Those are US numbers only. The CDC estimates that 291,000 to 646,000 people die worldwide every year. You cannot take the US mortality rate and assume it would apply to any other country and especially not China.
I wouldn't use the word primitive, but inconsistent, non-patient-focused and underfunded in many places.
Larger cities can have excellent treatment, smaller cities less so. After a car accident I had pin-hole surgery on a badly broken collar bone (three pieces and several fragments) and only afterwards discovered the lead surgeon was internationally published in leading journals for his work, and the second surgeon would soon be departing for Northern Europe for a 2 year secondment to complete his PhD. Physiotherapy with minimal but sufficient. After-patient care consisted of being invited to dinners with other ex-patients for sharing over dinner, which is very unlike the West.
Certainly I was fortunate and the vast majority of care is not like this, which is why I don't use the word 'primitive' but prefer 'inconsistent'. The doctors described hospitals more like factories: There's a lot of throughput. He chuckled "You get lots of practice, but the focus is on how to do things better."
Edit: When I say 'not patient focused' here's a typical process flow:
1. Go to ER. Have a friend, family member or colleague pay a fee for consultation for a General Practitioner, and specify Chinese Medicine or Western Medicine GP.
2. Wait to see the GP, usually in a queue or ticketing system. There's a nurse on front desk and if it's obvious and urgent you'll be fast-tracked.
3. See the GP. They'll have some idea and request further work, like an X-Ray, Blood Test, CT Scan, etc. That's all in ER. Have the friend, family member or colleague pay a fee for that and wait in a queue/ticketing system or get fast-tracked again.
4. Get the results and return to GP for further prognosis. They'll recommend medicine (go to the front desk, pay a fee, etc, then go to a separate part, typically a separate floor, for that), operation, or other work. At this point you're referred to a specialist department and need to make your own way there, or if urgent have a wheelchair or stretcher and nurse take you there.
5. Turn up at the specialist department. Now this varies. For urgent treatment you'll likely be seen immediately, better, larger hospitals work 24/7. For non-urgent there might be a ticketing system. For something like a bone operation as I had there'll be a junior doctor on front-desk who will make a further assessment. If non-urgent and they're busy, schedule a few days later.
6. A ward consists of several rooms, typical Marie-Curie design with a central lift block and wards coming off from that. Rooms are rarely individual, if fortunate you'll have 2 to a room, sometime 8 or more. Some pre-op, some post-op. Nurses don't do a lot other than administer drips, observe, and escalate to the doctor on-call. For stuff like getting in or out of bed when you can't walk, friends, family or colleagues are there for that. Often you'll see family members on rotation with a small chair or camper bed next to the patient. You can also hire private unskilled unqualified helpers.
How to choose a hospital: Always go with a Medical University. It's a rule-of-thumb the world over and especially true in China. They have the most experienced, best qualified, best paid (outside of a handful of private international hospitals in Shanghai/Beijing/etc) doctors. If there's a #1, #2, #3 etc affiliated hospital, go to the #1, if that's too far, go down the numbering system until distance/urgency tradeoff works best. If you're out in the countryside, the quality of the care isn't likely to be the best.
Sorry, wrote quite a lot there. Thought it would be interesting to share with Hacker News as most readers here probably won't have had experiences with hospitals in China.
In the crisis like Wuhan at the moment I imagine they'd be incredibly overworked.
Well it might be partially due to culture. Large parts of population is skeptical to the modern western medicine, and rather use traditional Chinese medicine practices.
I think you're a bit off the mark. Healthcare is cheap in China, but people are even poorer. Only rich people can afford the important stuff. It's common for young people from poor families to work or forgo their education to pay their sick parent's medical costs. Usually old people just die because they can't afford medical care where in the west, they would be treated. Also doctors are poorly paid and commonly supplement their income with under the table drug sales. Oh, and most of them prescribe fake herbal medicines as if it was real and patients are fooled by it because their culture tells them it works. Imagine getting a vial of homeopathic diluted water and a sugar pill when you complain about a cough. I once knew someone who had TB and was recommended to treat it with an OTC sachet of herb from the pharmacy! It's common to find beggars outside hospitals with signs asking for money to continue their treatment. Insurance? Yes, that exists but the excess is often something like 1/3 the total cost so if you couldn't afford it yourself, you still can't afford it with insurance. That's if you have a high enough income to afford insurance in the first place.
> Imagine getting a vial of homeopathic diluted water and a sugar pill when you complain about a cough.
This happens regularly in western europe, especially by pediatricians. The charitable interpretation is that the doctor knows the child will get better in a few days anyway, but has to give _something_ to soothe the parents. Giving the substance-free stuff is better than unnecessarily medicating the child, and placebo-effect can also play a positive role.
In your subsequent comment you add the important point - this is Germany. Having lived both in Germany and (now) in China, i can confirm that both of these countries have a problem with quack medicine. I've never been anywhere else in the world where you need to argue with pharmacists to persuade them to sell you evidence-based medicine.
In China there is some historical reason for it - Mao needed something to placate the peasants while trying to figure out how to provide healthcare to rural areas[0]. Unfortunately the government is still trying to figure that out.
I don't know what the history is in Germany that caused it to be the way it is.
Note that homeopathy was invented by a German doctor, Samuel Hahnemann. It grew big at the turn of last century, with hundreds of homeopathic societies with their own apothecaries.
Today, lobbying powers of a profitable industry also play into it.
The parents that know they're gonna get a placebo because the kid will get better regardless probably aren't bringing their kids to the doctor for the kinds of ailments that result in a placebo.
Anecdotally, 90% of the times I've taken my toddlers to the doctor I've gone home with advice to take paracetamol and wait it out.
Kids can get high fevers really fast and you just want to make sure their lungs & heart are ok, they don't have a throat / ear infection etc. A doc can verify that for you in 5 min so I rather be safe than sorry, an "OK" is all I need.
> Insurance? Yes, that exists but the excess is often something like 1/3 the total cost so if you couldn't afford it yourself, you still can't afford it with insurance.
The scary part is that of the official 8,200 or so people that have been confirmed to have the virus there's been 171 deaths, and 143 recoveries. So more people dead than recovered, does make one wonder about the 8,200.
Seems few believe the official numbers, people visit numerous hospitals without being able to seen, and even those that get seen have problems getting tested, and people who posts about the situation get the post pulled or pressured to pulled themselves.
Here's an article describing the censorship (pulled posts), arrests for "rumor mongering", difficulty in getting tested, etc:
Well there is something to be said for both potential biases in those counts. First of all, those being hospitalized are obviously among the most severe cases. And presumably people with the mildest cases will potentially not even be diagnosed, so the mortality rates would be skewed higher.
And secondly, that more people have died than have recovered doesn't say much other than that it takes longer to recover than to die. If you are going to die, it would appear that it would happen sooner rather than later. Whereas if you aren't going to die, you may take awhile before you've been officially cured.
That isn't to say that is absolutely what is happening here. But both scenarios are fairly likely, and therefore should mediate some of the bleakness of those numbers for the time being.
The numbers we're getting out of China are a mess and almost entirely useless.
There are reports of hospitals turning people away unless they a very sick, and also not testing every ill patient because they're overwhelmed.
I've see death certificates posted online with "viral pneumonia" because they aren't able to test everyone - and certainly don't bother testing those who have already died.
The errors are both ways and huge.
The only thing we can conclude is that it's contagious, deadly, and more deadly than the seasonal flu.
There was one interesting number though. The Japanese had been evacuating 200 people from Wuhan and found 3 cases. Assume that a plane of evacuees like that is somewhat random sampling. And that evacuees have similar or better hygiene. This puts infection rate at 1% of the population. Official population of Wuhan is 11 million, it is possible that it is larger. This puts the number to 100k cases.
Isn't taking the population of Wuhan as 11 million cherry picking? You could choose the population of central Wuhan and get a higher estimate or the population of Hubei province and get a lower estimate. Presumably the distribution of Japanese people evacuated does not match the distribution of people in Hubei province, since many will be tourists (more likely to be in the city centre). Moreover their chance of being infected will depend on where they were staying: there is an epicenter.
But yes it does indicate that the real number is much higher than the confirmed cases. It's really hard to track an outbreak of this magnitude especially when many people are carriers showing mild symptoms. It's actually a good thing if cases are being severely underestimated as it implies a lower death rate (deaths are harder to fudge).
Are you sure about this? AFAIK, the Chinese government does not disclose someone as dead by this virus unless they tested the person positive. That means that if someone dies from respiratory complications on the street or in their home, they will write it off as pneumonia. Right now Wuhan city only has the capacity to screen roughly 6000 samples everyday. Add to this that many sick people are basically just told to go home. Not many cars are driving, city is shutdown so god knows how many are sitting lifeless in their livingroom.
I have also seen much evidence that communities are barring the doors of infected households so they can't leave their apartments.
The death count can only be expected considerably higher than reported.
Korea evacuated 400 today, 1 couldn't board the plane because known infected, on arrival 4 were tested and found to be infected. This is consistent with the Japan flight from yesterday that you mention.
On top of that, 2 of the returnees refused to be tested. Who knows what they're up to… work? Seeing family? Hanging around in the park with a Strong Zero for a chat?
Medically it seems much more specific though. You could die from numerous things after a gunshot wound, so naming the specific cause of death is more accurate.
> Most patients were men, with a mean age of 55·5 years (SD 13·1; table 1). 50 (51%) patients had chronic diseases, including cardiovascular and cerebrovascular diseases, endocrine system disease [and some others]
The findings conclude:
> In general, the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia
Also the group was self-selecting of people who went to hospital before Jan 20th.
In summary: old men with pre-existing health conditions are going to have a rough ride. Am yet to see this play out in 2020 Presidential Election odds though.
>50 years is not old. I don't know what is considered old but I know that >75y has a two magnitudes higher mortality rate with the flu.
I doubt that the 50 years old Hospital doctor who died had any serious per-existing health condition. In fact, you could argue hat most doctors have a stronger immune system than average since they are exposed to more germs due to their profession. So this 50y old professional dropping dead is a bad sign! (and hands off to him for his bravery in doing his job).
You could only argue that he cough the strain very early. A virus jumping into a new species is more aggressive at the beginning, later it adopts more to the new host and becomes less aggressive.
The new world, post smallpox that wiped out up to 90% of the population. That's setting quite a low bar though, it would still be about on par with the black death.
One could argue that thinning the population of the older demographic with pre-existing (and expensive) conditions could be a net benefit to governments with socialized healthcare. See Taiwan which has repeatedly had to refund their system because of an aging population and the related growing costs.
I'm not disputing your point, but with respect to Taiwan, the fact that visiting a doctor is almost a sport certainly doesn't help - An average of 14 visits per year per person:
>There is a high level of health seeking behaviour in Taiwan. It is part of the Taiwanese culture to take medicines or to seek medical help frequently, even for minor ailments.
>The average outpatient department visit rate is 14 times per year per person.
That's not what I meant. I was saying that there's at least 50% chance that you might be immune to this virus. Who knows, there might be 1000 people who were infected but never went to hospital because they got better without medical care.
There was no sarcasm here. The comment just states that the virus' 0 day fatality rate is at most 50%. Why are you offended by this fact? Obviously we might see some twists like the virus becoming more resiliant, and obviously we won't shut down all research. The actual death count of this disease will be much lower.
Trust me, I know what I'm talking about. I've played plague inc.
It's like a worse version of the flu. The way that you'll die from the flu is getting a secondary pneumonia infection from Staph aureus or Steptococcus pneumonia, the virus just makes you more susceptible and weaker.
The major lethal consequence for this virus in the Coronavirus family is Acute Respiratory Distress Syndrome (ARDS). A strong outcome for this is we knock you out, put a tube down your throat, and have you breath via mechanical ventilator. It's intense to say the least.
I’ve heard that “the common cold” is actually a few completely different infections that isn’t worth strictly classifying for the most, and that coronavirus is one of them. If so, this is “a common cold” except maybe death rates are statistically higher.
The flu is the influenza virus, period. The common cold is typically caused by a rhinovirus, but coronaviruses, adenoviruses, and influenza viruses can cause colds too.
Sure, and there are around 160 known types of rhinovirus, 50 adenovirus types, and now 7 known forms of human corona viruses. Flu refers to a specific family of RNA viruses, common cold is a much more broad term.
People mistakenly calculate %2 and %50 simultaneously because they assume that when a case is confirmed the death or cured status is also determined at that moment.
In reality, though, people who are going to die don't die at the moment of infection confirmation and people who are going to live do lag in the log because it takes time to confirm if someone has recovered and virus-free.
Some will suggest to simply compare the deaths to the confirmed case from a week? ago but this assumes that the patients are admitted at the same stage of their infection and all cases at the time are accounted for(deaths are probably much better tracked than the infection and the publicity has a huge impact on the reporting). It would be a guesstimate at best.
I would say, let's stick to official numbers since the calculation requires each patients timeline. Surely an educated guess can be constructed by modelling the patient prognosis and virus behaviour but that also requires much more data than what the public has.
With this formula, there is no need to guess the "patient timeline". If you do the math right now for the largest case study known to date (published yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... covering 99 patients, 11 dead, 31 recovered) you get:
This formula gives a pretty good estimate of the eventual observed CFR according to the paper I referenced above. Of course, there are caveats, for one deaths or recoveries may not be properly tracked: there could be many patients with mild cases that are not even detected/confirmed and end up recovering on their own.
The problem is that the method that you use and the paper referenced (https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408...) only applies the calculation on data 3 weeks, 4 weeks and 5 weeks after the epidemic has peaked. Of course you can get valid data once things have peaked and are slowing down. The issue is trying to get valid data while still in the exponential growth portion. And it seems like this method would have all the same flaws as other methods on rapidly changing data (if not worse due to the lag between recovery and deaths.).
I'm not an epidemiologist, but I believe I see flaws in your application of the methods from the paper.
[1] At the bottom page 481 it clearly say the virus peaked on March 27th. The first date they use data for the e2 calculation is April 6th. Two full weeks past the peak.
Patient timelines still matter. It takes longer to recover than it does to die, so it would make sense to compare current recoveries with the number of deaths from several days ago. But without knowing the patient timeline, I couldn't tell you how many.
How does that produce a meaningful number?
If you got 1000s of infected people, and 1 dies... The formula would be 1 / (1 + 0) = 100%. What does that mean?
You simply have to have the known numbers of confirmed dead and recovered patients.
The way you used it "1 / (1 + 0) = 100%" means just "the knowledge used in the formula is that one patient died, zero recovered." In that case, yes, the fatality rate is "everybody dies." But using the sample of 1 is of course not meaningful for any statistics, not only for that formula.
Nothing conclusive but if a new disease emerges has a mortality rate even approaching 9% and a basic reproduction number (R0) of 1 or greater, it's a significant cause for concern. Combined with the incubation period, asymptomatic transmission, and the population density in which the outbreaks occurred, in this case it's enough to declare a global public health emergency.
The official figures in China are 8,163 cases 171 deaths which is 2% right now, but take these with a big grain of salt. They could go up (some of those confirmed cases will be very recent and may get worse) or down (more cases might have happened but be unreported). Its really hard to tell what it will look like in a month or two.
I watched the whole thing. It was riveting. Don't forget to turn on CC if you need translation. It is a volunteer transalation.
The reporter, Chen Qiushi, describes his observations in Wuhan, a city of more than 10 million.
His preamble:
"My name has been flagged in China."
"If the content contains 'Chenqiushi' or 'CQS', or my face, it will not be sent on Wechat.
... if you [share on wechat], your wechat account will be deleted, like mine.""
He describes visits he made to hospitals in Wuhan and the general state in the city.
It is well worth listening to / reading.
Some points that stuck with me:
People cannot get to hospital because there is a critical lack of transportation.
There is a critical lack of test kits, so residents do not believe they will be diagnosed, so they stay home.
It goes far enough that your concern is valid. Since HN is not exactly mainstream and many Chinese people are posting similar kinds of videos, you're probably okay in this case. However, if you want to make honest comments about China online and still want to travel there, I highly recommend that you post anonymously.
TL;DW/DR the subtitles: he saw a lot of chaos in Wuhan's hospitals. Not enough testing kits, not enough government-requisitioned emergency taxis. Taxi drivers were already talking to each other in December saying "avoid the market".
If you don't want to read subtitles for 26 minutes here's all the subtitles copy-pasted from the video: https://pastebin.com/6hJ4h4rm
(You can hit the "..." above the red subscribe button and select "open transcript", but it shows up in a tiny window).
I suppose the WHO saying they're very impressed with how China is handling the situation is because they felt the pressure to save China's face.
2 - There's not enough transportation, test kits, masks, and hospital beds, or volunteers
3 - Many sick people are not even bothering to go to the hospital
4 - There's poor communication and rumors flying around
5 - People are frightened, panicking, and suspecting the worst
This tells me that:
A - there are likely way more people infected than there are confirmed cases, but possibly more deaths too of those who never made it in to hospitals
B - Many wouldn't have died had they had more adequate health care, better transportation and more test kits
So, for the rest of us who are sitting on our hands now, glued to social media or the television waiting to see how this will unfold, our time would be much more productively spent planning for when the outbreak hits our local area.
Volunteer. Get connected with volunteer organizations. Donate. See what you can do to ensure there's adequate transportation, communication and resources when the outbreak hits your area.
One thing I'm really curious about that I haven't heard covered yet is if people who get sick and recover become immune. If so, they should feel safe in volunteering to come in contact with the sick and help them directly after they've recovered themselves.
Cooperation, preparation, organization, and mutual aid are crucial.
The way the central government is handling this is impressive, quarantining a city of that size is unprecedented and has bought the world extra time to prepare.
Yes the WHO are playing politics when they focus on the good things China is doing and ignore the bad. But personally I think they are closer to the truth than those who present an entirely negative version of events. China's response has been 70% good :)
> The way the central government is handling this is impressive
Not really, they jailed the experts who told them that they needed to act quickly, sat on it for a month, and finally did something about it when it was already out of hand.
Huh, I would say you're in the wrong thread to claim it's "impressive", if this guy's video is to be believed, it's a whole lot of chaos and lack of supplies...
We have gone from the first confirmed human-to-human transmission to tens of thousands of cases in something like two weeks. No amount of preparation will prevent chaos and shortages in a situation like this.
I watched the CDC press conference today and saw nothing but fear written on their faces. And that is with far more advanced notice than the Chinese had.
Totally off topic but... Chinese seems like a very efficient language. The guy doesn't seem to be speaking so fast but the subtitles are conveying a lot of information really fast.
Here's [1] a paper on information density vs speed of speech, done by the University of Lyon. I am not sure how accurate their methods are, but they seem to believe that some languages convey more information per syllable and for 5 out of 7 languages, that ones with lower information density are spoken faster. Note that the sample size was only 59 and only compared how fast 20 different texts were read out, all silences that lasted longer than 150 ms were edited out as well.
The official figures in China are 8,163 cases 171 deaths which is 2% right now, but take these with a big grain of salt.
I wouldn't even go that far. I've been using this as an excuse to figure out the D3 v5 API using the Johns Hopkins data. Most provinces outside of Hubei are not reporting deaths yet. It's possible nobody's died outside of Hubei, but that seems suspect to me. There is almost certainly strong federal and local pressure to under report deaths, but this sort of thing is much harder to hide in Hubei because it's the epicenter.
I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.
More to the point, Hubei is reporting 204 deaths and 5,806 confirmed cases which works out to about 3.5%. This is compared to 76 deaths and 1,423 confirmed three days ago (or 5%). If you'd like to look at death compared to known outcomes you're looking at about 64% of the outcomes being death (204 deaths, 116 recoveries). It's not clear which part of the equation is lagging more in Hubei.
> I don't believe for a moment that China would've attempted to quarantine 60 million people so quickly if the case fatality rate were only 2%. 2% is bad but SARS saw around 15% in many countries and things weren't locked down this tightly.
presumably fatality is only one of many factors here. 15% of 100 infections is a different beast than 2% of 1M. And if it takes up to 14 days to see symptoms...
That 2% is only among those confirmed. When most people get sick they just stay home, then get better and never visit hospital or get into confirmed cases. Those who die usually have some other disease as well.
On April 1st 2003, when SARS was in full swing, the WHO reported 1622 cases and 58 deaths. That is a rate of 3.5%. In June 2003 (at the end of the SARS outbreak) the official figure was almost ten percent. From this comparison you can expect the mortality rate of the new corona virus to be at around 6 to 8%.
It is dangerous to extrapolate like this because the big differences are in incubation time and the fact that the novel coronavirus is likely spreadable before the carrier has a fever or other detectable sign. If that's the case, tracking the spread might as well be impossible because multiple people could be the potential source without a clear way to trace it, especially in a hospital setting.
On the flip side, the R0 (rate of transmission) and death rate might be a good clip lower than currently estimated. On the other hand, China walled off a city but part of their motivation might have been the flack they got for moving slowly with SARS.
I saw an interview with a German virologist. Her estimate was to have fatality rate of around 2%. Also stated the issues of calculating these number during the outbreak as not all cases are known, not everyone is either cured or dead. She also hinted at a bias towards the severe cases as most minor ones, symptoms like a cold, aren't reported yet and most likely not admitted to a hospital.
As she said, we will only know once the thing is over.
It's currently 171 deaths, 8,288 confirmed infected, which is 2% dead. However, what needs to be taken into consideration is that infected individuals don't die the day they are confirmed infected, there is a lag of several days.
Assuming the average time from symptom onset and diagnosis to death is 7 days, we're looking at at 20% death rate (830 confirmed infected 1 week ago). Even a 5 day lag between symptom onset to death is a ~9% death rate (1,975 confirmed infected 5 days ago).
This is exactly how the fatality rate of SARS played out.
I'm not an expert on viruses by any means but that seems unnecessarily pessimistic. The number of infections is likely much much higher than the confirmed cases (laboratories have only so many test kits available per day) but most people stay asymptomatic. This would reduce the actual mortality rate, not increase it.
If indeed most people stay asymptomatic (but contagious), you're right that the actual mortality rate is lower. But this same outlook would translate to an increase in total fatalities as it greatly complicates containment.
The number of infections is likely much much higher than the confirmed cases (laboratories have only so many test kits available per day) but most people stay asymptomatic.
Do you have evidence of that in this case?
Viruses vary widely on how many are asymptomatic. My understanding is that having people be infectious and asymptomatic only happens with diseases that are well-adapted to their hosts. Which this one, having recently crossed a species barrier, isn't. (Its fatality rate is also high for the same reason.)
However that is a general understanding and I don't have data to base it on on this case. Do you?
If they in fact can't transmit, then this is OK. If they can or, even worse, have a long latency period and will show symptoms in 2 weeks, that is very, very scary.
Our best tool for diseases like this is contact tracing. And asymptomatic carriers make that very hard.
(Useless trivia, the first documented asymptomatic carrier who was infectious was a short order cook named Mary Mallon. She is better known as Typhoid Mary.)
When she was first identified, she cooked for a number of families. The outbreak that got her put away for life was due to working as a cook at Sloane Hospital for Women.
7 days is too short. In the 2 Lancet studies (the 41 person cohort and the 99 person cohort), the time from diagnosis to the first recorded death is 11 days later, but most happened sometime after that. It's likely safe to say that diagnosis to death is 2-3 weeks.
The number of deaths is likely to be much more accurate than the number of infections, which are likely much more than 8,288, leading to a much lower fatality rate.
- how many infected but not confirmed. They could be asymptotic or mild enough not to seek medical treatment. This would increase the denominator.
- time between infection to first symptom to death. Therefore we don’t know which way the remaining confirmed cases will go. Probably increase the numerator over time but don’t know by how much.
IMHO assuming a 2% rate this early is a bit disingenuous. This due to the 8,288 confirmed cases not having registered an outcome yet. If you look at people cured vs. people dead, the picture looks much worse, but yeah a lot of variables still come into play (they were prob. the most vulnerable, they were the first ones so treatment may not have been the best, etc.).
We don't know how many people are infected. We only have numbers of confirmed cases and those numbers are heavily skewed because 1) people don't know they are sick 2) stay at home or 3) are not diagnosed properly. Those diagnosed in China are probably severe cases with a multiple not being diagnosed. Also, it is unclear how good the reporting is.
We don't know how many of those who are infected will die and how many will recover. We only know of deaths of confirmed patients in the hospital. Of roughly 10000 confirmed cases 200 are dead, 200 are recovered and 9600 are yet to be determined. From that you could deduce 2% or 50%, less than 2% or more than 50% or anything else. Right now we don't have good data. Also we don't know how long it takes to die or to recover and on most patients we will probably lose track.
Since the infection takes about 2 weeks, we have to wait a few weeks until the smoke starts clearing.
It seems to be too early to tell. There are most likely a lot of undocumented infected cases as well as the incubation period for the virus might be different than the flu. Which can move mortality rate both ways.
Not being flippant, as you've had good answers already, I can tell you the rate of fear of this novel coronavirus:
100%
Streets are deserted. The few that go out all wear a mask. Restaurants, museums, cafes, bars have been demanded shut across the country, ostensibly until the end of the weekend but I can see this being extended. The first working day after the Chinese New Year was supposed to be February 3rd, but the city I'm in have extended this to February 9th - offices have been told not to open. Shops are open, there is food, and new fresh vegetables, fruits, meats are being stocked.
Ignore the people telling you it's 2-3%. The case fatality ratio is between 9 and 56% according to proper epidemiological methods, such as using the formula "deaths / (deaths + recoveries)": https://mobile.twitter.com/zorinaq/status/122242770872387993...
e₂(s)=D(s)/{D(s)+R(s)} which is: deaths / (deaths + recoveries)
The paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate (in fact in their example it slightly underestimates the actual case fatality rate)
If hospitals err on safe side and do not report recoveries promptly (they probably have other business to deal with), applying this method at such early stage would not result in correct numbers, even supposing the virus is well-studied enough to tell when a patient has recovered.
Agreed, when using the "deaths / (deaths + recoveries)" formula, recoveries being under-reported is possible and would skew the CFR upward. But also, if deaths are under-reported in the same proportion as recoveries, then it would not affect the CFR.
I suppose one way to reduce uncertainty is to examine a cohort of patients and follow it meticulously. To do that, we can look at the 99-patient case study published in The Lancet yesterday: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... 11 died, 31 were discharged, and 57 remain in the hospital. This suggests a CFR of 11/(11+31) = 26% The assumption epidemiologists make when they use this formula is that the 57 still in the hospital have the same chance of dying as those who already died in the hospital.
...that's not the assumption epidemiologists make. For the very simple reason that there are many "just so" stories you can tell about those still in the hospital - are they sicker, and thus there longer? Are the secondary cases, which in the case of MERS had a much lower CFR?
This is a very straightforward application of survival analysis, and those still in the hospital are "censored" observations - we know their outcome takes place in the future, but we're not sure when.
There are methods for calculating things like CFR in the presence of censoring, which will change based on what type of model you're using.
Assigning 50% chance of death to any patient remaining in the hospital when calculating mortality rate would be nuts, I can only thank the epidemiologists for not publishing the number.
Not 50%, you misunderstand me. I edited my comment to clarify. What I meant is out of those who came out of the hospital (either dead or recovered), 26% died. So those remaining in the hospital are assumed to have a 26% chance of dying.
Another way of looking at probabilities, out of the 57 patients left in the hospital:
If 0 die (ie. all recover), the CFR is 11% (11 deads, 88 recovered)
If 15 die (26% of 57 still hospitalized), the CFR is 26% (11+15=26 deads, 73 recovered)
If 57 die, the CFR is 69% (11+57=68 deads, 31 recovered)
So the CFR bounds are 11-69% and if the trend on remaining patients continue it should be 26%.
Looking only at hospitalized populations creates severe selection bias when applied to the question people want answered here, namely "If I get nCOV, what's my chance of dying?" Only the most severe cases a physician sees end up hospitalized, and only the most severe cases within the general population end up being seen by a physician and confirmed as nCOV. You've already got two levels of selection bias (with an unknown percentage passing through each filter) before reaching the denominator in your numbers.
Not only that, but Wuhan's hospitals and health care system in general seem to be overwhelmed.
In other places that are better prepared and which have more resources the outcomes will likely be better, in worse prepared places with fewer resources the outcomes will likely be worse.
Let's keep that in mind before we extrapolate from Wuhan to the rest of the world.
Correct there is a bias. However even when comparing the coronavirus to the seasonal flu (hospitalized patients only), the coronavirus still looks much more severe:
Only 7% of hospitalized flu cases died in 2018-2019 (34 157 out of 490,561): https://www.cdc.gov/flu/about/burden/index.html
The coronavirus would thus appear to be 4 times more deadly (26%.)
I suspect that “chance of dying” varies based on treatment, and that treatment in an overwhelmed Wuhan hospital is likely not the same as treatment as, say, the first patient in France to get the disease.
"I suspect that “chance of dying” varies based on treatment, "
I doubt this. WHile this may be true for a known disease, we have to ask, how much can the hospital do in this cases? It is a little bit like HIV in the beginning. Watch them die?
Interestingly, China is trying HIV medications on the infected.
One of the main causes of death of the new coronavirus seems to be Acute Respiratory Distress Syndrome (ARDS). This can be treated fairly effectively with ventilation, but such treatment would obviously require a bed, ventilation system, and attentive nurses, at the very least. It's easy to imagine how these requirements may currently not be met for all patients with ARDS symptoms in Wuhan.
couldn't believe these numbers, read the link. correctness is obvious in retrospect, numbers are trivial to calculate by hand by just looking at daily data.
"Just looking at daily data" is your mistake. Essentially, it takes N days for the virus to kill, so deaths will lag confirmed cases by N days, and thus the calculated case fatality rate using this method is incorrect. This is why epidemiologists call it a "naïve esimator" (see section 3.1 in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540071/).
Which describes both the CORE and DAILY forms for an electronic database.
Some selected sentences from the pdf:
===
* The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data
may be collected retrospectively if the patient is enrolled after the admission date.
* DO NOT INPUT ANY PATIENT IDENTIFIERS: THIS INCLUDES NAMES, ADDRESSES, DATE OF BIRTH OR PLACE OF BIRTH.
* Step 1: Contact EDCARN@who.int to become a contributor to the nCoV global platform.
* Step 2: You will be contacted by ISARIC, platform manager, for assignment informational pack and instructions on
how to use the REDCap nCoV platform.
[...]
* If your site would like to collect data independently, establishment of locally hosted database is possible.
* Standard reports will be provided on regular basis to all contributors. Additional analysis for operational public
health purposes will be determined by an independent WHO clinical advisory group.
===
As you can see, the only way to get this anonymized data, is to be a contributor, and to be a contributor, you'd have to be a hospital, or somehow be granted access by WHO.
Remember the live outbreak map by John Hopkins? It also displays the number of people that recovered, the dates and definition of recovery duration are helpful in estimating mortality. Note that the other maps and graphs online only publish contaminations and deaths, which is not useful for calculating mortality. Why does John Hopkins deserve access, and why can I not get access, if I wish to fit a statistical model to the epidemic observations?
Use their API or the web search, however you like.
If you're going to complain about not having up to the minute data available for 2019-nCov, keep in mind that they're not getting the data submitted regularly from China, it's all in daily reports rather than from hospitals.
There's not much point, because the data WHO has on the outbreak is being collated from Chinese sources who probably aren't telling the truth. WHO doesn't have a lot of people on the ground in Wuhan and the rest of China feeding them information.
I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless. It's likely that at this point the Chinese government doesn't even have accurate data.
>There's not much point, because the data WHO has on the outbreak is being collated from Chinese sources who probably aren't telling the truth.
1) No dataset is perfect, and everything leaves traces, so clever people can and do constantly deduce insights from apparently worthless data.
2) It is in the interest of the Chinese to cooperate with submitting these CRF's to their best ability.
3) The little data the WHO does release to the public seems quite accurate for an outbreak, if you look at the log-linear plots and so on. (I am not saying the "known infections" represent the actual number of infections, just that it looks like accurate reporting of exactly that "known infections", and if one reads the forms you see it was designed to take into account overcapacity effects, like sending a patient back home, forwarding to a different hospital, etc...).
>I'm sure there's a database for this outbreak in there somewhere, but I'm also sure the data presently in it is useless.
What do you mean with "in there somewhere" ?
1) If you mean the WHO has the database, then of course the WHO has the CRF database, that's what my original message pointed out.
2) If with "in there somewhere" you meant that it's publically available on their website, then no, it isn't it explicitly states it isn't:
" State Parties are invited to contribute Anonymized nCoV Data to the nCoV Data Platform. State Parties should please contact WHO at EDCARN@who.int to obtain more information about, including log-in credentials for, the nCoV Platform.
To preserve the security and confidentiality of the Anonymized nCoV Data, State Parties are respectfully requested to take all necessary measures to protect their respective log-in credentials and passwords to the nCoV Data Platform. "
So they are sitting on the data as I originally claimed. On some of the clearly popularity boosted "contra-infodemic" threads, they even openly admit they can't give more detailed information even though they have access, when people ask them what they base their numbers on. [throughout the rest of the threads they typically go to great lengths to give the impression they work on the same aggregate numbers you and I can publically see, as if there is no censorship on the anonymized CRF data]
Also, why would I care about live to the minute data? I am looking for the actual data (noisy or not), and I don't care if it's delayed by a few days.
As I said, I am would like to build a statistical model.
As a lesson, perhaps not for this epidemic, but then the next: if the average chinese person can afford a smartphone, then surely they can afford a couple of UV-C LED's with a battery pack, with the LED's shining through a reflective manifold (think a pipe bent back and forth with U-bends), then breathing airflow together with proper dose (X mJ per square cm) should sterilize microbes, viruses in the air. Then it just needs to be recharged, instead of trying to manufacture 61Mega masks a day. The air sterilizer (to be attached to a face mask) could be reused for new epidemics every 5 or 10 years (in which time they might have bought 3 or 4 cell phones...)
EDIT: I see on change.org that there have been petitions towards the WHO on other issues before, perhaps someone should submit a petition to release the CRF database to the public domain. And it's not a question of hosting bandwidth, since the WHO can publish cryptographic hashes, and put up torrent magnets...
It's too early for data on this coronavirus. There isn't enough organizational capacity in Wuhan to properly capture the numbers; to start with it's difficult for people to get to the hospitals because transit is shutdown, and if they get there it's often pointless because there are very few test kits and no free beds. How many have been infected is impossible to determine.
This is (imo) the right course of action to (at minimum) alert countries wrt the gravity of this outbreak; however, I was disappointed to see the tiptoeing around potentially offending China. From the press conference, it seemed that Dr. Tedros made it painfully (maybe even unnecessarily) clear that this action wasn't faulting China for their handling of this situation. It's just weird to see that global politics is creeping into these public health decisions.
It's not just politics. This is matter of trying to placate China so that they don't hide numbers from international/outside health organizations to save face.
My understanding is that China was less than forthcoming about actual infection/death rates when SARS was making it's rounds.
Disclaimer: I do not have a source for this. This is heresay from the hubub around the current crisis so take it with a grain of salt.
I was surprised by an NPR blurb yesterday talking about how China may have to put off its annual Communist party planning meeting, and how that would be an embarrassing concession by the Chinese.
I was so disappointed in them. How should it be embarrassing to take a deadly and contagious pneumonia outbreak seriously? Do you want them to feel they should hide it?
(You being NPR). I know you don't mean anything bad by it.
I think you’re reading that incorrectly. NPR is likely not saying they should be embarrassed, they’re saying they would be embarrassed. That’s just a fact.
Or they are just concentrating on stopping the diseas and don't really care about the politics. If sucking up to China will help then why not? Less serious people (like Trump) can bluster about after lives have been saved.
Health care is rife with problems of shame, and how it prevents people from getting treatment, from STDs to drug dependency to psychological conditions.
The WHO is simply simply scaling up some tactics used in routine care to the nation-state level. Which, incidentally, is pretty close to their original charter.
It is not a real-time map, I find it bizarre that people believe that we can track the population's wellbeing in real-time. Are you ready to be hooked up to such a system?
About the update rate: It's updated regularly. If you want to go down this rabbit hole, is 1m update real-time? Is 1s update realtime? Where do you draw the line? For most people, anything less than 12h, in the case of tracking confirmed cases, is perfectly fine described as "real-time"
About the data: Obviously it's showing confirmed cases and not actual health of people. The UI makes that pretty clear, it says "Confirmed cases" in big font. No one expects the latter...
No information is available real time. There will always be a lag even with stock trading. Determining what is acceptable for real time depends on the context. A few seconds would be unacceptable for stock information but would be more than enough for a 911 real time notification system to first responders. 12 hours for global viral outbreak stats seems acceptable for real time status.
CSSE is manually aggregating data from official sources. It's updated, at most, twice a day so there is hefty lag from when the official numbers are updated and CSSE updates their site. It's about the best source of statistics that laypeople will have but it's hardly worth calling it 'real time'.
If I "touch a.txt" then run "ls", and see "a.txt", I'd consider my filesystem realtime. There's no point in being pedantic about "but there's a 50ms delay when I hit enter after typing ls so it's not realtime!!!".
"Realtime virus outbreak" implies that the site is somehow automatically identifying where the virus is and updating it's stats, rather than waiting for a human to update it.
Since "implies that the site is somehow automatically identifying where the virus is" is obviously impossible with current tech & infrastructure, the next most "real-time" interpretation is that it has the most up-to-date data as it becomes available... which it basically does AFAIK, assuming it automatically pulls from its data sources, such as the WHO situation report feed.
It's not impossible, most countries have digitized medical records. It wouldn't be technically difficult to automatically send out a ping to a centralized location when a new patient is diagnosed with novel coronovirus. Politically, on the other hand, it's not going to happen.
I don't think that's the case, it is a map of data updated by an editor. The website in question doesn't seem to fetch data automatically as the sources are making it available.
I don't believe that the data on this website is gathered through automatic means.
Real-time is not all about latency, live TV or a Skype call also has a latency but it is real-time for all means and purposes since it is automatically gathered, transformed and transported without human labour and immediately.
I don't believe that the data on this website is gathered through automatic means.
Almost all of it is done by hand by the folks at the Johns Hopkins University's CSSE department. It gets updated around twice a day and they're constantly fiddling with the layout and whatnot.
In other words, it is a plot of data that is regularly updated.
No, it's updated quite irregularly. Given the time difference between the East Coast and China I'd expect that quite a bit of delay is to be expected between information being released and CSSE updating their site. They're also combining data from different sources and clearly are batching updates together.
This comment and the replies to it really give a glimpse into the psyche of the more pedantry-prone members of HN.
For me, if someone says X, and a literal interpretation of X would be impossible/ridiculous, I naturally assume the more generous interpretation Y. I would find it bizarre to believe that X was intended.
Some people however cannot escape the interpretation X, and find the statement bizarre fullstop.
> For me, if someone says X, and a literal interpretation of X would be impossible/ridiculous, I naturally assume the more generous interpretation Y. I would find it bizarre to believe that X was intended.
I naturally assume it either doesn't know what it is talking about, or is trying to be manipulate through intentional misuse of words.
Words have meaning. You don't get to arbitrarily decide to change that meaning. I'm not defending the extreme pedantry, but at some point word use is just flat wrong, and that is the case with the original post.
Although not on topic, I think you point highlights a rather unaddressed issue with data and systems relevance. As you imply, not only is it inherently not possible to track a whole population's "wellbeing", doing so in "real-time" is even more ludicrous. So many measures and metrics are really nothing more than utter fabrications that are totally incompatible in spite of being named similarly, and no, that hardly ever seems to dissuade anyone from hooking up to anything but the most obviously egregious offending systems and their garbage data/information.
Just a single aspect of this issue is, what does real-time mean for aggregate, global measures? Days? Hours? Is it somehow more useful to have 100% accuracy at either interval? And what are the criteria that even determine accuracy at all, let alone precision. This is all a kabuki dance with approaching no relevance, especially in the case of the pandemic when there is also approaching zero confidence in the Chinese numbers at all, and it does not matter how many fancy dashboards are put together by "hooking up to such a system", when the numbers could be 2x as high, 5x, 100x, or who knows because they very system of governance and ideology actively evades honesty and responsibility.
ALL of these numbers should be fundamentally caveated every single time any of them are provided with "that they are Chinese data and the Chinese lie about lying, while lying about the fact that they lied. At the very least currently, trusting any Chinese person is an act of insanity, regardless of whether any given individual Chinese person is honest 100% of the time. How much more do people have to be lied to, deceived, cheated, stolen from, plundered, spied on, and infected with communicable diseases that could crash all of civilization by killing millions before we realize there is a mentally ill manic insanity going around that starts with the insanity of not having a common framework for data and information collection, processing, and conveyance.
I would say flightradar24 is real-time plane tracking and wouldn't say that Reddit is a real-time news source. The difference would be that there's a system in place that consistently and automatically updates the information by gathering data from other real-time systems.
another one here: intraday real-time coronavirus infected count predictor with log scale. If I am right it goes up every minute or so https://www.coronaviruschart.com/
It seemed during the conference that they were trying their best to not step on Beijing's toes. I wonder if they think China would stop cooperating if they called them out on their poor containment procedures.
> How is locking down an entire city "poor containment".
Because it followed a week of ignoring the issue and then another week of arresting people who were reporting on the issue. This has been an issue since December 28th, but China and the WHO are pretending it began just recently.
It's "containment" in much the same way that the Soviet Union just couldn't stop lying about Chernobyl because people miles away were melting from the inside, so they took drastic actions to pretend they were on top of things.
Those "hospitals" they are building (and selectively live streaming parts with glorious Party tunes on the background)? Those were resorts that were almost complete, but since tourism in the area is going to be dead for a decade, they're turning them into hospitals and claiming they're brand new buildings.
What is staggering to me is not that China finally moved when it realized the problem could not be swept under the rug, it's that the WHO is going along with the doublespeak of saying "all is well" but then also declaring an emergency, but don't cancel your trips to China!
Can you find me what the 8 people arrested for actually wrote?
5 have been arrested in Malaysia and 2 in Thailand also, have read the viral fake news they wrote and have no problems with their arrest at all.
In the shadier parts of the internet I'm already seeing services for ruining your competitors with viral social media fear campaigns.
r/Australia has a big sticky of all the nonsense being peddled in the country and the NSW health department is constantly having to repudiate popularly shared content. The bullshit asymmetry principle at work.
> China finally moved when it realized the problem could not be swept under the rug
Again, if this outbreak was in the US or Northern Europe, would they _move_ as quickly? Would huge cities be quarantined? Find it incredibly hard to believe.
It's 2020, hiding things a la Chernobyl is not so easy. I think they are doing a half decent job given the circumstances and it's just the usual China bashing by people who have absolutely no idea about the country and only knowledge comes from the newsmedia
> Can you find me what the 8 people arrested for actually wrote?
One of the doctors saw the initial cases before they were officially confirmed. He told the news in WeChat groups to their friends who were also doctors about a SARS-like virus that's being identified and warned their doctor friends to beware. The other 7 just spreaded the message and they are also doctors. They weren't arrested though. They were warned by the police and forced to promise that they won't do it again.
You speak of quarantining huge cities like it's some sort of accomplishment worthy of praise and not a brute force response to the effects of their own negligence.
Being critical != bashing, why are you being so defensive about the situation? Why are you trying to drag other countries down saying they wouldn't do any better? What is your goal?
Like the hospitals being almost finished resorts? They are building these things from the ground up, there was nothing there, you could even see this in those live streams, from multiple camera angles.
Corona virus was first detected in mid December. Things got pretty serious over the next 4 weeks, 5M people left the city before any containment happened.
So of course now everywhere in China has it, not exactly a good containment. The Wuhan mayor said he'd been talking to the China administration for 4 weeks before being allowed to talk about it to the public.
On timeline of events, there was a week or so of delay between first death + ICL paper and the city lockdown. It can be argued the lockdown was very late.
The OP might also mean poor containment within China - which is only relying on other countries right now.
Certainly later than one would hope, but is there a real world benchmark for the handling situations like this that they fell short of? Have similar viruses crossed over in other countries and been handled better?
apparently science is not working as "how things feel/look like", but about evidence and proof. Same thing applies to gov or org, it's not guided by message on social media, but according to the guidance and standard procedure. This kind of practice are very normal cross every industry, from construction safety guide to medicine testing.
According to [1], WHO or CDC will only report phase 2 and take actions when there is no evidence of human-to-human infection, and declare phase 5 or 6 base on the information unveiled. And from [2], declare PHEIC when there is human-to-human infection cross border.
> A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:
* serious, sudden, unusual or unexpected;
* carries implications for public health beyond the affected State’s national border; and
Without delving into any of the numbers here since they're still mostly speculation (we don't know how many people are really infected / dead), I think it's safe to say that two deadly seasonal illnesses is worse than one and is an outcome worth trying to prevent.
The issue isn't absolute numbers. We don't know the deadliness of the current outbreak. Lets take the flu for example. According to CDC https://www.cdc.gov/flu/about/burden/preliminary-in-season-e.... The death rate is around 0.09% at the worst according the numbers on the cdc estimates (Which is a very pessimistic estimate). If the coronavirus has a mortality rate of 1/100 it would make 10x more deadly than the flu.
I would love nothing more than to wager on that claim with anyone keen.
This thread is full of cringeworthy doomsdayers and armchair epidemiologists throwing around unsubstantiated nonsense. When your only knowledge of this comes from the media people should be a bit more selfaware.
The fact that qAnon folks are all over this and one day old accounts turning up saying millions will die speaks volumes for the level of discourse here.
Bet on the above comment stands for anyone. $1000 USD sound ok? Put your money where your mouth is.
How are you any different than the other “armchair epidemiologists” in this thread? If anything, I’d say you’re worse than others as you want to profit over a potential pandemic where thousands may die.
The stock market has taken a hit over this outbreak fear. Go place your contrarian bets there if you’d like.
It's actually very simple. The Flu has a stable amount of people it kills per year and is already quite established in the human population so it infects a very large number of people per year. nCov on the other hand is a new and poorly understood virus and has only just been introduced to humanity. Extrapolating the number of people it's killed out a few weeks or months, the death rate would be much higher than the flu. The mortality rate is also not firmly understood, with estimates ranging between 2% and 20%.
The reported confirmed counts have grown by a factor of ~1.5 every day, fitting reasonably well with exponential growth. If this rate continued, in 35 days it would reach the world population. Obviously, in the real world the growth flattens out way earlier, from natural causes, and especially because of the attempts to confine it.
Comparing the total number of cases or deaths to flu outbreaks from previous years does not make much sense at this point, when the numbers are growing rapidly, but in a month they probably are easier to compare. Neither does comparing average counts per week, because the growth is not linear. The data for the progression of flu (or any other disease) outbreaks exists, and comparing to their growth rate would put it better in perspective. Regardless of armchair analysis, the WHO declaration means it's something requiring unusual action, which flu is not.
Something else to consider is that flu outbreaks aren't typically taken very seriously by most people, while the widespread fear and media coverage of the 2019-nCov all but guarantees more serious responses from both the general public and the government.
Consider the recommendations to thoroughly wash one's hands during flu season as a precaution against getting the flu. How many people take that advice seriously? You can bet there'll be a lot more hand washing all around once this coronavirus hits people's local areas, not to mention all the mask wearing that'll happen (though unfortunately, most people will be wearing those dinky surgical masks which will be of dubious effectiveness), and people isolating themselves.
On the other hand, we have vaccines for the flu that are available well in advance of flu outbreaks (though not nearly enough people take them), while we've got no publicly available ones for 2019-nCov. That's another confounding variable that makes it hard to compare the two.
As an exercise in understanding exponential growth, for one month would you rather receive $20,000 or 1 penny on day one, 2 on day two, doubling each day until the end of the month. Try it with a calculator or program.
People are concerned because this has a high growth rate that, unless contained, would cause large number of deaths
More importantly, the flu has a vaccine. New versions of it are released each year according to what health organizations think will be the dominant variants.
But, it has a vaccine. If it were necessary to prevent a pandemic, governments around the world could create emergency vaccination programs and emergency production programs for more of the vaccine, and they could be tailored to the strain that was creating the danger.
That's not an option to stop this Coronavirus at all.
* Coronavirus infected can be contagious for longer than flu patients
* The longer incubation period means more chances for people to get sick, especially since the disease comes on gradually. People will think they have an ordinary cold, go to work, and infect people.
* We understand the progression of the flu in most variants. We don't know all the effects of the Coronavirus, we just have descriptions of the symptoms.
* Flu is basically everywhere already, Coronavirus is not. It's not a choice between one or the other, it's a choice between one or both. If we could declare an emergency and have some chance of stopping flu from getting to some part of the population, we would.
* People with compromised immune systems like the elderly, or babies, or people with existing illnesses or lung problems know to avoid people infected with influenza. Since it's possible for people capable of infecting others with Coronavirus to not even know they carry it, it's harder to avoid for those vulnerable to it.
It's much cheaper to respond to a virus like this in early stages than it is to wait until we see "how serious" it is. All in all, getting things moving now is a good idea.
You mixed up your numbers. 3-5 Mio SEVERE CASES, not overall infections.
> Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths.
> The flu has resulted in 9.3 million to 49 million illnesses each year in the United States since 2010. Each year, on average, five to 20 percent of the United States population gets the flu.
Let's assume 10 mil Corona cases in US (like flu lower bound), with 2% mortality. That's 200k deaths. If we assume 49 mil cases (flu higher bound), it's 1 mil deaths just in US.
This 2% number that keeps being thrown around is based on dividing the number of confirmed deaths (which is likely to be relatively accurate) by the number of confirmed infections (which is almost certainly a massive underestimation). It's basically meaningless.
Simply because it has a mortality rate a couple of orders of magnitude greater than the flu's. Something like 8 percent of the world gets the flu in a given year. Millions will die if that happens for this one.
Assuming the CFR remains stable. Most new infectious diseases rapidly drop in mortality because of natural selection: those variants of the virus that make people sickest result in their hosts not surviving or not coming into contact with other people to spread the virus, so the strain that becomes endemic tends to become less virulent and more adapted to its host. This has happened with leprosy, syphilis, HIV, and Ebola, and there's no reason to believe it wouldn't happen with nCOV (if the outbreak isn't contained entirely, as SARS was).
It's highly unlikely that those ambulances are related to the virus. There are 0 confirmed cases in Northern Ireland, and if it was a suspected case the government and media would be all over it to find people who were potentially infected.
While infected to mortality is 3% according to official numbers, which is bad, recovered:dead is less than 50% by the same numbers. Ok have trouble with these reported numbers however, and believe recovered higher. We just don't know. Cross species infection vectors are never good.
Maybe the emergency is less about severity and more about the urgency of attempting containment.
The possibility has been raised that if this goes global, it could become an illness that, like the flu, just sort of continually floats around and we're stuck dealing with it. We don't really want another such illness. If freaking out about it right now can even move the needle on the odds of avoiding that scenario, it might be a good plan.
If nothing else, it's worse in that there's zero vaccination mitigation available. If the flu vaccine was 0% effective this year, that would also be a health emergency.
On top of that, it seems to have worse mortality rate, transmissibility rate, and asymptomatic contagion -- so a little worse in every way, probably.
As with the flu, you're very unlikely to be personally killed by it unless you're over 65, under 5, or in poor health.
You're correct. See [1]. It's usually less than 50% effective, and as low as 19%. A troubling fact is that effectiveness has been on a downward trend the last 4 years.
Quote "One European study in 2008 found a 66% vaccine efficacy (VE) against confirmed influenza for children aged 9 months to 3 years, while a Japanese study of children aged 6 months to 6 years found VE against influenza A ranged from 42% to 69% depending on the vaccine match"
Please don't post unsubstantive comments here. If you know more than others, share some of what you know so that we all can learn, or simply don't comment.
Could you add the timeframe of each pandemic? I believe the coronavirus is 1-2 months old, but how long was SARS to get to 774? I feel like the comparaison isn't great without timeline.
It's also worth noting that the ~8k confirmed cases are bottlenecked by how fast China can perform tests. Here's an article guesstimating that there were up to 100k infections a few days ago:
> It's also worth noting that the ~8k confirmed cases are bottlenecked by how fast China can perform tests.
Do you have more info on this? I thought the test was a simple swab deal that a country like China could crank through like nobody's business. Like, at least for a few more orders of magnitude.
The number of cases reported has been going up by 30% to 70% every day. People in China are taking a number of measures to limit spread but given the potentially long contagious incubation period of the virus it might be a while for that to reduce the visible increase even if it has been relatively effective.
It seems that this virus spreading too easy, so it's not possible to contain it, not now anyway. The best we can do is to slow it down and develop treatment as soon as possible to reduce number of lethal cases. But it'll infect the whole world anyway and poor countries with bad medicine system will struggle a lot.
Virulence versus pathogenicity. Perhaps you contend that SARS' pathogenicity is greater than this coronavirus'? But virulence demands our attention, too. Why? Because public engagement can help prevent its spread.
When AIDS/HIV was near its peak, folks would often compare it in a similar fashion to cancer. If we ignore the fact that cancer is a big diverse bucket, most/many cancers really don't have any 'virulence' so getting public attention to drive best practices to mitigate spread just don't make any sense.
Running the official numbers, mortality rate is less than 3%. If we plug in estimative models claiming 25000+ unrecorded infections, mortality is less than 1%.
Unless you are in a sensitive age group or have other health problems, data suggests you're most likely to get over it as a regular flu.
It's not all perfect and is worse than a regular flu, but especially now after the announcement some people may way over-stress themselves which doesn't do good to your immune system.
You cannot calculate mortality rate as most people haven't recovered fully. We have 3% mortality rate at the moment, but we do not know how many of those infected are still in early stages and what will be the final number of deaths.
If we looked at deaths against reported recoveries than the rate is much higher (I am guessing a lot of recoveries are not reported).
These calculations assume that no one else infected dies. Seems overly optimistic, especially given that ~1200 patients are in serious or critical condition.
That's true. Still as someone with anxieties I find it a useful perspective to assess personal threat level.
First reaction is "I need to avoid becoming infected at all costs". However, the costs are steep. An extreme plan to “sit at home with a month’s worth of supplies” seems plausible, but it would not be healthy to reduce movement so much and if everyone suddenly starts doing that there will be issues with food availability in the area (I live in HK).
If I am statistically so unlikely to die from this infection, I am going to take measures that prevent me from spreading it to someone who isn’t, but I won’t e.g. panic and call police if someone without a mask is near me.
No, but in the absence of that, it seems strange to unpin the denominator while leaving the numerator fixed and then presume that that tells you anything useful.
Setting number of infected humans at 30k, there can be as many as 300 deaths for mortality to be limited to 1%.
Unfortunately, both numbers are fluid, but the assumption is that death count is less so. If the number of deaths is underreported by orders of magnitude then my argument would not stand of course.
EDIT: I consider the number of deaths unlikely to be very underreported based on personal communication with folks in China and HK. There is a fair amount of panic on social media, but “someone I knew died, it seems related to the new virus and deaths may be underreported” so far seems not among the things people panic about. Most panic (some of which is being blown out of proportion for hype and metrics by less than scrupulous sources) appears to be fueled by other things: number of people admitted to the hospital, possible hospital staff infections, and others panicking.
Stupid question: is it possible that hygiene practices contribute to outbreaks like this?
I remember reading or hearing that one input to recent wildfires was the fact that decades of controlled burns to limit the spread of wildfires left a lot of available fuel that otherwise would have burned naturally.
So in that vein, do we have humans with compromised immunity thriving but susceptible to inter-species mutations like this novel coronavirus?
I think you're remembering the fire bit backwards. A lack of controlled burns due to discontinuation of indigenous practices and budget cuts combined with increased fire fighting (preventing natural burns) caused fuel to build up in forests that would have burned away in smaller fires. Many plants in Australia are actually adapted to frequent fires like the eucalyptus tree whose oils ignite during fires to wipe out all competitors near their seeds, which also require fire to germinate. Because of the intensity of the fires this year, it became too hot for many of those species and they now wont be able to reestablish.
A similar problem developed in California due to overzealous fire fighting that built up the forest floor over decades and led to some devastating fires.
In Australia, a larger factor is that cotton farmers have literally been stealing water from the Murray-Darling catchment system, resulting in the entire bush becoming much drier for the past decade.
Do you have any source for that? Cotton farms have taken significant flow and effected the river itself. But I've not seen anything that links these farms to the bush around the region.
The Murray-Darling river system covers most of NSW and Victoria, so it's not hard to intuit that a drier river system will result in drier conditions in NSW and Victoria. I don't have a source which says "the fires were predominantly caused by the drying of the river system", but given the geography it seems more unlikely (at least to me) that it didn't have a significant impact.
> I think you're remembering the fire bit backwards. A lack of controlled burns due to discontinuation of indigenous practices and budget cuts combined with increased fire fighting (preventing natural burns) caused fuel to build up in forests that would have burned away in smaller fires.
It's not always a lack of funding or will (though that's not helping). Burns can only be done when it's safe to do so. There are fewer safe days in recent years.
An additional worry is that northern and southern fire seasons will overlap, leading to a global strain on shared resources.
Hygiene practices can prevent the spread of diseases like this. Wash your hands, don't touch your face, etc. Wear a surgical mask and limit interactions with others if you're sick.
But this virus spreads via droplet transmission, so just being within 6 feet of someone who's infected (and coughs/sneezes) is enough to spread it.
If you're referring to the overuse of hand sanitizer and other disinfectant agents, it might be reasonable to conjecture that their use contributes to the spread of pathogenic bacteria because they destroy non-pathogenic bacteria that could out-compete the pathogenic ones for resources. But this is a virus. It doesn't reproduce outside the body, so I don't think that train of thought applies here.
> If you're referring to the overuse of hand sanitizer and other disinfectant agents
I'm thinking more generally: I was thinking along these lines because the news report I heard [1] described 'wet markets' as a place where disease spread. I'd never heard of it before. But it occurred to me that centuries ago, this kind of thing might have been more common. Processes and regulations for handling of animal products are a net benefit but I wonder if there are any drawbacks.
Oh, eating of bushmeat is certainly how this made the jump from bats to humans in the first place. But it doesn't really have anything to do with its spread among humans.
"But this virus spreads via droplet transmission, so just being within 6 feet of someone who's infected (and coughs/sneezes) is enough to spread it."
On the other hand, people don't seem to be symptomatic for 2 weeks, so they won't be coughing or sneezing during that time, so ordinary hygiene should be enough to prevent most infections during the incubation period.
After people do become symptomatic, the widespread media attention and fear among the general public will likely cause them to go to the hospital or isolate themselves from each other, which should further reduce infections.
Somewhat. However, the virus is a novel mutation, which means that even if we exposed ourselves to other similar viruses at younger age, it wouldn't help. At least that's my understanding.
On evolutionary timescales, it's better to expose whole population from time to time, so that we don't lose the immune system response against these altogether.
Back when we didn't have good hygiene, we had Spanish Flu and Black Plague. It's hard to imagine such massive outbreaks these days in developed countries.
No, Eric Ding has been tweeting pretty terrible misinformation, and is being rightly dragged for it by pretty much every epidemiologist I know on Twitter, including myself.
His takes are bad.
He's called this virus's R0 the worst he's seen in his career, which is absurd. He's conflated R0 and attack rate. Familiar errors because no one pays attention to ID epidemiology until there's an outbreak, and then suddenly decides they're an expert.
If one must go to Twitter for ones epidemiology, I'd suggest Tara Smith (@aetiology) or Maia Majumder (@maiamajumder), both of whom are actual ID epidemiologists and science communicators.
I’ve seen your comments on several CoV articles here, and this one, like the others, has really helped me contextualize the information I’m seeing and feel a little less nervous. Thanks for taking the time to add your input here.
We all seem to be talking about guesstimates and data we can't be sure of, but I see little talk of what we can do.
If this were a tech problem - a big problem that seemed insurmountable - I would break it down into chunks as best I could, look at all the parts of the chain, and ask myself which I could be most effective in tackling first. Treat it like a sprint. Which part of the chain would that be?
With the caveat I'm not a domain expert, obviously, I'd go for the lack of testing kits - what makes testing for something like this so hard and so hard at scale?
Maybe it isn't and it's the supply of kits. Is this not something that is also "fixable"? There's a lot of intelligent and capable people on this forum, why not throw some pasta at the wall?
Well, as far as throwing pasta at the wall - it sounds a little bit like Engineer's disease to think that we can come up with a solution by thinking hard on the problem https://news.ycombinator.com/item?id=10812975
Obviously I'm as arrogant as the the next guy, but I think that arrogant next guy is probably already working on this issue and has a bunch of background in domain expertise and specific knowledge of the logistics I won't manage in a side project while commenting in between fixing bugs on the Equity/Credit analysis app I'm working on right now.
Just my 2 cents, and 2 cents is not worth much in this economy.
Throwing pasta at a wall implies that the idea of coming up with an idea is unlikely, thus not being arrogant, but also points out that it is possible, which it is.
As it is, I'd prefer the focus moved to solutions from speculation, at least it's an attitude I'm more comfortable with.
I don't think testing for this is actually that hard or that hard to scale - we had the full virus sequenced and its genome up on the internet within a couple weeks. Initially we do pcr based tests (easiest to "develop" - you just find the right primers which takes a couple more nites and then maybe a week or two to make sure it works). And there's already talk of people using new tools like SHERLOCK (CRISPR based diagnostics tool, and other tools like LAMP could be used as well (it's a special type of very fast, very sensitive pcr) since I recall some work done with LAMP in previous coronavirus outbreaks. One thing potentially making it hard is just getting equipment/kits into shut down cities (see article discussing Roche's diagnostics effort linked below). There are definitely challenges, but in diagnostics, the technology has come a long way to allow cheap, rapid, scalable testing.
If true, it's mainly because nCov can spread before showing any symptoms. And if true, that testing before 1 week after infection showing negative sign makes it worse.
Now imagine how to prevent a net virus from spreading, where it doesn't show any symptom and scanning it before 1 week shows negative result, while during that time it can easily infect other.
Testing in real people isn't cheap, and currently there is no proven cure either (afaik).
Vaccine is the best solution but it hasn't been found yet.
One of the downstream incentives for this action is that folks like the CDC can point to it as a reason to make more resources available. Concretely, they can order the production of the oligomers needed for PCR testing.
I’ve been seeing this type of reaction a lot lately, but isn’t locking down 1/5 of the worlds population a bit extreme? I mean it’s not like we have a zombie virus going on here.
You might want to give http://www.gleamviz.org/simulator/ whirl. You can simulate any epidemic model on a real-life datasets of mobility and healthcare access around the world.
The tricky part is know exactly what the "correct" epidemic model is: length of latent/infectious/etc periods, etc.
Full disclosure: I was once one of the main developers of this epidemic modeling framework.
Coincidentally I was just looking at gleamviz the other day (I was googling around for accurate modeling programs). Sadly when I tried the linux version, it segfaults after some Qt error.
If containment measures begun on January 22 are effective, cases should begin falling from trend over the next few days (27th through Feb 5 or so). We're at about 10,000 identified cases, I expect that will climb to ~50k, with about 1,000 - 2,000 deaths.
I'm not an epidemiologist, but rather a space alien cat, so factor accordingly.
here is simple intraday real-time coronavirus infected count predictor with log scale. If I am right it goes up every minute or so https://www.coronaviruschart.com/
Apart from more people falling sick (as bad as that is), is there a more fundamental concern that if it runs wild in a less developed country, it'll mutate into something more dangerous? As infections climb, the coronavirus (based on less stable RNA) gets more chances to mutate into something even more virulent or deadly?
Is that a universal truth, or is it historical? Situational? This virus is said to spread well before a person even knows they're infected. A mutation could simply extend that period. Or it could increase the degree to which it is contagious without affecting mortality, right? Or are you saying that this simply doesn't happen in the real world? Flu viruses only mutate with regards to lethality, and only in a way that works against its overall impact?
"Is that a universal truth, or is it historical? Situational?"
It it experience based on historical data. A virus jumping to a new host (species) will be more aggressive in the beginning until it has adopted (mutated) to his new host.
While this is not a universal truth, it is experience and could also be backed up mathematically (>host dies to soon, virus can not spread) and by game theory.
WHO spent the majority of the press briefing in very eerie and artificial sounding praise of China. Also, despite declaring a global emergency, they advise against restriction measures for international travel, which personally boggles the mind.
At some point they vapidly ask "Where is the science behind this?". The science behind this is the discovery of viruses and the impossibility of teleportation.
WHO spent the majority of the press briefing in very eerie and artificial sounding praise of China.
I wonder if they don't want to piss off China and make it say, "Fine, we're not going to cooperate with you. We'll handle it ourselves."
From what I've read, China, and especially the Chinese government, doesn't seem to respond well to the sort of light criticism that people and governments in the west would blow off.
This was my interpretation also. From non-reporting through December to rapid change at the end of December to lockdown of any social venue from museums to restaurants throughout the country since Jan 25th, WHO are giving support to the policy awareness change.
Source: Live in China.
Watching the group in Imperial College closely as they've been giving closest analysis so far.
>they advise against restriction measures for international travel, which personally boggles the mind.
>At some point they vapidly ask "Where is the science behind this?". The science behind this is the discovery of viruses and the impossibility of teleportation.
but it's true though. there's limited evidence that travel bans will stop the spread of the infection. the evidence ranges between "no effect at all" to "delayed infection by a few days".
This doesn't make any sense if I step through it mentally. If you're a carrier of a virus and you have to hoof it to my end of the world, it's going to take you a whole lot longer to get there than if you flew. This is absolute fact. The faster vectors you give to something to transport a thing, that thing will move to its destination that much faster.
> But the trouble is, they don’t appear to be helpful. At best, travel restrictions, and even airport screenings, delay the spread of disease but don’t impact the number of people who eventually get sick. Instead, they make it harder for international aid and experts to reach communities affected by disease. They are also expensive, resource-intensive, and potentially harmful to the economies of cities and countries involved.
On the H1N1 travel bans:
> Again, reduced travel delayed (by three days!) but didn’t stop disease spread. The authors wrote, “No containment was achieved by such restrictions and the virus was able to reach pandemic proportions in a short time.”
So, why?
> It’s expensive and nearly impossible to seal off the borders of a country, the authors of the paper wrote. People will inevitably move — even indirectly from the countries that are quarantined.
The article is innumerate, conflating "doesn't stop" with "doesn't mitigate." The reason is, epidemics don't play out in a manner such that everybody gets exposed with the same severity or to an identical strain of the virus.
That's why staying home from work when sick actually helps.
Because now they have to go through all the paperwork, waiting and hassle to document that they "clearly" are essential... several times. Bureaucracy is never, ever frictionless.
Do you have a strong prior for large bureaucracies, especially at their interfaces with one another, not being sluggish? If so, how do you come by it? If not, whence comes the doubt whose benefit you seem so anxious to give?
My comment is rooted in a general reluctance to make assumptions about things that have empirical or theoretically provable answers, particularly ones that could be obtained without much effort. Some people call it "science."
Yes, I have lots of knowledge of bureaucracy. Do you have any firsthand knowledge to expect that this one specifically will be entirely unlike any other bureaucracy in existence?
I don't understand what your point is. Are you saying the bans are not limited to non-essential travel? Because everything I've read about them thus far has said they are.
>it's going to take you a whole lot longer to get there than if you flew. This is absolute fact.
The article doesn't deny that. One study found exactly what you've claimed.
>A study looking at [the arrival of H1N1 swine flu in 2009] found [travel restrictions] “only led to an average delay in the arrival of the infection in other countries (i.e. the first imported case) of less than three days.”
The problem with quarantines seems to be that their effects are minimal unless you lock everything down AND somehow find and quarantine the already infected who got in, which no country has ever done.
There are many variables when it comes to travel restriction. "Travel restriction" is simply not a binary category which you either have or do not have. Hence, I'm unconvinced by a universal conclusion of "travel restriction does not work" from a few retrospective studies of a few heterogeneous cases of past travel restrictions. I maintain that we should not give in to the conclusion that global spread of infections is simply inevitable, except by chance, and write off restricted mobility completely.
While it's true you cannot prevent with certainty every possibility of the virus coming here, but by implementing travel restrictions you do inhibit and create barriers of it's spread.
This can mean The difference between multiple cities being ravaged by a disease instead of smaller groups of infected individuals.
On the other hand, there simply cannot be literature to back it up unless it is tried systematically. These two things are in direct opposition. In any other experiment, we wouldn't treat the presently available level of evidence as indicative of the final state of knowledge on the matter.
Other studies say travel restrictions delay infection by 2-3 weeks which is precious extra time for vaccine development and rollout. An extra month matters
Thanks for this. Another excerpt I found particularly interesting:
> Internal travel restrictions in England, Scotland and Wales in the United Kingdom were predicted to have minimal impact on the magnitude of the peak and in delaying the spread of the epidemic – possibly because there are some densely populated urban areas and relatively high levels of population movement. However, in a recent review, it was estimated that a combination of internal and international travel restrictions could help to stagger the impact of a pandemic within a country such as the United Kingdom, by desynchronizing localized outbreaks.
This is exactly the kind of unforeseen interaction effects I had in mind a few comments above when I said I'm not convinced we are able to conclude that "travel restrictions do not work" from the present studies. This particular effect will quite obviously also depend on epidemiological factors such as the length of incubation period, whether the disease is transmissible during the incubation period and so on.
There are far too many variables to account for and far too little experimentation has been done so far to conclude anything firmly.
"Notably, the new coronavirus provides a new lineage for almost half of its genome, with no close genetic relationships to other viruses within the subgenus of sarbecovirus. This genomic part comprises also half of the spike region encoding a multifunctional protein responsible also for virus entry into host cells[30, 31]. The unique genetic features of 2019-nCoV and their potential association with virus characteristics and virulence in humans remain to be elucidated."
Hmmm... interesting.
Edit, full title of article.
"Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event"
You can get a lot done if you don't care who gets the credit for it. The WHO wants to stop the spread of the virus. If buttering up China and praising them in public gets this done, then so be it.
> WHO spent the majority of the press briefing in very eerie and artificial sounding praise of China.
This was my favorite:
> "The main reason for this declaration is not what is happening in China but what is happening in other countries," said WHO chief Tedros Adhanom Ghebreyesus.
The way all global superpowers and, by extension, their organizations have to babysit China's government has gone from ridiculous to ridiculously dangerous. Politicans pretend not to notice human rights abuses, ignore the fact that the regime is repressive and a danger to its own people, and now try to act like saying 'Hey, the virus originated in this country, hope they contain it' is some horribly offensive thing. It's unjustifiable in my eyes.
Please don't take HN threads further into nationalistic flamewar. It makes discussion nastier and more predictable—the two things we're most hoping to avoid here.
Grow up. WHO is not an organization to talk about human rights or other things. It's HEALTH, that's what the H is in. China started of slow, but they have really stepped up in doing their part to help contain the virus. Nothing wrong with recognizing their effort. Let's not forget that the scientists working around the clock in that country are not "China" but individuals like you and me.
a) 'Grow up' is not useful discourse, please leave that stuff on social media.
b) Recognizing their effort is fine and the right thing to do. Saying 'oh, we don't need travel blocks' when the virus seems to mainly be spread from one province is dangerous. And this following part is just wildly misleading and a clear attempt to babysit the Chinese government's feelings:
"The main reason for this declaration is not what is happening in China but what is happening in other countries," said WHO chief Tedros Adhanom Ghebreyesus.
If I see anyone even trying to go for the bathroom door without washing their hands I'll definitely be shouting at them until they wash their hands and follow them (at a sanitary distance) in order to ruin their day and make sure everyone they come in contact with knows they've got significant amounts of fecal matter on their hands.
>The premise of the sketch is that Abbott is identifying the players on a baseball team for Costello, but their names and nicknames can be interpreted as non-responsive answers to Costello's questions. For example, the first baseman is named "Who"; thus, the utterance "Who's on first" is ambiguous between the question ("Which person is the first baseman?") and the answer ("The name of the first baseman is 'Who'").
I'm not asserting initialism vs acronyms. I'm talking about the grammar of "Who did".
If you actually meant the World Health Organization, you'd have to interpret that as "World Health Organization did". This is obvious incorrect, and rather should be "The World Health Organization did". So there is no way for your daughter to have interpreted what you said as talking about the World Health Organization, whether initialism or acronym.
> Sorry if I took you away from fact checking open mic night. :-D
No, I wasn't distracted at all. Thanks for the concern, though.
It's about time... All early characteristics of the novel coronavirus indicate it's far more dangerous than SARS/MERS/seasonal flu (which kills 30-60k/year in the US) so, unless a cure is found soon, we should expect it to kill more people than these other diseases combined :
https://mobile.twitter.com/zorinaq/status/122263149332482867...
I think it would be more helpful to cite actual epidemiology research and public health professionals rather than people who seem to use people's fears to garner attention.
Edit: In order to make this a little less dismissive, the actual argument in that Twitter post is that due to lag between first symptoms appearing and death, you can't divide fatalities by total cases to get the mortality rate, and should instead use total cases N days ago. Makes sense superficially, but
* cases that get reported are biased towards people who get more sick
* the 20-56% mortality rate claimed based on guessing N=6 is inconsistent with the mortality rates outside of China, where no one has died so far.
But I'm no epidemiologist, so don't believe me either.
The rates for Chinese provinces except for Hubei seem inconsistent with 20-56% mortality too. The ten provinces outside Hubei that have the most confirmed infections are:
Although there's a clearly a lag between confirmed cases and death, there's likely to be less lag in outcomes between patients who recover and patients who die.
On this admittedly small sample, we get 29 recovered and 3 deaths, or about a 10% death rate. That's still pretty high, but it's nowhere near the 20-56% death rate.
If people go from being infected to dying more quickly than they go from being infected to being declared to have recovered, then that would lower the rate. The recovered rate seems to have been increasing faster than the death rate in the last couple of days, which might indicate this is the case. In addition, these cases obviously only include patients who present with symptoms. If some people are asymptomatic, that would also lower the death rate.
One other observation, for what it's worth. According to the John Hopkins site, between 29th Jan and 30th Jan updates (that's the data I happen to have access to), we have worldwide:
* 29th: deaths 133, recovered 126
* 30th: deaths 171, recovered 143
But for Hubei, we get:
* 29th: deaths 125, recovered 88
* 30th: deaths 162, recovered 90
Which looks like the death rate is going up in Hubei.
Subtracting Hubei though, for the rest of the world (but mostly China) we get:
* 29th: deaths 8, recovered 38
* 30th: deaths 9, recovered 53
* difference: deaths 1, recovered 15
Of course these numbers are too small to have real significance, but they're worth watching over the next day or two. It looks like outcomes are very different outside of Hubei from in Hubei.
It's consistent with natural selection. Cases inside Hubei likely have fewer viral generations (= less mutation) than cases outside. Additionally, every case outside has a population bottleneck in that it was transmitted through a host that was well enough to travel. The most virulent cases would be expected to sicken their hosts and discourage travel or extensive social contact.
Surely all current cases have experienced roughly the same number of viral generations? A death outside Hubei today will be caused by a virus with roughly the same number of generations as a death inside Hubei. Yet a smaller fraction seems to be dying outside Hubei.
Other possible explanations are that the healthcare system in Hubei is overwhelmed, so more patients die, or alternatively they're just too busy to accurately report recoveries.
Hubei is estimated as being max at the 5th generation, and genomes so far have indicated less than 0.02% genetic variance. I don't see evolution playing a succincts) significant role in this timescale.
Not really surprising considering medical resources in Hubei are heavily strained, not all severe cases can be diagnosed timely and given enough attention afterwards, which is not true elsewhere.
Edit: Oh you mentioned this yourself in another comment.
Just to update with the latest statistics, since 29th Jan, up to 30th Jan 9:30pm EST, for rest of world outside Hubei, there have now been 1 death and 33 recovered. So the trend seems to be that the death rate (calculated as deaths/recovered) outside Hubei is falling. Still early days and small numbers though.
«cases that get reported are biased towards people who get more sick»
True, the data is biased.
«the 20-56% mortality rate claimed based on guessing N=6 is inconsistent with the mortality rates outside of China, where no one has died so far»
It's not statistically inconsistent. When China had 100 cases confirmed, they had reported only 2 deaths. Now there are 100 cases outside China, so statistically we should expect 2. 0 actual vs 2 expected is statistically insignificant. Also the rest of the world is so much more prepared after the wake-up alarm call from China that out of the 100 confirmed outside China, they are probably receiving superior healthcare than overwhelmed Chinese hospitals. I would expect the mortality rate outside China to be slightly inferior.
It also means though, that the first death outside China should happen soon. I predict in the next week.
> It's not statistically inconsistent. When China had 100 cases confirmed, they had reported only 2 deaths. Now there are 100 cases outside China, so statistically we should expect 2. 0 actual vs 2 expected is statistically insignificant.
My point here was that the China data is probably biased because the medical system there is overtaxed, but outside of China it isn't. Therefore, estimating mortality based on non-China data seems safer, and no one outside of China has died so far.
If I take your low end mortality estimate, 20%, and apply that to the number of non-China cases 6 days ago (12), you get only a 6% probability of all of these people surviving. Note that this already contains a lot of assumptions (going back 6 days, taking your lowest mortality estimate) that work in favor of your alarmism.
When the WHO declares something a "global health emergency" we have valid reasons to be alarmist :)
I think that "going back 6 days" is insufficient, so your conclusion of a 6% probability is unsupported. Given the extreme state of paranoia around the world (eg. authorities testing people coming out of airplanes) it is likely that cases outside China are detected very early after the onset of symptoms. As such, death, when it takes place, will probably take more than 6 days after a confirmed case is detected.
In fact, the studies in The Lancet document cases of patients that take much more than 6 days to die.
We can speculate all night, it remains speculation. All I've done is use the numbers you suggested to point out inconsistencies. Yet you keep finding reasons for why we are almost literally all going to die (with mortality rates of up to around 50%), when you have no more insight into this than anyone else in this thread.
Everybody is taking this seriously, but playing prophet of doom is really shitty and has all sorts of potential negative consequences in the real world.
I suppose I didn't communicate clearly. I never said we are all going to die. For one, we are probably going to find a vaccine or treatment. And the eventual observed CFR may end up being in the lower end of what I quote (9%) instead of the upper end (56%).
You tried to point out 1 inconsistency, and I replied back saying it wasn't an inconsistency ("0 actual vs 2 expected is statistically insignificant.") It's too early to tell if the CFR outside China will differ from the CFR in China.
Yes, and the medical professionals dealing with this are getting statistics about diagnosis and recovery rates and times by analyzing case histories, not applying estimation formulas to totals.
Data gets aggregated and used in mathematical models that can predict outcomes in various hypothetical scenarios, but given that this is a real-world situation, the professionals are going to be looking at the actual data first to find out what’s happening. They can directly answer questions such as, of the patients diagnosed 1 week ago, what’s their status today?
Anyone looking at only total numbers of cases per day simply doesn’t have the data required to compute the things they’re trying to compute with much accuracy. It’s possible to produce estimates with confidence intervals based on sensitivity analysis, but nobody doing that with any care using aggregate data is going to come out with a number as high as 20% for a lower bound. Given that N=6 is a guess, the range reported should be bounded by plugging in plausible extreme values for your guess of N, not assuming your guess of N=6 is exactly correct.
>Cases that get reported are biased towards people who get more sick
True, however I fail to see how this point is relevant when comparing statistics with past diseases - as the same could be said of our historical data we have for SARS or anything else. In any case, we only have reported confirmed cases. Doesn't seem to make sense to me to factor in a unknowable variable here but not in other cases...
Well keep in mind that China, at least Hubei is overwhelmed. But if anywhere else on earth it ramps up to 100k sick quickly will be overwhelmed as well.
It remains to be seen if the rest of the world can keep the infection rate low enough to not repeat the Hubei progression.
Stop spreading misinformation and getting your information from Twitter, and when you do—try reading it first.
Even when compared to SARS in that chart it looks like it has a lower R0 value and about the same fatality rate, minus some odd outliers and what it likely fake news (it doesn't have a fatality rate of 56%). And the citation for that 56% number is a link another link to Twitter… that is self referential. And actually I think YOU are also that person.
When people talk about "fake news" this is what they are talking about. This is like 3-layers deep of fake news. You are linking to yourself in a post that uses yourself as a citation.
Yes I made the table, but which part of this table is misinformation? All data is valid. Twitter is not a good format to present a bunch of data, hence the convoluted link to a link to a link...
However, for your information, the 56% case fatality ratio is calculated according to an epidemiological method known to produce a good estimate. See https://pdfs.semanticscholar.org/ebf2/48c9fc0a1a23d1778b9408..., section Simple Estimators, specifically this formula:
e₂(s)=D(s)/{D(s)+R(s)} which is: deaths/(deaths+recoveries)
And the paper concludes: "The second simple estimate based on the ratio of deaths of those for whom the outcome is known, e₂, is reasonable at most points in the epidemic" ie. produces a good estimate of the eventual observed case fatality rate.
That's a non-answer. My data is valid. I challenge you to point out specific errors.
My data comes from two sources:
1) Initially I replicated the chart by Dr. Melvin Sanicas, a vaccinologist and public health physician, that he posted on twitter (here: https://twitter.com/Vaccinologist/status/1220469109378502658). He had no citations for his numbers. So I performed light fact-checking but didn't bother documenting citations for each number because (a) he is a doctor and (b) his chart got massive reviews on twitter and no one pointed out significant errors.
2) For the rest of the number, I plugged them in myself WHILE adding proper citations to either peer-reviewed papers or to the best estimates available today.
As to empty cells, they are empty when the data is not yet researched, or not known, or because it is irrelevant (eg. for most older diseases that have vaccines available I didn't bother researching if asymptomatic transmission is possible because it is irrelevant: most people in developed countries are vaccinated as such such diseases are no longer prevalent.)
Okay here's an answer: the whole thing is misinformation. Mashing together incomplete data sets to make a point is… nothing. That's not a thing. That's not science or data. That's garbage.
If you're not a troll you should take a step back and actually THINK about what you are doing. You are creating misinformation, posting it, then reposting it elsewhere and citing yourself.
Stop it. Stop being a garbage human trying to scare people with nonsense. Be better. No "what ifs" or "whatabouts". Delete your comments, delete your tweets and try to be a better person.
Another non-answer. It is perfectly valid to compare various epidemiological characteristics like I did, and like Dr. Melvin Sanicas did (are you going to criticize him too?) A lot of us on HN are sufficiently educated to have decent discussions about topics we are not experts in. If you have constructive criticism, give it to me instead of your non-answers.
Q: “Yes I made the table, but which part of this table is misinformation?”
A: The entire table is misinformation.
It is not valid to do what you did. You are wrong. You are misleading people. The “question” is whether you are doing it intentionally or not. I don’t have that answer, only you do.
Some actions warrant uncivil responses, and trying to induce the pain of unnecessary panic in other people to shill a social media account is among them.
Viruses tend to become less deadly as they spread because dead people don't spread disease. Typically it mutates slightly into a less deadly strain. Then that strain spreads more quickly and gives the population some level of immunity against the more deadly one.
> Viruses tend to become less deadly as they spread because dead people don't spread disease.
This is why the longer incubation time of this coronavirus is such a concern. It gives a potentially fatal disease more time to spread before it self limits. Also, I've heard reports that some infected are asymptomatic, so it may continue to spread even while taking out some people.
Not if this Coronavirus is asymptomatic for two weeks. These are still China claims and the west is still suspicious. But if this is true then holy cows.
I was asking specifically about this claim: “Viruses tend to become less deadly as they spread“
I understand the basics of evolution. I also don’t have any trouble understanding the trades between transmission and virulence. However, this is not the same as saying that the typical virus becomes less virulent over the short term during a major outbreak.
No infectious disease epidemiologist I know would lump SARs, MERS and seasonal flu together like that, and I'd argue the data very much doesn't support the assertion that this disease is significantly more dangerous.
Serious, yes. But it's quite a hurdle to go from what we're seeing now to "worse than seasonal influenza".
I don't know enough to directly question your numbers, but you should be upfront that 1. you're quoting your own twitter feed from another username, and 2. you're not an expert (at least in the standard sense of the word) in epidemiology or a related field.
* 15,000,000 – 21,000,000 who had the flu
* 8,200 – 20,000 deaths from the flu
The morality rate ranges from 0.03% to 0.09% or 3/10000 9/10000
https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...