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50% – 75% of cases of Covid-19 are asymptomatic

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Re: 50% – 75% of cases of Covid-19 are asymptomatic

#301
post #212

Earlier quoted context omitted.

> and push it higher than a normal flu season. last major flu season in Italy killed 24k people. We didn't immolate the global economy as a result

Why didn’t the hospital system collapse because of the flu?

Because the health care system is built with those estimates in mind.

It's the same with electricity infrastructure on climatologically hot days. The infrastructure is only built to handle a certain normal peak load. COVID-19 like a heat wave, is abnormal.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#302

Earlier quoted context omitted.

You don't seem to be contradicting me. I'm not saying everything is normal or other operations weren't cancelled. I'm saying that at this time, Italy is saying they have not run out of capacity to treat CV patients. And they definitely aren't 200% over capacity (for CV) as claimed.

They have not enough ICU beds. That is pretty much the definition of running out of capacity.

OK, so I read the Daily Mail article. I think there are a couple of things going on here.

Firstly, hellofunk made a claim of "health care systems stretched to beyond 200% capacity". I asked where that number came from because it contradicted what I'd read. S/he's provided a source, which is this quote from the DM:

Another medic in northern Italy told a friend in the UK that hospitals were running at '200 per cent capacity' with operating theatres hurriedly converted into intensive care units.

So this is a snippet from a private conversation with a friend repeated on Twitter, and it grew in the telling ("at 200%" became "at over 200%"): it's not a formal claim by someone with all the data. It's a claim that's painting a picture of what it looks like inside a hospital where one person works.

Secondly the report I cited has this:

"Over three weeks, 1,135 people have needed intensive care in Lombardy, but the region has only 800 intensive care beds, according to Giacomo Grasselli ... Grasselli coordinates all the state-run intensive care units across Lombardy."

When I read this the first time I thought, OK, so then they've surely run out of beds and are turning away people they could save. Confusion followed when I read this:

Lombardy intensive care coordinator Grasselli said he believed that, so far, all patients with a reasonable chance of recovering and living an acceptable quality of life had been treated. But he added that this approach is under strain. “Previously, for some people we would have said, ‘let’s give them a chance for a few days.’ Now we have to be more stringent.”

The first quote doesn't actually say they've run out of beds. That would be true if everyone needed to stay 3 weeks. If the average recovery time is 14.7 days then 1135 people could be treated with 800 ICU beds without anyone being turned away, whilst being at full capacity.

In the DM article the anonymous doctor claims Lombardy's healthcare system is one of the best in the world (sometimes this is phrased as most efficient, which isn't quite the same thing: you'd expect a highly efficient healthcare system to run out of capacity earlier than a less efficient one, I suppose). The Reuters article says:

Intubating can be taxing on the body, especially for older patients, says Grasselli ... adding that he would never intubate his 84-year old father. Before the coronavirus broke, “we more often had the luxury to try to intubate patients who were at the limit,” said Mario Riccio, head of anaesthesiology at the Oglio Po hospital near Cremona. Now that’s changed.

So some of this notion of rationing of healthcare is that before, Lombardy could afford to try extreme and risky measures to extend every life even in cases where the likely outcome was severe damage to the body from the procedure. Now they can't afford to take such measures anymore.

Medical systems don't have a hard notion of capacity. Total capacity is flexible: when under stress doctors are forced to triage more aggressively and drop the most extreme treatments. It may not make sense to talk about running out of capacity in a world where medical systems can keep otherwise terminal patients alive indefinitely; there is always triage even in quiet times. I'm not sure how best to measure it but it may be unduly alarming to say Lombardy has run out of beds.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#303

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…

Or it could be like the 1918 Spanish flu - a bad first wave that was most dangerous to the elderly, and a second wave that mutated and killed mostly young adults.

As I understand it (please correct me someone if I'm wrong), this was a freak mutation. Not to suggest it couldn't happen again. And we 100% should be prepared. But the concept of a virus leaving, mutating to be more deadly, and coming back, isn't on the 'expected' path.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#304

Earlier quoted context omitted.

I don't know why there would be any reason to believe that would be the case. Generally viruses become less deadly over time, not more. The Spanish flu was an outlier.

If only optimism could kill viruses.

Not to mention if pessimism could kill viruses!

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#305

Earlier quoted context omitted.

This has been so widely reported, not sure where to start. Operating rooms at many Italian hospitals have been closed and turned into ICUs to handle the demand, which means that surgeries in many places are no longer possible. You can read about this in any of hundreds of media outlets. Here's one: https://www.dailymail.co.uk/news/article-8095835/Overwhelmed...

You don't seem to be contradicting me. I'm not saying everything is normal or other operations weren't cancelled. I'm saying that at this time, Italy is saying they have not run out of capacity to treat CV patients. And they definitely aren't 200% over capacity (for CV) as claimed.

You seem to be living in a different factual world than the rest of us, where ICU cases are in hallways and surgical suites is not "over capacity", and leaving people to die of suffocation without standard lifesaving treatment is not unusual.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#306

Earlier quoted context omitted.

When it comes to these estimates, the WHO seem to be really bad at their job. But the reality now is that no matter what the estimated CFR is, Covid-19 guarantees that without containment there will be significantly more people in need of hospital care than there will be beds and support staff. And that will affect the final mortality rate, and push it higher than a normal flu season.

> and push it higher than a normal flu season. last major flu season in Italy killed 24k people. We didn't immolate the global economy as a result

If we wait for new pandemics to kill more people than the flu to take them seriously, then it's too late to act.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#307

"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…

The employer wants a doctor's note, for you to get a paid sick day? They explicitly do not trust your self-assessment?

I think this is a cultural defect. Evidence? We keep getting most everything wrong and paying more per capital to do it. The free market failures. The government failures. Their various incentives are widely considered flawed or perverse. We even fail to have effective conversations, almost immediately they get rail roaded, and we allow them to be rail roaded. The language strikes me as a lot of attachment/adoration for ideological things like "the free market" and "proper regulation" and being unable to get past our emotional attachments to these things.

Literally the entire rest of the industrialized world does this better and cheaper per capita, and somehow Americans keep defending the system using various slogans and name calling.

I think it's bad culture, like a national mental health disorder, resulting from long term cognitive dissonance. The longer it continues, it's like a perpetually recurring psychological trauma, at a national level.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#308
post #298

Earlier quoted context omitted.

Meh. An actual leader would clearly articulate what is going on—he hasn’t done that. An actual leader would tell people not to panic—hasn’t done that. An actual leader would take strong, very visible action against people hoarding supplies or worse reselling them for profit—toilet paper memes are funny until you run out. And quite frankly a real smart leader would have started testing the fuck out every person with a…

It’s up to the states to manage hoarding and reselling, and they are.

Sure but the president’s job is to tell people to chill the fuck out. So far, he is not.

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#309
post #237

I live in Japan and I experience mild symptoms since last Wednesday but not sure if my symptom is due to Covid-19. In Japan, You have meet two conditions to take a CPR test. 1. the symptoms with fever of 37.5 degrees or more continue for 4 days or more (for the eldery and those with underlying disease, "4 days" becomes "2 days") 2. you have strong laxity (malaise) or breathlessness (dyspnea), or you have underlying d…

I would assume its because the number of people with similar symptoms far exceeds the capacity to test for covid-19. If the numbers in this article[1] are accurate there were around 2.23 million people who went to the doctor for flu related symptoms from January 21 to 27, 2019.

1. https://www.nippon.com/en/japan-data/h00386/japan-gripped-by...

Re: 50% – 75% of cases of Covid-19 are asymptomatic

#310

Earlier quoted context omitted.

Yeah,and the high hospitalization and ICU rates become high case fatality rates once medical infrastructure is saturated, as well as increasing the case fatality rate for every other condition that creates a critical need for inpatient care. That's where Italy definitely is, and where it seems Iran is evn moreso (though they are less public about it.)

What no one is talking about is how much social distancing/isolation is needed to avoid hospital saturation. I ran the numbers for Canada, and it looks like we'd need isolation measures for 2+ years. I don't see how that's a feasible solution long-term.

So, wild speculation aside, what numbers did you use to base your model on, and what is your qualification to do anything like that?
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