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Open letter from Italy to the international scientific community

left.it

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Re: Open letter from Italy to the international scientific community

#341
> From our data, about 10% of patients require ICU (Intensive Care Unit) or sub ICU assistance and about 5% of patients die.

I think that we really need to understand precisely what conclusions these represent when we see statements like this.

Exactly what does "10% of patients" mean? 10% of those who test positive? 10% of those who test positive and also show symptoms?

It seems that a majority of people who contract the virus and test positive (let alone those who are exposed) do not show any symptoms at all.[0]

Of those who do show symptoms, estimates regarding how many any seek out, receive, or require care vary widely, so much so that it's very difficult to draw any conclusions using any dataset that I've seen.

So I ask: When the authors here say "From our data", exactly what dataset are they using and what operations are they performing on this dataset to arrive at this number?

This is crucially important, because if this 10% is actually 10% of those who already seek treatment for respiratory illness, and also subsequently test positive for COVID-19, then the death rate is actually much, much lower than most of the published reports.

It seems to me that we need to know the answer to this before proceeding with any other restrictive public policy solutions.

I'm particularly concerned with the decision to close schools, which in many cases (at least here in the USA) is inevitably going to lead to kids being placed with grandparents for care, which is a terrible outcome if our goal is to reduce exposure to vulnerable populations.

It is OK to question the panic. It is OK to believe, as I do given the available data so far, that the panic is more harmful than the virus itself. I have started a subreddit to gather data and opinions inclined toward using this as an opportunity to appropriately prepare rather than race to drastic solutions likely to hurt vulnerable populations.[1]

0: https://eurosurveillance.org/content/10.2807/1560-7917.ES.20...

1: https://www.reddit.com/r/PrepareInsteadOfPanic/

Re: Open letter from Italy to the international scientific community

#342
post #328
post #313

Earlier quoted context omitted.

No leader wants to take drastic action for their nation when the number of deaths they can point to for justification is smaller than the number of deaths for the seasonal flu. If they save lives and prevent the disease from spreading, it looks like they over-reacted and unnecessarily tanked the economy.

This. No self-preserving politician wold have reacted early to this. And you don't get to that level without being self-preserving.

Taiwan's leadership, ahem. Only 50 or so cases and their approval rating has soared.

Re: Open letter from Italy to the international scientific community

#343

Earlier quoted context omitted.

The full danger was unknown in the initial stages. Provincial officials were downplaying it for various reasons, and until the very end of December it wasn't known to even transmit person-to-person. Once the threat was clear, the government of China acted much more alacrity and decisiveness than any Western country, which have had months of advance notice.

The fact that there wasn't a credible free press to report responsibly on an emerging illness or a free vote to hold officials accountable are not at all unrelated to the authoritarian system that allowed them to build a hospital fast or close a city or whatever they did well on. I'll admit, though, that I wouldn't trade my right to vote for a cure for the common cold, coronavirus, or anything else.

> authoritarian system that allowed them to build a hospital fast or close a city or whatever they did well on.

Look, this is a dangerous meme in more ways than one. Italy and Spain managed to lock down entire cities, and those are countries with a strong tradition of democracy. Emergency powers, martial law etc. are a thing, and there's even quite a bit of precedent for using them to deal w/ disease outbreaks. Even in the US.

Re: Open letter from Italy to the international scientific community

#344

I've seen comments here trying to play down the message or discredit the signatories of this letter. Don't. Please take it seriously. This is not sensationalism. What the letter means is that if your country is not there yet, you might be DAYS away from widespread panic and total lock down. I'm writing this from Barcelona, Spain. This last Sunday, 6 days ago, I went on a walk with my girlfriend, had a nice lunch, too…

I fear that the situation is already at that state in the USA. There are 1600 confirmed cases but the lack of tests hides how many real infections there are.

There are far more than that today, the number you're quoting is the last cdc report (published mid day Friday). Current number is likely around 3000. NYT last published ~2700 from aggregating state reports, and their per state numbers were a bit lower than every state website I checked.

And this is with extremely limited testing.

Re: Open letter from Italy to the international scientific community

#345
post #251

Earlier quoted context omitted.

That is the most useful graph on this subject so far. Go look at it now. Most countries have exactly the same growth trajectory measured from 100 cases. That's solid data about how this behaves. Singapore and Hong Kong have been able to slow things down by strong measures, but it's still a straight line on a log graph, just with 1/3 of the growth rate. Italy is on the same line, just 8 days ahead of Europe and 13 day…

I have one issue with or maybe just question about this graph. Why it starts with 100 detected cases? It seems like arbitrary round number, but it also seems to be the smallest arbitrary-looking number that makes SK overlap other countries. Why is that? Why is the initial slow spread in SK irrelevant? What caused it to be initially slower than in other countries?

This doesn't really matter, you're just doing that to make it easier to compare. Shifting South Korea so it doesn't overlap the other countries is possible but not terribly useful.

They do seem to be missing Denmark though, which should stick out somewhere top-left of Norway.

Re: Open letter from Italy to the international scientific community

#346

Earlier quoted context omitted.

No, not even close. Those wet markets are a fucking nightmare. There are truly optimized for pulling new diseases into the human population. Thousands of animals, hundreds of different species, many known to be reservoirs of potential human pathogens, crammed together in close proximity with each other and with humans who eat them. In his interview with Joe Rogan, Michael Osterholm called it "the perfect experiment t…

You are missing the point of my comment. A bat infecting a pig or some other two step is a pre-cursor to many Zoonotic events. Those wet markets are indeed a huge accelerator. But the pre-conditions exist in many places and all it takes is one butcher that isn't paying attention and you've got the ball rolling. Africa and Asia have a lot of this and so are a recurring theme in these very unfortunate stories. But it c…

What you're saying doesn't make any sense. You said, "A bat infecting a pig could easily happen in Italy". How is a careless Italian butcher in any way comparable to a seething, filthy wet market where live pigs and bats are crammed into stacked cages? How much bat do you think they eat in Italy? Do Dutch butchers serve bat or pangolin or dog meat, or keep wild birds in cages on top of ferrets, which are good animal models for human influenza infections?

As a vegetarian, I'll happily acknowledge the barbarity and health hazards of factory meat production in the Western world. But this really is a tortured apples-to-oranges thing you're doing here. There is simply no valid comparison between a European meat grocer and a Chinese wet market, and I think you know it.

Re: Open letter from Italy to the international scientific community

#347

Earlier quoted context omitted.

"China could afford to take the economical hit" The faster and better that you deal with it, the smaller the economic hit is going to be. China is going to be the big winner here.

Maybe not. You want a society to develop herd immunity for a flu-like disease during warmer weather months. Since they failed to contain it, the disease is just going to show up in China again but this time from sick people traveling to China. The worst case scenario is lockdown during warmer months and then having it flare up again in winter months. That said, we could just apply medical quarantine procedures used f…

Even if it's not contained world-wide, there's still the chance that a vaccine can be developed to provide the immunity later.

Re: Open letter from Italy to the international scientific community

#348

Earlier quoted context omitted.

It gets hospital-level serious for 20% of cases? I thought the lethality rate wasn’t even that high for the most at-risk demographics (something like 14%).

> It gets hospital-level serious for 20% of cases? I thought the lethality rate wasn’t even that high for the most at-risk demographics (something like 14%). Well, substantially all of the cases that end up dying go to the hospital first, and many more besides that and up recovering. It shouldn't be surprising that the hospitalization rate is higher than the fatality rate.

About 15-20% require hospital care of some kind. Then depending on how prepared/overrun the health care system is, 0.6-5% cases are fatal. These numbers are ballpark and the lack of data makes it hard to know with confidence. The CFR gets more severe with age and comorbidities.

Re: Open letter from Italy to the international scientific community

#349

It's unlikely that other countries can do what China has done. As an example, China is able to do 200 CT scans a day at each fever station throughout the affected regions. In the US we can maybe do what 10 CT scans a day with a single machine? In China they were able to figure out within a short duration if someone needed to be quarantined. They built hospitals in days. It's not just about locking down. China has peo…

Do CT scans even help?

They're an effective diagnostic, faster than testing for the virus directly. At least they seem to be effective at these fever clinics. NYTimes Daily podcast had a good explanation of how these fever clinics work.

Re: Open letter from Italy to the international scientific community

#350
post #321

Earlier quoted context omitted.

> There are 1600 confirmed cases but the lack of tests hides how many real infections there are. 2,695 at the moment, per the NYT tracker https://www.nytimes.com/interactive/2020/world/coronavirus-m...

Last official update from cdc was 1629 [0]. NYT seems to be aggregating data from state reports, and even that is out of date. NYT reports 607 in WA, but the state itself reports 642 [1] (cdc reported 457 in WA on Friday). [0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html [1] https://www.doh.wa.gov/Emergencies/Coronavirus

2969 right now at https://coronavirus.1point3acres.com/. That site aggregates from news media reports and is the most real-time of the various sites I've seen. Plus it gives county-level breakdowns and links to reports with further details.
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