The world is probably going to lose 5 2.5-10% of its population (380 190-760 million, see here for the reason for my edit), worse than the Spanish flu even on a percentage basis. I didn't realize this until now (or rather, these facts didn't become salient until now), but the current CFR estimates for COVID-19 are based on hospitals not being overwhelmed, whereas Spanish flu CFR was based on hospitals being overwhelmed (plus they didn't have the life-saving technology we have today anyway, like oxygen concentrator and mechanical ventilator). If hospitals are overwhelmed, which seems very likely at this point, most of the people needing to be hospitalized (10-20% of infected, which will themselves be ~50% of world population according to epidemiologists) will probably die. See Forget about mortality rate, this is why you should be worried about coronavirus for more details but I actually arrived at this conclusion myself shortly before coming across that. My own realization was triggered by reading this post.
Just for the record, I think that this estimate is pretty high and I'd be pretty surprised if it were true; I've talked to a few biosecurity friends about this and they thought it was too high. I'm worried that this answer has been highly upvoted but there are lots of people who think it's wrong. I'd be excited for more commenters giving their bottom line predictions about this, so that it's easier to see the spread.
Wei_Dai, are you open to betting about this? It seems really important for us to have well-calibrated beliefs about this.
Yeah, I kind of wrote that in a hurry to highlight the implications of one particular update that I made (namely that if hospitals are overwhelmed the CFR will become much higher), and didn't mean to sound very confident or have it be taken as the LW consensus. (Maybe some people also upvoted it for the update rather than for the bottom line prediction?)
I do still stand by it in the sense that I think there's >50% chance that global death rate will be >2.5%. Instead of betting about it though, maybe you could try to convince me otherwise? E.g., what's the weakest part of my argument/model, or what's your prediction and how did you arrive at it?
Epistemic status: I don't really know what I'm talking about. I am not at all an expert here (though I have been talking to some of my more expert friends about this).
EDIT: I now have a Guesstimate model here, but its results don't really make sense. I encourage others to make their own.
Here's my model: To get such a large death toll, there would need to be lots of people who need oxygen all at once and who can't get it. So we need to multiply the proportion of people who might have be infected all at once by the fatality rate for such people. I'm going to use point estimates here and note that they look way lower than yours; this should probably be a Guesstimate model.
Fatality rate
This comment suggests maybe 85% fatality of confirmed cases if they don't have a ventilator, and 75% without oxygen. EDIT: This is totally wrong, see replies. I will fix it later. Idk what it does to the bottom line.
But there are plausibly way more mild cases than confirmed cases. In places with aggressive testing, like Diamond Princess and South Korea, you see much lower fatality rates, which suggests that lots of cases are mild and therefore don't get confirmed. So plausibly there are 4x as many mild c
...In places with aggressive testing, like Diamond Princess and South Korea, you see much lower fatality rates, which suggests that lots of cases are mild.
With South Korea, I think most cases have not had enough time to progress to fatality yet. With Diamond Princess, there are 7 deaths out of 707 detected cases so far, with more than half of the cases still active. I'm not sure how you concluded from this "that lots of cases are mild". Please explain more? That page does say only 35 serious or critical cases, but I suspect this is probably because the passengers are now spread all over the world and updates on them (e.g. progressing to serious or critical) are no longer being provided (unless someone dies).
So plausibly there are 4x as many mild cases as severe cases. This gets us to like 3% fatality rate (again assuming no supplemental oxygen, which I don’t think is clear and I expect someone else to be able to make progress on forecasting if they want).
Also don't understand this part. "4x as many mild cases as severe cases" is compatible with what I assumed (10%-20% of all cases end up severe or critical) but where does 3% come from?
Update on Diamond Princess: as of now, Wikipedia says that the death toll is 14, or 2% of the passengers who tested positive within the first month. However, the dead all seem to have been elderly (there were many elderly passengers, as expected for a cruise liner). More specifically, 11 of them were over 70, another was over 60, and two others were of undisclosed age due to family wishes.
I don't know how to adjust those results for demographics, and of course you can't use them to predict what would happen without hospital care. But it's a promising sign (relative to Wei'd predictions) that we've made it this far without anything obviously worse than what happened in Italy and Spain, and even those have seen far less than 0.1% of their population die. NYC is estimated to have a 20% rate of infection, and it too has had less than 0.1% of its population die (though this may rise somewhat, as their wave of cases crested fairly recently).
I think the estimates in your links are not central estimates, even conditioning on 10% of the world being infected. The analysis in the Medium article basically assumes the worst case on every axis. So yeah, that will look pretty bad. And I think it is a good way to get a picture of what the right tail on this looks like. But it's pretty far from the most likely outcome. Mitigating factors that are ignored:
China got a lot better at managing the epidemic over time, and everyone can learn from that. (See the WHO report linked in the reddit post: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf)
Related to the above, we're starting to get a sense of how it spreads, which should help us to slow the spread
Fatality rates so far may be much smaller than these worst case estimates, if the number of mild cases that were not detected is large. This is more likely to be true in Wuhan, where capacity for testing may have been stressed as well as capacity for treating. It is also more likely in the worlds where where ~50% of people become infected
Most published estimates of R0 are closer to the smaller end of the scale reporte
It seems like your arguments can be summed up as "if we slow the spread enough, hospitals won't be overwhelmed" but the US only has 924,107 beds in total, and if each case takes 4 weeks to recover ("People with more severe cases generally recover in three to six weeks.") we can treat 11 million people or 3.4% of the population over a year, but that would mean death rates from other diseases would rise a lot since those patients wouldn't have beds. Many countries do have a lot more beds per capita than the US (which surprises and confuses me) but presumably they're almost all being used already?
ETA: Actually the limiting factor probably isn't hospital beds but equipment for treating respiratory disease. For example according to this paper:
The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2-23.1)
This works out to be about 65,000 in the whole country which is a small fraction of what's needed to treat the number of people who will need them (.05 * .5 * 327e6 = 8,175,000) even spread out over a year or two.
If hospitals are overwhelmed, which seems very likely at this point
Data to support this: Daegu has a population of 2.4 million, 3146 COVID-19 patients, and 2000 patients waiting for hospital beds, meaning it can treat .05% of the population at a time. Note that South Korea has the second highest number of hospital beds per capita in the world.
As things get out of hand, I would expect countries to throw a ton of money at it, basically like declaring war. When a ton of money is thrown at it, will hospitals still be overwhelmed?
I think that your estimate of 2.5-10% population loss is derived from (50% infected) * (10-20% "severely ill" from the JAMA article) * (50-100% of severely ill patients die with severe overcrowding). I think that the last 2 numbers are questionable. Worldometers says that 8% of current cases are "serious/critical", which as I understand it is roughly the threshold for being in the ICU/requiring breathing machine in normal circumstances. To get a 10-20% case fatality rate, we would need most patients with serious cases to die (feasible given lack of breathi
...Is the 5-10% global mortality prediction conditional on COVID-19 infecting >10% of the world, or unconditional?
What do you think of the prospects for antivirals like remdesivir to be tested and mass-produced? How much could they lower CFR?
Why do you think other predictions, such as those given by Metaculus 1, 2, 3 are much less pessimistic?
Do you think shorting the market is a good idea still?
Yes, the current fatality rate is low due to the factor you mention. But it's also high due to the fact that many cases are mild and not being counted, right? Isn't it unclear at this point which effect is stronger?
So extrapolating from the current Singapore+Diamond Princess numbers, assuming 50% worldwide infection rate and 0-100% dead among severe/critical cases - and no hospital care - about 0.5%-3% of the world population will die.
Yes as part of a team on standby briefed on contact tracing protocol in Singapore I can confirm, we only call and inform potential contacts . They are not tested unless I'll.
Seems possible but I don't really understand where China's claims about asymptomatic cases are coming from so I've been hesitant about putting too much weight on them. Copying some thoughts on this over from a FB comment I wrote (apologies that some of it doesn't make total sense w/o context).
tl;dr I'm pretty unsure whether China actually has so few minimally symptomatic/asymptomatic cases.
---
Those 320,000 people were at fever clinics, so I think none of them should be asymptomatic.
The report does say "Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission."
But from a quick skim, I don't think the basis for that finding is mentioned anywhere in the report. My guess is that Chinese officials told them that there were very few asymptomatic cases among people who were tested through contact tracing (which theoretically should test cases whether or not they're symptomatic.
I hav...
Also, due to exponential spread, most of the 100 (or low hundreds) will have been infected recently, not enough time to have progressed to "severely ill" yet.
I'd greatly appreciate it if you could respond here:
I'm confused by the predictions of death rates for the global population -- seems like that's what would happen only if the 50% of world population is infected all at once. Is it just exponential growth that's doing the work there? I'm also confused about how long contagion is well-modelled as exponential
but the current CFR estimates for COVID-19 are based on hospitals not being overwhelmed
That seems a bit misleading because current CFR estimates are largely driven by cases from Hubei province, where the hospitals are already overwhelmed. You could argue that there's room for things to get worse, and I probably agree with that. But I don't see how this consideration warrants such a huge update to the CFR estimates. It seems to be already factored in to quite a large degree.
For specifics: The Imperial College estimate gave a 95% confidence inter...
From The Politics Of Plague, which I came across just after writing the above:
There was a terrible famine in Russia, in 1891-92. The tsarist government botched the handling of the catastrophe. This deeply undermined public confidence in the political order, and threw fuel on the smoldering revolutionary fire. Do not doubt for a moment how the state’s inability to handle a major public health crisis can shake the political order to its foundations. The American people already have very low confidence in our public institutions. We could be headed into uncharted waters, and indeed, may already be in them, but we just don’t realize it yet.
Trump will be blamed ... probably fairly judging from his performance so far
This Twitter thread has a great explanation of what I meant. I don't understand why prediction markets aren't reacting to this. (Maybe this particular issue with testing is too hard for voters to understand, but the "It's going to disappear. One day it's like a miracle, it will disappear" quote... Doesn't the attack ad write itself here?) Is this another failure of market efficiency, or is there some reasonable explanation?
I'm don't know how to update on points 1 and 3 given this recent poll from March 11-13:
But public attitudes about the coronavirus — including President Donald Trump's handling of it — are starkly divided along partisan lines, with [81% of] Republican voters having confidence in Trump's dealing with the outbreak, compared with just [13% of] Democrats who agree.
Indeed, 45 percent of all voters approve of Trump's handling of the issue, which is almost identical to his overall job rating in the poll.
To me, this isn't much evidence against, since the USA
...I could see any of those playing out too.
I find the third bullet perhaps the most unsettling.
I posed a question about what impact the outbreak might have on adopting block-chain within the global supply chain management (or simply shipping/trade related should be included). That relates to your last point. Perhaps we have a technology that could counter the more psychological "we cannot handle X" view.
[Edit -- I also wanted to suggest we should look at the EU in this regard as well. The political ramifications seem to get global as well as the m...
Depends on if immunity is long-lasting, since cold-causing coronaviruses produce immunity with a tendency to fade over 3 years or so, and if vaccines are an option given that 10 years of SARS vaccine development has generally crashed and burned at the animal testing phase. A highly contagious disease with a 10% hospitalization rate and 2% death rate breathing down your neck for multiple flu seasons sounds rather problematic.
Depends on if immunity is long-lasting
I've seen speculation that COVID-19 does not confer meaningful immunity, and we've already seen a reinfection. If true, this looks less like "we have a new winter disease" and more like "this is the new normal."
I remain skeptical of these stories. These people are being tested with excruciatingly sensitive molecular tests after leaving severe disease in a way that is not common in other health contexts. We know that people can shed deactivated measles virus that can be detected by PCR for weeks after they recover. If I was going to guess, I would suspect that what you have is people who got a severe infection with a damaged respiratory system are then coming down with secondary complications while still shedding detectable virus, or their immune system falls apart due to severe complications allowing remnant virus to replicate up to detection levels.
It could be an indication that severe disease can produce a long lingering recovery and you're not always out of the woods when you are getting better. But the notion of people who had managed to clear the thick hot and heavy infection getting reinfected by a few hundred viral particles from outside their body again so quickly just doesn't sit well with me. If reinfection happened I would expect it to take years...
I just saw a story suggesting that the COVID-19 is showing signs of a mutation that is very HIV like, making it more likely to infect. This is the second time I've read something like that. The other claimed that the structure of this virus made it more likely to bind to a human cell than SARS.
Would like your thoughts if you've seen these as well.
I wish news media people would stop with the 'HIV' nonsense. Sorry but it just gets on my NERVES at this point.
Every statement having anything to do with HIV goes back to a single preprint that came out a few days after the first genomes, from a lab in India that if this manuscript is any indication has a severe quantity over quality program. The SARS-CoV2 genome has a few percent difference to the SARS genome from a decade ago. There are a couple of small insertions in the protein that the virus particle uses to bind to the human ACE2 protein and gain access to cells for replication. These insertions are indeed a big piece of what makes it so infectious, it binds to human cells much stronger than the SARS virus did. This lab, though, just ran a sequence search and freaked out over the fact that there were matches to these small ~5 amino acid sequences in a few HIV genomes (and didn't talk about the bacterial and plant genomes you can also find matches in).
They neglected to report something called the 'expectation value', the number of times you would expect to find those sequences in a sequence database by random chance. It was high. Short sequences...
I can get why this gets on your nerves (very complex subject that few understand -- I don't).
Thanks for share and sorry to be part of the problem. The key for me was the increase ability to bind with human cells which seems to be true. The "fake news" connection with HIV cannot help and clearly was not needed.
Thanks for the more technical details! Really glad we have someone like you participating here.
Increased investment in supply chain automation to lessen any future impacts.
A breakdown of the existing global economy and increase in closed and regional trading blocks.
More xenophobia, perhaps leading both genocide in some locations.
Increased investment in work place sanitation and sterilization (not of people) technologies that might become part of national/regional building codes for public buildings and areas.
Recognition that China has been grossly lying about the event and what the CPC knew about the timing and infection rates leading to further isolation in global politics, possible ending its belt and road, string of pearls plans.
End of Xi Jinping's rule? I think it less likely that it would produce the demise of the CPC but that is likely more about the impact to the rank and file, and lower level officers experience the infections -- thought could as easily go the other way and lead to a stronger hand in direct governance by the PLA.
Increased medical evaluation for vacations on cruse ships and pre-boarding checks for potential risks
Assuming that the outbreak is really just getting started outside China and the infection such that identifying the infected spotty (I've seen statements to the effect only 30 to 50 percent of the infected or currently being identified) the current global production structure will largely halt. This will produce a depression scenario that is likely worse than that of the housing crisis of 2009. Such an even will likely move production in two directions -- one more generalize production when a number of the currently outsourced activities are brought in house, the other to seek production options that can be efficiently executed at smaller scales but geographically diversified. In cases were economies of scale can not be avoided increased monopolization but that monopolist will diversity geographically.
Last, nothing -- in 3 years everyone will be acting exactly the same as they were in November 2019.
I would actually put the highest probability on the last possible result.
To what extent is the anti-China narrative simply a lot of people here collectively agreeing with the official Western news story that has been agreed on in the last three years, and how much of this is an actual assessment of how China has behaved/ How it will be perceived as having behaved?
I mean from my point of view, while clearly the low level people at the city level in Wuhan failed fairly badly when faced with a novel and very fast moving problem, at the national level though it looks like the Chinese government has reacted about as aggressively and...
Decline of the custom of hand-shaking in western countries
Dramatic growth of robotization of the outside work – cars, delivery, field work, – and even more investments in related AI areas.
Changes in fashion - more "closed" closes, similar to biohazard suites.
Baby boom to "repopulate" the Earth.
More investment in medicine. Hygiene will be new religion.
Higher interest in global catastrophic risks and their prevention.
Decline of tourism, cruise ships, airlines, hotels, restaurants, churches, mass sport, prostitution. Boom of VR.
Decline of public transport and boom of private cars (likely electric and self-driving).
Decline of mega consumption and oil consumption - lower oil prices, less emissions.
Decline of large cities, growth of prepping and small self-sufficient country houses.
One note: China's policies will be seen as a failure due to their initial denial and persecution of the medical professionals attempting to call attention to the issue, they have already undermined any response's success or failure
I disagree. I think that might be how China's policies are viewed, but I think a more likely outcome is that they will actually work to dramatically slow the spread of the virus within China. The denials and coverups early on will seem inconsequential compared to the millions of lives saved by the quarantines.
With the benefit of hindsight, I judge this prediction to have been 100% correct. Anyone disagree?
With the benefit of hindsight, I can say that #3 was true, #1 and #4 are ambiguous, and #2 was false. (Fatalities were high but not that high; in some countries they got within about an order of magnitude of what I said, but no higher. The hospitals were not overwhelmed and the fatality rate was less than I naively guessed.)
Update: I just came across this poll, which presumably is biased etc. but still, pretty amazing, I predicted a rise in authoritarian sentiment but I would not have predicted anything nearly this extreme, especially after the virus has mostly run its course and vaccines have been deployed:
– Fifty-nine percent (59%) of Democratic voters would favor a government policy requiring that citizens remain confined to their homes at all times, except for emergencies, if they refuse to get a COVID-19 vaccine. Such a proposal is opposed by 61% of all likely voters, including 79% of Republicans and 71% of unaffiliated voters.
– Nearly half (48%) of Democratic voters think federal and state governments should be able to fine or imprison individuals who publicly question the efficacy of the existing COVID-19 vaccines on social media, television, radio, or in online or digital publications. Only 27% of all voters – including just 14% of Republicans and 18% of unaffiliated voters – favor criminal punishment of vaccine critics.
– Forty-five percent (45%) of Democrats would favor governments requiring citizens to temporarily live in designated facilities or locations if they refuse to get a COVID-19 vaccine. Such a policy would be opposed by a strong majority (71%) of all voters, with 78% of Republicans and 64% of unaffiliated voters saying they would Strongly Oppose putting the unvaccinated in “designated facilities.”
– While about two-thirds (66%) of likely voters would be against governments using digital devices to track unvaccinated people to ensure that they are quarantined or socially distancing from others, 47% of Democrats favor a government tracking program for those who won’t get the COVID-19 vaccine.
How far are Democrats willing to go in punishing the unvaccinated? Twenty-nine percent (29%) of Democratic voters would support temporarily removing parents’ custody of their children if parents refuse to take the COVID-19 vaccine. That’s much more than twice the level of support in the rest of the electorate – seven percent (7%) of Republicans and 11% of unaffiliated voters – for such a policy.
Perhaps there’s some obvious way in which I’m misunderstanding, but if10% of people contract the virus over a shortish time frame then won’t essentially everyone contract it eventually? Why would it reach a 10% penetration and then stop? Isn’t this like asking what happens if 10% of people contract influenza? Maybe in a given year your odds of getting the flu are X% but your odds of getting it once in 10 years are roughly 10*X%. Am I missing something that implies the virus will be corralled and gotten under control at a certain point?
I do have a model where that happens, that is fairly high in my actual scenario estimates right now -- basically everyone in Iran, the poor parts of the Middle East and Africa gets exposed, which is enough for the more than 10% of the global population, and then basically nobody anywhere else gets it because all of the countries with strong states that are interconnected end up using the quarantines and travel restrictions to shut down the spread of the virus, which we know works from China (probably less than 5% of the population Wuhan itself is going to come down with the virus).
Maybe birth rates will increase if there are massive quarantines, for the same reason birth rates are said to increase during natural disasters (???). Very uncertain. Just throwing this idea out there, since I've seen little discussion of it.
Brainstorming some possibilities, not taking myself too seriously:
--2020 will be remembered as a year of death and disruption; the economy will suffer massively, perhaps enough to count as a recession.
--Many old people will die (something like 10%?) this is a big higher than the current fatality rates but I predict they will rise once hospital systems are overwhelmed. This will have a few knock-on effects: 1. Health care expenditures will drop for the next few years, since old and sick people are the biggest source of such expenditures and the population of old and sick people will be substantially smaller. 2. There will be a noticeable increase in average spending money available to younger people due to inheritances. 3. Politics in the USA at least will shift noticeably (though not dramatically) to the left, since the dead people will be disproportionately right-leaning. 4. Politics worldwide will generally shift in a more radical direction, since the proportion of young people to old people will increase. 5. One of the contenders for the US presidency might die before the election. (This is unlikely even if 50% of the world gets infected, but it is likely enough to deserve mention I think.)
--China's dramatic and draconian measures to contain the virus will come to be seen as a success story, something that would have worked if only other nations had behaved similarly (and perhaps, if China keeps its border closed, it actually will work for China at least?). This leads to an increase in authoritarianism in general around the world, made substantially stronger by the general tendency of authoritarianism to rise during crises.
--The world will, in general, take pandemic risks much more seriously from now on, making it substantially harder for something like this (or worse) to happen again.