In the interpretation of the NYS serostudy most favorable to your argument (assume perfect specificity), with 21% actually infected in NYC proper, based on the death statistics and the population of NYC, C19 appears to be a full order of magnitude more lethal than any recent flu strain. That's more than "somewhat" more lethal.
Putting this into perspective: in roughly a single month, we've already doubled the 7-year average annual number of flu deaths.
Project those C19 stats out across the whole population, and assume (generously) herd immunity effects at 70% that halt the progression, and you're looking at mortality rate that swamps that of all wars, terrorist attacks, and natural disasters faced by the US for the last 50 years, right?
Put differently, unchecked and with that extrapolated fatality rate, we'd be looking at something like 53 years worth of flu deaths at the average annual flu death rate? (Again, I'm just averaging the last 7 years for which we have flu stats; they range between ~12k-45k.)
>Putting this into perspective: in roughly a single month, we've already doubled the 7-year average annual number of flu deaths.
I am really surprised how often I have seen "it is just the flu" type rhetoric upvoted on HN. I thought this was an intelligent, technological, scientific, and logical community. I don't see how anyone can square the idea that it is just the flu with evidence like what you posted above. COVID-19 has already accumulated a higher death toll in the US than any flu in over 40 years (I'm sure it is longer, but that is as far back as I can find data on with a quick Google search). That is all with basically the entire country under stay at home orders. There would be hundreds of thousands if not millions of deaths if we treated this like the flu.
I never said that this is "just the flu". I put some thought into my comment, and it's provoked some discussion.
Let me provoke some more: I predict that, by the end of this year, the number of total deaths in people over 85 will be about the same as last year.
I'm using the fact that most deaths from this virus occur in people who are already ill from other conditions. Frail old people are much more vulnerable to succumbing to infections.
Last year, about 13.5% of people over age 85 in the USA died [1]. That high death rate means that, at some point in the year, 13.5% of those people fell very ill, and had only months to live. This year, without the pandemic, a similar proportion of people would be close to death. If they caught the virus that causes covid-19, their death would be hastened. However, they would have died anyway, this year.
I know it's callous to say "they would have died anyway," since death is a terrible thing. However, humans have a limited lifespan, for some mysterious reason, and at some point our bodies start to betray us: we develop heart disease or cancer, and our immune systems become less effective. It's as if our bodies are lowering their defenses, almost inviting death. Often, along comes a flu, to finish the job. This year's angel of death is a different respiratory virus, not influenza.
According to this admittedly outdated CDC page[1], the 85+ age group makes up 30% of COVID-19 deaths. Even if you are right about that group (which I think is feasible but unlikely), there is still a huge population of people who are dying who were not previously close to dying.
That's not an entirely fair way to slice, since only 6% of deaths in any age group are folks without comorbidities. I'll dig up the reference, pretty sure it was NYC data. We'll have to wait for the dust to settle but I'm pretty sure we're looking at an upper bound worst-case of basically everything we've measured re COVID.
I'm at a loss for why anyone should care about the fact that younger people dying have "comorbidities". If asthma or hypertension have suddenly become a death sentence, that is a very big deal; virtually every American has families with one of the "qualifying" C19 comorbidities.
It's not a death sentence by any stretch, you're substantially overreacting.
CDC data puts the US flu fatality rate at 0.1% (up to 20-60,000 deaths for 45,000,000 annual infections ~= 0.1%) and serology studies are putting COVID at around 0.3% -- not adjusting for comorbidities. So it's worse than the flu overall, but massively skewed older so for young and especially young and healthy people it's not materially different than the flu. For kids, its better than the flu -- which kills both the young and the old.
And yeah, the flu kills seemingly young and healthy people, too, we just don't really talk about it.
For old folks, it's much worse. We need to keep them safe, but that doesn't mean we need to freak out about children catching it when they're gonna be just fine. [1] Remember 99.2% of the folks who died in Italy averaged 80.5 years old with an average of 3 comorbidities. Zero health professionals under the age of 49 died in Italy despite constant and repeated exposure. [2]
Not everyone is equally affected by COVID and for the overwhelming majority (99.7% of all people), it's by no means a death sentence.
I strongly suggest you read [2] for perspective. I know all the breathless screaming on television has colored your perspective on all this, and yeah, it's not great. However, allow data to be your guide. We're gonna be just fine.
It is weird how you are insistent on focusing in on how comorbidities impact COVID patients but ignore the same comorbidity issues for flu patients. Also not all comorbidities are created equal. I can understand the original argument if everyone dying of COVID-19 had stage 4 lung cancer, but there are people dying with chronic conditions like asthma that traditionally have little impact on life expectancy.
Also the 0.3% number you are referencing is being questioned as other serology studies have shown it to be 2x-3x higher. The reality of the situation is that we don't know the exact fatality rate of COVID-19. What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly. We also know that the coronavirus is much more infectious than the flu. Like previously mentioned, we have already passed the worst flu numbers even while most of us are under a stay at home order. It seems like no matter how you look at the data, the only way in which COVID-19 is not worse than the flu is how it impact the very young. COVID is more deadly in basically every other way. I honestly don't see what people gain from continuing to downplay this disease in relation to the flu.
> It is weird how you are insistent on focusing in on how comorbidities impact COVID patients but ignore the same comorbidity issues for flu patients.
That's fair, although age matters way, way more, so we can elide the bit for future re-readings.
> Also the 0.3% number you are referencing is being questioned as other serology studies have shown it to be 2x-3x higher. The reality of the situation is that we don't know the exact fatality rate of COVID-19. What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly.
I'm not just referencing the Gangelt data, but also the Vo data, and the Santa Clara data (which is very much in question now). That was also approximately the IFR for the Diamond Princess (0.85%) but of course Diamond Princess skewed much older so likely that IFR represents an upper bound. There are precious few population studies for us to reference, but they're far more valuable for making public health decisions than the ratio of people who go into a hospital as compared to come out. That only defines the numerator, without defining the denominator.
I'm also basing it on the estimates during the pandemic that H1N1 had a CFR of 0.1-5.1% from country to country, and landed on an IFR of 0.02%, or one-fifth the lowest estimate. [1]
> What we do know is that it is at least a few times more deadly than the flu and potentially an order of magnitude more deadly.
Not for all demographics. It's demonstrably less fatal for children, which the flu does not spare, and approximately the same for folks under 49.
> Like previously mentioned, we have already passed the worst flu numbers even while most of us are under a stay at home order. It seems like no matter how you look at the data, the only way in which COVID-19 is not worse than the flu is how it impact the very young. COVID is more deadly in basically every other way.
There's reasons you shouldn't compare COVID's current numbers to an average flu season. One being that COVID's new so none of us have immunity. It's also more virulent. It's affecting a similar size population but just all at once instead of spread out, so it's impact is concentrated in time. That makes it not particularly meaningful to project out. Not to mention that flu number is after a vaccine and after a lifetime of exposures, so likely doesn't represent an apples to apples comparison. If the flu vaccine is 10-60% effective, you should probably multiply the number of expected flu cases by up to 2 - or more. Think of it more like the first time someone caught the flu.
Further, the flu changes regularly, and comes back at us repeatedly, and COVID may well not -- early indications are promising in that regard.
I'm not trying to downplay anything, I'm trying to synthesize the data we do know and not fall into the panic that is dominating the discourse. We shouldn't make big decisions while scared senseless, we should allow the data to dictate as much as possible.
Saying this disease is a "death sentence" for an asthmatic 20 year old is panic. It's just not that. 17% of hospitalizations involved asthmatics in the month of March [2] while 8% of the US population has asthma. So I guess your risk is doubled. From 0.3% to 0.6% without adjusting for age. That is not a death sentence.
I'm just letting you know this is where I drop out of this debate.
You are not being consistent in your arguments. You are criticizing me for not making an apples to apples comparison and in the same paragraph you are doing exactly that by talking about all the preventive measures that reduce flu deaths while ignoring that the country is currently shutdown to prevent COVID deaths.
You are cherry picking statistics to support your point while ignoring data that conflicts with it. For example the data coming out of New York suggests a higher fatality rate and the numbers you are using from the Diamond Princess are either out of date or flat wrong.
You are both putting words in my mouth and pretending I didn't say things that I did. No one here ever said "this disease is a "death sentence" for an asthmatic 20 year old". I already admitted that the only group that has less to fear from COVID than the flu is the very young, yet you are still bringing up that point when I am talking about overall fatality rates.
> You are not being consistent in your arguments. You are criticizing me for not making an apples to apples comparison and in the same paragraph you are doing exactly that by talking about all the preventive measures that reduce flu deaths while ignoring that the country is currently shutdown to prevent COVID deaths.
Apologies, what I was trying to say is that comparing COVID now to an average flu isn't an apples to apples comparison even if the numbers land where they are now, for all those reasons, some of which are non linear. This is including the ones you mention. The flu has a vaccine, and plenty of past exposures. COVID has the shut-down -- though it also has huge virulence and asymptomatic transmissions that appear to be ongoing.
> You are cherry picking statistics to support your point while ignoring data that conflicts with it. For example the data coming out of New York suggests a higher fatality rate and the numbers you are using from the Diamond Princess are either out of date or flat wrong.
Indeed the Diamond Princess number was out of date. I'm suggesting that there's a broad spectrum of CFR estimates (0.08% to 15%) and there's reasons neither is representative.
> You are both putting words in my mouth and pretending I didn't say things that I did. No one here ever said "this disease is a "death sentence" for an asthmatic 20 year old".
GP, who I realize now is not you said: "If asthma or hypertension have suddenly become a death sentence, that is a very big deal;..."
It'll be interesting to see where the dust settles.
Speaking as the person you thought you were replying to: "younger" as in "than 85+", the context of the thread. "20 years old" is something you made up to make your argument look more sound than it is.
The 20-ish demographic is actually the worst case with respect to asthma, representing a larger than average proportion of asthma-positive COVID hospitalizations because they don't really have many other co-morbidities and they're young. It's all in the link I provided. 20-ish is actually to your advantage, not mine. I'm not trying to "win" anything, just provide some perspective.
If you thought programmers were 'scientific and logical' you'd be dead wrong. I used to think that too but after years of experience and seeing so many cargo cult, gut feeling, lazy opinions, bad optimizing just within programming itself, you realize that as a group we are quite prone to emotional argument, lack of discipline and general laziness with argument or research on a topic.
Also: even if it was "just the flu": another flu would be a catastrophe all its own! You can still die of the flu, even in the post-C19 (or F19) world!
Not necessarily. The flu mutates substantially and often, and new subtypes keep popping up making a consistently effective vaccine elusive (flu shots are 10-60% effective each year based on our ability to guess which strains will dominate). There's no meaningful evidence indicating the same is true for COVID yet, so once we've all had it -- or a vaccine -- it could be over just like that, never to be heard from again. Unlike the flu. In the full course of time the flu may well prove to be much more dangerous.
Time will tell. Not saying one way or the other just that the worst case you've illustrated is far from a foregone conclusion.
>I am really surprised how often I have seen "it is just the flu" type rhetoric upvoted on HN
This is a unfair way to respond to [alejo's] comment. The fact that you have responded in this way to this thoughtful response suggests to me that the problem may lie in the way you are reading, understanding, and internally labeling other people's views.
This idea of putting 50 years of any war/ attacks etc is misguided and it’s a wrong use of statistics. A better approach would be to take into account other diseases as you have with its close relative the flu. Others on the list would be other types of diseases. Because all of those dwarfs numbers from wars etc.
Why is it "misguided and a wrong use of statistics"? It's true that the flu kills far more Americans than the last 50 years of war has. If a new disease emerged that was just the flu in a different form, and we retained the mortality rates both from the flu and that new disease, that alone would be extremely alarming: a new cause of death, displacing none of the other deaths, that exceeds most other causes!
Honestly, I think we don't do nearly enough comparisons between disease mortality and other causes of mortality. A "War On Cancer" would have done us far more good than the wars we declared in the 2000s would have.
Nixon signed a bill in 1972 that declared just such a "war on cancer". This war has not been won. A few cancers have been reduced, but cancer as a whole remains intractable. Most of the decline in cancer deaths over the past decades are due to fewer people smoking.
I'm not saying that wars on "terror" are a good thing. It's just that cancer is a very tough problem.
the more precise wording would be that you're comparing different time periods and then using that to extrapolate rationale. that's an error of statistical reasoning.
the more accurate exapolation would be relative to the first 4 months of every other studied emerging disease, considering the estimated errors of each of the important variables. you'd fit the various current studies on corona/covid, considering the high uncertainty as (large) estimated error, and providing a range of future outcomes with probabilities on them.
instead, you're asserting your worst possible scenario as the most likely outcome.
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now on the idea that we're entirely too blasé about preventable mortality in general, i agree. if we rigorously and intelligently attacked auto accidents, if we addressed cardiopulmonary diseases caused by pollution and poor habits, and if we regularly shut down the economy for the past decades because we want to reduce the hundreds of thousands of contagious disease fatalities every year and had the socioeconomic safety nets in place for that all along, then the current actions would seem more reasonable.
instead, the response is out of proportion with our own past actions because of panic and fear. it happened with 9/11, mass shootings, fukushima, and everything else. the herd is not good at reasoning about rare and novel mortality events.
"...and assume (generously) herd immunity effects at 70% that halt the progression..."
That's not generous, or not generous, it's just a ballpark guess based on the best (conflicting) data we have so far. You're also discounting the fact that with every individual to gain immunity, the transmission rate is reduced. You're also extrapolating from what may be the worst possible phase of this virus. As time passes we develop better treatments and medications, we have more necessary equipment where it needs to be, we have better early detection and so on.
"...you're looking at mortality rate that swamps that of all wars, terrorist attacks, and natural disaster"
Lots of things swamp those numbers. For example, the flu.
This visualization is from before the acknowledgement that COVID-19 deaths were only counting confirmed positive / presumed positives from the earlier set of CDC symptoms, not the 3x larger set of symptoms revised last week.
Also doesn't account for second order deaths such as those with other health problems not seeking treatment from an overloaded system, or providers in the system committing suicide from PTSD.
55k/yr is also much higher than the actual average number of flu fatalities per year, which is closer to 35k even if you include the preliminary stats from the last 2 years (which captures the particularly bad flu year we had in the '17-18 season).
On the other hand, you can't discount the fact that 20-60K Americans die of the flu each year after we developed a vaccine due to its propensity to mutate. The vaccine is only 10-60% effective depending on the year, while early signs are pointing to COVID not mutating in the same way so a single vaccine (or single infection) may be enough to protect you -- potentially for a very long time.
Taking into account the lack of all immunity to and lack of vaccine for COVID to date, and just how much more virulent COVID is (therefore front loading the disease burden) in the full course of time the flu is almost certainly going to take a much, much larger toll.
It's killed 600,000 people per year, each and every year you've been alive worldwide. So far, COVID is at 1/3 of a year's worth of flu deaths -- let alone a lifetimes -- and are approaching 25%+ of the population of some high profile cities infected. Once it gets to 70% or so, it's most likely going to burn itself out due to herd immunity.
Why are you moving the goalposts? We're discussing US mortality figures, and in the US we have good stats on this, and they average out to ~36k fatalities annually.
I'm not moving any goalposts, goalposts remain in tact. And I'm using the same source: both numbers come from the CDC. So for your reading pleasure:
"It's killed 20-60K people per year, each and every year you've been alive in the US. So far, COVID is at about a year's worth of a bad flu deaths in the US -- let alone a lifetimes -- and are approaching 25%+ of the population of some high profile cities infected. Once it gets to 70% or so, it's most likely going to burn itself out due to herd immunity."
That the flu is a reasonable baseline was obvious enough that I included it in the comment you responded to. The comparison is not reassuring. And the notion that "every individual that gains immunity reduces transmission rate" is exactly what "herd immunity" captures.
Herd immunity occurs when enough members of a population are immune to make sustained transmission impossible. But the transmission rate declines with every immune member of a population, far before herd immunity occurs. Same logic, but a different phenomenon, and one most people seem to overlook.
You're trying to bring galactic brain thought to a rather mundane, simple, calculation. (Fine, 1993) Please don't try to be a contrarian when out of your field, you end up making 'not even wrong' statements
It brought me great delight to watch you confidently declare _you_ are the one with a full nuanced and fair grasp of this situation.
You calculate herd immunity % from R0, and it's odd to decide 70% is not generous and ballpark guess because you think the data "conflicts" - there's no
"conflicting" between values in a range, go ahead and cherry-pick the lowest R0 you've seen and find out what the herd immunity % required is based on that (higher than 70%)
Won't even touch you trying to pretend this is the same as the flu, plenty of other threads address that.
I've made it clear already, but just to reiterate, this is one of the worst comments I've seen on HN in a while.
Project those C19 stats out across the whole population, and assume (generously) herd immunity effects at 70% that halt the progression, and you're looking at (a) mortality rate that swamps that of all wars, terrorist attacks, and natural disasters faced by the US for the last 50 years, right?
Yes. "Flattening the curve" just means keeping the hospitalization rate below what the medical system can handle. The curve stays flat near the peak rate. See the curves at [1]. The Financial Times has been updating those daily since early March. Some countries show a decline, but other than China and South Korea, which did heavy testing and lockdown, most countries peak and decline a bit, then level out above 50% of peak.
That continues until "herd immunity", either via vaccine or exhaustion of uninfected people. That's somewhere around 70-80% for this.
The vaccine situation is looking up. At least two vaccines are already beginning clinical testing for effectiveness. One from Oxford, one from Germany.
As I understand it, and I'd be happy for expert correction: lockdown has additional benefits beyond curve flattening; it also accounts for decreased transmission, which can get us to a point where we can track and suppress outbreaks individually while opening up the economy. That's essentially what seems to have happened in South Korea.
The lockdowns appear to have also stopped transmission of most other infectious diseases. Notably, influenza.
Influenza has a lower R0 than SARS2, and it absolutely kills people. Worth destroying our economy over, all by itself? Ehhhh... I mean, we could have done this at any time, and we didn't, so no.
Nice side effect that translates directly to lives saved? Absolutely.
Does it offset other probable side effects, such as increased heart attack mortality from patients being unwilling to go to the hospital, or increased suicide risk from sudden business failures and unemployment?
No idea, like, none. Biostatisticians are going to be crunching 2020 for the rest of the decade.
The decision is not in reality between "destroying the economy" and "opening the economy up", because even in places that aren't doing strict lockdown, economies are cratering. Even if you opened everything up, people would still make their own decisions to participate or not in the economy, and right now, it looks like they're going to make the economically painful choice.
So then: if you're going to take on a massive economic hit just from altered consumer behavior, does it make sense to get the worst of both possible worlds by also relaxing regulatory constraints that are demonstrably saving lives?
You're drawing more out of that turn of phrase than I intended. Which makes sense under the circumstances, people are drawing lines in the sand and "open at all costs" is one of those lines.
It's not my stance. This is more narrowly-focused than that: we could end the flu season early, every year, by imposing lockdown from January 1st to February 15th.
But we don't, and this isn't the flu, it's a novel disease which kills many more people by even the most conservative estimate.
Still, as a side effect of the eminently rational (and economically painful) precautions which we've taken against it, ending the flu season a couple months early is a nice bonus.
One factor people often forget in the fatality equation is the attack rate, or how many people can be potentially be infected. For the flu, it is around 10% to 15% yearly. For C19, it could be >80% given that there is no natural immunity nor vaccines. Taken that into account, C19 could be at least 40x deadlier than the flul (Flu: 0.1% CFR 10% AR, C19: 1% CFR 40% AR). The 0.1% CFR for the flu is taken from the estimates of the 1957 and 1968 pandemics, which left 100K fatalities in the US. Estimates for the seasonal flu are lower than 0.1%.
Putting this into perspective: in roughly a single month, we've already doubled the 7-year average annual number of flu deaths.
Project those C19 stats out across the whole population, and assume (generously) herd immunity effects at 70% that halt the progression, and you're looking at mortality rate that swamps that of all wars, terrorist attacks, and natural disasters faced by the US for the last 50 years, right?
Put differently, unchecked and with that extrapolated fatality rate, we'd be looking at something like 53 years worth of flu deaths at the average annual flu death rate? (Again, I'm just averaging the last 7 years for which we have flu stats; they range between ~12k-45k.)
(Happy to have my math corrected).