Coronavirus

[cubsfan]

 

Good discussion.

 

It's still a potential huge leap forward and an important step toward getting us back to normal. Testing is important for treatment of individuals, but also important for knowing who has had exposure and adjusting models based on that data, but also it allows the individual who is likely no longer susceptible to make informed decisions, and return to a more normal life.

 

Draconian steps are likely needed. CV is so widespread within the USA and many other countries, that we need to do everything we can to rob the fire of fuel and oxygen. Shutdowns are one part of that equation, but antigen testing will allow us to return to normal much faster. Don't forget to make an estimate of how long it would take to roll out yet another testing system on a wide scale nationally.

https://foreignpolicy.com/2020/03/18/america-united-states-lockdown-coming/

 

IMHO - the link RTF just posted is a must read. Not pleasant, but critical consideration.

[KJP]

https://www.bloomberg.com/news/articles/2020-03-19/coronavirus-in-young-people-is-it-dangerous-data-show-it-can-be

 

The data bears out that concern. In Italy, the hardest hit country in Europe, almost a quarter of the nearly 28,000 coronavirus patients are between the ages of 19 and 50, according to data website Statista.

 

Similar trends have been seen in the U.S. Among nearly 2,500 of the first coronavirus cases in the U.S., 705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. Few died.

 

 

Thanks for sharing Kaegi.

This is really important. It shows what I was saying weeks ago regarding the data out of China. The risk to younger people is lower, but after adjusting for triage, you will see that the risks for young people have been understated and the risk for older people are overstated if you exclude periods when the health system is overwhelmed. During periods when the healthcare systems have been overwhelmed, out comes for older people became horrific. This break point needs to be understood and new data regarding the experience in the USA will really help.

 

Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.?

[Kaegi2011]

 

Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.?

 

 

Unfortunately the article does not provide much from a scientific perspective, only a few anecdotes. 

[Read the Footnotes]

https://www.bloomberg.com/news/articles/2020-03-19/coronavirus-in-young-people-is-it-dangerous-data-show-it-can-be

 

The data bears out that concern. In Italy, the hardest hit country in Europe, almost a quarter of the nearly 28,000 coronavirus patients are between the ages of 19 and 50, according to data website Statista.

 

Similar trends have been seen in the U.S. Among nearly 2,500 of the first coronavirus cases in the U.S., 705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. Few died.

 

 

Thanks for sharing Kaegi.

This is really important. It shows what I was saying weeks ago regarding the data out of China. The risk to younger people is lower, but after adjusting for triage, you will see that the risks for young people have been understated and the risk for older people are overstated if you exclude periods when the health system is overwhelmed. During periods when the healthcare systems have been overwhelmed, out comes for older people became horrific. This break point needs to be understood and new data regarding the experience in the USA will really help.

 

Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.?

I'm not sure exactly what you're asking, but here are a couple of quick comments.

 

There is some very disturbing information in other sources about sudden death involving heart attacks that gives reason to be very concerned about obesity as a comorbidity in the USA. The point at which cardiac function becomes a concern seems to be primarily so late in the disease progression, that I am not sure it will end up being a major factor in the USA for younger age groups, but is likely a major factor with increasing age.

 

Smoking is more likely to be an issue among the 20-44 age group. The people who say that vaping and marijuana are not dangerous typically are not focused on the impact of particulates in the lungs. The cilia is responsible for removing particulate matter from the lungs, and the health of cilia will be a very important factor for survival of a severe cases of COVID-19. Anyone who has subjected their lungs to a particulate burden should try to reduce exposure immediately if they have any concerns about developing a severe case of COVID-19. This includes any type of smoking, or pollution, and particulate matter from sanding, industrial processes, construction, demolition, etc.

[minten]

.

 

Perhaps interesting to add (and surprising to me): in my country it turns out 75%(!) of deaths reported so far didn't die in the ICU, because they were never there. Not because ICU's were over-run (they're not, they still have space), but because the patients were in such bad health even before the virus hit them it was decided not to put them through extensive treatment and let them pass in, for example, their nursing home.

[Kaegi2011]

Another concerning article (tho like a day or two late):

 

https://www.wsj.com/articles/singapore-taiwan-and-hong-kong-face-second-wave-of-coronavirus-cases-11584445836

 

I think this is the reason why China is imposing quarantine for all international travelers. 

 

Would still love to hear from folks about whether the virus is endemic and whether we need to quarantine for longer to ensure new cases don't flare up after initial wave. 

[StubbleJumper]

 

If you were a 70 year-old retired doctor or nurse and you took the time to pull up the morbidity and mortality numbers by age group off of the WHO's website (or other websites) would you come out of retirement?  If I were 70 years old, I'd be trying desperately to dodge this one...  I am guessing that, as a group, retired health professionals are not in desperate need for an extra $10,000, so it's a bit hard to imagine that they would be motivated to expose themselves to a bunch of sick people.

https://nypost.com/2020/03/18/in-one-day-1000-nyc-doctors-and-nurses-enlist-to-battle-coronavirus/?utm_source=reddit.com

 

 

So are they selfless servants of the people, who are taking on a considerable risk to themselves out of an altruistic desire to help others?  Or are they uninformed and have not pulled up the morbidity and mortality numbers?  Really, this virus is one that 70+ year-old people should be desperately trying to dodge.

 

 

SJ

[KJP]

https://www.bloomberg.com/news/articles/2020-03-19/coronavirus-in-young-people-is-it-dangerous-data-show-it-can-be

 

The data bears out that concern. In Italy, the hardest hit country in Europe, almost a quarter of the nearly 28,000 coronavirus patients are between the ages of 19 and 50, according to data website Statista.

 

Similar trends have been seen in the U.S. Among nearly 2,500 of the first coronavirus cases in the U.S., 705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. Few died.

 

 

Thanks for sharing Kaegi.

This is really important. It shows what I was saying weeks ago regarding the data out of China. The risk to younger people is lower, but after adjusting for triage, you will see that the risks for young people have been understated and the risk for older people are overstated if you exclude periods when the health system is overwhelmed. During periods when the healthcare systems have been overwhelmed, out comes for older people became horrific. This break point needs to be understood and new data regarding the experience in the USA will really help.

 

Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.?

I'm not sure exactly what you're asking, but here are a couple of quick comments.

 

There is some very disturbing information in other sources about sudden death involving heart attacks that gives reason to be very concerned about obesity as a comorbidity in the USA. The point at which cardiac function becomes a concern seems to be primarily so late in the disease progression, that I am not sure it will end up being a major factor in the USA for younger age groups, but is likely a major factor with increasing age.

 

Smoking is more likely to be an issue among the 20-44 age group. The people who say that vaping and marijuana are not dangerous typically are not focused on the impact of particulates in the lungs. The cilia is responsible for removing particulate matter from the lungs, and the health of cilia will be a very important factor for survival of a severe cases of COVID-19. Anyone who has subjected their lungs to a particulate burden should try to reduce exposure immediately if they have any concerns about developing a severe case of COVID-19. This includes any type of smoking, or pollution, and particulate matter from sanding, industrial processes, construction, demolition, etc.

 

Yes, those are the types of things I was getting at. 

 

Given all the other measures we've taken, when will we temporarily ban the sale of cigarettes?

[Read the Footnotes]

 

If you were a 70 year-old retired doctor or nurse and you took the time to pull up the morbidity and mortality numbers by age group off of the WHO's website (or other websites) would you come out of retirement?  If I were 70 years old, I'd be trying desperately to dodge this one...  I am guessing that, as a group, retired health professionals are not in desperate need for an extra $10,000, so it's a bit hard to imagine that they would be motivated to expose themselves to a bunch of sick people.

https://nypost.com/2020/03/18/in-one-day-1000-nyc-doctors-and-nurses-enlist-to-battle-coronavirus/?utm_source=reddit.com

So are they selfless servants of the people, who are taking on a considerable risk to themselves out of an altruistic desire to help others?  Or are they uninformed and have not pulled up the morbidity and mortality numbers?  Really, this virus is one that 70+ year-old people should be desperately trying to dodge.

SJ

 

You are certainly right to be concerned for them, but remember there are ways to minimize the risks some of which I addressed in our first discussion of this topic a week ago:

 

 

4) Yes, that could be an issue, but:

a) unlike finance the psychopaths are usually concentrated in a limited number of specialties. Volunteers and conscripts will probably be more common in other countries that are showing a more coordinated response and preparation. At risk workers can be assigned to low risk duties. Remember, there are still going to be people getting in car wrecks and chronic conditions aren't going away either.

b) There will be heroes all over the world. China doesn't have a monopoly on heroes.

Hospitals will be doing their best to provide physical separation between COVID-19 patients and the rest of the hospital. In the best cases, they might be completely separate buildings and access will be strictly controlled to protect the non-COVID-19 hospital. This has been successful in the past in some cases depending upon controls being rigorously imposed.

 

[StubbleJumper]

 

If you were a 70 year-old retired doctor or nurse and you took the time to pull up the morbidity and mortality numbers by age group off of the WHO's website (or other websites) would you come out of retirement?  If I were 70 years old, I'd be trying desperately to dodge this one...  I am guessing that, as a group, retired health professionals are not in desperate need for an extra $10,000, so it's a bit hard to imagine that they would be motivated to expose themselves to a bunch of sick people.

https://nypost.com/2020/03/18/in-one-day-1000-nyc-doctors-and-nurses-enlist-to-battle-coronavirus/?utm_source=reddit.com

So are they selfless servants of the people, who are taking on a considerable risk to themselves out of an altruistic desire to help others?  Or are they uninformed and have not pulled up the morbidity and mortality numbers?  Really, this virus is one that 70+ year-old people should be desperately trying to dodge.

SJ

 

You are certainly right to be concerned for them, but remember there are ways to minimize the risks some of which I addressed in our first discussion of this topic a week ago:

 

 

4) Yes, that could be an issue, but:

a) unlike finance the psychopaths are usually concentrated in a limited number of specialties. Volunteers and conscripts will probably be more common in other countries that are showing a more coordinated response and preparation. At risk workers can be assigned to low risk duties. Remember, there are still going to be people getting in car wrecks and chronic conditions aren't going away either.

b) There will be heroes all over the world. China doesn't have a monopoly on heroes.

Hospitals will be doing their best to provide physical separation between COVID-19 patients and the rest of the hospital. In the best cases, they might be completely separate buildings and access will be strictly controlled to protect the non-COVID-19 hospital. This has been successful in the past in some cases depending upon controls being rigorously imposed.

 

 

No, I go beyond that concern for the 70+ year-old age group.  Really, if there is a group that should be taking to heart the recommendations surrounding social distancing, it's that group.  It's not just about whether they will be working specifically with Covid patients, but it's also about how many different people they would rationally choose to interact with on a daily basis (I made the same observation about supermarket workers). 

 

From where I sit, a full-blown pandemic that gets out of control likely offers people a generic ~60% likelihood of catching the virus.  If you are 20 years old, that's probably not something that should keep you awake at night.  But if you are in that 70+ group that faces a potential 5% mortality rate if you catch it, maybe it's time to cut down on the number of people with whom you interact and the frequency of interactions.

 

If I were a retired doctor or nurse and somebody asked me to come out of retirement to staff a tele-health phone line which could be done from home, I'd be fine with that.  But any job involving exposure to 100 people per day?  That becomes cumulatively very risky.  No thanks.

 

 

SJ

[cobafdek]

 

Any details about potential attributes among the 20-44 group, e.g., higher percentage of smokers, etc.?

 

 

Unfortunately the article does not provide much from a scientific perspective, only a few anecdotes.

 

The reason may be a paradoxical one.  It may be because they are healthier.  They therefore have healthier immune systems, and in response to a novel infection they mount an extremely vigorous immune response known as the cytokine release syndrome, or "cytokine storm."  Most of the symptoms you experience from a viral infection is actually your immune systems fighting the virus.

[Liberty]

"The first coronavirus case in the U.S. and South Korea was detected on the same day. By late January, Seoul had medical companies starting to work on a diagnostic test — one was approved a week later. Today, the U.S. isn’t even close to meeting test demand"

 

https://www.reuters.com/article/us-health-coronavirus-testing-specialrep/special-report-how-korea-trounced-u-s-in-race-to-test-people-for-coronavirus-idUSKBN2153BW

 

Peter Attia:

 

"Just received word from an ICU doctor at a small NY hospital: They are officially out of ventilators and are now double venting patients with COVID (using the same ventilator for 2 infected patients). Do everything possible to avoid infection. PLEASE ISOLATE as best you can."

 

Testing works: "How one small town at the center of the outbreak has cut infections virtually to zero: test all 3,300 in town, isolate the 3 percent who tested positive. Infection rate 10 days later down to .3 percent."

 

[Dalal.Holdings]

https://www.bloomberg.com/news/articles/2020-03-19/coronavirus-in-young-people-is-it-dangerous-data-show-it-can-be

 

The data bears out that concern. In Italy, the hardest hit country in Europe, almost a quarter of the nearly 28,000 coronavirus patients are between the ages of 19 and 50, according to data website Statista.

 

Similar trends have been seen in the U.S. Among nearly 2,500 of the first coronavirus cases in the U.S., 705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. Few died.

 

 

 

Look at the table (% of total cases in that age group), not the graph (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

[Kaegi2011]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital. 

[Kaegi2011]

Another interesting chart...

 

[Dalal.Holdings]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

Well that's not surprising. Some people on here still think this is like the Flu and/or there is nothing we can do. All you had to do was look at other countries where they were ahead of us and see this was not the case. It's like the data is all right there and people still cannot understand it.

[KJP]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

With n=705 for 20-44, I think you really need more information about the characteristics of the 100 that were hospitalized to know what the increased risk factors are and whether you have any.  We think we know some (smoking, obesity), so assuming those don't apply to you, you're hospitalization rate ought to be lower.  What it actually is though, remains unclear.

[Dalal.Holdings]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

With n=705 for 20-44, I think you really need more information about the characteristics of the 100 that were hospitalized to know what the increased risk factors are and whether you have any.  We think we know some (smoking, obesity), so assuming those don't apply to you, you're hospitalization rate ought to be lower.  What it actually is though, remains unclear.

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

One of the advantages of widespread testing is you also throw in mild/asymptomatic in so those people reduce the spread (by cancelling their Spring Break plans and staying away from grandma and grandpa) and people freak out less about mortality.

[StubbleJumper]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

 

Well, I would suggest a little caution on the interpretation of that.  The table covers confirmed cases, and it includes the column for hospitalization.  It doesn't say why people were hospitalized.  There may have been a number of people that were hospitalized out of an abundance of caution or as part of a quarantine effort.  What should be more concerning than the hospitalization column is the ICU column.  You might be put into a hospital for a night or two "for observation" but usually you don't end up in the ICU unless you absolutely need to be there.  The ICU numbers for the young who were diagnosed are pretty high.

 

 

SJ

[ERICOPOLY]

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

 

This is correct IMO.  The rate of spread ought to be higher amongst the young as well (think malls, night clubs, and party party party).  So it stands to reason there are simply far more cases amongst the young because of rate of spread.  And for the reason you point out, we therefore have a lot of serious cases even though they represent a lower proportion of the total unknown number of cases for young people.

[Read the Footnotes]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

With n=705 for 20-44, I think you really need more information about the characteristics of the 100 that were hospitalized to know what the increased risk factors are and whether you have any.  We think we know some (smoking, obesity), so assuming those don't apply to you, you're hospitalization rate ought to be lower.  What it actually is though, remains unclear.

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

One of the advantages of widespread testing is you also throw in mild/asymptomatic in so those people reduce the spread (by cancelling their Spring Break plans and staying away from grandma and grandpa) and people freak out less about mortality.

Many of the questions we all want answered can't be answered except with hindsight in a couple of years. That is always the case with NOVEL epidemics or pandemics.

 

The article gives us some good, but not perfect data to work with that will allow people to make somewhat more informed decisions regarding their individual risks and the risks to society.

 

Unfortunately, some of us are better equipped to interpret the data than others. This situation is laying bare my belief that a larger emphasis in education on statistics and probability would be a huge benefit for society. This board as a group is probably more sophisticated than most, but even among us their is a wide variation. Plus one of my friends who teaches statistics loves to remind me that even PhD specialists in stats, make boneheaded basic mistakes because it's hard for most all of us to overcome the way our own brains work.

 

For now, I take some comfort in the fact that whether or not it is the complete story, articles like this one might serve to scare some of the subsections of our population who still are not as scared as they should be.

[Dalal.Holdings]

 

It should be noted that due to testing shortage, those young folks and everyone else tested are likely to be the more symptomatic ones due to strict testing criteria in the U.S.. So even looking at hospitalizations as % of positive cases is likely sampling bias--you are not counting all the young folks walking around with this who have no or mild symptoms because they are never offered or are flat out denied testing.

 

 

This is correct IMO.  The rate of spread ought to be higher amongst the young as well (think malls, night clubs, and party party party).  So it stands to reason there are simply far more cases amongst the young because of rate of spread.

 

CDC on clinical criteria for testing...

 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

 

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:

 

Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.

 

This testing recommendation from CDC effectively biases those who get tests to older folks or people with preexisting medical problems (again, more likely to be older folks). Furthermore, it also depends on symptom severity and generally we know younger folks (based on data from China) show mild/no symptoms hence they are unlikely to get approved for a test in the United States. The older folks are more likely to throw a fever and develop shortness of breath.

 

This leads one to conclude that the younger people who test positive for this illness must be the sicker younger folks who have this (because they were not denied a test) and we are excluding younger people with mild/no symptoms (who are denied testing). So the overall mortality/ICU stay skews higher since we are only looking at younger patients who are sicker to begin with.

 

Again, for the 100th time explains the downside of being limited on testing. The U.S., being among the last developed nation to get this outbreak is among the most unprepared. A travesty of leadership.

[writser]

For now, I take some comfort in the fact that whether or not it is the complete story, articles like this one might serve to scare some of the subsections of our population who still are not as scared as they should be.

 

Sure. In practice however I'm afraid there is basically zero overlap between a) the subset of the population that should be far more scared and b) the subset of the population who would even consider reading an article like that.

[Kaegi2011]

 

Look at the table (population adjusted), not the chart (raw numbers). Young people by and large do well. There will be younger patients who develop severe infections and unfortunately may even die, but the risk is much greater for older folks.

 

No disputing that.  However, the hospitalization rate is much higher than I expected.  I thought for me (in the 20-44 group) - it was going to be a bad flu.  I didn't think i'd have a 1/5 to 1/7 chance of going to the hospital.

 

 

Well, I would suggest a little caution on the interpretation of that.  The table covers confirmed cases, and it includes the column for hospitalization.  It doesn't say why people were hospitalized.  There may have been a number of people that were hospitalized out of an abundance of caution or as part of a quarantine effort.  What should be more concerning than the hospitalization column is the ICU column.  You might be put into a hospital for a night or two "for observation" but usually you don't end up in the ICU unless you absolutely need to be there.  The ICU numbers for the young who were diagnosed are pretty high.

 

 

SJ

 

Very fair.  However, in reading twitter and also hearing Othropa people are getting turned away from any care and/or testing.  So I don't think they were put into hospitalization out of caution.  If anything it looks like the other way around.

[Kaegi2011]

 

This testing recommendation from CDC effectively biases those who get tests to older folks or people with preexisting medical problems (again, more likely to be older folks). Furthermore, it also depends on symptom severity and generally we know younger folks (based on data from China) show mild/no symptoms hence they are unlikely to get approved for a test in the United States. The older folks are more likely to throw a fever and develop shortness of breath.

 

This leads one to conclude that the younger people who test positive for this illness must be the sicker younger folks who have this (because they were not denied a test) and we are excluding younger people with mild/no symptoms (who are denied testing). So the overall mortality/ICU stay skews higher since we are only looking at younger patients who are sicker to begin with.

 

Again, for the 100th time explains the downside of being limited on testing. The U.S., being among the last developed nation to get this outbreak is among the most unprepared. A travesty of leadership.

 

I thought about that, and you could def be correct.  But even if we 4x the denominator, the probability is still much higher than I expected.  Where it becomes not a concern is if the undercount relative to older population is like 10-20x. 

 

Also, european countries are seeing similar trends, so not a US only issue.