Why is Japan still a coronavirus outlier? • Hacker News Board

Re: Why is Japan still a coronavirus outlier?

#411

Post by paulddraper » Sun, Mar 22, 2020, 9:21 PM UTC

mikekchar wrote: post #198

paulddraper wrote: post #100

Earlier quoted context omitted.

And yet, there have only been 36 reported deaths in the entire country. As long as you test symptomatic cases, the death count should at least be reliable, right? That a third the deaths of South Korea (who has very aggressively contained).

Kind of extrapolating from other countries, I think this points to the number of cases as being about 3-4x higher than reported -- if you are trying to do an apples to apples comparison (which is virtually impossible, but...). Also, I think it's instructive to look at the ratio of people tested to the number of positive results. Wikipedia has about 18k people being tested as of 2 days ago (compared to the nearly 70k…

I'm not talking about cases, I'm talking about deaths.

There could plausibly be 10x more cases than reported.

But it's much harder to under-report deaths. And those are low.

Re: Why is Japan still a coronavirus outlier?

#412

Post by jjeaff » Sun, Mar 22, 2020, 10:07 PM UTC

brigandish wrote: post #335

javagram wrote: post #315

Earlier quoted context omitted.

There is evidence indicating it helps to prevent infection and to help prevent spreading infection. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153448/ “The overall effectiveness of vaccination and mask wearing was 9.9% and 8.6%, respectively.” There aren’t nearly enough masks to go around for the general population so it would be reckless to recommend people in the USA wear (commercial quality) them right now due…

That paper also has: > Hand washing (1.447, 1.274–1.644) and gargling (1.319, 1.183–1.471), however, were not associated with protection. In the natural setting, hand washing and gargling showed a negative association, which may have been due to inappropriate infection control measures or aggregating infected and non-infected children to conduct those measures. So hand washing isn't effective and masks are? That's th…

I think there are plenty of other studies showing that hand washing can make a big difference.

But I don't think that negates the whole paper. It could be that the methodology used for the hand washing data is more flawed than the mask portion.

Re: Why is Japan still a coronavirus outlier?

#413

Post by jjeaff » Sun, Mar 22, 2020, 10:11 PM UTC

LyndsySimon wrote: post #344

ALittleLight wrote: post #342

Earlier quoted context omitted.

If masks don't prevent you from getting infected then why do medical professionals want masks? Everything I've read suggests that masks reduce your risk of infection, and that pairs with the common sense idea that filters in front of your respiratory tract entrance would reduce the risk of foreign particles entering and infecting you.

Simply putting on a mask does a great deal to limit the spread of a virus you already have - you’re not spewing particles all over your environment due to respiration. Simply putting on a mask does very little to keep you from getting sick, because you’re very unlikely to be following proper PPE donning/doffing procedures. Unless you your house set up as a “clean zone” with two rooms between it and the outside world…

Oh, so that's why every hospital room has an air sealed clean zone that medical professionals have to enter to put on ppe?

For those that don't know, this is sarcasm. Most ICUs don't have any sort of sealed off clean zone.

Re: Why is Japan still a coronavirus outlier?

#414

Post by jjeaff » Sun, Mar 22, 2020, 10:13 PM UTC

l0ner wrote: post #358

ALittleLight wrote: post #342

Earlier quoted context omitted.

If masks don't prevent you from getting infected then why do medical professionals want masks? Everything I've read suggests that masks reduce your risk of infection, and that pairs with the common sense idea that filters in front of your respiratory tract entrance would reduce the risk of foreign particles entering and infecting you.

They simply need masks to protect their patients. They can never be sure that they themselves are not infected, and they treat a lot of severly ill (non COVID-19) patients in hospitals. If they spread the virus, those patients are at very high risk.

If that were true, all the medical professionals in America would already be infected.

Proper use of PPE very much decreases your chances of infection.

Re: Why is Japan still a coronavirus outlier?

#415

Post by raybb » Sun, Mar 22, 2020, 10:49 PM UTC

delhanty wrote: post #205

We've been discussing these questions recently on the #covid19 channel of the HN Tokyo Slack [0] - all the same sort of points raised as below - but nobody knows for sure. There was an outbreak in Hokkaido a few weeks ago and that was the Japan hotspot for a while. The governor there quickly declared a state of emergency and that was brought under control - if you believe the official figures that is. The best Japan…

Do you know if there are slack workspaces for other regions?

Re: Why is Japan still a coronavirus outlier?

#416

Post by shalmanese » Mon, Mar 23, 2020, 4:58 AM UTC

claytongulick wrote: post #329

wolco wrote: post #249

Earlier quoted context omitted.

At a 4.3% death rate if the same number were infected you would be looking at 2 million in the US.

4.3% is just simply wrong, even by absolute worst case measures. Please don't spread this number. Even in Wuhan, they revised the official number down to 1.4%, and every serious epidemiologist is saying it's likely much lower, because of undocumented cases. (Current models have it at 86% unreported).

It's by far not the worst case number. To get the worst case number, we need to know these variables:

% of your population that eventually gets infected * % of all cases requiring hospitalization * % who get no medical attention * Death Rate for people who get no medical attention OR ~0.5 - 1%, whichever is higher.

We can start putting error bars around these figures: Best estimates from China/SK & Diamond Princess all indicate that ~20 - 30% of cases at most are asymptomatic and if ~20% of all symptomatic cases require hospitalization, that means the lower limit is ~15% of all cases require hospitalization. If you go with the "herd immunity" approach of 70% of people eventually getting it, then ~10% of all people require hospitalization which is 10 - 1000x overwhelming of the hospital system, no matter how much you "flatten the curve" so 90+% of people will just flat out receive no medical intervention.

The only other key number left in the equation is what % of hospitalized cases, if given no attention, will eventually die and the data from Italy seems pretty grim. Italy in a few days, will already have more deaths than ICU beds which means the untreated death rate might be as high as 50% vs 5% for treated.

Multiply all of these numbers together and it's not hard to see how 4.3% might end up being a conservative estimate of the death rate.

It also becomes obvious that the ONLY variable that matters in this equation is the % of people eventually infected. If you can keep it below 1% forever, you're in a reality far different from if it goes above 30%.

Re: Why is Japan still a coronavirus outlier?

#417

Post by l_davis » Mon, Mar 23, 2020, 6:29 AM UTC

dragonwriter wrote: post #192

l_davis wrote: post #180

Earlier quoted context omitted.

I ordered cotton masks from Etsy. They are supposed to arrive by the end of the month. Select vendors in the US for speed. Amazon has lots of cotton masks, but they all seem to be shipped from China, which means they will take awhile to arrive. (Am assuming US buyers. Looks like Etsy vendors are all over though so you can probably find a vendor locally in many countries.) There are plenty of patterns for cotton masks…

> I ordered cotton masks from Etsy. “Cotton masks” from Etsy are almost certainly not the same thing as the medical/operation/surgical masks being suggested, which typically have a melt-blown polymer filter layer between non-woven fabric exterior layers. It's true that even medical providers are turning to these type of masks as emergency supplies (and calling on hobbyists to make them for medical use!) because actua…

They aren't the same thing as medical masks. I'm well aware of that. But if people start making their own or get them from providers that aren't supplying medical needs anyway, it could very well reduce spread without taking masks from medical providers.

Why is Japan an outlier? One thing they do differently from most of the rest of the world is wear masks. Not perfectly but certainly more than in the US. And many Japanese are making their own now as they can't find professionally made ones either.

Yes it's a desparate measure but this is becoming more serious by the day.

I did have the opportunity to ask a Japanese person his opinion on why the rate of increase is lower than in the US. One reason he gave is wearing masks. Another one is the practice of taking shoes off when entering one's home (you bring in fewer pathogens that way). He did preface his answer with the statement that he is not a medical professional and that he was stating that it was his opinion only. But maybe something to consider.

Editing to see that the question I answered might suggest that I was saying those types of cotton masks are medical grade. I didn't mean to suggest that and agree that it's not responsible for someone to use a medical grade mask now without a medical need. My apologies for any misunderstanding I created.

Re: Why is Japan still a coronavirus outlier?

#418

Post by delhanty » Mon, Mar 23, 2020, 7:19 AM UTC

raybb wrote: post #415

delhanty wrote: post #205

We've been discussing these questions recently on the #covid19 channel of the HN Tokyo Slack [0] - all the same sort of points raised as below - but nobody knows for sure. There was an outbreak in Hokkaido a few weeks ago and that was the Japan hotspot for a while. The governor there quickly declared a state of emergency and that was brought under control - if you believe the official figures that is. The best Japan…

Do you know if there are slack workspaces for other regions?

HN Kansai meetp & slack are here:

http://hnkansai.org/

https://hnkansai-slack.now.sh/

HN Fukuoka is here:

https://www.meetup.com/Hacker-News-Fukuoka/

I found them via the unofficial HN meetup page maintained by Anton Tarasenko here:

https://github.com/antontarasenko/hacker-news-groups

Re: Why is Japan still a coronavirus outlier?

#419

Post by dwild » Mon, Mar 23, 2020, 3:22 PM UTC

tomerico wrote: post #11

bruxis wrote: post #5

> New tests that produce produce results in 10-15 minutes are becoming available, but even with the improved tech, under the current policy a test will only be administered in the most extreme circumstances, when people have had a fever for four days or more . This is an important factor that may indicate this "outlier" is more of a delay, rather than a reality of some exception. As a resident, I'm quite concerned ab…

Extreme testing policies wouldn’t hide exponential growth - if it is growing exponentially, you’d expect the number of people meeting the criteria to also grow exponentially.

> if it is growing exponentially, you’d expect the number of people meeting the criteria to also grow exponentially.

I don't know for Japan, but here in Canada, on top of showing symptoms, we need to have taken an international flight, or be in contact with a known carrier. The number of people having taken a flight won't grow... that's for sure, and contact, well it's recursive at that point and depends on whether you were in contact with someone that has taken a flight, has shown symptoms, has taken the test instead of following the quarantine asked, and has been positive. So essentially in our case, the number of people meeting the criteria can only go down actually.

We would expect the number of people requiring hospitalization with symptoms to grow though. I don't know if that's enough to skip the criteria though, here in Quebec our number of death got lowered yesterday because the test came back negative...

It does makes sense though to keep theses criterias, because most case doesn't require hospitalization, and there's a very limited amount of test available. In Quebec it seems like we are now able to carry enough test for people with theses criterias, so with some luck, we will remove the contact criteria soon, and get a better picture of the propagation.

In South Korea 30% of the infected are in the 20-30 range, it's most probably the same everywhere but we just don't know it because they would most probably be asymptomatics.

Re: Why is Japan still a coronavirus outlier?

#420

Post by mekster » Mon, Mar 23, 2020, 5:16 PM UTC

tasogare wrote: post #46

thelittleone wrote: post #32

Earlier quoted context omitted.

I spent some time in Japan for work and was always amazed how many people had face masks on (even when there is no pandemic) and the prevalent of wearing gloves (driving etc). With my limited time there it seemed to be one of the most proactively sanitary cultures I’ve seen. Also it seemed to me that at business meetings generally people bow instead of shaking hands. And I wonder if this reflects the general approach…

You can’t find masks anywhere since more than a month. Few people wear them (I would say about 30%). Granted, people have less physical contact. The real reason for the low number of cases is the lack of tests. I’ve spoken today with multiple Japanese friends and other residents, all think the government is lying and hiding it to save the Olympics. We will see the truth in a month...

I see more like 70% wearing in Tokyo.