Islands, Italy and the Upper Bound of COVID-19

The hardest-hit COVID-19 locations in the world are the islands of San Marino and Andorra and the countries of Italy and Spain.

San Marino has a population of 33,000. This is eight times the population of the Diamond Princess cruise ship (3700, 700 cases). Ten of the people who had been on the ships, the Diamond Princess and the Grand Princess (3400 passengers, 103 cases), have died.

San Marino has found 223 cases, 21 deaths and 15 new cases were added yesterday. San Marino seems on pace to add 600 to 2000 cases. Those would be 20000 to 80000 cases per million.

This would mean that the hope that there are vast percentages of people who caught COVID-19 and became immune would not be as large as some hope. China found that 85% had no symptoms or mild symptoms. If 8% of population tests positive for active coronavirus then that larger pool might only be twice as big as what China detected. Hitting a 0.3% active case detection might mean that there are 50 times as many hidden infections and recoveries.

Andorra has a population of 76,000. Andorra has 267 cases and added 43 new cases yesterday. Andorra seems on pace to add 2000 to 8000 cases. If Andorra matched the Diamond Princess they would have 14,000 cases.

Italy has a population of 61 million. Italy has 1431 official cases per 1 million people.
The Lombardy region of Italy has 10 million people. Lombardy has 3500 cases per 1 million people.

New York state has found 45,000 cases and has a population of 20 million. This is 444 cases per million. New York City has 23000 cases and has a population of 8.6 million. This is 374 cases per million. New York can get 50 to 200 times more cases before full saturation limited the spread. New York City could hit 180000 to 700,000 cases as an upper bound. However, there will not be 100% of people getting the disease.

This is an estimation before we get the serosurveys that find the exact percentage of people with COVID-19 antibodies. Those surveys will indicate when we will get to herd immunity limits.

SOURCES – Worldometers
Written By Brian Wang,

25 thoughts on “Islands, Italy and the Upper Bound of COVID-19”

  1. Also, the claims of a much lower death rate that have been repeatedly floated here are bunk if most of the cases are detected.

  2. Yes you could.

    But we are talking about what has actually happened over the past few months, not what COULD be done with a significant change in behaviour (and change in the HVAC systems).

  3. We have literally centuries of disease outbreaks having their origin in China.
    Some characteristic, or combination of characteristics, of the climate/zoology/culture/whatever results in a high chance of crossover there.
    Long predating any deliberate bio warfare research.

    This doesn’t disprove the bio lab theory. But it means that merely starting there is no evidence for the lab theory.

  4. There is no vast unknown CV epidemic.

    Which is bad news. Such an epidemic would mean that the population was mostly safe and would soon be mostly immune.

  5. I read that this is what they are aiming for. In most countries an ordinary doctor cannot order the test.

  6. This is like a case study in why it’s a bad idea to extrapolate ratios from very small numbers of data points. 21 deaths does not equal “619 per M”. It’s 21 deaths. How many of those were San Marino residents? How many were tourists?

    Also, San Marino and Andorra are not islands. They are small landlocked countries – San Marino is completely surrounded by Italy. Andorra is on the border of France and Spain.

  7. Here in North Carolina there have been 16,000 tests and only 750 positives. If there were massive unknown CV cases, those tests would have revealed it. Instead, these were people who were known to be in proximity of a virus case or presented symptoms like CV and the majority of them tested were negative.

    There is no vast unknown CV epidemic.

  8. Yea, but you could do *just* the skiing and skip the crowding into coffee shops, couldn’t you? So it should be sufficient to just ban the “gathering-in-large-numbers-in-confined-spaces”…?

  9. This is like wondering why a specific combination of numbers was the winning lottery ticket: given random viral mutations the epidemic will start where the mutation occurs. If the environment (density of host population, temperature etc) is favourable then the infection can spread and become epidemic, but even in optimal environment (poor hygene, frequent exposure to potential host animals…) you do not get an epidrmic if you do not have the mutated virus.
    The virus genome has been sequenced and it is of natural origin. It just happened in a certain area and not in another one.

  10. Yep, I am appalled by the fact that someone could write a full post on something without even checking some basic information

  11. So… going outside in the freezing cold all day and then clustering together inside in chalets, crowded coffee shops and bars where people are squashed into small rooms with recirculated air to keep warm.

    I can believe that this would spread Covid-19 very well.

  12. I wonder why Coronavirus started In China instead of Indonesia.. I was watching YouTube about countries that eat bushmeat and you would wonder why we haven’t had this problem before… like there’s really a biolab somewhere in China creating weaponized Coronaviruses and their bug escaped…

  13. Not Germany. Their government official said yesterday that they are not testing anyone who wants to be tested. The test has to be ordered by a physician.

  14. How do you figure 0.3% active case detection? At the very least, I’d expect 80-90% of severe cases and closer to 100% of critical cases to be detected in developed countries. If those are 20% of all detected cases, then also about 5 times as many mild cases should be detected. That should add up to much more than 0.3% of all active cases, unless severe cases are a lot more rare than current estimates.

  15. We’ve covered this before. The asymptomatic cases (not merely mild cases) would probably more like 20% (at most) of the essential work force. Look up the analysis of Diamond Princess cases, and apply the ratios from that to the demographics of essential workers.

    And the existance of asymptomatic cases just means that if we’re not careful, at some point nearly all of our few remaining essential workers might actually be infectious!

    If that’s going to happen, I sure want our health officials to be aware of it and to be warning people not to order take-out food or go see a doctor if they can avoid it. Even better if we could be testing enough to detect those asymptomatic cases ASAP and send them home.

  16. It’s a good point, but if essential workers fall into the same demographic generally as everyone else then 85% will have little to no symptoms

  17. Australia is going into hard lockdown and hopefully, according to medical journalist Dr Norman Swan, will be able to open up again in 6 weeks. The 6 week lockdown is to stop the spread in its tracks, save our tiny health system from being overwhelmed by the 10% hospitalisation rate, and give our government time to buy in MILLIONS of test kits so we can fastidiously track and trace like South Korea. Now that America is in such a bad way with Covid 19, maybe Uncle Sam will have to introduce this program?

  18. In keeping with this site’s focus on the future, I’m wondering if we may be headed toward a next stage of this crisis where the virus has spread through “essential workers”. In a few weeks or a month might many of them be out sick for weeks? What do we do then?

    Are the managers of the essential workers planning ahead? Are the police keeping a reserve force to call in when they have to dismiss all active officers for having COVID-19 or having been exposed to officers that do? How about the hospitals?

    Are public health officials tracking statistics and making projections specifically for essential workers?

  19. One of the trends in the Covid-19 data is that winter sports resorts have high levels of infection, Switzerland has a high rate of infection. In the United States, Vail, Aspen, Park City, Crested Butte and Sun Valley are all high infection rate islands. Fortunately, isolation should work well since the visiting skiers have returned home.

  20. On the other hand, we should not wait for herd immunity, this is the 21st century after all. S. Korea probably was able to stop the epidemic without reaching herd immunity and with screening by request, targeted quarantine and very little restrictions. That should be the stellar example.

    Germany is already moving to a similar level of screening and notifications and is aiming to lift more restrictions after they go below case doubling every 10 days. That is a very common sense approach.

    At any rate, the point where the epidemic is considered non dangerous cannot be calculated alone on base of share of people with antibodies, but a combination of that together with level of screening relative to the number of infections, share of discovery by screening and rate of number of infections growth.

Comments are closed.