It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here?
- Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
- Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
- All we can do is alter the timetable to keep the hospitals functioning, which has been done successfully in many places throughout the world albeit at great cost.
There's both good news and terrible news in those facts but none of it really seems to be in the consciousness of the public or of leaders, whereas "oh no you can maybe get it 8 hours after a guy sneezed in a lobby" is everywhere. Along with "everyone who stays at home is a hero" as we set ourselves up for a second Depression.
The death rate is 0.5% IF there's really good medical treatment. If there isn't then not only does the death rate from the covid go up but so do death rates for every other condition requiring medical treatment. And not only during the pandemic but for a some time afterwards as the health system recovers. That's not counting those who survive but have some form of permanent damage.
The way to avoid that is to at least spread out the impact over time. Telling people it'll be okay leads to no one listening and the health system collapsing. That's human nature. Telling people it's the apocalypse means most listen and the health system survives. Welcome to humanity.
I'm just very skeptical of this kind of noble lie. If authorities are known to tell people what's convenient for them to believe rather than what's true, is anyone going to end up listening to them in the end?
Agreed, it'd be wrong to tell people it's okay. It's not okay, a lot of people are going to die, and even more people would have died if we didn't take costly measures to stop it. This has been and will be the worst experience of a lot of people's lives, and it'd just be a lie in another direction to pretend that's not so.
What seems to be a noble lie is the apocalyptic mindset, where the coronavirus is literally the only thing that matters and we must never ask if a particular mitigation is worth the cost. Many authority figures are promoting this idea, even though they clearly don't believe it themselves and couldn't formulate effective policy if they did.
> even more people would have died if we didn't take costly measures to stop it.
The example of Sweden seems to disagree with this assumption. They never locked down, and the current mortality is (1,203 / 10,330,000) * 100 = 0.0116%
First case on Jan 31st, no lockdowns, death rate has already flattened. Where is that crazy scary exponential growth?
Sweden as the great success story when it is suffering the same economic devastation as its neighbors but a higher death rate is an interesting argument.
The thing about the lockdowns is that evidence so far indicates that stopping 80% of non-essential economic activities voluntarily is about as bad for the economy as stopping 90+% on a mandatory basis, but it seems that the health outcomes are much better in the latter situation.
I discount any comments that argue IFR as the sole basis for how quickly we can let the disease spread to save jobs on a short term basis.
Hospitalization is a more important factor as it the death count goes up dramatically without intensive care.
These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
"Significantly less than 200 million Americans catching it" is still on the table.
"Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily.
This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs.
This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed.
It isn't hopeless.
> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.
This is a great comment, thanks. So isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease?
For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine.
I think we need to explore alternatives to lockdowns because I believe the economics of lockdowns will make them impossible to continue for very long. At the moment people see this as a "be heroic and do the right thing" issues, but most people don't yet understand the severity of the economic impact and haven't yet been personally affected by it. Lockdowns will probably become politically untenable by May or June whether anyone today likes that fact or not.
Eh, it's kind of like the decision on how bags of groceries to carry from the car to the house at once -- it's faster the more you take, but the more you carry the more likely you are to drop them and the more catastrophic the accident becomes when it happens.
It's tricky to take large bites here because of the short doubling time compared to the relatively longer recovery time -- in the ~3 weeks it takes your currently-infected cohort to recover, your infected population could increase 100-fold if you aren't careful. Mistiming things -- misjudging how many people are currently infected -- by a couple of days can be difference between exposing 10% of your population to the risk and exposing 15%. There's a reason pandemics are often compared to forest fires.
This will get easier as time goes on, as the doubling period gets longer and longer.
Based on current estimates of how many people will die in the US, you can infer that we currently expect 5-10% of the population to be exposed in this first wave; I believe what widespread testing there has been in Italy leans towards about 10% of that population having been exposed there as well.
""isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease?""
Only if you would like to see the hospitals overwhelmed with cases that don't result in fatalities but kill lots of other people and also kill people with underlying conditions that would otherwise live full and productive lives.
Chicken pox was a steady state. It sucked that kids got it, but their parents and most adults were likely immune, so when they brought it home from school, it didn’t spread to parents.
But if you expose kids to COVID now, they will in turn expose their parents, who will expose their coworkers, etc, etc
I could see that being effective strategy if we didn’t have a vaccine in 30 years, but for now, most people are still susceptible.
>For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine.
Because kids are the most likely to ignore even simple ways of preventing infection. Then you get exponential growth via kids and the health system implodes.
How does this square with Denmark, which is opening schools tomorrow? It's possible they're wrong, but they must at least have some reason to think what you're saying won't happen.
You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.
What's your source for 2%? A recent study which was featured on Hacker News estimated the infection fatality rate at 0.66%. [1]
I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2]
Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one).
In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it.
The CFR in Italy is nearly 13%. Even if you make incredibly generous assumptions that there are no unreported deaths and they're only catching 10% of cases that still leaves the infection fatality rate at twice the number you propose
That's almost certainly untrue. Recent studies have show that as many as 38% of the Italian population has been infected at this point [1]. That gives a fatality rate 0.03%. Let's say the official death count is 10x undercounting, you're still left with 0.3%.
Testing is severely undercounting cases here. People who just experience fever are told to self-isolate and aren't tested. Not all of these (luckily) end up hospitalized, so those are never, ever counted.
With an older population, a problematic medical system, and being caught totally unprepared, isn't Italy the worst case scenario? I don't think it would be representative of what's going to happen in other countries from here on out.
The US has a population riddled with comorbitities (obesity, heart disease, diabetes, etc.), a problematic medical system, and was caught totally unprepared. Isn't the US the worst case scenario, with the most deaths and most infections in the world?
I use the 0.66% number myself when estimating things, but it's worth noting that that is that papers best-guess estimated infection fatality rate for China, based on its demographics.
The paper has an overall estimate of the infection fatality rate for all ages of 0.2-1.6%.
And that also assumes everyone can get medical care, if all of the cases are happening at the same time, the mortality rate would increase as resource constraints force medical providers to pick who gets care.
No, 2% is the case fatality rate. The true overall mortality is far lower. Germany did a randomized test recently of a town and calculated that 2% of the population is actively infected, 14% possess antibodies indicative of a current/prior infection, and overall 15% have been infected at some point. Once this broader testing was completed, the overal mortality was found to only be 0.37%. For comparison, a typical flu season is 0.1%.
That is incorrect. The worst flu wave to hit Germany in the last 20 years, 2017/2018, killed appoximately 25000 people (excess mortality). That's 0.03%, and it's not typical. Often, the number is much lower.
Note also that the results from the Gangelt study you're referring to are preliminary; there's a press release but no paper yet, not even in preprint.
> That's 0.03%, and it's not typical. Often, the number is much lower.
0.03% or 0.1% or 0.66%, the number is low enough to be perceived as not too dangerous by general populace. Contrast that with 13% mortality rate for Italy that was widely spun a month ago. Now _that_ was scary!
Just in support of your argument, new data is showing that the fatality rate is lower then previously estimated, due to a large number of undetected cases.
I've seen a few more of these data points coming out, and nothing is 100% conclusive, all the new data points are showing that it's less bad than mainstream thinking suggests.
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc.
> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.
> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
This doesn't seem right to me. With social distancing now, and testing and tracing once we have enough tests available, it seems to me that we should be able to keep the total number of infected people well below 200M, even if a vaccine takes the expected 18-24 months. If there's a solid argument that this is not the case, I'd like to hear it.
2) Testing and tracing is working fairly well in S. Korea because they're treating it like a war, and they've been orgainzed since fairly early on. The US is not organized.
What most people, including HN, miss is that passing a test today means nothing about tomorrow.
Based on Italian serological and all cause mortality data I have seen, the death toll would more likely be about 1.4%. 0.5 IMO is quite optimistic. 0.1% of New York's population has already died.
This also discounts the unknown possibility of disability, reinfection, and limited time immunity.
- Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
- Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
- All we can do is alter the timetable to keep the hospitals functioning, which has been done successfully in many places throughout the world albeit at great cost.
There's both good news and terrible news in those facts but none of it really seems to be in the consciousness of the public or of leaders, whereas "oh no you can maybe get it 8 hours after a guy sneezed in a lobby" is everywhere. Along with "everyone who stays at home is a hero" as we set ourselves up for a second Depression.