Misleading graph. Most deaths due to flu happen because of opportunistic pneumonia and they are a separate category in CDC statistics.

The worst seasonal flu week was the 2nd week of 2018 with slightly more than a thousand flu & pneumonia deaths a day in the US, 200 of them attributed to influenza and 800 to pneumonia. There probably were some people who died due to chronic disease complications on top of that. That’s still less than Corona peak will be and likely way less than what it could be if people kept acting like it’s just a flu, but not quite to the degree the picture suggests.

On masks and more.

Let’s say R = N * p, where R is the reproduction number, N is the average number of contacts between an infected and people without immunity and p is the average probablity of getting infected during a contact. In order to sufficiently slow the epidemic we need to push R close to 1. Below 1 in order to stop it.

The only relatively inconsequential way to lower N is to tell everyone with respiratory infections to stay at home for a couple of weeks. Other measures that reduce N are isolation-testing-tracing, social distancing and enough people getting infected. These are all bad.

Testing and tracing looks better than the other two because it doesn’t involve as much quality of life loses, but it doesn’t scale. People seem to be forgetting that thousands of trained professionals in full sets of disposable PPE doing swabs 24/7 and all the labs in the country running the tests overwhelms the system in its own way. That might change with mass production of reliable express tests, but I imagine that’s about as far away as effective antivirals.

Measures that lower p, on the other hand, only require competence. They might even end up being a net positive for the quality of life since incidence of other diseases will be lowered without disproportionate economic burden needed for social distancing.

Masks for all is currently such a big thing because it’s so obvious and yet our governments except for some East Asian and some Eastern European ones are refusing to implement it due to epistemic crisis. Masks alone don’t seem to be enough, at least not with the comliance level they get in Japan, but there are other things that can be done by the governments and the people that aren’t being done.

Better hygiene. Masks for all. Better ventilation everywhere (almost nobody caught Corona outside spaces with stagnant air according to the Japanese). Vitamin D and zinc supplements. Better sleep. Disease control specialists can probably come up with dozens of these public health measures. Their guidelines are usually not taken very seriously but the state shouldn’t limit itself to PSAs now. If anything, lockdowns showed that people are more than fine with enforcement of compliance.

Western epidemiologists were predicting that about 60-70% of the population need to be infected for herd immunity to do its job. Germans even went ahead and said it could be higher. That’s the thing that led to such an averse reaction to the plans involving letting her spread. The cost would likely be too high and no statesman wants to be the one responsible. But what really needs to happen is reduction of R by 60-70%, not that share of population getting immunity. If we lower probablity of getting infected during a contact by half through public health measures and allow people to decide on their own how much social distancing isn’t going to hurt them, we only need 15%-20% of the population to get immunity before the disease will start burning out. The epidemic would progress slower too, not overwhelming the system the way it does when left unchecked. It doesn’t have to last years like in some projections because the number of people that need to be infected is much lower.

I believe this is the exit unless we can outright eradicate the disease. Implement as many p lowering measures as possibe. Cancel large events. Make sure hospitals don’t turn into hot spots. Tell people to stay at home if they are sick unless they get severe symptoms. Tell high risk groups to stay at home period. Allow the low risk groups to get it over with without straining the healthcare too much.

That sounds a lot like what the UK wanted to do but they didn’t consider all that many possible measures for p reduction except hand washing and didn’t want to enforce compliance. That obviously didn’t work out very well. Now the entire population is under house arrest and it’s not even a reasonable long term solution. Japan and Sweden seem more successful but failing in similar way trying to depend on generally cooperative population.

Now, places that are already in the world of hurt need to shut down. If a sizeable proportion of the local population is already infected and the hospitals are collapsing then even radically slowing the spread won’t do anyone much good. These places need to either implement very hard lockdowns or accept that some people will die. Places with low number of infected per capita should concentrate on investigating ways to lower the probability of getting infected during a contact and enforcing compliance instead of focucing on reducing contacts. Even 10% of the cost of a month long shut down of a first world country should be enough to fund every transmission prevention measure in the books.

There isn’t much travel between Cox’s Bazaar and the UK.

In a few weeks containing a few hundred strong localized outbreak won’t be a problem even without hard measures. Testing is becoming better, contact tracing is becoming better, PPE production is being ramped up, institutional response is becoming better, individual response is becoming better. Every little measure lowers reproduction number a little bit. If we can reduce R_eff to below 1.5 without lockdowns then there isn’t really any point in shutting down anymore since our response will continue to get better faster than the disease will spread.

We need short term lockdowns now because these little measures need to become a reality first and the number of currently infected needs to be significantly lowered. We don’t want to freeze the situation at the current level because healthcare is already overwhelemed in some places.

Seems short term if enough red voting boomers in FL and TX die from Corona this year.

Corona viruses are notoriously unstable. Any vaccine will be temporary with diminishing effects.

Mitigation to build herd immunity, the more closely managed the better, is the only way out.

Huh?

I guess closely managed mitigation means R is as close to 1 as possible so it doesn’t overwhelm the healthcare. If you have the confidence that you can do that then why not take the next step and push it slightly below 1? It’s possible even without a vaccine, at least in most developed countries. There are dozens of ways to reduce R by a few percent that are much more cost effective than extensive lockdowns or lying back and thinking of England every time there is a new Corona strain. If we adopt enough of them at once we won’t have to deal with extreme options.

There is more than a billion people confined to their homes right now. Most of them have learned more about infections and hygiene in the last several weeks than they would during their whole lives otherwise. At least some of them are thinking about how they can better avoid diseases and a few of them even come up with practices that will spread. Sanitation standards are being updated across the globe. Relevant products are being developed by corporations. Killing germs in the air is more in demand than ever. Soon most offices and shops will look like a cybergoth rave at a laboratory.

Spanish flu changed a lot of old habits and this pandemic will too. A lot of filth will be cleaned up. It might turn out that Corona will save more boomer lives in the long run than it will reap because with all the measures that are being implemented to contain respiratory diseases seasonal flu is going away too.

There is an exception to East Asian countries. Japan still seems to be clinging to the mitigation strategy they had decided on back in February. They followed those old flu pandemic guidelines that the Western countries came up with and gave up on containment as soon as community spread was confirmed. Although now that the Olympics are officially postponed there are concerned voices within the government. The growth of new daily cases is slow but it’s not getting slower and at some point it will become unmanageable. At that time they will have to shut down anyway and deal with a geographically widespread epidemic instead of a few epicenters they had a few weeks ago. Honestly not sure what their endgame is unless it’s geronticide.

Belarus might require a humantiarian intervention by Russia if things get really out of hand. With an epidemic within the country and Lukashenko himself not taking it seriously there is a real chance he himself will go down soon.

We don’t know what inherent symptoms of Corona are, it’s still a novel disease. There were reports of rare cerebral infection cases in Asia.

https://www3.nhk.or.jp/nhkworld/en/news/20200308_07/

What we do know is that in severe cases Corona causes hypoxemia, significantly lowered white blood cell count and elevated blood pressure, which greatly exacerbate any comorbidity or secondary infection. In these cases fatality can be attributed to comorbidity (Germans only add respiratory failure fatalities towards Corona death toll) or to Corona (Italians count any death of a Corona positive patient). I don’t think that attributing all deaths of people in their 80s to Corona is right, but not counting people who die a few decades early due to chronic diseases deteriorating during a Corona infection doesn’t seem right either.

https://academic.oup.com/nsr/advance-article/doi/10.1093/nsr/nwaa036/5775463

According to the Chinese there is already a faster reproducing more virulent strain of SARS-CoV-2 that becomes dominant without interventions.

What’s with Americans and making everything about their elections? There are countries out there that don’t have Democrats blaming Corona on Trump but they still have the virus.

Corona kills boomers and the older gen xers primarily. If it’s allowed to spread in America and many of them die then the US will become a socialist Latin American country faster than you can say “hey esse.” Things to consider here.

The WHO specifically said no reinfection.

I mentioned that reinfection doesn’t make any sense. The WHO didn’t explain why people test positive again and what are the ramifications. There simply were no studies on it yet.

I have 6 deaths and 706 infections, so again about 0.845%.

As of the last update 34 are in critical condition and half of those die according to the WHO. Some serious and severe cases turn critical later on. The time from onset of symtpoms to death is 2-8 week.

Diamond Princess is a good petri dish for fatality rate in a controlled environment with good healthcare, but we need to let it run its course before making conclusions.

Reinfection doesn’t make any sense.

What we know is that there are people who A) test positive again and B) become symptomatic again. Sometimes both.

A simply means that tests detect Corona particles. What does that mean? We don’t know. It could be false positives or it could be tests detecting antibody-bound particles that weren’t yet flushed out of the system completely and that weren’t detected before due to false negatives. In these two cases it wouldn’t really mean anything.

B could be explained by secondary infections. Respiratory diseases are not uncommon.

The bad scenario is that sometimes Corona goes dormant and then a relapse happens weeks later. In that case you never really recovered the first time and didn’t develop full immunity. It would be a nightmare for containment attempts, but I don’t see a lot of evidence supporting this scenario since the “reinfected” don’t seem to be dying much.

It’s not about China anymore. Now that that they are done with the initial epidemic, China will snuff out its outbreaks with rapid draconian movement restrictions in any districts with new cases of atypical pneumonia. They already have the infrastructure for it. A great time to be a sinotriumphalist.

It’s not about supply side problems anymore. The West believes that quarantines don’t work so they will focus on mitigation rather than complete prevention. It’s a sensible strategy, but it will create anxiety even assuming low ball estimates of fatality rate ~0.5%. That’s still 1 in 200. Not high but one would rather avoid it if possible. When the infected could be everywhere, what will the idea that people can realistically die because they had a contact with them do to consumer confidence and spending? How many people will decide to skip vacations, going to the movies or even to the local fast food place? How many people will start saving just because the world is going to shit around them? A more stable economy could weather the storm, but ours was on its last legs even without any pandemics.

China did its best and isn’t on the list of countries to have an epidemic anymore. The problem now is Corona is obviously spreading in the West and less obviously in third world countries that can’t even detect it. The cat is already out of the bag, it was back in mid-January when the Chinese started traveling for the Lunar New Year. Now it’s everywhere. Stopping a flu in Congo, even the idea sounds ridiculous. People speculate about how bad it can get once the healthcare system is overwhelmed like in Wuhan, but some countries (many countries) don’t have much of a healthcare system in the first place.

Seasonal flu is over a hundred different strains of influenza that were endemic for quite a while. What Corona should be compared to are novel flu pandemics.

Day 45 of WHO observation
Swine flu: 25,272 infected; 139 dead
Corona: 79,774 infected; 2,628 dead

Estimated results of Swine flu pandemic: 15%-20% of the world population infected and 250,000-500,000 people dead.
Estimated results of Corona pandemic: ?

Some considerations wrt fatality rate:

1. Many severe cases in the Chinese CDC study were still unresolved by the time it was published. I doubt that CFR for younger people in that sample would go apocalyptically high, but it wouldn’t remain at 0.2% either. At the same time many mild and asymptomatic cases that would be more prevalent in younger people were never diagnosed. Seems like a case of garbage in, garbage out to me. The only real conclusion is that younger people are a lot less susceptible, but that was observable from day 1 and is in line with 2003 SARS fatality figures.

2. The state of immune system at the moment of infection seems to play a big role. Initial depressed lymphocyte count could spell the difference between a week long flu and severe viral pneumonia with acute kidney injury. Big implications for the third world populations, chronically sleep deprived shift workers, recently recovered or still suffering from other infections, etc.

3. I probably don’t need to mention it, but early supportive care is important.

Now, I believe that the consequences of Corona could be much larger than mortalities from Corona itself and that’s not limited to triggering the global recession that was long overdue as is. From the top of my head some possibilities are:

1. Any clinical setting would become a nightmare to be in for the foreseeable future.

2. Even a bad seasonal flu epidemic can push a healthcare system to its peak capacity. A turboflu like Corona would just shatter it. Some smaller countries in Europe have less than 500 ICU beds, at least 75% of which are in use at any given time. People with otherwise treatable conditions would start dying even without being infected.

3. Corona would decimate upper echelons of bureaucracy and academia in much of the first world. Regardless of whether you think it’s a good thing or not, the impact would be ‘uge.

4. Consequences for the undeveloped countries. With the global economic downturn, essential goods exporters starting to hoard and a new disease raging through the population, what would happen to the poorer countries? The possibilities are endless. Staying on topic of disease, I seriously doubt that 2014 West African Ebola epidemic or 2018 Kerala Nipah outbreak would be contained as easily (if contained at all) in the context of Corona pandemic. The Ebola outbreak still isn’t fully contained in Eastern Congo as far as I can tell. That could be a spark that turns into a fire if left unchecked due to bigger problems.