D&D and the rising pandemic

[Krachek]

I think that covid-19 is a poor choice for the contagion spell.

 

[Sacrosanct]

I think anyone who is sick and goes to a game, whether that be a private game or to an FLGS, is being very irresponsible. But I have always thought that, even with the normal flu. No one wants your illness Karen.

Re coronavirus, no impact to our games as of yet, and I live in a town with one of the first US cases and the hospital near my house had 20 workers put into quarantine who were exposed, and a few days ago the middle school where I live had a kid test positive.

Just be careful about touching things, and wash your hands often. Wash them well. And if none of your group has been exposed or is sick, game on.

That said, I think the number of cases is higher than reported here because we're still not testing for it hardly. When you suddenly increase the number of tests, you're gonna get more positive results. Doesn't mean it suddenly and exponentially spread, it just means we're finally testing a large pool. So people need to prepare themselves to hear of more cases and not panic. Wishful thinking, I know.

 

[Sacrosanct]

What exactly do you think is a rational reaction to a disease with apparently an R0 of higher than 2.5 and a mortality rate of higher than 3.4%?

I'm not denying that there is a certain amount of hype, but those two numbers I think pretty much tell the whole story. You either believe those numbers are real, or you don't - in which case your distrust extends to far more than just 'the media'.

So, as for myself, I don't think we'll meet for two reasons.

First, and most importantly, for the sake of people outside our group who would be at high risk in the event of a general epidemic. For the sake of the elderly, it just doesn't make any sense to put our enjoyment ahead of their lives.

And secondly, several members of my group have the single most important co-morbidity factor - high blood pressure. So, even though mortality in our age group is quite low, with the high blood pressure present in it's in the 1% range. And that's to not even get into the relatively high risk that they'd need to be on oxygen for 2 to 4 weeks.

Not to belittle the importance of the virus, because it is important, but even most of the medical community cautions against using that mortality rate. Most credible sources say they don't know, rather than give that number, or if they do, it's always with the same caveat: only the most severe cases have been tested, and no one with just minor symptoms have been tested yet, so it skews the number. We won't know until much later what a more accurate fatality rate is. It would be like only factoring in those people who went to the ER for the flu, to calculate the fatality rate of the flu.

 

[akr71]

Considering that one group is my family, who I live under the same roof with, eat with, etc - Yes, we will continue to play.

The other group I play with is 8 of us, 5 of which are coworkers. Yes we will continue to play.

Other factors - there are no confirmed cases in the province I live in, or the neighboring one --> Lets keep playing. My wife is a nurse with the Department of Public Health who would bitch-slap me if I let hysteria ruin our social-life.

Having said that - we have cancelled game night in the past because someone was not feeling well, or was dealing with sick children and we will do it in the future if the need arises.

 

[Umbran]

What exactly do you think is a rational reaction to a disease with apparently an R0 of higher than 2.5 and a mortality rate of higher than 3.4%?

So, to put this in perspective for folks who are not data scientists or statisticians...

The R0 is the number of people that a sick person will then infect. It is highly dependent on how the population responds to the epidemic.

Typically, the flu has an R0 of about 1.3. Covid-19 has an R0 somewhere between 2 and 3 outside of China - likely around 2.5. This may not sound like much of a difference, but after 20 "generations" of passing along an illness, an R0 of 1.3 would result in 146 infections, but an R0 of 2.5 would result in 36 million infections.

The number of people found with covid-19 infections doubles every 3 to 6 days. Ten days ago, Italy thought it was fine. Today? Their hospital system is overrun, and they are putting up tents outside hospitals to deal wiht the overflow, and there's nationwide policies to restrict spread of the disease.

Compared to the reading I've done, the mortality rate Celebrim has here is high, and I home he doens't mind a correction. His number has been floating around, and seems to be based on a statement of the WHO that 3.4 percent of people with reported covid-19 infections worldwide had died. This is NOT THE SAME as the mortality risk for infection, as many infections happen but never see a health care professional. There is an esimation step that happens between Celebrim's number, and the actual mortality risk.

The flu has a death rate of around 0.1% of infections. Marc Lipsitch, the director of the Center for Communicable Disease Dynamics at Harvard, estimates that for covid-19 it is 1-2%. The latest epedemiological modeling found a 1.6% rate in China in February, sixteen times higher than the flu.

 

[Celebrim]

There is an estimation step that happens between Celebrim's number, and the actual mortality risk.

That estimation step is already factored into the 3.4% estimate. The number for those with verified infection is 5.7%.

I haven't read the papers you linked to yet, but every estimate I've seen for incidence rates under 2% postulates that there is a very large number of undetected cases in the population. The evidence for that is fairly weak though, and depends on a relatively large percentage of the population being asymptomatic.

Though, even if it were 2%, that would still be extraordinarily high from a historical perspective. It's been over 100 years since the last appearance of a novel airborne disease with R0 around 2 and mortality rate around 2%.

 

[jgsugden]

Be safe, not paranoid.

If you're sick, at all, do not go. Skype in if you still want to play.

If you go, wash your hands and don't touch your face - WHICH IS ADVICE YOU SHOULD ALWAYS FOLLOW.

Wipe down the play area /meeting area with some disinfectant before and after the session / event.

Send me $50.

If we all followed this simple advice all the time, tens of thousands of lives in the countries where we play these games might be saved. It would nearly wipe out the flu in those countries.

 

[Sacrosanct]

That estimation step is already factored into the 3.4% estimate. The number for those with verified infection is 5.7%.

I haven't read the papers you linked to yet, but every estimate I've seen for incidence rates under 2% postulates that there is a very large number of undetected cases in the population. The evidence for that is fairly weak though, and depends on a relatively large percentage of the population being asymptomatic.

Though, even if it were 2%, that would still be extraordinarily high from a historical perspective. It's been over 100 years since the last appearance of a novel disease with R0 around 2 and mortality rate around 2%.

Where are you getting your figures? Asnof now, 116000 confirmed cases, 4000 deaths. That's 3.4%. I've never seen your higher figure. The math doesn't work out like that.

And what do you mean the evidence is fairly weak of lots of people with it haven't been confirmed? That makes zero sense. People with minor symptoms don't tend to go to the ER to get tested. And here in the US, we don't even have many tests TO test cases. Our testing here is very small, and it's entirely plausible that many more people have it but don't know.

 

[DND_Reborn]

What exactly do you think is a rational reaction to a disease with apparently an R0 of higher than 2.5 and a mortality rate of higher than 3.4%?

I'm not denying that there is a certain amount of hype, but those two numbers I think pretty much tell the whole story. You either believe those numbers are real, or you don't - in which case your distrust extends to far more than just 'the media'.

I won't deny those numbers, they (or close to them) are fact. But, this is the problem with statistics, you can slant them however you want. The media often (not always) slants them to create fear and sensationalism because those things sell.

Here are some other numbers (based on information from @J-H map):

0.005% of the Chinese people have caught the virus or roughly 1 in 17,500.
About 3.75% mortality rate. Which means 1 in 465,000 Chinese roughly will die from the virus given the current numbers.
And so far roughly 60% have recovered in China while the rest remain ill.

Compare those numbers to the odds of death from any number of other things (U.S. only, sorry) (Odds of Dying - Injury Facts):

You are more likely to be struck by lightning than die of the virus. Or die in a car accident, die by gunshot, or any number of things. I'm sorry because I know that sounds sensational, but it is more about keeping things in perspective. But the virus is new, and news, and all over the media and Internet.

So, as for myself, I don't think we'll meet for two reasons.

First, and most importantly, for the sake of people outside our group who would be at high risk in the event of a general epidemic. For the sake of the elderly, it just doesn't make any sense to put our enjoyment ahead of their lives.

And secondly, several members of my group have the single most important co-morbidity factor - high blood pressure. So, even though mortality in our age group is quite low, with the high blood pressure present in it's in the 1% range. And that's to not even get into the relatively high risk that they'd need to be on oxygen for 2 to 4 weeks.

That's admirable, but by that logic you should not drive to your sessions either as you are more likely to kill someone (of any age) in a car accident than cause their death through the spread of this virus.

Again, I am not trying to belittle the virus or the seriousness of the horrible deaths caused by it. And in areas where it is high I encourage people to take precautions. But I also encourage people to drive safely, only use prescription drugs, and so on for their general well-being and that of others.

 

[Umbran]

That estimation step is already factored into the 3.4% estimate. The number for those with verified infection is 5.7%.

I believe you are mistaken. My sources say differently:

From The Washington Post
"This week, World Health Organization Director General Tedros Adhanom Ghebreyesus stated an undisputed fact: 3.4 percent of people with reported covid-19 infections worldwide have died. Or the fact was undisputed until misinterpretations set in, almost immediately. Some in the news media mistook the statement as meaning an alarming 3.4 percent mortality risk for coronavirus infections overall. "

From ADJUSTED AGE-SPECIFIC CASE FATALITY RATIO DURING THE COVID-19 EPIDEMIC IN HUBEI, CHINA, JANUARY AND FEBRUARY 2020

"We estimated the age-specific case fatality ratio (CFR) by fitting a transmission model to data from China, accounting for underreporting of cases and the time delay to death. Overall CFR among all infections was 1.6% (1.4-1.8%) and increased considerably for the elderly, highlighting the expected burden for populations with further expansion of the COVID-19 epidemic around the globe. "

This last is an academic paper that actually handles the estimation, by epedemiologists - the people whose job it is to estimate such things. If you have a better citation, please give it.

I haven't read the papers you linked to yet, but every estimate I've seen for incidence rates under 2% postulates that there is a very large number of undetected cases in the population. The evidence for that is fairly weak though, and depends on a relatively large percentage of the population being asymptomatic.

No. It depends on a large percentage of the population not going to the hospital and getting tested. For most folks, the symptoms are very similar to a cold or the flu. Most people don't go to the doctor for such things, much less get tested for covid-19.

Though, even if it were 2%, that would still be extraordinarily high from a historical perspective. It's been over 100 years since the last appearance of a novel disease with R0 around 2 and mortality rate around 2%.

A mortality rate 16x that of the flu is scary, yes. No argument. It has impact well beyond just the people who die from covid-19. It also tends to fill up the health care system such that those who have other life threatening issues will not be able to get care - this being seen in Italy today, for example.