Mar 22, 2020

> Except China is clearly lying about having their outbreak contained. I'm not sure why this is so difficult for everyone to realize.

You have no data to back up your totally spurious allegations. Are you just outright speculating? If you're going to say something so bold, citations are necessary.

What we do know is this:

- Apple has re-opened their factories and all 42 Apple stores in all of China [1], and closed their Apple stores in the entire rest of the world [2]. There is absolutely no reason to believe that Apple would do this except in the face of evidence. What kind of PR nightmare do you think they'd be inviting if it was discovered they put lives at risk to placate the PRC?

- Tourist attractions and factories are re-opening. [3]

- The WHO said: "China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic. A particularly compelling statistic is that on the first day of the advance team’s work there were 2478 newly confirmed cases of COVID-19 reported in China. Two weeks later, on the final day of this Mission, China reported 409 newly confirmed cases. This decline in COVID-19 cases across China is real." [4]

- I've no doubt this will be confirmed via observation of atmospheric release of nitrous oxides in short order.

Fine, if you don't want to believe China, Apple or the WHO (and soon NASA), you better have some data, otherwise it's just breathless unsubstantiated fear-mongering and conspiracy theories.

[1] https://www.theverge.com/2020/3/13/21177964/apple-stores-chi...

[2] https://nypost.com/2020/03/17/apple-extends-coronavirus-trig...

[3] https://www.forbes.com/sites/jamesasquith/2020/03/21/no-new-...

[4] https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 20, 2020

You are wrong according to the WHO investigation of the events in China.[1]

You are wrong according to the statistics that came out of Korea - if there was an invisible group of asymptomatic, Korea's infection rate couldn't have been controlled. [2]

This destructive belief has persisted for a while because it made sense for various flu epidemic and gave the comforting idea most infections would be harmless. But is now with us at scale and all the evidence points to a rough 20%, 1-in-5 hospitalization rate [3]. I wish actual authorities would spend more time debunking this (even get fully clear on it themselves).

[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...

[2] Look at covid19info.live and look at the South Korean statistics. There's reason to think Korea found most if not all infection. Similar reasoning also applies to China.

[3] Edit: Discussion of CDC study: https://thehill.com/policy/healthcare/488325-cdc-data-show-c...

Mar 16, 2020

> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion".

The Professor of Clinical Immunology of the University of Florence, Sergio Romagnani

> Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.

https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Clinical and epidemiological data from the Chinese CDC and regarding 72,314 case records (confirmed, suspected, diagnosed, and asymptomatic cases) were shared in the Journal of the American Medical Association (JAMA) (February 24, 2020), providing an important illustration of the epidemiologic curve of the Chinese outbreak. There were 62% confirmed cases, including 1% of cases that were asymptomatic, but were laboratory-positive (viral nucleic acid test).

https://www.ncbi.nlm.nih.gov/books/NBK554776/

Weird discrepancy on the order of 75x. I'd love to trust the experts, but who? I am leaning towards truly asymptomatic spread being rare, since you get infected by SARS-CoV-2, not COVID-19 (COVID-19 is the disease), the level of uncertainty of 25% is higher than for other reports, and the main reported mode of transmission is through symptomatic cough droplets.

Mar 14, 2020

The February report from WHO did not list runny nose as a symptom. If you do have a runny nose, though, that increases the riskiness of hand-nose contact as an infection pathway.

https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 10, 2020

The WHO report has sort throat listed in about 13% of cases, so yes not very common.

As of 20 February 2020 and based on 55924 laboratory confirmed cases, typical signs and symptoms include:fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgiaor arthralgia (14.8%), chills(11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%)

Page 12

https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 08, 2020

https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.

Mar 05, 2020

The WHO has been reporting ~1% of cases are asymptomatic, this has it's own caveats because it comes after China's lock down but there's little reason to believe there a huge numbers of unknown cases out there, at least in countries testing well.

> With a virus which can be extremely mild in the vast majority of cases

I haven't seen a breakdown of how many get what the "mild" symptoms, but anything not requiring hospitalization including pneumonia are considered mild. Many of these mild cases would at least be going to their doctor to get a week off work.

Edit - found a break down: https://www.who.int/docs/default-source/coronaviruse/who-chi...

> As of 20 February 2020 and 12based on 55924 laboratory confirmed cases, typical signs and symptomsinclude:fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgiaor arthralgia (14.8%), chills(11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestiion (0.8%).

Those symptoms are worthy of a doctor visit and skipping work.

Mar 03, 2020

> I mean, you can't really say the author can't assess the situation because of a lack of expertise, and then immediately assess the situation with a lack of expertise.

This is the assessment of the WHO, not mine. https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 03, 2020

The incubation period is not 25-30 days. The mean incubation period is 5-6 days, range 1-14 days.

Source: Page 12, paragraph 2. https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 02, 2020

Striking summary from the WHO report: https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

Mar 01, 2020

> In the study last week from NEJM of 1099 hospital patients

BTW that NJEM paper you keep referencing is very out of date. Yes it passed peer review and was published last week, but it's using data from Jan 29. It was actually written nearly a month ago; I found a preprint of that paper posted Feb 3. You'd be aware of this if you were actively following the novel coronavirus situation.

There's a more up-to-date paper published by China CDC that covers 72,314 patients / 44,672 confirmed cases using data thru Feb 11. I would reference figures from that paper instead.

> I think you may be giving OP too much credit with their use of “cases” implying hospital cases (which is the 5% ICU number, it is not 5% of infections require the ICU) ... It is absolutely not 5% of “known” cases.

No, he's correct. Current evidence shows at least 5% of confirmed cases require ICU care. From the WHO China report, they note that 6.1% of all cases are critical. They define critical as the following: "Critical cases are defined as respiratory failure requiring mechanical ventilation, shock or other organ failure that requires intensive care."

These numbers are not just a China fluke. We're seeing similar critical percentages in other countries. For example, as of today, Singapore has 106 confirmed cases of which 7 are critical (~6.6%).

> I don’t think HN commentators should play epidemiologist

Isn't that what you're doing?

[0] http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...

[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 01, 2020

That's unfortunately a common misunderstanding of how CFR or case fatality rate works. It begins huge as only the most serious cases are identified as nCoV and it falls as the long tail comes into view.

Over the last few days, we've seen thousands of recoveries and tens of deaths. Marginally, it's 0.6% globally from the latest WHO data. The media is sensationalizing this and playing on peoples fears and emotions.

Check out the graph on page 13 of the WHO report: https://www.who.int/docs/default-source/coronaviruse/who-chi...

> Aside from that, a much larger (as of yet unknown) number have permanent lung scarring. That's not a joke. Read about SARS and MERS long-term prognosis from similar scarring.

To your own point, we have no idea if it's even a thing. Just because SARS, MERS and nCoV are all coronaviruses doesn't mean they act the same way. MERS has a 35% fatality rate vs. and I can't stress this enough 0.6%, so two whole orders of magnitude less fatal.

Mar 01, 2020

> However, the total number of COVID-19 cases is likely higher due to inherent difficulties in identifying and counting mild and asymptomatic cases.

> Nevertheless, all CFRs still need to be interpreted with caution and more research is required.

Like the cruise ships:

> The ministry has tested 4,061 people so far, of which 705 were positive, including 392 people who were asymptomatic.

So seems your estimate of "huge numbers of asymptomatic" is not far from the mark. Apologies. See also:

> Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report [due to contact testing] went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.

https://www.who.int/docs/default-source/coronaviruse/who-chi...

Mar 01, 2020

Science: https://www.who.int/docs/default-source/coronaviruse/who-chi...

Feb 29, 2020

I'm seeing current numbers show 41,490 active and 45,112 resolved. Between your numbers and mine, the number of deaths increased by 507 and the number of recoveries increased by 21,693. This means the fatality rate for this set of resolutions is still lower, 2.2%. This trend is fairly pronounced downward as the WHO report on the matter calls out, we've learned a lot about the disease and are identifying a lot of totally asymptomatic cases [1]

[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...

Feb 29, 2020

The WHO pins it at 0.7% and falling as understanding thereof and treatment improves [1 - page 12, graph on page 13]. This makes a lot of sense as the earliest numbers were based only on people presenting severe symptoms, and huge quantities of people with nCoV are completely and totally asymptomatic.

As with the flu, mortality is highest in older people, and the immunocompromised.

[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...

Feb 28, 2020

Can you cite some of the worldwide public health community that disagrees with the assertions? All the alarmism I've seen is coming from a media, typically with wildly outdated or incorrect statistics.

WHO's clickbait ten tips for conoravirus include statements such as "Most people will have mild disease and get better without needing any special care." [1]

If you read the stuff they've been publishing, you'll get quotes such as "Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases", and "Recognize that COVID-19 is a new and concerning disease, but that outbreaks can managed with the right response and that the vast majority of infected people will recover;" [2]

They also discuss how we're already seeing the death ratio dropping substantially, and treatment is being improved: "In China, the overall CFR was higher in the early stages of the outbreak (17.3% for cases with symptom onset from 1-10 January) and has reduced over time to 0.7% for patients with symptom onset after 1 February (Figure 4). The Joint Mission noted that the standard of care has evolved over the course of the outbreak." [2]

CDC publications and announcements follow similar sentiments.

Edit: adding NEJM quote that supports my assumption about sampling issues: "We found a lower case fatality rate (1.4%) than the rate that was recently reportedly, probably because of the difference in sample sizes and case inclusion criteria. Our findings were more similar to the national official statistics, which showed a rate of death of 3.2% among 51,857 cases of Covid-19 as of February 16, 2020. Since patients who were mildly ill and who did not seek medical attention were not included in our study, the case fatality rate in a real-world scenario might be even lower. Early isolation, early diagnosis, and early management might have collectively contributed to the reduction in mortality in Guangdong." [3]

[1] https://www.who.int/dg/speeches/detail/who-diretor-general-s...

[2] https://www.who.int/docs/default-source/coronaviruse/who-chi...

[3] https://www.nejm.org/doi/full/10.1056/NEJMoa2002032