John Ioannidis

He emphasizes the cruise ship ( why ignore other whole countries?) and he distorts that example. Most never caught it: of those that did, all had excellent medical care. That’s no longer possible when many millions get infected – resources are limited.

He suggests a scenario in which 1% of the population gets infected and 0.3% of that 1% die. We are not seeing that low level of fatality in China, or Korea, or Italy.  As for 1% getting infected, where the fuck does that come from? When a new pathogen shows up, no-one is immune, and the only limiting factor ( barring intelligent human action)  is having  enough contract it, recover, and develop immunity that the virus has trouble find vulnerable hosts. The limit, in a simple model, is when R0, multiplied by the fraction of never-infected people, is less than 1.0 .  Since R0 is something like 3 ( assuming no major efforts at social distancing etc), that would require infection of 2/3ds of the population of the United States – with a death rate well above the 1% we’re seeing in places like South Korea.  More like 4%, or even higher.

Again, where in the name of God does this 1% come from?  Is Wuflu supposed to quit because he’s caught his limit?

The Faroe Islands had an epidemic of measles in 1846, investigated by Peter Panum, a young Danish doctor. There had been no measles in the Faeroes for 65 years – so only some elderly people were immune. Out of some 8000 inhabitants, how many ended up contracting measles? Was it 1%, due to some kind of  viral gentility?  2%? 10%?

No: 6000 out of 8000 faroese got the measles, the kind of result you expect from a simple model.  75%.  Measles has a high R0 ( ~10), which would have predicted 90% – but people over 65 had already had it, and even the Faroese don’t practice perfect panmixia.

The Spanish flu had an R0 around 2.0 . There had been an antigenically related flu around 1890, so older adults were  less vulnerable. The percentage infected  ranged up to 50% – which, against, is approximately the limit predicted by the value of R0.

When a pathogen is NOT novel, sure, you can have lower fractions of people vulnerable, because many people are already immune,  and the fraction infected can be low.  If it depends upon some regionally varying vector, like mosquitoes, sure, it doesn’t have to sweep across the whole country.  If its R0 is only greater than 1.0 in some subpopulations, as was the case with HIV, it may spread only in those subpopulations.

But Wuflu IS novel, and does NOT depend upon a vector.  The vulnerable subpopulation is those that breathe.

So,  the surprise-free prediction is that it hits > 50% of the population –

Unless we stop it.

 

 

 

 

 

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221 Responses to John Ioannidis

  1. enyeword says:

    Would you mind linking to the piece you’re responding to, for the sake of both posterity and me?

  2. drlorentz says:

    The likely reason Ioanndis focused on the cruise ship is that every single person on the ship was tested. That removes the bias of not having tested asymptomatic or mildly symptomatic individuals, which evidence suggests are the majority. In the ship sample, ~60% were asymptomatic. The bias of testing only obviously sick people underestimates the denominator in the calculation. Using the age distribution data, he was able to rescale the ship rate to the US population. The principal limitation of his fatality rate estimate is the small number in the sample.

    Is there any other case where people were randomly tested, regardless of symptoms?

    • gcochran9 says:

      You know, I’d bet money there’s some other reason.

      • allensheep says:

        Quality of medical care for people on the cruise ship?

      • kpkinsunnyphiladelphia says:

        Greg, I think you are being slightly unfair to Ioanndis. His point, which is a very good one, is that we don’t have truly statistically valid data, and we are making very draconian decisions based on incomplete data at best, and misleading data at worst.

        We need statistically valid ongoing population sampling in the United States of America — which, last I looked, is not like northern Italy with its substantial Chinese ex pat population and high proportion of elderly people, or Wuhan, a population dense geography with pretty shitty (literally) sanitary practices and large male cohorts who smoke.

        We do national polling all the time. Let’s do it for this, and really get a sense of how the models are looking relative to what the sampling is telling us. We should not only do virus testing/sampling but also serological testing/sampling to track antibody development.

        So, yeah, let’s lock down for a while, but let’s do some real statistical sampling.

        Of course, we WON’T do that because that would require “precious” test kits to be used randomly, as opposed to simply giving it to those we THINK may be infected, and thus providing more potentially misleading data that may drive us back into our caves and lead to an economic depression which, frankly, may — and I stress the word MAY — be FAR worse.

        • gcochran9 says:

          There is nothing wrong with decent statistical sampling, but the thrust of his article is mad as a hatter.

          • The old “Mathematicians vs. Soft Science” battle again rears its head.
            John Ioannidis is “mad as a hatter” for being a skeptic of CoronaMania.
            Lucidly articulated statistics, but to the soft scientists like yourself, he’s “mad as a hatter”.
            So, you are clearly confident in your belief that COVID-19 is an epochal, near-extinction level virus, and that the USA, despite the largest government project since WW2 in terms of dollars and man-hours, is still not doing ENOUGH.
            Now, let’s put your theory to the test:
            By your theory, England, which is employing few of these measures (we’ve all seen the videos of Italian flights coming in, unchecked), should have the populace wiped out and/or their infrastructure crumble from demands of the sick and dying. England is also far more demographically dense than the sparsely populated USA, and therefore your theory states that their demise must happen very soon.
            So, WHEN, precisely, will England be genocided by COVID-19, as your beliefs state?
            Please give a date by week. We’re all bored as hell of your (and others’), “Not now….but SOON!” doomsday prophecies.
            I think you’ll agre that we need to see TOTAL MORTALITY RATES skyrocket because, as the brilliant mathematician Ioannidis points out (and this is well documented in other infectious disease outbreaks), assigning cause of death is usually a subjective judgment, and the only way to know whether your theory is right is if the YTD deaths have skyrocketed from YTD deaths over the previous year.
            (Spoiler: They haven’t. Anywhere. Including Italy.)

            • gcochran9 says:

              In northern Italy, total mortality rates have skyrocketed. ” 400 people died in Bergamo and 12 neighboring towns — four times the number who died the same week the previous year, according to the Bergamo mayor’s office. Only 91 of those had tested positive for the virus.”

              • Italy’s YTD deaths in 2020 are same as 2019.
                You specifically described this as an extinction level event, obediently repeating the talking points from the American media, the government, and your I F***ING LOVE SCIENCE! websites.
                You, being a soft scientist, also raged-snarked a brilliant and incredibly accomplished mathematician for his objective analysis. (Yes, we know that anthropologists struggle with math. But it wasn’t THAT hard.)
                Again: You are supporting the largest USA government project of modern times.
                Please give a date of when your theory of this mass genocide will finally come to fruition.
                Because rather than providing a falsifiable theory, you’re instead just rabidly defending vague doomsday prophecies from your beloved government.

              • gcochran9 says:

                I never called it an extinction event. And, as to just how soft a scientist I am – you don’t know me very well, do you?

              • John Massey says:

                I have to admit that I have never found Physics to be particularly soft.

            • YTD deaths haven’t skyrocketed in Italy?

              Is that why Italian hospitals are overwhelmed with the sick and the dying? Because they have that exact same problem every year?

              Does that explain why the country is practicing triage, by effectively not providing life-saving care to those over the age of sixty who need it? Because that’s just business as usual in Italy?

              Does that explain why the Italians have deployed their military to truck the dead out in convoys to crematories and morgues? Because military conveys routinely transport the dead in Italy?

              Or perhaps a Stanford professor and his pea-brained fanboy got it wrong.

        • gcochran9 says:

          You needed one sick Chinaman to get this thing going in Lombardy.

          • kpkinsunnyphiladelphia says:

            Right, one sick Chinaman was enough to start it, but if you start a fire in the desert, it goes nowhere, while starting one in an drought ravaged uncleared forest with dry underbrush is a catastrophe.

            Location and its characteristics matter. See the Kirkland nursing home.

            Meanwhile, take a look at this:

            https://www.cebm.net/global-covid-19-case-fatality-rates/

            These Oxford guys are not flamethrowers like Iaonnidis, but they too, note the issue of selection bias, and, frankly the models we’ve seen so far succumb to that problem. Even Iaonnidis concedes at the end of his piece that this could wind up like the Spanish flu (which was why I pointed out that you were “slightly unfair” to him).

            But we really do not know the CFR for the United States, or for regions of the United States. Should we lock down, say, Iowa? Speaking of fire in a desert, do we know what’s REALLY happening in Phoenix? Or hot and humid places like Mobile? New Orleans maybe should lock down, because of the last influx of out of towners in Mardi Gras, but should Lafayette? Shreveport?

            What we don’t know if vastly larger than what we do, and we are making very dramatic national level decisions for a country of 330 million people based on statistical modeling that might barely get you a D in a grad level course.

        • David Chamberlin says:

          Ladies Gents and Tweeners I submit to the following. 99% of the general population is some combination of ignorant, stupid and emotional and is never going to extrapolate WTF is highly likely to happen. Now the remaining 1% could tell you the fucking ball is going to keep rolling down the hill but they are drowned out by the screeching idiots. Now I could try and raise my voice but why bother. Personally I prefer absurdity to patience and reason. I’m result oriented, this way I’m amused and spare myself the wasted frustration of not being understood in the slightest. Were are going to run out of toilet paper, that MAD MAX movie shoulda been about a truckload of toilet paper not a truckload of gasoline. The rich will have Bidets and the poor will have a buttgoat tied to the side of their outhouse. I’m not going to explain how that works.

          • David Chamberlin says:

            I have read good non fiction for all my life, and thanks to the guidance of Razib Khan and Greg Cochran I have read some of the best. What I learned was two fold. First I knew little, second I knew more than all the other fools that were not reading like I was. I knew how disease had changed human history. I knew it would again. So I am not surprised. Others are and i don’t want to preach and I don’t want to teach. They could have looked up, they could have looked around, but they didn’t. Read the best non fiction, seek it, love it, and always wonder. It might just do you good, in a pinch.

    • Jack Amok says:

      There’s another population where everyone has been tested – the Life Care center in Kirkland. Both the inmates and the staff. So far, 81 out of 120 residents are positive (67.5%) and at least 25% of the staff (still some tests waiting to come back). I don’t think the fatality rate is useful for the broad population as all of the residents had some sort of serious pre-existing condition to be in there, but it is high – at least 25% and sadly probably not done yet.

      It’s a smaller sample size than the cruise ship, but I don’t think the disparity in numbers is a sample size issue.

      • Jack Amok says:

        Update: Fatality rate of the residents is currently 42% of all those who tested positive, and 28% of the entire population. 120 people, 81 tested positive, 34 currently dead of it. It’s an at-risk population to be sure, but those are damn grim numbers. Not all of those 120 were hospice-types either. Many were relatively healthy elderly people in for a couple of weeks to recover from surgery.

        • j says:

          Update from Kirkland: https://lcca.com/downloads/kirkland/Kirkland-Update-03202020.pdf
          Note normal death rate of 3 to 7 residents per month. Anyway, the excess deaths are … excessive. I don’t understand the “Employees lost” figures. Lost means resigned? hospitalized? …

          • gothamette says:

            I don’t understand “Employees Lost” either. Lost track of? Disappeared??

            That would be very concerning. Wouldnit?

            • j says:

              Probably the illegal Phillipine personnel caught cold feet. It must be depressing to work in a death factory.

              • gothamette says:

                Illegal Filipinos in Washington State? Well, I don’t know much about that part of the country. In my experience Flips tend to be legal. They are nice people.

          • Jack Amok says:

            Those numbers from LCCA do not quite jive with what is being reported locally. Who to trust more, the State Dept. of Health, the local newspaper, or the nursing home accused of hiring low-quality staff that they underpay and overwork and who are looking at one ugly lawsuit from families of dead people? As the say on detective dramas, they all have motive.

            “Lost” must mean quit.

      • gothamette says:

        I was thinking of this. I think the critics would say that the residents aren’t a good proxy for the general population – but they would have no answer for the staff. 25% is pretty close to the Diamond Princess, and to 1918 (28-33%). Even at 20% we’re staring into the abyss.

    • From the land of the ice and snow... says:

      Iceland are doing huge scale samples relative to population, pretty close to random.

      Finding lots of asymptomatics, about 50%. Like Diamond Princess. 409 cases total at latest date, 1 death so far (an Ozzie tourist), very few hospitalizations – https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Iceland.

      A further advantage of that is that Iceland seems to be going random sample on tourists too. Since we have no particular reason to believe tourists are less or more likely to be Cov19 positive (maybe they’re young and fit, but maybe not so much, and anyway that matters only to CFR, not prevalence), that gives us a back of an envelope estimate for prevalence in countries that are don’t have Icelandic levels of national greatness (like the US or UK, for’ex, though to be fair, does anyone?).

  3. Ludwig Fahrbach says:

    Thanks for your analysis. I had read Ioannis’ piece and stumbled over the same issues (why 1%, why only cruise ships), but as a layperson I can only reach a rather superficial judgement and must look for confirmation by knowledgable people. The comments on Ioannidis’ piece (in the comment section of that web site) make the very similar points, so the matter seems to be clear in this case.

    It is surprising and sobering that Ioannidis’ reasoning is so bad. He is a star among medical statisticians. How does that happen?

    Could you comment on this piece:
    https://www.scribd.com/document/452183475/Imperial-College-COVID19-NPI-Modelling-16-03-2020#from_embed

  4. j says:

    How does that happen? The Diamond cruise ship population was 3711 and 712 (19%) were infected. 8 of them died (2.1% of the population on the ship, that is, 1.1% of the infected). Of the Japanese nationals evacuated from Wuhan, 30% was found to have been infected. Interpolating the cruise ship and the Japanese in Wuhan numbers, a rough guess al ojo de buen cubero may be an infection rate of 25% of the adult population. An efficient hi-tech dictatorship will cut this rate as it did in the People’s Republic of China, Singapur, etc. and as from yesterday, Israel.

  5. j says:

    Correction: 0.21% instead of 2.1%.

  6. James Thompson says:

    thanks. BBC has a country by country rate, with the cruise ship given as a separate entity. Of course, the beauty of the cruise ship data is that they were all tested. They had mixed before, but were then confined to their cabins. Discussions of the data should take that into account, plus the excellent medical facilities you have already mentioned.

  7. teageegeepea says:

    “Most never caught it”
    Why do you think that was the case? I had heard the ship compared to a prison or hospital where spread should have been especially likely.

    • gothamette says:

      Most never caught it

      Meaning 80%. 20% did. Yet Ioannidis said 1% would be infected. Even I know that 100 minus 80 is 20. I’m good enough for that.

      My guess is that this was a typo. I’m serious. Total fucking fuck up – but a Freudian typo. He meant for it to be 1%. His unconscious mind created the mistake.

      Oh wait, Greg hates Freud. Whatever.

      Ioannidis fucked up, bigtime, and the fucking whole paper is fucking worthless.

      • gcochran9 says:

        Combined with ignoring all the country-level examples, giving insane advice to subway riders – something else is going on.

        • gothamette says:

          Fear?

          • jbbigf says:

            Ioannidis cites a 1% “case fatality rate”, as 7 died out of 700 cases. It is curious that he does not mention how many people were on the ship, but the number seems to be 3711. He thinks this situation is more telling than “whole countries” because everyone on the ship was tested. Everyone in Italy has not been tested.

            It seems like a reasonable analysis, although hardly conclusive. I am especially wondering about the validity of that test. How do you test a test? But it does seem that conditions on that ship were worse than most people will encounter. Everyone must have been exposed multiple times, and only seven of them died.

            • gcochran9 says:

              It’s utter nonsense. Ioannides posits a 1% infection rate: guess what the infection rate was with a new flu strain ( H1N1) in 2009? In the US?

              24% ( from serological evidence) . A fair number of people were at least partially immune, and influenza is not as infectious as COVID-19. With an R0 of around 1.3 ( typical flu number), that’s not far from what you’d expect:
              1.3 * (1 – 0.24) = 0.988, < 1.0

              So, what’s your excuse?

              • jbbigf says:

                He posits a 1% “case fatality rate”, not infection rate. For example, suppose 700 people got a disease, and seven of them died. That would be a “1% case fatality rate”. And that is exactly what happened on the Diamond Princess, the only existing situation for which we know the infection rate. Assuming the test is any good.

              • gcochran9 says:

                He does posit a 1% infection rate, and a 0.3% IFR. Read it again. Perhaps you filtered it out as unbelievably stupid.

            • gothamette says:

              He said both.

              1% infection rate. Quote:

              “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”

              I am screenshotting this in case he does an oopsie.

          • j says:

            Let’s be civil and call it cognitive bias, such as underestimating greatly the probability of undesirable outcomes and overestimating favorable and pleasing outcomes (wishful thinking). Fortunately, Greg seems free of it.

            • j says:

              I tried to reply to Gothamette’s “Fear?”

            • gcochran9 says:

              Weel, there was the time an old friend started saying things that made no sense, but not nearly as stupid as what Ioannides just said. Turned out he had glioblastoma. How’s that for civility?

            • gothamette says:

              We’ve already got confirmation bias.

              But that 1% is a huge blooper. To my knowledge no one is Twittering about it. It should be notorious.

              • Howitzer Daniel says:

                Gothamette – well …. Maybe his editors took out four words “one percent will be infected with a lethal strain” (9 words) was what he wanted to say, not “one percent will be infected” (5 words), or maybe his editors took out 2 words —– “one percent will be infected before summer” (7 words) , not “one percent will be infected” (5 words). Or maybe it was his fault, not his editor’s fault, maybe he rushed the last draft and forgot to qualify his terms.

                If he meant to say what he actually said – that we should treat this virus as only likely to affect one out of a hundred people – then he either has knowledge no one else has or he is dreaming.

                To be fair, in greater China itself, and in Arizona and Georgia and in every town along the Great Mississippi it looks right now like less than one percent will be infected before summer. I hope I am right about that.

                Not true in Lombardy or Teheran or the beloved Wuhan town center, I guess, but maybe I am “Stupid”

                (you have no idea how much easier my life would be if I actually were stupid for a human.

                I admit I am stupid when compared to angels, but nobody wants to hear my details on that.

                And I do not blame them).

                That being said, I am on the side of the people who think this is going to be the worst respiratory illness year, worldwide, since the Great War. I have lived a long time and I can’t remember a year where the ICUs were overflowed in any part of Europe by the flu.

                Only God knows what went on in China back before Western Media had been invited in, there are no good historical accounts of infectious diseases in Mao’s China.

                I also want our friends in Asia to stop eating bats and dogs, that is one of my motivations.

                And yes Taleb could be a little more grateful to all those crustaceans whose ink he eats.

                Not gonna happen, I think, but one can hope.

              • gcochran9 says:

                He multiplied that 1% by 0.3% and got the answer – sure, he meant 1%. But why?

                As for < 1% in flyover country by June – no way, barring a ferocious crackdown.

              • John Massey says:

                Veneto village of 3,300 50km from Venice tested early and tested everyone, and got 3%.

                https://www.abc.net.au/news/2020-03-21/one-italian-town-is-bucking-the-countrys-coronavirus-curve/12075048

              • gothamette says:

                I personally do think it was a sloppy copy-editing error. Which in this case is unforgivable and which Ioannidis should acknowledge & apologize for.

                That said, people really are scared shitless of China, and I am sick of it. When all this shit is over, I want ’em to pay. Trump’s basic sentiment towards them has been vindicated.

                We need to know what went on in Lombardy and Veneto. I simply can’t believe that it was one guy. There are thousands of Chinese living in Lombardy.

                Milan has Italy’s largest Chinatown. Milan is the capital of Lombardy. Does anyone believe that Lombardy became infected by one guy? I do not.

              • gcochran9 says:

                How can it be a copy-editing error when the product of (population)x(percentage infected)x(death rate) is there and correct?

                One guy is all that is needed: but by sequencing, we may be able to tell.

              • gothamette says:

                It’s a glaring error which he should be forced to acknowledge & apologize for in public.

                Do you have friends in high places? Put the screws on them. Tell them to do this.

                Ram this down his throat.

              • gcochran9 says:

                I wish I could say “I know a guy”, but I don’t, really.

  8. mapman says:

    There has to be a term for it if it does not exists: “an intellectual whore”. It goes like this:

    – A guy has a nice idea, enunciates it eloquently.
    – The guy is hailed as an intellectual messiah, a prophet of the enlightened age.
    – The guy loves the limelight. Really, really loves.
    – The guy is so in love with it, he is willing to say or do almost anything to keep it up.
    – Unfortunately, nice and original ideas are very hard to come by.
    – So the guy becomes “edgy”, “controversial” and “contrarian” – starting to spout all kinds of pure bullshit just to stay “relevant”.

    Many have gone down this tube, most recently Taleb and now Ioannidis. Besides this article, Ioannidis previously claimed (100% evidence-free) that

    “you shouldn’t worry if the subway is your only option right now. The risk would be extremely low with pubic transportation or rideshares”

    https://www.bustle.com/p/is-public-transit-safe-during-the-coronavirus-outbreak-heres-what-experts-say-22606052

    If someone did listen to his advice on SARS-2, that’s a real physical harm brought about by the professor of medicine.

    • gcochran9 says:

      Something wrong here, for sure, but I would guess that the root cause is something else.

      The subway advice is psychotic.

      • mapman says:

        Yes, the subway advice is crazy. But his STAT article is deranged too:

        “If we had not known about a new virus out there … at most, we might have casually noted that flu this season seems to be a bit worse than average”.

        One does not have to be a scientist to just notice that respiratory support in ICUs being overwhelmed in several countries in a short span of time is not exactly an example of how a typical flu season goes.

        Ioannidis is 54 in California. He runs about a non-zero chance of not only getting the thing but also end up being hospitalized to the ICU. Should this happen, I can’t help wondering if he will issue an apology.

        • gcochran9 says:

          Sure, it is deranged, but I felt that screaming about it might not be the most effective ways of clarifying things. so I held back. It was hard.

          Theory 1: he’s paralyzed with fear: like a rabbit in front of a snake. There were scads of guys with HIV that tried to argue it away. (then they died.) But somehow that doesn’t feel right.

          • mapman says:

            I am sticking with my original theory: He has gone Taleb.

            • gothamette says:

              Taleb is very C19 astute.

              • mapman says:

                Yes, he is. Which proves that he is not demented. Good to know! His previous stances in GMO and IQ were just as idiotic as Ioannidis’ take on SARS-2, though. Evidently, the “intellectual whore” is a complex syndrome.

              • gcochran9 says:

                I can’t think of anything particular interesting that Taleb has ever done. Forget him. Ioannides has said very useful things about statistically weak studies, but here, he’s dead wrong. I would guess that he knows nothing about the dynamics of epidemic spread, but that doesn’t seem enough to explain this cosmically dumb piece.

                More research is needed.

          • gothamette says:

            I didn’t read this when I suggested “fear” above.

            Maybe it’s that. His hands shook so much he entered in wrong numbers, and the secretary didn’t correct it.

        • John Massey says:

          Theory 2: He stands to lose a truckload of money on the stock market.

          That was an unworthy thought, but I had it anyway.

          • gcochran9 says:

            A goodly fraction of public statements have a nasty reason behind them.

            • Thersites says:

              Some people scoff at the religious notion of plagues and natural disasters as the wrath of an angry God at sinful mankind. When you watch such problems get exacerbated and prolonged by human avarice, spitefulness, and mendacity, though, the point isn’t hard to see.

          • Petja Ylitalo says:

            “Theory 2: He stands to lose a truckload of money on the stock market.”

            Why would he have kept those stocks? For a low millionare, exiting all your stocks can usually be done in a day pretty easily, some illiquids might take a couple of days.

        • John Massey says:

          Theory 3: What mapman said.

      • Roffo says:

        Not all political adversaries are happy with the current precautions taken; they may be successful.
        Buy a famous doctor and propagate doubt to throw a clog in the machinery. Expect the common shills to surface.

      • gothamette says:

        Since you mentioned “psychotic” you should see this:

        https://www.powerlineblog.com/archives/2020/03/stop-the-insane-overreaction.php

        This is a mainstream Republican blog. I don’t read it but someone who still thinks this is much about nothing brought it to my attention.

  9. Jon says:

    Ioannidis is “professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University”. According to Greg Cochran, who apparently is an expert in everything, he is a psychotic idiot. Fortunately, in a few weeks we should be able to see who the idiots are.

    • gcochran9 says:

      “Experience keeps a dear school, but fools will learn in no other”

    • gcochran9 says:

      I know this is pointless, but if you had half a brain, you would consider evidence and arguments, rather than credentials.

    • j says:

      Iannidis made a simple reading comprehension mistake. It happens in the best families. Greg suspects something else is going on.

      • gothamette says:

        People ARE scared shitless of China. I know I said that already but it’s true, bears repeating. Today I saw someone on TV, I wish I remembered his name. A real louse. When he was asked whether China lied at the beginning of the Wuhan crisis his eyes dropped (that’s what you do when you lie) and he said, “Possibly.” Then he launched into a rant against Trump.

    • mapman says:

      One HAS to be an idiot if claiming this in the face of all the evidence we have:

      “If we had not known about a new virus out there … at most, we might have casually noted that flu this season seems to be a bit worse than average”.

      • michaelthau says:

        I don’t know anything about how virus’s spread, was just looking to learn a little, and wound up here. But all of you people calling him an idiot for that quote plus those agreeing don’t seem to know how to read very well. He’s clearly talking about US rates in isolation. He’s saying that if the only data we had was U.S data, this flu season would only seem a bit worse. This really oughtn’t to be necessary to point out to people so obviously convinced of their superior minds, but here’s what precedes the quote that’s supposed to be so idiotic:

        “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.”

        The “idiotic” quote that follows is clearly a way to illustrate that the numbers he’s citing are “within the noise.” He’s obviously projecting possible U.S numbers and claiming that in isolation they wouldn’t amount to much more than regular flu numbers rather than claiming that data from outside the U.S. isn’t noticeable. I can’t say whether the projection is reasonable, but it’s incredible to have to belabor the meaning of a few simple English sentences to people so intellectually self-satisfied.

        As a few others have already pointed out, he also explains exactly why he focused on the cruise ship. I can’t say whether his reasons are good enough to justify the weight he’s putting on it, but they do make sense. And reading the author of the blog try to make it seem wrong-headed and mysterious without even seeming to notice that the explicit reason was given let alone address it, doesn’t inspire confidence.

        Finally, the blog’s author seems to also be claiming that weight shouldn’t have been placed on the cruise ship because most never got the infection. But the article’s author was explicitly extrapolating from those infections rates because the people on board, according to him, interacted a lot after the virus was introduced and contagious but before they isolated themselves. Maybe he shouldn’t have done so — though researching this I’ve read reports that even when they were supposedly isolated there was plenty of contact — but, again, not noticing that it was one of his major points betrays someone who just isn’t paying any attention to what he’s reading.

        Credentials certainly shouldn’t matter. But not comprehending simple sentences because you’re full of yourself and in a rush to be insulting and dismissive does.

        • gcochran9 says:

          ” Last week alone, 400 people died in Bergamo and 12 neighboring towns — four times the number who died the same week the previous year, according to the Bergamo mayor’s office.”

          I would not call a 4x death rate “within the noise”, because it isn’t. Only about a third of those excess deaths were diagnosed with coronavirus – lots of people are shuffling off this mortal coil without getting that degree of attention.

          Would you like to know the odds of having 400 deaths, by chance, when the normal number during that period is 100 ?

          Want to guess?

          • Mark says:

            https://swprs.org/a-swiss-doctor-on-covid-19/
            There seems to be some doubt about the numbers from Italy and how they relate to deaths actually caused by SARS-CoV2. For those that can’t be bothered to click the link it seems that 99% of the dead had a co-morbidity, and the median age was 81!

            • gcochran9 says:

              Yes there is. Something like two-thirds of the deaths caused by coronavirus haven’t been attributed ( died before they were tested)/ But when the overall death rate triples or quadruples, it doesn’t take a mathematician to see a real problem ..

          • Deckin says:

            Certainly 4x previous year’s deaths sounds outside expected values, but given the population structure of Italy, 1x year over year is also probably unlikely. To really get some teeth into this, there’s a comparison town nearby that may offer answers.

            The nearby town of Lodi (a very famous and beautiful place in its own right), where I lived long ago, instituted, if reports are accurate, pretty good lockdown measures early on. And from what I’ve read, they’re doing much better than Bergamo and other Lombardian cities. So there we’d have a pretty good idea of what year over year deaths ought to be in a demographically similar population. That would be good info.

            As a complete color commentary aside, these towns have their own lore about each other, as might be expected. For instance, it’s said by locals that Brescia has the most overworked prostitutes. The saying of the overworked is that one is working harder than a Brescian whore.

            More to the point (but still pure color commentary), the Bergamaschi are known for eating anything that flies. They will eat the smallest birds, usually by roasting and then popping the whole thing, less the head (presumably!), into their mouths a una volta. And, the joke goes, they even eat bats. Just saying.

            • gcochran9 says:

              Death rates normally don’t change much from year to year. Show some sense. If we assume that last year was average – then 100 is probably with 10 of the true average. Poissonian. What are the odds of getting 400 or more deaths by chance, if the true average is around 100? Kinda low, in the sense you wouldn’t have expected to see it happen once in the last 100 billion years. Thirty sigma. Only 91 of them officially died of coronavirus ( i.e. were tested). But, in reality, about 300 of them did. So the official Italian coronavirus death toll of 793 for yesterday should be multiplied by about 3. It’s gotta be well over 2000.

              • Mark says:

                Greg. Your reply to my reply above did not have a ‘reply’ button! A technical hitch I’m sure ;-). Please post some evidence to support two claims you’ve made:
                1.“Something like two-thirds of the deaths caused by coronavirus haven’t been attributed ( died before they were tested)”
                2.”Only 91 of them officially died of coronavirus ( i.e. were tested). But, in reality, about 300 of them did.”
                Many thanks.

              • Mark says:

                Greg, thank you for your reply below. I did read somewhere that in the UK where I live death rates (at least flu-related) are all over the place. I.e. one year 28k, the next 1.7k. That’s a bigger swing than that outlined above. Any comment?

              • gcochran9 says:

                I was not talking about differences in the death rate due to flu ( a small fraction of he overall death rate): I was talking about the TOTAL death rate quadrupling.

        • mapman says:

          Even with the most charitable reading you insist on, one still has to be an idiot to project the numbers he is projecting: He has a picture of ICUs being overwhelmed in front of him yet to keeps spouting nonsense how all of it is no big deal. And do note that Ioannidis is consistent about this nonsense – see his idiotic claim that the danger of getting infection while riding subway is “extremely low”.

  10. Enquiring Mind says:

    Scenario:

    100 people, life expectancy 80 years; i.e. = 8,000 life-years.

    Say the virus kills 5 of the 100 people. Three people lose 10 years each, one loses 20 years, another 30 years. Total life-years lost = 80.

    Expressed in life-years lost, this scenario produces a loss of 1%.

    Question:

    Is this scenario excessively optimistic?

    I think the answer is “no” and I wonder, why are we crippling the world’s economy to prevent a 1% loss (probably less)? You will now tell me why this is all wrong…

  11. gothamette says:

    About random sampling.

    This website aggregates all tests, positives and negatives.

    https://covidtracking.com/data/

    (Not crazy about the way they show it – looks as if deaths are included in total, but anyway)

    Compare WA and NY States. Look at huge difference in positive/negative.

    What’s going on there?

    Can we regard either state as random sampling?

    • mapman says:

      With not a whole lot of testing done and tests not validated properly (in all cases, pretty much unknown false negatives or positives), it’s a surest bet that the sampling is not random.

      state positive negative deaths total
      WA 1,376 19,336 74 20,712
      NY 4,152 18,132 29 22,284

      Just looking at it, my bet would be that the two states primarily use very different PCR tests.

    • dux.ie says:

      At this stage random sampling is wasteful. As the cited NY memo elsewhere on this thread shows that NY does not have the capacity (running out of swaps and their containers) to test those asymptomatics and mild to moderately ill persons.

      From various observations it seems that the preferred minimum testing capacity NTest
      /NConfirmed = 5 (the green line), e.g. 3 days after I observed that the Lombardia data dipped below this limit there was a report that Lombardia had problems with testing. To be able to do extensive contact tracing even with contacts with no symptoms required at least NTest/NConfirmed=20 (the purple line), like in the case for Korea and Veneto.

      From the US data, NY has been hugging the minimal green line for quite some time. The early NY data are questionable as they fluctuated too much. Those tested in NY are obviously already very very sick and hence the higher positives. Whereas for WA they have spare capacity to do contact tracing even for most of the contacts with or without symptoms and hence their lower NConfirmed rate. OR despite complains of unable to request test on demand seems to have capacity to do considerable contact tracing (hugging the purple line) if the tests are properly rationed. Watch out for the busket cases of NJ and LA heading to disaster sooner or later.

  12. jb says:

    Greg, what is your best case scenario? Do you think it’s possible eliminate the virus worldwide? If not, won’t it always be threatening to return, and won’t we always need to be taking economy-crippling measures to prevent that? An effective vaccine would solve the problem — do you think that’s possible? Likely? That’s the only alternative I can think of to either letting the virus burn through the population (maybe quickly, maybe slowly), or permanent lockdown. If you’ve come up with a better non-vaccine endgame than those I’d be very interested in hearing about it.

    • gcochran9 says:

      Pretend you’re me. What do you think I’d suggest?

      • mapman says:

        I’ve been pondering this for a while. Here:
        – Go nuclear on it and pretty much shut down everything.
        – CDC must tell everyone that masks are a good thing (but even more so, are gloves)
        – Start treating everyone right away. Chloroquine, protease inhibitors, nucleoside analogs – anything goes. Just keep all records.
        – Start sequencing all deceased.
        – Massively fund vaccine development (most of it will be wasted by parasite biotechs but that the cost of doing business).

        • German_reader says:

          “CDC must tell everyone that masks are a good thing (but even more so, are gloves)”

          Why gloves? I understand the benefit of masks, given droplet (and possibly airborne) infection through the mouth or nose, but what’s the benefit of gloves? If you get the virus from a surface and then touch your eves, what good would gloves do?

          • mampan says:

            It is still possible that the primary infection route is fomites. In this case, being able to remove disposable gloves would be a great benefit.

            BTW, stay away from public toilets as much as you can: the virus survives surprisingly well in aerosols and fecal matter contains a lot of it. (Every flush generates aerosols)

      • jb says:

        Not much chance of getting you to spell it out, is there? My guess is you would suggest suppressing it as hard as possible right now and hoping for a vaccine to solve the problem in the future. But I’m not you, and I was wondering what endgame the real you is hoping for when real you is feeling optimistic. Long term lockdown in the absence of a vaccine just strikes me as a different (and arguably worse) kind of a disaster.

        • gcochran9 says:

          Add in antivirals, serums, improved case management, increased hospital capacity, intelligent testing and monitoring ( temperature scans). Then vaccine, about which there is no special difficulty.

          Masks.

          singapore, Taiwan, south Korea, Japan, china re managing to do business. We will too, after we get it under control – so where’s the deep pessimism coming from?

          • jb says:

            Masks forever? That’s pretty pessimistic! If you think though that a vaccine will not be especially difficult then that’s the answer I was looking for, so thanks. I’ve seen pessimism about a vaccine elsewhere — too much mutation! — and it’s not something I can judge for myself.

            • gcochran9 says:

              Who said forever? But masks are simple, cheap, effective, and don’t much interfere with work.

              • ASR says:

                Masks sounds like a much better solution than shutting down a significant part of the economy and denying a significant portion of the labor force their livelihoods. The real problem is that the West’s political “leadership” went from complacent indifference to panicked overreaction with nary a rational thought in between.

              • Half Carlyle says:

                Why not anyway? I live in Asia and people think it’s very strange that Westerners go around coughing openly all the time. Especially when one is feeling ill, why not just normalize mask-wearing?

          • jb says:

            BTW, there are no masks to be had where I live, but I do have a good supply of sturdy paper towels, and it turns out that paper towel masks are easy to make, don’t look too stupid, and are better than nothing.

            • gothamette says:

              Somewhere in these comments I gave a link to a high fashion brand that is now making masks. NYC used to be the center of the garment industry. It still has some capacity. If Bill Dumb Blasio wasn’t so stupid he could probably get the costume shops of the Met and the NYC Ballet to crank them out. Not N95s, but the other type.

              The paper towel mask is a great idea – if you can get paper towels.

          • DdR says:

            I’m assuming that travel, especially intercontinental, will inexorably change. I can foresee every passenger being screened with temperature scans before boarding.

            Whoever makes HEPA filters is gonna make a ton of money long-term. Every building, cruise ship, etc., will likely have them installed just in case.

            You didn’t mention ventilators, but I assume you’d state that we need to channel resources towards producing an overabundance of technology that hasn’t changed much since invented almost 100 years ago.

            • John Massey says:

              Erm…..you mean on US airlines they are not already doing that?

              Bloody hell, I’m not even allowed into the gym I go to every day before the little girl/gym attendant scans my temperature and confirms that I am permitted to proceed into the inner sanctum to heave some lumps of rusty iron around.

              • DdR says:

                Man, all of the gyms in my state have closed down. I would gladly submit myself to a temperature scan in order to do a workout.

                I hadn’t heard about domestic airlines scanning passengers. I just flew last week, and none of that was going on. Do you have a more recent experience?

              • John Massey says:

                No.

      • dearieme says:

        Kill the superspreaders?

    • Anonymous says:

      I prefer most ridiculous case scenario over best case scenario. It’s equally likely and far more entertaining. We are going to run out of toilet paper and we really are going to miss it . Only one thing to do. Tie a buttgoat to the outhouse. Yep, you read that right. Once your butt’s been on one hole long enough you stick it out the side hole and …organic bidet.

  13. jbbigf says:

    Hmmm, you’re right, he does say “and that 1% of the U.S. population gets infected (about 3.3 million people),”, which is far less than the infection rate on the DP. But he also says;
    “In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.”

    I think he just got confused, but you’re right, he did get confused. The infection rate on the DP was about 20%, which would scale to 660,00 US deaths at a 1% case fatality rate.

    • gcochran9 says:

      You can predict the infection rate from the R0, assuming that you let Nature take its course. I keep saying that: is it so hard to understand? This is more infectious thanh the flu: unless you stop it, something like 67% of the population would be infected – and the CFR would be way higher than 1% in that scenario. because the majority of people that needed supplementary oxygen (or stronger interventions) would not get them.

    • gcochran9 says:

      He’s a big boy: he didn’t get ‘confused’. He lied.

    • gothamette says:

      “The infection rate on the DP was about 20%, which would scale to 660,00 US deaths at a 1% case fatality rate.”

      I don’t expect that you’ve read each and every comment here over the past few days but I’ve said that about 12 times.

      It’s not difficult to understand.

      Yet many people are STILL resistant. I’m writing them off and moving on. I suggest we all do this.

  14. Skeptic21 says:

    Greg,

    The princess cruise ship represents a controlled experiment where everyone was tested, we do not know the real prevalence in Italy. On a cruise ship, who’s passengers are presumably older, the case fatality rate was 1%. In South Korea, a country that did extensive random testing, the case fatality rate was much lower.

    South Korea had 8,654 total cases and 94 deaths, which equals a death rate of a little over 1%.
    https://www.worldometers.info/coronavirus/

    A Boston Celtics player Marcus Smart just tested positive for Corona virus and is in self-quarantine; he is totally asymptomatic. Four New Jersey nets players tested positive for Corona Virus; three were asymptomatic and one had mild symptoms.

    The fact is: there are many mild and asymptomatic cases of corona virus and this leads to a gross underestimate of the prevalence.

    If half of all Americans caught this thing, and one percent died, that would result in more than a million and a half deaths. This justifies taking fairly drastic measures to prevent it’s spread, but it also suggests that panic about corona virus is unjustified.

    -Ben

  15. tc says:

    For the conspiracy theorists out there.

    “Outpatient testing must not be encouraged, promoted or advertised.”

    • j says:

      Interesting. Dr Oxiris is saying that “We dont care if you are infected or not, go home! Anyway, we cannot do anything.” If so, the published numbers of infected are meaningless. Probably the published numbers of killed by the disease are also meaningless. I dont know, maybe this Advisory is helpful. BTW, she specializes in eradicating health inequities, racial justice, community engagement, etc. Greg asked above “Where’s the deep pessimism coming from?”. From here.

    • Reader506 says:

      This is not crazy while they are under shutdown and lack testing and PPE resources.

      Once situation is under control testing coverage becomes much more important.

  16. jbbigf says:

    You could certainly predict the infection rate from the R0 if you knew the R0. But calculating R0 requires knowing the number of cases, and we don’t have that number. Except for the DP, where the system appears to have reached equilibrium with about 20% infection. You may be right that the medical care on the DP was better than will be provided to the general population.

    In any case, I don’t think it’s fair to say he “lied” when what he did was to produce a hypothetical with an IR of 1%, which was not supported by the evidence he relied upon. He also produced a competing hypothetical with a 60% IR. Why would he do that if his intent were to knowingly underestimate the IR?.

    • gcochran9 says:

      Lied. The 1% number is ridiculous. I’m quite serious: a deliberate lie. Dunno know why.

      R0 can be figured out from watching the rate of spread. Works even if not all cases as symptomatic. rate of growth tells the story.

      ” reached equilibrium” = “locked all the doors” No way 17% infected was equilibrium.

      • jbbigf says:

        R0 is a (sometimes) useful fiction. It is not a property of the infectious agent, it is a property of the environment in which it spreads. From the DP results, it seems likely to me that some large fraction of people will never get this disease, even if exposed. The question, then, is whether the extreme measures being implemented in the US will prevent infections in any susceptible people, and if so, how many. Of course, we will never know.

        • gcochran9 says:

          On the Diamond Princes, they shut their doors and tried to avoid becoming infected, after they were quarantined.

          Of course R0 is a property of the infectious agent, although environmental factors also matter. Measles, in the same environment as influenza, spreads much faster.

           Except for (possibly) rare mutants, it is likely that everyone (that hasn't already coronavirus) is susceptible.
          
  17. Rob says:

    Does a horse need to be infected by a pathogen to mount a humoral response? Would it be possible to isolate the coronavirus, then shove it into a horse, either as aerosol, or injected, at make serum from the horse’s blood?

    That might get around the severely limited availability of human serum.

    • gcochran9 says:

      If horses are susceptible to this, yes we could. We used horses to make serums against pneumococcal pneumonia.

      • mapman says:

        Of course horses will make antibodies. How could they not? The question is what % of those will be neutralizing. Virus is quite different from bacterium. In the bacterial case, opsonization is the predominant mechanism, which is why the pneumococcal pneumonia approach worked. Also, injection of serum from another species needs to work right away (or risk anaphylactic shock).

      • Rob says:

        Has anyone tried?

  18. Rob says:

    Does a horse need to be infected by a pathogen to mount a humoral response? Would it be possible to isolate virus, then shove it into a horse, either aerosolized or injected, and then isolate antibodies from the blood?

    Could be a way around the severely limited quantity of human serum.

  19. R49 says:

    Hello,
    the 1% CFR deduced by the 7 (now 8) deaths of the 712 cases on the Diamond Princess ignores that there apparently are still 14 cases left without an outcome, with people who are in a serious or critical state. This means that in theory, the CFR might have to be adjusted by counting 8+14 out of 712. Let’s pray for the 14 and hope that only 1-3 die. You’d still go from the 1% (7 out of 712) to something like 1.5% (8+1-3 out of 712).
    Best regards.

  20. Space Ghost says:

    Maybe we should check his bank accounts for large incoming wire transfers from Chinese SOEs.

  21. “The vulnerable subpopulation is those that breathe.—-” ?
    Here in Italy 99.2% of deaths bases on data from the ISS (national healh institute) had 2 or 3 other complications and average age is 80 and 74% males
    There is basically nobody in good health that has died so far
    So about 5-10% of the population is at risk, elderly people with also other issues
    A 70 years old Womenwith no other problems is at risk more or less the same as for influenza…

    But the stories about ICU being saturated are misleading because is all concentrated in a few areas, it is hard to understand why
    in Rome with 4 millions people only 6 deaths
    in the South almost nobody

    • gcochran9 says:

      “vulnerable” = those that can catch it. Only some get very sick.

      With a fast-spreading virus, a fairly short difference in the time an infection is locally established can make a huge diff in local incidence at a later time.

    • Ledford Ledford says:

      How may American people over, say, 45 don’t have “other complications,” or under-lying conditions? Many count obesity as a condition.

  22. Scott Novak says:

    Off topic but Coronavirus related:

    Taiwan and other East Asian nations claim a mask shortage – despite having the bulk of world N95 and surgical mask productive capacity. Even the 23 million nation of Taiwan makes more masks than the US. The reason they claim a shortage is that their goal is to flood nearly every man, woman and child with a continual mask supply – not just health care professionals. To be clear I agree with the East Asian mask consensus and not with the CDC/WHO consensus that only Health-Care Professionals need them, but that is besides the point because our Health Care Professionals do not even have enough.

    China and Taiwan have banned exports. We can expect China to do this – but Taiwan is supposed to be our friend and we have helped them for decades – to the point of risking war with China – to keep them independent. Yesterday Taiwan not-so-generously proposed to start supplying us with 100,000 per week. This is 1/700th or 0.14% of their production of 70 Million per week. Forget about their claimed mask shortages – we must remember that is only because they are attempting to nearly blanket every single person in their country of 23 Million with continuous masks. That is their right to try and is probably wise, but given our robust and necessary protection of their independent existence, why are we not firmly asking – arm twisting behind the scenes if you will – to get them to supply more like 1 million per day? We could pay dearly for them – almost no price is too high – so Taiwan can save face. Our health care professionals in a nation of 320 million should come before every man woman and child in Taiwan getting one. American lives are at stake.

    • John Massey says:

      You’re not getting it. 70 million/week is only 3/person/week. Every time you take a mask off (carefully), you need to dispose of it (carefully) and put on a new one, otherwise you just risk infecting yourself with whatever has landed on the outside of the mask. Taiwanese are not blanketing their people at all; they are not supplying them with enough. No country in the world is producing enough to adequately supply its own citizens, hence the global shortage. (Medical workers in Wuhan were wearing adult diapers so they didn’t have to go to the toilet, because they didn’t have enough PPE to keep taking it off and putting new stuff on every time they needed a piss.)

      Eye protection is also advisable if you are worried about droplet infections, which you should be.

      Gloves are pointless for general public. Just avoid touching your face until you have properly washed or disinfected your hands. Infectious disease specialists in Hong Kong have said that the main benefit of wearing a mask for the general public is that it reminds people not to absent mindedly touch their faces – pretty questionable statement, but that is what they said. I suspect they said that in full knowledge that people have been re-using masks because they are in critically short supply.

      The USA needs to gear up fast to make its own masks. Surely there are enough enterprising people there to do it – should have started a long time ago, like a lot of things should have, in a lot of countries. I can think of very few countries that have stayed ahead of the curve on this. Most have started from the “don’t over react” position and then just reacted belatedly to every new development. No point saying that now – well, there is; it’s to hammer home the point that countries need to stop just reacting and get ahead of it.

    • gothamette says:

      We really need to take a cold, hard look at our relations with China when this is over. Taiwan?

      “given our robust and necessary protection of their independent existence”

      Why?

      “, why are we not firmly asking – arm twisting behind the scenes if you will”

      If it’s behind the scenes we wouldn’t know. I think we are.

      • Scott Novak says:

        Gothamite, functionally, China and Taiwan each ramped up production enormously and banned export to us. I never ever once said we have to look at our relations with Taiwan when this is over. But do you go to your enemies for help in a crisis or your friends? We have no leverage over China but we have leverage over Taiwan with our long friendship and that is why I am ranting about Taiwan. Why would I waste time ranting about China when it was predictable they would do this and was actually predicted and they won’t budge because they are a basically an enemy.

        All I am saying is we need masks right now and I don’t care what the Administration has to tell Taiwan to get them immediately – promise them nuclear powered attack subs and F-22s for all I care. If China doesn’t like that then they can give us a few hundred million masks – immediately delivered!!!!!

        Who knows what other medical products this also applies to?

        If pressure is behind the scenes, we should have made this happen weeks ago… time is of the essence here. Not sure if the Administration realizes that.

        • gothamette says:

          I agree w/you about everything. I wasn’t criticizing you. Well everything except promising Taiwant nuclear powered attack subs and F22s. We should just tell them to send us masks and if they refuse, we’ll nuke them.

          • Scott Novak says:

            It’s OK even if you had been, I just got a little worked up about this. Wow you are pretty hawkish!!! If you live in New York City – with all sincerity I wish you the best of luck. I guess we all will need it eventually – I am in California and I am not sure how we ended up a bit behind New York in this crazy race.

            • gothamette says:

              I cannot believe what is happening.

            • gothamette says:

              ” I am in California and I am not sure how we ended up a bit behind New York in this crazy race.”

              NYC has a huge population density – 26K per square mile. That must have something to do with R-naught. Of course I’m comparing a state w/a city.

            • Anonymous says:

              I don’t see what’s so hawkish about what I said.

    • Regret says:

      Why are don’t we have domestic production of N95 masks? Why has the worlds supply been allowed to consolidate into a couple of countries?

      Questions for tomorrow, they don’t help us squeeze masks out of someone right now, but they sure as hell shouldn’t be forgotten.

  23. Thagomizer says:

    A bit of a tangent, but has anyone looked into attaching a HEPA filter to a CPAP machine and having cashiers / uber drivers / people who don’t need to move too much wear it on the job?

    They are already widely available and it seems like it’d be helpful.

  24. gothamette says:

    If you’ve had one of the other four strains of coronavirus, would you be immune to WuVirus19?

  25. david says:

    Most of you will hate me for saying this: The average age of death from covid19 in Italy is 81. Arent we just panicking to swap one cause of death for another? When people die of “old age,” its influenza, pneumonia, alzheimers, respiratory failure, organ failure, or having food, water and oxygen unplugged in the hospital. I think We will all mostly contract this covid19 and be fine. Those who arent, well they were going to pass away within months anyway from one of the aforementioned “natural causes.” Is it worth throwing away the entire planet’s economy to extend a dying person’s lifespan by a few months?

    I read somewhere that Italy decided not to assist most elderly as well. Not sure if true, but it would be a decision i might make to save respirators for the young.

    • gcochran9 says:

      Good to know where you stand.

      • sorengard says:

        Actually David is asking the sensible question. We as a nation collectively accept risk and death every day as the price for living. We lose over 35,000 lives every year in highway fatalities and nobody bats an eye. Yet we’re shutting down significant portions of the economy “out of an abundance of caution” for a virus that will likely end up killing far less than our preventative measures will in the form of homelessness, unemployment, and lost savings. (The CFR has already been revised downward from 3.4% to 1.4% with further downward revision likely for the U.S. given our demographics relative to China and Italy.) Unfortunately, the MSM has whipped the public into such a frenzy that we can not even have a rational dialogue about whether we’ve gone overboard. I suspect when all is said and done, the cure will prove far worth than the disease.

        • gothamette says:

          We’ve already explained this a million times.

          A novel virus ripping through the population will cause numerous infections, a certain percentage of which will require hospitalization, which will swamp our system.

          THINK, please, before you spout off.

          Above someone gave the stats of the Life Care Center: 25% of the employees. Diamond Princess (if you don’t know what that is, learn): 20%.

          WRT to old folks hogging the ventilators, hospitals have protocols about treatment and these protocols adjust according to patient caseload, age, and severity of illness. When a hospital is overloaded with dozens of sick patients, all 80+, they are at that point administering compassionate end-of-life care to many of them.

          Satisfied?

          • sorengard says:

            I’ll excuse your tone other than to say I’m quite well versed on the various stats. I believe the problem is that you don’t understand how many deaths we are likely to have caused with our preventative measures. It is almost certain a significant amount of people will die from the economic measures we’ve taken. The academic literature is pretty clear on what losing one’s livelihood does to one’s life. It may not be as dramatic or as sudden as falling victim to the virus but it is just as real and likely to claim more lives. How you refuse to even acknowledge or quantify is beyond me. As an aside, I’d love to sell you life insurance.

            Second, while I recognize the DP is as pure a sample as we have (and the one I rely on in my models), a simple Baysean analysis (and my first year grad students) would put the infection rate well above that. The Institute of Disease Modeling (the authority on pandemic modeling) has already addressed in great detail both the DP sample and the flaws in the Imperial study.

            Third, until we have truly random, consistent sampling in this country we will not know the extent of the spread (R-naught). To claim otherwise, as you do, is not only foolish but dangerous.

            • gothamette says:

              “. I believe the problem is that you don’t understand how many deaths we are likely to have caused with our preventative measures.”

              How many secondary deaths would be caused if we don’t take preventative measures?

              And I’m speaking with someone who thinks the infection rate will be well above the DP? Jesus. I’m only banging on the DP because it’s the LOWEST boundary. Jesus again.

              You don’t like my tone? FOAD.

            • gothamette says:

              Just came across this.

              https://www.claremont-courier.com/articles/news/t36254italy

              “Despite what the news media might be reporting or the skeptics might be blogging about, Italy is in dire straits…Italy’s hospitals, clinics and medical centers have been overwhelmed and over-run by the ever-increasing number of coronavirus victims, to the point where the health care system is on the verge of collapse.

              As I wrote previously, it has now become the official policy of the Italian government to require physicians and health care workers to deny medical treatment and care (other than to stabilize and comfort) to the elderly and infirmed…those whose pre-existing respiratory and/or cardiac conditions would statistically prevent recovery. For all intents and purposes, these people are being turned away from hospitals and clinics and sent home to die.

              I was wrong. They are not even being given compassionate end-of-life care.

          • sorengard says:

            Your comment is naive if you don’t realize a significant amount of people will die from the economic measures we’ve taken via unemployment, homelessness, and lost retirement savings. The academic literature is pretty clear on what losing one’s livelihood does to one’s life. It may not be as dramatic or as sudden as falling victim to the virus but it is just as real.

    • It's Not Unusual says:

      Not an unusual stance in “normal times”.

      The number of commentators I’ve come across in the last year who have balked at the US spending probably about 10% of its GDP per year in excess of what is required to cover mortality reduction in the age range 0-70, on adding perhaps months of life expectancy to older adults…. is high.

      Bricking about a further 25% of annual GDP to add about a year to the same subset (rough estimate of what Cov19 lockdown and full diversion of medical resources would really entail and give) would probably raise the same objections. Comparing like for like.

      • david says:

        There must be opportunity cost at least. Imagine the lifesaving technological advancements that wont come to fruition because we’re in another recession.

        Plus all those starving babies on tv who survive on our foreign aid and charity. Theyll probably go hungry and never realize their dreams of seeing Paris.

  26. j says:

    There are vaccines for cows and other domestic animals for coronavirus diseases. So producing the vaccine for the human animal is a question of investment and time. It has to be made super-profitable.

    • jbbigf says:

      Actually, producing the vaccine is not difficult. You may recall that the first vaccination consisted of scratching a servant-girl’s hand and rubbing some organic matter into the wound. There are laws now against that sort of thing, and complying with those laws will increase the time-to-vaccine from a couple weeks to a couple years.

      So, a lot of people seem to think this is a terrible crisis, but not terrible enough to relax those laws. Of course, there are countries that don’t have those laws, so they may produce vaccines pretty quickly.

  27. Rob says:

    Let’s say we find some people who have cleared SARS 2 infection. Could we take say, 5 B cell lines that produce broadly neutralizing antibodies they make, clone the genes, and put them into vectors that can transduce B cells in vivo, and use them to produce a pseudo-vaccine?

    That might get around the Th2 immune reactions that killed model animals given SARS vaccines.

  28. SteveB says:

    Measures to deal with this outbreak using social isolation will also affect other diseases. If I were one of many viruses, or bacteria, I’d be quaking in my coat. Is it possible we will get to eradicate other illnesses, even if we can’t eradicate Covid? They will be caught in the cross-fire, so to speak.

    • Coagulopath says:

      It’ll help, but I don’t know we’ll actually eradicate any diseases.

      So many of them exist in animal reservoirs: bats and camels for MERS, birds for avian flu, monkeys (or something else) for ebola.

      Getting animals to observe social isolation is tough.

  29. Johnny C says:

    I’ve noticed a striking correlation (this is likely evolutionary and/or stage in life) between fear of Covid19 and age/fitness status.

    Aren’t scientists supposed to be rational? This correlation, which is so high that some might call it causation, is pretty obvious to everyone around the forum world or blogosphere at this point.

    Methinks it is akin to Upton Sinclair’s “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

    [insert perceived life]

    I mean, I get self preservation, I’m a human too … But at least I’m honest.

    • reader506 says:

      I’ve noticed a striking correlation between people who aren’t concerned about covid19 and people who either fail to think things through systemically, at least, assuming you haven’t already failed to understand the basics of exponential transmission in a population with no immunity.

      • Johnny C says:

        Systematically, yes, I have. That’s why I ask you where you get your reliable data, which is Dr. Ioannidis’ question. Joe Williams questions it again at the start of this post and you all just call everyone names who are actually using logic, reason, skepticism = yes, the scientific method.

        Repeat after me, transmissibility means nothing! I don’t know what is so thick in your and Cochran’s skulls about this fact. One must have that R0 with a problematic pathogen, and you have NOT proven anything of the sort!!!

        Your fear is clear and palpable, just like Cochran’s. Just because you think you are in danger doesn’t mean your fear should be exported and take away everyone else’s freedoms. And these aren’t reasonable measures, they are people’s livelihood for basically a bad influenza bug, at best.

        No cases in Pakistan, India. No end of the world stories in Japan. Sweden doesn’t have any real issues beyond any normal flu season. But keep saying “Lombardy” or some other topic relatd to 85 year old 7 disease laden italians, yes, that is a real stump for the scientific method.

        At this point, it’s embarrassing.

      • jbbigf says:

        “A population with no immunity” is not necessarily the same thing as “a population in which everyone is susceptible”. Presumably, no one on the DP had immunity, but only 20% of them got the disease.

  30. Lazarro says:

    I’ve seen some worse stats in recent past in Italy, beyond the fact that a massive vaccination campaign this January might have put those 80 year old obese smokers (my former countrymen) over the top:

    https://www.ijidonline.com/article/S1201-9712(19)30328-5/fulltext

    ps – I’m from Rome, but practice here in the USA

  31. Sinij says:

    Assuming Italian scenario plays out in US, what are the chances that we will see famine in urban centers?

  32. dux.ie says:

    http://www.sfu.ca/sfunews/stories/2020/03/impact-of-covid-19-on-gender-focus-of-new-study.html
    “Impact of COVID-19 on gender focus of new study”

    Sooner or later this will happen. They want part of the $50 Million research grants. Will they address the COVID.19 gender fatality gap or pretend it is not there??

  33. David Chamberlin says:

    The USA is not going to be another Italy it is going to be quite a lot worse. It’s a partnership between an idiot for a president and a public that can’t understand that crowding the retail stores is a terrible idea. Today like the last seven days the stores are breaking records for sales. It’s not just the grocery stores, it’s home improvement stores, it’s whatever you fear might run out. So it goes. You can defend or attack our president, I don’t care, but don’t leave the idiotic public free of blame. The Home Depo is jammed with people breathing on each other buying stuff for their home improvement projects while they are out of work. We can’t do what China did and we won’t. Game Stop is decreed an essential business and is open and is filled with people. Gotta buy those video games while out of work, never mind the bug.

    Watch these numbers, https://www.worldometers.info/coronavirus/ watch the USA vault to the world leader in Covid19, just a matter of time. This fool, or liar, take your pick, says 1% of the public gets infected, Cochran says 50% if we don’t stop it. I’m pissed. We could have stopped it but we wont. Those numbers at worldometers shows the USA at number two in Covid19 infections only we don’t have the tests so we aren’t even counting most of those infected.
    I’m hunkered down, hope you are. Youngsters fetch my goodies and deposit it safely where I can grab it. You can risk hacking your lungs out on a cot in emergency hospital set up in a local high school, I can’t believe people don’t know better, bad choices all around.

    • John Massey says:

      You are right, Dave. Time-adjusted, Spain is doing worse than Italy, and the USA is doing worse than Spain. The current attack rate in NYC is 1 in 650, admittedly worse than anywhere else.

      And here’s me worrying myself sick because in Hong Kong it’s 1 in 21,000.

      No, don’t all rush over here, even if you can get a flight, which you probably can’t now – we’ll just put you all in quarantine, and it won’t be fun.

  34. dux.ie says:

    Neil Diamond: Stay safe out there! “Hands… washing hands..”

    “Would you believe you come along … Hands… washing hands.. Reaching out … Don’t touch me .. Won’t touch you … Sweet Corona …”

  35. Anon says:

    Munk Debate – John Ioannidis of Stanford vs Sten Vermund of Yale

    https://munkdebates.com/podcast

    Dear Member:

    Two leading epidemiologists join us for a special podcast episode on COVID-19. Are we enforcing strict social distancing measures and nation-wide shutdowns without reliable information about the virus?

    Click here to listen to the all new and original Munk Debates Podcast featuring Professors John Ioannidis of Stanford and Sten Vermund of Yale.

    You can also download the episode wherever you get your podcasts: Apple, Spotify, iHeart and Google.

    Let the debate begin!

    Warm Regards,
    Rudyard Griffiths,
    Chair, The Munk Debates
    @rudyardg

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