Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought?
I also want to add that this doesn't make the virus less deadly. It just gives it a very population varied IFR. It appears far more deadly for some populations. Near harmless for others. But no clear way to confine it to the harmless crowd.
> But no clear way to confine it to the harmless crowd.
That won't be what the public policy decisions will be based around if the asymptomatic and already exposed rate is so high.
We don't know enough to make that decision yet, but testing more broadly was the first step.
Remaining steps:
- Do they get sick in two weeks?
- Skip testing for current sickness, and test for antibodies instead.
- Get a better antibody test that is more accurate
- Understand how well antibodies work, and for how long
and then we can make decisions, even if they are as simple as "this is a systemwide over the air update, some people will get bricked"
it's becoming clear that we might end up with a society where the average BMI is under 24.9 simply due to the lower oxygen and resource requirements to support those body systems.
Not sure I follow. I confess I'm biased in thinking we could have locked down nursing homes and shaved a large chunk of deaths. Catch is, we should have done that in January.
I'm in the UK, I can't see this being accepted: it would be pretty hard for every care home to have space found near it to create temporary housing for all the workers. And basically imprisoning workers just because of their current job wouldn't be popular with the population -- if they quit, how do you replace them? Who would sign up?
Confining people to their own home, and locking them in their workspace are markedly different.
I'm not sure there's a better solution; financial incentives and let the workers decide if they want to do it? Care home workers have their own families and dependents too, but that could make it possible for many of them without having to lock them up against their will.
Apologies, my thought was it would not have to have been Draconian. We could have basically done a tight job on funneling access to them. Would have been expensive, but so is everything we have been doing.
Which is a large part of my point/question. Would it have been more effective than what we have been doing?
This is frustrating with a lot of news coming out that it had been spreading longer and faster than thought. Conceivable that much of the peak in deaths is the highest risk crowd having hit a saturation.
Like with the death rate, I expect we'll seamlessly transition from "this isn't proof, in 2 weeks you'll see" to "this isn't news, everyone always believed that so it doesn't imply any changes in strategy".
Well, it isn't proof. It is evidence, though. And in two weeks, we will have a lot more evidence.
A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. It could also be there are bad and not-so-bad strains. Or it could be bad down-the-line.
Until we do have proof, I'm advocating being conservative. In 2 weeks, we'll know if people are turning up in ERs or in morgues. In a few months, we'll know about lung damage, immune system damage, strokes, or a lot of the other potential consequences. In a year, we'll know about vaccine and long-term immunity.
I think the key problem here is failure to understand risk management. I can believe one think, but act another way just in case I'm wrong. Or I can be unsure. And so on. That nuance is lost in the right/wrong discussions.
> A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad.
I think at this point we know enough to say:
1) For most of the population, the virus is not that serious
2) For a subset of the population the virus is seriously deadly. For example, ~20% of NY state coronavirus deaths were from nursing homes, ~37% are 80 or older. By contrast, there were 2 people under the age of 10 at the time of this post. [0]
> I think the key problem here is failure to understand risk management
I think another key problem is a failure to be frank about the cost-benefit of our actions. I have had to make stronger cases about changing the color of a button or optimizing a backend call than I've seen presented by authorities who are shutting down or reopening or anywhere in between.
On 1), what do you consider "not that serious"? IE, what are your metrics of choice, and what are the acceptable values?
Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy. Second order effects include reduced vehicle deaths, reduced deaths from pollution, etc. IE, my discussions has felt agenda driven because it considers first order effects only.
If we're going to compare apples-to-apples, I'm willing to have that conversation. If the conversation is limited to "people die during recessions", it's a pretty clear signal that agenda is driving and would not be a productive use of my time.
If the argument is that more people will die from economic recession, it's a necessary component. What's the rationale for excluding it? Without 2nd order effects, it doesn't seem like the correct comparison.
We are quite a lot of people that fear the operation will be successful but the patient is dead with the Corona actions being taken. Case in point, 26.5 million americans have sought unemployment benefits (https://vastuullisuusuutiset.fi/en/weben/women-bear-brunt-of...).
Your argument supports the statement that coronavirus is not as dangerous for young people compared to old people. And that it's really serious for old people.
There remains a required link to why this isn't serious for young people. And from there, an argument that this situation is better than the other scenarios (including 2nd order effects from other scenarios).
If I break both of your legs, that's serious. You're not dead.
If you catch AIDS, that's pretty serious. You're also not dead for a pretty long time.
If I poke your eyes out, that's serious. You're also not dead.
You've redefined a serious medical problem at one which kills you. COVID19 disables far more people than it kills. We don't know how many more, and we won't know for quite a while. With lung damage, most doctors believe the damage is permanent, but some believe people will recover in a decade or two. With other organ damage, we're just speculating.
> Over 90% of the dead so far are old with comorbidites such as Hypertension and Diabetes
What's your definition of "old"?
I looked at your statista.com link and about 2/3 of deaths in NY are from people aged 75 and up. That leaves a non-trivial number of deaths for "middle-aged" people (and maybe younger).
Also, I don't know many middle-agers without some co-morbid condition, so I'm not sure we can just ascribe the deaths exclusively to "old sick people" because an enormous portion of the US population is "sick" with a morbid condition.
That being said, I will admit that there are many conflicting pieces of data flying about.
Are the PCR and antibody tests reliable enough to base our lock-down decisions?
Do we already have "herd immunity" and we're just too stupid/reluctant/lack-the-testing-capacity to realize it?
I have no clue. From my vantage-point it seems that most of us have our philosophical flags planted and we aren't willing to soberly assess where we are and maybe change our opinions.
It would be "nice" to have an AMA from an epidemiologist with expertise in this area to cut through the noise.
Coronary Heart Disease, Lung cancer and Hypertension can all be mitigated by a healthy life and the numbers seem to suggest that Corona has made these illnesses even more serious than before.
An AMA would be great and i can certainly see that being middle-aged with a co-morbid condition has gotten a lot more serious.
As mentioned before, 20% of NY deaths are nursing home patients. 37% are 80 or older.
I'm on mobile and a bit lazy, but check out death rates for the flu in younger populations and compare them to this virus. The virus has a higher mortality rate but not enough to be worth worrying about in younger populations.
>Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy.
While keeping the benefits in mind is an important part of this analysis, the fact is the pre-quarantine deaths were already accepted as "worth it" given that there was no political will to reduce them.
But yes, we should tally the reduction in deaths, pollution, etc.
So 13k deaths in NY (so far) are under 80 years old. That sounds pretty dangerous to me.
Comparison to the flu could indicate that we underindex on all these other causes of death. It doesn't make those death numbers some magical line where now it's worth it, because Coronavirus deaths in 2 months equal annual flu deaths.
If you're adding everything up, please don't omit the costs of long-term disability from COVID19-related lung damage. That swings the numbers completely.
If it were just 3.6% of the US population dying, I would understand the economic versus public health argument. It comes down to values at that point: how much is a human life worth?
But that changes completely when you consider how many people we'll either need to support for decades, or who will have lower economic output. Those costs get astronomical, and at least by my ballpark estimates, align public health with economic outcomes completely.
A question for you: If you're so sure about the severity of the virus, then I'd like you to tell me what you know about the long term rammifcations of the virus on people that exhibit symptoms.
If you can't, then perhaps it might be a good idea to reconsider advocating for reopening the economy. Because for all we know, this could end up being another Chickenpox situation leading to something similar to Shingles. We don't know enough about the virus to make reckless remarks such as yours.
Generally speaking? it's probably a good idea to delay opening things back up until we know the full extent of the virus, yes. If the antibodies only confer short-term protection and people could get reinfected again (as some indications have shown), it MIGHT be a bad idea to reopen the economy and pave the way for a second wave of the virus, you know? Just throwing that out there.
If you think things are bad now, do you honestly think things would get better if we had to go through this again because we decided to stop early? Though given you seem to be peddling the idea that this is all a conspiracy by activists to keep us at home forever, I'm willing to bet you're not going to engage this point with any sort of good faith.
You say it's a conspiracy theory, but you agree we should stay at home until the "full extent of the virus" is known, and long-term effects by definition aren't going to be visible any time soon. Do you have a plan for how we could discover such things faster than a year or two?
I asked the OP to tell me what the long-term effects of the virus are given that they said for most of the population, the virus is not that serious. They haven't provided that information yet, so I'm going to assume they don't have it.
I do not have that information either. Until we (and 'we' as in medical professionals) figure out the best way to deal with the virus and any potential effects in the long term then yes, we should stay at home. Because there's still a lot of unknowns.
That's the position I would describe as "we should stay at home forever". I'm glad we could get onto the same page that my conspiracy theory was indeed true! When people in future conversations insist that your proposals are a strawman, I'll make sure to step in on your behalf, and explain that some people really do think we should be required to stay home for the indefinite future.
> If you can't, then perhaps it might be a good idea to reconsider advocating for reopening the economy.
Can you prove that coronavirus didn't give me protection from some other more severe illness a la cowpox and smallpox?
No?
We can both come up with creative scenarios.
We are severely impacting the quality of life of hundreds of millions of people. We should have a reason to do so grounded in fact and educated guesses.
What reason do we have to suspect your scenario? What are the odds that it will occur? What are the odds it's going to be severe? What's the anticipated quality of life impact and with what confidence intervals?
Also: even if it did create this situation, and we know it for sure, what can we do about it?
We don't have a vaccine. We don't have effective treatments. Those are potentially years away, if they ever materialize at all.
How long, and how severe, should a lockdown be to prevent a hypothetical scenario? What are the impacts of a quarantine that's long enough to guarantee a vaccine with, say, 90% confidence?
The main reason why we are severely impacting the quality of life for millions of people is because our government is not willing to act to either provide some sort of basic income, supplies or guarantee survival for small businesses.
As I've mentioned in other posts here, we're remarkably lucky that COVID-19 isn't something currently far more threatening. Considering attitudes such as yours would easily lead to mass extinction as we strive to save an imaginary economy rather than the people.
As for how long and how severe a lockdown should be, I leave that up to the medical community. You and I are not part of that community and are not nearly educated to make that decision for them, so trying to argue that the economy must be opened up now is an argument made from ignorance.
The economy is not some magic genie that will give us what we want if we ask nicely. It is simply impossible to leave major sectors shut down for months. Most members of the medical community lack the necessary understanding of economics to make informed, rational trade-offs on this issue.
The major reason for suspecting long-term consequences were initially extrapolations from SARS and other related diseases. This was speculation. This was confirmed with chest x-rays in China: long-term lung scarring. People wrote this off, since it came from China. This was recently re-confirmed in Europe. Young people come off of COVID19 with reduced lung capacity.
What we should be doing is mitigating damage to those hundreds of millions of people. That's a lot easier to do than just about anything else in this equation.
We don't know the virus is not serious for most of the population. We know most of the population won't die of it in 2-3 months. We have evidence of lung damage, increased risk of stroke, and a slew of other things which /are/ serious, and may impact a broader segment of the population.
We've redefined "serious" to mean in an ICU, on a ventilator, within a few weeks of catching it (or in some cases, we've defined "serious" to mean dead within a few weeks). By that definition, AIDS isn't serious for most of the population.
There is a distinct lack of ROI calculations, but my ROI calculations lean towards a much stricter shutdown than we have in place right now, together with thoughtful actions to protect the economy.
Unless your plan to deal with mortality in at-risk populations is to simply deny them medical care, then any plan which involves ignoring these populations and their use of extremely limited (in terms of the total population) medical resources is going to kill far more then the number implied by current COVID-19 mortality rates.
The estimate of 1% mortality is with medical intervention. The estimate of hospitalization rates ranges from 5% to 15% (sometimes higher). If you get a disease serious enough to require hospitalization, and there are no hospital beds/nurses/ventilators etc. available, then it is very likely you will die.
But of course it's worse then that: because hospital resources are generally somewhat fungible - at least for ICU/surgical treatment. So not only does your mortality shoot up to ~5% at least, literally every other treatable but potentially life endangering condition (say appendicitis - which occurs at a rate 1.1 per 1000 people per year, or an estimate of 300,000ish cases yearly in the US) has now become, quite likely, untreatable - and thus lethal (appendicitis will definitely kill you, untreated).
Lots of people seem really latched onto that 1% number or whatever they imagine it to be, without any actual consideration of the context of what that figure is actually all about, or you know, an explanation things are "not that bad" yet hospitals can't get PPE, and ventilator triage is in progress, and local morgue capacity has been overwhelmed.
> Before the deluge of "But wait two weeks" comments, I just want to ask at what point we accept that the potentially of totally asymptomatic cases is insanely high, far higher than anyone thought?
Presumably in two weeks, when we know whether more of these thousands of people go on to develop symptoms or not.
Is anybody following up on stories like this? Do we have any from two weeks ago?
The asymptomatic rate being that high and that many people being infected implies three things.
1) that the asymptomatic rate for this Coronavirus is much higher than other Coronaviruses.
2) but at the same time, it's more deadly than most Coronaviruses.
3) and it's also the R0 is much higher than other Coronaviruses.
Isn't it more likely there's a testing issue? This seems a lot like a person that runs a SQL query that overturns all established data at a business, and instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong.
I'm not saying the tests are inaccurate. I'm saying when you get highly conflicting data that has critical implications, you shouldn't jump to conclusions. And you should prepare for the worst case, not assume the best.
R0 depends on the population you measure. In a high contact, crowded place, the R0 could be very high. In a population staying at home, the R0 could be very low.
The best follow-up we have is from the cruise ship, where at the time of testing more than half of those who tested positive were asymptomatic, but ultimately something like 80% of the confirmed infected ended up with symptoms.
Just curious - do you have any sources for this? I've heard it a few times and just looked it up - I found a paper [1] from March 12 that used "statistical modelling" to predict ~20% asymptomatic after a delay, but several articles 1-2 weeks after 12th indicating that they were still seeing ~50% (e.g. [2]). I think all the articles with that 50% number were based on the same test, but couldn't find anything suggesting that there were follow-ups to confirm the 20% prediction.
Isn’t this all very tainted that people on a cruise ship confined with people that have it are receiving naturally higher and repeat exposure to active virus than anywhere else?
In this study they tracked 104 patients from the cruise ship, from Feb 11 to Feb 25. Started with 43 asymptomatic (41%), went down to 33 asymptomatic (32%).
Feb 25th seems to predate the reports of the more comprehensive testing that found the near 50% asymptomatic rate.
In particular, that CDC report I linked above citing 46.5% is from late March (early release on March 23, published on March 27th).
That report cites a website by the Japanese Ministry of Health, Labour and Welfare [1], which itself confirms that 46.5% (331/712) is up-to-date as of March 26th.
I'm not very knowledgeable about stats, to be perfect honest, but I think your paper must've turned out to be a red herring. Maybe they got unlucky with their sample?
This is absolutely my reading. That someone is not really observing or listening to prisoner symptoms with much care either because of distrust between the prisoner and the medical technicians or because prisoners receive such poor care.
Sure, in New Mexico there are routinely lawsuits against the state and county’s for completely ignoring inmates’ communicated medical needs (or worse).
Amnesty International campaign against this and are currently calling for the release of ICE detainees.
Judging by a skim of their releases even those obviously gasping for air don’t necessarily get the care they need. It’s a truely massive system which in itself is part of the problem, though the exceptionally low bar for the care of prisoners is Amnesty’s primary angle.
I'll venture a guess that by Wednesday the news cycle will be deep in the implications of very high asymptomatic case count... Assuming we don't start seeing contradicting evidence.
I’m confused about this version of events that some are supporting. In your view, why does the media have a motive to engage in a secret conspiracy to not present any solutions other than an endless shutdown? How would that benefit ‘The media’?
I don't really have enough karma to be able to waste responding, but I'll make an exception for you, since you asked more politely than most.
First, there's not much secrecy involved. It isn't a secret at all that, Hollywood, the American mainstream media, and the political left are all on the same side. It's been obvious for 30 years now.
What we are currently living through is a left-authoritarian consolidation of power. Like other similar consolidations in the 20th century.
That is why, within 24 hours of the first house-arrest orders, propaganda about how our old lives of freedom are gone forever because they were "irresponsible", and how we must all get used to "the new normal" began.
Dr. Fauci says that physical human contact is a thing of the past ("nobody will ever shake hands ever again"), governors, especially those of "blue states" have all acted to either make their house-arrest orders indefinite (like in CA) or to declare that they will continue for multiple years (as VA announced yesterday, for example).
Enforcement is gradually increased everywhere, and citizens are increasingly encouraged to snitch.
Political protests are banned. Even organizing them online is being locked down, with states pressuring Facebook and Google into deleting people's accounts if they even mention the existence of a protest.
The thing is, it takes time to take a society used to freedom and fully consolidate it.
The house arrest orders are the start -- now, when the government eventually let's people out of their houses, but only on conditions (like wearing a tacking wristband, showing your papers to any government official, having to have "a legitimate purpose"), people will be so desperate to leave home that they'll agree.
With "contact tracing" apps and "mandatory isolation", the government will be able to declare any person they need to silence as "contaminated", and they go back to imprisonment, with no recourse, no due process, no burden of proof. Even better, having communicated with a "contaminated" person automatically adds you to the list of the unpersoned.
The economic disruption has already made 1 in 4 Americans dependent upon government handouts to survive. Every week, another 4-5% join them. An authoritarian government needs it's people to be dependent for survival, in order to ensure cooperation.
Meanwhile, the food supply is being turned off. We already have a third of our food production offline, and are most of the way toward driving all independent farmers and ranchers into bankruptcy. We are pretty much guaranteed to have widespread hunger by the fall. This will leave the way for a government takeover of food production.
But, in order for the consolidation to work, they have to keep us all imprisoned willingly until they finish consolidating enough power to make it permanent, or we will all just go back to our lives as free people, the economy will recover, and people won't be dependent upon the would-be dictators for their continued survival.
The next 3-6 months are critical to breaking the back of the capitalist system and soften everyone up to accept the new freedomless world. It will take that long to drive enough people to poverty, hunger, and desperation for them to be willing to go to the authoritarians and beg to be ruled.
This isn't a secret, and it isn't really new. It's more or less how every current left-authoritarian state was formed -- only with more technology and fewer guns.
That's the power of owning the education system, the media, and all of the big tech businesses.
You don't need the presidency when you can make the presidency meaningless. Look at Trump -- every time he tries to take any position at all, he gets wrecked and ultimately loses. The media destroy him, the tech companies disband any gatherings of his followers.
Besides, unlike the left, the right and Republicans are a fractious, disunited lot. They can't hardly agree on anything -- too many incompatible viewpoints -- so they're almost completely ineffective anyway.
It's not a secret! Many media outlets and government officials have been very explicit about it: shutdowns are the only option for us, it's irresponsible to demand a date when they'll end, and it's very offensive to ask whether they're worth the cost.
I do share your confusion about why the media would say such things, but they are.
I'm not at all confused about why journalists relay information such as that, because generally it is combined with a very reasonable logic about why we're doing that.
Like Dr Fauci said, the virus decides the timetable, not us. Nobody knows when it will be safe to reopen.
Many businesses are simply not safe for people to mingle in. Many people don't want to understand or take the distancing guidelines seriously, if they're even adequate.
As far as whether they're worth the cost, there's plenty of room for speculation about that. I do think that reducing a potential overload on hospitals is a wise plan.
The media is not monolithic, but a large subset of it is fervently against Trump, against Trump supporters, and against Republicans in general. The worse the pandemic and shutdown get, the more this subset of the media can use it to bash Trump, Trump supporters, and Republicans. Generally speaking, the worse the economy gets, the less likely that the incumbent president will be re-elected. I don't think that this media slant is the result of a conspiracy, though, at least not for the most part. I'd guess that probably most of the slant comes from subconscious bias, not conscious intent.
I'm against Trump too, for various reasons - for example, I don't like his authoritarian mindset, his stance on torture, his stance on surveillance, and his foreign policy towards Iran - but I'm not a fan of the constant hysterics of the anti-Trump media either. Some of those people would claim that Trump was somehow being deceitful and evil even if he just said that 2 + 2 = 4.
There are, I'm sure, other sources of media bias on this matter as well, but this is the one that immediately comes to my mind.
How do you feel about the right-wing media that was obsessively critical about Obama for strangely irrelevant things such as his choice of mustard or color of suits?
It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
>How do you feel about the right-wing media that was obsessively critical about Obama for strangely irrelevant things such as his choice of mustard or color of suits?
I feel that it was idiotic propaganda.
>It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
The problem as I see it is too many Trump haters go beyond the many valid reasons to hate him and instead, due to conscious or subconscious bias, start to do things like take things he says out of context, or read more into those things than is necessarily justifiable, or try to paint him as a uniquely evil figure even though we have had presidents in recent memory who literally supported death squads in third world countries... etc.
It’s not like this is the first population that has been nearly exhaustively tested. There was the cruise ship, there was the navy ship, etc. Those have shown between <20% (among the elderly cruise ship demographic) to 60% (among healthy soldiers) asymptomatic.
This certainly adds another data point, but I wouldn’t throw conventional wisdom out the window yet.
Note that until this past week, officially, the symptoms had to be the first three defined by CDC, not the eight or so CDC have expanded now: fever, cough, shortness of breath, chills, repeated shaking, muscle pain, headache, sore throat and new loss of taste or smell, could all appear between two and 14 days after exposure.
In the field it appears many/most of the less severe cases don’t exhibit the initial set they had defined, so patients experienced illness written off as not COVID-19.
From what I’ve heard from the field, a careful patient history finds there was typically a bout of unusual “but it can’t be COVID” illness with a set of the expanded set of symptoms in almost every “asymptomatic” patient.
It’s further speculated these variations may have to do with level of exposure and path of infection, along with the earlier noted lung health and comorbidities.
When at least one large studied group has an outcome (symptomatic recovered, asymptomatic recovered, or dead). So for this group I guess a few more weeks.
When we know the full extent of the virus? It's an easy question to ask, but an incredibly hard one to answer.
For example, they've been finding that the virus can trigger strokes in otherwise healthy individuals. That's individuals that either exhibit no symptoms or minor symptoms. So while they may otherwise be asymptomatic, we can't know unless we do a full extensive test to see if they're also suffering from unseen clotting issues.
I've been tracking the antibody study results in a spreadsheet, and they are suggesting a 10-20x undercount of cases in the official "confirmed" numbers. You can see the data I've collected here: https://docs.google.com/spreadsheets/d/16onEUBWIV5IqN1RCvTla...
I think antibody tests will soon become more useful for tracking disease progression in a population than the viral tests. The collection methods may skew things but they still are much more close to a random sample than the viral tests which have lots of issues with test shortages and people unable to get tested (or not wanting to go to the hospital with mild symptoms).
"In order to test the detection sensitivity and specificity of the COVID-19 IgG-IgM combined antibody test, blood samples were collected from COVID-19 patients from multiple hospitals and Chinese CDC laboratories. The tests were done separately at each site. A total of 525 cases were tested: 397 (positive) clinically confirmed (including PCR test) SARS-CoV-2-infected patients and 128 non- SARS-CoV-2-infected patients (128 negative). The testing results of vein blood without viral inactivation were summarized in the Table 1. Of the 397 blood samples from SARS-CoV-2-infected patients, 352 tested positive, resulting in a sensitivity of 88.66%. Twelve of the blood samples from the 128 non-SARS-CoV-2 infection patients tested positive, generating a specificity of 90.63%."
That gives us 62% false positive ratio according to (where a study finds the prevalence to be 6% of subjects using the test):
In some cases we have research being carried out with such low positive results that they can entirely be accounted for by the low specificity. So for example if you took samples from 100 people, based on 90% specificity, even if everyone had never had corona, 10 could be found positive.
I wonder what's the process through which false positives happen in this case. Previous infection by milder Coronaviruses?
Edit: I'm looking at the reddit post but I have a lot of reservations with the "prevalence 0.06", unless we'll use the test to test absolutely everybody and not only people who are suspect. Has that calculator been validated as well?
If the test was 12 false positives in 128 negatives, how come they can claim the false positive rate is 60%?
"Our data from this week and last tell a very similar story. In both weeks, 6% of participants tested positive for COVID-19 antibodies, which equates to 165,000 Miami-Dade County residents"
That is what the commentator is referring to in the linked post.
So if you plug their own figures into the calculator:
Sensitivity .8866
Specificity .9063
and a Prevalence of .06 based on the study, you get the 62% false positive rate.
As the prevalence increases, as with the NYC study which found the positive rate to be 21% (prevalence), the false positive rate decreases, down to 28% of the NYC study.
Yes. That’s one possible explanation. Interestingly quite a lot of people might be somewhat immune to the new Corona virus due to anti bodies from previous Corona cold infections. More than 30% showed such antibodies in a recent study.
https://www.finanzen.net/nachricht/aktien/drosten-hinweis-au...
(Sorry that the only source I have ready right now)
The password you need to Google for why it happens is "antibody cross reactivity." Not necessarily other coronaviruses but I imagine they're disproportionately more likely to cause it.
This is from ARCPoint Labs, where I took my antibody test:
The Antibody test is a serology test which measures the amount of antibodies or proteins present in the blood when the body is responding to a specific infection. This test hasn’t been reviewed by the FDA. Negative results don’t rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic lab should be considered to rule out infection in these individuals. Results from antibody testing shouldn’t be used as the sole basis to diagnose or exclude SARS-CoV-2 infection. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.
There are many different tests, from different manufacturers. Some of the tests have higher false-positive rates than others. Some have higher false-negative rates. Even a survey with an imperfect test can be designed to yield reliable data.
i don't understand the value of this multiplier. Case statistics are not an official census, it's incidental , depending on the criteria with which each region makes tests. Case numbers are unimportant, it's the total infections and consequent deaths that matter
You're probably right that they shouldn't be, but case statistics are regularly treated as an official census. I've seen many news articles in the vein that suchandsuch country is handling it better or worse because of their case numbers, or statistics like CFR that are computed from official case numbers.
That just doesn't seem true. In the US testing strategies are rapidly changing, since health officials indicate this will be essential to safely removing restrictions.
One reason is that early on when the curves looked pretty much exponential, folks were trying to pin down how bad it could get, and when. This was when the worst case scenario was for nearly the entire population to get it. I'm not quite sure we're completely out of that woods yet.
I know that the California studies used the same test kit. It had 2 false positives out of 371 samples of pre-covid19 cases, and has a 10-20% false negative rate. Because the case numbers are so small, the false positives can skew things quite a bit. I took the midpoints of their 95% confidence intervals in the spreadsheet.
It depends on the study, I've been using their reported confidence intervals. The two California studies (Santa Clara and Los Angeles) used the same kit, which has 2 false positives of 371 tests, and 10-20% false negative rate.
It's worth noting that is the manufacturer claim but has not held up to independent validation.
Specifically, the Premier Biotech/Hangzhou Biotest Biotech test was validated by a Chinese provincial CDC and found 4 false positives out of 150. [1]
It was also validated by the COVID-19 Testing project and found 3 false positives out of 108. [2]
The Biomedomics test used in the Miami Dade study was also validated by the COVID-19 Testing Project and found 14 false positives out of 107. [2]
Hence I would recommend taking the results of the California and Florida studies with a huge grain of salt as the prevalence rates they found were within the false positive rates of the tests used.
I did similar calculations, and found the institutions in charge give us very unreliable data. The term "corona case" is very, very, ambiguous and cannot the understood as such without a detailed explanation on how the counting was done.
Thanks for sharing.
I found the peek in all-case mortality also very interesting, because that way counting is much more unambiguous: dead is dead.
They showed a clear diversion from the "average" in recent weeks, but... they did not show the stdev for the averages. Finally I found a chart that shows that "outliers" are not uncommon.
Yea, I agree that the case counts are very different between regions. I think the more interesting column is the IFR estimate based on the antibody study results, since dead is dead as you say.
It is interesting though that the median undercount is converging to ~10-20x. Perhaps the protocols across regions are similar enough that the confirmed case counts are somewhat comparable.
It seems possible to me that there are variations, mutations, in different regions that might account for some of the variance in apparent R value and such?
> Dead is dead, unless the state finds a way to claim that it was not a COVID19 dead.
It's just a matter of demanding tests to declare as a COVID death and do not providing enough tests.
Brazil, for example, has an artificially low count of cases due to the lack of tests and a similarly low number of deaths. However, cases of death by "pneumonia", generic types of SARS and "unexplained respiratory diseases" skyrocketed: https://oglobo.globo.com/sociedade/coronavirus/alem-da-covid...
I would add that it doesn't have to be a malicious government purposefully undercounting. It's very easy to undercount or misdiagnose even with competent and well meaning people. Specifically every pneumonia death, heart attack, stroke is a potential undercount, and people aren't "bad people" or evil for making the wrong conclusion about the ultimate cause, especially when testing is less available and frequent than it should be. Also I have heard that there are a significant number of people dying of COVID19 in their homes and that those are more likely to be undercounted vs. a death in a hospital.
No. Not unless. You misunderstand what all cause mortality means. The state can count COVID19 deaths as all bungee-jumping related the number still shows up in the total death rate. If you know what is the usual statistic you can show if there is an effect.
This is what “dead is dead” mean. One can argue what should count as a COVID19 case, and how exactly we are counting. There is a lot less argument over who is dead and who is not.
a family member who is a doctor at a hospital told me that any patient that dies of a respiratory illness is being marked as covid19 even if they were never tested for it. dead truly means dead. dead by covid19 does not.
Outliers such as this one are not uncommon in the winter. They are in April. According to that chart there isn't a single point outside of winter months as high as this year.
There is a very noticeable spike in the worst hit countries: Italy, Spain, France, Belgium, Netherlands and the UK.
The cumulative excess deaths for all Europe in the last two months matches the COVID-19 reported deaths (around 100000).
The spike receding is due to incomplete data rather than a reduction in deaths. Deaths (especially in the current circumstances) can take a couple of weeks to get registered properly.
also need to take into account the decline in deaths from other factors due to quarantines, social distancing, and improved hygiene. less driving, less spread of other infectious diseases, etc.
> The cumulative excess deaths for all Europe in the last two months matches the COVID-19 reported deaths
This article claims that most Covid-19 hotspots have significantly more excess deaths than reported covid deaths. Suggesting that there is a lot of underreporting. NYC being a notable exception. I think several countries count only corona deaths in hospitals, but systematically miss all deaths in care facilities. https://www.spiegel.de/wissenschaft/corona-todesfaelle-wie-v... (charts should be readable despite any language barrier)
(I don't defend either view. As the old joke goes, don't trust any statistics you haven't manipulated yourself :) Statistics and causality have always been difficult, even more so in exceptional time with imperfect short-term data only.)
There is under-reporting that's for sure, but there is also a delay in all-cause mortality. In some cases, the same country both over and under reports. To be honest, I am surprised to see such a close match. I expected similar numbers, but this is within ~10%, which I suspect is a coincidence. But still, that's interesting.
Another coincidence is that the country that is most suspected of under-reporting, Germany, is also the least represented in EuroMOMO. There is data for only 2 regions.
Italy, Spain and France, the most significant contributors both in COVID-19 related deaths and excess mortality in general, all count deaths in care facilities now. I don't know about the UK though. Deaths at home are probably not counted, but according to the authorities, they are a minority: COVID-19 does not happen suddenly and people normally have time to go to the hospital. Still significant though.
My gut feeling is that there are actually ~50% more deaths than reported. But we'll have to wait for at least a few months to get proper statistics.
New York has been criticized for retroactively adding older cases. The Johns Hopkins data just tacks it on to the end of their time series, creating a weird spike and screwing up what the data represents:
> The cumulative excess deaths for all Europe in the last two months matches the COVID-19 reported deaths (around 100000).
Where's the noticeable spike for Ireland? Where's the spike for Portugal? Where's the spike for Luxembourg? Where's the data for the rest of Germany outside of Hesse and Berlin? Where's the spike for Austria? (And this is not a criticism of them, but they only track Western Europe by the looks of things.)
Don't know where Euromomo is getting its data from but I suggest to you that it's incomplete.
This NYT article[0] (other publications like The Economist[1] have arrived at similar numbers) show that the cumulative excess deaths for France, Netherlands, Switzerland, Spain, and England & Wales sometimes far exceeds reported Covid-19 deaths.
Of the countries you mention only Belgium is actually reporting accurately. (As is Sweden btw, a country you do not mention.) Note that both are smallish countries.
As of 14 hours ago Chris Giles (FT economics editor) tweeted[2] "A cautious estimate of the total number of UK excess deaths linked to coronavirus stands today at 42,700" (He updates this most days.) Worldometer[3] currently has the UK on 20,319 deaths. Quite a difference.
In fact, the numbers show that in Europe actual deaths are between 1.4 [Swiss] and 2.1 [British] times higher than the reported numbers for countries that are under-reporting.
Btw, you say that there are 100,000 deaths? EU 27 has 96,533 deaths as of this moment. EU+UK has 116,852 deaths as of this moment. And Europe in its entirety[4][5] has 122,568. (Am tracking these figures using a spreadsheet.)
Let's say that the adjustment we have to make is between 1.4 and 2.1 and let's ignore population size and pick 1.75 and then lower that to take into account that some countries are accurately reporting and let's err on the conservative side so let's choose 1.66… repeating as our adjustment rate, agreed? This gives us an estimated excess # of deaths for Europe of 204,280. Twice the figure you've given.
(Europe is generally taken to extend from the Atlantic states of Ireland, Portugal, and Iceland in the West to the Ural and Caucasus Mountains in the east, from Scandinavia in the north to Italy and Greece in the south.)
There's a simple reason for that: the lockdowns are killing lots of people and will kill even more. That's not under-reporting but rather an obvious outcome of clearing the health system in expectation of a surge that never came. Probably the UK will see an extreme form of this effect as people are encouraged to see the NHS as a sort of public park that everyone has to take care of rather than a large mechanical system, as in countries with private/insurance based healthcare.
Admissions at hospitals have collapsed: in the UK they halved. Admissions due to respiratory illnesses however didn't really go up, not surprising when you consider the small absolute numbers. There is now a massive backlog of operations and diagnostics for cancer that health systems will struggle to clear in time.
There's a story with some analysis of that problem here:
In the past the recommendations of epidemiologists have ended up killing a lot more than they saved, with the 2001 foot and mouth epidemic in the UK being a classic example. It's likely it will be true again this time.
Your sheet is interesting. Looking at it, the IFR varies from 1.66% down to .11% and the 0.11% is for the Santa Clara, which many considered rather suspect.
The 1.66%, otoh, seems reasonably in line or at least compatible with what's been observed in Korea and elsewhere.
Given age is going to skew things a good deal, it seems like a picture is emerging but not that new a picture. An IFR of even 1% is pretty bad, especially given these statistics show how infectious this virus is.
The numbers that are quoted for Austria (which has the listed IFR of 1.66% in the document) weren't obtained via antibody tests, but via PCR tests. Here's a better source than the one linked in the document: https://www.sora.at/uploads/media/Austria_COVID-19_Prevalenc...
Most of those tests were done on April 4th and 5th which was 3 weeks after Austria started relatively strict lockdown measures, which also impacts that number, as this will result in the test to find an even lower number of positive people.
To be clear: it would be the most dangerous general epidemic disease since the advent of vaccination, and by a significant amount. You need to go back to measles and polio to find general population outbreaks that were more lethal.
A very important thing is that % is concentrated among old and people with preexisting health conditions.
Not every death is the same - a 80 year old with weak immune system could have lived 5 years longer without corona, but a healthy 20 year-old dying from cytokine storm caused by influenza has lost potentially 60 years of healthy life - the loss is much worse.
To be perfectly fair (and for the record I'm very much not among the "sacrifice the old and weak" set!): not as much as covid.
The elderly and immunocompromised obviously die more to almost every illness. But the effect is really pronounced with covid. And most other viral infections tend to kill children at higher rates too, and covid very notably does not. It's definitely an interesting aspect of the disease, though it's produce a kind of horrifying calculus among a lot of the right wing in the US.
OK, so how many "influenza death equivalents" are we looking at? What's your metric for how bad this is? I mean, I think that's a little ghoulish, obviously, but if people really want to make this argument I'd really like to see the kinds of well-founded numbers that the experts are producing. Medical ethics is hardly a new field, after all. You'd think someone would have pulled some analysis off the shelf.
Instead, the people pushing "these people would have died anyway" seem to be almost exclusively political actors (or their proxies on social media sites like this one) with a goal of either defending the inaction of the current administration or pushing a policy goal that necessarily sets the virus loose on the public.
But if you really want to make a numerate case for not trying to save the old and sick, I'd genuinely and carefully read it.
I think there are already such calculations for approving drugs on public health programs - cost of treatment vs years of quality life provided.
So you would need to estimate the number of years lost vs the economic damage. This is impossible to get right on both sides but at least it gives you a framework.
I agree we should consider years of life lost but the figures are a bit higher than they ones you're using. 14 years on average for men and 12 for women. Not 60 years but more than 5.
https://wellcomeopenresearch.org/articles/5-75
Not every death is the same - a 80 year old with weak immune system could have lived 5 years longer without corona, but a healthy 20 year-old dying from cytokine storm caused by influenza has lost potentially 60 years of healthy life - the loss is much worse.
In a triage situation, where you have to decide between different people dying, such choices are unavoidable or necessary. But I want highlight that you are talking about this stuff to say that it's OK to plan for the death of "a 80 year old with weak immune system could have lived 5 years longer" versus no death at all. And that's not OK.
But those discussions happen all the time. If there is a drug that can extend the life of this person for 5 years but it costs X - should it be covered by society ? At what X does it become unacceptable ? The highest numbers I've seen argued are in the 200k/year but realistically it's much lower depending on the country.
Well, there are two kinds of choices that are generally considered radically different.
One choice is providing some opportunity for further life beyond what's expected. That's generally considered something society likes but isn't obligated to provide. Society doesn't obligate it's member to spend money developing some miracle-extend that gives someone five more years.
The other choice is taking life that would normally be expected. That is something that society very much frowns on. If you could protect someone and you don't do it 'cause it would cost you money, you may wind-up in jail for murder.
Very quantitatively oriented people seem to have a hard time grasping why there's a difference here. But I think it's very rational in an evolutionary game-theoretic compact kind of way. Everyone is a member of society and values everyone else's life highly, more highly than immediate material things though maybe not more highly than other people's lives. This gives member of society basic security - you are thinking my insulin might worth just stealing and selling on the open market, me murdering you first might be my best strategy. You can see where things break down? The "social contract" is kind of the way around this.
You can self isolate without quarantine measures in effect so your point isn't that strong to me and you are ignoring that one of the biggest destabilising forces in history is economic downturn. US-China relations have been bad for a while now and both sides are throwing blame at each other as a populist policy (China has a US origin story allegedly). If this pushes the economy in to a global depression who knows what will happen s few years down the road. Taiwan, Korea, plenty of places that could erupt if things become politically unstable - both in the US and China.
Self-isolating vulnerable populations is almost impossible. You're talking over 100M in the US.
And not doing anything (pretend it's just the flu) will result in 50M dead world wide. Everyone worried about a new depression should realize one is going to happen no matter what we do now. The only thing we can do is act in a humane fashion.
Your number is highly suspect. About 16% of the US is 65+, or roughly 50M.
Where do you get your 50M worldwide figure? When a new flu appears, Neil Ferguson claims his 3K lies of undocumented C code forecast 200M will die. These numbers are all speculation and worse predictors than throwing darts at a board behind your back.
One third of the US population is considered at risk due to comorbidities. With over 328M people in the US, that's roughly 100M.
If you look worldwide, there are 7.8B people. If herd immunity takes 60% of the population becoming infected, that's 4.6B infections. With an IFR of 1%, that's 46.8M deaths. 460M hospitalizations (where possible).
Even say the IFR is overstated as some like. Say it's a magnitude less, comparable to the flu at .1% Now you are down to 4.7M deaths, but still the 460M hospitalizations. Still one of the most serious crises in the last 100 years.
Basically everyone who dies from this has a preexisting condition, but basically everyone in the US will develop at least one of the big three (hypertension, diabetes, or obesity) at some point.
We don’t cry about the millions of heart attacks that are easily prevented. We definitely don’t Give a damn about some person dying of cancer when they are smokers. Why are we drawing a distinction here?
You chose to eat X and not exercise for years/decades. A middle class American has enough education and purchasing power to know and behave accordingly.
Does it suck? Yes, but i find it incredibly unfair and hypocritical towards the rest of the world by ruining their lives based on the extremely old and or fat/unhealthy population.
It's interesting that this jibes with conventional wisdom. Since nearly the very beginning of when people started looking at graphs of case counts, my colleagues and acquaintances (mostly scientists) assumed a ratio of roughly 10x. Folks would look at any graph and automatically bump it up by an order of magnitude.
Maybe we can institute a work-recovery program where inmates can do high-exposure work (once they are truly recovered). give them experience and a feeling of duty and purpose.
Nah, they'll probably just keep using em for slave labor.
I'm in a high risk category with an incurable respiratory condition. I'm convinced I've already had it and I'm mostly recovered now.
I was mostly asymptomatic. The biggest thing going on was that I was very tired, which was also something easily explained by other things going on, so I was basically already on the mend before I concluded I must have had it.
I believe we are barking up the wrong tree. We are looking for respiratory distress because it leads to low oxygen levels. I think we need to be looking more at what it does to the blood. Fortunately, some doctors are looking in that direction, but I think not enough, probably.
My symptoms were similar to anemia. It's easily missed because you mostly lack energy.
Again, there can be lots of reasons a person has low energy. It can be quite hard to say "Clearly, this symptom is indicative of Coronavirus."
So I suspect a lot of people will never be overtly symptomatic in the ways the world is looking for with its huge focus on lung issues.
Doctors are already seeing blood clots in many COVID-19 patients. Strokes, heart attacks, and pulmonary embolisms appear to be much more common than with other forms of viral pneumonia. Some hospitals have incorporated blood thinners into their treatment protocols.
I also had an interesting discussion with someone who is apparently some kind of medical researcher about zinc and blood stuff. This was very helpful to me and my sons in trying to recover our energy levels, which also firms up my suspicions that a. we had the infection and b. my mental models are less wrong than some of what is out there.
People can test positive and are most contagious before they show symptoms. As opposed to influenza where people with symptoms are most contagious. The delay in the onset of symptoms is why this is a very difficult virus to contain.
Further, the accuracy of our tests is questionable and hopefully improving.
Finally, viral shedding has been seen up to 35+ days since symptom onset. Meaning if they showed symptoms a month ago, they may still test positive.
Our prisons do not reduce crime. All of these people should have been released months ago.
[EDIT:] Apparently these propositions are not self-evident to all HN downvoters. They follow directly from several other propositions that really should be obvious. USA imprisons vastly higher percentages of its population than other nations. Yet it still has higher crime than those other nations. QED.
No-one is assuming - we are weighing evidence and there is far more evidence that it does provide at least some immunity than none - it seems oddly disingenuous of WHO to make statements like this because they know how it will be interpreted.
The WHO says that we can't assume someone is 100% guaranteed to be immune when they have antibodies. That's true, and it's an important flaw in the idea of immunity passports that they're tackling - you couldn't send people with immunity passports into quarantined nursing homes or allow them to attend potential superspreading events.
Herd immunity doesn't require perfect immunity or a 100% guarantee of it. No reasonable expert doubts that herd immunity is possible, although some argue it's too costly.
Not sure why I am getting downvoted, I guess covid-19 shaming is a thing. From what I've read people who appear to get it again is actually just a relapse of the original infection[1].
I must say that for a community of rather technical people when not scientists and engineers, hackernews has a surprisingly high level of FUD-pushers and doomers on that topic. I put that on account of anxiety.
> As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.
The most likely thing is that it does mean immunity, but the WHO isn't going to say that without clear evidence.
You can be reinfected. It sounds like there's already some evidence suggesting that reinfection is at least significantly less likely than initial infection.
NYC shows that you will end up with probably 0.3% or more of the population dead before you get herd immunity. 0.3% of the entire US population is 1 million people.
It doesn't appear to mention what type of test was done. Were they checking for current active infection, or for antibodies which would indicate if the person has ever been infected? (if the latter, they may have had symptoms back then)
I am not willing to even consider these results until more details about testing are revealed. There has already been so much misinformation about testing and results that I am incredibly skeptical of any results now.
Same here. Is there any chance the viral load test is also testing positive for other coronaviruses that are not SARS-CoV-2? Because I can't find any information addressing that.
The test seems so freaking flawed to me, if you test isolated ISS astronauts, you would get half of them infected. Or probably aliens are infected too. Maybe some people who are dead for million years are infected as well. No one freaking talks about the test being flawed (rtpcr).
I don't know a lot about the antibody tests. Is the novel coronavirus novel enough that they know exactly the kind they're testing? Is it a specific test for SARS-CoV-2?
There are many antibody tests. The one I’ve read about (from the Charité in Berlin) was designed (or found) to also test positive for the “original” SARS, and for very closely related bat viruses (neither of which should present an issue when testing humans today), but not for other corona viruses (such as the common cold etc.).
That test has also very carefully been validated, with excellent sensitivity (=few false negatives) and specificity (=few false positives). Not sure all available tests have gone through quite so thorough validation.
The Ohio prison system is probably testing for the presence of the SARS-CoV-2 virus, not antibodies. That testing is specific to the virus (the type of test can respond to multiple viruses, but being specific to the target is one of the design criteria).
An antibody test should also generally be well targeted.
The idea is that nicotine may lower your chances of infection, but once established I imagine that smoking will definitely reduce your chances of survival.
Well, it lowers your chance of being listed as an infected person.
Presuming this is true (lots of evidence but still much too early to be sure), there's two possibilities: nicotine makes a person less likely to be infected, or nicotine makes it less likely that the infected will develop any symptoms. No symptoms, no test, that's been the rule until quite recently.
If it's the latter, it could explain what's going on here. I doubt that's the explanation, but it's possible.
A couple more possibilities could be that smokers are less likely to notice any symptoms they might have, or are less likely to report those symptoms and get a test. Smokers are probably less conscientious on average - it's almost the definition of lack of conscientiousness.
No, that can’t be the case here, because a shockingly large proportion of people tested positive according to the article. (Thus, either the false positives are negligible, or the test employed has a an astronomical false positive rate (bad specificity)).
You're right, they get a positive result for almost all the population!
Wait, does that pass the smell test? Do prisions become huge flu hotspots as well? The Diamond Princess outbreak didn't have that kind of numbers... What's more likely at this point, the numbers from the article or human error?
My respects to anybody trying to do actual science with this kind of data in this kind of situation...
Densely crowded environment where people were unlikely to maintain social distancing, poor quality health care, probably poor quality sanitation. It seems reasonable to me that a prison would fare worse than a cruise ship.
Not quite this huge, but then again states generally try to get them flu vaccines. It's reasonably common for prisons to enact emergency measures to stop the spread of the flu.
> They started with the Marion Correctional Institution, which houses 2,500 prisoners in north central Ohio, many of them older with pre-existing health conditions. After testing 2,300 inmates for the coronavirus, they were shocked. Of the 2,028 who tested positive, close to 95% had no symptoms.
This is the relevant response. What the commenter is trying to imply is that the authors of this study are so staggeringly stupid that they overlooked the possibility of false positives when designing this experiment.
In reality, this test would need a false positive rate of over eighty percent to explain this kind of asymptomatic infection rate.
Also, prisons are useful because due to the close quarters it can be taken as a given that a substantial proportion of the population is infected, further minimizing the danger of these sorts of errors. The choice of population suggests a sophisticated experiment design, and the commenter is implying that the study authors made a statistics 101-level error.
As someone else has said on another comment, it just needs the experimenter to be infected and a bit careless, and there is your high percentage of positive results.
Plus yeah, to be honest, you dismiss staggering stupidity leading to juicy headlines at your own risk.
It's a prison population. Prisons and nursing homes are both seeing shockingly high infection rates because of the nature of what they do, which involves confining groups of people in close quarters.
People in nursing homes are elderly. Lots are dying.
People in prison aren't uniformly elderly. You are bound to see more variation in symptoms.
(Plus, as stated elsewhere, the opinions and experiences of known criminals tend to get discounted, so the report of lack of symptoms may be more about that than about the general resilience of the population. Also also: It's well established that if you ignore, dismiss and neglect someone enough, they stop complaining because they know it doesn't do any good. Aka learned helplessness.)
Wild speculation is not the solution to lack of information. We all want to know how reliable these tests are. I don't understand why we can't find this information. But that is not an excuse to make nonsense assumptions and craft imaginary narratives.
Plugging the 96% into New York numbers results in 155,000 / 4 * 100 = 3,875,000 infected people in NYC, or about half the population.
This is assuming that tests in NYC currently include every infected and symptomatic person. Considering the official advice for people with mild symptoms is to stay home (and not seek a test), that assumption is ... optimistic.
It also wouldn't fit with the anti-body tests that have been done in NYC that showed figures closer to 15-20%.
So I'd expect about 1/2 to 2/3 of these 96% to develop symptoms within the next week.
The other possibility is the prison population not being representative of the general population. That's probably true in terms of fatality rates, because they are younger. I'm not entirely sure if that age imbalance is just as strong for any symptoms as it is for risk of hospitalisation and death.
I've read that asymptomatic carriers are though to be less infectious than those with symptoms because of the lower concentration of virus in the saliva. Also, many virologists mentioned in recent texts that the initial concentration of the virus you receive can affect how sick you'll get - the more viruses you're exposed to, the faster they can invade the body and the more severe it will get.
Can those two facts be combined into a theory that asymptomatic carriers are more likely to produce more mild and asymptomatic cases?
Don't know if it makes any sense (probably not), but it would certainly explain how in some closed environments there's a prevalence for mild cases, while in others there's a plenty of very sick people, regardless of the age.
> Netherlands National Institute for Public Health and the Environment
> The Netherlands National Institute for Public Health and the Environment, is a Dutch research institute that is an independent agency of the Dutch Ministry of Health, Welfare and Sport. RIVM performs tasks to promote public health and a safe living environment by conducting research and collecting knowledge worldwide.
I live in the Netherlands and I think you could say that we actually have it quite under control (relatively speaking of course). We never reached peak ICU capacity and the ICU occupancy has been steadily declining for more than two weeks now[1]. Our schools for children between the ages of 4 and 12 are scheduled to partially open again on the 11th of may[2].
We, the Netherlands, got it under control because we went into stricter lockdown against the advice of the RIVM. Above assumptions led to advice against a lockdown.
Only under pressure of the IC doctors on Sunday the 15th of march did the prime minister close all schools and restaurants. (A high school is like a festival every day)
The policy and advice of RIVM has been wrong and misleading from the end of February. For many of us it was already clear they lost control beginning of March.
This article in the Volkskrant describes how the RIVM was panicking beginning of March, but the prime minister wanted to present "good weather", and they also send their stock of masks to China beginning februari:
https://www.volkskrant.nl/nieuws-achtergrond/nederland-stuur...
Even now they are not testing healthcare people with symptoms in elderly homes and also not providing any sort of masks. Claiming the available masks are not of sufficient quality, they prefer to send healthcare people to work without masks then to get high quality masks even if it is without the preferred certificate.
Last point. Under control is relative. The IC capacity reached a higher number then we ever anticipated, still more IC beds are occupied by corona patients then we had in total beginning of 2020. https://stichting-nice.nl/
The data doesn't support any of this. Overlaying the R0 estimation and the date that interventions were taken shows that the original "stay home when sick, wash hands and don't shake" advise had the biggest effect. This also matches most research that has been done on influenza.
The lockdown on schools and restaurants had a much lower effect.https://www.volkskrant.nl/nieuws-achtergrond/corona-onder-co...
The RIVM lost the battle in Februari not in March, this is was what my initial comment referred to.
Throughout Februari and March they had the following policy:
- Clearly stating and assuming that asypmtomatic people cannot or are extremely unlikely to transmit (had letters sent to schools and events I particpated in, was also on their website). True or not, there was no data to backup this up and an assumption like this has big consequences when false.
- When from risk area AND with symptoms as a policy they didn't test. In general the whole focus was to test as minimal as possible. Causing us to be completely caught off guard of the true scope untill March.
- Clearly trying to sell the idea that masks don't work for normal people, while at the same time trying to claim them for themselves
- As a policy not testing healthcare people, not even with symptoms. First random test of healthcare people with symptoms in the south was only done on the 8th of march, they were shocked by result (and for a long time untill march allowing people to work with symptoms ). https://www.rivm.nl/nieuws/steekproef
- As a policy "non-essentials" healthcare people get no protection unless evidence of covid and hardly get tested. 900 of 2100 healthcare/elderly houses now have the virus with 20 to 30 percent death rate.
- Failed attempt of centralised buying of masks and other protection wear
- Till the end of Februari claiming they had it under control
- etc...
There is more things to point out but Ill leave it at this. The above assumptions and actions are a big part of what made the Dutch ministery fail to deal with the crisis properly and on time. Like many of the Western democracies. If they would have acted in Februari a full lockdown probably could have been prevented or shortened, lives would have been saved and many other treatments wouldn't have been cancelled or postponed.
The article i've linked to above talks about the doctor who did the opposite in the North, and was succesful with it, they even tried to force him to follow their policy.
To come back to your article. The short answer we don't have enough data (yet) to make such conclusions.
It seems reasonable that from the 9th of March the infection rate went down. This was the week all of Europe freaked out and many people started working from home, even if it wasnt official policy except for in the South of Holland (this idea was good, but too late). Certains schools already (partially) closed, partly because not enough teachers were showing up.
Whether or not school en restaurant closure lead to a lower infection rate is not clear from the data. The RIVM's analysis indeed suggests that it only had a small impact. The English analysis of the Dutch data in the same article does suggest a bigger impact. It's telling that the RIVM doesn't trust their own analysis enough to turn in into policy, you can watch the briefing of Dissel of last week, they only very slowly open the elementary schools in a few weeks from and don't open restaurants and high schools till the end of may.
That article has 1906 (her engagement as cook in the Warren household) to 1932 (her paralysis) as the period of her infection of others, assuming after her paralysis she didn't infect anyone else.
That's still not 38 years; it's not especially important a point - she infected others over at least 2 extended periods amounting to mor than a couple of decades in total.
It's interesting to me, I thought nih.gov was a scientific publication but at least one part of that document appears to be opinion asserted as fact (~"she never intended to abide by the conditions of her release").
> ... 1906 ... to 1932 ... as the period of her infection of others ... That's still not 38 years ...
I never stated that she infected others for 38 years. Being an asymptomatic carrier does not require continually infecting others, only that the carrier maintains the infection without showing symptoms. [1] Additionally, the NIH article isn't complete in listing likely infections, as evidenced by comparing it to the Wikipedia article. Nor does is state that she continued to infect others until her paralysis in 1932.
As for the 38 years, the Wikipedia article notes 1900 as the first known, likely infection of a family she worked for. Then, from the NIH article:
> A post mortem revealed that she shed Salmonella typhi bacteria from her gallstones ...
Her death (and, presumably, post mortem) was in 1938. "Bacterial shedding" [2] implies infection and, thus, being a carrier in 1938, though asymptomatic. I arrived at 38 years by considering her likely a carrier from 1900 to 1938.
I have been wondering about the effect of the degree of initial infection. I kind of assume the virus grows exponentially inside the body and would dwarf the initial constant. If a low initial dose affects the severity of the disease, I think that would be incredibly useful to know. I also wish there was info on percentage of infection via fomites vs inhalation.
I think it’s the opposite. The initial conditions have a profound effect on the exponential nature of the growth. Half the dose could mean that your immune system can suppress it. There is probably critical rate at which both growth rates match.
I don't think my response is 100% correct. The rate of change (derivative) of an exponetial function is another exponential function. d/dx(2^x) = (2^x)*ln(2). And if the base is e, then d/dx(e^x) = e^x.
Yo people, I don't understand why my statements are correct - please someone with a math background or an epidemiologist comment here, I suck at math and I don't understand how these growth rates compare. My comment is being upvoted but it may not be true.
Under the exponential growth model, the increased incubation time (before you hit the same total population size) is inversely proportional to the log of the initial dose, so (e.g.) 1/100th of the initial dose gives you only ~7 (log2(100) = 6.64) additional doubling times before arriving at the same population size. While this is not insignificant, it does mean that initial dose is potentially much less important than sources of variability that affect the in-host doubling time.
The math is a simplification of a biological process that is highly variable and poorly documented. Your original idea is a fine hypothesis, though the suitability of the params behind exponential growth is mostly irrelevant.
We’re learning a lot about virology during this time. Infection and immunity are not binary, and now we have enough data to recognize that. We will also learn a lot about mutation, things like carrier recombination. I think this will change everything about how we attempt to control things through vaccination.
If the immune response occurs in constant time, and is able to neutralize up to a constant number of viri at that engagement time, then you'd expect to see bimodal outcomes.
Early on, there was some discussion of the possibility that folks whose initial exposure is via the eyes would have a more mild illness than if the exposure was via nostrils or inhalation, because the immune system would have time to begin work while the virus was multiplying more slowly in tissue less suited to it.
I haven't heard anything in weeks studying anything like this, though, so I don't know where we ended up, if, indeed anybody knows anything at all.
Not expert but I think if the initial constant can be several orders of magnitude different (I guess a few when airborne vs billions in a droplet) then it can impact the delay of the infection and give time for the immune response.
Most infectious diseases are dose dependent in their effects actually, which can be a bit counterintuitive. I dont know of any data for covid yet, but heres a paper on influenza, another viral disease:
"The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. The patient would develop pustules identical to those caused by naturally occurring smallpox, usually producing a less severe disease than naturally acquired smallpox. "
> I kind of assume the virus grows exponentially inside the body and would dwarf the initial constant.
That assumes your immune system wouldn't kick in during the asymptomatic phase or a time close to exiting the latter. But your immune system would actually kick in as soon as it detects the infection, which would plausibly be much earlier. That would effectively buying you time to figure out which antibodies to produce before things become out of control.
I remember one of the health experts in a Sam Harris podcast saying in an interview the dosage affects the severity and that this is seen in some other viruses (though I don't recall which ones). That's one reason doctors and nurses might be getting hit so hard, due to the continual exposure.
Where did you read that? Superficially that might make sense - less virus particles == less obvious symptoms - but there are a wide variety of virus responses that show virulence and infectiousness aren't necessarily correlated.
If anyone wants to read more about this I can't recommend highly enough the book Spillover by David Quammen, which was published in 2012, and covers zoonotic (animal-to-human transmission) viruses, including SARS. Reading the section on SARS made the hairs on the back of my neck stand up. It's uncannily similar to what's happening with Covid-19, and explains a lot of the background involved in these kinds of viruses.
I actually do remember reading that this was true specifically in the case of COVID — that more exposure so far seems to correlate with a worse infection.
Sadly, I have no idea where I read this. But... I know I did! Recently! Maybe NYT?
Yeah, I saw it too. The hypothesis, as I recall, is that the more virions inhaled, the more likely some of them will get deep in the lungs where they can do the most damage.
I read something like that too. I came away thinking that ingestion might be a better way to get it than inhalation. I think you really need to keep it out of the lungs and nervous system. But that's all my impression from who knows where.
Thanks - that's the kind of thing I was looking for, but this line stuck out to me: "However, the evidence of the relationship is limited by the poor quality of many of the studies, the retrospective nature of the studies, small sample sizes and the potential problem with selection bias." The book I mention gives me enough reason to doubt that what we know about Covid-19 at this point is anything like the whole story.
A crude mathematical model from Swedish authorities on the Stockholm outbreak used two parameters: 1: the fraction of undetected cases (assumed to be mild or asymptomatic) and 2: the relative infectiousness of that group compared to the “detected” group.
The larger the undetected group is, the lower their relative infectiousness has to be in order to fit the observations. The best fit I believe was 1/25 detected and 11% infectiousness of the undetected group.
Yes absolutely. The actual parameters would be different everywhere but they seem to indicate that the symptomatic group is more infectious (which I guess is the base hypothesis for a droplet transmitted disease).
>> Also, many virologists mentioned in recent texts that the initial concentration of the virus you receive can affect how sick you'll get - the more viruses you're exposed to, the faster they can invade the body and the more severe it will get.
That is basic infections 101. When you are exposed to any dangerous virus a race starts between the virus and your immune system. If the virus starts out only infecting a handful of cells, your immune system has a head start in developing antibodies before symptomatic infection sets in. (This is also a basic principle behind many vaccines.) But if you are hit will a massive viral load that instantly infects every cell in your lungs, the immune system is fighting uphill from day one. A massive initial viral exposure can also trigger an excessive immune response, for instance dangerously high fever. Such an immune response can be as deadly as the virus. Much covid research is going into not defeating the virus directly but regulating/slowing the immune response to the patient survives their own immune response.
This principal explains why healthcare workers are suffering so. They are exposed to constant massive doses of virus, possibly from multiple patients carrying slight different versions of the virus. So they get sicker than people who are exposed in the general community.
There's already a comment above pointing out that it might be the initial infection location plays big role. Seems very likely that poor ventilation (in e.g. medical facilities) is main cause of severe cases.
Also, the virus is replicating exponentially only if it can reach many uninfected cells. It takes ~10 hours for an infected cell to start producing virus. Not sure whether non-specific immune system can somehow "contain" virus, would be great to learn about that.
It depends. If you're not going to develop symptoms for another 14 days then yeah, you're not infectious. But for a few days before symptom onset you become just as infectious as you will be after symptom onset - which is one of the things that makes this virus hard to stop.
A low initial dose doesn't seem to affect the course of the infection much, though. For a sufficiently low dose either none of the viruses find an ACE2 receptor or your innate immune system wipes up the virus without you noticing (as it does for you with other viruses every day).
There's some evidence that particularly high doses can cause particularly bad prognoses. We have pretty good evidence that this is the case with measles. There's very anecdotal evidence suggesting that maybe this is the case with SARS-CoV-2. But it looks like low doses lead to a chance of no infection, not a chance of an asymptomatic one.
So, it looks like most asymptomatic infections later become infectious. Basically every person who gets symptoms had a multi-day asymptomatic infectious period they went through. SARS-CoV-2 does a better job than most of avoiding the automatic immune system because its large genome lets it encode a bunch of proteins that aren't for making new viruses but rather screwing with the immune system in ways that let it reach high numbers before the immune system catches on. Every virus that can actually make you sick does this but SARS-CoV-2 seems better than most. But frequently you're able to fight off the infection at a later point before the part of the automatic immune system reaction that makes you feel sick kicks into play but after you're got a chance to infect other people.
The normal course of the automatic immune system wiping out an invading pathogen without you noticing is that it happens immediately without you noticing and you never get a chance to infect anyone. But if that doesn't happen for COVID-19 or influenza or most things there'll be a time period after infection but before you notice anything where you're infectious. For COVID-19 this period is particularly infectious compared to the flu or SARS-1 or most things. It might be that flu and other coronaviruses tend to people who are infected enough to transmit the virus but never go on to develop symptoms. I don't know in that case.
WHO have maintained for months that asymptomatic patients are not infectious.
Until very recently they still said
"The risk of catching COVID-19 from someone with no symptoms at all is very low."
They now say
"Some reports have indicated that people with no symptoms can transmit the virus. It is not yet known how often it happens. WHO is assessing ongoing research on the topic and will continue to share updated findings."
Yes, the WHO was incorrectly relying upon information provided by China. Since then it has become an accepted fact that asymptomatic transmission of SARS-CoV-2 is not only occurring, but is one of the primary transmission vectors.
I remember Robin Hanson [1] used the second fact to recommend "variolation", injecting everyone with a tiny amount of the virus so that they'll get the immunity without the sickness (making it a "natural vaccine").
Prof. Dr. Drosten (inventor of Covid-19 test) said in the interview below that there is a study which shows asymptomatic adult shed as much virus as symptomatic ones. He also said there is no good study on how many viruses are shed by kids.
Does anyone know if there's been any studies on those who have taken no medications at all in past X days vs those that take any (either OTC or otherwise) and those with and without symptoms?
I ask because I'd assume drug use would be lower in prisons, and among those in poorer countries. I'm just wondering if a particular set of drugs could accelerate/make this worse?
That said, I'm not sure this is even possible to obtain metrics on, it'd just be interesting to see if there's any type of correlation to rule out. I realize there's been conflicting studies on whether certain heart meds may accelerate, but I've not been able to find anything about any drugs use whatsoever.
As a Canadian, I'm shaking my head at our officials who said "we do know that asymptomatic people are not the key driver of epidemics" as a response to concerns back in January of the potential for the virus to grow in our country via incoming travelers who came from hot spots and were not screened or forced to isolate if they expressed no symptoms.
Now our long term care facilities are being overrun with cases potentially because we waited until deaths piled up before testing asymptomatic caretakers for the virus.
So, in two weeks, if these prisons are still 96% asymptomatic - then what?
I hope that’s the case, everyone should. I have yet to see a single indication this is worse than than anyone’s projections. I think that’s a dangerous scenario for the next time a virus comes along.
If there is any perceptionat all of overreacting, it’ll be a cry-wolf scenario with a lot of people.
Then that would be really weird given other closed groups we've observed and tested closely like the Diamond Princess and would probably be evidence for a significant mutation.
Agreed 100%. Here in BC, public health wasn't even saying, "It's not known whether asymptomatic carriers can spread the virus," but actually, "Evidence suggests asymptomatic carriers can not spread the virus." Something that as far as I can tell was never actually true. This was reported in public briefings, was repeated by public health nurses on the call-in lines, and was distributed as the government's official position to daycare workers, presumably among others. Really mind-boggling to me. I can only assume somewhere along the line lack of evidence got confused for evidence of lack, and just kept getting parroted from there.
> "Evidence suggests asymptomatic carriers can not spread the virus."
I don't understand this. How would that even work? If you're infected, what would stop you from shedding virus like anyone else? Is there a precedent for this, for respiratory viruses?
Typhoid Mary was a real thing. No matter the precedent for a particular class of virus, this is still a different virus that has clearly evolved higher virulence, and better safe than sorry. In this case, we're sorry
I think the rationale behind this argument was a thought/hope that the disease was primarily being spread by sneezing or coughing, and if you weren't doing that then you weren't going to spread it.
Influenza starts being contagious a few days before symptoms start and stops being contagious a few days before symptoms end, so yes. But the profile for SARS-CoV-2 is particularly front-loaded compared to other viruses where peak infectivity is basically right as symptoms appear. With many other diseases if you catch all symptomatic cases that's enough to drive R well below 1 and from a public health perspective that's all you need.
Exactly like in Sweden. Our ministry of health has _almost_ given up the claim that asymptomatic carriers don't spread the virus by now, so... Progress!
Ultimately this has exposed that WHO is a malicious institution which actively undermines the public health for Tedros Adhanom's personal relationship to the cause of the CCP and of fascism more generally.
Each of our government's dangerously false statements has come from the WHO, and trusting them has been the primary mistake made in assessing this threat.
"no evidence of Human-to-human spread" when they had evidence, "no evidence of asymptomatic spread" when we all had evidence, "no evidence of aerosol spread" when there was evidence in public view: The WHO been there at every step to cast doubt on the seriousness of this threat, and to discourage us from considering and addressing the avenues of spread.
Blanket implies "all". Are the OP's following statements incorrect?:
"no evidence of Human-to-human spread" when they had evidence, "no evidence of asymptomatic spread" when we all had evidence, "no evidence of aerosol spread" when there was evidence in public view
Taiwan warned the WHO with respect to human-to-human transmission. Is this in dispute?
From your link, the message that Taiwan sent to the WHO:
""News sources indicate at least seven atypical pneumonia cases were reported in Wuhan, China". It also said while China's health authorities replied to the media that the cases were believed not to be SARS, "they have been isolated for treatment"."
Furthermore, from the picture: "I would gladly appreciate if you have relevant information to share with us."
So Taiwanese authorities read publicly available news sources about seven atypical pneumonia cases in Wuhan, and because the media reports said the cases were being isolated for treatment, they asked the WHO if they had any additional information.
Unless I'm reading it wrong, this does not mean that Taiwan had any additional knowledge other than what they had read from publicly available information.
> Unless I'm reading it wrong, this does not mean that Taiwan had any additional knowledge other than what they had read from publicly available information.
You are reading it wrong. Taiwan also relayed that PRC doctors were talking to ROC doctors, letting them know that the staff at hospitals were being infected with a new respiratory illness, which would indicate human-to-human spread. They told the WHO about this in December, the WHO continued to contend that there was "no evidence" to suggest human to human spread.
It turned out that another type B variant was the dominant one that year (https://en.ssi.dk/surveillance-and-preparedness/surveillance...) which caused a total of 1,644 deaths in Denmark, which is almost four times the current death toll for Corona virus in Denmark.
It says for example this:
"Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days."
And yet here we are with a 96% asymptomatic rate being reported in a prison.
I would rather that the WHO delayed their news flow, instead of reporting too soon on what they think. Oh, and probably they should trust the Chinese regime less than they do.
I'm not sure calling them a malicious institution is too much. The WHO pushed hard on the idea that there definitely were no asymptomatic cases and China had confirmed this for sure using arguments that seemed utterly nonsensical - like, they were essentially arguing that asymptomatic cases didn't exist because testing of people with symptoms didn't find them. They had a whole campaign of interviews with US publications to spread this, as part of a broader regurgitation of dubious Chinese propaganda about things like how exactly they contained their own outbreak.
Its the same story in Wuhan, probably quite a few asymptomatic carriers until the death toll start rising because of the exponential growth and came on the radar.
A test is a snapshot of time. A person could pass a test and be shedding viruses two days later. A person could shed viruses, get over it, and pass a test.
No mention of what kind of test was performed. And this article is not alone - most don't bother.
The kind of test matters. A qPCR tests the presence of an active infection. Antibody test determines past exposure.
Each has different expectations for symptoms, communicability, and prognosis.
It's not a lot to ask - just report the kind of test that was done, and do so with in the first two paragraphs. Then let me draw my own conclusions about what the study means.
That's a minimum. Ideally, an article would mention the exact brand of test that was performed. If heterogeneous testing methods were used, report that as well.
If it were an antibody test then I don't think it would be correct to say that they "tested positive for coronavirus", and also it wouldn't make sense to talk about their symptomaticity
Lets not get too excited about this. Whatever the numbers, that's interesting and worth recording for planning. But whatever they are, they result in "way too many deaths". This is still a very dangerous and rapidly-spreading virus.
Any herd immunity scenario is conditionnal on immunity is long-lasting, which is far from certain considering related viruses are recurring seasonally or in single-digit year intervals.
Even if infection doesn't confer permanent total immunity, subsequent reinfections are likely to be less severe as the immune system is primed to respond. So herd immunity is still a viable strategy.
Where is the cutoff between "way too many deaths" and not too many deaths? I don't mean to be glib, but it is an important question that needs to be weighed against destroying all of our economic institutions.
There are viral infections for which vaccines were never successfully developed, despite over a decade of research and trials. There is no guarantee a vaccine will be developed for SARS-CoV-2 in anything approaching a timely manner. People need to weigh the costs and risks of a near total freeze on economic activity against those of letting the virus run its course until herd immunity develops.
There are 115 trials underway. There are 100,000 very smart investigators working day and night. There has already been tremendous progress.
My niece works at a lab developing a cheap test. Two of their researchers have already died of this virus (they went to work despite the risks). Don't make fools of them, by falling into despair and negativity.
I hope they succeed in creating a vaccine for COVID19, but resting the lifting of a highly destructive mass-lockdown of healthy people on a hope, is reckless.
Contingency plans need to be created; a definite end date for the lockdowns, irrespective of whether a vaccine exists.
The ability to produce food or manufacturer essential items doesn't suddenly disappear. If you think money flow suddenly makes things disappear remove your brain worm.
You know what can disappear, become depleted, or stretched to thin? Trained medical personal. And money flow can't replenish that resource.
First of all, please don't be uncivil. Getting upset and insulting people is no way to discuss a complex issue.
As for your post; that ability gradually disappears, just as it gradually builds up when the economy is functioning properly.
Capital depreciates. A washing machine breaks down, and in the absence of a repair service provider, or an ability to pay them, the washing machine loses its utility, and a person's quality of life regresses, which has long term implications for their health.
Beyond simple equipment malfunctions, the complex interplay of incentives, trust and relationships that constitutes a productive enterprise are also disrupted and destroyed by shocks and bankrupties.
It takes years to get a productive enterprise up and running. The bankruptcies happening now will hurt the production of goods/services for years to come.
Fewer goods/services translates to a lower quality of life from less labor-saving specialization/technology, which in turn increases the strain on individuals, and thereby reduces their life expectancy.
The economic factors that affect life expectancy are far more numerous and complex than an inert piece of equipment for harvesting crops or manufacturing goods, and your analysis ignores all of that.
You should at least be able to grasp the implications of the statistical evidence, which clearly show that all things being held equal, every percentile drop in GDP is associated with a drop in life expectancy.
To discount the Economy's relevance to human life is deeply misinformed.
>>You know what can disappear, become depleted, or stretched to thin? Trained medical personal. And money flow can't replenish that resource.
Completely irrelevant to my point. I wasn't suggesting that minimizing strain on the healtcare system isn't important, or even that it isn't more important than avoiding doing some amount of harm to the general economy.
I was simply contesting your claim that the Economy is irrelevant to sustaining human life. I am criticizing how you rudely implied that even suggesting the damage to it should be weighed against the deaths caused by the SARS-CoV-2 pandemic, deserves nothing but derision and contempt.
Strawman. Weigh it against suspension of economic institutions, new rules to mitigate the damage, and new institutions that operate on more rational basis.
Yeah, one leap I often see made is, say a study shows "only" a 0.5% case fatality rate, about 5x as bad as an average flu. It's natural from there to then think letting it run unchecked would only be about 5x as bad as a flu. Very bad, certainly, but perhaps manageable. But that ignores the fact that there is a flu vaccine, and even without one the natural rate of spread of the flu is lower than this virus. So without measures, many more people would be infected and so it would be much worse than 5x an average flu, even if the CFR is indeed 0.5% (for example).
Of course, that doesn't mean these numbers aren't useful for planning and determining what degree of intervention is warranted, as you say.
Edit: could one of those down-voting explain? If I'm making a mistake here I'd like to understand it.
On the other hand this means it is much more infectious and there are many more infective asymptotic carriers. This will almost certainly make it impossible to contain using traditional public health means such as contact tracing and quarantining.
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[ 3.9 ms ] story [ 430 ms ] threadThat won't be what the public policy decisions will be based around if the asymptomatic and already exposed rate is so high.
We don't know enough to make that decision yet, but testing more broadly was the first step.
Remaining steps:
- Do they get sick in two weeks?
- Skip testing for current sickness, and test for antibodies instead.
- Get a better antibody test that is more accurate
- Understand how well antibodies work, and for how long
and then we can make decisions, even if they are as simple as "this is a systemwide over the air update, some people will get bricked"
it's becoming clear that we might end up with a society where the average BMI is under 24.9 simply due to the lower oxygen and resource requirements to support those body systems.
How would you do that without locking down the rest of the population? You're going to isolate all nursing home workers?
Confining people to their own home, and locking them in their workspace are markedly different.
I'm not sure there's a better solution; financial incentives and let the workers decide if they want to do it? Care home workers have their own families and dependents too, but that could make it possible for many of them without having to lock them up against their will.
Which is a large part of my point/question. Would it have been more effective than what we have been doing?
This is frustrating with a lot of news coming out that it had been spreading longer and faster than thought. Conceivable that much of the peak in deaths is the highest risk crowd having hit a saturation.
Its the plan for making a plan.
A lot of this is like Russian Roulette -- there's a huge amount about this virus which we don't know, and it could be super-bad or not-that-bad. It could also be there are bad and not-so-bad strains. Or it could be bad down-the-line.
Until we do have proof, I'm advocating being conservative. In 2 weeks, we'll know if people are turning up in ERs or in morgues. In a few months, we'll know about lung damage, immune system damage, strokes, or a lot of the other potential consequences. In a year, we'll know about vaccine and long-term immunity.
I think the key problem here is failure to understand risk management. I can believe one think, but act another way just in case I'm wrong. Or I can be unsure. And so on. That nuance is lost in the right/wrong discussions.
I think at this point we know enough to say:
1) For most of the population, the virus is not that serious
2) For a subset of the population the virus is seriously deadly. For example, ~20% of NY state coronavirus deaths were from nursing homes, ~37% are 80 or older. By contrast, there were 2 people under the age of 10 at the time of this post. [0]
> I think the key problem here is failure to understand risk management
I think another key problem is a failure to be frank about the cost-benefit of our actions. I have had to make stronger cases about changing the color of a button or optimizing a backend call than I've seen presented by authorities who are shutting down or reopening or anywhere in between.
[0] https://covid19tracker.health.ny.gov/views/NYS-COVID19-Track...
Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy. Second order effects include reduced vehicle deaths, reduced deaths from pollution, etc. IE, my discussions has felt agenda driven because it considers first order effects only.
If we're going to compare apples-to-apples, I'm willing to have that conversation. If the conversation is limited to "people die during recessions", it's a pretty clear signal that agenda is driving and would not be a productive use of my time.
The deaths in New York are quite telling for who is at risk, see https://www.statista.com/statistics/1109867/coronavirus-deat....
Over 90% of the dead so far are old with comorbidites such as Hypertension and Diabetes, see https://www.bloomberg.com/news/articles/2020-03-25/most-nyc-....
So i agree that "not serious" is an accurate statement.
There remains a required link to why this isn't serious for young people. And from there, an argument that this situation is better than the other scenarios (including 2nd order effects from other scenarios).
See https://www.statnews.com/2020/03/30/what-explains-coronaviru...
That could explain why Monaco and Japan have not seen a lot of deaths, while Italy and Spain for example have.
In the US it would help immensely i think, if obesity and hypertension became a focus area when this crisis is over.
Deaths are telling for who is dead, not for who is at risk of lung damage, compromised immune system, or other consequences.
Africa have registered 1,297 deaths with a population of 1.2 billion (https://www.africanews.com/2020/04/24/coronavirus-in-africa-...).
Given the fact that 8.8 million die yearly, i'd say that for Africa this disease can be classified as 'not serious'.
If I break both of your legs, that's serious. You're not dead.
If you catch AIDS, that's pretty serious. You're also not dead for a pretty long time.
If I poke your eyes out, that's serious. You're also not dead.
You've redefined a serious medical problem at one which kills you. COVID19 disables far more people than it kills. We don't know how many more, and we won't know for quite a while. With lung damage, most doctors believe the damage is permanent, but some believe people will recover in a decade or two. With other organ damage, we're just speculating.
What's your definition of "old"?
I looked at your statista.com link and about 2/3 of deaths in NY are from people aged 75 and up. That leaves a non-trivial number of deaths for "middle-aged" people (and maybe younger).
Also, I don't know many middle-agers without some co-morbid condition, so I'm not sure we can just ascribe the deaths exclusively to "old sick people" because an enormous portion of the US population is "sick" with a morbid condition.
That being said, I will admit that there are many conflicting pieces of data flying about.
I have no clue. From my vantage-point it seems that most of us have our philosophical flags planted and we aren't willing to soberly assess where we are and maybe change our opinions.It would be "nice" to have an AMA from an epidemiologist with expertise in this area to cut through the noise.
Coronary Heart Disease, Lung cancer and Hypertension can all be mitigated by a healthy life and the numbers seem to suggest that Corona has made these illnesses even more serious than before.
An AMA would be great and i can certainly see that being middle-aged with a co-morbid condition has gotten a lot more serious.
Death rates, hospitalization rates, etc.
As mentioned before, 20% of NY deaths are nursing home patients. 37% are 80 or older.
I'm on mobile and a bit lazy, but check out death rates for the flu in younger populations and compare them to this virus. The virus has a higher mortality rate but not enough to be worth worrying about in younger populations.
>Regarding the cost-benefit discussion, my perspective is that people only want to discuss the downsides from a reduced economy.
While keeping the benefits in mind is an important part of this analysis, the fact is the pre-quarantine deaths were already accepted as "worth it" given that there was no political will to reduce them.
But yes, we should tally the reduction in deaths, pollution, etc.
Comparison to the flu could indicate that we underindex on all these other causes of death. It doesn't make those death numbers some magical line where now it's worth it, because Coronavirus deaths in 2 months equal annual flu deaths.
If it were just 3.6% of the US population dying, I would understand the economic versus public health argument. It comes down to values at that point: how much is a human life worth?
But that changes completely when you consider how many people we'll either need to support for decades, or who will have lower economic output. Those costs get astronomical, and at least by my ballpark estimates, align public health with economic outcomes completely.
If you can't, then perhaps it might be a good idea to reconsider advocating for reopening the economy. Because for all we know, this could end up being another Chickenpox situation leading to something similar to Shingles. We don't know enough about the virus to make reckless remarks such as yours.
If you think things are bad now, do you honestly think things would get better if we had to go through this again because we decided to stop early? Though given you seem to be peddling the idea that this is all a conspiracy by activists to keep us at home forever, I'm willing to bet you're not going to engage this point with any sort of good faith.
I do not have that information either. Until we (and 'we' as in medical professionals) figure out the best way to deal with the virus and any potential effects in the long term then yes, we should stay at home. Because there's still a lot of unknowns.
Can you prove that coronavirus didn't give me protection from some other more severe illness a la cowpox and smallpox?
No?
We can both come up with creative scenarios.
We are severely impacting the quality of life of hundreds of millions of people. We should have a reason to do so grounded in fact and educated guesses.
What reason do we have to suspect your scenario? What are the odds that it will occur? What are the odds it's going to be severe? What's the anticipated quality of life impact and with what confidence intervals?
Also: even if it did create this situation, and we know it for sure, what can we do about it?
We don't have a vaccine. We don't have effective treatments. Those are potentially years away, if they ever materialize at all.
How long, and how severe, should a lockdown be to prevent a hypothetical scenario? What are the impacts of a quarantine that's long enough to guarantee a vaccine with, say, 90% confidence?
As I've mentioned in other posts here, we're remarkably lucky that COVID-19 isn't something currently far more threatening. Considering attitudes such as yours would easily lead to mass extinction as we strive to save an imaginary economy rather than the people.
As for how long and how severe a lockdown should be, I leave that up to the medical community. You and I are not part of that community and are not nearly educated to make that decision for them, so trying to argue that the economy must be opened up now is an argument made from ignorance.
What we should be doing is mitigating damage to those hundreds of millions of people. That's a lot easier to do than just about anything else in this equation.
We've redefined "serious" to mean in an ICU, on a ventilator, within a few weeks of catching it (or in some cases, we've defined "serious" to mean dead within a few weeks). By that definition, AIDS isn't serious for most of the population.
There is a distinct lack of ROI calculations, but my ROI calculations lean towards a much stricter shutdown than we have in place right now, together with thoughtful actions to protect the economy.
The estimate of 1% mortality is with medical intervention. The estimate of hospitalization rates ranges from 5% to 15% (sometimes higher). If you get a disease serious enough to require hospitalization, and there are no hospital beds/nurses/ventilators etc. available, then it is very likely you will die.
But of course it's worse then that: because hospital resources are generally somewhat fungible - at least for ICU/surgical treatment. So not only does your mortality shoot up to ~5% at least, literally every other treatable but potentially life endangering condition (say appendicitis - which occurs at a rate 1.1 per 1000 people per year, or an estimate of 300,000ish cases yearly in the US) has now become, quite likely, untreatable - and thus lethal (appendicitis will definitely kill you, untreated).
Lots of people seem really latched onto that 1% number or whatever they imagine it to be, without any actual consideration of the context of what that figure is actually all about, or you know, an explanation things are "not that bad" yet hospitals can't get PPE, and ventilator triage is in progress, and local morgue capacity has been overwhelmed.
Presumably in two weeks, when we know whether more of these thousands of people go on to develop symptoms or not.
Is anybody following up on stories like this? Do we have any from two weeks ago?
1) that the asymptomatic rate for this Coronavirus is much higher than other Coronaviruses.
2) but at the same time, it's more deadly than most Coronaviruses.
3) and it's also the R0 is much higher than other Coronaviruses.
Isn't it more likely there's a testing issue? This seems a lot like a person that runs a SQL query that overturns all established data at a business, and instead of first assuming that their query is wrong, they instead assume everyone at the business is wrong.
I'm not saying the tests are inaccurate. I'm saying when you get highly conflicting data that has critical implications, you shouldn't jump to conclusions. And you should prepare for the worst case, not assume the best.
R0 depends on the population you measure. In a high contact, crowded place, the R0 could be very high. In a population staying at home, the R0 could be very low.
All those 3 numbers you cite are taken from the same small set of models where the rate of asymptomatic cases is an input. So, no, that's not right.
The best follow-up we have is from the cruise ship, where at the time of testing more than half of those who tested positive were asymptomatic, but ultimately something like 80% of the confirmed infected ended up with symptoms.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078829/
[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm
I probably saw that factoid hyped up in multiple media stories which misconstrued the original paper.
If anyone knows of more reliable recent sources about this, it would be great to clear it up.
Also lots of information in the comments.
https://www.medrxiv.org/content/10.1101/2020.03.18.20038125v...
In particular, that CDC report I linked above citing 46.5% is from late March (early release on March 23, published on March 27th).
That report cites a website by the Japanese Ministry of Health, Labour and Welfare [1], which itself confirms that 46.5% (331/712) is up-to-date as of March 26th.
I'm not very knowledgeable about stats, to be perfect honest, but I think your paper must've turned out to be a red herring. Maybe they got unlucky with their sample?
[1] https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/newpage_000...
https://www.santafenewmexican.com/news/local_news/what-happe...
https://www.amnesty.org/en/latest/news/2020/04/usa-covid19-p...
Virus aside, when are they not?
First, there's not much secrecy involved. It isn't a secret at all that, Hollywood, the American mainstream media, and the political left are all on the same side. It's been obvious for 30 years now.
What we are currently living through is a left-authoritarian consolidation of power. Like other similar consolidations in the 20th century.
That is why, within 24 hours of the first house-arrest orders, propaganda about how our old lives of freedom are gone forever because they were "irresponsible", and how we must all get used to "the new normal" began.
Dr. Fauci says that physical human contact is a thing of the past ("nobody will ever shake hands ever again"), governors, especially those of "blue states" have all acted to either make their house-arrest orders indefinite (like in CA) or to declare that they will continue for multiple years (as VA announced yesterday, for example).
Enforcement is gradually increased everywhere, and citizens are increasingly encouraged to snitch.
Political protests are banned. Even organizing them online is being locked down, with states pressuring Facebook and Google into deleting people's accounts if they even mention the existence of a protest.
The thing is, it takes time to take a society used to freedom and fully consolidate it.
The house arrest orders are the start -- now, when the government eventually let's people out of their houses, but only on conditions (like wearing a tacking wristband, showing your papers to any government official, having to have "a legitimate purpose"), people will be so desperate to leave home that they'll agree.
With "contact tracing" apps and "mandatory isolation", the government will be able to declare any person they need to silence as "contaminated", and they go back to imprisonment, with no recourse, no due process, no burden of proof. Even better, having communicated with a "contaminated" person automatically adds you to the list of the unpersoned.
The economic disruption has already made 1 in 4 Americans dependent upon government handouts to survive. Every week, another 4-5% join them. An authoritarian government needs it's people to be dependent for survival, in order to ensure cooperation.
Meanwhile, the food supply is being turned off. We already have a third of our food production offline, and are most of the way toward driving all independent farmers and ranchers into bankruptcy. We are pretty much guaranteed to have widespread hunger by the fall. This will leave the way for a government takeover of food production.
But, in order for the consolidation to work, they have to keep us all imprisoned willingly until they finish consolidating enough power to make it permanent, or we will all just go back to our lives as free people, the economy will recover, and people won't be dependent upon the would-be dictators for their continued survival.
The next 3-6 months are critical to breaking the back of the capitalist system and soften everyone up to accept the new freedomless world. It will take that long to drive enough people to poverty, hunger, and desperation for them to be willing to go to the authoritarians and beg to be ruled.
This isn't a secret, and it isn't really new. It's more or less how every current left-authoritarian state was formed -- only with more technology and fewer guns.
You don't need the presidency when you can make the presidency meaningless. Look at Trump -- every time he tries to take any position at all, he gets wrecked and ultimately loses. The media destroy him, the tech companies disband any gatherings of his followers.
Besides, unlike the left, the right and Republicans are a fractious, disunited lot. They can't hardly agree on anything -- too many incompatible viewpoints -- so they're almost completely ineffective anyway.
In 10 seconds, it would be a crime to disagree with the left -- just like they've succeeded in doing online and in places like Europe.
These days, each election is potentially the last one.
I do share your confusion about why the media would say such things, but they are.
Like Dr Fauci said, the virus decides the timetable, not us. Nobody knows when it will be safe to reopen.
Many businesses are simply not safe for people to mingle in. Many people don't want to understand or take the distancing guidelines seriously, if they're even adequate.
As far as whether they're worth the cost, there's plenty of room for speculation about that. I do think that reducing a potential overload on hospitals is a wise plan.
I'm against Trump too, for various reasons - for example, I don't like his authoritarian mindset, his stance on torture, his stance on surveillance, and his foreign policy towards Iran - but I'm not a fan of the constant hysterics of the anti-Trump media either. Some of those people would claim that Trump was somehow being deceitful and evil even if he just said that 2 + 2 = 4.
There are, I'm sure, other sources of media bias on this matter as well, but this is the one that immediately comes to my mind.
It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
I feel that it was idiotic propaganda.
>It seems to me that almost all of the criticism of Trump is well justified by his incoherence, rudeness, anti-intellectualism, blatant nepotism, lack of structure, refusal to divest, repeated untruthful statements, lack of logical consistency, questionable policies, and apparent tendency towards cronyism.
The problem as I see it is too many Trump haters go beyond the many valid reasons to hate him and instead, due to conscious or subconscious bias, start to do things like take things he says out of context, or read more into those things than is necessarily justifiable, or try to paint him as a uniquely evil figure even though we have had presidents in recent memory who literally supported death squads in third world countries... etc.
This certainly adds another data point, but I wouldn’t throw conventional wisdom out the window yet.
In the field it appears many/most of the less severe cases don’t exhibit the initial set they had defined, so patients experienced illness written off as not COVID-19.
From what I’ve heard from the field, a careful patient history finds there was typically a bout of unusual “but it can’t be COVID” illness with a set of the expanded set of symptoms in almost every “asymptomatic” patient.
It’s further speculated these variations may have to do with level of exposure and path of infection, along with the earlier noted lung health and comorbidities.
When at least one large studied group has an outcome (symptomatic recovered, asymptomatic recovered, or dead). So for this group I guess a few more weeks.
For example, they've been finding that the virus can trigger strokes in otherwise healthy individuals. That's individuals that either exhibit no symptoms or minor symptoms. So while they may otherwise be asymptomatic, we can't know unless we do a full extensive test to see if they're also suffering from unseen clotting issues.
https://www.oxfordbiosystems.com/COVID-19-Rapid-test
"In order to test the detection sensitivity and specificity of the COVID-19 IgG-IgM combined antibody test, blood samples were collected from COVID-19 patients from multiple hospitals and Chinese CDC laboratories. The tests were done separately at each site. A total of 525 cases were tested: 397 (positive) clinically confirmed (including PCR test) SARS-CoV-2-infected patients and 128 non- SARS-CoV-2-infected patients (128 negative). The testing results of vein blood without viral inactivation were summarized in the Table 1. Of the 397 blood samples from SARS-CoV-2-infected patients, 352 tested positive, resulting in a sensitivity of 88.66%. Twelve of the blood samples from the 128 non-SARS-CoV-2 infection patients tested positive, generating a specificity of 90.63%."
That gives us 62% false positive ratio according to (where a study finds the prevalence to be 6% of subjects using the test):
http://vassarstats.net/clin2.html
In some cases we have research being carried out with such low positive results that they can entirely be accounted for by the low specificity. So for example if you took samples from 100 people, based on 90% specificity, even if everyone had never had corona, 10 could be found positive.
Credit to this post:
https://old.reddit.com/r/COVID19/comments/g7f373/second_roun...
However it should be noted the article in question for this submission does not mention the type of test used.
Edit: I'm looking at the reddit post but I have a lot of reservations with the "prevalence 0.06", unless we'll use the test to test absolutely everybody and not only people who are suspect. Has that calculator been validated as well?
If the test was 12 false positives in 128 negatives, how come they can claim the false positive rate is 60%?
https://www.miamidade.gov/releases/2020-04-24-sample-testing...
"Our data from this week and last tell a very similar story. In both weeks, 6% of participants tested positive for COVID-19 antibodies, which equates to 165,000 Miami-Dade County residents"
That is what the commentator is referring to in the linked post.
So if you plug their own figures into the calculator:
Sensitivity .8866 Specificity .9063
and a Prevalence of .06 based on the study, you get the 62% false positive rate.
As the prevalence increases, as with the NYC study which found the positive rate to be 21% (prevalence), the false positive rate decreases, down to 28% of the NYC study.
The Antibody test is a serology test which measures the amount of antibodies or proteins present in the blood when the body is responding to a specific infection. This test hasn’t been reviewed by the FDA. Negative results don’t rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic lab should be considered to rule out infection in these individuals. Results from antibody testing shouldn’t be used as the sole basis to diagnose or exclude SARS-CoV-2 infection. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.
https://tildes.net/~health.coronavirus/o6a/coronavirus_antib...
I don't know what tests the other studies used.
Specifically, the Premier Biotech/Hangzhou Biotest Biotech test was validated by a Chinese provincial CDC and found 4 false positives out of 150. [1]
It was also validated by the COVID-19 Testing project and found 3 false positives out of 108. [2]
The Biomedomics test used in the Miami Dade study was also validated by the COVID-19 Testing Project and found 14 false positives out of 107. [2]
Hence I would recommend taking the results of the California and Florida studies with a huge grain of salt as the prevalence rates they found were within the false positive rates of the tests used.
[1] https://imgcdn.mckesson.com/CumulusWeb/Click_and_learn/COVID...
[2] https://covidtestingproject.org/
Thanks for sharing.
I found the peek in all-case mortality also very interesting, because that way counting is much more unambiguous: dead is dead.
They showed a clear diversion from the "average" in recent weeks, but... they did not show the stdev for the averages. Finally I found a chart that shows that "outliers" are not uncommon.
https://imgur.com/IPNiXRe
It is interesting though that the median undercount is converging to ~10-20x. Perhaps the protocols across regions are similar enough that the confirmed case counts are somewhat comparable.
Unrealistically low death stats coming from Turkey compared to cases easily refute that argument.
Dead is dead, unless the state finds a way to claim that it was not a COVID19 dead.
It's just a matter of demanding tests to declare as a COVID death and do not providing enough tests.
Brazil, for example, has an artificially low count of cases due to the lack of tests and a similarly low number of deaths. However, cases of death by "pneumonia", generic types of SARS and "unexplained respiratory diseases" skyrocketed: https://oglobo.globo.com/sociedade/coronavirus/alem-da-covid...
This is what “dead is dead” mean. One can argue what should count as a COVID19 case, and how exactly we are counting. There is a lot less argument over who is dead and who is not.
It seems I actually missed the mention of "all-cause" while reading the comment.
https://www.euromomo.eu/
There is a very noticeable spike in the worst hit countries: Italy, Spain, France, Belgium, Netherlands and the UK. The cumulative excess deaths for all Europe in the last two months matches the COVID-19 reported deaths (around 100000).
This article claims that most Covid-19 hotspots have significantly more excess deaths than reported covid deaths. Suggesting that there is a lot of underreporting. NYC being a notable exception. I think several countries count only corona deaths in hospitals, but systematically miss all deaths in care facilities. https://www.spiegel.de/wissenschaft/corona-todesfaelle-wie-v... (charts should be readable despite any language barrier)
(I don't defend either view. As the old joke goes, don't trust any statistics you haven't manipulated yourself :) Statistics and causality have always been difficult, even more so in exceptional time with imperfect short-term data only.)
Another coincidence is that the country that is most suspected of under-reporting, Germany, is also the least represented in EuroMOMO. There is data for only 2 regions.
Italy, Spain and France, the most significant contributors both in COVID-19 related deaths and excess mortality in general, all count deaths in care facilities now. I don't know about the UK though. Deaths at home are probably not counted, but according to the authorities, they are a minority: COVID-19 does not happen suddenly and people normally have time to go to the hospital. Still significant though.
My gut feeling is that there are actually ~50% more deaths than reported. But we'll have to wait for at least a few months to get proper statistics.
https://www.corriere.it/politica/20_marzo_26/the-real-death-...
New York has been criticized for retroactively adding older cases. The Johns Hopkins data just tacks it on to the end of their time series, creating a weird spike and screwing up what the data represents:
https://battlepenguin.com/tech/fighting-with-the-data/
Where's the noticeable spike for Ireland? Where's the spike for Portugal? Where's the spike for Luxembourg? Where's the data for the rest of Germany outside of Hesse and Berlin? Where's the spike for Austria? (And this is not a criticism of them, but they only track Western Europe by the looks of things.)
Don't know where Euromomo is getting its data from but I suggest to you that it's incomplete.
This NYT article[0] (other publications like The Economist[1] have arrived at similar numbers) show that the cumulative excess deaths for France, Netherlands, Switzerland, Spain, and England & Wales sometimes far exceeds reported Covid-19 deaths.
Of the countries you mention only Belgium is actually reporting accurately. (As is Sweden btw, a country you do not mention.) Note that both are smallish countries.
As of 14 hours ago Chris Giles (FT economics editor) tweeted[2] "A cautious estimate of the total number of UK excess deaths linked to coronavirus stands today at 42,700" (He updates this most days.) Worldometer[3] currently has the UK on 20,319 deaths. Quite a difference.
In fact, the numbers show that in Europe actual deaths are between 1.4 [Swiss] and 2.1 [British] times higher than the reported numbers for countries that are under-reporting.
Btw, you say that there are 100,000 deaths? EU 27 has 96,533 deaths as of this moment. EU+UK has 116,852 deaths as of this moment. And Europe in its entirety[4][5] has 122,568. (Am tracking these figures using a spreadsheet.)
Let's say that the adjustment we have to make is between 1.4 and 2.1 and let's ignore population size and pick 1.75 and then lower that to take into account that some countries are accurately reporting and let's err on the conservative side so let's choose 1.66… repeating as our adjustment rate, agreed? This gives us an estimated excess # of deaths for Europe of 204,280. Twice the figure you've given.
[0] https://www.nytimes.com/interactive/2020/04/21/world/coronav...
[1] https://www.economist.com/graphic-detail/2020/04/16/tracking...
[2] https://twitter.com/ChrisGiles_/status/1254105061745098752?s...
[3] https://www.worldometers.info/coronavirus/country/uk/
[4] https://en.wikipedia.org/wiki/Europe [5] https://www.reddit.com/r/europe/new/
(Europe is generally taken to extend from the Atlantic states of Ireland, Portugal, and Iceland in the West to the Ural and Caucasus Mountains in the east, from Scandinavia in the north to Italy and Greece in the south.)
Admissions at hospitals have collapsed: in the UK they halved. Admissions due to respiratory illnesses however didn't really go up, not surprising when you consider the small absolute numbers. There is now a massive backlog of operations and diagnostics for cancer that health systems will struggle to clear in time.
There's a story with some analysis of that problem here:
https://www.telegraph.co.uk/news/2020/04/26/what-second-coro...
In the past the recommendations of epidemiologists have ended up killing a lot more than they saved, with the 2001 foot and mouth epidemic in the UK being a classic example. It's likely it will be true again this time.
The 1.66%, otoh, seems reasonably in line or at least compatible with what's been observed in Korea and elsewhere.
Given age is going to skew things a good deal, it seems like a picture is emerging but not that new a picture. An IFR of even 1% is pretty bad, especially given these statistics show how infectious this virus is.
Most of those tests were done on April 4th and 5th which was 3 weeks after Austria started relatively strict lockdown measures, which also impacts that number, as this will result in the test to find an even lower number of positive people.
To be clear: it would be the most dangerous general epidemic disease since the advent of vaccination, and by a significant amount. You need to go back to measles and polio to find general population outbreaks that were more lethal.
Not every death is the same - a 80 year old with weak immune system could have lived 5 years longer without corona, but a healthy 20 year-old dying from cytokine storm caused by influenza has lost potentially 60 years of healthy life - the loss is much worse.
The elderly and immunocompromised obviously die more to almost every illness. But the effect is really pronounced with covid. And most other viral infections tend to kill children at higher rates too, and covid very notably does not. It's definitely an interesting aspect of the disease, though it's produce a kind of horrifying calculus among a lot of the right wing in the US.
OK, so how many "influenza death equivalents" are we looking at? What's your metric for how bad this is? I mean, I think that's a little ghoulish, obviously, but if people really want to make this argument I'd really like to see the kinds of well-founded numbers that the experts are producing. Medical ethics is hardly a new field, after all. You'd think someone would have pulled some analysis off the shelf.
Instead, the people pushing "these people would have died anyway" seem to be almost exclusively political actors (or their proxies on social media sites like this one) with a goal of either defending the inaction of the current administration or pushing a policy goal that necessarily sets the virus loose on the public.
But if you really want to make a numerate case for not trying to save the old and sick, I'd genuinely and carefully read it.
So you would need to estimate the number of years lost vs the economic damage. This is impossible to get right on both sides but at least it gives you a framework.
Seeing those numbers makes me more supportive of the isolation measures.
In a triage situation, where you have to decide between different people dying, such choices are unavoidable or necessary. But I want highlight that you are talking about this stuff to say that it's OK to plan for the death of "a 80 year old with weak immune system could have lived 5 years longer" versus no death at all. And that's not OK.
One choice is providing some opportunity for further life beyond what's expected. That's generally considered something society likes but isn't obligated to provide. Society doesn't obligate it's member to spend money developing some miracle-extend that gives someone five more years.
The other choice is taking life that would normally be expected. That is something that society very much frowns on. If you could protect someone and you don't do it 'cause it would cost you money, you may wind-up in jail for murder.
Very quantitatively oriented people seem to have a hard time grasping why there's a difference here. But I think it's very rational in an evolutionary game-theoretic compact kind of way. Everyone is a member of society and values everyone else's life highly, more highly than immediate material things though maybe not more highly than other people's lives. This gives member of society basic security - you are thinking my insulin might worth just stealing and selling on the open market, me murdering you first might be my best strategy. You can see where things break down? The "social contract" is kind of the way around this.
And not doing anything (pretend it's just the flu) will result in 50M dead world wide. Everyone worried about a new depression should realize one is going to happen no matter what we do now. The only thing we can do is act in a humane fashion.
Where do you get your 50M worldwide figure? When a new flu appears, Neil Ferguson claims his 3K lies of undocumented C code forecast 200M will die. These numbers are all speculation and worse predictors than throwing darts at a board behind your back.
If you look worldwide, there are 7.8B people. If herd immunity takes 60% of the population becoming infected, that's 4.6B infections. With an IFR of 1%, that's 46.8M deaths. 460M hospitalizations (where possible).
Even say the IFR is overstated as some like. Say it's a magnitude less, comparable to the flu at .1% Now you are down to 4.7M deaths, but still the 460M hospitalizations. Still one of the most serious crises in the last 100 years.
Basically everyone who dies from this has a preexisting condition, but basically everyone in the US will develop at least one of the big three (hypertension, diabetes, or obesity) at some point.
Kinda sucks if you have any of those conditions right now though.
You chose to eat X and not exercise for years/decades. A middle class American has enough education and purchasing power to know and behave accordingly.
Does it suck? Yes, but i find it incredibly unfair and hypocritical towards the rest of the world by ruining their lives based on the extremely old and or fat/unhealthy population.
And your comment comes across as extremely crass and insensitive.
What do you mean? There were vaccines in 1918.
https://www.reddit.com/r/LockdownSkepticism/comments/g6eqtt/...
It may be helpful to you.
Thank you for tracking these metrics.
Nah, they'll probably just keep using em for slave labor.
I was mostly asymptomatic. The biggest thing going on was that I was very tired, which was also something easily explained by other things going on, so I was basically already on the mend before I concluded I must have had it.
I believe we are barking up the wrong tree. We are looking for respiratory distress because it leads to low oxygen levels. I think we need to be looking more at what it does to the blood. Fortunately, some doctors are looking in that direction, but I think not enough, probably.
My symptoms were similar to anemia. It's easily missed because you mostly lack energy.
Again, there can be lots of reasons a person has low energy. It can be quite hard to say "Clearly, this symptom is indicative of Coronavirus."
So I suspect a lot of people will never be overtly symptomatic in the ways the world is looking for with its huge focus on lung issues.
I also had an interesting discussion with someone who is apparently some kind of medical researcher about zinc and blood stuff. This was very helpful to me and my sons in trying to recover our energy levels, which also firms up my suspicions that a. we had the infection and b. my mental models are less wrong than some of what is out there.
Further, the accuracy of our tests is questionable and hopefully improving.
Finally, viral shedding has been seen up to 35+ days since symptom onset. Meaning if they showed symptoms a month ago, they may still test positive.
https://www.aarp.org/health/conditions-treatments/info-2020/...
[EDIT:] Apparently these propositions are not self-evident to all HN downvoters. They follow directly from several other propositions that really should be obvious. USA imprisons vastly higher percentages of its population than other nations. Yet it still has higher crime than those other nations. QED.
[EDIT:] 'thendrill you appear to be hellbanned.
Basically nerds and useful idiots with hi iq...
https://www.who.int/news-room/commentaries/detail/immunity-p...
Herd immunity doesn't require perfect immunity or a 100% guarantee of it. No reasonable expert doubts that herd immunity is possible, although some argue it's too costly.
[1] https://thehill.com/changing-america/well-being/prevention-c...
> As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.
The most likely thing is that it does mean immunity, but the WHO isn't going to say that without clear evidence.
Pretty funny, good enough for reuters but not for HN it seems...
That test has also very carefully been validated, with excellent sensitivity (=few false negatives) and specificity (=few false positives). Not sure all available tests have gone through quite so thorough validation.
An antibody test should also generally be well targeted.
The idea is that nicotine may lower your chances of infection, but once established I imagine that smoking will definitely reduce your chances of survival.
Presuming this is true (lots of evidence but still much too early to be sure), there's two possibilities: nicotine makes a person less likely to be infected, or nicotine makes it less likely that the infected will develop any symptoms. No symptoms, no test, that's been the rule until quite recently.
If it's the latter, it could explain what's going on here. I doubt that's the explanation, but it's possible.
https://www.qeios.com/read/article/571
https://www.qeios.com/read/article/571
Could this be an artifact of that plus low actual incidence like:
- False positive rate of 10%
- 100 tests
- 1 true positives. All with symptoms
- 9 false positives. All without symptoms (duh!)
Headline: "90% asymptomatic!"
Truth: "Shitty test procedure!"
Yes, yes, I know you know this. Do you think people doing tests and writing headlines know this?
What is the false positive rate?
Probably.
" Do you think people writing headlines know this?"
Maybe, but unlikely that they care, if the result is a flashing headline.
Wait, does that pass the smell test? Do prisions become huge flu hotspots as well? The Diamond Princess outbreak didn't have that kind of numbers... What's more likely at this point, the numbers from the article or human error?
My respects to anybody trying to do actual science with this kind of data in this kind of situation...
Drawing signal out of the noise right now is very, very difficult.
What's more likely, a population that gets all infected all at the same time, or one person infected being careless with samples?
Then there's more: given how many tests of similar populations are getting done, what are the chances that some have a careless infected tester?
You would expect spread to be absurdly more efficient in a prison. Less physical separation, less hygiene, less everything.
In reality, this test would need a false positive rate of over eighty percent to explain this kind of asymptomatic infection rate.
Also, prisons are useful because due to the close quarters it can be taken as a given that a substantial proportion of the population is infected, further minimizing the danger of these sorts of errors. The choice of population suggests a sophisticated experiment design, and the commenter is implying that the study authors made a statistics 101-level error.
Plus yeah, to be honest, you dismiss staggering stupidity leading to juicy headlines at your own risk.
People in nursing homes are elderly. Lots are dying.
People in prison aren't uniformly elderly. You are bound to see more variation in symptoms.
(Plus, as stated elsewhere, the opinions and experiences of known criminals tend to get discounted, so the report of lack of symptoms may be more about that than about the general resilience of the population. Also also: It's well established that if you ignore, dismiss and neglect someone enough, they stop complaining because they know it doesn't do any good. Aka learned helplessness.)
This is assuming that tests in NYC currently include every infected and symptomatic person. Considering the official advice for people with mild symptoms is to stay home (and not seek a test), that assumption is ... optimistic.
It also wouldn't fit with the anti-body tests that have been done in NYC that showed figures closer to 15-20%.
So I'd expect about 1/2 to 2/3 of these 96% to develop symptoms within the next week.
The other possibility is the prison population not being representative of the general population. That's probably true in terms of fatality rates, because they are younger. I'm not entirely sure if that age imbalance is just as strong for any symptoms as it is for risk of hospitalisation and death.
Can those two facts be combined into a theory that asymptomatic carriers are more likely to produce more mild and asymptomatic cases?
Don't know if it makes any sense (probably not), but it would certainly explain how in some closed environments there's a prevalence for mild cases, while in others there's a plenty of very sick people, regardless of the age.
> Netherlands National Institute for Public Health and the Environment
> The Netherlands National Institute for Public Health and the Environment, is a Dutch research institute that is an independent agency of the Dutch Ministry of Health, Welfare and Sport. RIVM performs tasks to promote public health and a safe living environment by conducting research and collecting knowledge worldwide.
I live in the Netherlands and I think you could say that we actually have it quite under control (relatively speaking of course). We never reached peak ICU capacity and the ICU occupancy has been steadily declining for more than two weeks now[1]. Our schools for children between the ages of 4 and 12 are scheduled to partially open again on the 11th of may[2].
[1] https://nos.nl/artikel/2331720-coronacijfers-van-25-april-ri...
[2] https://nos.nl/artikel/2331460-kabinet-wil-basisscholen-voor...
Only under pressure of the IC doctors on Sunday the 15th of march did the prime minister close all schools and restaurants. (A high school is like a festival every day)
The policy and advice of RIVM has been wrong and misleading from the end of February. For many of us it was already clear they lost control beginning of March.
There was one hero in the North of the Netherlands who went against RIVM and the Minister of health: https://eenvandaag.avrotros.nl/item/het-gelijk-van-microbiol....
This article in the Volkskrant describes how the RIVM was panicking beginning of March, but the prime minister wanted to present "good weather", and they also send their stock of masks to China beginning februari: https://www.volkskrant.nl/nieuws-achtergrond/nederland-stuur...
Even now they are not testing healthcare people with symptoms in elderly homes and also not providing any sort of masks. Claiming the available masks are not of sufficient quality, they prefer to send healthcare people to work without masks then to get high quality masks even if it is without the preferred certificate.
Last point. Under control is relative. The IC capacity reached a higher number then we ever anticipated, still more IC beds are occupied by corona patients then we had in total beginning of 2020. https://stichting-nice.nl/
For most of the hospitals in the Netherlands most operations and treatments are still postponed. For instance for many cancer patients the date of their treatment is still not sure: https://www.volkskrant.nl/nieuws-achtergrond/chemo-uitgestel...
Throughout Februari and March they had the following policy:
- Clearly stating and assuming that asypmtomatic people cannot or are extremely unlikely to transmit (had letters sent to schools and events I particpated in, was also on their website). True or not, there was no data to backup this up and an assumption like this has big consequences when false.
- When from risk area AND with symptoms as a policy they didn't test. In general the whole focus was to test as minimal as possible. Causing us to be completely caught off guard of the true scope untill March.
- Clearly trying to sell the idea that masks don't work for normal people, while at the same time trying to claim them for themselves
- As a policy not testing healthcare people, not even with symptoms. First random test of healthcare people with symptoms in the south was only done on the 8th of march, they were shocked by result (and for a long time untill march allowing people to work with symptoms ). https://www.rivm.nl/nieuws/steekproef
- As a policy "non-essentials" healthcare people get no protection unless evidence of covid and hardly get tested. 900 of 2100 healthcare/elderly houses now have the virus with 20 to 30 percent death rate.
- Failed attempt of centralised buying of masks and other protection wear
https://www.volkskrant.nl/nieuws-achtergrond/jos-de-blok-buu...
- Till the end of Februari claiming they had it under control
- etc...
There is more things to point out but Ill leave it at this. The above assumptions and actions are a big part of what made the Dutch ministery fail to deal with the crisis properly and on time. Like many of the Western democracies. If they would have acted in Februari a full lockdown probably could have been prevented or shortened, lives would have been saved and many other treatments wouldn't have been cancelled or postponed.
The article i've linked to above talks about the doctor who did the opposite in the North, and was succesful with it, they even tried to force him to follow their policy.
To come back to your article. The short answer we don't have enough data (yet) to make such conclusions.
It seems reasonable that from the 9th of March the infection rate went down. This was the week all of Europe freaked out and many people started working from home, even if it wasnt official policy except for in the South of Holland (this idea was good, but too late). Certains schools already (partially) closed, partly because not enough teachers were showing up.
Whether or not school en restaurant closure lead to a lower infection rate is not clear from the data. The RIVM's analysis indeed suggests that it only had a small impact. The English analysis of the Dutch data in the same article does suggest a bigger impact. It's telling that the RIVM doesn't trust their own analysis enough to turn in into policy, you can watch the briefing of Dissel of last week, they only very slowly open the elementary schools in a few weeks from and don't open restaurants and high schools till the end of may.
do you carry it forever? does it attack eventually?
what happens if you are an asymptomatic carrier and get a vax?
https://en.wikipedia.org/wiki/Mary_Mallon
That's still not 38 years; it's not especially important a point - she infected others over at least 2 extended periods amounting to mor than a couple of decades in total.
It's interesting to me, I thought nih.gov was a scientific publication but at least one part of that document appears to be opinion asserted as fact (~"she never intended to abide by the conditions of her release").
I never stated that she infected others for 38 years. Being an asymptomatic carrier does not require continually infecting others, only that the carrier maintains the infection without showing symptoms. [1] Additionally, the NIH article isn't complete in listing likely infections, as evidenced by comparing it to the Wikipedia article. Nor does is state that she continued to infect others until her paralysis in 1932.
As for the 38 years, the Wikipedia article notes 1900 as the first known, likely infection of a family she worked for. Then, from the NIH article:
> A post mortem revealed that she shed Salmonella typhi bacteria from her gallstones ...
Her death (and, presumably, post mortem) was in 1938. "Bacterial shedding" [2] implies infection and, thus, being a carrier in 1938, though asymptomatic. I arrived at 38 years by considering her likely a carrier from 1900 to 1938.
[1] https://en.wikipedia.org/wiki/Asymptomatic_carrier
[2] https://www.google.com/search?q=bacterial+shedding
Edited to add: Here's a preprint that is relevant to the "initial dose vs. immune system response" thought: <https://www.medrxiv.org/content/10.1101/2020.03.26.20044487v...
Perhaps a more mild initial growth stage gives the immune system more time to respond.
I haven't heard anything in weeks studying anything like this, though, so I don't know where we ended up, if, indeed anybody knows anything at all.
The virus will grow exponentially, but so will the immune response, so starting conditions are important.
This is a basis for the old pre vaccine "variolation" strategy of getting immunity. Some radical thinkers argue for it as a Covid remedy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342672/
Covid in your alveoli is very bad. Covid in your throat not so much.
"The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. The patient would develop pustules identical to those caused by naturally occurring smallpox, usually producing a less severe disease than naturally acquired smallpox. "
https://en.wikipedia.org/wiki/Variolation
That assumes your immune system wouldn't kick in during the asymptomatic phase or a time close to exiting the latter. But your immune system would actually kick in as soon as it detects the infection, which would plausibly be much earlier. That would effectively buying you time to figure out which antibodies to produce before things become out of control.
If anyone wants to read more about this I can't recommend highly enough the book Spillover by David Quammen, which was published in 2012, and covers zoonotic (animal-to-human transmission) viruses, including SARS. Reading the section on SARS made the hairs on the back of my neck stand up. It's uncannily similar to what's happening with Covid-19, and explains a lot of the background involved in these kinds of viruses.
Sadly, I have no idea where I read this. But... I know I did! Recently! Maybe NYT?
The larger the undetected group is, the lower their relative infectiousness has to be in order to fit the observations. The best fit I believe was 1/25 detected and 11% infectiousness of the undetected group.
That is basic infections 101. When you are exposed to any dangerous virus a race starts between the virus and your immune system. If the virus starts out only infecting a handful of cells, your immune system has a head start in developing antibodies before symptomatic infection sets in. (This is also a basic principle behind many vaccines.) But if you are hit will a massive viral load that instantly infects every cell in your lungs, the immune system is fighting uphill from day one. A massive initial viral exposure can also trigger an excessive immune response, for instance dangerously high fever. Such an immune response can be as deadly as the virus. Much covid research is going into not defeating the virus directly but regulating/slowing the immune response to the patient survives their own immune response.
This principal explains why healthcare workers are suffering so. They are exposed to constant massive doses of virus, possibly from multiple patients carrying slight different versions of the virus. So they get sicker than people who are exposed in the general community.
https://theconversation.com/coronavirus-does-the-amount-of-v...
Also, the virus is replicating exponentially only if it can reach many uninfected cells. It takes ~10 hours for an infected cell to start producing virus. Not sure whether non-specific immune system can somehow "contain" virus, would be great to learn about that.
A low initial dose doesn't seem to affect the course of the infection much, though. For a sufficiently low dose either none of the viruses find an ACE2 receptor or your innate immune system wipes up the virus without you noticing (as it does for you with other viruses every day).
There's some evidence that particularly high doses can cause particularly bad prognoses. We have pretty good evidence that this is the case with measles. There's very anecdotal evidence suggesting that maybe this is the case with SARS-CoV-2. But it looks like low doses lead to a chance of no infection, not a chance of an asymptomatic one.
The normal course of the automatic immune system wiping out an invading pathogen without you noticing is that it happens immediately without you noticing and you never get a chance to infect anyone. But if that doesn't happen for COVID-19 or influenza or most things there'll be a time period after infection but before you notice anything where you're infectious. For COVID-19 this period is particularly infectious compared to the flu or SARS-1 or most things. It might be that flu and other coronaviruses tend to people who are infected enough to transmit the virus but never go on to develop symptoms. I don't know in that case.
Until very recently they still said
"The risk of catching COVID-19 from someone with no symptoms at all is very low."
They now say "Some reports have indicated that people with no symptoms can transmit the virus. It is not yet known how often it happens. WHO is assessing ongoing research on the topic and will continue to share updated findings."
https://www.nejm.org/doi/full/10.1056/NEJMoa2008457
[1] http://www.overcomingbias.com/2020/03/variolation-may-cut-co...
https://tvthek.orf.at/profile/Additional-Content/1670/Langfa...
I ask because I'd assume drug use would be lower in prisons, and among those in poorer countries. I'm just wondering if a particular set of drugs could accelerate/make this worse?
That said, I'm not sure this is even possible to obtain metrics on, it'd just be interesting to see if there's any type of correlation to rule out. I realize there's been conflicting studies on whether certain heart meds may accelerate, but I've not been able to find anything about any drugs use whatsoever.
Now our long term care facilities are being overrun with cases potentially because we waited until deaths piled up before testing asymptomatic caretakers for the virus.
I hope that’s the case, everyone should. I have yet to see a single indication this is worse than than anyone’s projections. I think that’s a dangerous scenario for the next time a virus comes along.
If there is any perceptionat all of overreacting, it’ll be a cry-wolf scenario with a lot of people.
I don't understand this. How would that even work? If you're infected, what would stop you from shedding virus like anyone else? Is there a precedent for this, for respiratory viruses?
Each of our government's dangerously false statements has come from the WHO, and trusting them has been the primary mistake made in assessing this threat.
"no evidence of Human-to-human spread" when they had evidence, "no evidence of asymptomatic spread" when we all had evidence, "no evidence of aerosol spread" when there was evidence in public view: The WHO been there at every step to cast doubt on the seriousness of this threat, and to discourage us from considering and addressing the avenues of spread.
Blanket implies "all". Are the OP's following statements incorrect?:
"no evidence of Human-to-human spread" when they had evidence, "no evidence of asymptomatic spread" when we all had evidence, "no evidence of aerosol spread" when there was evidence in public view
Taiwan warned the WHO with respect to human-to-human transmission. Is this in dispute?
https://www3.nhk.or.jp/nhkworld/en/news/20200412_01/
>not the conversation we have in Hacker News comments.
These are precisely the sorts of conversations people should be having.
Indeed.
""News sources indicate at least seven atypical pneumonia cases were reported in Wuhan, China". It also said while China's health authorities replied to the media that the cases were believed not to be SARS, "they have been isolated for treatment"."
Furthermore, from the picture: "I would gladly appreciate if you have relevant information to share with us."
So Taiwanese authorities read publicly available news sources about seven atypical pneumonia cases in Wuhan, and because the media reports said the cases were being isolated for treatment, they asked the WHO if they had any additional information.
Unless I'm reading it wrong, this does not mean that Taiwan had any additional knowledge other than what they had read from publicly available information.
You are reading it wrong. Taiwan also relayed that PRC doctors were talking to ROC doctors, letting them know that the staff at hospitals were being infected with a new respiratory illness, which would indicate human-to-human spread. They told the WHO about this in December, the WHO continued to contend that there was "no evidence" to suggest human to human spread.
In the 2017/2018 flu season the WHO recommended a trivalent vaccine for the common flu (https://www.who.int/influenza/vaccines/virus/recommendations...)
It turned out that another type B variant was the dominant one that year (https://en.ssi.dk/surveillance-and-preparedness/surveillance...) which caused a total of 1,644 deaths in Denmark, which is almost four times the current death toll for Corona virus in Denmark.
Another example: On the 3rd of march the general secretary of the WHO issued this statement: https://www.who.int/dg/speeches/detail/who-director-general-...
It says for example this: "Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days."
And yet here we are with a 96% asymptomatic rate being reported in a prison.
I would rather that the WHO delayed their news flow, instead of reporting too soon on what they think. Oh, and probably they should trust the Chinese regime less than they do.
The kind of test matters. A qPCR tests the presence of an active infection. Antibody test determines past exposure.
Each has different expectations for symptoms, communicability, and prognosis.
It's not a lot to ask - just report the kind of test that was done, and do so with in the first two paragraphs. Then let me draw my own conclusions about what the study means.
That's a minimum. Ideally, an article would mention the exact brand of test that was performed. If heterogeneous testing methods were used, report that as well.
Don't bet the farm on it.
No it doesn't. Like the statement alone doesn't even have any credence, let alone following through with it.
Incredibly daft.
And nobody plans to stay in this mode forever. Medicine is making tremendous progress at an astonishing rate. They just need time.
Stay patient.
My niece works at a lab developing a cheap test. Two of their researchers have already died of this virus (they went to work despite the risks). Don't make fools of them, by falling into despair and negativity.
I hope they succeed in creating a vaccine for COVID19, but resting the lifting of a highly destructive mass-lockdown of healthy people on a hope, is reckless.
Contingency plans need to be created; a definite end date for the lockdowns, irrespective of whether a vaccine exists.
You know what can disappear, become depleted, or stretched to thin? Trained medical personal. And money flow can't replenish that resource.
As for your post; that ability gradually disappears, just as it gradually builds up when the economy is functioning properly.
Capital depreciates. A washing machine breaks down, and in the absence of a repair service provider, or an ability to pay them, the washing machine loses its utility, and a person's quality of life regresses, which has long term implications for their health.
Beyond simple equipment malfunctions, the complex interplay of incentives, trust and relationships that constitutes a productive enterprise are also disrupted and destroyed by shocks and bankrupties.
It takes years to get a productive enterprise up and running. The bankruptcies happening now will hurt the production of goods/services for years to come.
Fewer goods/services translates to a lower quality of life from less labor-saving specialization/technology, which in turn increases the strain on individuals, and thereby reduces their life expectancy.
The economic factors that affect life expectancy are far more numerous and complex than an inert piece of equipment for harvesting crops or manufacturing goods, and your analysis ignores all of that.
You should at least be able to grasp the implications of the statistical evidence, which clearly show that all things being held equal, every percentile drop in GDP is associated with a drop in life expectancy.
To discount the Economy's relevance to human life is deeply misinformed.
>>You know what can disappear, become depleted, or stretched to thin? Trained medical personal. And money flow can't replenish that resource.
Completely irrelevant to my point. I wasn't suggesting that minimizing strain on the healtcare system isn't important, or even that it isn't more important than avoiding doing some amount of harm to the general economy.
I was simply contesting your claim that the Economy is irrelevant to sustaining human life. I am criticizing how you rudely implied that even suggesting the damage to it should be weighed against the deaths caused by the SARS-CoV-2 pandemic, deserves nothing but derision and contempt.
Of course, that doesn't mean these numbers aren't useful for planning and determining what degree of intervention is warranted, as you say.
Edit: could one of those down-voting explain? If I'm making a mistake here I'd like to understand it.
The rates are interesting data. But don't make the leap to "not dangerously infectious"