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Despite all the modeling and conjecturing, as far as I know refrigeration trucks were never needed in New York City to stack the dead bodies before. There are a boatload of known unknowns and unknown unknown with this pandemic, but the overwhelming death in New York City (and Italy) is a fact. At a minimum, any talk of this being roughly like a bad flu is sheer stupidity at this point. Do understand that I am not belittling the disease.I'm not one of those "don't worry, it's just another flu" deniers.My comments should be read carefully:I noted that a certain study suggested that the infection fatality ratio (IFR) could be lower than other estimates, and could be as low as that of seasonal flu.But IFR is just one factor in the severity of an epidemic.Even if true, the IFR can only be lower than other estimates (good) because the case count is vastly higher (bad).The death counts to date (high and bad) are unchanged. Nothing in what I said, nor implied by the study, suggests otherwise.I specifically mentioned that, even if the low IFR were true, the Covid-19 outbreak would still be far worse than seasonal influenza for a variety of different reasons.The biggest one is that, for this hypothesis to be true, the disease would be hitting a very much larger percentage of the population--larger than any seasonal influenza--due to vastly higher contagion.Plus the fact that it is compressed in time: the disease can and does sometimes crash local health care systems.And of course the rapid spread means there is no seasonal vaccine available.As a very wild guess, it seems plausible that even if the paper's results were true to the optimistic side,it might still be maybe 3-6 times worse than a bad influenza season in terms of total fatalities.Far more deaths in absolute numbers, and a far worse spike in caseload with all that that entails.A bad influenza season generally causes over 50000 deaths in the US.A figure 3-6 times that is not anything to belittle, nor would I.But it would still be nice news, since it's much better than (say) 10-25 times worse, the sort of figures you might get from other studies.Emphasis on "very wild guess".All we know for sure is that at any given level of the population getting infected, a lower best-guess IFR estimate would be better news.What the researchers infer from the data might be right, or it might not.But it is superficially interesting.The number of people visiting doctors with "reportable threshold" influenza-like illnesses, but not influenza,and in excess of what would be normal for this time of year, was running around 200 times the number of reported Covid-19 cases in the same time frame.(extrapolated from a big sample)Plus, geographically, this effect was biggest in places that Covid-19 is known to be relatively prevalent.A lot of those doctor's visits are presumably Covid-19 cases, but we don't know how many.Some unknown fraction of those cases will be other things, meaning the hidden Covid-19 cases would be lower than that figure suggests.But all asymptomatic and mild (e.g. fever under 100F) Covid-19 cases would still be uncounted, meaning the undiagnosed Covid-19 cases would be higher than this metric could catch.There are wild unknowns in the interpretation, but even with big error bars an "excess" of 23 million non-influenza symptomatic influenza-like illnesses in three weeks is something in need of an explanation.Surely some disease, or set of diseases, is causing that bump.There is a known epidemic going on with generally very low testing rates, so there is one obvious potential explanation worth considering as a candidate.From a high level perspective, we'll know soon.If I were a betting man, I would wager on the more optimistic (IFR<0.2%) interpretation being mostly wrong. (a bet I'd love to lose, of course).My own speculation is that first wave "peak daily cases" might be hit soon in the US, but that the curve will not end up being symmetrical but positively skewed.Big rise, peak, very long slow fall because of a nearly steady stream of new cases for quite some time.Why this idea?In Italy daily deaths 15 days before the peak were 20% of the peak.But 15 days after the peak, deaths were still 67% of the peak, suggesting a slow wane.Given the relatively spotty lockdown situation in the US, it seems reasonable to posit a weaker fall-off rate than in Italy.Jim
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