Princess analysis — and that 1% of the U.S. population gets infected (about
> 3.3 million people), this would translate to about 10,000 deaths.”

Why would we use the Diamond Princess CFR instead of China's, or Italy's, or
South Korea's? Where does the idea of 1% come from? Both of those numbers
sound ridiculously optimistic to me. Furthermore, death isn't the only
negative outcome - what do we know about permanent organ damage (lungs, heart,
liver, kidneys) in survivors?

~~~
Barrin92
>Why would we use the Diamond Princess CFR instead of China's, or Italy's, or
South Korea's?

because everyone on the diamond princess was tested. So we know for sure how
many cases we are dealing within the sample.

~0.3 and ~0.9% are also not optimistic guesses but the current numbers for
Germany and SK. Italy sits at 9%. So the situation is either that Italy is
vastly underestimating cases, or Germany and South Korea have lost a magnitude
of corpses somewhere. I find the latter less likely than the former.

~~~
rramach
John's analysis is cherry picking in many ways. Death rate in Diamond Princess
is 1.1% today and 2% is listed as severe. Assuming 50% of severe make it,
final fatality rate for the ship may end up closer to 2%. John then adds a 50%
discount factor but it is not clear how he picked that number. Also, the 1% of
population infected seems to be another number pulled out of a hat. If we are
basing our figures based only on the ship with no other assumptions, we have
to go with 20% infection rate. Thus, one reasonable estimate of risk from the
ship data is 20%x2%x330M = 1.3M deaths if we wait for "evidence" and did
nothing. Clearly, this argues for doing something!

Edit: Also, Germany does not test dead folks for coronavirus while Italy does.
Further, SK death rate has gone up to 1.3% (0.9% is an old number) and many
more are in severe category. Thus, the sub 1% numbers seem more like the
outliers than the above 1% numbers.

~~~
ant6n
The Diamond Princess is also likely not a random sample of the population -
they are healthy enough to be fit for travel.

~~~
giantDinosaur
You don't need to be particularly fit or healthy to go on a cruise. Yes, sure,
you can't be on life support, but generally 'healthy enough' to travel on a
cruise is exactly what I'd expect from any random sample of the overall
population.

~~~
kgwgk
You may not understand what "random sample of the overall population" means if
you would expect every single person in the sample to be healthy enough to
travel on a cruise. Almost 1% of the population in the US has Alzheimer
disease or other dementias, for example.

~~~
giantDinosaur
I noted exactly that in my comment. Yes, not all the population can go on a
cruise. No, it's not like it's only the healthiest 20% of the population that
can. If I randomly sampled the population I'd expect the majority to be
capable of a cruise. What do you think cruises are like?

~~~
kgwgk
If you agree that they are not a random sample of the population - they are
healthy enough to be fit for travel (like the majority of the population) you
are not trying to contradict ant6n's comment as I thought. I misunderstood, my
apologies.

~~~
rvnx
and it's not a small travel (e.g. the British tourists that went on board the
Diamond Princess).

If you are not in good health at the beginning, you don't adventure yourself
10 hours+ from your home. So this group is likely in better shape than average
population.

------
jsnell
The title is funny, since Ioannidis is actually the one proposing measures
("do nothing") based on no evidence and exaggeration. Basically every number
in the paper is tainted by him cherry-picking the most optimistic number
possible, and then trying to twist it further into something even better.

Like his argument for the R0 being near 1.3 is just that it's "probably" the
case.

At some point we need to be able to call the data we have good enough for
making decisions.

~~~
hyperbovine
Weirdly enough, just yesterday I took all available sequence data currently on
GISAID, used it to estimate R0, and got ... 1.3.

~~~
CydeWeys
If that were true then how can you possibly explain how rapidly the pandemic
is spreading?

~~~
marknutter
It's curiously spreading at the exact same rate that tests are being
administered. Curious indeed..

------
Geee
I saw the videos from Wuhan hospitals 2 months ago and it was clear that the
severity of this was off the charts. You can pretty much scale up the
situation from a single hospital, because it tells you that it's impacting
locally more than the hospital can respond.

You don't need "evidence" of how many are actually infected or what is the
correct R or CFR or which way it spreads. Just look how it's impacting the
local health care system. If it exceeds the capacity by X % that's how big a
problem it is.

~~~
amykyta
Spot on. Too many comments are see-sawing on details of parameters and trade
offs but just talk to a doctor in NYC, they are out of room in ICUs and
terrified about triaging that will start taking place.

~~~
irq11
Mt. Sinai in NYC is not currently reporting shortages of any kind. They are
_preparing_ for shortages, but are not currently experiencing them:

[https://www.westsiderag.com/2020/03/23/mt-sinai-setting-
up-o...](https://www.westsiderag.com/2020/03/23/mt-sinai-setting-up-outdoor-
tents-to-extend-emergency-rooms-hopeful-comments-on-supplies)

Perhaps you want to reconsider your news sources.

~~~
fcurts
Hospitals in Italy are currently reporting dramatic shortages of many kinds.

------
jamilbk
It’s much easier to quantify the harms of allowing business as usual and
letting the infection spread (namely # of deaths) than it is quantifying the
cascading repercussions of a massive global economic meltdown.

Accordingly, world leaders are being judged based on their ability to contain
the spread rather than prevent economic devastation.

As a society we are faced with navigating the delicate balance between how
many lives we put to risk vs how much economic turmoil we can tolerate.

With so little data on the latter (economic crashes absolutely can lead to
deaths as well), it feels like we aren’t equipped to make educated policy
decisions on how far we should go to limit the spread.

I hope after all this we can create a more cohesive playbook for navigating
these tradeoffs in the future. Many of these public health orders feel like
knee jerk reactions lacking evidence.

Better to err on the side of caution I suppose.

~~~
joe_the_user
An economy is not something that one should have to shovels lives into to keep
going. And in any case, if we sacrifice all the lives this virus could take to
the economy, it won't help the economy at all - the massive dislocation
involved in the deaths will certainly be far worse than the shutdown, if you
really want to think that way.

All that said, part of the collapse of things like the stock market comes
through the financial system having been built up into finely tuned but
extremely fragile edifice - end QE created an environment of limitless
leverage and short-term thinking. This environment created the situation of
not having future resources, of jury rigging everything to work in a super-
efficient but fragile fashion (the 737Max being a perfect product of this
paradigm).

Covid shock is logical result - in another, a more far seeing society might
have made preparations beforehand, had an epidemic team in place, etc.

So a lot of things are collapsing because they weren't built to last to begin
with, not because of the virus.

~~~
ltbarcly3
>> An economy is not something that one should have to shovels lives into to
keep going.

I mean I want to agree in principle, but this is just an incorrect statement.
It's a matter of what is a good-enough tradeoff of risk and reward. If you
make people drive to work, some will die. If you want to mine lithium, some
people will die in industrial accidents that wouldn't have died if you never
built a lithium mine. If you are only willing to accept 0.000% risk, then we
have to respond with a full economic shutdown whenever there is a flu
outbreak, or even a common cold outbreak, because people will die if we don't
stop the spread. All economic activity leads to deaths, most of the time the
deaths are less obviously linked, and at a much lower rate, so we don't
connect the fact that people commute to work in trains, and so the economic
activity they are commuting into work to engage in directly causes their death
in the form of the flu, train crashes, pedestrian accidents, and so on.

There is also a question of net lives lost, or harm minimization. Economic
activity also leads to resources which can be used to tend for the sick and
elderly, or better nutrition, or education, and to sum up everything that
isn't eating acorns you can find on the ground (except even that is a form of
economic activity). I would assume that just letting covid run free would be
dramatically worse than shutting down the economy for a few weeks, but then
what the endgame is I'm not sure, it really does depend on the death rate in
an ICU vs with limited medical support, and the amount of economic harm this
causes.

However, I think we can learn a lot from this outbreak. I was very, very
embarrassed to wear my filter mask when I went to the store, so I only wore
work gloves up until yesterday. Now I'm sitting in bed with a fever wondering
whether I'm about to start coughing up blood (probably not, it's still more
likely to be the flu). Next flu season (or, sadly, next covid season) I think
I will wear my mask, though.

If people start wearing fashionable masks and gloves in the winter, we can
virtually eliminate lots of communicable diseases.

~~~
wegs
There is no trade-off. Exponential functions are pretty binary. We contain
this (R0<1) or we let this kill 3.6% of the population, and likely permanently
harm the lungs of many more.

A core problem is that we're not looking at how to mitigate damage to the
economy. We can handle a month or two of the economy shutting down, no
problem. You'll get your new car 2 months later.

Most of the damage is auxiliary: businesses going bankrupt, people defaulting
on mortgages, etc. All of that can be mitigated with the right measures.

[https://docs.google.com/document/d/1YbtJGn7ida2IYNgwCFk3Sjhs...](https://docs.google.com/document/d/1YbtJGn7ida2IYNgwCFk3SjhsZ0ztpG5bMzA3WNbVNhU/edit)

The economic harm of losing 2 months of production -- or even a year of
production -- is much smaller than the economic harm of supporting people
disabled by coronavirus for the rest of their lives. That is assuming we
mitigate the economic fall.

~~~
ltbarcly3
>> The economic harm of losing 2 months of production -- or even a year of
production -- is much smaller than the economic harm of supporting people
disabled by coronavirus for the rest of their lives.

That is a tradeoff? I don't understand how you are disagreeing with what I
said. You are literally spelling out what we are trading off, the fact that
its a very good trade (in your opinion, which is based on expert advise and
almost certainly correct, but there are no guarantees) doesn't make it stop
being a trade. In fact, that is how all tradeoffs work, one option is better
than the other so you pick it.

------
ExtremePopcorn
Context for the author:
[https://en.wikipedia.org/wiki/John_Ioannidis](https://en.wikipedia.org/wiki/John_Ioannidis)

He wrote a column a couple days before this paper. Linking the response as
well.

[https://www.statnews.com/2020/03/17/a-fiasco-in-the-
making-a...](https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-
the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-
data/)

[https://www.statnews.com/2020/03/18/we-know-enough-now-to-
ac...](https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-
decisively-against-covid-19/)

~~~
joe_the_user
It's kind of a shame that he's wound-up writing an article like this. It
certainly discredits him in my eyes and it seems utterly opposed to stated
principles of evidence based medicine.

As others have noted here, the article calls for action based on very little
data and lots of ad-hoc speculation. It also cheery picks its and falsely
claims we don't have enough data.

I wonder if thinking all research is false too much lets jump to the idea you
dream any opinion that's convenient.

Moreover, Ioannidιs has absolutely jumped into advocating this position from a
partisan political position, with his positions picked up by partisan
political sites such as the dailywire.com; Headline: "Stanford Professor: Data
Indicates We’re Severely Overreacting To Coronavirus"
[https://www.dailywire.com/news/stanford-professor-data-
indic...](https://www.dailywire.com/news/stanford-professor-data-indicates-
were-overreacting-to-coronavirus)

------
ajnin
What Ioannidis is advocating is to do nothing until we have scientific
certainty of what the correct decision should be, and only then act. What he's
not taking into account is that the situation is unfolding right now, and if
"do nothing" turns out not to have been the correct decision then you can't go
back and change that. If we overreact and cause 20% unemployment for the next
year, then a harm has been caused, but if we underreact and 20 million people
die, then another harm would have been caused. In the face of this
alternative, with not enough data to know the probability of outcome #2, but
with enough to know that it _can_ happen, then I think it is rational to
choose the route that most surely avoids it.

~~~
wwweston
> if we under-react and 20 million people die, then another harm would have
> been caused

And it's worth noting if anything on the order of millions of people die, then
there going to be economic impacts -- that's a hell of a demand crater and
productivity shock.

~~~
Gibbon1
Worst case. Instead of quickly developing herd immunity, the US ends up with
persistent low level outbreaks over two to three years like the 1918 flu. If
that happens the rest of the world will quarantine us.

~~~
ClumsyPilot
What are you trying to say? If the rest of the world would develop hard
immunity, they would have no need to quarantine you.

~~~
Gibbon1
Assume they don't, assume they manage to stop community spread of the disease
instead. Then they don't have herd immunity.

------
dannykwells
Let's check back on this piece in...2 weeks, say, when there are 10,000+
Corona deaths in the US. Well see how it ages then.

Source:
[https://www.nytimes.com/interactive/2020/03/21/upshot/corona...](https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-
deaths-by-country.html)

427× 16 =11102

~~~
usaar333
That rate is highly unlikely to hold. There's enough stay in place
restrictions in effect to drive it down after about a week or so.

FWIW, at this point, it looks like NYC is going to take a huge hit and the
other outbreaks (Seattle, California) will look mild comparitively.

~~~
joe_the_user
Washington state doesn't have a statewide lockdown, I don't know if even
Seattle has a lockdown. California is doing the best but there are still
crowds defying the lockdown at beaches and parks. Just as much, grocery stores
are open as usual and even with most people trying to do social distancing,
I'm doubtful you're clamping that hard on the infection, unfortunately.

I think the best is that when fatalities spike here in California, we're in
better shape to intensify the lockdown.

~~~
rbritton
Washington does as of 5:00 pm PDT today.

~~~
DoreenMichele
I've dug through everything I can find. I'm feeling really stupid at the
moment, but I cannot find a confirmation of that 5pm start time, though it
does appear to start today and "immediately." It runs through April 6, but
could be extended.

Tweet is from 6:50pm:
[https://twitter.com/GovInslee/status/1242267557295321090](https://twitter.com/GovInslee/status/1242267557295321090)

[https://medium.com/wagovernor/inslee-announces-stay-home-
sta...](https://medium.com/wagovernor/inslee-announces-stay-home-stay-healthy-
order-4891a7511f5e)

[https://www.governor.wa.gov/sites/default/files/proclamation...](https://www.governor.wa.gov/sites/default/files/proclamations/20-25%20Coronovirus%20Stay%20Safe-
Stay%20Healthy%20%28tmp%29%20%28002%29.pdf)

~~~
rbritton
That’s when the announcement of it was broadcast, which is why I used that
time.

~~~
DoreenMichele
Thanks.

------
cxhandley
Imagine this. Your driving down the freeway at 60 mph, accelerating at 30%.
The car in front of you puts on the breaks. Before you react, you first gather
your speed gun, check the deceleration rate of the car in front, then
calculate based on your speed when you should put your breaks on. I'm all for
the scientific approach, but in this particular instance, our survival
instincts need to take precedence. Please, we need to stop peddling evidence
based approaches for an exponential situation.

~~~
michaelmcmillan
Stepping on the breaks perfectly align with what we know scientifically.
People think of science as something very narrow – but it's also evidence and
rationality. What China and South Korea have done works. What other
alternatives do we have?

~~~
rimliu
Except China and South Korea did different things.

~~~
michaelmcmillan
Which is consistent with what I wrote.

------
fbn79
"And yet it moves" Galileo Galilei
[https://en.m.wikipedia.org/wiki/And_yet_it_moves?wprov=sfla1](https://en.m.wikipedia.org/wiki/And_yet_it_moves?wprov=sfla1)
. I agree that in many axpects the situation is exagerated, in primis by
general panic. But If the Covid is not much worse than flu why in Italy we
have military trucks convoy that transport death to southern regions because
the wait line for crematory in North is becomed too long?

~~~
listsfrin
In normal times Italy has a death rate of 10 deaths/1000 people. Which
translates to ~1500 daily for a population of 60 millions. What were they
doing previously with the dead?

~~~
gpderetta
Those people haven't stopped dying. As a comparison, 700 people have been
dying every day for covid-19 in Italy. Also deaths are not (yet) evenly
distributed but greatly concentated in the north.

~~~
listsfrin
You are building the world around your arguments. You have no proof but still
talk, talk, talk.

~~~
CydeWeys
What does that even mean? The world is what it is. Italy is seeing huge
increases in background death rates at the moment, owing solely to COVID-19
(while at the same time seeing diminished deaths from things like traffic
accidents, though not remotely enough to make up for all the extra COVID-19
deaths).

What is your argument exactly? It's a fact that Italy is running at a higher
overall mortality rate owing to COVID-19.

------
postalrat
[http://www.euromomo.eu/](http://www.euromomo.eu/)

Mortality across Europe has drastically declined in the past few months. Seems
like everyone sitting at home is saving a ton of lives. Fewer accidents, fewer
sicknesses, maybe even people eating a bit healthier.

Why stop locking yourselves indoors when so many lives are being saved by not
leaving home?

~~~
antpls
It kinda proves the point that covid19 alone is less deadly than many other
causes

~~~
cycrutchfield
I don't see how you've come to that conclusion.

~~~
antpls
Did you look at the charts? If you didn't know there is a global epidemic,
would you have been able to see it on these curves?

In France and Italy, there were between 50000 and 60000 deaths per month in
2018 and 2019. If most of those people died because of 2 or 3 accumulated
factors, covid19 would be just one more factor. But maybe those people would
have died one month later anyway without covid19

~~~
cycrutchfield
I don't understand people like you who can look at the current numbers and say
"Oh, it's not so bad" while also conveniently ignoring that the numbers are
growing exponentially. People that are raising the alarm are not talking about
the numbers now, they are talking about the numbers in the future if nothing
is done to address it.

~~~
antpls
This is a new virus, _no one_ knows about the future. Data we have now could
be biased toward an hidden variable we didn't figure out yet.

~~~
lifthrasiir
One can predict the future with bounded error bars though. Weeks of
observation yielded some numbers including R0 around 2 and CFR around one
digit percent (yes, we still don't know if it's around 1% or 2%, but it is
certainly not 0.1% [1] or 10%), so 0.1---5% of the total population will die
somehow due to COVID-19 if absolutely nothing is done. For the reference, less
than 1% of the total population dies each year in developed countries. Enough
reason to be alerted.

[1] CFR is a function of age (notably among others) and more careful analysis
would involve demographics. Still, the rough order of magnitude doesn't
change.

------
yurlungur
It's easy to point at others for imperfect data and imperfect science when the
situation is evolving so fast and data is so hard to come by. It seems to me
that papers being retracted due to inaccurate evidence is not a sign of
sensationalism but of sound science. Once can argue that more diligence should
be practiced in the review process, but I assume everyone is trying their best
to get the information out there ASAP.

In any case, policies need to be enacted now (or rather two weeks ago) in any
but the best case scenarios. There is no time to wait for more accurate
information. If one argues that exaggeration is rampant and we should learn
more before making hasty decisions, then that's essentially arguing for
inaction. Even if that was the right action I suspect the induced panic in the
society will be even greater.

The author also seems to be implicitly weighing the dire consequences of a
pandemic (maybe millions more people dying) against the supposed reputation
damage to science, which is bizarre to say the least.

~~~
ropiwqefjnpoa
The response will have it consequences too, lost lives, destroyed businesses,
ruined families, lost requirement savings.

~~~
cycrutchfield
That's not an argument for letting this disease burn through our entire
population. That's an argument for the government to step up and assist people
during this time.

Edit: and who gives a shit about your retirement account.

~~~
vixen99
People who for whatever reason are utterly dependent on support from the state
might well give a shit about the state's decreased capacity to provide aid
thanks to additional demand on the part of those whose retirement funds (which
allowed them to be self-sufficient) have been destroyed.

~~~
kevingadd
At least in my country a big chunk of grandma and grandpa's retirement is
subsidized by government programs, if not directly provided by government
programs. The same way we provide disability coverage for people who end up
out of work through no mistake of their own due to on-the-job injury, etc. You
might have your own 401k you deposited salary into or have extra private
disability insurance but a big chunk of your safety net here is a government
program that you pay into while you're able-bodied and working and then draw
out of when you're disabled and/or retired.

It's not as if a disease mitigation shutdown is the only thing that's going to
crater grandpa's 401k. His stock holdings took a big hit during the 2008 crash
too (as did mine).

Acting to preserve the economy first and foremost will not help those people.
You have to keep them alive first while coming up with effective strategies to
look after them later in the event that their retirement funds somehow
evaporated. What good is protecting their retirement funds if the retiree
isn't around to spend them?

------
2008guy
The answer seems so obvious. Do a hard, air tight quarantine of people of
advanced age. People who are borderline or sick are told to stay inside.
Encourage the rest of society to go about business as usual. Provide
government support for all of it. Some people will die but probably less than
if we have to do this over and over again without ever gaining herd immunity.
And few enough to massively ease the burden on hospitals. And it’s the best
way to avoid Great Depression 2020.

~~~
gyulai
...keep in mind, that it may be the case that we're being lied to when we're
told that young and healthy people have nothing to fear. The following article
seems to suggest otherwise: [https://www.propublica.org/article/a-medical-
worker-describe...](https://www.propublica.org/article/a-medical-worker-
describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients)

~~~
gyulai
Another data point: The following source gives additional detail on the kind
of thing that is meant by "preexisting condition" when they say "people
without preexisting conditions have nothing to fear". One of them is high
blood pressure. Who doesn't have high blood pressure, these days.

[https://www.cebm.net/global-covid-19-case-fatality-
rates/](https://www.cebm.net/global-covid-19-case-fatality-rates/)

------
jtsnow
Ioannidis continues to push this evidence-based approach, but I have not yet
seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam.
They argue that one doesn't need raw evidence to act if the statistical
evidence shows that the risks are catastrophic. They published a paper on
January 26th which lays out arguments for why conventional risk management
approaches are inadequate in these situations. [1]

This paper was met with disregard on HN [2], but the persistent reach of
Ioannidis shows why Taleb's arguments have value.

Some on Twitter argue that the WHO statement on January 14th shows where
Ioannidis' approach fails: "Preliminary investigations conducted by the
Chinese authorities have found no clear evidence of human-to-human
transmission..." [3] Authorities were looking for evidence before taking any
action.

[1] [https://necsi.edu/systemic-risk-of-pandemic-via-novel-
pathog...](https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-
coronavirus-a-note)

[2]
[https://news.ycombinator.com/item?id=22154333](https://news.ycombinator.com/item?id=22154333)

[3]
[https://twitter.com/WHO/status/1217043229427761152](https://twitter.com/WHO/status/1217043229427761152)

~~~
avsteele
I find Taleb's argument specious. The risk inherent in a reaction can be
pretty catastrophic as well; for example we are now seeing some project 20%+
unemployment in the next quarter.

In addition, we do have data on the possible harms from Coronovirus, since we
have more CFR data at this point. This puts bounds on possible harms. For more
detail see John's other article in statnews. The results of the Diamond
Princess cruise ship also are telling [1].

It looks like Iceland has about 1% of its people infected [2]. This didn't
happen overnight, and Iceland is doing OK.

[1]
[https://twitter.com/maximlott/status/1241718453700038658?s=2...](https://twitter.com/maximlott/status/1241718453700038658?s=20)

[2] [https://www.government.is/news/article/2020/03/15/Large-
scal...](https://www.government.is/news/article/2020/03/15/Large-scale-
testing-of-general-population-in-Iceland-underway/)

~~~
natalyarostova
Well, consider if we reacted late January when he wrote that article it would
have been very cheap to contain...

~~~
Barrin92
Then the immediate question is, the next time we react early and it turns out
we overreacted, is that something you're going to register as well? In
particular in authoritarian countries like China which actually have a history
of vast overreaction based on a 'security-first' mindset.

Ioannidis actually points to one other example in the article. There are
several corona strains already in circulation with fatality rates as high as
8% among the elderly. If this reaction is rational, are we irrational not
locking down everything every winter?

~~~
natalyarostova
Maybe we can just lock things down when we sport extremely dangerous new
viruses. It doesn’t seem that tricky to me. I was following this from late
December, and it was clear it was a potentially huge risk.

------
rdlecler1
You need to know if you’re walking through a two way door or a one way door. A
two way door you can course correct. A one way door you can not which requires
a different risk strategy. Evidence suggests a one way door.

------
RobertRoberts
Common sense needs to prevail over mania, numbers over hyperbole and science
over conjecture. But even then, this is hard if our data is collected poorly
and then poorly disseminated.

So what is the answer then? Maybe a strengthening of resolve against all forms
of panic?

Is there a single event in history has been solved by panic?

~~~
partiallypro
The craziest stat I heard today was on my local news, and it was about COVID19
in the county, Davidson County (Nashville, TN,) they said of all the active
cases in the county only 2 had been hospitalized. That's out of 163. The
others were sent home to be quarantined and medicated. I was floored. Why are
stats like that not shared? That seems like very valuable information.
Hospitalization rates should be one of the main stats being shared, imo.

~~~
joe_the_user
Sure but most of those are new cases. Do you have any idea what happened with
those cases two weeks later or even if it's been two or three weeks for the
cases? You'd only expect that 16-32 would require hospitalization in any case.
But on the other hand, you can expect 326 visible or invisible cases the next
week and gradually things get difficult, if the trend that's been documented
continues.

~~~
partiallypro
I can see that, but I also can see that this could give us insight into the
virus as it spreads throughout the population. Like, what if it is mutating,
becoming weaker/stronger, hospitalization rates would give us insight into
that.

------
johnohara
The acid test for this article will take place towards the end of this week
and into next according to the Surgeon General.

Honestly, we're all holding our collective breath and waiting to see whether
or not the U.S. begins to approach the same values associated with the Diamond
Princess.

So far, the mortality rate of those testing positive, asymptomatic and
symtomatic, published by the CDC today, is 0.0119 compared to the DP's 0.013.

The mortality rate as a percentage of all passengers and crew aboard the DP is
0.002 (9/3711).

The infection rate as a percentage of all passengers and crew aboard the DP is
0.192 (712/3711).

Dr. Deborah Brix indicated during today's WH presser that it's possible 70% of
the U.S. population will be "exposed" to the virus by the end of 2021.

(327,000,000 * 0.70) * 0.19 = 43,491,000 potential positives if the DP number
is used.

To date in the U.S., the reported percentage testing positive of the total
number tested is 0.115. I'm not sure where this number keeps coming from.

At the moment, the Diamond Princess represents the best set of data for
comparison.

~~~
tlrobinson
Why do we expect to get better mortality data in the US than other countries?

~~~
joe_the_user
I don't think many people knowing the facts are expecting that. It's that
people, including me, dread the moments when the facts become manifest. This
will prove us right but I will take no comfort in that confirmation. On the
off chance that these (implausible sounding) arguments turn out right, well,
woohoo, great.

~~~
johnohara
Finishing the math on this is very sobering which is why I was intrigued by
the original post.

I truly hope John Ioannidis is correct and SARS-CoV-2 is not as virulent. We
are about to see in the next week or so.

~~~
joe_the_user
The big thing is he's making a big assumption that there's some natural limit
to the total infection rate that can be achieved by the virus - less than 100%
and less than the 30% of the cruise ship. That seems plausible but it's
essentially based on zero evidence. Diseases have wiped out societies so
there's no rule I can saying Covid couldn't achieve a disastrous 30%
penetration of the population. No country has had the guts just say "let's see
how far this can go" and fortunately so.

An extreme worst case would be maybe 3% of the population dying. The Syrian
civil war killed 2% of the Syrian population over several years, so this
sounds bad. But US regular death rate is about 0.88% you could fudge and claim
people would barely notice. But Covids is a very messy death and would destroy
the health care system, which people would notice.

------
dannykwells
Can we revisit this now that it's clear how wrong John was? The US already has
6000 deaths from only 250k confirmed cases. It is assured we will cross the
10kthreshold,and likely the 100k one.

It's important to hold people accountable for their (massive, scary,
indefensible) assertions.

------
sago
I am worried there is a fine line between 'realism' and a backlash against
care for the elderly and chronically ill.

When people realise that their earnings have been slashed, they have been
burdened with years of increased taxes, the economy has plunged, and swathes
of businesses have gone bust, for the sake of people who were going to die
soon anyway...

Realism is good. But it is easy to 'evidence' biased anti-vulnerable feeling
with 'realism'. I'm not convinced that if most people understood the realistic
risk to themselves, they would do what's necessary to protect the people at
much greater risk. The last week of the 'let's be realistic' zeitgeist on the
news comment thread I visit.

As usual with such pessimism, I really hope I'm wrong.

~~~
CriticalCathed
>I am worried there is a fine line between 'realism' and a backlash against
care for the elderly and chronically ill.

I guarantee you that if we don't target our lockdowns on the at-risk
population (elderly being the most numerous in that group), whatever backlash
there is will be worse when the general population realizes they aren't at any
significant personal risk.

~~~
paulryanrogers
> ... when the general population realizes they aren't at any significant
> personal risk

With 15-20% of confirmed cases needing intensive care and symptoms developing
at roughly the same rate, it becomes a perfect storm. So deaths may begin with
only the elderly or immune compromised, it likely won't stop there as the
younger folks need care they can't get. Perhaps they survive anyway, but an
unknown number with permanent lung damage and lower quality of life.

General population may come to any number of realizations. The underlying
reality may never become entirely clear to any of us. Y2K probably could have
been much worse. Yet the media coverage around the aftermath gave the
impression it was no big thing.

------
gyulai
Collecting stats on the progression from clinical presentation of the patient
all the way to death seems to me a bit tedious, since death is altogether
somewhat rare and when it does occur it's a lot of factors playing together.

But the following article really put the fear of god in me, as it's the first
source I've discovered that gives you an idea of the rate at which patients
progress from clinical presentation to "going severe". Here a doctor gives
details on the criteria they use for separating patients which are not
altogether that restrictive, basically just saying that the patient must test
positive or have been in contact with someone who did: "We have an observation
unit in the hospital, and we have been admitting patients that had tested
positive or are presumptive positive; these are patients that had been in
contact with people who were positive." Elsewhere in the article there is
mention of the rate at which these patients progress to going severe: "About a
third have ended up on ventilators."

[https://www.propublica.org/article/a-medical-worker-
describe...](https://www.propublica.org/article/a-medical-worker-describes--
terrifying-lung-failure-from-covid19-even-in-his-young-patients)

My guess is that the clinical point of view around Covid-19 is currently
probably a well-kept secret among clinicians and that Ioannidis probably
doesn't have access to that kind of "inside information".

------
cmurf
This didn't get enough attention the first time around.

 _We know enough now to act decisively against Covid-19. Social distancing is
a good place to start_ \- Marc Lipsitch reponding to John Ioannidis.

Previous conversation
[https://news.ycombinator.com/item?id=22620283](https://news.ycombinator.com/item?id=22620283)

------
js2
Link to the paper itself (which I can’t find anywhere on the abstract page);

[https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.13222](https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.13222)

------
giarc
I published a paper on outbreaks in a hospital setting and the problem is
there is not a single RCT on methods to stop outbreaks. The problem is no
organization is willing to approve a trial where you don't follow your
protocols and commonly accepted methods to control the spread (ex. closing
common areas, isolating patients, cohorting staff, enhanced cleaning). There
is a good blog post about 'Riding the Wave' that basically says that perhaps
the outbreak would have ended itself and we simply just take credit saying
"what we did worked" but in reality we'll never know.

~~~
robocat
South Korea got their infections down and their economy isn’t in the toilet.
Compare to Italy’s reactive policy and subsequent failure.

Or look to Taiwan and Japan with economies running and infection rates under
control (at present).

Your “perhaps the outbreak would have ended itself” will be shown to be false
in multiple countries that lack the resources to manage their infection
transmission rates... We have heard of Iran, but wait until we find out what
happens in other poor countries...

~~~
yibg
I’m really worried about India. So far it’s not a huge outbreak there yet, but
they are hitting the beginning stages of the steep curve.

------
EmilioMartinez
A discourse vacuum was produced by lack of proper channels. I myself wouldn't
have been so engaged in reading those papers and sifting through videos from
obscure sources had I felt that the officials were not sleep at the wheel.

I'm still dumbfounded that China is let off the hook for delaying information
a whole month, but even after declaring mass quarantines the west's officials
took more than a month to take notice.

------
zby
One thing that seems really important is that we get testing right. Here is a
paper stating up to 80% of false positives:
[https://pubmed.ncbi.nlm.nih.gov/32133832/](https://pubmed.ncbi.nlm.nih.gov/32133832/)
If that was true it would make all the stats nearly useless. I have also heard
that the so called 'quick tests' are even worse.

~~~
fsh
The group at Charité Berlin which developed the WHO test claims they had no
false positives in hundreds of trials.

------
yters
What if corona is already very widespread and not especially lethal? The
increase in cases may be a function of test coverage.

------
Medicalidiot
There's a tonne of speculation about CFR still at this time. Maybe I'm
hyperbolic, but there are still ~1,500 serious/critical cases in China which
is 1/3rd of all active cases. I have a feeling like the 4% CFR is high here
because many of the COVID cases became clinical diagnoses instead of rtPCR; in
other words, the Chinese physicians started using CT scans and clinical
presentation to diagnose COVID instead of testing. Normal viral pneumonia
diagnostic criteria is a chest radiograph and clinically compatible features
(e.g. fever, cough, dyspnea, etc.). My take away is that they probably ran out
of test kits and therefore many asymptomatic patients are out there.

As time progresses I have a feeling that the official CFR in China is going to
spike soon when they start deciding to take people of ventilators, unless the
CCP decides to pour massive resources into keeping these patients alive.
Regardless, I have a feeling like the number of deaths/resolved is
significantly lower than what it actually is and I wanted to nerd out here for
a second because I love talking about medicine.

Edit: I want to say that I still think that we should be taking this entire
pandemic seriously and am in no way commenting on this article's suggestion
that we are in anyway over/underreacting. I'm making a comment on CFR.

------
anonu
I found this bit from the paper interesting.

    
    
      A Google search with “coronavirus” yielded 3,550,000,000 results on March 3 and 
      9,440,000,000 results on March 14. Conversely, “influenza” attracted 30- to 60-fold less 
      attention although this season it has caused so far about 100-fold more deaths globally 
      than coronavirus. 
    

First off, I am not sure how to comprehend those numbers. Back in the day a
"result" was a page. What is that today? Are there really $9bn+ pages of
useful content that mentions coronavirus? The number seems a bit arbitrary...

Second, the major issue with comparing flu deaths and coronavirus deaths is
time. We have only known about covid-19 for a handful of months. The flu in
all its forms has been with us for millennia. You simply cannot compare the
two. For me this bit throws the credibility of the paper out the window.

------
lubesGordi
If this is exaggerated, then surely there have been other epidemics that have
gone through the world and had similar effects numbers wise (with cfr for
example), and he would be able to refer to them as par for the course.

~~~
guscost
[https://en.wikipedia.org/wiki/Epidemiology_of_pneumonia](https://en.wikipedia.org/wiki/Epidemiology_of_pneumonia)

------
yread
The virus mostly kills old people and people with comorbidities who would die
anyway. Economic crisis come every ~10 years so it would come anyway. See what
I did there?

------
f0ok
This sounds more like an opinion paper than a study.

------
Fjolsvith
Someone ought to research out the number of cell phone accounts that have been
terminated in China in the last three months. I saw a video last night
claiming it was on the order of 2.1 million.

If you didn't know, the Chinese government tracks their citizens movement,
social activities and pretty much everything through their phones. If you
don't have a phone in China, you are a non-person, or perhaps you've died.

------
alexk307
How was this peer reviewed?

------
Klinky
Is this paper basically saying China and Italy's troubles with COVID-19 "ain't
no big deal", and that New York and Washington are not struggling?

>"Leaving the well-known and highly lethal SARS and MERS coronaviruses aside,
other coronaviruses probably have infected millions of people and have killed
thousands"

This is not cited, and seems like potentially exaggerated non-evidence based
information.

~~~
tobyjsullivan
For what it's worth, the US CDC has said this about (H1N1)pdm09. I'm not sure
if H1N1 is a coronavirus though and I don't know if there's any published
research supporting this. But the author's statement seems reasonable enough
given it was qualified with "probably".

> From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million
> cases (range: 43.3-89.3 million), 274,304 hospitalizations (range:
> 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United
> States due to the (H1N1)pdm09 virus.

[https://www.cdc.gov/flu/pandemic-
resources/2009-h1n1-pandemi...](https://www.cdc.gov/flu/pandemic-
resources/2009-h1n1-pandemic.html)

~~~
mikeyouse
Nope - MERS and SARS were the only large Coronavirus outbreaks. H1N1 is an
Influenza A strain (similar to the so-called Spanish Flu).

~~~
jeltz
That is untrue. There are coronavirus outbreaks all the time. What makes MERS
and SARS special is that they are the only known human coronviruses with high
mortality.

------
fcurts
> An argument in favor of lockdowns is that postponing the epidemic wave
> (“flattening the curve”) gains time to develop vaccines and reduces strain
> on the health system. However, vaccines take many months (or years) to
> develop and test properly.

It's not only about vaccines but about treatments in general. There is a good
chance that we'll have a drug that significantly improves outcomes long before
we have a vaccine. I don't understand how a peer-reviewed paper can overlook
this.

------
wideasleep1
Sadly, my takeaway/tl:dr Everything you've heard or read is fake news, we know
almost nothing. Ironically uses 'gone viral' when he crits a fellow doc (cite
12) on the mask 'issue', and clearly we can't even get these experienced pros
on this very topic to agree on much of anything, but will print regardless.

~~~
thomasfromcdnjs
I'm also in this camp. I feel like it is the rational position too.

So much margin for error in about 300 different facets.

~~~
wideasleep1
Based on my comment's downvotes, and no feedback, I have to assume I've either
1) Misread the article, 2) Misinterpreted the article, 3) Didn't clarify my
position sufficiently.

This recent HN post has a pretty good summary of where I think we all are on
the given 'mask issue' topic:

[https://news.ycombinator.com/item?id=22673242](https://news.ycombinator.com/item?id=22673242)

Suffice it to say, these clap-back articles among the medical elite in
supposed positions of authority don't clarify the facts any better than the
sketchy policies being made on nebulous data. But I guess we are in a state of
'real-time' peer review, and everyone left guessing the outcomes.

------
patrec
I will go out on a limb here (I'm hardly a domain expert) and make the
following prediction: In retrospect this will be seen as the moment when peer
perception of Ioannidis fell from major scientific figure to reckless (or
worse!) fraud.

The problems with what he writes seem to me to be so severe, I cannot fathom
how it ever made peer-review.

His original article assumed, with no measures taken, a peak infection rate in
the US of 1% of the population. For that to be true, R0 would need to be
around 1.01 (herd immunity to restrict further spread is achieved at around
1-1/R0). This is totally insane, there is literally no way covid-19 could have
spread internationally as fast as it does with this R0 (you can work out R0
quite well from the growth rates, the main problem is reporting quality, but
death figures are presumably fairly accurate).

He also gave a plausible lower bound of CFR of around half of seasonal
influenza, 0.05%. For comparison the Italian CFR currently skews closer to 9%!
Even accounting for immense underreporting, there is no way to reconcile these
discrepancies (a factor of 200x). He upwards adjusts a tiny bit in this
article, but it is still extremely hard to reconcile the situation on the
ground in Italy with what he is writing.

All the countless additional severe problems with his argument (cost
asymmetries, health care capacity, ...) pale in comparison to these two.

~~~
patrec
There are two pretty simple and detailed arguments above why what Ionnidis
wrote is preposterous, if you disagree, why not engage with them?

------
didibus
Is this a case of Frequentist vs Bayesian?

------
ropiwqefjnpoa
There was a comment on HN a few days ago basically saying, "what's wrong with
panic, maybe we should be panicking" and I just found that comment
frightening. We mock all the "idiots" buying up the toilet paper, but panic
clouds the clear thinking of even the "intelligent". It can absolutely effect
our leaders and medical professionals.

~~~
catalogia
Reading that comment charitably, I guess they meant something about fear
sometimes being a productive motivating emotion. In my view, panic is fear
strong enough to override rationality. Cool-headed fear might be a good thing,
but panic usually isn't.

~~~
ropiwqefjnpoa
Right, panic is pure emotion, fight or flight, hard be rational in that state.
Covid19 is "sobering". 100 years since the 1918 flu and we still aren't ready.
Even with the billions we spend on health care.

------
jp_sc
So.... was this sponsored by the airlines or by the hotels chains?

EDIT: After what happened in Spain and Italy, countries where the initial
reaction was "let's not overreact", I don't believe any scientist can speak on
those terms without a hidden agenda.

~~~
markcmyers
Whatever the numbers say, it is hardly the case that anybody has underreacted.
Everywhere, we've always been at least three weeks behind the curve, which is
an eternity when dealing with this virus.

~~~
maxerickson
Do you mean overreacted where you have written underreacted?

