You should check the numbers coming out of Italy. It’s not 1% if the medical system is overwhelmed. Moreover, you do realize that’s 3 million dead in the US alone?
It's also not the reported number in Italy. The sources of error in the data are enough to make the data fairly meaningless.
1. We have no idea how many people were infected
2. We have no idea how many people who have died died from Covid 19
3. The population pyramid in Italy is extremely disparate from the rest of the world.
The medical system being overwhelmed is a portion of the contribution, and what it means to be 'overwhelmed' is about as clear as what it means to have an error in your application. Are you overwhelmed due to lack of beds? Lack of ventilator access? Lack of doctors? What are the numbers for these in the remainder of the world?
Treating any modeling we have of the impact of Covid 19 as reliable is an exercise in insanity.
EDIT: To be clear this isn't to say that the responses are unwarranted. It's just to say that they are conservative and acting on knowingly incorrect information. If they were the right decisions remains to be seen. The impact of global financial collapse isn't just 'stocks down', but has tangible impacts on life expectancy, healthcare quality, and quality of life globally. Time will tell.
> Treating any modeling we have of the impact of Covid 19 as reliable is an exercise in insanity.
In detail, yes. In general, you can still make some good back-of-an-envelope calculations.
Conservative estimates are that the coronavirus has a CFR of about 1% given adequate medical care (South Korea's statistics, where testing has been comprehensive enough that we should have identified any wide pool of asymptomatic cases), and another low estimate of its R0 factor is 2. Left unsuppressed, this implies that the disease would spread to infect about half of the population, and it would kill 1% of those infected.
For the United States, that implies that a "flattened curve" -- where mitigation prevents medical resources from being overwhelmed but does not fully suppress the disease's spread -- will kill about 1.6 million people.
Beyond that, we know that the disease requires intensive care at some multiple of the death rate (say 2x) and hospitalization at another multiple (say a further 3x). These estimates are reasonably consistent with New York's numbers (https://nymag.com/intelligencer/article/new-york-coronavirus...). Testing shortfalls could make these multiples worse, if there are hospitalized or ICU patients positive for the virus but not included in these totals.
Given overwhelmed medical services, we can presume that a large fraction (say half?) of ICU patients would die for want of care, and a smaller but still significant fraction of hospitalized patients would do the same (1/8?).
This implies that an un-flattened curve would have roughly triple the death rate, with the excess caused by inadequate care. With a 3% inadequate-care CFR, if left to run its course the disease would then kill about 4.8 million Americans.
> It's just to say that they are conservative and acting on knowingly incorrect information.
If policymakers are acting on "knowingly incorrect information," it's because their assumptions are too benign rather than too severe. I believe that my estimates above should be uncontroversial, and to the extent they err I've tried to err on the less-deadly, less-contagious side.
Various models and data sets put asymptomatic cases at between 20% and 50%. Those are fully asymptomatic - i.e. total end-to-end progression with either very mild symptoms indistinguishable from a minor cold, or no symptoms at all.
It's almost impossible to estimate expected population mortality with limited and noisy data, but I've seen estimates from 1.5% to 0.05%.
The only thing that can be said with certainty is that social distancing, testing, and tracking all do a lot to prevent initial infection, and good access to ICU hugely improves chances of survival after infection.
The rest is guesswork at this point. Having said that - my current hand-wavy estimate of deaths in the UK is high five, low six figures. Multiply by five or so for the US.
> Various models and data sets put asymptomatic cases at between 20% and 50%. Those are fully asymptomatic - i.e. total end-to-end progression with either very mild symptoms indistinguishable from a minor cold, or no symptoms at all.
That's why I use South Korea as a model. They've tested enough that they should have found the majority of asymptomatic cases, and they still have CFR above 1% (1.7% as of this writing).
That also puts a bound on reasonable levels of occult spread. We can support maybe 50% of cases being totally asymptomatic and undetected, but if that is significantly greater then we'd see contact-tracing (again, SK-style) entirely fail as a control measure.
So it seems like an absolute best-case CFR is 0.5%, if it would be 1% among symptomatic cases and there again that many that never notice / are diagnosed with the disease. For the UK, that would give an optimistic projection of (66e6 * 50% * 0.5% =) 165k deaths in a "herd immunity" outcome with a "flat curve", so this is consistent with the range of your "hand-wavy estimate."
We will not know how effective testing has been until we have serological tests. There are a few assumptions being made regarding the efficacy of testing, and contact tracing will certainly miss pockets of asymptomatic people.
The financial probelms are a given. Joining some political death cult to sacrifice the weak and elderly portion of our population to feed the COVID-19 Volcano isn't going to make the virus end any sooner, and you'll have even fewer consumers left after it's all over if governments choose to go that route. The virus doesn't care, and as far as I'm concerned any economic system that isn't capable of protecting the vulnerable isn't worth reviving.
”Joining some political death cult to sacrifice the weak and elderly portion of our population...isn't going to make the virus end any sooner”
Barring the development of a vaccine (which is far from guaranteed, and a year or more away, in the best case), letting the virus sweep through the population is pretty much the only thing that would bring this to an end quickly. We could achieve herd immunity in a few months and have it behind us.
This situation is a direct tradeoff of time (and money) for lives.
Letting it sweep through uncontrollably quickly by pretending it's business-as-normal out there will lead to many times more deaths due to hospital overutilization.
Our current actions are focused on the goal of leveling the curve, not putting up a wall. There aren't armed guards outside our homes preventing us from leaving. The grocery stores are open. We can come into contact with others to order just about all goods we've always been able to order. We can go to parks and trails and beaches. This will cause more infections, and we all know it; but thanks to these measures, ER visits in our city are down over 20%, allowing healthcare some capacity to deal with the influx infected people, and our daily growth of infections doesn't look exponential anymore.
This thing hospitalizes many young (under 40 years of age) people as well, and in our state that has been on lockdown for longer than many others, medical fellows and residents from unrelated specialties are being asked to help with COVID-19 cases. In a week or two at most it's expected they'll be required to help. If our government wasn't taking these defensive measures, we'd already need more space to store the bodies.
Yeah, I get it. It was implicit in the point I was making: we’re explicitly trading time for lives.
Literally the fastest way to get this over with is to let it sweep through the population. More people might die if we did that, but it would get it over with quickly.
Remember, it's a ratio. What matters isn't the raw number of missed cases, it's the ratio of missed-to-detected cases versus uncounted-to-counted deaths.
If Italy has missed half of its deaths but also half of its total cases, the fatality ratio would remain the same. To bring its CFR down to the level of South Korea, you'd have to make the implausible assumption that Italy has caught nearly all of its deaths but missed more than 85% of its total cases.
Yes, I know it’s a ratio. That’s why I used the term “numerator” and “denominator”.
It’s not at all implausible that Italy has missed the vast majority of it’s cases, because they’re barely testing, and they’re not testing minor cases. It’s essentially guaranteed that they’re missing a huge number of cases.
A reasonable estimate is that they’re missing 10 cases for every one they actually detect. The error in the denominator is much larger than the error in the numerator.
It's universally true that the people eager to feed the olds (and a bunch of non-olds, too) into the wood chipper never seem to have their, and their parents', do-not-treat orders signed.
