Very cool project, and a fun article, though I can't help feel like this thing is more likely to kill you than nCoV-19. It's got a mortality rate of 0.7% (same order of magnitude as the garden variety flu) and I'm betting there's a much more than 0.7% chance this thing blows your lungs clean out haha.
15%-25% have severe symptoms. 5%+ critical. Of the first 100 cohorts in Wuhan with critical symptoms, 49 died (2.5% mortality rate). Patient-1 in Italy is a 38-year-old marathon runner. He is unconscious, intubated, and fighting for life. Doctors say they need "luck".
Doctors and nurses are dying from this. They did not die from treating patients with the garden variety flu. Conservative estimates put the mortality rate at 2.3%, with only room to grow as people die years later.
If you have severe symptoms, but are send home to self-quarantine, because the hospitals are over capacity, death rate is estimated at 80%-85%.
Exactly. The current mortality rate is predicated on the fact that people with confirmed cases are getting complete medical care. Instead it would be clearer if this were indicated as a given only because of the circumstance that there are still enough hospital beds for everyone being infected.
The more important factor is the hospitalization rate. If enough people become sick and hospitals become overloaded with patients they cannot treat to recovery faster than the virus spreads, there would be no choice but to send them elsewhere and the mortality rate would drastically increase. There are only so many professional medical staff but the virus has no limits on the amount of people it can spread to, and it sounds like the amount of continually attended medical care necessary for complete recovery is substantial.
Combine that with the fact that licensed virologists are giving estimates of 40-70% of the global population becoming infected, and I'm beginning to question why nobody in my immediate circle is taking this as an imminent and serious threat to their health.
I think the reason why people dismiss this is that they are either stupid (including intentional ignorance) or scared (to even think about this).
I think that there is also huge amount misinformation circulating initiated by the people who should know better (especially should know better when to not give wrong answer then they actually have no idea).
Or because the data doesn’t bear out the panic. South Korean CFR is 0.2% and over 55% asymptomatic means it may be less fatal than the H1N1 influenza A virus. People are hoarding tinned food over something as severe as the common flu. Yeah another virus isn’t optimal but it’s by no means the apocalypse.
- Fully educate the general public on the seriousness of COVID-19 and their role in preventing its spread;
For the public:
- Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and that the vast majority of infected people will recover;
So the WHO tells you it's serious and concerning. Not that it is as severe as the common flu. Did we see proper management of outbreaks in the West? Well...
> "The incompetence has really exceeded what anyone would expect with the C.D.C.," said Dr. Michael Mina, an epidemiologist at Harvard University.
About hoarding canned foods:
> We're asking folks in every sector, as well as people within their families, to start planning for this, because as we've seen from the recent countries that have had community spread, when it hit in those countries, it has moved quite rapidly
> Dr. Theresa Tam: Prepare ... Some of those steps include stocking up on needed prescriptions ahead of time so there is no need to do so during a possible pandemic. She also recommended people stock up on non-perishable food.
Both Canada and US CDC have told people to prepare, including stocking up on non-perishable food. What's the worst thing that could happen when this turns out to be a tempest in a teacup? You eat from your pantry the next few months, or you donate it to a homeless shelter. What's the worst thing that could happen, when you don't prepare, and this turns into quarantine-levels bad? You'll have to live with the guilt of ridiculing people for preparing for one. The other bad things are unspeakable.
The data you gather may not bear out the panic, but can you think of a reason for that, something to do with social order and public policy in light of a global pandemic?
CFR is not everything, you may survive the first round, with neurological damage, bone damage, lung damage, testicular damage, heart damage, psychological damage, and kidney damage.
> it’s by no means the apocalypse
This may be how you cope, but you can't say this for sure. There is a proper chance at a global crisis, with the impact of the Spanish Flu or WWII. There is too much uncertainty to be complacent and factually discard this. This novel virus is from extremistan, and we "just don't know the damage this virus can do".
> So the WHO tells you it's serious and concerning. Not that it is as severe as the common flu. Did we see proper management of outbreaks in the West? Well...
As they should have until they knew it wasn't as serious as they initially expected.
> CFR is not everything, you may survive the first round, with neurological damage, bone damage, lung damage, testicular damage, heart damage, psychological damage, and kidney damage.
There's zero evidence for any of that.
> This may be how you cope, but you can't say this for sure. There is a proper chance at a global crisis, with the impact of the Spanish Flu or WWII.
There's zero evidence for that too.
Yet another day goes by, yet another day with fewer active cases than the previous day. Yet another day with more resolutions and fewer deaths. We're down to 39K cases active from a peak of 58K.
3 weeks ago the first Italian got infected. 25% of Italy is now quarantined, no way to go out and buy tinned foods, without risking a 3 months detention and 200$ fine. U.S. hospitals seemingly prepare for 96 million Americans infected, 4.3 million needing hospitalization, and 480.000 deaths, or, to explain to their bosses: "10 times a flu season from hell" on top of their regular work. [1]
Italian hospitals are proposing an age limit for admission to the ICU for viral pneumonia / breathing problems, so they can focus on the young people who will have more years to live.
In China we read that those people go home and take their last breath with their family, watching or hearing their old ones take their last breath, maybe some anti-virals if still available, maybe an open-source pandemic ventilator made by citizen scientists?
Or can we all work together, to reduce the community spread of this virus by just 1% by taking a pro-active scientific approach? 100s of thousands of Americans (or even world citizens) could be saved or improved, if we stop talking about a "carona flu" now.
[1] CDC estimates that influenza was associated with 490,600 hospitalizations, and 34,200 deaths during the 2018–2019 influenza season.
The WHO pins it at 0.7% and falling as understanding thereof and treatment improves [1 - page 12, graph on page 13]. This makes a lot of sense as the earliest numbers were based only on people presenting severe symptoms, and huge quantities of people with nCoV are completely and totally asymptomatic.
As with the flu, mortality is highest in older people, and the immunocompromised.
Thank you for providing the source. This helps tremendously in clarifying and advancing the discussion.
We need to be careful about what exactly the WHO is reporting. In this case, they are reporting estimates of the crude fatality rate defined as deaths / total cases. This will equal the mortality rate once the outbreak is over, but has limited use during the outbreak as they call out in footnote:
> The Joint Mission acknowledges the known challenges and biases of reporting crude CFR early in an epidemic.
During the outbreak, a better but still imperfect estimate is deaths / settled cases where settled cases is the sum of deaths and recoveries. [1]
Indeed, I am basing my confidence on the trendline in the graph on page 13. The number of people infected (41K) is about two thirds now as compared to the peak (58K), and the CFR is dropping exponentially as cases resolve.
The situation outside of Hubei looks encouraging but the data appears to indicate that there is probably a threshold of patients (different for each country) from which the mortality starts to rise.
Reasons behind this might be either institutional or purely statistical that is it might be possible that each country can keep alive at least certain number of critical patients and starts to fail when certain number is exceeded and it is possible that smaller number of patients are not representative enough and do not contain high risk patients (elderly, people with other chronic illness etc).
Like you say, if you are over 70 and get it, your mortality rate would be more like 10%, even with these lower numbers.
> This makes a lot of sense as the earliest numbers were based only on people presenting severe symptoms, and huge quantities of people with nCoV are completely and totally asymptomatic.
Isn't another possible explanation that it simply takes very sick people a few weeks to die from it, so if you start counting a week farther back then the confirmed-then-died rate will be higher? (Due to undercounting of people who are going to die from it but haven't yet.)
For comparison, the H1N1 influenza (the most common subtype in 2009) had a fatality rate of 0.45%. In the elderly (65+) studies shown it had a case fatality rate of up to 10% [1].
WHO wants to have their cake and eat it too. They designate Covid-19 as the severe disease, and want only those numbers confirmed with tests. Then to calculate death rate they look at everyone who is infected with novel coronavirus, including those that have not recovered yet.
> huge quantities of people with nCoV are completely and totally asymptomatic.
From 72.314 cases, as of February 11, 2020, only 889 asymptomatic cases (1%).
> However, the total number of COVID-19 cases is likely higher due to inherent difficulties in identifying and counting mild and asymptomatic cases.
> Nevertheless, all CFRs still need to be interpreted with caution and more research is required.
Like the cruise ships:
> The ministry has tested 4,061 people so far, of which 705 were positive, including 392 people who were asymptomatic.
So seems your estimate of "huge numbers of asymptomatic" is not far from the mark. Apologies. See also:
> Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report [due to contact testing] went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.
From same report: "6.1% [of infected] are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure)."
This does not look like the kind of thing you can treat DIY style.
"Early estimates place it far higher than 0.7%" seems both incorrect and a bit alarmist.
From what I've read (see below), the current consensus is that China is under-reporting total infected, possibly by an order of magnitude. China also made several missteps in their initial and ongoing response that is likely increasing their mortality rate, especially in Wuhan and surrounding Hubei. Worldwide, there certainly are and will be people who are infected but are asymptomatic, and don't even know (and of course aren't being counted at all).
I would expect that the mortality rate outside China is -- and will stay -- sub-1%, unless it mutates and becomes more deadly, or if health services eventually become overwhelmed due to quick spread. Analysis of primary data seems to indicate that even non-Hubei China has a mortality rate around 0.7%; Hubei's mortality rate is skewing the total upward by a lot. Rest-of-world looks to be around 0.6% so far.
It looks to me that there is probably a threshold of patients (different for each country) from which the mortality starts to rise.
Reasons behind this might be either institutional or purely statistical that is it might be possible that each country can keep alive at least certain number of critical patients and starts to fail when certain number is exceeded and it is possible that smaller number of patients are not representative enough and do not contain high risk patients (elderly, people with other chronic illness etc).
If you look at the recent data then when number of patients approaches 100 then mortality (CFR) exceeds 2%. Only exception seems to be South-Korea. Diamond Princess is not representative because patients are now evacuated and counted under their countries statistics.
