Iceland's COVID-19 random sampling results: C19 similar to Influenza

I vehemently disagree with this analysis on multiple levels.

Firstly, Iceland is not 'randomly' testing people. People are signing up to be tested voluntarily. That population is likely to contain a larger fraction of people who have reason to think they were exposed or feel sick. Thus 0.8% is an overestimate of the fraction of the population that has been infected.

Secondly, the asymptomatic period is on average a week or so for those who develop symptoms, with hospitalization often occurring upwards of a week after symptoms, and death often occurring more than 2 weeks after symptoms. With doubling times in a mixing population of less than a week, deaths track infections several doublings before the current number of infections. Indeed, in both China and Italy new confirmed infections only began flattening out 2 weeks after a lockdown, with deaths lagging significantly later. This thing is damn infectious and still expanding, it is not anywhere near a steady state anywhere but East Asia that would allow naive numbers even in Iceland to be meaningful. That naive 0.06% becomes 0.5% if you take into account only 3 doublings, and easily 1% if you accept the sampling is biased.

I take issue with a LOT of things in the linked posts.

Regarding 'only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity ': Trying to make the distinction between 'death with the virus' and 'death from the virus' is just irresponsible and downright stupid at this point, given that the death rate right now in North Italian towns at the center of the situation is >10x the normal death rate per day. The virus is *causing* these people who were living with and managing these pre-morbidities to die. Similarly, even if the average age of deaths is only a year or two below the life expectancy right now, it's not like the human mortality curve is completely rectangular. People routinely die a decade before and a decade after the expectancy number. Unless somehow it's ONLY perfectly people who are less than a year from death who are kicked over, which we KNOW is not the case given the death rates among 60somethings and 50somethings and healthy young doctors, you are losing a lot of life years here.

Something on average killing people at the life expectancy is NOT the same as only losing very little life. To take it to an extreme, you could kill EVERYONE above the life expectancy and an equal number of people just below the life expectancy, and have knocked off on average a decade of life. It should also be noted that some all-cause death rates are coming out in North Italy, and the excess deaths over this time last year are 3x the confirmed covid deaths. A lot are being missed.

Not to mention all the people whose lungs are going to be permanently damaged after surviving and other morbidities, which is much less focused in the elderly than the deaths given that the ICU and hospital admissions are rather less focused in the elderly than the deaths are. According to links in the above writings, 0.5% of flu cases in the 20-45 age group result in hospitalization compared to 10% in the over 65 age group, and taking population into account that results in ~7x as many flu over-60 hospitalizations than 20-45. Current American test results, however, have only ~2x the over-65 covid hospitalizations as 20-45 hospitalizations. If hospital capacity is breached, the death rate of younger people could rise drastically as a result. For those who get this, it is NOT just as dangerous as flu.

The linked analysis dismisses hospital overload causing a higher death rate among ICU patients, on the assumption that severity is lower than reported and it just won't happen. But this is happening *right now* in Italy and Spain, and will be starting soon in New York. And data is indicating that surviving ICU stays for this disease are ~3x as long as ICU stays for flu.

That Iceland's currently 1% infected as of now doesn't say anything about how infected it would be after a few weeks of no-special-controls measures (comparable to folks' behavior in a regular flu season). This is the beginning of this virus's worldwide course. It's dishonest to compare a snapshot now with the accumulated total of a whole flu sason.

That's terrible news! It means that on top of the meager coronavirus there's another unidentified disease overcrowding the hospitals, causing respirator shortages all over the world, and threatening to kill millions of people!

Interestingly, there were explosions of H1N1 flu in 2009 on cruise ships, but no reports of death clasters on cruise ships. Thus covid is at least 10 times worse.

What’s your take on the South Korean data?

They were testing thoroughly (30 negative tests for every 1 positive) all the way through their outbreak so either they were useless at choosing who to test (seems unlikely as they got the outbreak under control pretty fast) or they were finding nearly everyone. Their CFR was 1.3%.

How many times more contagious (if uncontrolled) and critical/fatal (without hospital overcrowding) is it than a typical flu?

Diamond Princess indicates at *least* 2x on both counts IMO. I think it's a bit shady to say that 2x is ' well within the range of uncertainty ' as if that means something.

I hope it's only 2x worse; I believe 5x on contagion and 3x on severity pre-overcrowding.

Very first serology data coming out.

164 close contacts tested by PCR and serology. 16/164 of contacts PCR+ & all PCR+ also serology+. Additional 7/164 were serology+ but PCR-. Overall 23/164 close contacts + in at least one test; 10/23 were asymptomatic.

Asymptomatic fraction circa 50%. Upper range of what I thought likely. Not the vast majority at all. Actual death rate in the normal population most likely circa 0.6%.

https://t.co/nPiD6UP1eY?amp=1

This isn't a random sample afaik. That said, 2x worse than a very bad flu year falls well within the current projections (flu: 8% of population, up to 60k dead, COVID maybe 15-20% infected 100-200k dead). Could also do 3x that though pretty easily.

I'd like to see a model for knock-on deaths from hospital overwhelm.

If it's very contagious (it is), the damage could easily become 50x current. It's true that as and if we learn outcomes per infection are not as bad as feared, we will relax. While we should be skeptical of hype, we need to act aggressively early on until we know more about how to treat and how important it is to slow or limit the spread.

Good analysis, close to my calculations of 0.04% - 0.17%(from Iceland data) averaging around 0.1% which is almost perfectly in line with seasonal flu. I actually suspect that coronavirus will in the long run(after a vaccine and treatments/medication) actually be a lot closer to swine flu(0.03%), implying that seasonal flu might be quite a bit worse than Cov2 NOT the other way round as reported thus far by the media. The only mitigating factor I can think of is the shorter incubation period for swine flu which might mean that Cov2 has a little more time to get around the population asymptomatically thus increasing it's transmissibility or R_0.

I also did a crude but interesting analysis based on the symptomatic testing conducted in the States. It turns out that about 16% of all symptomatic people tested have the virus in the US. If we consider the widely accepted figure of ~3 flu like illnesses for every adult per year(more for kids) we can estimate that in the US alone some 990 million flu like infections occur every year. Flu season and similarly "cold" season lasts for about 16 weeks from mid December to mid April where thereafter the regular summer/late spring/early fall rate of the flu virus drops to less than half(0.4 to be exact). Using this information we can work out that for a period of two weeks during flu season some roughly 52 million Americans have some sort of flu-like virus(a lot of whom show no symptoms). Knowing that Cov2 is about 19% as common now as would be other viruses any other year this leaves us with ~9.925 million infections. As of today there have been 3,402 deaths and 3,893 that are critical. Given that the mortality rate of all critical/serious cases is around 27% we can assume that the total death tally will be around 4453 assuming no more spreading occurred as of about a week ago( a big assumption I know, but there is also a lag in testing percentages so I think this is a safe assumption and works for our example). You might ask why I am using a two week interval and well I am assuming that most cases have occurred within that 2 week interval(I did say this was a crude analysis). In any case, if we crunch the numbers this works out to about 0.045% IFR, which is actually surprisingly similar to Iceland and within it's range of 0.04% - 0.17%.

Something interesting to note is that the deCODE tests are done on asymptomatic cases only(according to Kári Stefánsson). This wildly skews the results since as much as 50% of cases are asymptomatic or so mildly symptomatic as to go mostly unnoticed. Which means we could safely double the rate of infection his data reveals...?