41–50 of 480 posts
Earlier quoted context omitted.
I really, really hope so. My hope is it is way more widespread than we think, and while that means it's going to be near impossible to contain, the denominator is so large that the CFR ends up being much lower than expected.
Maybe in the end the CFR will be the same as the regular flu.
Earlier quoted context omitted.
CFR, whatever it is, isn’t the most significant detail. What is “terrifying” is its high contagiousness combined with its high hospitalisation and ICU rates.
But, like CFR, we don’t know how high the rates are if we have no idea how many people have or had it. Here’s a few first hand accounts of what the illness was like. These folks aren’t even that young and they describe it as being quite mild: https://www.nbcnews.com/video/coronavirus-patient-from-diamo... https://www.adn.com/opinions/national-opinions/2020/03/01/i-... https://www.msn.com/en-us/news/us/don-t-panic-say…
The Professor of Clinical Immunology of the University of Florence, Sergio Romagnani
> Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report 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.
https://www.who.int/docs/default-source/coronaviruse/who-chi...
> Clinical and epidemiological data from the Chinese CDC and regarding 72,314 case records (confirmed, suspected, diagnosed, and asymptomatic cases) were shared in the Journal of the American Medical Association (JAMA) (February 24, 2020), providing an important illustration of the epidemiologic curve of the Chinese outbreak. There were 62% confirmed cases, including 1% of cases that were asymptomatic, but were laboratory-positive (viral nucleic acid test).
https://www.ncbi.nlm.nih.gov/books/NBK554776/
Weird discrepancy on the order of 75x. I'd love to trust the experts, but who? I am leaning towards truly asymptomatic spread being rare, since you get infected by SARS-CoV-2, not COVID-19 (COVID-19 is the disease), the level of uncertainty of 25% is higher than for other reports, and the main reported mode of transmission is through symptomatic cough droplets.
"Everyone we found to have Covid-19 had serious symptoms, so we don't want to waste money testing you if you don't!" I feel this is a trillion dollar mistake, testing more aggressively like South Korea means that you don't have to deploy the army and quarantine people. I had mild symptoms and they refused to test me, what am I to do? Self quarantine without a notice and hence without pay? I could work from home, but…
> Self quarantine without a notice and hence without pay? If you have symptoms of _any_ illness you should always get a sick leave and stay at home. It does not matter if it's covid, seasonal flu or just a common cold - sick leave and stay at home.
"Everyone we found to have Covid-19 had serious symptoms, so we don't want to waste money testing you if you don't!" I feel this is a trillion dollar mistake, testing more aggressively like South Korea means that you don't have to deploy the army and quarantine people. I had mild symptoms and they refused to test me, what am I to do? Self quarantine without a notice and hence without pay? I could work from home, but…
> Self quarantine without a notice and hence without pay? If you have symptoms of _any_ illness you should always get a sick leave and stay at home. It does not matter if it's covid, seasonal flu or just a common cold - sick leave and stay at home.
Asymptomatic for the entire duration of infection? That sounds bad for reducing R but good for the health of the individual.
I would assume that asymptomatic person has a lesser concentration of virus and hence would be less contagious than the really sick ones
I wonder if this will be like H1N1. At first we only identified extreme cases and we had these terrifying reported fatality rates. Then we identify more and more mild or asymptomatic cases and the rates drop and drop. We’ve already seen how CFR was reported as 3 or 4%. Then on the cruise ship full of people over 60 it’s 0.7%. If there are lots of mild or asymptomatic cases it will likely be much lower. H1N1 was ident…
Here's a paper from 2013 that surveyed CFR reports for H1N1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/ After a long discussion about the varying definitions of the numerator and denominator, they had this to say:
> Given that estimates of the infection fatality risk are unlikely to be available early enough for decision-making in a pandemic, a more feasible solution may be to measure the case fatality risk among symptomatic cases. ... Such estimates based on symptomatic cases may provide timely but imprecise estimates of seriousness for risk assessment.
CFR is not population mortality, and is usually not even infection fatality rate--but, confusingly, sometimes is as there's no official definition. After COVID-19 passes I suspect and hope that the medical community will tighten down definitions. CFR should be restricted to symptomatic cases approximating the type of severity that consumes non-negligible medical resources. Early on in an outbreak it's the only possible practical definition for tactical management of medical resources. An ER doctor couldn't care less how many infected people are convalescing at home. IFR (infection fatality rate) should be explicitly broken out. It's an important numbers to have, but often impossible to pin down until late in the game, sometimes only after the epidemic has passed. And IFR is most useful combined with r0, which has it's own definitional problems--do you care about hypothetical r0, r0 with social distancing, etc. Population mortality rate is even more difficult pin down.
I'm not a doctor, but I feel like "CFR" is one of those terms which was never meant to be consumed by the public. Early on it was probably taken for granted by the medical and scientific community to be a "case" as understood by doctors, who would typically only diagnose a specific illness when a patient presented with moderate or severe symptoms that required intervention. But as the medical and scientific community grew more diverse (and lab tests grew increasingly cheaper) the implied assumptions behind "case" became less and less valid, and they completely fall away in public discourse. These types of definitional problems are familiar to those of us in the tech sphere.
Does that mean 25-50% are severe? Is this a bimodal distribution?
Earlier quoted context omitted.
CFR, whatever it is, isn’t the most significant detail. What is “terrifying” is its high contagiousness combined with its high hospitalisation and ICU rates.
But, like CFR, we don’t know how high the rates are if we have no idea how many people have or had it. Here’s a few first hand accounts of what the illness was like. These folks aren’t even that young and they describe it as being quite mild: https://www.nbcnews.com/video/coronavirus-patient-from-diamo... https://www.adn.com/opinions/national-opinions/2020/03/01/i-... https://www.msn.com/en-us/news/us/don-t-panic-say…
While it's true that the hospitalization / ICU / mortality rates may be lower because we don't know the full number of cases, it still seems to be an immediate and acute problem.
Regardless of the rates, the absolute number of people being hospitalized in Italy was enough over overrun their healthcare system. The same situation looks to be on track in many European countries (Spain, France, UK).
So, the worst-case scenario may be less bad than predicted (let's certainly hope this is the case!), the number of case's we're identifying and having to deal with is still dangerously high.