
Current estimates about the Covid-19 fatality rate may be too high - nsainsbury
https://www.wsj.com/articles/is-the-coronavirus-as-deadly-as-they-say-11585088464
======
nodamage
A few thoughts:

1) Extrapolating from the infection rates of very specific groups (for
example, evacuees) to the entire population without taking into account
transmission dynamics and the time between infection and detection does not
make very much sense. The authors naively multiply the infection rate among
evacuees by the population of Wuhan to conclude that Wuhan must have had
178,000 infections at the end of January. By comparison, epidemiological
models have estimated there were around ~20,000 infections at that time
[1][2][3]. What conclusion should we draw here? If you use sloppy, back of the
napkin math to over-inflate the infection count by 10x then you can
correspondingly deflate the mortality rate?

2) Speculating about the mortality rate of Covid-19 based on several gigantic
assumptions ("If our surmise of six million cases is accurate, that’s a
mortality rate of 0.01%") seems borderline irresponsible. Numerous researchers
have been modeling this virus and have generally arrived at numbers in the
range of 0.5% to 1.6% [4][5][6][7][8][9]. The authors don't present any
compelling reason why we should doubt those numbers.

3) Ultimately the mortality rate is not as important a number as the
hospitalization rate. The authors would have you believe this virus is no
worse than the flu, but this is not congruent with the number of reports
coming out of places like Italy and New York saying they're about to run out
of ICU beds, or China rushing to build temporary hospitals to house all of the
patients that need critical care. What the mortality rate might be under ideal
circumstances where every patient receives adequate medical care might be
significantly different compared to a scenario where you've run out of ICU
beds and have to start rationing ventilators.

[1]
[https://www.mdpi.com/2077-0383/9/2/419/htm](https://www.mdpi.com/2077-0383/9/2/419/htm)

[2]
[https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v...](https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v2.full.pdf)

[3]
[https://www.mdpi.com/2077-0383/9/2/523/htm](https://www.mdpi.com/2077-0383/9/2/523/htm)

[4] [https://www.imperial.ac.uk/media/imperial-
college/medicine/s...](https://www.imperial.ac.uk/media/imperial-
college/medicine/sph/ide/gida-fellowships/Imperial-College-
COVID19-severity-10-02-2020.pdf)

[5] [https://institutefordiseasemodeling.github.io/nCoV-
public/an...](https://institutefordiseasemodeling.github.io/nCoV-
public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-
preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html)

[6]
[https://cmmid.github.io/topics/covid19/severity/diamond_crui...](https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html)

[7]
[https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...](https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf)

[8]
[https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v...](https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.full.pdf)

[9]
[https://www.nature.com/articles/s41591-020-0822-7](https://www.nature.com/articles/s41591-020-0822-7)

~~~
glofish
one important element is a behavioral pattern

A person with flu and fever would probably stay home and just rough it out, a
person with fever fearing the coronavirus will probably rush to the hospital.

If everyone having a fever in a flu season would go to the hospital and would
demand medical attention we would be running out of hospital beds in normal
scenarios as well.

~~~
thdrdt
Well at least in the Netherlands your claim is false.

They don't want you at the hospital unless it is absolutely necessary. Got a
fever and still able te breath: stay at home.

~~~
viklove
It's the same in the US. They won't even test you here unless you're having
trouble breathing.

~~~
earonesty
That's not even true. I've had pain breathing for weeks, they still won't
test. They prescibed corticosteroids, antibiotics and bed rest. They won't
test until you're nearly dead. the CFR here is _wildly overestimated_.

~~~
VBprogrammer
While that is clearly true, it doesn't change the fact that every population
to encounter this virus so far has overwhelmed the available medical
provisions. There are people in Italy choosing to drown in their own bodily
fluids rather than face the dying the same way in isolation.

It doesn't really matter whether the odds are more like winning a bottle of
wine in a charity raffle or losing a game of Russian roulette.

------
ekidd
They have a good point about missing data, but they're glossing over the fact
the fatality rate goes up drastically if the medical system fails.

I 100% agree that we should be running antibody tests to see how many people
have caught COVID-19 and recovered. All of our testing until recently was
based on RNA tests, which may only be positive during a relatively short
window. (I saw a case study claiming that even some hospitalized patients are
testing negative inside 7 days.) We _need_ to know how many people catch this
and beat it quickly.

That said, even in populations that have been RNA-tested early and extensively
(such as the Diamond Princess and South Korea), the number of completely
asymptomatic cases is less than 50%. Using the most optimistic data, I
personally have less than a 0.5% chance of dying _assuming I get all the
medical care I need._

And that's the problem. This virus hospitalizes about 20% of identified cases.
They require some supplemental oxygen, and maybe an IV. With good care,
probably less than 1% die.

So there are really _two_ key fatality rates:

1\. How many people die if they get all the care they need, and

2\. How many people die if 30+% of the population catches this at the same
time?

Even if we're overestimating (1) by a factor of 10, that's still enough to
make (2) catastrophic. What happened in Wuhan and Lombardy can happen here,
and there's absolutely no reason that it couldn't get 10x worse. Even if we're
overestimating the disease.

So let's start testing aggressively for antibodies. Until we get that number,
I'm all for extreme caution.

~~~
downerending
> the fact the fatality rate goes up drastically if the medical system fails

We all assume that this is so (and I hope it is), but this is not completely
clear. It might be that for covid-19, help from the medical system doesn't
matter much, given our current state of medical knowledge and care. And
iatrogenic harm cannot be discounted. Certainly we cannot ethically run the
experiment.

As a single anecdatum, there was a (BBC?) piece on a hospital in the worst
Italian region, showing a number of people on ventilators. The narrator
explained that the staff was demoralized by the fact that everyone they had
put on a ventilator died anyway.

~~~
pessimizer
At the very least the fatality rate for non-coronavirus emergencies goes
vastly up if the beds are filled with coronavirus sufferers.

~~~
downerending
It's complicated. I vaguely recall a study that indicated that fatalities for
some condition that might normally indicate surgery fell when the doctors
needed were out of town for their annual conference. Don't recall the details.

And also, we should hope that proper triage will mean that the non-coronavirus
emergencies that matter will indeed be allocated a bed, etc.

I have little doubt that this will be awful, but the counterfactual scenarios
are difficult to evaluate.

------
justinclift
> So if 100 million Americans ultimately get the disease, two million to four
> million could die.

Seems to miss any mention that people who get sick - but _don 't_ die - seem
to be having pretty severe (sometimes permanent looking) damage.

Aka, they're only counting "deaths", when they should also be including other
very serious negative consequences too. :(

~~~
rimliu
At this point "severe permanent damage" is pure speculation.

~~~
downerending
I don't have the link, but there was a study of the SARS outbreak that
indicated that something like 20% of the victims were unable to return to
their prior professions.

It's a different, though related virus, but there is some reason to believe
that at least some victims will have lasting effects.

~~~
tartoran
[https://www.thestar.com/life/health_wellness/2010/09/02/sars...](https://www.thestar.com/life/health_wellness/2010/09/02/sars_survivors_struggle_with_symptoms_years_later.html)

------
kasperni
> the real fatality rate could in fact be closer to 0.06%

If you take a look at Diamond Princess.

~ 4000 on board

* 712 cases

* 10 deaths

Gives a case fatality rate of 1.4%.

The average age onboard was ~60 years (don't know if it includes staff) which
is definitely higher than average. However, the two numbers (1.4% and 0.06%)
sounds very far apart.

~~~
simik
US population median age is 39. Fatality rate for people under 40 is <0.2%.
Fatality rate of people aged 60+ is >3.6% [1]

So, no, 1.4% and 0.06% sound about right given the age difference.

[1]
[https://ourworldindata.org/coronavirus](https://ourworldindata.org/coronavirus)

~~~
JoshuaDavid
Except that the US isn't composed of 327 million 39 year olds, it's composed
of a fairly even mix of people of various ages. If you multiply the case
fatality rates from your link [1] by the population in each age bracket [2],
you come up with a projected CFR of about 1.8% in the US, assuming that a
similar fraction of people in each age range are infected.

    
    
           Age  | US Pop |  CFR  | Est Deaths if
                |        |       | 100% infected
        --------+--------+-------+--------------
         0 -  9 | 40.01M |  0.0% | 0.00M
        10 - 19 | 41.97M |  0.2% | 0.08M
        20 - 29 | 45.43M |  0.2% | 0.09M
        30 - 39 | 43.63M |  0.2% | 0.09M
        40 - 49 | 40.46M |  0.4% | 0.16M
        50 - 59 | 42.83M |  1.3% | 0.56M
        60 - 69 | 37.41M |  3.6% | 1.35M
        70 - 79 | 22.66M |  8.0% | 1.81M
        80+     | 12.68M | 14.8% | 1.88M
        --------+--------+-------+--------------
          Total |327.08M |  1.8% | 6.02M
    

1.4% is believable with those numbers. 0.06% is not plausible at all in the
context of those numbers.

[1]
[https://ourworldindata.org/coronavirus](https://ourworldindata.org/coronavirus)
[2] [https://www.statista.com/statistics/241488/population-of-
the...](https://www.statista.com/statistics/241488/population-of-the-us-by-
sex-and-age/)

------
kator
FTA "But a 20,000- or 40,000-death epidemic is a far less severe problem than
one that kills two million."

Meanwhile,
[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)
shows Deaths: 19,603

I'm not an epidemiologist but how can we barely at the mid-point of the spread
and say things like the above, while the hard facts already show we're at 20k
deaths?

While I agree the actual rates are hard to know until we have robust antibody
assay in larger populations, it seems a bit hand-wavy to say "oh it's just not
that bad, here look at these random samples we looked at it and it'll be ok."

~~~
xscott
Let's compare apples to apples and stick to the US for a minute, which is what
I believe the WSJ was doing. The winter of 2017-2018 was a bad flu year, and
there were about 61,000 deaths from it in the US (uncertainty interval: 46K to
95K) [0]. According to the worldometers site, there are 785 deaths so far in
the US from corona virus [1].

It's probably a poor estimate, but if we could extrapolate from the US
population to the world population, 1.28 million died from the flu that year
(61e3*7.8e9/372e6).

[0]
[https://www.cdc.gov/flu/about/burden/index.html](https://www.cdc.gov/flu/about/burden/index.html)

[1]
[https://www.worldometers.info/coronavirus/country/us/](https://www.worldometers.info/coronavirus/country/us/)

EDIT: I found another link with a better estimate for world deaths from the
flu. According to the World Health Organization, between 290,000 and 650,000
die from the flu each year [2]. So my estimate above was off by a factor of
two.

[2] [https://www.who.int/news-room/fact-
sheets/detail/influenza-(...](https://www.who.int/news-room/fact-
sheets/detail/influenza-\(seasonal\))

~~~
DanBC
The death rate in the US is doubling every 3 days. (A bit less than 3 days.)
What will it look like in 21 days?

    
    
       0      785
       3     1570
       6     3140
       9     6280
      12    12560
      15    25120
      18    50240
      21   100480

~~~
xscott
Yes, exponential curves are scary. So are logistics curves.

We should know in 21 days if your prediction is right.

~~~
wilgertvelinga
Five days later it doesn't look far off: 3,178 deaths in the USA according to
worldometer.

~~~
xscott
Not sure if you're still checking back, but at day 15 the US deaths are at 16k
where his prediction says 25k.

~~~
DanBC
That's good.

The cumulative deaths are now doubling at a slower rate (something like 5.5
days?), partly because stronger social distancing measures have been put in
place.

But also, let's see what the CDC says next week, because those figures are
laggier but more accurate.

[https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm](https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm)

~~~
xscott
And how long do you predict a 5.5 day doubling period to continue?

~~~
DanBC
For clarity, I'm not predicting.

15 days ago was just after New York and California implemented shelter-in-
place orders, so we'd expect to see levelling in the numbers of daily new
infections starting about two weeks after (now), with levelling in daily new
deaths about 10 days after that (about 20th April).

Here's what other people are predicting - a peak on April 12th with over 2000
deaths in one day, and total cumulative deaths just over 23000 .
[https://covid19.healthdata.org/united-states-of-
america](https://covid19.healthdata.org/united-states-of-america)

~~~
xscott
> For clarity, I'm not predicting.

Why are you stating this now, and not when you wrote the 100,000 number above?
If that wasn't a prediction, what was it?

~~~
DanBC
I was reminding you that 785 deaths so far to covid-19 is nothing because the
US was at the beginning of the exponential growth in deaths.

What were you doing when you said "there are 785 deaths so far in the US from
corona virus" and compared that to a figure of 61k flu deaths?

(Leaving aside the fact that you're counting covid and flu deaths differently
in your comparison -- over counting flu and under counting covid)

~~~
xscott
I've looked at your other posts, and you seem like a reasonable enough person.
I don't have a horrible beef with you, but in general I really despise it when
people do the chicken-little doom and gloom thing and project gazillions of
deaths on every latest horrible thing. Yes, awful things happen, but it's like
a disgusting yearly sport for arm chair experts to exercise their righteous
indignation at all of us while preaching how we're all going to die from
Africanized bees, Zika, H1N1, whatever. Usually it's mixed with some other
two-faced political agenda. You didn't really do that, but maybe you'll
forgive me for thinking your exercise in exponential growth fell into the same
category.

These predictions are always shown to be exaggerated after the fact, and then
the doomsayer gets to say something like, "Yeah, if it weren't for all of us
telling you" or "You're ungrateful for disregarding all the hard work of
everyone who came together to blah blah". There's no accountability for, or
end to, the bullshit.

Moreover, while it's a morbid task, rational adults should be able to ask
whether the costs we've paid dealing with this corona virus are worth it. At
758 deaths, and even 21 days later at 26,300 deaths, we've wrecked the lives
of millions of people in the US. It's hard to find stats, but tens of millions
of people are now unemployed, and many of their lives suck because of it.
Doing arithmetic on suffering and death is distasteful, but there is some
point where you wouldn't ruin N people's lives to save just 1 person from
dying. Particularly when some of those N people are going to commit suicide in
response etc... I won't be making any predictions, but other really bad things
can happen when you've got a huge number of people who can't afford food or
rent.

Two years ago, approximately 61,000 people died from the flu in the US and we
didn't do anything more than make flu shots more available. As for over vs
under counting, I hope you're not doing that pedantic "pneumonia isn't the
flu" thing. The point is that 150,000 people around the world die every DAY
from something, and 10,000 - 100,000 people in the US die every year from
something with symptoms close to corona virus.

~~~
DanBC
> Two years ago, approximately 61,000

If you're going to mention flu deaths please at least count covid-19 deaths
using the same method.

> people died from the flu in the US and we didn't do anything more than make
> flu shots more available.

We have internationally coordinated campaigns of surveillance and data
gathering. We have rapid vaccine development. We have global, regional, and
local flu strategies. We have pandemic preparedness programmes. We put in
place public health measures -- you may not have seen those but they're there.

> Moreover, while it's a morbid task, rational adults should be able to ask
> whether the costs we've paid dealing with this corona virus are worth it. At
> 758 deaths, and even 21 days later at 26,300 deaths

Do you know that you're undercounting covid-19 deaths? The number you quote is
deaths in US hospitals. Many people die with covid-19 outside hospitals,
mostly in care homes. This is partly because hospitals in some places are
overwhelmed and they're triaging elderly frail people onto palliative
pathways. And yet we still have people like you denying the reality by quoting
statistics that you do not understand: covid-19 is causing massive excess
mortality.

------
jkh1
Related pieces by John PA Ioannidis:

\- Coronavirus disease 2019: the harms of exaggerated information and
non‐evidence‐based measures[1]

\- A fiasco in the making? As the coronavirus pandemic takes hold, we are
making decisions without reliable data[2]

There are two ways of getting the answer to the question: get relevant data to
make reliable predictions (e.g. test for prevalence in the population) or run
the experiment (which some governments seem prepared to do)

1-
[https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222](https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13222)

2- [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/)

~~~
fsh
One problem with this is that in the early stages of the spread you would have
to run hundreds of thousands of tests daily in order to get statistically
significant results. This is clearly impossible with the available lab
infrastructure. And this is ignoring the possibility of getting false
positives. Maybe it will be possible to get quantitative results with fast
antibody tests in later stages, but at that point it is probably much too late
to act.

------
op03
Everything feels "deadly" in the hyper connected world.

The hyperconnected world is like a baby's brain which is more connected than
an adult. As learning happens connections are culled [1]. To the baby every
new piece of info is mesmerizing or frightening. The brain hasn't yet
understood how to process things, what to filter out, what to focus on etc

With this new networked world/hive mind, reactions to every new event are much
like the reactions of a Baby as it blunders about discovering a new world.

[https://www.edge.org/conversation/alison_gopnik-a-
separate-k...](https://www.edge.org/conversation/alison_gopnik-a-separate-
kind-of-intelligence)

~~~
H8crilA
Are you just ignoring the basic fact that this thing can potentially compound
on a daily basis with population being the only upper limit? Because that
seems pretty easy to understand.

------
jerome-jh
Knowing the fatality rate requires knowing the number of people infected: we
all know the figures we currently have are mostly a low estimate for a number
of reasons already discussed at length.

We must also know the number of fatalities, and this will only be known
_after_ the epidemic once we calculate the over-mortality compared to a normal
year. So the current numbers are a low estimate too.

In the end we can tell nothing about the fatality rate which is the _ratio_ of
those values.

Hence governments make a guess and act accordingly. Only those who test large
scale and isolate only positive people act rationally.

------
wcoenen
> _Elective procedures will need to be rescheduled. Hospital resources will
> need to be reallocated to care for critically ill patients. Triage will need
> to improve._

If we'd let this thing run its course, wouldn't almost all corona patients
have to be refused in hospitals and instead die at home? Normal "triage"
doesn't cut it. You'd basically paralyze normal health care for months, which
would come with an additional death toll. This is already happening even with
the lockdowns.

~~~
jonathanstrange
Isn't normal triage designed to optimize the number of patients cured or some
similar metric? How does that not "cut it"?

~~~
khafra
I believe he's saying that "improving triage" is like tuning the engine of
your Civic before you run a quarter mile against a top fuel dragster.

Technically speaking, it will help, a little. But to actually measure up to
the challenge you'd need to completely replace the entire thing with something
vastly more capable.

------
charles_f
Something I'm wondering about all this, if you look at the current and
unprecedented almost worldwide policy of self isolation and distancing through
the prism of unintended consequences, cobra effect, natural selection, and
Spanish flu with deadly second wave (and corresponding deadlier strain), I'm
wondering: aren't we creating a perfect ground to selecting the most durable
and transmissible strain of the sars-cov2?

~~~
eternauta3k
Yes, in the same sense that sterilizing with bleach selects for microbes which
can survive bleach. But it's so hard to survive bleach that it's not a real
concern.

------
northsentinel
Spain just recorded 738 deaths in a single day. We will certain know within a
week of monitoring Spain and Italy as to who was right and who was wrong. It
isn't something I would gamble on personally. I also don't see the act of a
complete shut down as being more economically-damaging then a drawn out
partial shutdown.

Also, the other side of the equation is said to be perfect, but as was shown
the other day, a lot of elderly people are left for dead in their homes or
retirement villages and not reported. Also, I don't know if all deaths in
hospitals are checked for coronavirus.

~~~
DesiLurker
they just wanted to delay action until we are locked on the preferred course
and they got it with testing screwups. more reaction time we burn in
indecision easier it is to say its too late to do much.

------
haltingproblem
Both the authors of this piece are not infectious disease epidemiologists. One
([https://profiles.stanford.edu/eran-
bendavid](https://profiles.stanford.edu/eran-bendavid)) is an infectious
disease doctor who focuses on the effects of economics, politics, and the
environment on health.

The second
([https://healthpolicy.fsi.stanford.edu/people/jay_bhattachary...](https://healthpolicy.fsi.stanford.edu/people/jay_bhattacharya))
focuses on "the constraints that vulnerable populations face in making
decisions that affect their health status, as well as the effects of
government policies and programs designed to benefit vulnerable populations. "

This is not the time for folks to hit the pages of the WSJ to start developing
their viral infectious disease modeling muscles. Imagine if you asked a
compiler writer to start developing a commercial OS.

These folks fundamentally do not understand viral growth models. Their article
demonstrates their lack of understanding and they keep falling back to the
normal models (pun intended) of epidemiology based on the usual statistical
machinery. This is a common problem in this analysis. I made a more detailed
comment further down that demonstrates the pitfalls of this thinking.

(edits: grammar)

------
deodorel
Hello, just an info, in my hometown, Bucharest, population approx 3mil,they
just announced they will test everyone. Some good data will come out if this.

~~~
smallgovt
That's good to hear (that 100% testing will take place). Where can we follow
up on the testing results and subsequent fatality statistics?

------
Dwolb
The conclusion of the article isn’t controversial but the logic is incomplete.

Of course policy-makers should continuously evaluate whether or not shutting
down a whole economy is worth it. Definitely we need better testing to
understand the true number of infections.

But you can’t completely disregard current human responses when a) the
condition can be fatal (game over, there’s no retry) and b) the virus can
leave behind long-lasting damage.

In this case a purely quantitative argument based on fatality statistics feels
myopic.

For sure agreed we need to find ways of gathering more and accurate
information.

------
m0zg
Re-posting the most informative visualization I have found on this topic so
far: [https://www.politico.com/interactives/2020/coronavirus-
testi...](https://www.politico.com/interactives/2020/coronavirus-testing-by-
state-chart-of-new-cases/)

See dramatic ramp-up in testing, and where the number of tests administered is
significant, a reasonable approximation of the infection rate can be
established. So the recent blow-out in NY was actually a good thing and it
does not reflect the true daily infection rate: they just didn't know how many
cases they had. They still don't in fact, asymptomatic cases don't get tests,
and those who had the virus and now have immunity (of which Cuomo's advisors
suspect there's at least 100K) can't be tested without the new serological
test currently under development.

The only reliable metric of severity remains the number of deaths, and until
that gets into tens of thousands (i.e. exceeds that of flu), any panic is
premature. We're not Italy. We're not Spain. The current level of response to
this is unprecedented.

~~~
hcknwscommenter
"The only reliable metric of severity remains the number of deaths"

Completely agree.

"until that gets into tens of thousands (i.e. exceeds that of flu), any panic
is premature"

I completely and totally disagree with this statement. By the time you get to
>10s of thousands of deaths (e.g., about 20 days ahead of the actual infection
rate) before you implement severe social distancing and Wuhan-style lockdown,
you are set up for a guaranteed million deaths by the time it's over. 10's of
thousands of deaths is too damn late. The time to act was a month ago. We are
already chasing the dragon, and a number of miracles will need to happen to
get this thing under control without 100,000 deaths.

~~~
m0zg
You're ignoring the economic damage. That has non-zero fatality rate as well.
As cynical as that sounds, you have to balance the two. You can't shut down
the economy for more than a few weeks before supply chains fall apart and you
start running out of food and necessities, not to mention anything more
complicated. Any given widget typically relies on hundreds, if not thousands
of suppliers upstream, to manufacture, and if you shut down some of those
suppliers, you lose the ability to make the widget, or at least do so quickly.
That "global economy" everyone was so proud of a few months back? It got a
swift kick to the nuts in all this. Moreover, Europe will have to restart
production also, for the same reasons, within no more than a month.

Also, you're making decisions based on pure panic in the absence of reliable
information, and you're making them country-wide even though the country is
not uniformly affected. The reality on the ground is some parts of the country
need to remain more operational than others for us to pull through this, and
aiming for sub-flu levels of fatalities is an unrealistic goal, no matter how
much fear mongering you see from the press. It's simply not going to happen,
even if COVID19 is cured entirely, if for no other reason that we can't cure
the flu. 60K people die every winter, nobody gives a shit. 1K people die of
coronavirus - everyone loses their mind.

Now granted, it could get much worse very fast, but that's why we're ramping
up testing so massively: to be able to offer a more adaptive, more localized
response that doesn't shut everything down.

~~~
hcknwscommenter
"You're ignoring the economic damage." No i am not.

"You can't shut down the economy for more than a few weeks before supply
chains fall apart and you start running out of food and necessities, not to
mention anything more complicated. "

The California shut down has no affect on food and consumer necessity supply
chains.

"Also, you're making decisions based on pure panic in the absence of reliable
information"

This is not pure panic and there is information, and we know EXACTLY how to
model in the uncertainties and confidence intervals surrounding best estimates
of CFR, R0, etc. We have very good numbers from S. Korea. We have very good
numbers from Diamond Princess and we can stratify based on age and prior
health status and cross-check with Korea. WE are not in a blind panic. The
press is not fear mongering. We are running out/ have run out of ventilators
in NY. It has already TODAY gotten much worse very fast, and it should be no
surprise to anyone who was paying attention to Italy two weeks ago. 1K deaths
today, following an exponential growth pattern makes the numbers VERY scary in
two weeks and that's assuming our healthcare system is not overwhelmed.

"but that's why we're ramping up testing so massively"

Are we? Not yet? And why not? Because Trump didn't want his numbers to look
bad so he ordered the CDC to insist all tests were run through them. Now our
country is scrambling to catch up. We will ramp up testing, I am sure. It is
in the works, but we still haven't actually done it on the scale we really
need. NY is getting sort of close, but not really. Even they have to at least
double. EVERYWHERE else in the U.S. is laughably behind.

~~~
m0zg
> The California shut down has no affect on food and consumer necessity supply
> chains.

Citation needed. If it has "no effect" then we should just get rid of whatever
they shut down, since it's clearly not necessary.

> We have very good numbers from Diamond Princess

We don't. All the people who died there were in their 70s and 80s and had pre-
existing conditions as well. And it was a single digit number. One would have
to be totally statistically illiterate to extrapolate that to a country the
size of United States.

> 1K deaths today

Yes, the slope can get pretty scary in the middle of a sigmoid. But there
weren't "1K deaths today", and they are seeing gradual reduction in the number
of daily new cases. This is especially encouraging given that they're doing a
ton of tests now.

> Are we?

Yes: [https://www.politico.com/interactives/2020/coronavirus-
testi...](https://www.politico.com/interactives/2020/coronavirus-testing-by-
state-chart-of-new-cases/). With half a million tests given so far, best I can
tell we have the highest testing throughput in the world, and it keeps on
increasing. It's very impressive actually. I wish we didn't fumble it so badly
out of the gate, NY could be much better now if they had more reliable info
earlier.

What we need is serologic test to determine approximately how many people had
asymptomatic COVID19. Some studies suggest there could be a ton of those,
which would explain why Wuhan did not experience a second round of epidemic
after lifting most of the restrictions and putting people back to work.
Assuming, of course, we're not getting fake news from there.

~~~
hcknwscommenter
"then we should just get rid of whatever they shut down, since it's clearly
not necessary."

That is pure nonsense. Do you suggest an economy that only includes what is
"necessary?"

"> We have very good numbers from Diamond Princess

"We don't. All the people who died there were in their 70s and 80s and had
pre-existing conditions as well. And it was a single digit number. One would
have to be totally statistically illiterate to extrapolate that to a country
the size of United States."

Straw man much? I see you elided my whole point about using the VERY GOOD and
comprehensive S. Korea numbers and also using them to extract the signal from
the Diamond Princess numbers? What is your agenda here? To just confuse
everyone?

"gradual reduction in the number of daily new cases" What are you talking
about? This is flat out wrong. We had 13K NEW cases TODAY, an all time high
for the U.S. and we are certainly only getting started. The numbers have been
rising every day for the past week.

"With half a million tests given so far, best I can tell we have the highest
testing throughput in the world" That is again, JUST PLAIN WRONG. That's .5M
tests since JANUARY. Now, if we continue increasing at the rate we did this
week, then we will have adequate testing in place in about two weeks. I hope
that happens, but it's doubtful. Every increase has met with a new bottleneck
somewhere in the chain.

"which would explain why Wuhan did not experience a second round of epidemic
after lifting most of the restrictions and putting people back to work"

Again, what nonsense is this? Wuhan is not lifting "most" of the restrictions
until April 8. They loosened a number of restrictions a few DAYS ago. The
virus has an incubation time of 14 days. Are you that mathematically
illiterate to see the uselessness of your already incorrect "fact?"

~~~
m0zg
> We had 13K NEW cases

I've misread, sorry. I thought you were talking about Italy, which is seeing a
reduction in the number of daily cases. So will New York, a week or so from
now.

> nonsense

You need to choose your words better if you expect me to discuss this with
you. At the moment you seem too frightened to have a rational conversation.

~~~
hcknwscommenter
"so will new york, a week or so from now"

Again, that is completely contrary to any reasonable interpretation of the
data we have. In other words nonsense.

I'll check back in a week and see if you are capable of having a rational,
fact-based, conversation.

------
neonate
[https://archive.md/j8FFk](https://archive.md/j8FFk)

------
s9w
Somethng else I wonder about all this: Let's look at Germany and say we have
about 10000 new cases per day with the current measures, including unknown
infections and some handwaving. That's a lot of days until you reach a
significant portion of the polulation (~80 million).

~~~
pintxo
The calculation for Germany is as follows (from [1]):

\- There are about 28k ICU beds in German

\- Usual occupancy is 80%, expectation is that 50% can be reserved for
Covid-19 patients by delaying elective medical actions

\- This gives us 14k ICU beds to treat Covid-19 patients

\- Estimate is that about 5% of all infected will require about 7 days of ICU
treatment

\- This tells us, we can at most have 2k new patients requiring ICU treatment
per day

\- Knowing that the 2k are only 5% of total cases, the number of infected the
health care system can take care of is 40k/day.

Obviously this calculation will change with more precise information about the
estimated numbers.

[1]
[https://www.youtube.com/watch?v=Fx11Y4xjDwA](https://www.youtube.com/watch?v=Fx11Y4xjDwA)
(sorry, German only)

~~~
s9w
Well we would need 2000 days of those 2k days to even reach 50% infection of
the total population. That is simply not possible to sustain with these
extreme measures.

~~~
erikpukinskis
That’s exactly right. On the other side of the shutdown, you need to do
proactive screening and quarantining people who came in contact with sick
people to create the conditions where you can safely ease the shutdown.

Absent that, there’s not much point of the shutdown. I guess it buys time for
medical professionals to retrain and gather supplies, which is crucial.

------
KaoruAoiShiho
There's insufficient data to say whether the death rate is actually low or
not. But this will be interesting to see play out politically, if the
Republicans agree to open up and there is mass deaths as a result this could
sink the party for decades.

~~~
benmmurphy
Even if opening up leads to massive deaths it can still be the correct thing
to do. Here in the UK the NHS uses a system called QALYs which is
approximately years of life saved to evaluate the effectiveness of NHS
interventions. The NHS generally will only introduce new interventions if they
$s per a QALY is low enough. The spectrum of options for dealing with the
pandemic are a trade off and if the damage to the economy is high enough then
even a high death rate might not justify a strong intervention. During the
NHS's normal operations there are a bunch of interventions that NHS is not
pursuing because the cost is higher than the marginal cost they are willing to
spend for a QALY. The NHS is killing large numbers of people right now by not
pursuing these interventions but everything is a tradeoff and stopping death
is not an absolute.

~~~
slv77
The case fatality rate for 20 to 30 year olds is somewhere between 1 and 200
and 1 in 400. This population is one of the the least susceptible and the
chance of death is roughly the same as doing 5 to 10 BASE jumps.

The economic harm arguments assume that the economic harm of the pandemic is
confined to government imposed restrictions. When going to the movies carries
the same risk as the most extreme sports it is reasonable to expect that most
people are going to self isolate.

Of course given the lag it is possible given the growth curve that people
could blindly find themselves jumping off a metaphorical cliff. At the same
time I’d suggest that the significant amount of trauma the survivors would
face would have significant repercussions for the economy.

------
imtringued
Case fatality rate (CFR) is meaningless for the general public. A case is
basically any person that went to the doctor and received the permission to
get tested and eventually became a patient. Knowing the CFR for a disease is
therefore very valuable for doctors because they know that x% of their
patients may die. However, it is very possible that the vast majority of
Covid-19 cases never become patients.

This doesn't mean that the quarantine is pointless. Even if covid19 is as
"harmless" as influenza, having two influenza type diseases is still worse
than only having one.

------
lukasm
Q: how accurate are the covid19 reported deaths? My guess is that they measure
immune cells from blood (cytokine storm), but they can't know for sure if
covid19 was they cause of death. It means we have an upper bound of deaths.

~~~
watwut
Not necessary. People who die before being tested are not tested in many
places.

------
yodsanklai
> We should undertake immediate steps to evaluate the empirical basis of the
> current lockdowns.

I think there's not enough data available to evaluate if these lockdowns are
justified. Especially the cost of the lockdowns are hard to assess. We won't
know until it's over.

But even if the mortality rate is vastly over-estimated, it will be hard for a
leader to justify that their country has twice the mortality rate as the
neighbor country (even this rate is low, and even it a lockdown was avoided).

Besides, most countries are imposing a lockdown anyway, so "do like everybody
else" is a safe bet for our leaders. Plus, the population asks for it.

------
haltingproblem
There are people who build and grok models (A) and people who build
epidemiological models (B) and then people who built epidemiological models of
infectious diseases (C).

It is a common error for folks in set A to believe that they can understand
models built by folks in set C. It is a subtle but serious error for folks in
set B to believe they can understand models by set C e.g. John Katz of Yale
who is a doctor focusing on diets and wrote a woefully misguided article in
the NY Times.

Roughly, I find the confounding factors about models about the current
epidemic seem to the following:

1- 1% of the population severely affected etc. (see: Diamond Princess). What
they fail to appreciate is that the Diamond Princess was an enclosed
environment and the outbreak was controlled and _limited_ to the population on
board. In the general population, a virus with an R0 of 3 will infect 50,000+
people in 10 infection steps.

2- What most people miss is the collision of the 1% severity with the capacity
of the medical system. This second-order effect is something hard to
understand. 1% of the US is 3.6 million. Even if 10% of those cases turn up at
the ER in the same year and occupy the beds for 2 weeks each it will be a
disaster.

3- #1 and #2 interacts with life as usual demands on the health care system –
accidents, heart attacks, strokes, etc. to create third order effects – more
deaths as there are no beds and no personnel to deal with them.

4- PPE running short and causing infections amongst medical personnel leading
to their quarantine, hospitalization or death (Wuhan, Italy, Spain) decimates
their ranks and accentuates the stress on the health care system……. 20% of
lost capacity translates to some fraction more deaths and more stress on the
rest of the medical population.

I am sure there are factors I have missed.

We have seen many contrarian viewpoints. None of these contrarian thinkers
make any concrete suggestions (Ionnadis, Katz, Friedman, Gillespie, Hanson)
except making ominous predictions to how wrong we are and we need more data.
Meanwhile ER doctors say this is the worst they have ever seen and bodies keep
piling up. These contrarian thinkers provide no simulations of how saving the
economy will lead to lesser deaths. Just hand waving and finger jabbing.

The contrarians seem to think that the playbook to deal with the epidemic has
been improvised. Or that this is something modelers are thinking up on the
fly. These playbooks have existed for decades with very good understanding of
the dynamics and were used during SARs, Ebola and heck even back during the
Spanish Flu. What seems to be lacking was parameters specific to Covid-19. Its
R0, CFR, co-morbidities, etc.

The reason Taiwan, Korea and Singapore were able to act so decisively and fast
was that they just dusted of the SARs playbook and knew almost exactly what to
do. Taiwan enforced the first measures in early Jan.

I will take the word of the viral epidemiologists over the contrarian's
armchair speculations and continue to overreact. I recommend you should too.

~~~
hcknwscommenter
Well put. And conservatively stated. Re: point 2, your "in the same year" is
what we likely face with high levels of social distancing. What's even more
alarming is what happens if we stop the shut downs and "go back to work."
That's a guaranteed disaster. You mention 50,000 people in ten steps. That
number grows to millions in just a few additional steps.

------
hprotagonist
for the last time it’s not the death toll it’s the _massive_ numbers of
immunologically naive people of all ages who need advanced medical care all at
once.

------
earonesty
One of the biggest reasons the rate may be too high is the method of
attribution. For example, in Italy, post-mortem testing of people who were
origially presumed dead of other illnesses accounted for a large portion of
testing. When it turned out they had COVID-19 at the time of death, the
_cause_ was attributed to COVID-19 regardless of comorbidities:
[https://www.bloomberg.com/news/articles/2020-03-18/99-of-
tho...](https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-
died-from-virus-had-other-illness-italy-says)

In other words, many of those who died today _would have died_ within the
year. Many were already in and out of hospitals for serious diseases.

So, not only is the IFR wildly unknown without serology tests. The CFR itself
is also severely biased.

Currently in the U.S. you cannot get tested unless you have severe, life-
threatening illnesses.

The fact that the U.S. has such a low CFR speaks very well of healthcare in
the U.S.... considering the majority of those tested have severe symptoms.

------
altoidaltoid
It has been horribly fascinating watching the (coordinated?) campaign to
downplay either the fatality rate or just write off a percentage off the
population dying as the "cost of doing business".

~~~
meowface
People should care about the facts, whatever they may be. If the fatality rate
really is lower than what was previously reported, it's a disservice to the
public to not report that. These are objective data and statistics, if they're
accurate and put in the proper context (e.g. grouped by ages and pre-existing
conditions).

The exchanging deaths vs. economic health thing is a subjective policy
position, which is different, and doesn't necessarily change even if the
fatality rate is lower than reported. If it still appears to be more
contagious and more fatal than the flu, I think most people will continue to
support the lockdowns.

~~~
hcknwscommenter
"If it still appears to be more contagious and more fatal than the flu"

If? The amount of magical thinking required to still have some doubt about
this is undefinable. Spain is converting ice-rinks into morgues to store the
freaking bodies. NYC has run out of ventilators and the federal response is
something like: NY could have had some at a good price in 2015.

~~~
meowface
I'm just speaking in a neutral way. As in "if it remains the case that...". Of
course, I do think it is the case, and am not doubtful at all. It seems to be
incontrovertible. I'm talking about how I expect the population to react based
on their perception of the situation.

------
ash
Without paywall: [http://archive.vn/cgCff](http://archive.vn/cgCff)

------
rancidhell
at this point who cares? we know that older people are at risk and do we
really want to risk our parents/grandparents/neighbours health? it's not worth
it. isolate yourself, clean your hands and face, and help fellow humans.

------
fl0wenol
Not quite, but within a margin of error as described.

Are you a glass half empty or half full person?

------
sytelus
TLDR; the article argues that the actual fatality rate is possibly 0.06% as
opposed to 1-6% touted in media.

The reasoning is based on estimating actual cases given confirmed cases. For
example, in Italian town Vò, the entire population was tested to find a
prevalence rate of 2.7%. Apply this to the whole province to estimate actual
cases and then divide that by confirmed deaths. So assuming that unconfirmed
cases mostly recovered without an event, the actual fatality rate goes down to
0.06%.

Arguably, the author doesn't have a lot of other strong data to back this up.
Also, this would imply that a large part of the infected population simply
recovered without needing to possibly sick treatment.

If this is true, however, it would mean we just had a 2 trillion dollar party
:).

~~~
vmilner
0.06% is hard to reconcile with 10 out of 712 cases on the Diamond Princess
liner proving fatal.

~~~
sytelus
The cruise ship with a higher level of density and socialization than New York
City is not really comparable with regular townships. Also, the cruise ship
population is very biased towards the old population.

~~~
nutjob2
Density only affects the speed of spread. It largely[1] doesn't affect how
many people will die. Over time everyone will get infected unless the virus is
wiped out.

[1] there is speculation that greater exposure to the virus may make some
people sicker

------
jonathanstrange
tl;dr The case fatality rate is usually much higher than the real mortality
rate.

People and health professionals have pointed that out from the start and it
should be hard to find anyone who doesn't know that by now.

> _A universal quarantine may not be worth the costs it imposes on the
> economy, community and individual mental and physical health._

Sure, you can use expected utility theory to calculate that. What result you
get depends a lot on the monetary value you attribute to a human live, or, if
you think that's better, on the value of quality-adjusted life years (QUALYs).

If you're particularly sociopathic you can also reverse-engineer the simple
models used in order to find the value judgments that will give you the
decision result you want. Just tweak the values for QUALYs, lower the
estimates here and there, and the result is that it's better to save the
economy (or vice versa, depending on what you want). Call me cynic, but I'm
sure plenty of people around the world are doing that right now.

~~~
makomk
People should understand that, but the media reporting has been absolutely
atrocious. CNN even ran an article arguing that the reason not testing as
widely was correlated with a higher reported fatality rate (as a percentage of
cases) was because widespread testing reduced the fatality rate by simply
reducing the number of people who got it, which is... not exactly the right
conclusion, shall we say.

It's not like there's been a shortage of folks who happily multiply the CFR
figures by 60, 70, 80% of the entire population and present this as the
inevitable death toll of, generally, the actions of the political party they
oppose.

~~~
hcknwscommenter
"CNN even ran an article arguing that the reason not testing as widely was
correlated with a higher reported fatality rate (as a percentage of cases) was
because widespread testing reduced the fatality rate by simply reducing the
number of people who got it, which is... not exactly the right conclusion,
shall we say."

It is a factor though, and not a minor one. You test widely enough and you can
track, trace, and quarantine your way to containment or at least massively
flatten the curve and thereby avoid overwhelming the medical system and
spiking CFR. That is exactly what S. Korea did. You didn't link to the
article, so it's hard to tell if you are just a troll or not. If the article
stated that as a factor, it is not wrong at all. IF the article stated that as
THE reason, well it's pretty misleading. Did the media mess up here? We shall
never know I guess unless you can produce a link.

------
julienchastang
Is there any explanation as to why this thread is "flagged"? It seems like the
original article and the discussion here are of good quality even if some of
the ultimate conclusions maybe flawed.

~~~
dang
Usually when there's an ongoing divisive story, follow-up posts get flagged by
a coalition of (1) users who don't like the article because they favor the
opposing view, and (2) users who are just fatigued by all the articles on the
topic. In most cases the first group alone isn't enough to win the tug-of-war
with upvotes.

Moderators sometimes override flags when an article is good and the discussion
seems able to be substantive (enough). That's arguably the case here, so we'll
try overriding the flags. (This is not an endorsement of the article.)

------
erikdlarson
Let's prove it. Go, go, go! Let's beat Iceland! We can do it.
[https://www.cloverpop.com/blog/we-need-a-covid-19-testing-
mo...](https://www.cloverpop.com/blog/we-need-a-covid-19-testing-moonshot)

~~~
erikdlarson
Or if we're really dreaming big, let's beat the Faeroe Islands.

In the whole world, there are only two places that can reasonably claim to be
taking a scientific approach to those aspects of this virus at this point:
Iceland and the Faeroe Islands. Both have tested about 3% of their populations
(that’s about 6X better than South Korea, 12X better than Italy, and 100X
better than the US). Iceland is trying to test a representative population,
although their testing is still skewed towards ill and exposed people. The
Danes of the Faeroe Islands are tracing almost 100% of cases.

We should still do testing of sick people to support healthcare decisions as
we are today. We should do more testing of exposed people for containment like
in South Korea and Germany. But that doesn't help much with the broader
governmental and societal decisions we need to make. We must do more. Embrace
the "and." No more "or."

Since everything is moving so fast, just keep it bold and simple: Race For
COVID-19 Truth -- Test 30 Million People In 30 Days.

------
davedx
The WSJ has a history of climate change denial too. They are 100% not a
publication that follows science at all.

You may also not be surprised to know they're owned by News Corp.

~~~
jonstewart
In particular, this is in their Opinion section. WSJ News still has a great
deal of credibility and integrity, though maybe center-right pro-business. The
Opinion section, however, has long been divorced from reality; the joke is
that it’s simply wishful thinking salve to corporate executives.

~~~
ardy42
> WSJ News still has a great deal of credibility and integrity, though maybe
> center-right pro-business. The Opinion section, however, has long been
> divorced from reality; the joke is that it’s simply wishful thinking salve
> to corporate executives.

I'm soon to be a non-subscriber, but I might have kept my subscription longer
if the WSJ app had a setting to suppress the opinion section. It's not even
interesting, and I'm far from a doctrinaire left-liberal.

------
whb07
Why is this flagged?

Can anyone or a mod enlighten me?

dang?

~~~
dang
[https://news.ycombinator.com/item?id=22688861](https://news.ycombinator.com/item?id=22688861)

------
DesiLurker
if its really so low then why are they scrambling to pass a 2T bailout
package. just let it rip through the population because 'its just a flu bro'
and it will be over in a month and a half.

/s

as I see it this is BS propaganda from WSJ to normalize whats coming next,
push to open businesses.

~~~
traden209
earnest answer: because even if it had a 0% fatality rate, the sheer number of
people who would be out sick for a week at the same time would decimate the
economy. The bailout package is probably not going to be enough.

~~~
nutjob2
That is a reach. Although people stop spending the delayed demand will return
once the danger has gone. People will want holidays and cars that they put off
buying. Demand will produce jobs. Even businesses that failed will be replaced
by new ones that satisfy new demand.

This is different to something like 2008 where people no longer trusted
financial and other institutions.

~~~
Gibbon1
I was thinking that too. We've normalized bad responses to finance driven
recessions. Where trying to make the finance sector whole results in a half
decade of lost ground for the real economy.

This is more like pre-1970's recessions where the central banks squeeze the
money supply for a couple of months. Or WWII mobilization. In each of those
cases the economy came roaring right back due to pent up demand.

We will get the worst of both worlds if our response to this is to either a)
let it 'run it's course' or b) try to make the finance sector whole. The US is
looking at both those options and the result will be catastrophic of they come
to pass.

------
phenkdo
There are some credible voices skeptical of the current doomsday predictions
from Dr. Fauci et al, vis-a-vis the national quarantine.

Unfortunately, this too has become a partisan political issue with dems for
shutdown/quarantine, and republicans for opening up.

~~~
willis936
It’s funny that the Republican plan involves the manslaughter of their voter
base prior to the next election.

[https://en.wikipedia.org/wiki/Social_Darwinism](https://en.wikipedia.org/wiki/Social_Darwinism)

~~~
dang
Please don't take HN threads further into political or ideological flamewar.
It leads to predictable, bad places.

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

~~~
willis936
I genuinely disagree that this is a flamewar topic. I posted about a political
party’s actions the same way I would post about any other organizations
actions.

~~~
dang
I believe you, but what makes it a flamewar topic is how other people are
going to react. The results will be predictably dismal. Actually you combined
two flamewar topics there: a partisan one and an ideological one.

This is a moderation issue because such flamewars aren't only off topic, but
destroy the intellectual curiosity that HN exists for.

