COVID-19: known unknowns and unknown unknowns
There are a great many highly important facts about COVID-19 that are unknown. Many of us know they are unknown, but many people think they are known. An obvious one is the case fatality rate from the disease. It only can be calculated properly if you know the denominator: how many people contract the disease. The numerator is somewhat easier to determine: how many people who contract it die of the disease.
Both require testing. Is is likely that, although some deaths from the disease have been missed or misattributed (false negatives or positives), the majority of people who become critically ill and die of COVID-19 have at some point have been diagnosed. That’s the numerator.
The denominator is a whole other story. In no country has testing been anywhere near universal, even for symptomatic individuals – especially if their symptoms are mild, which is common. Asymptomatic individuals are generally not tested, and yet we know from the Diamond Princess data that, at least in that situation, half the infected people had no symptoms at all.
So we have almost no idea what the denominator should be. We can assume it’s not smaller than the number of confirmed cases, but we also can assume it is magnitudes bigger.
Until we know those things we cannot say what the case fatality rate is, or the death rate in the general population. And yet planning – and calm vs. panic – depends on knowing these and other facts such as ease of contagion. Contagiousness (not just a theoretical RO, but how it actually works in real life conditions as any pandemic runs its course) tells us what percentage of the population will get it. The case fatality rate tells us what percentage of those people who have the illness will die. And another good statistic to know for the sake of planning is what percentage of people will become ill enough to need major medical intervention in order to survive.
Those are the known unknowns. But if you read articles and comments around the internet or in the news, you’ll probably notice a great many people spouting facts and figures about them as though they mean something they don’t mean. For those people, they are unknown unknowns,things they think they know the correct answer to and yet are not even aware they don’t actually know it.
The death rate and/or case fatality rate from COVID-19 are often quoted, for example. Or there’s tremendous alarm about the number of confirmed cases going up without a simultaneous report on how much testing has gone up in the same area, and how many of the diagnosed cases are mild and how many serious. Huge decisions are being made on the basis of today’s numbers and the public really doesn’t know if they are valid.
Here’s a good discussion of the dilemma (hat tip: commenter “physicsguy”):
This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future…
Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%…
That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.
Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes.
There’s much more at the link that’s well worth reading. But I want to highlight these two thoughts which parallel ideas I’ve had for quite some time [emphasis mine]:
In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.…
If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year.
Our attention was drawn to COVID-19 right at the outset by the bad situation in Wuhan, which was dramatic and well-covered by the media. And now Italy. But what this means for us, and what it means worldwide is still unclear. Is the worst-case scenario correct, is the best-case scenario correct, or is it something in-between? Our lives – and not just our actual lives, but our economic, social, political, and psychological well-being – may depend on knowing the answer.
Very well said, Neo.
Thanks.
Very nice. Sorry to nit-pick a little:
“In no country has testing been anywhere near universal, even for symptomatic individuals – especially if their symptoms are mild, which is common.”
Maybe I’m wrong, but I thought S. Korea did check all symptomatic people. That’s why their number are so useful. Unless the claims about S. Korea are way overblown, I’m thinking that their playbook should become the new standard for developed nations. It doesn’t seem that even at this late date the U.S. is anywhere near the Korean response in testing or in confining the infected.
____
Then there are critical case numbers and death numbers. I think we can say that in Italy many of the patients who are mostly likely to die are receiving the least care, and at least a few are receiving no care at all. I’d guess relatively few of these critical cases are getting virus tested (but logged as positive based on symptoms?), unless they came in earlier for testing. One would hope that critical cases that receive no care at least get logged as a critical case, but who knows?
_____
As mentioned in the previous post in the comments, some doctors are treating with a combo of hydroxychloroquine and azithromycin. The latter is a basic antibiotic. So I think the medical pros know that patients can get layered infections and that you have to treat the whole patient, not just one infection.
I’m glad you referenced the article I posted a link to earlier this morning from the fellow at Stanford
The Impeachment that killed Americans
https://spectator.org/the-impeachment-that-killed-americans/?utm_source=American%20Spectator%20Emails&utm_campaign=06d8363604-EMAIL_CAMPAIGN_2020_03_18_01_34&utm_medium=email&utm_term=0_797a38d487-06d8363604-104593417
Over there at Breitbart, Joel Pollak, one of the serious journalists of the day, has put together this telling timeline that shows exactly what Democrats were doing as the coronavirus loomed. Here’s the link to Joel’s story — and here’s his very revealing timeline:
January 11: Chinese state media report the first known death from an illness originating in the Wuhan market.
January 15: Speaker of the House Nancy Pelosi (D-CA) holds a vote to send articles of impeachment to the Senate. Pelosi and House Democrats celebrate the “solemn” occasion with a signing ceremony, using commemorative pens.
January 21: The first person with coronavirus arrives in the United States from China, where he had been in Wuhan.
January 23: The House impeachment managers make their opening arguments for removing President Trump.
January 23: China closes off the city of Wuhan completely to slow the spread of coronavirus to the rest of China.
January 30: Senators begin asking two days of questions of both sides in the president’s impeachment trial.
January 30: The World Health Organization declares a global health emergency as coronavirus continues to spread.
January 31: The Senate holds a vote on whether to allow further witnesses and documents in the impeachment trial.
January 31: President Trump declares a national health emergency and imposes a ban on travel to and from China. Former Vice President Joe Biden calls Trump’s decision “hysterical xenophobia … and fear-mongering.”
February 2: The first death from coronavirus outside China is reported in the Philippines.
February 3: House impeachment managers begin closing arguments, calling Trump a threat to national security.
February 4: President Trump talks about coronavirus in his State of the Union address; Pelosi rips up every page.
February 5: The Senate votes to acquit President Trump on both articles of impeachment, 52-48 and 53-47.
February 5: House Democrats finally take up coronavirus in the House Foreign Affairs Subcommittee on Asia.
And there, in black and white, is exactly the problem. Republicans at the time warned that Democrats were so mindlessly obsessed with impeachment that other issues were being routinely ignored. Immigration, trade, health care, and on and on went the list of concerns that were being ignored in favor of the impeachment obsession.
The main problem with the coronavirus is not the mortality. It’s the ability to saturate health systems. The fatality rate doesn’t seem higher than the seasonal influenza. But seasonal influenza doesn’t collapse hospitals. You don’t see ICUs overloaded with flu and patients in the hallways because of the flu.
It’s not the mortality rate. It’s the psychological blow of watching the hospitals collapsing… even if the final death toll is not really that high at the end of the day.
Modern land mines don’t intend to till but to disable. An injured and disabled soldier demoralizes and requires resources. In a similar way, if you wanna create panic with only a few deaths, make the patient stay in the ICU for weeks. 50 people occupying an ICU for weeks will make it unavailable… and people panic when they see things that they took for granted unavailable.
This virus is actually a lesson about how a moderately harmless virus can spread the panic.
Totally agree, Neo. Death rates are thrown around indiscriminately; and based on garbage data. On one hand we are told that we really don’t know the number of cases; then, told that the mortality rate is higher than with other pandemics. Therefore, draconian action is required. It is as though everyone has forgotten everything they learned about fractions. Or maybe fractions aren’t taught any more. Rumsfeld, wise man that he is, cautioned us about making policy assumptions based on unknown unknowns.
I suspect that when this is over, and the data studied dispassionately, assuming that happens, we will learn that the mortality rate was lower than with many risks that we accept routinely
California is locked down. I am appalled.
Wife asked, “well, what would you do?”.
Replied. It started out sensibly. If you are vulnerable, isolate yourself. Use good hygiene. If you are younger, and have no other risk factors, use good hygiene and maintain some degree of social separation in public places. If you get sick, isolate yourself. If you get seriously ill, seek medical attention. Stay away from ERs unless it is critical. Otherwise go about your business.
That sensible advice was soon overwhelmed. Various entities have knowingly or unknowingly created a sense of panic. I believe that politicians are running scared. They are in a race to prove that they are ahead of the pack; and they are exacerbating public fear to justify their actions.
I am told that I am in a state of denial. Skepticism is not denial.
Yann, no need to collapse hospitals; and so far we have collapsed none. Sensible precautions.
Addressing another unknown:
Phase 1 — institute 15 day national disruption, strangling virus!; Phase 2 — ?; Phase 3 — Profit!
Or to put it another way, we’re in a 15 day boondoggle which, sure, slows the rate of infection, but after which leaves the nation right back where it started: the virus is still at large — if commerce and normal life return the virus re-accelerates the rate of infection, and “Bob’s your Uncle”, the nation has to return to another debilitating disruption — or else, in fact, was never to be allowed to leave the first disruption.
“No end in sight” can’t be a pleasant message to have to deliver, and yet may be the only truthful, if harsh, message possible. We don’t — can’t know the end, but we can know a mere 15 days cannot be the answer.
But the Underwear Gnomes know.
Don’t they?
It only can be calculated properly if you know the denominator: how many people contract the disease.
and MIT just developed the test that will help with that question.. ie. an antibody test that can be given to find out if one was ever exposed
the current tests are about whether one is currently infected, NOT if one has had it and no longer does.
Much of the rest of your comments are about what i call disconnected data… ie. mathematical lies by omission..
for instance… saying X went up three hundred percent matters whether your talking about a number going from 1 to 3, or 100,000 to 300,000
without other pieces of information, we think we know the answer (we had this argument with the voting in germany 1933 etc… it was mostly women, which is why the numbers are given in percentages… you HAVE to go into the data to know the actual numbers the percentages are based on… otherwise they appear to say that this was not the case!!!!!!! but 1,773,700 million did not return to partake in any kind of voting… not to mention more ripples from larger numbers…
but what is more worrisome is that people are so mathematically illiterate that Newsome could spout a number out of thin air, a number that vastly exceeds our ability to even test for, and have no one question it. that whatever color the blinders are this day, people are blindly following a leadership that is blatantly lying to them and employing them in mass destruction of their own future and future economics without their even registering it… and if they do, having that deflected to a wrong target because they cant asses the meaning of who said what means what.
these are dark days for a bright future if ever one could contemplate
[if you go back, you will see that the posts you reference are exactly what i said in the beginning of your coverage… it was obvious that this was about something else… like destroying elderly retirement accounts so they would vote on false promises… ie exploiting ignorance, trust, and a potential crisis we as a population did not understand. a form of economic warfare on the people]
Artfldgr:
A moment before I saw the above comment of yours, I had just put up a post on that very thing: the serological test. See this.
I was also shocked by that Newsom figure when I first read it.
TommyJay:
I was using “symptomatic” even more broadly. In South Korea, I believe they’re tested the vast majority of people with typical symptoms who notice those symptoms. I am assuming there are a lot of people with mild symptoms who just haven’t paid attention, and/or those with atypical symptoms who are not thinking it has anything to do with COVID.
physicsguy:
I’ll add a hat tip.
Good point Neo.
And I stepped on or over your other good point. Yes, doctors are aware of layered infections. But one of your two-pronged points was, how do we numerically count the disease after the patient dies or gets better. RNA tests and autopsys are definitive but many or most cases won’t get that.
There’s a study (waiting for review) out on the original Wuhan situation proposing an R0 of over 5, around 19% of the population infected and a final IFR of .04-.12% Some of us armchair epidemiologists have suspected for a while that this is closer to the truth than the original story China put out.
If that’s the case, the problem is entirely in the vast numbers: an entire flu season that unfolds in two or three weeks in a population with no prior immunity.
Serological tests should clarify this.
Edward,
Thanks for that timeline. I had been wondering about that stuff while talking to my wife the other day.
I can only speak for myself but the memory plays funny tricks and had separated both events (Virus/Impeachment) chronologically in my mind. And I would have sworn that the Impeachment Fiasco had finished before SARS-CoV-2 had even made the national news scene (I had been seeing reports of the virus in some of the conspiracy and fringe sites since December).
Thanks!
Neo> I was also shocked by that Newsom figure when I first read it.
Newsom studied political science so that is understandable. Angela Merkel’s doctorate thesis was on quantum chemistry and she said “that 60% to 70% of the German population could contract the coronavirus at some point, “
As I reflect on the massive sudden dislocations, I am beginning to be inclined to let the healthy huge majority of the population return to normal living, keeping the geezers and the vulnerable (diabetics, chemo patients, COPD, etc.) isolated, and just let her rip and get it over with. The ICU bed need for the healthy population majority is hopefully not at or beyond capacity in that scenario.
Voila! Instant herd immunity!
Hell, the flu vaccine two years ago was basically ineffective; OK, so its R-naught was much lower, but still…just wash your hands!
Mind you, I’m not running any numbers or estimates.
Just a thought, as I see my fellow citizens buying groceries since almost all other venues have closed by governor’s edict, and the national financial impacts are already enormous.
This is a small sample, but it may be worth noting as the data plays out. In my county (Snohomish, WA – just north of King County and the nursing home outbreak) the number of new cases is on a rising curve. However, for the last four days the total number of new cases has leveled off. This, when testing has increased. Interesting, but maybe only a pause. It has only been nine days since Governor Inslee ordered crowd restrictions, social distancing, and other measures. Patient one was the man from Wuhan that was diagnosed on 1/21/20. Since then the number of new cases has grown to 385. The number of new cases has been increasing each day since 3/7/20 when ten new cases were reported – probably due to increased testing because of the nursing home outbreak. On 3/16/20 there were 54 new cases. Since then the new cases have been 3/17 – 35, 3/18 – 35, 3/19 – 30, 3/20 – 35. Clearly, a lot of infections for one county, but maybe the rate is leveling off. It’ll be interesting to follow for the next two weeks. I’m hoping to see a distinct slowing by April 1st.
One month from the beginning of the governor’s order will be April 11. Hopefully, things will be much clearer as to whether the crowd restrictions and social distancing is working and how well.
“The Man From Wuhan” should become a film title within a few years. Best if it’s put on something good, memorable, effective. CCP sons of bitches need to be recalled for decades hence.
Andy:
But I’m assuming Newsom has some medical or epidemiology-savvy advisors. So how on earth did he get that figure?
As far as Merkel goes, I have no problem with what she said except for the fear factor if she didn’t explain properly. There can be a virus that affects almost an entire population but if it’s mild for all but a few of them, then the damage done isn’t that great.
I keep harping on this…
I think you are using the wrong statistical term for what you are attempting to argue. “Death rate” is a synonym for “mortality rate,” which is the proportion of deaths **per unit of population.** You seem to be describing what is called the “case fatality rate”, in which the denominator is the **number of infected people.** At least, this is the distinction in definitions per Wikipedia. Indeed, in the quoted material here, the latter statistic is used. So, to the extent that actual numbers (percents, ratios) are being compared, and both terms and both concepts are being used ad libitum, it’s awfully hard to make sense of the comparisons.
From TheWu-HanClan twitter, video of the bulk (5:42) of the Alexander-Trump exchange in the presser (Fauci steps in too): https://mobile.twitter.com/ASimplePatriot/status/1241134418644717568
Yes Cicero. But, the barn door is open–or whatever analogy you prefer.
Wife just told me that Victor Davis Hanson has an article expressing fear for the future of the country on the present course. Interestingly, she did not say he was in denial.
I can’t speak to the statistical analysis. About the only thing I learned from my courses in numerical analysis and modeling is that everything depends on the quality of the data and the assumptions.
The alarms are being sounded on incomplete statistics and the models are based on assumptions that moderate actions will have no effect.
I just saw some of the worst news I have seen in some time. President Trump on TV praising Gov Newsom’s bold actions.
Well Lamont, like the good lemming he is , just followed Newsome and shut down Connecticut tomorrow. How the state survives without the insurance industry, Pratt, Sikorsky, Electric Boat, is beyond me. I think it’s time for the tree of liberty to be watered.
Edward, re “The Impeachment that killed Americans” excellent!
physicsguy, what on God’s Green Earth did we do to deserve this crop of leaders? “Lemmings”, perfectly said.
https://www.aa.com.tr/en/europe/italy-reports-record-627-covid-19-deaths/1773472
“Italy on Friday reported 627 new deaths from the novel coronavirus, a new grim record that brings the number of total deaths to 4,032, the highest in the world.
The latest figures provided by the Italian Civil Protection Department show that the total number of cases in the country continues to grow, climbing by 14% from Thursday to reach 37,860.”
For the math challenged, that means more than 10% of the confirmed coronavirus cases in Italy have died and the number of infected continues to grow. It’s all well and good to bandy about calculations and projections but that is the real world situation staring elected leaders in the face right now.
And I write that as someone who believed early on and continues to believe that we may very well be overreacting to this situation. But I get the impression that a lot of small/limited government types are reasoning backward on this. They don’t like the actions being taken, so they’re looking to undermine their necessity.
But there’s nothing extraordinary going on. This is how you deal with pandemics. This isn’t climate change. Disease outbreaks are something human beings have been dealing with for thousands of years. The rules on what to do are fairly well-established and all you folks speculating about the real death rate and such are rolling dice with the lives of literally MILLIONS of people, except you don’t have any money on the table.
Mike
MBunge:
The real death rates are of the utmost importance. That is what people are relying on when they institute measures to check the pandemic, and that is the only way we can know anything about the costs/benefits of very extreme actions. Do not pretend that the remedies have no cost; they do, and it can be a great one. They are not benign and they are not moderate; they are extreme.
We need to know what the disease is doing, for real. Italy is a very bad case: why? Why is it so much worse than anywhere else, including China (if you believe China at this point)? We need to know that, too.
In the meantime, it’s not as though the US is just sitting and doing nothing.
I don’t believe — at least I haven’t seen — any way to calculate the rate of new infection, since the numbers they post don’t distinguish between people who newly got it, which is the really important stat, and people who’ve had it but just now got tested. The “New Cases” number is misleading.
“Do not pretend that the remedies have no cost; they do, and it can be a great one.”
I’m not denying the cost of what social distancing and these varying degrees of shutdown are doing to the economy. When this is over, we ABSOLUTELY need to go back and figure out if we overreacted and if we did, we ABSOLUTELY need to figure out how to not overreact in the future.
But, to use an analogy, we’ve already jumped out of the plane. We’re already plummeting toward the ground. And I’m seeing too many right-leaning folks saying we shouldn’t pull the ripcord on our parachute. Instead, we should just close our eyes and hope to land on something soft.
For example, the shelter-in-place order in California. That’s an extreme action but in this kind of situation, those are the kind of actions you have to take BEFORE the facts on the ground might justify it because by the time things are bad enough that shelter-in-place seems reasonable…it’s too late. The disease has already spread too far.
Mike
Mike Bunge uses all caps to shout out a straw man, because he, unlike everyone else knows the answer and knows that the situation in Italy is the same as in Washington, and in California, and in Connecticut. Because, well, he knows, and no one else has skin in the game.
Contrary to his sureity, indications are that the curve in Washington may already be flattening, and yes we have had one Wuhan virus fatality this week in our local hospital, here in eastern Washington, Mr. Skin in the Game.
“Contrary to his sureity, indications are that the curve in Washington may already be flattening”
Wow. There are INDICATIONS the curve MAY be flattening. Yup. That’s certainly enough evidence to endanger the lives of millions of people.
And no, something happening to someone in your general vicinity is NOT “skin in the game.”
To try and make this clear to any who may want to willfully misunderstand me, here’s an AP snippet.
“TOPEKA, Kan. (AP) — As most of the U.S. raced to get ahead of the coronavirus pandemic, conservative Republican lawmakers in Kansas have moved to limit the Democratic governor’s emergency powers that include the ability to establish quarantine zones if the need arises. Conservatives are angry with Gov. Laura Kelly’s order to close all of the state’s K-12 school buildings for the rest of the spring semester and view it as an overreaction that is stoking panic. And, despite Kelly’s past support for gun-rights measures as a legislator, a few of them argue that her bold action on the coronavirus means she might go after firearms.”
Now, assuming the AP isn’t lying (which is not at all a safe assumption), THAT is what I’m talking about. That gun thing at the end there doesn’t sound like something you’d hear from people who were just “looking at the numbers.” It sounds like people letting their small/limited/anti-government attitudes color their reaction to a potential health catastrophe.
Mike
Mike Bunge:
Nice to know you know what skin is and who has it. Millions of lives at risk and yet everyone doesn’t agree with you. May you can try double caps.
Wowser bowser, those indications are based on data from Washington where lots of actual non MIke Bunge people have their own skin in the game. Tool. Who is holding your beer while you run around with your hair on fire?
Edward on March 20, 2020 at 4:35 pm said:
The Impeachment that killed Americans
* * *
Kind of a “Democrats lied, people died” sort of thing?
And to Fractal and others: I don’t remember hearing any news about this disease during all the impeachment brouhaha, and I read widely (at least on the Right).
The only thing that sounds even remotely familiar is the then-complaint about limiting flights from China, and I can’t even swear that isn’t just a planted memory.
https://www.thenewneo.com/2020/03/20/that-was-then-reactions-to-trumps-january-31-travel-restrictions/
Also, only a very few sites are continuing to carry news about RussiaGate, SpyGate, Mueller’s report, Flynn’s major upset in his case, and so forth.
Some day when we surface from the Wuhan-wouhaha, it will take a lot of catching up.
As a nation, we don’t seem to be able to multi-task our news processing very well.
Of course, Democrats don’t want us reading continuing reports about their years-long perfidy (or their senile candidate), so maybe they are accelerating the virus reports as a distraction.
Sane analysis from McCarthy:
https://www.nationalreview.com/corner/coronavirus-pandemic-us-fatality-rate-steady-about-1-percent/#slide-1
Mike Bunge:
Here is what our Democrat Governor Jay Inslee hasn’t done: lock down.
https://www.seattletimes.com/seattle-news/while-other-states-order-residents-to-stay-at-home-to-stem-coronavirus-washington-resists-heres-why/
I guess we in Washington don’t have any skin in the game. Total cases today (3/20/20) in WA – 1534, quite a bit less than the light your hair on fire exponential growth projection mentioned in this link:
https://hotair.com/archives/allahpundit/2020/03/19/seattle-flattening-curve/
3/18 1,187
3/19 ?
3/20 1,534
Oldflyer on March 20, 2020 at 8:07 pm said:
..
I just saw some of the worst news I have seen in some time. President Trump on TV praising Gov Newsom’s bold actions.
* * *
That’s how he operates. Do you really think he actually approves of Newsom’s actions, or Xi’s or Putin’s when he tells them they’re doing something great?
He’s leveraging compliments to get them to do what HE wants.
https://spectator.org/the-real-threat-to-our-democracy-during-coronavirus/
The bulk of the story is about how the Democrats fiddled with impeachment while the world burned, but the above paragraph was part of a lengthy exposition on why Trump is not a dictator — he doesn’t act like one, despite all the hyperventilating of the MSM & the Left.
This is now known.
https://pjmedia.com/trending/watch-scenes-from-medieval-europe-burning-the-dead-and-overwhelmed-hospital-staffs/
I’ll cut the long story short, but if you are a military history buff, the preliminary exposition is well worth reading.
https://pjmedia.com/vodkapundit/battles-of-the-bulge-what-wwii-can-teach-us-about-stopping-the-chinese-flu/
I live in Seattle, and a couple of my friends are nurses. I talked with them today over chat, and they both said their hospitals are slammed with cases and they’re running out of protective equipment and the staff are barely holding it together and their plans and forecasts change so fast they don’t even bother printing them out.
I have no reason to doubt them. On the other hand, you don’t ask the soldier in a foxhole who’s getting shelled how the overall war is going. Or even the battle.
On the other hand, I talked with an ER doctor friend of mine last Saturday, and he said, eh, he’d seen a couple of cases but none of them were a big deal. So yeah, I get exponential growth and all, but who’s right? And why can’t we get good transparent numbers from our local Public Health authorities to know if it’s going to be three days before our hospitals are overwhelmed or three weeks or three months?
I live in Seattle, and a couple of my friends are nurses. I talked with them today over chat, and they both said their hospitals are slammed with cases and they’re running out of protective equipment and the staff are barely holding it together and their plans and forecasts change so fast they don’t even bother printing them out.
There are about 1,500 cases in the entire State of Washington, per worldometers. None are classified as ‘serious-critical’ and no new deaths were recorded in Washington yesterday. There are about 12,000 hospital beds in Washington state. If 20% of your non-serious / critical cases had a hospitalization, they’d be occupying < 3% of your beds even if they were there for weeks on end.
but whose death hasn’t been attributed to the coronavirus because they died at home or in a nursing home and so they weren’t swabbed,” he said, according to Reuters.
About 7,000 people will die in a typical month in Lombardy, and about 3,000 in Veneto. The 2,700 coronavirus deaths in these two provinces in the last month are an additional increment atop that.
AesopFan,
That Patton reference is very interesting. I plan on looking it up later when I have time but I’m going to have to avoid the PJ media paywall.
Like I said tracking this virus early, it was on the radar of a lot of fringe sites. I’m pretty entertained by the fringe conspiracy stuff: a lot of it is very creative. But this time, they actually called it. So, they got it right once out of a hundred or more times.
Morning update: 19,300 active cases. The curve for active cases is still exponential to within 1 sigma, which I’m sure will please the politicians no end to justify more draconian measures. I also started plotting Connecticut cases, now that Lamont has shut down the state. For CT, the rise from the 16th to the 19th was exponential, but the last 2 days there have been no new active cases (190); which I assume justifies Lamont’s actions /sarc off.
Total number of serious cases for the entire US is stuck at 64 for the last 5(!) days, despite the active cases going from 6000 to 19000. If on the 17th we take 64/6000 = 1%, then with 19,000 cases we should see 190 serious cases. This tells me that maybe a large portion of the growth in active cases may be due to testing increases rather than true spread of the disease.
Interesting article for consideration on Fauci: https://www.americanthinker.com/blog/2020/03/anthony_fauci_the_nihs_face_of_the_coronavirus_is_a_deepstate_hillary_clintonloving_stooge.html
One other thing: Willis now has a dedicated page on WUWT. Please look at his first graph from yesterday plotting deaths. Especially pay attention to the right side vertical axis where he plots deaths as a percentage of the population. For the US that is currently < 0.0001% ( 1 x 10^-6 !) If that number holds, you have almost the same chance of hitting the powerball match 4+PB as dying from the virus.
https://wattsupwiththat.com/daily-coronavirus-covid-19-data-graph-page/
I agree with this: “It’s not the mortality rate. It’s the psychological blow of watching the hospitals collapsing… even if the final death toll is not really that high at the end of the day.”
I’d like to see a full-scale Manhattan-Project effort put into protective equipment, ventilators, and chloroquine supplies. If you remove the prospect of collapsing hospitals, all the rest of the risks subside to the level of background anxiety we always feel, knowing we’re mortal. The only way to afford Manhattan Projects is to have a working economy.
“It’s not the mortality rate. It’s the psychological blow of watching the hospitals collapsing… even if the final death toll is not really that high at the end of the day.”
In tracking the number of serious/critical cases worldwide which dropped to 4% from a steady 5%, I’m starting to believe this is the meme that has driven the overreation. I remember reading an article by the man who headed the Canadian Health system during the Swine Flu and he made the point that it was important to deal with “what is” and not allow “possibilities” to determine the response. Commenters here have shared graphs and historical/current information and applied the mathematics that has brought facts and perspective and exposed the lies being used (Newsom!) to impose destructive measures on our society. I’m not even saying it was intentional, but fear breeds fear and we’ve now experienced what that looks like in the USA.
Sharon:
Powerline has a good short take on the “whatever the cost to save one life logic” put in place in NY, CA, CN, IL and other places.
https://www.powerlineblog.com/archives/2020/03/the-days-dumbest-comment.php
Very very seldom do I disagree with Neo, but here is one case on her definition of unknown unknowns:
they are unknown unknowns,things they think they know the correct answer to and yet are not even aware they don’t actually know it.
(Along with known-knowns, known-unknowns [classic risk] & unknown-knowns)
That’s NOT what I understood Rumsfeld to be talking about, and it’s not what the Nuclear Power industry means. (I worked at EPRI in Palo Alto in nuclear power while studying decision analysis at Stanford.)
Here’s the more normal idea, explaining “all 4” of the possible combinations:
https://www.managementyogi.com/2019/09/risk-classification-known-knowns-known-unknowns-unknown-knowns-and-unknown-unknowns.html
(unknown risks)
a) You don’t know about it. b) Others within the org/ community don’t know about it.
[Unlisted (c) – Sci Fi writers have imagined it. Or, (d) not.]
Congratulations, Neo, you are defining some other kind of knowns.
I suggest you call them “Fake knowns”. Said by
a great many people spouting facts and figures about them as though they mean something they don’t mean. For those people, they are unknown unknowns [fake knowns], things they think they know the correct answer to and yet are not even aware they don’t actually know it.
Not unknown unknowns, but Fake knowns — NOT one of the 4 types of “known / unknown” possibilities. Even tho Mark Twain also pointed it out as the major problem:
“What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.”
https://www.goodreads.com/quotes/738123-what-gets-us-into-trouble-is-not-what-we-don-t
We get into trouble when we believe Fake Knowns (like so many Trump haters believe).
Risk management terminology, and the whole risk management edifice, assumes this risk away. Very unwisely.
What I really like about this site is how careful the known-unknowns, risks, are discussed (tho without probability estimates, which I love and are needed for comparison)
Fake knowns – rather than False knowns.
There are two types of errors in all systems: False positive, false negative (Type I and Type II errors).
In medical trials, like testing for Chinese virus, there will be uninfected people who test positive (false +), and there will be infected people who test negative (false -).
In any justice system, the false positive is wrongly convicted innocent, the false negative is criminal who is judged not guilty.
In almost all cases, the more you avoid Type I error, the more Type II errors you get. Our justice system is heavily biased against wrongly convicting innocents (yet still quite a few “convicted murderers” were later shown to be not guilty.)
In this Chinese virus reaction, one could say “not doing enough” was false positive, and “doing too much” was false negative. I would say this, because I like a system biased against Type I errors.
But one could also say “assuming the worst” is false positive (too much action), and “assuming the best” as false negative (not enough action). Positive & negative are not good terms here.
“Too much vs too little” seems better, and all politicians want to avoid “too little” at this point.
So it should be “too little (T1) vs too much (T2)” — but hard to be consistent!
Art:
There are about 1,500 cases in the entire State of Washington, per worldometers. None are classified as ‘serious-critical’ and no new deaths were recorded in Washington yesterday. There are about 12,000 hospital beds in Washington state. If 20% of your non-serious / critical cases had a hospitalization, they’d be occupying < 3% of your beds even if they were there for weeks on end.
I know, which is why none of this adds up. Are we not reporting the “serious” cases properly? Is everyone at the hospitals freaking out only because they don’t have the PPE they need and are starting to get infected? Do they maybe need to start streamlining their protocols? (I’ve been to the ER with my daughter a couple of times and OMG the man-hours just to resolve a cut that needs stitching…)
And every time I pose questions like this on Facebook I get accused of not taking the virus seriously and I should just trust the experts and OMG DON’T YOU UNDERSTAND EXPONENTIAL GROWTH?!!! [roll eyes] (I probably understand it better than most, thank you. Now answer my damn question.)
By the way, where are you finding state-level data? All I can find is nationally-aggregated numbers.
Edit ran out: Never mind, just click through to state data. But it doesn’t have “serious/critical” at the state level, which is what I would like to know.
Somebody pointed me to a US Hospital Beds Dashboard where you can zoom by state and county and hospital type.
Short term acute care hospitals in King County, Washington (i.e. Seattle and Kirkland) are at about 65% capacity right now, which hasn’t changed more than a percentage point in a day or two.Misread the page, dammit. That’s “average bed utilization rate” so it’s not real time data either.Brian Lovely:
State data here.
Neo, thanks, I got to that site from another post here.
But the threshold that everyone keeps citing in their “pandemic math” articles is number of ICU beds and how if we saturate them everyone is going to die, and I can’t find ICU occupancy by state anywhere. Nor does that site give a “serious case” percentage or number.
Brian Lovely:
The site I’ve seen that gives “serious case” numbers for the entire US is this one, and the number has been frozen at 64 for many days. So I don’t know how current it is. It don’t think I’ve ever seen figures for that on a state by state basis.
As for the ICU beds, what really matters is how many beds are free and how many used. Quite a few ICU beds in each state are for babies, by the way; it’s adult beds we’re mainly interested in. I once saw a chart that showed the number of bed per so many people in each country, but not in each state.
Wow. I just heard a doctor from Bergamo Italy who said that the number of elderly deaths has gone up 5 fold compared to last year. Numbers in the thousands. Many are in retirement homes and many are in hospice style locations. He said only 1/4 of these fatalities are even being logged as to the cause of death. So no, tracking deaths isn’t great data either.
TommyJay:
No, of course it’s not “great” data. But it’s better at the moment than tracking the number of diagnosed cases, much better.
And in the US so far, or other countries that have not been overwhelmed (so far), it actually does seem to be good data. In Italy, a country where things are way out of control, it’s not.
It’s also not very good in China or in Iran, countries that may either be misrepresenting their data and/or not even able to keep good data because of being overwhelmed.
“If the coronavirus caused the shutdown, even temporarily, of the New York Times and MSNBC, it would not be entirely in vain. But I don’t suppose that is going to happen. “Essential” means different things to different people.” – PowerLine
Different essentials indeed.
Democrats are keeping their focus on the really important things about a pandemic and national crisis:
https://www.breitbart.com/politics/2020/03/20/coronavirus-massachusetts-exempts-abortion-from-nonessential-elective-surgery-ban/
Some other essential things in NYC.
https://www.thegatewaypundit.com/2020/03/new-york-deems-liquor-stores-essential-says-they-can-stay-open-during-coronavirus-shutdown/
It’s to discourage the rise of bootleggers, of course.
On the other hand, other people see essentials differently.
https://www.breitbart.com/politics/2020/03/21/ohio-orders-abortion-clinics-to-stop-performing-elective-abortions/#
https://www.breitbart.com/politics/2020/03/21/illinois-governor-lists-gun-stores-as-essential-exempts-them-from-forced-shutdown/
Something is going on with Italy’s death rate calculation. They’ve screwed up bad somehow, attributing deaths to Wuhan covid19 that shouldn’t have been.
Tyler Cardon, twitter (down in a longer thread): “This means the number of deaths directly caused by Covid-19 in Italy is 484.”
https://mobile.twitter.com/TyCardon/status/1241502265543925762
The number crunchers have embarrassed themselves repeatedly on this matter. They are just awful.
So true Neo. Use the best data. My impression is that Italy is so screwed up that none of their data is very meaningful, unless someone can untangle it. What if the untangling is politically incorrect? Would they do it anyway?
Watt:
You are correct. I was using the term “death rate” and trying to make it clear what I actually meant, because “case fatality rate” seemed too technical and I thought I could make my point clear without it.
But on reflection, I think it’s best to use the more technical term. I’m going to go back right now and change replace “death rate” with “case fatality rate” in order to make it crystal clear.
From the article (March 9) by Richard Schabas, a retired physician. He was Ontario’s chief medical officer of health for 10 years, and was chief of staff at York Central Hospital during the SARS crisis in 2003. I mentioned this in a different comment:
“But we also need to be sensible. Quarantine belongs back in the Middle Ages. Save your masks for robbing banks. Stay calm and carry on. Let’s not make our attempted cures worse than the disease.”
https://www.theglobeandmail.com/opinion/article-strictly-by-the-numbers-the-coronavirus-does-not-register-as-a-dire/
Sharon W on March 22, 2020 at 10:42 am said:
… Save your masks for robbing banks.
h/t commenter on TWIP at PowerLine Saturday.
https://uploads.disquscdn.com/images/3fc99f4d2bbfc06fae516a1eda652cb8e26fca13994462fe286e0fa75c7ef48a.jpg