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Italy and South Korea virus outbreaks reveal disparity in deaths and tactics (reuters.com)
389 points by joe_the_user 18 days ago | hide | past | web | favorite | 395 comments



Italy has an older population, hence more susceptible to deaths and spreading of the virus:

- Average age of death due to Coronavirus in Italy is 82 [1]

- In Italy, 3.65% of the population is 80 or older [2].

- In Korea, 1.75% of the population is 80 or older [3]

[1] https://www.epicentro.iss.it/coronavirus/bollettino/covid-19...

[2] https://www.populationpyramid.net/italy/2019/

[3] https://www.populationpyramid.net/republic-of-korea/2019/


Something that is not much talked about is the fact that many people apparently die from a sepsis (bacterial) that is caused by the primary infection.

In Italy, it is almost customary to pop medication that contains antibiotics whenever you feel a bit under the weather. I lived in Italy, I experienced this first hand even from my more educated friends.

Because of this Italians have an antibiotics resistance of 26.8% [1].

I do not have data for South Korea but in Germany, where I live, antibiotics are not available over the counter. You always need to see a professional and then they are much more expensive that e.g. in Italy.

The resistance rate here in Germany is 0.4% [1]. That's 67 times (!) lower than in Italy.

[1] https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&He...


This is fascinating, I didn't know that data about antibiotic resistance was available like this, and definitely had no idea there was such huge variation between countries.

Surely this should be considered a major public health emergency in itself?

Are the countries with high percentages taking steps to limit antibiotic use? Coming from the UK the idea of letting people buy antibiotics as easily as painkillers seems crazy.

And what the hell is going on in Greece!?


> Surely this should be considered a major public health emergency in itself?

Indeed. There's an episode of Sam Harris's podcast with Matt MCarthy from last summer. The episode title is The Plague Years, and they go into quite a bit of detail on this sort of thing and ruminate about how low on the radar it is for most people (if it even registers at all), despite the seriousness of the situation.


3.65% / 1.75% ~ 2.09, so the difference in age profile might explain a factor 2 in the mortality ratio of Italy vs South Korea.

The actual ratio is currently 7.9: 827 out of 12462 cases in Italy (6.6%), 66 out of 7869 cases in South Korea (0.84%).


A large number of South Korea infections are even younger due to how it spread.

Italy: Above 80: 1,532 (18.4)% vs age 20-29: 296 (0.0)%

South Korea: Above 80: 243 (3.1)% age 20-29: 2,261 (28.7)%

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

Of note, neither country has had anyone under 30 die. Deaths in the 80+ age range are 8.23% in South Korea and 13.2% in Italy.

PS: South Korea saw 2 deaths under age 50 where Italy has seen 1. So this age is by far the largest factor.


A large number of South Korea infections are even younger due to how it spread.

Another possibility is that Italy doesn't have a handle on who is or isn't infected so what they report are the obvious infections, who tend to be older.


>Another possibility is that Italy doesn't have a handle on who is or isn't infected so what they report are the obvious infections, who tend to be older.

This is very likely the case, as can be seen in the positive test outcome rates.

16.7% in Italy vs. 3.6% in South Korea

Italy has run around 60k tests.

South Korea are testing around 15k people/day and have tested 234k people in total. They've even setup drive-through testing centers where anyone can drive through, get tested, and get results via SMS in under a day.

The result of this is likely a much larger number of asymptomatic or mild cases in the South Korean numbers, which based on the China data, tend to be a lot younger.

https://www.cdc.go.kr/board/board.es?mid=&bid=0030

https://github.com/pcm-dpc/COVID-19/blob/master/schede-riepi...


Yup. Meanwhile, the New York Times has run an article about how northern Italy is "a warning to the world" with the eye-catching claim that "about 50 percent of the people who tested positive for the virus required some form of hospitalization": https://www.nytimes.com/2020/03/12/world/europe/12italy-coro... Between this and other reporting, I'm starting to wish they hadn't opened up their paywall for coronavirus articles.


This makes sense. Now that Italy has ramped up testing to 13k per day we should see a correction in due course.


So if we assume a similar death rate, we could use the deaths to estimate how many are actually infected in Italy?


Yes, not only in Italy, but in most other places. This article explains well how deaths (or hospitalizations) are correlated to actual infections (most of which go unnoticed), and also why reduction of social interaction is effective but its effects take a while to show:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...


Nice - or as satisfying as something can be under the horrible circumstances - this is exactly what I've been arguing here.


In many (technically former) "red zones", especially in Lombardy, they tested also asyntomatic family members of infected people, or their contacts. I'm not sure how inaccurate it is, but I have no idea what has been done in SK.


South Korea traces the movement of everyone who tests positive, puts the movements online and tests those who were exposed to someone positive (this is in the article I believe). It's a massive effort but with the world economy at a stand-still, what else do people have to do?

North Italy has a population of 27 people btw so the 10K that are registered as positive as a drop in the bucket.


I guess I'm lucky enough to know one of these 27 people.


Fine, 27M(million)

"Why must I always explain" Bob Dylan


It is possible you are right. IIRC, 17% of those tested were positive in Italy. That's a very high percentage. Very likely the actual infected number is much higher.


Yup, you probably only have to look at the counts of infected tourists coming back. In Norway that is 89 from Italy, and 112 from Austria (25% of the total infected as of writing...)


True, same here, in The Netherlands. Of the first 500 reported cases, around 25% were tourists returning from the Alps region (northern Italy, western Austria), and around 50% were traced to secondary infections from those first 25%. The other 25% were unexplained, hence we're now in the endemic spread phase.

FAFAIK, we've never had a policy to pre-emptively test every returning tourist, and even now we don't test everybody. The current policy is to test new cases only if they have no relation to an already-established case. For example, people living in the same house as a known Corona case will not get tested. If they start showing symptoms, they're automatically assumed to have contracted it.


Is Norway testing everybody coming back into the country?


No. In fact they just revised their testing criteria and will not test most people who are asked to quarantine at home. Testing is expected for people who have acute respiratory illness, people who are hospitalized, health care workers handling these cases, and immune-compromised people with mild symptoms.


It’s unlikely that 14,000 infected 20-29 year olds where missed as a significant fraction end up in the ICU. Which means even if the ratio is off, the breakdowns are still significantly different.


I'm not sure how the media should report on deaths over 80, or even over 90.

It's not that old people aren't worthy of protection, but when you're 85 in the US you have a 10% chance of dying in the next year for any and all reasons.

So saying this disease kills 15% (for example) of 80+ year olds without context sounds horrific, but contextualized in the actual risks of just being very old to begin with, sounds much less scary.

If Italy, for example, were to report on the number of fatal infections in people younger than the natural life expectancy, the fatality rate would drop in half.


Fatality numbers won't reflect those who developed permanent lung damage or had to go into intensive care.

Best not to suggest anything that might down play the seriousness considering how infectious this virus is. (Otherwise it may encourage risky behavior.)


I think it's best not to overstate like the media currently has been (at least here in the USA) which is that everyone should be panicky and worried if they'll be alive next week.


Permanent lung damage? Link please?


It's far too early to draw any conclusions, but the HK Hospital Authority has suggested that they are seeing reduced lung function in some "recovered" patients.

https://www.scmp.com/news/hong-kong/health-environment/artic...


but what about the risks of over-selling this disease? Look at Italy for example. I've read self-reports from healthcare workers claiming 200% hospital capacity. I can only image the needless death resulting from such panic.

Mind you that isn't covid 19 putting them over-capacity. In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds. So it seems incredibly unlikely anything but panic is to blame for such absurdly high over capacity.


> In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds.

Do you have a source for this comment? This WaPo story from 6 hours ago says differently:

https://www.washingtonpost.com/world/europe/italy-coronaviru...

> Giulio Gallera, Lombardy’s health chief, said Thursday that the region would reach its capacity in “five, six or seven days,” even if it tried to add more beds in hospital “cellars.” In an interview with Italy’s La7 channel, Gallera described the possibility of adding 500 intensive-care beds at Milan’s expo center, the kind of rapidly assembled zone that China created in the hard-hit Wuhan area.


lombardy has 7280 confirmed cases [1] lombary has a population of 10MM (wikipedia) italy has 3.18 hospital beds per 1000 [2]

the math for that adds up to 31,800 hospital beds 7280 confirmed cases is 22% - so my sources were off or wiki is wrong as originally I recall reading lombardy has a 16MM population.

I will say that your article claims they haven't run out of ICU beds yet but that number is surprisingly high for ICU needs to cover covid 19. The article implies 600 ICU cases from covid 19 - that's over 12% ICU from confirmed covid 19 cases, which is more than twice what china reported.

It's also very surprising how few ICU beds they have allocated towards ICU....

The USA has something like 14% of hospital beds as ICU beds [3] but Italy appears to only have have less than 3% of their beds available for covid 19 ICU

[1] https://www.statista.com/statistics/1099375/coronavirus-case... [2] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [3] https://www.sccm.org/Communications/Critical-Care-Statistics


Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season most of those beds are already filled. The hospitals may be extrapolating the growth rate of the disease and realizing how soon they will have problems. Or given the nature of the outbreak it could be that even within Lombardy there are areas with much higher concentrations of cases, like there are more cases, inc. per capita, in Wuhan than other cities in Hubei.

What's not plausible is ICU beds being taken up by people who don't have the disease (maybe miild-to-moderate flus or bad colds) and are just panicking. Emergency room lines, sure. Test shortages, absolutely. But hospitals will not put someone who's just scared and doesn't even need to be admitted at all into the ICU.


> Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season

Remember that there's a difference between hospital beds and ICU beds.

In the UK, we maintain 80% utilisation of our ICU beds all year round[0], with very little change in the number of beds available in real number terms. We have ~4100 total ICU beds, which can be expanded to ~5000 if all operating theatres, etc are shut down and used as ICU equivalent instead.

While getting past flu season will help the total number of beds, it does nothing for the ICU.

This is the other reason why it's increasingly important to https://www.FlattenThesCurve.com and employ social distancing techniques. The rate of patients being admitted into ICUs needs to be slowed as much as possible. Once we're out of capacity, every additional patient has a much higher probability of dying than the overall fatality statistics indicate.

[0] https://www.england.nhs.uk/statistics/wp-content/uploads/sit...


There's a typo, it's https://www.flattenthecurve.com/


The NHS regularly has to cancel routine operations in order to free up space for flu patients during the flu season, which might be one reason why the bed usage seems so uniform. Obviously if they're already doing that for flu it leaves less slack in the system if something else comes along.


1. Not every hospital bed is the same as a bed for a highly infectious disease

2. Other things still happen to people and those people need to have their hospital beds.

3. I'm not a hospital planner but I think there may be other things that determine capacity than just hospital beds. I worry that the hospital bed metric is actually a bad metric. Obviously adding hospital beds implies adding people to staff those beds, but also adding people probably also means adding all sorts of other infrastructure to support those people.

As a developer it reminds me of a project that goes way off schedule, you don't bring the project back on track just by adding developers because of the overhead more developers add to your system. Probably most hospital administrators have never actually experienced operating at capacity, so estimations of what would happen could be off and are being corrected now.


Italy has about 12.5 ICU beds per 100,000 people. ICU beds are not the same as hospital beds.

https://www.statista.com/chart/21105/number-of-critical-care...


Maybe you shouldn't transfer every confirmed case into hospital since most cases will do just well ... unless they don't. (Not questioning the danger of this virus.)


Your 10% premise is wrong because you're conflating intensive care capacity and regular hospital beds. You can't just put Covid patients in with the general hospital population and it isn't trivial to convert other hospital beds to the requirements of Covid while ensuring you keep everyone else in the hospital safe from infection. Lombardy does not have anywhere near enough intensive care capacity to handle the cases they've already seen, much less anything further.

You can see that in the death rate, it's happening because they can't care for the volume of older intensive care patients properly. They don't have the medical infrastructure capacity to do it. That's why Italy and other European nations such as France have an extreme variance in mortality rates, despite France and Italy both having similarly old populations. Germany is even older than Italy and I'm skeptical we're going to see anywhere near a 6% mortality rate there (their rate is very low so far). Italy's mortality rate has been abnormally high from the first few thousand cases in, when it quickly began overloading their healthcare system in Lombardy.


A quick google suggests around 15% of hospital beds are ICU and covid 19 cases that end up in the hospital, only 5% end up in ICU. So that's an interesting line of thinking but it lacks supporting evidence that covid 19 is overwhelming ICU.

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

edit to address your edit: The mortality rate is often wildly inflated with new diseases. That's because most people don't seem to understand real mortality rate vs confirmed cases mortality rate. Obviously when a disease is new the confirmed cases will be confirmed against the people showing serious symptoms. Then when you pretend deaths/confirmed cases == mortality rate you end up with a wildly inflated mortality rate. Until we understand how many people are asymptomatic we won't have a real mortality rate that is reliable.


Percentage of ICU beds varies widely. Minnesota, for instance, a state in the US, has about 500 ICU beds [1] and over 10,000 hospital beds total [2]. ICU beds are already heavily used and sometimes there simply are not enough, before COVID-19 has even shown up. Average inpatient stays right now are 4.21 days in Minnesota [3]; I can't find a reliable number for length of stay for COVID-19 patients, but it is longer.

There is plenty of evidence that in Italy COVID-19 has overwhelmed ICU beds. They are trying to transport people to ventilators via helicopter. We do have at least twice the ICU bed capacity in the US (compare info from [4], [5]). But many other people need these ICU beds -- it's not like other illnesses will just stop for our convenience.

[1] https://minnesota.cbslocal.com/2020/03/08/talking-points-pre... [2] https://www.ahd.com/states/hospital_MN.html [3] https://www.mnhospitals.org/mn-hospitals/quick-facts [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ [5] https://link.springer.com/article/10.1007/s00134-012-2627-8

Edited to add: remember, included in most totals of ICU beds are neonatal and pediatric ICU beds, which won't help much with COVID-19.


The ICU beds are also taken by all the other sick people. Only a minority is actually free. And people don’t end up in the ICU because they panic: I spoke to several Italian hospital doctors and they are overwhelmed by the troves of patients who can’t breathe.


Right: we do have those ICU beds because people are in them.

Toolz, I just don't understand your math. You seem to assume that a neonatal ICU bed is just as good for a 55-year-old man as an adult one, and that no one is going to have any other ICU-needing illnesses for the duration of this epidemic. That's quite puzzling. Can you support these ideas?


I just read an article that claimed Lombardy has 737 ICU beds available for covid 19. Given Italy has a 3.18 beds per 1000 people that means they have less than 3% of their hospital beds available for covid 19 patients. That's absurd. In relation the USA has roughly 14% of their beds as ICU beds according to a reference from https://www.sccm.org/Communications/Critical-Care-Statistics


You seem to think that for some reason, ICU beds go unused except in a situation like this? ICU capacity is probably built to meet some fraction of demand in normal circumstances. Those beds weren't all unused before this outbreak started.

737 ICU beds available isn't the same as the total number of ICU beds. Normal health problems that need hospital treatment (strokes, heart attacks, car accidents, etc.) are still happening during this outbreak (well, car accidents are probably reduced now with Italy's lockdown protocols).


Someone else posted else thread that in UK at any time 80% of all ICU beds are in use. It is likely a similar percentage in Italy.


Hospitals worldwide have very little spare capacity and even less spare ICU capacity. A normal hospital bed isn’t going to help much. They are very likely to be overwhelmed, especially in countries that have not been able to delay initial spread due to lack of testing and containment.

This probably won’t kill millions (though it could worst case) but hospitals being overwhelmed would lead to an exponential rise in deaths, and many deaths from other causes as other treatments are abandoned. The situation is serious and will require significant measures to bring it under control, it is not yet being taken seriously enough in the US.


Are ICUs even helpful against the disease? I wonder if any triage experiments are being run with randomization.


When you have ADRS ICU treatement is pretty much the only thing keeping you alive. "Randomized trial" in this context means russian roulette - if you don't get a ventilator you'll die almost certainly.

Evidence [0] (partly based on COVID-19, parly on MERS) also says that NIV has a significantly worse outcome than ventilation. People are already getting NIV in some hospitals because they ran out of tubed ventilators.

[0] https://www.who.int/docs/default-source/coronaviruse/clinica...


An additional factor in why the death rate is so high in >75 year olds is that most deaths happen when ICUs are overwhelmed, and older ages get triaged into not getting a ventilator. There is a much higher rate for them naturally, but this amplifies the disparity even more.


You will not feel this way when you're 80


The problem is that this disease forces everyone to pretend they are 80. Give the old the care they need but don't drag down the young.


you could also say that for people 80 and above, this epidemic will more than double their already significant chances of dying this year...


My parents are in the range

And they live in Italy

Still the heat wave in 2003 killed 18 thousands people in a month and 15k in France in only half a month.

Old people are vulnerable to many things, unfortunately


That's a really hard thing to say this early. For all we know many 80+ people are asymptomatic and most older people aren't negatively affected at all by covid 19. It seems really dangerous to conflate actual mortality rate with mortality rate among the confirmed cases. Those numbers will be drastically different with diseases that have many asymptomatic carriers.


https://www.worldometers.info/coronavirus/coronavirus-age-se...

80+ age category has a 21.9% death rate in confirmed cases.


Of those in that group what % had a pre-existing condition? That is, is it age or age + illness? My sense is it's the latter.


I don't have the numbers ready, but my guesstimate is that about 100% had the pre-existing condition of old age.


Also when 85+ year olds die for other reasons, they don't all occupy ICUs for days or even weeks as in the case of COVID-19.


I'm surprised to hear someone be so blunt about their ageism. This thing has brought about a great deal of it already, with many saying, " it only affects the elderly" as if that's a worthwhile argument for not being too worried. Reminds one of indifference to AIDS in the 80s because it "only affects homosexuals"


> It's not that old people aren't worthy of protection, but when you're 85 in the US you have a 10% chance of dying in the next year for any and all reasons.

Some of the people that die from this would have died anyway, but for the most part this is on top of that 10% chance. Same for young people, there's something like a 0.2 chance of death every year and this is basically doubling that.


The numbers for 20-29 are probably not comparable. South Korea has been testing a lot of people per day. Italy, like many other countries, is overwhelmed, so there are probably many healthy-feeling infected 20-somethings who haven't been tested and aren't counted.


If you factor in collapse of medical services -- Italy ran out of ventilators / ICU beds--the gap becomes clearer. You have to look at over 60 as more likely to be hospitalized, putting strain on medical system.


This doesn’t account for it because South Korea didn’t even have the number of serious cases that Italy has.

The real answer is simply that the number of tests is not equal to the number of cases.

The number of positive tests is a factor of the number of tests done, and how selective the testing was allowed to be. It is only loosely related to the number of infected people (technically it is the lower bound).


>>"The real answer is simply that the number of tests is not equal to the number of cases."

I think you are right, but, assuming all the deaths are reported, the obvious implication is that the mortality rate is a lot lower than 3%

If fact, looking to Germany, I would say that it's around 0.2, 0.3 %

That would be the good news, the bad news is that it's extremely contagious, probably because nobody is immune to this thing.

Of course, I'm only a random guy in the Internet, so take it with a grain of salt.


I think the current most credible estimate is 0.8%-1%. That's what the UK government has been planning for, for example.


Makes sense, it's difficult to calculate without knowing the number of tests that are being done in every country.


>The real answer is simply that the number of tests is not equal to the number of cases.

Ye olde "3.6 roentgens. Not great but not terrible" factor.

https://m.youtube.com/watch?v=Mg5HOnq7zD0


My comment was directed at age structure of population accounting for difference in mortality, complicated by effective collapse of medical care in certain regions of Italy that meant severe cases that could have been managed because critical and then fatal without ventilation support.


As far as I can tell from the media, Italy has not run out of intensive care units yet. See e.g. this:

https://www.washingtonpost.com/world/europe/italy-coronaviru...


Here are two reports that would indicate that the standard of care has been substantially reduced

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-h... "Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air."

----

https://www.euronews.com/2020/03/12/coronavirus-italy-doctor... "Another nurse working in Lombardy, the Italian region the worst hit by COVID-19, told Euronews the situation was "dire" and far worse than it is being portrayed in the media.

Speaking to Euronews on the condition of anonymity, she said: "We have hundreds of cases in our hospital. Half of our operating block has been dedicated to COVID-19 patients. The situation is dire. Anesthetists – despite them playing it down a little bit on the media – have to choose who they attach to the machine for ventilation, and who they won’t attach to the machines"

---

A first person report from Seattle ICU doctor https://www.facebook.com/marie.e.will/posts/1016307125424515... "Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS. Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d.

I decode this as they have half the amount of Remdesivir they need, only treating for 5 days when recommended course is 10.

The other thing that appears to be going on, and it's also hinted at in report from Seattle, is that old patients are being moved to hospice or "comfort care" who would not have been three months ago because of lack of supplies/personnel/equipment.


Going through your links:

#1 provides no numbers and no details beyond a claim that "They lack machines to ventilate all those gasping for air."

#2 does not even go that far: it speaks of "a huge turnover issue and leaving hospitals at near capacity" (near, not above, contradicting #1)

#3 is from an intensivist in Seattle, Washington, not from Italy.

I chose the Washington Post link because it provides numbers: "Lombardy has just 737 intensive-care beds available for coronavirus patients. More than 600 are filled. [...] The region is racing to bring more beds online; it added 127 on Thursday."

(Lombardy is the region with most cases.)

This is consistent with the claim in your link #2 that hospitals are near capacity (and not above it, as suggested by your link #1).

The point of all this pedantry is simply that I don't think saturation can be invoked yet to explain the high Italian mortality rate.

Addition:

Here's a slightly older Italian source (March 11) which puts nation-wide ICU capacity in Italy at 5090, with 887 in use:

https://www.linkiesta.it/it/article/2020/03/11/italia-corona...


#3 was to show what can happen in one hospital. These patients are hard to transfer. Lombardy is about 9200 sq mi. (about 100 miles square). If you need a ventilator you may not be able to withstand a 50 mile ambulance ride. But I concede I cannot offer conclusive proof that Italy is out of ventilators.


Lombardy started transferring intensive care patients to other regions a week ago:

https://ilmanifesto.it/lombardia-paziente-trasferiti-fuori-r...


from the translation it does not appear they are moving Covid-19 patients: "For the first time, Lombard hospitals have had to resort to the Remote Health Relief Operations Center (CROSS), which intervenes when a region is no longer able to cope with the number of patients and must seek help from other regions. The Civil Protection has ordered that a number of ICU patients in Lombardy for other diseases be transferred to hospitals in neighboring regions."

Note this is first time it's been triggered which indicates it's a difficult and risky process.

Article also notes "The people in charge of intensive care in Lombardy have sent a dramatic appeal to Governor Attilio Fontana: "Healthcare facilities are under greater pressure than any possibility of adequate response", the doctors write. "Despite the enormous commitment of all healthcare personnel and the deployment of all available tools, correct management of the phenomenon is now impossible."

This sounds like a system that's out of ICU beds.

see also https://jamanetwork.com/journals/jama/fullarticle/2763188 "As of March 8, critically ill patients (initially COVID-19–negative patients) have been transferred to receptive ICUs outside the region via a national coordinating emergency office."


> Speaking to Euronews on the condition of anonymity

This should imply heavy fines. Creating panic while covered by anonymity is very easy and it brings no value to society. If officials later on try to bring real numbers nobody listens.


The infection in Italy started in hospital or in retirement home (I don't remember which), so the first infected were people > 70.

In South Korea it started in a cult, where most people were young < 40, and moslty women (which have less CFR than man for COVID-19).

And the rest was South Korean lack of regard for privacy (they have a map for each case where you can trace where and when a given infected person was - so you can check if you were near him/her) and technological superiority.


> The infection in Italy started in hospital or in retirement home (I don't remember which), so the first infected were people > 70.

Italy's patient #1 is 38 (see the article). Patient #0 has not been identified.

> In South Korea it started in a cult, where most people were young < 40

That would be the Shincheonji Church of Jesus:

https://en.wikipedia.org/wiki/Shincheonji_Church_of_Jesus#As...

I don't know what their age profile is, but the outbreak began with a 61-year old ("Patient 31"), and several people mentioned here are above 50 (the founder is 88):

https://www.nytimes.com/2020/03/10/world/asia/south-korea-co...


About 80% of South Korean cases were less than 60 years old, with a peak in the 20s [1]. It is widely rumored that Shincheonji prefers to recruit young people who are easier to exploit.

[1] https://coronaboard.kr/#age-card


My guess is that there are a lot of unreported cases in Italy while in Korea authorities seem to ran more vigorously tests. So the latter might have much more accurate numbers than the former.


That seems the obvious explaination.


More rigorous tests than Italy, seriously?


> More rigorous tests than Italy, seriously?

SK leads the world. 3,692 / 1MM pop vs Italy 826 / 1MM pop.

Source: https://www.vox.com/science-and-health/2020/3/12/21175034/co...


You say "rigorous tests" OP said "vigorously tests". Very different meaning. The test in both countries is essentially the same, and thus the same rigor (in terms of sensitivity and specificity). The vigor by which the testing was performed (in terms of #people tested as a % of total pop) is WAY WAY higher in S. Korea.


South Korea used to be at about the same development index as Italy maybe...20 years ago? Today it's tied with Israel (as of 2018) and above Spain, France, and Italy.

The PPP is also about 10% higher than Italy and has about half the unemployment rate.

Most importantly it has one of the most advanced healthcare systems in the world. https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...


South Korea also has 4x as many hospital beds per 1000 people as Italy does.

They still suffered a shortage of hospital beds in the hard-hit area around Daegu, so much so that some people died while waiting.

Italy and other countries with fewer hospital beds will have to resort to what China did: build makeshift hospitals, fast.

https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...


Afaik they’ve already started with that in one the affected regions.


Yeah, I also heard that China is sending to Italy the materials they don't need anymore, since they started dismantling the temporary hospitals in Wuhan. That would be very helpful.


>temporary hospitals

were not hospitals at all, just isolation units for temp quarantine


Yes and yes


It's also easier to leave Italy and spread the disease because it doesn't have a DMZ in the North and lots of migrant workers and other EU nationals, free to leave at any time. Some have fled the lockdown using ferries through Croatia or Greece and then on to their home countries. When the North was quarantined, many Italians irresponsibly fled to the South, prompting the authorities to issue a country wide lockdown. Good luck trying to escape by ferry from Korea to Japan, Russia or China in the middle of a pandemic. North Korea is out of the question. Also Koreans are likely to obey the rules imposed during a healty emergency crisis (they also has a MERS epidemic in 2015), while Italians are more likely dismiss them as nonsense.


Except if the increased rate of death is from the medical system being over capacity.... this still wouldn't be a good test of quality of their responses, but more just revealing the capacity of their medical system.


Maybe co-morbidities or general health per age is better in S. Korea.


It's all the kimchi.


How long can the virus survive in a container of kimchi? I truly would like to know.


Please don't conflate case fatality rate with actual fatality rate. South Korea has almost certainly just had more time and "medical bandwidth" to find more of the minor and asymptomatic infections that make up potentially 80%+ of the total, and turn them into cases by diagnosing them.


I thought that actual fatality rate is always higher than measured in case of exponentially growing pandemics. Just imagine the case where it takes 20 days for people to die. Your calculations of fatality rate this early in the disease would be conservative.


A far bigger factor in a disease like this, where 80%+ of people have mild illness, is all the people that were never recorded as cases because their symptoms were too mild or were non-existent.

People want to use CFR as a measure of how worried they should be, or as some kind of comparison between countries, and it's totally inappropriate for either purpose.


If they are never recorded does that not mean they infect more people and that results in sicker population creating more burden to the health system - resulting in more deaths?

The statistics always seem to go up no matter what kind of interpretation.


The point is that deaths - the numerator of the case fatality rate - are basically always recorded, whereas cases - the denominator of the case fatality rate - represent only a subset of the people that are infected.

When the health system is severely overburdened, that subset because a smaller and smaller proportion, as scarce resources are used for testing of people presenting at hospitals rather than population-based testing.

People who are asymptomatic or have minor symptoms don't present at a hospital, so they don't get tested, so they never get recorded as a case (which, by definition, requires a test and a diagnosis).

The real population fatality rates are guaranteed to be lower than the CFR unless you believe that every person who is infected is being tested and diagnosed, and it's my opinion that they'll be much lower.


There are also cultural differences, Italians like to hang out in groups, outside, personal space is much smaller, people hug and kiss and touch all the time. Also they're not really the most disciplined nation, lots of them simply ignored the safety rules, continued to go out, there were even some cases where infected people run away from quarantine.

And additionally the spread of virus is not uniform as it depends on social circles, so it's very hard to compare the situations using just general population stats. In South Korea one of the early patients infected more than a thousand other people, while some patients infected no one else or only a few. It's totally random event, and a few patients like that can create a huge differences in the spread of the disease. In Italy they've had the bad luck that early on virus got into hospitals and retirement homes, so the most sensitive population was massively affected.


I think there is another factor as well: have a look at train stations during rush hour on East Asia currently vs. Europe. 1) the density is significantly higher but 2) nearly everyone is wearing surgical masks now. I think that mask wearing is an effective measure to slow down the spread, acting at the sender side rather than the receiver (which Western people tend to focus on). You can see a similarly lower exponential spread in other Asian nations compared to Europe and I think that masks plus a lesser degree of body contact can explain this largely.


Part of the problem is that pretty much everybody in East Asia already owned at least one mask.

In Europe pretty much nobody owned a mask prior to COVID-19. And masks have been sold out for weeks. If masks were easily available you'd see people wearing them I'm sure.


This is partly an effect of cultural issues related to immunity and how it's perceived in most europe countries.

Even putting aside the whole deliberate sharing germs and force building body resistance, wearing a mask is seen as anti-social, somewhat selfish, weak and alarming.

People's reactions to a mask is really ranging from "you shouldn't wear it at all, we're among friends (at work)" to "if you're that ill you shouldn't get out of your home and take a sick leave". There few middle ground, accepting wearing a mask just in a case, or for some benign infection.


At least in The Netherlands there are still plenty of masks to be found. You won't find the surgical masks anymore but masks for construction work is still plenty available.

I think most europeans look down on wearing masks as something stupid, most europeans also think hand sanitizer is stupid. (This just applies to my dutch family and friends over there, I am currently in Thailand and always wearing a mask and hand sanitizer)


You can't know who has the virus so everyone has to wear the mask to prevent the spread.


Except no one seems to wear them fully correctly, and a lot of people don't have the proper rating of mask. Not to mention theres a limited supply of masks.


>In South Korea one of the early patients infected more than a thousand other people

Really? That's horrifying. Any links about that?



Did they infect 1000 people, or were they the index case for a group of 1000?


They seem to have infected hundreds at minimum, a few thousand potentially. They are the index case for up to 80% of the infections in South Kore. https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTER...


The part of Italy hit also has air quality, per aqi searches, that is comparable to the region in China that was hit hard.

Have people looked that it is not age, but baseline damage to your lungs that is the main factor in serious cases? Older people will have more exposure to local air pollution, just from having lived longer. That existing damage can be what contributes to complications, right?


Source? Right now air in Wuhan [0] seems to be significantly worse than Milan [1]. Both cities are under some level of quarantine, but it has been stricter and going on for much longer in Wuhan. Chinese sources say that the air in Wuhan is much better than it was before the quarantine. We can assume that the difference between the two cities would be even larger during normal activity.

Edit: Milan is much closer to Seoul [2] than to Wuhan.

[0]: https://www.airvisual.com/china/hubei/wuhan

[1]: https://www.airvisual.com/italy/lombardy/milano

[2]: https://www.airvisual.com/south-korea/seoul


I used those sites and looked at daily historical. I grant that China was strictly worse. But Milan is strictly worse than everywhere else getting hit.

Edit: and the air being better after the quarantine would support my hypothesis. It wasn't that that helped, but the better air. (Which is still very bad)


The daily historical on that website goes back to February 12th. Wuhan has been in lockdown since January 23.


I'm now on my phone, but the site I used went back longer. I'll compare when I can.

And again, China was worse. Italy is just worse than all places I checked that had a lot of cases, but not as many severe cases.


For reference, this is the site I found that went back farther. Milan is not constant days of 150, as Hubei is. That said, it is littered with many high value days. Contrasted with Seattle, which has been steady below 60 for the time period.

Take this over to Australia [below], and you can see that even they had terrible air as recently as mid January.

Contrast to Norway [also below], which has hovered on fine air quality for the entire time. Same for Japan, all told.

Basically, the worse your air quality, the more severe cases you are seeing. To a marked degree.

Edit: Just eyeballing, Milan is worse than Seoul. Agreed not as bad as Hubei. But between.

Seattle: https://air-quality.com/place/united-states/seattle/9e80e347

Hubei: https://air-quality.com/place/china/hubei/7991f3c2

Milan: https://air-quality.com/place/italy/metropolitan-city-of-mil...

Australia: https://air-quality.com/place/australia/victoria/def9c265

Norway: https://air-quality.com/place/norway/troms/a70875e7

Japan: https://air-quality.com/place/japan/tokyo/c8969bc2


I wonder if and how long-term smokers are skewing the stats.


That hinges a lot on if I'm right. Which is still unlikely, as much as I'm find of my own opinions. :)


No, the far more likely explanation is that the total number of cases reported for Italy don't reflect reality.

Because they are overwhelmed Italian hospitals basically send people home if they have a fever or other symptoms with no test administered, instructed to come back in case the symptoms worsen, only people having trouble breathing being admitted in the ICU.

Italy could easily have in reality 10 times the number of reported total cases or more.


> Because they are overwhelmed Italian hospitals basically send people home if they have a fever or other symptoms with no test administered,

Sources, please.

> only people having trouble breathing being admitted in the ICU.

Well, why would you put someone without respiratory failure in an ICU to egin with?

Also, Italy performs 1 test per 1000 people [1]. Surely there are more cases than the reported ones, but 10 times? I am no statistician, but wouldn't it require extreme bad luck to miss so many cases with such extensive testing?

[1] https://www.worldometers.info/coronavirus/covid-19-testing/


As posted else thread, the percentage of positive tests in Italy is almost 5 times larger than in Korea. This probably means that the infected population is much higher than what's being reported.

In the initial weeks of the crisis, the Italian government said that they would switch to only reporting symptomatic cases [1] ("because that what every body else is doing") instead of all positive tests. I do not know if they followed through, but that would make a large difference if Korea was reporting everything.

edit: as far as I understand, that only changes what they report in the official numbers that make the news. The actual medical data might contain the real numbers.

edit2: if they started doing what they said they would, the actual positive rate would be even higher. So the issue is likely that they are just not testing as much.

[1] https://www.wired.it/scienza/medicina/2020/02/28/coronavirus... (in Italian)


> This probably means that the infected population is much higher than what's being reported.

Agree, is the logical thing. The bigger the sample, the better the results.

Another possible option could be that caucasian people is more susceptible for some reasons than asian people. The reasons could be genetic or cultural (i.e previous exposition to similar viruses by gastronomy). Without more data, I would take the first option as closer to truth.


Did they test random people or only people with symptoms? If the latter then your distribution is heavily biased and a 10x difference is not an outlier, it's the expected outcome.


According to those stats 14% of people tested were positive and of those, about half had to be admitted to hospital. It's clearly very far from a random sample.


Also keep in mind that the false negatives for the tests is pretty high, because the tests require a significant viral load in the blood and in some cases it can take several days after the symptoms set in.


Just look at how many people from other other countries got infected in northern Italy a few weeks ago. Italy had diagnosed a few hundred cases, yet suddenly hundreds and hundreds of people who were in the area and have returned home now have it in other countries. It's clearly far more highly prevalent than testing suggests.


A big part of the answer is in the article: SK have tested 5 times more people so picked up more mild cases in their stats


Yeah, but they've also been able to significantly slow the spread, growing at what looks to be closer to 10% day-over-day (doubling every week). Most everywhere else is seeing 25-35% (doubling every 2-3 days).


These go hand in hand. In the US we cannot slow the spread because we refuse to test anyone who doesn't need acute care or who doesn't have documented contact with travelers or foreign nationals. The research from Helen Chu's lab at University of Washington shows that this means we missed the start of community transmission entirely in Washington.

Here, there are health care workers who can't get a test! They deal with people with significant health problems every day and could be spreading it all over -- but because they didn't travel, they can't get a test.


The massive shortage of tests doesn't help either.

There's plenty of blame, but I'd assign most of it to US politics.


New cases in SK are on a downward trend for around 10 days now. They achieved a reproduction value that is quite a bit below for at least the last 3 weeks.


https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...

SK has 12 hospital beds per 1,000 people vs 3 in Italy.


I can understand how it is more susceptible to death but I don't see the connection with spreading. Old people tend to move about much less and none of the references support that older people are in any way more responsible for spreading the virus.

I think much better explanation would be that Italy has a lot of tourism, it is basically a tourism hub for northern and eastern Europe. Tourism == a lot of people moving about, very frequently, then leaving the country. Almost all initial cases here in Poland seem to be connected with somebody coming back from vacation in Italy.


It's not just the deaths now, but the trajectory. Korea has this under control, Italy won't for another 1-2 weeks.


More susceptible to deaths I understand, but is an older population more susceptible to spreading of the virus? Is probability of "infection given exposure" (as opposed to being a carrier) also greater with age? (I know that's true for kids, but hadn't heard if that trend continues across all age ranges.)


> South Korea has since reported 67 deaths out of nearly 8,000 confirmed cases, after testing more than 222,000 people. In contrast, Italy has had 1,016 deaths and identified more than 15,000 cases after carrying out more than 73,000 tests on an unspecified number of people.

Surely the testing is a huge factor. Test more people you'll find more people infected, so the fatality rate will get smaller. If you're like the US and test very few you get the huge fatality rates we saw in Washington.

If you could quickly and accurately test everyone in the country today we would know how to isolate and the whole thing would be over very soon. Not having a reliable test makes this whole problem as bad as it is.


Singapore is probably doing as best as any country could hope to.

https://www.npr.org/sections/goatsandsoda/2020/03/12/8145224...

Also, as an American, I'm embarrassed by my country's response and by how my president addresses the nation. PM Lee shows how you talk to your country:

https://www.youtube.com/watch?v=3mYs1Uyx3c8

His original address five weeks prior:

https://www.youtube.com/watch?v=dExr76Wckr8


Singapore has been competent, but Taiwan's response has been more impressive.

It's very close to the hot zone, millions of people travel to and from mainland China every year, it has roughly the population of Australia living on 10% of the land Japan has, the WHO refuses any cooperation, and yet there have been under 50 cases and no local transmission.

Not only that, but as a democratic state, Taiwan's control measures have been remarkably measured.

I'd credit two factors:

1) Imposing travel limits three weeks before China even admitted there was an outbreak. After SARS, the TW government had a plan for this epidemic and a healthy skepticism for both official news and the WHO.

2) Taiwan has a relatively high trust society. People generally trust the local CDC and make a genuine effort to take preventative measures, even those primarily for the safety of others. A phone alert is generally all that's needed as a quarantine reminder for those exposed.


> After SARS, the TW government had a plan for this epidemic and a healthy skepticism for both official news and the WHO.

That's not surprising, since the WHO doesn't recognise Taiwan as an independent country and refuses to help them, I'm glad they were able to take their own successful measurements.


Meanwhile, around here people break advised self quarantine because "fork off, I'm fine".

No trust in government and a general attitude of "it's just a flu, and I got things to do"...


Where is "around here"?


Romania, which is also severely underprepared for a real outbreak. At least they're locking down borders and checking people, there's a lot of them going to/from work around the EU.


> TW government had a plan for this epidemic and a healthy skepticism for both official news and the WHO.

Which is notable that the US CDC seems to be following WHO closer than anyone, at least early on...


China reported Covid19 to WHO on 31 Dec 2019, do you say that travel curbs were put in Taiwan in early December?


Taiwan started acting on 31st Dec. https://jamanetwork.com/journals/jama/fullarticle/2762689

Taiwan has had a spectacular response to the virus - that is the gold standard that Italy (or Korea) should be compared against.


They were hit badly by SARS and learnt a lot of valuable lessons. This is our European SARS moment, hopefully.


I think the parent is referring to when China officially, publicly admitted the problem, which was three weeks after it notified the WHO.

Taiwan implemented more stringent inspection requirements for people arriving from the Wuhan area as soon as China notified WHO, on 31 Dec 2019.


JAMA article about Taiwan - they made changes after SARS to have a faster response and what they did worked to contain the spread even though there is a large flow of people to/from China. https://jamanetwork.com/journals/jama/fullarticle/2762689


Being a small country definitely helps in situation like this, it is not likely US as a big country can be as effective as Singapore. What do you want the government to do? lock down cities with troops?


I would be proud to vote for someone like this.


Let’s not get carried away in our praise of Singapore’s leaders. Singapore is an authoritarian state and Lee is a part of the ruling family.


For all those interested in how Singapore can possibly be a duality of "sometimes good sometimes bad", just look at how Singapore treats its Malay population as second class citizens.

For example, if a Singaporean Malay marries a Malaysian Malay, there is still a large chance their Permanent Residency application will be denied. This usually doesn't happen to someone who marries Han Chinese, of which Singapore is 70%.


Edit: If you're saying that the "reported" death rate "appears" lower based on reported statistics, then yes testing more people can make it seem like the actual death rate is lower. Otherwise:

> 67 deaths out of nearly 8,000 cases

> 1,016 deaths and identified more than 15,000

> Surely the testing is a huge factor.

No, you can not be sure at all, especially since it is well-known that hospitals have limited capacity to treat pneumonia (ventilators and doctors trained to use them). Get sick when hospital has no capacity to treat you, and you're more likely to die. Death rate will increase very rapidly when rates of infection pass a certain point.

Testing is important, yes, but the real important part is slowing the transmission rate to a manageable level.

> If you could quickly and accurately test everyone in the country today we would know how to isolate and the whole thing would be over very soon.

Only if you can do it more-or-less completely. Otherwise, you're actually prolonging the problem. The reason we want to slow the transmission of the virus is to keep life-threatening cases at a reasonably low rate.


Surely the testing is a huge factor. Test more people you'll find more people infected, so the fatality rate will get smaller. If you're like the US and test very few you get the huge fatality rates we saw in Washington.

Uh, yes, South Korea testing lots of people shows the overall fatality rate given a functioning medical system. It also allows much better isolation, understanding of the progression of the disease, stopping that progression and so-forth. So sure, the Korea rates don't prove Korea has magic dust that cures the problem but shows the Korean model is effective.


> If you're like the US and test very few you get the huge fatality rates we saw in Washington.

Most of the fatality rate in Washington is due to it spreading in a single nursing home. IIRC, it was 19 deaths from that one nursing home.

More vigorous testing comparable to SK likely wouldn't have caught the issue in this one nursing home in time as it spread like wildfire there. Only if the testing had caught the single employee that was the source would it have made a difference.


If testing were a huge factor, we'd expect to see a disaster in Japan, which is doing _very_ little testing. Instead, it seems to be doing even better than South Korea.

I think the masks are more likely to be having an impact.


i don't understand how knowing that you have the virus makes it less likely that you will die from it. There's no cure right? and at this point, anyone with a flu or cold will assume they have it and act accordingly, right?


It makes you less likely to give it to other people. Which makes people less likely to go to the hospital. Which makes the hospital less likely to run out of beds and equipment. Which makes the people with serious cases less likely to die. Which might even be... you in a few more days if you have a case that develops complications!


It doesn't change the actual odds, it changes the perceived / measured odds.

Imagine 100 people contract the virus, 10 develop serious symptoms, and one dies.

In country A, with widespread testing, 40 of the 100 are identified. The visible statistics are 40 cases, one death, death rate of 2.5%.

In country B, with poor testing, only the 10 with serious symptoms are identified. The visible statistics are 10 cases, one death, death rate of 10%.

Again, this is about the reported statistics, not the underlying truth of the disease.


It also changes how people react and what they do.

Right now I see so many people carrying on their life as usual, because they think there aren't many infected people around them. That impression is a consequence of the lack of testing. It's likely that there are quite a few people around them who are sick and spreading this disease, and if more people realized that they'd act differently.

Resources and isolation measures are also directed to places where there are a lot of known infections, but if those infections are undetected very little gets done about them.

The relative lack of testing is a nightmare in the making.


You are correct, though though actually more complex than this.

1. Death from complications takes some time. You won't really know the real numbers until enough time has passed for the serious cases to resolve one way or the other.

2. Treatment makes a difference. Odds of death increase dramatically when treatment is not available.


So based on that Italy’s true infected count is 15 times what they’re reporting or closer to 225,000 cases.


There was a Dr from John's Hopkins on CNBC tonight who said he estimated there are 250k-500k infected people in the US right now.


No it doesn't. But what you ultimately want to know is the real number of infections. Testing is the best way to estimate that number. If you test just a few people you might e.g. miss a large portion that is either asymptomatic or is categorized as having a flu or cold. In this latter case, of course, the calculated lethality is higher than in the former - i.e. if you test lots and lots of people.


> If you could quickly and accurately test everyone in the country today we would know how to isolate and the whole thing would be over very soon.

i don't understand. let's say that tests are super accurate, a negative test result does not mean you won't spread virus in the future. You may have virus the next day or an hour later. tests are important for treatments but i don't think they are effective as a basis for isolation.


There's sooooo many lies being propagated by different governments on the true state of things. This afternoon I watched a live broadcast of parliament in which the minister of health claimed Belgium was doing far more extensive testing than any other country on earth. This at a time when standing instructions to medical personnel are to only test people that are already admitted to hospital because of severe pulmonary conditions. It is impossible to get a test under any other circumstance as all test request have to follow a central approvement procedure and non are approved barring these conditions.

These outright lies are propagated by the political parties that are far more concerned with 'the economy' than with any public health. It is really saddening that his is going on.


The surgeon general just gave a press conference in Baton Rouge with the governor of Louisiana saying we should only test people (or prioritize testing of) people with symptoms. This when we know asymptomatic people can be contagious for days.

The Port of New Orleans is testing embarking cruise ship passengers but not disembarking (!) ones. This when we have community spread in the parish already and have gone from 1 to 6 to 11 cases this week alone.


> we know asymptomatic people can be contagious for days

Although it is technically correct, this is the least contagious way. AFAIK most sick people were near sick persons for a considerable amount of time.

[0] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryo...


Your link is giving a 404. (It looks like it's pasted in twice.) And with regard to the cruise ships, see Question 13 of your linked FAQ.

It seems false positives are a real thing [1] but can we afford even one asymptomatic infected individual that might be a super spreader? In shifting away from containment are we just accepting these?

[1] https://news.ycombinator.com/item?id=22566923


His link had the url twice concatenated. If you remove that part then it works [1]. Here is a google translation of the relevant section:

> Although the possibility of transmission from an asymptomatic person has been reported (https://www.nejm.org/doi/full/10.1056/NEJMc2001468), little is known on how Coronavirus disease 2019 (COVID-19) spreads from person to person. Generally speaking, with most respiratory viruses, people are thought to be most contagious when they are most symptomatic. https://www.cdc.gov/coronavirus/2019-ncov/about/transmission...

That CDC link [2] states that:

> People are thought to be most contagious when they are most symptomatic (the sickest). Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

[1] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryo...

[2] https://www.cdc.gov/coronavirus/2019-ncov/about/transmission...


As to my second point, the Japanese are not letting people disembark cruise ships willy-nilly without being tested as per that link


> There's sooooo many lies being propagated by different governments

Just a question, if I may: how do you know that? Which international sources do you have that justify you releasing such a strong statement?


Over here, the parliamentary debate was streamed publicly. The instructions issued to medical personnel are also posted public.

There were HUGE discrepancies between those 2 sources of 'information', the quotes being added for the former case.

As such I have 100% certainty. I was validated later that night when despite our health minister claiming that 'we have it 100% under control' and our prime minister stating we were NOT going to be moving beyond 'stage 2' for now, a few hours later we moved to 'stage 3' and declared a national emergency.

Now for the speculation: Among those closer and more knowledgeable than me the rumor has it the health sector threatened the government to go public with the real state of affairs in the hospitals and in first line care if they would continue to refuse to take serious action.


I've seen English politicians constantly boast on TV that they've caught it very early and they've done better than anyone in the world...


As a UK citizen I am honestly terrified by my governments response and actions. In years to come I fear it’s going to be the textbook example of exactly how not to manage these types of situations.


I thought that - but then I watched today's press conference with the chief scientific adviser and chief medical adviser. They made some very good cases for not locking stuff down just yet.

Primarily you need to consider the behaviour of people. This is going to go on for a while no matter what we do and if we lockdown people now, by the time we hit the peak they will be ready to give up and go outside again. We need to save the drastic measures for the peak in order to spread the damage out and make sure they are effective. I was previously critical of the government but honestly I think it makes a lot of sense.

We need to consider the effectiveness of measures. Banning all flights into the US from Europe may sound like a grand plan but in reality it's not going to make a big dent and the economic damage is going to be huge. But it sounds good and in the current climate where we're being led by panic that's the plan people will like.


Until today, European airlines were flying empty “ghost” planes because they had no passengers, but they wanted to keep their landing slots.

Yesterday I talked to a colleague who relayed the story of a transatlantic flight this week, where only 6 seats were filled, out of 36 in the section.

I don’t think there’s much remaining travel left to be banned. The resulting economic impact therefore can’t be that big.


>> The resulting economic impact therefore can’t be that big.

The impact on the spread of the virus can't be that big either. My point though is that big flashy moves like banning all flights appear to do very little compared to more mundane tactics. At least based on the info in the press conference I'm referring to the data doesn't support flight bans, banning large gatherings etc.


You shouldn't discount the psychological factor of these things. Today, 1 day after the big move by the US to ban flights from Europe, we're seeing a lot more movement from various governments and states in taking action against the virus' spread. So even though the action itself might not be that useful, it's big enough that it gets people attention and it seems to have moved people across governments into more action.


True but I'd still go back to the UK advice: the virus is going to spread (we aren't going to stop it) so we need to focus on spreading the peak out so we can deal with it. If we force people to make drastic changes too early (well before the peak) then when we actually need them to make those changes (just before the peak) they will be burnt out and won't do it nearly as effectively.


Until recently I would have said the same thing as you, but I'm increasingly convinced that the drastic changes (closing schools, social distancing etc) are exactly what we should be doing to spread the peak out.

The peak is coming either way. Continuing to allow people to mix with each other as normal will make it steeper and more intense.

This article [0] makes the case well.

[0] https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...


I concur.

Boris Johnson looked very tired, but actually - and I can’t believe I think this - did a good job yesterday.

I was thinking after — they’re damned if they do and damned if they don’t.

Many people seem to want draconian measures now, judging from the WhatsApp photos going around.

Then there’s the markets etc etc who want stability etc.

The “any fever or persistent cough = self isolate” was a good call i think.

It takes a lot of untested sick people - potential cases - out of circulation before all hell breaks loose.

It buys time with minimum disruption - many people might take the time off sick anyway if they’re already ill.

Also buys time to implement infra. and org. planning.


> We need to save the drastic measures for the peak.

If you only act when you hit the peak, any measures will be moot. Countries need to act now to reduce that peak and flatten the curve.

But sure, why not letting thousands of Atletico supporters into Liverpool, while Madrid has 1k+ cases. Was it also a "drastic measure" to play a football match behind closed doors?


> "Our aim is to try and reduce the peak, broaden the peak, not suppress it completely," he said.

> "Also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.”

They’re not acting only when the peak hits. They’re staging the response.

More serious measures come in as the number of transmission go up. And that’s all about managing the resources of the NHS over a long period of time.

Introduce lockdown now, sure, you delay the peak. But you don’t spread it out over a longer time period. People will stop caring and start ignoring advice.

The timing is critical.

https://www.bbc.co.uk/news/uk-51865915


I'd suggest watching the government press conference today where the chief science advisor + medical officer explain it. They explain exactly why you're wrong (and I'm more inclined to believe them after hearing them make the case).


One thing I don't understand is how the UK infection rate has stayed so low up until now. It seems to be pretty much blind luck.


They dont test people, its that simple.


Italy got caught by surprise - they only found out that they had cases when a 38 year old (!) walked into an ER with advanced symptoms. Given that this age bracket is not commonly affected by these harsher symptoms it is clear that they had long ongoing community transmission which has now culminated in the current catastrophe.

Germany is doing a bit better in this respect, it took them 1000 cases to 'get' the first death, showing that they have caught it very very early, due to their decentralized testiing system. That said, NPI must be ramped up significantly...

The US is maybe the most troublesome target for this virus in the developed world. A healthcare system that works well for few rich cancer patients is the opposite of what you want for a disease like COVID19.


It could also be cultural. Statements from Italian doctors I've seen said that their patients usually don't go to the hospital unless they really need care. That could've been the same here, people trying to sit it out until they needed intense care. In Germany, even people with very mild symptoms got tested early which helped to track down infections more easily. That also explains the low mortality rate.


> showing that they have caught it very very early, due to their decentralized testiing system

This is why I'm terrified of people that want to centralize things even more in the federal government.

Centralization produces systems that are not anti-fragile.


Germany is counting deaths differently. If you have heart issues and you die due to a heart attack you're not counted as a COVID death. In Italy you are as long as you test positive.


> If you have heart issues and you die due to a heart attack you're not counted as a COVID death

That doesn't seem to be the case - a man from Baden-Württemberg, who died earlier this month, was only tested positive AFTER he was already dead for a few days and counted towards the statistic.

This means your general statement cannot be true.


Sorry, but this is bogus.

EDIT: I do not mean to imply that Italy failed in any respect. Italy has one of the best HC systems in the world.

The only reason this testing aspect worked out well for Germany is a very localized testing system. This type of 'federalism' is now a big issue though, as the gov can't simply ban events - only the states and communes can.


That might actually be more representative, as it indicates how many people without specific co-morbidities die.


No it isn't.


I noticed something else that might be an interesting correlation: available "acute" hospital beds.

I don't have time to do the full correlation, but here's the data:

https://stats.oecd.org/index.aspx?queryid=30183

Select "Curative (acute) care beds"

Scroll down to the Per 1000 population.

Italy: 2.62

Korea (assuming South): 7.14

The list of countries in that table is a good bit shorter than the countries fighting Covid-19, but I think it might be illuminating.

Can someone draw that up? Compare, perhaps, current death rate by country with available "Curative (acute) care beds" per 1000?


Shoot...

United States: 2.44

Interestingly, that's 20% lower than in 2000 (3.04)

At least Japan is in an OK spot, at 7.79


> Interestingly, that's 20% lower than in 2000 (3.04)

Almost the exact trend in Canada. I hope this is just a quirk of the data, because we would be screwed for this in 2000, and being at least 20% more screwed means we're extra screwed.

In effect, it seems that in Canada have fewer overall hospital beds per capita than Italy has acute care beds.

We are completely unprepared, and in terms of time, not far behind Italy.


Warning tho with those statistics that are also to be found at Eurostat. Curative (acute) care beds are NOT ICU beds.

They're just normal hospital beds.

example, the netherlands have a total of around 1300 ICU beds (source https://healthmanagement.org/c/icu/issuearticle/organisation...).

the number there is 50k ... which is indeed about the amount of normal beds excluding ICU and other few specific beds.


That is a big factor. And: available nursing staff. Beds aren't enough. You need the right people to operate a large number of patients at the same time.


From what I read, medical equipment seems to be the bigger issue in parts of Italy right now. You can only convert beds to ICU if you have the right equipment. Nursing staff is obviously necessary but that doesn't appear to be the most limiting factor at the moment.


Italy has not yet reached the limit for ICU beds, whatever it is. People dying here is still within capacity, for now.


That disagrees with all the information that has been coming out of Italy for the last three days.

Perhaps because hospitals there (and in general) are always running at 80-100% capacity, so it didn't take much for the extra COVID-19 cases to max them out.


Indeed most EU ICU services are already usually running at around 90% with the usual issues (including the Flu). And please also do consider that most of theses cases are within the Lombardy region and that most ICU patients are very difficult if not impossible to transfer safely to other regions. While the ICU beds are limited, the amount of ambulances equipped with ICU equipment is probably even smaller (and will also require an ICU nurse+doctor on board during the transfer).


And then there is looming material shortage.

For instance, in my home town (Kraków, Poland), hospitals cancelled planned procedures yesterday - not due to the amount of COVID-19 patients itself (Poland still has double-digit number of reported cases), but because the hospitals run out masks, gowns and gloves. Which means that once coronavirus patients start appearing, things will get really ugly real fast.


I guess you mean the total national capacity, not the local capacity in the most affected towns?

Symptomatic patients are probably not going to be transferred over long distances, right?


This outbreak is a litmus test for the competence of countries. It's already shone a bright light on the fragility of global supply lines, cheap travel and open borders. These are the aspects of life most likely to change after this is all over.


>These are the aspects of life most likely to change after this is all over.

People will forget about this in a year and go back to life like it's always been. Short term convenience trumps everything except short term negative consequences.


No. I remember 9/11, and this feels worse. The world won’t be the same for a decade. Are you too young to remember when you could just walk straight onto a plane without being searched? Those days never came back.


From now on, a serious pandemic will never be some weird future scenario ever again. It will be a politicized issue.

We are seeing a real pandemic - something that has been the stuff of Hollywood movies for most in our generation. Maybe it's comparable in some aspects to the only other WHO-official pandemic: HIV/AIDS.

But this has an order of magnitude more impact on the entire planet and societies as we know them.

The stock markets look like load test graphs I see in Grafana every day. Steady ramp up and then after 90 minutes boom its over back to 0.


America is still not the same. I'm not talking about airport security, although that's a minor, minor difference. I'm talking about the government, the society, the culture. The terrorists won on 9/11 and they've been winning every day since. America is not a free country, if it ever was. The surveillance state has been ramped up. The police state has been ramped up. Wars have been ramped up. We started a war with a completely unrelated country and killed millions. Life for most citizens is absolute shit, barely making it by.

9/11 was not just a battle. It started a war the terrorists have been winning ever since. That's probably why there haven't really been any major attacks since then. Why try to attack America when us idiot Americans are attacking each other and bringing down the empire ourselves? The terrorists are just watching with glee.


The American ideal was land of the free and brave, and the writing at the Statue of Liberty welcomed poor refugees. But now Stephen Miller sits in the White House and is whispering Nazi ideas into a senile infant's ear.


I remember 9/11, saw the second plane hit with my own eyes. Other than airports and flying being more inconvenient nothing fundamental really changed as I saw it. People still traveled, people still flew and so on. Now you just budget an extra hour before a flight.


Geopolitics has seen massive impact since then. For example, the rise of ISIS is a direct descendant of the Iraq war which is a direct consequence of corrupt and criminal decision making by the Bush/Cheney admin in response to 9/11.

Debatable if the Arab Spring would have occurred without it, as the Middle East might have been much more stable.


Hear hear. And war refugees entering Europe is causing right-wing populism to rise (not that years of stupid austerity polcies was helping).

Would Brexit have happened without 9/11?

There's an ancient TIME article I have in my archives highlighting how the Dubya admin ignored Clinton's intelligence team's attempts to hand over info about the threat of a terrorist attack in the US. Would 9/11 have been prevented if Gore had won 2000? God damn hanging chads and rigged elections...


Sure but the comment I responded to wasn't about geopolitics but daily life changes.


Because geopolitics does not change daily life? Damn, you should see some geopolitics where I live.


Pretty much the US just introduced the security measures other countries had had for years before.


The TSA has been proven many times over to be totally ineffectual security theater - theres this popular report from a few years back that the TSA has a 95% failure rate when their measures are tested[1].

It doesn't go anywhere because there is now a lot of private industry in it for contract money to supply the spectacle whom have the lobbying power to keep it in place, but it is a total waste of money and gross violation of privacy for no positive benefit to society.

[1] https://www.huffpost.com/entry/tsa-fails-95-percent-tests-ho...


Ok, I misspoke : the US introduced less effective security measures than other countries had before.

In particular you'll see other countries focus on measures like interviewing (briefly) the passengers as they board.


> I remember 9/11

It's not the same stuff! Terrorism is backed by people actively wanting to harm other human beings, while the appearance of a new dangerous virus is a random process.


I think more of the 2004 tsunami.


I can imagine that the one thing people will remember is stocking up on supplies.

Expect even emptier shelves way earlier when the next epidemic comes.


People stocked up supplies all over Europe when Chernobyl happened. This is not what we remember most. What we remember is "nuclear is dangerous". Some countries decommissioned their own power plants and didn't build new ones anymore. Example: Italy.

I'm sure that if everything ends well I'll remember being at home for a few weeks. I'm sure this is going to be a major turning point in history (more than Chernobyl and 9/11) but I'm not betting on what's going to be the direction it takes.


Sometimes, I wonder if even that last part is the case. A lot of people do absolutely insane things for short term convenience.


In a year, it might still not be over.


Not for something this big, and for something that won't go away for 18 months MINIMUM


Re cheap travel and open borders, Jiangsu province, China is 300 miles from Wuhan, has 21 active cases, 610 recoveries and 0 deaths and presumably cheap travel and not much borders to Wuhan. On the other hand the US say is expensive to travel to and has a leader that goes on about closing borders, 2000 cases, 41 deaths and rising rapidly. The difference is competent policy not borders and cheap travel.

I'd like to hope, wishful thinking here, that there might be a trend towards requiring more scientific competence in our leaders going forward.


> It's already shone a bright light on the fragility of global supply lines, cheap travel and open borders.

Are you serious? Those are the things that have given us so much prosperity in the last decades, and indeed no government has dared interrupt the flow until it has become unavoidable due to major national heath danger.


Which is a major failure in risk assessment. You know, that thing capitalists are supposed to be good at.


IMHO one consequence will be death of neoliberalism (started with Reagan/Thatcher but going philosophically to Hayek and Friedman). It is quite likely that U.S. will nationalize health care as a response to this crisis. But more broadly, the idea that government is a useless economic actor and shouldn't dictate economic policy will become laughable in the response to the crisis.


> It is quite likely that U.S. will nationalize health care as a response to this crisis.

If you think half the country infected with a virus and a million deaths is enough to topple a several hundred billion dollar insurance racket that has endured for over half a century exploiting health and wellbeing for profit...

I wish we would get single payer out of this, but the plague of greed in medicine is way too deep to be excised in a few months from a regular old viral plague.


I think you should stop saying it is impossible. You know, billions just vanished on the stock market.

If enough people will believe that it is possible to change, it will change.


I agree although the racket is more like a trillion. It is not just the insurance (payors) but also all the brokers and other rent seekers. I think there is 0% chance of nationalized health care in the US. Look at Obamacare; it didn't really work and took forever to get passed and most of the regulations have been rolled back. There are other things that I think could fix our health care and actually get passed and stick but Medicare For All isn't it. Too many in the US associate socialism with communism and think it unfair.


That mindset is a bit self-defeating, isn't it? I wonder if people thought we would have public schooling in the country 150 years ago, or that blacks could go to school with whites 100 years ago. Or that Germany would be the largest economy in Europe as a democratic republic, 70 years ago.

Things take time.


Do you remember ebola? I don't.


You are referring to the West African Ebola epidemic that started in 2014. There is also an ongoing outbreak in the DRC that started in 2018. That probably isn't receiving much international support right now.


Ebola never got to America.


I am not American, and there were infected people in my country. We had a right wing government then also, and since all the media is left wing here, they made an incredibly huge deal out of it. And now nobody remembers a thing.


Ah sorry, forgot we are not the center of the universe as usual.


It's been making the argument that Korea's aggressive testing has allowed them greater control over the epidemic.

Of course, there are a variety of other factors at work. Italy is the second "oldest" country in the world after Japan so Coronavirus infections just would be more deadly there. Also a lot of the Korean infections were confined to a single city in Korea (though the Italian infections also had an epicenter).


If Italy is the second oldest country in the world after Japan, how do they have 800 deaths compared to 16 in Japan? Something about those numbers seems off. Is it because Japan's elderly population tend to live in rural areas compared to Italy's or something else societally related?


meh. I've been married to a Japanese for over 2 decades now, and lived in Tokyo for many years including when Fukushima happened. I wouldn't trust Japanese politicians with their reported numbers any more as I'd trust China or the US.

There is one difference in Japan to Italy that might explain the lower infection rates: it's socially accepted to wear face masks (not only since covid but since the 90ies actually!)


Even if the numbers aren't reliable, reports of Japanese intensive care units being overrun aren't easy to hide, but Japanese hospitals don't seem to be under the same pressure as hospitals in Italy.

Making mask wearing more acceptable might be a cultural adjustment humanity has to make as we become more urbanized and globalized if it'll help reduce the severity of disease transmission. Looks like Japan's stumbled onto a very useful societal adaptation.


Japan's problem is a bit different -- it's estimated that there are 30+K old folks dying unnoticed in solitude every year (Kodokushi) in Japan, even without the Wuhan virus. As cynical as it may sound, that may be why Japan doesn't even bother testing their citizens for the virus.

https://www.nytimes.com/2017/11/30/world/asia/japan-lonely-d...


Japan has a lot of intensive care units. I guess it comes with having a generally older population.


but not compared to other developed countries (except England):

          [1] [2]
  Germany 3.7 24.6
  France  3.3 9.3
  England 2.7 3.3
  USA     2.4 20
  Canada  2.4 13.5
  Japan   2.2 4 to 5
1. Ratio of physicians to patients (per 1,000 population)

2. Number of ICU beds (per 100,000 population)


Where did you get these numbers? I’m fairly certain I’ve seen Japan being ridiculously high in these numbers before.

Edit: Never mind, that was total number of hospital beds. The number of ICU units is really small.

https://link.springer.com/article/10.1007%2Fs00134-015-4165-...


Do you have a source for those numbers? They differ significantly from https://stats.oecd.org/index.aspx?queryid=30183, but perhaps your source is more reliable.

Edit: nevermind, I misunderstood the definition of "Curative care (acute care) beds in hospitals".


Now that you understood it, can you explain what the difference is? It's not obvious to me either.


FWIW. My wife is Japanese and I lived in Japan through Fukushima as well.

A lot of people seem to think that Japan must somehow have a higher infection rate but I haven't seen any evidence that this is true.

For all the docileness of the mainstream media and the lame-duck politics it is a free and democratic society. The government couldn't hide a mass outbreak of corona virus anymore than it has been able to hide any other scandal. In fact almost certainly less given the levels of public interest.

The Ministry of Health and Welfare publishes updated statistics daily (https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_... -- in Japanese). looking at the current stats published there's not really any obvious problems. They're seeing about an 8% positive rate on corona virus tests and 1.8% of those with confirmed infections have died. This is well below the rates seen in Iran, Italy, America and China suggesting they've been relatively thorough in catching infections, although less so than South Korea.

In truth the Japanese healthcare system is probably the best in the world at providing population level care. Since long before Corona virus standards of hygiene have been very high. Masks and hand sanitizer bottles have been a common site for a long time, hand washing and gargling is heavily encouraged, and direct contact (hand shakes, hugs, back pats .etc.) is very restrained.

Whats more for all the criticism it copped the Japanese government has been pretty decisive in responding to corona virus. It's shut down schools. It's shut down public spaces (museums, libraries .etc.). It's discouraged crowds. It's encourage working from home. It's restricted travel from hot spots. It's isolated those with infections. Also most age homes seem to have gone into lock down weeks ago.


Japan for whatever reason has a pretty low testing rate. It's impossible to know if that is a confounding factor or not at this point. Their infection count/death count and test count are remarkably similar to the USA.

https://www.vox.com/science-and-health/2020/3/12/21175034/co...


I'd speculate that Japan isn't in the situation of the infection getting out of control.

But none of posts should be construed as "Joe's complete model of Coronavirus dynamics." There are many things we don't know and can't predict. My main argument is every country needs much testing and much surveillance of the situation - IE, the Korean model is good, that is all.



I'd be surprised if 57% of Japanese men washed their hands properly, judging by what I see when I'm in a mens room in Japan.

I'm inclined to go with the other comment nearby that says not to trust any figures coming out of Japan as a better explanation for the disparity.


That, and Japan's first recorded infection was almost two months ago.


Korea had people actively (hard to believe, I know) making things much worse. But they didn't downplay it for the first two weeks after the virus took hold. With these exponential issues time is everything.


Yup, Korea's Patient #31 made things a lot worse, or else they would be doing much better right now.


For others wondering about the story behind Patient 31, here’s an article with a timeline: https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTER...


not sure if i missed it but did patient 31 recover?


No, she hasn't recovered and still under observation according to the ongoing briefing from DaeGu (10:30AM KST, March 13)


Would you be able to explain what did they do?


"Of the 152 cases [article dated Feb 21] that have been found in the city, the majority have been linked to a [church], where Patient 31, a woman said to be in her 60s, is known to have attended at least four services before being diagnosed." https://www.independent.co.uk/news/world/asia/coronavirus-so...


As of last night the number of cult-linked cases was "more than half". So > 3500. It turns out that in addition to worship services teice per week a lot of the cult members save money by living together. So even though worship has been stopped for nearly a month, new cult cases are still being reported.


Went to two massive church gatherings while advised to isolate, gatherings with 1000 people.


I'm curious if something like this can be considered criminal. What if the mortality rate was higher? If the mortality rate was 100%, ethically would this be murder?


It can be. There's a criminal investigation of the cult's leadership ongoing.


It's not really a church. They're a secretive society of church corrupters spreading false teachings.


From what I've heard, the Sincheonji church had a long tradition of sending followers to other churches, hiding their identity, so that they make a lot of friends there, start small clubs and bible studies, and eventually convert them into their own church. (I even heard there were cases when they converted a pastor, winning over a church wholesale, though that might be a bit embellished.)

The problem was so bad that, even before the current epidemic, other "regular" churches had a sign saying "No member of Sincheonji is allowed in our church." So, yeah, not exactly your garden variety Christian church.

When you think about it, this behavior would make Sincheonji a perfect vector for spreading the virus. And that's what happened. Yikes.


I mean, let's not throw stones when we live in glass houses. Pretty much every religion teaches that the others are false teachings.


If there are thousands of people, are they really that secretive?


They have over 200+K members now, but they are secretive in that they don't identify themselves as such when they recruit other church members.

Or worse, even after the outbreak, some didn't reveal their affiliation with the cult. In one instance, a dude leading Daegu city's outbreak management team, didn't reveal his affiliation with the cult until after test came positive and coworker were also infected. They also refused to give names of their cult members, even as most of new Wuhan virus cases were linked to the cult and the gov't actively sought their members for quarantine.


Now you’re just being intriguing... I have to know now.


All religions spread false teachings.


I think there's some hints she might have caught it from the church gatherings rather than the other way around.


I think it was on purpose,part of a doomsday cult.


oh now I am .curious what that person did?


Went to church. Twice.


And a buffet brunch!


The buffet brunch was especially egregious because she came from the doctor's. She chose the buffet instead of getting a coronavirus test as the doctor suggested. And then she went on to a sermon.


age is correlated, not causal. there are simply too many other factors.

a generally compliant national attitude, combined with aggressive testing, and community-orientation probably had as much to do with south korea's success so far.


> Italy is the second "oldest" country in the world after Japan [..]

By median age Germany is actually older than Italy, though. Not sure how age really correlates here.


Per https://www.worldometers.info/coronavirus/coronavirus-age-se... the number of deaths is very strongly correlated with how many are 70+.

Median and average don't matter. Density of senior citizens does.


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