Fauci is not sure and said “So even if it goes down to 1%, it’s still 10 times more fatal [as the seasonal flu].". https://www.cnbc.com/2020/03/04/fauc...ronavirus.html

Donald Trump said "Personally, I would say, the number is way under 1%" https://www.npr.org/2020/03/05/81251...irus-messaging

I think the 0.1% number comes from this editorial in the NEJM. (in was mentioned earlier in this thread)

https://www.nejm.org/doi/full/10.1056/NEJMe2002387

That was published a week before the congressional hearing cited in the CNBC story.

To me that looks like no one is certain yet.

I think this was before that, but I�m not certain.


Thanks for finding it. And you�re right I think, no one is certain.

The US cases are growing fast, about 150 new cases in the last 24 hours, even with the very tragically limited testing. They will go higher than Japan today, and probably be in the top 5 most infected countries in 3-4 days (in raw numbers).

for those who don't do the twitter, here's a lovely compilation of a math nerds' tweets about the possibility of overwhelmed hospitals and systemic healthcare failure in the united states.
worth a read.

https://threadreaderapp.com/thread/1...459003909.html

excerpt:

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc). 7/n
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients). 8/n
By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) 9/n

Thanks for posting. I had seen this earlier today. Just in case people wonder why a math nerd is someone to give credence, she is actually a Biomechanics Engineer with a Biology PhD. In her Twitter feed she retweets many other people who have relevant backgrounds and are posting important insights.

Well a PSG match was postponed yesterday. https://bleacherreport.com/articles/...virus-concerns

This was a big deal in France. People were NOT happy. And if this affects the Champions league, the public could rise up against it.

I'm going to _try_ to be less active on this thread: this thread was extremely valuable over the last two months since COVID-19 was really such an unknown...and most governments were minimising threats...I think that will become less and less the case as the pandemic progresses.

Re: potential outcomes, this link about pandemic preparedness from Johns Hopkins, adapted from an influenza document, really tells the stark reality. There are two scenarios: 1968-like and 1918-like. Even the 1968 scenario is scary, but I think we're actually more like the 1918 scenario.

Although I agree that we don't know the denominator of true infected, Diamond Princess is the best 'contained' point outbreak we have: the demographics are skewed, to be fair, since it was a much older than average population. But the number of asymptomatic individuals appears to be ~50%, it _may_ be a bit higher with a younger demographic, but I think the mortality rate is going to be well above 0.2%, and could well be 1% or even slightly higher, and that is under optimal care scenarios. The hospitalization rate is the biggest concern, as I and others have said all along: this has serious implications for _all cause mortality_. And I don't think this rate will be under 3%, which is just too high for us to cope with.

Finally, I think China is going to aim for a 'last man standing' approach: they have been remarkably effective in bringing things under control: but the biggest take home message is that it worked MUCH better outside Hubei, i.e. restrict activities EARLY. I have a suspicion they will try to hold out until a vaccine is available...which may mean torching their economy for 6 months, or more...but if the rest of the world suffers even greater losses, it's all relative.

A couple of points that others raised asking me, that I only just read: a) mouthwash: I don't think this is a good idea, at least excessively. Yes, the mouthwash will kill the virus, but only while it's in the mouth, and damaging your mucosa by excessive use will instead increase susceptibility, b) mask re-use: I think we SHOULD be re-using masks, even in hospitals, let alone personal use. I do NOT recommend spraying with anything, that will potentially damage integrity. For 'home' remedies, I suggest putting the mask safely in a ziplock bag, disinfecting hands after that, then exposing to sunlight for 2-3 days, or at least keeping in a warm place. No guarantees (this is EVIDENCE-free SPECULATION), but that should probably decrease viral particle load by 1000x fold more.

Closing shot: disappointed that the Cruise industry really believes enhanced screening can prevent further outbreaks, especially since we know full well that half of those infected won't have a fever, and even 15% of those coming to medical attention won't have a cough,

Be well all!

tb

Grand Princess plan:

https://www.latimes.com/california/s...in-san-antonio

- Ship docks in Oakland on Monday
- people needing medical care will receive it in CA
- CA residents to be transported to a federal facility in CA for testing and isolation
- other pax to be transported to other states� fed quarantine facilities
- crew to be quarantined and treated (?) aboard
- ship will not remain in Oakland, but not clear where it is going

Doc, don't leave us please. You are one of only two people writing in this thread who is the specialist in the field, and the second person writes even less.

What I observe is following - before all this was developing in far far away land for vast majority of readers/writers of this thread, for them it was like watching war on CNN on their bedroom TVs - part of excitement, part of entertainment, part of Monday morning quarterbacking.

And last week this suddenly knocked on their doors.

Seems a lot of people are right now going thru five stages of grief. And in this and other threads one can find plenty of examples of people in each stage.

What you wrote in this thread not only provided valuable information to the audience but I'm sure motivated number of people to change their stance on this.

This is an interesting take, but equally makes some pretty massive, and possibly wrong, assumptions.

1. Trusting Italy's numbers.
2. Hospitalisation lasting for weeks.
3. The ratio of sick requiring beds (20%/10%/5%/2.5% etc) and how that moves the day the US runs out of beds.
4. Numbers of HCW requiring masks.
5. Number of HCW in total.

The line I have the biggest problem with is:

"Importantly, I cannot stress this enough: even if I�m wrong � even VERY wrong � about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically na�ve population work"

I don't have that much time to go through it all, so this will be a very potted analysis buy lets dive in to numbers 2 and 3:

2. All Hospitalisations lasting weeks - this is not true. We do not currently understand the normal disease progression in the most severe cases, but 'weeks' for the majority of patients is most likely not true. Current US protocol is that when discharge is clinically indicated the patient has to have 2x negative test results 24 hours apart, this is quite extreme (but necessary currently) but ads on roughly 1.5-2 days to each stay. Currently, and factoring that all in you're probably looking at 7-12 days at a maximum for an average stay in hospital. Now- as we get a clearer grip on disease progression and what best treatment is, this will most likely decrease. Equally- and this is a bit macabre- quite a few of the most unwell/ frail (those who would take the longest to recover) will die relatively early on in the time, freeing up the beds.

3. The ratio of the sick requiring beds and the affect of that on moving the day the US runs out of beds - The truth is, we have no idea of what this number will be- but currently we are at an (extremely cautious) stage whereby quite a few of the very but not severely or critically unwell are getting beds in hospitals, arguably . As above- with time, disease understanding increases, treatment gets more refined and a need for hospitalisations decrease. However the major issue with her analysis is that there is no acknowledgement of the recovery/death rate in the calculations... this means that this quote: "even if I�m wrong � even VERY wrong � about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks." argues against her own point. By changing the timeline by 'weeks' completely changes the nature of the threat she is warning about massively, and by 'days' significantly.

Finally:

"And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?
Worst case, I�m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out."

This statement is really not helpful. In an article arguing about how supplies and supply chains will be hit during this crisis, the author is actively encouraging panic buying. Please folks, don't go and panic buy tons of stuff. It's counter productive to buy 300 cans of black beans. Quote from Prof Stephen Taylor: " We know that washing your hands and practicing coughing hygiene is all you need to do at this point. But for many people, hand-washing seems to be too ordinary. This is a dramatic event, therefore a dramatic response is required, so that leads to people throwing money at things in hopes of protecting themselves.�

This is not an argument not take this potential pandemic seriously, but more to encourage people reading both the pessimists' and the optimists' views on this to take a step back and just evaluate the facts being presented, even if they are done so in a quasi-scientific way.

It�s really not a choice between do nothing or buy 300 cans of black beans and shouldn�t be presented as such.

As I have mentioned several times over the course of this thread, my preparations are designed to reduce my need to go shopping (or dining out) once the community spread in my area would expose me to risk. I didn�t buy 300 cans of black beans, I bought five. And some packs of red/black beans and rice. We eat that anyway, and having five vs 1 in the pantry is neither an indication of panic buying nor did it put any strains on the supply chain. I also bought some other shelf stable food items. Overall enough for two to comfortably eat for about two weeks, though I fully expect to supplement it with fresh items until/unless it gets really bad.

Here is a (IMO) sensible article from Consumer Reports on what one might want to do to prepare:

https://www.consumerreports.org/coro...tined-at-home/


(ignore the title of the story as it really isn�t about quarantine prep, but about social distancing prep)

We can use Singapore example. Totally there are 150 cases.
https://www.moh.gov.sg/news-highligh...tion-confirmed
60 hospitalization, 9 critical. 15% of hospitalized are in critical condition. Or 6% from total 150 cases. That quite large figure, what do you think?

Now, let's look at the dashboard https://go.gov.sg/covid-19-dashboard
and also look at past releases https://www.moh.gov.sg/covid-19/past-updates from these releases you will see entries like following:

Now, if I had enough time, I could go and spend several hours to see one which days each of above cases were reported and calculate precise number of days they've stayed in hospital. And do the same for every single of 90 discharged case.

So question - how many cases do we need to have to calculate average discharge time with 95% of confidence? 100? 1000? 5000?

It's not speculation - it is just logic....

To piggy back on this, the most accurate and complete data sets we seem to have are from S. Korea, the Wuhan Princess (albeit skewed to older), and to a lesser extend, published data from Chinese samples, like this one. The data suggest mortality rates around 0.7-0.8% for S. Korea (0.7% now, and likely 0.8% as some more of the critical will die), 1-2% for WP (1% now, and with another 20% from the critical cases dying, it will go up to 2%). These under optimal health care conditions.
If we look at the Chinese data, 14% of the cases were severe, and 5% were critical. From the critical, 49% died, leading to an overall fatality rate of 2.3%

What does this mean for the rest of the world? If this is relatively contained, and some decent health care is maintained, the true overall fatality rate is likely to be around 0.5-1%. However, if it becomes widespread and infects more people and starts overwhelming the health care systems, the overall fatality rate will likely be 2.5 - 5% of those infected, and may even go higher.

Practically, what that means, is that the 14% of the overall cases who will be classified as severe would have to ride this in their homes (or warehouse-style make shift hospitals/isolation units). From the 5% which will be classified as critical cases, some/few may have access to ICUs or other hospital care and survive, or worst case scenario almost all 5% perishes. And then the question is how much spread there will be, with some estimates ranging between 10-70% of the world population, which will affect the raw numbers, and in turn, the overall fatality rate.

So, good scenario likely around 0.5% fatality rate, bad scenario 2.5 - 5% fatality rate, and the raw numbers will vary, based on how much transmission will occur.