
How much ‘normal’ risk does Covid represent? - robrenaud
https://medium.com/wintoncentre/how-much-normal-risk-does-covid-represent-4539118e1196
======
ekidd
> _This suggests that COVID-19 very roughly contributes a year’s worth of
> risk._

Yes. If I get all the medical care I need, then I have only an 0.15% chance of
dying. (Well, more than that, because I'm male, and our numbers are twice as
bad.)

But I have a 4.9% chance of being hospitalized, which generally means
supplemental oxygen and an IV. And if we let this disease just burn through
the population, then my state would be looking at something like 13,000
hospitalizations for 700 beds. And the numbers get much worse for older
people.

Personally, I could live with an 0.15% chance of death. But a 4.9% chance of
getting stuck in a field triage hospital with inadequate care, struggling to
breathe? Not so much. And what about my older relatives?

~~~
mathdev
> But I have a 4.9% chance of being hospitalized

You are not taking into account the asymptomatic rate, among other mistakes.

~~~
ekidd
> _You are not taking into account the asymptomatic rate_

I'm using the Imperial College of London hospitalization numbers, from the
table quoted in the article. These give a hospitalization rate that's about
half that of earlier tables. So I'm guessing they probably include around 50%
mostly asymptomatic cases, which is in line with heavily-tested populations
like the Diamond Princess and South Korea.

~~~
mathdev
The number comes from the column named "symptomatic cases requiring
hospitalisation"

~~~
ekidd
You're right, I was misreading the column header. If we assume 50%
asymptomatic, then that would get me down to, say, a 2.5% chance of needing a
hospital.

Which means, in the absence of drastic curve flattening measures, a 2.5%
chance of half-drowning in my own lungs in a hospital corridor full of cots.
Still sounds pretty awful.

The key number we're missing is how many people catch the virus, but who
defeat it quickly enough that they never show up on an RNA test. We'll need
antibody surveys to figure that out. The Diamond Princess had 712 positive out
of 3,711, but some people were tested fairly late. So if we assume half the
ship caught it, that could cut the numbers in half again.

~~~
mathdev
> So if we assume half the ship caught it, that could cut the numbers in half
> again.

Actually by a factor of four if we assume that the virus managed to reach
everyone it was going to reach on the cruise ship and doesn't spread better on
land.

And if only those 712 caught it, that reduces your number by a factor of five.
So we are already down from 4.9% to between 0.5% and 0.625-1.25%.

~~~
natrik
Agree with mathdev here.

Looking at the data from
[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)

It seems logical to state, at least within the US, the accuracy of _deaths due
to COVID-19_ are more accurate than _total cases of COVID-19_. There are a lot
of asymptomatic people out there. Even if someone has it with mild symptoms
they are told to stay home and only reach the hospital if symptoms are severe.
Deaths are more accurate as I assume a test can be performed posthumously for
COVID-19.

So, even with this exaggerated ratio, the US has 5 deaths/1M pop. One can
reasonably argue this might've been worse if no quarantine measures were in
place. However if the true rate is less than 1%, I think the economic effects
will be more impactful.

The above link also shows ~27k deaths worldwide due to COVID-19 at the moment.
Italy had ~25k deaths due to the flu alone in 2016/2017.

~~~
tromp
That number is still rising exponentially though in Western countries due to
lack of social distancing and mask wearing discipline. I fear we'll be
approaching a million deaths worldwide in a matter of weeks.

~~~
Mikeb85
Not a chance. When all is said and done it'll be less than 100k.

------
fbn79
In Bergamo (Northern Italy, 120,000 inhabitants) in the last two years, the
average number of deaths between 1 and 24 March has been 98 people. This year
it’s 446, clearly because COVID. Many COVID death are not reported because of
absence of official verification.Data source
([https://www.bergamonews.it/2020/03/27/gori-a-bergamo-
dall1-a...](https://www.bergamonews.it/2020/03/27/gori-a-bergamo-
dall1-al-24-marzo-446-decessi-348-piu-della-media-degli-ultimi-anni/362792/)).

~~~
incangold
Your numbers don’t disagree with the article.

The data in the article tell us that most of those 446 deaths in which C19
played a part would have happened in the next few years anyway.

So we would expect fewer people to die in Bergamo next year, because they died
this year instead. And then fewer than normal expected the year after, and so
on, although it gets increasingly noisy with time.

We’re measuring the impact of COVID in deaths, by and large. A more useful
unit for some purposes is quality-adjusted-life-years (QALYs).

For people who die, the QALY impact of C19 would have been how many years of
full health the person had left, if they had not died after catching the
virus.

But similarly, for people who don’t die shortly after contracting it, C19 can
still have a QALY impact, and we’re not reporting or even measuring that much.
Patients often have reduced lunch function even after “recovering”; there will
be patients in whom C19 triggers post viral fatigue, which can last years; in
the worst cases patients will be stuck with ME/CFS or similar for the rest of
their lives.

Very little about the philosophy, economics, politics or science of dealing
with C19 is simple. Although clearly some things are: if I don’t go near
people with the virus, I won’t catch it; if we flatten the curve, fewer
patients will die; the old and the infirm are more at risk. But those few
simple parts don’t necessarily make the whole simple.

~~~
greenhatman
But won't people who survive have an increased chance of death in the next few
years as well? Seems probably that they would.

So overall deaths per capita will probably still be much higher than before
for the next 5 to 10 years. Maybe longer.

------
leto_ii
Some comments on the concluding remarks:

> So, roughly speaking, we might say that getting COVID-19 is like packing a
> year’s worth of risk into a week or two.

Sure, but it also means these deaths are piled up on top of everything else.
It's not like people will stop dying of other causes.

> many people who die of COVID would have died anyway within a short period

This strikes me as completely unfounded. Diabetes or an age > 70 aren't
imminent death sentences in a developed country.

> if COVID deaths can be kept in the order of say 20,000 by stringent
> suppression measures, as is now being suggested, there may end up being a
> minimal impact on overall mortality

In a sense this is a tautology. Of course, if we keep deaths to a low number
there won't be an impact on mortality rates.

~~~
monadgonad
> Sure, but it also means these deaths are piled up on top of everything else.
> It's not like people will stop dying of other causes.

You're misunderstanding: the people who die of COVID-19 will stop dying of
other causes, because they've died of COVID-19. There will be a decrease in
other-cause mortality...

>In a sense this is a tautology. Of course, if we keep deaths to a low number
there won't be an impact on mortality rates.

...thus what it means is that if the COVID-19 deaths are kept to people who
are ill enough that they would have died within the year anyway, those deaths
won't be extra mortality across the year. If on the other hand COVID-19
spreads a lot and kills people who wouldn't have otherwise died, there will be
extra mortality.

~~~
leto_ii
Even among the chronically ill and the elderly, the number that die in any
given year will be dwarfed by that of covid deaths (if the virus burns through
the population).

------
nabla9
This risk measures risk to expected lifespan with and without COVID-19. It's a
good way to put things into context.

If you compare deaths directly, you get really horrific numbers.

For example: Covid will kill significantly more people in the US than WWII and
the deaths will occur within roughly a year or year and a half. (WWII lasted 4
years for the US but the popuation was also smaller). If that sounds horrible
and unacceptable, consider that tobacco related deaths (including second hand
smoke) in the US kill more than WWII every year.
[https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...](https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm)

Because the deaths will come in short time span and hospitals will be out of
capacity the situation will be warlike in countries that fail mitigation.
Hospitals running out of capacity kills more of people than the disease.
Isolation failures due to hospitals not having testing equipment and
protective gear will add unnecessary deaths too. The risk from the disease
itself is comparable to lifestyle risks and many other risks.

~~~
nroets
And how does it compare to deaths related to automobile accidents ?

~~~
nabla9
Automobile accidents are order of magnitude smaller risk.

In the US automobiles kill roughly the same amount of people annually as year
in the Vietnam war. Something like 30k+ annually. You can actually subtract
some car deaths from covid deaths because there is less traffic.

9/11 or terrorism in general so low risks that it's quite clear that
responding for terrorism with conventional war and trillions of dollars is
insane.

~~~
logicchains
What about after accounting for life years lost? Young people are most likely
to die in auto accidents, and they may have 50-60 years of expected life left,
whereas the majority of deaths from coronavirus would be people who have way
fewer years left.

------
thinkingemote
The comments on the post suggest there are some major flaws. One graph
compares two different rates on the same axis, and some others show small
difference in logarithmic scales.

Can anyone look into these criticisms and see if they hold weight?

~~~
ajnin
What that comment is saying is that the two axis have different units (a
unitless risk for covid case fatality and a time^-1 rate for mortality), so
you can't compare them. Which is true, but if you multiply the rate by 1 year,
then the units become the same and the values don't change, so that becomes
comparable. I still think it makes sense to compare the risk of dying of
covid-19 if you catch it vs the risk of dying of any cause in the next 12
months. 1 to 2 years worth of risk still seems like a lot to me

~~~
iguy
Right, and plotting the comparison to 1 year's risk seems entirely sensible to
me. That seems approximately the right "compared to what?" scale to be using,
otherwise almost any numbers multiplied by 300 million end up looking huge.

One thing this plot does very well is put into perspective the extra risk to
the elderly.

------
usrusr
Deaths are easy to count, but I'm far more interested in what Covid-19 does to
survivors. I find reports of permanent lung damage showing up in scans of
people who never even noticed an acute illness far more concerning than any
single digit death percentage.

~~~
casperc
Source?

~~~
usrusr
Just tidbits, nothing worth referring. But too many to for comfort. Systematic
studies either don't exist or they get lost in the noise of death-counting.
It's particularly hard to find even speculative opinion because the same lung
damage keywords that would describe outcomes are also preconditions associated
with greatly elevated risk, so there's naturally a lot of charter about that.

------
Gatsky
Looks like the gender disparity in mortality is not being taken into account.
The excess risk for men is probably double what he estimates.

[https://www.theguardian.com/world/2020/mar/26/men-are-
much-m...](https://www.theguardian.com/world/2020/mar/26/men-are-much-more-
likely-to-die-from-coronavirus-but-why)

------
filleokus
How much higher will the rate of death be in 2020 compared to 2019? Some
people that dies from/with Covid would have died from something else just
days/weeks/months later, but not all of them. But how many are “extra” deaths?

I’m not saying the answers should influence our policy decisions necessarily,
but it’s still an interesting question.

~~~
samsonradu
With the recent movement restrictions I would also expect the car crash death
rate to fall considerably so the numbers might be skewed. For 2018 there were
25100 deaths reported for the 28 EU states [1].

[1]
[https://ec.europa.eu/commission/presscorner/detail/en/MEMO_1...](https://ec.europa.eu/commission/presscorner/detail/en/MEMO_19_1990)

------
maest
> a steady increase which is remarkably linear, apart from a sad bump in late
> teens and early 20’s, whose cause is all too clear.

Any idea what this "clear" cause is?

~~~
mkl
That confused me too. The tone suggests they think it's suicide, but more than
twice as many people that age die in traffic accidents. Maybe I'm
misinterpreting. Certainly not "all too clear" though. US 20-24 years fatal
crash rate: 36.3/100,000 [1], and US 15-24 years suicide rate: ~15/100,000
[2].

[1] [https://www.autoinsurance.org/age-groups-fatal-
crashes/](https://www.autoinsurance.org/age-groups-fatal-crashes/)

[2] [https://www.sprc.org/scope/age](https://www.sprc.org/scope/age)

~~~
iguy
The UK has about 1/4 the rate of traffic deaths [1], and possibly even more
than that in young people. Although it also has 1/2 the rate of suicides (no
idea about age distribution though).

[1]
[https://en.wikipedia.org/wiki/List_of_countries_by_traffic-r...](https://en.wikipedia.org/wiki/List_of_countries_by_traffic-
related_death_rate)

[2]
[https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...](https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate)

------
fxj
The mortality during WWII was 9% over 6 years (1939-1945) for Germany, which
gives a comparable number to that of corona virus now. So we should compare
the current pandemic to 1 year of WWII with all the misery and suffering of
the people instead of talking about "normal" or "abnormal" risk.

just my 2ct

~~~
remmargorp64
Yeah, but one huge difference there is that wartime ravaged physical cities
and buildings with bombs, and all sorts of other things. The coronavirus isn't
having any affect on *physical", real objects (other than people), so it's not
realistic to assume that it will have anywhere even close to the same side
effects as a 6 year war. Comparing it with world war 2 is hyperbolic, at best.

------
muzani
Nice graphs, but I have to question if the numbers are accurate. Let's take UK
stats as an example - good healthcare, good coverage of testing, moderate
panic levels.

11,658 cases as of writing. 578 deaths, 135 recoveries. 163 in serious
condition.

1.4% critical, 4.7% deaths, that's not too bad.

But what worries me is that statistic with 578 deaths and 135 recoveries. This
is probably because there's a lot of unreported cases, maybe 10,000 people
feel sick, stay at home, don't want to tell anyone, and a portion of those die
because it's too late, or have an asthma attack classified as Corona. But it
looks like a 80% mortality rate from this really pessimistic angle. What am I
missing here?

~~~
jspash
I'm not sure I agree with "good coverage of testing". As of today (27th Mar)
there have been roughly 100,000 people tested out of 66,440,000. That's a mere
0.015% of the population tested. I think that's around 1 out of every 6,600
people (unless my maths are wrong).

They aren't even testing all people with symptoms yet here. Only if they are
severe or the patient is high risk.

~~~
muzani
Yeah, it was hard to pick something at random. But I figure it was better
than, say, Brazil or US.

------
nroets
How much will life expectancy be reduced if the disease just runs it's course
? (or if we don't enforce a lockdown) ?

~~~
paulie_a
For me it reduces my life expectancy from a decade or two, to a year or two.

------
fjallstrom
I love the simplicity in this statement: "So average risk of death doubles in
8 years."

~~~
paulie_a
The statement is a nieve one to say the least. While the discussion revolves
around math and y axis etc, here is the simple math: due to covid I have 12-18
months left before I die.

~~~
SahAssar
What is the math that leads you to saying 12-18 months?

~~~
paulie_a
A particular medication I am on has a life expectancy of that time frame.

------
justforyou
Conspicuously absent from all these armchair "normal risk" discussions is the
impact of living the rest of ones life marred by complications (such as
painful glass like lesions in the lungs) after surviving.

------
klaudius
...

~~~
paulie_a
Yes, the author of that is a conspiracy but that wants to think they are
smarter than everyone else..."The world is suffering from a massive delusion".
The only delusion is the fantasy world the author lives in.

------
mathdev
It is amazing how the whole society can spiral into madness almost overnight.
The COVID histeria reminds me of descriptions of the mood among the Hutu
people in Rwanda in 1994, also driven by fear instilled by the media. We still
have some window left to turn back from the brink.

~~~
maest
Do you disagree with the estimated mortality rates or with the tradeoff
between economic and human loss?

~~~
mathdev
Both, but also with including the time spent under house arrest in life
expectancy with full weight, disregarding the side-effects and tail risks of
such isolation imposed on everyone, both social and economic. Most of all,
with the irrationality and cowardice of risking everything for a few months
(weeks?) of average life expectancy.

~~~
cycrutchfield
I'm glad that you are comfortable making that choice for other people. After
all, it's most likely not you that will have to bear the consequences.

~~~
mathdev
Likewise.

~~~
cycrutchfield
I'm sure your social life will recover just fine. After all, you seem to value
it more than human lives.

~~~
logicchains
Do you drive a car? If so, by your logic you value your own convenience more
than human lives, because driving kills over a million people and maims tens
of millions more people every year.

~~~
Der_Einzige
The response to coronavirus also nearly eliminates automobile fatalities. Try
again

~~~
logicchains
The point is that most people generally don't consider a response like this is
justified for the sake of reducing deaths from automobile accidents (I've
never seen anybody argue that everyone should not leave their houses, to
prevent auto accidents).

------
csomar
\- The linear graph shows a linear increase for Covid mortality vs. an
exponential one for normal deaths.

> So, roughly speaking, we might say that getting COVID-19 is like packing a
> year’s worth of risk into a week or two. Which is why it’s important to
> spread out the infections to avoid the NHS being overwhelmed.

These numbers, afaik, are just wild guess-estimates. The real numbers are
still not known because we are yet to have a breakdown from an country that
went with herd-immunity and see how that did pan-out.

But the real question is: Is the mortality rate, overboard, increase and if
so, is it increasing significantly.

Italy is recording ~700 deaths per day. But ~2.000 deaths per day happens on a
regular basis. If we were to pack a year of deaths into a two weeks slot, then
we should see ~40.000 deaths every 24 hours. We are clearly very far from
there.

It's surprising that no country is doing that but what we should do is test
people randomly. That will estimate the % of the population that is currently
infected with Covid-19 and determine a more accurate fatality rate.

It's very possible that the Covid is a nothing-burger really and the recorded
deaths would have died naturally anyway.

~~~
londons_explore
In the early phases, random testing to estimate what proportion of the
population are infected is prohibitively expensive - you'd need to test
hundreds of thousands to find just a few infected.

In the later phases, you want to know who has been infected, yet the commonly
available test in fact measures who is currently infected (ie. It can't detect
those who are still liable to get infected, which is what you need for good
modelling).

Antibody tests which are being prototyped by many groups should fill this
need.

~~~
sfj
Even testing 100 people would still be informative and give you an upper and
lower bounds on the number infected. You don't need an exact number to form
policy.

~~~
SahAssar
We can only test for active infections, not past infections. The disease is
still rare enough to not allow for sparse testing but common and infectious
enough to spread quickly. The disease is still not fully known. The disease
can take up to (or longer) than 14 days to show the symptoms to show that we
should test a person. The disease can spread from non-symptomatic persons.

Can't you see how these factors mean that testing 100 people would not lead to
a proper representative sample?

I don't think 100 people would be enough to properly and statistically test
for a common cold, much less for a disease like this.

~~~
sfj
> Can't you see how these factors mean that testing 100 people would not lead
> to a proper representative sample?

Where did I ever write this? I wrote it would give us an upper and lower
bound.

