CFR

You have to consider the situation in which the cases overflow the ICUs – that is likely to be the typical patient. When you see a CFR based on the ratio of deaths to known cases, it skews low, because it takes a while for this to progress to the point of killing people. What you want is the number of people infected three weeks ago that have died divided by the number of people that contracted it three weeks ago – and even that is conservative, because some deaths will take longer.

> 5%, probably, except where social distancing and lock-down keeps it from overflowing the ICUs.

 

 

 

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131 Responses to CFR

  1. G L says:

    While it’s true that using current fatalities underestimates the numerator of CFR, the denominator may be misleading since it only includes diagnosed cases. Untested, asymptomatic, and mildly symptomatic cases don’t show up. The fatality rate that matters in assessing the probability of death after being infected would have to include all those cases. Right now there are fewer than 200 confirmed cases in the US. There could easily be ten times as many infected individuals. Or not. If it were so, using the number of dead three weeks from now would overestimate the probability of dying.

  2. Edward says:

    In the UK, we have fewer than 6000 critical care beds, some of which aren’t ICU beds but rather “high dependency” beds. They’re usually at more than 80% or 90% occupancy. If 25% of the population got infected at once (if we implement social distancing measures, shouldn’t happen), and just 1% of those infected required ICU care, then 165,000 ICU beds would be needed. UK Government continues to delay social distancing measures, saying they’re going to wait until the end of the month.

  3. Coagulopath says:

    Though doesn’t CFR normally skew high since it depends on reported cases (which are more likely to be severe ones?)

    • gcochran9 says:

      Bruce Aylward, looking at things in China for W.H.O, thinks that there weren’t a lot of unreported cases.

      • dearieme says:

        Are these W.H.O. people being suckered in the Margaret Mead style? How many of them speak any of the Chinese languages? Are they like the gormless western intellectuals who visited Stalin’s starving USSR and reported on how well fed everyone was?

        These, by the way, are genuine questions not rhetorical ones. I have no idea of the answers. Who does?

        • John Massey says:

          If you bothered to read the WHO China mission report, you would know.

          I know the answers.

          I also know why Aylward was satisfied that there were not a lot of unknown cases.

          • dearieme says:

            “If you bothered to read the WHO China mission report, you would know.”

            What a daft reply. The question isn’t what they say it’s how they can know what they claim to know.

            • John Massey says:

              Did you read it?

              • Still uninfected says:

                Don’t engage dearieme when he gets in aggressive mode to defend his initial position and doesn’t move the conversation forward. He tries to be snarky and authoritative like Cochran but he is not that smart or knowledgeable to pull it off like the host manages to do most of the time.

              • John Massey says:

                OK.

            • dearieme says:

              Ah, you really shouldn’t have asked me to look at it. More than half the members seem to be citizens of China (or Hong Kong) in the employ, judging by their job titles, of the Chinese government.

              So the notion that this is some sort of independent, critical scrutiny seems far-fetched to me.

              That’s assuming that the “WHO Report” to which you refer is the one entitled “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)”. Or is there a report which really can be honestly described as a “WHO Report”?

              • John Massey says:

                Have you read it? You seem to be taking a very long time to read it. Perhaps it is beyond you, like most things.

          • On page 9 they cite statistics from Guangdong which is highly misleading because Hubei has officially 50X more infections and half the population. So Hubei is where the hospital system was most egregiously overwhelmed and allegedly such a large proportion with symptoms were not being tested. I computed an estimate in my recent blog of 1.2 million infections in Hubei.

            • John Massey says:

              They are not happening, so your computation must have been wrong.

              • We know from “suspected cases”, anecdotal reports, and circumstantial evidence of the massive increase in beds for mild cases after Feb. 5 in Wuhan, that 70 to 90% of the infected weren’t being accounted for in the official “confirmed cases”. Details of the computation are on my blog with the low end ~0.5 million infections to date. Which seems to concur with estimates arrived by other methods such as the Lancet paper.

                In another comment below you claim infection rate of 4% in some areas of Lombardy that you also claim exceeds all but Hubei rates of infection. Hubei has a population of 59 million.

                WHO’s Aryland was employing the 0.47% incidence in Guandong to argue that not many missed infections in Hubei. This is an intentional obfuscation of reality — a lie.

              • John Massey says:

                I was not claiming anything. I was quoting. Who’s Aryland?

                Never mind; your comment is so garbled that I don’t see a point.

              • gothamette says:

                He means Bruce Aylward.

  4. Stuart Harvey says:

    The ratio of deaths to known cases in China, as of March 3rd, was 3.6%. Because of the length of time the illness had been present in China this will tend to make that estimate more realistic. Lots of qualifiers of course including accuracy of data but probably better than the frequently suggested 1 – 2%.

  5. Freddy says:

    This is an exponential growth thing, I think. If the total number of cases doubles every three weeks, and it takes three weeks for infected people to maybe die from it, the (naive) death % estimate will be off by a factor 2. (Unless you do as Greg describes.)

    If the number of infections doubles every ten days, but people only die after 21 days on average, would we expect the death count to be underestimated by a factor ~>4?

    I don’t see what the ICU’s have to do with this point, though.

  6. That’s the estimate for CFR, but what is the percentage that survives but winds up with permanent lung/kidney damage? Some SARS survivors wound up with various long term conditions, e.g. pulmonary fibrosis. Haven’t seen any published studies looking into risks associated with this yet.

  7. NobodyExpectsThe... says:

    In Italy it has been around 3% from the get go. Dont know if their healthcare system is a mess yet, but no need to wait 3 weeks to be above 1-2%

  8. Craken says:

    A CFR over 5% implies that those who are old enough to be at risk (let’s say over 30) would face a CFR over 7.5%. I’m aware of only one situation in which we have a good handle on the relevant numbers: the Diamond Princess outbreak. Everywhere else the number of undiagnosed cases is unknown, leaving the infection rate and the CFR unknown. So far the Diamond Princess CFR is <1%, albeit with good medical care. I agree that the CFR for symptomatic cases that receive no medical treatment would be high. Based on the lax response in every respect, it seems that the Western world is determined to give a sequence of national demonstrations proving this point.

    • gcochran9 says:

      The risk is concentrated in those over 60. The key situation is one in which oxygen and ventilators are not available. With enough cases, you reach that situation.

      • gl says:

        The press accounts are maddeningly vague on all this. Diamond Princess patients were taken to a special facility. But what care did they require – how do we know if they were on ventilators, or were they just quarantined? I’ve see US corona survivors on TV – “was just like a bad cold” – how do we understand the bad cases, frequency and care required?

      • Rosenmops says:

        You can buy an oxygen concentrator for under $1000. CDN. No doubt cheaper in USA. But I’m not sure how useful just having extra oxygen would be.

    • gcochran9 says:

      The victims in the Diamond Princess had good medical care. if the disease becomes common enough, that will no longer be possible.

      • gothamette says:

        Also, among which populations will the virus likely spread?

        We have large numbers of illegals in the US. Also homeless. I was in a Starbucks earlier today that a homeless guy uses for his home away from home. He was coughing, and not into the crook of his elbow. I moved away.

        I’ve heard the situation in California with homeless encampments is crazy. I can just imagine the virus tearing through one of their encampments like wildfire. That will put a lot of strain on social services.

  9. David Chamberlin says:

    I have been studying the statistics given to us and thinking about variable mortality rate under different circumstances. There are going to be breakdowns not only in fundamental services but key medical supplies. It’s not IF it happens but when, unfortunately. You absolutely positively do not want to find yourself in that 10% of the covid19 infected population that requires serious medical care when the health system is completely overloaded. So…..if you are over 65 or have lung problems limit going to indoor crowded places as much as possible when Covid19 hits hard. It hasn’t yet, but it will. China did this and it worked.

    • David Chamberlin says:

      I look at the statistics given to us and I have to conclude at this point that Covid-19 is pretty much unstoppable in any country excluding communist China and even there it has just been put on hold temporarily while everyone is forced to not leave their homes. The projected outcome, which of course can change because we know so little about Covid-19 is an infection rate of 40-70% of the population in the next year. It could diminish in the summer and come roaring back in the late fall, we just don’t know. Cochran is projecting a high mortality rate, 5%, but it is correct assuming that the health system is completely overloaded which of course it will be if a high percentage of the population has Covid-19 at the same time. The mortality rate can drop to as low as .5% and that is pretty much the very old with optimum health care. South Korea appears to be pulling this off right now.

      • The spread also seems to have been stopped in Japan, which doesn’t force anyone to do anything (although many people have started working from home, and children aren’t going to school).

      • gothamette says:

        “The projected outcome, which of course can change because we know so little about Covid-19 is an infection rate of 40-70% of the population in the next year. ”

        Why would the infection rate be higher than that of the Diamond Princess, which was 19%

        • David Chamberlin says:

          The one epidemiologist that estimated that 40 to 70% of humanity would be infected by Covid19 was talking about a full 12 to 18 months. Who knows, I certainly don’t.

          • gothamette says:

            I still don’t see why that would be.

            The people on the Diamond Princess were essentially locked up in a tainted environment, they were middle-aged or older, and still “only” 19% infection rate. That’s awful, and what happened to them was an ordeal, but it’s 40%-70%.

            For those who care, here’s the link and the quote:

            https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/

            • gothamette says:

              oops NOT 40% to 70%.

            • gcochran9 says:

              Something like that would be the limit if the only factor stopping spread was partial exhaustion of fresh hosts: you eventually get to the point where R0 < 1.0, because many of the potential infectees have already gone through it and are immune.

              • Seems I’ve read that immunity to corona viruses is much more short-lived than for influenza and also there’s potential for antibody dependent enhancement on second infection if your antibiotics have dropped into a specific range (not too low and not high enough), which in theory could cause hemorrhagic fever given the antibodies enable the virus to bypass ACE2 and infection immune cells. Point being that the sequels of the virus could potentially get much worse. I presume you’re read the paper on the peculiar gain-of-function as well. I’m still learning. This is not my field of expertise.

              • David Chamberlin says:

                Hi Gothamette. I misunderstood what John was talking about, that’s all. Covid-19 is far more infectious than the 1918 virus. BUT.. there are a number of factors that make the infection rate extremely variable in different environments. Simply saying the R naught of Covid-19 is higher than any kind of flu including the 1918 Spanish Flu is mostly true but not completely true because the R naught of Covid-19 is near 1.0 in China right now and probably sky high in Iran right now. Flu viruses chug along at an R_naught between 1 and 2 when it isn’t hot out and dips below 1 when it is. Covid-19’s R-naught has a far larger range. It can be successfully quarantined with extreme measures like is being done in China right now but the Flu cannot because a quarantine requires a longer time between initial infection and becoming contagious.

            • simon says:

              They were supposed to be properly quarantined. So the fact that 19% still got infected is not encouraging. Also, the rate seemed to be increasing up to the point they moved people off the ship – so far as we know it could have gotten much higher with more time.

              • John Massey says:

                No, the World Health Organisation has been tracking them all since they were all got off the ship, and the rate of infections both while on the ship + since they have all got off has topped out at 19%.

              • gothamette says:

                John – aren’t you leaving out the time factor? The passenger from HK embarked on 20 January. The ship was quarantined on Feb 4. By March 1, all had been removed from the ship. Perhaps if the passengers had been on the ship longer more would have been infected??

                I’m not smart enough to figure this out but I can’t believe that time isn’t a factor here. In a free society, you’ll have this virus circulating and people can’t be evacuated – they can only be quarantined. A sort of reverse evacuation.

              • gothamette says:

                “o far as we know it could have gotten much higher with more time.”

                Yes, exactly.

              • gothamette says:

                “properly quarantined”

                Dunno about that.

                Crew members described scenes of confusion and chaos, in which there was little separation between the healthy and the sick. “As a crew you don’t even know who is positive – you’re dealing with them and you’re going around the ship, eating in the mess together,” said another staff member, James Reyes, who worked in housekeeping.

                https://www.theguardian.com/global-development/2020/mar/06/inside-the-cruise-ship-that-became-a-coronavirus-breeding-ground-diamond-princess

                OK, it’s the Guardian, but still.

                We need an accurate analysis of what, exactly, went on on the DP.

              • John, simon is referring to if the passengers had stayed longer on the cruise ship. He clearly states this.

              • John Massey says:

                We are not going to get it.

              • David Chamberlin says:

                Responding to John Massey saying “We are not going to get it.” You might not get it this year because you live in Singapore, I expect I will because I live in the USA. Reading the coronavirus dashboards every morning just to see what’s happening around the world I think it’s sensible to conclude 1) it’s blowing up, 10 t0 20+% increase in total cases daily in most countries, with just a few exceptions. 2) Time is on Covid19 side. It can wait till next year to sweep through Singapore or where ever it misses this year. It also appears it will be endemic, like the flu. 3) For one China that can hold the line there are 100 countries that can’t. 4) The experts I have read that I respect put it very simply, “If there are a lot of asymptomatic cases than we can’t stop this.” There are loads of asymptomatic cases. 5) A vaccine appears to be a year plus away. However, I wouldn’t be at all surprised if our ingenious world wide medical community comes up with something in the meantime to diminish it’s effect or lower it’s extremely high infection rate.

              • John Massey says:

                Dave, no, I was responding to gothamette saying we need a detailed analysis of what happened on the Diamond Princess, and just saying we are not going to get that detailed analysis. I wish we could.

              • gothamette says:

                This is getting a bit confusing so let me recap.

                Dave Chamberlin (and others) are saying that the 19% Diamond Princess infection rate isn’t directly relevant because Massey is leaving out the time factor. Given time, the infection rate would have been greater.

                1918 flu infection reached 33%

                Massey is saying that the Diamond Princess 19% infection rate is the limit because they were trapped. Time factor not relevant because of this.

                I don’t know which side is right, but I believe I have accurately summed up the two opposing sides.

                (I believe that we could reach 33%. Someone will have to convince me that it could be higher – is there something about a coronavirus that is potentially more infectious than flu – even the highly infectious 1918 virus?)

  10. David Chamberlin says:

    Highly recommended link to watch regarding variable mortality rate because of mutational change.https://www.youtube.com/watch?v=7YI2tOoVVpk&t=5s

    It was always expected that Covid-19 would mutate to more or less virulent strains. Here it is explained by a medical professional that this has happened. It’s a six minute youtube lecture that is very clear and I don’t need to summarize. The less deadly strain is spreading faster as was predicted by theorists. so now we have three important factors that influence mortality rate. Age, health care, and which mutated strain of Covid-19 that is caught.

  11. Erik Sieven says:

    It would be really interesting to see age-specific CFR calculated in this way. For most people these would be the relevant numbers

  12. Lomez says:

    Does CFR usually make some estimate for mild/undiagnosed cases? So true CFR is deaths / cases 4-6 weeks prior + some estimate of undiagnosed cases. Still very very grim, but I think that’s why the cited figure is still 3.4% rather than 5%+

  13. gothamette says:

    Situation in Italy has gotten much worse.

    https://www.euronews.com/2020/03/05/two-more-people-die-from-covid-19-in-france-says-the-country-s-health-ministry

    “Italy says it’s had 41 new COVID-19 deaths in just 24 hours”

    Very shocking.

  14. John Massey says:

    Three factors are strongly influencing reported CFRs:

    How much testing is done. South Korea is testing the shit out of everyone – they’re brilliant. Japan is not. Iran is not. Germany was not – don’t know now. Italy? The USA? Better not talk about the USA.
    Stage of progression of the disease.
    Whether hospitals can cope with number of severe and critical patients or not. Compare CFR in Hubei Province > 4% with other provinces < 1%. This makes a very big difference.

    There is also the study that says there are two strains. I want to see that study peer reviewed by reviewers who know what they are talking about, replicated by a different research group, and on a much bigger sample, before I am willing to give it any credence at all.

    • gothamette says:

      There’s another infected ship: The Grand Princess. Being held off the coast of CA.

      https://www.cnn.com/2020/03/05/health/california-coronavirus-cruise-ship-thursday/index.html

      Moral of the story: don’t go on cruise ships named Princess.

      Let’s watch this ship and see what happens.

      • John Massey says:

        Already >20 infections on board. But the USA is being a lot more sensible/responsible than the Japanese health authorities were with the Diamond Princess – they are going to berth the ship at a non-commercial port ASAP and get everyone off, not keep them all cooped up offshore for an extended period.

        USA 1 Japan 0

    • gothamette says:

      “Three factors are strongly influencing reported CFRs:”

      If you are a very old person and you go to the hospital for any reason, what is the CFR?

      • John Massey says:

        Depends what you go in for, and whether you can avoid nosocomial infections while you are in there.

        • gothamette says:

          No, the question is a general one. You’re drilling down – I’m asking a general question.

          But if you want to drill down, limit the question to: what is the CFR of 70+ admitted to hospital for ANY respiratory issue.

          • John Massey says:

            No idea. My policy on hospitals is, if I find myself in one, to get out of it as quickly as possible. Doctors working in hospitals who I have talked to agree that my policy is a wise one.

  15. swampr says:

    Korea seems to be getting ahead of its outbreak, which is heartening news. Their industrial level drive through testing works and they are mostly following known transmission chains now. Incredibly, the US testing debacle continues today, a month in. Santa Clara County (Silicon Valley) says they are “no longer in containment mode as it’s getting harder to trace the contacts of each confirmed case”. What?
    This was supposed to be China’s Chernobyl but now it’s turning into ours.

  16. John Massey says:

    Greg, not 1918 H1N1 influenza, but there’s this on the 2009 H1N1 pandemic. Top End means northern coastal strip of Northern Territory of Australia. Significance of that is that there are a lot of remote communities of Aboriginal people with little to no European admixture; some have a small amount of old Austronesian admixture [from traders who went to get sea slugs to sell to the lucrative Chinese market (Chinese eat them because they are good for the health, I’m assured), and that’s probably where dingoes came from – what do you have to trade that a nomadic hunter gatherer would want in exchange for dried sea slugs? Dogs – Indonesian village dogs, ancestral to dingoes]. But they’re likely to be the ‘purest’ Aboriginal population in the country now. Confounding factor – they also have very poor access to health care. Needless to say, the conclusions were never followed up. Because they never are.

    https://www.mja.com.au/journal/2010/192/10/disproportionate-impact-pandemic-h1n1-2009-influenza-indigenous-people-top-end

  17. The Z Blog says:

    One of my readers posted a link to this: https://wmbriggs.com/post/29566/, which had a link to this interesting report in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMe2002387

    “On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

  18. j says:

    It seems to me that the corona pneumonia is similar to the common cold we have each winter. The brutal overreaction of the insecure Chinese government, that did not want to be seen hiding information and mismanaging like with the SARS epidemy, caused the current alarm. At this point irrational panic has seized the world: a good time to buy shares on the cheap.

    • Coagulopath says:

      It seems to me that the corona pneumonia is similar to the common cold we have each winter.

      At the risk of sounding like Bill Clinton, it depends on the meaning of “similar”.

      A CFR of 5% makes it an order of magnitude more dangerous than the flu, let alone the common cold, which kills almost nobody.

      Many people will think they have the cold, though.

      • j says:

        Common cold kills lots of aged, sick people. Every winter, our local hospital corridors are full of old people with viral pneumonia. “The US census for 2000-2001 listed pneumonia/influenza as the seventh leading cause of death. Severe influenza seasons can result in more than 40,000 excess deaths and more than 200,000 hospitalizations. Patients aged 65 years or older are at particular risk for death from viral pneumonia as well as from influenza not complicated by pneumonia. Deaths in these patients account for 89% of all pneumonia and/or influenza deaths.” This is from Medscape, but there are many other sources. At the risk of being called an idiot by Dr Cochran, coronavirus at this point looks like a bad flu.

        • The Z Blog says:

          Well, for the sake of argument, let’s use the CDC estimates on the influenza burden. The average estimated deaths attributable to the flu is 37,000, so let’s say 40,000 to be fair to you. The average number of people getting the flu is 28.6 million. The fatality rate works out to be 0.14%.

          Now, the current CFR of the Wu-flu is 3.4%, which is probably the high, given what we have for data at this point. More time and knowledge will bring that number down, one would think. On the other hand, the CFR for SARS is 14% and the CFR for MERS is a little higher. Let’s be wildly optimistic and say the Wu-flu clocks in at a third of the current number.

          How many people need to get the Wu-flu to equal the common flu death toll? Off the top of my head about 3.5 million people. How long before that many Americans get exposed to it, assuming no preventative measures? About three weeks, based on the current estimates.

          That’s why people are taking this so seriously.

          • wwebd says:

            “That’s why people are taking this so seriously.”

            Well, there’s that, and then there’s this.

            Say you live in a lousy unhealthy apartment which was fairly clean when you moved in.

            step one: At 3 months, you see a few cockroaches. (that is where we were with the earlier notable SARS).
            You kill them all with RAID. And hope to never see cockroaches in your apartment again.

            step two: At 6 months you get lazy about housekeeping and you see dozens of cockroaches, you don’t do what you need to do, and at 7 months you see dozens more cockroaches (that is where we are with our current 2020 coronavirus, and yes dozens and dozens of cockroaches, reproducing at cockroach rates, are something about which one always says, “that is gross”, and “That’s why people are taking this seriously”).
            That is a disaster, you can’t bring a date home with you, and on top of that you live in an infested apartment.

            But say you don’t take it “really” seriously.
            You kill most of the cockroaches and you exclusively eat out for a couple months, so there is no food in your house to attract cockroaches (China today, early March 2020), and you are hopeful that you have solved the problem.

            step three (anywhere from late 2020 to 2029, in this scenario) … But you did not move out, and at 9 months you notice black mold in the bathroom and near the air conditioning vents. (This is something I hope will not happen, but it might – this horrible virus might not be important in itself but might be important because it is the first wave of the sort of thing that happens when, due to globalization and accumulated stupidity, we have made the world as inhospitable to staying healthy as the lousy unhealthy apartment I am describing here. It might not just be that bats and their multifarious contributions to zoonotic diseases are on the cusp of a golden age for such unwanted things, which would be bad in and of itself, but it might be that, cumulatively, something else has gone wrong that triggers such things, AND similar things, some of them almost as bad, some of them maybe worse). (remember that extra-solar rock that passed through the solar system last year – was it the first ever, or just the first we noticed because we were in a position to notice, as was pointed out on this website when it happened? predictions depend on changes in ability to perceive, which is dependent on our condition, such things as the extra-solar-system rock) but also depend on changes in conditions that have nothing to do with our perception or lack thereof of such conditions (maybe we are entering a part of the Milky Way, either through our own fault or not, where those rocks are more common)… verb sap. sufficit – “conditions, he said” —- “what’s the rumpus?”)

            step four: (and I fervently pray that the real-world analogy of this step never happens, but worse things have happened on small scales in lots of countries that are full of people who just did not care enough about their fellow citizens, you can read about it in the history books, and there is no reason that such things could not have happened at larger scales). At 10 months you are woken up in the middle of the night by a mouse that is scrambling around in the bathtub, you have no idea how it got there. The next day you see mouse-bites in almost everything that is made of fabric, the couch, the curtains, even your bedspread.

            You can move out of a lousy apartment. In our globalized world, you need to localize your problems, if you don’t, nobody can move out of a lousy apartment without moving into the lousy apartment next door.
            So yes this is serious.

            When I was young and full of love for humanity, I decided to live in a lousy apartment for a couple years, because typically people who understand logic and science avoid living in such places, and I was curious about what I (when I was young I thought I understood logic and science) might learn, in my capacity as one of the very few people who understand logic and science and who would consent to living in such a place, out of their love of humanity, for a couple years. I might not know much about DNA and epidemiology, but I am an expert on human stupidity, and on lousy apartments , full of cockroaches, mold, and mice, and while I am certainly not an expert on cockroaches, mice, and black mold, I know what the signs of nasty infestations are, and how they sometimes progress as time goes by.
            and I definitely can say:
            “I am taking this seriously”.

            (and I refrained from conspiracy theories, even though I give the least unlikely of them, in this case, at least a one in hundred chance of being true).

          • j says:

            Thanks Z, your deductive reasoning looks seamless, yet let’s observe real life cases like Iran. “Iranian health officials initially boasted of their public health prowess. They ridiculed quarantines as “archaic” and portrayed Iran as a global role model. President Hassan Rouhani suggested a week ago that by this past Saturday life would have returned to normal.” The virus has been raging freely in Iran for weeks, a medically underserved country governed by ignorant clerics. Following your logic, thousands must by dying by now and hundreds of thousands in the coming weeks. That scenario cannot be hidden. I hope it will not happen.

            • The Z Blog says:

              We really have no idea what is happening in Iran. Italy is probably a better example. They are now shutting down in order to contain the virus. How long can any modern country quarantine itself before social unrest and economic calamity?

              Again, this is not the flu. We don’t face economic calamity from the sniffles. We don’t need to lock down cities for the flu. I completely agree that much of the hyperbole is ridiculous and disappointing. The snarky indifference is just as stupid.

            • Exurban4627 says:

              Good God! The Islamic Republic of Iran is impaired by globalist thinking too. Seriously, I did not know that. I did know that they are every bit as indifferent to the suffering of the little people as globalists elsewhere.

    • gcochran9 says:

      If this were your first post I would certainly think you an idiot. But you’ve often been sensible. So, did you have a stroke?

      • Maciano says:

        Yes J has me worried, too.

        • j says:

          Thanks, no stroke yet. The whole world is chattering about a terrible epidemy, but all I see is one already half dead senior gone here, two there, 3073 in China + 413 in the rest of the world (WHO Situation Report Number 47). Few excess deaths considering the age and health status of this population. No mass graves anywhere, not even in the Islamic Republic. The exponential graphs are impressive, but that is the nature of winter flu epidemies. It is bad, yes, but the panic is excessive. Why are elementary schools closed? Why is my wife furiously disinfecting my PC? 🙂

          • Rosenmops says:

            j, are you trying to be funny? This is not something to joke about.
            We now have dozens of covid-19 cases in Canada brought in from Iran in the last week, because our idiot prime minister refuses to close the border.
            And there is a photo of a mass grave in Iran going around on Twitter.
            https://twitter.com/search?q=iran%20mass%20grave&src=typed_query

            I don’t know if the Twitter stuff is legit, but it is certain that Iran is a train wreck and many people are dying.

            Twitter also shows people collapsing in the streets in Iran

            https://twitter.com/search?q=iran%20mass%20grave&src=typed_query

            • John Massey says:

              Iran? The USA is a train wreck, with incompetent CDC and a President who says it is OK for infected people to go to work.

              • David Chamberlin says:

                You are correct. There are multiple false statements thrown out by politicians in the USA but here are the facts. Trump did not defund the CDC. He attempted to defund it but congress didn’t let him. The pandemic team of top scientists at the CDC was not fired by Trump by resigned en masse because of their frustration of dealing with the Trump administration. They were never replaced. With no one at the wheel of the ship the test kits that were made to diagnose Covid-19 were utterly botched. Mongolia, I repeat Mongolia is doing a far better job of testing for Covid-19 and keeping it out of their country than the USA. I could go on, but why bother. I will just provoke stupid political rants.

              • gothamette says:

                @Dave Chamberlin,

                Please go on. It’s difficult to separate the reflexive anti-Trumpers from the reasonable critics. You’re doing a good job. So as long Greg approves you, I’ll read you.

              • David Chamberlin says:

                I’ll wait for a few days to update, once there is new information. I see some comments on these threads implying predicting a dire outcome is just gloom and doom. I suggest anybody who wants to decide for themselves what’s going on in the here and now just google Coronavirus dashboards and glimpse at the percentage of new cases country by country each and every day. Exponential growth of… go low end, 10% a day and you can see why Cochran thinks the hospital care will soon be overwhelmed.

            • gothamette says:

              @Rosenmops,

              I’d be leery of pictures like this. You can take a photo from anywhere and caption it with anything.

              That said, I take this guy seriously:

          • John Massey says:

            Keyboards are fomites, and often found to carry more pathogens than toilets. Also mobile phones. Wipe with alcohol wipes.

          • Tim Burr says:

            No, I think you are reasonable. This has the vibe of Doom Porn, where people get upset if you don’t act as scared as you should over their latest breathless announcement!

            But at least it is a good shake-down which exposes weaknesses in our system and helps us prepare for the future.

          • Labayu says:

            There are some cases in which younger people are hit hard for no obvious reason. For example the 38 year old bus driver in East Jerusalem who is now unconscious and hooked up to a ventilator after driving around some infected Greeks who were asymptomatic at the time. The reason it is worthwhile to contain it as best as is reasonably possible is because the CFR will certainly be much higher if health services become completely overwhelmed.

          • gothamette says:

            “Why is my wife furiously disinfecting my PC? 🙂”

            Because she is sensible, and knows her husband is not. 🙂 🙂 🙂 🙂

            • j says:

              Those horrible Iran pics are convincing (not fake) and the stock exchange is crashing (it not a “correction”), so the situation is starting to worry me. But spring is around the corner and the vaccine is on the way. My wife upgraded our health insurance to Platinum.

  19. Yulia says:

    If control measures begin to reduce the transmission rate, could this create a selective pressure favoring a mutated form with lower lethality but more transmissibility?

  20. R49 says:

    There is a new paper out in “Cell”. The authors from Germany write that they have investigated the pathway that SARS-CoV-2 uses to infect lung cells. In particular, they found the docking protein (ACE2) and that a transmembrane protease, TMPRSS2, is nearly essential for the virus to enter the cell. There are known TMPRSS2 inhibitors, such as camostat, which is already approved in Japan as a medication for pancreatitis. This means clinical trials could start immediately.

    Is the world getting lucky 😀 ?!?

    https://www.cell.com/cell/fulltext/S0092-8674(20)30229-4
    PS: This is a crosspost, but I am very curious to hear your thoughts.

  21. John Massey says:

    Estimated that 4% of the whole population of Lombardy are infected. That’s crazy high, much higher than Wuhan, which is much higher than anywhere in China outside of Hubei Province.

    High fatality rate in Italy. Official statement is that a lot of the regional hospitals in Lombardy (Lombardia, whatever) can’t cope. I’m not surprised. Plus claimed that a lot of the fatalities had co-morbidities, mostly cardiovascular disease.

    Vaccine ready for trials and emergency use in China shortly. There is a Mainland Chinese law that permits emergency use of vaccines while they are still undergoing trials, apparently. Not in Hong Kong though, damn it – different legal jurisdiction.

    But the way things are going in China, they might not have an emergency that warrants taking a risk on it.

    • gothamette says:

      “Estimated that 4% of the whole population of Lombardy are infected. That’s crazy high, much higher than Wuhan, which is much higher than anywhere in China outside of Hubei Province.”

      Are you really surprised?

      I read on a tweet that 10% of doctors in Lombardy are infected, although that’s just a tweet, so take with a grain of salt.

      • John Massey says:

        It’s not the whole of Lombardy, it’s the worst affected areas of Lombardy. I originally misquoted, and subsequently corrected myself.

        Yes, I am surprised.

        I believe zero on Twitter. I won’t use it, it’s worthless.

        I think I’m out of here. I’m not learning anything useful, so I’m not seeing a point.

        • gothamette says:

          The guy on Twitter is a physician, who quoted some reputable sources. His numbers are at least as believable as the ones you’re supplying:

          I will miss you and hope you return.

          • gothamette says:

            John,

            The numbers at the Life Care Center in Kirkland, WA, are worse than the Diamond Princess:

            (Yes, I posted this tweet above but it bears repeating, and the tweeter is an epidemiologist)

  22. John Massey says:

    Sorry – that should be in the worst affected area of Lombardy, not all of it. Precise language is important.

  23. sinij says:

    Bo Winegard was fired for continuing researching, talking, and publishing about human biodeversity.

    https://quillette.com/2020/03/06/ive-been-fired-if-you-value-academic-freedom-that-should-worry-you/

  24. Sinij says:

    Bo Winegard was fired for his research and talks.

  25. gothamette says:

    “You have to consider the situation in which the cases overflow the ICUs – that is likely to be the typical patient. ”

    What kind of numbers are we talking about here?

    John Massey says that the Diamond Princess is the upper bound: 19% infected. That’s about 63M people.

    So how many would be so affected that they would end up in an ICU – 5% of that? That’s 3.2 million.

    If it’s more like the 40% infected at Kirkland Life Care, double it.

    The first is bad, the 2nd catastrophic.

    Someone tell me that I’m wrong.

    • gothamette says:

      PS to above – I understand that this doesn’t happen all at once, it’s over a period of time. Still….

    • John Massey says:

      Someone at Razib’s said he had checked, and the USA has 100,000 ventilators.

      • gothamette says:

        Well, let’s not get 200,000 C19 patients, then.

        • John Massey says:

          It’s worse than that, because the ICUs need to be somewhere reasonably near where the severely ill patients are, otherwise they will die before they get there. Sorry if that is stating the obvious. Currently 3 clusters: NYC, Seattle, California, but who knows once the USA collectively have done enough testing, which is going to take a while.

          Upper bounds: 1918 influenza 27% in three waves. 2009 H1N1 11 to 21%.

          Pick a number.

          Epidemics become self-limiting at some point and peak, because some % of the population have been infected and have immunity, so it becomes increasingly difficult for the virus to keep propagating. At some point, herd immunity kicks in.

          So – Kirkland 40%? Tested and proven, or? Let’s assume 40%, but a care home for the elderly is not a normal real life situation for most people. Whatever, Kirkland was a shit show:
          https://www.kuow.org/stories/the-days-leading-up-to-the-outbreak-at-life-care-center-in-kirkland

          BTW, care homes for the elderly in most places are a disgrace. I’m talking whole of ‘developed’ world.

  26. Abelard Lindsey says:

    In the absence of any other data, the numbers available to us suggests a 1918 Spanish Flu level event. Is this a reasonable estimate? Could it be worse? Perhaps it won’t be as bad?

    Any suggestions for investment portfolio?

  27. Pincher Martin says:

    One thing I noticed when reading The WHO report on China is that the CFR decreased substantially over time as care improved.

    From the WHO report:

    …the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1- 10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak.

    That CFR after February 1st of 0.7% is close to the current CFR reported for South Korea. It would appear that early identification of the disease helps the treatment of it.

    • gothamette says:

      Sure – and we will have less cases if we test and quarantine, quarantine and test.

      But we aren’t, so we’re f’d.

      Cases will surge in NYC in the next few days.

      • Pincher Martin says:

        Sure – and we will have less cases if we test and quarantine, quarantine and test.

        We will eventually test. Maybe not this week, but eventually. The CDC just announced that U.S. medical facilities will be receiving several million test kits in the next two weeks. If true, then by April testing in U.S. shouldn’t be a problem.

        I also want to quarantine, but I’m not sure what that has to do with the dramatically lower CFR in China after February 1st. Once you’ve already caught the disease, how does quarantining lower the CFR?

        Yes, I read Greg’s argument about the ICUs, but there were still many thousands of Chinese who became sick after that date, and the sickest of them were entering medical facilities that were already inundated with coronavirus patients. But according to WHO, the CFR in China still went lower – dramatically lower. That does not match with what Greg is saying about the CFR – that it will go up after the ICUs are full. China was still building hospitals in the quarantined areas on February 1st.

        The WHO report is not specific, but it suggests that the lower CFR had something to do with the “evolving standard of care.” I read that to mean that if you know early that someone has coronavirus, then there are some treatments you can use to help prevent death. Unless someone here wants to argue that China had the ability to manufacture or replicate thousands of ICUs in the quarantined areas within a month.

        • gothamette says:

          “We will eventually test.”

          We had a month to prepare and we did nothing.

          Another ignore.

          • Pincher Martin says:

            We had a month to prepare and we did nothing.

            Are you unable to focus? That has nothing to do with the discussion. The CFR in China fell dramatically even after hospitals were swamped.

            In fact calling what happened in China a dramatic drop is understanding it. According to WHO, the CFR after February 1st went from 17% to 0.7%. Even if you take into account that WHO did not disregard recent infections which had not progressed enough to result in a death, that drop is still dramatic.

            If it happened in China, even after infected patients were swamping the hospitals in infected regions, then it could happen in the U.S. where we have nowhere near that level of infections.

            Another ignore.

            Good. You apparently have nothing worth adding to this discussion.

            • Pincher Martin says:

              In fact calling what happened in China a dramatic drop is understanding it.

              “…understating it.”

            • gothamette says:

              “Are you unable to focus?”

              I’m quite able to focus.

              Trump pissed away a good month to prepare for this. Nobody gives a shit about his golf game.

              He calls this a flu, He’s completely unaware of the seriousness of the issue. He’s unfit for office. I’m not going to get into a stupid tit-for-tat about whether he’s better or worse than the other bozo. They both suck and we are f’d.

              • Pincher Martin says:

                You remain unable to focus.

                I don’t care about the politics of this issue. I’m not defending Trump. Try to focus.

                Look at the CFR. Focus on the CFR. That’s the issue in this thread. If you doubt that, look at the title of this thread.

                Test kits are coming out in the U.S. That they are coming out later than they should have is irrelevant. They are still coming out. Hence, most likely within the month, the U.S. will soon be able to broadly test anyone who we suspect has coronavirus. So they will be out before the U.S.has reached a critical point that China had already passed on February 1st when the death toll was already well over 200 and the number of infected numbered around 10,000.

                Since that date, the CFR in China has fallen to 0.7% from 17%. Even if we assume that the WHO did not account for those newly-infected who were not sick long enough to die from the disease, the drop is still dramatic. And something must account for it other than quarantines or that Wuhan suddenly got high-quality health care after February 1st.

    • Rosenmops says:

      Perhaps in the early stages they were only diagnosing people who were quite sick, which would make the CFR higher.

      • Pincher Martin says:

        That’s a possibility. It’s also possible that when you know quite early that someone is suffering from coronavirus there is a medical care regimen that helps prevent death.

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