[arcticbull]

1. It's old people AND people with comorbidities, which is a ton of people.

Yep, and they should shelter in place. Nobody else should.

2. Lots of old people, which for Covid is about 65, still work full time jobs. Some of them fly every week. These aren't 95+ year olds.

Yep, and they should shelter in place, because they're in a risk category.

3. I'm sure people of all ages think their life is very valuable, and very few people consider themselves candidates for sacrifice. Certainly not for privacy concerns.

That's an unfortunate way of looking at this. The reality is everything we do in life involves risk. There's risk of harm in shutting down the economy, and there's risk of harm in opening the doors. The lifetime risk of death being involved in a car accident is 1%. The lifetime risk of dying of an opioid overdose is 2%. COVID is much lower than both. Locked inside domestic violence is up, alcoholism is up -- liquor stores are considered essential so alcoholics won't come in to hospital due to withdrawal.

What we do know is if we lock things down, then one person flies in from a foreign country with the disease the whole thing starts over. Hiding inside is not a sustainable strategy.

Which is why Sweden remains open for business. And you know what? They're doing just fine [1].

4. 10x deadlier than the flu.

It is not. We do not know how deadly it is, all we know is that of people who go to the hospital (implying that they're showing serious symptoms) between 0% and 9% of people, depending on their age and comorbidities, die.

That's adverse selection sampling bias. Studies show there's huge, huge quantities of people who either show no symptoms at all (which is the thing that makes this disease a challenge) or exhibit mild flu-like symptoms.

The numbers we're seeing are an upper-bound, by an order of magnitude. It's likely in line with the flu, although we should consider in line with the flu is bad -- it kills 650,000 people each and every year we've been alive.

It's also much harder to immunize against the flu (19-60% effective) due to its propensity to mutate and the huge number of strains that show up each season, with different ones being dominant each year.

On the other hand, COVID does not mutate -- or has not yet.

[1] https://www.forbes.com/sites/jamesasquith/2020/04/04/no-lock...

[usaar333]

1. A healthy 30 something has an IFR of something like 0.1%. Doesn't justify a lockdown for a year; does for a couple months.

3. Sweden has experienced over 500 covid deaths in a week. That's a 30% excess death rate. Hardly "fine".

4. I see little evidence it is in line with the flu, unless you are talking about historically deadly flus, not seasonal ones. Flu would not have killed 1.5% of the Diamond Princess population that was infected. 0.7% IFR seems about right (Diamond Princess, Iceland, etc. suggest around this) and that's >7x bad seasonal flu years.

[arcticbull]

> A healthy 30 something has an IFR of something like 0.1%. Doesn't justify a lockdown for a year; does for a couple months.

It's not 0.1% for a 30-something. The Gangelt survey showed a total population fatality rate of 0.37%, and so far the CFR has ranged from 0% in children to 0.1% for 30-somethings to 15% for 85 year olds.

The Gangelt survey showed 0.37% actual vs. a CFR of 2% overall in Germany so we can divide the CFR for each age group likely by 10. It's probably close to 0.01% for a healthy 30-something.

> Sweden has experienced over 500 covid deaths in a week. That's a 30% excess death rate. Hardly "fine".

It ... is fine, when you take into account that they're never going to get it again, whereas every other country in the world is vulnerable to a single person showing up and re-starting the entire process for everyone. It's not this lockdown I'm worried about it's the next one, when a single person shows up in downtown NYC and we're right back at it again.

Hiding inside is not solving the problem because it's an incredibly infectious disease. Unless you can lock down every single person in the entire world for the entire duration, it will fail.

> I see little evidence it is in line with the flu, unless you are talking about historically deadly flus, not seasonal ones. Flu would not have killed 1.5% of the Diamond Princess population that was infected. 0.7% IFR seems about right (Diamond Princess, Iceland, etc. suggest around this) and that's >7x bad seasonal flu years.

The Gangelt survey showed 0.37% vs the flu at 0.1%. It's worse, I've long maintained it's worse, but it's not massively worse. Certainly not stop-the-world worse. [1]

[1] https://www.technologyreview.com/2020/04/09/999015/blood-tes...

[detaro]

(It's currently (among other points) debated how well the tests used for the Gangelt survey can tell SARS-CoV-2 from other coronaviruses, and given how little they've published unclear how they corrected for that. Hopefully they'll release more info soon, but lots of experts are skeptical of this specific study, they might very well have classified a bunch of folks that had a cold as "corona")

[usaar333]

We have to be pretty careful about demographic adjustments. Does the town surveyed have any nursing homes or hospitals? If not, that'll drastically drop the death rate.

By my napkin math, you get to about a 2-fold difference which explains the 0.37% vs. 0.7% numbers. But remember the flu 0.1% also includes those highly susceptible people.

[arcticbull]

Heh, the delta is likely because: (1) Iceland has had 6 deaths so it's way, way too early to draw any conclusions from Iceland and (2) everyone onboard the Diamond Princess was onboard a cruise ship, and cruises tend to skew old. The median age of passengers was 69. That age group is affected ~100X harder than young folks (9% CFR vs 0.1% CFR) [1]. If you've got more data to back 0.7% please do share but I've found none compelling so far.

Although for what it's worth Iceland is showing 6 deaths and 1600 confirmed cases for a fatality rate of --- wait for it --- 0.35%.

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm#T1_down

[usaar333]

My numbers generally comes from https://www.thelancet.com/journals/laninf/article/PIIS1473-3....

That paper would give about 3% for a 70 year old. But remember that cruise passengers are healthy enough to be on cruises. 1.5% death rate seems about reasonable when you correct for that (again, this is where you might see that 2x difference).

Iceland has a considerable number of unresovled cases. Whether you use 7 deaths out of 751 recovered, or 20% hospitalization death rate, you get somewhere on the order of 0.9% CFR.

[arcticbull]

This is all case data, not population studies. The Gangelt study is different because they tested the entire population and not just people walking into hospitals. They found the CFR in Germany (2%) was roughly 10X higher than the actual mortality rate in town.

The CFR is always going to suffer from adverse selection bias at this stage because they're only including people sick enough to walk into a hospital, and not folks who were asymptomatic, and not folks who got mild symptoms and didn't tell anyone. That's going to be basically every young person. Only the old end up in hospital and they're dramatically worse hit.

Population studies are not directly comparable. A global CFR of 1.5-2.5% sounds right, but that doesn't mean that's a mortality rate. The mortality rate is closer to 0.37% based on the population study I cited.

You seem to be arbitrarily multiplying and dividing CFR by 2 to fit a narrative. I'd love to see other population data but I think this was the first and only study, which is why the numbers are much different than you're citing.

[DiogenesKynikos]

The ratio of asymptomatic to symptomatic people has been measured, and it's not nearly as high as you're saying. China has been quarantining and testing every single person entering the country, and they find that 2/3rds of cases are asymptomatic.

Moreover, Germany has conducted a randomized serological survey of the population of one town where there was a large outbreak, and determined that the true mortality rate was about 0.4%, which is an order of magnitude higher than mortality due to the flu. That's the mortality if there's excellent healthcare and the system isn't overwhelmed. Mortality will also depend on the age structure of the population, rates of obesity and smoking, etc.

Because a large fraction of the population is immune to the seasonal flu (both through vaccination and previous infection), far fewer people contract it than would contract CoVID-19 in an uncontrolled epidemic.

The combination of a much larger rate of infection than the flu and far higher mortality means that CoVID-19 would kill orders of magnitude more people in one year.

[arcticbull]

> Moreover, Germany has conducted a randomized serological survey of the population of one town where there was a large outbreak...

1. Results showed 0.37% mortality rate, which is an order of magnitude lower than the fatality rates being published, which is what I claimed -- so I re-iterate: "The numbers we're seeing are an upper-bound, by an order of magnitude." [1]

2. 14% of their town has had it already. [1]

3. That 0.37% rate includes all the old and at-risk folks which I was already suggesting we isolate. Since we know the fatality rate for them is 9% in hospital vs 0.1%, I'd suggest that the actual mortality rate of my plan would be incredibly low. [1] We don't know the demographic distribution of the town, and we do know that the disease is incredibly age-dependent so it's hard to project that onto the population.

Either way the flu is 0.1% so this isn't 10X worse, it's 3.7X worse. At most.

4. The study shows 15% of them are already immune to COVID.

[edit] I found the data [2]. Out of a population of 12,000, 6500 of them are in a risk group (over 45). So 55% of town. This needs to be projected onto the world population factoring into account non-linear risk response.

> Because a large fraction of the population is immune to the seasonal flu (both through vaccination and previous infection), far fewer people contract it than would contract CoVID-19 in an uncontrolled epidemic.

I don't think they are. The flu mutates regularly, and there's a ton of strains. Vaccinations are only 19-60% effective depending on the year. This is evidenced by the 650,000 worldwide deaths (60,000 US) and the 45,000,000 US cases of the flu each year.

[1] https://www.technologyreview.com/2020/04/09/999015/blood-tes...

[2] https://www.citypopulation.de/en/germany/nordrheinwestfalen/...

[DiogenesKynikos]

> The flu mutates regularly, and there's a ton of strains.

... which a substantial fraction of the population is immune to. Only 5-20% of the population gets the flu each year. CoVID-19 will infect 60-70% of the population, at a minimum, unless measures are taken to contain its spread.

> Results showed 0.37% mortality rate, which is an order of magnitude lower than the fatality rates being published

I've seen most people assuming a mortality around 1%, which is not that far off from these results. In Italy, 1% may well be correct, given how the healthcare system was overwhelmed there.

> I'd suggest that the actual mortality rate of my plan would be incredibly low.

If you can successfully shield the entire at-risk population, which easily approaches half the population of many countries. Once you add up old people, obese people, people with diabetes, smokers, people with heart conditions, and all the other at-risk groups, you come to a sizeable fraction of the total population. Trying to shield those people while the virus infects most of the rest of the population sounds incredibly risky to me. It's not even obvious that you can achieve natural herd immunity without at-risk people getting sick, because you need 60-70% of the population to get sick.

Overall, I don't understand the motivation behind such a risky plan. Why not just go through a 6-week period of lockdown, and then control the epidemic afterwards with extensive testing, good contact tracing and social distancing measures? Countries other than the US appear to be successfully implementing this strategy. Some, such as South Korea, were acted competently enough that they didn't even require the lockdown phase.

[arcticbull]

> Only 5-20% of the population gets the flu each year.

Only 20% of America is 70,000,000 people. That's staggering. The economic impact of the flu is enormous.

> I've seen most people assuming a mortality around 1%, which is not that far off from these results. In Italy, 1% may well be correct, given how the healthcare system was overwhelmed there.

It may be 1% in Italy because the population of Lombardy was overwhelmingly old, and overwhelmingly sick. The average age of death in Italy was 80.5 and the average number of underlying medical conditions was three.

[amadvance]

> may be 1% in Italy because the population of Lombardy was overwhelmingly old

Multiple official sources in Italy estimate that the real number of infected is 10 times the reported one. This explains the high dead rate.

[DiogenesKynikos]

> Only 20% of America is 70,000,000 people. That's staggering.

So imagine 4x as many people getting infected with a virus that is many times as lethal.

> It may be 1% in Italy because the population of Lombardy was overwhelmingly old, and overwhelmingly sick.

And the US has other problems, such as obesity. But the mortality will be much higher wherever the virus overwhelms healthcare systems. As we've seen, that can happen very quickly.

[arcticbull]

If we, again, assume that 15% of the US has already had it (as in Gangelt), and that herd immunity kicks in at 60-70%, that means we'd expect to see another 45-55% of the population -- 147-179 million cases. If we actually isolate the vulnerable, basically nobody would die.

[joshuamorton]

> The lifetime risk of death being involved in a car accident is 1%.

You're off by a factor of 100. It's .01%.

> The lifetime risk of dying of an opioid overdose is 2%.

For who? Someone who uses opioids? Maybe, on average, again you're off by a factor of 100 or more.

> We do not know how deadly it is, all we know is that of people who go to the hospital

No, of people who test positive, which includes people with relatively mild symptoms that don't go to the hospital, but had reason or ability to get tested.

South Korea is probably the best current testbed here, they had very widespread testing and they've had very, very slow growth recently so the CFR numbers are probably relatively accurate. They see a 3% CFR.

> Which is why Sweden remains open for business. And you know what? They're doing just fine [1].

Normalized by population, Sweden has seen more deaths and more infections than California, by about 50%, and it will likely continue to grow at a similar rate. The problem with exponential growth is that things look like they're doing just fine until suddenly they aren't and there's no way to fix things.

[arcticbull]

> You're off by a factor of 100. It's .01%.

> For who? Someone who uses opioids? Maybe, on average, again you're off by a factor of 100 or more.

No, lol, it's not. Those are averages across the US population. Your lifetime odds in the US of dying in an automotive accident is 1:103 [1].

I should have said accidental poisoning which is 1:64 [2] but half of that is actually opioids (1:96) so you're still more likely to die of an opioid overdose than being a party to a car accident. Most people don't set out to get hooked on Oxy, they get hurt or undergo surgery, are prescribed them, and that's that.

There's 40,000 deaths per year related to car accidents, which if you multiply out by the average lifetime (78.69 years) is right around 3.2 million, or 1%.

This is fair to compare against COVID because due to its extremely limited propensity for mutation, the COVID mortality rate does represent what approximates lifetime risk. (i.e. unlike the flu, you won't get it again).

> South Korea is probably the best current testbed here...

I argue the best testbed is the German study I cited where they actually tested... everyone. CFR is not mortality rate, its about an order of magnitude higher, again, I cited my data. And in my intuitive explanation that you're not factoring out adverse selection risk of only very sick people going to the hospital in the first place.

> Normalized by population, Sweden has seen more deaths and more infections than California.

Because everyone in California is inside. I'm sure they've seen an order of magnitude more flu deaths too because nothing spreads when you're inside. They're probably seeing infinitely more car accident deaths, too. Life's risky, and you're not comparing honestly.

[1] https://www.iii.org/fact-statistic/facts-statistics-mortalit...

[joshuamorton]

> Your lifetime odds in the US of dying in an automotive accident is 1:103 [1].

No they're not. The lifetime odds for the average American are. For opioids as an example, as someone who doesn't use opioids, my lifetime odds of dying from an overdose are essentially nil. The distribution is bimodal.

> This is fair to compare against COVID because due to its extremely limited propensity for mutation, the COVID mortality rate does represent what approximates lifetime risk. (i.e. unlike the flu, you won't get it again).

You claim this with great certainty, but it hasn't been around long enough to know that it won't mutate in annoying ways.

Further, it's still not fair to compare that way. In the past 2 decades, we've had 4 or more dangerous flus that aren't seasonal (SARS, MERS, H1N1, H5N1, COVID-19). Of these, most weren't infectious enough to be super dangerous, but two were (H1N1, COVID-19), each of which killed at least 100K people worldwide, and COVID-19 is on the path to claim a million lives worldwide this year.

That's not a once-in-a-lifetime event, it's once a decade or even once every few years.

> I argue the best testbed is the German study I cited where they actually tested... everyone.

And the flaws in that study have been noted elsewhere. SK is a better testbed since they also tested huge swaths of people, even those not showing symptoms, and

> CFR is not mortality rate

The CFR of the flu is .1%, which would make COVID more contagious, and 30x more deadly. I'm not sure why the mortality rate matters since given the higher infection rate, COVID would have an even higher mortality rate.

> Life's risky, and you're not comparing honestly.

And the risk from COVID goes up if everyone catches it simultaneously. The CFR goes up even further if hospitals are overwhelmed.

[arcticbull]

> No they're not. The lifetime odds for the average American are. For opioids as an example, as someone who doesn't use opioids, my lifetime odds of dying from an overdose are essentially nil. The distribution is bimodal.

So now you accept that I wasn't off by 2 orders of magnitude, but are pedantically calling out that I wrote "your" even though I specifically wrote "Your lifetime odds in the US" -- which, if we're going to be entirely pedantic, applies to everyone on earth. Maybe look up your numbers and share them?

You're ignoring how people end up addicted to opioids. The shape of the distribution is both entirely irrelevant and you haven't cited your source.

This makes me think your goal is to win an argument instead of having a genuine discussion.

> You claim this with great certainty, but it hasn't been around long enough to know that it won't mutate in annoying ways.

I'm citing data from experts [1].

> ...we've had 4 or more dangerous flus that aren't seasonal (SARS, MERS, H1N1, H5N1, COVID-19).

SARS, MERS and COVID are not flu viruses, they're coronaviridae. H1N1 and H5N1 are mutations/subtypes of the Influenza A virus. The coronaviridae are different.

> And the flaws in that study have been noted elsewhere. SK is a better testbed since they also tested huge swaths of people, even those not showing symptoms...

SK has not tested huge swaths of the population, they've tested around 1%. [2] They may have tested more than most people, but that's not what you claimed. They've tested some not showing symptoms. Huge difference as compared to testing 100% of the population.

> The CFR of the flu is .1%, which would make COVID more contagious, and 30x more deadly.

The study I referenced mentioned 0.1% for the flu vs 0.37% for COVID. Feel free to read it. That would make it 3.7X not 30X. Because the flu has been around so long the fatality rates are largely determined by mathematical modeling, and are very close to the actual fatality rate. On the other hand, we're still figuring it out for COVID.

Yes, its is more contagious. Nobody's argued that.

> And the risk from COVID goes up if everyone catches it simultaneously. The CFR goes up even further if hospitals are overwhelmed.

Which is why, scroll back up, we isolate the vulnerable.

[1] https://www.washingtonpost.com/health/the-coronavirus-isnt-m...

[2] https://www.barrons.com/articles/south-korea-coronavirus-cov...

[joshuamorton]

> So now you accept that I wasn't off by 2 orders of magnitude.

You're right, but it doesn't make the numbers you're citing any more relevant.

> SARS, MERS and COVID are not flu viruses, they're coronaviridae. H1N1 and H5N1 are mutations/subtypes of the Influenza A virus. The coronaviridae are different.

Who is being pedantic now? The point is that novel viruses are not a once in a lifetime occurrence, so you can't compare the risk of "COVID-19" to "lifetime death rate", since a new novel virus will come along in a few years. The danger is not covid-19 in particular, but novel viruses in general, and doing nothing would lead to a 1-year fatality rate for a novel virus on par with the lifetime danger of driving. Which means the lifetime danger of the virus is 20x or more the danger of driving. That's

> The study I referenced mentioned 0.1% for the flu vs 0.37% for COVID. Feel free to read it. That would make it 3.7X not 30X. Because the flu has been around so long the fatality rates are largely determined by mathematical modeling, and are very close to the actual fatality rate. On the other hand, we're still figuring it out for COVID.

Yes, but the CFR of the flu is well understood. The CFR of COVID-19 is not, and your entire argument is based on one study which is not conclusive, has had some flaws pointed out elsewhere in this thread, and generally doesn't match observed CFR elsewhere.

> Which is why, scroll back up, we isolate the vulnerable.

Which, ask any epidemiologist, doesn't work, since hospitals get overwhelmed anyway. The hospitalization rate of young people is still pretty high (maybe not quite 20% as it is for the overall population, but still more than 10%), they just don't die with reasonable care. There's a fair number of cases of healthy 20-something year olds who end up hospitalized for a week due or more due to COVID and need ventilators. Not to mention healthy something 40 year olds.

Even if you manage to perfectly isolate every at risk person, there's still a nontrivial risk of overwhelming ICUs anyway. And then the fatality rate among young people would go up as they couldn't get good care. And you're not going to perfectly isolate every at risk person. So the you have more young people hospitalized, more old people hospitalized, and well you're in a bad spot.

Or you end up expanding the definition of "at risk" to include "obese, heart disease, diabetes, or high blood pressure", and you've ended up essentially where we are now, with the majority of the US population in an "at risk" group.

> SK has not tested huge swaths of the population, they've tested around 1%

You realize that for population level statistics, that's fine. That means that 490000 tests have returned negative. If, as the Italians think, 10x as many people are infected, somehow there would need to exist 100K+ infected people, showing no symptoms, basically none of whom appeared in the 490000 negative samples. Such a probability is negligible. The sample sizes are large enough to remove the possibility.

[darkwater]

Well, in the US for seasonal flu the deaths estimation [1] for this season are 24k-60k deaths, for covid19 is 60k-240k, where 60k is applying lockdown, not "everybody work normally". And obviously they are on top of the typical deaths.

[1] https://www.statnews.com/2020/04/09/its-difficult-to-grasp-t...

[arcticbull]

The German survey showed an actual fatality rate of 0.37% vs the flu at 0.1%. We know herd immunity is in the cards due to the lack of mutation of COVID, and that kicks in at 60-70% of the population.

The German study also suggested up to 15% of people may already have it, so we can further reduce this number (an incremental 45-55% of the population getting infected) -- So, if we run some simple arithmetic, we'll see the number of fatalities will be approximately 60-70K.

This is in line with the number of fatalities in a difficult flu season. The difference is because COVID does not mutate (or has not yet), this will be a one-off, one-time, one-year issue. The flu kills 60,000 each and every year. The Swedes have it right.

We can mitigate this by isolating the vulnerable.

So yes, we are, in fact, overreacting.

[EDIT] I wonder if this is in fact in excess of deaths we'd see anyways. I'd imagine an 80.5 year old with 3 underlying medical conditions (average in Italy of the dead) isn't just as vulnerable to a bad flu as they are to COVID, so if COVID takes them, the flu won't.

[1] https://www.technologyreview.com/2020/04/09/999015/blood-tes...

[camelite]

Firstly, the German study analysed one small particularly hard hit town, so how you are extrapolating this to "people" in general is puzzling.

Secondly, there is a very wide range of reported fatality rates, with myriad factors known and unknown, so why you've chosen the lowest one globally (which, by the by, has always been an outlier and in any case is edging up past 1%) as the "actual" rate is, again, puzzling.

Finally, you are making a giant but unfortunately common logical error in using these already questionable death counts to make the case for an overreaction without attending to the obvious fact that without this "overreaction" every town, village and city on Earth would be Bergamo, where army lorries are conscripted to transport the dead from overwhelmed mortuaries, or worse.

Do better friendo.

[arcticbull]

> Finally, you are making a giant but unfortunately common logical error in using these already questionable death counts to make the case for an overreaction without attending to the obvious fact that without this "overreaction" every town, village and city on Earth would be Bergamo, where army lorries are conscripted to transport the dead from overwhelmed mortuaries, or worse.

Italy has the highest average age in Europe, and we know the virus is about 100X worse for people over 65 than it is for a 20 year old. Lombardy is the oldest region in the oldest country in Europe. The average age of the dead in Italy is 80.5 and has 3 underlying medical conditions. That's why it's so high there. I specifically called that out in the [EDIT].

I'd suggest doing some more reading.

The demographics in Gangelt skew older too, but otherwise they appear thoroughly average, and a totally reasonable representative sample. Especially as you yourself call out they were "particularly hard hit."

[camelite]

You don't see me claiming that the global death rate is 10% though, do you?

[vanniv]

This actually isn't entirely on top of the typical deaths, as many of the folks dying of COVID are folks that were very likely to have died from their other underlying conditions anyway this year.

Especially now that we are counting all deaths in COVID-positive or presumed-positive individuals as COVID deaths regardless of cause of mortality.

[DiogenesKynikos]

The spike in mortality across northern Italy contradicts your claim that these people would have died anyways this year.

[jeremyjh]

The estimate for the "no mitigation" scenario by the Imperial College is 2.2 million deaths [1] in the US. There is a large range of estimates that have come out since then to take into account the mitigation that has happened and how effective they have been. Lately things have been looking better but without some comprehensive contact tracing and isolation system we cannot "reopen" and drop those mitigations without moving back into the range of hundreds of thousands of casualties.

https://cleantechnica.com/2020/03/18/imperial-college-epidem...

[arcticbull]

That write-up was based on extremely early CFR data, with no population studies having been conducted at the time. Latest data is pointing to, as I called out, a fatality rate of 1/10th the CFR. This is especially true as we're counting anyone who tested positive for COVID as a COVID death, even if they were hit by a truck.

[DiogenesKynikos]

With a CFR of 0.4%, 1 million Americans would die.

Of course, if more than 200 million Americans came down with CoVID-19 in a short span of time, the health system would collapse.

[jeremyjh]

Is that why they are digging mass graves in New York?