California’s Roadmap to Modify the Stay-at-Home Order [pdf]
gov.ca.gov
gov.ca.gov
The mismatch between their models and the observed data does not engender confidence.
[1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California...
It does not. The exponential curve, per the graph legend, is what would be expected without intervention.
The best fit line of new cases after 4/4 is a linear function with a definitively negative slope. It is conclusively not a function that contributes to the upward, concave blue line on the state's graph.
What going to happen is indeed inherently uncertain so we pretty much have to prepare for the worst plausible series of events. Once it becomes clear that a better outcome is fairly likely, then the plans can shift.
[1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California.... [2] https://covid-19.direct/state/CA
Current Hospitalizations, which is the number we should be most concerned about, and is reflected by the orange dots on the state's graph, should start low, max out at a number, and eventually return to 0. That should follow something like a bell curve.
I think the confusion is between the "total infections" curve and the "current hospitalizations" curve. The difference between them is huge, and really important. The "Flatten the Curve" idea refers to keeping the number of hospitalizations at any one moment below some upper limit, ideally the state's number of available ICU beds. That's a bell curve.
I think the confusion is that if the CDF is the logistic function, then the PDF is the logistic distribution. This is what archgoon is saying.
Bell curve refers to a Gaussian distribution, which is different but looks similar.
https://en.m.wikipedia.org/wiki/Logistic_distribution
http://visionlab.harvard.edu/Members/Anne/Math/Logistic_vs_G...
However, in the case of a virus, you eventually run out of population to consume; so you tweak the model to be "Let the rate of infection be the probability that a infected person encounters a non-infected person" (nicely, for a large population, this will give you the same results initially). This is, approximately, proportional to the product of the number of people who are infected times the number of people who are not infected (think back to chemical reagents and reaction rates). That is, (1-infected(t)) * infected(t). A function who's rate of change is that is the logistic function (and you can verify by taking the derivative of 1/(1+e^-t))
This is a simple model, ignores geography, ignores population change, and ignores changing behavior. It basically pretends everyone is an ideal gas molecule in a volume. But if you want to model something that "grows exponentially with a limit" it works alright.
I don't know under what assumptions the rate of change would yield a bell (normal) curve. (e^-x^2).
At some point, there's saturation, and "herd immunity". For this virus, that's somewhere in the 60%-80% range of the population. US population is around 333,000,000, so saturation is somewhere above 200 million.
We're nowhere near that. Current known US total cases are nearing 2 million. Current estimates of undetected cases are in the 80% range, so current total cases is probably around 10 million. So about 20x more people have to get sick before herd immunity. That's well over a year away.
- Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.
- Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
- All we can do is alter the timetable to keep the hospitals functioning, which has been done successfully in many places throughout the world albeit at great cost.
There's both good news and terrible news in those facts but none of it really seems to be in the consciousness of the public or of leaders, whereas "oh no you can maybe get it 8 hours after a guy sneezed in a lobby" is everywhere. Along with "everyone who stays at home is a hero" as we set ourselves up for a second Depression.
You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.
I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2]
Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one).
In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it.
[1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
Adjust your numbers for population. Per capita numbers for the US are far from the worse case scenario.
[1] https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early...
Takeaways: Old population, Pre-existing conditions, Skewed testing
The paper has an overall estimate of the infection fatality rate for all ages of 0.2-1.6%.
https://www.tagesschau.de/regional/nordrheinwestfalen/corona...
That is incorrect. The worst flu wave to hit Germany in the last 20 years, 2017/2018, killed appoximately 25000 people (excess mortality). That's 0.03%, and it's not typical. Often, the number is much lower.
Note also that the results from the Gangelt study you're referring to are preliminary; there's a press release but no paper yet, not even in preprint.
0.03% or 0.1% or 0.66%, the number is low enough to be perceived as not too dangerous by general populace. Contrast that with 13% mortality rate for Italy that was widely spun a month ago. Now _that_ was scary!
"Significantly less than 200 million Americans catching it" is still on the table.
"Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily.
This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs.
This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed.
It isn't hopeless.
> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.
For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine.
I think we need to explore alternatives to lockdowns because I believe the economics of lockdowns will make them impossible to continue for very long. At the moment people see this as a "be heroic and do the right thing" issues, but most people don't yet understand the severity of the economic impact and haven't yet been personally affected by it. Lockdowns will probably become politically untenable by May or June whether anyone today likes that fact or not.
Because kids are the most likely to ignore even simple ways of preventing infection. Then you get exponential growth via kids and the health system implodes.
It's tricky to take large bites here because of the short doubling time compared to the relatively longer recovery time -- in the ~3 weeks it takes your currently-infected cohort to recover, your infected population could increase 100-fold if you aren't careful. Mistiming things -- misjudging how many people are currently infected -- by a couple of days can be difference between exposing 10% of your population to the risk and exposing 15%. There's a reason pandemics are often compared to forest fires.
This will get easier as time goes on, as the doubling period gets longer and longer.
Based on current estimates of how many people will die in the US, you can infer that we currently expect 5-10% of the population to be exposed in this first wave; I believe what widespread testing there has been in Italy leans towards about 10% of that population having been exposed there as well.
But if you expose kids to COVID now, they will in turn expose their parents, who will expose their coworkers, etc, etc
I could see that being effective strategy if we didn’t have a vaccine in 30 years, but for now, most people are still susceptible.
Only if you would like to see the hospitals overwhelmed with cases that don't result in fatalities but kill lots of other people and also kill people with underlying conditions that would otherwise live full and productive lives.
We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc.
> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.
Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.
The way to avoid that is to at least spread out the impact over time. Telling people it'll be okay leads to no one listening and the health system collapsing. That's human nature. Telling people it's the apocalypse means most listen and the health system survives. Welcome to humanity.
Really, if every jurisdiction in the world overwhelms their hospital capacity it won't be ok.
What seems to be a noble lie is the apocalyptic mindset, where the coronavirus is literally the only thing that matters and we must never ask if a particular mitigation is worth the cost. Many authority figures are promoting this idea, even though they clearly don't believe it themselves and couldn't formulate effective policy if they did.
The example of Sweden seems to disagree with this assumption. They never locked down, and the current mortality is (1,203 / 10,330,000) * 100 = 0.0116%
First case on Jan 31st, no lockdowns, death rate has already flattened. Where is that crazy scary exponential growth?
The thing about the lockdowns is that evidence so far indicates that stopping 80% of non-essential economic activities voluntarily is about as bad for the economy as stopping 90+% on a mandatory basis, but it seems that the health outcomes are much better in the latter situation.
You can't know that without testing the whole population, or at least getting some controls.
This also discounts the unknown possibility of disability, reinfection, and limited time immunity.
NY population is 18.8M. 0.05% of the population has died.
You’re citing numbers released by the city where they haven’t confirmed cases, so it doesn’t answer the OP’s question.
Just one example, tests of pregnant women coming into labor in New York show that 1/6 of them are positive for nCov, but 85% are asymptomatic or presymptomatic. (https://twitter.com/CT_Bergstrom/status/1249836446569181186)
Another example, Denmark is finding potentially as high as 30-80x undercounting of cases, which would bring the fatality rate down to 0.1-0.2% (like a bad flu season) [https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_...]
I've seen a few more of these data points coming out, and nothing is 100% conclusive, all the new data points are showing that it's less bad than mainstream thinking suggests.
This doesn't seem right to me. With social distancing now, and testing and tracing once we have enough tests available, it seems to me that we should be able to keep the total number of infected people well below 200M, even if a vaccine takes the expected 18-24 months. If there's a solid argument that this is not the case, I'd like to hear it.
2) Testing and tracing is working fairly well in S. Korea because they're treating it like a war, and they've been orgainzed since fairly early on. The US is not organized.
What most people, including HN, miss is that passing a test today means nothing about tomorrow.
Hospitalization is a more important factor as it the death count goes up dramatically without intensive care.
These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.
The exponential curves are somewhat useful early in an outbreak. It's confusing right now because some places are still "early" and some places are way past the point where those curves are descriptive. So they won't describe NYC at all but they're still somewhat working nationally.
It's 2 million worldwide. The US is now above 600,000:
Eg, https://www.johndcook.com/blog/2010/05/18/normal-approximati...
Not a good sign if people are making actual decisions based on this.
It's pretty sloppy to show surge capacity on the same graph as total hospitalizations, not active active hospitalizations.
I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control, when data shows the situation is even better than the most optimistic models were predicting. And by that I mean, pretend I was on HN 3 weeks ago predicting 25K deaths in the USA by today. I’d have been downvoted into oblivion and told I was delusional. But here we are.
Clearly NYC was hit far harder than the rest of the country, but it seems like every state and municipality is simply basing their models on NYC case numbers scaled by population. I don’t get it.
A week ago, I remember reading how the Bay Area was bracing for a bracing for a surge and it was the calm before the storm. The Santa Clara county covid-19 dashboard told a different story: day-over-day, new cases were roughly the same for the past two weeks. 2+ weeks into the lockdown, there was obviously no surge coming.
https://i.imgur.com/LrFZj3S.png
Looking at that chart on the April 7th, nothing pointed to a surge.
It's mid-April now. Where is the Death Wave? Either this virus is much less infectuous than it was touted, or much less deadly. Or both.
Sweden never locked down. Denmark is opening up after a lockdown. Italy that was touted as the prime example of hell on earth, had ~21,000 people died by official count. Even if it was undercounted by 50%, that's roughly 40,000 people, mostly elders on their last breath, out of country of 60 mln. And that's the worst case so far, in the world of 7 billion people.
Disregard all that, we're still being told daily that it's "war zone", the zombie apocalypse is just around the corner, etc. Only Big Brother like surveillance is going to save us. The lockdown is not an extraordinary measure anymore, it was an absolutely necessary first step, and now we have to take it further. Much further.
I wonder what it felt like for people in 1932 Germany.
1,200 people dead of 10.3 mln is 0.012% of the populace. Not good but not scary either, for the Worst Pandemic Of Our Lifetime.
I would agree that modeling after NYC seems like a bad idea given the lack of density and public transportation. On the other hand, Michigan looked pretty exponential, and as the lagging cases came in from other states, they also began to look fairly exponential as well. Despite cases staying elevated for now, the exponential growth has died down.
The US missed the worst of hospitals being overrun and it running away in multiple cities.
I want to add ", so far" to the end of that sentence. I do not hold hope that this will be true as we fight among ourselves to reopen various portions of the country/economy.
But things won’t be the same after reopening as they were before. People will be wearing masks (I see a lot of that already), keeping distance, etc. Couple that with common sense restrictions like “keep the elderly and sick at home”, “no big public events”, “no sporting events”, and “lots of restaurants have gone out of business”, it’s clear the opportunity for infection spread will be lower.
Further, these estimates are much older than the data so showing their accuracy is useful.
The brighter dashed line is there to show what happens if intervention is disabled completely.
I really like that the milestones are placed as questions, rather than dates. It is the right way to message the unknown.
It turns out that social distancing is working better than expected, or the virus isn’t as contagious as expected, or slightly less severe than expected. That doesn’t mean the lockdown was the wrong thing to do, or that it isn’t still necessary. What it does mean is that we’ll be able to start easing restrictions as the hospitalizations continue to drop — and perhaps we can stop it completely with testing and contact tracing.
This shows laudable transparency, in my view.
(Also the model was directionally correct, it’s not like it was entirely the wrong shape.)
[1] https://covid19.healthdata.org/united-states-of-america/cali...
If you want to see examples, check out their predictions on Italy. Their figures have been underestimating by over 50%, and the gaps will widen each day over the upcoming week. Heck, the ranges for the last few days have been outside their confidence interval.
Do you have a background in disease modeling or anything?
I'm curious.
[1] https://www.sfgate.com/coronavirus/article/Think-you-got-the...
[2] Analysis of #infected today from #dead today, using following assumptions:
1. death statistics are reliable, since cause of death tests can adequately collect fluid samples (a major source of inaccuracy in COVID-19 testing), source = talking to medical staff at Bay Area sites.
2. E[days between first infection and death] = 14 (lost the source at the moment), Therefore, number of dead today D => number of infected 14 days ago = 100 D
3. rate of death increase consistently trends around 25%/day or 15% with full lockdown, source CDC situation reports worldwide excluding regions with restricted access to journalists
4. therefore, #infected today = #infected 14 days ago growing at 25% daily = 22X, or 7X if your region was locked down for last 2 weeks
5. so #infected=2200D or 700D
[3] Last week, CDC reported 2 deaths today for Iceland, and admittedly-non-random sampling by DeCode indicated upto 1% of population have/had virus, upto 3600. Iceland has done strict quarantining of confirmed and suspected cases, and extensive testing since February, so despite no lockdown, I would put them at the 700X end of the estimate. They report ~1000 confirmed cases, so they would actually estimate 3600-1000 infected so far. My estimate would have indicated 2200-700 X D (= today's deaths, 2) = 4400 to 1400 cases.
As another data point, the theory of this thing being widespread in the population seems far fetched to me.
While I understand that many folks from Wuhan travel all over the United States, the non-stop options from Wuhan to NYC and, if I recall correctly, SFO and LAX meant that more opportunities existed for early spread than the middle of Colorado. In fact, I can't actually pinpoint a city in San Miguel County, Colorado -- can you? (https://goo.gl/maps/F7CJ3yfDKaf1gQjDA) I guess there's a post office in Egnar... Telluride maybe?
Certainly the sparse population created natural social distancing precluding its spread.
[1] https://www.telluridenews.com/news/article_1547199f-46bc-547...
And you guys want to take it to 85%.
I would look to the deaths curve much before the new cases curve, even though it's less responsive to changes. I assume fewer deaths have slipped through the cracks (though I'm sure some have).
https://raw.githubusercontent.com/lettergram/covid19-analysi...
They also barely tested at all prior to 04/04/2020:
https://raw.githubusercontent.com/lettergram/covid19-analysi...
In generally though, the rate of positive tests is increasing nation wide:
https://raw.githubusercontent.com/lettergram/covid19-analysi...
Implying we are still on a solid growth curve, as our testing capacity has maintained relatively constant levels:
https://raw.githubusercontent.com/lettergram/covid19-analysi...
I can't speak to the hospitalization levels, but I suspect people are avoiding the hospital. My roommate decided not to get tested and stay home, even though he was having difficulty breathing. He seems past it after a couple weeks.
This is not surprising. When tests were scarce, tests would be rationed to those most suspected of infection.
Literally just today Mayor Garcetti announced testing for everyone is available.
Remember, this is the USA.
I just got an email from local urgent care that they have the fast test equipment that can offer a result within 15 minutes if you are negative.
The situation is changing quickly
That's a big chunk on top of current testing, but probably not enough to make it easy to move forward with a testing based strategy.
As countries increase their testing capacity it is quite possible some countries (or states) will end up eventually reporting accelerating numbers of diagnoses even if the actual new case rate in the population is falling.
One way to mitigate that is to report only cases requiring hospital admission. This isn't ideal by any stretch, but is a reasonable proxy for the spread of the virus and at least gives a good indication of the impact on the health care system.
It doesn't count all the frail people living in care or nursing homes who are put onto a palliative pathway and allowed to die, for example.
This could be about half of all Covid-19 deaths.
https://ltccovid.org/2020/04/12/mortality-associated-with-co...
> Data from 3 epidemiological studies in the United States show that as many as half of people with COVID-19 infections in care homes were asymptomatic (or pre-symptomatic) at the time of testing
> Data from 5 European countries suggest that care home residents have so far accounted for between 42% and 57% of all deaths related to COVID-19.
Their graph is linear growth in new cases per day until 4/4, followed by a gradual but spiky decline, even as tests/day keep increasing.
Once testing becomes more available, doctors use it to rule out COVID even on patients who aren't very sick, to help make sure they those patients aren't spreading it, instead of just making treatment decisions.
Ideally once testing capacity gets high enough we could start testing every contact of an infected person, or just randomly sample people.
How are you defining lock down here? I live in Australia and most people I know have been working from home for weeks and have had kids out of school during that time. All restaurants have been closed for a while now. There are stops/checks at border entry points between states, even at points 1-2 hours in from the border, enforced quarantine for anyone arriving interstate. Weddings restricted to 5 people, funerals to 10. People are getting fined $1k+ for non-essential travel (group of kids this week copped big fines for getting up and congregating to see the sunrise).
At almost every "essential" business I've visited, there have been spacing markers on the floor. Supermarkets have plastic shields between the checkout operator and shopper. Gloves, hand-washing, etc at any food pick-up place I've seen.
I don't favour our current leaders at either state or national level, but since Morrison's Hillsong weekend, he's barely put a foot wrong. Senior politicians have been serious and escalated restrictions as appropriate (ignoring Ruby Princess). I'm sure there are more serious levels of lock down, but it's been part of the response in Australia.
One serious loss in productivity comes in overseeing homeschooling while trying to work from home. Can't imagine many non-essential businesses are running anywhere near 100%.
This "roadmap" is quite scary as this is not a plan that would pass muster in in YC Boardroom. (1) The one chart with data is horribly innacurate: (a) It shows interventions causing worse than no interventions in the short term? (b) Shows hospitalizations increasing despite the fact that they have not for some time. (c) Shows "Surge Capacity" as a static value, which you would hope they are increasing if they really think this is the issue.
(2) It does not specify in any fashion what the different levels of coming back are. When can medical procedures resume? When can non-essential work where social distancing is easy resume (e.g. Los Angeles apparently has banned gardeners, who don't need to get near a soul)?
(3) If he believes masks work (as I do and as indicated in this presentation), why are masks not required and businesses shut down? Shouldn't we do the less painful and restrictive measure first before we shut down businesses?
(4) Most importantly there is not an actual goal clearly articulated here. Is he going for suppression? Is he going for mitigation?
I like many others are deeply upset by leadership from both parties, at all levels of government.
Yes, I agree. What’a really upsetting is they try to justify why less transparency is good thing. When they are using this only as way to impose their authority.
I'm sitting at home in Michigan where the governor has closed almost all businesses. Politicians bicker over weather governors or the president have the authority to reopen things. And yet there is no plan as far as I can see. No goals, no criteria to trigger next steps, nothing. Meanwhile the press just snipes at people.
But yeah, the slide thing is kind of silly. Looks like they did most of the work with a 4:3 template, then realized halfway that it would be shown on a widescreen projector/TV.
instead, focus on putting political pressure on your state and local politicians to come up with a concrete plan and timeline, as they're the ones who do hold power in this case.
If my state would manage to kill 100% of the virus within its borders by quarantine-like measures, and then reopened the economy and everything else before other states and countries do the same, we'd quickly get the spread back on track. So if there's no federal/worldwide cooperation on that coming from the top, local politicians must push up as hard as they can for a global plan to be made.
At the very least, there must be a plan per continent.
no governing body would open up everything immediately and let everyone go wild mixing it up. reopening will be controlled and coordinated enough to keep a lid on transmission rates (as implied by the CA roadmap), rather than attempting to eradicate all transmission in one globally-synchronous attempt. that would be wholly unrealistic.
For example, even in your own example here are several situations you didn't account:
-- The availability of tests for the public at large
-- Whether we're doing temperature checks everywhere
-- Whether we're requiring people to download a contact tracing app
-- How much capacity we have in the hospital system even though cases are going down
-- If we can find a drug that helps shorten the time people spend in a hospital
-- If we find new information like masks don't help or they greatly help
-- We run out of swabs but cases are low
There are a lot of factors that has to go into how the government changes the rules and while it might make it easier for the public to be at ease when the rules are hard, it also makes it a lot harder to adjust the rules.
I think being upset at the government is your right, but I also think you should channel your energy into something more productive and thank that at least in California we acted a lot faster than other areas of the country.
I think Governor Cuomo said something very interesting the other day, to paraphrase, when he was asked whether he should've started stay at home earlier and if that would've saved lives. Of course it would have, but the interviewer is not taking into account compliance and public sentiment. Likewise, for you, I think you're viewing this problem from a very individualistic point of view to get strict rules on what happens when, but you're not accounting for the edge cases where the government needs a backdoor to change the rules with new information and to play it close to public sentiment.
Sure, keep the green columns internal, but broadcast the "Levels" and restrictions, incorporate your bullet points (like temp checks). That way people can prepare for moving to "Level 4" with a rough timeline. With a possible second wave and next fall/winter being inevitable I don't think anyone would be surprised about moving backward.
Personally, I'm not upset by this. It just doesn't seem very useful to the public.
I personally think there is zero downside to publishing the numeric targets. Of you get more data in to change them, just change them (it's at least better than now where they have dates that they just keep changing). I don't see how having a date that you keep changing is locking political leaders more than metrics that you change.
All of those numbers in green have been called out as likely incorrect at the moment. You can see positive tests jump as more are done in the daily numbers. In situations where people are dying they're often foregoing tests to save them for the living. At some point we'll hopefully have wider testing which will change the numbers and likely the criteria for level changes.
While I am highly confident I didn't get everything right, I did account for the testing angle because I think that while tests are coming in on average (something like 7 days) very high positive, it is a very good sign that test quantity is wildly off. That is why I personally look at that metric. If 95% of tests are coming back negative (assuming good tests), that is a sign testing is going well. If 40% are positive, we aren't testing enough and should be conservative.
If our testing goes up which dramatically shoots up cases, even though its is a good thing I think its prudent to potentially escalate measures to be sure.
It should only be when everything is at least as good as a certain level should things decline. So for example if there are 1000 new cases in a week in california, with 2% growth rate, but 25% positive tests for some reason, then lock it down again (this is a very made up example).
I'm living on the West Coast, but the way I remember the news from NY was that De Blasio wouldn't shutdown the city because he said he lacked the authority; he passed the buck to Cuomo to issue shutdown orders. Cuomo said that it was the Federal governments responsibility to organize and order shutdowns, passing the buck to Trump while implicitly admitting it was something that needed to be done. Trump in turn said that it was the states' responsibility. Importantly, De Blasio and Cuomo knew the stance of the person they were passing the buck, which means they knew nothing would be done. Equally as importantly, they both ended up later ordering measures they previously refused, and otherwise contradicting their earlier selves.
Meanwhile, over here on the West Coast, we saw real leadership--making hard decisions in a moment of public paralysis.[1] Cuomo and De Blasio seem to be smart administrators, at least smart enough to recognize and follow expert, consensus opinion smacking them in the face. But they clearly suck as leaders.
I'm still astonished how quick we all are to retcon recent history. (And I don't mean to imply that you are doing that, though I am responding to a sentiment that seems to defend Cuomo.) Similar revisionism happened after 9/11 and the Great Recession, where people ended up judging people and events according to narratives and sentiment that arose weeks and even days subsequent, despite obvious contradictions with then recently reported facts.
[1] Not just politicians. Noteworthy (and apropos HN) is how Seattle Flu Study researchers stuck their necks out and bent the law rather than twiddle their thumbs while the CDC fumbled.
https://missionlocal.org/2020/04/covid-atlantic-london-breed...
I knew Breed jumped the gun and thought it a little showy, but I assumed she did it partly to get ahead of the rumor mill. Maybe her office coaxed the TV station (KTVU?) to leak it early?
Anyhow, this is all largely irrelevant. I purposefully didn't single out Breed in my previous comment. What's relevant is that these counties had clearly been working on this order long before the announcement, which means that for her part Breed would have known about it and approved of it days prior. Which is in stark contrast to mayors like De Blasio and most other politicians outside the West Coast and especially outside the Bay Area--Newsom was almost too late in ordering a state-wide shutdown, judging by how bad Los Angeles got. They were consistently days late, during a time when days and even hours mattered.
I'm not very concerned by Breed trying to capitalize on her decisions. What matters is that she has made decisions that could have easily resulted in intense blowback (and still might) while others sat around on their thumbs too afraid of the political costs. There's plenty to still criticize Breed for, but relatively speaking she deserves some praise. And that's basically how the Mission Local article lands, too.
EDIT: See also Breed's first tweet at 11:57AM, which I think comes before her press conference, though Youtube isn't showing the time of the video, just the date. https://twitter.com/LondonBreed/status/1239626809865416704 Speaking of which, it's highly annoying how the SF Chronicle and the Mercury News update their articles in ways that obscure the timeline of what was said and when.
I mean, it does until challenged, and it could impose restrictions on entering government buildings -- but the government really doesn't have an unlimited authority to declare arbitrary restrictions on the right of people to peaceably assemble.
Not legally, anyway.
The virus poses a larger threat to national security than the Viet Cong, after all.
There's no such thing. The idea that a right is inalienable is aspirational. While we should respect it, we should also respect that nothing is absolute and the best laid plans of mice and men and whatnot. We cannot allow perfect to become antithetical to good.
I'm sure Earl Warren said that to himself when he locked up the Japanese Americans during WWII.
Especially when the country isn't even sure about bump stocks.
How about we address such things on a case by case basis?
Yes it does. This is war.
But in a way, you are right. We are in a war for our futures, and we are losing.
There's some limit to these powers, e.g. a quarantine in SF in the year 1900 was struck down as being racially discriminatory in a way not justified by public health (only ethnic Chinese were quarantined). But courts are reluctant to second-guess this kind of thing unless it seems like a pretext.
That’s great, but right up until the shutdown, De Blasio and other NYC officials were encouraging New Yorkers to go out and support their local theaters, restaurants, and bars. And at no point did initial shutdowns meet with any substantial resistance. This is just retconning the history of the past six weeks to make himself look better.
This is the factor that has been missing from all the reporting on this crises. The goal of suppressing the virus to zero and merely seeking mitigate the virus surge effect on available ICU beds leads to drastic differences in all metrics most notably “peak deaths”. If the goal is mitigation with rolling shutdowns, there will be many many more deaths. Virus suppression require several months of shutdown. This is the most basic result of the “models”.
None of the major outlets have reported on this at all.
Secondly, most of your nitpicks are great if you want to nerd out over the details of the epidemic, but most people are not going to find small details like static versus dynamic surge capacity or suppression versus mitigation useful at all or relevant to them at all.
A sprinkling of Dunning-Kruger here..
Sorry, but what's your expertise in what real public health plans look like? And why are you criticizing a slide deck as if it were a carefully considered public health plan?
If you want to talk about what you'd like to see, great. We all want things, and communications can always be better. But I don't understand why you're treating your preferences as overriding, especially when you don't even know who the author is. (Hint: it's not a he.)
This issue (the issue of reopening) is not actually that much of a health discussion. It's a discussion about tradeoffs of a horrific deadly shutdown vs a horrific deadly disease. Health experts can help determine R0 and Rt and IFR, but they can't make these tradeoffs for us, it's ultimately a question for society.
We have to change the conversation from yelling at each other to debating the real details.
Pointing out that you don't know the source is not an ad hominem, because you are apparently offering yourself as an expert as to what a good plan is here. You also don't appear to know the difference between medicine and public health. The latter, of course, is very much about the tradeoffs between medical and other societal factors.
So I'll ask again: given that you are presenting your opinions as more pertinent than the experts here, what's the expertise you're basing that on?
This “Roadmap” was likely rushed out as part of a coordinated political response to threats made by the POTUS to override state decisions.
It was framed in the local press even before it was announced that the governor would be discussing which metrics the state would be looking at to determine when and how to start opening things back up.
It was shocking/hilarious/predictable to see the headlines streaming out even before Newsoms press conference was over that “California releases plan to reopen economy”.
If I was expecting a plan, and then opened this PDF, I would want to rip it to shreds as well.
And Newsom's twitter seems to really allude to it being "like a plan" with tweets about this like: "@GavinNewsom lays out parameters and tools needed before the state modifies California’s statewide stay-at-home orders" https://twitter.com/CAgovernor/status/1250136291347324928?s=...
and they "announced a shared vision" https://twitter.com/CAgovernor/status/1250212300147101697?s=....
A bunch of "parameters", "indicators", "vision", and "roadmap" to describe this one thing, means most people are going to expect something plan-like.
Was this thing rushed out? Probably. But why? This is literally the most important thing that Newsom could have been working on for the last 3 weeks. He pre-announced this yesterday, he could literally have had his whole team work on nothing else.
I mean if I had to make one of the top 10 most important announcements of my life tomorrow, I would really make sure it was good.
But to be fair, and I think this was at least part of your point, maybe it is exactly what he wanted. This is a political document, not really meant for California citizens to understand what the goal of the state is, what measures will be taken, and what kinds of numbers will be looking at to make decisions.
If I draw out a map to Disneyland, even going as far to include which freeway exits to take, or maybe even going further as to plot out a few stops for gas, this still says nothing about when I will actually start the trip, how fast I’m going to drive, how much coffee I’m going to drink beforehand and how many bathroom breaks that will require, how many flat tires I’m going to get, how many times I’ll get rear ended by another driver who is playing with their phone, or how many times I will get pulled over by the cops on the way.
Some of that information is impossible to know, and some of that information has a low ROI in planning further.
> This is a political document
I feel strongly this is the case.
That's incredibly vague. Almost worthless, given that they already extended the order by another month at the last minute.
It's the exact same situation in France where we're planning to go out of lockdown in 4 weeks. It seems unclear that we'll have the needed tools by then. It's not even clear that they'll work but there are no other options.
At least the California roadmap isn't pretending they have the answers to the question they raised...
Talk about cynicism.
In France, we need to fill a form every time we want to leave our homes. Any non-work related trip should be limited to one hour and 1km, at most once a day.
This was decided with no vote or concertation within a couple of days. It also applies to people who live in rural area. They even fly drones in the mountains in order to catch lonely hikers breaking the rules. It's crazy.
Worth than that, part of the population is getting obsessed about rule-breakers, as if lone cyclists suddenly became a danger for the nation. The police is flooded with calls of people denouncing cyclists, hikers, or joggers...
Funny thing, our president said in his speech that this pandemics shall not restrict our freedom.
I've definitely noticed on Facebook, since the beginning of this, there's a lot of shaming of people doing X, virtue signalling, I'm doing this right, how about you? etc. There's a huge political correctness and peer pressure angle to the social distancing policies.
Most people seem onboard with this so far, but I think at some point, the tide will shift. There will be growing social unrest. We're a social species, we're not meant to live in isolation indefinitely.
The way this lockdown has been implemented is going to cause a lot of problems at the society level afterwards.
Why would anyone trust them to not abuse this data?
If they wanted people to volunteer information, maybe they shouldn't have repeatedly abused trust.
It's like choosing N.Korea as an example and asking why you should trust them with your civil liberties.
https://privacyinternational.org/sites/default/files/2017-12...
Do you _really_ trust Apple and Google? I'm sorry but I don't.
Why? Canada is giving every Canadian $2,000 every month. Why can't the US do the same while we let this thing subside fully?
Instead we're bailing out corporations, while giving everyone a one-time $1,200 check, while expanding unemployment checks by merely $600.
No they're not, if you worked even one hour, you don't qualify for any of the $2,000. Your income must be zero to qualify for that program.
What's needed is money for households to pay for them, which is the biggest concern at the moment, but which can technically be solved by giving households a cheque.
I get the point though, and it's a fair one, but the "eventually" is important to consider here. Eventually when? No one is arguing in favor of permanent sheltering, Implying that the only option is to reactivate the whole economy "soon", knowing that there could be adverse health consequences isn't giving the alternative options, some of which might be better for public well-being, the consideration they deserve.
[1]: https://money.cnn.com/2018/07/02/news/companies/auto-tariffs... [2]: https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/20...
Some outbreaks are smaller, but you'll note that they all leveled off at roughly the same time and on the same schedule. That's because we locked down on "New York's schedule"[1]. If we didn't, these places which seem to have "handled" the outbreak would look like New York.
The plans should absolutely be regional in that the lockdown rules should be based on infection rate thresholds, etc... But to do that they all need exactly the same per-capita testing resources. It's the same plan.
[1] Really that's not true. We locked down on Seattle's schedule, because they moved first on most things. Seattle had by far the biggest early outbreak, but peaked earlier, peaked lower, and is now one of the better managed areas in the country. Cuomo gets all the attention but it's really Jay Inslee who saved us all.
For all the various politicians are talking about "following the science", there's very little actual science backing up these measures. We're pretty much making it up as we go, and you would be hard-pressed to find "scientific" justifications for most of what we're currently doing.
Is there a cite for that? Because that's not the way the data looks.
Everywhere was growing with roughly the same exponent before lockdown. The numbers were bigger in NY because it grew longer pre-detection, but there's no reason to believe that everywhere else was any different. Really this disease's growth constant looks shockingly consistent almost everywhere in the world.
> It's unclear to me why we're making these policies at a federal level.
We... aren't. Literally every existing lockdown regime is being enforced at the state level or lower. For the Boise example you mention, the relevant regulation is a stay in place order from Gov. Little in late March.
Edit to show the point better: Go here (easily the best visualization site, FWIW), scroll to the bottom where you can see a log chart of per-capita infection rates normalized to a single "start time" metric, and compare the Idaho chart with the New York one.
https://91-divoc.com/pages/covid-visualization/
They are almost exactly the same chart, modulo a vertical offset and a kink in NY data in the second week (which consensus says is the testing backlog finally catching up).
If Idaho's detached housing and automobile dependence was reducing its rate of infection spread, it should be visible in the slope of this line. And it clearly isn't.
Shelter-in-place is a good general rule - we can roll it back when we've got infrastructure to vaccinate people.
I'm not sure what you're referring to about vaccination. As California's roadmap lays out, we'll need to roll back shelter-in-place long before vaccines are available and find less costly ways to mitigate the virus.
No, they weren't. You're just asserting that this is true. There's effectively no way to know what the doubling rate was in a place like Boise before the national lockdown, because the numbers were in the low single digits:
https://covid-19.direct/metro/Boise?tab=glance
But even ignoring that...the site you're linking to shows a wide range of slopes on the per-state graph. You just think they look the same, because the log Y-axis compresses dramatic differences in scale, particularly near the origin. New York, NJ, Michigan and Louisiana are well above the diagonal line, while states like Wyoming, Montana, Vermont, Maine etc. are all well below it.
That's a doubling period of less than three days. It was spreading every bit as fast as New York was. It looks like exactly the same chart with a different constant factor. Yet you insist that these identical results are somehow due to different underlying behavior? Why? Where's the research showing that?
Because the pretty obvious hypothesis is that the disease was spreading the same way because it's the same disease and doesn't care about whether you live in Boise.
Number of cases is largely a proxy for how many tests are being done (https://fivethirtyeight.com/features/coronavirus-case-counts...). Looking at deaths is more accurate, and that shows Idaho (and all other states) well below New York.
Dates are not trivial when people's very livelihoods are at stake.
Basically, just like you don't want to overwhelm hospitals, you don't want to overwhelm your contact tracing infrastructure
but i routinely see people with masks and gloves on while walking outside. not shopping, or going to shop, just walking. it's so odd, and frankly, wasteful.
I think I disagree.
It seems that face masks are quite effective in reducing the spread of illness. For example, look at the numbers in South Korea, Japan, etc. (where mask-wearing is common) compared to ours. Masks don't need to do 100% of the job -- rather, we would hope that in combination with moderate social distancing, better hygiene, improved testing, etc. we could reduce the rate of transmission. If each infected person spreads the illness to an average of only 0.9 others, then it won't do much more damage.
Now, from an economic angle, the US government just passed a $2 trillion stimulus package, which works out to about $6,000 per American. There are calls to spend much more money. Suppose we spend 5% of this on face masks, so $300 per American.
Currently, face masks can be bought at $20 for a box of 50 on Amazon. That gets 750 face masks to every American, at a cost that is cheap relative to the other costs of Covid-19.
And this is ignoring economies of scale. If the government decided to distribute free face masks in every school, every restaurant, in every theater, etc., then it could produce them at much cheaper than 40 cents each.
All in all, it seems like a potentially good investment.
it's a virus that rides on tiny masses of water to hopefully jump into the nasopharyngeal cavity of the next host. if it doesn't make it to those warm and juicy brachiae, it exponentially decays to the elements in hours. relative to air, those virus-laden water masses are heavy. most fall at your feet. some fly a few feet. very few make it many feet.
then imagine your chances of making a full-court basket (94 feet, 9.4" diameter ball in 18" hoop) and then divide those odds by the several orders of magnitude smaller that viruses are relative to us.
wearing masks (or gloves) outside makes no sense. you might as well walk around with your own lightning rod too then.
emergency personnel, medical professionals, and essential business workers should wear masks because they are at elevated, face-to-face risk.
This is an extremely strong statement. Although it might be plausibly true, my impression is that the transmission of the disease isn't well enough understood to make such assertions with confidence.
Can you cite a reference for your claim?
I think it is agreed that physical distancing alone while inside of closed spaces with strangers is an extremely good idea. Wearing masks is, potentially, also an extremely good idea.
Shouldn't we adopt any and all measures that have the potential (not certainty; potential is enough) to substantially cut down on Covid-19 transmission, and whose economic and other costs are comparatively modest? Even if we later determine that only one of these measures was really necessary, I doubt that we'll regret our efforts.
There seems to be a huge difference in the trajectory of cases in Japan, vs South Korea, so I don't know what you think you're saying, if you group them together. In South Korea, cases went up and then apparently flattened out almost completely. In Japan, the graph I saw has been lower than in other places but is, almost uniquely, not flattening so far, even in the way that Italy or the US has.
So it makes no sense to me to combine them and say "look, that is the example". If one is the example, the other most likely isn't.
Putting on a mask takes a few seconds, so compared to all the suffering it might prevent, even at 0.01% probability, it's well worth it.
risks differ with context.
A plausible rule of thumb seems to be: if you could smell someone's cigarette smoke, you could inhale their viruses. I certainly smell smoke from smokers I pass on the street.
but here's some additional intuition:
1. it's true that virus particles are roughly the same size as smoke particles, but infected people exhale virus "pucks" that are agglomerations of multiple viruses and water, leading them to fall while smoke floats (giving us the 3-6 foot rule, per prior coronavirus studies).
2. a single virus particle in the air without water could float around but is overwhelmingly likely to fall apart quickly. the air doesn't provide the countervailing forces to keep it together, and the bombardment of energies from all around also pull it apart.
3. the fact that a homemade mask allows smoke right through but filters out some portion of the virus pucks (as per your prior link) is evidence in itself of the differential affinities of smoke and virus pucks.
but let's face it, most people wearing masks (outside) do it because they think it's protecting them from the filthy other people. however, if you're sick, all you're doing is concentrating the virus pucks in one place right in front of a face we'll each touch 30 times an hour. no lay person consistently observes the contamination rules that hospital personnel do, especially when infection rates are <0.1% and failure to do so has no obvious downsides. masks could in fact be more dangerous because of a false sense of security.
Have you seen any of the photos of the packed subway trains, a week and a half into the lockdown? Seattle doesn't see that sort of thing even in rush hour.
Likewise, if you live in a highrise in New York, you're going to be taking the elevator to go get groceries. Usually with other people...
And, honestly, the US numbers are highly inaccurate as well due to a simply lack of an ability to test (instead of a lack of will to publish the real numbers).
@MarkLevineNYC BREAKING: NYC publishes, for first time, data on fatalities that includes "probable" cases (those without a confirmed test result).
It has pushed the death toll in NYC up by 57%.
Was 6,589 before this adjustment. Now stands at 10,367. This is a painful but necessary accounting.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
https://www.cdc.gov/healthequity/lcod/
At least that is what I could find. I was curious to see if I could find some month to month chart on all deaths for March, February, and January. I could not find one.
New York didn’t think they’d top Wuhan.
That makes me think its sterling example of why we need a county-by-county. Don't just base it on infection levels though, as you pointed out. Include hospital support, ppe levels, interconnectedness, etc.
I don't imagine there will a increased multiplicity of confusing rulesets beyond what we have now, either. Many counties will simply adhere to some standard recommendation from their state, and the rest will copy one of a small number of recommended levels along a spectrum of openness.
I don't see why any "deemed safe" county wouldn't be overrun by visitors from unsafe counties, making the county unsafe again. Maybe you could find a county so remote it wouldn't matter but whether those extremely isolated places are opened up now or not probably doesn't matter either way. I doubt they're much effected by this situation regardless.
Are you thinking of the people who would be willing to drive far distances simply to, for example, go out to eat? I would assume that this analysis would be included. Close proximity to a large population that's on lockdown is, in my opinion, a reason to keep the lockdown in a county, even if that county doesn't yet have many cases. But the next county over might or might not open up. Sure, people near the border from the second county will just go into that third county, and that's fine - as long as there aren't too many people coming from the first county.
Politicians and pundits simplify and say stupid things, when taken literally, but when it really comes down to it no one is really suggesting that the state of affairs within a county be the sole determining factor for the degree and form of economic activity which will be permitted. We have to look at the larger region. But once we look at the larger region, it will probably make perfect sense to completely lift the shutdown in some counties (esp. in Alaska, Montana, Wyoming, etc) while keeping a strong shutdown in other places.
Edit: I assume that we will also be looking at individual industries independently. Can the companies in a certain industry in a certain region reliably commit to following strong anti-COVID practices? If so, we might let them open up, while other industries are not allowed to. We don't have the time to create certification bodies or licensing departments to handle these specifics, so politicians will just have to make the best decisions they can.
> How prepared is our state to test everyone who is symptomatic?
Another view is that opening the economy should involve testing people who are NOT symptomatic.
Quoting from an MIT Technology Review article (https://www.technologyreview.com/2020/04/08/998785/stop-covi...):
> The key, says Romer, is repeatedly testing everyone without symptoms to identify who is infected. (People with symptoms should just be assumed to have covid-19 and treated accordingly.) All those who test positive should isolate themselves; those who test negative can return to work, traveling, and socializing, but they should be tested every two weeks or so.
...
> He calls the $2 trillion legislation passed by Congress “palliative care” for the economy. If you took $100 billion and put it into testing, he says, we would “be far better off.”
Obviously for medical intervention purposes, you need to sometimes test people with symptoms. But for epidemiological and economic ones, it may be more important to test those without. So maybe neither is wrong, just different purposes.
Incidentally, the same article presents a reasonable argument that while keeping the economy shut down causes damage, opening it too early might cause more long-term economic damage than it prevents in the short term. If so, choosing between the economy and saving lives might be a false choice.
Testing people with symptoms is a waste of tests. When tests are in short supply assume everyone with symptoms is positive, isolate them and test their contacts who don't have symptoms. As of last week, Boston Medical Center had a 44% positive rate on the tests they were running on symptomatic people. They could find more positive cases per test by testing people without symptoms.
https://www.medrxiv.org/content/10.1101/2020.03.27.20043968v...
It's not, though. Someone suffering from severe symptoms that aren't COVID-19 may have other treatment options available, and may be placed in hospitals with less strict isolation requirements. In a perfect world we would have isolation beds and supplies for everybody, but that still doesn't get around the fact that treatment for COVID-19 and bacterial pneumonia are two different beasts, and both lead to similar end results.
And someone suffering from severe symptoms has other diagnostic options: a chest X-ray or CT.
If your goal is to find people with coronavirus (and this should be your goal if you want to slow its spread) you'll almost always find more of them by testing people without symptoms.
Together, those two things tell me we should have such a large testing capacity that testing symptomatic people isn't a stretch. (Of course, we might need more reliable tests if their medical situation is shaky, which is the different category of testing capacity.)
We should, but we don't. Group testing dramatically expands the number of people we can test. However group testing collapses at high prevalence. Since we expect people with fever and cough to be more likely COVID+ than the general population prevalence when we can only run a limited number of cases we'll inevitably miss more positives by testing people with symptoms.
Because that's not a safe assumption. Hospitalizations are still going up in areas across the US, even in areas of US that are now on week 4 or 5 of lockdown.
Michigan, for example, is on week 4 and while the growth of the curve is slowing, hospitalizations still continue to rise every single day - https://www.clickondetroit.com/news/michigan/2020/04/13/mich...
I haven't found great info on how well these countries have implemented contact tracing, but they do have per capita testing rates much higher than the US (and vastly higher than California).
Here's an interesting article that describes some of the specific precautions Denmark is taking as they open up some schools tomorrow: https://www.thelocal.dk/20200413/schools-and-day-care-centre...
France is going to release lockdown in a month. My impression is that this is mostly for economical reasons because it was unsustainable. I'm not confident we'll deal with the epidemics much better this time. The gvt still hasn't released their roadmap, but they hope to improve their testing capacity, the availability of masks, and to enable contact tracing using some hypothetical app. There's no silver bullet, but we just hope that it'll work, otherwise we'll have to go into lockdown again (or not if it appears too costly). Our gvt hasn't communicated clearly on the possible outcomes. The president speech was mostly unsatisfying politician rhetoric, trying to avoid the fact that they didn't anticipate the crisis, and that they had no satisfactory solutions.
I highly doubt that will happen. The preferred approach seems to be incremental opening to try and control the transmission rate. There might be one or two very stupid leaders who want to open things up with a bang (cough Trump cough), but the European nations currently easing restrictions seem to being doing so very cautiously.
It seems that France is not much better prepared now that we were before the lockdown (masks/tests/contract tracing apps are still nowhere to be seen at that point).
As for our leaders, they distinguish themselves in their rhetorics and in some symbolic measures, but I have the feeling everyone is following the same path.
Exceptions are some Asian countries who seem to have the epidemics under control). They are the big winners...
Hospitals in California aren't overrun. We were insisted upon that the "flattening the curve" was to prevent the medical system from being overwhelmed. With what we've been able to do, we're not even close to having overrun hospitals. By now, we should have ramped up the system to account for greater numbers of severe cases.
Given that, we should quarantine the vulnerable population and allow the rest of the population to get things back to normal. Otherwise, we'll come out of this with no herd immunity, potentially making the last month a total loss, and creating further loss in the near future.
Covid cases were doubling every 3 days (up to 5).
Would it be correct to say that had we waited another week, hospitals would have been overrun?
If that's the case then I understand why health authorities are cautious.
[1] https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
I have a friend who works at the Kaiser in Oakland in ER, and she says it has been pretty empty right now, relative to a typical flu season.
The data linked shows about half the beds are taken up by COVID-19 patients, and the other half are other cases. They claim to have 77 standard ICU beds, and 300 surge beds available. Of those, 34% of the standard and 94% of the surge beds are unused. So out of 377 total beds, 5% are taken up by COVID-19 patients.
I think it's hard to estimate the doubling rate based on the numbers we have out there. Confirmed cases is a poor proxy for actual cases, since it depends a lot on testing rates, who gets tested, etc. A lot of new data is suggesting that coronavirus spread further we previously though, and that it started spreading in America sooner than we previously though. We don't know the true numbers because they didn't start testing for coronavirus in America until March, and even then it was at a very low rate.
For each 1% increase in unemployment, several thousand people die. Unemployment substantially increases the risk of mortality.
That would mean 200-300k people die from increased unemployment. Terrible.
The new virus’s worst case is more along the lines of 2-3 million, and at that point we’re probably in health care meltdown which would make it much worse than even those staggering numbers.
So yes, we don’t want to shut down the economy for 6 months, but it’s critical that we don’t swerve too far out of control. We can pay people to stay alive. We can’t wave a financial wand and solve the virus.
Mortality rates actually decreased during the Great Depression.
Also, this isn’t a normal “unemployment” situation either — disaster relief isn’t out of the question.
If you filled up 25% of capacity with Covid patients, then you were only 2 doubling cycles (10 days) away from being having completely full hospitals. I don't think a 10 day buffer means that you're not even close to having overrun hospitals.
I found this: http://pandemicbreak.org/
Widespread testing might not be that far off and feedback might not be that delayed.
Edit: Since HN won't let me comment fast enough I figured I'd share the information here.
We were referred to Stanford by our PCP yesterday. We were not members of Stanford Health prior. The process looked like this:
- Video chatted with our PCP yesterday evening, who referred us to Stanford Health.
- Video chatted a few hours later with a physician from Stanford Health who approved the test.
- Scheduled the test for noon the next day
We are not overtly symptomatic for most of the symptoms (at the moment, it has been worse) and have not travelled abroad in a relevant timespan.
[0] https://www.stanforddaily.com/2020/04/04/stanford-researcher...
But like quenching an old school high gain regenerative reciever.. the Pandemic Break doesn't require any feedback!
The ~2week quarantine time exponentially reduces carriers at a faster rate than the ~2 week open time allows them to spread.
The idea is to allow commerce/socialization to be shifted into the open time while keeping the number of infected falling to deal with super-spreading or other events. This way though you could have a wedding and keep your parents... or have a corner store and the old grocer, a bar and a bartender.
You do ask what billionaire funds that website you cite. No contact details usually indicate a Citizens United style slush fund.
In this particular case, the plan is great for personal life but is clearly infeasible economically. You can't just toggle a factory on and off every 2 weeks; it depends on supply chains extending weeks into the past and feeds into chains extending weeks into the future. Any complex business which is turned off in the 2 week breaks isn't going to be sustainable in the other 2 weeks.
Now consider the alternative. You know that you will be open in 2 weeks, you know when you need get parts there, and you know when demand will show up. You can still use some amount of "essential" work at the corners. The point of the two phases is to make sure that things don't blow back up again and to make it obvious to everyone that it's fair.
Then, demand is shifted rather than destroyed and the economy can function at slightly reduced capacity while still keeping the viral contagion controlled (not some crazy let's hope there's herd immunity and let everyone get it, or we'll keep the ICUs full for 18 months and hope the immunity lasts that long).
A new antibody study in LA may give us better numbers: https://www.latimes.com/california/story/2020-04-10/coronavi...
My one hope is that the leaders of these states (CA OR WA) do not follow the “noble lie” strategy adopted by the WHO and others to manipulate the population. Insofar as coercive orders are tolerated at all, they must be accompanied by truthful metrics, believable goalposts, and a practical mindset that doesn’t aim for perfect outcomes.
Positive tests could trigger notifications based on data collected by voluntary contact tracing apps. By only testing the symptomatic, mathematical models will continue to lack data for the subset of population that is already immune.
We also need to test asymptomatic cases that would benefit from therapeutics which work best in early stages. We need to avoid cases reaching late-stage, where e.g. > 80% of people on ventilators do not survive. The federal government has allowed pharmacies to administer tests, once these become available.
> Slide 5: Have we worked with businesses to support physical distancing practices and introduced guidelines to provide health checks when employees or the general public enter the premises?
Is this alternate A/B work days for employees to reduce building occupancy by 50%? Do "health checks" mean forehead or long-distance thermal sensor temperature measurements before employees (customers?) enter buildings?
> Slide 6: Do we have the ability to quickly communicate the need to reinstate these measures?
Existing SMS text messaging for government alerts. No need for dedicated/mandatory apps.
That already exists.
https://khn.org/news/how-do-we-exit-the-shutdown-hire-an-arm...
The roadmap appears to be "we have no idea, so we'll set un-measurable goals and pretend we've hit them, once the collateral damage of economic collapse is unbearably large"
Still, it seems like a properly framed argument like yours would need to start with "They have no plan" and then move on to... a plan.
There are no good plans. At the end of the day we stay home, wait for infection rates to go down, and then spend a ton of money on testing and tracing. The other alternatives are to re-spawn the outbreak or to wait for a vaccine, both of which are even more expensive.
But that plan needs to happen at the federal level, California doesn't have the money.
A peeing section in a pool simply diffuses and doesn't spontaneously generate another high-density peeing section elsewhere in the pool.
We wish Covid-19 would simply diffuse down with distance.
That's not the chlorine alone. The ammonia in the piss combines with the chlorine to create chloramine, which causes the eye burning and respiratory problems associated with pool water. It doesn't even take that much piss in the first place, and once it diffuses in the water, it will affect the whole pool.
I'd say it's an excellent analogy. Whether it's noticeable or not, if one person pisses in the pool, everyone's swimming through their piss.
I'm grasping at straws but maybe you are estranged and your family is on the street but they won't let you into the hobo-hotel?
Every other circumstance I can think of is a Federal issue closing borders for people that aren't Americans.
Just use your head, don't do things that will risk spreading the disease. Taking public transit to/from your family a few times a week is very dangerous. Going someplace and staying there is not.
I live in Iowa, and we keep getting shit on from the national media for not having gone into "official" lockdown.
Everything I've heard / read suggests we're in exactly the same amount of lockdown as anyone else. We just aren't calling it that.
>defines a goal or desired outcome and includes the major steps or milestones needed to reach it.
Yeah its missing some specifics but there are certainly goals stated before the decision to relax the stay at home policy is reached.
This document seems hand-wavy and doesn't answer anything.
Second, if everyone not explicitly at high risk went about their normal business, some percentage of them would still need medical attention and the hospitals would run out of beds, leaving some to die.
Second: That's the nature of nature. If you want, you can protect yourself, stay home!
2. Even if it were a possibility, it's that vs. shutting down peoples lives for a very long time. "Is your life worth my liberty?" - that's something we fundamentally disagree on.
By doing a bunch of the steps implied in the document my chance of surviving is better, by keeping the infection rate in the populace lower so that I'm less likely to get infected and die before the vaccine arrives.
The population of the US is ~300 million. The average lifespan is ~80 years.
We have a growing population, but supposing we had a stable population, that would require a bit more than 3 million people to die each year.
Basically my point is, in a stable situation, that order of people will already be dying yearly.
I don't know what the actual numbers are for the county, but basically since people live less than 100 years, if we had a stable population (which at some point we'll need to return to), then roughly 1% of the population needs to die every year.
Consider an emergency, where someone who wants to shelter needs to go somewhere (say, the hospital, airport, etc), or receive someone at their house (say a doctor, technician, etc). Or consider groceries and other needs that come from the outside but are brought to people sheltering. You want "the outside" to be as clean as possible in those cases too.
Perfect isolation from the outside world isn't possible, but with a general shelter-in-place, there's fewer chances that "the outside" is virulent. Very similar to herd-immunity and vaccines.
Taken like that it becomes more like restrictions on pollution or laws against corporate espionage in how the government shapes the economy already.
Then that's the reality. Again, I don't believe we should be forced to be locked down by the government, let alone some rinky dink local government politician on a power trip. Leave it to the individual.
Where is our leadership when we need it?
a) California’s testing and reporting infrastructure is absolutely abysmal, arguably the worst in the country
b) there are very few signs that it will improve anytime soon
California leaders haven’t had to confront this publicly because much of the last one month had been focused almost exclusively on reducing fatalities and increasing hospital capacity. Testing matters but not that much for the most acute cases.
It matters a lot more in determining the the rate of incline/decline of new infections, both numbers that will increasingly matter more as fatalities and hospitalizations stabilize.
So, unless you believe california results are 10x off, based on empirical results and your assertion that the testing and reporting infrastructure is "the worst", the state of california has at least done a fair job of managing its effort in the face of a limited resource. Knowing in detail what's going on is strictly secondary to reducing deaths.
That said, I do think as new casualties and hospitalizations are on the decline, test reporting and infrastructure matters disproportionately more for the next phase (planning for gradual reopening) and phases after.
A man gets hit by a bus and tests positive for Coronavirus, I don't care what the science has to say about it, that is not a Coronavirus death and you can't change my mind.
Do you have any evidence California is different?
N.Y.C. Death Toll Soars Past 10,000 in Revised Virus Count The city has added more than 3,700 additional people who were presumed to have died of the coronavirus but had never tested positive.
https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...
4% of the patients diagnosed with coronavirus in the US have already died (and many more of the currently diagnosed patients are still sick and have not yet died but will in the future). It's wildly implausible that a meaningful fraction of 4% of that sample could have coincidentally died within a few weeks of getting diagnosed with the coronavirus, but for entirely unrelated reasons. If 4% of the population were dying every few weeks, humanity would be virtually extinct within a few years. Your "stat-padding" theory doesn't pass a basic smell test.
You can construct far-fetched pathological scenarios for how 1 or 2 people might be wrongly identified as coronavirus victims, but you can't explain away 26k deaths with baseless conspiracy theories.
The risk factors for normal causes of death are basically identical to those of covid-19 ( age, vascular disease, cancer, respiratory disease, ect). I think it is reasonable to wonder how many of the people who died from covid-19 were already loosing a battle with pre-existing condition.