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The optimistic take on Covid-19


Aurelius
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There is so much information out there regarding Covid19. It’s hard to distinguish signal from noise. I believe the following information is signal. Hopefully this is useful.

 

I’d love feedback. Especially if you believe I’m wrong.

 

Alright… lets go!

 

Some 20 years ago the Faroe Islands (google it) had severe problems with their salmon industry. The salmon had gotten infected with ILA virus. The Faroe Islands invested in research equipment to do testing for the virus.

 

Fast forward to the present.

 

There is no country in the world that has done more tests and tracing per inhabitant than the Faroe Islands. Testing is fast and easy. Thus far 2.482 have been tested. The population of the country is only 52.500. 4,7% of the population have been tested!

 

Results:

Infected: 132

In hospital: 2

Intensive care: 0

https://corona.fo/

 

Zero critically ill out of 122 infected. Good news! But it would be nice if the sample size was larger.

 

It gets better… (I believe)

 

Iceland is, I believe, the country in the world that has done the 2nd most testing per inhabitant - 3,2% of all islanders have been tested.

 

Results:

Infected: 737

In hospital: 15

Intensive care: 2

Died: 2

covid.is/data

 

Mortality rate in Iceland 0,27%.

If we add the numbers of both countries the mortality rate drops to 0,23%.

 

Note: the true mortality rate should be even lower, as not every person infected will be counted for. In fact you would have to assume the mortality rate probably ought to be way lower, as there is no chance to catch and count all infected people.

 

The average health of people in Iceland and the Faroe Islands is similar with Scandinavian countries. Age demographics are probably also quite similarly distributed as well.

 

There’s more good news!

 

In Iceland they’ve done something very interesting. They have done a large scale screen test of asymptomatic people only:

 

Results:

Diagnosed tests: 5.571

Positive samples: 48

Indicating that approximately 1% of the general population has the virus.

 

The populationg in Iceland is 364.000. Extrapolating the findings of the large scale testing there should be approximately 3.640 persons with the virus in Iceland. The mortality rate obviously plummets with these numbers.

https://nordiclifescience.org/covid-19-first-results-of-the-voluntary-screening-on-iceland/

 

Another interesting fact they’ve found in the Faroe Islands is that there are two different types of Covid19:

-one type who is more severe, but doesn’t transmit very easily

-and another type who is less severe, but transmits more easily

 

That seems like good news to me, as it will be easier to not catch the bad Covid19, if you are a person at particular risk and take the recommended precautions.

 

The obvious problem thus far has been the lack of knowledge about the denominator. Thus wildly exaggerating that statistics on how lethal Covid19 is.

 

https://www.ft.com/content/5ff6469a-6dd8-11ea-89df-41bea055720b

 

"The new coronavirus may already have infected far more people in the UK than scientists had previously estimated — perhaps as much as half the population — according to modelling by researchers at the University of Oxford.

 

If the results are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, said Sunetra Gupta, professor of theoretical epidemiology, who led the study. The vast majority develop very mild symptoms or none at all.

 

“We need immediately to begin large-scale serological surveys — antibody testing — to assess what stage of the epidemic we are in now,” she said.”

 

Besides we might get the answer “within days”

https://www.theguardian.com/world/2020/mar/25/uk-coronavirus-mass-home-testing-to-be-made-available-within-days

 

Sweden is and will be an interesting case to look out for. As I understand they’ve done very little to mitigate the spread. Groups shouldn’t gather when over 500! Borders partly closed. Gymnasiums and universities closed. Kindergarten and regular schools still open. As well as public sector and most of the business sector.

 

Sweden has thus far had 62 people die of Covid19.

Denmark has shutdown almost everything. 34 people have died in Denmark.

Sweden has recorded 82% more deaths than Denmark. Sweden has 74% more people than Denmark.

 

Michael Levitt praised Israel for its preventative measures. He said most people are naturally immune, and that since the infection rate in China is slowing down, "the end of the pandemic is near."

https://www.jpost.com/HEALTH-SCIENCE/Israeli-nobel-laureate-Coronavirus-spread-is-slowing-621145

 

This got longer than I intended. Needless to say I am very optimistic/bullish. This has the potential to be over before we know it!

 

A lot of people are really bearish people. I get it - it could be very scary.

 

At this point though I’d be scared shitless sitting on a lot of cash. But that’s just me :-)

 

Lets see what happens.

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I'm pretty optimistic about the medium term.

 

However, the way to look at Iceland is that we're dealing with a disease that has exponential growth and takes 3-4 weeks to kill people.  Few enough people are infected that most of the cases are likely to have happened in the last few weeks, which means that it hasn't had enough time to kill people.  Using the number of deaths as a numerator and the number of infections as the denominator to figure out a mortality rate doesn't make sense early in a pandemic.

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I'm pretty optimistic about the medium term.

 

However, the way to look at Iceland is that we're dealing with a disease that has exponential growth and takes 3-4 weeks to kill people.  Few enough people are infected that most of the cases are likely to have happened in the last few weeks, which means that it hasn't had enough time to kill people.  Using the number of deaths as a numerator and the number of infections as the denominator to figure out a mortality rate doesn't make sense early in a pandemic.

 

Yeah, the better estaimate would be to calculate how many people were infected 3 weeks ago and use that as the denominator to calculate morbidity. As far as the two strains are concerned, there are report of people who got infected by Covid-19 twice, perhaps by the two differently strains subsequently. Which also implies that getting infected by one strain doesn’t make you immune against the other. This is similar to the Spanish flu, where two strains existed and it was the second wave that killed a lot of people with a more deadly strain.

 

Also, how do you explain Italy and now Spain?

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You can also look at the cruise ship that had the infection. It was discussed on the corona virus thread but only 0.16% ended up as fatalities. This on a packed cruise ship with no concept of social distancing.

 

My only concern at this point is government overreaction.  We can be right on the lethality but still wrong on the economy.

 

The Democrats are so riled up right now, I mean look at some of these threads we have here, I think they will try to tank the economy just to hurt trumps election prospects. 😯

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You can also look at the cruise ship that had the infection. It was discussed on the corona virus thread but only 0.16% ended up as fatalities. This on a packed cruise ship with no concept of social distancing.

 

I'd agree with you except the real issue is the healthcare system getting overloaded causing the morbidity rate to skyrocket.  I think that's one of the big problems in Italy.  With the cruise ship, everyone who needed access to ventilators got them, because the system wasn't overloaded.

 

If the healthcare system were infinitely expandable, this pandemic wouldn't be a big deal.

 

We can be right on the lethality but still wrong on the economy.

 

Oddly enough, I agree with you on this one.  The government reaction, particularly in the USA, was terrible, and that's going to kill the economy.

 

The Democrats are so riled up right now, I mean look at some of these threads we have here, I think they will try to tank the economy just to hurt trumps election prospects. 😯

 

Yeah, this is what I meant when I said on the coronavirus thread that Trump was doing the standard playbook, encouraging his supporters to focus on the "us vs them" and rally around him rather than focus on his incompetence.

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Aurelius, what you are saying is that it is possible things are much better than people fear. It is definitely possible since we know so little yet about this three month old virus. The opposite of Iceland is Italy. It bothers me how little of the reporting ever mentions confidence intervals or any measure of uncertainty around their estimates. Those ranges in terms of total lives lost are enormous, from a few hundred thousand to millions.

 

Unfortunately decisions are required now (even the decision to wait and watch), before a full study can be done. They will be proved right or wrong with hindsight, after lots of economic and possibly human damage.

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There is so much information out there regarding Covid19. It’s hard to distinguish signal from noise. I believe the following information is signal. Hopefully this is useful.

 

I am emotionally sympathetic to this, and I hope it is true.  I have speculated in the main Coronavirus thread that widespread serological testing might bring the CFR way lower. 

 

But I think we're still in a fog-of-war situation.  With the passage of time, the fog is only starting to lift, and optimistic information is beginning to emerge, which you've summarized nicely. 

 

 

I thought this was a terrible article, both in the timing of publication and what Ioannidis was missing.  He is an influential academic and has had a distinguished career.  His article was widely circulated among influential people, and it might have done even worse damage if it came earlier.  It was denounced by several of us in the main Coronavirus thread on it's very publication date (March 17).

 

Like a typical academic, he calls for more data.  This would be appropriate in any other sedate research setting, like a university lab.  It is completely inappropriate in an interconnected, complex, dynamic situation like a pandemic that plays out in real-time in the real world involving real people.

 

In the beginning of a potentially deadly event, it is natural to hope for the best, but wiser to prepare for the worst.  Ioannidis doesn't seem to get that.  There is no sense of urgency in his writing.  It is as if he is positioning himself for the future when, if things turn out o.k., he can cite his article to point out how prescient he was.  Watch for his media appearances in the future.

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The Democrats are so riled up right now, I mean look at some of these threads we have here, I think they will try to tank the economy just to hurt trumps election prospects. 😯

 

Yeah, this is what I meant when I said on the coronavirus thread that Trump was doing the standard playbook, encouraging his supporters to focus on the "us vs them" and rally around him rather than focus on his incompetence.

 

I can't argue with the results.

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I'm aware of previous work by Ioannidis and it is high quality. While he hits the mark in saying we are making decisions without data, this article is off side in that he offers no proposed solution. We can see a tsunami coming off shore. The only tool we have to possibly prevent a disaster is social distancing. This article https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/ offers a friendly response to Ioannidis' and conclude with "no choice but to buy time with social distancing"

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The problem isn't the mortality rate, it's the virulence - how many people get infected and how fast. If current doubling time in your part of the world is 4-5 days (number of cases double every 4 to 5 days), in approx 6 weeks there will be roughly 1024x more cases (10 doubling times) . So if your region has 500 cases now, in 6 weeks it will be 500,000. Some people will die. Some young people will die too. However, the point is that the hospital system will be overrun. That means people who need usual life saving type treatments (heart attacks, strokes, cancer therapy....) won't be able to be accommodated. Article on the math of pandemic - by using simple math and data available in the news the author concluded on March 12 that social distancing was mandatory to flatten the curve: https://medium.com/@Jason_Scott_Warner/the-sober-math-everyone-must-understand-about-the-pandemic-2b0145881993

 

 

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I was on a conf call today with a surgeon from Brooklyn who said their one hospital has 180 Covid patients admitted with 90 of them on a ventilator in the ICU - their previous capacity for ventilated patients was 60 prior to emergency expansion. Means that other sick people just won't get care.

 

There's 2 things people can do: provide emergency services (healthcare, fire, police, stock grocery stores so that people can eat) or do your part to help society by "bending the curve" and be strict in social distancing. If one can change the doubling time from 5 days to 7 days or 10 days or longer, it will prevent the entire healthcare system from being overrun.

 

Currently most hospitals in N. America are not doing elective surgeries - keeping the beds open for the oncoming onslaught - which has arrived in NYC already.

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https://www.cloverpop.com/blog/we-need-a-covid-19-testing-moonshot

In the whole world, there are only two places that can reasonably claim to be taking a scientific approach to those aspects of this virus at this point: Iceland and the Faeroe Islands. Both have tested about 3% of their populations (that’s about 6X better than South Korea, 12X better than Italy, and 100X better than the US). Iceland is trying to test a representative population, although their testing is still skewed towards ill and exposed people. The Danes of the Faeroe Islands are tracing almost 100% of cases.

 

Because they have relatively low numbers of hospitalizations and deaths, the information they are uncovering has been hidden in the press. However, their information is currently the most accurate information out there about the spread of infection. Here is what they’ve learned:

 

Their reported rates of infection in their general populations are about 2X higher than Italy and 10X higher than the rest of the world (about 2,000 infections per million people vs about 200 infections per million or less). This is true even though they’ve tested relatively few people and their samples were still skewed to the sick or exposed.

Their rates of hospitalization per case (2.5% in Iceland) and death per case (0.15% for both combined) are about 10X lower than the rest of the world.

In the Faeroe Islands, scientists doing almost complete contact tracing have found some evidence that one strain of the virus is far more contagious.

 

This might explain alot:

What if we had only the information above, and none of the other terrible true-but-skewed information flooding the news about doctors and nurses facing impossible decisions, PPE shortages and piled up coffins? What could explain what we were seeing?

 

One explanation is that this new coronavirus is at least 10X more contagious and at least 10X less deadly than we think it is. The CDC data could be showing that younger people are being less careful than older people, so they’re getting sick sooner. The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain.

 

Given that information, the pandemic could be summarized this way: A highly contagious virus with a 1-3% hospitalization rate and 0.1-0.3% death rate.

 

In other words, it could be like the entire flu season getting piled into a few weeks everywhere it hits.

 

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This might explain alot:

What if we had only the information above, and none of the other terrible true-but-skewed information flooding the news about doctors and nurses facing impossible decisions, PPE shortages and piled up coffins? What could explain what we were seeing?

 

One explanation is that this new coronavirus is at least 10X more contagious and at least 10X less deadly than we think it is. The CDC data could be showing that younger people are being less careful than older people, so they’re getting sick sooner. The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain.

 

Given that information, the pandemic could be summarized this way: A highly contagious virus with a 1-3% hospitalization rate and 0.1-0.3% death rate.

 

In other words, it could be like the entire flu season getting piled into a few weeks everywhere it hits.

 

The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain

 

This contradicts China data. If disease is highly contagious and impossible to contain, then there should be the same amount of deaths in all provinces rather than being superconcentrated in Wuhan.

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This might explain alot:

What if we had only the information above, and none of the other terrible true-but-skewed information flooding the news about doctors and nurses facing impossible decisions, PPE shortages and piled up coffins? What could explain what we were seeing?

 

One explanation is that this new coronavirus is at least 10X more contagious and at least 10X less deadly than we think it is. The CDC data could be showing that younger people are being less careful than older people, so they’re getting sick sooner. The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain.

 

Given that information, the pandemic could be summarized this way: A highly contagious virus with a 1-3% hospitalization rate and 0.1-0.3% death rate.

 

In other words, it could be like the entire flu season getting piled into a few weeks everywhere it hits.

 

The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain

 

This contradicts China data. If disease is highly contagious and impossible to contain, then there should be the same amount of deaths in all provinces rather than being superconcentrated in Wuhan.

 

 

Not so contagious it is impossible to contain, but watch the video above to see the kind of actions China has taken to contain it. are we going to do that here in the United States (or something even remotely similar?) -- should we?  Just because they were able to get it under control with their actions, doesn't mean we will with ours.

 

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I like this thread.  Thanks for doing a great writeup.  I think the death rate for <60 is quite small perhaps 20-30 bps.  Tons of cases are not being testing as people with no to few symptoms are not tested. Germany has low rates of death for younger people.

 

The amount of brainpower on this problem is incredible.  Man vs Covid essentially.  Man will win in the long run.

 

Also - everyone should wearing masks.  No downside - if you have 1 or make 1 and wear it. 

Lower chance of infecting others and protects yourself.  Western cultures need a culture shift immediately.

Masks should be worn - even homemade ones.

https://medium.com/@matthiassamwald/promoting-simple-do-it-yourself-masks-an-urgent-intervention-for-covid-19-mitigation-14da4100f429

 

However - I think it is best to think in probabilities about this.  chance of 2 month recover vs. 12 months. 

The models I have seen seem to indicate 4-8 months (or longer) for this to die down, unless severe lockdowns.  Very fluid though.

 

And it really has to die on a worldwide basis because it can easily come back.

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This might explain alot:

What if we had only the information above, and none of the other terrible true-but-skewed information flooding the news about doctors and nurses facing impossible decisions, PPE shortages and piled up coffins? What could explain what we were seeing?

 

One explanation is that this new coronavirus is at least 10X more contagious and at least 10X less deadly than we think it is. The CDC data could be showing that younger people are being less careful than older people, so they’re getting sick sooner. The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain.

 

Given that information, the pandemic could be summarized this way: A highly contagious virus with a 1-3% hospitalization rate and 0.1-0.3% death rate.

 

In other words, it could be like the entire flu season getting piled into a few weeks everywhere it hits.

 

The Italy and China data could be showing that the disease runs its course in a few weeks, since a highly contagious disease is impossible to truly contain

 

This contradicts China data. If disease is highly contagious and impossible to contain, then there should be the same amount of deaths in all provinces rather than being superconcentrated in Wuhan.

 

...

Not so contagious it is impossible to contain

...

 

That's not what the OP's quote argues.

 

I agree with you that virus was mostly contained in China. And I disagree with OP's quote and conclusions stemming from it.

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great post Aurelius.  value added.

 

relying to another post:  "The problem isn't the mortality rate, it's the virulence - how many people get infected and how fast." 

 

I disagree wholeheartedly.  every flu season we are indifferent to virulence and mortality..I suppose because we offer a predictive vaccine, we believe we are doing enough.  I doubt anyone on this board would have known before covid-19 that there are 10,000-50,000 flu-related deaths in US every year.

 

yes the facts have changed with a novel virus, but every season we have some novel viruses (hence vaccinated people still get sick), and the development of antibodies by the vast majority of infected by covid-19 is a big plus and necessary to deal with covid-19...which is why all of our focus should be on ring fencing and protecting elderly/immune compromised.  that we only recently barred visitation to nursing homes is batshit crazy.  that is the first thing we should have done

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I like this thread.  Thanks for doing a great writeup.  I think the death rate for <60 is quite small perhaps 20-30 bps.  Tons of cases are not being testing as people with no to few symptoms are not tested. Germany has low rates of death for younger people.

 

The amount of brainpower on this problem is incredible.  Man vs Covid essentially.  Man will win in the long run.

 

Also - everyone should wearing masks.  No downside - if you have 1 or make 1 and wear it. 

Lower chance of infecting others and protects yourself.  Western cultures need a culture shift immediately.

Masks should be worn - even homemade ones.

https://medium.com/@matthiassamwald/promoting-simple-do-it-yourself-masks-an-urgent-intervention-for-covid-19-mitigation-14da4100f429

 

However - I think it is best to think in probabilities about this.  chance of 2 month recover vs. 12 months. 

The models I have seen seem to indicate 4-8 months (or longer) for this to die down, unless severe lockdowns.  Very fluid though.

 

And it really has to die on a worldwide basis because it can easily come back.

 

I've been thinking about masks.  I'd be ramping up mask production as fast as possible.  But, I've never worn one in my life as far as I can recall, and I'd need one or two a day.  Same for the rest of my family.  A billion or more a week in the US.  I figure it would take many multiples of current mask production.  How possible is that?

 

Regardless, I'd push hard on masks.  Absent a treatment, this will at the least be around in the fall.

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"I was on a conf call today with a surgeon from Brooklyn who said their one hospital has 180 Covid patients admitted with 90 of them on a ventilator in the ICU"

 

report from good friend who is a pulmonologist/ER in Jax.  10-20 hospitalizations, zero on ventilators/ICU. 

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I’ve spent a few hours trying to find statistics for different countries. What I’ve tried to find is:

1. Countries that have tested a lot. Preferably over 1% of the population.

2. Cases (infections)

3. Deaths

I’ve noticed a huge problem - it’s super difficult getting the information on how many tests countries have done. Everyone seems to report on infections and deaths. I’m no expert, but you’d think reporting on the denominator would be of vital information!

 

Any recommended site that tracks: countries; number of tests done; infections; deaths?

 

Norway has tested over 1,4% of it’s population:

Tests: 73.089

Cases: 3.346

Deaths: 14

Mortality rate: 0,42%

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I like this thread.  Thanks for doing a great writeup.  I think the death rate for <60 is quite small perhaps 20-30 bps.  Tons of cases are not being testing as people with no to few symptoms are not tested. Germany has low rates of death for younger people.

 

The amount of brainpower on this problem is incredible.  Man vs Covid essentially.  Man will win in the long run.

 

Also - everyone should wearing masks.  No downside - if you have 1 or make 1 and wear it. 

Lower chance of infecting others and protects yourself.  Western cultures need a culture shift immediately.

Masks should be worn - even homemade ones.

https://medium.com/@matthiassamwald/promoting-simple-do-it-yourself-masks-an-urgent-intervention-for-covid-19-mitigation-14da4100f429

 

However - I think it is best to think in probabilities about this.  chance of 2 month recover vs. 12 months. 

The models I have seen seem to indicate 4-8 months (or longer) for this to die down, unless severe lockdowns.  Very fluid though.

 

And it really has to die on a worldwide basis because it can easily come back.

 

I've been thinking about masks.  I'd be ramping up mask production as fast as possible.  But, I've never worn one in my life as far as I can recall, and I'd need one or two a day.  Same for the rest of my family.  A billion or more a week in the US.  I figure it would take many multiples of current mask production.  How possible is that?

 

Regardless, I'd push hard on masks.  Absent a treatment, this will at the least be around in the fall.

 

I agree on masks. It’s the only stopgap measure available and it seem to be proven to work. That’s what the government should be working on, production capcityfor  hundred millions of mask/ month.

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I’ve spent a few hours trying to find statistics for different countries. What I’ve tried to find is:

1. Countries that have tested a lot. Preferably over 1% of the population.

2. Cases (infections)

3. Deaths

I’ve noticed a huge problem - it’s super difficult getting the information on how many tests countries have done. Everyone seems to report on infections and deaths. I’m no expert, but you’d think reporting on the denominator would be of vital information!

 

Any recommended site that tracks: countries; number of tests done; infections; deaths?

 

Norway has tested over 1,4% of it’s population:

Tests: 73.089

Cases: 3.346

Deaths: 14

Mortality rate: 0,42%

Still very hard to interpreted that data. Because presumably a lot of the reported cases are people who just got infected, just got sick, are just admitted to the hospital etc. Only in 3 or 4 weeks time you will know how many deaths there are from the current sample of 3346 cases. But that's something you can only track if you get case by case information, and you won't have that.

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