[HN Gopher] Preliminary test results suggest 21% of NYC resident...
___________________________________________________________________
Preliminary test results suggest 21% of NYC residents have Covid
antibodies
Author : kgwgk
Score : 239 points
Date : 2020-04-23 17:21 UTC (5 hours ago)
(HTM) web link (www.6sqft.com)
(TXT) w3m dump (www.6sqft.com)
| SiempreZeus wrote:
| Can one buy such an antibody test online?
| aazaa wrote:
| > In his press conference today, Governor Cuomo revealed the
| preliminary results of a first-phase antibody test that surveyed
| 3,000 New Yorkers over two days in 19 counties at 40 locations
| that included grocery and big-box stores. The sample suggests
| that 13.9% of New York State residents have the antibodies,
| meaning they had the virus at one point and recovered. Of the
| regions tested-Long Island, NYC, Westchester/Rockland, and the
| rest of the State-New York City had the highest positive rate at
| 21.2%. The potential good news to come to light is that the death
| rate may be far lower than some estimates, at 0.5%.
|
| This still is not a random sampling. It only samples from
| shoppers at grocery stores and big-box retailers. Imagine doing
| the same study, but of people who ordered groceries online only.
| Would you expect to see big differences in exposure rate? I think
| so.
|
| The study itself isn't linked anywhere, nor have I seen it
| elsewhere. Science is all about the details. It's not hard to
| imagine half a dozen ways that the bottom line result of this
| study could have been skewed by decisions made by the study
| authors and ground team.
| CydeWeys wrote:
| > This still is not a random sampling. It only samples from
| shoppers at grocery stores and big-box retailers. Imagine doing
| the same study, but of people who ordered groceries online
| only. Would you expect to see big differences in exposure rate?
| I think so.
|
| There's a larger, related problem with this: It's way over-
| sampling people who go outside a lot and make unnecessary
| trips, and undersampling people who don't. I'm in NYC and I'm
| only going to one store a week (the grocery store). So I'd have
| much less chance of being included in this study than someone
| who hasn't changed their habits and is still shopping much more
| frequently. And there's a direct correlation between how often
| you're going shopping and how likely you are to have been
| exposed to COVID-19.
|
| So yeah, it's very far from a random sampling, and it is
| specifically over-sampling people who are more at risk. So I'd
| take it with a grain of salt; it could actually be way off.
|
| They should've activated the jury selection tool for this and
| gone to people's apartments to draw blood. That way they'd
| correctly sample the people who aren't leaving home at all, or
| only do so rarely.
| shironineja wrote:
| So if 100% of the USA gets it at 330 M people that amounts to:
|
| 1,650,000 deaths.
|
| It is unlikely 100% will catch it from a single wave however.
| CubsFan1060 wrote:
| Which is about 1/2 of what die in a normal year. The real
| question is how much do those circles overlap.
|
| Are we saving lives, or are people now dying in June that
| would have died in November anyway?
| [deleted]
| phyzome wrote:
| There's a metric called something like "estimated years of
| life lost" based on mortality rate by age and life
| expectancy, but you'd also want to factor in _individual_
| life expectancy--a lot of the people dying from this
| already had other health conditions.
| digitaltrees wrote:
| Yes more people will live if they have access to care
| because the system isn't overwhelmed. People in the later
| stages will also benefit from the institutional knowledge
| hospitals gain from treating patients. There will also be
| more PPE and essential medication that will make treatment
| more effective. Time is our ally.
| wh1t3n01s3 wrote:
| Herd immunity will cap the total %! The second wave will be
| less contagious where current infection rate is higher.
| caoilte wrote:
| You don't get herd immunity until you hit at least 70%so
| that isn't very reassuring
| TheBlight wrote:
| Sure all of these studies are potentially flawed but they're
| all generally pointing in the same direction. There are many
| more infections than we know about and the CFR is not anywhere
| close to the actual IFR.
|
| NYC is an outlier with a 21% infection estimate but for the
| rest of NY (outside NYC metro/Westchester/LI) the estimate is
| 3.6%. Santa Clara estimate was 3%. LA County estimate was 4%.
| Seems like a trend is developing.
| jnbiche wrote:
| The CFR will be much higher than the IFR. For example,
| approximate flu IFR is 0.05%.
| scythe wrote:
| In comparing the COVID-19 IFR to the flu IFR, it is
| important to remember that flu vaccines are widely
| available and limit the spread of influenza. For example,
| CDC retrospectives for 2018-9 estimate that 35M
| Americans[1] got influenza over the flu season, or less
| than 12%.
|
| By contrast, the current COVID-19 infection rate in New
| York (from these data) is _already_ higher than 12%. So
| COVID-19 has the potential to infect a larger proportion of
| the population than the flu usually does.
|
| (If the CDC data is correct, the flu shot may save around a
| hundred thousand lives per year. Don't skip it!)
|
| 1: https://www.cdc.gov/flu/about/burden/2018-2019.html
| __blockcipher__ wrote:
| That point is entirely true but doesn't really change the
| policy implications unless you believe that we can
| actually contain this thing indefinitely (i.e. that a
| given individual can avoid being exposed to it
| indefinitely)
| Scipio_Afri wrote:
| Exactly, CFR is always expected to be higher than the IFR.
| Most people getting sick don't go to the doctor. The CFR is
| an indication of how many people feel they need to go to
| the doctor and get treatment due to how severe the illness
| is. And of those that seek treatment how many die.
| wtvanhest wrote:
| "Preliminary test results suggest 21% of NYC residents have
| Covid antibodies"
|
| Should be re-written as:
|
| "Preliminary test results suggest 21% of of people approached
| in a crowded grocery store and who would agree to give blood
| have Covid antibodies"
|
| All of these tests suffer the same sample bias, and that
| sample bias is massive.
|
| People who are already in a grocery store (risky behavior),
| who are willing to give a blood sample (believes they may
| have been previously exposed) are not the same as people who
| are leaving their house only for very limited purposes and
| ordering food online.
|
| If we assume that the % of people shopping in grocery stores
| and willing to take the test are in risk group A, and the
| people not shopping are in risk group B. We can run the
| following quick analysis.
|
| First, assume risk group A is 5 times as likely to have had
| COVID than Risk group B (but plug any assumption in there
| necessary)
|
| Then assume that risk group A is only 10% of the population,
| then rerun the numbers as follows:
|
| For every 100 people in risk group A who tested, 21 were
| positive.
|
| Risk group A is 100 people, and risk group B is 900.
|
| Risk group A's 100 were 21 prior positive. Risk group B's 900
| could be estimated that 4.2 people per 100 were positive, so
| in total of the 900 people 37.8 were positive.
|
| 21+37.8 = 59 people of 1000, or 5.8%.
|
| Plug any numbers you want in the analysis, but the
| assumptions drive huge variability in the % of New Yorkers
| infected. Without a less biased sample, we really don't know
| much other than that way less than 21% of New Yorkers have
| anti-bodies.
| slg wrote:
| >There are many more infections than we know about and the
| CFR is not anywhere close to the actual IFR.
|
| That is the optimistic takeaway.
|
| The pessimistic takeaway is that even the hardest hit areas
| are nowhere near herd immunity levels and that we are either
| going to be isolating until a vaccine is created or we can
| expect to see a lot more death once nonessential people are
| forced back to work.
| __blockcipher__ wrote:
| At this point people advocating the position you're
| advocating for are in a state of denial (this is my
| opinion, not a matter of fact, obviously). Your assumption
| is that we can effectively prevent the majority of the
| nation from exposure via lockdown.
|
| Not only does evidence seem to point against that, but when
| you do the math on mortality due to suicide and overdose
| it's not clear that containment would even save more lives
| in the long run.
|
| Here's how you can tell people's philosophical positions:
| if they talk about fear of a "second wave" they are
| Containers, since that implies the initial "wave" will not
| infect the majority; ie the virus is successfully contained
| (EDIT: See https://news.ycombinator.com/item?id=22961927
| for the caveat here).
|
| Ironically, leaders like Fauci are verbally saying that
| containment is not the strategy, yet every word that he
| says and the IMHE model everyone is relying on are all the
| result of a Containment ideology.
|
| The alternative is what I would call Pareto mitigation. The
| vulnerable portion of the population self isolates, while
| the rest of us are _allowed_ to resume working and living
| more or less normally (still no large gatherings
| presumably).
|
| I'd like to take this moment to put out a brief PSA that
| the serological data coming out, while not 100% reliable,
| is all telling more or less the same story. Let's look at
| these IFRs (the second link is CFRs but for Italian
| healthcare workers who presumably are all getting tested so
| I'm treating it as a de-facto IFR):
|
| https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_anti
| b...
|
| https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_
| i...
|
| (I'm linking to the reddit comments instead of the actual
| study because they're really nice tables and the links are
| still there for anyone who wants to double check)
|
| As others have said, for those around age 45 or less, Covid
| is equally or less dangerous than Influenza. And particular
| for those under 30 the flu is an order of magnitude more
| deadly at least.
|
| In the general population overall, Covid is undeniably more
| deadly than the flu, but only about 3-5x (and I think 3x
| personally right now).
|
| Recall that the flu is characterized by deaths in the very
| young and very old, while being less harmful to those "in
| between", purportedly due to the "cytokine storm" which is
| a scorched earth reaction of the immune system. Covid is
| very different, it is extraordinarily deadly to the very
| old, extraordinarily non-deadly to the very young, and
| about the same as the flu to those in between.
|
| A disease with such a "spiky" (highly variable) mortality
| rate based on your risk factors is precisely the kind of
| disease that is most effectively treated with risk-informed
| self quarantine rather than a national lockdown.
|
| Unemployment is correlated with a 2-3x higher chance of
| suicide, of which perhaps half can be explained away by
| mental health confounds [1]. There's unique factors in play
| here - rampant social isolation and widespead
| fearmongering, propagated even by health experts and
| "trusted" news sources at times - that lead me to believe
| that the spike in suicide and overdoses will actually be
| much higher than predicted by just unemployment alone.
|
| We're currently at 50,000 suicides per year in the US as a
| base rate, it is not unimaginable that we would see at
| least 50,000 _extra_ suicide deaths attributable to a
| mixture of lockdown and the general socioemotional
| environment.
|
| --
|
| I haven't even gotten to the philosophical battle of
| "freedom versus security". I am, ideologically, someone who
| drank the koolaid and really believes in freedom and civil
| liberties over "security" (which I view as illusory
| anyway), but _even just viewed through the lens of reducing
| mortality_, _the evidence is stacking up that lockdown is
| going to do more harm than good_.
|
| Is the evidence fully settled? Of course not. But it's
| shocking to me how many people seem to be operating off of
| the projected CFR's we had in early February, shouting from
| the rooftops about "1 in 20" people dying (random recent
| case in point: https://news.ycombinator.com/reply?id=229527
| 64&goto=threads%...). I don't know whether it's just that a
| large swath of the population already had clinical anxiety
| which is further magnified by social isolation and social
| media and news headlines, or whether something else is at
| play, but I'm very concerned about the state of discourse
| in the United States right now, and more broadly, the
| entire world. In fact, ironically I feel a bit luckier to
| be in the US than some of these other countries because in
| the US _every_ issue is partisan, which while entirely
| irrational means that roughly half the country will be in
| favor of ending the lockdown at any given time (the
| position I am advocating for, within reason, insofar as
| hospitals are not overwhelmed), as opposed to other places
| where you can get given a $1600 ticket for driving a car by
| yourself, based off of a superstition that _being outside_
| causes Covid as opposed to exposure to infected respiratory
| droplets...
|
| --
|
| EDIT: Lastly I should mention that in a perfect world we
| could have voluntary variolation; I would love to be able
| to expose myself to a controlled dose of SARS-CoV-2 and
| self isolate for several weeks to ensure that I can never
| pass on Covid to someone else. Unfortunately that would be
| very hard to make a reality due to the political
| environment, even though I am advocating for it to be
| totally voluntary. I was heartened to see this recent paper
| toying with a variant of that approach: https://www.medrxiv
| .org/content/10.1101/2020.04.12.20062687v... (I don't agree
| with an "Immunity Card" for ideological reasons but I'm
| glad we have a paper attempting to model it out which does
| show benefit of voluntary self exposure)
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pd
| f/v05...
| nostromo wrote:
| > when you do the math on mortality due to suicide and
| overdose it's not clear that containment would even save
| more lives in the long run.
|
| I'm waiting for people to do the analysis of mass
| unemployment from lockdown leading to people losing their
| healthcare, just in time for the pandemic to widen or
| return this summer or fall.
|
| You're exactly right to consider all of the externalities
| of our current approach.
| __blockcipher__ wrote:
| I hadn't thought of it specifically in terms of our
| broken employer-based healthcare system. That's a really
| good point.
|
| I quit my job Feb 7, before all this unfolded. And COBRA
| costs me $612.54 per month.
|
| For the same reason I was able to quit my job, I will be
| totally fine. I have over 5 years of living expenses in
| liquid assets, so I will be fine.
|
| But for someone who was living paycheck to paycheck and
| lost their job because it's not the type of job that can
| work from home, how the hell could they possible afford
| healthcare?
|
| Along those lines, I do really think that part of the
| reason so many people don't see the harm in locking down
| for the next several months is because, like me, they
| work in the tech industry and really have not been
| affected by this as far as employment goes.
| mlyle wrote:
| Hey, I'm in broad agreement with you, but, a nit ...
|
| > Here's how you can tell people's philosophical
| positions: if they talk about fear of a "second wave"
| they are Containers, since that implies the initial
| "wave" will not infect the majority; ie the virus is
| successfully contained.
|
| Here in the SF Bay Area we pretty effectively blunted the
| first wave with public health controls, which meant
| health care was not stressed much. Despite the Stanford
| serosurvey saying that we have 3% with a history of
| infection, the real number is probably more like 1%.
| Daily case counts are decreasing, so the initial "wave'
| did not infect the majority.
|
| It's not enough to decrease Rt noticeably at all. We need
| to figure out how to loosen up controls in a way that
| provides economic benefits, keeps a nice constantish burn
| towards herd immunity, but with enough safety margin to
| prevent catastrophe that New York got too close to.
|
| Instead, our public health seems to be further tightening
| instead of experimenting with small measures to relax the
| controls. There's a loud contingent advocating what would
| effectively be permanent controls.
| __blockcipher__ wrote:
| So, that's definitely a good point to raise. I agree and
| should have been more clear. I think there should not be
| a second wave because I think we need to resume more or
| less normal society and let people naturally get exposed
| (since voluntary self exposure will not ever be tenable
| in the US I fear).
|
| But given the way that California aggressively locked
| down early into this, I agree that we have been sloping
| down and thus there is guaranteed to be subsequent waves.
|
| Basically, the waves are real but are arbitrary and are
| caused by our own misguided interventions.
|
| > We need to figure out how to loosen up controls in a
| way that provides economic benefits, keeps a nice
| constantish burn towards herd immunity, but with enough
| safety margin to prevent catastrophe that New York got
| too close to.
|
| 100% agreed. Now the argument I do somewhat agree with is
| that it's very hard to get that balance right when
| dealing with exponential transmission. Which is why on
| balance I'm leaning much more towards "we'll cross that
| bridge when we get there" (because the alternative is
| that we have to stay permanently locked down).
|
| Also the portion of the population I am advocating should
| be allowed to return to work is precisely the portion of
| the population that produces very low hospitalization
| rates.
|
| I strongly believe that anyone who has been reading CNN
| the last few weeks would be _shocked_ to learn that we
| get 1 hospitalization for every 500 20-29 year olds
| infected (and again, these numbers are not fully settled
| but they're at least in the right order of magnitude IMO)
|
| > There's a loud contingent advocating what would
| effectively be permanent controls.
|
| Yup, this is what has me really scared. The widespread
| belief being that it is actually plausible to avoid ever
| getting infected and therefore any infections that follow
| a softening of lockdown introduce deaths that never would
| have occurred in the hypothetical alternate universe.
|
| --
|
| So, thanks for raising that point, I fully agree. The
| TL;DR is that implicit in "we need to watch out for the
| second wave" is the notion that "we need to fight these
| waves and halt their spread" which I strongly disagree
| with.
|
| EDIT: And just to be clear, if we "re-open" we'll still
| all be wearing masks and keeping arbitrary distance
| between each other so it's not like we're all running
| around exchanging bodily fluids willy nilly. But I really
| do think that the shutdown has been, in some part,
| effective in curtailing spread, and thus naturally I
| would expect a higher infection rate following a re-
| opening.
|
| EDIT 2: Removed the part about the political leanings of
| those advocating for long-term lockdown because it's
| going to set off people's defense mechanisms and
| potentially cause them to draw the wrong impression of
| what I'm saying
| dktoao wrote:
| Thanks for this comment, puts into words what I have been
| casually thinking. Also, this is the strategy in Sweden,
| seems to be working out fine for them.
| __blockcipher__ wrote:
| Thanks, I've been trying to find the words as well, which
| is really difficult when expressing a position that runs
| counter to "we need to lock down for the next 18 months"
| is basically characterized as wanting to kill granny.
|
| I generally have to spend more time prefacing the ideas
| with "I'm not a trump supporter and I think covid is real
| and I think it's more deadly than the flu and..." than
| talking about the actual ideas themselves. Especially on
| Reddit...
| slg wrote:
| I agree with some of what you said here, but there is one
| specific point I want to disagree with. All the
| projections for unemployment related deaths are based on
| society functioning as it previously did. I think many of
| the people who are suggesting we are in for long term
| isolation are also suggesting a much bigger increase in
| the social safety net to help people through these
| difficult times.
| __blockcipher__ wrote:
| Right, but I think some of that suicide rate comes from
| the lack of "purpose" (it's silly that we rely on our
| jobs for purpose but we really do), or more broadly the
| desynchronization of one's internal schedule that many of
| us have experienced (which leads to worse sleep and
| therefore higher mortality).
|
| I also think that given we know about the level of
| competence of our government, it will be very difficult
| for "real" safety nets to be put into place. That's not
| even getting to the partisan divide inherent to our
| system.
|
| So in my eyes, we had one big problem, covid, and turned
| it into two big problems, covid and an economy in ruin.
| And these two problems affect a greater set of
| individuals than either one alone. Since a huge number of
| deaths from Covid are those who weren't working because
| they're 70+.
|
| Lastly, one of the most "famous" social safety nets in
| America is social security, which is a farce that is
| known to redistribute money from the poor to the rich.
| (It is an eternal frustration of mine that the Left in
| America is so heavily in favor of social security despite
| it being flawed from its inception) [1]
|
| [1] See Milton Friedman's excellent take
| https://www.youtube.com/watch?v=rCdgv7n9xCY
| slg wrote:
| I will grant you the lack of purpose being a motivator
| for suicide, but none of us know how that would transpire
| during a global pandemic. I know there is debate over the
| specifics over Maslow's hierarchy of needs nowadays, but
| generally speaking I think a lot of us will focus less on
| these internal issues in times of external danger.
|
| Also if we are going to use government incompetency as an
| argument here. I would throw it right back at you and say
| I have little faith in the government implementing a
| reopening plan that doesn't either kill people are damage
| the economy long term.
|
| Lastly it is a false dichotomy to present a choice
| between protecting people from COVID-19 or protecting the
| economy. If we refuse to do the latter, we are going to
| ruin the economy anyway. Hundreds of thousands of people
| dying would certainly put a damper on demand. And while
| there are certainly people protesting about reopening
| sooner, I don't think think movie theaters would be
| selling out if they opened tomorrow.
| arcticbull wrote:
| > The pessimistic takeaway is that even the hardest hit
| areas are nowhere near herd immunity levels and that we are
| either going to be isolating until a vaccine is created or
| we can expect to see a lot more death once nonessential
| people are forced back to work.
|
| The third option is, when you take into account that it's
| approximately as bad as the flu for folks under 40, we let
| out the young and keep the older folks and the vulnerable
| inside. This will boost our progress towards herd immunity
| without materially increasing the death counts.
| slg wrote:
| I have never heard of any healthy person under 40 dying
| from purely the flu. COVID-19 is certainly less dangerous
| to the young than the old, but there are plenty examples
| of it killing young and otherwise healthy people.
| TheBlight wrote:
| See: https://www.cdc.gov/flu/about/burden/2018-2019.html
|
| Search for "Table 1: Estimated influenza disease burden,
| by age group -- United States, 2018-2019 influenza
| season"
| slg wrote:
| I skimmed through that so please point it out if I missed
| it, but the numbers don't seem to account for
| comorbidities. The question was whether COVID-19 is more
| dangerous than the flu to healthy young people not all
| young people.
| mlyle wrote:
| Just because you've not heard about it, doesn't mean it
| doesn't happen. Seemingly healthy young people die from
| the flu each year.
|
| Since Feb 1, 204 people from 15-34 have been confirmed to
| have died from COVID-19 in the US. 162 people from age
| 15-34 have been confirmed to have died from influenza in
| the same period.
|
| I don't think you'll find either statistic broken down by
| comorbidities.
| dboreham wrote:
| That's pretty bad considering only perhaps 5% of the
| population has been penetrated with covid-19 vs 100% for
| the flu. Assuming a 70% eventual population infection
| rate, using your data we should expect to see around 2900
| deaths in that age cohort. Annualized flu numbers would
| be around 500. So covid-19 by your data is 6x more fatal.
| mlyle wrote:
| 100% of the population was not penetrated with the flu
| between February 1 and now. Evidence implies a similar
| proportion of the population was "penetrated" with
| COVID-19 and the flu in that time.
| slg wrote:
| You mind sharing the source on those numbers because the
| total deaths is somewhat meaningless without the number
| of infections which I imagine is much higher for the flu?
| Even those absolute numbers show total deaths being just
| over 25% higher for COVID-19 than the flu.
| mlyle wrote:
| Table 2:
| https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
|
| The statement you differed with is "The third option is,
| when you take into account that it's approximately as bad
| as the flu for folks under 40," You're ignoring data in
| order to make a wishy-washy statement that it must be
| much worse for people under 40 based on anecdotes you
| hear.
|
| I don't agree flu infections were higher for those 2
| months, either. Distancing has been spectacularly
| effective against influenza, since it has a lower Rt in
| the absence of controls. Under 1% of influenza
| surveillance tests are positive right now, which is a
| level usually only seen in the middle of summer.
|
| Our best guess for _overall_ infection fatality rate is
| about 0.3%, double or 3x influenza (because of the very
| high death rate in the elderly), but COVID-19 deaths
| overall have been 4x influenza in that time period,
| indicating that COVID-19 prevalence is higher.
| __blockcipher__ wrote:
| Well even with your somewhat BS qualifier of "no
| comorbidities", the evidence is pretty unanimous that
| Covid and Influenza are not even the same ballpark.
| Worrying about a healthy young person dying of Covid is
| more akin to worrying about a healthy young person dying
| of cancer than it is to bacterial meningitis or
| something.
|
| As I've said elsewhere, Influenza is defined by being
| deadly to the very young and very old, and so-so to those
| in the middle. Meaning that healthy young people do
| regularly die of the flu (it's still rare in absolute
| numbers, but it happens WAY more than covid).
|
| Unfortunately, and I know people read this stuff and
| their quack heuristics start firing, the reason people
| are so afraid about Covid's impact on young people is
| because the mainstream media has intentionally
| promulgated a narrative that "young people are at risk
| too" because they fear that otherwise young people
| wouldn't submit to glorified house arrest for months
| straight.
|
| Yes, young people get _infected_ by sars-cov-2, but they
| do not develop deadly cases of covid in any appreciable
| numbers. You really should be worrying far more about the
| flu as it pertains to a college-aged demographic.
|
| EDIT: I do need to find some sources for you though. I
| saw some NY data broken down by comorbidites but am
| having trouble finding it.
| qqqwerty wrote:
| You can't have it both ways. If IFR is low, then that
| means R0 is way higher than we thought, which also means
| isolating only the vulnerable will not work.
|
| The fact is, the number of deaths is too high in NYC to
| be able to cherry-pick your way to an argument that
| supports your view. Either R0 is really high, and we need
| to shutdown to prevent it from infecting the entire
| population in a very short time span, or the IFR is way
| higher than the flu and we need to shutdown to prevent it
| from killing a lot of people.
|
| The only sane way to open things back up at this point is
| to implement widespread testing and contract tracing.
| mlyle wrote:
| > If IFR is low, then that means R0 is way higher than we
| thought, which also means isolating only the vulnerable
| will not work.
|
| No. If you miss a constant percentage of cases, you get
| the same shape of exponential curve.
|
| That is, a virus with an R0 of 2 and 1 case doubling to 2
| and 2 cases doubling to 4.... looks the same when you
| miss 99% of infections and see 1 of 100 infections
| doubling to 2 of 200 doubling to 4 of 400.
|
| This fallacy has been common in the response to this
| data, but it makes no sense. Large numbers of missed
| cases shift the curve forward and backward in time, and
| don't change the shape of it.
|
| All of the current findings are still consistent with R0
| in the range of 2.0 to 2.5.
| [deleted]
| CubsFan1060 wrote:
| I don't think this a binary outcome. Getting closer to herd
| immunity also makes things better. Take NYC. Now 1 out of 5
| people you see can't infect you (assuming having antibodies
| means immunity). The closer we get, the better it is.
| Having 21% "immune" leads to far different outcomes than
| .1%.
| badfrog wrote:
| > The closer we get, the better it is. Having 21%
| "immune" leads to far different outcomes than .1%.
|
| It depends on how long the immunity lasts. If it's
| permanent, this is indeed great. If it lasts only a few
| months, this 21% won't make any difference for another
| wave of infections this fall.
| __blockcipher__ wrote:
| We use the term "immunity" but we should remember that
| there is a difference between the presence of active
| antibodies and the presence of immune "memory cells". The
| latter hang around long-term, even if the former
| disappear. So at a minimum if one does develop infection
| they will recover far sooner and with better outcomes.
| And likely will reach a far lower peak viral load which
| might bring down transmission.
| slg wrote:
| I'm no expert here, so someone can correct me if I am
| wrong. But I believe as long as each infected person
| spreads it to more than 1 other non-infected person the
| disease will continue to spread until there is a herd
| immunity level of infections. That spread rate will
| decrease as more people have antibodies, but it seems
| unlikely to get below 1 since even all the stay at home
| orders haven't been able to get that number much below 1.
| mynegation wrote:
| Sustained spread of the infection stops when percentage
| of people having immunity is 1-1/R0. So if R0 for
| Covid-19 is (hypothetically) 3, you need 67% immunity to
| reach herd immunity. For highly contagious diseases like
| smallpox that number is very close to 100%
| monadic2 wrote:
| > Sure all of these studies are potentially flawed but
| they're all generally pointing in the same direction.
|
| How on earth could you differentiate this from the sample
| bias?
| TheBlight wrote:
| All three studies created their sample groups differently.
| Are all three methods flawed in some way? Sure. Is it more
| reasonable to completely ignore the picture all three are
| painting or to consider there might be something to the
| trend?
| zamfi wrote:
| > Are all three methods flawed in some way? Sure.
|
| They're not just all flawed in _some way_ -- along at
| least one dimension they are flawed in the _same way_ ,
| that is, they all have a biased sample of the population
| that seems more likely to be infected than a true random
| sample.
|
| So, sure, they're "created differently", i.e., they're
| not all facebook ads, or grocery stores, but all those
| methods bias towards higher infection rates, don't they?
|
| Given that, you'd expect high precision, low accuracy --
| these tests all paint a trend for sure, but we don't know
| how close that trend is to reality.
| Karrot_Kream wrote:
| > Sure all of these studies are potentially flawed but
| they're all generally pointing in the same direction
|
| That's unfortunately not the way statistics works. Combining
| multiple bad tests just makes the results incorrect or highly
| uncertain; the devil often is in the details. The
| Stanford/Santa Clara County study is a good example of how
| the details can really undermine a study.
|
| Things do indeed seem to be converging to the idea that the
| CFR is not near the IFR, but none of this is new news, and
| the IFR remains very close to what most epidemiological
| predictions indicated early last month. If anything, it
| confirms that COVID is a difficult beast to tame.
| TheBlight wrote:
| We don't have perfect studies and perfect data but calling
| these tests "bad" seems slightly unfair. They give us an
| imperfect but useful snapshot of what's going on. But
| thanks for the condescension. I'd expect nothing less on
| HN.
| CydeWeys wrote:
| The study is dramatically over-sampling exactly the
| people who have the most potential exposure to COVID-19,
| and dramatically over-sampling the people who don't.
|
| This could easily be way off. It's not testing the people
| who aren't home at all, and it has a low chance of only
| testing the people who leave home rarely, only when
| strictly necessary. It's mainly finding the people who
| leave home a lot.
| TheBlight wrote:
| How do you know how often these people are leaving their
| homes? Everyone has to leave their home to go to the
| grocery store eventually or someone in their family does.
| Yes there are delivery services but the vast majority of
| people aren't using those.
| kgwgk wrote:
| The more often they go, the more likely you encounter
| them.
| t2riRXawYxLGGYb wrote:
| This was my thought exactly. Some of my friends in the Bay area
| got COVID-19 (confirmed positive tests) after quarantining for
| over two weeks at home and taking all of the precautions. The
| only place they had been was the grocery store, so they suspect
| that they got it there.
| usaar333 wrote:
| Are they not taking public transit? Your friends must be some
| of the most unlucky people ever. The Bay Area has had under
| 3k cases since the start of April outside group living
| settings (nursing homes, homeless shelters, etc.). That's
| ~1/2000 chance of getting covid from anywhere outside.
| mhandley wrote:
| The incubation period runs out to around 27 days, though
| above 2 weeks is uncommon. It seems possible one of them
| already had it before quarantine, and just happened to be one
| of those who had a long incubation period.
|
| https://www.worldometers.info/coronavirus/coronavirus-
| incuba...
| badfrog wrote:
| > New York City had the highest positive rate at 21.2%. The
| potential good news to come to light is that the death rate may
| be far lower than some estimates, at 0.5%.
|
| How do they get to 0.5%? According to NYC data if you include
| "probable" cases, 15,400 people, or 0.18% of the population,
| are already dead. Wouldn't that imply 0.9% fatalities if the
| whole city was infected?
| schrodinger wrote:
| Maybe that's including the large number of deaths that are
| presumed COVID but weren't officially confirmed by a test?
| guscost wrote:
| It would not be ruled as a significant factor leading to
| death in many of those cases, and for the rest, NYC residents
| might be more at risk due to higher average viral dose
| (subways). Also there is a lag in IgG antibody production,
| the test has imperfect sensitivity, and some portion of
| exposed people may never develop detectable antibodies. Some
| of these confounding variables are probably baked into the
| estimate.
| badfrog wrote:
| > some portion of exposed people may never develop
| detectable antibodies.
|
| Interesting. Would those people still develop some form of
| immunity/resistance?
| guscost wrote:
| I think so, but I'm not an expert. See discussion:
| https://news.ycombinator.com/item?id=22958660
| arrrg wrote:
| The death rate of 0.5% falls right in the range of what
| modelers have been using, by the way. Not exactly very positive
| news.
| nikolay wrote:
| Yeah, still 150,000 death toll if everybody gets infected.
| And this is not considering the permanent lung and other
| tissue damage that's getting reported from "recovered"
| patients.
| hcknwscommenter wrote:
| You are one order of magnitude too low at 150,000. It's
| much worse than that.
| newacct583 wrote:
| Right. Really this study is just confirming (with higher
| error bars than we'd like) what we already strongly
| suspected.
|
| Note that as others are pointing out, that 0.5% isn't really
| extrapolated correctly. The tested case deaths are looking
| like they're only 70% of the total or so. Also using a
| current death count with contemporary infection counts is a
| mismatch, because it forgets that ~35% of the people
| currently in the hospital won't ever leave, which is about 5k
| more deaths.
|
| So a better calibrated CFR might be 1% or so, which is even
| closer to the range we've all been assuming.
| cozzyd wrote:
| IFR, not CFR
| usaar333 wrote:
| Except this data is also lagging by three weeks, depending
| on what antibodies are being checked. Some deaths today
| have come from infections in April, so the net effect could
| be a wash.
|
| And where are you getting a 35% death rate for "ever
| hospitalized"? It's realistically somewhere around 15%-20%,
| though with major age skew. (https://www.thelancet.com/jour
| nals/laninf/article/PIIS1473-3...)
| hcknwscommenter wrote:
| It is very positive in that we can be more confident that our
| assumptions are close to reality. 0.5%*330M still equals
| 1.65M deaths, or (very roughly) 5M ICU beds. Spread out over
| 52 weeks, that's a lot of ventilators and ICU beds and PPE,
| but it is a target. A very big juicy target that we can and
| should aim directly at, and HIT.
| nateberkopec wrote:
| It's more or less epidemiologically impossible that you
| will see an attack rate of 100% (as you just assumed). Once
| attack rate reaches >40~60%, the reproduction number drops
| below 1 because there just aren't enough uninfected hosts.
| mrb wrote:
| If this study is accurate, then 1.8 million NYC resident are
| infected. So 15 411 deaths (as of today, including 5 121 probable
| deaths) suggests COVID-19 has a fatality rate of MINIMUM 0.9%
| which is in line with previous estimates (between 0.5 and 1.6%)
| and this is MINIMUM 9 times more fatal than the flu (0.1%).
|
| Edited to add "MINIMUM", as there is a lag between case detection
| and death (I should have known better to mention it, as I blogged
| about it: https://blog.zorinaq.com/case-fatality-ratio-ncov/)
| ashaiber wrote:
| The city itself actually estimates a total of 15,411 deaths so
| far the the figure is already closer to 0.9%, and there are
| still people dying in the city every day so will likely end up
| a bit higher (of course, all of this assuming the study
| actually represents reality).
|
| https://www1.nyc.gov/site/doh/covid/covid-19-data.page
| Merrill wrote:
| You also have to adjust for the people who are already sick
| but haven't died yet. That would likely get you somewhere
| between 1 and 1.5%. So for herd immunity in the US at
| 200,000,000 recovered, that would be 2 to 3 million. That's
| consistent with earlier projections.
| glofish wrote:
| one problem with all these projections is that they all
| assume everyone is the same and that it is just a matter of
| chance. Not true in the least bit.
|
| those most susceptible get the disease first, those most
| sensitive die first -
|
| I believe the ratios will not stay the same, but
| continuously tick downwards
| Jovbrev wrote:
| On the other part, those who are more vulnerable are more
| aware, and are implementing more measures in their daily
| living, hence they are not getting infected as much,
| currently.
|
| Hope it stays that way.
| glofish wrote:
| Not sure that makes any difference.
|
| Not only are death rates sharply higher in older people,
| but their infection rates relative to the population are
| also higher as well.
| pjc50 wrote:
| So .. drawing a line between two points, if NY had 20%
| immunity for 15k dead, that implies there will be 60k dead by
| the end of the process. Roughly one 9/11 every week or so?
| dragonwriter wrote:
| > If this study is accurate, then 1.8 million NYC resident are
| infected. So 10 290 deaths (as of today) suggests COVID-19 has
| a fatality rate of 0.6%
|
| No, it doesn't, because the usual time to death, if it causes
| death, isn't zero, so you need to compare the number of deaths
| a couple weeks from now with the number of infections today to
| get a closer-to-accurate number.
|
| Also, you are using the 10,290 confirmed deaths and i ignoring
| the 5,121+ additional identified probable COVID-19 deaths. So,
| between those two things, the actual fatality rate if the
| current infection estimate from this study is right is probably
| 2-3 times the figure you cite.
| mrb wrote:
| You are correct, edited.
| gridlockd wrote:
| The time to go positive on an antibody test is not zero
| either, probably 7 to 14 days. Also the infection rate is
| lower now than it was in the past. I doubt this adds up to
| more than 50% higher mortality.
| mediaman wrote:
| Interesting thought experiment: if NY daily deaths over the
| next two weeks average 400, that's 5,600 upcoming deaths from
| people presumably infected now. If about one-third of deaths
| are not accounted for (5,121 unidentified as a portion of
| identified+unidentified), then we'd have about 8,400 new
| deaths projected over two weeks including the likely
| unidentified deaths.
|
| As a percentage of those who were infected as of this study,
| that's a 1.3% infection fatality rate.
|
| Obviously some conjecture and estimates there, but it seems
| to be on the high range of early estimates (though much lower
| than the 3%+ rates derived from CFR with undercounted
| denominator).
| newacct583 wrote:
| You can derive that from better data. From
| https://covidtracking.com/ we can see that 57k people have
| been hospitalized in New York State so far, with 15k still
| in the hospital. Of the 42k who aren't, 16k died[1], so
| we'd expect that about 5k of the people currently in the
| hospital won't be coming home (some of these statistics are
| pretty depressing).
|
| So two methods give us similar counts, matching up very
| closely with the separately measured CFR from way back in
| the original outbreak. That's pretty good back-of-the-
| envelope work.
|
| [1] this isn't quite right as not every fatality was a
| hospitalized case.
| joe_the_user wrote:
| Also,
|
| I don't the flu's fatality is calculated against every
| _exposed_ to the flu but against everyone who gets sick with
| the flu. If the flu also 50% asymptomatic exposed individuals,
| that would know it 's fatality rate down further for
| comparison's sake.
| mdavidn wrote:
| We calculate both. Case fatality rate (CFR) is based on
| patients who test positive, whereas infection fatality rate
| (IFR) is based on all infections. We don't yet have adequate
| random sampling to have confidence in IFR estimates.
| LandR wrote:
| I feel a blanket IFR figure isn't all that helpful.
|
| Won't there be a high level of age stratification in there.
| Over 60, death rate will be way higher than if you are younger
| and probably close to zero under 20.
|
| It seems better if we could have a risk per age group to see
| who can go back to a somewhat normal life and protect the most
| vulnerable.
| izend wrote:
| Making it the worse pandemic in decades but no where near the
| Spanish Flu.
| vladislav wrote:
| The Spanish flu had a smaller outbreak in the Spring and came
| back with a vengeance the following Fall, so hold that
| thought.
|
| https://www.history.com/news/spanish-flu-second-wave-
| resurge...
| rechristened wrote:
| Or as bad as the 1957-8 "Asian Flu" that most people haven't
| even heard of.
| dragonwriter wrote:
| Well, sure, but the "Spanish" flu (only called that because
| Spain is the first country severely hit that didn't lie and
| cover it up because of WWI) was accelerated by both the
| physical conditions created by WWI and the fact that covering
| it up to avoid revealing weakness to wartime opponents
| hampered response in many early-hit countries and obstructed
| information flow.
|
| It's also nowhere near the HIV/AIDS global epidemic in likely
| total impact, but it's a lot more acute in it's impact than
| HIV/AIDS.
| downerending wrote:
| > only called that because...
|
| Also worth noting that a huge number of names in biology
| are quite arbitrary and/or accidents of history.
|
| Or tech, for that matter. Fewer and fewer "hard disks"
| involve any actual _disk_ , and more non-floppy floppy
| disks were made than actual floppy ones. Etc.
| mmastrac wrote:
| Hard to compare directly against the Spanish Flu as medicine
| has had 100 years of progress, but assuming you are talking
| about overall impact, agreed.
| cozzyd wrote:
| The age distribution was also significantly different then.
| glofish wrote:
| not to mention the Spanish Flu hit children just as hard as
| the old.
| mrb wrote:
| I disagree. It's simply too early to make that determination.
|
| The Spanish Flu had a estimated infection fatality ratio of
| >2.5%
| (https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article). As
| another commenter pointed out, the COVID-19 IFR is 0.9% in
| NYC. The difference between 2.5% and 0.9% is only 2.8x.
| However the IFR is not only underestimated due to the lag
| between case detection and death, but it's also probably a
| lot worse in many other parts of the world (third world
| countries, etc). So it's possible the difference is only
| 2-fold, which would make both pandemics relatively
| comparable.
| Symmetry wrote:
| I hope that the numbers stay at .6% and that the difference
| from previous estimates might even be improvements we've made
| in figuring out how to care for people suffering from Covid-19.
| But I remember being happy at how low South Korea's numbers
| were when their epidemic peaked and receded then watching the
| case fatality rate slowly climb up to the 2.2% it's at today.
| So I'm not counting any chickens just yet.
| disantlor wrote:
| these comparisons to the flu usually don't seem to factor in
| transmissibility. seems you cant leave that out of the equation
| and only look at death rate
| formercoder wrote:
| It's important to know how risky it is to get this thing.
| That way we can make informed decisions about opening up.
| SAI_Peregrinus wrote:
| And also the risks of non-death injury from it. Long-term
| reduced lung function isn't good.
| bo1024 wrote:
| Note that deaths lag positive cases by some time (2 weeks
| maybe?).
| vikramkr wrote:
| Cuomo made the caveat during the press conference that these
| samples were collected in grocery stores etc, so might be
| higher than people at home etc
|
| edit: and also potentially lower than in the essential worker
| populations. So some caveats to keep in mind
| asah wrote:
| omg yes - tons of people switched to grocery delivery esp
| since NYC has so many terrific options and virtually every
| grocery, market & specialty store already delivered, even
| before COVID.
| wtvanhest wrote:
| The study is biased in that it pulled samples from a grocery
| store based on people opting in. If I walk in to a grocery
| store and someone offers to give me this test, I am going to
| say no for 2 reasons:
|
| 1) I have not been sick since last fall
|
| 2) I don't want to take additional risk getting bloodwork done
| by someone who is testing people for covid19 antibodies. I want
| to take a little risk as possible and return home to my family.
|
| So basically this test only possibly grabs people who are
| willing to risk going to the grocery store rather than having
| food delivered, and who are willing to take on additional risk
| of getting tested. It is even less likely that a person not
| taking risk, who never had any symptoms would get tested than a
| person who had had symptoms.
|
| The entire premise that this represents the population as a
| whole is completely flawed.
| DeonPenny wrote:
| It's also lower than the 3% that was predicted that people used
| to justify the shutdown and closer inline with the swine flu or
| rotovirus.
| rallison wrote:
| An IFR of 0.6%, with 2/3 of the US infected (about what you'd
| need for herd immunity at an R0 of 3), means ~1.3 million
| deaths. That's well in line with the models. The distinction
| between CFR and IFR was not news to the experts.
| dragonwriter wrote:
| > It's also lower than the 3% that was predicted that people
| used to justify the shutdown and closer inline with the swine
| flu or rotovirus.
|
| The shutdown wasn't, and isn't, based on the fatality rate
| under current conditions as much as the shape of the curve of
| various medical resources being required (total hospital
| beds, ICU beds, ventilators, PPE for healthcare workers,
| etc.), the anticipated speed of being able to bring more
| online, and the likely impact of exceeding available supply
| on death rates and other health outcomes, both for COVID-19
| victims and patients with other health conditions. (A
| potential problem which was significantly realized in Italy,
| where things like ventilators were for a while allocated
| based on other factors besides medical need, since the number
| with need exceeded the supply.)
|
| It's important to remember that the fatality rate of a
| disease isn't a constant, and changes to conditions (like, we
| can no longer provide ventilators to everyone who needs one)
| can change that rate.
| empath75 wrote:
| Nobody ever seriously suggested it was 3%. The estimates were
| always around 1%
| DeonPenny wrote:
| https://www.cnbc.com/2020/03/03/who-says-coronavirus-
| death-r...
|
| I mean there were articles like this all of march. I'm not
| saying the WHO or CDC might of said something different but
| lets acknowledge there were articles proclaiming a 3% death
| rate.
| grandmczeb wrote:
| Lots of people were seriously suggesting >3%.
|
| Edit: Removed the term revisionism since I wasn't aware of
| the historical connotation.
| SketchySeaBeast wrote:
| Regardless of initial estimates, how is 0.6% - 1% "closer
| inline" to 0.026%[1]? Even based upon the low range that's
| 30X more fatal.
|
| [1] http://news.bbc.co.uk/2/hi/health/8406723.stm
| gdulli wrote:
| The shutdown addresses more qualitative aspects of the
| situation. Even if flattening the curve doesn't reduce the
| area under the curve, it still avoids a potential large
| numbers of otherwise avoidable deaths because fewer people
| have it at once, keeping hospitals under capacity, and more
| people will get it later when we know better how to treat it.
|
| And the earliest predictions have to be the least accurate,
| because they're based on the least amount of data. But early
| on is when you need to act.
| guscost wrote:
| While this is great information, a few facts will still confound
| attempts to speculate based on this number:
|
| - The production of IgG antibodies is mostly delayed until after
| an infection is cleared.
|
| - This is a random sample of people who were outside, it's not
| representative of the total population.
|
| - Non-trivial numbers of people may never develop detectable
| antibodies for SARS-CoV-2:
|
| https://www.medrxiv.org/content/10.1101/2020.04.17.20061440v...
|
| https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v...
| zucker42 wrote:
| I'm sorry, I don't know much about medicine so maybe you could
| clear up what those studies found. If I understand correctly,
| they both looked at COVID-19 patients and the first one found
| 83% had detectable antibodies and the second one found 163 /
| 173 had detectable antibodies? Or maybe I just completely don't
| understand it.
|
| Also it looks like they chose people with symptoms (i.e.
| "COVID-19 patients"). Would we expect the amount of detectable
| antibodies to be less, more, or the same among
| asymptomatic/mildly symptomatic people, or do we not know?
| guscost wrote:
| I'm not a professional and some of this interpretation may be
| wrong:
|
| In the first report, 83% of people who tested positive for
| viral RNA (an active infection) had immune T cells that seem
| able to neutralize the virus, possibly _without_ antibodies.
| I don 't see any information on whether these patients were
| also tested for antibodies later, but in theory some of them
| could have cleared the infection without developing any.
|
| Another cohort of healthy blood donors was tested for SARS-
| CoV-2 antibodies, and among the samples that did not have
| them, 34% had T cells that _also_ seem able to neutralize the
| virus. They note that these cells appeared to work in only
| one of the two ways that were observed with the PCR-test-
| positive patients ' T cells. The idea is that this one method
| of neutralizing SARS-CoV-2 could be a carry-over from other
| human coronavirus infections in the past, and any antibodies
| generated by this method would be ignored by tests specific
| to SARS-CoV-2.
|
| Also the seronegative healthy donors skewed female and
| younger compared to the PCR-test-positive patients, but I'm
| not sure if that is significant.
|
| In the second report, around 5% of people who tested positive
| for viral RNA (had active infections), and then recovered,
| still developed no detectable antibodies. It's possible that
| more than 5% of exposed people are clearing the infection
| without developing antibodies, because this sample was taken
| from confirmed cases, and someone with pre-existing immunity
| may be less likely to develop symptoms.
|
| Of course, keep in mind that both of these are preprints, and
| may contain methodological errors.
| zucker42 wrote:
| Cool, great information, thanks!
| CubsFan1060 wrote:
| If I follow, your first and third points would indicate the
| number may actually be higher?
|
| Additionally, does your third point also indicate that they
| will never be immune, or just that we won't be able to test for
| it?
| guscost wrote:
| All three could push the true total higher, but number two
| easily could push it lower instead. And I'm not a
| microbiologist but I think lack of antibodies only means that
| we won't be able to test for past infection. The seronegative
| patients (determined by a very precise method for measuring
| antibodies) in the second cited paper were still able to
| clear their infections.
| tempsy wrote:
| Also don't know if people with antibodies can still spread the
| virus to others or whether antibody levels (not just presence)
| determines whether you can be reinfected.
| daxfohl wrote:
| I find myself reconsidering the original proposition by England
| to isolate the most vulnerable for a couple months and let the
| virus work its course through the less vulnerable population.
|
| If death rate is substantially lower among the under 50 crowd,
| this could work its way through with a fairly low death toll, and
| result in a herd immunity within a couple months. This slow burn
| approach we're doing however seems possibly to be the precise
| worst way to handle it, leaving the virus in the population for
| as long as possible, reducing the ability for our vulnerable
| population to avoid it.
|
| Note I think the best possible solution is a complete lock down
| for a couple months until the virus is more or less eradicated,
| as Wuhan did. But I don't think it's a realistic option in our
| society.
| Reedx wrote:
| Sweden didn't lockdown and might have herd immunity in weeks,
| according to their chief epidemiologist. It'll be interesting
| to see how this plays out in the long run.
|
| _"In major parts of Sweden, around Stockholm, we have reached
| a plateau (in new cases) and we're already seeing the effect of
| herd immunity and in a few weeks' time we'll see even more of
| the effects of that. And in the rest of the country, the
| situation is stable," Dr. Anders Tegnell, chief epidemiologist
| at Sweden's Public Health Agency
|
| Tegnell said sampling and modeling data indicated that 20% of
| Stockholm's population is already immune to the virus, and that
| "in a few weeks' time we might reach herd immunity and we
| believe that is why we're seeing a slow decline in cases, in
| spite of sampling (testing for the coronavirus) more and
| more."_
|
| https://www.cnbc.com/2020/04/22/no-lockdown-in-sweden-but-st...
| cm2187 wrote:
| It might be herd immunity. If might also be that this disease
| is seasonal. Either way it is an interesting metric.
| deanclatworthy wrote:
| I don't get it. We have numerous reports of the antibody
| tests being inaccurate. We have numerous reports suggesting
| you can get the disease twice => once does not equal
| immunity. So how exactly are these Swedish scientists testing
| for immunity?
| m4rtink wrote:
| I would not really call the Swedish model successful - Czech
| Republic and Sweden have both about 10 million inhabitants.
|
| Things moved pretty quickly to pretty comprehensive lockdown
| here in Czech Republic, including mandatory mask wearing. So
| far this seem to be effective, with combined death toll
| currently at 210. In comparison Sweden has almost 10x as
| much, 2010 dead.
|
| Looks like if more has been done less people could have died,
| not to mention the alarming news about organ damage, virus
| resurgence and questionable long term immunity.
| chasd00 wrote:
| as others have said, the area under the curve remains the
| same. The idea with Sweden is, after one year, the deaths
| will be about the same as everywhere else.
| alkonaut wrote:
| Q is how many are dead when a region has 80% immunity
| (through vaccination or infection). Those dead should
| include also deaths due to lack of planned care, cuts in
| healthcare due to recession, suicides due to unemployment
| and so on.
|
| Those countries that lock down and stop a first wave with
| only a few percent infected are basically betting on the
| arrival of effective treatment or effective containment.
|
| Those that don't are betting that containment is impossible
| and effective treatments and vaccines are a year out at
| least.
|
| It's impossible to say which scenario is right but I know
| I'd place my bet the same as the Swedish state
| epidemiologist.
| jdm2212 wrote:
| The outcomes aren't just death and recovery. There's also the
| possibility of long-term heart, lung, and kidney damage. And
| the blood thinners used to prevent coronavirus blood clots can
| cause brain bleeding. Those happen in younger people, too.
|
| And realistically there's no way to isolate those over 50. They
| generally live with, work with, or are cared for by younger
| people.
| taeric wrote:
| This feels like fear talking. As more data comes in, we are
| seeing more people with no affects. Not just mild, but nigh
| non existent.
|
| It is agreed that something gives people severe cases. Severe
| includes death and recovered with damage. We don't seem to
| have data letting you know who or what would land there.
| cryoshon wrote:
| we have absolutely no clue regarding the long-term impacts
| of exposure to this virus for asymptomatic people or
| otherwise.
|
| we cannot gamble with our future so carelessly on the basis
| of preliminary data. here is a vignette to explain why.
|
| once someone is infected with HIV, most people experience
| flu-like symptoms for a week or two which then resolve
| either with or without treatment. in some people, the virus
| is cleared so effectively after the initial infection that
| they will test negative for HIV. then, over the span of
| months and years, their immune system is silently and
| entirely asymptomatically destroyed, leaving them none the
| wiser until they progress to AIDS and get extremely sick.
|
| COVID hasn't given us any indication of similar activity.
| but we know so very little that we can't take the risk,
| especially not with millions and millions of people. i will
| also note that we are unlikely to rule out these kinds of
| hypothetical risks anytime soon. so caution is our only
| defense against disaster.
| djrogers wrote:
| > COVID hasn't given us any indication of similar
| activity. but we know so very little that we can't take
| the risk
|
| We take that risk with other viruses and bacteria
| literally all the time. If hypothetical but unlikely
| risks become thejustification for destroying people's
| livelihoods and the world ecomony, we're all dead anyway.
| cryoshon wrote:
| as a former immunologist, i can assure you that with
| common viruses and bacteria, we have years and years of
| knowledge about how they perform, thereby making the
| risks of exposure calculable.
|
| it is this body of knowledge which allows our society to
| normally function even during a typical flu season. we
| understand the upper and lower boundaries of the
| consequences, and we can make an informed judgment about
| what we should do to navigate the environment
| accordingly.
|
| the idea of throwing open the gates to allow everyone to
| get infected is a dangerous fantasy. at best, it's taking
| a leap of faith with other people's health without
| knowing whether there is a long way down or not.
| taeric wrote:
| I didn't realize this thread was about throwing open the
| gates. That said, I think there is an argument for more
| directed isolation measures for at risk groups. Fearing
| that there may be other unknowns doesn't seem to allow
| for any progress.
| guscost wrote:
| > we cannot gamble with our future so carelessly on the
| basis of preliminary data. here is a vignette to explain
| why.
|
| Yes we can, and will. We're gambling with every choice we
| make about how to respond to this, and anyone claiming
| that their plan is 100% "based on science" is full of
| shit. For example, every country enforcing a lockdown is
| gambling that it won't lead to civil war.
| easytiger wrote:
| > hasn't given us any indication of similar activity. but
| we know so very little that we can't take the risk
|
| There's little reason to believe it's significantly
| different to any other Coronavirus. Speculating that's
| it's suddenly going to be aids++ is pointless
| scaremongering.
|
| The main* reason it was a "big deal" was the lack of
| common immunity thus leading to potentially rapid spread.
| Deaths in the vulnerable from the side effects of this
| kind of thing are perfectly normal and perfectly well
| understood and there is very little treatment
| ericb wrote:
| I don't think necessarily aids++, but speculating about
| long term effects is not pointless, or unreasonable.
|
| https://www.thestar.com/life/health_wellness/2010/09/02/s
| ars...
| easytiger wrote:
| As with any viral pneumonia
| ericb wrote:
| Any _novel_ viral pneumonia.
|
| A garden snake and a cobra are both snakes. Belonging to
| the same category says nothing about the potency of their
| bite. We have no idea what kind of snake this is yet.
| [deleted]
| op00to wrote:
| Do non-severe cases cause lung damage too? Is the lung
| damage heal able?
| taeric wrote:
| That is the point of my question. There has been no
| evidence of damage in non severe cases. Indeed, we are
| having to get complicated testing to find out many people
| had it at all.
| proto-n wrote:
| How about this article [1] (translation at reddit [2])
| about german divers who had "mild cases" (no
| hospitalization, recovered at home) and were found to
| have suffered permanent lung damage, so severe that they
| can't dive anymore.
|
| [1] https://www.rainews.it/tgr/tagesschau/articoli/2020/0
| 4/tag-C...
|
| [2] https://www.reddit.com/r/Coronavirus/comments/g3rv7h/
| permame...
| taeric wrote:
| My ability to navigate Reddit is embarrassing. Never
| found the comment with the translation. Saw some of the
| discussion, though.
|
| Sounds like a promising lead to go down. I think my other
| criticisms are still unaddressed. Scarring damage is
| tough to place in age. Is plausible that they had some
| pre existing damage already.
|
| Funny to see the comments talk if walking pneumonia. I
| had that a decade ago. Was cake compared to whatever hit
| me early March.
| proto-n wrote:
| I think the fact that they used to dive but now can't
| kind of places most of the damage as recent.
|
| My link should be a direct link to the comment. The
| bottom of the comment is hidden by default, but half of
| it is visible (and you can unhide the rest using the big
| blue button). I hate the new reddit design.
| bryansum wrote:
| Absence of evidence is not evidence of absence.
| taeric wrote:
| But there is evidence in all of the asymptomatic people
| getting tested and not having any affects worth making it
| into a report.
|
| Could they have hidden damage that we can't detect?
| Plausible. But that is true of many activities. And
| illnesses.
| rootusrootus wrote:
| There have been a number of reports of folks who were
| diagnosed with otherwise asymptomatic COVID when they had
| a CT for an unrelated reason that showed their lungs with
| GGO. And in some cases they have shown no signs of
| recovery even weeks later.
| taeric wrote:
| A link would be awesome. And we would still need to
| ascertain that they did not have this damage before
| getting covid. :(. CT scans have a troubled history of
| seeing damage that preexisted. (See back pains)
| op00to wrote:
| How could we even tell? Biopsy? Lol no thanks.
| taeric wrote:
| Presumably you could find some evidence. X-ray? Just
| listening to lungs?
| sbohacek wrote:
| While this is anecdotal, it indicates that people with no
| symptoms can have lung damage (pneumonia), but not
| necessarily long-term damage:
|
| https://www.nytimes.com/2020/04/20/opinion/coronavirus-
| testi...
| eloff wrote:
| I disagree, see my sister comment.
|
| Even without data on lingering deficiencies, we can
| speculate with confidence that it carries a cost.
| taeric wrote:
| Speculation is fine. But we need data to back it. Right
| now, we don't. Could hypothesize that many being found
| with damage surviving, had damage going in. Would neatly
| explain why it hit them so hard.
| eloff wrote:
| I'm not speculating about the long term effects of
| covid19. I'm saying all sickness carries a cost as
| currently understood according to our theories of
| cellular senescence. You've missed my point entirely.
| taeric wrote:
| And you are missing mine. Agreed there could be long term
| things. Yes, we should study that and watch for it.
|
| If that is the extent of your point, then my response is
| "yes, and?"
|
| Your framing, though, begs the question that mild cases
| have long term damage. We have zero evidence of that.
| Literally none.
| eloff wrote:
| You're still missing my point.
|
| I'm saying all sickness comes with a long term cost. It
| gives you a shove toward the grave. Covid19 falls into
| that category, regardless of how much or little we know
| about it.
|
| Now you could argue that sickness and aging don't work
| that way. I don't think you'd be right, but you can make
| that argument.
|
| Your argument about the long term effects of covid19 is
| not relevant to the point I made.
| DeonPenny wrote:
| But you shouldnt do that. Just like when we believe the
| death rate was 3% it seems we can't be confident in
| anything we've been told.
| eloff wrote:
| You've missed my point.
| eloff wrote:
| Yes, recovery is not binary. Even if you recover fully you've
| expended some percent of your finite lifetime capacity to
| heal your organs. It may well have taken years off your life.
| That's true for other illnesses to. The flu doesn't just cost
| you a week of productivity.
| ver_ture wrote:
| I think I'll try to get back into running again.
| DeonPenny wrote:
| Wouldnt that mean quartine would never work because it make
| sense that those younger people going outside would make
| those 60 olds sick regardless of the quarantine.
| jdm2212 wrote:
| The SK/Taiwan/Chinese/Singapore approach to quarantine has
| been to isolate people away from their families if they're
| thought to be sick (i.e., in a hotel or military barracks).
| That's how you make quarantine actually work.
| DeonPenny wrote:
| That seems like a much cheaper solution.
|
| Aside from china who were welding people regardless of
| there sick status and had millions of faulty tests.
|
| Everyone else on that list has lower death numbers and a
| economy not going into the toilet.
| daxfohl wrote:
| But that's going to happen anyway because people will catch
| it until we hit herd immunity. Unless a vaccine comes out
| before we get there, which seems pretty iffy at this point.
|
| I do think we can plan for the isolation of that population
| for a couple of months if we have some strong leadership.
| Unfortunately that seems to be lacking right now.
| cycrutchfield wrote:
| >But that's going to happen anyway because people will
| catch it until we hit herd immunity
|
| It's about managing the hospitalization rate so that the
| medical system doesn't get overwhelmed.
| daxfohl wrote:
| I was responding to the contents of the parent comment. I
| agree with you (see a separate branch of the comment
| tree), but that's not part of what the parent comment was
| talking about.
| eloff wrote:
| All things equal, it would be better to get it out of the way
| sooner. However, what it doesn't account for is:
|
| 1) can we flatten the curve enough that some people never get
| it because we get a vaccine?
|
| 2) can we flatten it until we find an effective treatment
| protocol, saving lives?
|
| 3) if we did nothing would the hospitals be overwhelmed leading
| to additional loss of life and a higher death rate?
|
| The first two are speculative, but the last one is pretty much
| certain looking at Italy and NYC. Without lockdown it could
| have been so much worse.
| luckylion wrote:
| If we prolong it a lot with all the associated cost and 1 and
| 2 never happen, we've lost not just a large part of the
| economy, but also lives without anything to show for it.
| cycrutchfield wrote:
| I don't think you quite understand what happens to the
| fatality rate once hospitals become overwhelmed. That 1%
| IFR will quickly become 3-5% IFR.
| treis wrote:
| That isn't supported by any facts and is totally wrong.
| Our ability to treat viral pneumonia is very limited. We
| aren't saving 60-90% of patients that otherwise would die
| which your numbers imply. We can move the needle a bit
| and maybe save 20% of them. As an example, 90% of
| patients that go on ventilators still die.
|
| Even in a situation where hospitals are getting
| overwhelmed it won't make much difference. Much of the
| care that happens is pointless. That 85 year old obese
| patient with chronic heart failure ain't making it no
| matter what you do. So if we are getting overwhelmed we
| can triage and not see much impact on fatality rates
| because patients like that are dying either way.
| Slartie wrote:
| > As an example, 90% of patients that go on ventilators
| still die.
|
| That's in New York, and probably because they only put
| the really worst cases on ventilators because there
| weren't enough ventilators. In Germany, that number of
| deaths on ventilators is at around 30%. This shows that
| this quota is entirely useless to make your argument, and
| that maybe you should curb your intuition a bit when it
| comes to estimating percentages of potentially saveable
| people, especially if those estimates are then used to
| effectively sentence people to certain death.
| treis wrote:
| Do you have a cite for that 30% number?
| luckylion wrote:
| That's a different argument. I'm saying that "lockdown
| until we have a vaccine or great treatment" might mean
| "lockdown until 2030". We already see heavy economic
| damages, civil unrest and riots after 4-8 weeks. Make
| that 40, 80 or 200 weeks and the world will be very
| different.
| cycrutchfield wrote:
| A handful of peabrained astroturf protestors does not
| equal "civil unrest and riots". Also nobody is arguing
| for "lockdown until we have a vaccine", that is a
| strawman. The strategy has always been to buy time for
| testing capacity to get high enough to support less
| restrictive mitigation efforts. Along the way we will
| likely pick up additional things like antibody testing to
| identify the immunized and treatment options that work
| (clinical trials still in progress).
| luckylion wrote:
| Are you suggesting the riots in the banlieus in France
| are done by "astroturf protestors"?
|
| And "flattening the curve" to buy time until we get a
| vaccine or a very successful treatment was literally in
| the comment I replied to. Not as in "we must lockdown
| until then", but as a goal we may reach if we continue
| with strict measures.
|
| It's fine to want that, we just have to be aware that it
| might not happen (or might not happen soon) and that it
| isn't free.
| lbeltrame wrote:
| > Also nobody is arguing for "lockdown until we have a
| vaccine"
|
| Some pepole in Italy were _actually_ arguing for stronger
| limitations for 18-24 months until a vaccine was ready,
| and IIRC someone mentioned on HN a similar strategy (2
| months closed - 1 months open) suggested for the UK.
|
| So, there are people (in the authority chain) proposing
| for that. Whether they'll get listened to or not, it is
| another matter entirely. Personally I hope they don't.
| lbeltrame wrote:
| Option 2 _can_ be the most realistic, depending on the
| outcome of the currently-going clinical trials. There quite a
| bunch closing by June (although most of these are on
| repurposed drugs, and with not too large sample sizes).
| daxfohl wrote:
| Yeah, I have less and less hope in a vaccine. We'll likely be
| well on the way to herd immunity before one is ready.
|
| For #3, I agree. I'd be interested to see the math on how
| many under-50's need hospitalization, ventilation, and how
| severe of an additional effect would that have. It may be
| that it requires less medical capacity to support a high
| percentage of the healthy population contracting the virus,
| than a far lower percentage of the general population
| (including over-50 crowd) contracting it. Or it may require
| vastly more capacity. I have no idea.
|
| The other thing to take into account is the effect dragging
| this out has on developing economies. It seems like this is
| shutting down international supply chains and food shortages
| could result. So that's what's got me feeling like more
| aggressive action should be considered.
| klmadfejno wrote:
| I've been making many posts arguing against the efficacy of
| lockdowns (and been getting shat on by points I find mostly
| naive). I think something like this is probably the best
| approach because it minimizes economic harm while also trying
| to minimize hospitalization rates among the elderly.
|
| But even if we pretend we could implement a perfect bubble for
| everyone over 50, they're not especially safe when the lockdown
| is lifted for them. The virus will still exist, and people over
| 50 tend to spend time with people over 50 (see: homophily).
| Once it enters the social network, herd immunity doesn't exist
| because your local community of old people are both super
| vulnerable to acquiring the disease and few of them have
| immunity from past exposure because of the lockdown.
|
| Locking down the country until the virus is eradicated is not a
| realistic option and its incorrect to think Wuhan has "done"
| this
| formercoder wrote:
| Any time I try and make counterpoints to lockdowns or even
| logical evaluations of them online the downvotes and hate
| start flowing. There is a huge bias among those in our
| circles towards locking down as long as possible, because all
| of us can work from home and aren't worried about feeding our
| families.
| TheCowboy wrote:
| Arguing it's a matter of bias sidesteps the reasoning for
| lockdowns. This is like when someone dismisses someone for
| possessing a political bias---that's not an argument.
|
| And framing it as lockdown vs. being able to feed your
| family is a false dichotomy. It seems like a waste to even
| get into the finer details if this is where you're coming
| from, but keep calling it hate while ignoring the
| criticism.
| SpicyLemonZest wrote:
| No, it's a very real dichotomy. People won't literally
| starve in the US, but waiting in a bread line for hours
| is very different than feeding your family through your
| own money and effort.
| wvenable wrote:
| > But even if we pretend we could implement a perfect bubble
| for everyone over 50, they're not especially safe when the
| lockdown is lifted for them. The virus will still exist, and
| people over 50 tend to spend time with people over 50 (see:
| homophily).
|
| The point of the lock down is to prevent the spread of the
| virus from happening too fast and overwhelming the healthcare
| system. It is not to prevent people from ever getting it as
| that's clearly not possible. You seem to be missing that
| point in your argument.
| TheCowboy wrote:
| > I've been making many posts arguing against the efficacy of
| lockdowns (and been getting shat on by points I find mostly
| naive).
|
| I skimmed some of your comment history. Your comments aren't
| as rock solid as you believe, and there are many points
| either glossing over things or complete ignorance.
|
| > More people will die if the lockdown is lifted, and many of
| those who would have died anyway will die sooner.
|
| Are you really arguing many would have died anyways? How
| many? What percent? You're ignoring the reality that in
| regions with overwhelmed healthcare systems they're having to
| engage in triage (read: many people are dying who would not
| have died anyways) since they cannot treat everyone. This
| isn't just for covid-19, but for people with other treatable
| conditions.
| glofish wrote:
| Well, it looks like in the end that much-criticized imperial
| model might be right on transmission rates but way off on the
| fatality rate and with that predicted deaths.
|
| It pretty much looks like none of the epidemiological models are
| reasonably accurate on both, case numbers and fatally rates
| zucker42 wrote:
| Which model and what fatality rates did they predict?
| rallison wrote:
| If the results from this NY study hold, the numbers are
| basically exactly in line with the Imperial College study. That
| study assumed an IFR of 0.9%, and the NY results imply an IFR
| right around that.
| guscost wrote:
| If you're fitting a model to observations, they'll have
| something of an inverse (but of course non-linear)
| relationship. So if your virulence estimates are worse than
| your transmissivity estimates, or vice versa, the bad
| measurement is going to push the model out of whack.
| cycrutchfield wrote:
| How are they off on fatality rates? Also note that the fatality
| rate is an input to the model, not a prediction of the model.
| djrogers wrote:
| I'm starting to wonder if there aren't 2 (or more) transmission
| methods for this virus with differing symptoms. Aerosol
| transmission with 'I got a cold' type symptoms, and droplet
| transmission with 'I got the worst cold I've ever had' type
| symptoms.
| gridlockd wrote:
| Another factor couldd be where the virus load lands - in the
| lung or the throat.
| grandmczeb wrote:
| Why would different transmission methods result in different
| symptoms?
| taeric wrote:
| Viral load, is what this typically refers to. Akin to an
| allergic person seeing one cat versus a room full of them.
|
| And, of course, for some people with allergies, contact where
| a cat has been is enough. ;)
|
| So... Complicated.
|
| Edit: was corrected down thread that this is infection dose,
| not viral load.
| grandmczeb wrote:
| There's a very weak association between viral load and
| symptoms once you're infected.
| taeric wrote:
| But that is what the thread was talking about, right?
|
| Would be nice to see studies. My intuition is that it is
| weak. But my intuition doesn't count for much here.
| grandmczeb wrote:
| Is it? I read the original comment as saying there were
| significantly different symptoms based on the
| transmission method. Even assuming that the transmission
| method results in a significantly different viral load,
| that's not enough to explain differing symptoms since
| there's not a whole lot of observable difference between
| cases with different severities[1,2]. There are some
| studies that show a relationship, but nothing strong
| enough to explain a dramatic difference.
|
| If it's true that the transmission method makes a big
| difference, it's more likely due to some other reason.
| E.g. maybe mild strains spread more easily in the air
| (although as far as I know there's no evidence that's
| true.)
|
| [1]
| https://arxiv.org/ftp/arxiv/papers/2003/2003.09320.pdf
|
| Page 3. "We did not observe significantly different viral
| loads in nasal swabs between symptomatic and
| asymptomatic."
|
| [2] https://www.medrxiv.org/content/10.1101/2020.03.15.20
| 036707v...
|
| Page 4. "There was no obvious difference in viral loads
| across sex, age groups and disease severity"
| taeric wrote:
| Fair. My entry to this thread should have begun with a
| question mark. I thought the point of different
| transmission methods, as frames, was referring to
| potential differences in viral load.
| grandmczeb wrote:
| Rereading your first comment, I think you might be
| thinking of infection dose. Viral load is the amount of
| virus present in a patient. Infection dose is the amount
| you're exposed to.
| taeric wrote:
| So, I was indeed mixing those up. I think most of the
| following points stand?
| grandmczeb wrote:
| There's not much evidence that infection dose matters in
| terms of case severity either, other than you're just
| less likely to be infected in the first place.
| etimberg wrote:
| Perhaps different amount of viral load
| [deleted]
| duxup wrote:
| It sure would be nice to find out the virus is far more
| widespread / exposure is higher than expected if only that would
| seem to indicate that the light at the end of the tunnel is
| nearer than we think ... and a lot of people have been exposed
| and doing well.
| seemslegit wrote:
| 0.5% IFR is still very high, I wonder what the antibody detection
| threshold is - i.e. is it possible that a lot more people have
| been exposed but don't have detectable antibody levels ? Would it
| qualify as infection in the sense that they are not susceptible
| for covid19 in the near term ?
| ccleve wrote:
| This study doesn't appear to suffer from the same methodology
| problems as the Stanford study of a few days ago. In that study,
| they recruited people through Facebook, and reported an infection
| rate that was low enough that it could have been caused by false
| positives.
|
| Here, it's closer to a random sample, but more importantly it
| shows really high rates. Those rates overwhelm any error due to
| false positives.
|
| Also, it shows numbers that are in line with our intuition. It
| shows higher infections in NYC, and higher infections among
| blacks. That reflects what the hospitals are seeing.
|
| This study may well be really good news.
| vkou wrote:
| The major methodology problem with the Stanford study was not
| that they recruited participants through Facebook.
|
| The major problem in the Stanford study was that they ran a
| test that has a 3% false positive rate, and found that 3% of
| the test-takers tested positive. (And that apparently the
| asymptomatic COVID-19 rate is 90+% - which does not square with
| the Diamond princess data).
|
| They could have ran that same study back in 2018, and would
| have gotten the exact same garbage results.
| 8ytecoder wrote:
| (Reposting my comment again here)
|
| This one's from a different company (BioMedomics) and it was a
| random test of people pulled straight off the streets. Happened
| at an entirely different geographical area (Chelsea,
| Massachusetts) as well. I don't want to be too optimistic but
| there are some signs that we are heavily under-counting the
| actual number of cases (at least in the US).
|
| https://www.bostonglobe.com/2020/04/17/business/nearly-third...
| mlthoughts2018 wrote:
| The rates being this high actually casts doubt on the study.
| It's very very implausible, and suggests almost surely a
| selection bias in the sample towards a population much more
| likely to have contracted it.
| zucker42 wrote:
| Why is it implausible? The resulting fatality rate seems
| close to other scientific results I've seen.
| mlthoughts2018 wrote:
| Actually in reading closer and seeing the data is collected
| at big box & grocery stores, it's almost surely very biased.
|
| This cohort would skew younger and wealthier, which
| correlates with better preexisting health and fewer risk
| factors, and would exclude populations who systematically
| left the city, or who have known heightened risk factors.
|
| Comparing the death rate overall with the infection rate of
| this skewed sample would be likely to greatly underestimate
| the actual death rate of the virus.
| Gibbon1 wrote:
| This weekend San Francisco plans to do a hard test of about
| 6000 people in a couple of square blocks of the Mission
| district. They are going door to door to encourage people
| to get tested.
|
| Still biased but probably better than anything so far.
| zucker42 wrote:
| Is there a write-up for this study? Or anywhere with
| data/methodology released?
|
| Also, is this particularly good news? Using the raw numbers
| from the headline and the deaths from here
| https://www1.nyc.gov/site/doh/covid/covid-19-data.page we can
| make coarse fatality rate estimates. I assume population of NYC
| is 8,400,000.
|
| 10290 / (.212 * 8.4e6) = 0.6%
|
| Including probable deaths (which makes the death count line up
| more closely with excess deaths)
|
| 15411 / (.212 * 8.4e6) = 0.9%.
|
| So it seems consistent with a IFR of 0.5%-1%. However, this
| doesn't account for the lag between antibody presence and
| death. Also, we don't know what bias sampling from grocery
| stores introduces, it could affect the results in either
| direction. Hopefully, New York releases a paper so we can get
| more accurate estimates.
|
| It's good to see a prevalence study with presumably less flaws.
| credit_guy wrote:
| Yes, the study is really good news for NYC. My thinking is that
| the state of emergency, currently in place until 5/15, will be
| extended at most once to 6/15. After that we'll be somewhat
| open for business. I imagine everyone will be advised to wear
| mask/gloves, to keep the social distance and to keep washing
| hands. Lots of people will continue to work from home, others
| will bike to work. Being summer, the virus will not be that
| contagious. When the November rebound is forecast to happen,
| the herd immunity will be much higher, hospitals better
| prepared, the medical world will have learned the most
| effective ways to treat this disease, so the fatality rate will
| go down to levels seen in Germany, or lower. Bottom line, I
| don't think we'll have another shelter-in-place in November-
| December.
| laurencerowe wrote:
| It's really difficult to compare the currently reported
| fatality rates between different countries and regions since
| the amount of testing varies so greatly.
|
| Compared to many other countries, Germany has likely
| confirmed through testing a higher proportion of its total
| number of cases in the country, lowering the reported
| fatality rate.
|
| In countries where testing is less widely available only
| those already showing severe symptoms get tested
| disproportionately, so confirmed cases are more likely to be
| fatal even if they get good hospital care.
| robocat wrote:
| > Being summer, the virus will not be that contagious.
|
| I think that is still scientifically debatable, good
| overview: https://www.newscientist.com/article/2239380-will-
| the-spread...
|
| Certainly it is still transmissible in hot countries.
| credit_guy wrote:
| Thanks for the link. It's a good read.
|
| That said, science is enamored with significance levels,
| p-values, etc. Most people just do that because that's what
| they've learned, and think that's how it should be done.
| They don't think it comes from Bayesian inference, where
| you put a very low prior probability of a drug being useful
| (because the very vast majority of chemicals we could put
| in our bodies are either harmful, or have harmful side-
| effects). In this case, the Bayesian prior is that common
| colds in general become less prevalent during the Summer,
| and Covid19 is caused by a coronavirus, which is related to
| viruses causing the common cold. The burden of proof should
| be lowered many, many times, but I nobody who did these
| statistical surveys did that, because this is a total no-no
| in the field.
|
| So, I'll state my conclusion, after reading your link: the
| infectiousness of Covid19 is more likely than not to
| decrease in the Summer, based on the studies that were
| performed. It will not decrease to zero, so that does not
| contradict your statement that it is transmissible in hot
| countries.
| edmundsauto wrote:
| Which infectiousness rate are you talking about? How
| could your prediction account for the impact of increased
| immunity and other interventions?
|
| My point is that the infectiousness will decrease in the
| summer because of these factors. There isn't much reason
| to think there is anything special about it being Summer.
|
| Finally, it's a very tenuous link between common cold
| prevalence and coronavirus.
| hcknwscommenter wrote:
| It will increase, because vastly more people will have
| already been exposed. The seasonal variation in the cold
| exists for many reasons, including SCHOOL is open, and
| people tend to congregate in enclosed spaces more. None
| of these things are relevant to COVID
| matwood wrote:
| > the Bayesian prior is that common colds in general
| become less prevalent during the Summer, and Covid19 is
| caused by a coronavirus, which is related to viruses
| causing the common cold
|
| MERS is also a coronavirus and does just fine in the warm
| climate of the middle east. I hope that warmer temps slow
| the spread, but it's far from certain.
| hcknwscommenter wrote:
| It's not just far from certain. It is simply unlikely.
| The "hypotheses" for explaining seasonal variations in
| transmissibility are nothing but a wild-guess/hope.
| ethbro wrote:
| It seems reasonable that lipid encapsulated viruses are
| fairly stable in a variety of temperature ranges, no?
|
| On the other hand, I can see the additional environmental
| UV saturation and vitamin D having a noticeable effect.
|
| Even a small decrease in environmental persistence should
| help, given its infectiousness.
| dboreham wrote:
| Only 60k more deaths to go until herd immunity.
| eanzenberg wrote:
| This study is good news... I'd be interested to project the
| rate of infections WITHOUT shutting down the economy for what's
| now going on 6 weeks. Seems like it was all in vain.
| tunesmith wrote:
| Sorry, can someone spell out how this might be good news? 21%
| is still a long way from herd immunity, and NYC's hospital
| system has been severely strained getting to this point. On top
| of that, the hospitalization rate still seems disproportionate
| to someone getting the flu - maybe it's five times as fatal,
| but it's > 5x the flu hospitalization rate. It's not like the
| virus has _become_ less dangerous, we 're just realizing how
| dangerous it has been, what with the impact we've already
| experienced.
|
| Besides, generally if a virus is less fatal than previously
| expected, it means it's more contagious, meaning that much
| harder to get to herd immunity.
|
| Good news would be things like: evidence the virus has mutated
| into something less severe; evidence of an anti-viral treatment
| that improves outcomes for everyone so it's not as big a deal
| to catch it; evidence that community spread has halted in an
| area and the boundaries are controlled so people in that area
| can feel secure they won't catch it; evidence of an impending
| vaccine.
|
| Is this good news just because we're finally establishing that
| people have caught it once can't re-catch it for now? I guess I
| can see that as good news but that is so expected that it's
| more like it would be horrendously bad news if we found
| evidence that recovered people _didn 't_ have antibodies. But
| generally I don't really see what policy impact this has, other
| than identifying a pool of workers that can go work in meat-
| packing factories without fear of catching it again.
| shakopeeant wrote:
| This is good news because the mortality rate keeps coming
| down... If you don't know why that's good news then back to
| your bunker.
| cm2187 wrote:
| I don't know if the hospitalisation rate is so out of whack
| vs the flu. It should be higher. But does 20% of the
| population catches the flu in a matter of weeks?
| glofish wrote:
| it is more like would the 20% population go to the hospital
| if they suspected they had the flu
|
| if they did the hospitalizations would rise as well
|
| one reason the hospitalizations are falling has less to do
| with the numbers of cases and more with doctors ability to
| better tell who might need it.
| creaghpatr wrote:
| Much of the population gets a flu vaccine so would be
| tricky to compare.
| cm2187 wrote:
| My very point. It contaminates people at a slower pace,
| for that reason and cross immunity, higher R0, etc.
| revnode wrote:
| > Sorry, can someone spell out how this might be good news?
|
| It's good news because it strongly suggests that mortality is
| much less than previously suspected. There were numbers
| floating around from anywhere between 10% to 3% a few weeks
| back. A mortality rate < 1% is very good news because it
| means fewer people will die in the long run.
| kgwgk wrote:
| > mortality is much less than previously suspected
|
| Mortality remains pretty much as suspected already two
| months ago:
|
| "Based on these available analyses, current IFR
| estimates10,11,12 range from 0.3% to 1%. Without
| population-based serologic studies, it is not yet possible
| to know what proportion of the population has been infected
| with COVID-19."
|
| https://www.who.int/docs/default-
| source/coronaviruse/situati...
| zucker42 wrote:
| The princess cruise ship study also gave an IFR (for
| China) of 0.5%, and an early epidemiological modeling
| study put the symptomatic CFR at 1.4% which would imply
| 0.7% IFR assuming it's 50% symptomatic.
|
| https://www.nature.com/articles/s41591-020-0822-7
|
| https://www.medrxiv.org/content/10.1101/2020.03.05.200317
| 73v...
|
| 0.5% to 1% has been the most plausible for at least a
| month, and this NYC study seems to exactly line up with
| that.
| zaroth wrote:
| Two weeks _after_ that the WHO released a widely cited
| report claiming a fatality rate of 3.4%.
|
| "Globally, about 3.4% of reported COVID-19 cases have
| died. By comparison, seasonal flu generally kills far
| fewer than 1% of those infected."
|
| https://www.who.int/dg/speeches/detail/who-director-
| general-...
| tunesmith wrote:
| CFR will be higher than IFR due to undercounting
| infections.
| makomk wrote:
| Yes, and then almost the entire US press spun the 3.4%
| figure as the real WHO-confirmed fatality rate and sub-1%
| numbers as a Trumpian lie as part of a stupid, cynical,
| partisan attempt to get Trump. There's been a lot of
| that. (The UK press, meanwhile, happily quoted the 1%
| figure - if I remember rightly, some outlets like the
| Guardian with both UK-facing and US-facing sides pushed
| both narratives to different audiences at the same time.)
|
| In reality, the WHO number was just confirmed deaths
| divided by confirmed cases, which was of course almost
| completely meaningless.
| longtimegoogler wrote:
| This comment is entirely wrong. The mortality rates are
| right in line with what was expected with an IFR of > .5%
| unlike the Stanford study which was claiming something much
| lower.
| ummonk wrote:
| Mid single digit percentage mortality rates were the
| numbers for case fatality rate, not infection fatality
| rates. Infection fatality rates have consistently been
| around 1%.
| exclipy wrote:
| 21% sounds much closer (eg. months) to herd immunity than
| previous estimates (eg. up to a decade).
| qqqwerty wrote:
| The only good news that I am getting out of this, is that NYC
| seems to have avoided the dreaded 3-5% fatality rate that was
| the presumed worse case scenario (massive community spread,
| overloaded healthcare system). But the lockdown likely helped
| a lot, and it seems like they are seeing around 1% IFR, so I
| am not sure this really changes anything. Our understanding
| of the disease and how to treat it may also be getting
| better, but it still seems like if we let this thing run wild
| through the population (as some people on here are proposing)
| local health care systems will collapse and we will have a
| IFR orders of magnitude higher than the flu.
|
| And as you pointed out, if the study came back with an
| infection rate of 50%, I am not sure I would consider that
| good news either. That means it would be nearly impossible to
| isolate vulnerable populations. So while a 50% infection rate
| would mean the IFR is lower, it also means opening things
| back up and only isolating the vulnerable would not work to
| protect them.
| electricviolet wrote:
| If the infection rate were 50% we would be close to herd
| immunity (which I've read would require about 70% for this
| virus), so that would be better news in a sense.
|
| Unfortunately 21% is a long way from 70%, and it's taken a
| massive amount of death to get to that point.
| lostapathy wrote:
| The herd gets substantial benefits long before you get to
| 70% or whatever rate for full herd immunity.
|
| The spread starts to slow before that point. If you're
| walking around infected and 20% of the people you come in
| contact with cannot catch it from you, 20% less people
| are going to catch it, no matter how much you cough on
| them.
| qqqwerty wrote:
| The R0 value impacts herd immunity %. So if NYC is
| already at 50%, then it means R0 is much higher than we
| thought, which means herd immunity would probably be as
| high as +90%. With numbers like that, not shutting down
| would result in the entire population getting infected in
| the span of a month or two.
|
| The point I was trying to make, was that for the 'open
| back up' crowd, they are arguing that the IFR is similar
| to the flu, and only vulnerable populations are really
| impacted. So they say we should open up and just keep
| vulnerable population in lockdown. But they are ignoring
| the implications of the R0 value in their argument. i.e.
| if the IFR is really as low as they think (and
| consequently, the infected population is as high as they
| think), then nothing short of a total lockdown (or very
| aggressive testing and contract tracing) would stop
| vulnerable populations from getting infected.
| dwaltrip wrote:
| I agree with everything you are saying. This does look like
| good news.
|
| However, we should remember that this is probably a mild
| overestimate, as the study population was assembled from those
| who were out and about (shopping at the grocery store, etc).
| People who are more strictly staying home -- and thus less
| likely to have been infected -- wouldn't be included in the
| survey.
| bob33212 wrote:
| Another way to look at it is that 20% of people most likely
| to contribute to a high transmission rate already have had
| it, in turn flattening the curve by a considerable amount
| Symmetry wrote:
| And the specificity of the test might be worse than advertised
| but it wouldn't be credible that it could be making a big
| different with the 20% positive rate here.
| cjhopman wrote:
| Sure, but a person who goes to the store 7 times a week is ~7
| times as likely to have been sampled compared to someone who
| goes only once a week. They are also ~7 times as likely to have
| contracted covid-19 at the grocery store. It's likely that they
| are also, in general, isolating less than the other.
|
| This sampling would have a (possibly slight, but still unknown)
| bias towards people who are isolating less (who you would
| expect to then have a higher than average percent positive for
| antibodies, assuming isolating is helpful).
|
| I don't think anyone knows whether or not this is a more
| representative sample than the stanford study.
| ferzul wrote:
| otoh, it gives about the same ifr as the recent study in
| geneva. at the end of the day, it looks like the first wave
| will have an ifr of about 0.6% - more than ten times greater
| than the flu, but not the bubonic plague
| alkibiades wrote:
| going 7 times doesn't actually increase the likelihood 7x but
| your point still stands that they would be far more likely to
| get it
| karagenit wrote:
| Well, sort of. The increase in likelihood of being sampled
| due to going to the store N times more than the average
| person is a function of N and P (the probability of being
| sampled in any given trip) such that
|
| f(N, P): (1 - ((1-P)^N)) / P
|
| For a large P you're right, but as P gets very small (let's
| say that in any given trip you have a 0.01% chance of being
| sampled) then the increase in likelihood of being sampled
| approaches N times as much (in this example, it would be
| 6.999 times as likely). Of course, this assumes they're
| taking measures to ensure no one gets sampled twice.
| CyberDildonics wrote:
| They also said people who went to the grocery store 7x as
| much were 7x as likely to be infected which is what I
| think this person was replying to.
| taeric wrote:
| Maybe, more rapid trips may reduce your odds of being
| there when the sample happens on a day. Such that you may
| have a lower p. :)
| JetSetWilly wrote:
| In the other direction, people who are sick or have recently
| been sick may well isolate and avoid going to the grocery
| store, dragging the detection rate back down.
| fyp wrote:
| Even with worst-case scenario of bias, this is still
| extremely good news. My worry was always with super spreaders
| who refuse to isolate but the data is suggesting that those
| spreaders will still soon achieve herd immunity among
| themselves. As long as the rest of the society behaves we
| will still hit zero cases relatively quickly.
|
| (which wasn't always clear to me before since I initially
| predicted that this will take years to work out)
| analyst74 wrote:
| > those spreaders will still soon achieve herd immunity
| among themselves
|
| that's not what herd immunity means, unless we isolate
| those spreaders so they don't get in touch with "non-
| spreaders"
| RandallBrown wrote:
| The non-spreaders are the people who are self isolating.
|
| I think they're saying that people who go out and spread
| the disease will quickly catch it, recover, and be unable
| to catch it and spread it. That relatively small group of
| people who are refusing to self isolate, will gain herd
| immunity, causing the virus to die out in that group of
| people, preventing them from giving it to the non-
| spreaders that have been at home the whole time.
|
| Whether or not it will work out that way, I don't know.
| athrowaway3z wrote:
| What?
|
| All of these numbers are inline with what experts have been
| saying and modeling for more than a month. We will be
| dealing with this for at least another year. We will cycle
| through policy to loosen up and close back down a little.
| In the best case for NYC they are 1/4th of the way to herd
| immunity in numbers. With the drop in transmissions, this
| might be 1/8th of the way in terms of time. There will be
| more deaths in the future than have been recorded so far.
|
| Look for the bright side in things, but zero cases is a
| pipe dream.
| zaroth wrote:
| 25% prevalence is absolutely not in line with what
| experts were saying on March 23rd. Nor was an IFR of
| 0.5%.
|
| The CDC reports that flu has an IFR of ~.13% in the US
| (61,000 deaths out of 45 million cases). That makes 0.5%
| roughly 3.3 times worse, not 10.
|
| Also, herd immunity does not require 100% having positive
| antibodies, it will show an effect on Ro starting around
| 65%.
| hcknwscommenter wrote:
| It's not 25%. 0.5% versus 0.13% is not the only issue
| here in terms of how much worse it is. It's the long time
| in the ICU. The flu kills you fairly quickly or you get
| better fairly quickly, so you don't take up hospital
| capacity so long. Herd "immunity" does not require 100%,
| but that's a decent approximation. Sure, I'll grant that
| it "starts" to show an effect around 65%, but the effect
| is not so strong. 70%, much stronger. 80% very strong.
| Heck, you could probably do containment by then without
| waiting to get to 100%. Because inadvertent spreading
| would be so low.
| newacct583 wrote:
| Herd immunity doesn't mean 100% exposure. It means a high
| enough incidence of antibodies such that the effective R0
| goes lower than one, meaning that new outbreaks tend to
| shrink over time and not grow.
|
| With most endemic viruses, antibody incidence is
| somewhere around 30-50% I believe, but I haven't seen any
| modelling for what covid is expected to do specifically.
| djannzjkzxn wrote:
| While this dynamic may exist in some form, I don't think
| it's a powerful enough affect to stop the spread. There is
| not a firm dichotomy of spreaders vs. isolators and the
| composition probably changes over time, such that the virus
| still has many opportunities to spread to previously-
| isolated groups.
| hcknwscommenter wrote:
| I don't think you are looking at this right. It will still
| take about a year (+/- a few months) for this to run
| through the population of the country. NYC spreads faster
| and was hit harder and earlier. Still only about 1/5 have
| had it. The remaining 4/5 (maybe 3/5 if there is some
| fraction of people that just are naturally
| immune/resistant) are going to get it. It's going to be a
| while to get there.
| wbl wrote:
| Superspreaders aren't connected to each other.
| WrtCdEvrydy wrote:
| Unfortunately, unless you go door to door knocking... you're
| gonna get biased data.
| ineedasername wrote:
| Or truly random sampling that includes appropriate
| proportions of sub groups, e.g, socioeconomic status etc.
| Otherwise you have to know on _all_ of the doors. But it 's
| still a lot: for a 95% confidence level and 2% margin of
| error, for NYC you would need to test about 2,400 people.
| Assuming a response rate of 10%, you need to knock on
| 24,000 doors.
| austingulati wrote:
| Wouldn't the ability to refuse taking the test introduce
| bias? i.e. the 10% that do take it still may not be
| representative of the entire population. Likely better
| than the grocery store sample, but still not ideal
| qqqwerty wrote:
| Yeah, that is still an issue. You can offer compensation
| to incentivize participation. And you can pre-select your
| sample (instead of random door-to-door) and require
| multiple follow ups with the selected persons to reduce
| nonresponse bias.
|
| You can also do a separate phone survey in addition to
| surveying the test participants. Questions like "Do you
| think you have had COVID?" and "How many times per week
| do you leave the house?". If the responses for the test
| participants vary significantly from the phone survey
| participants, you can try and weight your data
| accordingly.
| ineedasername wrote:
| Sure, phone surveys for political purposes (presidential
| approval ratings etc.) have to deal with that all of the
| time. There are methods for estimating non-response
| impact. [0] One method of _mitigating_ it that I 've seen
| it to reach out again to non-responders. You then analyze
| _their_ results to see how they differ from the baseline
| responders to estimate the non-responder population. If
| there 's little/no difference, you can be fairly
| confident the risk of bias is low. It's called non-
| response follow up, and is a pretty common method.
|
| There's also literature that suggests that you don't
| discard outlier values in the actual responders as they
| may help approximate the non-responder population, i.e.,
| the non-outliers represent typical responders while
| outliers are more likely to represent non-responders [1]
|
| [0]https://www.warc.com/content/paywall/article/jar/resea
| rch_no...
|
| [1] https://bmcmedresmethodol.biomedcentral.com/articles/
| 10.1186...
| jonas21 wrote:
| Even with door to door knocking, you're going to introduce
| a bias -- toward people who are around to answer the door,
| which would tend to undersample essential workers.
| AznHisoka wrote:
| Or people who will try to talk to you from their balcony
| rather than answering the door.
| 3fe9a03ccd14ca5 wrote:
| What's weird is that the Stanford study was suggested to have
| _exaggerated_ the results, since those who suspected themselves
| as having the virus at one time were more likely to volunteer
| (allegedly). However, those results were nowhere near as big as
| this (I think like 2%-3% versus the 20%!)
| jdm2212 wrote:
| Roughly 1/1000 New Yorkers have died of coronavirus. At a 1%
| IFR, that suggests at least 10% of the state has gotten the
| virus. Probably more, because deaths are undercounted and
| many people who will die of the virus already have it but
| haven't died yet.
|
| In the Bay Area, almost no one has died of coronavirus so the
| infection rate should be next to nil.
| brandmeyer wrote:
| I was astonished by your 1/1000 figure and had to look it
| up... If anything, its too _low_. 15k deaths
| (proven+probable) in 8M people is almost 2 /1000.
|
| https://www1.nyc.gov/site/doh/covid/covid-19-data.page
| [deleted]
| jdm2212 wrote:
| I was referring to the state -- but, yeah, it's even
| worse in the city :(
|
| and 2/1000 people * 1% IFR => 20%
| chasd00 wrote:
| that's crazy to me, what are the demographics of NYC? Is
| the population more susceptible to dying of Covid19
| somehow? I still can't get my head around why NY has
| suffered so disproportionately.
| saalweachter wrote:
| The most likely answer is that NYC was just a good place
| for it to spread which had plenty of travelers to get
| things started fast, but that that the death rates aren't
| particularly high -- everywhere that has fewer deaths has
| just had less of their population infected ... so far.
| kayoone wrote:
| Germany has about as many cases in total as NY, yet less
| than 1/2 of the deaths. The death rate seems high in NY,
| maybe because hospitals could not cope?
| saalweachter wrote:
| Germany has about as many _diagnosed_ coronavirus cases;
| the difference could be wholly explained by Germany
| testing more people. (Germany has administered 2 million
| tests, New York State [I didn 't see a figure for the
| city], about 700 thousand.)
| WrtCdEvrydy wrote:
| It's a small state with a lot of people packed next to
| each other. Lots of people use public transit... subways
| are less than six feet apart.
| badfrog wrote:
| I don't think that fully explains it. There are plenty of
| European cities of similar density to NYC that haven't
| been hit nearly as hard. Naples Italy, for example.
| nicoburns wrote:
| If the NY subway is anything like London, people will be
| less than 6 inches apart at rush hour. I imagine that
| will have played a big part in the spread in both of
| those cities.
| credit_guy wrote:
| Yes, the subway is the correct answer. That's how this
| virus spread like wildfire in NYC. Second reason could be
| the elevators in the tall buildings (there are plenty of
| those).
| rocha wrote:
| A counter argument is that the same didn't happen (or
| hasn't happened yet) in cities that also have massive
| public transportation systems like Tokyo or Seoul. There
| is probably many confounding factors, such as mask use,
| no talking on the subway, etc, to make pointing to one
| particular factor very hard.
|
| EDIT: typo
| cmurf wrote:
| Those cities see more widespread use of masks generally.
| And specifically once COVID-19 was common knowledge, so
| was the use of masks.
|
| Widespread mask usage doesn't happen in NYC, same as the
| rest of the U.S. It's very recent this is practiced in
| the U.S., whether voluntarily or by order of a handful of
| local governments. And in my local area where it's not
| mandatory I only see about 3 in 4 using masks.
| ummonk wrote:
| And Japan has a culture of talking quietly which greatly
| reduces droplet transmission even beyond the practice of
| wearing masks.
|
| NYC has a culture of yelling.
| nicoburns wrote:
| Do you get yelling on the subway in NYC? Passengers in
| London famously don't even make eye contact.
| rocha wrote:
| Yep, I agree with you. I was trying to make the point
| that massive transportation is not the only factor at
| play. Like you said, there are many others that should be
| considered.
| rocha wrote:
| In my opinion it is more likely that the main cause is
| that the infection got here very early, and that the
| mitigation and containment measures started very late in
| comparison with cities of similar size and density (Seoul
| for example).
| joshfraser wrote:
| population density. you have the density of Asia without
| the propensity to wear masks.
| matwood wrote:
| A dense, mega-city is the worst case scenario for an
| infection to spread.
| badfrog wrote:
| > I still can't get my head around why NY has suffered so
| disproportionately.
|
| Compared to California, NY locked down much later and did
| it in slow, incremental steps.
| core-questions wrote:
| There are many close-knit communities in NYC and the
| surrounding area where people live much more densely
| (i.e. large family in a single house) and congregate more
| often with one another than do West Coast types. Jewish
| communities in New York seem to be especially hit by
| this; not sure if this is because they did not follow
| social distancing guidelines, or if they're not possible
| to follow given unavoidable physical constraints.
| ars wrote:
| > Jewish communities in New York seem to be especially
| hit by this
|
| From my understanding they are not hit any harder than
| other groups, they are just way more visible.
| myth_drannon wrote:
| Yes, if you look at Israel and Montreal, Ultra-Orthodox
| communities were hit very hard. Based on infections
| numbers, not deaths(since it's mostly very young
| population). Lack of communication and distrust of local
| authorities (only praying to G-d will help...)
| rubidium wrote:
| But we already know the actual infection rate is higher in
| NYC than CA. The main point that the antibody tests help
| uncover is death rate.
| bhouston wrote:
| NYC and standord are markably different scenarios. But in
| each case the percentage of baseline infection to deaths is
| similarish, even though the percent compared to total pop is
| quite different.
| zucker42 wrote:
| Nope, the Stanford study had a much lower prediction of the
| infections to deaths ratio, but that's because its analysis
| of the data was just wrong.
| TheBlight wrote:
| What's interesting is if you look at the rest of NY numbers
| (-NYC,LI,Westchester). That has infection at 3.6%. Santa
| Clara was estimated to be 3% and LA county 4%. So it's in
| strong agreement with those areas.
| kgwgk wrote:
| But the number of deaths does not agree.
| TheBlight wrote:
| Can you elaborate?
| kgwgk wrote:
| Percentage of people with antibodies is similar (if you
| take those studies at face value).
|
| Percentage of people dead is not.
| toufka wrote:
| There also appears to be a difference in the strains. The
| NYC strain seems to mostly come from the European branch,
| while the CA infection comes directly from China (and
| likely much earlier in 2020). There appears to be some
| difference in virulence between the strains.
|
| https://www.medrxiv.org/content/10.1101/2020.04.08.200569
| 29v...
|
| and
|
| https://nextstrain.org/ncov/global
| kgwgk wrote:
| I've never looked into that (I know of the hypothesis,
| though) but IFR in South Korea also seems to be around 1%
| (or higher), not 0.1%
| cma wrote:
| Exaggerated in that the California study predicted a flu like
| IFR (Ioannidis, one of the authors, has been pushing that as
| his pet theory for over a month). This shows it is more
| likely several times that.
| glofish wrote:
| it doesn't contradic Ioannidis at all. He might be right in
| the end, and that would be an incredibly bitter pill to
| many.
|
| We are getting closer and closer to the flu fatality rate.
|
| from 5% to 3%, then 1% now 0.5% - smart money (and common
| sense) would bet that the rate will continue to drop,
|
| I would expect that people living in healthier environment
| than NYC will fare even better. No way NYC IFR is the upper
| bound for the rest of the country. You could just as well
| expect it to be 10x higher than other places.
|
| the flu rate is 0.1%, thus we already hit the order of
| magnitude.
| jsnell wrote:
| That's some major revisionism. No credible source was
| ever suggesting a 5% IFR. For example the Imperial model
| was using 0.9% given UK's age distribution. That looks
| likely to be spot on.
|
| And Ioannidis? He was quite certain that the _CFR_ was
| going to be a little higher than 0.1%. Yes. CFR, not IFR.
| So he 's off by _two orders of magnitude_.
| cma wrote:
| At various points in interviews and articles he used
| Diamond Princess, South Korea, Germany, Iceland as strong
| evidence of miniscule fatality rates, in every single
| case selectively ignoring that deaths lag symptoms which
| was already well known at the time. All of them had their
| death rates double or more after he used them, and it was
| easily predictable based on recent exponential growth and
| death lag.
|
| In his stat article he was saying it is conceivable if we
| didn't know about it we wouldn't have been able to even
| detect it in the death numbers after it ran its course
| (he has since walked that back).
|
| Even the other day after his serology preprint he was
| saying it doesn't seem to have a higher chance of killing
| you than seasonal flu for each person infected:
| https://www.youtube.com/watch?v=cwPqmLoZA4s&t=1h9m50s
|
| And he claims the WHO said 3.4% of people who get
| infected would die:
|
| https://www.youtube.com/watch?v=cwPqmLoZA4s&t=12m54s
|
| But they actually said that was the case fatality rate at
| the time. Their actual quote was:
|
| > Globally, about 3.4% of reported COVID-19 cases have
| died
| longtimegoogler wrote:
| His data from the Diamond Princess is completely
| outdated. He cited 7 deaths. We are now up to 13 with 7
| more on critical condition. He has been completely wrong
| in each of his predictions.
|
| I would respect him more if he just argued from am
| economic perspective that the economic damage is greater
| but his wild hypotheses about Covid being comparable to
| the common cold or flu have been completely refuted by
| all data.
| rallison wrote:
| > We are now up to 13 with 7 more on critical condition.
|
| Minor note, but it appears we are up to 14 now - https://
| en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_D...
|
| > Another Japanese man in his 70s died on 14 April,
| making him the fourteenth fatality.
| zucker42 wrote:
| I'm sorry but 0.1%-0.2% directly contradicts 0.6%-0.9%
| (or higher because that doesn't account for the lag
| between infection and death). That's a 3 to 9 times
| higher death rate.
| ferzul wrote:
| 0.1% is the flu cfr. 0.6ish% seems to be the corona ifr.
| these are comparing chalk and cheese. how many people who
| get the flu never rock up to a doctor? the ifr for flu is
| closer to 0.01%.
|
| the worst case scenarios are disproven it is true - but
| so is the idea that it's just a flu.
|
| let us be grateful this trial run of a deadly global
| pandemic was only moderately bad.
| cma wrote:
| .1% is flu IFR but if I remember right the number doesn't
| include true asymptomatics which are estimated at up to
| 75% (which could bring it down to 0.025%). I'm not sure
| on this, that was on a CDC page I saw.
| glofish wrote:
| first you say 0.1% is the CFR for flu then, in the same
| sentence you claim that it is probably closer to 0.01%
| because people don't go to doctors with the flu.
|
| Are you arguing that after all this time we still don't
| know what the actual CFR for flu is? And that the
| reported CFR is a gross overestimation? - I find that
| hard to believe.
|
| To me, this feels that once this disease hits the
| reported flu numbers people start arguing that oh wait,
| the flu is actually even less dangerous ...
| jsnell wrote:
| Oh, wait. You don't understand that the CFR and IFR are
| not the same thing? That explains a lot. I thought you
| were just being disingenous when comparing the early CFR
| statistics to the current IFR estimates.
|
| The CFR is, by definition, computed from known cases.
| It's thus trivial to determine exactly: just divide the
| confirmed deaths by confirmed cases. So we definitely
| know the CFR of flu. The problem is, of coures, that it's
| highly likely to be an over-estimate.
|
| On the other hand, the IFR is hard to determine, since we
| don't know which cases we missed, nor whether the
| unresolved cases will end up living or dying. Which is
| why all we have is estimates.
| jdm2212 wrote:
| NYC is a younger, healthier city than the national
| average. NYC also has one of the best medical systems not
| just in America, but in the world.
|
| Roughly 0.2% of everyone in NYC has already died of
| COVID-19. So 0.2% is pretty close to a hard lower bound
| on the IFR for COVID-19.
|
| And I don't think anyone serious suggests every NYC
| resident has had COVID. I don't think anyone seriously
| suggests even half of NYC has had COVID.
| glofish wrote:
| All I am saying people there breath the NYC air every
| single day. Can't possibly be good for them, especially
| in the light of some chronic pulmonary inflammation
| induced deaths.
|
| The point on the lower bound of 0.2% is informative. I
| did not know that.
| timr wrote:
| That lower-bound argument is overly simplistic.
|
| There are huge error bars on that ratio, because "the
| population of NYC" is not something easily defined, and
| the death count (at this time) includes a lot of "excess
| deaths" that almost certainly have nothing to do with the
| virus (e.g. untreated cardiac arrest).
| taeric wrote:
| That it's a lower bound for IFR in NYC. With how widely
| that changes based on age alone, it could also vary based
| on location. Such that NYC could conceivably have the
| highest value for that in the US.
| jdm2212 wrote:
| NYC is younger and healthier than the US average so these
| are lower bounds for national average outcomes.
| taeric wrote:
| A datum that is hard to square when the deaths are still
| dominated by the older population. If you had convinced
| everyone over seventy to move out of NYC last year, their
| CFR would be a fraction of what it is now.
| kgwgk wrote:
| So the IFR will be lower in the rest of the country than
| in NYC because... they are going to send everyone over
| seventy to the Moon or something?
| taeric wrote:
| No. I was not claiming it would be lower. Apologies if
| the framing said it that way. I was just pointing out
| that we really don't have bounds on this anywhere else.
| cycrutchfield wrote:
| NYC is on average younger than the broader US population.
| taeric wrote:
| And the deaths are concentrated on the older population.
| They do have younger people. They also have more nursing
| homes and assisted care. They literally have more of
| everything.
| cma wrote:
| We're looking at per capita rates though so doesn't
| matter if they have more of something in absolute terms.
| taeric wrote:
| Could. If the agitating factor to severe cases is car
| exhaust, as an example. There are usually tipping points
| to that kind of thing.
|
| Look, I agree that I don't know. Just trying to get that
| uncertainty in the counter claims, as well.
| cma wrote:
| I'm talking about having more number of nursing homes
| because they have "more of everything", not making an
| argument about density and pollution or anything like
| that.
| cma wrote:
| 3.4% was never stated to be anything but the case
| fatality rate. The WHO's statement was:
|
| >Globally, about 3.4% of reported COVID-19 cases have
| died
|
| Ioannidis acknowledged that in his original STAT article:
|
| >Reported case fatality rates, like the official 3.4%
| rate from the World Health Organization, cause horror --
| and are meaningless.
|
| Maybe because he had an editor. But I saw him in a recent
| video claim the WHO said 3.4% of people who _get
| infected_ would die. A blatant lie:
|
| https://www.youtube.com/watch?v=cwPqmLoZA4s&t=12m54s
| ineedasername wrote:
| I couldn't find any detailed write up about their selection
| methods for participants, only the basics of where they found
| them. Without that, it is very hard to determine whether or not
| there's some flavor of selection bias: If it is voluntary, and
| they do not screen out people who report having had cold/flu
| symptoms, then they run the risk of attracting a
| disproportionate number of people who volunteer because they're
| curious if their prior symptoms were actually coronavirus. That
| would make it far from a random sample. The fact that they
| sampled only people actually leaving their house is also a form
| of selection bias: these are the people more likely to be
| exposed and may represent a disproportionately high infection
| rate as well. So I await further information.
|
| That said, even if it's overall 0.6%, that is still 6x higher
| than flu, and higher than H1N1 which had a CFR around 0.1 for
| areas with adequate health care. (much higher when there was
| not adequate care, but that is not dissimilar to Covid.)
|
| So no matter what, no one should be walking away from this
| study saying "See it's no big deal! Just the Flu/Cold etc!"
| CodeWriter23 wrote:
| I argue there is inherently less sampling bias in this study
| than testing people at the hospital who have shown up due to
| severe symptoms.
| ineedasername wrote:
| Those are the people who constitute the denominator for the
| CFR. It's a completely different metric. You would never
| try to impute population exposure from such cases. This
| study is trying to to impute population exposure. There
| isn't any comparison between the two in terms of which has
| more/less selection bias, they are completely different
| things.
| CodeWriter23 wrote:
| Didn't stop the news media from tabulating a death rate
| based on hospital cases alone.
| ferzul wrote:
| 0.6% this is the estimated ifr. comparing it to the cfr of
| flu is not right, which is about ten times less than the flu
| ifr - or about 60 times less than this figure. your
| conclusion is upheld, but even moreso
| zaroth wrote:
| According to the CDC, the estimated prevalence of
| symptomatic flu last year was 45 million illnesses and
| 61,000 deaths.
|
| For NY, assuming it's evenly distributed, that would
| translate into 13.8% of 20 million = 2.8m symptomatic flu
| cases and 3,753 deaths.
|
| COVID appears to be _significantly_ more prevalent (roughly
| twice as prevalent in just 3 months as flu gets all year
| despite incredible efforts), and roughly 2-3x as fatal.
| hcknwscommenter wrote:
| I think you need to rethink essentially all of your
| assumptions/math. COVID is not more prevalent than the
| flu and certainly more than slightly more fatal.
| zaroth wrote:
| 20% infection rates already puts SARS-CoV-2 at higher
| prevalence than the flu. And we're barely a couple months
| into the time period of significant spread.
|
| Why would you think that SARS-CoV-2 would not be more
| prevalent than the flu? The fact that we have no natural
| immunity, combined with how virulent it is, indicates the
| endpoint infection rate will be significantly higher than
| an average flu season.
|
| "In the U.S., for example, in recent years about 8.3% of
| the total population get sick from flu each season, a CDC
| study found; including people who carry the flu virus but
| show no symptoms, that estimate ranges to up to 20%."
|
| The endpoint percentage of fatalities is a multiple of
| the infection rate times the fatality rate. Both numbers
| are equally important.
|
| We've been hearing the "10% hospitalization" and low-
| single digit CFR numbers for months. At 20% prevalence,
| the NYC actually had 1.7 million cases, 36,723
| hospitalizations, for a hospitalization rate of ~2.1%.
| vannevar wrote:
| According to the CDC web site, those numbers are 35.5M
| flu cases and 34,200 deaths
| (https://www.cdc.gov/flu/about/burden/2018-2019.html),
| giving an IFR of more like 0.1%. Which would put COVID-19
| at more like 5-6x more fatal than the flu. Combine that
| with the virtually complete lack of natural and
| vaccinated resistance compared to the flu, and it's clear
| that the potential fatality totals for COVID-19, absent
| drastic action, would be much, much higher than for the
| seasonal flu.
| zaroth wrote:
| It seems the CDC has different data depending on where
| you look. The 45 million / 61,000 numbers are here, for
| the 2017-2018 season, see Figure 2:
|
| https://www.cdc.gov/flu/about/burden/index.html
|
| And on the page specifically for 2017-2018 season, they
| have different numbers still;
|
| "CDC early estimates indicate that more than 900,000
| people were hospitalized and more than 80,000 people died
| from flu last season."
|
| https://www.cdc.gov/flu/spotlights/press-
| conference-2018-19....
|
| I agree 100% it will be significantly more prevalent, due
| to the nature of the virus combined with the total lack
| of natural or vaccinated immunity.
|
| However, it's not clear at all what our "drastic action"
| is achieving, aside from 20 million unemployed and
| trillions of dollars spent trying to hold everything
| together. 20% prevalence doesn't exactly speak volumes
| towards the efficacy of social distancing.
| Retric wrote:
| That 45 million in your first link is Symptomatic
| Illnesses which represent ~2/3 of total cases as
| _Approximately 33% of people with influenza are
| asymptomatic_. https://en.wikipedia.org/wiki/Influenza
| So, total infections would be closer to 67.5 million.
|
| But, it's important to keep things in context, another
| year lists 9.3 million symptomatic infections and 12,000
| deaths. The average year is well below peak years.
| Retric wrote:
| Flu is generally well under 0.1% of those infected on
| average. If you're comparing them you want to either include
| or exclude asymptotic people from both populations.
| "Symptomatic Illnesses"
| https://www.cdc.gov/flu/about/burden/index.html
|
| As to NYC deaths, many people currently infected will die in
| the future. You can make various estimates to account for
| this but a reasonable first approximation is to double
| current deaths based on NYC's infection curve vs South
| Korea's.
| greendave wrote:
| As an asymptotic* person, I resent your hyperbola.
|
| (Sorry, couldn't resist).
| ineedasername wrote:
| Flu rates are based on all known knowledge, population
| testing, etc. We don't have that for covid-19. If you want
| a good apple-to-apples comparison of lethality of another
| pandemic, you need to find CFR numbers that were available
| _during_ the pandemic. That is what I provided in my post.
| Here is the source I got them from [0] which gives the CFR
| at the 10-week mark for H1N1, somewhat similar to where we
| are now. Here 's the relevant quote:
|
| > _" The overall case fatality rate as of 16 July 2009 (10
| weeks after the first international alert) with pandemic
| H1N1 influenza varied from 0.1% to 5.1% depending on the
| country."_
|
| [0] https://www.cebm.net/covid-19/global-covid-19-case-
| fatality-...
| godelski wrote:
| Why does recruiting through Facebook invalidate the results? If
| it is a representative sample it is a representative sample
| regardless of how people were recruited.
| dragonwriter wrote:
| > Why does recruiting through Facebook invalidate the
| results? If
|
| Because "people who both use Facebook and don't automatically
| discount every ad or other solicitation on Facebook not from
| someone they personally know, especially if it invokes a
| major news story, because of the risk of it being a scam
| looking to steal personal information or do something
| similarly nefarious" are not representative of "people".
| godelski wrote:
| If a representative portion of the population didn't click
| on Facebook ads then Facebook wouldn't generate revenue
| from these ads. Testing doesn't rely on the person being
| intelligent either. Because it sounds like you're just
| saying "results are bad because only idiots would click on
| a Facebook ad".
| zucker42 wrote:
| The Facebook ad essentially said "get tested for COVID-19
| here", so very plausibly infected people could be more likely
| to respond.
| alteria wrote:
| One critique was that the segment of the population who would
| respond to the ad and actually test may be more likely to
| have experienced COVID-like symptoms.
| chockablock wrote:
| Also people reported sharing the Santa Clara link with
| others who might want the test (due to having had
| symptoms). In principle you could have the same problem
| with this survey: call your buddy and say "come on down to
| Costco--they're doing free antibody tests".
|
| The obvious fix is to not tell people the results of their
| own tests. Not sure of the ethics/consequences of that
| approach.
| [deleted]
| dchichkov wrote:
| What is the percentage of people with innate immunity to
| COVID-19?
| smartmic wrote:
| What I learned from an article of a major German newspaper is
| that in order to really estimate the quality of testing, two
| criteria are important: sensitivity and specifity of the
| applied test.
|
| If the real infection rate is still low throughout the
| population, a random sampling will not lead to reliable results
| (you could also toss a coin).
|
| Although the article is in German, it is worth to have a look
| on the graphic in the middle of the page, it should be
| understandable.
|
| https://www.sueddeutsche.de/gesundheit/corona-test-antikoerp...
| sjg007 wrote:
| Is this antibody test specific for covid-19 or would it be
| positive on other coronaviruses? That's a real concern since the
| other 4 coronaviruses are endemic.
| ummonk wrote:
| 0.2% of people in NYC has died from Covid-19, so this is exactly
| what we would expect.
| TechBro8615 wrote:
| So, at what point can we declare the lockdown to be a harmful
| overreaction and start opening countries up? Will we hold anyone
| accountable for models which proved to be pessimistic by orders
| of magnitude, causing implosion of economies around the world?
| sacred_numbers wrote:
| I think,if anything, that this new data validates the lockdown.
| New York City has been hit hard by this virus (0.2% of the
| population; for comparison 0.3% of the US population died in
| WW2) and there are still approximately 80% of the population
| that hasn't gotten it yet. If 70% of the population of NYC ends
| up getting it over the next few months, that would mean
| something like 50k to 60k dead just in NYC. If 70% of the US
| population ends up getting it that would be 1-2 million dead.
| Locking down in the face of those numbers is not an
| overreaction, although maintaining lockdown until a vaccine may
| be an overreaction. I think we should be devoting huge amounts
| of resources to manufacturing face masks and testing kits so
| that we can safely ease out of lockdown without causing more
| outbreaks like we saw in New York or Italy. Ending the lockdown
| without a plan, though, is highly unethical in my opinion
| [deleted]
| esoterica wrote:
| 0.18% of the entire NYC population is already dead from the
| coronavirus and by the time this is over the number will
| probably reach or exceed 0.3%.
|
| If you want the whole country to get herd immunity you will
| probably see similar mortality rates across the country. 0.3%
| of the US population is 1 million people. How have the models
| been proven to be "pessimistic by orders of magnitude?
| cdash wrote:
| Just so you know, around 3 million people die in the US every
| year, many of the million people you expect to die would have
| ended up being counted in that 3 million background
| statistic.
|
| More importantly, herd immunity is the ONLY solution on the
| table right now, the lockdown is not about stopping the virus
| in its tracks. It is about spreading it out over a period of
| time.
| esoterica wrote:
| >the lockdown is not about stopping the virus in its
| tracks. It is about spreading it out over a period of time.
|
| It's unclear what the lockdown is about at all since the
| government messaging has been incoherent. Many countries
| have (so far) succesfully contained the virus without herd
| immunity through contact tracing, and the US government has
| been making vague comments about pursuing something along
| those lines despite not doing anything to increase testing
| volumes to the levels necessary for contact tracing.
| usaar333 wrote:
| Depends where you are. The Bay Area is contact tracing
| every case and as a result is at a really low new case
| count (Santa Clara County is at 11 per million/day over
| the last week, significantly lower than successful
| country's peaks (NZ/SK), while still having tighter
| restrictions.
| outworlder wrote:
| Sure, let's ignore the hospitals getting overloaded.
| bbarn wrote:
| At the point where more deaths are caused by the global socio-
| economic collapse than COVID-19 would have caused at even
| pessimistic projections.
|
| At this point, I'm not convinced in either direction.
| luckydata wrote:
| you're getting the wrong message from all of this.
| thehappypm wrote:
| This data might suggest that the lockdowns suppressed the
| infection rate down to 20% at this moment in time.
|
| Without a lockdown, a month more of infections would have
| likely bumped NYC to achieving herd immunity, or 60-ish
| percent, since 20% to 60% does not take long with exponential
| growth.
|
| This means two things. One, it would mean that we would have
| almost certainly overwhelmed the hospitals with triple the rate
| of infections. We've be leaving people dead in the streets and
| it would be a humanitarian disaster as every hospital was at
| double capacity.
|
| It would also have meant that the curve would be flattened for
| good.
| joe_maley wrote:
| >It would also have meant that the curve would be flattened
| for good.
|
| I have yet to see any evidence that covid antibodies provide
| long-term immunity. We can't say with any certainty that the
| curve would be permanently flattened. It may just be
| flattened for a few weeks, a few months, or a few years.
| amalter wrote:
| That the 0.5% death rate in NYC is not higher is _because_ of
| the pause. We saw the death rates spike at the peak of the
| curve. We saw the hospitals near total collapse. We even have
| an example of what would happen if we didn't flatten the curve
| (Northern Italy). We have another counterexample of California
| that shows NY's pause was late.
|
| I guess Sweden is the counter-counter example. I think the US
| would have needed to have built out a far different medical
| system to achieve what they have.
|
| For a few days at the end of March and beginning of April, the
| hospitals came so, so close to collapsing. Just a few more days
| up the curve and we would have run out of beds. (In reality, we
| did run out of beds, as you can see stories of many turned away
| from hospitals in those dark days, but it wasn't quite a
| systematic collapse).
|
| All of this happened, we were here to record it. Models are
| models, and we're in the early days of a deadly, virulent,
| confusing pandemic. But there is no doubt that our reactions
| and solidarity saved lives. The imperfect models helped us get
| there.
|
| Now, there is a more reasonable question of where do we go from
| here. For urban metropolis like NYC, I think a slow re-open
| like Germany. We slightly open the spigit so that 20% becomes
| 40% becomes 60% (and hopefully immunity is _immunity_ ) and we
| achieve herd protection (at great cost).
|
| And likely the less dense, the slower we'll need to go
| (depending on hospital saturation).
|
| I certainly will cheer the scientists who took the best
| information they had at the time and worked with the leaders to
| make the best decisions they could. Yes, I will indeed hold
| them "accountable".
| chasd00 wrote:
| has anyone modeled at one point deaths from economic collapse
| overtake deaths from Covid19?
| bbarn wrote:
| That was the first thing I said, 2 months ago, and got told I
| was a selfish asshole and had no clue what I'm talking about.
| This is going to be a real big history lesson for our
| grandchildren on how not to handle a situation in one way or
| another, unless the media rewrites the narrative.
|
| Oh, wait.
| robocat wrote:
| I would be very sceptical about any models produced in the
| US, since the issue is so partisan, and one can tweak
| variables to prove whatever outcome one wants from a model.
|
| I think the lost life-years of economic hardship could easily
| outweigh the lost life-years of Covid deaths. That is because
| economic hardship affects younger people, while Covid deaths
| primarily affect people with not many years left to live. But
| there are many other external costs (social costs if your
| grandma dies) and economic benefits to deaths (lower pension
| payments, home availability?).
|
| However, given current information, a lockdown for weeks to
| months seems to make sense, since the consensus is that
| economic collapse is not yet immanent, and that steps can be
| taken to help keep the economy spinning when lockdown
| restrictions start to be relaxed.
| watwut wrote:
| Economic hardship affects middle aged and old people too.
| cryptonector wrote:
| At 21% it would be time to end the shutdown.
|
| EDIT: Read the comments below.
| SketchySeaBeast wrote:
| I'd think it'd be decided based upon the new cases and
| hospitalization and death rates, not an estimate of population
| with exposure.
| cryptonector wrote:
| Sorry, but that's dumb. If 1/5th of the population has been
| exposed, then you know the total strain on the healthcare
| system is extremely unlikely to top an additional 4x what it
| has been, but not only it has 1/5th the population being
| exposed not in fact been enough to overwhelm the healthcare
| system, as more of the population is exposed you begin to get
| herd immunity, so in fact the total strain on the healthcare
| system is extremely unlikely to reach a total of 5x what it
| has been, very likely not even half that.
|
| Give all of that, it makes no sense to continue the shutdown
| considering how costly the shutdown is.
|
| To those who think this is a question of saving lives, that's
| not so. At this point the disease _will_ work its way through
| the population because there 's no time to finish testing,
| producing, and distributing a vaccine, which means the only
| question is of managing the maximum load on the healthcare
| system. Moreover, many of the most vulnerable have been hit
| already, and those who haven't can be protected by measures
| far short of a shutdown.
|
| No, at 21% it is most definitely time to stop the shutdown.
| (Note: not all the measures, just the shutdown.)
| SketchySeaBeast wrote:
| We don't know that actually 21% have been exposed - hence
| the use of "preliminary" and "suggest". We need actual
| positive results that aren't based upon hiding behind the
| repeated use of "extremely unlikely". It seems like a bad
| idea to gamble based upon an initial suggestion.
|
| The only actual good indicator we have is the rate of
| change of deaths and hospitalizations.
| zucker42 wrote:
| That doesn't make sense to me. I would think you'd want to get
| to the point where you've reached the carrying capacity, so
| that "overshoot" of the equilibrium doesn't result.
| cryptonector wrote:
| See my other reply below. You can't overshoot 100%, and long
| before we get there herd immunity takes hold, and there's no
| question of the disease being kept from working its way
| through -- only a question of managing the rate at which it
| does. All in all the economic damage of continued shutdown
| does not make sense at this point (at 21% of the population
| exposed). We should stop now.
| zucker42 wrote:
| Your comment doesn't address my point. See this Twitter
| thread,
| https://twitter.com/CT_Bergstrom/status/1251999295231819778
|
| specifically this comment:
|
| https://twitter.com/CT_Bergstrom/status/1252008040376614912
|
| for a good illustration of what I'm talking about. Keeping
| the rate of transmission low through the peak can
| definitely save lives.
| ineedasername wrote:
| I couldn't find any detailed write up about their selection
| methods for participants, only the basics of where they found
| them. Without that, it is very hard to determine whether or not
| there's some flavor of selection bias: If it is voluntary, and
| they do not screen out people who report having had cold/flu
| symptoms, then they run the risk of attracting a disproportionate
| number of people who volunteer because they're curious if their
| prior symptoms were actually coronavirus. That would make it far
| from a random sample. The fact that they sampled only people
| actually leaving their house is also a form of selection bias:
| these are the people more likely to be exposed and may represent
| a disproportionately high infection rate as well.
|
| So I await further information.
|
| That said, even if it's overall 0.6%, that is still 6x higher
| than flu, and higher than H1N1 which had a CFR around 0.1 for
| areas with adequate health care. (much higher when there was not
| adequate care, but that is not dissimilar to Covid.)
|
| So no matter what, no one should be walking away from this study
| saying "See it's no big deal! Just the Flu/Cold etc!"
| SketchySeaBeast wrote:
| Do you have a source for the CFR of 0.1 for H1N1? I could only
| find this[1], which is a much smaller number.
|
| [1] http://news.bbc.co.uk/2/hi/health/8406723.stm
| ineedasername wrote:
| You may be looking at "settled" numbers when all was said &
| done and all facts were known. That's not an "apples to
| apples" comparison with current covid-19 knowledge.
|
| Here's my source [0] and the relevant quote, below. It is the
| CFR _during_ the H1N1 pandemic, 10 weeks into it, which is
| why it is a much more appropriate (though not perfect)
| "apples to apples" comparison with Covid-19:
|
| > _" The overall case fatality rate as of 16 July 2009 (10
| weeks after the first international alert) with pandemic H1N1
| influenza varied from 0.1% to 5.1% depending on the
| country."_
|
| [0] https://www.cebm.net/covid-19/global-covid-19-case-
| fatality-...
| cm2187 wrote:
| Another datapoint suggesting the death rate of this virus is
| within 0.5%.
| vkou wrote:
| 15,000 deaths (So far) in NYC. 8.4 million people. If 20% of
| the population has had it, the death rate is 1%... Assuming
| that none of the currently infected die. Which is an
| unreasonable assumption (As the mean time to death from the
| point of infection seems to be ~2 weeks, and infections have
| doubled over the past 2 weeks.)
| kgwgk wrote:
| But those currently infected are not included in the 20% of
| the population that has had it. Or maybe some are, but most
| of those infected now who may still die, do not have
| antibodies yet.
| Exmoor wrote:
| Also another data point suggesting that the virus is much more
| contagious than the early estimates said.
|
| I personally don't see how the test, track and trace efforts
| that have been touted as the only way to open things up can
| work with a virus with these characteristics. You would need to
| test a huge percentage of the population each day with quick
| results tests and something like that is many months away from
| being possible assuming it ever would be possible.
| GVIrish wrote:
| The key is testing, contract tracing, and quarantining when
| the number of cases is small. That's what South Korea, New
| Zealand, and a few other countries did and they've all
| suffered relatively few fatalities. You still need a massive
| amount of tests to contain an outbreak, but the upside is
| that if you contain it early you don't need toe enact clumsy
| and broad measures like lockdowns.
| istorical wrote:
| More contagious OR began community spread and became endemic
| much earlier.
|
| r0 is part of the formula for total infected at X/Y/Z date
| but so is date of initial infection and size of initial
| infected population.
| daxfohl wrote:
| I agree. But it seems to have worked in Korea. The math
| doesn't seem to reconcile somehow. Actually probably the
| prevalence of masks explains the difference.
| taeric wrote:
| The math seems to point more to there being another factor
| to what makes it severe, in my eye.
|
| Going by the news we have seen, elementary schools could
| have 80%+ infection rates and fewer deaths that NY has
| seen. Similarly, are there other factors besides age? (Age
| feels way more like a proxy.)
| grumple wrote:
| The death rate would go up if more people had the virus at
| once, which is the entire reasoning behind isolating.
| gridlockd wrote:
| I am wondering that number, if the limiting factor is
| ventilators, but the CFR of people on a ventilator is close
| to 90% either way.
|
| Other cases may just need oxygen supplementation, which is
| more manageable.
|
| It is pretty clear now that Germany is not that far from from
| Italy in terms of CFR when controlled for age.
| Spooks wrote:
| I wonder if we did these preliminary tests with the flu if we
| would see a large death rate drop for influenza as well
| nullc wrote:
| The US's influenza mortality figures are a combined influenza
| and pneumonia figure because they usually don't even bother
| actually screening for influenza.
|
| Research attempting to determine how much of that figure is
| infected with influenza have found figures like 1/3rd (though
| with large differences year to year).
| gok wrote:
| ...when people are able to get treatment.
| lukasm wrote:
| Yes, but the age is a 10x factor, os CFR would be much
| different in Nigeria (average age is about 19) and Italy
| (average age 45). We have two good petri dishes:
|
| USS Theodore Roosevelt - 600 cases out of 4800. 5 sick, one
| dead (41 years old). which means hospitalisation is at 0.83%
| and CFR is 0.016% (1% dead or in hospital). Not idea what is
| the average age, probably around 30-35.
|
| Diamond Princess: 700 of 3711. CFR 1.1%, average age around 50.
|
| What worries me the most though is potential mutations and
| death rates when you are infected with Covid-19 and flu at the
| same time (or other pathogens).
|
| https://www.reuters.com/article/us-health-coronavirus-usa-mi...
|
| https://www.nature.com/articles/d41586-020-00885-w?utm_sourc...
| rallison wrote:
| > which means hospitalisation is at 0.83% and CFR is 0.016%
| (1% dead or in hospital).
|
| 0.16%, not 0.016%.
| rckoepke wrote:
| Average age on an aircraft carrier appears to be 19 [0], 20
| [1], and/or 24 [2] years old.
|
| 0: https://www.nytimes.com/2008/04/20/arts/television/20jens.
| ht...
|
| 1: https://archive.defense.gov/news/newsarticle.aspx?id=15334
|
| 2: https://mashable.com/2016/06/23/what-its-really-like-to-
| live...
| cozzyd wrote:
| I had the opposite conclusion. There are between 10k-15k
| COVID-19 associated deaths in NYC, depending on how you count
| (the higher rate is consistent with the excess-mortality data,
| I believe). That by itself produces a range of ~0.56%-0.86% if
| you assume 21.2 % of NYC has been infected (larger range if you
| allow for some error on the infection rate, obviously).
| Moreover, we don't know what fraction of the currently-infected
| who will die have already died. A reasonable guess might be
| 50%, which would mean that the fatality rate for NYC is
| somewhere between 1.1 and 1.7%.
|
| Either way, based on NYC, 0.5% might be a hard lower bound on
| the all-population fatality rate (of course, maybe NYC is not a
| representative sample for some reason)
| cm2187 wrote:
| 0.5% comes from Cuomo's presentation [1].
|
| Also your 50% seems very high to me. My understanding is that
| 50% is about the death rate of covid patients requiring
| ventilation, so the overall death rate of people hospitalised
| for covid must be well below that.
|
| Also if you factor this timing impact, you have the same
| timing impact on the denominator, i.e. people who are
| infected but haven't developped antibodies yet.
|
| [1] https://youtu.be/TisDYYWJgBA?t=967
|
| [edit] in fact for the 50%, we have an idea from Cuomo's
| presentation charts. The gross daily hostpitalisation rate as
| of 10-15 days ago was about 2000-2500 per day, and the number
| of death now is about 500 per day, so that suggests roughly a
| 20-25% death rate for hospitalised people (I am sure there
| must be some more precise figures somewhere).
| cozzyd wrote:
| 50% is not the death rate, but the fraction of those who
| are an infected and have died to those who are infected and
| who will have died (since there is some lag between
| infection and death).
| lucretian wrote:
| no, the death rate for ventilated covid patients is
| something like 80-90%. this is based on a NYC study
| published yesterday.
| lukeinkster wrote:
| The death rate of those requiring ventilation in NYC is
| closer to 88%
| https://jamanetwork.com/journals/jama/fullarticle/2765184
| tricolon wrote:
| Outside the context of this virus, for adult men, the
| survival rate one year after mechanical ventilation might
| be 30 percent:
| https://www.ncbi.nlm.nih.gov/pubmed/8404197/
| grandmczeb wrote:
| It's not clear what kind of antibodies they're testing for,
| but it can take up to 4 weeks after infection to develop
| detectable levels of antibodies. It takes on average ~3 weeks
| after infection to die. There needs to be some time lag
| adjustment in your calculation, which would likely result in
| a lower IFR.
|
| IMO the two effects probably about cancel each other out and
| we're looking at <1% IFR for the population tested (AFAIK
| children weren't included).
| cozzyd wrote:
| I guess I would assume they would have corrected for any
| time-lag in the result, but I have not read the study in
| detail
| grandmczeb wrote:
| Right now it's just a press release so there's not much
| to read. Cuomo's statement reads to me that is just
| demographically adjusted though.
| rubidium wrote:
| " Moreover, we don't know what fraction of the currently-
| infected who will die have already died. A reasonable guess
| might be 50%" I lost you at reasonable guess. Why not ~1%?
| vkou wrote:
| If the mean time between infection and death is 2 weeks
| (Mostly true), and the virus has doubled every two weeks
| (True in NYC), then assuming that not a single new
| infection takes place starting today (Obviously not true,
| but this is a hypothetical), then in two weeks, you would
| expect to have twice the deaths that you do right now.
| cozzyd wrote:
| 1% would imply an unrealistically high-fatality rate, so
| that can't be right.
| zucker42 wrote:
| The virus takes time (2-3 weeks) to kill people, and the
| prevalence was presumably measured within the last week.
|
| Therefore, we have to take out the cases that occurred in
| the last week or two. I would suspect that 50% is on the
| upper end of how much the death lag could skew the results,
| but 20-50% doesn't seem unreasonable.
| Avamander wrote:
| Mortality rate, case fatality rate and infection fatality rates
| are all different things and have different values.
|
| Infection fatality rate of the virus could be within 0.5%
| (because its the one that tries to take into account everyone
| who has been infected), mortality rate is very likely still the
| one WHO has published and the third, case fatality rate is ~38%
| in the US.
| rimliu wrote:
| What? 38 out of 100 infected in US die?
| saalweachter wrote:
| Infection fatality rate, the big number everyone is trying
| to figure out, best guess is somewhere around 1% right now,
| with a confidence interval of something like 0.3%-2.5%
|
| Case fatality rate, calculated as "number of deaths" /
| "number of known cases", usually something like 10% in most
| countries, although occasionally much lower or higher for
| the odd country that has really good or really bad testing.
|
| Resolved case fatality rate, calculated as "number of
| deaths" / "number of recoveries + number of deaths", which
| has been around 40% in the countries that have been hit
| hardest for the duration of their outbreaks. Tends to go
| down after the curve is bent, because it takes people
| longer to recover than die in most of these cases.
| 3fe9a03ccd14ca5 wrote:
| At what point have we scientifically reached "herd immunity"? Is
| it 50%, 90%, 99%?
| disillusioned wrote:
| The percentage scales with the R0 of the virus. The more
| infectious the disease, the higher the percentage of infected
| people for herd immunity to take shape and effectively push the
| Rt/R0 < 1.
| [deleted]
| caiobegotti wrote:
| https://en.wikipedia.org/wiki/Herd_immunity#Mechanics
| SpicyLemonZest wrote:
| Although it should be noted that incomplete herd immunity
| will still help, by reducing the number of other containment
| measures which must be taken.
| [deleted]
| grey-area wrote:
| More like 50-80%, you just need spread to be impeded so that r
| falls below 1, but for that many people to get it would mean
| very high deaths, in the US 1% of 80% of 320m is > 2m deaths.
| nullc wrote:
| Keep in mind that if 21% of NYC residence have been infected
| this probably implies R0 in that population was higher than
| in most prior estimates of R0, which increases the threshold
| of immune people before R0 falls below 1.
| votepaunchy wrote:
| It also implies that the R0 of the already-infected
| population is higher than that of the not-yet-affected
| population.
| robocat wrote:
| R0 varies hugely. The R0 for highly connected people
| meeting others regularly, will be far higher than the R0
| for people who only leave the house once a week. The R0
| in a crowded prison will be far higher than the R0 of
| rural farm owners.
| buboard wrote:
| i think people misunderstand what herd immunity is. If NYC has
| 80% infection rate, then people within NYC can assume immunity.
| People outside NYC having 5% are still vulnerable
| jaynetics wrote:
| 60-85%
|
| 1-1/R0
|
| Most commonly the R0 of is assumed to be 2.5-3.0, but estimates
| range up to 6.5.
|
| https://academic.oup.com/jtm/article/27/2/taaa021/5735319
| [deleted]
| pkaye wrote:
| Probably in the 80-90% range depending on the reproduction
| number. It would be 1-1/R0 from my understanding.
| colinmegill wrote:
| Garbage news source
| ccleve wrote:
| The Governor's press conference was covered by the major media.
| The slides are there, also.
| CubsFan1060 wrote:
| The slides contained in it were shared by the governor. Though
| maybe you're calling him a garbage news source.
| lettergram wrote:
| I've continuously questioned the antibody tests...
|
| My understanding (from NBC news) was that at least some of the
| antibody tests were derived from a couple who were on the princes
| cruise. They never showed symptoms, but tested positive. IMO it's
| quite possible that they never had it and those tests were
| inaccurate (right at the start of the outbreak, no symptoms,
| etc).
|
| Further, these antibody tests likely weren't fully vetted nor
| were the samples they derived it from. For instance how often
| does another coronavirus set off this antibody test?
|
| Personally, I'm just waiting to see. I actually do suspect 20%
| have been infected, so it fits my expectations, but that's not
| validation.
| JamesBarney wrote:
| > The reason the tests were randomly taken from those at grocery
| and big-box stores is that these were people not isolating in
| their homes and presumably not at work and therefore not
| essential workers.
| chrisseaton wrote:
| I don't understand - essential workers still going to work also
| have to eat, and so go to grocery shops like other people.
| istorical wrote:
| The sampling location isn't meant to exclude essential
| workers, it's meant to avoid only sampling essential workers.
|
| IE: if you measured at workplaces that would capture only
| essential workers, if you measure at people's homes during
| work hours, you get people who mostly are quarantining, if
| you measure at a grocery, you might get a mix of both, etc.
| chrisseaton wrote:
| > isn't meant to exclude essential workers
|
| But is specifically says
|
| > and therefore not essential workers
|
| It doesn't say 'not only' - it says 'not'.
| tree3 wrote:
| > presumably not at work and therefore not essential
| workers.
|
| "presumably" is the key word. They aren't saying
| "definitely".
| cm2187 wrote:
| I don't know what to make of that. I would expect people at
| work to have higher infection rate (not the least because many
| of these jobs involve contact with the population). It also
| filters out older and sick people. So intuitively I would
| expect to undershoot the actual rate.
| CubsFan1060 wrote:
| I read it as people shopping, not people that work there. So
| folks who are out-and-about, but are not in the more likely
| to have it groups (healthcare workers or people working at
| the grocery store). You're right about older and sick people.
| cm2187 wrote:
| No that's what I meant. People shopping and therefore not
| at work. Therefore intuitively I would expect the
| population tested to be less contaminated than the
| population not tested (because at work).
| [deleted]
| watwut wrote:
| People who work also shop. People who work in stores also
| shop in stores. At that time, they could be randomly
| tested like non-workers.
|
| So workers are not excluded from study.
| rubidium wrote:
| I'm an essential worker going to the grocery at 10am because
| there's less people there. My hours are flexible at work and
| we're set up to do staggered shifts to minimize number of
| people in the building.
| [deleted]
| vkou wrote:
| If this study is accurate, and is not just working on garbage
| data, and if these antibodies actually mean long-term immunity,
| this means one of two things:
|
| 1. If the lockdown is lifted, we will see another ~60,000 to
| 100,000 deaths in NYC, before it will hit herd immunity.
|
| 2. Or, the lockdown will continue.
|
| The accuracy of antibody studies has been called into doubt, and
| as far as I know, nobody has ever followed up on whether or not
| people with study-detected antibodies can catch the virus. The
| data for the latter is unlikely to be available until the second
| wave hits.
| joe_maley wrote:
| > if these antibodies actually mean long-term immunity
|
| This is the big unknown that seems to be largely ignored, thank
| you for bringing it up. I am frequently seeing "herd immunity"
| thrown around without any qualification on the durability of
| the associated antibodies.
| grey-area wrote:
| That would be a very useful follow up study with this same
| population.
| DeonPenny wrote:
| We'd also need to make the decsision to continue a lockdown
| over a virus with a 99.5% survival rate or not. Seeing at the
| flu has a 99.9% survival rate does it make sense to destroy the
| economy over that.
| vkou wrote:
| First of all, it's not 99.5%. A naive interpretation of these
| numbers is a 1% death rate, not 0.5%. 15,000 dead, out of an
| estimated ~1,680,000 with antibodies.
|
| Second of all, deaths lag infections, and the actual death
| rate is closer to double the current death rate.
|
| Third of all, you have no idea that if someone has
| antibodies, they are immune. As far as I know, nobody has
| tried infecting antibody-positive people... Or released
| studies that followed up on them, compared to an antibody-
| negative control group.
|
| Fourth of all, World War II 'only' killed 3% of the world's
| population.
|
| And lastly, if you lift the lockdown, and everyone gets sick
| all at once, the infection rate will spike dramatically.
| Because when hospitals are overloaded, people who can be
| saved are left to die. Not to mention that you'll be killing
| thousands of doctors, due to the high viral load they are
| exposed to.
| DeonPenny wrote:
| Only if you think cuomo presentation is wrong because that
| what they quoted. Also you numbers are wrong 15,000 is only
| .18% of 1.6 million not 1.8%.
|
| Also death lag infections in numbers but that wouldn't
| change the ratio of deaths to infections. Unless the
| infection rates are going up or down. Right now infection
| rates are lowering so you'd expect the death to infection
| rate to continue to stay in line with the 0.5% infection
| rate.
|
| Also we have never shut down the economy with other disease
| it was generally assumed that you'd at least have limited
| immunity to disease with antibodies. I don't think swine
| flu or bird flu had this react why should this.
|
| If we know only the sickest people are getting sick why
| don't we lift the quaretine on the people less likely to
| get sick or people with antibodies. It seems like we made
| the lockdown decision based on a lack of data. I don't know
| if continuing to do it when we do make sense. Especially
| because it could make people more sick not less.
|
| Edit: correction used 8 million as denominator. 89% is
| correct
| saalweachter wrote:
| 0.89%: https://www.google.com/search?q=15000+%2F+1.68+mil
| lion+*+100
| Jeema101 wrote:
| It's possible that a less interventionist approach by the
| government would also have the exact opposite effect by
| reducing public confidence in the response, and in the safety
| of going outside, since nothing is being enforced.
|
| As Joseph Stiglitz said the other day "In those circumstances
| it won't be the government enforcing the lockdown, it will be
| fear. The concern is that people are not going to be spending
| on anything other than food and that's the definition of a
| Great Depression."
| legulere wrote:
| Stating the survival rate really hides how there is around an
| order of magnitude difference in the death rate.
|
| And that ignoring that while immunity towards various types
| of influenza is widespread, there is no previous immunity
| against COVID-19 apart from a handful of people that had SARS
| or MERS before.
| tunesmith wrote:
| Hospitalization rates per infection are greater for covid
| than for flu. What matters is hospital capacity, to protect
| against greater non-covid death rates.
| DeonPenny wrote:
| But we can't say that it could just be that infection
| because of a lack of herd immunity is the only thing
| preventing something like the flu from having the same
| result.
|
| If they have the same hospitalization rate yet covid-19
| infection rate is twice the flu because of the lack of
| immunity you would immediately double the hospitalizations.
| There's two variables in that equation
| SpicyLemonZest wrote:
| I agree, but this is not universally believed. Many people
| argue that hospital capacity is _not_ what matters, and we
| must continue lockdowns even if hospitals won 't be
| overloaded to eradicate the disease.
| DeonPenny wrote:
| But if that held then we'd eradicate flu and the common
| cold two. Quarantines don't eradicate disease they slow
| the spread but the area under the curve is constant. I
| doubt will change the number of infected is a constant
| regardless of the rate.
| tunesmith wrote:
| Ah, yeah. If hospitals are fine, I think lockdowns can be
| swapped for a contact tracing system, assuming enough
| people use it and assuming easy test access and 24-hour
| test turnarounds. (And even then... use masks.)
|
| But, in the absence of that, if a hospital is at 50%
| capacity, I don't agree with opening up a lockdown until
| a hospital gets to 95% capacity.
|
| (The game changes entirely if we get a good anti-viral.)
| djrogers wrote:
| The purpose of the lockdown isn't to hide until the virus
| magically disappears, it's to flatten the curve and allow the
| virus to spread slowly enough that it doesn't overwhelm the
| healthcare system in any given place.
|
| Maintaining a lockdown will not lower the number of people who
| get the virus, it will merely extend how long it takes to get
| there.
| legulere wrote:
| Flattening the curve until there is a vaccine might be the
| right plan for a influenza pandemic. For COVID-19 we can go
| further: we can bring down infection rates so much that
| contact tracing becomes feasible again.
| lbeltrame wrote:
| At least if you heard the statements of my government (Italy)
| from a couple weeks ago, they were hoping (or so the press
| said) to "reduce infections to zero".
|
| Since then, quite obviously, they backtracked from those
| statements.
| usaar333 wrote:
| Matters where you are. The Bay Area is keeping their lockdown
| up so they can contact trace and crush any infection spike.
| Otherwise, we're going to be locked down until a vaccine at
| the current new case rates.
| CubsFan1060 wrote:
| There is no reason why an all or none approach is necessary
| here, is there?
|
| By my count, 10,120/15,740 of deaths have been folks over 70.
| If you kept people over 70 locked down (including their
| caretakers), you could significantly reduce the number of
| deaths while increasing the percentage that have had it.
|
| In fact, only 9% of New York's population is over 70. So
| theoretically (though clearly not practically), you could get
| over the percentage required for herd immunity while reducing
| the deaths by 66%
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