Ok, is now a good time to start taking this seriously?
Spanish Flu had an R0 of about 2[1]. Current published estimates for 2019-ncov are 2.3-3.8 for this paper [1] and there's another floating around which gets as high as 6-8.
SO stock markets are the measure if a pandemic is taken seriously or not. I wuld rther say that the measrues being taken are good enough for the mrkets to not worry. Or that markets simply don't care.
But than again, WiseTech Global, a logistics software company, lost quite some value over this. Kind of rediculous but still.
If you can show a model for a travel restriction that would actually help to prevent the spread, I'd love to see it. The travel restrictions are in place for political reasons, not well-evidenced public health reasons.
Well, Italy just closed of roughly 50k people. And didn't airlines limit flights to China? What do you expect, a complete, worldwide shutdown of travel? Even between, say, Canada and Greenland?
And there are others that are much lower. It's also worth remembering that given many cases are asymptomatic, or are so mild that people may not see a doctor, the number of cases does not accurately reflect the number of infected people. So these mortality rates should not be read as an indicator of your chance of dying if you are infected with the virus.
One reason that many people don't seem to be "taking this seriously" is because the narrative of people who keep fearmongering about COVID-19 just doesn't make sense.
There are still direct flights from China to many countries, and they're not empty.
Screening is mostly based on taking people's temperature with handheld devices that have twice registered my temperature as 32C (no, I wasn't rushed to a hospital). Where more reliable screening has been implemented, there have been many documented failures.
Many quarantine protocols are voluntary / honour-based. People from cruise ships where they were exposed to others who were infected have dispersed worldwide with varying levels of monitoring (in some cases none).
If this thing was half as deadly and easily-spread as continues to be claimed on the Internet, 200 new cases in Italy wouldn't be international news at this point.
I assume you're being facetious, but regardless of early failings and a lack of transparency, it's hard to imagine any other country imposing a quarantine on a city the size of Wuhan in the manner they have, or building hospitals at the rate they have.
Particularly the point about "Why build hospitals?" Because in strongly centralized, command political systems, grand projects are one of the few things done well. And so crisis management becomes "What can we build, to show we're taking it seriously?"
Even outside of centralised, command political systems many of the responses seem to be in the vein of "what can we do to show we're taking it seriously?" Many actions such as the travel restrictions have gone directly against public health advice, but are easy to implement and politically very successful.
Facetious? 80% of China's GDP has been shut down for a month[1]. U.S. markets dropped another 3 percent today. The CDC tweeted today that people from "all sectors as well as people within their families" should prepare.
Get your head out of the sand. The sooner people take this for the threat that it is and start stockpiling basic supplies, the less likely it will be that everyone runs to the store simultaneously.
Frankly, much of the world (aside from China) seems to be taking this way too lightly. Those 200 new cases could easily turn into thousands in a matter of weeks. It seems to spread so rapidly that you really don't want it to take root in your country.
That's the thing though: it either doesn't spread very rapidly except in very specific circumstances, or it has way more asymptomatic/mild cases than is commonly claimed. Otherwise we would already see far more confirmed cases than there are.
Given the massive economic damage that the measures already taken are inflicting, I for one am very glad that it's not being "taken more seriously" than it is. I have predicted, and continue to predict, that when we're looking back at this, the response to COVID-19 will have done far more damage than the virus.
What do you consider “very rapid”? It has spread significantly faster than the swine flu epidemic did in its first two months.
> I have predicted, and continue to predict, that when we're looking back at this, the response to COVID-19 will have done far more damage than the virus.
That is rather likely and would mean that the containment efforts worked. Remember that the economic cost of containment shouldn’t be compared against the damage caused by the virus, but by the counterfactual damage that would be caused by an uncontained pandemic (which would be absolutely catastrophic given that the case fatality rate rises to the mid single digit percentages once healthcare infrastructure is saturated).
The problem is that many of the measures taken in the name of "containment" (travel restrictions for example) are likely ineffective and are explicitly disrecommended by public health experts. They are just easy measures to implement quickly, and are effective politically because they play to the population's pre-existing tendencies toward xenophobia.
“The mortality rate of patients with 2019-nCoV infection was lower than that of Severe Acute Respiratory Syndrome (SRAS) and Middle East Respiratory Syndrome (MERS).”
Is this a typo or are they politicizing SARS here so people think it’s something else?
Err... Not obviously? They're comparing it to a similar recent respiratory epidemic that raised concerns of a pandemic. That could be politically motivated, but it strikes me as reasonable and it's a commonly drawn comparison.
Please update the title to remove the typo (s/morality/mortality), from the abstract: "the mortality rate of patients with 2019-nCoV infection was 4.8%".
The flu only has a 0.1-0.05% mortality rate. The early symptoms of of it are flu-like but the severe respiratory symptoms that set in and make it difficult to breath are not like your typical flu, to my knowledge.
They give a "cough" incidence of 70.8% and a acute respiratory distress syndrome incidence of 14.8% in their paper. Meaning even a lot of people diagnosed with the infection show no respiratory symptoms, let alone severe ones. I therefore wouldn't dismiss the possibility of a high number of unreported cases, where people didn't develop any major symptoms and thought it was a cold or flu if they noticed symptoms at all.
Since the common cold is caused by coronaviruses a decent chunk of the time, I'm not sure it's even inaccurate for someone with a non-severe case of covid-19 to conclude that they have a cold.
Maybe that's the tricky part that helps it spread. Having a cold isn't enough to stop most people from going out in public. In my experience among people I know in the US and Canada, having a mild cold isn't enough for people to stay home from work.
But while a covid-19 infection might really be just a cold to a large chunk of people who get it, it's unusually deadly to a non-trivial percentage of people as well.
are the flu stats verified like the ones for this infection? or is the flu estimated among the population with a rougher method? For now I bet that there are a lot of people positive that are not being tested, in Italy they discovered a patient 1 only because they were "luky", and began testing a lot of people finding many positive cases.
I'm confused, I thought that what the paper defines as Mortality Rate is called Case Fatality Rate. Could someone explain to me what the difference is?
Mortality Rate is number of deaths divided by total infected count estimate.
E.g. it includes self reported cases and estimated using infection rates. (R0 mostly.) It does not exist when mode of infection is not entirely clear it when number of cases are low.
Case Fatality Rate is number of deaths divided by number of confirmed cases, which are usually hospitalizations.
Mortality Rate is usually much lower than Case Fatality Rate.
Thanks a lot! So if the paper is correct and the mortality is 4.8%, then the CFR would actually expected to be higher. I'm kind of disturbed by this because I've seen numbers for CFRs between 2%-3%, which is already quite high. These should be higher then, right?
If you look at the breakdown of infections vs deaths in China[1], you'll see that the death rate outside of Hubei is far lower than the death rate inside. As of yesterday, Guangdong, for instance, has had 1345 confirmed cases, but only 6 deaths -- in spite of the fact that at least 800 of those had been exposed more than 2 weeks ago[2].
The most likely explanation to me is that the hospitals in Hubei have been overwhelmed. Obviously that means we should be vigilant about limiting the spread of the disease, so that hospitals elsewhere aren't overwhelmed. But catching it isn't the immediate death sentence headlines like this indicate.
The scary thing about this virus, isn't the mortality rate, but the high R0 value and the potentially high proportion of infected people who are classified as severe cases.
Assuming that 20% of the US population (330 million) gets it, we're looking at about 13.2 million (20%x20%x330 million) patients who require admission to an ICU ward. Needless to say, that is enough to overwhelm the healthcare system and hospitals, and increase the overall mortality rate, when people who requires ICU are turned away due to lack of beds or equipment.
As it is, the best option would be to delay the spread as much as possible, so that the number would be spread across a time-span for as long as possible.
I don't think that number is accurate because so many people are not tested. Only people with severe infections are tested or those who have been in contact with known infected people.
With the deaths in Italy it is now also unclear if one person actually died from COVID-19 or if it was the late stage cancer they had.
If you charge $1,400 to each suspected person then either the testing will bankrupt the population or people are going to hide from testing. If coronavirus arrives in bulk in the US, then it's either going to be "Medicare for coughs for everyone" or a pandemic.
Are you sure? I couldn’t say with certainty whether any emergency service is covered by my insurance. There are no blanket statements and a relatively high co-insurance to ER services. Most policies have over $10,000 in co-insurance so stating that 90% are technically covered doesn’t actually respond to the parent’s claim. You’d have to know intimate details for how the service is billed which is apparently impossible before receiving service. If you don’t believe me call your hospital or your physician or your insurance company and ask what your out-of-pocket would be. Nobody can tell you.
What percentage of that insurance doesn't involve arcane rules about what's covered? My parents recently learned, following my dad's heart attack, that our town's ambulance was considered "out of network" and told they should have shopped around first. I had the pleasure of overhearing this conversation. Combined with the fact that many rural and suburban folk can't afford a $20 copay for a regular checkup let alone thousands of dollars for their deductibles, I put little confidence in that 90% coverage.
The article explicitly says that (a) he has insurance (b) this is out of pocket after insurance and (c) the insurance is disputing whether to cover this at all:
> Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a preexisting condition.
Also for the irony:
> Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance
Another thing to consider is that more public facing jobs like the Starbuck's barista, is also part of the population that fears doctor/hospital bills the most.
> The scary thing about this virus, isn't the mortality rate, but the high R0 value and the potentially high proportion of infected people who are classified as severe cases.
This is kinda where I'm at right now. The true mortality rate is almost certainly well below the 3% being reported now due to a high number of mild unreported cases. That said, the speed with which it is spreading combined with the potential severity is cause for concern.
If we compare this to the previous SARS and MERS events the trajectory is worrying. The SARS epidemic lasted 19 months and resulted in 8400 confirmed cases. The MERS epidemic has been ongoing since 2012 (very few cases after 2015 though) and resulted in 2500 confirmed cases. The current Coronavirus epidemic has only been going for a little over 2 months and we're already over 80,000 confirmed cases with no indication of a slowdown.
As a counterpoint though, from October through December of last year, there were 3.7 million cases of the flu in the US alone.
Beyond hospital admissions being overwhelmed in Hubei, the rate of infection spreading probably far exceeded their ability to test everyone and as a result there were probably considerably more infections than the official numbers.
eg from Jan 26
>Prof Neil Ferguson, a public health expert at Imperial College, said his “best guess” was that there were 100,000 affected by the virus even though there are only 2,000 confirmed cases so far https://www.theguardian.com/science/2020/jan/26/coronavirus-...
I'm less worried about death rate than the long term damage I might likely suffer from. The paper mentions that the onset of pulmonary fibrosis may be close to levels seen in SARS/MERS (~45%) and usually develops 3-6 months after the infection. There has also been another paper[0] indicating high chances of testicular damage.
There is an interesting thought experiment here. Hospitals are a large vector for spreading the disease. On the individual level you'd want to stay away from them as much as you can. On the collective level, that behavior is counter-productive ofc.
If I understand the relevant parts of this paper correctly, then this pulmonary fibrosis is not an ongoing and worsening condition in patients recovered from SARS. They "merely" attest that there was more long-term damage to those patients lungs that took months to recover (if at all).
Not in the field of medicine though, so I might be incorrect.
We know the death rate raises with time, we have seen this before with SARS. It takes people time to die.
We are you contradicting what we know? This needs a good reason. We've even been through this stage in Hubei, it started low if you just superficially look at figures.
"In the early stages of the SARS epidemic, health officials estimated the mortality rate at less than 4%. More recently, officials have cited rates in the 6% to 7% range. Today's SARS figures from the WHO—6,903 cumulative cases and 495 deaths—point to a case-fatality ratio of 7.2%. But WHO officials note that this calculation underestimates the rate, since some currently ill patients will die of the disease."
> It takes people time to die. ...We've even been through this stage in Hubei, it started low if you just superficially look at figures.
Right, that's why I used Guangdong as an example, and not (say) Korea or Japan, and compared cases 2 weeks ago vs deaths now. How long a lag time do you think is better?
Hard to say. 4 weeks at least I think. 4 weeks to start to snuff it. But it will be longer for many people. It's a good question, that's in part what the OP is trying to work out.
Look at the (ongoing) deaths on the Diamond Princess
That is a possible explanation, but not necessarily the most likely explanation.
It's also quite plausible the Hubei numbers are being scrutinized and processed differently (perhaps with input or oversight from the central government) whereas the other provinces are relying more on local provincial officials' reporting. There is a high incentive for these officials to avoid reporting negative news, so a bias towards low numbers would not be surprising.
We should rely more on international numbers instead of Chinese ones and particularly look askew at the China ex-Hubei numbers.
4.8% is pretty alarming..! wouldn't there be an inherent bias, though, towards patients that display such severe symptoms that they would require medical care? Currently, to me at least, these cases in Italy seem to indicate that plenty of cases go unnoticed because many of those infected show few to no symptoms (which makes this virus all the harder to isolate)
there aren't enough test kits, and for some people the serious/critical period in ICU can be a month, which means the CFR will always be skewed more or less.
Well... I'm in my hometown in Italy right now, people are advised to work remotely or avoid mass transit, everything closes after 6PM, museums/theaters/schools are closed, a small percentage of the population is going a little crazy so please everyone we must start asking ourselves some questions about those wild numbers that come out and people reporting them must be a little bit more responsible.
We had 7 fatalities here in Italy in an really big area, all of those people were old (some very old) and with other aggressive diseases or health problems going on, but we keep saying we have 200something people positive to COVID-19 making the mortality rate 3.5% BUT those 7 people are absolutely not representative of the 3.5% of total population so we must be missing people that are positive to the virus but don't get tested and never will.
We don't have enough test kits, we don't have enough personnel, we cannot overwhelm every lab in northern Italy just to start testing everyone for COVID-19 so many people without symptoms or with light symptoms are going on with their lives without ever being reported as positive... you get tested if:
- you met with someone that died
- you have severe symptoms
- you have light symptoms and you are old or have some other disease
- you live in one of the (really small) isolated areas
- you escape from the areas that are isolated
- you are close to someone that have escaped
If you are young and have a cold, even if you want to get tested, no one will come. I know from first hand some 4 people that are sick right now (symptoms like normal cold or a mild influenza) and one person that had I bad influenza finishing last week... are they positive? We will never know, now scale that up to the millions of people living in northern Italy
- emptying supermarkets and fighting for products that finish instead of waiting for the shelves to be refurbished (with police interventions, etc.). I've seen people buy 20kg of pasta or 100 water bottles on Sunday
- buying cleaning products and useless face masks for 10+ times the price
- firmly believing that COVID-19 is a military plan or a disease made to kill old and sick people to lower costs
- avoiding all Chinese people, Chinese food or Chinese shops (some people are afraid of goods made in China)
- faking some other illness to avoid going to work
And we could go on with a lot of other senseless things people are doing...
Why in the world would you close stores early? That just means that more people will have to shop at the same time, which would seem to increase the likelyhood of infection.
73 comments
[ 3.3 ms ] story [ 125 ms ] threadSpanish Flu had an R0 of about 2[1]. Current published estimates for 2019-ncov are 2.3-3.8 for this paper [1] and there's another floating around which gets as high as 6-8.
1. https://www.ncbi.nlm.nih.gov/pubmed/19545404/
2. https://www.sciencedirect.com/science/article/pii/S120197122
But than again, WiseTech Global, a logistics software company, lost quite some value over this. Kind of rediculous but still.
One reason that many people don't seem to be "taking this seriously" is because the narrative of people who keep fearmongering about COVID-19 just doesn't make sense.
There are still direct flights from China to many countries, and they're not empty.
Screening is mostly based on taking people's temperature with handheld devices that have twice registered my temperature as 32C (no, I wasn't rushed to a hospital). Where more reliable screening has been implemented, there have been many documented failures.
Many quarantine protocols are voluntary / honour-based. People from cruise ships where they were exposed to others who were infected have dispersed worldwide with varying levels of monitoring (in some cases none).
If this thing was half as deadly and easily-spread as continues to be claimed on the Internet, 200 new cases in Italy wouldn't be international news at this point.
Particularly the point about "Why build hospitals?" Because in strongly centralized, command political systems, grand projects are one of the few things done well. And so crisis management becomes "What can we build, to show we're taking it seriously?"
Even outside of centralised, command political systems many of the responses seem to be in the vein of "what can we do to show we're taking it seriously?" Many actions such as the travel restrictions have gone directly against public health advice, but are easy to implement and politically very successful.
Get your head out of the sand. The sooner people take this for the threat that it is and start stockpiling basic supplies, the less likely it will be that everyone runs to the store simultaneously.
1.https://www.cnbc.com/2020/02/01/coronavirus-more-of-china-ex...
Given the massive economic damage that the measures already taken are inflicting, I for one am very glad that it's not being "taken more seriously" than it is. I have predicted, and continue to predict, that when we're looking back at this, the response to COVID-19 will have done far more damage than the virus.
> I have predicted, and continue to predict, that when we're looking back at this, the response to COVID-19 will have done far more damage than the virus.
That is rather likely and would mean that the containment efforts worked. Remember that the economic cost of containment shouldn’t be compared against the damage caused by the virus, but by the counterfactual damage that would be caused by an uncontained pandemic (which would be absolutely catastrophic given that the case fatality rate rises to the mid single digit percentages once healthcare infrastructure is saturated).
Is this a typo or are they politicizing SARS here so people think it’s something else?
From what I’ve heard, CIVID-19 has symptoms very similar to the flu.
Maybe that's the tricky part that helps it spread. Having a cold isn't enough to stop most people from going out in public. In my experience among people I know in the US and Canada, having a mild cold isn't enough for people to stay home from work.
But while a covid-19 infection might really be just a cold to a large chunk of people who get it, it's unusually deadly to a non-trivial percentage of people as well.
E.g. it includes self reported cases and estimated using infection rates. (R0 mostly.) It does not exist when mode of infection is not entirely clear it when number of cases are low.
Case Fatality Rate is number of deaths divided by number of confirmed cases, which are usually hospitalizations.
Mortality Rate is usually much lower than Case Fatality Rate.
The most likely explanation to me is that the hospitals in Hubei have been overwhelmed. Obviously that means we should be vigilant about limiting the spread of the disease, so that hospitals elsewhere aren't overwhelmed. But catching it isn't the immediate death sentence headlines like this indicate.
[1] https://www.who.int/docs/default-source/coronaviruse/situati...
[2] https://www.who.int/docs/default-source/coronaviruse/situati...
Assuming that 20% of the US population (330 million) gets it, we're looking at about 13.2 million (20%x20%x330 million) patients who require admission to an ICU ward. Needless to say, that is enough to overwhelm the healthcare system and hospitals, and increase the overall mortality rate, when people who requires ICU are turned away due to lack of beds or equipment.
As it is, the best option would be to delay the spread as much as possible, so that the number would be spread across a time-span for as long as possible.
With the deaths in Italy it is now also unclear if one person actually died from COVID-19 or if it was the late stage cancer they had.
If you charge $1,400 to each suspected person then either the testing will bankrupt the population or people are going to hide from testing. If coronavirus arrives in bulk in the US, then it's either going to be "Medicare for coughs for everyone" or a pandemic.
https://www.cbo.gov/publication/55085
> Hospital officials at Jackson told the Miami Herald that, based on his insurance, Azcue would only be responsible for $1,400 of that bill, but Azcue said he heard from his insurer that he would also have to provide additional documentation: three years of medical records to prove that the flu he got didn’t relate to a preexisting condition.
Also for the irony:
> Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance
This is kinda where I'm at right now. The true mortality rate is almost certainly well below the 3% being reported now due to a high number of mild unreported cases. That said, the speed with which it is spreading combined with the potential severity is cause for concern.
If we compare this to the previous SARS and MERS events the trajectory is worrying. The SARS epidemic lasted 19 months and resulted in 8400 confirmed cases. The MERS epidemic has been ongoing since 2012 (very few cases after 2015 though) and resulted in 2500 confirmed cases. The current Coronavirus epidemic has only been going for a little over 2 months and we're already over 80,000 confirmed cases with no indication of a slowdown.
As a counterpoint though, from October through December of last year, there were 3.7 million cases of the flu in the US alone.
eg from Jan 26
>Prof Neil Ferguson, a public health expert at Imperial College, said his “best guess” was that there were 100,000 affected by the virus even though there are only 2,000 confirmed cases so far https://www.theguardian.com/science/2020/jan/26/coronavirus-...
There is an interesting thought experiment here. Hospitals are a large vector for spreading the disease. On the individual level you'd want to stay away from them as much as you can. On the collective level, that behavior is counter-productive ofc.
[0] ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...
We are you contradicting what we know? This needs a good reason. We've even been through this stage in Hubei, it started low if you just superficially look at figures.
"In the early stages of the SARS epidemic, health officials estimated the mortality rate at less than 4%. More recently, officials have cited rates in the 6% to 7% range. Today's SARS figures from the WHO—6,903 cumulative cases and 495 deaths—point to a case-fatality ratio of 7.2%. But WHO officials note that this calculation underestimates the rate, since some currently ill patients will die of the disease."
(2003) http://www.cidrap.umn.edu/news-perspective/2003/05/estimates...
Right, that's why I used Guangdong as an example, and not (say) Korea or Japan, and compared cases 2 weeks ago vs deaths now. How long a lag time do you think is better?
Look at the (ongoing) deaths on the Diamond Princess
https://www.princess.com/news/notices_and_advisories/notices...
It's also quite plausible the Hubei numbers are being scrutinized and processed differently (perhaps with input or oversight from the central government) whereas the other provinces are relying more on local provincial officials' reporting. There is a high incentive for these officials to avoid reporting negative news, so a bias towards low numbers would not be surprising.
We should rely more on international numbers instead of Chinese ones and particularly look askew at the China ex-Hubei numbers.
We had 7 fatalities here in Italy in an really big area, all of those people were old (some very old) and with other aggressive diseases or health problems going on, but we keep saying we have 200something people positive to COVID-19 making the mortality rate 3.5% BUT those 7 people are absolutely not representative of the 3.5% of total population so we must be missing people that are positive to the virus but don't get tested and never will.
We don't have enough test kits, we don't have enough personnel, we cannot overwhelm every lab in northern Italy just to start testing everyone for COVID-19 so many people without symptoms or with light symptoms are going on with their lives without ever being reported as positive... you get tested if: - you met with someone that died - you have severe symptoms - you have light symptoms and you are old or have some other disease - you live in one of the (really small) isolated areas - you escape from the areas that are isolated - you are close to someone that have escaped
If you are young and have a cold, even if you want to get tested, no one will come. I know from first hand some 4 people that are sick right now (symptoms like normal cold or a mild influenza) and one person that had I bad influenza finishing last week... are they positive? We will never know, now scale that up to the millions of people living in northern Italy
What are they doing?
- emptying supermarkets and fighting for products that finish instead of waiting for the shelves to be refurbished (with police interventions, etc.). I've seen people buy 20kg of pasta or 100 water bottles on Sunday
- buying cleaning products and useless face masks for 10+ times the price
- firmly believing that COVID-19 is a military plan or a disease made to kill old and sick people to lower costs
- avoiding all Chinese people, Chinese food or Chinese shops (some people are afraid of goods made in China)
- faking some other illness to avoid going to work
And we could go on with a lot of other senseless things people are doing...
Edit: formatting
> faking some other illness to avoid going to work
Sounds like business as usual. /s
People always do all the things listed above, it is just that this time more people are doing them and more heavily