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Living in a time of COVID-19

We’ve come really far over the past month or so in relation to coronavirus. There are lots of resources online and people should be making recourse to them. medRxiv and bioRxiv are great. If I were you, I would at least read the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). But, please read everything with skepticism and a grain of salt.

I’ve been “monitoring the situation” since January…with alarm beginning in the first week of February. My own family’s actions have moved from “social distancing” to isolation. Work-from-home, cancellation of playdates, and keeping children out of the schools. All of these actions exhibit guesswork and decision-making on incomplete information. In the WHO-China report, they note that “people interviewed by the Joint Mission Team could not recall episodes in which transmission occurred from a child to an adult.” And yet children do seem to shed RNA after infection, and many experts do think they can transmit.

Unless you’ve been sleeping under a rock, you’ve seen this table:

AGE
DEATH RATE
confirmed cases
DEATH RATE
all cases
80+ years old
21.9%
14.8%
70-79 years old
8.0%
60-69 years old
3.6%
50-59 years old
1.3%
40-49 years old
0.4%
30-39 years old
0.2%
20-29 years old
0.2%
10-19 years old
0.2%
0-9 years old
no fatalities

 

But strangely many older people I know did not know about the age profiles of the fatalities. Many people are promoting the idea that this is as risky as a bad flu season. This is wrong. The case fatality rate for flu pandemics seems to be in the ~0.1% range. The initial case fatality rates for coronavirus seems to be closer to 1%, though I assume that we can drive that down some. But, I have a hard time imagining that it will be as low as the flu. With its spread, with R0 going above 1, one can imagine a large proportion of the population being infected in the United States, resulting in hundreds of thousands of deaths. And yet many people are complacent, going on vacations and not altering their behavior in any manner.

After spending a fair amount of time reading papers and data I think there will be some patterns that will play out.

  • Age is a huge factor. Therefore, societies which are very young-skewing will probably not see the chaos and suffering that societies with many older people (China and Italy) will experience.
  • There are mixed reports from the analysis of spread in regards to temperature and humidity. But I suspect that on the margin there will be some effect of warmer temperatures, though please remember that many of these pandemics with seasonal patterns come back in waves in subsequent years.
  • Men seem to be more susceptible than women, and most definitely to dying from the disease. One of the preprints I read shows that boys are more likely to be infected than girls. This rules out, to me, smoking as driving the sex difference. Please note that the ACE2 gene which is responsible for the receptor in which coronavirus targets is on the X chromosome.
  • I assume there is some difference between ethnic groups, and if there is some difference East Asians are possibly more vulnerable since it was selected in that population first. We won’t know for a long time yet, and Whatsapp chains arguing there is an “African gene” or “Indian gene” which is protective are clearly misguided (the one paper I saw which looked at allele frequency differences showed a fair amount of overlap between populations).

There are lots of people with lots of information. You make your own decisions. Until the government makes it for you. But, I have to say that one thing that is really disturbing is the message out of Fox News and its penumbra of pundits that people are trying to create a panic to destroy the economy and undermine the Donald Trump. I have been having discussions with Right-leaning people since January about the virus, and most of us have been getting progressively more alarmed by the week. It is true that some people see a political opportunity in the crisis, but this is not a manufactured pandemic, and it will have a massive impact on life and liberty in this country. The median age of the Fox News viewer is 65. Many of the people who are being told that this is just like a bad flu season are the highest risk of dying. I am pretty sure that people in my orbit will die unexpectedly within the next 3 months of coronavirus.

Michael Brendan Dougherty writes in National Review, I Fear the Coronavirus. He says that people have told him “It’s just like the flu, but not as bad.” I hope that these people are correct, but I’m 99.9% they are wrong.

Meanwhile, certain groups of liberal intellectuals seem to periodically become more focused on anti-Asian racism, or see the virus as an opportunity to make fun of enemies.

My own take is that we’ll have time for culture wars after the suffering and deaths of the next few months. Let’s pause on that for a moment.

Anyway, I’ll let readers leave their comments here.

20 thoughts on “Living in a time of COVID-19

  1. My aunt and uncle are caught in the south of Italy at the moment. He’s 82 and she’s 77; I’m extremely worried for them.
    Here in Nantes, France, there haven’t been any particular precautions taken by the government apart from the nation-wide ones, although with a centre of infection not too far from us in Auray, I think we’ll start to see school closures etc relatively soon.

  2. My region is now affected and one of the problems is, that for a lot of people its actually milder than a real flu. So for them its unnecessary panic on the individual level.
    I can just repeat what I said before: All depends on your immune response.
    Age and sex are definitely risk factors statistically, but individually, your immune response and current health condition is key.
    Many people might not even notice its Covid-19, while others will collapse within days.
    What I heard about Italy is that once you have the real epidemics, like in Iran and Northern Italy, the real death rate will rise at Wuhan levels, in the worst case up to 5 percent.
    The reason is simple: The worst affected 5 percent need intensive, highest quality care to survive without big damages to their health.
    If a hospital gets 1 new such patient each day, its possible. If they get 10 or more a day and the personell and supply chain is affected, its no longer possible.
    So the rates for dead and damaged patients will double and triple or worse once the epidemics is out of control.

    What really makes it a big threat most people ignore. Its the mutation potential in this now huge population.
    The Spanish flu’s first waves were not as deadly, but it got much worse. The first wave killed elderly and weak, the second the best and young.
    Nobody of the careless morons can tell for sure were this will end. They should have done everything to keep it down and failed so miserably.

  3. This is worse than the flu, and the flu is a horrible disaster. If we could get rid of the flu, we would, but it is considered impossible once something like this is spread all over. We have, or had, one shot at avoiding a new yearly plague. Yes, it is very expensive, but the alternative is not cheap either.

    > for a lot of people its actually milder than a real flu

    A lot (I read 65%-85%) of flu infections are completely asymptomatic, many of the rest are very mild, not even a fever. And still flu is one of the hardest strains on health services.

    Another point not discussed is that pneumonia hits you quite hard. I had it on my 20s, quite healthy (50 m freestyle in 28.95), no intubation, no UCI, just straight antibiotics, and even after notional recovery I was too weak to leave the house for three months. And everybody reports on the high level of pneumonia hospitalisations for CoVid-19.

    Survivors of SARS had bad long term outcomes: https://www.chinadaily.com.cn/china/2010-02/25/content_9499037.htm (it seems that steroids are not recommended any more for viral pneumonia, but there are plenty other issues)

  4. I wonder if Razib thinks a mask and an oxygen ionizer are products one should be getting?

  5. Unfortunately you are absolutely right, Razib.

    I write from North East Italy, now all blocked because in Lombardy, the area of ​​the first virus outbreak, intensive care posts are running out, and doctors will be forced to choose to treat those who have the most chance of survival, that is, the youngest.
    We have come to those dramatic moments that you fear for your country, and we are facing an almost total closure and economic disaster in the hope of slowing down or stopping the virus.
    We listen to expert doctors, government directives, we stay at home if not for necessary things, companies and our work are suffering. Doctors and nurses are working twice or triple the usual. They are real heroes.

    that’s how it goes
    Sorry for my bad english

  6. The fact that some countries like China, Singapore, and Hong Kong have been successfully able to contain it and the United States has failed to do so—even with a long runway of warning— shows the abject failure of the Trump administration in addressing this. Once the cat is out of the bag, it falls on his shoulders and should be his downfall.

  7. Pushback. It is exactly like the flu in terms of killing people. Basically kills people over 65. 95% of flu deaths are over 65 as well. We’re not seeing pediatric cases of this which is a difference, but pediatric flu deaths are a fraction of elderly deaths.

    If anything, it is less lethal than the flu –but the severe pneumonia will quickly overload a hospital as it taking 2-3 weeks of oxygen to recover which takes up beds.

    The big difference between the two is the course of the disease. You get exposed, a few days later come down with a cold. Then you “recover” and think it nothing. For 85% of people it is over. For 15% of people you recover but your cough gets worse and worse until on day 10 you got to hospital and there is a fluid in your lungs.

    The challenge is getting that 3% of people who need oxygen. Might not be worth it as it looks as the majority of those people will die as they have underlying conditions.

    But how will people who are under 65 who have a nasty case of pneumonia appreciate being told to go home, don’t go the hospital and you’re probably recover? Again panic is the bigger danger.

    I think Razib is underestimating the climate factor here. It isn’t just the temperature. You’ve also got the humidity to think about — both in terms of degrading the proteins but more importantly in terms of improving your eplitheial cells to resist the virus. Then you’ve got to throw in sunlight which is increasing every day and destroying the virus. There is a reason that coronaviruses are seasonal and will be basically gone by May — and back in November.

    There is some evidence that the virus is NOT using ACE2 to get inside cells; ACE2 expression is what SARS used but is actually higher in young people than old which is sort of the reverse pattern.

  8. The fact that some countries like China, Singapore, and Hong Kong have been successfully able to contain it and the United States has failed to do so—even with a long runway of warning— shows the abject failure of the Trump administration in addressing this. Once the cat is out of the bag, it falls on his shoulders and should be his downfall.

    China contained it? Obviously not, given it started there and has now spread across the globe, and within China saw massive portions of the country shut down with loss of life (massive loss of life if various reports leaking through the internet are to be believed). The Chinese effort does not at all appear to be successful unless you uncritically believe the CCP propaganda.

    But any stick will do, I suppose.

  9. To me it seems a bit irrational for Trump to issue statements that will lead to a reduction of his voters. But maybe that’s nothing unusual, all the irrationality. And interesting how much vitriol was poured on Dougherty in the comments section of his article. A magazine for true believers I guess?

    In any case, it will not be pretty there.

    While here in a Northeastern European country where I live, most of the government’s health officials (bureaucrat-doctors) seem to think that there’s no “scientific reason” to cancel mass events, because there’s no evidence that it would slow the epidemic! Can too much scientific education really make a person moron, as well as too little?

  10. Time enough for the Culture Wars after this is over?

    Between pestilence and the collapse of markets, I’ve a feeling that the rider of the Pale Horse will be Sulla.

  11. @charlie: That’s just wrong, the flu has a death rate of 0,1-0,2, Covid-19 of 1-5 percent, depending on the profile of the infected people and the quality of the medical care. That’s not comparable at all. Even more important, much less people getting the flu need medical care in a hospital at all, while its about 10-20 percent for Covid-19.

    The only good news about it is, that so far the youngest are save (0-9), but even above 10 the rate is not better for Covid-19 but comparable, and with every age decade the risk jumps up.

    To even compare it with the flu is wrong, to say its
    “If anything, it is less lethal than the flu”
    that’s fake news and its irresponsible to spread something like that. Nowhere Covid-19 can be described being “like a regular flu”.

    The flu too is not harmless, I personally know people which got serious issues after being infected as kids, but Covid-19 is just another category and its future mutations and pathogenic potential is completely unknown, a potential risk, if it really being established and comes back seasonally, of great magnitude. There is nothing to trivialise about it.

    As for the USA vs. other countries, I’d say the problem goes much beyond the current presidency, because the CDC and public health system being in bad shape for how long? That’s actually one of the problems in Northern Italy too. Many private hospitals which are not as closely interconnected and a fairly individualist approach to life and politics. A lack of centralised and effective organisation. I’d say Trump acted wrong, but he is not the blame alone, its the American system as such which will fail. That’s the problem of the Liberal system as a whole and the more Capitalist and Liberal, the more problematic it is.
    There is a reason why nations which needed to face great organisational challenges, the typical river civilisations, tended towards autocracies. Because even if with a delay, when they act, the whole country being activated at once.

    If one private hospital blames the other and no one is in charge, with the public resources being completely depended on private businesses, you will lag behind, at least initially. Until the private sector develops solutions which might, in some respects, even be better. But you don’t stop an epidemic in such an uncoordinated, particular and indivdiualist way.

    That the USA tried to develop their own test instead of using the existing one just adds up to the chaotic organisational fallacies this administration didn’t produce, but largely inherited. Obama wouldn’t have been able to turn everything around on his own neither.

  12. I just saw a really disturbing graph – which I believe came from twitter – an hour or so ago, tracking cases in different countries on a logarithmic scale. Essentially, the USA and the other major European countries are seeing straight-up logarithmic growth of new cases. The way it is currently going, the U.S. will have as many cases as Italy has today in 11.5 days. Meaning somewhere in the range of 100 deaths daily. Given the U.S. seems to be way behind in testing, it may happen even more quickly than that. Italy jumped to having more than 10 daily casualties on March 2, then more than 100 on March 8.

    I shudder to think what Italy’s casualty rate will be like in two weeks. I guess it will continue to provide a glimpse into our future, given Iran has been strangely opaque through this whole thing (well, more strangely opaque than normal).

  13. Pushback. It is exactly like the flu in terms of killing people. Basically kills people over 65. 95% of flu deaths are over 65 as well. We’re not seeing pediatric cases of this which is a difference, but pediatric flu deaths are a fraction of elderly deaths.

    i posted the table. it’s not like flu. this is how lies spread, you just rephrase it obscuring more specific detail.

    10x more fatal
    2x more contagious
    likely longer progression of disease especially for critical cases
    not like flu

  14. Karl Zimmerman: Do you mean exponential growth or logarithmic growth? With the former, the growth rate is constant so you can talk about the doubling period. With the latter, the growth rate declines pretty rapidly. Most likely, (and I think it is — must be — pretty obvious) we are in the exponential interval of logistic growth.

  15. A. Karhukainen,

    To me it seems a bit irrational for Trump to issue statements that will lead to a reduction of his voters.

    Suppose he issued orders to do what must be done. The market would likely crash earlier, and he would be accused of panicking the country with the wildest and most baseless speculations. In fact they were already going with this when the China traveler quarantine was instated.

    Suppose everyone obeyed him as the Emperor. No cases here. They would say he was overreacting to a nonexistent threat, and try to get people to grumble that, now, the President is acting dictatorially and indeed abusing his power, and forcing everyone to potentially do nothing at home – be bored and lose money. And for nothing! No cases! Crashing the economy! What was he thinking?

    Just a few examples of why it is not so straightforward.


    While here in a Northeastern European country where I live, most of the government’s health officials (bureaucrat-doctors) seem to think that there’s no “scientific reason” to cancel mass events, because there’s no evidence that it would slow the epidemic! Can too much scientific education really make a person moron, as well as too little?

    If they needed scientific “education” to grasp that, they were already a moron. As we see, any education they had did not help them, assuming they are not hiding their true motives. Do not be too much of a teacher’s pet

  16. I have a very close friend who runs a company that manages supply chains into China. He forwarded the report from his VP-HR today. Their China based employees are back to work. Their suppliers are functioning at 90% in the upper part of the chain and 80% in the base.

    I think this thing will blow over. Forecast upper 50s lower 60s here for the rest of the week. I don’t expect spring until mid April hereabouts. But, the warm weather will kill the epidemic. it always does.

    Winter weather forces people to stay inside and be in contact with infected people. In warmer weather, people can go outside. Are your chances of being infected higher in a gym or running in the park?

  17. “Believe It or Not, There Was Actually Good COVID-19 News Today: It’s not where you’d think.” by Billy Duberstein on Mar 10, 2020
    https://www.fool.com/investing/2020/03/10/believe-it-or-not-there-was-actually-good-covid-19.aspx

    China reported only 19 new cases in the country today, with 17 in the city of Wuhan, where the virus originated. That’s a fairly remarkable decline in a country that experienced a huge explosion of cases just a little over a month ago. Since late December, China has reported 80,000 cases, with 67,000 in Hubei province, home of the origin city of Wuhan. The recent declines are fairly striking, considering the degree to which other countries have recently had difficulty containing the virus. It’s also a testament to the unprecedented lockdown measures the Chinese government put in place in Wuhan in late January.

    In fact, the situation has improved so much that Wuhan recently shut down 11 of the 14 temporary hospitals it had built for the influx of new patients. And in perhaps an even more important symbolic move, President Xi Jinping visited Wuhan today, the first time he has done so since the virus erupted around the New Year holiday.

    * * *

    In addition, several leading Chinese companies are reporting that they’re getting back to normal operations. E-commerce giant Alibaba is reportedly back to full staffing for its package delivery unit Cainiao and food delivery unit Ele.me. Alibaba rival JD.com just reported a strong quarter and projected that it would grow sales “at least” 10% year over year in the first quarter — a quarter in which a large part of the country was on extended holiday and a major city was completely locked down. And CNBC is reporting that iPhone giant Apple has reopened 38 of its 42 Apple stores in China, up from 29 on Feb. 24 and zero on Feb. 9, when Apple shut down all of its stores as a precaution. In addition, Apple said its production facilities in China are back to 50% capacity, and should be at full capacity by the end of the month.

  18. A real anomaly in COVI-19 is that it has not killed small children. Influenza kills lots of small children. Is disease that does not kill small children that worrisome?

    “How Vulnerable Are Children to the New Coronavirus?: So far, kids seem to be surprisingly less at-risk to severe infection. But they could play a key role in spreading it, so experts say it’s crucial to follow precautions.” By Sumathi Reddy on March 10, 2020
    https://www.wsj.com/articles/how-vulnerable-are-children-to-the-new-coronavirus-11583858781

    ” … Only 2% of the patients in a review of nearly 45,000 confirmed Covid-19 cases in China were children, and there were no reported deaths in children under 10, according to a study published in JAMA last month. (In contrast, there have been 136 pediatric deaths from influenza in the U.S. this flu season.) …

    “You would think [children] do worse as they do with seasonal influenza but that hasn’t been reported yet,” says Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group in Rochester, Minn. …

    Trends in South Korea so far look similar. Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10 to 19 years old. …

    Typically with the flu and other respiratory viruses, children under 2 are at risk of suffering from complications such as bronchitis or pneumonia because their airways are narrow. These viruses typically cause swelling and inflammation of the airways, says Dr. Poland. …

    Even though respiratory diseases, such as asthma, are an underlying medical condition that pose a greater risk of serious illness, there haven’t been any reports so far of asthmatic children being hospitalized or dying of Covid-19. …

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