Comment by nodamage | Hacker News Reader

Comment by nodamage | Hacker News Reader

A few thoughts:

1) Extrapolating from the infection rates of very specific groups (for example, evacuees) to the entire population without taking into account transmission dynamics and the time between infection and detection does not make very much sense. The authors naively multiply the infection rate among evacuees by the population of Wuhan to conclude that Wuhan must have had 178,000 infections at the end of January. By comparison, epidemiological models have estimated there were around ~20,000 infections at that time [1][2][3]. What conclusion should we draw here? If you use sloppy, back of the napkin math to over-inflate the infection count by 10x then you can correspondingly deflate the mortality rate?

2) Speculating about the mortality rate of Covid-19 based on several gigantic assumptions ("If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%") seems borderline irresponsible. Numerous researchers have been modeling this virus and have generally arrived at numbers in the range of 0.5% to 1.6% [4][5][6][7][8][9]. The authors don't present any compelling reason why we should doubt those numbers.

3) Ultimately the mortality rate is not as important a number as the hospitalization rate. The authors would have you believe this virus is no worse than the flu, but this is not congruent with the number of reports coming out of places like Italy and New York saying they're about to run out of ICU beds, or China rushing to build temporary hospitals to house all of the patients that need critical care. What the mortality rate might be under ideal circumstances where every patient receives adequate medical care might be significantly different compared to a scenario where you've run out of ICU beds and have to start rationing ventilators.

[1] https://www.mdpi.com/2077-0383/9/2/419/htm

[2] https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v...

[3] https://www.mdpi.com/2077-0383/9/2/523/htm

[4] https://www.imperial.ac.uk/media/imperial-college/medicine/s...

[5] https://institutefordiseasemodeling.github.io/nCoV-public/an...

[6] https://cmmid.github.io/topics/covid19/severity/diamond_crui...

[7] https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...

[8] https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v...

[9] https://www.nature.com/articles/s41591-020-0822-7

I got a story about the Wall Street Journal. Back in the mid 1980's Genentech had it's 'clot busting' drug Alteplase in trials. And Genentechs stock was on a tear. And then one day the news came that the FDA rejected approval saying they needed more data.

Next day I read a howling butthurt editorial in the WSJ with my morning coffee. Basically accusing the FDA of murder.

Since then I don't take the WSJ at face value. The only thing they care about is making money on corporate stocks.

Same thing is going on here. The WSJ only cares that they've taken a bath.

one important element is a behavioral pattern

A person with flu and fever would probably stay home and just rough it out, a person with fever fearing the coronavirus will probably rush to the hospital.

If everyone having a fever in a flu season would go to the hospital and would demand medical attention we would be running out of hospital beds in normal scenarios as well.

You wouldn't run out of ventilators, though, as has happened in different countries with COVID-19.

Can't you efficiently filter for this by only counting the ICU beds (rather than just hospital beds)?

Well at least in the Netherlands your claim is false.

They don't want you at the hospital unless it is absolutely necessary. Got a fever and still able te breath: stay at home.

Too true

It's the same in the US. They won't even test you here unless you're having trouble breathing.

That's not even true. I've had pain breathing for weeks, they still won't test. They prescibed corticosteroids, antibiotics and bed rest. They won't test until you're nearly dead. the CFR here is wildly overestimated.

While that is clearly true, it doesn't change the fact that every population to encounter this virus so far has overwhelmed the available medical provisions. There are people in Italy choosing to drown in their own bodily fluids rather than face the dying the same way in isolation.

It doesn't really matter whether the odds are more like winning a bottle of wine in a charity raffle or losing a game of Russian roulette.

> If everyone having a fever in a flu season would go to the hospital and would demand medical attention we would be running out of hospital beds in normal scenarios as well.

You don't get admitted to hospital because you ask. You get admitted to hospital because a doctor admits you. Currently even covid-19 patients don't get admitted to hospital by asking. They need to be pretty severely ill to get admitted to hospital. Health care professionals are triaging as much as possible, and sending people who are suspected (or even confirmed) to have covid-19 back home unless the patient really needs to be admitted.

Despite all this triage hospitals are over run and many countries are experimenting with field hospitals built in large sporting gym halls or convention centres.

One thing that doctors are telling us is that covid-19 is not like flu for their patients.

> we would be running out of hospital beds in normal scenarios as well.

You don't get a hospital bed just because you ask for it, you get one if a Doctor thinks you need one.

So your premise is inaccurate.

The hospital won’t admit you unless you have respiratory distress.

thank you so much for the insights

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