
Clinical characteristics of 50k patients with 2019-nCoV infection - fortani
https://www.medrxiv.org/content/10.1101/2020.02.18.20024539v1
======
gwd
If you look at the breakdown of infections vs deaths in China[1], you'll see
that the death rate outside of Hubei is _far_ lower than the death rate
inside. As of yesterday, Guangdong, for instance, has had 1345 confirmed
cases, but only 6 deaths -- in spite of the fact that at least 800 of those
had been exposed more than 2 weeks ago[2].

The most likely explanation to me is that the hospitals in Hubei have been
overwhelmed. Obviously that means we should be vigilant about limiting the
spread of the disease, so that hospitals _elsewhere_ aren't overwhelmed. But
catching it isn't the immediate death sentence headlines like this indicate.

[1] [https://www.who.int/docs/default-
source/coronaviruse/situati...](https://www.who.int/docs/default-
source/coronaviruse/situation-
reports/20200224-sitrep-35-covid-19.pdf?sfvrsn=1ac4218d_2)

[2] [https://www.who.int/docs/default-
source/coronaviruse/situati...](https://www.who.int/docs/default-
source/coronaviruse/situation-
reports/20200204-sitrep-15-ncov.pdf?sfvrsn=88fe8ad6_4)

~~~
fortani
The scary thing about this virus, isn't the mortality rate, but the high R0
value and the potentially high proportion of infected people who are
classified as severe cases.

Assuming that 20% of the US population (330 million) gets it, we're looking at
about 13.2 million (20%x20%x330 million) patients who require admission to an
ICU ward. Needless to say, that is enough to overwhelm the healthcare system
and hospitals, and increase the overall mortality rate, when people who
requires ICU are turned away due to lack of beds or equipment.

As it is, the best option would be to delay the spread as much as possible, so
that the number would be spread across a time-span for as long as possible.

~~~
pjc50
Never mind that, far before you get to 20% the billing issues will destroy the
system: [https://www.miamiherald.com/news/health-
care/article24047680...](https://www.miamiherald.com/news/health-
care/article240476806.html)

If you charge $1,400 to each suspected person then either the testing will
bankrupt the population or people are going to hide from testing. If
coronavirus arrives in bulk in the US, then it's either going to be "Medicare
for coughs for everyone" or a pandemic.

~~~
swebs
This is something insurance will cover, and 90% of the American population are
already covered under health insurance.

[https://www.cbo.gov/publication/55085](https://www.cbo.gov/publication/55085)

~~~
jschwartzi
Are you sure? I couldn’t say with certainty whether any emergency service is
covered by my insurance. There are no blanket statements and a relatively high
co-insurance to ER services. Most policies have over $10,000 in co-insurance
so stating that 90% are technically covered doesn’t actually respond to the
parent’s claim. You’d have to know intimate details for how the service is
billed which is apparently impossible before receiving service. If you don’t
believe me call your hospital or your physician or your insurance company and
ask what your out-of-pocket would be. Nobody can tell you.

------
01acheru
Well... I'm in my hometown in Italy right now, people are advised to work
remotely or avoid mass transit, everything closes after 6PM,
museums/theaters/schools are closed, a small percentage of the population is
going a little crazy so please everyone we must start asking ourselves some
questions about those wild numbers that come out and people reporting them
must be a little bit more responsible.

We had 7 fatalities here in Italy in an really big area, all of those people
were old (some very old) and with other aggressive diseases or health problems
going on, but we keep saying we have 200something people positive to COVID-19
making the mortality rate 3.5% BUT those 7 people are absolutely not
representative of the 3.5% of total population so we must be missing people
that are positive to the virus but don't get tested and never will.

We don't have enough test kits, we don't have enough personnel, we cannot
overwhelm every lab in northern Italy just to start testing everyone for
COVID-19 so many people without symptoms or with light symptoms are going on
with their lives without ever being reported as positive... you get tested if:
\- you met with someone that died \- you have severe symptoms \- you have
light symptoms and you are old or have some other disease \- you live in one
of the (really small) isolated areas \- you escape from the areas that are
isolated \- you are close to someone that have escaped

If you are young and have a cold, even if you want to get tested, no one will
come. I know from first hand some 4 people that are sick right now (symptoms
like normal cold or a mild influenza) and one person that had I bad influenza
finishing last week... are they positive? We will never know, now scale that
up to the millions of people living in northern Italy

~~~
jamesrcole
> _a small percentage of the population is going a little crazy_

What are they doing?

~~~
01acheru
Just a small list:

\- emptying supermarkets and fighting for products that finish instead of
waiting for the shelves to be refurbished (with police interventions, etc.).
I've seen people buy 20kg of pasta or 100 water bottles on Sunday

\- buying cleaning products and useless face masks for 10+ times the price

\- firmly believing that COVID-19 is a military plan or a disease made to kill
old and sick people to lower costs

\- avoiding all Chinese people, Chinese food or Chinese shops (some people are
afraid of goods made in China)

\- faking some other illness to avoid going to work

And we could go on with a lot of other senseless things people are doing...

 _Edit: formatting_

~~~
majewsky
> buying cleaning products and useless face masks for 10+ times the price

> faking some other illness to avoid going to work

Sounds like business as usual. /s

~~~
01acheru
Beside sarcasm... you are right, especially in Italy :)

People always do all the things listed above, it is just that this time more
people are doing them and more heavily

------
jonathanstrange
I'm confused, I thought that what the paper defines as _Mortality Rate_ is
called _Case Fatality Rate_. Could someone explain to me what the difference
is?

~~~
AstralStorm
Mortality Rate is number of deaths divided by total infected count estimate.

E.g. it includes self reported cases and estimated using infection rates. (R0
mostly.) It does not exist when mode of infection is not entirely clear it
when number of cases are low.

Case Fatality Rate is number of deaths divided by number of _confirmed_ cases,
which are usually hospitalizations.

Mortality Rate is usually much lower than Case Fatality Rate.

~~~
jonathanstrange
Thanks a lot! So if the paper is correct and the mortality is 4.8%, then the
CFR would actually expected to be higher. I'm kind of disturbed by this
because I've seen numbers for CFRs between 2%-3%, which is already quite high.
These should be higher then, right?

------
thepangolino
I still would like to see the age repartition and most importantly a study on
unreported cases.

From what I’ve heard, CIVID-19 has symptoms very similar to the flu.

~~~
chrisco255
The flu only has a 0.1-0.05% mortality rate. The early symptoms of of it are
flu-like but the severe respiratory symptoms that set in and make it difficult
to breath are not like your typical flu, to my knowledge.

~~~
rndgermandude
They give a "cough" incidence of 70.8% and a acute respiratory distress
syndrome incidence of 14.8% in their paper. Meaning even a lot of people
diagnosed with the infection show no respiratory symptoms, let alone severe
ones. I therefore wouldn't dismiss the possibility of a high number of
unreported cases, where people didn't develop any major symptoms and thought
it was a cold or flu if they noticed symptoms at all.

~~~
rpeden
Since the common cold is caused by coronaviruses a decent chunk of the time,
I'm not sure it's even inaccurate for someone with a non-severe case of
covid-19 to conclude that they have a cold.

Maybe that's the tricky part that helps it spread. Having a cold isn't enough
to stop most people from going out in public. In my experience among people I
know in the US and Canada, having a mild cold isn't enough for people to stay
home from work.

But while a covid-19 infection might really be just a cold to a large chunk of
people who get it, it's unusually deadly to a non-trivial percentage of people
as well.

------
BillyTheKing
4.8% is pretty alarming..! wouldn't there be an inherent bias, though, towards
patients that display such severe symptoms that they would require medical
care? Currently, to me at least, these cases in Italy seem to indicate that
plenty of cases go unnoticed because many of those infected show few to no
symptoms (which makes this virus all the harder to isolate)

~~~
snemvalts
there aren't enough test kits, and for some people the serious/critical period
in ICU can be a month, which means the CFR will always be skewed more or less.

------
CHsurfer
What's a morality rate? Is it a typo or an actual indicator? I found this:
[https://www.hsph.harvard.edu/population-
development/tag/mora...](https://www.hsph.harvard.edu/population-
development/tag/morality-rate/) but it seems to be a typo.

~~~
fortani
Yeah, that's a typo, it should be mortality rate.

------
gerardnll
Is this 4.8% mortality number from cured/dead patients or also counting
ongoing cases?

------
loyukfai
*mortality

------
ArmandGrillet
Please update the title to remove the typo (s/morality/mortality), from the
abstract: "the mortality rate of patients with 2019-nCoV infection was 4.8%".

~~~
fortani
Can't edit the title anymore. Could an admin eg: @dang edit it, thank you.

------
toptal
“The mortality rate of patients with 2019-nCoV infection was lower than that
of Severe Acute Respiratory Syndrome (SRAS) and Middle East Respiratory
Syndrome (MERS).”

Is this a typo or are they politicizing SARS here so people think it’s
something else?

~~~
Spare_account
I can't see any typos in your quoted text. Am I missing something obvious?

~~~
jobigoud
SRAS instead of SARS, Maybe?

~~~
Spare_account
Wow, how did I miss that. Sorry everyone

------
allovernow
Ok, is _now_ a good time to start taking this seriously?

Spanish Flu had an R0 of about 2[1]. Current published estimates for 2019-ncov
are 2.3-3.8 for this paper [1] and there's another floating around which gets
as high as 6-8.

1\.
[https://www.ncbi.nlm.nih.gov/pubmed/19545404/](https://www.ncbi.nlm.nih.gov/pubmed/19545404/)

2\.
[https://www.sciencedirect.com/science/article/pii/S120197122](https://www.sciencedirect.com/science/article/pii/S120197122)

~~~
_-___________-_
And there are others that are much lower. It's also worth remembering that
given many cases are asymptomatic, or are so mild that people may not see a
doctor, the number of cases does not accurately reflect the number of infected
people. So these mortality rates should not be read as an indicator of your
chance of dying if you are infected with the virus.

One reason that many people don't seem to be "taking this seriously" is
because the narrative of people who keep fearmongering about COVID-19 just
doesn't make sense.

There are still direct flights from China to many countries, and they're not
empty.

Screening is mostly based on taking people's temperature with handheld devices
that have twice registered my temperature as 32C (no, I wasn't rushed to a
hospital). Where more reliable screening has been implemented, there have been
many documented failures.

Many quarantine protocols are voluntary / honour-based. People from cruise
ships where they were exposed to others who were infected have dispersed
worldwide with varying levels of monitoring (in some cases none).

If this thing was half as deadly and easily-spread as continues to be claimed
on the Internet, 200 new cases in Italy wouldn't be international news at this
point.

~~~
allovernow
Are they consistent with China's unprecedented response?

~~~
_-___________-_
I assume you're being facetious, but regardless of early failings and a lack
of transparency, it's hard to imagine any other country imposing a quarantine
on a city the size of Wuhan in the manner they have, or building hospitals at
the rate they have.

~~~
ethbro
I thought this article was interesting:
[https://www.theatlantic.com/technology/archive/2020/02/coron...](https://www.theatlantic.com/technology/archive/2020/02/coronavirus-
and-blindness-authoritarianism/606922/)

Particularly the point about "Why build hospitals?" Because in strongly
centralized, command political systems, grand projects are one of the few
things done well. And so crisis management becomes "What can we build, to show
we're taking it seriously?"

~~~
_-___________-_
This makes a lot of sense.

Even outside of centralised, command political systems many of the responses
seem to be in the vein of "what can we do to show we're taking it seriously?"
Many actions such as the travel restrictions have gone directly against public
health advice, but are easy to implement and politically very successful.

