Just a tidbit on which to ruminate
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yes but this is with the country locked down. The concern is with things opened up weâll have lots of mini-New Yorks, where already 1 in 591 people in the state have died of this. Thatâs a ton.
I hope weâve ramped up our testing/tracing game enough that this doesnât happen but I have no doubt that the overall death rate is going to exceed what weâve seen so far, which we have to remember is just from six weeks.
Also the flu/covid compariosn you have (5 to 8 times as deadly) isnât right. Thatâs comparing estimates of flu deaths based on flu hospitalizations in 13 states, to actual case count deaths of COVID-19, which the vast majority of people think are underestimated. Partly, this is because the CDCâs projections of flu deaths is probably inflated; some fraction of people who die of pneumonia are assumed to have died of flu, but that probably isnât the case. Many experts think true mortality from flu is closer to 0.05%, rather than the widely touted 0.1% Best estimate on infection fatality rate for COVID is about 0.5% to 0.8% (case fatality rate would be double). But thatâs still more than 10 times flu when youâre comparing apples to apples.
I also think many people are looking at that worst-case --the number of dead people â and thinking itâs not horrible. But 20% of the people who become noticeably sick with COVID have pneumonia that requires hospitalization! And among the 80% of âmildâ cases, some fraction have pneumonia!! To me thatâs mind-blowing because my dad has had pneumonia 3 or 4 times. It takes weeks for him to recover. So weâre talking about something that is very disabling for those that do get sick.
My FIL (ER doc in NYC and NJ), has positive antibodies but had no noticeable symptoms. New data suggests even 50% people who have never been exposed to SARS-CoV-2 have T-cells that react and bind to it, likely because of past exposure to other coronaviruses. These people test negative for COVID antibodies, meaning theyâve never been infected. So my guess is the portion of the population that has some early immune response to it due to past coronavirus exposure never know they are sick. But the ones who do get sick get very sick.
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@Sam, the thing is, many people who die would have died in a six-month period anywaysâŚsure. Most people who die in general are old and sick. But the best actuarial estimates we have so far find that people who die of COVID-19 are having about 5 to10 years of life shaved off by the disease. Thatâs pretty significant.
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I agree it is significant.
The point in trying to make is, as others have been pointing out the total case count is probably substantially underreported, the total deaths attributed to it are probably over reported, leading to a substantial overstatement of its overall mortality
Thatâs not to say it shouldnât be taken seriously, it should be.
I thought the shutdown was temporary to give the medical system a chance while weâre waiting and waiting for treatments and the pinnacle of a vaccine.
The people Iâve seen most upset about slowly reopening are the same people who have the resources and opportunity to work from home and manage isolation (a choice) safely.
I still mitigate risk the same way as my extended family membersâŚbut the difference is that I feel less fearful and less outraged at societyâŚand that emotional disconnect when looking at the same situation is evidently a relationship wedge. 
Quarantine cannot last forever. People who want to keep quarantiningâŚdo it!
Wash your hands. Donât touch your face. Avoid crowds. Live and let live bc itâs going to happen anyway. Suicides, abuse, hunger, financial ruin which is going to lead to suicide, abuse and hungerâŚthis was never the plan.
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there is no data suggesting deaths are overreported. Thatâs inaccurate. Rather most experts who actually count deaths think it is being undercounted.
Does not negate the fact that death rates are lower than youâd expect based on symptomatic cases, or that thereâs uncertainty. (Also, death rate isnât a static thing, it depends on the health of your population etcâŚ)
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Disagree. Even Dr Birx has acknowledged that people who would have died regardless if they are âpresumedâ to be covid positive are being counted as covid deaths. That, by definition is an over reported death.
I agree with your article in that it can be difficult to categorize⌠which is why the cdc is counting all cases as covid deaths. They had to adopt a uniform standard of how they were going to define it, and in this case thatâs the approach they went with
I think the problem is that the goals were really poorly articulated by public health experts. The goal was only ever stated as âflattening the curveâ and the idea that we could actually prevent infections and âcrush the curveâ rather than spreading out deaths was never put forward. But the fact is, most places that are reopening are likely to have all the work of quarantine undone because they donât have any tracing/isolating capability. Testing is ramping up, but most places donât have enough tests to stop a new massive outbreak should one occur. In South Korea, one guy went clubbing and infected 100 people, those people had 10s of thousands of contacts, and required 46,000 tests to keep the outbreak from mushrooming into a huge disaster. Do we have that ability to do those things? And are we using logic/case reports on actual spreading to see which businesses are low/high risk? Is reopening actually being governed by data?
I personally think 98% of businesses can be reopened while maintaining numbers where they are, but some I think are insane (fitness classes, concerts, bars!!!, church, and restaurants that donât have adequate spacing or ventilation). Church is a separate issue; I do think peopleâs right to religious freedom should hold sway, but then churches need to do things like have more services with half-attendance so that people arenât sitting next to each other. and maybe donât have people sing along to the hymns because talking loudly and singing seem to be a big spreader of the disease.
In my opinion, we should have been really robustly ramping up contact tracing and we could be like other countries â able to reopen without having large fractions of our population infected.
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I agree. To each their own. To be clear, when I personally complain, Iâm only referring to those who donât need to go out âŚnails, hair, bars, etc., Those arenât necessary at this time. Work? Hell yesâŚif you canât work from home, you have to do what you have to do for your family. Iâm talking about risk-takers who are doing careless things that arenât critical right now and, in the grand scheme of things, wholely unimportant.
âŚbut if they want to risk themselves and their lives, as you say, âdo it!â
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but CDC is not the one classifying all COVID deaths. Death counts are created using a patchwork of local/state reporting.
For instance, in Wisconsin, any death classified as COVID has to be reevaluated by the examiner to rule out other causes. Another state might have a more liberal approach and say anyone who died with covid is a covid death. But there is no single âCDC death countâ metric that does not rely on county coronerâs cause of death determination. Those standardized death counts by the CDC, where they are actually reviewing death certificates, can take months to years to come out. What we have is the result of several jurisdictions and hundreds of individual coroners. There is no widespread conspiracy to âovercountâ COVID deaths.
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I certainly donât think thereâs a widespread conspiracy⌠I think thereâs a very liberal framework how how they are counted, and Iâm not even critical of that approach⌠but I do think it leads to an increase in the numbers.
I think thatâs pretty evident when we look at the overall expected death rate over this time frame + the covid deaths does not = anywhere near what it would be expected to if that number of deaths were âadditionalâââ Chrisâs chart above is quite illustrative of that
Thank you God. I hope you donât get a headache from your halo being on top right.
My gym is on the verge of reopening, however they are using fans to run a negative pressure in the building and are limiting the classes to 10 people with all the equipment facing outwards, while having an airflow study being done by OHSU researchers prior to opening. So I am excited to get back to the gym. It will be safer than walking in my neighborhood. Donât underestimate the ingenuity of people to open responsibly. I am really insulted that people including my governor wonât allow proper reopening based on the belief that people wonât do the right thing. It would also be awesome if we had a county dashboard the tracked hospital utilization and whenever we get over a trigger amount we close until we drop below that utilization, but that is apparently too much to ask.
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Making a dashboard should be easy, but defining a trigger amount is in fact quite difficult. Itâs a combination of factors. Hospital admissions (both ICU and non-ICU), number of Covid cases and the reproductive number all play a role, but none of them is the sole deciding factor.
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@Chris, i wish I was as optimistic about people in general. My experience is that lots of people are fabulous and really ingenious. And a lot of people are total dumb-dumbs. And most are in between. The trouble is that it only takes a small population of the latter to mess it up for everyone elseâŚ
Your gym sounds like itâs taking things seriously but I canât imagine many others are doing the same. I have heard no updates from my gym about whether or not theyâre doing anything differently. Also, some types of gyms (my husband has a rock-climbing gym membership)-- I just donât see how they can prevent the fomites. I mean, your job is literally to grab onto a rock hold that who knows how many other people have touched beforehand.
The interesting thing in the South Korean case report on gym transmission is that high-intensity Zumba classes were hotspots of disease transmission, but the same infected instructors who taught pilates and yoga did not transmit the virus to anyone else. Makes me think the heavy breathing/intensity really plays a role. So maybe you need way more spacing in an aerobics class than a yoga class. And you also should be slashing the number of ellipticals/bikes/treadmills more dramatically than say the number of weight machinesâŚ
We have that hospital dashboard in California. Not sure whatâs going on in Oregon. Newsom has generally been pretty good on this, I think. The
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My governor is allowing restaurants to open shortly, but they have to only seat a limited number of people (which makes sense) but they also have to close at 10. The governors reasoning is that because people drink in restaurants, after 10 pm they arenât responsible enough to social distance. That is her reasoning.
Instead of the thought that people want to eat out, and since they can only seat a limited number, lets let them stay open longer so more people can be served and more people can get back to work in a safe manner.
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I think the hours might play out unexpectedly⌠In the Bay Area at least, the cost of paying servers is the biggest expense, so it might be better for the restaurants to operate with fewer open hours.
I would love it if restaurants could set up an âorder aheadâ system where people do sit down to eat, but they call in their order and pay for it in advance. Less lingering at a table for a while while you wait for your food. That will certainly increase overall usage of tables and make things more like fast food, but would probably help restaurants maintain their overall head count without making things too cramped. Not the ideal restaurant experience, but Iâd personally rather way have that than have my favorite places be completely closed.
Also would love to see some busy streets, like Valencia, closed down to car traffic so that our small, cramped restaurants can utilizes street space as seating.
Interesting, that is not my experience at all. A lot of the people I see most upset are the essential workers or retail workers who are being forced back to work in potentially unsafe conditions. In many cases, they are screwed because even if immunocompromised, they will lose their unemployment eligibility if they donât return to work, despite feeling unsafe doing so. They are the ones being economically coerced to put their bodies at risk because of re-opening. Whereas many of the people I see demanding haircuts and whatever are people who have much more financial privileges.
The people who are really screwed are service industry workers though, because their unemployment is based off of base pay (which is incredibly low), not tipped earnings, which is their real income. Many of the ones I know want to go back because unemployment isnât sufficient for them and they canât survive otherwise, but they still donât feel comfortable/safe about it. It reflects our broken system around service workers more than it does their genuine desire to re-open.
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Careful about the exact conclusion, though. That 55,000 is a net number, and itâs for six weeks up to mid-April (guess from eyeballing the graph and Mar 22 label) but weâre in late-May. That 55,000 contains the number of people who died but normally wouldnât have (e.g., from corona) minus the number of people who didnât die but otherwise would have (e.g., people who stayed home so didnât get into fatal car crashes or accidents at work), minus an additional âthresholdâ fudge factor I guess to cover uncertainty in the counts.
Weâll have to see what the numbers look like after another 6 or 10 weeks of partial reopening. The behavior of an exponential process buried in a large background is incredibly non-intuitive in that it looks like nothing is out of the ordinary until all of a sudden it is huge and wild.
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As an aside, I think this article has some really fascinating details about transmission. I would love if this type of data was used to inform which places can be reopened and how:
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