Initial Covid-19 infection rate may be 80 times greater than originally reported • Hacker News Board

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#71

Post by SifJar » Wed, Jun 24, 2020, 8:28 AM UTC

verylittlemeat wrote: post #45

azinman2 wrote: post #31

Earlier quoted context omitted.

Except you can see the excess total deaths compared to previous years and how well it correlates and is otherwise unexplained [1]. A lot of the labeling occurred because people couldn’t get tested yet presented symptoms that indicated covid. In that situation, you can’t say 100% without a test, yet it’s the reasonable conclusion in a pandemic. [1] https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Something worth keeping in mind is how many fewer people died of other causes compared to previous years [1]. Yes, the data will show an excess number of people died versus previous years but I believe the parent comment is saying we should pay close attention to what the cause of death really means in terms of age and comorbidity. [1] https://i.imgur.com/HfaMhcK.jpg

One further thing to bear in mind here is that some causes of death can be expected to be decreased on account of lockdowns e.g. accidents - less people out and about, less people driving etc. will naturally lead to less accidents. Of course on the flip side, more people stuck at home & using the time to do renovation work etc. could lead to an increase in e.g. power tool related accidents.

Other causes of death such as flu can likely also be assumed to be decreased as a side-effect of lockdown

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#72

Post by majewsky » Wed, Jun 24, 2020, 8:31 AM UTC

jakeogh wrote: post #43

unlikelymordant wrote: post #36

Earlier quoted context omitted.

You can just look at the all cause excess deaths and see that the number of people that have died so far this year is much higher than previous years in New York. So whether you agree that person A died from covid or not, there were many more deaths due to something.

What is the effect of fear? Cortisol spikes and avoiding going to the doctor for what would normally be a good reason need to be researched.

That is something worth researching, but even then, it's still justifiable to count a death by fear as a death by pandemic, given that it wouldn't have happened without the pandemic.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#73

Post by ddxxdd » Wed, Jun 24, 2020, 8:33 AM UTC

ageitgey wrote: post #57

adamhearn wrote: post #25

Earlier quoted context omitted.

This is completely anecdotal, but my good friend’s brother is an ER doctor. He said the hospital required them to label the cause of death for all patients in the hospital as covid if there was as much as one symptom. I don’t want to downplay the sadness of the deaths, but I think it is a bit foolish for us to base our number of deaths of off untested patients...

How you label the deaths is not that big of a deal in the larger scale. If you want to know the true toll of the epidemic, just look at this year's deaths vs. an average of previous years. It's simple and transparent. Here's that data for England: https://imgur.com/sxoolBX I get why everyone is questioning everything, but there isn't some big conspiracy here. Lots of people died of COVID. Most of them were 80+. You p…

But then we get to the question of whether those deaths were caused by COVID or other causes.

We know that traffic fatalities in some areas have risen drastically due to the lockdowns: https://abc7.com/traffic-fatalities-california-highway-patro...

We also know that doctor visits have gone down due to the coronavirus, leading to medical staff being laid off: https://www.npr.org/sections/health-shots/2020/04/02/8262324...

We also know that hospitals are financially incentivized to diagnose a patient as COVID positive: https://www.usatoday.com/story/news/factcheck/2020/04/24/fac...

And there are German serological studies that suggest a COVID death rate of 0.39%, in contrast with the NYC study that claims a death rate of 1%

Taking this altogether, and we have plenty of wiggle room to suggest that even the excess deaths don't necessarily imply that COVID is extremely deadly.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#74

Post by yomly » Wed, Jun 24, 2020, 8:35 AM UTC

scarmig wrote: post #51

AmericanChopper wrote: post #41

Earlier quoted context omitted.

Singapore has had a death rate of 0.06%, with ~42k cases. The main difference between them and the rest of the world has been how much they test. New York has more hospital beds per 1,000 than Singapore does for instance. There’s no other factor that could possibly explain the death rates being off by more than 3 orders of magnitude between those two places.

That doesn't explain it, though: the number of NYC deaths so far is 0.2% of its population. Assuming 100% of NYC is infected, that's a floor of 0.2% IFR. No amount of under testing can explain that. Which isn't to say that Singapore's death rate is an undercount, but that higher testing rates can't explain it.

You can't just data this stuff. There's so much nuance and context in the data that it's very hard to compare countries.

Singapore is militant on testing everyone. This presumably gives a high fidelity on the "true" spread of the virus.

What is also true is that Singapore has been extremely militant on isolating and controlling the virus. Their staff have ample PPE and their hospitals have very successfully isolated covid positive patients. For instance, anyone positive here is quarantined in a govt run facility and cannot return home until testing negative two days in a row. This may have recently relaxed but was true throughout circuit breaker/lockdown. I believe they are also trying to partition covid patients from non covid patients at the hospital level. (eg NCID)

Both anecdotally from frontline doctors, and from reading various news reports, a big problem about the first wave of covid was how the problems can snowball. Hospitals were very easily filled up with sick patients, but worse any existing patients could very easily catch covid. For example cancer patients who are immunocompromised.

So the lethality of the disease is actually a function of its local penetration as more people die if hospitals effectively experience cascading failure.

My understanding is that tipping point is quite fine, this is especially true back in March when everyone was still hoping it wouldn't reach their shores, and hospitals had very limited space for isolating covid patients and for treating patients that required ICU.

While hospitals have been empty I also know that hospitals have become extremely aggressive at not accepting patients. For example, my friend's mother was bedridden for a month but was never seen by a doctor. Meanwhile you have people dying at home and in care homes, so I think "hospitals are empty" doesn't tell the whole picture.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#75

Post by ageitgey » Wed, Jun 24, 2020, 8:52 AM UTC

ddxxdd wrote: post #73

ageitgey wrote: post #57

Earlier quoted context omitted.

How you label the deaths is not that big of a deal in the larger scale. If you want to know the true toll of the epidemic, just look at this year's deaths vs. an average of previous years. It's simple and transparent. Here's that data for England: https://imgur.com/sxoolBX I get why everyone is questioning everything, but there isn't some big conspiracy here. Lots of people died of COVID. Most of them were 80+. You p…

But then we get to the question of whether those deaths were caused by COVID or other causes. We know that traffic fatalities in some areas have risen drastically due to the lockdowns: https://abc7.com/traffic-fatalities-california-highway-patro... We also know that doctor visits have gone down due to the coronavirus, leading to medical staff being laid off: https://www.npr.org/sections/health-shots/2020/04/02/826232…

You are conflating a lot of different things.

Traffic fatalities were actually down overall (total numbers), but up per mile driven. In other words, people were driving much less and dying in lower total numbers, but the people who were driving were driving faster and thus a bit more likely to die. That article is poorly written to generate headlines and clicks.

Arguing over a specific IFR is also kind of pointless because the disease is so age and condition dependent. Whether the true overall IFR in a population is 1% or 0.4% doesn't really matter - it's a bad representation of the overall situation. COVID is a disease that kills a very large percentage of 80+ but is quite low risk for younger people. A single number doesn't capture or represent that. Demographic differences between 2 cities could easily cause a large skew in actual IFR.

Hospitals are (possibly) financially incentivized to diagnose COVID in the US. But this is a world-wide disease and no other country has the insane US healthcare system where that would matter.

> Taking this altogether, and we have plenty of wiggle room to suggest that even the excess deaths don't necessarily imply that COVID is extremely deadly.

That's not correct. It's absolutely clear from the numbers across many countries that COVID is extremely deadly if you are 80+ and not deadly at all if you are 15. Make of that what you will. Arguing over IFRs and hospital reimbursement is missing the point. It's simultaneously true that COVID is very deadly for some groups but may not be deadly at all for you and your friends.

There's a good argument to be made over how much of the excess death is due to secondary effects (untreated heart attacks, delayed cancer treatments, etc). But there's no way to arrange the numbers such that COVID doesn't obviously kill a lot of old people. Just look at the death rates in care homes / retirement homes. It was like a plague ravaging them.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#76

Post by WildParser » Wed, Jun 24, 2020, 9:13 AM UTC

MattGaiser wrote: post #24

goatinaboat wrote: post #5

At this point every scientist in the world is throwing any random theory out there in the hope one sticks and they will be showered in new funding. The track record of Neil Ferguson‘s Group at Imperial is representative of this industry, however. https://github.com/mrc-ide/covid-sim/issues/176

Don’t models assume a lack of action? Given that an alarming model is going to alter our behaviour, it seems unrealistic to expect them to match what actually happens.

From infection date ~29.February till May the growthrate in Germany is behaving mathematically exact - following a Gompertz-Model.

It's not really clear if actions and visible behaviour changes did much - all of them came way too late - and there is no sign of a trendbreak that indicates any improvement.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#77

Post by globular-toast » Wed, Jun 24, 2020, 9:22 AM UTC

adamhearn wrote: post #25

crooked-v wrote: post #18

Earlier quoted context omitted.

Well, that obviously depends on where 'around you' is. Compare to New York City, where there have been an estimated 17,000 deaths (and even that's probably undercounted, going by some studies of excess deaths compared to previous years), and at the peak there were hundreds of unclaimed bodies per week being buried in mass graves.

This is completely anecdotal, but my good friend’s brother is an ER doctor. He said the hospital required them to label the cause of death for all patients in the hospital as covid if there was as much as one symptom. I don’t want to downplay the sadness of the deaths, but I think it is a bit foolish for us to base our number of deaths of off untested patients...

Similarly, several people I know have self-diagnosed themselves with COVID-19 due to just one symptom. In some cases the symptoms have disappeared the next day. In many cases the people are the "usual suspects" who seem to get ill several times a year anyway. I'm not aware of a single person who has definitely had COVID-19.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#78

Post by fastball » Wed, Jun 24, 2020, 9:28 AM UTC

majewsky wrote: post #72

jakeogh wrote: post #43

Earlier quoted context omitted.

What is the effect of fear? Cortisol spikes and avoiding going to the doctor for what would normally be a good reason need to be researched.

That is something worth researching, but even then, it's still justifiable to count a death by fear as a death by pandemic, given that it wouldn't have happened without the pandemic.

You can have a pandemic without fear though.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#79

Post by occamrazor » Wed, Jun 24, 2020, 9:31 AM UTC

jakeogh wrote: post #43

unlikelymordant wrote: post #36

Earlier quoted context omitted.

You can just look at the all cause excess deaths and see that the number of people that have died so far this year is much higher than previous years in New York. So whether you agree that person A died from covid or not, there were many more deaths due to something.

What is the effect of fear? Cortisol spikes and avoiding going to the doctor for what would normally be a good reason need to be researched.

Reduced access to healthcare, counterintuitively, reduces mortality in the short term, because it reduces complications from medical interventions.

On the medium and long term instead it increases mortality, as expected.

Moreover, lockdowns and social distancing also reduced flu deaths.

This means that the total number of deaths attributable ti Covid may in fact be higher than the excess mortality over the average of previous years, although it is difficult to quantity the difference.

Re: Initial Covid-19 infection rate may be 80 times greater than originally reported

#80

Post by grey-area » Wed, Jun 24, 2020, 9:34 AM UTC

arrrg wrote: post #50

jjjensen90 wrote: post #15

Earlier quoted context omitted.

Because it's possible that there are many, many infected who don't seroconvert or ever manifest symptoms, and therefore would not have been tested with a PCR test, and would have a negative antibody test. We can see this in effect in studies of household attack rates and seroconversion. See this recent preprint and interesting thread (/r/covid19 is a strict science sub, not to be confused with /r/coronavirus) https:/…

But does this get us a lot? In Brooklyn and Queens between 0.2 and 0.25 percent of the total population (!) died. So this sort of puts a floor on the IFR and 0.2 is not that far off from the IFR determined through serological testing – maybe a half or a third of that. So yeah, maybe there is an effect – but can it really be a drastic effect? I don’t think there are orders of magnitude of difference in there, maybe a…

But looking at NYC now, after peaking in April, infections and deaths are way down and stabilised, in spite of rising infections in surrounding areas and very few travel restrictions. So something is going on that we don't understand, and it could have a significant impact.

If we have a higher immune population than we think, NYC might have passed the worst, if not millions will die in a second wave (though there are no signs of that yet). So this does matter.