Contributor Post Created with Sketch. Coronavirus Isn’t a Pandemic

 

The world is in a full state of panic about the spread and incidence of COVID-19. The latest worldwide tallies, as of 12 p.m. ET March 16, 2020, are:

The most dramatic news of the day has been the sudden spike in the number of Italian cases, totaling 24,747 with 1,809 deaths, which may grow to exceed the 3,099 in China.

Overlooked is the good news coming out of China, where the latest report shows 16 new cases and 14 new deaths, suggesting that the number of deaths in the currently unresolved group will be lower than the 5.3 percent conversion rate in the cases resolved to date. In my view, we will see a similar decline in Italy, for reasons that I shall outline in the remainder of this article.

From this available data, it seems more probable than not that the total number of cases worldwide will peak out at well under 1 million, with the total number of deaths at under 50,000 (up about eightfold). In the United States, if the total death toll increases at about the same rate, the current 67 deaths should translate into about 500 deaths at the end. Of course, every life lost is a tragedy—and the potential loss of 50,000 lives worldwide would be appalling—but those deaths stemming from the coronavirus are not more tragic than others, so that the same social calculus applies here that should apply in other cases.

These are deeply contrarian estimates. In dealing with any future prediction it is necessary to develop some model. Right now, the overwhelming consensus, based upon the most recent reports, is that the rate of infection will continue to increase so that the most severe interventions are needed to control what will under the worst of circumstances turn into a high rate of death. This pessimistic view is well captured in an op-ed by Nicholas Kristof and Stuart Thompson, who offer this graph to stress the importance and the immediacy of the looming crisis.

The model here projects a slow takeoff, a sharp rise, and an equally dramatic decline, with a huge cumulative total of deaths. The authors allow that if moderate precautions are taken, these totals might be reduced by about half. The key assumption of this model is a replication rate of 2.3, whereby each person who is infected then infects two others, seemingly without end. But the model does not specify the periodicity of the replication rate or allow it to vary with any downward changes in viral toxicity or human behavioral responses that delay interaction. Nor does the model recognize that if the most vulnerable people are hit first, subsequent iterations will be slower because the remaining pool of individuals is more resistant to infection. And finally, the model explicitly ignores the possibility that the totals will decline as the weather gets warmer.

The writer Tomas Pueyo has struck a similar chord with his viral post “Coronavirus: Why You Must Act Now.” That article contains graph after graph indicating an exponential expansion of cases in the last several days, and then claims that these infections will translate themselves into a similar number of deaths down the line unless radical countermeasures are taken.

Much of the current analysis does not explain how and why rates of infection and death will spike, so I think that it is important to offer a dissenting voice. In what follows, I look first at the trends in the American data, and then, building on my conclusions there, I construct a theoretical framework to evaluate the evolution of the coronavirus in other places.

Based on the data, I believe that the current dire models radically overestimate the ultimate death toll. There are three reasons for this.

First, they underestimate the rate of adaptive responses, which should slow down the replication rate. Second, the models seem to assume that the vulnerability of infection for the older population—from 70 upward—gives some clue as to the rate of spread over the general population, when it does not. Third, the models rest on a tacit but questionable assumption that the strength of the virus will remain constant throughout this period, when in fact its potency should be expected to decline over time, in part because of temperature increases.

As of March 16, the data from the United States falls short of justifying the draconian measures that are now being implemented. As of two days ago, 39 states have declared states of emergency, and they have been joined at the federal level with President Trump’s recent declaration to the same effect. These declarations are meant to endow governments with the power to impose quarantines and travel bans, close schools, restrict public gatherings, shut down major sporting events, stop public meetings, and close restaurants and bars. Private institutions are imposing similar restrictions. The one-two punch of public and private restrictions has caused a huge jolt to the economy.

The irony here is that even though self-help measures like avoiding crowded spaces make abundant sense, the massive public controls do not. In light of the available raw data, public officials have gone overboard. To begin with, the word pandemic should not be lightly used. Recall that the Spanish influenza pandemic, fully worthy of the name, resulted in perhaps as many as a half-billion infections and between 50 and 100 million deaths, worldwide, of which some 675,000 were Americans, many coming back from Europe in the aftermath of the First World War. The World Health Organization recently declared coronavirus a pandemic at a time when the death count was at 4,000, presently being just over 6,500. It will surely rise no matter what precautions are taken going forward, but what is critical is some estimate of the rate.

By way of comparison, the toll from the flu in the United States since October ran as follows: between 36 to 51 million infections, between 370 thousand to 670 thousand flu hospitalizations, and between 22 thousand to 55 thousand flu deaths. That works out to between roughly between 230,000 to 320,000 new infections per day, and between 140 to 350 deaths per day for an overall mortality rate of between 0.044 percent to 0.152 percent.

As we think about the mortality rate of COVID-19, there are some important pieces of data to consider. The chart below documents the most current numbers reported by the New York Times (as of March 16) for the four hardest-hit states:

Note that Washington state, with 676 reported cases and 42 deaths, has a mortality rate of 6.21 percent, which can be traced to a nursing facility in Kirkland, WA. While only contributing 57 cases, it was the source of 27 of the reported deaths, almost two-thirds of the fatalities. (We should expect, as has been the case, that the mortality rate in Washington will decline as the newer cases will not come exclusively from that high-risk population.) The next three states have 1,577 diagnosed cases and 11 deaths for a mortality rate of 0.69 percent, a number which has trended lower over the last few days. Unlike the deadly exposures in Kirkland, the exposures in New York state produced many documented illnesses, but only two deaths even after two weeks of exposure. And while it is easy to miss latent cases, it is harder to miss any virus-related death. Given that the incubation period is about two weeks, the pool of cases before March 1 should be small.

Many of the dire media accounts do not mention evolution. After the initial outburst in Kirkland, the target population was fitter. It is instructive therefore to look at the total number of cases, which spiked from 70 cases on March 5 to 672 cases on March 15. But those figures do not presage an increase into the thousands of daily cases that would be needed to reach the totals of the flu season. The current numbers are about 3 percent of the rate of new flu cases in the 2019-2020 virus season. Even if there is some undercounting, it is highly unlikely, given the relatively short (two-week) incubation period, that the number of current cases will more than double or triple. It is also unlikely that most of the increase in reported cases (as opposed to deaths) will be in the population over age 70. More importantly, these numbers, as reported by the Centers for Disease Control, do not give any indication of heightened severity.

What, then, does all of this portend for the future of COVID-19 in the United States? Good news is more likely than bad, notwithstanding the models that predict otherwise. The deaths in Washington have risen only slowly, even as the number of infections mount. The New York cases have been identified for long enough that they should have produced more deaths if the coronavirus was as dangerous as is commonly believed.

But why might the dire predictions be wrong? Consider the New York Times graphic below, which catalogs the daily totals of new coronavirus cases:

The theoretical answer to the question of how deadly the virus will turn out lies in part in a strong analytical relationship between the rate of spread and the strength of the virus. Start with the simple assumption that there is some variance in the rate of seriousness of any virus, just as there is in any trait for any species. In the formative stage of any disease, people are typically unaware of the danger. Hence, they take either minimal or no precautions to protect themselves from the virus. In those settings, the virus—which in this instance travels through droplets of moisture from sneezing and bodily contact—will reach its next victim before it kills its host. Hence the powerful viruses will remain dominant only so long as the rate of propagation is rapid. But once people are aware of the disease, they will start to make powerful adaptive responses, including washing their hands and keeping their distance from people known or likely to be carrying the infection. Various institutional measures, both private and public, have also slowed down the transmission rate.

At some tipping point, the most virulent viruses will be more likely to kill their hosts before the virus can spread. In contrast, the milder versions of the virus will wreak less damage to their host and thus will survive over the longer time span needed to spread from one person to another. Hence the rate of transmission will trend downward, as will the severity of the virus. It is a form of natural selection.

One key question is how rapidly this change will take place. There are two factors to consider. One is the age of the exposed population, and the other is the rate of change in the virulence of the virus as the rate of transmission slows, which should continue apace. By way of comparison, the virulent AIDS virus that killed wantonly in the 1980s crested and declined in the 1990s when it gave way to a milder form of virus years later once the condition was recognized and the bathhouses were closed down. Part of the decline was no doubt due to better medicines, but part of it was due to this standard effect for diseases. Given that the coronavirus can spread through droplets and contact, the consequences of selection should manifest themselves more quickly than they did for AIDS.

It is instructive to see how this analysis fares by taking into account the Korean data, which is more complete than the American data. South Korea has been dealing with the coronavirus since January 20. Since that time, the Korean government has administered a total of 261,335 tests to its citizens. In press releases updated every day, the Korean CDC is reporting (as of March 15) 8,162 total infections against 75 deaths for an overall mortality rate of 0.92 percent. But as shown in the table below, the age-disparity in outcome is striking:

Clearly, the impact on elderly and immunocompromised individuals is severe, with nearly 90% of total deaths coming from individuals 60 and over. But these data do not call for shutting down all public and private facilities given the extraordinarily low rates of death in the population under 50. The adaptive responses should reduce the exposures in the high-risk groups, given the tendency for the coronavirus to weaken over time. My own guess is that the percentage of deaths will decline in Korea for the same reasons that they are expected to decline in the United States. It is highly unlikely that there will ever be a repetition of the explosive situation in Wuhan, where air quality is poorer and smoking rates are higher.

So what then should be done?

The first point is to target interventions where needed, toward high-risk populations, including older people and other people with health conditions that render them more susceptible to disease. But the current organized panic in the United States does not seem justified on the best reading of the data. In dealing with this point, it is critical to note that the rapid decline in the incidence of new cases and death in China suggests that cases in Italy will not continue to rise exponentially over the next several weeks. Moreover, it is unlikely that the healthcare system in the United States will be compromised in the same fashion as the Italian healthcare system in the wake of its quick viral spread. The amount of voluntary and forced separation in the United States has gotten very extensive very quickly, which should influence rates of infection sooner rather than later.

Perhaps my analysis is all wrong, even deeply flawed. But the stakes are too high to continue on the current course without reexamining the data and the erroneous models that are predicting doom.

© 2020 by the Board of Trustees of Leland Stanford Junior University.

Published in Healthcare
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  1. Albert Arthur Podcaster

    I think this thing is being exaggerated. Yes, lots of people will get sick and even die. But that happens all the time. I’m glad Richard mentioned the current flu stats. I actually looked those up myself earlier today. Imagine if the news was breathlessly reporting every new flu diagnosis?

    • #1
    • March 16, 2020, at 7:20 PM PDT
    • 13 likes
    • This comment has been edited.
  2. Skyler Coolidge

    I like professor Epstein. I really do. But this reminds me of his irresponsibly ill-informed commentary regarding firearms. I’m not sure I should take the say so of a professor of economics over the multitudes of experts on disease control. He may very well be right, but I’d rather hear that from an expert.

    • #2
    • March 16, 2020, at 7:26 PM PDT
    • 5 likes
    • This comment has been edited.
  3. iWe Reagan
    iWe Joined in the first year of Ricochet Ricochet Charter Member

    Fantastic. Complete agreement.

    We should limit quarantine to at-risk people. Don’t destroy the economy and so much besides just to flatten the curve of infection when the most people won’t even know they have a bug, let alone be seriously inconvenienced or hospitalized.

    • #3
    • March 16, 2020, at 7:30 PM PDT
    • 10 likes
  4. iWe Reagan
    iWe Joined in the first year of Ricochet Ricochet Charter Member

    Skyler (View Comment):
    He may very well be right, but I’d rather hear that from an expert.

    argumentum ad verecundiam

    • #4
    • March 16, 2020, at 7:31 PM PDT
    • 5 likes
    • This comment has been edited.
  5. James Gawron Thatcher
    James Gawron Joined in the first year of Ricochet Ricochet Charter Member

    Richard Epstein: Based on the data, I believe that the current dire models radically overestimate the ultimate death toll.

    Richard,

    Slamminnnn!!!

    Thanks, Richard.

    Regards,

    Jim

    • #5
    • March 16, 2020, at 8:04 PM PDT
    • 4 likes
  6. DonG (skeptic) Coolidge

    Some doctor on the special Ricochet podcast said that flattening the curve allows for more generations of the virus and that allows for more mutations and that over time the more milder mutations would proliferate, because the nasty versions kill the host quickly while the milder ones allow the host to spread more instances. 

    I don’t see anything to indicate that this thing will not spread like the Spanish flu to 30% of Americans. Herd immunity is low and it spreads well. I also assume a death rate similar to seasonal flu. Yes, the age range for seasonal flu is skewed lower because of immunization programs for the elderly, but we will probably throw expensive viral treatments at COVID-19 to keep that 0.1% case-fatality rate. 

    • #6
    • March 16, 2020, at 8:05 PM PDT
    • 2 likes
  7. Stina Member

    iWe (View Comment):

    Skyler (View Comment):
    He may very well be right, but I’d rather hear that from an expert.

    argumentum ad verecundiam

    This is a fallacy when used against a logical argument.

    Is it a fallacy when the premises are in dispute?

    To determine if an argument is logically sound does not assume premises are true. What if one of the premises is false? Is appeal to a knowledgeable authority a fallacy to ascertain truth of a premise?

    • #7
    • March 16, 2020, at 8:06 PM PDT
    • 6 likes
  8. Skyler Coolidge

    iWe (View Comment):

    Skyler (View Comment):
    He may very well be right, but I’d rather hear that from an expert.

    argumentum ad verecundiam

    It’s not a fallacy when nonexperts have no idea what they are talking about. Epstein has shown in the past that he is quick to pontificate about things he knows nothing about. Absent that dismal display of ignorant blathering about firearms, I might accept this analysis.

    • #8
    • March 16, 2020, at 8:23 PM PDT
    • 4 likes
  9. Skyler Coolidge

    On the other hand it is starting to seem that a few sensible precautions to not gather in stadiums is now transmogrifying into my vet refusing to meet people in the office and they only hand out medicines in the parking lot.

    • #9
    • March 16, 2020, at 8:28 PM PDT
    • 8 likes
  10. Valiuth Member
    Valiuth Joined in the first year of Ricochet Ricochet Charter Member

    Great, so what are we to make of the triage and death rate in Italy? Which according to accounts seems to match hospitalization and death rates experienced in Wuhan when the virus initially came on the scene? The response to which was massive forced isolation and quarantine by the Chinese government. Which about 4 weeks later has yielded a substantial drop in spread and death caused by the disease. But again the Chinese government was put in a situation where they felt forced to initiate even by their own standards drastic measures.

    We saw in the US what van happen if this disease hits a vulnerable community. So far half the deaths in the US have come from its spread in a retirement home. It would be great to simply isolate the infected, but the CDC botched the initial rounds of testing. So we dont really have a good grasp on who and how many have it. We can be sanguine, but our atitude doesn’t dictate the reality that actually is. So absent massive testing and targeted isolation what is the other solution than a blaise attitude? 

    The data we have on this disease from all over the world indicate it is far deadlier on average than the flu, and to a higher degree than the flu causes hospitalization. So if it were to spread as much as the flu its results would be several times worse, maybe about 10 times worse. We have enough samples world wide to be confident in this assessment. It is a substantial n value we are working with.

    Also, on the matter of the flu. Perhaps the casual reference to it should probably make people more conscientious of the problem that the flu is. The practice of washing your hands, covering your cough and staying home when sick rather than going about would do wonders in combating the flu every year. Not to mention taking the flu vaccine. 

    No matter what we do the spread of this virus will reach a limit. Biology dictates this. Given the lack of vaccine or drugs our only choice to decide where that limit is are policies of isolation. It’s a hard and simple logic, and no one has to like it for it to be true. 

    We messed up the early testing and tracking, a muddled message from the administration has convinced far too many that there was no danger, and the stark reality coming out of Itally has underscored how devastating these mistakes are. The Fed is panicking and the President is disavowing all responsibility. Why would people and government officials panic? I mean when a hurricane comes not even as many people die as are killed by the flu…

     

    • #10
    • March 16, 2020, at 8:39 PM PDT
    • 8 likes
  11. Ontheleftcoast Member

    Pandemic:

    A pandemic (from Greek πᾶν pan “all” and δῆμος demos “people”) is a disease epidemic that has spread across a large region, for instance multiple continents, or worldwide. A widespread endemic disease with a stable number of infected people is not a pandemic. Further, flu pandemics generally exclude recurrences of seasonal flu.

    COVID-19

    Disease epidemic: ✓

    Multiple continents: ✓

    Not a stable number of infected people: ✓

    Not the seasonal flu: ✓

    Title of post: This is not a pandemic.

     

    • #11
    • March 16, 2020, at 8:44 PM PDT
    • 7 likes
  12. drlorentz Member
    drlorentz Joined in the first year of Ricochet Ricochet Charter Member

    Stina (View Comment):

    iWe (View Comment):

    Skyler (View Comment):
    He may very well be right, but I’d rather hear that from an expert.

    argumentum ad verecundiam

    This is a fallacy when used against a logical argument.

    Is it a fallacy when the premises are in dispute?

    To determine if an argument is logically sound does not assume premises are true. What if one of the premises is false? Is appeal to a knowledgeable authority a fallacy to ascertain truth of a premise?

    It is a misuse of the fallacy. Epidemiologists and other medical professionals have deeper understanding than lay people. Their conclusions are not simply based on dogma. 

    Just as I would not expect Prof. Epstein to know as much about atmospheric physics, lasers, or fluid dynamic turbulence, so I would not expect him to have deep understanding of epidemiology and virology. And I certainly wouldn’t let him touch anything in my lab.

    • #12
    • March 16, 2020, at 8:51 PM PDT
    • 9 likes
  13. Hoyacon Member

    Skyler (View Comment):

    I like professor Epstein. I really do. But this reminds me of his irresponsibly ill-informed commentary regarding firearms. I’m not sure I should take the say so of a professor of economics over the multitudes of experts on disease control. He may very well be right, but I’d rather hear that from an expert.

    Is it possible that this is becoming a proxy war for libertarians and quasi- libertarians who are highly suspicious of any government action that amounts to “telling us what to do”?

    • #13
    • March 16, 2020, at 9:58 PM PDT
    • 3 likes
  14. Steven Seward Member

    Mr. Epstein, this is a huge breath of fresh air! There are so many people losing their heads over this thing. Even right here on Ricochet, many people who are normally rational are believing the hysterical hype.

    My wife is a researcher who is charged with doing lab detection of the Covid 19 virus as soon as they get the latest high-tech machine this week. I’ve been looking at all the data I can find, and nothing at all justifies these crazy projections being put out by the Press. As bad as the infection and death rates seem to be, they aren’t even in the ball park with common flu viruses. 

    For example, Italy, which is touted as the absolute worst case in the World, has lost 2,158 people to the Covid 19 virus to date. That sounds scary until you find out that they lost 68,000 people to the flu during the 2016 season! Both the infection rate and the death rates have already been leveling off in the first countries to get it, China and South Korea, and neither country lost an appreciable percentage of their people, compared to most “pandemics.” The other countries will start following suit as we near the end of flu season, and this wild mania will drift away, leaving psychologists scratching their heads.

    • #14
    • March 16, 2020, at 10:20 PM PDT
    • 15 likes
  15. drlorentz Member
    drlorentz Joined in the first year of Ricochet Ricochet Charter Member

    Richard Epstein: Overlooked is the good news coming out of China

    Not to put too fine a point on it, China took some draconian measures to slow the spread of the disease in Hubei province, including confining people in their homes by welding their doors shut. On the order of 100M people were put under quarantine. Given that such steps are not going to be acceptable in Western countries, it is inappropriate to compare the experiences of the two countries. Had the Chinese government not taken action, there’s little doubt the death toll and the economic effects would have been far more severe.

    Richard Epstein: Recall that the Spanish influenza pandemic, fully worthy of the name, resulted in perhaps as many as a half-billion infections and between 50 and 100 million deaths, worldwide, of which some 675,000 were Americans, many coming back from Europe in the aftermath of the First World War.

    Indeed it is well to recall the Spanish flu pandemic of 1918. Current estimates of the mortality of COVID-19 are roughly the same as for the Spanish flu. (The US mortality rate for the Spanish flu was estimated at around 0.5%.) The estimates for COVID-19 may yet be revised downward but they are the best we have now and we must act based on our best current knowledge.

    The data below should give anyone pause. It is a semilog plot wherein a straight line means exponential (geometric) growth. The surprising behavior of this kind of growth is the subject of the legend of the invention of chess: the numbers remain low for a long time and then suddenly rise. The exponential rates continue to remain high in most Western countries. Italy, France, the UK, and the US cases double every three days. Japan’s and Singapore’s rates double over a much longer time, roughly every eight days, because they have taken decisive measures to control the spread. Hubei province initially was also following the higher rate until the Chinese government instituted strong measures.

    In a couple of days, Italy is on track to reach the same level as Hubei province. One can hope that the measures the Italian government has put in place will bend the curve soon. The US is about 20 days behind Italy. Today, the president announced new measures and guidelines that will help the US be more like Japan. These have already been adopted in many jurisdictions. We will get through this but not if we adopt Epstein-esque complacency. No other serious person is.

    Notes:
    Horizontal axis is day of year (DOY), the number of days since Jan. 1, 2020.
    Vertical axis is the number of cases per one million of the population (log).
    Sudden jumps in the early data are caused by broadening of testing.
    data source: Johns Hopkins University CSSE; the JHU CSSE visualization

    • #15
    • March 16, 2020, at 10:24 PM PDT
    • 5 likes
  16. Snirtler Member

    Hoyacon (View Comment):

    Skyler (View Comment):

    I like professor Epstein. I really do. But this reminds me of his irresponsibly ill-informed commentary regarding firearms. I’m not sure I should take the say so of a professor of economics over the multitudes of experts on disease control. He may very well be right, but I’d rather hear that from an expert.

    Is it possible that this is becoming a proxy war for libertarians and quasi- libertarians who are highly suspicious of any government action that amounts to “telling us what to do”?

    Even people I associate with libertarian positions disagree among themselves. Check out their Twitter feeds: Russ Roberts, Tyler Cowen (and his econ blog), Nassim Taleb (he’s sort of a sui generis thinker)–they disagree with Professor Epstein.

    • #16
    • March 16, 2020, at 10:27 PM PDT
    • 1 like
  17. Steven Seward Member

    DonG (skeptic) (View Comment):

    I don’t see anything to indicate that this thing will not spread like the Spanish flu to 30% of Americans. Herd immunity is low and it spreads well.

    Why would you assume that the U.S. will have 30% infected when China only had about .006% of its population infected and it is now leveling off with extremely few new infections per day. 30% is a rate several thousand times greater than .006%.

     

    • #17
    • March 16, 2020, at 10:31 PM PDT
    • 3 likes
  18. Ontheleftcoast Member

    Richard Epstein: Recall that the Spanish influenza pandemic, fully worthy of the name, resulted in perhaps as many as a half-billion infections and between 50 and 100 million deaths, worldwide, of which some 675,000 were Americans, many coming back from Europe in the aftermath of the First World War

    Recall also that this is an analysis made with the most accurate diagnostic and analytic instrument in existence: the retrospectoscope.

    Recall also that we no longer depend on physical diagnosis in every case to determine that a patient has, say, tuberculosis. In advancing civilizations we can diagnose the disease sooner and often treat it before it does too much damage. Even before curative therapies were developed, diagnosis permitted the isolation of patients to minimize the spread of the disease.

    We do not yet have the full clinical picture of COVID-19, we don’t know the R0, and we don’t yet understand clearly how lethal it is. The USA has not yet ramped up diagnosis enough to understand how widely distributed spreaders of the disease are in the population.

    What we do know is that the incubation period is mostly up to 2 weeks, with a few reported outliers up to twice that.

    What we do know is that if we minimize the opportunities a carrier has to give the virus to someone else for a couple of weeks (in the case of the SF Bay Area where I live, the public health authorities went for 3 weeks) we stand a very good chance at preventing a disease that we suspect might be disease as severe as the Spanish flu — which we won’t know for sure until it’s too late to contain if we take inadequate measures — and which already is a pandemic (albeit technically defined as I did above) from becoming a pandemic “fully worthy of the name.”

    Professor Epstein excels at retrospective analysis; I have both enjoyed and benefited from reading what he writes and listening to him talk. But this is not like the usual subjects he talks about. This is more like a prosecutor applying for a search warrant for premises suspected of containing an active weapon of mass destruction with a ticking clock; the judge does not have much time to reach a decision.

    One more thing/postscript: It is definitely true that not everything billed as exigent actually is, and that not every disease outbreak that technically meets the criteria for an epidemic needs an urgent and draconian response.

    When enough data has been collected months from now, we will know whether today’s measures were excessive or whether managed to dodge a bullet. We’ll probably at least know in a month or two whether COVID-19 in the US actually is a disease as severe as Spanish flu in enough of the population to matter. But if it is and we take inadequate measures today, we’ll really be behind the 8 ball.

    • #18
    • March 16, 2020, at 10:52 PM PDT
    • 6 likes
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  19. Steven Seward Member

    drlorentz (View Comment):

    Indeed it is well to recall the Spanish flu pandemic of 1918. Current estimates of the mortality of COVID-19 are roughly the same as for the Spanish flu. (The US mortality rate for the Spanish flu was estimated at around 0.5%.) The estimates for COVID-19 may yet be revised downward but they are the best we have now and we must act based on our best current knowledge.

    The mortality rate of a virus is not a very reliable indicator at all of how many people are going to die from an outbreak or pandemic. Here’s one comparison. The mortality rate of flu is about .1% and it kills somewhere in the range of 250,000 – 500,000 people each year. Mortality from the SARS virus is in the range of 10%. That is 100 times more lethal than flu, yet, in the SARS epidemic of 2002, only 774 people died. Ebola has a 70% mortality rate but it killed nobody in the U.S. after a tiny outbreak.

    • #19
    • March 16, 2020, at 10:52 PM PDT
    • 7 likes
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  20. Weeping Member

    DonG (skeptic) (View Comment):
    I don’t see anything to indicate that this thing will not spread like the Spanish flu to 30% of Americans.

    Just to help keep things in perspective, according to Wikipedia:

    Estimates vary as to the total number who died. An estimate from 1991 says it killed 25–39 million people. A 2005 estimate put the death toll at probably 50 million (less than 3% of the global population), and possibly as high as 100 million (more than 5%). But a reassessment in 2018 estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population.

    <snip>

    In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population).

     

    • #20
    • March 16, 2020, at 10:57 PM PDT
    • 2 likes
  21. Scott R Member
    Scott R Joined in the first year of Ricochet Ricochet Charter Member

    Well I’d put Richard Epstein’s IQ and understanding of statistics ahead of Nicholas Kristof’s any day.

    In any case, he’s a brilliant guy with a thorough argument — not the sort of thing that should be casually dismissed. Is he right to be that optimistic? Let’s hope.

    • #21
    • March 16, 2020, at 11:36 PM PDT
    • 11 likes
  22. drlorentz Member
    drlorentz Joined in the first year of Ricochet Ricochet Charter Member

    Steven Seward (View Comment):
    The mortality rate of a virus is not a very reliable indicator at all of how many people are going to die from an outbreak or pandemic.

    I made no such claim and it is misleading to imply otherwise. The mortality rate is one piece of the puzzle. The other, the one you missed, is the percent of infected individuals. That is what all the control measures are attempting to minimize. 

    You might wish to review my comment, in particular the graph that is all about the number of infections. One reason the Spanish flu, which had a somewhat lower case mortality rate that current estimates for COVID-19, was so deadly is that about 30% of the US population was infected. 

    Steven Seward (View Comment):
    Here’s one comparison. The mortality rate of flu is about .1% and it kills somewhere in the range of 250,000 – 500,000 people each year. Mortality from the SARS virus is in the range of 10%. That is 100 times more lethal than flu, yet, in the SARS epidemic of 2002, only 774 people died. Ebola has a 70% mortality rate but it killed nobody in the U.S. after a tiny outbreak.

    Great pains were taken (successfully) to contain SARS and Ebola. Those efforts failed with COVID-19. There were other key differences. Ebola had a high mortality rate, which meant that it wasn’t readily transmitted: dying and dead people are poor transmitter of disease. COVID-19 has an incubation period during which individuals can still transmit the disease and many are asymptomatic carriers. Ever heard of Typhoid Mary?

    Another key distinction is that, unlike COVID-19,

    Ebola disease spreads only by direct contact with the blood or other body fluids of a person who has developed symptoms of the disease.

    Ebola may be spread through large droplets; however, this is believed to occur only when a person is very sick.

    The Spanish flu is a closer analogue than Ebola or SARS. Neither of the latter were pandemics, using the dictionary definition of the word versus the idiosyncratic Epstein definition. This thing is a pandemic. If we’re lucky, it won’t play out like the Spanish flu. Actually, luck has little to do with it; sensible precautions will help.

    • #22
    • March 17, 2020, at 12:49 AM PDT
    • 4 likes
  23. Steven Seward Member

    drlorentz (View Comment):

    Steven Seward (View Comment):
    The mortality rate of a virus is not a very reliable indicator at all of how many people are going to die from an outbreak or pandemic.

    I made no such claim and it is misleading to imply otherwise. The mortality rate is one piece of the puzzle. The other, the one you missed, is the percent of infected individuals. That is what all the control measures are attempting to minimize.

    You might wish to review my comment, in particular the graph that is all about the number of infections. One reason the Spanish flu, which had a somewhat lower case mortality rate that current estimates for COVID-19, was so deadly is that about 30% of the US population was infected.

    If it is the infected rate of individuals that you are worried about, I already showed that the infection rate for China is .006%, and it has more or less stopped at that level. The Spanish Flu’s infection rate of 30% is an astounding 5,000 times higher. They are not even comparable. The country with the absolute highest rate of infection, according to the Worldometers website, is Italy with an infection rate of .046%. Even this is 1/652 of 30%. All other countries are considerably less than this. I have no idea what all the lock-downs are all about.

    • #23
    • March 17, 2020, at 2:18 AM PDT
    • 8 likes
  24. Steven Seward Member

    drlorentz (View Comment):

     

    Steven Seward (View Comment):
    Here’s one comparison. The mortality rate of flu is about .1% and it kills somewhere in the range of 250,000 – 500,000 people each year. Mortality from the SARS virus is in the range of 10%. That is 100 times more lethal than flu, yet, in the SARS epidemic of 2002, only 774 people died. Ebola has a 70% mortality rate but it killed nobody in the U.S. after a tiny outbreak.

    Great pains were taken (successfully) to contain SARS and Ebola. Those efforts failed with COVID-19. There were other key differences. Ebola had a high mortality rate, which meant that it wasn’t readily transmitted: dying and dead people are poor transmitter of disease. COVID-19 has an incubation period during which individuals can still transmit the disease and many are asymptomatic carriers. Ever heard of Typhoid Mary?

    I’m sure you are correct about those diseases, but the Corona virus is still not being transmitted to very many people.

    • #24
    • March 17, 2020, at 2:29 AM PDT
    • 4 likes
  25. iWe Reagan
    iWe Joined in the first year of Ricochet Ricochet Charter Member

    Steven Seward (View Comment):

    I’m sure you are correct about those diseases, but the Corona virus is still not being transmitted to very many people.

    Or it is widespread already, but it’s asymptomatic for most. In which case, it is much less deadly.

    • #25
    • March 17, 2020, at 2:38 AM PDT
    • 6 likes
  26. Bryan G. Stephens Thatcher
    Bryan G. Stephens Joined in the first year of Ricochet Ricochet Charter Member

    Richard Epstein: But the current organized panic in the United States does not seem justified on the best reading of the data. In dealing with this point, it is critical to note that the rapid decline in the incidence of new cases and death in China suggests that cases in Italy will not continue to rise exponentially over the next several weeks. Moreover, it is unlikely that the healthcare system in the United States will be compromised in the same fashion as the Italian healthcare system in the wake of its quick viral spread. The amount of voluntary and forced separation in the United States has gotten very extensive very quickly, which should influence rates of infection sooner rather than later.

    So the extensive forced and voluntary separation will influence rates of infection. Good. But at the top of this paragraph that is called organized panic. Panic is bad. 

    I am confused. 

    • #26
    • March 17, 2020, at 2:46 AM PDT
    • 4 likes
  27. Bryan G. Stephens Thatcher
    Bryan G. Stephens Joined in the first year of Ricochet Ricochet Charter Member

    Hoyacon (View Comment):

    Skyler (View Comment):

    I like professor Epstein. I really do. But this reminds me of his irresponsibly ill-informed commentary regarding firearms. I’m not sure I should take the say so of a professor of economics over the multitudes of experts on disease control. He may very well be right, but I’d rather hear that from an expert.

    Is it possible that this is becoming a proxy war for libertarians and quasi- libertarians who are highly suspicious of any government action that amounts to “telling us what to do”?

    Libertarians have no good answers in place for plagues. 

    • #27
    • March 17, 2020, at 2:49 AM PDT
    • 1 like
  28. Doctor Robert Member

    Steven Seward (View Comment):
    For example, Italy, which is touted as the absolute worst case in the World, has lost 2,158 people to the Covid 19 virus to date. That sounds scary until you find out that they lost 68,000 people to the flu during the 2016 season!

    This is interesting. That’s two-three times the number of people that the US is said to have lost to flu in 2016. Perhaps the Italian heath system is poorly adapted to treating viral pneumonia?

    The CDC is not impressing me in this. Note in their summary of 2015-2016 flu season, that they don’t count the deaths. What a crock of s.

    https://www.cdc.gov/mmwr/volumes/65/wr/mm6522a3.htm

    • #28
    • March 17, 2020, at 2:58 AM PDT
    • 4 likes
  29. Doctor Robert Member

    Weeping (View Comment):

    DonG (skeptic) (View Comment):
    I don’t see anything to indicate that this thing will not spread like the Spanish flu to 30% of Americans.

    Just to help keep things in perspective, according to Wikipedia:

    Estimates vary as to the total number who died.

    <snip>

    In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population).

    Interesting numbers.

    Let us see how Spanish Flu compares to Wuhan Flu. People are estimating a lethality rate of 1% for Wuhan, see Richard’s Korean data above. I will Show My Calculations, as my calculus professor used to demand.

    Let’s average “0.48 to 0.64” to 0.55%, and round “105 million” to 100 million, keeping everything at two significant digits.

    28% of the population of 100 million infected = 28,000,000 infected

    0.56% of the population died = 560,000

    What is the death rate?

    28,000,000 = 560,000 X

    Drop four zeroes.

    2800 infected, 56 died. 2800 = 56X

    Divide by 56

    50 = X

    50 infected, 1 died.

    So the Great Spanish Flu, by these numbers, had a death rate of 1/50. 2%.

    Does that seem familiar?

    A 2% death rate in 1918 would translate to a 0.2% death rate today. We have steroids, O2, ventilators, ephedrine, etc. We also have ten times as many elderly people as a percentage of population, this is now 23%.

    I’m gonna go out to work today and see four patients. My other 12 have been cancelled by administration to limit opportunities to spread the virus. A virus which is as yet unreported in my county, which has caused no deaths among 182 confirmed cases in my state, nor any deaths in the immediately adjacent state of CT.

    At least I will have a chance to catch up on my paperwork, licensure, journal subscriptions etc. I won’t be able to go out to lunch, though, because the restaurants are closed, nor can I go buy a new suit for my upcoming trip to Amsterdam because the mall where my haberdasher works is closed and there’s no travel to Europe anyway.

    This “pandemic” is a crock. It is seasonal flu with a Wuhan twist, and it kills only old folks (like me). Keep the old folks home, and you solve it.

    It will end on November 4, or when enough people raise their voices in opposition to the intentional crippling of our economy which is being foisted upon us.

    • #29
    • March 17, 2020, at 3:08 AM PDT
    • 12 likes
    • This comment has been edited.
  30. Gazpacho Grande' Coolidge

    Skyler (View Comment):

    I like professor Epstein. I really do. But this reminds me of his irresponsibly ill-informed commentary regarding firearms. I’m not sure I should take the say so of a professor of economics over the multitudes of experts on disease control. He may very well be right, but I’d rather hear that from an expert.

    You might not need an expert in viral mortality. It’s a statistical analysis. The South Korean data speak volumes in terms of a) who gets it, and b) who is most likely to die from it. In the US, it’s a national overreaction, fueled by media, social and otherwise.

    I’m no expert either, but the annual flu precautions are largely ignored by enormous chunks of the country, yet tens of thousands more people become infected, and thousands die. Annually. I can’t recall, annually, if I’ve been sent home to work or not, during flu season.

    Oh wait. I can recall. It’s never happened.

    • #30
    • March 17, 2020, at 3:46 AM PDT
    • 12 likes