> fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years.
The problem with all of these numbers is that they assume sufficient medical care and access to an ICU.
> In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died.
If we assume that ICUs are overloaded, how many of the that 2-4% would die?
Not that this doesn't count the people who won't catch the virus because of herd immunity. There may also be some people who are immune, or who defeat the virus quickly enough to not show positive on an RNA test.
That report just sources the same CDC report, but I think it gets some of its conclusions wrong.
It says:
>In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died.
But the CDC report indicates that 12% total (of all cases) are known to have been hospitalized, and of that number, 20% were age 20-44. So that would mean that (0.12*.2=) 2.4% of people total were 20-44 and in the hospital. Now 29% of all cases were in that age group, so that would mean for the 20-44 age group there was a (2.4/29=)8.3% chance of hospitalization.
Maybe I misunderstood something there, but I think I'm right.
I think you're reading it right, assuming they do know the ages of all people hospitalized, and the total cases with known+unknown age have close to the same distribution as the cases with known age. 102 hospitalizations / 1226 total cases = 8.3%.
A huge remaining unknown is how many people were infected but not tested, which would tend to reduce that 8.3% but perhaps not to a negligible level.
Actually that's not correct. The CDC study has a lot of null data and there's some very inconsistent excluding of data while calculating these numbers. I had to work with it in Excel for awhile to reconstruct the approximate raw numbers.
Out of 4226 cases
2449 have known ages
705 were 20 to 44
~488 of that age have a known age and hospitalization status
~101 of that age were hospitalized
~14 of that age went to ICU
(14.3% of the known # of cases for that age and 20.8% of the known # of cases for that age with a known hospitalization status were hospitalized)
Check this against Figure 2 in the CDC study and you will see where the StatNews article is pulling its data from.
This is very sobering information. Please stay safe!
It says "Among 508 (12%) patients". 508 is 12% of the whole 4226, not just the 2449 with known ages. 20% (102) of those 508 were aged 20-44.
It's not known how many of the 4226 were aged 22-44, but if it's roughly the same as the 29% of known ages, that would be 1226.
102/1226 is 8.3%.
I hate to say it, but it seems the table at the bottom is overestimating the proportion of hospitalizations by ignoring 1777 patients who have an age even if it's unknown, instead of making an estimate for them.
The reason that the unknown ages were excluded from Figure 2 is because the hospitalization status is also unknown. You assumed that 0 of the unknown cases were hospitalized. Instead, you could also assume that hospitalization rates for the unknown cases are roughly the same as for the known cases. If you do that you actually get the higher of the 2 numbers in Figure 2's range. So for the 20-44 age group, that's 20.3%. If you instead assume that people with a known age, but an unknown hospitalization status were not hospitalized, then you get he lower number in the range, 14.3%.
It's a very fair point that any of these assumptions could be inflating the rates. There are a whole bunch of other factors around asymptomatic, what the eventual outcome will be in the cases that are early-stage and who gets the limited number of tests in the USA that makes it currently impossible to know the true infection fatality rate or infection hospitalization rate.
I see, you're right. What I wrongly assumed was that they were receiving spotty data about overall cases but more thorough data about cases leading to hospitalization.
I also just noticed the age brackets for the 508 known hospitalizations only add up to about 91%, so apparently 9% of those are also unknown age.
It's too bad they didn't publish this in a live form so we could see how it changes as more data comes in. Maybe they will do a follow-up using the same methods at some point.
Note the caveat here: "the initial approach to testing was to identify patients among those with travel histories or persons with more severe disease, and these data might overestimate the prevalence of severe disease". One of the things that makes it frustratingly hard to tell the real likelihoods is that almost all data has this problem to some extent, except maybe the Diamond Princess cases, and there weren't enough young people on there to get good numbers.
"A renowned research professor in France has reported successful results from a new treatment for Covid-19, with early tests suggesting it can stop the virus from being contagious in just six days.
Professor Raoult is an infectious diseases specialist and head of the IHU Méditerranée Infection, who has been tasked by - and consulted by - the French government to research possible treatments of Covid-19."
I'm no industrial chemist, but from a glance at the chemical formula [1], I'm going to guess that it could be produced by the trainload (provided that you shoot the FDA first, which we should have done on the first day of the epidemic judging by their track record so far)
Former process chemist here. Yep, you could produce trainloads of this stuff within the month if you bypass the FDA, and even if you do play by the book, current capacity could easily crank out kilos of GMP HQ a day.
Could you expand a bit on the required base materials and possible bottlenecks? Would third world countries be able to produce this, and would export restrictions on reagents/chemicals limit production for some countries?
There were 5.7 million american prescriptions for Hydroxychloroquine in 2017, and the wholesale price quoted on wikipedia is 5 dollars for a months worth of pills.
I don't know how difficult scaling up production is, but the above numbers make me hopeful.
A tweet I saw yesterday said 95% recovered on the medicine. 90% of the control group still contagious. Haven't looked up the post again, but it was something I found either on that same twitter feed or a source he was pulling from.
I believe average hospital stay for those that need to be hospitalized can be upwards of 3 weeks though. So something that cuts it down to a week or avoids the need for the ICU bed altogether would be a game changer.
From the doc [0]: "At day6 post-inclusion, 100% of patients treated with hydroxychloroquine and azithromycin combination were virologicaly cured comparing with 57.1% in patients treated with hydroxychloroquine only, and 12.5% in the control group (p<0.001)."
The markets are reacting to the total shutdown of the service sector. That's going to cause a lot of pain whether or not this turns out to be the answer.
If it turns out that there’s a cheap, widely available, already-studied treatment that achieves something even close to the 100% cure rate observed in the paper, the timeline for total shutdown looks much shorter, no?
You don't think the markets would skyrocket if a real cure that is easily manufactured was discovered today? Sure, there's still a lot of pain to follow but the markets have priced in a lot of really bad scenarios where the virus kills large numbers and shutdowns last a long time.
It has a broad effect on the immune system and inflammation beyond it's anti-bacterial effects. Lots of changes to the production/expression of different factors and cell mechanisms. I don't think it's fully understood how it helps in situations like this but probably related to inflammation and reducing the cytokine storm.
note that Gregory Rigano is a lawyer with no medical training who has been writing about this with a cryptotrader (James M. Todaro).
Distribution of preprint by google drive remains highly suspect, as does the fact that the nominally illustrious first author communicates by a gmail address despite google scholar listing him as having a normal educational email address https://scholar.google.com/citations?hl=en&user=n8EF_6kAAAAJ...
That said, i know plenty of intensely brilliant weirdo researchers -- but i'd take this with big grains of salt. and i have no idea why a z-pak is a booster for an antiviral therapy.
I really want this study to be legit, but there are a few more weird things:
1. the evidence-free claim of “full peer review”, 2. the fact that patients who refused or met “exclusion criteria” for the drug served as a portion of the control group, and were the only members of the control group from the same region as the experimental group, 3. the removal of people from the experiment group because they went to the ICU or died (only three of first and one of second, but a rather bizarre thing to happen before claiming 100% cure), 4. the lack of coverage from any major news source, despite this being reported about a day ago.
i'm with you, i want this to be onto something but i'm like, constitutionally ill equipped to reject the null on this evidence. Too much time in the lab during normal life, maybe. To your points:
- The twitter guy makes the peer review claim, and i think it's wrong. he is not an author of the paper or affiliated with them, he's just shilling it to elon musk for reasons.
- regionality isn't something i'd considered. I can understand the exclusion group being the control in exeptional cases, like a global pandemic.
- of more concern to me are the either confusing or cargo-culted figures at the end. what in the world is a t- and p value column doing next to age data? why are there nominal p-values per day of administration?
There are indications that one of the things that makes it so lethal is that the effect on the respiratory system makes patients susceptible to secondary infections, possibly bacterial. May be wrong, but if it’s true and this pans out it could turn the tides. Your skepticism is healthy but I hope this works out.
An old malaria and autoimmune drug is showing promise as a potential treatment for COVID-19 – although health officials are urging caution until clinical trials are done.
The drug, hydroxychloroquine, sold under the brand name Plaquenil, was reported March 9 in Clinical Infectious Diseases journal to be effective at killing the virus in laboratory experiments. In a letter in Cell Discovery Wednesday, the study’s authors, mainly from the Chinese Academy of Sciences in Wuhan, wrote, “(W)e predict that the drug has a good potential to combat the disease.”
They're showing caution because Chloroquine can have some ugly side effects. Probably better than dying, but if it only has a marginal efficacy then it may be doing as much harm as it does good.
For coronaviruses chloroquine works by increasing endosomal pH and interfere with terminal glycosylation of the cellular receptor.[42][43] In late January 2020 during the 2019–20 coronavirus outbreak, Chinese medical researchers stated that exploratory research into chloroquine and two other medications, remdesivir and lopinavir/ritonavir, seemed to have "fairly good inhibitory effects" on the 2019 novel coronavirus. Requests to start clinical testing were submitted.[44][45][46] Chloroquine phosphate had been also proposed as a treatment for SARS-CoV with in vitro tests successfully inhibiting the virus.[47]
On 19 February 2020, preliminary results found that chloroquine may be effective and safe in treating COVID-19 associated pneumonia.[48][49] There is evidence to indicate the efficacy of chloroquine phosphate against SARS-CoV-2 in vitro, on Vero cells.[50] The Guangdong Provincial Department of Science and Technology and the Guangdong Provincial Health and Health Commission issued a report stating that chloroquine phosphate "improves the success rate of treatment and shortens the length of patient’s hospital stay" and recommended it for patients diagnosed with mild, moderate and severe cases of novel coronavirus pneumonia.[51]
Chloroquine have been recommended by Chinese, South Korean and Italian health authorities for the treatment of COVID-19 [52][53][54], however they have noted the important contraindications for people with certain heart conditions, diabetes, etc.[55][56] In February 2020, both drugs were shown to effectively inhibit COVID-19 in vitro [57], however a further study concluded that hydroxychloroquine was more potent than chloroquine, with a more tolerable safety profile. [58] Preliminary results from a multicentric trial, announced in a press conference suggested that chloroquine is effective and safe in treating COVID-19 associated pneumonia, "improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course".[59]
On 16 March 2020, advisor to the French Government on COVID-19, Professor Didier Raoult, announced that a trial involving 24 patients from the south east of France supported the claim that chloroquine was an effective treatment for COVID-19.[60] 600mg of hydroxychloroquine was administered to these patients every day for 10 days. The drug appeared to be responsible for a "rapid and effective speeding up of their healing process, and a sharp decrease in the amount of time they remained contagious".[61] The study also suggested that taking chloroquine in combination with the antibiotic azithromycin - which is known to be effective against complications from bacterial lung disease - led to even better outcomes. Professor Raoult said the results showed there was "a spectacular reduction in the number of positive cases" with the combination therapy.[62] At 6 days, among patients given combination therapy, the percentage of cases still carrying SRAS-CoV-2 was no more than 5%.[63]
How is it “full peer reviewed” when it’s explicitly an early release draft? Just saying it’s peer reviewed when it clearly isn’t sounds the scam alarms. A Covid Forsythia.
The study itself is interesting, I’m sure, to people in the field (though reading about the study is a bit odd. Of their test group they simply remove six from consideration for reasons like “they died”), but is irrelevant to a layman.
We are undoubtedly going to have hundreds of “this is the cure” claims that aren’t the cure. The way this is presented has significant indicators of not being credible.
Google Drive, some guy claiming that something that isn't peer reviewed at all is "full peer reviewed", pimped on Twitter. Is HN this gullible? How is this nonsense at the top?
Please just stay at home. At all times. I've locked myself in weeks ago, before the government of my country ordered lockdowns. Even if the true fatality rate in your age range is low - you'll kill some old person out there. Perhaps dozens. It's the most you can do. Bill Ackman does a good job of explaining why you should do that (and why should all countries be shut down):
It is. The quarantines/border-restrictions are not permanent measures, and acting swiftly is the correct way to nip it in the bud.
> Shutting down the country destroys everything.
Empty hyperbole. Death tolls in the tens of millions is a far worse outcome, as is stressing our current healthcare systems well beyond their capacities.
Mind boggling that someone could think that a month or two months shutdown "destroys the economy", but all Americans infected and several % dead doesn't "destroy the economy".
I agree, this clearly needs a govt bailout. Fed already rains liquidity into the treasuries like a madman, just wait till it buys corporates and God knows what else. Treasury should now simply guarantee salaries. The unconditional helicopter money is a good idea too. This will bridge the discrepancy between financial time (which has not stopped) and economic time (which is stopping, slowly, but has to come to a full stop).
But at any rate, lives > economy. Only one of those is a renewable resource.
We live in a deflationary environment (just look at what are the interest rates doing, world-wide). There's no supply problem, there's a demand problem. "Killing Boomers" will actually make things worse.
What do you think the death toll of shutting down the economy is going to be? I'm willing to bet that it turns out to higher than 10s of millions long term.
Nearly 10 million people die every year from hunger [0]. How much progress are we going to lose on that by putting the economy into a recession?
Global warming is an incoming emergency that threatens global stability. What are the odds that it leads to widespread war, widespread famine, or both? How much are we increasing those odds by starting a recession instead of continuing our R&D work at full speed hoping to find a (actually implementable) solution?
How many lives will be lost due to less funding for medical care and research? Both in the US where poor people can't afford it, and the rest of the world where less wealth means less taxes means less funding for the health care system? What if the next virus that comes along is more akin to the one that wiped out the American Chestnut trees (100% death toll) instead of just doubling your chance of dying when you get it?
Empty would imply devoid of content, it's pretty obvious they were speaking metaphorically. As for if it's a good idea, you're insane if you think some of the timelines being discussed, like the 18 month one, are realistic. Americans might put up with this for a couple months tops but taking a full year off is for the Europeans with nothing better to do.
That's some serious ageist hate coming from people who may get to be old themselves someday, with younger generations cheering for their death. The Golden Rule didn't get learned, I guess.
The economy will not be destroyed. It will merely change.
It will be actually "destroyed" if the virus is not stopped.
For God's sake people stop thinking about your S&P500 index funds for a second. Also, if you still want to be selfish, your index funds will go down to ~zero if the virus is not stopped.
Looking at this in dispassionate economic terms...
It’s not clear to me that letting the virus run it’s coarse would hurt the economy.
Some (but certainly not most) very old people would die, but they are not in their productive years. Their assets would pass to younger people who would be more inclined to put them to use in the economy.
This is how I see it too. We are not going to able to stop the virus, it's everywhere already. Shutting down the country may delay this a bit which is good for hospitals but terrible for everything else.
The difference in death toll would be minimal, but the difference in the economic recovery will be substantial.
Have you noticed that China has stopped it? And that new cases stopped growing in Italy? Unless you assume the US will be especially bad at handling the problem it seems like there is a solution - do what other countries did.
Not everything is about dispassionate economics. In the "we do nothing" scenario, everyone with 150 friends loses 1-5 of them, and about as many will have decreased quality of life.
What's the death toll with the 'shut it all down' scenario? Not much better! It's already spreading uncontained everywhere. Shutting it all down will not stop all the deaths. Not even close.
This virus roughly doubles your chances of dying this year, if you catch it. It's not the bubonic plague. It will not by itself stop the economy or cause us all to starve to death.
Oh please. When this is all over, the economy is going to come roaring back. Too many people, too much pent up anticipation in all sectors. American businesses will start looking to diversify their supply chain so this won't happen again. That alone will start a ton of new business initiatives around the world.
Which is exactly why social safety net programs exist and continue to function during these times. Not to mention the checks that will be mailed out to every taxpayer soon.
We can and should essentially shut down the country
We don't have a safety net that can feed the whole country. Some people still have to work to actually grow the food, do the distribution, and feed everyone. How is that going to happen if everyone sits at home for 2 months?
I partially own, while my parents run, a cafe that's pretty fucked. I'm incredibly aware of these concerns. I just think that health comes before economy. Without healthy people, you don't have an economy.
I don't think we can make such a blanket assertion. The US markets have lost 10T in value over the past month. If the virus infects 70% of the US population with a 2% mortality rate, 4.2M ppl will die. It's obviously not so simple, but we're sacrificing $2.4M in market cap per life saved. At some point, the tradeoff makes no sense in light of the fact that we could invest in life saving technologies/solutions that save more lives down the road.
I think that an extra 57 million people dying is devastating, and we should do everything in our power - even if it means shutting down restaurants - to prevent 57 million needless deaths.
Problem is the current plan will not save 57 million people. Not even close. The mortality rate will still be 3.6% and we still expect 70% of the population to get infected.
So if it was as simple as you say, then sure. Let's shut it all down. But shutting it all down is not going to save us from Covid19.
But infection rate being so high when left unchecked means the small % of deaths could be hundreds of thousands or even millions all over the world. Also Italy almost had a death rate of 8% yesterday which is huge.
Plus when hospitals get overloaded, patients needing critical care for problems other than covid-19 will die as well.
Seeing the replies, it seems that most people agree that it is worth it.
But in the last few weeks I keep wondering if our reaction to covid-19 is consistent with our reactions to other causes of mortality. For example:
- 1.25 million people die in road crashes every year, yet we have collectively decided that abandoning cars is too large a sacrifice to make.
- global warming has the potential to cause huge devastations and millions of death, yet we fail to make the adequate sacrifices to limit our emissions.
So, is there something different about covid-19 that warrants these differences? Is the fatality rate higher, for example?
Or could it be a difference of game theory? For example for global warming, everybody has to participate in order to see gains.
Or maybe humans have a natural fear of germs and react stronger to contagious diseases than to other risks? I remember reading that argument in Factfulness.
Global warming is too abstract, hard to reason by some due to the distance of cause and effect.
Car driving fatality is fairly bounded. 124 ppm/year in USA.
Coronavirus 19 has the possibility to mutate and keep waving over the world, killing an unbounded number of people, which is downright terrifying. The best-case estimate of fatality is 5000 ppm and >50% of Americans getting it, that's 20x more deadly than cars.
That's substantially less deadly than cars. 20 years of car crashes are equivalent to this virus, and we've had and will continue to have a lot more than 20 years worth of car crashes. 5000ppm by your estimate die once, and then the virus probably stops being a problem.
We can have some faith that this virus is a one time event because
- A vaccine will probably be invented before long.
- Effective treatment will probably be discovered.
- If there is no vaccine and no treatment for some reason. You probably can't catch it twice, maybe everyone gets it once, but after that only kids get it, and kids don't die from it anyways.
to prevent the 1.25 million auto deaths, we have to stop (or drastically curtail) driving forever, or until we invent reliable autonomous driving systems (quite a long time from now). the drastic measures to slow the outbreak of are only expected to be in effect for a couple months or a year at most.
people are willing to take drastic measures over a short period of time to prevent a large number of deaths. this doesn't imply they are or should be willing to take the same drastic measures indefinitely.
Agreed that COVID-19 is a serious threat worth countering.
Our under-reaction to other serious threats is probably both psychological and evolutionary. Psychologically, COVID-19 is salient because it’s a novel threat and our brain is hardwired to notice and react to changes. Evolutionarily, humans have encountered and survived infectious disease, but car crashes and global warming are historically new.
If COVID continues to kill people at the same rate in Italy as it does today, it will kill about ~150k people.
Applied to the whole world, the risk is killing easily 10x as much as cars.
If cars suddenly became 10x more dangerous, I'm sure it'd cause mass panic. Especially if cars became 20 to 30x more dangerous specifically to our parents or grandparents.
The US GDP is $19 trillion. If we just stopped everything, we would be missing $1.6t per month. Conceivably, the government could pump that much money into the economy by just writing checks to everyone so that they could pay their rent, their mortgage, and their landlord could pay their mortgage. We'd need to write checks to businesses too. And this is worst case. The economy hasn't shut down. Many of us are still employed and getting paid and I certainly am very grateful for that. But I'm not going to the pub every weekend so those people need cash.
If we can treat this as hitting the pause button on the economy, and find a way to fund it during this period, then we can press the play button and carry on where we left off. Of course that would require Russia, OPEC and the US to stop pumping oil. And a billion other details. But there's a lot of us, and we don't have much else to do.
This could be an economic disaster, but it doesn't need to be.
Sure, another alternative is we kill all the old people and all the doctors and nurses. Apparently some people aren't worried about the old people, but surely their self interest benefits from not killing all the doctors and nurses?
He walked that back later and said he was buying stocks. From his Twitter...
'Some investors have been confused by remarks. To clarify, I am confident the president will do the right thing in temporarily shutting down the country and closing the borders. If that happens, we can win the war against the virus and the markets and the economy will soar.'
' That is why we are buying stocks. These are bargains of a lifetime if we manage this crisis correctly.'
Yeah, basically if the virus spreads doesn't matter what you're holding now. And if the country is shut down now then things will eventually improve. He said he's buying even in that interview and explained this position very clearly.
Kind of an "undefined behaviour" sort of thing - one branch of the conditional "cannot" happen, so you can assume it doesn't.
I don’t think his tweet walks back the needed actions he described earlier on CNBC. The tweet just expresses his confidence that President Trump will take those necessary actions.
This is not a selfless thing to do (if it were, we could isolate only high-risk groups rather than everyone). If we all get it simultaneously, and run out of nurses and ventilators, the fatality rate might not be low.
Wouldn't it be easier and perhaps better to only quarantine the old and those most at risk, then spend millions of dollars and community time to support them utterly through the next 3-6 months till the virus dies out?
The other approach is what we have now in the US, which is rolling quarantines as we put out virus outbreaks like brushfires. It disrupts everyone's life and makes it harder to get supplies to those most at need as everyone is constantly preparing themselves for a personal lockin.
I believe it was just one big one that had a lot of very old and very frail. Staff didn't pick up on what was going on and by the time they connected the dots people were dying.
Regardless of the number of nursing homes, the point stands that the figures are skewed by a few clear outliers.
My very naive take: could the difference in mortality between South Korea and Italy be explained by how SK tried antiviral drugs even when there was no strong evidence yet, while Europe stuck to anti inflammatory which we know now to be linked to severe outcomes?
Also, the probability of receiving a prescription drug is almost linear with respect to age.
So, could the highest death of >60 y.o. with comobidities be explained similarly by them taking drugs that have a negative impact on the disease?
Some threads on the internet say to stop taking ACE inhibitors because they boost ACE2, the gate that the virus uses to get into our cells. However, other threads on the internet says that while ACE inhibitors boost ACE2, they also cause them to be blocked (bound) by ATR-1, so you're good. Unless you stop, in which case now you have twice as many ACE2 and they're all unblocked.
So I'm listening to what the doctors say and not the internet.
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[ 5.3 ms ] story [ 174 ms ] threadThe problem with all of these numbers is that they assume sufficient medical care and access to an ICU.
This report here breaks down how many people need an ICU by age: https://www.statnews.com/2020/03/18/coronavirus-new-age-anal...
> In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died.
If we assume that ICUs are overloaded, how many of the that 2-4% would die?
Not that this doesn't count the people who won't catch the virus because of herd immunity. There may also be some people who are immune, or who defeat the virus quickly enough to not show positive on an RNA test.
It says:
>In contrast, among people 20 to 44, 14% to 21% of 705 cases were admitted to hospitals and 2% to 4% to ICUs; 0.1% to 0.2% died.
But the CDC report indicates that 12% total (of all cases) are known to have been hospitalized, and of that number, 20% were age 20-44. So that would mean that (0.12*.2=) 2.4% of people total were 20-44 and in the hospital. Now 29% of all cases were in that age group, so that would mean for the 20-44 age group there was a (2.4/29=)8.3% chance of hospitalization.
Maybe I misunderstood something there, but I think I'm right.
A huge remaining unknown is how many people were infected but not tested, which would tend to reduce that 8.3% but perhaps not to a negligible level.
Out of 4226 cases
2449 have known ages
705 were 20 to 44
~488 of that age have a known age and hospitalization status
~101 of that age were hospitalized
~14 of that age went to ICU
(14.3% of the known # of cases for that age and 20.8% of the known # of cases for that age with a known hospitalization status were hospitalized)
Check this against Figure 2 in the CDC study and you will see where the StatNews article is pulling its data from.
This is very sobering information. Please stay safe!
It's not known how many of the 4226 were aged 22-44, but if it's roughly the same as the 29% of known ages, that would be 1226.
102/1226 is 8.3%.
I hate to say it, but it seems the table at the bottom is overestimating the proportion of hospitalizations by ignoring 1777 patients who have an age even if it's unknown, instead of making an estimate for them.
It's a very fair point that any of these assumptions could be inflating the rates. There are a whole bunch of other factors around asymptomatic, what the eventual outcome will be in the cases that are early-stage and who gets the limited number of tests in the USA that makes it currently impossible to know the true infection fatality rate or infection hospitalization rate.
I also just noticed the age brackets for the 508 known hospitalizations only add up to about 91%, so apparently 9% of those are also unknown age.
It's too bad they didn't publish this in a live form so we could see how it changes as more data comes in. Maybe they will do a follow-up using the same methods at some point.
Scientific -> what a layperson would say
Mild -> sick
Moderate -> hospitalized
Severe -> deathly ill
UPDATE:
Full peer reviewed study has been released by Didier Raoult MD, PhD drive.google.com/file/d/186Bel9….
After 6 days 100% of patients treated with HCQ + Azithromycin were virologically cured
p-value <.0001
covidtrial.io
https://twitter.com/riganoesq/status/1240273631604809728?s=2...
"A renowned research professor in France has reported successful results from a new treatment for Covid-19, with early tests suggesting it can stop the virus from being contagious in just six days.
Professor Raoult is an infectious diseases specialist and head of the IHU Méditerranée Infection, who has been tasked by - and consulted by - the French government to research possible treatments of Covid-19."
https://www.connexionfrance.com/French-news/French-researche...
[1] https://en.wikipedia.org/wiki/Hydroxychloroquine
I don't know how difficult scaling up production is, but the above numbers make me hopeful.
There are widespread report of lung damage for severe Covids patients who recover.
[0]: https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS...
Sample size is only 36. 20 treated patients. 16 control.
That's the kicker. We are still waiting to see. One guy did it. Now others need to try it and see if it helps.
How would that help vs a virus? Or does it just help the body from having other unrelated things to also fight?
Distribution of preprint by google drive remains highly suspect, as does the fact that the nominally illustrious first author communicates by a gmail address despite google scholar listing him as having a normal educational email address https://scholar.google.com/citations?hl=en&user=n8EF_6kAAAAJ...
That said, i know plenty of intensely brilliant weirdo researchers -- but i'd take this with big grains of salt. and i have no idea why a z-pak is a booster for an antiviral therapy.
1. the evidence-free claim of “full peer review”, 2. the fact that patients who refused or met “exclusion criteria” for the drug served as a portion of the control group, and were the only members of the control group from the same region as the experimental group, 3. the removal of people from the experiment group because they went to the ICU or died (only three of first and one of second, but a rather bizarre thing to happen before claiming 100% cure), 4. the lack of coverage from any major news source, despite this being reported about a day ago.
- The twitter guy makes the peer review claim, and i think it's wrong. he is not an author of the paper or affiliated with them, he's just shilling it to elon musk for reasons.
- regionality isn't something i'd considered. I can understand the exclusion group being the control in exeptional cases, like a global pandemic.
- of more concern to me are the either confusing or cargo-culted figures at the end. what in the world is a t- and p value column doing next to age data? why are there nominal p-values per day of administration?
- there might not be coverage, but merck is shipping a boatload of the stuff anyway: https://www.fiercepharma.com/pharma/bayer-preps-u-s-donation...
https://www.forbes.com/sites/marybethpfeiffer/2020/03/18/sci...
An old malaria and autoimmune drug is showing promise as a potential treatment for COVID-19 – although health officials are urging caution until clinical trials are done.
The drug, hydroxychloroquine, sold under the brand name Plaquenil, was reported March 9 in Clinical Infectious Diseases journal to be effective at killing the virus in laboratory experiments. In a letter in Cell Discovery Wednesday, the study’s authors, mainly from the Chinese Academy of Sciences in Wuhan, wrote, “(W)e predict that the drug has a good potential to combat the disease.”
https://www.nbcnews.com/health/health-news/here-are-some-exi...
For coronaviruses chloroquine works by increasing endosomal pH and interfere with terminal glycosylation of the cellular receptor.[42][43] In late January 2020 during the 2019–20 coronavirus outbreak, Chinese medical researchers stated that exploratory research into chloroquine and two other medications, remdesivir and lopinavir/ritonavir, seemed to have "fairly good inhibitory effects" on the 2019 novel coronavirus. Requests to start clinical testing were submitted.[44][45][46] Chloroquine phosphate had been also proposed as a treatment for SARS-CoV with in vitro tests successfully inhibiting the virus.[47]
On 19 February 2020, preliminary results found that chloroquine may be effective and safe in treating COVID-19 associated pneumonia.[48][49] There is evidence to indicate the efficacy of chloroquine phosphate against SARS-CoV-2 in vitro, on Vero cells.[50] The Guangdong Provincial Department of Science and Technology and the Guangdong Provincial Health and Health Commission issued a report stating that chloroquine phosphate "improves the success rate of treatment and shortens the length of patient’s hospital stay" and recommended it for patients diagnosed with mild, moderate and severe cases of novel coronavirus pneumonia.[51]
Chloroquine have been recommended by Chinese, South Korean and Italian health authorities for the treatment of COVID-19 [52][53][54], however they have noted the important contraindications for people with certain heart conditions, diabetes, etc.[55][56] In February 2020, both drugs were shown to effectively inhibit COVID-19 in vitro [57], however a further study concluded that hydroxychloroquine was more potent than chloroquine, with a more tolerable safety profile. [58] Preliminary results from a multicentric trial, announced in a press conference suggested that chloroquine is effective and safe in treating COVID-19 associated pneumonia, "improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course".[59]
On 16 March 2020, advisor to the French Government on COVID-19, Professor Didier Raoult, announced that a trial involving 24 patients from the south east of France supported the claim that chloroquine was an effective treatment for COVID-19.[60] 600mg of hydroxychloroquine was administered to these patients every day for 10 days. The drug appeared to be responsible for a "rapid and effective speeding up of their healing process, and a sharp decrease in the amount of time they remained contagious".[61] The study also suggested that taking chloroquine in combination with the antibiotic azithromycin - which is known to be effective against complications from bacterial lung disease - led to even better outcomes. Professor Raoult said the results showed there was "a spectacular reduction in the number of positive cases" with the combination therapy.[62] At 6 days, among patients given combination therapy, the percentage of cases still carrying SRAS-CoV-2 was no more than 5%.[63]
The study itself is interesting, I’m sure, to people in the field (though reading about the study is a bit odd. Of their test group they simply remove six from consideration for reasons like “they died”), but is irrelevant to a layman.
We are undoubtedly going to have hundreds of “this is the cure” claims that aren’t the cure. The way this is presented has significant indicators of not being credible.
Google Drive, some guy claiming that something that isn't peer reviewed at all is "full peer reviewed", pimped on Twitter. Is HN this gullible? How is this nonsense at the top?
https://www.cnbc.com/2020/03/18/bill-ackman-pleads-to-trump-...
It is. The quarantines/border-restrictions are not permanent measures, and acting swiftly is the correct way to nip it in the bud.
> Shutting down the country destroys everything.
Empty hyperbole. Death tolls in the tens of millions is a far worse outcome, as is stressing our current healthcare systems well beyond their capacities.
Two months? It’s difficult to think what will happen.
Economies don’t have a pause button. Companies, banks, and families quickly become insolvent.
But at any rate, lives > economy. Only one of those is a renewable resource.
Not sure I follow. Are you saying the economy is not a renewable resource? Cause I'm creating a new life as we speak.
Nearly 10 million people die every year from hunger [0]. How much progress are we going to lose on that by putting the economy into a recession?
Global warming is an incoming emergency that threatens global stability. What are the odds that it leads to widespread war, widespread famine, or both? How much are we increasing those odds by starting a recession instead of continuing our R&D work at full speed hoping to find a (actually implementable) solution?
How many lives will be lost due to less funding for medical care and research? Both in the US where poor people can't afford it, and the rest of the world where less wealth means less taxes means less funding for the health care system? What if the next virus that comes along is more akin to the one that wiped out the American Chestnut trees (100% death toll) instead of just doubling your chance of dying when you get it?
[0] https://www.theworldcounts.com/challenges/people-and-poverty...
It's wayyyyyy to late for that.
I'm not sure I want to be in their camp.
Even with all the generational resentment in the world, destroying the economy may be better than destroying lives.
But “Silent Generation Remover” is equally distasteful and doesn’t rhyme.
It will be actually "destroyed" if the virus is not stopped.
For God's sake people stop thinking about your S&P500 index funds for a second. Also, if you still want to be selfish, your index funds will go down to ~zero if the virus is not stopped.
It’s not clear to me that letting the virus run it’s coarse would hurt the economy.
Some (but certainly not most) very old people would die, but they are not in their productive years. Their assets would pass to younger people who would be more inclined to put them to use in the economy.
The difference in death toll would be minimal, but the difference in the economic recovery will be substantial.
As raw numbers but not percentages. 13% each of the past 3 days is better than the 15-25% (mostly nearer 25%) of the past few weeks.
I dont think Italy is over the hump yet
That is a huuuge emotional toll.
Don’t be dismissive of these concerns, they are very real.
We can and should essentially shut down the country
I don't think we can make such a blanket assertion. The US markets have lost 10T in value over the past month. If the virus infects 70% of the US population with a 2% mortality rate, 4.2M ppl will die. It's obviously not so simple, but we're sacrificing $2.4M in market cap per life saved. At some point, the tradeoff makes no sense in light of the fact that we could invest in life saving technologies/solutions that save more lives down the road.
Even doubling that does not "destroy everything"
So if it was as simple as you say, then sure. Let's shut it all down. But shutting it all down is not going to save us from Covid19.
Plus when hospitals get overloaded, patients needing critical care for problems other than covid-19 will die as well.
https://www.imperial.ac.uk/news/196234/covid19-imperial-rese...
But in the last few weeks I keep wondering if our reaction to covid-19 is consistent with our reactions to other causes of mortality. For example:
- 1.25 million people die in road crashes every year, yet we have collectively decided that abandoning cars is too large a sacrifice to make.
- global warming has the potential to cause huge devastations and millions of death, yet we fail to make the adequate sacrifices to limit our emissions.
So, is there something different about covid-19 that warrants these differences? Is the fatality rate higher, for example?
Or could it be a difference of game theory? For example for global warming, everybody has to participate in order to see gains.
Or maybe humans have a natural fear of germs and react stronger to contagious diseases than to other risks? I remember reading that argument in Factfulness.
In 2016 in the US 37k people died in car crashes.
At 2% fatality rate and 70% infection rate the virus will kill 4.6M Americans.
That's over a 100x difference.
Now show me a cause of death that involves 108 million people that's not taken seriously.
This is a serious pandemic.
Car driving fatality is fairly bounded. 124 ppm/year in USA.
Coronavirus 19 has the possibility to mutate and keep waving over the world, killing an unbounded number of people, which is downright terrifying. The best-case estimate of fatality is 5000 ppm and >50% of Americans getting it, that's 20x more deadly than cars.
We can have some faith that this virus is a one time event because
- A vaccine will probably be invented before long.
- Effective treatment will probably be discovered.
- If there is no vaccine and no treatment for some reason. You probably can't catch it twice, maybe everyone gets it once, but after that only kids get it, and kids don't die from it anyways.
people are willing to take drastic measures over a short period of time to prevent a large number of deaths. this doesn't imply they are or should be willing to take the same drastic measures indefinitely.
Our under-reaction to other serious threats is probably both psychological and evolutionary. Psychologically, COVID-19 is salient because it’s a novel threat and our brain is hardwired to notice and react to changes. Evolutionarily, humans have encountered and survived infectious disease, but car crashes and global warming are historically new.
Applied to the whole world, the risk is killing easily 10x as much as cars.
If cars suddenly became 10x more dangerous, I'm sure it'd cause mass panic. Especially if cars became 20 to 30x more dangerous specifically to our parents or grandparents.
If we can treat this as hitting the pause button on the economy, and find a way to fund it during this period, then we can press the play button and carry on where we left off. Of course that would require Russia, OPEC and the US to stop pumping oil. And a billion other details. But there's a lot of us, and we don't have much else to do.
This could be an economic disaster, but it doesn't need to be.
Sure, another alternative is we kill all the old people and all the doctors and nurses. Apparently some people aren't worried about the old people, but surely their self interest benefits from not killing all the doctors and nurses?
'Some investors have been confused by remarks. To clarify, I am confident the president will do the right thing in temporarily shutting down the country and closing the borders. If that happens, we can win the war against the virus and the markets and the economy will soar.'
' That is why we are buying stocks. These are bargains of a lifetime if we manage this crisis correctly.'
Kind of an "undefined behaviour" sort of thing - one branch of the conditional "cannot" happen, so you can assume it doesn't.
The other approach is what we have now in the US, which is rolling quarantines as we put out virus outbreaks like brushfires. It disrupts everyone's life and makes it harder to get supplies to those most at need as everyone is constantly preparing themselves for a personal lockin.
Regardless of the number of nursing homes, the point stands that the figures are skewed by a few clear outliers.
Also, the probability of receiving a prescription drug is almost linear with respect to age.
So, could the highest death of >60 y.o. with comobidities be explained similarly by them taking drugs that have a negative impact on the disease?
Some threads on the internet say to stop taking ACE inhibitors because they boost ACE2, the gate that the virus uses to get into our cells. However, other threads on the internet says that while ACE inhibitors boost ACE2, they also cause them to be blocked (bound) by ATR-1, so you're good. Unless you stop, in which case now you have twice as many ACE2 and they're all unblocked.
So I'm listening to what the doctors say and not the internet.