[hyperpape]

I don't understand what calculation you're doing here.

The worst flu season we saw in a decade killed (~80k / 300M) = .02% of the US population. NYC has seen ~14000 deaths, or .18% (~14k / ~8M) death rate for the entire population, and while the absolute worst may be over, people are still dying at a high rate in NYC.

The only way I can make sense of this is that you're somehow mixing figures relating to deaths in healthy populations (COVID) vs. overall death rates in flu (including older/unhealthy populations).

[smsm42]

I don't think it's right to compare whole US population with worst-case NY population. Of course worst-case would be much worse that average case.

[badfrog]

What exactly do you mean by worst-case here? The actual worst case would be if nobody took any precautions, which almost certainly would result in more than 0.18% of the total US population dying.

[smsm42]

New York seems to be affected by COVID pandemics way worse than any other place in the US. That's what I mean by "worst case".

[dboreham]

Way worse, today.

[smsm42]

Let's see. NY has 965 death per million. Next state is New Jersey (which is basically "New York by another name" in this situation) with 493. Next is Connecticut (see above) with 372. Next is Louisiana - which had a grand idea of proceeding with Mardi Gras - with 285. Do you think things will get three times as bad in Louisiana than they are now, while not getting any worse in New York? Or which state would you say would be the next worst case, not today but in the future? I'd certainly bet NY (with adjacent NJ and CT) will keep this sad championship.

[badfrog]

> Do you think things will get three times as bad in Louisiana than they are now

If people there stopped all preventative measures, yes it would get much worse than 3x.

[hyperpape]

Depends on what you're comparing. I agree we can't assume that the rest of the country will see similar infection rates. However, it's less clear to me that fatality rates would be incorrect.

On the other hand, there's one very specific way that considering NYC gives us data we can't (yet) get elsewhere. While it's possible that we're underestimating disease prevalence by 50x elsewhere, it's basically impossible in NYC (almost 2% of people already have tested positive, with less than 10% of the population being tested).

[makomk]

Note that the test NYC is using only tells you whether the person has Covid-19 at that point in time, so it's entirely possible to test even 100% of the population and still substantially underestimate disease prevalence if you tested most of them at the wrong time (which you probably would!)

[smsm42]

> However, it's less clear to me that fatality rates would be incorrect.

Depends on whether mortality rates can be variant on environmental conditions, such as viral load, population density, access to healthcare/ICUs, population socio-demographic profile, etc.

[hyperpape]

These are good points, and I think I ended up claiming a much stronger claim than I should've. There's plenty of reasons NYC could have a higher death rate than elsewhere. I don't know how precisely you could estimate the potential death rate from just NYC's data.

What I would still say is that it's reasonable to say "NYC has .18% of its population dead. It's extremely implausible that this disease is no more lethal than the flu is, when that's 10x the overall death rate from the flu. If you present me evidence suggesting that from elsewhere, it's going to have to be quite strong to overcome the evidence from NYC."

[weaksauce]

the flu would be way more deadly than it is if there wasn't a seasonal flu shot that gives herd immunity.

edit: it shouldn't be controversial to say that a thing that kills 30-80k per year with active measures of mitigation already something that would be more deadly without a vaccine. seriously reflect on that. the corona virus is something we need to take 100% seriously but also acknowledge that the flu is also very deadly... even more so without any mitigation (thankfully we have for the common flu)

[arcticbull]

The flu probably wouldn't be dramatically worse if we didn't have a vaccine. The vaccine isn't particularly effective all things considered, ranging from 10% to 60% depending on the year and how well scientists were able to guess which strain would be predominant.

The flu as-is causes 45,000,000 sicknesses every year in the US alone.

[arcticbull]

Nah, my calculus is basically as follows. The disease is not bad for people who aren't old, and who do not have pre-existing conditions. The data is pretty unequivocal there. The number of deaths under 20 worldwide rounds to zero. It's incredibly contagious (and contagious while no symptoms are shown), and a vaccine is 12-18 months away at a minimum. There's no way we're going to be able to contain everyone indoors, with no jobs, for 18 months while we await a vaccine that may not arrive. And that's just here in the US -- the weakest link dominates.

If we don't develop herd immunity ASAP, and instead pursue a course of lockdowns, as soon as we lift the lockdowns (either voluntarily or because people just walk out -- see the midwest), we'll immediately start playing rolling lockdown whack-a-mole as China is. The first contagious person who flies in from a foreign country (or domestically) without perfect lockdowns will re-ignite the wildfire.

We should do exactly what Sweden is doing and what the UK proposed: isolate and provide support services to those who are at risk, and let out those who aren't. I think it speaks volumes that Sweden's new infection rate stabilized at the same time as the rest of the world but without lockdowns.

It's really the only path forward. Is it perfect? Of course not. People will die. However, there's no world in which about 70% of the population won't get the disease before the vaccine arrives, so we need to control who gets it, when, and in what order, to minimize harm.

[rootusrootus]

> but without lockdowns.

While I agree mostly with your assessment, it's worth mentioning that the lack of official lockdown in Sweden doesn't mean there isn't a lockdown. According to Google's mobility data for Sweden, their lockdown activity looks pretty similar to what we see in the US. People are voluntarily staying home.

[balnaphone]

> their lockdown activity

Since Sweden doesn't have a lockdown, this statement is meaningless. A major objection to lockdowns is their involuntary nature. In general, there is a big difference between choosing to stay home, and being coerced (with the threat of force) to do so. One is "choosing to do what you believe is best", the other is "prison".

[qqqwerty]

And there are big differences in social cohesion between countries. Voluntary efforts appear to be sufficient in Sweden precisely because there is a high level of compliance.

In the meantime, the coastal town that I live in is getting swarmed with out of town visitors every weekend. This is in violation of the shelter-in-place orders. Other towns have stepped up enforcement to combat this type of behavior, but our police department is small and does not have the resources. We shut down the parking lots, but now they just park in the neighborhoods. And to add insult to injury, we have a large senior housing complex at the entrance point to my neighborhood.

I have little faith that the US could achieve the type of distancing and isolation necessary on a voluntary basis. There is a sharp vein of individualism that runs through our society that works strongly against us in these types of situations.

[arcticbull]

For what it's worth, Sweden's goal is to get 70% of the country infected to achieve herd immunity. They likely quite rightly believe that's the only way to stop the disease once and for all. While it's absolutely not okay to be anywhere near a seniors residence, the rest is likely tolerated because it's kind of the unstated goal to the extent healthcare facilities remain un-saturated.

It's by no means a "hope and pray it goes away" or a "lets wait it out until a vaccine" -- it's a "let's get everyone not in a risk category infected as fast as possible so long as the healthcare system retains some excess capacity."

[qqqwerty]

I think almost everyone you are debating in this thread would support opening things up provided a few conditions were met. The primary condition for most of us is we need adequate testing and contract tracing capacity. And the reason that this is necessary:

> healthcare facilities remain un-saturated

You can't simply look at the current burden on the health care system to guide the process. The virus has a 2-3 week lag time between when an infection cluster breaks out, and when the health care system starts to feel the impact. Without wide scale testing, we are just going to end up back in a lock down once the infection numbers start climbing again. And I can't think of a worse scenario for our economy than having to shut things down every other month because our government is to incompetent to implement a tracing program that multiple countries already have up and running.

[mcnamaratw]

Your calculus has no numbers in it.

[arcticbull]

Different kind of calculus.

[edoo]

The serological surveys are showing 50-100x infection rates of those tested. If tested healthy persons are dying at 0.5% that gets you to 0.01%-0.005% death rate in healthy persons. That number is lower than the all cause death rates of 25-34 year olds...

https://www.cdc.gov/nchs/data/databriefs/db355-h.pdf

[hyperpape]

I see. You're correct that while the overall death rates in NYC are vastly higher than any season flu, it's mathematically possible that those are all deaths of unhealthy people.

It's a creative interpretation of the facts.

One important note: it's impossible that NYC is overestimating cases by 100x. Close to 2% of NYC has confirmed cases.

[edoo]

New York is at 1.3 percent positive with new cases flatlining. That fits very squarely with what you'd expect to see based on the surveys. Healthy people aren't dying by any significant number based on New York's own published data. The only other one I've seen is MA that has 97.5% deaths with comorbidity. This is a huge overreaction.

[arcticbull]

99.2% of the folks who died in Italy averaged 80.5 and had an average of 3 underlying conditions, so that data lines up.

[vanniv]

The other thing to keep in mind with death counts, especially in NY and NJ, is that all deaths of likely-infected people are being counted as COVID deaths regardless of cause of death.

This has included a couple lf suicides of folks who had respiratory illness prior to death, and one person who got in an auto accident and died of head trauma -- but he had tested COVID-positive.

Yes, most people right now who get a respiratory illness and then die probably did have COVID -- and it is possible that some folks are dying of COVID and being uncounted to offset some of the overcounting -- but with death numbers counted so loosely, it is hard to know the real story, and impossible to do simple maths using rates from one place at one time to compute rates at other times or other places.

I tend to think that NYC must be approaching saturation, and that the true new-case numbers must be falling there, but it's impossible to answer with certainty using only the numbers we have here on the internets.

[DanBC]

> is that all deaths of likely-infected people are being counted as COVID deaths regardless of cause of death.

No, this isn't what's happening.

Doctors who are sure to the best of their knowledge and experience that the deceased had covid-19 will put covid-19 on the death certificate, and they will also say if they think it contributed to death.

That's not the same as "anyone who dies with covid-19 is being described as killed by covid-19".

[arcticbull]

I actually followed up with you on this one recently. This is in fact what's happening, and it varies by country/region/city to what extent.

In some countries they absolutely do count anyone who dies while in the possession of COVID as a COVID death, for instance Italy. " Italy’s death rate might also be higher because of how fatalities are recorded. In Italy, all those who die in hospitals with Coronavirus are included in the death counts."

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88% patients who have died have at least one pre-morbidity – many had two or three.” [1]

In New York they're counting speculative COVID deaths of anyone with respiratory illness even if they've never tested positive [2].

"A subtler issue is what to do when the patient has other serious medical conditions. If the person suffered from chronic lung disease, then became infected with the virus and died of pneumonia, the immediate or primary cause would be pneumonia as a result of COVID-19. The lung disease would be listed as a contributing condition, said Sally S. Aiken, president of the National Association of Medical Examiners." [3]

The CDC has guidance on this but it's fair to say its interpretation will vary from place to place. "COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death" -- that's pretty broad. [4]

Sorry, Dan, this is looking like it's not the Ebola infection you're making it out to be.

[1] https://www.cebm.net/covid-19/global-covid-19-case-fatality-...

[2] https://www.cnbc.com/2020/04/15/coronavirus-new-york-city-st...

[3] https://www.inquirer.com/health/coronavirus/coronavirus-covi...

[4] https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-I...

[DanBC]

You write this long post, but then finish with the CDC guidance which agree with what I said -- that doctors have to use be able to say to the best of their knowledge and experience that the deceased had covid-19 and that it caused death, or that it contributed to death.

The problem here is that you don't know what "COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death" means.

[DanBC]

Try to find some 5 year / 10 year averages to see how excess mortality because of covid-19 compares.

Here's one for the UK: https://twitter.com/ONS/status/1252518098047041536

[arcticbull]

It's not clear that 100% of excess mortality is COVID, or how that actually relates to its IFR. More data needed.

[DanBC]

Sure, all that excess mortality is likely to be an increase in cake-related death caused by quarantined shut-ins eating themselves to death.