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Comment by not_a_moth | Hacker News Reader

Watching this closely based in Singapore, the true mortality rate is probably an order of magnitude lower

a) The stats coming from Hubei are adverse selected; they are from patients who already had severe enough illness to go to the hospital

b) A vast amount of mild cases are not diagnosed or tested, this is for reasons related to self reporting and minimal screening efforts globally

c) The virus spreads rapidly (R0 of 4 in some estimates) and has had 3 months to sweep through Wuhan ; there appears to be a lot of death in Wuhan but that may be because most of the 11 million population was exposed

Maybe I'm confirming a bias, but I believe its true profile is something like a more rapidly moving seasonal flu

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They're also selected for people who made it to a hospital. The most frail types, or those who got sick after hospitals were filling up, could have died without ever getting to a hospital, and not even be counted yet.

Agreed but even if you think the real Wuhan death count is 10x the official (ie. ~10K deaths in Wuhan), there's still an order of magnitude lower mortality rate assuming there's been widespread exposure in the 3 months

We don’t know the actual death toll in Wuhan. The number we get is people who were diagnosed and then were determined to have died of the disease. What we’d really like to know is simply how many people have died of any cause, and then subtract a base rate. The total deaths figure is not being provided.

The number of deaths is not being accurately reported either, so both the numerator and denominator are inaccurate.

There are mixed reports coming out of China that claim 60% of bodies are collected from homes, not hospitals, and that only 20% of the dead are being counted as "confirmed" COVID-19.

Also, we do know reliably that about 10% of cases overall, require ICU & mechanical ventilation. I would not characterize that as "vast amount of mild cases"

The extreme steps taken by the Chinese government (which can be assumed to have the most accurate -classified - data), belies that belief. You don't shut down so much of your country over a somewhat more severe case of flu.

Two possibilities,

a) a faster spreading version of flu, which produces a greater overall quantity of severe cases, could be mistaken for a more virulent flu... which is what I believe most reports are doing now

b) the unprecedented lock down is because of the origins of the virus

Another possibility: the subsequent ARDS is catastrophic in smokers. In China, 41% of people smoke.

Good point. Is there a statistics about mortality in smokers vs non-smokers?

This is what I've seen so far:

https://www.preprints.org/manuscript/202002.0051/v1

There are also other hints that line up with this. The mortality rate in the recent 1000+ case study seems to be much higher in males, but the rate of smoking in China is also much higher in males, which could be a clue.

https://jech.bmj.com/content/71/2/154

It looks to me that when medical system is not overwhelmed then the outcome for patients does not look as grim as in Hubei. I think that we will have more clear picture of the situation in coming weeks the cases outside of Hubei are more recent.

> a) The stats coming from Hubei are adverse selected; they are from patients who already had severe enough illness to go to the hospital

I don't think this assumption holds true. In a panic, many people are trying to get diagnosed based on rightfully held fear. These are people who have the energy to travel to many hospitals and stand in lines for hours. In some places, people who are seemingly symptomatic are also encouraged/forced to be diagnosed despite not feeling the need to go to a hospital.

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