Open letter from Italy to the international scientific community
left.it
left.it
You may think "it's not here yet". It is.
You may think "the numbers are low". They aren't. We are failing miserably in our testing, our numbers are easily off by a factor of 10 (for infections).
You might not want to be "weird" and not want to practice social distancing. You need to.
You need to act when it feels too early and honestly, in the US, that was a week+ ago so at least act now.
I don't say these things to whip people up in a panic, I say them because we are about to get hit hard here in the US. If you know a nurse maybe send them a text and ask how they feel. I can tell you the nurses I know are freaking out because they know we are not prepared. A have a friend who works at a big hospital. They have 2 cases (at least as of a day ago) and they almost buckled under it. They don't have many masks, they don't have training, and the hospital itself has no plans in place. When asked "How many masks do we have?" the answer (on Thursday of this week) was "I don't know" from the head of infections diseases. Let that sink in. March 12th.
I can understand not knowing the count off the top of your head in November 2019, I can understand it in December 2019, I can still wrap my head around not knowing it in January 2020 but damn it... It's March, you are in a meeting to discuss COVID-19 and you don't know how many masks you have on hand?
The world has been warning us for months now and they had no plans for how to handle visitors. The nurses have not done n95 mask fit tests. They are not getting clear direction on how handle mask reuse. We are not prepared for this. If this hospital (which I would trust for any major procedure) is feeling the strain with 2 patients what happens when there are 4? 8? 16? 32?
[0] https://www.youtube.com/playlist?list=PLRgTUN1zz_oeQpnJxpeaE...
I have a difficult time grasping this part. It’s not like it’s something completely new. We encounter virus infections every year during flu season. The SARS outbreak was 18 years ago and MERS was 8 years ago. Did we not learn anything from it?
Sure, it was not as severe as SARS-CoV-2, but we should know how to handle it. I agree we should take precautions to stop spreading. But from seeing what is going on around here in EU, I am thinking that the panic is over-inflated and is doing more harm than good. Maybe it takes panic and fear to scare the majority of people into taking all precautions to stop the virus from spreading?
> Sure, it was not as severe as SARS-CoV-2, but we should know how to handle it.
The answer appears to be no, we didn't. Remember neither of those really hit here in the US.
CDC SARS FAQ [0]
> How many people contracted SARS in the United States during the 2003 outbreak? How many people died of SARS in the United States?
> In the United States, only eight persons were laboratory-confirmed as SARS cases. There were no SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.
CDC MERS FAQ [1]
> Q: Has anyone in the United States gotten infected?
> A: Yes, two patients in the U.S. tested positive for MERS-CoV infection, both in May 2014.
The hospitals (nurses at them) that I've heard from say they don't have the masks on hand and they have received no training for how to deal with something like this on this scale. In fact they are being told things contrary to their training like having them wipe down the disposable shield of a CAPR [2] with bleach to re-use it (they are supposed to be single use).
They have limited (10 in the case of the CAPR shields in one hospital) because it's only required for specific diseases that they see few to no cases of per year. They don't have stockpiles of n95 masks because they could alway just order more if they needed them (same with CAPR). They are having to use the CAPR's temporarily because you need to pass a n95 mask fit test [3] (to insure nothing can get in) but the nurses haven't done that. At one hospital they just so happened (dumb luck) to have someone working that day that knew how to administer it and so they have been rushing to have nurses complete it.
> But from seeing what is going on around here in EU
What do you mean by this?
[0] https://www.cdc.gov/sars/about/faq.html
[1] https://www.cdc.gov/coronavirus/mers/faq.html
[2] http://www.lbs-biotech.com/products/personal-protection/max-...
[3] https://www.osha.gov/video/respiratory_protection/fittesting...
The average person in the US rightly did not have much reason to be concerned a few weeks ago, but that's not the case anymore. It's important to understand that the situation has evolved rapidly for the worse here, and our response ("panic level" if you will) must escalate accordingly.
In particular:
- Each one of us is now at much higher risk of infection, possibly orders of magnitude higher than the official numbers suggest. The bungled testing rollout, the high level of community spread and the number of deaths together suggest the official numbers are grossly under-counting. [1] This is very different from a few weeks ago when the cases where mostly imported or had known transmission routes.
- A few weeks ago, the CDC was still hoping to contain the epidemic by tracing and quarantining cases. But that has changed. Whereas China, Hong Kong, Taiwan etc have succeeded in containing the disease so far, the US has already failed and the CDC now expects it to eventually spread to most of the US population. [2] Its strategy is now to slow it down enough to avoid what's happening in Italy.
- The situation in Italy has shown us the magnitude of human suffering that will result from people "under-panicking" and going about their daily lives at a similar stage of the epidemic. There will be a rapid explosion in cases, leading to a meltdown of the health care system. Many of us will lose our loved ones, and many of us will die unnecessary deaths from hospitals being overrun. Not to mention the impact on the economy, which we can't measure yet in Italy but could well be greater than the cost of locking down early.
So stop thinking "it's fine". It was a few weeks ago. It's not anymore.
[1] https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
[2] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summ... or https://www.youtube.com/watch?v=9cfYC4YLsu4
It could do that because it could afford to take the economical hit and because it is an authoritarian state, which means you can get almost everyone to obey, in one way or another. Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.
Why on Earth is this a good model?
Undoubtedly for the safety of citizens, but even with all the people shouting about a "fascist revolution" going on with the previous government, it only took three orders to strip everyone of most of their freedoms without anyone batting an eye (especially since no one knows for how long, the April 3rd date is a joke).
Quarantining is probably inevitable (although it won't help the overloaded ICUs until two weeks from now, so more capacity will always be needed), but following rules in place in an outbreak does not mean one should not question their principles.
And this letter should be sent to the media and the government, since both can't even understand an exponential, or basic statistics (even with the so-called "peak" reached, cases will keep on increasing until recoveries are due).
Personally I'd like fast-tracking of anti-SARS-CoV-2 drugs instead (those are the ones which will get out of this mess, quarantining is just flattening the curve, although immensely beneficial), along with setting up place for non-intensive care COVID-19 patients. Every ICU bed freed is a victory.
Why blame China for "allowing this virus to spread all around the world" when Italy allowed the same?
(Italy even had a warning that it was coming!)
But if we're looking for an example of how to solve the pandemic, when people point to China as an example, they aren't saying "we should spend a few weeks pretending the virus doesn't exist, threaten doctors who talk about it, order our labs not to study it, and THEN take decisive action". They're saying we should do the stuff that China did, starting from the decisive action part.
There's certainly lots of blame to assign to China and after all this comes back to a "normal" state again the international community should pressure China into eliminating the things that made all this possible: they should be draconic in not allowing things like the Wuhan wet-market be open ever again, all over China, for ever, they should be forthcoming in allowing international experts come and asses things as soon as a new disease manifests itself, they should allow their local medical experts have the upper hand over local Communist officials, at all times.
What China did is not something that other countries may want to replicate, but we should all be replicating the Korean and Japanese measures. Actually we should have been doing it weeks ago instead of pretending that if we didn't test then there would be no cases.
You do realize that some of their “decisive actions” included enforcing quarantine via welded-shut doors, right?[0] I don’t think you’re ready to handle the kind of “decisive action” that China took.
I don’t think you understand the significance of welding the doors shut... it means if they catch you outside you can’t claim you did it on accident. So, wink wink, they’ll cure you of the virus permanently after that.
Again, you’re not ready for Chinese-style “decisive actions.”
With the population it has, China could have been in a much much worse shape today were it not for the quarantine.
Not only that, refuse to acknowledge, or share any information to international communities. The amount of things they do just to saves faces.
That kind of not sharing information?
If you don't know the source (which is still unknown) then you cannot verify that it has spread human to human. (They should have assumed that it did)
Researches outside of China said there was no evidence of human to human transmission.
The first 2 weeks of January were handled rather poorly. But lack of information since then isn't really one of them.
What could China have done that would have made you personally happy?
People automatically distrust anything they say. What other information could they have provided?
When we had the first cases its only concern was whether a minority party would leave the coalition or not.
It wasn't fit for the emergency, any emergency. Unfortunately, that's what we will be stuck with until it's over.
Just like the spread of fire, the window of opportunity to put it out is right at the beginning.
Yes, Italy could put it out when it first came to Italy but they would have to do it many many more times to successfully contain it. China just had to do it once and they failed.
I'm well aware of how trials work (I happen to work in a scientific institution which does plenty). They may have been fast-tracked elsewhere, but not in my country.
So far there's just compassionate use, which means they're administered only to people who have truly severe sympthoms.
A vaccine can wait, to be honest, it's not as critical as a treatment to lessen the sympthoms. In fact, that's why Gilead is also testing their drug here (not sure when the actual protocols will start, though).
Note that I'm not advocating for "let's scrap all the trials stuff". But trials in phase III have, for obvious reasons, very lengthy time frames. And it's not the first time (I attended a talk a few years ago on the topic) where the system (which works, normally) shows its limits (not only emergencies, but for example orphan drugs).
And also take a look at what safeguards we are willing to cut when every day of delay is thousands of deaths.
China dropped the ball for a full 10 days back when the disease was nicely contained to a small part of Wuhan, and then largely to Wuhan itself and Hubei - they didn't let the population know about the danger, so for quite some time no one was thinking about protecting themselves by wearing masks, social distancing etc. But the trouble is, Italy then made the exact same mistake by being late with containment measures, and now the UK and US are doing the same. So there's nothing to roll one's eyes or raise eyebrows about.
Once the threat was clear, the government of China acted much more alacrity and decisiveness than any Western country, which have had months of advance notice.
That's for sure but there's a useful middle ground between mindless panic and total complacency, and these Chinese officials were way too far on the complacency side for quite some time.
They were correct in threatening a doctor who reported what he saw (facts) to retract his statements as being _false_?
The local government didn't want to believe in the threat and wanted very much to keep any negative news hushed out of fear of looking bad to the central government.
So there you have it, a country governed by fear where people prefer to hide issues instead of quickly seeking help.
They could have done it through internal channels, without the public knowing but no, they crushed the messengers and tried to hide the facts until it was too late.
The central government admitted it itself: https://news.rthk.hk/rthk/en/component/k2/1506445-20200203.h...
They did squash discussion of it.
Once the national government found out, they fired the local officials and lauded the doctor as a hero.
I'll admit, though, that I wouldn't trade my right to vote for a cure for the common cold, coronavirus, or anything else.
Look, this is a dangerous meme in more ways than one. Italy and Spain managed to lock down entire cities, and those are countries with a strong tradition of democracy. Emergency powers, martial law etc. are a thing, and there's even quite a bit of precedent for using them to deal w/ disease outbreaks. Even in the US.
In constitutional monarchy the monarch is Head of State, a figurehead role with no real personal power. Because monarchs are born not elected this figurehead has no semblance of democratic legitimacy, it's obvious to everyone that they shouldn't get any power, yet as a symbol they are long-lived and emphasise continuity even as political change happens around them.
Elected Politicians on the other hand actually run the legislature and executive government.
That is, the laws you obey are made by people you elected to make them, but at times of crisis the living symbol of your country isn't some politician roughly half the country doesn't like.
This works so much better than the US system that Americans charged with trying to make new countries or fix broken ones (after "regime change" for example) do not follow the US model for many decades. If you're an optimist, the US model worked once and maybe they got lucky. If you're a pessimist we're just waiting for the cracks to get bad enough that it falls apart.
You can't support that claim. Historically - all of recorded history - there are less than half a dozen examples that can be argued to be comparable to or to have systems that are more stable than the US over two centuries of time.
Go ahead and list all the constitutional + democratic systems that have lasted for more than two centuries. The European region barely had any democracies as recently as WW1. Here is what that looks like:
https://i.imgur.com/fnJNjIn.png
Now go back to 1850 or 1900. How many were there? So where do you plan to get your data from, to support your premise on stability?
There is long-term instability inherent in all functioning monarchy systems: the source of that instability is that people frequently don't like them, which is why nations have spent the last few hundred years gradually abandoning or neutering monarchy systems. Most of what remains is a cultural trinket. It's why the monarchy in the UK is little more than a facade, a figurehead; it has no real governing power or position, it is of relatively little political consequence and probably never will be again. Even including the UK in this, is a questionable data point because of that. What does the Queen do? Answer: not much, she is nothing more than a quaint cultural nod to the past at this point.
In fact the US has the opposite problem. Its system of government tends to produce too much stability and not enough dynamism (which is what the argument for many political parties is arguing in favor of). That stability often means the US moves slower on reforms and its system is highly resistant to change. Those are the trade-offs inherent in having greater stability.
Plenty of countries especially in Latin America copied this choice and it didn't work for them. I think the evidence supports the conclusion that's because it's a bad choice.
The danger was sufficiently known, sufficiently early.
Those sounding the alarm were silenced.
Uh, China dropped the ball for a full 3 months since the first reports of a novel respiratory disease started back in November. First denying it, then jailing the doctors who tried to raise the alarm. Not to mention not enforcing their own laws regarding food hygiene put in place after SARS which would have prevented the transmission in the first place.
Yeah, they're now showing containment measures that work. But they could have stopped this in its tracks before going global, or prevented it entirely.
Too little, too late.
The Doctor wasn't jailed ...
The virus was spread at the market. It didn't start at the market.
Until we know where it started we don't know if it would have stopped the virus or not.
Talking about the origin of this virus, this paper of 2015 is quite interesting: https://www.nature.com/articles/nm.3985 . In this paper, the wuhan P4 institute people basically described how they produced a prototype of the 2019 wuhan virus.
Without information about how this letter was prepared and signed among these people in detail, my hypothesis stands.
He is/was also a member of the CCP.
The virus came from bats. The "wildlife market" in question sold raw bat meat. How else would it have gotten there?
They eat lots of animals but bats are not one of them. (I'm sure there is a village in China where they do eat bats. It is a big country.)
The photos you see online of Chinese people eating bats are Tourist in the Pacific.
But this particular part of China does. It's more a subculture derived from one of the minority groups in that province, but it's there.
The original hypothesis was that some other animal sold at the market acted as an intermediate host between bat and human, just like the case in 2003 SARS, but this is also not proven.
If you have 3 people and one slips on a patch of ice and falls you could argue they should understand how ice works and should have been more careful, but if you have 2 other people see that person fall and they blithely walk across the ice and also fall, who should you judge more harshly?
For me personally, I'm going with the people who saw the result of the first event and then followed the same path.
Let’s put it this way, other countries have had a full 2 months of warning and preparation time and they are also dropping the ball.
Any delays by other 1st world countries after 31st Dec are largely their own fault.
Besides Italy did start to apply lockdown measures to specific towns, and closed schools when they had 20 cases. It was insufficient but at least it was an attempt. The US has had clusters out of control in Washington state for almost as long and the federal agencies were actually trying to silence them. And another in NYC, which is basically the economic powerhouse of the United States.
And it should've been clear with all the data we had that it would be. Don't get me wrong, I don't think any of the other western countries does it right. Italy got unlucky because it was the first country where shit hit the fan. Might as well have been Germany if they wouldn't have gotten lucky in stopping the spread from their Bavaria case. But I fully stand by my point anyways that no country in the west did a good job, and points like yours are weak excuses at best, since it basically boils down to "well we're delaying taking down our economy a bit and make sure the rest of Europe suffers too, so we're not as ducked in comparison to them." There's certainly some logic to that, but it shows how shallow our advanced civilized world really is.
FWIW I totally agree.
> Might as well have been Germany if they wouldn't have gotten lucky in stopping the spread from their Bavaria case.
Yes, that's what Italy was hoping to do. They didn't realize how contagious this thing is.
In the early stages in Wuhan the virus only existed in Wuhan. A severe lockdown that eliminated the virus there would have eliminated it completely. Full stop. It would have been gone forever.
A draconian lockdown right now in e.g. the UK, or even a few weeks ago, might have eliminated the virus in the UK, but then it would just come back in again. We can’t seal the entire country permanently.
Even in Wuhan, they are easing the lockdown so soon the virus will get back into Wuhan again. It’s just a matter of time before they have another outbreak. It’s simply impossible that it won’t happen.
Lockdowns are important tools to slow the spread of the virus, they are a vital part of our response, but they can only slow it down. They cannot stop it or eliminate it. Also lockdowns are most effective the first time you do them, and then they’re the most effective in the first few weeks.
Impose a heavy lockdown too soon, and it’s like using up your most powerful ammunition before the enemy is in effective range of your weapons. Letting the enemy get closer might mean accepting casualties early on, but fewer casualties overall and a better chance of victory. It’s a hard, painful choice to have to take.
That's not alarming.
What's alarming is that the Chinese regime admitted that the people who they placed in charge of the crisis response have been continuously lying and falsely reporting the real amount of victims and how far the disease has spread. They've done it jus prior of replacing them, but the Chinese regime just replaced them with loyalist party officials, which makes it sound like a desperate attempt to keep falsifying reports.
Pretty much all countries have mechanisms for emergency powers. China being authoritarian has nothing to do with it. I'm not familiar with Italy's constitution or laws, but I assume it has similar provisions?
> Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.
Huh? On the one hand you're arguing China was too draconian (and Italy shouldn't copy), then a sentence later you're complaining it wasn't enough and this is all China's fault?
What exactly do you suggest China ought to have done to prevent it from spreading outside of China? I haven't heard any reputable source suggest there was any practical way of containing it perfectly.
Your comment comes across as knee-jerk anti-China rather than anything based in science or public policy.
Of course there was. If they somehow magically divined the true danger of the virus the day they identified it.
But they didn't, it took time and observation, and they shut down the affected areas as soon as the extent of danger was realized and processed by their bureaucracy. There's plenty of things here that could've been done better, but it's asinine to blame them for the virus taking hold everywhere else. Doubly so given that most of the world had a month+ warning before they registered their first cases.
That is the issue here. They completely ignored it until people were dying in the hallways of hospitals and then implemented a draconian policy.
And now they're locking up anyone who criticizes them. See this article about "Gratitude education", a term that tops Orwell in its dystopian implications:
https://www.theguardian.com/world/2020/mar/09/gratitude-educ...
Well, at the very least, take it seriously when there were the first reports of "new viral pneumonia" in Wuhan, instead of locking up or censoring people who reported that.
Yes, this doesn't mean that other countries did not take it as seriously as they should have, and perhaps containment might have failed nevertheless. Still, it was a spectacular failure with long-lasting consequences on every other country in the world.
That, IMO, deserves blame, no matter if other governments are doing the same errors.
And, look — I’m sitting here in the US where I’ve been horrified at our own response over the last month. But the question was, could it have been contained? Looking at that timeline, it certainly seems possible that it could have been. Of course, we’ll never know.
https://www.wsj.com/articles/how-it-all-started-chinas-early...
The faster and better that you deal with it, the smaller the economic hit is going to be. China is going to be the big winner here.
That said, we could just apply medical quarantine procedures used for animals to humans. Get a lab test 48 hours prior to international travel and have an additional test performed upon landing at the destination. The first test minimizes the likelihood of someone with viral shedding traveling and the lab test upon landing let’s you get the person and isolate them immediately before they’ve shed virally.
China has more poor people than Italy, it stands to reason they are less well equipped to handle an economic down turn.
The economy is going to be hit either way, it's just a choice between A) a lock down but most people staying alive and healthy or B) lots of people dying or sick and an overrun health care system.
Maybe we don't know which one will have bigger impact on the economy, but we know for sure which one will lead to more human suffering.
While a state like China would be a bad idea, here in America we could perhaps learn the benefits of not heading too far in the opposite direction.
Quarantining is the only thing that will help in this situation. There's no other solution we have as a society to slow down the pace of infections. People who normally wouldn't die will die because of the lack of medical care.
The problem we face in the US is lack of testing, which makes it impossible to do anything except a quarantine.
The question is, for how long? Until the infection curve goes down? Until there is not a single infected cases in the whole country?
While you can't know when this will happen (especially the former, most models are inaccurate because too little is still known about this virus), I don't believe it is sustainable to keep an extended lockdown on a whole country (as opposed to "just" Hubei, which however has almost the entire population of Italy) more than a few months.
A significant proportion of infected need hospitalization to survive. If we all get sick at once, there simply aren't enough hospital beds to go around, not to mention other supplies. If the hospitals go far beyond capacity, the fatality rate will be _far_ higher than otherwise.
As to how long, I haven't seen good models. In the US we don't have very good data either, because we're testing basically noone.
Some of these models are also different in nature, which adds to the uncertainty: some are epidemiological models, some are economical (used to evaluate the impact of the measures on the long term).
Lastly, a lot of qualified people speak and try to give estimates. I'd love if they don't, because currently the best answer is "we do not know yet".
That said, I think that going over two months of lockdown will be probably ruinous for the country as whole.
And I'm not sure if people can hold psychologically being locked up for one year.
Probably if they handed some out and told people to take a few as soon as they got a cough + some temperature it would help things. (http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...)
Korea also hasn’t had any hospital breakdown related increase in the death rate.
Chloroquine may indeed work, but the Korean stats are misleading if you don’t adjust for ages.
Also very important to quantify side effect risks, even if it's a rough estimate. For example, if a 70 year old patient has already progressed to dyspena, they might have something like a 20% mortality rate from COVID. Even if there is a side effect profile for the treatment that normally would be considered very dangerous, it may be well worth it to administer it.
We see the same thing with chemotherapy or radiation treatment. The side effects are terrible and fairly often fatal, but they are safer than the disease. This is the situation in which we find ourselves.
https://www.sciencedirect.com/science/article/pii/S088394412...
What you're saying is true, but you're assuming that Chloroquine + Kaletra is better than Chloroquine by itself, and we don't have the data for that yet.
Do you have a source for the Chinese recommendations?
They state:
4. Antiviral therapies: Interferon-alpha (adult: 5 million units or equivalent can be added to 2ml sterile injection water and delivered with a nebulizer twice daily), lopinavir/ritonavir (adult: 200mg/50mg/tablet, 2 tablets twice daily; the length of treatment should not exceed 10 days), ribavirin (recommended in combination with interferon or lopinavir/ritonavir, adult: 500mg twice or three times daily via IV, the length of treatment should not exceed 10 days), chloroquine phosphate (adult 18-65 years old weighing more than 50kg: 500mg twice daily for 7 days; bodyweight less than 50kg: 500mg twice daily for day 1 and 2, 500mg once daily for day 3 through 7); umifenovir (adult: 200mg three times daily; the length of treatment should not exceed 10 days).
Pay attention to issues such as adverse drug reactions, contraindications (for example, chloroquine should not be given to patients with heart diseases), and drug interactions. Further evaluate the efficacy of current treatment regimens in clinical applications. Using 3 or more antiviral drugs is not recommended. Corresponding medication should be discontinued should intolerable side effects appear.
Source as I posted on other submissions
Chloroquine is mostly admitted as a valid treatment now
Chloroquine has a long history with many diseases of "sorta, but not really" working when subjected to actual test.
Please don't spread unsubstantiated info.
I haven’t found the source paper if there is one yet — I can’t read Chinese except with google translate
Chloroquines have a long history of this in viral studies.
That said, it’s an approved drug, so it will be applied and we’ll see how it goes. But don’t spread rumors about its effectiveness, because the truth is, we don’t know.
Relevant XKCD: https://www.xkcd.com/1217/
Chloroquines will be tried since they already pass the "safe" bar.
However, I suspect that if they worked "in vivo", we would have compelling data on that from China already. The fact that we don't have such data suggests that they don't.
We seem to have much better data about the effectiveness of standard anti-virals already.
Everyone wants a drug and vaccine, but good science takes time to happen. Make no mistake, no one wants a lock down, but so far, it's the only option in the lack of a functional medical solution. If tons of scientists tell us lock down is the only option for now, we should'd listen rather than discredit them.
Now, if someone really wants to move on to talk about politics. It's about a nation as a whole can do the right thing, not about authoritarian vs. democracy.
A ideal democracy society works because we trust reasonable individuals can collectively make the right decision. In this COVID-19 case, lock the hell down and do the best practice to stop it from spreading. I don't see why a functional democracy nation can't do that. But it has to be a functional one.
Unfortunately, authoritarian was necessary when the general population (including local governments at various level) cannot function as well. China for example, has to reply on THE ONE in the center to make the right call and execute order top down to be functional. At least according to the CCP, the general population cannot be trusted. Thus the authoritarian regime. It's easy to see it's effectiveness when there is the right order in place. But it's also equally easy to neglect the fact that such an order takes really long (from Dec 2019 to end of Jan) to materialize.
IMHO, I think both Italy and China failed here, while we are all ignoring the one did really well, at least so far, Japan. (Or maybe Taiwan and Singapore, but they are small states which is easier to govern).
As I said elsewhere, a vaccine is likely less "important" in the immediate, especially because it can have far deeper side effects, and no test has been done on humans whatsoever, while most of the drugs are on Phase III (earliest data should arrive in April, at least for the studies I looked up).
Lock downs will help. But they will help in the future. They won't help the overloaded ICUs now, because they're getting now people who had been infected up to 14 days before. In case of no drugs, the alternative is getting makeshift hospitals in place to lessen the burden on the health system, and procure more equipment. However, just as the government was extremely fast in getting people locked in their homes, it was not for these things.
> It's about a nation as a whole can do the right thing, not about authoritarian vs. democracy.
It's hard to tell when the same government gives contradictory or confused statements. Some blamed "the ignorant masses" for the panic fleeing last Sunday, but in my view, people weren't just well equipped to understand (plus the early leak of the document) what was going on. The media also cherry picks the bad apples very well.
It ultimately means that these methods should have been used in the past.
It does not mean that they should be not used today because without using them the future will be orders of magnitude worse.
I compiled a small investigation http://www.savespain.eu/italy-vs-germany It might be interesting for you.
If you want your future to be better, start acting today.
Every Italian should have realized by now that you should hide your grandma and grandpa if you want to see them alive.
That said, I would take any numbers coming out of China with a very large grain of salt; Italy looks way worse than China going by the numbers but I'd trust the Italian numbers more.
Also: it is much better to go by deaths and critical cases than it is to go by the number of cases themselves. The deaths and the critical cases are a lot harder to hide.
It's not but I guess it's the best they have right now.
Taiwan, Hong Kong, Japan and Singapore are still functioning and have "contained" the virus. The number of cases/deaths did not explode despite contracting the virus much earlier.
[0] https://www.ft.com/__origami/service/image/v2/images/raw/htt...
You know what is MUCH more effective than an authoritarian response? An _earlier response_.
An earlier response, even if it weaker, is much more potent than a stronger later response.
The intensity of china's response would not be necessary where the response is faster.
> but following rules in place in an outbreak does not mean one should not question their principles.
The best way to preserve civil rights and not have to bend them to protect against loss of life is to respond as early as you can reasonable justify.
In the US the fact that our principles (and laws!) tie our hands somewhat is all the more reason that it's important that we act aggressively within the space that our society allows.
> Personally I'd like fast-tracking of anti-SARS-CoV-2 drugs instead
Responding earlier keeps people alive longer for those drugs to become available.
There are legal and logistical challenges in preventing US residents from entering or imposing quarantine.
Would strong or (more importantly) earlier responses have been good? Absolutely! But a weak and late response is much better than an even later response (even if the later response is stronger).
By the numbers we should prefer a non-US-resident ban-- even without screening/quarantine-- on day 20 than a everyone-ban on day 40.
He was even called a dictator for that.
Correction: South Korea & Japan were "do not travel" not specific travel bans.
Japan: level 2 (exercise caution) https://travel.state.gov/content/travel/en/traveladvisories/...
Korea:level 3 (reconsider) https://travel.state.gov/content/travel/en/traveladvisories/...
Regardless, they're still a response which refutes your original point.
Absolutely. If this were Kerbal Space Program just about everybody would be able to tell you that the best moment to deflect an orbit is early on when you only need a little push for a giant effect later on. With exponential developments timing is everything.
I don't understand this logic. Because China made a mess at the beginning of the pandemic, so we shouldn't copy the model they employed at later stage that is proven to be working?
Or because China is an authoritarian state, so everything it does is bad and nothing we can learn from them? Well China has been copying and learning from any countries for a while now and that's what makes it stronger by day. Just keep blaming China and do nothing. That will surely make China less powerful and less influential.
You know what's scary? All major democracies failed to manage the pandemic while China becomes the most powerful country after all this.
1. https://www.bangkokpost.com/world/1879190/us-germany-battle-...
I mean sure - they dropped the ball on a new virus emerging from a familiar situation and getting blindsided by incompetent and image obsessed party officials who silenced the alarms and it took a while for the highly concentrated power structure of blindly loyal party officials to pivot and move.
However ...
It was not an unknown anymore for Europe There was months of warning time There is no suppression of scientific at scale There was daily warnings from WHO and many countries There was precedent for effective measures from Asia
There is no no no reason this should happen in a western democracy right.
And lets not even look at the US where image obsessed national officials with highly concentrated power and blind loyal party following have been actively downplaying (flu), suppressing the national response and hampering testing and effective containment.
It's like China in reverse - the stupid version playing out right in front of our eyes.
We all here love to repeat the virtues of western democracy over the autocratic China but right now we need to take a really good look at how much the theoretical ideals have been replaced by practices that combine the worst of both systems to absolutely devastating results.
If we don't want a major collapse down the road from all the other wait-and-see known threats, from antibiotic resistance to resource exhaustion to broken pension systems to climate change, we better start thinking about how we get of the 'reality is what we want it to be as long as we vote for people who tell us what we want to hear and cast out people who tell us what we need to act upon' train.
Darwin is about survival of the most adaptable to an ever changing world, not necessarily the strongest and right now China looks a lot more adaptable than we do- so if we like our values and system we better start making sacrifices to the gods of science and reality again.
That however would require us to even admit there is a problem and it's not looking promising
https://www.nature.com/articles/d41586-020-00548-w
https://www.nytimes.com/2020/03/05/opinion/coronavirus-china...
Xi was aggressive shutting stuff down but then went on to praise Chinese medicine (basically Naturopathy) multiple times after the Coronavirus became apparent. Which is where the quack medicine that results in people grinding up Pangolin scales and taking them like medicine, then eating the meat. Not to mention having markets with live wildlife in unsanitary areas in the middle of major urban areas with high density.
I'm surprised the continued spread of woo by Chinese authorities isn't taking more of a beating. Not just doing nothing, but promoting it.
Even the recent wildlife market "ban" has a giant loophole:
> The coronavirus epidemic prompted China to permanently ban trade of wild animals as food, but not for medicinal use.
https://www.nytimes.com/2020/02/27/science/coronavirus-pango...
Because it worked. Millions of lives have been saved - 1% of 1.3B is 13M people. That's 1/5 of Italy.
Are there better models? Maybe. But there are also much worse models, as I suspect we might soon find out in the US [1]. Personally I'd much rather take the Chinese model for the next few months than risk me and my family dying or going bankrupt over the next few months.
And, instead of thinking that China could "afford to take the economical hit", consider the economic impact of 13M people suddenly dying. At this point, there's definitely going to be a hit to the economy. It's just going to be either A) from stricter lock downs and government aid, or B) from more people dying due to overrun hospitals. It might not be a wash in terms of the dollar amount, but it's clear which option will save more lives.
[1] Comparing China and US response:
- China has made treatment (not just testing) for coronavirus free for everyone. In the US...better hope you have good insurance.
- Tests performed per million people: China 2,800, US 5
- China is ordering banks to increase loans to SMBs rather than hoarding cash to protect themselves. It has rolled out a bunch of policies to support SMBs and employees. The US...well, not much so far.
Sources: https://www.sciencealert.com/here-s-how-many-coronavirus-tes... https://qz.com/1813181/china-is-taking-pleasure-in-us-mishan... https://www.scmp.com/economy/china-economy/article/3052474/c... https://www.china-briefing.com/news/chinas-latest-regional-m...
This is an inacurrate estimation. I guess your figure of 1% is from South Korea case fatality rate. The confirmed cases represent a biased sample of the population, and the mortality rate could be lower in reality (but not higher).
> consider the economic impact of 13M people suddenly dying.
The mortality is mainly for 70+ years old people, who are already not in the workforce anymore.
Those numbers cannot help us to evaluate or to compare one state's measure versus another state's decision
Sure, the actual number will likely be different for each country / state / city, but doesn't really matter for the sake of the argument. I was using 1% as a lowball number. Official mortality rate from the WHO is 3-4%; some studies say 2%, Italy is reporting 7%.
And for those 80+, current data suggests a mortality rate of 1/7 - not far off from a round of Russian roulette.
So if you have 4 grandparents who are 80+, there's a ~60% chance at least one will die if the disease spreads through our population in the next few months.
> The mortality is mainly for 70+ years old people, who are already not in the workforce anymore.
Firstly, if hospitals are overrun (which is the way we're headed), people of all ages will die preventable deaths. Hospitals in the US are already postponing elective surgeries.
Secondly, it's simply not true that older people don't contribute to the economy.
The elderly still consume food, housing, health care etc., and a negative demand shock is a recipe for recession. For example, think about what happens to nursing homes or physical therapists if a large percentage of older people die. Or what happens to local housing prices if lots of homes are suddenly put up for sale because elderly owners died en masse.
And many older people continue to work and volunteer (e.g. just look at our president, congressmen, and senators), and that some grandparents help with child care (like in my family right now).
Sources: - https://time.com/5798168/coronavirus-mortality-rate/ - https://www.buzzfeednews.com/article/lamvo/coronavirus-death... - https://nypost.com/2020/03/12/heres-why-the-coronavirus-deat... - https://www.economicshelp.org/macroeconomics/economic-growth...
"That means the total number of reported cases is very likely an underestimate—and by not counting many mild or asymptomatic cases, we’re likely overestimating the disease’s overall mortality rate."
It is not possible to know the mortality rate with the information we have. Extrapolating that dubious number into a prediction of deaths is not a meaningful exercise.
In general, with exponential growth the best time to act was yesterday.
The amount of infected is not and will not ever be known and it's a dark time for statistics when many are taking the non-randomly tested and dividing by fatalities and projecting deaths on large populations.
Exponential growth is how successful infections progress. There is nothing new to see here. This sort of aggressive strain was easily foreseeable years ago and we rely on strategic, planned measures to be executed by government.
Random, localized shutdowns only serve to exacerbate the unwarranted panic we are now seeing. The time to think was years in the coming, the actions now display an enormous failure in leadership.
Always makes me sad when Americans willing give up essential liberty to purchase perceived safety. Personally I would much rather look the situation rational, may the assessment of risk for myself, then choose on my own what course of action(s) I will take. Not have those actions dictated and imposed on me by an authoritarian government.
I would rather lose my health or my life than to lose my liberty
Government never roll back control they have ceased. Look at the after effects of 9/11, those provisions where to be "temporary" yet have been renewed endlessly and will always be renewed
In other words, it's also your liberty vs other people's lives.
Are you going to be the grandson who kills his grandma? Or the employee who kills the CEO? Or the Trump supporter who ends up helping elect Biden?
What if they live with or are cared for by other family members?
How will they get health care for existing conditions? Hospitals have been shown to be a major vector for transmission [1]. And how do they even get to the hospital if they can't drive?
What about grocery shopping over the next few months? The National Guard is stepping in to help deliver food in New Rochelle now. Can that scale to the entire nation? For how long?
What if they live in a nursing home? Look what happened in the Seattle one [2].
[1] https://jamanetwork.com/journals/jama/fullarticle/2761044
[2] https://www.foxnews.com/health/washington-state-nursing-home...
Not sure how this is relevant to my post.
> What if they live in a nursing home in close proximity to other elderly people?
The nursing home could stock up and ban people from coming in or out of it.
Many older people cannot just stop getting medical care, and by doing so will be exposed to COVID-19. Especially because hospitals and clinics are overwhelmed by COVID-19 patients.
> The nursing home could stock up and ban people from coming in or out of it.
And all the nursing home staff will be locked inside and not leave for months? Where do they sleep / shower etc?None of the nursing home staff have families or children to care for?
My grandparents are long long dead
>>Or the employee who kills the CEO?
Maybe the CEO should have thought about that and given his employees a work from home, or other policies to allow themselves to self quarantine.
I also find it telling you talk about the employees giving it to the CEO and not the other way around... I am sure there is a Parable in there about unwashed masses
>Or the Trump supporter who ends up helping elect Biden?
Not a Trump supporter, but I do find it amusing you believe only Trump supporters support liberty, and only Biden supporters support authoritarianism
Though I dont think anything will help Biden win, he less electable than Clinton was in 2016
er...what are you trying to say? So other people's grandparents can go f* themselves?
> I do find it amusing you believe only Trump supporters support liberty
Nope, I mentioned Trump supporters because Trump was dragging his feet on cancelling his massive rallies [1]. Thankfully they've been cancelled now.
[1] https://www.vox.com/policy-and-politics/2020/3/11/21174945/b...
Trump said there is nothing to worry about. He even compared the numbers to flu numbers. This is similar to what the CCP did in the beginning.
Wuhan was locked down at 100 new cases a day. This is much faster response than countries who had seen Wuhan and even had better data.
The CCP did screw things up in the beginning, but made up for that by a very effective response. Countries are matching CCP on the initial response, but not ready to match the final response.
So there is no need to equate the need for an authoritarian government to successfully contain the virus.
So did Italy, and they even got a head start in knowledge about the virus of about a month. Yet, the majority of cases here in Germany can be traced back to Italy, and not directly to China.
It's depressing how every country still tries their best to ignore their own failings and defaults to "well China should have stopped it right in the beginning"
I am absolutely sure that things would have been at least as bad if not worse, had this virus originated in Italy. Or Germany, or pretty much anywhere else.
Any government or organization is problematic if it puts 'principles' over human lives.
In the first few weeks of the virus transmission in China, nobody can anticipate the lethality of the coronavirus. People may think it is just another flu. Who knows? Yes, there were delays in the reporting and yes it could have been handled better. But the following actions of China were swift and determined. The fact is the coronavirus has been contained in China. The cases reported in China are single digit today. Fact shows China's model is effective, no?
You think the governments in EU or US could have done a better job if the coronavirus first appeared there? I'd say no. Why? Because the EU and USA have all the data and information about the coronavirus shared by China for months. You have witnessed all the mess caused by the virus in China for months and so what? Trump was down playing the danger of COVID-19 just a few days ago. The USA cannot even cover a fraction of its citizens for testing the virus.
We know it seemed to be a god sent opportunity to point fingers to the "authoritarian" system of China at this moment. But guess what? The coronavirus does not slow itself down regardless you are a democracy or not. Prove your system/model is better by saving the lives of your own citizens instead of bashing China, will you?
PS. we still don't know from where/what the coronavirus come from. I suggest wait for scientific proof before jumping to the conclusion that it started from China. last time I checked, the Spanish Flu did not originate from Spain.
https://www.straitstimes.com/asia/east-asia/wuhan-doctors-sa...
China has implemented measures that have objectively worked: that have effectively contained an outbreak of this disease within their nation, despite having had the least knowledge and warning, and within a short amount of time. So, this is a good model to follow, in the absence of any other.
Certain Western governments appear to have decided to stretch the limits of that model to protect their economy in the short-term.
That will potentially result in everyone across the globe suffering further outbreaks.
Your assumption that drugs will save us is not safe. Novel drug development may be quick, or it may take decades.
Can we stop using mode of government as an explanation for success and failure?
Clearly your country have its head screwed on better than mine. Meanwhile, my president is complacency in chief, more worried about the stock market than lives being lost. The local governments know what they're doing moreso than the feds, when it should be the other way around.
South Korea certainly seemed to have its head screwed most on head. They learned from previous lessons and are very successfully in applying them.
It seems only SK has earned that right and has tested enough people to get reliable statistics. If you only measure the sick in the hospital...
[0] https://www.ft.com/__origami/service/image/v2/images/raw/htt...
Singapore and Hong Kong have been able to slow things down by strong measures, but it's still a straight line on a log graph, just with 1/3 of the growth rate. Italy is on the same line, just 8 days ahead of Europe and 13 days ahead of the US.
Only South Korea shows flattening so far.
The growth rate is the same in other regions but delayed, and there is some hope that the rest of the country might be able to cope with it better if the lock down measures are effective.
“It’s just the flu”
“It only kills 2% of people”
“The flu, cancer, car accidents, malnutrition, etc have killed far more people”
“People were worried about SARS, Swine Flu, and H1N1, and they turned out to be hardly kill anyone.”
“There number of cases here is small. Why are you panicking over nothing?”
“People need to stop panicking. People are going hysterical. The media is trying to make people panic. Just look at them hoarding toilet paper”.
“People are trying to ruin the economy over nothing”
“The experts — epidemiologists — say there’s nothing to worry about” (I’ve had this said to me and I was given a link to a news article that spun statements from some epidemiologists to make it sound that way. They were saying that they didn’t know how the situation would pan out, and this was presented as if it meant they didn’t think there was any issue).
I imagine that most people aren’t aware of the graphs. I imagine most people would be dismissive of them for reasons like the following:
They simply believe the apparent normalcy in front of them more than some abstract maths. They don’t grasp the notion of exponential growth, so it seems fanciful. They also don’t understand how it’s possible to project into the future like that. Maybe they think it’s just fear-mongering speculation. What concrete evidence do they actually have for the situation in Italy? And why should they believe what’s going on in a different country will apply to their country. Maybe their country has a good health care system, and they assume that Italy doesn't.
And even if they are, they aren't aware of log scale.
I've worked with, presented, and consumed a lot of scientific data over my career and I still have a tendency to assume plots are linear no matter how many times I tell myself to always check scale first.
The relevant axis on this chart is the time axis, the x axis. The chart is linear in it. You see a bunch of nearly identical trend lines, and you have to just count how many days a given country is behind Italy. It doesn't matter what scale the vertical axis is in.
I have to wonder how many non-specialists would even know what “log scale” means.
There's your answer. To 90% of elected officials, a "log scale" sounds like something a timber company might weigh their product with.
"Normalcy bias can cause people to drastically underestimate the effects of the disaster. Therefore, people think that they will be safe even though information from the radio, television, or neighbors gives them reasons to believe there is a risk."
People just don't want to believe a disaster is about to happen. They will grasp at straws to explain why everything is going to be fine.
That's usually not a problem because disasters are rare, but it will catch us under-prepped when an actual disaster happens.
They do seem to be missing Denmark though, which should stick out somewhere top-left of Norway.
I was just talking, via text, to a friend in Norway. They're going for major restrictions on contact and the people there are not worried enough yet. I sent her that graph.
Open air walks are ok, as long as you keep a reasonable distance to other people. Only go shopping if it's absolutely necessary.
And yet some people are still going to crowded bars, like nothing's going on. It's amazing how stubborn some people are.
[1] https://ourworldindata.org/grapher/covid-confirmed-cases-sin...
https://www.reddit.com/r/askscience/comments/fguheu/why_have...
Earl_of_Northesk: The RKI is conducting random sample testing to keep track of Influenza in Germany. These tests now also test on COVID-19. So far, not a single prior undetected case of COVID-19 has shown up in these samples. It is thus highly likely that the extensive early tracking and testing means that Germany has, in comparison to other countries, a very low rate of undetected cases, which would obviously lead to a lower mortality rate. That's what the President of the RKI also said in todays press conference together with Angela Merkel.
Painy_: How big is the RKIs sample size tho?
patientzero_: All cases that had the flu and went to the hospital. So the more severe once. But they also re-ran the tests from the beginning of the year to test for Covid-19. If you can't detect it in there it wasn't in the country most likely
Sounds like a massive amount of testing that no other country can match.
People will continue to get the Flu, Colds, HIV / AIDs even throughout this whole shebang. We need to know COVID19 cases specifically, to know if our lockdown methodology is being effective.
Once the growth is no longer exponential, measures can be rolled back slowly, especially if they have access to enough tests, masks and respirators.
The earlier action is taken, the cheaper it will be to stop this. Every week of delay can increase casualty rates by a factor of 10. A month of delay, can mean the difference between 10000 and 10 million dead.
Also, economic costs, both in direct treatment cost as well as the disruption to the productive side of the economy will rise sharply the longer we wait. (Well, at least if we don't see the death of sick and elderly as an economic benefit.)
Universal testing and full identification, isolation, and clearance of all patients across multiple checkpoints would result in the fewest number subject to confinement, confined in the least broad of areas for the shortest periods of time.
OTOH if insignificant testing has been achieved, lockdown itself will need to be inversely universal and long-lasting.
There is an exponential component involved, so the effect will be felt sooner than you think.
Theoretically either way, it's possible no one will be able to be unconfined across multiple checkpoints without a real-time valid negative test or credential.
That decision could be the same either way.
But the fewer and less reliable the tests, the fewer the number of citizens that can be expected to be allowed to move about with some freedom.
After pandemic stress exceeds the magnitude where there can be no treatment resources for additional patients anyway, movement will certainly not be relaxed, and those who might have had a chance with earlier & more thorough action & testing will be left to expire undertested in confinement.
Not every scenario is that uplifting.
Due to the excess rate of confinement resulting from inadequate testing, the greater stress on the marginal economic needs of a large contingent of the populace may result in a need for lockdowns to become oppressive enough to theoretically halt the spread of all possible crime in addition to disease.
Depends on how serious it gets, if it's bad enough you could get unrulyness or looting like there is during some disasters regardless.
i absolutely don't understand how can someone give any ratio about this disease knowing how only the most severe cases got tested ( except in SK), and that the symptoms are almost undistinguisable from the flu.
I would think that this can only give you the infected from a few clusters and you can be surprised by an unknown cluster of patients suddenly needing intensive care.
Edit: And due to the long incubation period, that cluster can be quite large.
Of course, after the disease starts propagating internally, testing becomes irrelevant, and it's time to reduce its spreading speed.
Increasing social distancing will naturally lower the exponential growth rate, but unless the growth becomes linear, there is no reason to believe that herd immunity is anywhere close.
In the asian countries, we more or less know that they have been able to contain the virus, instead of waiting for herd immunity. That meanst that they must have found most of the infected cases (or at least quaranteened them). This gives a good indication of how many deaths are caused by a given number of infected. The numbers are not different enough from Italy to think that more than (at most) a couple of hundred thousand in Italy have reached immunity. If so, it means that we have about 2 more orders of magnitude of growth before herd immunity can be reached. That would be hundreds of thousands of dead, if not millions, just in Italy.
However if the epidemic spreads from region to region, you could reach a local herd immunity in the first regions infected way before seing the country-wide curve becoming linear.
But thanks, trying to find a counter-argument to your post made me realize a single-curve model probably doesn't make a lot of sense to try and understand accurately the spread of an epidemic.
Start reading at "2. What Will Happen When These Coronavirus Cases Materialize?"
From his Medium profile page it seems he is a 'Storyteller' and 'Viral marketer'. So, someone who knows how to tell a story with confidence even if you know nothing of the subject.
I'm gonna listen to my government regarding this, rather than medium posts by viral marketeers. Thank you.
https://www.government.nl/latest/news/2020/03/12/new-measure...
https://www.rivm.nl/en/news/current-information-about-novel-...
> 15-03-2020 , 176 new patients, a total of 1135
> 14-03-2020 , 155 new patients, in total 959
> 13-03-2020 , 190 new patients, in total 804
> 12-03-2020 , 111 new patients, in total 614
> 11-03-2020 , 121 new patients, in total 503
> 10-03-2020 , 61 new patients, a total of 382
> 09-03-2020 , 56 new patients, a total of 321
> 08-03-2020 , 77 new patients, a total of 265
> 07-03-2020 , 60 new patients, a total of 188
> 06-03-2020 , 46 new patients, a total of 128
> 05-03-2020 , 44 new patients, a total of 82
> 04-03-2020 , 15 new patients, a total of 38
> 03-03-2020 , 6 new patients, a total of 24
> 02-03-2020 , 11 new patients, a total of 18
> 01-03-2020 , 1 new patient, a total of 7
...
Here's a log-scale graph: https://www.chartgo.com/embed.do?id=7e5c9f30aa
(And just for comparison, not log scale: https://www.chartgo.com/embed.do?id=7e5c9f30aa )
Looks like NL has had steady exponential growth over the past week or even 10 days.
As far as Mr Pueyo, in this context he appears to be an effective science writer, which is what matters. If you want a more succinct source from an academic, there's http://ctbergstrom.com/covid19.html .
N_obs = p_detect * 2^( n_days / T_double )
N_obs : The number of observed cases p_detect : The fraction of actual cases that are detected (assumed to be constant) n_days : number of days T_double : The number of days it takes for the number of real cases to double
If you examine the formula, the p_detect constant is almost insignificant. If T_double = 2, a difference in a detection rate of 0.2 and 0.8 is only 4 days for n_days.
As long as T_double is less than several months (and constant), an absolute catastrophy will occur. Within a weeks from now, nearly the entire fraction of the population that is receptive to infection will get infected, and will be sick basically at the same time. With 10-15% of the population requiring intubation, we can end up with a significant part of the population in each country ending up dead.
Obviously, all this is basic statistics and should be known to epiodemiologists, who hopefully have some input to policies.
For large N_obs, this will maybe be less important as you're going to find the severe cases anyway, but the uncertainty is significant in the beginning stages, and it is unfortunately these stages where actions will have most impact.
Itally has already passed the number of simultanous cases that their healthcare system can handle. I don't believe they really want to find out at what level the saturation point can be found. That could mean hundreds of thousands, potentially millions, dead.
This matters a lot. The first number is obviously important. The second matters so Italy can plan for whether things have peaked yet, or how many weeks out until it does.
Or, if applied to the US, 10 million.
Alternatively, we can shut down the virus in the same manners that China, South Korea or Singapore have been doing, and keep it supressed until we develop efficient treatment.
Unfortunately, that means shutting down all affected regions really hard, and maintain a high level of supression for maybe 2 years.
However, if we are going to do so anyway, both the human and economic costs will be lower the earlier we begin.
If we allow exponential growth to continue with a doubling time of only a few days (even if we can move it from 2-3 days to 6 days), the time until this move is forced is very limited.
If the real number of cases is doubling significantly faster than those detected -- say due to not testing them because their symptoms are mild enough to be missed entirely or to not seek treatment -- the calculations around things like mortality rate and severity of illness may yet change. As I understand it, scientists have already identified mutations of the virus that may also impact its ability to spread or injure infected hosts. I should note that these changes can swing both good and bad, I'm simply pointing out that there are more variables and that these variables changing may represent something not obvious from the equation.
I'm not an expert; I have fun reading about medical statistics. Most papers I've read take the time to examine these various confounding factors and what unexpected variations in their proposed equations might mean.
This could go in both directions. In both cases, though it would require that the high-risk subpopulation is primarily infected by each other (or staff) instead of being infected from the general population. If high-risk individuals are primarily infected by low-risk individuals, the doubling time for each group should be the same.
Note that such an effect could go in both directions. The high risk subpopulation could get it at a higher rate the rest if we let the infection spread like wildfire in hospitals and elderly housing centers, or it could spread at a lower rate if the risk patients are kept isolated.
But if someone throws on just enough additional Uranium for the pile to go supercritical, you would run for your life because none of the following will matter[1] all that much to the final outcome:
1) How much neutron radiation there was to start with.
2) The specific exponential growth coefficient.
3) How much total Uranium there is, as long as it's a nontrivial amount
4) Whether your Geiger counter is off by some constant factor or not.
None of those matter. It's going boom. It might go boom a bit sooner or a bit later, but it is going to go boom. That's just how exponential growth works. There's no maybe. There's no "let us wait and see". There's no "we'll hope for the best". No: It. Will. Go. Boom.
All of the factors that are irrelevant are just shifting a figurative vertical wall on your graph paper a bit to the left, or a bit to the right. It's adding or subtracting "a couple of doubling times". If the doubling time is short, then you're not really achieving anything by fiddling with constant factors.
With the Coronavirus just about every country has a doubling time of 4-5 days.
I live in Australia, where we're about a "month behind" everyone else. So of course, the dumbass government is saying things like "the heat here will slow it down". But it hasn't, our doubling time is 4.75 days at the moment. They're saying that it's "premature to lock down the country". No it isn't, it's already weeks too late and getting literally exponentially worse daily! They're saying that the hospitals are being prepared, but no amount of extra beds or ventilators will help. If they double the number, it just delays the catastrophe by 4.75 days. Not even a whole week! Quadrupling beds and ventilators buys just under 10 days before people are being turned away to go home and die.
So, again. I ask you: If you were the nuclear physicist in charge of a nuclear pile and someone told you it's gone critical and the radiation is rising exponentially, is your first reaction to: just "stand around and wait and see what happens", or to: take drastic action right this second? Do you SCRAM, or do you call the communist party leadership for permission? Are you the hero of the Chernobyl story, or the villain?
[1] Ignoring thermal effects slowing down the reaction. This actually has an analogy with disease spread, where there are fewer susceptible people remaining because everyone is already sick or dead. If we reach this point, we'll be seeing millions infected and hundreds of thousands dead.
That's why I dont understand the crisis communication on the subject. I understand exponential growth, I dont under and the panic about getting sick with a flu like virus.
If it was something causing skin lesions I'd be in panic mode because the victims would be at a higher risk of co-infectious diseases. This is not that. But hey, fuck my civil liberties some more, for that matter fuck my freedom and that of my countrymen. I dont give a fuck anymore.
The flu and the common cold virus behave comparably to the current pandemic. The flu in particular kills about 300K per year after infecting about 20% of the global population. That's a mortality rate of 0.02% and a survival rate of 99.98% for the general population, which is not a fun statistic, but nothing to panic about either.
Critically, the hospitalisation rates for the flu are so low that the current infrastructure can handle it. People still die, but only if they couldn't be saved with medical intervention. Much of the time they will receive treatment and live.
Even if you shift the numbers around a lot -- say, 50% infection rate -- the orders of magnitude come out to about the same. Governments can just put out ad campaigns to encourage people to get the flu vaccine to compensate for a particularly bad flu season.
The critical thing with the cold and the flu is that they move well past the initial exponential growth phase into a "logistic curve" long before the hospital systems become overloaded with the sick. That is, each new strain of the flu runs out of victims by hitting the population ceiling of 7.6 billion. Not everyone is vulnerable, and the rest either become immune or protected by herd immunity.
Now compare this to the Coronavirus. It has a mortality rate of about 0.8% of confirmed cases, with medical care. Much more importantly, about 10% of the confirmed cases required intensive care.
Nobody really knows the ratio of confirmed-to-real cases, but I'll be generous and assume that only 20% of all cases get a confirmed diagnosis, with 80% of cases just shrugging it off as a case of the "sniffles". Similarly, I'll assume that the virus will halt at around 20% of the total population.
For Italy, with a population of 60M people, that's 12 million infected, equivalent to 2.4 million confirmed cases, 240K in intensive care, and 19K dead.
But I lied.
I lied when I said "240K in intensive care". There just aren't that many beds, or intubation kits, or CPAP machines, or even oxygen masks. There aren't anywhere near enough doctors, or nurses, or any resource you care to name. I know this to be true because all of these things have run out already.
Long before the exponential curve starts to "slow down" and become logistic, the entire medical infrastructure becomes overwhelmed and the cases that "would survive with intensive care" turn into "deaths".
Worse, this happened at a "confirmed case count" of about 10K. I said 2.4M above!
The conclusion is that the Coronavirus can overwhelm medical systems waaaaaaay before it hits the "knee of the logistic curve", making it a nearly pure exponential curve. Exacerbating this is the incubation time, meaning that any measure taken today will have essentially no effect for at least a week.
Act now and save lives, act tomorrow and see your loved ones die.
This is the difference.
3blue1brown explains it quite well, and I recommend everyone watch his video: https://www.youtube.com/watch?v=Kas0tIxDvrg
Keep in mind, the UK advisors think the peak is maybe two months away, and that at-risk groups may need to self-isolate for a month either side of that peak. This is a far bigger response than any country has achieved so far (and it's extra difficult because the at-risk groups are probably the most dependent on external aid, as well as already lacking social contact). I don't think they're wrong to think that this will be difficult to achieve, and increasing the difficulty by starting earlier will make things worse.
There is no SCRAM button on this pandemic, not any more at least.
How have they achieved this? What concrete measures?
Assumption 1: Our country will not be able to take measures that are extreme enough to stop exponential growth. Assumption 2: Once a certain level is reached, we can drastically lower the doubling time so that the number of simultanious cases are kept below what our healthcare system can handle. Assumption 3: If we stay below the level that the healthcare system can handle, mortality rates will be low, maybe lower than 1%. Assumption 4: The total number of individuals that will require hospitalization is low enough that the healthcare system can treat all patients needing treatment in a few months.
If assumptions 2 is not met, the mortality rates of pations that require treatment is likely to be similar to what is seen in Italy, ie roughly 15%.
If assumption 3 is wrong, and the real mortality rate is about 3-5%, having about half the population infected, will still lead to huge numbers of dead, more than the population is likely to accept.
If assumption 4 is wrong. Italy is currently unable to handle 20000 cases. A country like the UK may be able to handle maybe 10000-20000 simultaneusly. If 10% of the population requires hospitalization, and each patient will stay there an average of 1 month, measures will have to be dragged out over several years, anyway.
Assumption 5: This only needs to be done once, meaning there will not be second or third waves or mutaded viruses that will need to spread in a similar fashion in the same time period.
At some point, I think every country will realize that they need to take drastic measures, enough to stop the spread from being exponential. Doing that after detecting 100000 cases is VERY different from doing it after detecting 1000.
The downside, of course, of preventing exponential growth, is that most measures will have to be kept in place until there is a vaccine or other cure, and that could take 2 years.
From my perspective, it appears that politicians do NOT want to take sufficiently drastic measures, as the economic consequences will be huge (let's assume that Spain and Italy will keep or increase the measures they already have for 2 years), and so far, their measures do not seem to be sufficient.
Folks with a stronger statistics background are welcome to correct me.
As a physicist I'm used to thinking about orders of magnitude and whether something grows like log(N) or N!. I'm pretty sure all the data points to this being O(a big problem) but I'd leave it to the epidemiologists to say anything with confidence.
I wrote an analysis of how this is going to hit Ireland, including the best calculations I could find on fatality rate:
https://medium.com/@fergal.reid/predicting-the-impact-of-cor...
I think that left unchecked this could kill millions of Americans in a couple of months. I'd love to be wrong.
February 9 is 1 1/2 pages.
March 13 is 10 full pages.
vs
>in a couple of months.
Why months? If there are 75% of the cases within 2 weeks, won't 75% of the deaths also occur within 2 weeks?
> It's now a well-established fact that older people and those with underlying health issues are more susceptible to succumbing to Covid-19. With 23 percent Italians aged 65 or above and a median age of 47.3, the Italian population is the oldest in Europe. This is chiefly responsible for the high fatality rate in Italy.[0]
Also these articles.[1,2] And similar to the age effect in China.
0) https://www.ibtimes.sg/fatality-rate-7-16-why-coronavirus-de...
1) https://nypost.com/2020/03/12/heres-why-the-coronavirus-deat...
2) https://www.theguardian.com/world/2020/mar/03/italy-elderly-...
Looking at the latest SitRep from WHO, my home country (Sweden) has small no. infected (775), but grew 25% vs the previous day. If that rate keeps up, number of infected will keep on doubling every 4-5 days and in 14 days' time will be at what Italy is today (17k infected). And then another week later it'll break 100k. Exponential growth is a bastard in that sense.
But still, maybe Italy is a worst case.
Trying to be optimistic here, being >70 and all ;)
They shouldn't have; what you're seeing is noise. There's a lag of roughly two weeks between when a person is infected and when they'll get caught by a test, so any benefits of the current lockdown will only be visible close to end of March.
How come there are so many cases per capita? All the neighboring regions like Poland, Russia and even the North of Germany, have fewer cases.
In short, the stated goal will always be achieved so it is a variable which can be struck from the equation. Having this as a goal is the equivalent of not having any goal at all.
[1] https://www.expressen.se/nyheter/strategin-lat-manga-smittas...
Sweden hasn't closed down schools etc like other countries have done so it's fair to argue that it's being done in practice, but it doesn't seem to be a conscious decision.
...which translates to...
State epidemiologist Anders Tegnell says the reasoning around herd immunity is partly correct but that it is not the organisation's strategy - our main goal now is to get the infection to spread as slow as possible
...but the Swedish government is not actually doing much to limit the spread of the disease other than telling people who show symptoms to stay at home. By now it has mostly been proven that infected people spread the infection for a few days before they show symptoms and the fact that children can be and often seem to be asymptomatic carriers the spread will be rapid and result in a large number of people in need of medical care. The Swedish health care system was already overloaded before the pandemic so it will not be able to handle a large number of patients in need of critical care. The same scenario is now playing out in Italy so this should not come as a surprise.
For Denmark we actually seeded our Corona spread by bringing home hundreds of infected (it turned out) from ski vacation in Italy and Austria (265 from Austria alone) and not putting them in quarantine.
1.25^3 ≈ 2 so the doubling period for 25% growth would be closer to 3 days.
So Italy is older in the sense of “more people who are very old”. But you are right that the mortality difference so far is not explained entirely by this gap.
It may be informative to watch how this evolves in Greece, and to a greater extent (due to more infection before a lockdown) France and Spain. Those are the next oldest countries in the EU by this measure, and all are well above 3%.
[1] https://ec.europa.eu/eurostat/documents/3217494/10166544/KS-...
We are at a critical point where we have just closed our seed round this past week. We have both put so much energy and time into this moment and we were ready to work harder and focus on scaling and growth.
Of course, the more tragic situation around us makes our issues seem small. I think we will likely announce to our team to work from home starting Monday. How surreal.
> When you're dealing with exponential growth, the time to act is when it feels too early.
You should have implemented WoH weeks ago. Thinking whether or not doing it now is a disservice to all humanity and a testament of why we have reached this situation as a society.
Do you not trust them the employees to work their part on their own?
Move your employees to WFH now.
Ensure you all have the infrastructure at home to support being as effective as possible.
If other companies did nothing, then you would do nothing.
Interesting. Entrepreneurs are usually way more forward thinking.
The first tested case. Given the delay between onset and diagnosis, + amounts of tests being actually done, + the couple days you mention, you may as well have over a thousand infected people in your city now, and you won't know until a) more tests start being made, or b) some of these people will start getting hospitalized in the next couple of days.
These people certainly have more exposure to other humans than most people do. But not so much that they should be making up whole percentages of the infected population. I believe they are just well connected and wealthy and it's easier for them to get tested.
You can't have confirmed cases without testing. I've come to believe these confirmed case numbers may be having a negative effect on our understanding of the situation.
One side: it's much more widespread than we realize.
Other side: it's much more mild and less fatal than we first thought.
That's all you need tk knoe.
The problem is twice as hard every time the number of cases doubles. If you don't want to work from home for many months, start working from home now.
Working from home isn't as bad as it seems. Modern collaboration tools are great. Our research group and wider laboratory have gotten into the swing of things within a week.
Are you sure? I think it's the other way around. Nothing I can do (apart from staying completely indoors, which I can't because I don't have enough supplies (food, etc.) to last for months) can prevent me from being infected (eventually). Luckily I'm in the low-risk group (young); I advised my parents the latter (hopefully they're following my advice).
Obviously there are a lot of people required to get groceries to you, but if you are not in medicine or groceries stay home. That is a large supply chain but sti tiny and even those people are not going to other functions which reduces risk
The right thing to do from every perspective is close your office. If any of your employees is has a risk factor and dies of covid you will spend the rest of your life wondering if you could have prevented it - trust me I know.
Businesses in Washington State have shuttered or gone to work from home over the last 3 weeks, had most businesses made this change earlier(eg: at the beginning of those 3 weeks) we would see much less spread and quicker easing of restrictions.
Is Alberta doing widespread Covid-19 testing yet? We had cases of teens with no international travel getting Covid-19 in February according to the Seattle Flu Study, there are likely more cases in Edmonton that exhibit minimal symptoms currently.
Seattle Flu Study: https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...
I wouldn't say that; reports coming out of Seattle look pretty grim.
"...Reports from the Seattle area, the epicenter of the U.S. outbreak, indicate that some of the city’s hospitals are nearly overwhelmed. One hospital’s note to staff, shared with New York Times columnist Nicholas Kristof, says the “local COVID-19 trajectory is likely to be similar to that of Northern Italy.” The hospital is down to a four-day supply of gloves..."
https://www.statnews.com/2020/03/14/coronavirus-hospital-wor...
If you’re in the United States, where testing has been infuriatingly limited, the fact of the matter is you have no idea what the spread in your community is. The numbers aren’t low because nobody has the virus, they’re low because nobody has been tested. If we did actual testing, they might come in low or they might come in high, who knows. As it stands, nobody has any real idea just how bad the spread is here. Absence of evidence is not evidence of absence.
Given that, the safest course is to assume the spread is high, and act accordingly.
This is the likely reason for such a high number of celebrities in the news testing positive -- it's already everywhere; they are the only ones getting tested.
[1] https://www.wkyc.com/article/news/health/coronavirus/ohio-de...
It is hindsight, but expontial grow means that despite not testing we didn't have a problem two months ago. Maybe we should have been in lock down a week ago, but anything sooner would be overreacting and not necessary. Most of the US is on lock down now which seems like about the right time to start. No more than a week sooner can be seriously argued.
Most people who get sick think its a normal cold. They stay at home for a week, and when they can barely breath anymore, they finally enter the emergency room.
If you make everyone work from home, you'll end up with a temporary loss in productivity (thus money, which again comes and goes). Even if one of them does get infected anyway, they won't spread it to the rest of the team. The relationship with your employees is preserved because you're not forcing them to take risks.
If you force them to work in the office, it's just a matter of time before all of them get sick. The productivity will drop to zero, yet you'll still have to pay them sick leave and their opinion of your company will be tainted forever because you and your greed are the reason they are now all sick.
Not to mention, this is all assuming your employees are relatively young and have no pre-existing medical conditions that would make the infection life-threatening. Otherwise, we're not just talking about relationships but actual lives being put at risk.
As a co-founder/CEO of any company your first responsibility is for the health of your employees and those that depend on them. If you play games with that then you should not be in a leadership position to begin with.
Here is the full text of our email, feel free to C&P:
As you are no doubt aware there is a virus on the loose
and it isn't pretty.
The better ways to acquire it are to spend some time with
a bunch of total strangers in close confinement sharing
each others air. This includes all forms of public
transport.
These are exceptional (hopefully!) circumstances and I want to
make several things perfectly clear:
(1) You do not have to travel if you do not want to,
there is no obligation to participate in any of
the jobs in the next coming weeks/months and
not participating will *never* be held against
you in any form. You may opt to participate
remotely instead of on-site without financial
penalty.
(2) If you do travel, please take all precautions
possible to avoid getting ill, I'd really hate
myself if it turns out that we caused people to
fall ill (or worse) on account of the work we do,
your health comes first, always.
(3) There is a lot of misinformation going around,
some of it - unfortunately - spread by authorities
that really should know better. The current figures
are - to the best of my knowledge - 2-3% mortality
rate and an R0 (the rate at which the disease
spreads) of about 3. This makes this virus between
20 and 90 times more dangerous than the seasonal
flu, which has a .1% mortality rate and an R0 of
about 0.7-1.
(4) If you decide to participate but not in person
then we should enable video conferencing to do some
of the interviews, these should focus on the people
lower in the food chain at the companies we look at.
Please let us know your preference in time, talk to
Marco to ensure he is aware of what will happen so
that we can communicate it to the customers and the
targets alike.
(5) The virus outbreak is still in its early days, the
situation is *extremely* fluid, and you should make
an effort to stay informed and adapt your plans
immediately if you feel the situation warrants it.
Please do communicate any such changes.
Best regards, and please stay safe,
When the first case was detected, the office was closed and work from home became mandatory at least through the beginning of April.
[1] https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
[2] https://docs.google.com/spreadsheets/u/1/d/17YyCmjb2Z2QwMiRR...
People will understand disruptions due to Covid. It's not business as normal. Google told the entire north american staff to stay home. Be glad that you can still all be relatively productive while remote, and enjoy your runway while you don't have to pay for the lights in your offices.
Thinking of the cancelation of the NBA season an how Mark Cuban's response was thar it seemed "crazy" and "surreal". Now, it seems obvious and late.
Don't wait - tell everyone now to work from home, prep like mad, and isolate hard.
The damage will be far less than anyone getting it. You'll also get down that critical learning curve far faster.
Congratulations, Good luck, stay well.
Exponential growth means employee expectations will go from "completely safe at work" to "don't leave home except for food" pretty fast. You don't want to be that guy who asks employees to violate the (possibly government imposed) lock down to keep the lights on.
I am shocked but not surprised by the behavior of my fellow citizens. Many people still went out shopping, went to the restaurants, still think it is a simple seasonal flu and do not at all comply with the recommendations of avoiding contacts.
The government decided at last today to close the restaurants and most of the shops except grocery stores and drug stores.
Also I think in France at some point the army will have to be called to help, to let policemen enforce the rules and be used to secure sensitive sites. With the periodic social unrest that France endures since the last major "ethnic" riots of 2005 and the more recent and more social yellow vest protests, I am afraid that in France there will be also a lot of indirect deaths of the sars-cov-2 pandemic.
This is what happened in Italy as well. 1. people are recommended to stay the fuck home and reduce physical interactions 2. most people don't care and carry on with their normal life 3. state now needs to enforce harsh rules because people don't seem to understand that it's serious 4. some people still don't care, go to parks, beaches, private parties
https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
"Flatten the curve" scenario requires r0 to between 1.0 and a small number above 1.0, like 1.1. In other words, it's not happening, you either contain the virus or let it explode.
https://twitter.com/trvrb/status/1237934525281259521
I think it's very likely that Wuhan or Italy style lockdowns will bring r0 under 1, based on the experience in Wuhan and Italy. That means the disease eventually dies out. Because it's endemic elsewhere in the world, it'll eventually be reintroduced and we get multiple waves, until eventually enough people have had it to generate herd immunity. But each wave starts back at the "containment" phase, with contact tracing and individual isolation, so combining lockdown + those measures + travel restrictions could probably buy enough time for a vaccine.
- Do you have to introduce new containment measures with every wave of reinfection?
- How many waves / months of total are required to achieve enough herd immunity while keeping the hospitals within capacity?
- Until a vaccine is developed.
- Yes
- Until a vaccine is developed.
They also release to the press the location/time infected person was at, such as name of hospital/events. And these are reported to the public.
So S. Korea does not do a carpet bombing type of lock down as China but more of a surgical strike type of lock down. But it is a lock down.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
> The lengths at which it went to contain the virus are mind-boggling. For example, they had up to 1,800 teams of 5 people each tracking every infected person, everybody they got interacted with, then everybody those people interacted with, and isolating the bunch. That’s how they were able to contain the virus across a billion-people country.
> This is not what Western countries have done. And now it’s too late.
The best way to explain the exponential growth (and shock people) is ask them about https://en.wikipedia.org/wiki/Wheat_and_chessboard_problem
Of course we all chose $100/day. Then she told us it was too bad we didn't take the other option, because we would have been multi-billionaires.
[...Array(31).keys()]
.map(num => Math.pow(2,num))
.reduce((total,num) => total + num)
/ 100
or since the sum is equal to the next sequential (2 to power of n+1) minus 1 cent => 2^31 - 1 = $21,474,836.47
I hope we get a lock down here. Many people are too selfish, arrogant, and stupid to make the right choices even when it is obvious.
Not exactly neighbourly though.
"In just 3 weeks from the beginning of the outbreak, the virus has reached more than 10.000 infected people."
Does this mean only tested 10.000 people? Reads a bit odd though too, i assume they were not infected already when the virus reached them?
"From our data, about 10% of patients require ICU (Intensive Care Unit) or sub ICU assistance and about 5% of patients die."
Is this from 10% of the people actually going to the hospital, or 10% of all tested, or 10% of all people that got the virus?
Read this one: "We are now in the tragic situation that the most efficient health system of the richest area of the country (Lombardy) is almost at its full capacity and will soon be difficult to assist more people with Covid-19."
This one. FTR, there's an additional 5% from this 10%, IIRC, which experiences multi-organ failure and dies within a few days.
Italian health services have tested more than 50k people (the number of tests is over 60k but some people got tested more than once). More than 12k were infected. This is likely to be an underestimate, since we know a lot of infections are asymptomatic.
Hopefully he/she was nabbed quickly, without spreading the disease to anyone else. Is Isreal using electronic tagging on those quarantined folks to ensure that they can't just leave their assigned place without anyone knowing about it?
It is unclear of the idiot that evaded quarantine is sick or only precautionary, but that's just the people we have—morons. Very different from Hong Kong and Singapore.
Huh? An ankle bracelet ("tag") is quite transparent, it's not covert "intelligence". The deal is, you get to wear it for a couple weeks while you recover from your potential illness, and you know you're being monitored so you're not going to just leave your assigned place and hang out anywhere else.
The fact that the US Senate did not speed up the emergency measure by staying is loosing 2 days. At that time the measures are in place the problem is twice as large. In normal times this is just a business day delay but in these times calendar days are the measure and weekends are counted too. We really need to start thinking and acting differently.
We're canceling/closing off large groupings of humans and basically hoping/praying? for the best for the next few weeks. It's sad. This type of haphazard response drives conspiracies and confusion that is then opportunistically taken advantage of by all sectors of power.
eg Fujian https://mackuba.eu/corona/#fujian_china
Taiwan https://mackuba.eu/corona/#taiwan
HK https://mackuba.eu/corona/#hong_kong
Taiwan is impressive in that they had thousands of flights a month to China, have only 30 active cases and no lockdowns. They had people ride on the planes from Wuhan to identify sick passengers during the flight and quarantine them on landing.
As a Brit I'm embarrassed by our performance in comparison.
Places without a problem yet should take reasonable sustainable precautions to flatten the curve instead. (https://www.flattenthecurve.com/)
The virus still spreads in lockdown, just at a slower pace. We will likely see resurgences when the lockdown(s) are lifted, but the idea is to plan to do that when we can handle it.
I feel like a lockdown / closure order for the Seattle metro counties will be coming within a week or so.
I suspect if we called up a militia leader from the back woods of Michigan or Kentucky, even they would consent to very temporary quarantines. Even if it meant US army troops patrolling their residential areas.
In fact, I suspect more conservative people would even be more in favor of stricter lockdowns, on average. While progressives are now following the advice of the medical establishment, the initial instinct is to not do things that "sound conservative" like shutting down borders and so on.
(Similarly, while many conservatives would agree with the idea of quarantines, they would remain very cautious of any unnecessary restrictions on their liberties, watchful of the government taking advantage of the situation to pass laws the conservatives oppose. If for example, the military patrols said they wanted to knock on every door and collect all the guns, their support would rapidly reverse itself.)
No offense meant to either side. I don't strongly identify with either of these labels. Just my honest opinion based on my personal observations.
(Also, I'm aware that particular conservatives and particular liberals may have expressed opposite views to those above, but I'm talking about my perception of the group average, not particular high profile examples. Also, particular individuals may take unusual stances due to personal business or financial interests.)
Statics say clearly what strategy could have been followed to take care of coronavirus without much disruption of the working force. And the people at the government are mostly old farts, which says quite a lot why they panic.
Please take it seriously. This is not sensationalism.
What the letter means is that if your country is not there yet, you might be DAYS away from widespread panic and total lock down.
I'm writing this from Barcelona, Spain. This last Sunday, 6 days ago, I went on a walk with my girlfriend, had a nice lunch, took beautiful pictures...
The virus was just some nagging news.. A couple of hundred people infected somewhere far away.
6 days later, we're at over 6000 infections, the country is in total lock down.
Same pattern as Italy (even faster), we're just a couple of days away before tens of thousands is reached. This is what exponential growth means.
Now more than ever we should look at the source of every information.
I know I'm going to get downvoted for saying this, but I think it is important enough.
Particularly not since none of the signatories could plausibly be accused of exaggerating the danger, in order to extract grant money. As goes the usual cynical claim of innumerate science-deniers.
South Korea has, at no point, made anything close to the country-wide “lockdown” we’re seeing in parts of Europe.
Korea’s reaction is amongst the most successful in the world, and involves contact tracing and isolation of the sick. When they have “locked down” anything, it’s been extremely small scale, on the order of a building or block. Similarly, Taiwan has had an immensely successful response, without resorting to these kinds of extreme measures.
This article is designed to scare, not to inform.
Path 2 is you fuck it up and Covid-19 is running rampant through your entire population. Of course at this point closing borders and contact tracing is 100% pointless. It's in this environment where lockdown is the only way you can accomplish anything.
Similar anecdote here.
My SO texted me earlier this week saying how she will be taking the train from Madrid to Barcelona to go back to her family. She figured it will be empty on Sunday at 6 am.
I have been following the situation evolve in Italy and told her to get on the train right away and leave immediately before it gets worse.
Luckily, the next day she was on the train. The lockdowns started happening shortly afterwards.
People should stay where they are. Lockdown is not a disaster. People fleeing lockdown are literally the carriers of this disaster.
Stay where you are, wait. Don't travel. Don't fight the locdown. Lockdown is the current, appropriate course of action. A very effective lockdown can eliminate the infection in, well, however long it took to eliminate it in Wuhan.
Fleeing the lockdown now is just going to another area that is going to be on lockdown later on anyway.
I hate to put this harshly but... She may well be fleeing with a life threatening virus that will kill her family. This has happened already, even documented, in China.
We can't look to our own comfort at this point. All my family visits are postponed and my food is mostly stocked up.
And it's a hard situation where we won't all make the best choices but still want to pressure everyone to make the appropriate choices.
True.
>She may well be fleeing with a life threatening virus that will kill her family.
And true.
There will be test of this thesis in Poland soon. As government closed down universities, some of them told students that they have to vacate their dormitories and go back home (dormitories are usually occupied by students from countryside and smaller cities), and it caused massive migration. It is already confirmed that students in my city were infected for two weeks, but is not known yet how widespread it was. To make situation worse, some dormitories are now being turned into quarantine hotels, so students are told to come back and take their belongings with them (initially they were told they can leave their stuff behind).
This is readily recognized.
And this can be motivation enough to relocate to a chosen area for upcoming lockdown, while some choice is still possible.
If you love your family and you have some sense of responsibility your duty is to stay where you are for a while. You can embrace your family in the near future.
It is expected that even with thorough reliable testing and rapid clearance of the non-contagious from confinement, the spread among previously unexposed confinees would be vastly greater than among the unconfined, or further the _isolated clean_.
There are 1600 confirmed cases but the lack of tests hides how many real infections there are.
2,695 at the moment, per the NYT tracker
https://www.nytimes.com/interactive/2020/world/coronavirus-m...
[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
You're kidding right? Under what conditions that things are fine are you preposing? If you're not taking this serious, and in the US, you're definitely part of the problem. That attitude, statistics aside, is going to get people killed.
Among the things you should have derived from reading more carefully is the fact that state I'm living in is taking it quite seriously. Personally, my hatches are battened down and I'm prepared to be isolated for at least a month, maybe two. (Have to admit it's hard to tell how far my supplies will go, I've never actually had to live on them before.)
You're talking to someone who specially prepped for this about seven weeks ago, in addition to the general prep I already had on hand. If you can match that, then maybe consider start lecturing me. I actually got a bit of flak from my wife for the amount of prepping I did, because it was before she'd hardly even heard there was a new virus. Now she's glad I did, because I bought all the things that are missing in the stores around here now long before it was "hoarding".
I'm in the top tier of taking it seriously. At the same time... Don't panic. Don't advise panic. Don't fall into the cognitive trap of modeling this as a zombie apocolypse or some other thing where the virus is intelligently seeking out victims. Isolation measures will slow the virus down. It isn't possible to keep it "out of the US" but it remains possible to keep it out of your county, or your city, or your neighborhood, with sufficient steps. Total doom is not yet inevitable, and even then, how you are impacted remains significantly under your control even if your government is feckless. Or, at least, it was, if you got your prep in before the panic rush... you may be a bit more at the mercies of your government now.
The exposure network hasn't been trimmed to zero, but its branching factor has been radically cut down. This is going to have an effect.
Put that all aside.
Remember-- the numbers we see now are a look at the PAST. The infection incubates silently for a median 5 days. Then symptoms present. Then a week goes by with relatively mild illness. THEN shit gets real. THEN comes the hospital visit, the fight for a test, the time it takes for the test results to come back (if it happens). THEN the number gets added. Then you see it on wikipedia or the news.
These numbers we're seeing today are a time machine view backwards to recognize infections from 14 days ago. So infections spreading TODAY will show up AFTER the current Italy-like situation has already taken hold in the United States.
If it is possible, STAY HOME.
And the "shit gets real" part only occurs 20% of the time, give or take - which means the virus might spread quite a bit while showing symptoms no more severe than a common cold. That also introduces some further unpredictable lag between any social distancing behaviors being introduced and their effects on the actual numbers.
We're using a cracked, dirty camera lens to film a small fraction of the tip of a rapidly growing iceberg.... And the photo processing time is two weeks.
Well, substantially all of the cases that end up dying go to the hospital first, and many more besides that and up recovering. It shouldn't be surprising that the hospitalization rate is higher than the fatality rate.
Death rates by age range also assume ICU care. It's virtually unheard of for healthy middle-aged people if they have access to good medical care, but plenty of 30- and 40-somethings can and have died from it once the hospitals are overrun.
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...
Source?
China plainly lied about the outcomes of the SARS epidemic and reported about half the fatality rate of nearly every other country. Hell, no Chinese person I've talked with recently believes the official numbers.
Essentially this was not in bad faith when it was published but it is now so out of date and misleading and sharing it now is dangerous in that it may cause people to ignore safety advice.
Given that people are making difficult choices right now that will impact the course of the epidemic we should be very careful sharing outdated information that could lead to people becoming infected.
China's numbers are a minimum. Many people are saying online they are a maximum. I.e. claiming that there are lots of hidden mild infections when there are not.
No, I am no. I am saying the study supercedes numbers reported by authorities. The point of the study was to scatter information on very opaque reporting.
> China's numbers are a minimum. Many people are saying online they are a maximum. I.e. claiming that there are lots of hidden mild infections when there are not.
That doesn't parse.
The way I interpreted that discrepancy is that in the presence of full testing and good ICU care, the death rate from COVID-19 is about 0.7-1%. When the hospitals get overloaded, as they've been in Wuhan and Italy, the death rate skyrockets to 5-10%. This also squares roughly with the number of people who need ICU care in places where the death rate is low. If you need ICU care and don't get it, presumably you'll be dead.
People need to stay home, period. Unless you work in healthcare, a grocery store, or some essential service, or are going to one of the same, you need to stay home. I know there's lots of reasons people aren't staying home yet, like they don't have paid sick leave, but still, none of this overrides the sheer importance of stopping the pandemic.
So the phrasing should be "Stay home, period." Not "Stay home if possible".
Pretending that the only disaster we are facing is medical is blinding yourself to the reality that we are trying to navigate our way between twin catastrophes.
[1] https://www.usnews.com/news/healthiest-communities/articles/...
[2] https://www.nytimes.com/aponline/2020/03/13/us/ap-us-virus-o...
[3] https://www.feedingamerica.org/sites/default/files/2019-04/2...
[4] https://www.theatlantic.com/health/archive/2017/07/how-job-l...
Plus, all the school districts that have shut down so far have continued to offer meals for students AFAIK.
Source: - https://www.buzzfeednews.com/article/lamvo/coronavirus-death... - https://www.santaclarausd.org/site/default.aspx?PageType=3&D... - https://www.sfgate.com/news/article/Bay-Area-school-closures...
But your point is right. "If possible" means "unless it's absolutely essential for your survival or the survival of others".
This is a real issue, and I have no solutions. The only thing I've been saying to them is that all bars and restaurants will be closed here in 2-3 weeks and that their bosses will understand then. They are understandably worried that in the aftermath of all of this, there will be so many unemployed servers/bartenders/cooks/drivers that it will be difficult or impossible to get their job, or any other job, back, with no way to pay rent in April or perhaps May either.
The only thing that might help there is if warmer weather reduces the spread. But then it could very well come back in the fall.
The fact that many people here and around the web are sharing stories of sick friends is are a set of anecdotes that would be nearly impossible if the reported numbers were correct.
I suspect by this coming weekend the US will feel very different. I wouldn't be surprised at all if a major update to official numbers came and completely changed the current state of where things are.
I still disagree with this, although I somewhat agree with your sentiment. The anecdotes I have seen range from extremely mild to nightmarish. A large fraction of those made me false, deliberately or by accident. I find the statistics still tell the most concrete story.
But one of those cases is the Prime Minister's wife.
Do we really think there are only 150 cases?
It's obviously way, way, way higher than that.
And this is with extremely limited testing.
Edit: others seem to feel the same. See epistatis' comment
The CDC is headquartered in Atlanta. Where do the COVID-19 tests from them come from? Where are they manufactured, what ingredients do they require, how much do they cost to make, how long does it take to make them? What's the hold up on getting "unlimited" tests from the CDC? Do the tests even come from the CDC? How many are they producing a day? What are their blockers?
[0] https://www.npr.org/2020/03/13/815522836/u-s-coronavirus-tes...
[1] https://www.statnews.com/2020/03/14/thermo-fisher-to-produce...
We have to face the truth that the quality of people we vote for government is not where it needs to be and that science has too long been discredited and ignored.
Some of asia learned from SARS but that's it.
Madrid was hosting marches, political rallies and soccer games with 10.000-100.000 people a week ago because people did not want to make the hard choices needed even as Korea was burning and Italy started to.
Excuses that China is authoritarian do not cut it - this was a huge fail of governance and doing what people are elected to do
At least German politicians had the sense to step aside and hand the mess they made to the scientific experts to clean up.
But now, on HN now we're mostly preaching to the choir...
I've been contacting the officials of my state and surrounding communities since February 28th urging action. If your community isn't taking action you should join in. Even if your politicians don't respond to math, they'll still respond to public outcry.
The best time to respond was a while ago, but today is still vastly better than tomorrow.
Exactly. Two weeks ago every coronavirus thread on Hacker News was full of deniers claiming this was no worse than the flu and this was all just media hysteria. Some probably still hold that opinion. I don't think they will be convinced until the hospitals start overflowing.
(Engineers to, too. I try hard to watch it and I still arrogantly show my ignorance sometimes.)
When Coronavirus appeared in Wuhan, I tended to the opinion that it would self-limiting in one fashion or another or that is would not be worse than the flu. Only people arguing with me and me investigating the facts changed that. And, yeah, changing your opinion is hard and imagining a force that will upend the world is hard so it's easy to imagine how people stay in their positions.
That said, we have a representative government with the aim of electing people who will think ahead and protect from purely reflex based views. And clearly that control has failed.
The potential for this kind of pandemic is something that the government was aware of and at least somewhat prepared for. It can be hard to imagine, but if all we had were the concerns of joe-everyman this would have caught us significantly more off-guard than it has.
Where I think we've faltered is in rapidly the hard decisions to trade-off short term economic impact vs long term health and economic impact. But there is still time to do a lot of good, and the level of our response seems to now-- finally-- be increasing exponentially along with the infection.
Interview: https://samharris.org/podcasts/190-respond-coronavirus
IE we should not allow people to take risks that are going impact all of society.
The virus has exploded the American myth that we can isolate individual behavior to individual rewards but also this myth means the country is going to seriously suffer.
We need to confront the fact that democracy in the West by now elects people who sell the most comfortable lies instead of people who help adaptation to reality.
I am hopeful that human civilization and ingenuity can invent or discover that. I am just not confident that it would be anytime soon.
Alternatively, they do, and the process of getting there makes them less likely to do the things they wanted to do.
Bring back sortition!
I guess anything less would be a dummy.
You don't have to be a mainstream follower to appreciate a high-performance leader
>who definitely understands Math
>who definitely understands Math
In future centuries we will look back and recognize this leadership characteristic is what has always been most advanced compared to all other outstanding choices.
Especially at times when the stakes get unusually high.
Organizations, communities, citizens, civilizations, and populations have always gone by the numbers.
And there's always a mainstream of some kind, with attitude being a thing among the moving weighted moving averages.
Seems like those furthest from the mainstream can also be most sensitive by nature to an _idiot-in-charge_ across various types of idiocy, and multiple levels of government, corporations, and other organizations.
Strongarm conformance and/or manipulated populism are some things that can give rise to a mainstream with ineffective recognition & response to dummy leaders and their destructive outcomes.
Since even a slightly above average problem-solving ability can make relatively genius moves compared to a slightly below average performer, it's tragic when there's not enough mainstream force to elevate the most mathematically competent leaders to handle high-stakes responsibilities.
Even more tragic when the mainstream is less-aware, and settles on preference for the dummy ones.
There was no excuse because there was never a chance for another outcome. The WHO was screaming into the void.
After that point it is mathematically clear that you're going to have deaths, and that similarly situated communities who react days later will have a lot more deaths. At that point the political calculus you're arguing for flips the other way around and encourages an over-reaction. ... except innumeracy is so common, we're not seeing too much evidence of that happening.
And my snarky side says there will be plenty more targets to blame in the coming weeks - think of it as an investment.
Science is supposed to mitigate the shortcomings of our natural intuitions and cognitive biases. The problem is that most people are not scientists. When a non-scientist is asked to trust a scientist, he or she is subject to all of the usual suspects: arguments from authority, confirmation bias, Bulverism, appeal to emotion, etc. What this means in practice is that scientists are generally not trusted over the word of one's friends and family.
But as has been pointed out before most people think if you do something big and dramatic to fix an oncoming problem, and it does fix it, lots of people will stupidly assume that you did not need to do the big, dramatic thing because it wasn't really a problem. So any politician who reacted appropriately would run the risk of fixing the problem and losing power in doing so, I would prefer to fix a problem like this even if it meant I would not have the power to fix later problems as my calculation would be if I do not fix this problem now I probably won't have the power to fix later problems anyway.
"The number of lily pads on a pond double every day. If it takes 20 days for the lily pads to completely cover the pond, how long does it take to cover half the pond?"
I think you will be surprised by how many people say "10 days."
Why is it relevant that people don’t correctly apply exponential reasoning automatically? Because when people encounter information in everyday life (outside of the specific job they’ve been trained to do) they tend to use intuitive thinking predominantly. This matters a hell of a lot when it comes to making political decisions of a technical nature, such as infectious disease planning and response. Lo and behold, this is the exact problem the Italians are trying to warn everyone about!
Relating this to the spread of the virus, people aren't carrying around an animation of this in their minds. Perhaps science communicators should do a better job of communication and produce such an animation? But then you're still not getting people to understand the concept. You're telling them "this is what it looks like, sort of, now just trust us." The problem is that people don't trust scientists (and mathematicians) as it is.
So if you explain to the politician, once you start getting cases in your country and give them the actual growth rates, and what slowing down the growth rates will mean, with nifty charts and so forth.
Like maybe they should do in the movie Outbreak where they have display of the red spreading across the country on its way to the White House, with a timeline animated below it, then the politician will understand the situation without intuitively understanding exponential growth.
I suppose reasonably competent data visualizers who have ever had to explain complicated things to non-technical people in an important meeting would know how to represent the concept in their particular domain without much problems.
on edit: changed our to your
This layman has read that we intuitively think of numbers logarithmically, which makes him wonder if we human beings do, in fact, intuitively understand exponential growth.
Exponential growth is like dynamite. It's absurdly fast, compared to anything people see in daily lives.
The only truly exponential example that comes to mind is milk souring. But that's too slow, unless you keep notes.
The real sad part of all this is that this is simply human nature. And we are next gonna go down the same path with climate change. And then not even lock downs will help.
Having seen the cutting of rural hospitals over the last two decades it will be a shitshow
It's also not necessarily an indictment of democracy- Taiwan clearly has been on the ball here. But it is absolutely an indictment of our current state of affairs in many western countries.
I did my numbers back in December. In January was already pretty worried, but I'm not an expert I thought. Maybe there's something I'm not taking in account.
So I kept reading about models and stats. Not that difficult. Ran my numbers again and again, yep it seemed pretty bad no matter what I cheated myself with parameters etc.
Then it came to Spain. I was pretty nervous by that time, kept it cool, tried to warn to people that this was no joke, everyone thought that I was a bit crazy and alarmist. Days passed, government went absolutely erratic and irreposible, lost all my trust in the lead epidemiologist and the ministry of Healthcare, not to mention the HUGE amount of healthcare workers that were insisting that it was just a flu and some of us were alarmists for two month and turned 360 in a few days.
Too late. Now I'm in it.
I have to say that some time ago I had a course of applied statistics with epidemiology exercises so I was not really an alien to it, but not an expert either.
And I don't believe you should have to understand exponential growth to listen to clear government messaging about the severity of a problem. This is a failure of messaging by the relevant authorities.
The leaders of the country, the people in power, and the populace are not math literate.
There are scandals in the sciences too. Peer review rings, studies that tend toward positive bias due to the pressure to publish, some studies being paid by big companies that favors their vested interests, etc.
There is a large faction of people in the USA who believe this a politically motivated hoax. This is the world we are living in. How can we vote in competent leaders when a large faction holds such strong influence?
This has nothing to do with the politicians.
It's super easy to retrospectively say "they should've done something else". You might think that even you would do the right choice, but you are wrong.
Such decision is hard for any authority. You may vote for any person in the whole world and the result would probably be similar. Lockdown delivered too early could send whole country into chaos.
Also China managed this so well that it actually could work counterproductive for other countries.
What I'm trying to say is: Don't judge others. You have little idea of the situation they are in, and saying retrospectively "you should've known better" is just childish. Just learn from their mistakes.
With your attitude, you can choose any party and will always be unhappy about the choice.
Also - doing nothing until it is too late - not even educating - is not even a choice. It's not a strategy. Its dereliction of duty.
Those are the conservative figures for influenza in the USA since 2019 November.
Where was your outrage last year and the year before. Couldn't we have prevented this influenza tragedy from happening all over again. Is this also dereliction of duty?
It is by observing others and judging their decisions and actions that we can learn and avoid other people's mistakes.
Is it not?
What you are asking about is just drawing conclusions. I wouldn't mix those up.
European governments were not the first to have to deal with the epidemic (China), nor among the first few (Taiwan, Hong Kong, South Korea, Singapore etc.). They were fully aware of what happened in Wuhan without early action. They literally just had to follow what Taiwan, Singapore, South Korea etc were all doing. Those countries had less information and less time to act, and yet they're riding this much better than much of Europe.
So why _shouldn't_ European governments have known better?
Wasn't until it got Italy hard that most people opened their eyes.
But the point I was trying to make was that saying that somebody should've done something differently is not helping anybody. That's just complaining and nobody needs that.
People will grasp at any excuse to convince themselves "it'll be fine, it won't happen to me". The fact it started in China made it easy - the Chinese government must be overreacting because it's authoritarian, it's halfway across the world, my government must have gotten this figured out, my health care system must be better than China's, etc etc. And of course the classic "it's just a flu".
It's sad that so many will suffer and die because of this.
It might be worth revisiting top comments on HN threads relating to Covid19 in the past few weeks. Quite telling how much the 'know-it-all' folks actually know about the real world - makes you even more afraid that these are the same people who run countries and have an outsized influence in the public sphere.
I gotta say this but I don't think we should put forward the position that total lockdown is an irrational position. Total lockdown seems fully rational, not a product of mere panic at all. Total lockdown worked in Wuhan. Absolute and complete isolation inherently results in exponential decline in the fashion that exposure result in exponential growh. It's a drag but it doesn't seem as much of a drag as millions of dead people.
And that is the bizarre thing I'm saying and hearing in the US - "Uh, just let it infect everyone" - "you know that promises to the largest loss of life on US soil ever" - "well, try to slow it down a bit". Jeesh.
From what I'm aware, if hospitals are able to handle the patients, it shouldn't be up to that level.
And the "slow it down" plan is primarily about not overwhelming hospitals.
There are no countries with mass infections where the fatality rate is plausibly below 1%. Of course, when the health system is overwhelmed, the fatality rate can be 4-5%. But let's just look at a 1% fatality rate to start with.
The US population is 327,000,000. Seventy percent of that is 228,900,000. One percent of that 2,289,000; A little more than two million people if we assume 70% infection and an orderly health care system. But that horrible figure isn't plausible.
Because there's more. Claims you can avoid the overwhelming of the health care system are clearly false. Dividing, assuming, unrealistically that the event could be divided evenly through a year, that means that, that many people dying in a year (365) involves 6271 people dying per day and ten times that many people, ~62,000 people, arriving very sick at hospitals, per day throughout the year. And that is far, far more than could be handled by the US health care system.
Moreover, spreading the deaths evenly is inherently unrealistic, the situation of "flattening the curve" (a good thing in itself), can't stop exponential growth as such. If you decrease the doubling time of a exponential curve, you still have a situation where most of the area, most of the deaths in this case, is in the last double. So the even supposedly flattened curve won't let things go smoothly IF we assume "everyone will get this". And that promises not just 2 million but 10 millions (at the 5% death rate). If assume the US current has 10,000 infections, we approximately 12 "doublings" away from 228,900,000 infections (70% of the population). If we slow the progression to year, half the infection will still happen in the last month, with 10% of those "serious", that 763,000 needing attention per day. We're now talking corpses in the streets levels of horror. And we'd have further deaths from this breakdown situation.
And back to the lockdown scenario. My answer is that Lockdowns are absolutely necessary and thankfully it seems likely in most situations they are coming. The figures above should show that alternative is effectively going to be complete breakdown of the health care system and effectively society.
> If you decrease the doubling time of a exponential curve, you still have a situation where most of the area, most of the deaths in this case, is in the last double.
The closer you get to affecting the entire population, the less exponential your curve becomes. Especially if you're assuming that a significant chunk of the population doesn't get infected, you have to have a curve that spends a lot of time slowing down. The max infection rate will be a lot lower than an exponential curve that keeps accelerating until it slams into a brick wall and somehow instantly stops.
South Korea has dealt the infection extraordinarily well and they have a %1 fatality rate. But even halving my figures, you get an insane result, an overwhelmed health system and so-forth.
The closer you get to affecting the entire population, the less exponential your curve becomes.
True but that STILL bunches up the deaths a lot, until are at a significant fraction of the population, the growth will exponential (and another point of realism, it's city by city also but health care is also city-by-city). The parabola shaped curves in the "don't flatten the curve" articles are bullshit (but the "don't flatten the curves" actions still should be done. It's just the idea that these will be enough that is untenable).
Edit: And I know well there are experts putting forward these arguments. As far as I tell, this an expression of sleep walking, cognitive dissonance or similar phenomena where people don't notice that their mental tools lead them to untenable approaches since they have relied on these tools for quite a while.
Edit2: I think the standard approach of health departments is "when you go past containment, you go to mitigation" and that's what they have been taught. The thing here is nations quickly discover that the situation cannot be mitigated and they have to go to containment on a region or nation wide basis - the situation in Italy, what the situation is becoming in Spain, what literally the situation should be throughout the entire world.
With an absolute best case CFR of 0.6%, that's near 2 Million dead. I struggle to think of a larger loss of life on US soil.
Assuming hospitals reach saturation fairly early, yielding a 5% CFR, and we're looking at 16.5 Million dead. That is... a lot. Like we have nothing here to compare that to. To put it into perspective, the US only lost 400 THOUSAND in WWII....
on edit: saw your other comment, and you're correct, little over 2 million is the low but totally unrealistic estimate.
https://www.euronews.com/2020/03/14/coronavirus-spain-bound-...
https://medium.com/@jb_89278/the-11-day-plan-to-contain-covi...
The guy is tech enterpreneur and VC investor who has been advising our (Czech) PM.
I'm personally a fan of controlled, opt-in infections to help speed up research for a vaccine along with moderate quarantine (cancel many public events, encourage self quarantine). It may not be as effective, but it's much less likely to end in riots.
Or maybe even twice per year, for the northern and southern hemispheres, if they have different flu season schedules. (Edit: Or just do it once per hemisphere, but with restricted travel between hemispheres during the quarantine.)
22 days at home every year... okay, a bit boring, and the economy would take a small hit from that... BUT, there would also be far fewer people taking sick days, and workers would also get more rest and come back more refreshed. It may only be a net loss of a couple days of work, lets say 3 days of work, 1% of Global GDP.
Global GDP grows at about 2-3% per year from what I can see. So a loss of 1% would set us back to the level of late 2019 or New Years' 2020, which was hardly the dark ages.
Not to mention Work From Home policies would adapt so it's likely very little productivity would be lost.
I hope in US we will not see this exponential infected scenario, finger crossed.
To not get exp you have to basically eradicate it (can be done locally with strict lockdown measures, but one day or another you will have to lift them...)
Berlin has canceled any gathering with more than 50 people. If it's less than 50 people, you have to keep a list of everybody who's there for a month. Schools are closed. As are recreational places (cinemas, clubs, museums, gyms, baths). Restaurants have to enforce 1.5 meters separation between patrons.
https://www.berlin.de/rbmskzl/aktuelles/rathaus-aktuell/2020...
It's not quite Italy yet but it's close.
I think that we really need to understand precisely what conclusions these represent when we see statements like this.
Exactly what does "10% of patients" mean? 10% of those who test positive? 10% of those who test positive and also show symptoms?
It seems that a majority of people who contract the virus and test positive (let alone those who are exposed) do not show any symptoms at all.[0]
Of those who do show symptoms, estimates regarding how many any seek out, receive, or require care vary widely, so much so that it's very difficult to draw any conclusions using any dataset that I've seen.
So I ask: When the authors here say "From our data", exactly what dataset are they using and what operations are they performing on this dataset to arrive at this number?
This is crucially important, because if this 10% is actually 10% of those who already seek treatment for respiratory illness, and also subsequently test positive for COVID-19, then the death rate is actually much, much lower than most of the published reports.
It seems to me that we need to know the answer to this before proceeding with any other restrictive public policy solutions.
I'm particularly concerned with the decision to close schools, which in many cases (at least here in the USA) is inevitably going to lead to kids being placed with grandparents for care, which is a terrible outcome if our goal is to reduce exposure to vulnerable populations.
It is OK to question the panic. It is OK to believe, as I do given the available data so far, that the panic is more harmful than the virus itself. I have started a subreddit to gather data and opinions inclined toward using this as an opportunity to appropriately prepare rather than race to drastic solutions likely to hurt vulnerable populations.[1]
0: https://eurosurveillance.org/content/10.2807/1560-7917.ES.20...
That kind of behaviour is not acceptable in the West (nor should it be, anywhere), but we still probably need to be taking this virus a bit more seriously than we are.
All you need is to pass a law and enforce it with police and military, it's not hard.
Since there is a good reason for the law, there won't be widespread resistance, and in fact on balance citizen are likely to help enforcement rather than hinder it.
Note that the page lists "the editors" (of the magazine) as the authors, and the first signature is by the magazine's publisher. The rest appear to be various academic personalities they have reached out to, many of them not from Italy or in Italy.
As for the contents, I don't necessarily disagree with the advice, but this letter is not particularly well written, nor particularly authoritative.
For example, this section:
> The beginning of the outbreak had the exact same number of infections in China, Italy, and other countries. The difference is that China strongly and quickly locked down Wuhan and all of the Hubei region 8 days before Italy [3].
This is an exceedingly poor phrasing, almost seeming to suggest that the outbreak started with a few cases everywhere in the world at the same time. Inadvertently or not, this dovetails with China's PR push trying to claim that the epidemic may not have started there (something that is readily disproven by all epidemiological and genetic evidence).
Even setting aside the potential for confusion, the claim on its face is clearly baseless. Maybe the outbreak started with ten people getting infected in the Wuhan wet market on the same day (if we go by the wet market theory), while in Italy it started with a single infected person entering the country. Or, vice versa, maybe in China it started from a single infected person, and in Italy it was brought in by ten different people carrying it into the country separately. Who's to say?
At any rate, if you look at the source for that claim, you can see that it is shifting the timelines to align at some particular point in the outbreak, and it is comparing the time from that point when China imposed the Wuhan lockdown with the time when Italy imposed the whole-country lockdown.
The source is certainly more interesting, and gives a better picture of the situation than the letter does (although we have seen similar and better analyses in English for a while). However, the "8 days" figure is somewhat arbitrary. For example, Italy imposed a partial lockdown on the areas of the country where individual cases were found days before they shifted to a whole-country lockdown. Maybe that date should have been compared instead?
By the best information currently available, the first case in Italy came from a person who was infected in Germany. According to the letter's claim, the outbreak starts with "the exact same number of infections" (one, presumably), and then grows at the same speed. But then Germany's timeline should be ahead of Italy, yet it's not.
Then there is the elephant in the room, of course. If you cannot rely on China's lockdown to contain the infection, then the rational and prudent thing to do was not to wait for outbreaks in other countries and impose lockdowns there. It was to restrict and heavily control international travel (cancel flights, test all passengers, force visitors to quarantine, etc.). Would that have been accepted by the public? Would that have been accepted by the authors of this letter?
tl;dr: title is grossly misleading, please correct.
This is a letter signed by non-experts (albeit sometimes scientists/engineers). To me, it comes off as the climate-change denier letters or 9/11 "truthers" letters.
Please let the experts do their job. Don't spread uninformed opinions backed up by Facebook posts and panicked researchers with expertise "relevant to virus spreading" such as electronics, architecture and art history.
Be safe out there but don't let the fear and resulting panic of this virus be worse than the virus itself.
The randos are providing much more value than the experts in the US. Other countries like South Korea and Singapore have experts who are doing quite well.
One frontline story among many here https://twitter.com/jasonvanschoor/status/123714289107769753...
At this point my region (Lombardia) appointed someone with the sole task of getting an emergency hospital up in Milano to house more patients, doing whatever it takes. Hopefully this will help.
Stop doing the internet equivalent of running around like a chicken with your head cut off. This is absolutely the Yinge to listen to experts, also known as people who know what they're talking about at a level much deeper than a few weeks' worth of regurgitated Reddit posts.
You're completely correct that the rate is more like 3-5% in Iran, Italy, and probably the US at this rate.
In places where no aggressive action is taken, fatality rates are much, much higher (3-5%) — because otherwise treatable cases can not be treated, and the marginally more ill die for lack of treatment.
The difference between 0.9% and 3% of the US population (per Census.gov ~329 million estimate) is 6.9 million people.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
The US is going to look like France and Italy in a week, 10 days at the most. This is a certainty.
Are you an epidemiologist?
The fact that we haven't spent $400 per resident to stockpile ventilators is a failure of society and a failure of government. The economic damage over these next few weeks will be far, far greater than $400 per resident.
The real shame is globalization. If manufacturing occurred in Europe. In North America...etc. we’d all just quickly ramp up our respirator production.
Instead the west outsourced this to China
The second part is, optimized supply chains that are effectively as empty as possible, all the time.
Here in Canada an 18-day rail blockade by native bands was enough to cause serious concerns in the supply of propane and other fuels in the eastern part of the country.
It's shocking that eastern half of Canada, the majority of its population, faces winters with just 3-weeks supply of fuel. The reason? Nobody wants to carry inventory.
So for many things, we outsource creation, AND we optimize-away buffer stock.
I wonder how hard it is, and how quickly a moderately intelligent person could be brought up to speed (at least enough to get better outcomes than just leaving the patient to die).