The article is interesting but it seems to be just a mathematical model rather than a biological study actually finding and studying people who had undocumented infections.
I know they have found people like that but I'd still be leery about going from data to a pronouncement since I assume the data just isn't extensive or reliable.
South Korea has been doing extensive contact tracing and quarantining from the start. They're as close to a statistical sample as we're going to get until large scale random antibody tests are done. At best the US could probably fit it into the census process.
Until you get a good bit of random antibody tests, it is all speculation. Nobody really knows how widespread this thing is, what its actual death rate is or anything else.
I personally wouldn't be surprised to learn the number of people who had it or have it now is hundreds of times higher than the "confirmed cases". I would also speculate that this virus has been in wide circulation for months now.
But my guess is as good as anybody else. Until we get actual, statistically valid high quality data.... all we have is speculation. I sure hope we are making the right call shutting things down as much as we are. People have to remember that there are serious physical health consequences to the actions being taken. Suicide rates will climb, alcoholism & addiction will jump, crime will go up, etc.
A few weeks of this kind of economic pause is one thing but at some point in the very near future people are going to want to know what the end game is.
As of today, Korea reports 274K tested, with 3.2% infected out of that. They also show strong signs of containment.
Those two datapoints indicate that they didn't miss many infected cases.
People overestimate the accuracy of this test as well. There's a doctor in Seattle who tested negative, and a few days later ended up in the ICU. He's currently in the process of dying. Just because the test says "no virus" (or vice versa) does not mean you're free and clear. Especially early in the disease cycle RT-PCR is known to produce false negatives sometimes.
The Seattle flu study is an example of what you want.
As https://komonews.com/news/coronavirus/seattle-flu-study-alle... shows, the USA was refusing to test Americans in Seattle while COVID-19 was actually spreading. When the Seattle flu study tested they found that it had already been locally spreading for weeks. And in fact most people who think that they have COVID-19 in the USA are unable to verify whether or not they have it.
This feels mixed. If true, it is more than just explaining how rapidly it spread, as the spread happened months ago. It also raises the question of why is it so severe some places, but less so many others?
The implication would be that, in the places where it's severe, transmission is actually completely uncontrolled and statistics fail to show it because of testing problems. I think Iran is the place to watch - there are other reasons to believe (such as the number of politicians infected) that the virus is there in large numbers everywhere.
The “from orbit” part is a little misleading I think. You can also see individual cars, down to their passenger windows, from orbit in the referenced photos. The photos are pretty detailed.
How did it spread long ago without killing a lot of elderly people back then, raising suspicion?
Perhaps elderly people often trickle in to ICUs with respiratory issues and as long as it’s flu season no one really notices some more dying 80+ people especially as there was no test for this virus?
> Perhaps elderly people often trickle in to ICUs with respiratory issues and as long as it’s flu season no one really notices some more dying 80+ people especially as there was no test for this virus?
I imagine most countries keep track of flu deaths and would have noticed an uptick.
ILI has seen a marked increase for the past couple of months. Deaths aren't going up, necessarily, but it is sad how many deaths flu and pneumonia cause each year, already.
I want to make it absolutely clear that I am not minimizing the coronavirus here, but the statistics would be lost in the noise. If known statistics are an order of magnitude too low, and there have actually been 800 deaths in the US instead of 80, that's still only about 3% of the total flu deaths this season. And flu seasons vary in intensity by a lot more than 3%.
The real problem is the concentration of number of cases in a big peak in a narrow space of time, so many people that should not die will die anyway by exhaustion of resources. Physicians will need to decide who to let die and who is treated and lives. This is what they are trying to improve when asking people not to go out for a couple of weeks
Yes, again, I'm not minimizing anything or saying coronavirus isn't a problem. I'm only explaining why statistics wouldn't currently detect a bunch of unknown cases.
This is my line of thinking, too. And I second your point of not trying to minimize it, but there appears compelling evidence this is already hit. Trying to determine what I could watch to get more or less confidence in this view.
I'm not good at reading Twitter threads. Will dedicate some time to it this evening.
Note also that I'm questioning if we will see an exponential rise in deaths. In large, I don't think that will be seen outside of places with poor lung health, if my hypothesis is right.
As I mentioned downthread, Iran is the country to watch for me. It's pretty clear that their infection is uncontrolled, and Rouhani claims that new infections have peaked. Now that we know the Bay Area is going on lockdown, I intend to drop coronavirus off my newsfeed for a few days and tune back in to see if he was right.
That really is just the country to watch for bad baseline health country getting it.
My hypothesis is a higher baseline lung health will result in a milder wave of infections. Essentially, it is not young that are getting milder cases, it is people with less damaged lungs.
And no matter how you slice it, the places that have had the most deaths, have by far the worst air quality.
Iran has pretty good baseline health. It's not amazing, but it's much closer to the US than the US is to Japan or Singapore. (And Italy is very healthy, one of the healthiest countries in the world in most rankings.)
Depends on the health. And the city you are looking at. The air in the area of Italy hit hard has really bad levels as far back as Jan. I didn't look father, but that satellite showed Italy bring terrible. Was that just a new thing?
So, my hypothesis is on base lung damage. And is spurred by kids not getting hit. I find it hard to think kids aren't getting sick.
If coronavirus has already hit America then that is a huge vote of confidence for the American medical system, which, in this hypothetical, has managed to deal with a major pneumonia pandemic without so much as calling in extra nursing shifts. That would suggest that America's medical system is ahead of Italy, which is suffering heavily due to running out of hospital space.
Not necessarily. My contention is that in places with many severe cases, there are also tons of mild cases. In particular, I see no reason to think the young population is not getting it. Toddlers and pre teens. Especially in areas with higher family residence.
So, my hypothesis centers around trying to give an explanation for why that population isn't impacted by severe cases. Going off how bad it hit me, if that is what hit me, best I have is lung health. And I don't have unhealthy lungs, all told. I do, however, have a distant history of asthma, and I find it plausible it did damage my lungs long ago.
To flip it some. They say even if you survive, you may have lasting lung scarring. What if that preceded the covid?
> To flip it some. They say even if you survive, you may have lasting lung scarring. What if that preceded the covid?
That doesn't make sense. Covid follows the same exponential curve in all countries. If the US has a bunch of latent infections, but no huge surge in pneumonia, then that would imply there is something special about Americans that keep them from developing the worst symptoms, or something special about American old people that, despite contact with the young silent carriers, they do not develop the disease. There is no reason to believe either of those are true.
They say we are a week or so behind Italy. Italy is experiencing hospital overruns. If the week-behind estimate (based on actual numbers) is overly conservative, then we would have expected to see hospital overruns in the United States from old people with pneumonia. However, we don't have that. Thus, if the week-behind estimate is overly conservative, we are certainly not at the same point as Italy or ahead of Italy, so we can say that we are anywhere from 1 week to 1 day behind Italy which is still a pretty good bound.
That is exactly what I'm asserting. That places not having a surge in severe cases are different than the places that have had a surge. That is literally my hypothesis.
The week behind curve on Italy is one to watch. My assertion is that we have had infections hitting here for at least a month. Probably longer. If we don't get the same severe case spike in a week, will everyone just keep upping their models? Because that is what it looks like people are doing.
No way to have the statistics get lost in the noise for a prolonged time and then suddenly switch to strong exponential growth that totally buries a developed medical system. If the ratio of sub-noticeable to noticeable cases was so much bigger, by the time you'd reach Lombardy-grade hospital influx the growth rate would already be shrinking from saturation. A virus that shows the infection rate documented by serious cases in hard-hit regions is unable to spread slowly in an unaware and unimmunized population.
Exponential growth is very good at getting lost in the noise for a prolonged time until suddenly it's not. Toy numbers: If you have 20K cases today with a 6 day doubling time, the first case was 84 days ago but 99% of the cases are new this month. (And in some sense this must have happened - everyone agrees there are a significant number of undetected cases, the only question is how many.)
Thank you for a cohesive answer. Yes, but if this is true and the number dead is not enough to even catch our attention when compared to flu dead, it would seem these economic and societal measures being undertaken are way out of proportion. In reality, if America were suffering a major pneumonia outbreak like Italy, we would be out of ventilators and deciding who dies. That is clearly not the case here, so we can rest assured that we are certainly behind Italy.
But my question is if we will see the same levels as Italy. Just glancing at their air quality, I couldn't go there without extra inhalers. Is that making them more susceptible to lung illness?
Is a question I haven't asked. Do they usually see more pneumonia than places like the states, anyways? Could be a proxy to test my hypothesis.
Could be, but not necessarily because coronavirus and flu target the same pool of people.
Those on risk groups had being first filtered (indirectly killed) by the economic scam. People unable to accurately heat their home in winter for example would suffer more pneumonias and having a logical explanation, nobody would care to search for a new virus among those cases.
Increase in coronavirus kills could be mitigated by other previous conditions and masked with a decrease in flu kills (by previous decrease in the pool of posible flu victims).
On the other hand, the virus appearing in Wuhan market was always of problematic explanation.
One hypothese could be that the market was linked with the labs somehow (origin in the labs). I always though this as a possibility worthing to explore.
... but I'm starting to think that another hypothese could be that Wuhan was not the first location, but one of the few places equiped to identify the virus and understand that was something more than a common cold. Virus taxonomy is really expensive, not much people can do it with new viruses and most hospitals will not care to test for just a strain of a common cold.
Also, keep in mind I'm proposing it is not elderly, that is the risk factor. It is lung health. I challenge that most places do not have the concentration of poor lung health to compare with where the serious cases have been.
Early in the flu season (nov/dec) as this would be, I imagine it’s still uncertain how bad the season will be, so it might just look like a bad year.
But I’m thinking they probably test at least bad cases for almost every common virus so they would have been alarmed by even a few deaths from pneumonia without positive tests. This is why I don’t believe the theory that many were infected long ago.
It too a nursing home in Seattle losing thirteen residents for them to test. So, there's more than just a few. And again, my hypothesis is that it isn't just elderly, but more exposed lung damage. Which, simple age is a good indicator for poorer lung health.
My hypothesis is it isn't just elderly. It is people with lung damage already. In the places it had been severe, that happens from exposure to daily air.
My perspective is someone in Seattle that had the worst asthma attack of my adult life a month ago. Literally couldn't breath well enough to talk for about a week with fever several nights. I've now seen my family get all symptoms but the breathing difficulty, fevers included. We can't get tested, as they are still mostly stonewalling. And I would likely be negative, even if I had it, at this point.
So, if I had it, and my family did too, why did I get severely hit, but they did not? Best I can fathom is baseline lung health.
Would love a better hypothesis. Or more tests I can look at.
That is my point. I am not high risk. But I did get hit hard.
I accept I might not have had it. And if we start seeing exponential increase in severe cases, I'll fully accept that. Until then, the evidence still looks heavy that I had it.
Do antibody tests exist at the moment? While not as critical as actual tests, it's not far behind if you could get a negative COVID-19 test and a positive antibody test.
It you weren't hooked up to a ventilator, you didn't get severely hit.
The "mild cases" in the statistics include people with pneumonia.
A few minutes later: keep in mind that there are ~1 billion colds a year in the US. Covid-19 isn't the only explanation for an illness, and not even the likely one.
UWVirology is prioritizing towards urgent cases, and even their ~2000 cases/day are only seeing 7% positive rate. There are a lot of bad colds out there.
I've had contact with people that have since tested positive. And I did two rounds of extended steroids. Not to mention emptied out an inhaler. And I don't consider myself old or at risk, all told. (I was daily biking during the first two days of this on a four hundred feet climb...)
So, no, I did not get hit severe in that I didn't die. I'm having a hard time thinking I just had a bad cold. Especially when I have seen all four of my kids get coughs and fevers since...
The closest I have come to this level of sick was a decade ago when I got walking pneumonia. And that was easy comparatively.
One thing to consider is every region has very different testing protocols and levels of testing. There is huge variation and bias in the dataset that makes it very hard to derive any kind of meaningful predictions. Not to mention population and socioeconomic factors vary widely from place to place.
Does this mean the mortality rate is, approximately, 10x less than currently estimated?
(86% of cases unreported, eg about 1 in 10 reported, assume that number of unreported fatal cases is 0)
Edit: closer reading suggests the optimism is sadly unwarranted, the headline under-reporting number of 86% is from the early pre-travel ban model, post-travel-ban estimates give a 65% detection rate, combined with the increased number of cases in this later period this implies that naive mortality estimates are more like 2x off than 10x off.
Well the cruise ship showed 55% of folks being asymptomatic and 80% of the remainder have mild flu like symptoms, and with an R0 of 2-3 for every person you do see get tested positive, there’s a mountain of folks spreading it without symptoms.
This also explains why Korea’s [edit: case fatality] rate is so low and so correlated with their high incidence of testing.
I wouldn’t be surprised if the majority of us have already had it. There’s a decent shot this all amounts to a big ol nothing burger.
Despite all experts saying it is actually a big problem? It's a disease that spreads rapidly and kills people who wouldn't otherwise have died. That doesn't sound like nothing to me.
It tends to work out better for those who overstate threat than those who understate, both in the moment (you get more attention) and after (if you’re right you get yet more attention, and if you were wrong everyone gives you a pass due to the mass collective panic).
Korea's mortality rate is about 1%, and that is primarily due to a relatively youthful population and the healthcare system not being saturated. I'll also note that 1% is still 10x deadlier than the flu.
I apologize, I'm just burnt out from reading comments from the millions of new epidemiologists spreading nonsense. I should probably take a break, but it's fascinating as much as it's antagonizing.
I am replying to the above person who stated "Korea’s mortality rate is so low". They did not specify a figure, so I used the commonly-cited figure that most people use as an estimate.
RT-PCR tests only show who has it now not who has had it before, we need antibody tests for that. We won’t know if it’s been going around undetected until we get that.
note: They don’t have a mortality rate they have a case fatality rate which always overstates the mortality rate. The two numbers converge over time, CFR down towards MR.
I mistyped in my original post which I have since edited.
Although the Diamond Princess had 100% testing and I’d wager much older demographic and with more comorbidities (and therefore much more likely to die). If anything that backs up the case Korea’s CFR is again overstated.
Almost certainly it was a much older demographic for Diamond Princess, although I don't have any precise figures. However, I will note that the 1% for the cruise ship is under the conditions of available healthcare resources (i.e. passengers were repatriated back to countries that had available resources able to care for them).
The danger with this disease seems to be that it is highly contagious and countries tend to see a huge spike in cases that completely overwhelms the healthcare system and leads to a several-fold increase in the case fatality rate (e.g. Iran, Italy).
So I agree that on its own COVID-19 is likely less fatal than some of the numbers we tend to see cited, but under outbreak conditions it can be much much more fatal.
While you’re right we also know the disease is 30X+ more fatal to the demographic aboard vs the general population (15%+ for old folks vs 0.2% for the young) even with the best medical care money can buy.
Mathematically this makes no sense. If we all had it already it wouldn’t have an R0 of 2-3. And, if you model the infection rate, even with it being highly exponential, it still takes many many months to spread everywhere because of a) the ~4 day delay from infection of a person to their infectious-ness b) it being a phenomena that must be seeded in each local community and c) applying the prior to the exponential function.
I won’t bother re-creating the epidemiological studies as professionals have much better simulations than I could offer.
I will urge you to read up on the models before assuming this thing is “already everywhere” which also implies it won’t grow exponentially.
> I wouldn’t be surprised if the majority of us have already had it.
The death count math and growth rate doesn't check out. If that were true (i.e that the total infection rate was already non-negligible) then the disease must have either been growing for months without detection and without spreading from Hubei, or it must in some crazy way be spreading much faster among the asymptomatic than among the serious cases.
The article argues for a roughly 6x undercount. That's still much lower than saturation, meaning that we have a lot of headroom to grow out of control still.
> it must in some crazy way be spreading much faster among the asymptomatic than among the serious cases.
Would that be surprising? If you're contagious a few days before any symptoms, you'd have plenty of time to transmit it to several other folks. Even if your case then becomes serious (which is not terribly likely in this model), you're going to be staying home or in treatment, and probably much more careful about contact with others.
I'd bet my own health that you're pretty darn close (but I'm still going to avoid visiting old folks for a while). From the conclusion:
> Presently, there are four, endemic, coronavirus strains currently circulating in human populations (229E, HKU1, NL63, OC43). If the novel coronavirus follows the pattern of 2009 H1N1 pandemic influenza, it will also spread globally and become a fifth endemic coronavirus within the human population.
This thing is extremely contagious, it's probably already everywhere, and there's a good chance it will be circulating indefinitely. Hopefully folks will just get tired of the panic after a while. And if we're lucky, this might lead to more awareness about the devastation that respiratory illnesses cause, especially to old folks, every year across the world.
If you want to yell at me because I'm not panicking enough, save your breath. I'm just as pissed at you for spreading a terrible mind-virus, so call it even if you must.
South Korea is about 0.9% currently, (deaths/confirmed-cases). If they have a lot of asymptomatic or untested people, that'd drag that rate down. Less than other countries since they test a lot. Their (deaths/(deaths+recoveries) is about 6% - that will drag the rate up as active cases resolve. The former rate went from 0.6% to 0.9% over the same time frame that the latter rate went from 28.5% to 6%. So... yeah, maybe they're around 1%, not counting asymptomatics.
I had this theory a few weeks ago, based on some personal experience and observations of unusual respiratory illnesses in people I know, including one hospitalization. However in recent days it seems unlikely to be valid due to the deteriorating situation in Italy and then Spain. It'd be wonderful if proven true. We will find out in the next 14 days.
>Overall, our findings indicate that a large proportion of COVID-19 infections were undocumented prior to the implementation of travel restrictions and other heightened control measures in China on 23 January, and that a large proportion of the total force of infection was mediated through these undocumented infections (Table 1). This high proportion of undocumented infections, many of whom were likely not severely symptomatic, appears to have facilitated the rapid spread of the virus throughout China. Indeed, suppression of the infectiousness of these undocumented cases in model simulations reduces the total number of documented cases and the overall spread of SARS-CoV2
This paper is about undetected carriers spreading SARS-CoV2 across China prior to the Jan 23 lockdown. It does not imply that 86% of all total infections that we see currently are undocumented, it only reflects the relatively narrow testing that was happening prior to Jan 23 (likely only the severe cases).
After Jan 23, China expanded its testing much more broadly, and other countries (such as South Korea) have done so as well. You should not take this paper to mean that the actual number of cases for these countries is larger by a factor of 1/(1-0.86).
Thank you, in parallel to this response I looked at the paper in more detail and updated the original comment. A shame, I was briefly optimistic about the news.
There is a strong desire by many (particularly on HN) to find any sort of evidence to support the contrarian notion that "Hey, it's not that big of a deal, everybody else is just overreacting!"
We should be conscious of this desire, and be careful assessing new evidence that comports with this notion.
This is a pretty insane take. Asking exploratory questions is not contrarian, it's scientific. Beyond that, HN has been oscillating between doomsdaying about CoV19 and calling it no big deal for weeks now.
But this isn't a bad thing -- having strong opinions and questioning the veracity of data is key to having informed, strong opinions.
Nothing scientific about misreading a scientific paper and drawing conclusions that aren't there. HN has a well-known contrarian bias that tends to manifest as a "we know better than the so-called experts" hivemind.
To misread a scientific paper you have to actually read it. Data analysis is a difficult field, and there are a number of studies where the data presented tells a completely different story than the scientists presenting it. Science is political and scientists are fallible. Confirmation bias isn't a plebian problem. Reading for your own understanding and asking questions is a necessary part of both scientific accountability and personal growth!
And, hearteningly, we see that OP has edited his comment to reflect the knowledge you passed along and has a better understanding of the situation. Inquiry at work.
Great. This is then one success story among many stories of failure to understand the scientific literature. Even now there is another story on the front page of HN where armchair epidemiologists are proclaiming in the comment section that this is no worse than H1N1. This shit is exhausting.
If South Korea and the UK, with fairly significant testing, have both found ~3% positives, then even if you assume the people tested were 100x more likely than the general population to have the disease, then in South Korea you'd have around 15k cases (about 2x reported) and in the UK around 19k (around 13x reported). If you assume the tested were only 10x more likely to be infected, those numbers scale correspondingly to 150k (20x reported) and 190k (130x reported).
As I understand it, yes. The probability of that, I'm not sure. This is where I found information about the nuanced properties of the test: https://www.youtube.com/watch?v=oGiOi7eV05g It's from there that I realized the test doesn't seem to be intended to be used in the way most people think -- it's supposed to be a "if a patient arrives in hospital with pneumonia, do this to tell if they have covid" tool, not a "if some random person wonders if they have it or not, run this test" tool.
> assume that number of unreported fatal cases is 0
While I agree with your overall point, I don't believe this is a good assumption. I think some percentage of unreported fatal cases are reported as pneumonia/cardiac arrest/etc.
I have been considering other ways to estimate this, and looked at numbers for Singapore, which I believe has particularly strict testing. They show a much lower mortality rate than the other estimates I have heard, but only at n=250. This may also be confounded by wealth/healthcare quality. Does anyone have a decent model of the mortality rate?
Assuming that someone who died from coronavirus is far more likely to have been tested for the virus than someone who's been infected by it, the true death rate of someone infected by the virus is probably far lower than the calculated death rate. (# of confirmed death / # of confirmed infections).
S.Korea did extensive testing, which reduces the number of unreported infections. So the calculated death rate in S. Korea is 4x lower than a comparable country like Spain, which has similar # of confirmed cases, population, GDP, and GDP per capita.
If we assume S. Korea's calculated death rate(<1%) is closer to the true death rate and apply it to other countries to derive the total # of infections (reported + unreported) based on the reported death count, we can see there may be far more infections than we know.
This is not really valid due to fatality rate being heavily dependent on age, comorbidities, and healthcare quality (which is itself dependent on case load), and the distributions of these differ greatly across countries. But, sure, you could try to normalize these to infer the actual case load.
It would be useful if this could be broken down into separate categories - estimated CFR without medical intervention, and likely CFR at various levels of intervention.
The former suggests what your population mortality rate will be if your healthcare system is overwhelmed, and could possibly be derived from Italian data. The latter gives you a resources vs effectiveness sweet spot that maximises health system throughput, so you can save the maximum number of lives over time given the resources you have (or can build/find.)
The age profile is relevant, but worryingly there seem to be a number of reports that it's not just the over-65s who are at risk.
I haven't seen anything more recent about this than the Chinese estimates from a month or so ago.
CFR can't be used to determine population mortality rate. It in no way reflects r0, and only tangentially at best hints at percentage of asymptomatic infections (and that's recent as there was never drive-by testing for any previous epidemic). Those two dimensions add unfathomable complexity to the equation. In many ways it's better to leave those dimensions out to improve the utility of CFR. A doctor doing triage or health department coming up with orders wants a simple, basic number, not a panoply of options that require data they won't have at hand.
We by all means should collect more data, just don't shoehorn it into such a very primitive yet very essential statistic. Give them new names and new, more appropriate semantics. I suspect that after this is over they're going to tighten the criteria around CFR, and in particular exclude by definition asymptomatic cases and possibly non-hospitalized cases. They never had to do that before as "cases" usually implied someone sick enough to be given a diagnosis, which in turn implied someone at least moderately sick--e.g. actual or suspected case of pneumonia.
It seems like the biggest confounder is age. If we stratify across age, we might be forgiven for ignoring differences in healthcare quality. The death rates by age in Korea are given here:
honest question: what is the death rate for an average person in their 80s?
ie: if you have cov2 you have a 7% chance of dying from it but dont you already have say a 50% chance of dying in your 80s anyway?
to be strictly logical and not emotional about this moral question: are we unhinging society (effects we cannot begin to calculate) to keep the fatality rate for the population 80+ at 50% instead of 57%?
in terms of costs to the healthcare system, might this equate to a net relief if the peak were accelerated instead of flattened?
It's not only about the old people. There are enough younger people that need medical care, even if they don't die from it.
And then it's also about the rest of the population that needs medical attention for a different reason.
Imagine the medicial facilities being flooded by COVID-19 patients. There are enough severe cases already in many countries that non essential operations are suspended.
Good luck getting adequate treatment for your broken leg.
so if you have flu like symptoms are you going to the hospital now? the vast majority of cov2 cases result in mild flu like symptoms and only 25% of the severe cases require medical intervention (according to WHO). so shouldnt the advice be to not seek medical attention at all? if you need the medical intervention youre in the 80 plus cohort that is already "flooding medical facilities" (been in one lately?). im just trying to do the long division and work out the logic that leads to the conclusion we should gamble with the livlihoods of huge percentage of the population for 7% mortality reduction in seniors. couldnt the exact same effect be achieved by quarantining seniors?
You have to remember that these fatality rates are with treatment, and old people will experience roughly 2 years of death rates within a few months in that case, leading to massive numbers of hospitalizations. That case load is absolutely not normal regardless of who's driving it. What's your plan exactly -- deny treatment to old people who have COVID-19? Not only will that increase death rates substantially, it's horrible.
And all of that is ignoring the possibility of people suffering nonfatal chronic health problems, which has been reported.
Meanwhile, remdesivir and lopinavir/ritonavir are in trials and once we actually have drugs available the hospitalizations would be shorter and the death rates much lower. At that point quarantine becomes less important.
Don't you first of all have to offset the infection rate by the time-to-death? I've been puzzling over all these extremely bad estimates we hear, and the only reason for it that I can come up with is that nobody wants to point at the much darker truth.
One study I've seen pinned the median time-to-death after symptom onset at 18 days. Even in Korea you won't get less than a 2-3% CFR with that estimation.
edit: I don't know anything about statistics by the way, please tell me that I'm wrong.
South Korea's CFR of <1.0% is a very optimistic figure. It is a naive calculation based on current # deaths / # infections.
1) But # infections were growing exponentially, we need to use numbers from the same cohort, which implies much lower # infections & higher CFR. Naive CFR will go up once infections grow more slowly. (It is already going up over time.).
2) South Korean confirmed cases are much younger than their median age, mainly between 20-29 years old (perhaps because of where superspreading events happen—that church). This age group has a much lower fatality rate from Covid-19.
3) # hospital beds per capita in South Korea is second highest among OECD countries (1st is Japan) and ~4 times that of the US. They already have patients waiting for beds.
Most countries will do much worse if they reach the same # infections per capita, since fatality rate surges to multiple times as high without proper care (as can be seen in several places around the world now, unfortunately).
(SK has ~12 beds/1000 capita; China ~4.3; US ~2.8)
Also, a very recent Lancet report calculates global CFR at 5.7%.
CFR (Case Fatality Rate) is based on the # people who were tested. IFR (Infection Fatality Rate) which includes people with no or mild symptoms will be lower.
"On this basis, using WHO data on the cumulative number of deaths to March 1, 2020, mortality rates would be 5·6% (95% CI 5·4–5·8) for China and 15·2% (12·5–17·9) outside of China. Global mortality rates over time using a 14-day delay estimate are shown in the figure, with a curve that levels off to a rate of 5·7% (5·5–5·9)"
Mortality rate depends a lot on treatment circumstances and the difference between optimal treatment and zero treatment could easily exceed the uncertainty from undocumented infections. This makes trying to figure out a single true mortality rate kind of pointless.
In the UK they only found 1,543 cases from 44,000 tests. That would seem to imply they're either incredibly unlucky with the testing, or it's not as quietly widespread as one might hope.
If uniformally randomly distributed that would imply a 3% population infection rate today, with an R0 of 2-3, 100% of the population either has had it or will have it by the end of next week. That would be wildly past the tipping point. Until we have an antibody test we can only know who has it right now, if you’ve had it more than 2 weeks ago you’re not going to test positive.
I’m not going to argue on the statistics, because I don’t quite get it.
You seem to be implying that maybe there are a load of us that had it already (and maybe, hopefully, that’s the case). But if so, doesn’t it seem weird that we’ve basically watched its progress as it’s spread around the world? Why would most people get it and be asymptotic followed by a series of unlucky people that are getting it now and falling ill? Though again, maybe I’m misunderstanding.
> You seem to be implying that maybe there are a load of us that had it already (and maybe, hopefully, that’s the case).
Yep, and that as a result our mortality projections from CFR are quite overstated.
> But if so, doesn’t it seem weird that we’ve basically watched its progress as it’s spread around the world?
I wouldn't be shocked to see a retrospective on this in the future tell us that we've been seeing the spread of availability of the test rather than the disease.
> Why would most people get it and be asymptotic followed by a series of unlucky people that are getting it now and falling ill?
Symptoms are basically the same as the flu for most people (Korea has a 0% CFR under 29, and 0.1% under 49), and for older folks, well, they're older, and basically anything can kill them. Some studies showed a fatality rate of 10% for the H1N1 flu -- and so far we're seeing a CFR of 15% for old folks in Korea. It's possible the fatalities we'd been seeing were written off as just that.
> I wouldn't be shocked to see a retrospective on this in the future tell us that we've been seeing the spread of availability of the test rather than the disease.
Ok, I could buy into that (and I really hope that's the case - though I'm still doubtful). The main thing I didn't realise was that the tests didn't show who had had it. Thanks for taking the time to work your point through with me.
It's certainly not uniformly distributed. Testing is not random. Typical test guidelines are to test when some combination of the following are present:
* Flu-like symptoms, after ruling out all other infectious causes
* Travel to a known outbreak region
* Close contact with a confirmed or strongly-suspected case
Asymptomatic people without known exposure are left untested (as is sensible to economize resources), and even people with mild symptoms but no known exposure may be left untested -- this makes it particularly difficult to catch the early stages of community spread, before people have had time to be hospitalized.
The mortality rate is definitely lower than anything being measured. But the lower bound is still high enough that this is very bad, maybe just not 'blight of the eons, scourge of humanity' level. If you are above 70 or have health problems, the mortality rate is extremely bad whatever the real number is.
> If you are above 70 or have health problems, the mortality rate is extremely bad
According to this article (https://www.businessinsider.com/coronavirus-death-age-older-...) an 80 year old has a 15% chance of dying. Is that actually "extremely bad" though? I think if 80 year old grandma got cancer and the doctors told you there was a 85% chance she'd recover, you might well breath a sigh of relief. For somebody that old, there are much worse mortality rates than that. Breaking your hip is more deadly than getting the coronavirus for people that old[0].
Rather the legitimate concern is due to how rapidly the disease is spreading. 15% is enough to kill TONS of people when you scale it up to the whole population. It's a high mortality rate considering the scope of the pandemic, but a relatively low mortality rate for the individual.
> How would you feel about being in a group of 7 of which one gets randomly shot?
That depends on how old I am. If I'm in my 80s with a fulfilling life behind me, playing russian roulette would disturb me a lot less than if were a young adult with a potential life before me. From elsewhere in this thread, it seems like simply being that old in the first place is like playing russian roulette anyway (https://news.ycombinator.com/item?id=22600562)
Now obviously in this case you'd be playing it twice instead of just once. But I hope that by the time I'm that old I've had enough time to come to terms with my mortality, write a will, make amends with family, etc. Because there are much worse prognosis's for somebody at that age than 15% mortality rate.
Or to look at this from another angle: 'extremely' bad is inherently relative. And taken relative to other common ailments people that old content with, I don't think 15% chance of death qualifies as 'extreme'. If 15% is 'extreme' then what adjective would you use for a cancer with a 50% mortality rate? "Super-dooper-uber extreme"?
> Or to look at this from another angle: 'extremely' bad is inherently relative. And taken relative to other common ailments people that old content with, I don't think 15% chance of death qualifies as 'extreme'. If 15% is 'extreme' then what adjective would you use for a cancer with a 50% mortality rate? "Super-dooper-uber extreme"?
You're missing the time frame. Getting cancer is a threat that many old people face but that's spread over decades.
With COVID-19, we face 70%-80% of the population being infected within a much shorter time, possibly a year or less (depending on how well or bad the delay measures are).
Yes, people die at that age for many reasons. But here, we have a potential death threat that is avertable and, most importantly, that affects the whole of society, not only old people.
Don't think that only old people get it and need medical attention. Lots of young people also need medical attention, even if they don't die from it. Ignoring long term effects from having caught it (as we don't know them yet), this alone would disrupt society. And then the secondary effects of people with other medical conditions not being treated as they are triaged.
Modern society doesn't need a lot to be disrupted. Look at how disruptive 9/11 was.
You guys are missing the point. It will be very difficult to access healthcare for the next 3 months because the system is going to be so overwhelmed by COVID-19 cases. There will be no available hospital beds.
Triage. I don't believe there will be any hospitals struggling to find hospital beds for young pregnant women because there are too many 80 year olds with corona.
Well I was referring to people over 70 as a cohort, we are saying the same thing essentially.
On an individual level however, adding an illness with 15% mortality on top of all the other things over 80s can get is a big deal.
80+ year olds are a varied cohort, and some are reasonably healthy, with multiple years left to live. The hip fracture data is biased because frail people with other problems are more likely to fall.
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[ 4.2 ms ] story [ 196 ms ] threadI know they have found people like that but I'd still be leery about going from data to a pronouncement since I assume the data just isn't extensive or reliable.
I personally wouldn't be surprised to learn the number of people who had it or have it now is hundreds of times higher than the "confirmed cases". I would also speculate that this virus has been in wide circulation for months now.
But my guess is as good as anybody else. Until we get actual, statistically valid high quality data.... all we have is speculation. I sure hope we are making the right call shutting things down as much as we are. People have to remember that there are serious physical health consequences to the actions being taken. Suicide rates will climb, alcoholism & addiction will jump, crime will go up, etc.
A few weeks of this kind of economic pause is one thing but at some point in the very near future people are going to want to know what the end game is.
As https://komonews.com/news/coronavirus/seattle-flu-study-alle... shows, the USA was refusing to test Americans in Seattle while COVID-19 was actually spreading. When the Seattle flu study tested they found that it had already been locally spreading for weeks. And in fact most people who think that they have COVID-19 in the USA are unable to verify whether or not they have it.
Perhaps elderly people often trickle in to ICUs with respiratory issues and as long as it’s flu season no one really notices some more dying 80+ people especially as there was no test for this virus?
I imagine most countries keep track of flu deaths and would have noticed an uptick.
Note also that I'm questioning if we will see an exponential rise in deaths. In large, I don't think that will be seen outside of places with poor lung health, if my hypothesis is right.
My hypothesis is a higher baseline lung health will result in a milder wave of infections. Essentially, it is not young that are getting milder cases, it is people with less damaged lungs.
And no matter how you slice it, the places that have had the most deaths, have by far the worst air quality.
So, my hypothesis is on base lung damage. And is spurred by kids not getting hit. I find it hard to think kids aren't getting sick.
So, my hypothesis centers around trying to give an explanation for why that population isn't impacted by severe cases. Going off how bad it hit me, if that is what hit me, best I have is lung health. And I don't have unhealthy lungs, all told. I do, however, have a distant history of asthma, and I find it plausible it did damage my lungs long ago.
To flip it some. They say even if you survive, you may have lasting lung scarring. What if that preceded the covid?
That doesn't make sense. Covid follows the same exponential curve in all countries. If the US has a bunch of latent infections, but no huge surge in pneumonia, then that would imply there is something special about Americans that keep them from developing the worst symptoms, or something special about American old people that, despite contact with the young silent carriers, they do not develop the disease. There is no reason to believe either of those are true.
They say we are a week or so behind Italy. Italy is experiencing hospital overruns. If the week-behind estimate (based on actual numbers) is overly conservative, then we would have expected to see hospital overruns in the United States from old people with pneumonia. However, we don't have that. Thus, if the week-behind estimate is overly conservative, we are certainly not at the same point as Italy or ahead of Italy, so we can say that we are anywhere from 1 week to 1 day behind Italy which is still a pretty good bound.
The week behind curve on Italy is one to watch. My assertion is that we have had infections hitting here for at least a month. Probably longer. If we don't get the same severe case spike in a week, will everyone just keep upping their models? Because that is what it looks like people are doing.
The US has three times as many ICU beds per capita as Italy. https://web.archive.org/web/20200313034908/https://www.forbe... I don't think it's a coincidence that Germany, which has performed much better than Italy, has almost as many as the US.
Is a question I haven't asked. Do they usually see more pneumonia than places like the states, anyways? Could be a proxy to test my hypothesis.
Could be, but not necessarily because coronavirus and flu target the same pool of people.
Those on risk groups had being first filtered (indirectly killed) by the economic scam. People unable to accurately heat their home in winter for example would suffer more pneumonias and having a logical explanation, nobody would care to search for a new virus among those cases.
Increase in coronavirus kills could be mitigated by other previous conditions and masked with a decrease in flu kills (by previous decrease in the pool of posible flu victims).
On the other hand, the virus appearing in Wuhan market was always of problematic explanation.
One hypothese could be that the market was linked with the labs somehow (origin in the labs). I always though this as a possibility worthing to explore.
... but I'm starting to think that another hypothese could be that Wuhan was not the first location, but one of the few places equiped to identify the virus and understand that was something more than a common cold. Virus taxonomy is really expensive, not much people can do it with new viruses and most hospitals will not care to test for just a strain of a common cold.
But I’m thinking they probably test at least bad cases for almost every common virus so they would have been alarmed by even a few deaths from pneumonia without positive tests. This is why I don’t believe the theory that many were infected long ago.
https://www.reuters.com/article/us-health-coronavirus-usa-nu...
My perspective is someone in Seattle that had the worst asthma attack of my adult life a month ago. Literally couldn't breath well enough to talk for about a week with fever several nights. I've now seen my family get all symptoms but the breathing difficulty, fevers included. We can't get tested, as they are still mostly stonewalling. And I would likely be negative, even if I had it, at this point.
So, if I had it, and my family did too, why did I get severely hit, but they did not? Best I can fathom is baseline lung health.
Would love a better hypothesis. Or more tests I can look at.
https://time.com/5802423/coronvirus-asthma-high-risk/
I accept I might not have had it. And if we start seeing exponential increase in severe cases, I'll fully accept that. Until then, the evidence still looks heavy that I had it.
Bad reasoning?
The "mild cases" in the statistics include people with pneumonia.
A few minutes later: keep in mind that there are ~1 billion colds a year in the US. Covid-19 isn't the only explanation for an illness, and not even the likely one.
So, no, I did not get hit severe in that I didn't die. I'm having a hard time thinking I just had a bad cold. Especially when I have seen all four of my kids get coughs and fevers since...
The closest I have come to this level of sick was a decade ago when I got walking pneumonia. And that was easy comparatively.
(86% of cases unreported, eg about 1 in 10 reported, assume that number of unreported fatal cases is 0)
Edit: closer reading suggests the optimism is sadly unwarranted, the headline under-reporting number of 86% is from the early pre-travel ban model, post-travel-ban estimates give a 65% detection rate, combined with the increased number of cases in this later period this implies that naive mortality estimates are more like 2x off than 10x off.
This also explains why Korea’s [edit: case fatality] rate is so low and so correlated with their high incidence of testing.
I wouldn’t be surprised if the majority of us have already had it. There’s a decent shot this all amounts to a big ol nothing burger.
It sounds like you may be interested in reading this paper: https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...
>I wouldn’t be surprised if the majority of us have already had it. There’s a decent shot this all amounts to a big ol nothing burger.
Unsupported by any evidence and complete wishful thinking. Please stop with the irresponsible speculation.
100% complete bullshit, nobody can know this kind of thing for sure right now.
I mistyped in my original post which I have since edited.
The danger with this disease seems to be that it is highly contagious and countries tend to see a huge spike in cases that completely overwhelms the healthcare system and leads to a several-fold increase in the case fatality rate (e.g. Iran, Italy).
So I agree that on its own COVID-19 is likely less fatal than some of the numbers we tend to see cited, but under outbreak conditions it can be much much more fatal.
I won’t bother re-creating the epidemiological studies as professionals have much better simulations than I could offer.
I will urge you to read up on the models before assuming this thing is “already everywhere” which also implies it won’t grow exponentially.
The death count math and growth rate doesn't check out. If that were true (i.e that the total infection rate was already non-negligible) then the disease must have either been growing for months without detection and without spreading from Hubei, or it must in some crazy way be spreading much faster among the asymptomatic than among the serious cases.
The article argues for a roughly 6x undercount. That's still much lower than saturation, meaning that we have a lot of headroom to grow out of control still.
Stay. At. Home.
Would that be surprising? If you're contagious a few days before any symptoms, you'd have plenty of time to transmit it to several other folks. Even if your case then becomes serious (which is not terribly likely in this model), you're going to be staying home or in treatment, and probably much more careful about contact with others.
> Presently, there are four, endemic, coronavirus strains currently circulating in human populations (229E, HKU1, NL63, OC43). If the novel coronavirus follows the pattern of 2009 H1N1 pandemic influenza, it will also spread globally and become a fifth endemic coronavirus within the human population.
This thing is extremely contagious, it's probably already everywhere, and there's a good chance it will be circulating indefinitely. Hopefully folks will just get tired of the panic after a while. And if we're lucky, this might lead to more awareness about the devastation that respiratory illnesses cause, especially to old folks, every year across the world.
If you want to yell at me because I'm not panicking enough, save your breath. I'm just as pissed at you for spreading a terrible mind-virus, so call it even if you must.
So, no.
This paper is about undetected carriers spreading SARS-CoV2 across China prior to the Jan 23 lockdown. It does not imply that 86% of all total infections that we see currently are undocumented, it only reflects the relatively narrow testing that was happening prior to Jan 23 (likely only the severe cases).
After Jan 23, China expanded its testing much more broadly, and other countries (such as South Korea) have done so as well. You should not take this paper to mean that the actual number of cases for these countries is larger by a factor of 1/(1-0.86).
We should be conscious of this desire, and be careful assessing new evidence that comports with this notion.
But this isn't a bad thing -- having strong opinions and questioning the veracity of data is key to having informed, strong opinions.
And, hearteningly, we see that OP has edited his comment to reflect the knowledge you passed along and has a better understanding of the situation. Inquiry at work.
https://drive.google.com/file/d/1DqfSnlaW6N3GBc5YKyBOCGPfdqO...
While I agree with your overall point, I don't believe this is a good assumption. I think some percentage of unreported fatal cases are reported as pneumonia/cardiac arrest/etc.
S.Korea did extensive testing, which reduces the number of unreported infections. So the calculated death rate in S. Korea is 4x lower than a comparable country like Spain, which has similar # of confirmed cases, population, GDP, and GDP per capita.
If we assume S. Korea's calculated death rate(<1%) is closer to the true death rate and apply it to other countries to derive the total # of infections (reported + unreported) based on the reported death count, we can see there may be far more infections than we know.
Is Spain and S. Korea really that much different to have a 4x difference in death rate?
The former suggests what your population mortality rate will be if your healthcare system is overwhelmed, and could possibly be derived from Italian data. The latter gives you a resources vs effectiveness sweet spot that maximises health system throughput, so you can save the maximum number of lives over time given the resources you have (or can build/find.)
The age profile is relevant, but worryingly there seem to be a number of reports that it's not just the over-65s who are at risk.
I haven't seen anything more recent about this than the Chinese estimates from a month or so ago.
We by all means should collect more data, just don't shoehorn it into such a very primitive yet very essential statistic. Give them new names and new, more appropriate semantics. I suspect that after this is over they're going to tighten the criteria around CFR, and in particular exclude by definition asymptomatic cases and possibly non-hospitalized cases. They never had to do that before as "cases" usually implied someone sick enough to be given a diagnosis, which in turn implied someone at least moderately sick--e.g. actual or suspected case of pneumonia.
https://www.businessinsider.com/coronavirus-death-rates-by-a...
20-29: 0%
30-39: 0.1%
40-49: 0.1%
50-59: 0.4%
60-69: 1.5%
70-79: 4.3%
80+: 7.2%
ie: if you have cov2 you have a 7% chance of dying from it but dont you already have say a 50% chance of dying in your 80s anyway?
to be strictly logical and not emotional about this moral question: are we unhinging society (effects we cannot begin to calculate) to keep the fatality rate for the population 80+ at 50% instead of 57%?
in terms of costs to the healthcare system, might this equate to a net relief if the peak were accelerated instead of flattened?
That's a standard actuarial problem, answered with life tables (https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_03.pdf -- pdf, US 2008). In said life tables, there is a 7% death rate between ages 83 and 84.
To an order-of-magnitude approximation, infection with the novel coronavirus seems to impose roughly one year's worth of mortality risk on the victim.
It’d be interesting to see how many healthy 80+ year olds have died.
There's a ~6% chance of dying during the year you turned 80. That chance goes up dramatically every year you get older. By 85 it's nearly 10%.
It would be interesting to calculate how this virus changes those rates. I feel like these kind of analysis are completely lacking in any reporting.
And then it's also about the rest of the population that needs medical attention for a different reason.
Imagine the medicial facilities being flooded by COVID-19 patients. There are enough severe cases already in many countries that non essential operations are suspended.
Good luck getting adequate treatment for your broken leg.
https://www.statnews.com/2020/03/16/coronavirus-model-shows-...
And all of that is ignoring the possibility of people suffering nonfatal chronic health problems, which has been reported.
Meanwhile, remdesivir and lopinavir/ritonavir are in trials and once we actually have drugs available the hospitalizations would be shorter and the death rates much lower. At that point quarantine becomes less important.
One study I've seen pinned the median time-to-death after symptom onset at 18 days. Even in Korea you won't get less than a 2-3% CFR with that estimation.
edit: I don't know anything about statistics by the way, please tell me that I'm wrong.
1) But # infections were growing exponentially, we need to use numbers from the same cohort, which implies much lower # infections & higher CFR. Naive CFR will go up once infections grow more slowly. (It is already going up over time.).
2) South Korean confirmed cases are much younger than their median age, mainly between 20-29 years old (perhaps because of where superspreading events happen—that church). This age group has a much lower fatality rate from Covid-19.
3) # hospital beds per capita in South Korea is second highest among OECD countries (1st is Japan) and ~4 times that of the US. They already have patients waiting for beds.
Most countries will do much worse if they reach the same # infections per capita, since fatality rate surges to multiple times as high without proper care (as can be seen in several places around the world now, unfortunately).
(SK has ~12 beds/1000 capita; China ~4.3; US ~2.8)
CFR (Case Fatality Rate) is based on the # people who were tested. IFR (Infection Fatality Rate) which includes people with no or mild symptoms will be lower.
"On this basis, using WHO data on the cumulative number of deaths to March 1, 2020, mortality rates would be 5·6% (95% CI 5·4–5·8) for China and 15·2% (12·5–17·9) outside of China. Global mortality rates over time using a 14-day delay estimate are shown in the figure, with a curve that levels off to a rate of 5·7% (5·5–5·9)"
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
The most likely explanation is that Korea is catching more mild cases that other countries are missing.
You seem to be implying that maybe there are a load of us that had it already (and maybe, hopefully, that’s the case). But if so, doesn’t it seem weird that we’ve basically watched its progress as it’s spread around the world? Why would most people get it and be asymptotic followed by a series of unlucky people that are getting it now and falling ill? Though again, maybe I’m misunderstanding.
> You seem to be implying that maybe there are a load of us that had it already (and maybe, hopefully, that’s the case).
Yep, and that as a result our mortality projections from CFR are quite overstated.
> But if so, doesn’t it seem weird that we’ve basically watched its progress as it’s spread around the world?
I wouldn't be shocked to see a retrospective on this in the future tell us that we've been seeing the spread of availability of the test rather than the disease.
> Why would most people get it and be asymptotic followed by a series of unlucky people that are getting it now and falling ill?
Symptoms are basically the same as the flu for most people (Korea has a 0% CFR under 29, and 0.1% under 49), and for older folks, well, they're older, and basically anything can kill them. Some studies showed a fatality rate of 10% for the H1N1 flu -- and so far we're seeing a CFR of 15% for old folks in Korea. It's possible the fatalities we'd been seeing were written off as just that.
Ok, I could buy into that (and I really hope that's the case - though I'm still doubtful). The main thing I didn't realise was that the tests didn't show who had had it. Thanks for taking the time to work your point through with me.
It's certainly not uniformly distributed. Testing is not random. Typical test guidelines are to test when some combination of the following are present:
* Flu-like symptoms, after ruling out all other infectious causes
* Travel to a known outbreak region
* Close contact with a confirmed or strongly-suspected case
Asymptomatic people without known exposure are left untested (as is sensible to economize resources), and even people with mild symptoms but no known exposure may be left untested -- this makes it particularly difficult to catch the early stages of community spread, before people have had time to be hospitalized.
According to this article (https://www.businessinsider.com/coronavirus-death-age-older-...) an 80 year old has a 15% chance of dying. Is that actually "extremely bad" though? I think if 80 year old grandma got cancer and the doctors told you there was a 85% chance she'd recover, you might well breath a sigh of relief. For somebody that old, there are much worse mortality rates than that. Breaking your hip is more deadly than getting the coronavirus for people that old[0].
Rather the legitimate concern is due to how rapidly the disease is spreading. 15% is enough to kill TONS of people when you scale it up to the whole population. It's a high mortality rate considering the scope of the pandemic, but a relatively low mortality rate for the individual.
[0] "The risk of death in the year following a fracture is about 20% in older people." https://en.wikipedia.org/wiki/Hip_fracture
Yes.
How much money would I have to offer you that you took your chances?
Unnecessary deaths are worse than life threats you can't do anything about it.
That depends on how old I am. If I'm in my 80s with a fulfilling life behind me, playing russian roulette would disturb me a lot less than if were a young adult with a potential life before me. From elsewhere in this thread, it seems like simply being that old in the first place is like playing russian roulette anyway (https://news.ycombinator.com/item?id=22600562)
Now obviously in this case you'd be playing it twice instead of just once. But I hope that by the time I'm that old I've had enough time to come to terms with my mortality, write a will, make amends with family, etc. Because there are much worse prognosis's for somebody at that age than 15% mortality rate.
Or to look at this from another angle: 'extremely' bad is inherently relative. And taken relative to other common ailments people that old content with, I don't think 15% chance of death qualifies as 'extreme'. If 15% is 'extreme' then what adjective would you use for a cancer with a 50% mortality rate? "Super-dooper-uber extreme"?
You're missing the time frame. Getting cancer is a threat that many old people face but that's spread over decades.
With COVID-19, we face 70%-80% of the population being infected within a much shorter time, possibly a year or less (depending on how well or bad the delay measures are).
Yes, people die at that age for many reasons. But here, we have a potential death threat that is avertable and, most importantly, that affects the whole of society, not only old people.
Don't think that only old people get it and need medical attention. Lots of young people also need medical attention, even if they don't die from it. Ignoring long term effects from having caught it (as we don't know them yet), this alone would disrupt society. And then the secondary effects of people with other medical conditions not being treated as they are triaged.
Modern society doesn't need a lot to be disrupted. Look at how disruptive 9/11 was.
On an individual level however, adding an illness with 15% mortality on top of all the other things over 80s can get is a big deal.
80+ year olds are a varied cohort, and some are reasonably healthy, with multiple years left to live. The hip fracture data is biased because frail people with other problems are more likely to fall.