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Ask HN: Are we overreacting to coronavirus?

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Re: Ask HN: Are we overreacting to coronavirus?

#111

Earlier quoted context omitted.

Thank your god you don't live in Bergamo (Italy) [1] right now and stop writing about things you don't know, you are just disrespectful to those who know better who won't write you here because they are either busy 14h/day saving lives or just trying to survive. [1] https://www.businessinsider.com/video-tour-coronavirus-icu-w...

I live a few hours from Bergamo. I'm writing these things anyway. Please don't try and shut people down who are posting factual information by claiming it's "disrespectful" - disrespectful to whom? The medics I quoted? The Business Insider article you link to is saying exactly the same things as the articles I cite about what happened in the USA in 2018: makeshift wards, extraordinary measures, more and more patients…

You confirm you are completely oblivious to what is happening around you, good for you. Even visual proof is not enough. Enjoy your "hospitals are not at full capacity" fairy tale, maybe you are lucky enough to not need to find an hospital. If you knew at least one person in the first line you would know better. But please do keep reading your comorting fairy tales if that helps you.

Re: Ask HN: Are we overreacting to coronavirus?

#112

Earlier quoted context omitted.

I live a few hours from Bergamo. I'm writing these things anyway. Please don't try and shut people down who are posting factual information by claiming it's "disrespectful" - disrespectful to whom? The medics I quoted? The Business Insider article you link to is saying exactly the same things as the articles I cite about what happened in the USA in 2018: makeshift wards, extraordinary measures, more and more patients…

You confirm you are completely oblivious to what is happening around you, good for you. Even visual proof is not enough. Enjoy your "hospitals are not at full capacity" fairy tale, maybe you are lucky enough to not need to find an hospital. If you knew at least one person in the first line you would know better. But please do keep reading your comorting fairy tales if that helps you.

You're reacting emotionally when what the world needs is cold rationalism.

As of Wednesday afternoon this week, Italian hospitals were not yet at the point of turning people away:

https://www.cnbc.com/2020/03/19/italys-death-rate-reaches-re...

Medical facilities in Lombardy will “soon” be unable to help new coronavirus cases, regional Gov. Attilio Fontana said Wednesday, as he urged everyone to stay at home.

That was based on a quick search of English-language material. Perhaps there's a more recent update from the last 48 hours where things have changed - I'd love more recent info. But at the moment I'm seeing a lot of people who clearly believe hospitals are turning people away en-masse already, and yet I keep finding news stories where it's being officially denied by the relevant health authorities. Are they all oblivious, living in a fairy tale too? If so, isn't that a shocking scandal that needs to be talked about right now?

Re: Ask HN: Are we overreacting to coronavirus?

#113

Yes. The biggest issue is that we lack any idea regarding how infected the population currently is, or was. We don't know if 25% of all Americans have had a minor infection at this point and are less vulnerable. We don't know how it hung around Washington State undetected for six weeks. On the one hand, when dealing with the risks associated with a pandemic it is wise to error on the side of caution, but as we go thr…

We don't know how bad this will be which is exactly why we're acting like it's going to be bad - assuming that it'll be fine is irresponsible at a time like this.

And the worst part is, assuming it works and the epidemic curve is flattened out, people will still see this as "proof" that it wasn't necessary.

Re: Ask HN: Are we overreacting to coronavirus?

#114
post #104
post #99

I'm from Spain, one of the most exposed countries right now. At first you see this as something distant, something that was happening in China as Ebola was happening years ago on Africa. It can't touch me. A few days ago the state of alarm began over here. Remain at home, minimal movement (just to go for groceries, pharma, the rest of retail businesses are closed now). It felt closer, but still you feel safe. You're…

This whole crisis is a test of healthcare systems. Germany got hit very hard with infections, but also has a really low fatality count. Spain only got 8% more infections but over a maginitude more deaths Edit: Spain also has only half of the population of Germany, so it's probably more like 16% more infections in relation to population.

It's a test of our healthcare systems that they can't possibly pass unless our government and society pass their tests. Any country that fails to get the general public sufficiently onboard to flatten the curve _will_ massively overload their healthcare system no matter how great that healthcare system is.

Re: Ask HN: Are we overreacting to coronavirus?

#115

Well, so far judging by deaths / cases on plague.com, we're looking at 4% fatality rate. The average seasonal flu fatality rate is 0.1%. The mortality rate for H1N1 was 0.02%. For Ebola, the average mortality rate is around 50%. China severely restricted travel and managed to keep the infection rate around 0.008% of their population. We're still in the early stages in the US, with about 0.00269% of the population inf…

The problem is, we're not testing people until they're already in hospital. So that 4% mortality rate is very much skewed. The vast majority of people who show symptoms are just self isolating and getting better without ever being tested. We have no clue how many of those people actual had COVID-19 and how many had something else, although the spread we have observed would suggest that it's probably on the higher side.

Given the lack of availability of testing, and the fact the the available testing is (rightly) being reserved for those most in need, I don't believe we can rely on the current mortality figures as any measure of accuracy. They're probably more like 0.5% at best.

Re: Ask HN: Are we overreacting to coronavirus?

#116
Can somebody with field expertise explain this to me:

The mortality rate is said to be between 3 and 5%. Experts are also saying that it does not draw an accurate picture of the situation because people aren't being tested nearly as much as should be required.

So the question then becomes, why aren't we ramping up tests among the general population to get a better idea of who to prioritise ? Surely if we know who needs urgent treatment and who doesn't we don't have to freeze the whole economy and put everyone in lockdown ?

What am I missing ? Am I being too naive ?

Re: Ask HN: Are we overreacting to coronavirus?

#118
post #98
post #48

Earlier quoted context omitted.

It's easy to get a low rate of false positives: Just always report no virus found. So, we care about both false positives and false negatives. Dr. Brix said as much recently.

Prof. Drosten is the chief virologist at Berlin Charité. I'm confident that somewhere in his medical education the concept of false negatives came up, and I'm also certain that he doesn't word his answers in an interview for the general public to the standards of the nitpicking HN population.

No, that misses a big point:

(1) Now, in the present context, quite broadly, the testing is important.

(2) The news media reports lots of testing, e.g., from China, South Korea, Italy, the US, etc., e.g., lots of the testing from early on.

(3) IIRC in some important respects, the good tests are super tough to do: E.g., Dr. Brix mentioned in one of the White House task force presentations that the test the US is using involves amplification which likely means the PCR (polymerase chain reaction), which before 1983 by Kary Mullis, was essentially impossible and remains astounding, amazing, and non-trivial, and then analyzing the results of the amplification, likely also non-trivial.

(4) So, we have to suspect that a lot of the tests done early on were not so good. By not so good, we have to mean rates of false positives and/or false negatives too high.

(4) IRCC, Dr. Brix did mention at one of those presentations that they, the US efforts, are willing to use only "approved" tests and that some of the tests submitted had false positives of, IRCC, 60%. Here we are on the way to coin flipping range.

E.g., there is a news story about a guy offering to do tests in his college dorm room. I can't say that that is impossible, but it sounds not so good.

Also for some days, a big news media issue was essentially "Where are the tests? Why can't we all get tested? When will we all get tested? What is the big hangup on the tests? Why do the tests take so long? Where has the Administration messed up? ...."

(5) And of course, it is easy to get a rate of false positives of 0% -- just always report no virus found. Presto, bingo, 0% false positives.

(6) The media has been reporting the results of lots of tests, getting headlines, news stories, eyeballs, attention, creating anxiety, getting ad revenue, etc. -- that is, dirty stuff.

So, we all have to wonder, for a lot of those early tests from out in Wherever Land, what the heck was the quality? Were they really doing PCR? In particular, what the heck were the rates of false positives and false negatives? We just CANNOT just take for granted that the tests done had any meaningful quality. Then we have a tough time using the reported data from such questionable tests to evaluate the transmission rate, etc. of the virus and, thus, plan how and estimate when we might defeat the virus. In this context, important, quite broadly important.

(7) So, very briefly, I mentioned, as Dr. Brix did in one of the presentations, that the rate of false positives is important and even at 0% can be from a silly (technical term, trivial) test.

This mention never claimed that the medical profession is not aware of the rates of false positives and false negatives. And I'm fairly sure that the medical statistics people, some of the best statisticians there are, are quite aware of the now classic Neyman-Pearson result on how, for whatever rate of false positives specified, can get the lowest possible rate of false negatives. I have a relatively general proof from the Hahn decomposition from the Radon-Nikodym theorem (Rudin in Real and Complex Analysis gives the novel von Neumann proof).

And for such things there is a lot more, e.g., the A. Wald work on optimal sequential testing* (a stochastic optimal control problem).

Moreover I have some qualifications in the field since I published peer-reviewed original research, in Information Sciences, on anomaly detection, both multi-variate and distribution-free. And there I used the S. Ulam result tightness that even in the medical statistics community is likely not well known (it's in P. Billingsley, Convergence of Probability Measures). So, I have some technical qualifications to talk about test quality.

But here I'm not trying to address, comment on, inform, educate, or critique the medical profession. Instead:

My real point is, as Dr. Brix also seems to have had in mind, for the news media reporting we just must keep in mind test quality in particular rates of false positives and false negatives.

Simple point. Maybe some people here read in some other intentions and objected to those. Again, simple point: In this context, we have to be careful about test quality, not just within the medical profession but, now, especially for what comes from the news media. Simple point. And in the context, an important point.

It appears that some people have missed this simple point and presumed I was making some other point.

Know of anything wrong with that simple, important point?

Re: Ask HN: Are we overreacting to coronavirus?

#120
post #86

Earlier quoted context omitted.

But how will you know that the extreme measures weren't warranted, if they're successful? The world's leaders are stuck between a rock and a hard place here: do nothing, and be known as the leader who didn't act and caused the deaths of thousands or millions. Act with appropriately extreme measures and prevent as many deaths, and everyone will think the measures weren't warranted because the measures were successful.

Because you’ll see other countries who didn’t and they aren’t dead. Not only that, is that at what point, is current and future generations well being worth to save the population that’s largely impacted by this? Meaning, it’s perverse to spend more resources on the elderly as opposed to the youth. This just dials up the perversion to an extreme.

What i don't get is that these rational thoughts backed up by hard facts that says Italy lost 60.000 people(!) over a three year period to the common flu, are being overheard/ignored in place of a response that threaten to throw organized countries into economic chaos.
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