Italian Daily Death Rate Up 20% Because of Coronavirus, Lombardy Up About 80%

One way of getting a perspective on the magnitude of the problem, at least today, and in what seems to be the hardest-hit country.

|The Volokh Conspiracy |

Italy's population is about 60 million, and its normal death rate is 10.6 per 1000, which is to say about 640,000 deaths per year, or about 1750 per day; the 350 or so extra deaths per day over the last couple of days (if this worldometers.info data is correct) are about 20%.

But apparently about 2/3 of the deaths have been in Lombardy (in Northern Italy; Milan is the capital), which has about 1/6 of Italy's population. If the daily deaths are likewise 2/3 in Lombardy (not certain, because it's possible that the geographical incidence of the deaths has changed over time), then we're talking about 240 or so extra deaths per day on top of the usual 300 or so in Lombardy, or about 80%.

These are unusually high numbers, of course, since Italy appears to have the highest death rate of any country right now; and of course they are just the numbers for the last couple of days. (Daily deaths in China have apparently fallen sharply, after climbing sharply and then staying high for a couple of weeks.) They are also back-of-the-envelope estimates based on imperfect data, but I hope they give a more useful perspective on the magnitude of the epidemic than do the raw numbers.

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  1. I wonder if any of the disparity is from transporting patients to Lombardy because they have the best or most hospitals for treats respiratory diseases. Would the deaths be counted in Lombardy or the original residence?

    1. Interesting. Had there been a lot of transports from across the country into the region early on? I haven’t read anything about that.

      1. Sorry, wasn’t clear. I have heard nothing of the sort. Just idle speculation.

        1. Ah. Okay. But it does raise an interesting point. People in outlying areas probably will end be transported around during this thing to more capable hospitals so it will probably skew infection/death rates in cities vs rural areas. But I’ve never really thought about how that’s counted.

          1. Lombardia was cordon off from the rest of Italy more than a week before the lockdown. Remember than many people from other regions come to Lombardia to work.

            1. Nobody is getting transported to the hospitals in Lombardy. The hospitals in Lombardy are so overcrowded that they are triaging and letting patients who are less likely to live die because they lack the capacity to treat everyone. If anything, patients would be transferred out of Lombardy to areas where there are fewer cases, but I don’t think that’s happening either because Lombardy has been cordoned off.

    2. Your calculations are compared to annual rates – you need to adjust all rates to the time that has lapsed – generously that would be a month. This is because it is likely that the deaths are going to peak soon and then drop for the rest of the year. Anyways think about an adjustment.

  2. What terrifies me is that about 15 years ago, there were rumors that the Chinese Government was working on racially-specific bioweapons. Wuhan is where Harvard’s Dr. Charles Lieber set up a research lab, apparently without Harvard’s knowledge. He’s facing a Federal indictment, along with two graduate students, one who is a Lieutenant in the Chinese Army and another who was detained at Boston’s Logan Airport, en route to China, with some 21 vials of biological materials that he has stolen from a Harvard-affiliated hospital and was trying to smuggle out of the country.

    This all happened last January.

    Now it is possible that it is all coincidental and it is possible that it isn’t — we have no way of knowing. It’s possible that the Chinese Government is telling us the truth where this came from (i.e. the Bat Soup) and it’s possible that it escaped out of their Level 4 lab. (It’s entirely possible that someone sold research animals for food — China *is* that corrupt, remember the plastic in the pet food?)

    Hence there is the possibility, I emphasize possibility, that there might — I emphasize might — be a genetic aspect to vulnerability to the Wuhan Virus. And as I understand it, there are genetic/racial differences between the people of Northern & Southern Italy.

    And that leads to some very chilling thoughts, doesn’t it?

    1. Hence there is the possibility, I emphasize possibility…..

      There’s also a possibility (I emphasize possibility) that the Loch Ness monster is being kept in a giant underground water tank below Area 51, but I don’t spend many sleepless nights worrying about it (OK, maybe a few….)

      1. But explain why all that water has suddenly appeared in the Nevada desert…. 🙂

      2. omg that’s hillarious!

    2. Look up Liebers research appears. Nothing near anything with diseases.

      This is dumb speculation. It was also dumb when the Canada Free Press pushed the nationalistic blame game yesterday.

      Spend you worries on something less fantastical. No shortage these days.

      1. There is an interesting Chinese study that appears to indicate that those with Type A blood might be more susceptible to the Wuhan Virus.

        I have issues with their research methods, and it isn’t clear if those with Type 0 blood are less susceptible or have a milder case (and hence do not need to be hospitalized) — but I understand why they used the data they could get, and what they found is what they found.

        And blood type is a genetic characteristic — your blood type is determined by what your parent’s blood types were. So if they are right, my concern is not quite as fantastical as you might think — although that doesn’t inherently mean that this was human-engineered to be so.

        1. There is a genetic component to vulnerability to all diseases.

          It’s the man-made bit that I’m quite skeptical of.

          1. In terms of if it is possible or if the CCP did it?

            40 years ago, wouldn’t you have been skeptical of fish genes being inserted into tomatoes?

            1. In terms of that’s what happened here. I’m not up on the latest in bioweapon capabilities. But that doesn’t matter – there is no evidence of that here.

    3. Why did you give up TV to get your doctorate?

  3. It may be even more alarming if we knew the age distribution of the 240 new deaths per day. It could wipe out nearly all members of the generation now 80+.

    We have this word genocide. Is there a word for extermination of a generation?

    1. Mortality has been analyzed in Italy based on more than 1000 deaths.
      >90 19%
      80 – 89 16.6%
      70 – 79 9.6%
      60 – 69 2.7 %
      50 – 59 0.6%
      <49 0.1%
      All ages 5.8%

      Source: Instituo Superiore di Sanitá "Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia Il presente report è basato sui dati aggiornati al 13 Marzo 2020"

      1. I would be interested to know (from anybody who can review and translate that report) if that is the estimated Case Fatality Ratio in Italy or the estimated Infection Fatality Ratio. The 70 to 79 rate would be just under twice the infection fatality ratio estimated elsewhere. The 80+ is high, too. (The 50-69 figures look to be in line with other reports.)

  4. Anecdotally, I have an awful lot of friends in lockdown in Piemonte, all very frightened.

    However, one thing that has to be noted is that Italy (and all of Europe) has a very elderly population, with over 22% above 65 (we are 16%). Their 60M live in 116.3K mi². Our @ 328M live in 3,115M mi² (excluding Alaska and Hawaii). That’s a bit more than Colorado. Its population is just under 6M. So, you have a large number of elderly people living one on top of each other. Their situation is not directly comparable to ours.

    China’s population is @ 1.5B. Their land area is 3.7M mi². However, the Gobi Desert is about 500K of those. Only 57K live in the Gobi. Our Usable land areas are about the same. Their situation is not easily comparable to ours. Our sparse population is a boon in pandemics.

    This disease hits the old more heavily than the young and the delta is huge. The mortality rate for those in their 80’s is near 15% from data I have seen from China and 10% for those over 70. It declines rapidly from there but still isn’t fun for those in their 50’s (me).

    The big thing to focus on, IMHO, is cardio. The victims die from congestive heart failure due to a massive amount of fluid buildup in their lungs and hearts too weak to keep the lungs clear. Social distancing, fresh air, sunlight, for Vitamin D (no damn sunscreen (build up a base tan first, it’s burns that cause cancer), and keep doing cardio, hopefully hiking outdoors.

    Please stay safe people!

    1. Actually a scatter plot of COVID mortality vs. median age show no correlation.
      It also shows that some countries such as Germany are actively manipulating the data to show mortality similar to seasonal flu.

      1. What scatter plot are you referencing?

  5. Calculating a death rate in a population during an epidemic (or a hurricane) is pretty meaningless. When this is all over, the death rate in that region will plummet to well below average for a while.

    1. Ouch, that is not meaningless to those families.

      You are suggesting that the extra deaths are weighted toward those with underlying health problems and who may not have much life expectancy anyhow.

      That may be correct logic, but it is horribly insensitive to call it meaningless. Shame on you.

      1. Get a grip, he obviously meant it was *statistically* meaningless…

        1. No you get a grip. Sensitivity means paying attention to how the speech may be heard (especially by the grieving), not what the speaker meant.

          1. Am guessing you might be the only person reading this who thought he meant that the deaths themselves were meaningless…

            1. No. You (and perhaps he) don’t understand the implications of what he is saying. In essence, he’s saying that if a bunch of old people and people who suffer from other conditions die in the epidemic, then the death rates for the next 5 or 10 years will be lower, because the people most likely to die will already have died. As the husband of an immunocompromised wife, I find that extremely offensive. And it is not statistically meaningless that those people live shorter lives. I would like to hear him justify his statement.

              1. Furthermore, even if his assertion that the premature deaths of the elderly and the infirm are statistically insignificant were correct (which it is not), it also ignores the evidence that many otherwise healthy people who have bad cases of COVID-19 but survive suffer significant permanent damage to their lungs. It is reasonable to infer that they will have shorter lifespans as well. In addition, the gross overcrowding in the Italian hospitals has led to inadequate care of people who do not suffer from COVID-19, some of whose lives will also be cut short. I hope that won’t happen here, but we’re heading in that direction.

              2. And yet, as an immunocompromised person myself I need neither explanation nor justification, as I read his intent as clearly stating that if you were to take the multi-year death rate (say, 2020-2030) you won’t see even a blip because of this, unlike many prior pandemics which had a greater impact on young and healthy people which would have long term impacts by removing people who were still in reproductive ages.

                It may be an unpleasant thought (I suspect my wife feels similarly to you), but it’s a useful observation because it (correctly!) reminds us that while we may lose loved ones (and if you have 4 grandparents still alive, make sure you tell them you love them now because the combined rate for all four is pretty bad) the ones we’re likely to lose are those we’ve had to consider anyway, rather than have to worry about our children.

                I’m prepared to say goodbye to my mother, but if I lost my kids I’d kill myself. Fortunately I get the better (less bad?) odds in this pandemic, and that’s a reassuring thing because it could always be much worse, and this is a helpful reminder of that.

            2. It never occurred to me that Thomas A Grugle, MD meant anything but “statistically meaningless”.

              First, the “MD” at the end of his screen name suggests the comment was written by a doctor or one playing a doctor on Reason.com. I would expect doctors to understand, focus on, and talk about statistics (although the results of a poll or study from a while ago where doctors were questioned about interpreting test results given statistics on the sensitivity and specificity of hypothetical tests was alarming).

              Second, the very notion of “death rate” is a statistical concept so my brain, using the art of understanding context, went to statistical concepts first.

              Third, I think the typical reader on this blog is going to be quite a bit more educated than the median person so I would expect the discussion to be more oriented towards science and logic than emotion.

              Fourth, the comment was a fairly insightful observation viewed through the statistical lens but only in that context.

              Unfortunately, some people like California Dreamer are unable to see beyond their personal situation and view the world objectively. They prefer to jump to conclusions that allow them to express outrage. I live in California but we have too many people here like California Dreamer which is why I will be moving now that I’m retired.

              1. “Fourth, the comment was a fairly insightful observation viewed through the statistical lens but only in that context.”

                No it’s not insightful. It’s obvious. If I was a lawyer, I would use reductio ad absurdum. A murderer might want to use that as his defense. “Doesn’t matter if I shot him. He would die someday anyhow.” Do you think the jury would consider that “insightful?”

                1. No, but that’s because the information is irrelevant to what the jury is being asked. But since we were asked by the OP to consider the death rate in Italy, observations about the uselessness of death rates are at least relevant, even if you don’t think they’re insightful.

      2. I’d rather have someone realizing that the data was meaningless than not realizing that and making decisions based on said meaningless data.

        Reality is that situations like this are not pretty — look up what the word “triage” really means…

    2. Completely agree. The information has limited value.

  6. Readers of this post might find this interesting.

    Why Italy and Iran?

    1. Wow. One Belt, One Road is probably ‘DOA’ now. That Johns Hopkins map reads like a travel itinerary for the damned Red Chinese. Those little fuckers were everywhere. And everywhere they went, they spread disease and death.

      China will have a time of reckoning when this is over. Depend on it.

      1. Some are using this to stoke anti-Chinese nationalism. Don’t fall for that. Pandemics are not a thing that can be blamed on a country.

        Though if you’re going for ‘Red Chinese’ and the diseased foreigner trope, I’d guess you’re too far gone to pull back now.

        1. Pretty sure that was meant at least partially tongue in cheek. Though I understand that in the current year it’s en vogue to assume the worst from people when it allows your outrage to gush out.

          1. Oh, that makes sense. It did seem out of character for XY.

            1. It was partly tongue in cheek.

              But if you look at the Johns Hopkins dashboard (I do), it really is quite amazing how the spread happens over time. Maps quite nicely when you overlay with airline and railway routes. Almost like petals of a flower or spokes in a wheel, with China as the center.

              Here in the US, we can safely assume we have 50K+ asymptomatic carriers, using 7K afflicted as a starting point, and assuming 15% (roughly 1 in 7) of total Wuhan virus (SARS-CoV-2) sufferers actually have symptoms severe enough to prompt them to get a test.

              1. Did this start in China? Yes.
                Everything needs to start somewhere.

                The path seems the usual style – I saw a black plague map that looked pretty similar to the spread here (absent the US of course)

              2. I’d say 50k is a pretty good starting point for the number of infected.

                Just don’t tell the government that. They’re committing economic suicide in states with less than 100 people (officially) infected (KY). Who knows what they’d do if they thought 7x that number.

        2. At the very least, the CCP (Chinese Communist Party) is responsible for failing to tell the world the truth about what they apparently knew last October. They cost us time and hence lives.

          And I’m not willing to dismiss the possibility that this came from the Wuhan Institute of Virology.

          And even if this did come from bat soup, researchers in Taiwan believe that the leaking sewerage pipes in Chinese apartment buildings helped spread it.

          1. Sure – but given our response once we did know, I don’t think we can claim much of a high ground there.

            You should dismiss things until there is evidence. As your attempt to tie in Lieber shows, this just opens up ways to buy into a false narrative.

            Sewage now? FFS, stop working so hard to blame China, it’s lunacy.

        3. “Pandemics are not a thing that can be blamed on a country.”

          Wrong. Civilization has been built on two bedrock principles:

          1. Freedom of expression; Freedom of speech
          2. Independent judiciary and the rule of law: protecting citizens FROM the state

          When a patient arrives at a hospital with an infection, in a western country that works under these principles: the lab tech looks at something they don’t recognize, they sequence it and find it to be something novel, and a massive apparatus jumps into action to contain it – spreading the word world wide, accepting all help.

          When patients arrived at a hospital with neither of the 2 bedrocks of civilization, the new infectious agent is found, and the people that found it are arrested, silenced and possibly jailed. Which leads to a global pandemic as it spreads uncontrolled.

          It has nothing to do with race or ethnicity. It is the system. I am certain that those diligent, hard-working Chinese scientists and doctors who first identified the novel virus would have done the right thing and been heroes if they had been living in a civilized country.

          This is the CCP Plague.

    2. From the article:

      “As a result of One Belt and One Road, there are more than 300,000 Chinese living in Italy.”

      To determine whether this explained the difference between Italy and, say, the US, I’d need to know how many “Chinese” are living in the United States.

    3. Readers of this post might find this interesting.

      Why Italy and Iran?

      What I find hilarious is that I took one look at the comments and was like, what the hell kind of site did I land in, with all these american flag, maga hats, and Mark Twain icons?

  7. This calculation seems faulty since at least some (possibly between 15-20%) of those “extra” Coronavirus deaths include people who would have died even without the Coronavirus. This isn’t the case with something like the flu that kills people of all ages and even the healthy.

    But even with the flu (or regardless of the cause of death), it seems incorrect to add the number of deaths reportedly caused by something in particular onto the daily average because doesn’t the average already include those kinds of deaths?

    For example, there were 24,981 flu deaths in Italy during the 2017 winter season. That works out to around 278 deaths per day. You can’t add those 278 deaths onto the daily average because the daily average included those kinds of deaths. Coronavirus is not as seasonal as the flu, but viruses like it are and kill people every day.

    I could be completely wrong and am open to any and all criticism in my thinking.

    1. Italy counts any death of a person in hospital as a COVID death.
      Germany counts the death of a person from COVID induced pneumonia as a pneumonia death, not a COVID death.
      Italy may be over counting but Germany is woefully undercounting.

      1. How do we know that the pneumonia was caused by COVID?

    2. “Coronavirus is not as seasonal as the flu’

      Arguing facts not (yet) in evidence.

      1. Actually, as it is a corona virus, and other corona viri are seasonal, ummm….

  8. Is there any more info on the likelihood that it’s sheer coincidence that the virus originated in the same local neighborhood as the Wuhan biosafety level-4 pathogen lab?

    1. Don’t be a conspiracy theorist.

      1. Isn’t his question precisely asking if anyone has built the statistics to determine if that particular theory can be safely disregarded though?

        Turn this around the other way: if a biological weapon were accidentally released, would it be in an area with a containment lab, or an area without one? If this were a false flag biological weapon release – like the Chinese Foreign Ministry’s Zhao Lijian claimed – would the US (or another) have released it where a containment lab is located, or somewhere else?

        What he’s getting at is not: is this true?

        Rather what he’s asking is: has anyone updated the Bayesian analysis of the non-natural causes as a source so that a layman can disregard these theories beyond a simple “trust us” from various governmental agencies?

        1. CCP agencies whom we know we can’t trust…

        2. That’s not what ML was doing. But even what you’re asking is conspiratorial. There is no evidence of a bioweapon. Demanding statistical investigations of what a bioweapon would look like is just buying suspicion where there is none.

          It’s dumb when China accuses us, and it’s dumb when we accuse China.

          This is no time for nationalistic tin-foil waving contests.

          1. Yes. Human cooperation is both extremely critical and extremely threatened in a scenario such as this. We should nurture and encourage it.

          2. It’s not dumb if there is a rational basis for it — and both the US & UN believe that the CCP has been doing Bioweapons research in Wuhan.

            Furthermore, the mere fact that the CCP is accusing us leads one to speculate that they, themselves, may have been doing it.

            1. This is dumb as hell.

            2. Even if there were some rational basis for the theory, it would be dumb to divert resources to that in our current predicament. Focus on fighting the virus, not each other. Later, we can analyze the data (which can and should be gathered in any case, though as with many things, cooperation will enhance this) to test hypotheses to our hearts’ content.

        3. Exactly Robert. And adding to the universe of non-coincidental possibilities, this could be a naturally occurring pathogen that originated in animals, was not engineered, was never intended for use as a bioweapon, but that nonetheless originated from the Wuhan lab.

          I’m not aware of any specific evidence of a non-coincidental scenario — beyond, of course, the monumental circumstantial fact of a seafood market less than 10 miles away from one of a handful of BSL-4 labs in the world being identified as the origin.

          On the other hand, there appears to be some evidence against specific non-coincidental scenarios, which may possibly count as evidence for this being mere coincidence. Braying, low IQ journalists and the NPCs like Sarcastro who follow them don’t count, of course.

          1. Genomic analysis appears to provide some evidence that the virus came from animals and was not genetically engineered or manipulated in a lab. http://virological.org/t/the-proximal-origin-of-sars-cov-2/398

          2. Two more general arguments against specific scenarios: a. Wuhan lab has protocols like other BSL-4 labs to prevent accidental release. b. Virus would not be an effective bioweapon and therefore could have been specifically intended for such use (this latter argument doesn’t strike me as particularly compelling).

          That’s all I’ve got.

          1. I deal in evidence. You admit there is none.

            Then you go and do what you do – deal in speculation.

            That’s not being an NPC, it’s not being a conspiracy theorist.

            And here the right-wing media is pushing this connection. And you’re right there with them. Like clockwork. Whose the NPC now?

            1. You deal in platitudes, politics and talking points. You never deal in evidence and are generally manifestly incapable of substantive comprehension or analysis. I like you though and appreciate your conversation on matters of opinion and politics and the like.

              1. Yeah, nothing you say about me is true. You’re mixing up disagreeing with your pro-Trump anti-immigrant nonsense with being incapable of analysis.

                I used to like you, but then you started embracing spinning this kind of conspiratorial nonsense. Your world is no longer closely related to the real world. Or at least the world you project on the Internet.
                And it’s always outcome-oriented nonsense. In this case, the right is trying to connect this to some intentional plot by China for whatever dumb reason. You’re right there with them.

                NToJ has a bit more time for your silliness than I do. As usual.

                1. You probably exist in a D.C. bubble. What you don’t realize is that a hundred million Americans are entertaining coronavirus-related conspiracy theories right now. The information I’m presenting is actually throwing cold water all over conspiracy theories. But you’re not credible if you don’t start with acknowledging the absurdity of this particular coincidence. You’re just dead wrong about me being outcome-oriented. Contrary to your suppositions, the more common conspiracy theory I’ve seen has actually been that the virus was planted in China by anti-Trump actors in the West. This appears stem from misunderstanding of a 2015 U.S. patent labeled “coronavirus” obtained by a British firm.

    2. I’m not even sure what evidence someone would provide you that would demonstrate “sheer coincidence”. To others’ questions, what exactly would the Bayesian calculation run as the numerator and denominator?

      I’ll try. The world is very large. There are 6B people in it. Any place that an epidemic begins will look idiosyncratic. But Wuhan is the ~40th biggest city in the world. So, in terms of actual places it could start, that puts it a high likelihood, at least relative to the innumerable places in the world.

      US experts have largely ruled out genetic engineering of the discovered disease. The mutation in this disease is “completely consistent with natural evolution.” And US intelligence experts have rejected that the Wuhan Institute of Virology is a bioweapon research center. (If you had another institute in mind, let me know.)

      Conceptually, it would be unusual for a foreign government to manufacture a disease in a bioweapon facility, and then have that very same bioweapon facility be the first to identify, analyze, and name the disease. I suppose a conspiracy theories would say: “THE PERFECT CRIME! THE EVIDENCE THAT THEY DIDN’T DO IT IS EXACTLY WHAT YOU’D EXPECT IF THEY DID!” Virtually all conspiracy theories have this condition. Evidence that supports the theory is accepted as evidence of the theory. Evidence that undermines the theory is accepted as evidence of the underlying conspiracy to hide the theory from the public.

      1. Agreed on all your points. “I’m not even sure what evidence someone would provide you that would demonstrate “sheer coincidence””. Me either. It’s a good question to ask, though, since that is the very assertion being put forward, e.g. from Vox: “The emergence of the virus in the same city as China’s only level 4 biosafety lab, it turns out, is pure coincidence.” The answer is, you would provide evidence against non-coincidental explanations and evidence for coincidental explanations. And that’s exactly what I’ve found since posting my comment, mostly just in the article I linked above. Among other things, the article notes that there are documented instances of SARS-CoV-1 escaping BSL-2 labs through being acquired by personnel. There is good evidence that SARS-CoV-2 was most likely not genetically engineered, created, or manipulated in a lab, though — or more particularly, in vitro.

        “Basic research involving passage of bat SARS-like coronaviruses in cell culture and/or animal models have been ongoing in BSL-2 for many years in multiple laboratories across the world25-28. There are also documented instances of the laboratory acquisition of SARS-CoV-1 by laboratory personnel working under BSL-2 containment29,30. We must therefore consider the possibility of a deliberate or inadvertent release of SARS-CoV-2. In theory, it is possible that SARS-CoV-2 acquired the observed RBD mutations site during adaptation to passage in cell culture, as has been observed in studies with SARS-CoV5 as well as MERS-CoV31. However, the acquisition of the polybasic cleavage site or O-linked glycans – if functional – argues against this scenario. New polybasic cleavage sites have only been observed after prolonged passaging of low pathogenicity avian influenza virus in cell culture or animals. Furthermore, the generation of SARS-CoV-2 by cell culture or animal passage would have required prior isolation of a progenitor virus with a very high genetic similarity. Subsequent generation of a polybasic cleavage site would have then required an intense program of passage in cell culture or animals with ACE-2 receptor similar to humans (e.g. ferrets). It is also questionable whether generation of the O-linked glycans would have occurred on cell culture passage, as such mutations typically suggest the involvement of an immune system, that is not present in vitro …

        Although genomic evidence does not support the idea that SARS-CoV-2 is a laboratory construct, it is currently impossible to prove or disprove the other theories of its origin described here, and it is unclear whether future data will help resolve this issue.”

  9. Hi Professor Volokh, an additional wrinkle is that the draconian lockdowns in Italy may be temporarily reducing deaths due to causes like accidents etc.

    So the additional death rate due to coronavirus may be even higher.

    1. That’s an unpleasant (but useful) insight.

      Thanks a lot dude, ????

  10. Italy has a much higher death rate because it has a much older population. One needs to normalize death rates according to age demographics.

  11. One comment above notes that “[o]ur sparse population is a boon in pandemics,” a fact Jefferson also noted way-back-when. There was significant discussion of population density back on Ezra Klein’s pre-Vox blog at WaPo (where many made ill-informed arguments favoring housing critical equipment in dense population centers while eschewing more properly distributed systems). Libraries are good models for health care systems: we do not put all of our books into a single central repository and we do not allow a single librarian (or board of librarians) to determine the content of libraries nationwide. Distributed systems offer critical advantages.

    Having said that, we must recall that immunity can be acquired via exposure, inoculation, or [implicitly] death: the rates of infection and death can be time-shifted (we can kick-the-can down the road… at this point, to sometime in the May-Nov window) by social distancing but the rates of infection cannot be permanently lowered until a greater of the population (the “herd”) acquires immunity by one of the three mechanisms. As noted in https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf , the time shifting due to social distancing manages available medical resources while facilitating (“buying time” for) both development of inoculation and development of herd immunity.

    1. “…the time shifting due to social distancing manages available medical resources while facilitating (“buying time” for) both development of inoculation and development of herd immunity.”

      And it does come with costs.

      1. When you shift the amount of time that the system is fully-stressed, you increase the non-virus related mortality. Patients with other conditions have a longer window when they are not receiving proper care.

      2. When the effect of time shifting is to cause millions of people to lose their savings, jobs, socializing and mental health your public health costs and ‘excess’ mortality over the next 6 years are so goes way up. Even cancer deaths will explode over the next few years due to the economic shutdown:

      https://www.hsph.harvard.edu/news/press-releases/economic-downturn-excess-cancer-deaths-atun/

      Deaths of despair will be orders of magnitude higher.

      I wouldn’t want to be the one who chooses which path is taken, but if you could look at the total mortality over the next 6 years or so, it is far from certain that the current path saves the most lives.

  12. “…or about 1750 per day; the 350 or so extra deaths per day over the last couple of days (if this worldometers.info data is correct) are about 20%.”

    This assumes that none of the 350 people who died would not have died but for COVID. The fatalities cluster with people who already have unusually high all-cause mortality risk.

  13. The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

    This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.

    The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

    Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

    https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

  14. A very good resource for Italy is GEDIVisual

    They are providing province breakouts and also include swabs/test given as well as stage of care (in-home isolation, non-ICU hospitalization, ICU).

    And it’s not all bad news in Italy. A good case study of what worked in Vo is on the promarket.org blog

  15. Why is anyone acting shocked that a government-run, third-world health care system can’t handle a hiccup? Canada brags about how few MRI machines it has. Britain doesn’t change the sheets between patients and on a good day people die in corridors. Italy’s a bigger dump than the two of them combined. These countries are proud of the fact that it takes months to see a doctor and many more months to see a specialist. If they could handle a spike in twisted ankles it would be a fucking miracle.

    1. The public health systems in Alberta and British Columbia have done a phenomenal job of contact tracing and isolation so far. Considering that these provinces, particularly British Columbia, had tens of thousands of people arriving from China, and Iran throughout January and February, with no airport screening, their current ICU caseload is shockingly low.

      Canada has fewer ICU beds, but more hospital beds per capita than the US. Germany and Belgium have the most capacity:
      https://secure.cihi.ca/free_products/ICU_Report_EN.pdf

      It will be interesting to see German data once this is all over.

  16. Everybody needs to stop reporting official numbers from China. They are worse than meaningless – they are pure propaganda.

    Xi has declared that all new cases of the Wuhan virus in China must now be declared ‘imported’. So it is written. So it shall be.

  17. This is what happens when someone with no clue of the situation and a very limited statistics background is allowed to use a calculator. All deaths in Italy where someone tests positive for CV-19 is recorded as a CV-19 death. In Lombardy, nearly 50% of patients that have passed away have had 3 chronic underlying conditions. The median age of death is 80.5. So, you are saying that every single case is purely due to CV-19 and that none of these people would have passed away had they not been infected with the virus? What about the air quality in Lombardy that these people have been breathing in for decades? Is that not as factor in their death? The number of deaths in Italy has been increasing significantly every year due to particulate air pollution. And what about the antimicrobial resistance rate being one the highest in the world in Italy, meaning people don’t respond to antibiotics for k. pneumoniae? Should the real (shocking) causes of these deaths (over prescription of antibiotics and toxic air) not be recognised? That is doing a huge disservice to the people that have died.

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