The same is true for rich people: you can afford to buy in bulk, to take advantage of special promotions. And sometimes, even when spending more money on products one gets to have better quality on the long run.
While I agree that some people need to create models, it is very important to understand that not everyone is able to create them. For example journalists should not be able to create such models, they lack the knowledge.
Agreed. That is an important point.
Let epidemiologist do the modelling, and use some back-of-the-envelope calculations to convince yourself of the orders of magnitude.
It's super annoying that everyone who knows what a jupyter notebook is now starts blogging about their own modelling efforts.
Atm it only takes a straight line through a couple of points to predict things for most countries, so I'd say yes.
The interesting question is whether they could help to implement useful political interventions based on which parameters matter.
The answer seems to be yes in many cases.
When I was in med school you didn't die because of the flu. People died because they had diabetes or HTA which got some complications like low immunity, a failing kidney and so on.
Covid-19 seems to hit a population by first of all killing all the people who are pretty ill even without covid-19. Lots of people die from covid-19, but those people would probably have died later that year anyway, so there's not much excess mortality.
Then, like all winter time respiratory illness it kills people who have comorbidities that probably wouldn't have killed them without covid-19. The people with moderate but well controlled asthma or diabetes -- the chronic conditions that we don't think of as life-ending.
Then the ICUs start feeling pretty overwhelmed, and the ages of the people dying gets lower, and they have fewer and less severe comorbidities. Maybe only a small percentage of these people die, but covid-19 infects so many people that this small percentage of a very large number ends up being pretty large.
This is the point healthcare systems start building field hospitals in sports halls or convention centres. It's when they requisition ice rinks to act as temporary morgues. They start locking down movement just to try to reduce this very large number of people getting infected.
ICU doctors and nurses are now overwhelmed, and they're improvising PPE out of binbags. They're reusing PPE using weird new sterilisation techniques. Other HCPs have less access to PPE, because it's all been used up. Where they would have had FPP3 and eye-shields they now have a plastic apron and a loop surgical mask.
And they're faced with something they feel like they should be familiar with (pneumonia is pretty common) but which doesn't act like other types of pneumonia. Here's one example, but there are loads more: https://twitter.com/iamyourgasman/status/1241267189048578048
> When I was in med school you didn't die because of the flu.
The real situation is a bit more complicated than that, isn't it? Plenty of people die from flu, and it's the flu that kills them, and we have medical statisticians who can tell us what the excess mortality is each year.
Different countries are defining this differently. China uses the type of definition you are using so their deaths from covid (or even flu) are really low. Italy is using the definion of had virus at death, which results in a possible over count.
All said covid is >7x as deadly as seasonal flu and you have more deaths with no comorbidities.
> Because all the studies I have read flu is a lot more dangerous
Every study I've seen the seasonal flu has a case mortality rate that varies form year to year in the close neighborhood of 0.1%, the low estimate of the case mortality rate I've seen for covid-19 is around 1% in countries with functional healthcare systems. The ratio of cases requiring hospitalization is similarly at least an order of magnitude greater for Covid-19, which is also why it poses a danger (already being realized in several parts of the United States, and very much realized, e.g., in Italy) of overwhelming the healthcare system, driving the car mortality rate higher for all conditions, including itself.
We don't annually overwhelm the healthcare system because of the seasonal flu and exhaust ICU capacity and PPE supplies, which should be a clue that whatever you are seeing claiming the flu is worse is not only bullshit, but bullshit that isn't even trying very hard to convince anyone paying even a little bit of attention.
I actually don't think deep analyses comparing covid to flu are outright bs, even if I'm skeptical covid could have such a low death rate. Reading a lot, I've generally come to the conclusion that IFR of covid-19 is under an order of magnitude higher than flu, even if likely considerably higher (my guess above is 7x, could be as low as 5x). Regardless, the pandemics speed is a huge problem which can overwhelm hospitals.
The only data broad enough to predict true cases is Diamond Princess or perhaps Iceland where you've had enormous testing. Even on Diamond Princess, you have 10/712 infections resulting in death which is worse than flu (for this population), but not 10x as bad. Iceland has 2 deaths and 25 hospitalized against 500+ cases 1.5w ago, suggestive of a sub 1% CFR.
Additionally, flu CFR is reduced by targetted vaccination of the most vulnerable people (demographics of who get infected are more likely to survive than general population).
> Even on Diamond Princess, you have 10/712 infections resulting in death which is worse than flu (for this population)
You still have to compare that to the baseline of the demographic. I.e. once you’re over eighty, you have almost a 1% probability to die within the next month.
> Additionally, flu CFR is reduced by targetted vaccination of the most vulnerable people
Yes, and COVID-19 would be a lot less bad if we had a broadly effective (even if as imperfect as the season at flu vaccine tends to be) generally available vaccine that would naturally be more likely to be taken by the most vulnerable, but alas we don't, which reinforces the point that COVID-19 is, in the real world, significantly worse than the flu, even if you could construct a counterfactual scenario where that would be less true despite the diseases each retaining their intrinsic traits.
Right and the "flu iir = covid iir" hypothesis would still lead to the real world pandemic being far worse (that's pretty obvious to anyone). You still have a disease with no vaccine that transmits extremely fast.
What would change though if that were true is that the calculus could shift away from locking down (SIP) to limited social distancing measures (to reduce r0) and a complete isolation of your most vulnerable populations. Basically, go for some sort of herd immunity if you can keep the herd's IIR below 0.01% or so.
10/710 infections on the Diamond Princess died. Would you expect flu to kill that many? (Older population but healthier than average older population).
Again, I don't subscribe to the hypothesis that flu iir = covid iir, but what you are seeing isn't incompatible with that hypothesis. The hypothesis is that iir is the same, but covid has a way higher transmission rate.
So what you are seeing in Italy (or Wuhan for that matter) is a symptom of:
1. A 4 month flu season compacted into a month
2. Hospitals collapsing from the load pulling death rate way up.
3. A lack of vaccination (which limits the deaths/year due to flu)
Honestly, we won't know what the case was until a few months from now when broad, randomized seriological tests are run.
In absolute values, it has already killed 30% more people than influenza. So, yes, I would say it is quite incompatible.
And of course lack of vacination is an important factor, but you can't exclude it.
edit: also even if it would kill in percentage the same amount of infected, an higher infection rate will converge to an higher total infected percentage of the population, so an higher absolute number of dead and critically ill.
“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.”
You are missing the market here. If you pay Canadians high wages and you set high prices for fruits you cannot sell them in poor countries. And this means that the profits for that Canadian corporation will be cut in half. And the rich people at the top will suffer.
In the mean time poor countries will start planting their own trees with their own people and appropriate prices for their country. And Mexico will have their own corporation making money.
In normal times Italy has a death rate of 10 deaths/1000 people. Which translates to ~1500 daily for a population of 60 millions. What were they doing previously with the dead?
Those people haven't stopped dying. As a comparison, 700 people have been dying every day for covid-19 in Italy. Also deaths are not (yet) evenly distributed but greatly concentated in the north.
What does that even mean? The world is what it is. Italy is seeing huge increases in background death rates at the moment, owing solely to COVID-19 (while at the same time seeing diminished deaths from things like traffic accidents, though not remotely enough to make up for all the extra COVID-19 deaths).
What is your argument exactly? It's a fact that Italy is running at a higher overall mortality rate owing to COVID-19.
The deaths were always real. Putting the whole planet on hold because some 80 years old with three associated illnesses died is a bit borderline SF and a bit borderline stupid.
It's not going to be 80 year olds dying if the hospitals are overwhelmed. 40% of people in ICU in italy are 19-40, basically, those who make up the majority of the workforce.
19-40 makes up 0.25% of the deaths (4 in total) [0]
In the US, of people aged 20-44, "only" 2.0-4.2% are admitted into ICU, significant, but making up only 12% of the ICU admissions, and 20% of the hospitalizations. [1]
I think you're confusing "dead" with "in the ICU". If you listen to the various interviews with Italian Drs, you'll learn that to make a recovery from the full-blown infection requires spending weeks on ventilation. So looking at the deaths count does not accurately capture the real problem, which is that you have an accumulated pile of people who are severely sick but will probably make some sort of recovery eventually. In the meantime your health system is offline.
I don’t believe that could possibly be true. The current ICU makeup in the US is 2-4% for ages 20-44. That’s a 10-20x increase you’re proposing. And yes, you can say that they’re triaging, but for this to be possible you’d need truly enormous numbers of infected individuals AND tons and tons of triaging going on which doesn’t feel accurate based on what news says.
It looks startling, but could be true. Reportedly, the health workers in Italy had to do some fairly brutal prioritisation in triage. If you have a lot more patients requiring ICU than you have stations, you end up with a high proportion of younger patients in ICU even if they are a low proportion overall.
Basically the current state of the internet in a nutshell right now. People assume any valid question of any data means that person is a denialist nutter or something. Fact is, we are working with very biased data and people, even the smart folks here, are misinterpreting it. The virus exists, but there is no data that tells us how widespread it is in the population. Odds are very good this sucker has been adrift for weeks or months and many of us already got it. But without good, random sampling we cannot prove or disprove that hypothesis.
About the only place I’ve seen where rational talk is allowed without getting flame to death is /r/covid19.
Hacker news, unfortunately, appears to have devolved into yet another place full of panic stricken people.
Your aggression is unwanted and unnecessary. I haven't validated anything; I speculated, with appropriate qualifiers.
I'm happy to defer to actual stats if you have any.
Page 5 of the recent well-respected Imperial paper on modelling approaches to managing the outbreak has statistics on hospitalisation that I imagine are the current best estimates.
For example, 3.2% of cases aged 30-39 require hospitalisation. Could that rise to 40% after triage? I'm not sure, it seems high, but it depends on what pressures the system is under.
Can't find the Italy link, but here's an article talking about hospitalizations and young people including alarming ICU cases: www.washingtonpost.com/health/2020/03/19/younger-adults-are-large-percentage-coronavirus-hospitalizations-united-states-according-new-cdc-data/
Quote from the movie The Big Short: "Every 1 percent unemployment goes up, 40,000 people die, did you know that?". That is probably an exaggeration, but I really hope people in power know what they are doing at the moment.
>The deaths were always real. Putting the whole planet on hold because some 80 years old with three associated illnesses died is a bit borderline SF and a bit borderline stupid.
Unfortunately this approach doesn't work unless you somehow deal with the relatives of the millions of 80 year olds who are now pissed off that the government let them die and their bodies rot in the streets, and you arrange for the army for force medical providers not to try to treat some proportion of the dying.
"More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease."
I feel like a huge number of Americans have high blood pressure and heart disease. Seems like it will still be very serious for a large number of people.
>705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care.
That's not a shocking number to you? 15% - 20% of people aged 20-44 ended up hospitalized? Even if no deaths were involved, that many young people ending up in the hospital is concerning.
I would be careful not to confuse correlation with causation here. Most old people have medical conditions. For example, about 75% of older people have high blood pressure [1] so seeing a 75% rate in the virus fatalities should not mean much.
I suspect age and immune function drive mortality, and the other factors are merely along for the ride.
When I studied medicine 15 years ago 130-139 mm Hg was not considered high blood pressure. We were young students and we were toying everyday measuring our blood pressure. Most males had over 130.
"The prevalence of borderline hypertension was calculated by determining the number of persons who had systolic pressures between 140 and 160 mm Hg or who had diastolic pressures between 90 and 95 mm Hg."
This is more inline with what I've been thought in med school in my time.
I don't think HN is the best place to ask for the moment. Speaking bad about the corona virus panic and the people creating it will get you many downvotes.
During the current crisis HN felt like a text-only Facebook.
