Ioannidis says: “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”
The Diamond Princess data shows deaths with a functioning health system. From WaPo: “a doctor at Papa Giovanni XXIII Hospital in Bergamo, where he said there are 500 patients in need of intensive care and just 100 ICU beds”. The deaths in Italy are often due to an overloaded health system, which can easily double the number of deaths. Why ignore that? Italy has 6000 deaths already with 1/5th the population of the US:
you need some powerful evidence to assume the US should expect to have a different path to end up with a total of 10k (by say the end of the year).
I think John has good reason to desire evidence based decisions, but sometimes you have to make decisions without enough data and change your game as it develops e.g. look at what effective entrepreneurs do in uncertain times?
Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's? Where does the idea of 1% come from? Both of those numbers sound ridiculously optimistic to me. Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors?
because everyone on the diamond princess was tested. So we know for sure how many cases we are dealing within the sample.
~0.3 and ~0.9% are also not optimistic guesses but the current numbers for Germany and SK. Italy sits at 9%. So the situation is either that Italy is vastly underestimating cases, or Germany and South Korea have lost a magnitude of corpses somewhere. I find the latter less likely than the former.
South Korea's naive case fatality rate (CFR) is already 120 deaths/9037 cases = ~1.3% today, gradually going up from ~0.5-0.6% a few weeks ago. Why? People in a functioning healthcare system take time to die and these people were infected during an expansion phase of spread which rapidly increases #cases (denominator).
SK's cohort CFR is even higher. More properly, we should use the infection number from 3 weeks ago because it takes 3-4+ weeks from exposure to death: 120 deaths/4335 cases = ~2.8%
Germany's current naive CFR at 0.4% will also rise in a similar manner for the same reasons. (You can bookmark this.)
South Korea has the 2nd highest number of hospital beds per capita in the world and 4 times the US number. Germany: 4th and almost 3 times.
South Korea's and Germany's hospitals were never overwhelmed in the same manner as Italy's. A major reason Italy's fatality number is so high is because doctors there cannot save everyone anymore.
But the denominator in this formula strongly depends on who and how often you test. In other words: You don't know the number of cases.
Obviously, people who are severely affected are tested more often. People with mild or no symptoms might never be tested, even if they want to (I'm not sure about South Korea but for sure this is happening in Germany).
Based on people in the German parliament and the German soccer league, you can currently guestimate that 1% of the population is already infected (1% of the parliament and 1% of the premier league players are infected. I suspect that they are tested more often and even without symptoms. Maybe they have more contact to other people - maybe not).
Yes, this is a wild guess, but much better than taking the confirmed cases which are heavily biased towards people where the infection causes problems.
Credible estimates of IFR from noted epidemiologists I've seen are around 1%, assuming that the healthcare system still functions, and much higher otherwise.
COVID-19's CFR & IFR might not even be the biggest problem. High rate of hospitalization and broken healthcare system, with all their ramifications, could be considered even worse.
If the Diamond Princess age group represents just 20% of a population (they are not all elderly), population IFR must be >= 1.4%/5 = 0.28% and likely higher. 0.28% is above the IFR upper range from the paper in your comment.
“Estimated fatality ratio for infections 1%
Estimated CFR for travellers outside mainland China (mix severe & milder cases) 1%-5%
Estimated CFR for detected cases in Hubei (severe cases) 18%”
By the MRC center at Imperial College:
Up to 8 weeks though I haven't found typical distribution/median. The increase in deaths might exponentially grow for a while after new patient load stabilizes.
Edit: Also, Germany does not test dead folks for coronavirus while Italy does. Further, SK death rate has gone up to 1.3% (0.9% is an old number) and many more are in severe category. Thus, the sub 1% numbers seem more like the outliers than the above 1% numbers.
Given all that they still had 9 deaths out of 712 infected with many still in critical condition.
based on what?
People with advanced COPD etc are everywhere but can walk short distances etc and prefer cruises to schlepping through airports and whatnot.
Knowing people who go on large long cruises they tell me they've never been on one where they didn't have at least one death. Indeed I know people with serious health issues who go on these knowing there is good on site medical care at hand.
This means you can’t simply look at the average age to estimate risk factors. Still a 2% risk of death per year x 3000 people = 1.15 deaths per week ignoring crew. In other words what you’re describing is still a fairly heathy population.
Except those higher odds of death are strongly associated with major heath issues. So, simply excluding the sickest 5% of the population makes a huge difference in survival rates.
That also seems wildly optimistic. 80% seems like a more reasonable assumption than 20%.
Also - 99.9% of those patients (pulled out of a hat) wouldn't have access to health care because the capacity was already overwhelmed, so the death rate will jump markedly.
If you are not in good health at the beginning, you don't adventure yourself 10 hours+ from your home.
So this group is likely in better shape than average population.
Considering how quickly the numbers get worse with age and ill heath many countries are at higher risk.
Fine numbers in the presence of a health system that is not overloaded, or a country that has managed to make effective changes to prevent transmission (how did they do that without science huh?)
By John’s numbers (0.3% die and 1% of population) Italy should get a total of 1800 deaths. Yet Italy is at 6000 and rapidly rising - using real numbers his assumptions are already wrong for a first world country that is a few weeks ahead of the rest of the world.
And why the fuck does he assume 1%? Because some actions have been taken? What actions can be taken since by his own words we lack evidence to make decisions...
Edit: by my calculations the US has 800000 cases at the moment (compared to ~40000 tested positive). 500 deaths with a 0.5% death rate, so three weeks ago there were 100000 cases, but it will have doubled 4 times in 21 days so there is now 800000 cases (already 0.2% of population). Three more doublings (easily realistic) beats John’s 1% within weeks. Ironically, going with his low mortality rate (0.025%) would mean US has 2% infected already...
Just highlighting this bit of the parent’s post. If you want hard evidence that COVID-19 is quantitatively and qualitatively different from other coronaviruses that, as John puts it in his article, “actually infect millions of people every year”… Italy is it.
If it was entirely based on age, you'd expect higher rates of death in Japan and Germany (both very elderly populations), lower in China (less elderly population) and much lower in Iran (young population).
Up until recently people hospitalized in NYC has had access to doctors and equipment, but NYC hospitals are already on the verge of being overwhelmed, and the crisis is just starting there. 2–3 weeks ago the “CFR” (i.e. deaths to date divided by known positive cases) was also very low in Lombardy.
The mass social distancing interventions they have undertaken in NYC should hopefully start kicking in, and we can all hope that the situation doesn’t get as bad as Lombardy, but in the mean time there are going to be thousands if not tens of thousands of deaths there, and it looks like doctors may soon end up facing choices about who to put on ventilators.
Compare to Germany: weeks behind SK but already more than three times as many cases, new case rate in the last few days of 2500-4500 (SK's max: 851), daily deaths in the last few days 10-29 and heading north. Actually the death rate must reflect an amazing health care system given 30k cases, but it's early days for Germany. Their pipeline is very full, agreed I wouldn't want to make a prediction there.
One of the main effect of that action (apart from slowing down spread) was that they managed to keep the virus away from the most vulnerable parts of the population. Look at the age distribution in SK: https://www.statista.com/statistics/1102730/south-korea-coro...
and compare that to Italy: https://www.statista.com/statistics/1103023/coronavirus-case...
German here. I assume the recent hard lockdowns will work out pretty much for us... I'm more worried about the US, this is gonna be a mass die-off, and the Trump government's handling of the issue is... let's say abysmal.
South Korea coped with the outbreak by having a test early, test often strategy, but the German strategy seems to be test eventually, test perfectly. That means that there isn't any process to flag essential workers and others as needing a good proper test. Korea's showed it's better to do a test with a high false positive and even a significant false negative many times a day and get the person out of circulation awaiting an accurate test, than to wait for them to find the symptoms concerning and ask for a proper test.
China coped with the outbreak by having actual curfews. Major lockdowns. The sort we couldn't reasonably expect. When I went to do my weekly/fortnightly shopping yesterday, I saw several police officers looking around into restaurants and on the local town square. Not hard to hide from. No-one cared what my business was.
Italy still hasn't really peaked. They did this test-free lock down strategy that Germany is doing. Apparently the amount of intercourse required for viral transmission is ridiculously low.
There's already tens of thousands of sick people here, and the government was very lethargic in their response. The peak will be huge. As I mentioned before, they gave up after Gangelt and seemed to act as if the whole thing would be minor. It took weeks after discovering a major problem existed that needed hard work before German authorities actually agreed to do hard work.
Learning lessons seems to be really hard for authorities at the moment, and I'm genuinely worried. It's like even ideas are subject to the European protectionism - better import a bad idea from Italy than an effective one from South Korea. My goal is to not get ill before there's space in the hospitals again, because any other goal seems unrealistic.
Germany just lost control last week, so I expect a lot more death starting next week.
Hopefully Germany's plan of isolation will reduce the spread enough, but we will see...
We must stop confusing the outbreak of diagnoses with the outbreak of cases. That's the mistake every government agency in the West has made, and it's why it spreads faster and better in the west than in South Korea or Taiwan.
While virus is actively spreading, taking "current death count / current total infected", can easily underestimate mortality rate by 5-10x because it takes quite a while from infection -> death.
Edit: now 1.37%, up again since I checked a couple hours ago.
The same rise in death rate was observed way back when SARS happened. At first people estimated death rate at 2-3%, and it was continually revised upwards as cases resolved.
Policymakers should use conservative estimates to be careful, but we still just don't know how deadly COVID-19 is.
I can't see the slightest basis for such an assumption. This an extremely infectious, quickly spreading disease. 30% of the US population seem like a more likely estimate.
SK has a 1.3% fatality rate at the end but that was with a functioning health case system. If even 1% of the US population get infect, the health system won't be function and you'll have a higher fatality rate.
Ioannidis addresses this in the article. Extensive community spread is actually unlikely to be the case for this virus, epidemic development is hard to discern from simply increasing rates in testing and sensitive populations seeking testing, and maybe most importantly there is little evidence that lockdowns and other extreme measures have significant impact on reducing this sort of respiratory infection, he cites this paper. 
" The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children.[...]Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure."
The lockdown in Italy has, thankfully, seemed to limit the virus to sublinear growth, using the very small sample of the past three days.
The question remains however why we ought to treat concerns about data about the virus different than concerns about data about the response to the virus. Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years?
It seems ironic that people critize Ioannidis for a sort of first-order error in thinking by not considering uncertainty. Yet causing damage and applying first-order thinking to disruption of global supply chains that likely will drive entire nations into deep recession and instability is apparently adequate.
Yeah, and if any of those other viruses caused a world wide pandemic, I missed it. The article is a specious disaster.
Why do we treat the virus like a black swan event, but not the unprecedented response of shutting economic and civil liberty down to a degree maybe not seen in 100 years?
An extreme provokes an extreme response? Of course?
Human lives are more important than economies. And economies can't function with massive loss of life anyway. Even more, this is a massive exogenous shock. Once it's done, the various players can pick up the pieces. Until then, it should be treated like a war. Society trumps economics (hopefully, otherwise both are headed for disaster, 1 million deaths+ was the Imperial College Report estimate for what happens if the US does nothing).
They do actually. Several of the outbreaks studied among the papers were influenza pandemics, coronavirus pandemics, and SARS. (page ~110-120)
This rhetoric you're starting here about bringing out the war drums to fight invisible enemies is exactly what Ioannidis is afraid of. It is not scientific, it is not based on evidence, and it does not, weigh the tail risk of a global economic breakdown. Which may, in fact, be literal war in some places.
There is a trade-off between the economic effects and response to the virus. It is not a binary question.
Science is a means of discovering the most likely state of things and an always uncertain one. Other human institutions have to come into play when it is necessary to act. Those institutions make the trade-off rather simply calculating them. In the current context, the institution of a war is appropriate (more appropriate than all the semi-wars we've had over the last 50 years in fact, better than "war on drugs" or "war on terror"). We confronted by tiny semi-living creature that happens to be very good at killing us. We should band together and engage in unified, determined action to protect ourselves.
As far the economy goes - the economy is a phenomena of society. The productive machinery should kept going as much as practical and the entire process managed by the government, essentially a machinery akin to WWII needs to be in place for the duration of this. Such war measures kept things running at that time and there's little reason to think they wouldn't work today. Now, as far as lots of people losing their investment. Well, sorry, investments aren't life. This, in a sense, very quick trip from 1929 to 1948 for y'all.
I’ve read from various sources influenza cause multiple hundred-thousand deaths every year.
Both could be true. For example, Germany doesn't systematically test dead old and/or hospitalized people for Coronavirus infections while Italy apparently does. Germany has more resources to test potentially infected people than Italy, where all resources are needed for treatment of the hospitalized cases.
In reality, both Italy and Germany will have infections in the 100.000s, most of them with mild or no symptoms.
This is a much more likely factor than the idea that Germany and South Korea are somehow 10x-30x more effective in testing their population than Italy.
Germany is at 0.42 and South Korea is at 1.24 now that more diagnosed people have had time to die.
Outside of Hubei and after the peak, sure.
Just look at the lag in China’s rate of infections vs deaths. They had 22 deaths on March 8th and 40 new infections. Further, new cases drops off vastly faster than infections with the sickest talking longer to get better and staying at risk of death for weeks.
There is a third possibility. False positive tests: Germany and South Korea may have less cases than they think they do.
Obviously not true
False positives are always possible in practice even if they aren't possible in theory
Get a bunch of tired lab techs running tests 24/7 and one of them will accidentally write down the wrong result at some point
Moreover it is statistically irrelevant, that would maybe account for 1%, but only if they would only note false positives.
Have you got a source?
Exactly: why all this focus on deaths, when sickness rates are massive and are sure to have horrific long terms outcomes for more people than those that die. Intensive care strongly implies bad things are happening.
John Ioannidis has been a fabulous force for good fighting scientific fraud and misinformation. But clearly he doesn’t know what effective decision making looks like. It usually doesn’t look very academic in my experience! edit: I mean decision making in an emergency (we did have two months to be proactive, but now we have a reactive emergency).
This has to be even more true with flu. If somebody had lung problems and the flu season makes things worse and she ends up dying, the doctors are not normally going to test for flu. And the cause of death is not going to be "flu".
What I am trying to convey is that both numerator and denominator of the death ratio are very noisy since they depend on who and when is tested.
I have been trying to understand for a few days how the numbers are really counted for COVID-19. And again, it pretty clear that we do not have the real data for a "normal" flu either.
So for now my understanding of how bad COVID-19 is compared to "standard" flu has been largely inconclusive.
One thing though started getting clearer. COVID-19 is a virus with no vaccine. I have largely underestimate the importance of immunizations and being in a good health. Now I started to picture more and more that without a way to keep our immune system alert against the viruses, we will be greatly screwed almost every year because the demographic at risk would inondate the health care system in a way that they cannot cope.
In this case now, you don't need that: the hospitals in Italy know for years how many new cases they get. Now it's like 50 times more cases that need hospital, and 50 times more dead.
It can't be anything but something completely new. If it's not a new virus X it must be a new virus Y as dangerous as X. But we know there is a new virus X. Old viruses simply had totally different need for hospitals:
In Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. The same with a need for the beds in the intensive care units.
And all the low CFRs he cherry picked have now increased dramatically.
Two weeks ago Italy had 463 deaths, and it now has 6000. I'm not convinced the US containment measures have been quick enough or effective enough to be significantly better than Italy, so I'd expect 10k deaths in under 3 weeks.
How orgs mess up handling complex problems, which they are not prepared for, or have the capacities, or time to handle has been studied ever since the second world war scientifically.
And science comes up with the concept of Bounded Rationality.
Which says if an org doesnt have the mental capacities, time, resources or the problem falls in a certain class of complex problems then whatever solution the org comes up with will be half baked.
And half baked solutions create their own issues and the cycle repeats creating a cascade.
Secondly when orgs Choose or are Forced to do something about problems above their capacities and naturally fail, they get blamed, they get defensive and react causing counter reactions which again produce a cascade of issues.
What gets lost in that blame game trap is everyone forgets that no one can solve the problem.
Bounded Rationality and more modern iterations of such theories suggest a simple solution - Pick simpler problems.
Reality and emergent behaviour throws us complex problemS (like a novel virus), so how does that advice help?
How people deal with that fact (or dont) is important.
The current response/reaction to that, is to blame/replace leaders/find false messiahs/feel good narratives/distractions etc but all that doesn't reduce complexity.
It doesn't require everyone to agree on what our collective and individual limitations are but just to focus on limitations of those we don't like.
Its a trap and what the theory says is it wont matter what people do in response to crisis when they are stuck in that trap.
Orgs do a bunch of things to create conditions where groups/factions don't get carried away by blindness to their own limitations. If you are interested in the subject start with Herbert Simon's books.
For anyone wondering, this quote is from  and doesn't appear in the linked article. I think the linked article is better worded and more nuanced.
> I think John has good reason to desire evidence based decisions, but sometimes you have to make decisions without enough data and change your game as it develops e.g. look at what effective entrepreneurs do in uncertain times?
I think comparing the measures that governments take with what effective entrepreneurs do is misleading for two reasons. First, for a country there is no single bottom line: a good balance has to be found between low mortality, good quality of life for those that do not die, and economy (which can be tied into the latter, or it can be independent if the government prioritises the wealth of a minority). Success of a company is mostly measured financially, or perhaps by visibility.
And second, the stakes are a lot higher for governments. They cannot fail and disappear if the measures are not a success. If they fail, human consequences are massive, but the country still exists. If entrepreneurs fail, the company might go into bankruptcy and disappear, but the impact is mostly financial. On the one hand this means that the risks can be acceptable if the consequences are only financial, and on the other hand this leads to a certain selection bias -- the successful entrepreneurs you see are ones that take risks and act decisively, and were lucky enough that their risks paid off.
How does he know that this is not happening? It's been published for Sweden that they now moved to use "Sentinel tests" to track the spread of the virus (https://www.thelocal.se/20200320/fact-check-has-sweden-stopp...). This might explain the reason why the Swedish government is still quite relaxed. However, I would be very surprised if other governments would not be doing the same. Maybe this is the reason why governments really increased the response, because they are acting on this data.
* Lower amount of population with High blood pressure.
* Lower median age.
* Not having the same one big family model as in Italy.
* Seeing how bad it can get in Italy and having a better response as a result.
Like his argument for the R0 being near 1.3 is just that it's "probably" the case.
At some point we need to be able to call the data we have good enough for making decisions.
A R0 of 1.3 with an incubation time of 1 week would not lead to the doubling of cases in 4 days. The whole thing is a crime against math.
I think calling that doing nothing is pretty generous. Since you disagree, what measure that he's proposing did you have in mind?
This is key — these countries were able to avoid lockdown by testing and tracing early, before the case load became unmanageable. In the US, we’ve missed that opportunity
We're a few days away from Korea's testing capability, if we haven't already matched it.
I think southeast Asia in general handles pandemics better. The people know how to respond and do so more quickly than Americans. Wearing masks, not going on spring break, etc.
According to , more than 290,000 Americans have been tested for the coronavirus (close to 1000 per million people) and in Washington and New York, over 3000 people per million have been tested.
What is South Korea's testing capability (tests per week)? They've had several weeks to get a lead in absolute number of tests performed, but if they've only done 6000 per million people in all that time, we've probably matched them in testing capability.
You don't need "evidence" of how many are actually infected or what is the correct R or CFR or which way it spreads. Just look how it's impacting the local health care system. If it exceeds the capacity by X % that's how big a problem it is.
Perhaps you want to reconsider your news sources.
Ok, let's look. There are 1175 serious/critical cases in the US . I assume all of them are hospitalized, and mild cases are asked to stay home. There are 900k plus total hospital beds in the US, and 132K ICU beds , resulting in the current COVID demand from hospitals to be between 0.1% to 1% depending on how many of them need ICU beds. What am I missing? Before I am accused of not understanding exponentiation, I am all for prepping, but much alarm is about how we are already running out of capacity.
Accordingly, world leaders are being judged based on their ability to contain the spread rather than prevent economic devastation.
As a society we are faced with navigating the delicate balance between how many lives we put to risk vs how much economic turmoil we can tolerate.
With so little data on the latter (economic crashes absolutely can lead to deaths as well), it feels like we aren’t equipped to make educated policy decisions on how far we should go to limit the spread.
I hope after all this we can create a more cohesive playbook for navigating these tradeoffs in the future. Many of these public health orders feel like knee jerk reactions lacking evidence.
Better to err on the side of caution I suppose.
All that said, part of the collapse of things like the stock market comes through the financial system having been built up into finely tuned but extremely fragile edifice - end QE created an environment of limitless leverage and short-term thinking. This environment created the situation of not having future resources, of jury rigging everything to work in a super-efficient but fragile fashion (the 737Max being a perfect product of this paradigm).
Covid shock is logical result - in another, a more far seeing society might have made preparations beforehand, had an epidemic team in place, etc.
So a lot of things are collapsing because they weren't built to last to begin with, not because of the virus.
I think this is almost the literal definition of the economy. I've been shoveling my entire life and eventually I will die.
I mean I want to agree in principle, but this is just an incorrect statement. It's a matter of what is a good-enough tradeoff of risk and reward. If you make people drive to work, some will die. If you want to mine lithium, some people will die in industrial accidents that wouldn't have died if you never built a lithium mine. If you are only willing to accept 0.000% risk, then we have to respond with a full economic shutdown whenever there is a flu outbreak, or even a common cold outbreak, because people will die if we don't stop the spread. All economic activity leads to deaths, most of the time the deaths are less obviously linked, and at a much lower rate, so we don't connect the fact that people commute to work in trains, and so the economic activity they are commuting into work to engage in directly causes their death in the form of the flu, train crashes, pedestrian accidents, and so on.
There is also a question of net lives lost, or harm minimization. Economic activity also leads to resources which can be used to tend for the sick and elderly, or better nutrition, or education, and to sum up everything that isn't eating acorns you can find on the ground (except even that is a form of economic activity). I would assume that just letting covid run free would be dramatically worse than shutting down the economy for a few weeks, but then what the endgame is I'm not sure, it really does depend on the death rate in an ICU vs with limited medical support, and the amount of economic harm this causes.
However, I think we can learn a lot from this outbreak. I was very, very embarrassed to wear my filter mask when I went to the store, so I only wore work gloves up until yesterday. Now I'm sitting in bed with a fever wondering whether I'm about to start coughing up blood (probably not, it's still more likely to be the flu). Next flu season (or, sadly, next covid season) I think I will wear my mask, though.
If people start wearing fashionable masks and gloves in the winter, we can virtually eliminate lots of communicable diseases.
This also sounds very short-sighted. Yes, people die in a lithium mine, but in most countries, I'm the one taking the risk to become a miner or not. Understandably, the situation isn't that easy: in some countries, you may indirectly or directly be forced to risk your life for the economy. Yet often, I don't see the physical risk-takers being particularly rewarded for their risk-taking either, with few exceptions. Miners are definitely not one of them. Its a difference between who is taking the risk and who's life is on the line: I don't mind risking my own life. I do mind the government toying with it while a prime minister is sipping tea in his comfy seat.
Reality is, the current economy is maintained through exploitation in one way or another, and its fragile balance is now attacked by a force that doesn't care about our economy. Every time people bring up the economy as an argument, its abundantly clear the people in trouble either can't make a buffer, or don't have the discipline to make a buffer. It wasn't that long ago we were forced to go through harsh winters using the harvest of a possibly failed summer and autumn. Yet today, the economy is in jeopardy if a quarter of all activity is told to shut down temporarily. Why can't make people a buffer? Why aren't people making a buffer? Why aren't governments prepared for this?
Something unexpected can always happen, we're not gods nor do we have crystal balls. In a competent software industry, you'd be summoned for making a fragile software system where traffic stops coming through. Yet now we tolerate the same in regards to our economy. It really is time we take a step back and go on the defense rather than looking no further than 3 months.
Well, not really. Lots of people would fail to prepare and rely on their community, and during times the community couldn't afford to help them, they would starve to death. Lots and lots and lots of people just starved to death. They didn't prepare enough, and then they slowly and painfully died from not eating anything. Lots of rich people said "they should have prepared", but it's hard to imagine what it's like to have to decide whether your children will have to be barefoot all winter, or just not go to school at all this year if you don't decide to sell a few extra potatoes instead of saving them.
A core problem is that we're not looking at how to mitigate damage to the economy. We can handle a month or two of the economy shutting down, no problem. You'll get your new car 2 months later.
Most of the damage is auxiliary: businesses going bankrupt, people defaulting on mortgages, etc. All of that can be mitigated with the right measures.
The economic harm of losing 2 months of production -- or even a year of production -- is much smaller than the economic harm of supporting people disabled by coronavirus for the rest of their lives. That is assuming we mitigate the economic fall.
That is a tradeoff? I don't understand how you are disagreeing with what I said. You are literally spelling out what we are trading off, the fact that its a very good trade (in your opinion, which is based on expert advise and almost certainly correct, but there are no guarantees) doesn't make it stop being a trade. In fact, that is how all tradeoffs work, one option is better than the other so you pick it.
But my hope is we can come up with similarly effective measures (e.g. require n95 masks in public, keeping the elderly at home, offer voluntary isolated infection to low-risk individuals to increase herd immunity, etc) that can achieve both.
(e.g. require n95 masks in public, keeping the elderly at home, offer voluntary isolated infection to low-risk individuals to increase herd immunity, etc)
These "get the economy going" measures are totally nuts. You know 10-20% of even fairly healthy people get pneumonia and require hospitalization for virus. Most young people survive but many of those surviving suffer permanent lung damage.
Further, people between 50 and 65 make a huge contribution to the economy and taking them out for an extended period would be highly costly like all this is highly costly (but quarantine should eliminate the virus so could be even quick). Just much, quarantining just some people would require moving a vast number of people from place. IE, what happen with young people living with old people (as happens a lot). The movement of people from place to place would naturally ... spread the virus extensively. More over, where do you get the extra places for either the young living or the old leaving? The UK talked about plans, true but abandoned quickly when infection began because they are obviously impractical fantasies.
Quarantining everyone is extremely simple and just requires doing what South Korea did but on a large scale.
This is not true. You are repeating misinformation.
http://demo.istat.it/index_e.html (see green section on the right, By Month)
Also the following study from August 2019 (before covid19) shows that Italy has more deaths due to influenza every year than any other EU country :
I’ve read that if an elderly person dies in Italy while they have the flu or coronavirus, then that is recorded as the cause of death.
Some other countries put down other reasons like diabetes complications, or heart failure. Possibly due to pressure from insurance, or avoiding liability for iatrogenic diseases, or avoiding KPIs targeting lower death rates for infections in hospitals.
You are jumping to conclusions based on a few numbers, without understanding the background of where those numbers come from or how to validly compare them between countries.
Actually I am judging countries by their ability to face facts, act proactively Over the last few months, act responsibly by making sensible decisions that are effective in controlling their outbreaks, while keeping their economy functioning.
A++ for Taiwan (they started acting on Dec 31st, and they had preplanned what to do if faced with a virus outbreak). Very few infections, under control, economy working at 100%.
A+ for South Korea, Vietnam, Singapore, Japan and South Korea. Fast actions, effective tracing, economies running.
D- for US: little pro-activity, rampant community transmission, head of state in the sand, focusing on not spooking economy while ignoring downside risks to same, extremely poor planning with poor medical stocks. Health system of many states likely to fail. Now headless chickening, with every state left to act for itself (except for some negative interference from GOP). Meanwhile democrats dropped ball on opportunity of a lifetime to act well and help before the shit hit the fan.
B for China: first to have to act, zero pre warning. China acted and seem to have done better than many other countries that had plenty more warning (yes, China did downplay, but that seems to have been internal and not aimed at other countries. Either way, other countries had enough information from the 31st December or at latest mid-January but didn’t act).
C- for New Zealand: some late actions, tried to protect tourism industry and now the whole economy is paying price with shutdown. Extremely poor communication with population (trying not to worry everyone?). Mostly wasted months with inactivity, lack of planning (from my POV watching what info was given to a nurse), lack of emergency medical equipment. However expect that we’ll now respond well given shock treatment of shutdown of whole country,
What do you like about their approach?
At the same time, economic problems affect everyone while it seems that covid-19 harm scales with age.
No easy solutions to be sure, but I have hope more data becomes available soon so we can implement more nuanced policies to achieve similar containment while preventing massive unemployment. Testing random samples of the general population would be a good first step.
It can easily happen that by killing economy in order to save lives, we may actually be doing the opposite in the long term.
I read on your link that average life expectancy in Italy is 83.4, about 4 years more than US (at 78.9). So I don't get your point unless you are speaking about the age structure: https://en.m.wikipedia.org/wiki/List_of_countries_by_age_str...
Personnaly, I have issues with people using economic data, read money, to define the value of other peoples lives.
He wrote a column a couple days before this paper. Linking the response as well.
As others have noted here, the article calls for action based on very little data and lots of ad-hoc speculation. It also cheery picks its and falsely claims we don't have enough data.
I wonder if thinking all research is false too much lets jump to the idea you dream any opinion that's convenient.
Moreover, Ioannidιs has absolutely jumped into advocating this position from a partisan political position, with his positions picked up by partisan political sites such as the dailywire.com;
Headline: "Stanford Professor: Data Indicates We’re Severely Overreacting To Coronavirus"
And it's worth noting if anything on the order of millions of people die, then there going to be economic impacts -- that's a hell of a demand crater and productivity shock.
There are significant economic impacts of the measures countries are taking, and the reality is people will only put up with quarantine so long. I think it makes sense to spend some time looking at the evidence because shutting everything down has significant negative impacts, both economically, and potentially with the spread of the virus if people give up on quarantine too soon. Given the evidence I have seen current measures make sense (at least in Ontario) but saying that we should just follow our survival instincts seems wrong, especially when everything is so distorted by the media.
427× 16 =11102
We should criticize and point out mistakes, but let's not demonize.
The world is complex and interdependent, overreacting can be just as bad as not doing anything, what we need to find is the right balance between the two approaches.
If we check back and he was right then what? You, like everyone else, will be elated.
Completely dismissing certain observations early on as 100% wrong is not the right approach. One has to navigate the path balancing the tradeoffs.
FWIW, at this point, it looks like NYC is going to take a huge hit and the other outbreaks (Seattle, California) will look mild comparitively.
I think the best is that when fatalities spike here in California, we're in better shape to intensify the lockdown.
If you look at thermometer data (less accurate, but a good predictor), there's little problem going forward in either state. (but serious problems in the NY metro area):
But I hope you're right! We all need to do our parts.
I'd also note that things are getting "hot" in other states and each has it's problems.
Tweet is from 6:50pm: https://twitter.com/GovInslee/status/1242267557295321090
Why do you think that?
If a 80 years old dies from heart attack and is tested positive by covid19, it will count as "dead by covid19".
The numbers we see in the news of "CFR" for the covid19 are, in my opinion, inaccurate. The number only shows the spread of the infection, not its actual fatality rate.
CFR doesn't translate to the additional death rate, but it does contribute to the death rate by unspecified amount. In particular high enough CFR directly translates to the additional death rate when it exceeds the original crude death rate.
The mayor of Bergamo, a city in northern Italy devastated by coronavirus, said on Monday that the actual death toll from the pandemic is likely several times higher than official count.
Giorgio Gori told NBC News on Monday that the total deaths in Bergamo are three to four times higher than during an average year, signaling that the virus is killing many more people than medical authorities have reported.
"We [have] evidence now in our territories that many people are unfortunately dying in their homes or in the residence for [seniors]," Gori said via Skype. "They are not officially tested because the test is only for people that go to the hospital with serious symptoms."
You can only extrapolate so far.
Edit: I was being sarcastic here. China messed up the initial response but their draconian tactics worked well.
Right... they're dying from covid-19.
What is your argument exactly? It's a fact that Italy is running at a higher overall mortality rate owing to COVID-19.
Mortality across Europe has drastically declined in the past few months. Seems like everyone sitting at home is saving a ton of lives. Fewer accidents, fewer sicknesses, maybe even people eating a bit healthier.
Why stop locking yourselves indoors when so many lives are being saved by not leaving home?
From your own link:
> Pooled estimates of all-cause mortality show normal expected levels of mortality in the participating countries.
The issue isn't that COVID is killing a lot of people right now on a continental level; in the scheme of things it's a statistical blip. The issue is the _potential_ deaths if it gets broadly out of control. If all Europe had rates similar to Northern Italy, this graph would look very, very different.
In France and Italy, there were between 50000 and 60000 deaths per month in 2018 and 2019. If most of those people died because of 2 or 3 accumulated factors, covid19 would be just one more factor. But maybe those people would have died one month later anyway without covid19
For example, one thing I've seen people worry about is that there could be huge numbers of undetected infections; one guy quoted me 1.5 million for the US's 40k known cases. This would be wonderful news if true - death rates and hospitalization rates are 37 times smaller than believed, and the theoretical peak is nearer than we'd thought? But I've universally seen people present these scenarios as bad news, because they've internalized "numbers going to grow exponentially" as an observed fact rather than a contingent conclusion.
 CFR is a function of age (notably among others) and more careful analysis would involve demographics. Still, the rough order of magnitude doesn't change.