
Evidence over Hysteria – Covid-19 - sprague
https://medium.com/six-four-six-nine/evidence-over-hysteria-covid-19-1b767def5894
======
loudmax
The trouble with an article like this is that it mixes well reasoned arguments
with nonsense. The economic cost of closing schools and shutting borders is
real, especially as the epidemic continues for months. The trouble is that the
article downplays the seriousness of covid-19. A mortality rate of 0.6% means
nearly one million deaths if covid-19 spreads to half all Americans.

The article points to South Korea as an example of a success story in the
fight against covid-19. South Korea immediately began widespread testing for
covid-19 as soon as infections were detected. They trace cases and isolate
people suspected of having become infected. South Korea has universal
healthcare, ranking first among OECD countries for access. All of this is
pretty much the opposite of we've been doing in the US, which is why a lot of
people here are worried about what's going to happen in the next few months.

It's reasonable to ask whether school closings or shutting borders are the
right policies. But we should be discussing alternative means of containing
the virus and we need to be clear what we're up against.

~~~
guscost
On the other hand, the problem with your argument is that there is absolutely
no way to be sure, today, that the mortality rate is even within an order of
magnitude of 0.6%. And as more evidence comes out that this thing is spreading
faster and more stealthily than expected, one consequence is that the true
mortality rate may be much lower than those estimates.

~~~
jsnell
The South Korean testing has been quite extensive, and not just limited to the
people with the most obvious symptoms unlike in the west. Given they appears
to have contained the virus without resorting to a full lockdown, it seems
unlikely they would have missed a large number of cases. If they had, those
asymptomatic or mild cases should be constantly restarting the chain of
transmission.

1.1% of their cases have died, and an additional 0.8% are in serious or
critical condition. And they're a best case scenario: the health care system
was not overloaded, and their diagnosed cases are skewing disproportionately
young.

The Diamond Princess also has had a fatality rate so far of 1.1%. In that case
we know with absolute certainty that there is no massive hidden iceberg of
infected but undiagnosed people. There might be a hidden iceberg of unreported
fatalities though, since once they were off the ship, the cases stopped being
tracked as Diamond Princess cases. On the plus side, the demographics
obviously skewed very old.

Anyway, there's very good reason to believe that the IFR is at least 0.6%.
Suggesting that it's actually <0.06% seems just ludicrous. Is there any
evidence at all supporting that, or are you just arbitrarily demanding
"absolute certainty" in a time-critical situation?

~~~
guscost
> If [South Korea] had [missed a large number of cases], those asymptomatic or
> mild cases should be constantly restarting the chain of transmission.

If enough people have already recovered from mild or asymptomatic cases (it
would have to be a pretty hefty percentage, granted) then that, combined with
not-total-lockdown conditions, could bring down the R0 value enough to cause
the same result. Do you think it’s much more likely that the virus has been
totally contained?

> The Diamond Princess also has had a fatality rate so far of 1.1%. In that
> case we know with absolute certainty that there is no massive hidden iceberg
> of infected but undiagnosed people.

This might be the strongest evidence against the “mild and everywhere” theory.
However, there are still something like five out of six passengers who tested
negative but could have recovered before they were tested. Even if they’re not
a great representative sample, testing them all for antibodies might be a good
move.

~~~
jsnell
> If enough people have already recovered from mild or asymptomatic cases (it
> would have to be a pretty hefty percentage, granted) then that, combined
> with not-total-lockdown conditions, could bring down the R0 value enough to
> cause the same result.

They're reporting basically no new cases at this point. For that to happen
naturally, they'd need to have gotten like 2/3rds of the population infected.
And it's quite hard to see how that could be true.

Korea had the most comprehensive testing (320k tests, available to basically
anyone with even mild symptoms). They have so far confirmed infections in
0.02% of the population, and only got positive results in less than 3% of the
tests. It's hard to believe that 60-70% of the population got infected, but
even in the skewed sample of people who got tested only 3% being positive.

Compare that with something like Switzerland where the number of confirmed
cases is at 0.08% of the population despite worse test coverage (basically
only get tested if your symptoms warrant hospitalization), and there's no sign
of it slowing down yet.

Or Spain which has 3x the cases of Korea on a similar population, has a health
care system that's melting down, and where more than 55% of the tests are
positive.

If herd immunity provided by all the undetected cases protected Korea, why is
it not kicking in anywhere else even once their infection rates are obviously
higher?

> Do you think it’s much more likely that the virus has been totally
> contained?

"Totally contained" is an exaggeration, since they are still finding new
cases. But given how long the infection rate has been stable, it does look
like they've managed to reach a R0 of almost exactly 1 with the aggressive
testing + tracing strategy.

The only alternative that's at all plausible is that the Korean numbers are
being fudged somehow, and they actually have a lot more cases than are being
reported. But then why aren't the hospitals in a crisis unlike in other
affected regions?

~~~
guscost
> They're reporting basically no new cases at this point.

It’s like 50-100 new cases every day, looks like. I’m getting out of my depth
with what exactly that allows us to rule out, but it sounds like “constantly
restarting the chain of transmission” might be the actual reality?

If that drops further, then maybe these new cases are just the ones that
incubated longer instead?

~~~
jsnell
> it sounds like “constantly restarting the chain of transmission” might be
> the actual reality?

Yes, but it's a tiny number of undetected cases restarting the chain, and
those chains being detected and lopped off before they have time to go
exponential. But it's just not possible that they have tens of thousands of
undetected cases that are spreading the virus further. That'd spin out of
control quickly.

------
sgt101
"Our focus here isn’t treatments but numbers. You don’t need a special degree
to understand what the data says and doesn’t say. Numbers are universal."

That's 180' from what I believe and have experienced repeatedly in industry
settings. Transforming the numbers to meaningful data is _always_ fundamental
to success. For example here the number of cases confirmed is determined by
the testing approach and process - you must know that to be able to make
meaningful comparisons (there are many other aspects to epi data but that's
just one).

------
drummer
This article has been censored by Medium. Can't say I'm surprised as it goes
against the official hysteria promoting big pharma narrative. This is what I
now get:

410 This post is under investigation or was found in violation of the Medium
Rules.

\--

It is archived here: [http://archive.md/yuaUq](http://archive.md/yuaUq)

~~~
eddyg
It also has been torn-apart by numerous people with way more credibility. e.g.
[https://twitter.com/CT_Bergstrom/status/1241522140559503360](https://twitter.com/CT_Bergstrom/status/1241522140559503360)

------
tjr225
Unrelated - is there a term for exhaustion of opinions?

I swear you could go into any HN comment thread related to this outbreak and
it breaks down to; Person A saying X is going to happen and then Person B
saying Y is going to happen and then Person C saying that No! Z is going to
happen!

How did everyone get so opinionated about something so unpredictable and
unprecedented? In any case I think we should all calm down regardless of how
dangerous this situation is. Stay sane, everyone!

~~~
ludamad
My family is unemployed right now, an opinion has to be formed, then we are
all kept indoors. I foresee continued growing pains

~~~
tjr225
But how can we form an opinion while shouting at each other? We know what the
answer is; and it’s called sharing. Unfortunately nobody seems to want to
entertain this idea.

------
xdandeman
Funny How many caught the flu? and is testing positive for Corona the same as
having Ebola or Leprosy ? or will you be sick for a week and recover like we
normally do from the flu>? Keep in mind more people have died in the U.S. from
seasonal, common flu than has died World Wide from this 'epidemic'. (Which
started in the most populous country so listening to the pundits it should
have had 100s' of millions deaths!) How is that possible?

------
nabla9
Maybe it's not a good idea to upvote these layman ramblings and influencer
opinions.

~~~
sakopov
Do you wager that the majority of news circulating today is written by
pandemic experts and medical professionals?

~~~
nabla9
There are large number of government organizations, pandemic experts, medical
professionals, and research groups communicating in the social media and
blogs.

There is no reason to post news articles or blogs from random Joes in HN when
you can post directly from experts.

~~~
dmix
There was a time when blog posts by “regular Joes” was the norm on HN and it
wasn’t necessarily a bad thing. Quality content can come from anywhere.

I’d rather judge them on the merits of their contribution than some meta
signals.

~~~
nabla9
> I’d rather judge them on the merits

This assumes that you can do that. If you are not an expert you can't possibly
have the background to put things in the perspective.

This is not the issue of the ability to read and study, it's about missing
variables and weighting evidence. If you don't have the background, you must
spend weeks studying to get some hold of issues.

Argument from authority is fallacy of reasoning but it's not fallacy when
learning and gathering relevant information. We you can reason only after you
have learned the subject.

Social media is full of people who learned basic math behind SIR model and are
building layman theories based on them.

------
hcarvalhoalves
Half of the article is about making numbers relative (active/total cases,
cases/population, etc).

But death toll is counted in absolute numbers. No one will think 1M deaths is
victory just because this is 1% of whatever. People are right to be
hysterical, we have tough times ahead.

~~~
guscost
By that logic, with those numbers (and if 1M is the total globally), then we
“lose” almost as badly to the seasonal flu, every year.

I’m not saying we shouldn’t care about deadly illnesses. But the world is a
dangerous place, and we’ve been pretty bad about changing that, historically.

Also, if we ruin 5 million lives to save (some percent of) 1 million, is that
worth it? How about ruining 50 million lives? We can save lives with drastic
measures, but drastic measures will have bad consequences too, and it seems
like nobody has any perspective on that.

~~~
scrollaway
What's the name of this fallacy?

1\. "New thing X puts us at risk of losing Y lives every day."

2\. "We lose Y lives to car accidents every day".

3\. "Ergo, X is harmless!"

You now have 2Y lives lost every day.

~~~
guscost
That’s not even _close_ to what I’m saying. How did you read my comment and
understand it as that??

------
wwweston
> Still, there is a massive blindspot with this type of graph. None of these
> charts are weighted on a per-capita basis.

Since this is an exponential phenomenon, I don't buy that "per-capita" matters
(on top of the fact that he seems to be pulling in numbers as a snapshot in
absolute time rather than windowed from initial cases).

If the numbers double every 5 days, the US can have 16 times the population of
some other smaller country and be only 3 weeks from the same per capita
effects.

------
hanche
Well, Farr's law is all about the general shape of an epidemic, plotted as
number of infected people against time. It does not say anything about the
location or height of the peak. The devil is in those details.

------
notacoward
Starts well enough, but gets more questionable in the middle and downright
risible at the bottom. Claims to be more objective, empirical, etc. than
others are unrelated to _actually_ being more objective, empirical, etc.

> driven by data from medical professionals and academic articles

...as filtered through one person's understanding and biases. Often this
results in a very different picture than perusal of the original source
material would.

> I’m most known for popularizing the “growth hacking movement” in Silicon
> Valley

That's an anti-qualification.

> Rank ordering based on the total number of cases shows that the US on a per-
> capita basis is significantly lower than the top six nations

This is right after he got done explaining why total number of cases of
useless. So _why is it here_? Because it suits the overall theme of minimizing
the threat.

> Daily growth rates declined over time across all countries regardless of
> particular policy solutions

Sounds compelling, but is it true? Note that the first chart is from
SoberLook, which is definitely not one of the top-tier sources cited at the
beginning of the article and not even one of those supposedly cited at the
bottom (Bloomberg, Johns Hopkins). Bit deceptive, that. I'll leave it to you
to figure out what kind of source SoberLook is. Oh, and we're using the
"losing metric" of total reported cases again. Doesn't everyone know by now
how fraught that is? The author certainly does.

The second chart already shows a very different story. There's no legend
(which is suspicious) but it's clear that many of the lines do _not_ flatten
out as would be necessary to support the author's claim.

> Both the CDC and WHO are optimizing virality and healthcare utilization,
> while ignoring the economic shock to our system.

We're starting to see a hint of where the author wanted to go with this,
probably before one word was written.

> According to WHO’s COVID-19 lead Maria Van Kerkhove, true community based
> spreading is very rare.

Hm. _Where_ did van Kerkhove say this? Why is there no specific citation, as
for more convenient factoids?

> The data from China shows that community-based spread was only a very small
> handful of cases.

Same as above. No citation. And does the data actually show that?

[https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmissi...](https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html)
"The virus that causes COVID-19 seems to be spreading easily and sustainably
in the community"

[https://www.who.int/docs/default-
source/coronaviruse/situati...](https://www.who.int/docs/default-
source/coronaviruse/situation-
reports/20200313-sitrep-53-covid-19.pdf?sfvrsn=adb3f72_2) "Community
transmissionis evidenced by the inability to relate confirmed cases through
chains of transmission for a large number of cases,"

Don't let the digression about aerosols (which nobody has claimed to be a
primary mechanism for spread of COVID-19) fool you; the experts, including
those included in the author's appeal to authority at the beginning, seem to
have very different beliefs than those he presents.

> Released on March 10th, one study mapped COVID-19 virality capability by
> high temperature and high humidity.

One study. Minimizing again. It's a very pretty temperature graph, which
doesn't actually prove _anything_. If you follow the link, you'll see that it
was actually limited to China, which might not tell us much about anywhere
else. What we actually know about the temperature sensitivity of coronaviruses
is that they're remarkably _stable_ up to about 37°C, and infectivity only
starts to decline above that.

[https://www.ncbi.nlm.nih.gov/pubmed/14631830](https://www.ncbi.nlm.nih.gov/pubmed/14631830)

> Children and Teens aren’t at risk

This does seem to be true, or close to it, for once. But why only talk about
the lowest-risk groups? Why not people in their 20s, or the high-risk folks at
the other end of the spectrum? Minimizing again.

This is getting long, so I'll stop dissecting each little piece. You get the
idea. Let's skip to the end, where the agenda becomes clear.

> Local governments and politicians are inflicting massive harm and disruption
> with little evidence to support their draconian edicts.

Very objective choice of words there. Inflicting. Draconian.

> Every local government is in a mimetic race to one-up each other in
> authoritarian city ordinances

Attributing motive.

> The COVID-19 hysteria is pushing aside our protections as individual
> citizens and permanently harming our free, tolerant, open civil society

More appeal to emotion, and expressive of the author's real priorities. Don't
get me wrong, politicians taking advantage of the situation to extend
authoritarian power is a real and valid concern. But no way in hell should it
be our _first_ concern. It certainly doesn't justify twisting the facts and
minimizing the threat that disease poses to the most vulnerable - not just the
old but also the homeless, the already ill, etc. Those people are not
expendable to "Support business and productivity" as the author puts it in a
heading.

~~~
ankushnarula
"Transmission in China happened among family members and close contacts. True
“community spread” was less common.

“This virus is not circulating in the community, even in the highest incidence
areas across China,” Van Kerkhove insisted.

What’s the difference between spread among close contacts and community
spread, you might wonder? Van Kerkhove said the data the mission saw in China
pointed to the virus finding its way into households and transmitting there.
One family member gets infected and infects others. The “secondary attack
rate” — the percentage of people in a household who got infected after someone
brought the virus into the home — was between 3% and 10%.

Van Kerkhove said true community spread involves transmission where people get
infected in a movie theater, on the subway, or walking down the street.
There’s no way to trace back the source of infection because there’s no
connection between the infected person and the person he or she infects.
That’s not what the Chinese data show, she said.

Marc Lipsitch, an infectious diseases epidemiologist at the Harvard School of
Public Health, found this claim puzzling. “I have reached out to the World
Health Organization to understand the basis of some of those statements. My
perception is that there is significant community transmission, especially
when you aren’t aware that someone is sick, because there’s not enough
testing,” he said.

[https://www.statnews.com/2020/03/06/were-learning-a-lot-
abou...](https://www.statnews.com/2020/03/06/were-learning-a-lot-about-the-
coronavirus-it-will-help-us-assess-risk/)

------
wrs
Great, so we just make sure there’s lots of testing being done so we can focus
our efforts, and hugely expand our health care system to take care of that
tiny 1% of the population. And we’ve got a whole week or two to do it. So
why’s everyone so worked up about it?

------
andbberger
Now is the time for extreme caution. We can laugh about how it was an
overreaction later.

~~~
dmix
When people are losing jobs at a higher rate than the worst recession in the
modern era, while kids miss out on critical education time, and everyone is
basically self-imprisoned in homes I think it’s fine to constantly question if
we are overreacting. Even if that answer is mostly no, we’re not.

Emergency funding will only go so far and once we get past a month of
extraordinary measures the serious pain hitting millions of people will be a
guarantee. Even in countries with far wider safety nets than the US, none of
them are designed to handle this sort of unprecedented event.

Then we see Hong Kong announcing 50 new cases in a single day [1] after
getting down to zero for an extended period. The only certainty is that there
will be no easy answers. Which I think the OP posts downplays in their ‘data
driven’ recommendations.

[1] [https://www.scmp.com/news/hong-kong/health-
environment/artic...](https://www.scmp.com/news/hong-kong/health-
environment/article/3076113/coronavirus-highest-risk-yet-new-covid-19)

~~~
hackeraccount
This exactly. Medicine is all about the dosage. If we are overreacting than
we're not helping people extra - we're actively hurting people.

------
cjbprime
Really sick of marketers acting like their "I write viral Medium posts!"
experience is an epidemiological qualification.

~~~
okareaman
This one is really much worse than any other I've seen. He is the 32 yr old
CTO of the California Young Republican Federation, without medical background,
who is recommending that schools reopen because closing them is
counterproductive. I'm not sure how this got upvoted on Hacker News to the
extent that it made the front page. Why did he write this? What is his agenda?

------
artsalamander
The very first chart this guy shows, and then rubbishes, is from the Financial
Times. The methodology behind the chart and why they show the data the way
they show it is explained pretty clearly on his twitter feed.

[https://twitter.com/jburnmurdoch/status/1241092187577819137?...](https://twitter.com/jburnmurdoch/status/1241092187577819137?s=20)

I'll probably do myself a favour and stop clicking on coronavirus medium links

------
wbronitsky
This is an article written by a “growth hacker” who knows literally nothing
about public health, claiming to explain public health to all of us.

This crap shouldn’t be on HN. This forum has become next to useless, slowly,
then all at once in the last few weeks. I would assert that this community
could do better, but at this point maybe it can’t.

------
cameldrv
This is a bad article.

------
IAmEveryone
This is bullshit. As but one example of the guy’s cluelessness: the curve of
(new) infections over time _is not a bell curve_. The shape is roughly
similar. But it has absolutely nothing to do with the normal distribution.

~~~
AuthorizedCust
If that is your only criticism, you may be throwing away a whole article over
a typo. The virus caseload in China is looking bell curve-ish.

I am not on board with everything in this article, though. I am unsure about
his proposition on reopening schools, for example. But I'm not throwing it all
away over that one part.

~~~
sgt101
Maybe you should because the fella has demonstrated sloppiness and ignorance
on one issue, and that shakes my faith in the quality of the rest of it. If
you are going to attempt to influence life and death policy you better be
good. Compare the quality of this article to the Imperial College report last
week.

~~~
sgt101
This fella goes to town on the nonsense in the GP :
[https://twitter.com/CT_Bergstrom/status/1241549349999411201](https://twitter.com/CT_Bergstrom/status/1241549349999411201)

