This is all fine and good. And I should state that I am on board with the actions (in San Francisco/California) taken so far. However, I'm not unconditionally so.
I get that right now we're buying time. My current understanding is that we're trying to slow the spread of the disease because the existing health care system was going to quickly collapse under the weight; whether or not that should have been the case or not is a discussion for another day. I also understand that we are -not- trying to contain the disease, just "serialize" its progression (so to speak) through the population.
Assuming that understanding is sufficiently correct, what I'm not hearing enough of is what is being done with the time we're buying. Many in the Hacker News audience likes to talk about "externalities" and how the wise appreciates those externalities in their actions. Shutting down the economy has externalities; those externatlities can be life or death as well. If the strategy of those implementing the "shelter in place" is one of just waiting it out: then I'm going to be off the wagon fairly quickly. I want to start hearing strategies that start to address the issues of how we minimize impacts of this problem. I want to know what we're buying for the pain that we're being sold on. I want to know when people estimate that the societal damages of the illness start to be outweighed by the damages of our response.
I see the admin of the site suggesting we're buying time for these things. I want to start hearing this from the officials making policy.
Garcetti, the Mayor of Los Angeles, covered this in his address last night.
We are buying time to get more tests, more hospital beds set up, more ventilators, more medicine. The Navy is talking about turning Aircraft Carriers into hospitals. China is getting things under control and switching factories to produce medical supplies. It takes time to build these logistics chains, and we are buying that time by slowing our economy down and implementing social distancing.
I agree that this information is not well-circulated right now.
Those are linear increases for an exponential disease. The time-buying has to be for something new that battles the exponential: rushing a vaccine, finding an anti-viral, or figuring out how we can actually practice containment. (Testing availability is part of that, but we'd also need a tracking system.)
Thanks for the link. Most involved read I've seen on strategy, but unfortunately for me I'm in the UK, so now I'm significantly more concerned than I was previously.
I will see what my MP has to say about it. Couldn't find a UK petition about it.
The damage of not minimising the spread starts with an overwhelmed medical system, and ends with too many people ill at the same time to keep the lights on and the stores stocked with essentials.
The details of managing the economics are more than a footnote, but if the worst possible peak isn't avoided everything else becomes irrelevant, because there's no surviving economy to speak of - except maybe one of local barter.
The economics are not externalities. The virus is.
The economics are a social and political choice. They don't actually require money or other symbols, although they'll probably be mediated through for reasons of comfort and familiarity.
They require enough basic provision of food and services to keep people alive, and enough provision of shelter to keep people from rioting, especially once winter comes.
The worst possible economic outcome - after a Killer Peak - is a critical mass of angry and hopeless people with nothing to lose.
Realistically, avoiding that will probably mean helicopter money and aggressive price controls to prevent gouging and profiteering. The usual rules about inflation won't apply because the alternative will be a cratering depression and mass deflation which will do far more harm to the economy than hand-outs will.
It may also mean something worse, like some form of civil conscription to get essential work done. I really hope that doesn't happen, not just because it's better to call for volunteers first, but because it's so easy to abuse politically.
But it's also true this has the potential to become the equivalent of a war time situation, and in extremis the rules may need to change to keep food+lights happening.
Shit choices. But it's a shit situation, and IMO there's no chance of business as usual returning for quite some time.
Thank you for this. You make the essential point that others are missing: flattening the curve isn't to buy time; it's to prevent massive loss of life and societal collapse. Buying time to improve prevention and treatment is of secondary concern.
The argument that we should find a balance between saving lives and maintaining a strong economy is reasonable, but seems to have a catch-22 to me. If our economy is truly "strong" it seems it should survive a few months of "social distancing", right?
Perhaps the argument would be better stated: We need to balance saving lives and maintaining the thin veneer that is our economy.
That isn't quite as inspiring, but perhaps that is reality? Even if our economy is a "veneer" we still need it. I find it less compelling though. I'm far more willing to trade lives for a "strong economy" than I am to trade lives for "the illusion of a strong economy".
"Grandma and Grandpa died at home without medical support, but at least our economy is 'strong', so strong it could probably survive weeks of social distancing!"
If our "prize" for sacrificing hundreds of thousands of elderly to an exceptionally uncomfortable death is an economy we all know can't handle even a minor pandemic and is incapable of doing what China and other countries have done, that will be a sad trade.
"Strong" is usually defined in terms of output. And I think we tend to forget that economy is literally people going around their day-to-day things - we tend to forget about that because our abstract models of it are, well, abstract. But if you, say, tell half of your population to not work, that's half of your economy. Not only that, but it's the half that actually produces physical goods. Take a strong man, and paralyze them waist down - are they still strong? Does it mean they weren't strong before?
The more interesting question is how much of our economy is literally waste. I suspect we'll find out.
That's 10s of millions of jobs. Livelihoods ruined.
Maybe your job is safe. Mine too. But you have to put yourself in the shoes of someone who is being financially ruined, and whose life expectancy will likely be greatly diminished as a result.
People not having jobs means they could end up homeless and vulnerable. Hard to practice social distancing in a homeless shelter and get access to adequate nutrition, especially if they become overpopulated, and there could be a huge amount of deaths as a result as well. Is the government going to suddenly pay everyone's rent that loses a job? $1000 checks won't pay rent in many part of the country.
It's interesting contrast to read Krugman's piece in the nytimes just yesterday.
He ignores the "economy", he says that layoffs are necessary, which is to basically suggest that the economy will adapt.
And everywhere you have internet commenters "But what about the economy?" and citing serious consequences of recession/depression in order to criticize isolation/quarantine/lockdown.
My understanding is that it is necessary to slow the progression to “flatten the curve” below hospital capacity, and that extra time for building increased hospital capacity is a nice side effect but not the primary goal. Basically, when more people get sick than the hospitals can take in, the mortality rate skyrockets, which is why Italy has more reported deaths than China right now.
Edit: Here’s the old paper from 2007 the CDC is using to inform some of the policy around “flattening the curve” below hospital capacity.
https://stacks.cdc.gov/view/cdc/11425
But after the three month delay, you’ll have the same exponential growth, if life goes back to usual. It’s even present in these plots, at the right hand side (see California). It’s unfortunate the plots aren’t extended more to show longer term trends.
Universal mask wearing combined with unlimited testing is the quickest way to get the economy restarted. We need to ramp up both. And of course more ppe for medical workers. We don't need a ton of ventilators. Without skilled medics ventilators by themselves are not useful.
It is terrifying how fast reasonable people have jumped on board with China-level lockdown policies that will decimate life-as-we-know-it after they end.
I've been reading every whitepaper and journal publication I can find on this disease.
The picture that I'm seeing is that this disease is both more infectious (higher R0) and less deadly than previously thought.
In light of those facts I am fairly convinced the lockdowns and resulting economic impacts will be worse than just isolating the most vulnerable and letting the rest of the population go about their business.
The fatality rate so far only applies as long as the health care system isn't overwhelmed though. Plenty of non-elderly are affected severely enough to need ICU care, and they will start showing up as fatalities once there aren't any free spots any more. Washington State is almost at this point and is preparing triaging procedures.
I'm astonished how many people think that they know better how to respond than the professional epidemiologists. If anything the response actually enacted is tempered from what they recommend by the politicians.
Being one of those reasonable people who has not fallen for the complete lockdown argument, I feel that the ball is rolling and no argument can reduce the measures right now.
In Denmark there are 42 people requiring ICU care and 13 deaths. Just two years ago more than 1.600 died due to the common flu, but that hardly got any coverage nor any of the counter-measures being employed right now.
If I should find some positive in this over-response, that would be the benefit for the environment due to less pollution.
If we could reduce emissions to the current level, the climate would be so much better for it.
I mostly agree with your underlying assumptions but I'm still advocating for a different course of action.
The problem with this disease is that while many people don't die, they require intensive care. As we can see in Italy currently this will overwhelm hospitals at some point (and Italy has already put drastic measures into place). At that point it becomes a huge problem for society: a lot of people are dying and the health system doesn't work anymore. People die because of appendicitis etc.
Did you read the Imperial College paper that starts the whole thing? That paper acknowledges multiple different strategy (with full lockdown being one of them) and details what the long term strategy could be.
The thing about exponential growth is that it is slow growing (relatively) in the beginning. This means if we cycled between lockdown and business as usual we can keep things contained quite easily. Not sure what would be most efficient, but something like 1 week lockdown every 2 or 3 weeks would keep the spread minimal until a long-term solution is found.
Obviously travel etc. gum up this plan but instead of containment or mitigation we can move to a "time gapped reset" policy that predicts a continuous growth/halt cycle for the virus instead of pointlessly trying to eradicate it completely.
> I want to know when people estimate that the societal damages of the illness start to be outweighed by the damages of our response.
Loss of life to the inner vs loss of life caused by economic consequences, I've seen that argument before and it's not entirely unappealing. But wherever I saw it there was the unspoken assumption that the economy would just continue completely unaffected by an uncontrolled epidemic. But much of the economic damage will be there no matter which path you take. There are likely same areas where a short, hard wave would even be worse, economically, than a controlled lockdown. The delta is even harder to estimate than the cost of slowdown strategies, but an argument that only looks at the economic cost of one option is flawed.
Personally, given the choice, I'd take option C, "show me a rerun of 2019". Unfortunately this isn't in the cards that we are dealt.
> Shutting down the economy has externalities; those externatlities can be life or death as well. If the strategy of those implementing the "shelter in place" is one of just waiting it out: then I'm going to be off the wagon fairly quickly.
I think the problem with this very common attitude is the demand for immediate answers, or else. It's an ultimatum.
We don't expect programmers and engineers to come up with complete, ready-to-commit solutions to a complex problem immediately. Thinking like a consumer doesn't help. An alternative is to demand transparency and to be engaged in the process of decision making. But that requires an attitude/intellectual realignment.
I don't think a complete solution is expected. An incomplete but scaffolded solution would be very well received. A clear statement that we expect infections to level off by date X and we can relax restrictions after condition Y would be very nice - especially since people could start making Y happen as fast as possible.
What's concerning about the current messaging is that it's not clear whether it's incorporated the underlying limits to how long people will tolerate a lockdown. An ultimatum is the right framing; decisionmakers need to know, and we need to know they know, that "then we'll lock down for 6 months" is not part of the solution space.
The thing about exponential growth is that it is slow growing (relatively) in the beginning. This means if we cycled between lockdown and business as usual we can keep things contained quite easily. Not sure what would be most efficient, but something like 1 week lockdown every 2 or 3 weeks would keep the spread minimal until a long-term solution is found. Obviously travel etc. gum up this plan but instead of containment or mitigation we can move to "time gap" reset policy that predicts continous growth/halt of the virus instead of pointlessly trying to eradicate it.
The Imperial report suggested this exact thing, but by their estimations, we'd still need to have lockdown in effect about 2/3 of the total time to prevent healthcare systems from getting overwhelmed in US and UK.
> Assuming that understanding is sufficiently correct, what I'm not hearing enough of is what is being done with the time we're buying.
This was along the lines of my first thoughts as well. Theoretically, we want to maximize the usage of our medical resources (personnel, reusable supplies such as bed space, non-reusable supplies such as medication that become available at a variable rate), to keep just enough below the capacity to handle the needs and allow for some spikes (if we can even get it that low).
To my eyes, that calls for the ability to reassess and shift directives for the public (that is, maybe ease up on shelter-in-place next week, but put it back the week after), track and optimize resource flow, and coordination between locales. As a national level emergency, it makes sense there would be national level coordination on how to deal with it. Instead it appears we have governors and mayors making their own calls on what to do based on what advice they are personally getting, and the health care system is just struggling to figure out what to do.
What we don't have is any leadership putting forth an actual plan, or any real indication that they are even attempting to do so, or that if they are that they're putting any real teeth behind making sure officials are on board.
I wonder the same thing. A lockdown cannot be done in perpetuity and I think even 90 days would be too long. So the best bet is a lockdown while we ramp up the healthcare system to deal with the outbreak as best as possible. At some point we will have to go back to some semblance of normal life as the economy and people’s personal finances can’t continue to lockdown. Unfortunately we don’t seem to ramping up the healthcare system enough during this lockdown period.
And no the vaccine is still too far in the future so the idea that the lockdown is biding time until the vaccine is ready is ridiculous.
Well said. Nobody seems to know what is being done with the time we're 'buying'. I get the feeling everyone just thinks if we sit at home for a month (or two? or three!?!), it will just magically go away. This site even admits "A second spike in disease may occur after social distancing is stopped". It's very possible that sitting at home will just delay the acceleration phase, and it will rear it's ugly head after we come out of out caves.
Why have we all (I'm speaking for people in the USA) immediately bought into the idea that shutting down out lives and the economy is the only way to combat this thing? South Korea didn't shut everything down in an authoritarian fashion, and they already have this thing beat. I know, not a fair comparison, USA is way bigger, less experienced in handling disease outbreaks, different governments, etc, etc. But aren't there smarter ways we can handle this than just blanket isolation & lock downs?
From the CDC:
"Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic."
So we know from South Korea's example it is possible to hit acceleration phase, execute a smart plan of attack, and have it carry you into deceleration, without blanket lock downs. Lock downs can still be an effective tool, and should be used in areas seeing steep acceleration to take pressure off the medical system.
Our plan doesn't have to be exactly the same, but we can learn from theirs. Seems like nobody is even trying to think out of the box. We just accepted that we have to turn our country into an authoritarian state and that's the only way to beat this.
Focusing on making testing widely and easily accessible is key for sure. If people could easily get a test, it would eliminate a lot of the fear/ uncertainly that is gripping everyone. Healthy people who are at low risk to get severe reactions could go about there lives normally, while still practicing 'social distancing' in public, not locked away in their homes in fear
>I know, not a fair comparison, USA is way bigger, less experienced in handling disease outbreaks, different governments, etc, etc. But aren't there smarter ways we can handle this than just blanket isolation & lock downs?
Not if you don't have as advanced infrastructure, quick government, and decisive politicians like Korea, and 1/4th of the country is in third world conditions regarding access to healthcare, or even shelter, etc.
> Health people who are at low risk to get severe reactions could go about there lives normally, while still practicing 'social distancing' in public, not locked away in their homes in fear
You don't need tests for that, just common sense. If you have low risk, by all means keep working while keeping high sanitary precautions. It's unrealistic to expect all people to stay at home, hence those of us who are likely to get a mild COVID-19 case should make sure the people at risk or already sick have services while they stay at home.
If you're healthy, take precautions and still get COVID-19, after recovering you become another line of defense with your new immunity.
That being said, tests are very important, but don't wait for free and widely available tests to decide if you can keep working, your circumstances decide that.
> Nobody seems to know what is being done with the time we're 'buying'.
You're allowing people to get infected, but reducing the rate at which they get infected, thus allowing your healthcare system to cope with the demand while the rest of society slowly builds immunity.
Basically we need a timeout to recover from and reassess a month of negligent inaction. The time to institute a "smart plan of attack" relying on easy testing/public temperature checks/physical distancing was three weeks ago, when we still had headroom to weather the results.
Notice that the CA style shelter in place has an uptick at the end. Once you let people out it starts right where it left off. My assumption is that this thing is not going to be eradicated and is highly contagious, so the only way it will stop is once there are enough people vaccinated or previously infected so the exponential decays. Under those assumptions, slowing it serves two purposes. One is to prevent deaths due to overwhelmed treatment facilities. The other is to prevent it from just hitting everyone. Maybe only 20-60 percent of the population needs immunity to stop it, but if it runs rampant we could overshoot that. I'm sure there are other reasons to slow it, and other models, other assumptions, etc...
* Build out a testing infrastructure that allows for targeted containment, rapid response, and chain-of-infection tracing without needing a full lockdown
If you do nothing, and an antiviral comes along in a month (which can stop severe disease), then you have effectively killed a lot of people unnecessarily. An affective antiviral is looking more and more likely, and unlike other approaches, can be scaled rapidly.
Apart from developing drugs, vaccines, and expanding hospitals, the time could allow us to produce enough tests to detect infected people before they are contagious. Perhaps even earlier, we could test all the contacts of people who were detected after they were already contagious.
With enough testing and sufficient frequency of testing, isolating just the people who test positive (and perhaps their contacts) should be enough to stop exponential growth, which means we could mostly return to normal life.
Agreed. Politicians just shutting things down without a plan for what we do in this time is unacceptable. A vaccine won’t be safely available for a year. Shutting down that long will destroy everything.
I liken it to the immune system. Shutting things down can work for a short period but if the system goes into a full panic it begins attacking good cells and shutting down organs and the host dies a slow, painful death.
We need to be using this bought time to building medical equipment, beds and places to put them, manufacturing existing therapies to help, training people to use specific equipment, creating a system for the most vulnerable to quarantine but get food, medicine, safely as they wait for acceptable safety to them.
We can’t lock down for months and months. People will eventually be fed up, see their risk is low, and throw the dice. The economy can’t grind to halt for a long time.
We need to prepare to minimize death and we need to do it now. Lockdown is not much of a strategy or something that will work beyond a few weeks before people ignore it massively.
We are trading economic output in exchange for lowering the transmission rate of the disease. By lowering the transmission rate, we are lowering the peak use of medical resources, lowering the loss of life. Your second paragraph acknowledges this, and I think pretty much everyone is on the same page here at this point.
But the question in your third paragraph "what is being done with the time we're buying" could be restated as "what are we getting for our loss in economic output _in terms of economic output_?' That's not what we are doing, we are giving up economic output, not getting it. Of course any schemes/inventions/techniques that increase the coefficient of return of this trade off would be welcome, but doesn't change the fundamental direction of the tradeoff.
And that's not to say we are doing nothing at all with that time. Maybe we have "more time to develop a vaccine", or "time to make ventillators."? But those _are_ economic outputs. Those actions trade back lives (via increased transmission rates) for production of utilities that we believe will save lives in an equation that nets a positive. And it's not to say that people won't do some productive things during this (like the memes of inventing calculus in isolation or whatever), but for sure society is reducing it's overall economic output.
So from this point on the questions (and threats of defection) you raise kinda presuppose that trading economic production for saving lives is not worth it (at whatever ratio you're expecting). Potentially this is because you expect higher economic costs/lower life savings than the generally accepted projections, or because you value life less, or you believe the economic loss will lead to greater loss of life long term. I think the burden then is on you to either produce better projections, or promote candidates into government/leadership positions that share your moral outlook, or formulate and promulgate a model that shows the dramatic effects you expect due to the economic loss.
To put it another way, a simplified answer to 'what are we doing with the time' could be 'approximately nothing', and our society at large seems to be on board with that trade. If you're not, change my/our mind.
>I also understand that we are -not- trying to contain the disease, just "serialize" its progression (so to speak) through the population.
That's not true. Even with massively ramped up hospital capacity, we'd still have to spread it out over years to support the whole population getting sick. And realistically, if you can keep the disease progression spread out over a long period of time, it means you've stopped the exponential growth (i.e. R0 <= 1), and it isn't that much harder to actually contain it.
What we want to do is to contain it using blanket measures until we can get our act together with large scale testing, contact tracing, and basic sanitation measures (e.g. general mask wearing, hand-washing, and social distancing by the public without needing to lock everything down). This was where China got to after an early lockdown, and it's where South Korea has always been (without the need for a massive lockdown in the first place). Then in a year hopefully the disease can be stopped altogether with mass vaccination.
There's even more, though. It gives us an opportunity to replenish masks, hand sanitizers, tests, and other supplies we have an immediate need for. Once this plateaus and stockpiles replenish, we can take some small steps to normalcy.
Medium term, we can more properly organize and distribute medical resources, assemble temporary hospitals, learn more about current anti-virals to better manage it, etc. Allowing even more steps towards normalcy.
The vaccine is immensely important, but there are major steps before then that we don't have to be completely locked down waiting for.
Here is what I wrote to my governor and local newspaper. Feel free to adapt and forward if anyone agrees:
Universal Mask Wearing Is the Quickest Way to Restart the California Economy
We urgently need universal mask wearing to slow down the spread of COVID-19 and restore our economy.
This is CDC's advice on how healthcare providers can protect themselves if they suspect that a patient has COVID-19:
" Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed." (What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-pat...)
If a facemask on a patient can protect the doctor in close proximity, it surely can also protect the general public. Yet the message from our nation's leadership is that mask wearing is ineffective for the general public (Why Telling People They Don’t Need Masks Backfired https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...). Yes, it is not 100% effective in protecting an individual from others, but it is absolutely effective in protecting the general public from a potential patient. This is the herd immunity we can quickly achieve without waiting for a vaccine:
"An 80% compliance rate essentially eliminated the influenza outbreak. " (Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak https://www.ncbi.nlm.nih.gov/pubmed/30229968)
California is in a unique place to lead the nation and restore its own economy. We have a large Asian population that are receptive to mask wearing but are wary of being singled out. We have technology companies that can come up with solutions for mask making. We have idled workers that can be quickly retrained to jumpstart mask manufacturing. China was able to ramp up production 12 times in February alone. We can do it too.
What we need to do is to legally require people to wear masks in public and in the workplace to protect each other. We don't need to wear N95 respirators that are hard to use and that should rightly be reserved for medical workers; we can wear masks that are much more breathable to protect others from our own droplets. By making it a legal requirement, companies like Tesla will be motivated to either quickly secure masks from suppliers or, better yet, start making and supplying masks for their own employees and for the public. Asian countries have shown that universal mask wearing can prevent large outbreaks and slow down the spread of the disease without shutting down their economy. Let's learn from their experience. Governor Newsom should immediately work on this with the state legislature in order to lead us to a speedy recovery.
I always took "Telling People They Don’t Need Masks" as there is about to be an immense shortage so known infected and medical staff should be prioritized. If everyone tried to start wearing masks a month ago we wouldn't have /any/ left and we'd probably see a lot more desperate acts around getting them. Not to mention the average person not wearing it properly and not getting proper protection.
Right now there's a huge shortage and we still have a very small number of cases--it's all people stockpiling and using them where it's not as critical.
Like you say, after we can replenish the supply I'm sure it will be more commonplace.
Simple DIY masks may be an effecive stop-gap measure until professional masks become available again in sufficient numbers [0]. Fully agree that official & media messaging with respect to masks is quite misleading, of course they work.
The UK chief scientist, Patrick Vallance, has stated that they suspect a winter resurgence is possible, thus I also question the value of waiting and flattening curves. World governments should clarify this matter by saying that a bad winter resurgence, months after nations are fatigued with lockdown, is definitely not going to happen.
But right now no government dares suggest any vision past a few months.
>The UK chief scientist, Patrick Vallance, has stated that they suspect a winter resurgence is possible, thus I also question the value of waiting and flattening curves.
By winter we'd have more equipment, masks, drugs tested, doctors taking a break, etc. The big spread also stops in warmer climate.
>World governments should clarify this matter by saying that a bad winter resurgence, months after nations are fatigued with lockdown, is definitely not going to happen.
Of course it's possible and very likely to happen. The answer is not no lockdown, it's a second lockdown then as the need arises.
This site openly admits the obvious flaws in their model:
- R0s for interventions are guesses, in some cases informed by data. There is no historical precedent for what is going on right now to draw from.
- The default R0 used in this model is an average. The model does not adjust for the population density, culturally-determined interaction frequency and closeness, humidity, temperature, etc in calculating R0.
- This is not a node-based analysis, and thus assumes everyone spreads the disease at the same rate. In practice, there are some folks who are “super-spreaders,” and others who are almost isolated. Interventions should be targeted primarily at those most likely to spread the disease.
Are there any epidemiologists using less naive statistical models who are producing easily readable results like this? The "average R0" logistic function model seems better suited for examining historical epidemics than estimating risk to inform decision-making for ongoing epidemics.
That's generally what you should do with a scientific model: state your assumptions and methodology clearly.
And most if not all scientific and engineering models spread properties across a group of objects and use averages. R_0 is an average. And it's the average behavior that matters here
In a well tested population, you might be able to focus interventions on infected people and their contacts. In the US population, the people most likely to spread the disease are those who interact most with other people. That means getting those people to reduce their interaction rate.
It's a semi-empirical model, as are many if not most models used to make decisions.
I agree. The graphs are very pretty but would look very different if the R0 was even slightly modified. The mortality rates probably varies widely by state demographics as well.
That said, the implication that strict isolation should be maintained is almost certainly correct.
Hey guys - owner of the model in question here. Thanks for your feedback, and yes, the model isn't perfect. Idea is just to give some forward-looking picture for policy-makers to use to make decision.
Interestingly, the model is not nearly as sensitive to R-values as you would think, until they get under 1.5 (half the current observed number in most places).
I still feel there is compelling evidence that lung damage from things such as exposure to local pollution is a big driver in serious cases.
I say this as someone that thinks they had it a month ago. I was on steroids for a week, then a respirator, then steroids for another week. Worst asthma attack of my adult life. I live in Seattle... (And yes, i had fevers)
I did not get tested, but having a hard time shaking that I had it. And if I did, so has my family. With my kids all having fevers, but no shortness of breath.
Edit: I hasten to add that I am socializing this as a call for what am I missing? I am not encouraging inaction.
Yeah this point has been bugging me for a while now. What’s the reinfection rate / immunity rate? I know there are some reinfections but does that mean everyone can be reinfected or is it just a fraction that don’t gain immunity?
There is also the question of why is it so severe in places? And could it get that severe elsewhere?
Studies of SARS showed that regions with high pollution were significantly more at risk for death from it. If that is the case for this, the severity expected in many parts of the world will be considerably lower than projected.
Again, stay home. I am not encouraging breaking self distancing. The panic message is worrying me because everyone seems to only be looking for reasons to panic.
I catch a cold once or twice each year. This year was different as we have a son in daycare, so we've been sick about once a month. In January we all went through a very weird flu. Bowel issues, followed by very dry and sore throat with a mild dry cough that lasted for just under two days, followed by what felt like a normal flu for another day and then came the respiratory issues, for me. I never before in my life had considered going to the ER for a flu, but that one felt different. I had trouble taking deep breaths. The discomfort lasted for several days and I felt slightly exhausted, but still roughly 80% normal. After a couple of days of that I asked my wife if I should consult. We chose not to and I took a few days off and everything went back to normal. All in all, I must have been "sick" for about 8-9 days. (EDIT: I am male, under 30.)
The symptoms as a whole didn't quite feel like a flu, we all thought they were weird, but hey who am I to know, right?
Well a few weeks later we remembered that two days prior to feeling ill, we had ordered some Chinese takeout. The delivery man (not a Chinese national) looked like he was going to collapse. He had trouble getting up the stairs, had a bad cough, looked like he had a fever - god knows why he was working. After taking the food and paying, I wondered if he'd make it back down the stairs but forgot about it for a few weeks.
We probably won't know if we had this bug or not, but it's definitely possible. Maybe I just happened to develop a respiratory distress caused by a bad flu right when the epidemic in China was not controlled, and not any other year prior. Who knows!
I don't get it, because these measures can't last forever. Let's pretend USA completely extreme isolates...step foot outside and you get arrested. Fine, the virus disappears in a month or two. Then what? Unless every single person on the globe does the same thing, you have to effectively keep your borders closed forever. This isn't a solvable problem at the state or national level, it's a completely global thing. We can attempt to slow it, but it's just gonna rear its ugly head again when we let our guard down.
These actions are for the ~5-10% of people who get this bug and who require intensive care in order to survive. The death rate is pretty low even for those who end up with severe symptoms if the full weight of modern medical technology and care can be applied to their recovery.
Right now, as I type this, many hospitals in the United States have had all of their excess intensive care capacity used up by Covid-19 cases. Not all, but many.
Once large groups of hospitals reach capacity, then there will be no choice but to black tag people who could otherwise be saved and leave them to die in the hallways.
You're right to note that this is a global problem. Given that, the vast majority of human to human contact is NOT cross border.
This bug is probably going to end up infecting most of the people in the United States. The main thing we can do at this point is to keep hospitals from being too overwhelmed, to keep the number of black tagged people, dying in the hallways, to a minimum.
> This bug is probably going to end up infecting most of the people in the United States.
Exactly. As you say, we need to flatten the curve to keep hospitals from becoming overwhelmed, and we need to use the time to develop treatments to save the vulnerable when isolation eventually fails.
> Right now, as I type this, many hospitals in the United States have had all of their excess intensive care capacity used up by Covid-19 cases. Not all, but many.
Do you happen to have a source for this? I haven't heard much about hospital problems yet.
The measure's are to get a hold on the explosive number of cases. Once we get a grip on it, then you keep it contained with aggressive testing + targeted isolation.
You don't need to keep your borders closed forever. You can allow outbound flights without restrictions and make everyone on inbound flights go to a centralized quarantine facility for 2 or 3 weeks + test them.
What about cargo? Better yet illegal cargo we can't seem to get a grasp on. Or illegal border crossings? It only takes a single thing/person to kick off a chain reaction that gets us back to here.
Hey - owner of the model in question here. The idea here is to buy time; time to roll out testing (so only those that test positive need to isolate), prepare beds and ventilators, and develop therapeutics (vaccines are likely quite a bit farther off).
The frustrating challenge to this is how long symptoms take to appear. Isolation will stop the spread from the individual but only after the virus has been spread around quite a bit already. So, sure, much of what you said about localized preparedness will need to happen but we won’t be able to do the kinds of things we did with diseases like Ebola to limit its spread.
The goal is to delay and fit into the number of bed and the logistic stuff in hospital.
If a person get good care in hospital the rate of survival would be totally different.
For those country which had sudden high fatality rate was because their resources and supplies were exhausted - there were no bed, no consumable, even no protection for the nurses.
The non-forever outcome is a vaccine. Covid-19 becomes endemic, always around, restrained by a vaccinated herd. It becomes like measles, small outbreaks here and there when sufficiently many unvaccinated come in contact.
The projections are ignoring a very important datapoint - there is significant evidence that COVID-19 does not have a positive R0 in warm climates. This means that in many areas, there is no need to flatten the curve - it will flatten naturally in the next month or two. On the contrary, by aggressively shutting down the spread now, we are leaving ourselves more vulnerable to winter outbreak which will be hard to stop.
Now the really terrible part is that the economic effect of the mass closure is going to grow exponentially. So layoffs start small and grow more massive week by week. And unlike COVID-19, that economic effect will not subside with the warming weather...
Here is some evidence:
Compare the slow growth in cases per day (green line) in CA and FL (warm) vs NY and WA (cold):
See for example how in Malaysia there was an outbreak due to a very large Muslim gathering with foreign travelers, that seems to diminish every day (indicated an R factor < 1) - https://www.worldometers.info/coronavirus/country/malaysia/ The same is true for Qatar.
Maybe I don't understand. The number of confirmed cases is going up exponentially in all of the warm locations you mention. This is in spite of a lack of testing. How is that evidence of R < 1?
What we are seeing is that the warmer the place, the slower the growth, with tropical or very warm places (Malaysia, Singapore, Taiwan, India, etc.) showing an R0 < 1
The point is that places like California will experience slow growth which will also decline quickly with the warming weather, not that every place has negative growth right now.
Is there any evidence beyond the layperson analysis you are submitting here in this comment?
My critique of this analysis is that there is no way you are controlling for all of the factors: different starting dates for community spread, uneven testing / reporting of cases, random luck due to super-spreading events, differences in behaviors between regions, and so on.
How can you reliably use confirmed cases to suggest a trend given the disparity between states in test availability, population density, and timeline of introduction?
We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed cases. And exponentially growing function will make it negligible.
We are looking just at the trend. And the testing methodology that different states take is just a multiplicative constant of the confirmed test. And exponentially growing function will make it negligible.
Consider that the evidence you are presenting does not show the actual influence of temperature on the virus itself. I would argue (anecdotally) that warmer climates mean people are less confined in general, therefore adding some element of "natural" social distancing.
Annoyingly, I would think it could proxy details that are reverse correlated. Colder means more gloves and fiddling with more clothes that cover the face, as an example.
Which is to say, I accept it is complicated. If it correlates with something, that is just another question. Not likely an answer in itself.
Brazil is not seeing any slowdown due to high temperatures. Looking at your cities on very different climates, temperature seems to not be a factor at all.
Sheltering in place would be less necessary if everyone would stay at least 2 meters apart, wear masks, wear gloves, not talk unnecessarily or cough/sneeze at anyone, and wash up with soap when they get home. Some people seem unable to stay away and feel compelled to get in your face and talk.
This is missing a HUGE point. At the very end of the California "shelter-in-place" plan, the numbers will go up. What it doesn't show is that this will merely delay the epidemic to 3 months in the future. The chart useless with only a 3 month time horizon.
Keep reading. This footnote is attached to the California-style scenario:
> * A second spike in disease may occur after social distancing is stopped. Interventions are important because they buy time to create surge capacity in hospitals and develop therapeutic drugs that may have potential to lower hospitalization and fatality rates from COVID-19. See full scenario definitions here.
Korea could test their way out of it, because they started early enough to contain it. US is past that point now - the scale of testing that we need to catch all the heretofore undetected cases is much bigger. And we need to find those cases to switch from blanket measures to targeted ones.
In the end, that's likely what we'll have to do anyway. But it'll take longer than 3 months.
I guess the operative detail is whether shelter-in-place will get us to a "23%" total infection rate vs 70%.
I wonder if that's accurate. I also wonder if this is recurring in the fall, and every year, and whether physical distancing will be mandatory every year?
How many recurrent seasons would it take for countries/society to adapt and cope (whether that's hugely more full-time remote workers, or blanket acceptability of it part-time/during such occasions, or something else) I wonder?
If you expect it to spread at the rate this thing spreads, after a couple of years nearly everyone will have been exposed to it and thus have developed an immunity (or died). From then on it mostly becomes a childhood disease, like measles. The goal thus becomes to spread out the exposures enough so that people who need medical help to survive their exposure can reliably get it.
Of course the above assumes that immunity really does develop after one exposure, and that the virus doesn't mutate into some sufficiently different form to reset the immunity counter to zero again. The evidence seems to indicate positive things on the immunity front, but it's still preliminary. And as for mutation, who can say?
Just one I think. People are already coping, and it's barely started. If people knew a 3 month shelter-in-place was a yearly rule, we could plan for it.
Readit News
I get that right now we're buying time. My current understanding is that we're trying to slow the spread of the disease because the existing health care system was going to quickly collapse under the weight; whether or not that should have been the case or not is a discussion for another day. I also understand that we are -not- trying to contain the disease, just "serialize" its progression (so to speak) through the population.
Assuming that understanding is sufficiently correct, what I'm not hearing enough of is what is being done with the time we're buying. Many in the Hacker News audience likes to talk about "externalities" and how the wise appreciates those externalities in their actions. Shutting down the economy has externalities; those externatlities can be life or death as well. If the strategy of those implementing the "shelter in place" is one of just waiting it out: then I'm going to be off the wagon fairly quickly. I want to start hearing strategies that start to address the issues of how we minimize impacts of this problem. I want to know what we're buying for the pain that we're being sold on. I want to know when people estimate that the societal damages of the illness start to be outweighed by the damages of our response.
I see the admin of the site suggesting we're buying time for these things. I want to start hearing this from the officials making policy.
We are buying time to get more tests, more hospital beds set up, more ventilators, more medicine. The Navy is talking about turning Aircraft Carriers into hospitals. China is getting things under control and switching factories to produce medical supplies. It takes time to build these logistics chains, and we are buying that time by slowing our economy down and implementing social distancing.
I agree that this information is not well-circulated right now.
EDIT: another commenter posted this great link which I will also share: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...
Giving up and attempting to resume normal activity is also unacceptable, full stop.
The best/latest explanation I've seen is https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th.... Please read it (everyone, not just parent) if you haven't already.
Then if you're frustrated that your political leaders aren't moving to make best use of your sacrifice... let them know!
I will see what my MP has to say about it. Couldn't find a UK petition about it.
The details of managing the economics are more than a footnote, but if the worst possible peak isn't avoided everything else becomes irrelevant, because there's no surviving economy to speak of - except maybe one of local barter.
The economics are not externalities. The virus is.
The economics are a social and political choice. They don't actually require money or other symbols, although they'll probably be mediated through for reasons of comfort and familiarity.
They require enough basic provision of food and services to keep people alive, and enough provision of shelter to keep people from rioting, especially once winter comes.
The worst possible economic outcome - after a Killer Peak - is a critical mass of angry and hopeless people with nothing to lose.
Realistically, avoiding that will probably mean helicopter money and aggressive price controls to prevent gouging and profiteering. The usual rules about inflation won't apply because the alternative will be a cratering depression and mass deflation which will do far more harm to the economy than hand-outs will.
It may also mean something worse, like some form of civil conscription to get essential work done. I really hope that doesn't happen, not just because it's better to call for volunteers first, but because it's so easy to abuse politically.
But it's also true this has the potential to become the equivalent of a war time situation, and in extremis the rules may need to change to keep food+lights happening.
Shit choices. But it's a shit situation, and IMO there's no chance of business as usual returning for quite some time.
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Perhaps the argument would be better stated: We need to balance saving lives and maintaining the thin veneer that is our economy.
That isn't quite as inspiring, but perhaps that is reality? Even if our economy is a "veneer" we still need it. I find it less compelling though. I'm far more willing to trade lives for a "strong economy" than I am to trade lives for "the illusion of a strong economy".
"Grandma and Grandpa died at home without medical support, but at least our economy is 'strong', so strong it could probably survive weeks of social distancing!"
If our "prize" for sacrificing hundreds of thousands of elderly to an exceptionally uncomfortable death is an economy we all know can't handle even a minor pandemic and is incapable of doing what China and other countries have done, that will be a sad trade.
The more interesting question is how much of our economy is literally waste. I suspect we'll find out.
Airlines, Bars, Restaurants, Hotels, Cruises, Conferences, Taxies, Hair Salons, Chiropractors, dozens more...
That's 10s of millions of jobs. Livelihoods ruined.
Maybe your job is safe. Mine too. But you have to put yourself in the shoes of someone who is being financially ruined, and whose life expectancy will likely be greatly diminished as a result.
There are major tradeoffs here.
He ignores the "economy", he says that layoffs are necessary, which is to basically suggest that the economy will adapt.
And everywhere you have internet commenters "But what about the economy?" and citing serious consequences of recession/depression in order to criticize isolation/quarantine/lockdown.
Edit: Here’s the old paper from 2007 the CDC is using to inform some of the policy around “flattening the curve” below hospital capacity. https://stacks.cdc.gov/view/cdc/11425
I've been reading every whitepaper and journal publication I can find on this disease.
The picture that I'm seeing is that this disease is both more infectious (higher R0) and less deadly than previously thought.
In light of those facts I am fairly convinced the lockdowns and resulting economic impacts will be worse than just isolating the most vulnerable and letting the rest of the population go about their business.
https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v... (Suggests the R0 is much higher and IFR much lower than reported)
https://www.epicentro.iss.it/coronavirus/bollettino/Report-C... (shows that the people dying are very old and very sick already. Also given the fact that part of the population is so impacted strongly suggests the disease is much more widespread)
Also, all of the celebrities, politicians and athletes that are testing positive are proof, in my opinion, of how wide this has gone.
I'm astonished how many people think that they know better how to respond than the professional epidemiologists. If anything the response actually enacted is tempered from what they recommend by the politicians.
If I should find some positive in this over-response, that would be the benefit for the environment due to less pollution. If we could reduce emissions to the current level, the climate would be so much better for it.
The problem with this disease is that while many people don't die, they require intensive care. As we can see in Italy currently this will overwhelm hospitals at some point (and Italy has already put drastic measures into place). At that point it becomes a huge problem for society: a lot of people are dying and the health system doesn't work anymore. People die because of appendicitis etc.
We will all catch this unless we stay locked up until the vaccine comes.
So, expect everyone to catch it.
Obviously travel etc. gum up this plan but instead of containment or mitigation we can move to a "time gapped reset" policy that predicts a continuous growth/halt cycle for the virus instead of pointlessly trying to eradicate it completely.
Loss of life to the inner vs loss of life caused by economic consequences, I've seen that argument before and it's not entirely unappealing. But wherever I saw it there was the unspoken assumption that the economy would just continue completely unaffected by an uncontrolled epidemic. But much of the economic damage will be there no matter which path you take. There are likely same areas where a short, hard wave would even be worse, economically, than a controlled lockdown. The delta is even harder to estimate than the cost of slowdown strategies, but an argument that only looks at the economic cost of one option is flawed.
Personally, given the choice, I'd take option C, "show me a rerun of 2019". Unfortunately this isn't in the cards that we are dealt.
I think the problem with this very common attitude is the demand for immediate answers, or else. It's an ultimatum.
We don't expect programmers and engineers to come up with complete, ready-to-commit solutions to a complex problem immediately. Thinking like a consumer doesn't help. An alternative is to demand transparency and to be engaged in the process of decision making. But that requires an attitude/intellectual realignment.
What's concerning about the current messaging is that it's not clear whether it's incorporated the underlying limits to how long people will tolerate a lockdown. An ultimatum is the right framing; decisionmakers need to know, and we need to know they know, that "then we'll lock down for 6 months" is not part of the solution space.
This was along the lines of my first thoughts as well. Theoretically, we want to maximize the usage of our medical resources (personnel, reusable supplies such as bed space, non-reusable supplies such as medication that become available at a variable rate), to keep just enough below the capacity to handle the needs and allow for some spikes (if we can even get it that low).
To my eyes, that calls for the ability to reassess and shift directives for the public (that is, maybe ease up on shelter-in-place next week, but put it back the week after), track and optimize resource flow, and coordination between locales. As a national level emergency, it makes sense there would be national level coordination on how to deal with it. Instead it appears we have governors and mayors making their own calls on what to do based on what advice they are personally getting, and the health care system is just struggling to figure out what to do.
What we don't have is any leadership putting forth an actual plan, or any real indication that they are even attempting to do so, or that if they are that they're putting any real teeth behind making sure officials are on board.
And no the vaccine is still too far in the future so the idea that the lockdown is biding time until the vaccine is ready is ridiculous.
Why have we all (I'm speaking for people in the USA) immediately bought into the idea that shutting down out lives and the economy is the only way to combat this thing? South Korea didn't shut everything down in an authoritarian fashion, and they already have this thing beat. I know, not a fair comparison, USA is way bigger, less experienced in handling disease outbreaks, different governments, etc, etc. But aren't there smarter ways we can handle this than just blanket isolation & lock downs?
From the CDC:
"Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic."
So we know from South Korea's example it is possible to hit acceleration phase, execute a smart plan of attack, and have it carry you into deceleration, without blanket lock downs. Lock downs can still be an effective tool, and should be used in areas seeing steep acceleration to take pressure off the medical system.
Our plan doesn't have to be exactly the same, but we can learn from theirs. Seems like nobody is even trying to think out of the box. We just accepted that we have to turn our country into an authoritarian state and that's the only way to beat this.
Focusing on making testing widely and easily accessible is key for sure. If people could easily get a test, it would eliminate a lot of the fear/ uncertainly that is gripping everyone. Healthy people who are at low risk to get severe reactions could go about there lives normally, while still practicing 'social distancing' in public, not locked away in their homes in fear
Not if you don't have as advanced infrastructure, quick government, and decisive politicians like Korea, and 1/4th of the country is in third world conditions regarding access to healthcare, or even shelter, etc.
You don't need tests for that, just common sense. If you have low risk, by all means keep working while keeping high sanitary precautions. It's unrealistic to expect all people to stay at home, hence those of us who are likely to get a mild COVID-19 case should make sure the people at risk or already sick have services while they stay at home.
If you're healthy, take precautions and still get COVID-19, after recovering you become another line of defense with your new immunity.
That being said, tests are very important, but don't wait for free and widely available tests to decide if you can keep working, your circumstances decide that.
You're allowing people to get infected, but reducing the rate at which they get infected, thus allowing your healthcare system to cope with the demand while the rest of society slowly builds immunity.
Sorry you are inconvenienced.
* Rapidly expand healthcare capacity
* Develop a vaccine
* Build out a testing infrastructure that allows for targeted containment, rapid response, and chain-of-infection tracing without needing a full lockdown
With enough testing and sufficient frequency of testing, isolating just the people who test positive (and perhaps their contacts) should be enough to stop exponential growth, which means we could mostly return to normal life.
I liken it to the immune system. Shutting things down can work for a short period but if the system goes into a full panic it begins attacking good cells and shutting down organs and the host dies a slow, painful death.
We need to be using this bought time to building medical equipment, beds and places to put them, manufacturing existing therapies to help, training people to use specific equipment, creating a system for the most vulnerable to quarantine but get food, medicine, safely as they wait for acceptable safety to them.
We can’t lock down for months and months. People will eventually be fed up, see their risk is low, and throw the dice. The economy can’t grind to halt for a long time.
We need to prepare to minimize death and we need to do it now. Lockdown is not much of a strategy or something that will work beyond a few weeks before people ignore it massively.
Would this work for ya?
But the question in your third paragraph "what is being done with the time we're buying" could be restated as "what are we getting for our loss in economic output _in terms of economic output_?' That's not what we are doing, we are giving up economic output, not getting it. Of course any schemes/inventions/techniques that increase the coefficient of return of this trade off would be welcome, but doesn't change the fundamental direction of the tradeoff.
And that's not to say we are doing nothing at all with that time. Maybe we have "more time to develop a vaccine", or "time to make ventillators."? But those _are_ economic outputs. Those actions trade back lives (via increased transmission rates) for production of utilities that we believe will save lives in an equation that nets a positive. And it's not to say that people won't do some productive things during this (like the memes of inventing calculus in isolation or whatever), but for sure society is reducing it's overall economic output.
So from this point on the questions (and threats of defection) you raise kinda presuppose that trading economic production for saving lives is not worth it (at whatever ratio you're expecting). Potentially this is because you expect higher economic costs/lower life savings than the generally accepted projections, or because you value life less, or you believe the economic loss will lead to greater loss of life long term. I think the burden then is on you to either produce better projections, or promote candidates into government/leadership positions that share your moral outlook, or formulate and promulgate a model that shows the dramatic effects you expect due to the economic loss.
To put it another way, a simplified answer to 'what are we doing with the time' could be 'approximately nothing', and our society at large seems to be on board with that trade. If you're not, change my/our mind.
That's not true. Even with massively ramped up hospital capacity, we'd still have to spread it out over years to support the whole population getting sick. And realistically, if you can keep the disease progression spread out over a long period of time, it means you've stopped the exponential growth (i.e. R0 <= 1), and it isn't that much harder to actually contain it.
What we want to do is to contain it using blanket measures until we can get our act together with large scale testing, contact tracing, and basic sanitation measures (e.g. general mask wearing, hand-washing, and social distancing by the public without needing to lock everything down). This was where China got to after an early lockdown, and it's where South Korea has always been (without the need for a massive lockdown in the first place). Then in a year hopefully the disease can be stopped altogether with mass vaccination.
Keeping in mind that something like 80% of people will only experience mild symptoms, does this assertion still hold?
a) Saves millions of lives.
b) Allows researchers to develop, produce and distribute a safe vaccine.
Medium term, we can more properly organize and distribute medical resources, assemble temporary hospitals, learn more about current anti-virals to better manage it, etc. Allowing even more steps towards normalcy.
The vaccine is immensely important, but there are major steps before then that we don't have to be completely locked down waiting for.
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Universal Mask Wearing Is the Quickest Way to Restart the California Economy
We urgently need universal mask wearing to slow down the spread of COVID-19 and restore our economy.
This is CDC's advice on how healthcare providers can protect themselves if they suspect that a patient has COVID-19:
" Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed." (What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-pat...)
If a facemask on a patient can protect the doctor in close proximity, it surely can also protect the general public. Yet the message from our nation's leadership is that mask wearing is ineffective for the general public (Why Telling People They Don’t Need Masks Backfired https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...). Yes, it is not 100% effective in protecting an individual from others, but it is absolutely effective in protecting the general public from a potential patient. This is the herd immunity we can quickly achieve without waiting for a vaccine:
"An 80% compliance rate essentially eliminated the influenza outbreak. " (Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak https://www.ncbi.nlm.nih.gov/pubmed/30229968)
California is in a unique place to lead the nation and restore its own economy. We have a large Asian population that are receptive to mask wearing but are wary of being singled out. We have technology companies that can come up with solutions for mask making. We have idled workers that can be quickly retrained to jumpstart mask manufacturing. China was able to ramp up production 12 times in February alone. We can do it too.
What we need to do is to legally require people to wear masks in public and in the workplace to protect each other. We don't need to wear N95 respirators that are hard to use and that should rightly be reserved for medical workers; we can wear masks that are much more breathable to protect others from our own droplets. By making it a legal requirement, companies like Tesla will be motivated to either quickly secure masks from suppliers or, better yet, start making and supplying masks for their own employees and for the public. Asian countries have shown that universal mask wearing can prevent large outbreaks and slow down the spread of the disease without shutting down their economy. Let's learn from their experience. Governor Newsom should immediately work on this with the state legislature in order to lead us to a speedy recovery.
Right now there's a huge shortage and we still have a very small number of cases--it's all people stockpiling and using them where it's not as critical.
Like you say, after we can replenish the supply I'm sure it will be more commonplace.
[0] https://medium.com/@matthiassamwald/promoting-simple-do-it-y...
But right now no government dares suggest any vision past a few months.
By winter we'd have more equipment, masks, drugs tested, doctors taking a break, etc. The big spread also stops in warmer climate.
>World governments should clarify this matter by saying that a bad winter resurgence, months after nations are fatigued with lockdown, is definitely not going to happen.
Of course it's possible and very likely to happen. The answer is not no lockdown, it's a second lockdown then as the need arises.
- R0s for interventions are guesses, in some cases informed by data. There is no historical precedent for what is going on right now to draw from.
- The default R0 used in this model is an average. The model does not adjust for the population density, culturally-determined interaction frequency and closeness, humidity, temperature, etc in calculating R0.
- This is not a node-based analysis, and thus assumes everyone spreads the disease at the same rate. In practice, there are some folks who are “super-spreaders,” and others who are almost isolated. Interventions should be targeted primarily at those most likely to spread the disease.
Are there any epidemiologists using less naive statistical models who are producing easily readable results like this? The "average R0" logistic function model seems better suited for examining historical epidemics than estimating risk to inform decision-making for ongoing epidemics.
And most if not all scientific and engineering models spread properties across a group of objects and use averages. R_0 is an average. And it's the average behavior that matters here
In a well tested population, you might be able to focus interventions on infected people and their contacts. In the US population, the people most likely to spread the disease are those who interact most with other people. That means getting those people to reduce their interaction rate.
It's a semi-empirical model, as are many if not most models used to make decisions.
That said, the implication that strict isolation should be maintained is almost certainly correct.
Interestingly, the model is not nearly as sensitive to R-values as you would think, until they get under 1.5 (half the current observed number in most places).
See here: https://www.researchgate.net/figure/Doubling-time-Average-do...
Dead Comment
I say this as someone that thinks they had it a month ago. I was on steroids for a week, then a respirator, then steroids for another week. Worst asthma attack of my adult life. I live in Seattle... (And yes, i had fevers)
I did not get tested, but having a hard time shaking that I had it. And if I did, so has my family. With my kids all having fevers, but no shortness of breath.
Edit: I hasten to add that I am socializing this as a call for what am I missing? I am not encouraging inaction.
Studies of SARS showed that regions with high pollution were significantly more at risk for death from it. If that is the case for this, the severity expected in many parts of the world will be considerably lower than projected.
Again, stay home. I am not encouraging breaking self distancing. The panic message is worrying me because everyone seems to only be looking for reasons to panic.
The symptoms as a whole didn't quite feel like a flu, we all thought they were weird, but hey who am I to know, right?
Well a few weeks later we remembered that two days prior to feeling ill, we had ordered some Chinese takeout. The delivery man (not a Chinese national) looked like he was going to collapse. He had trouble getting up the stairs, had a bad cough, looked like he had a fever - god knows why he was working. After taking the food and paying, I wondered if he'd make it back down the stairs but forgot about it for a few weeks.
We probably won't know if we had this bug or not, but it's definitely possible. Maybe I just happened to develop a respiratory distress caused by a bad flu right when the epidemic in China was not controlled, and not any other year prior. Who knows!
Right now, as I type this, many hospitals in the United States have had all of their excess intensive care capacity used up by Covid-19 cases. Not all, but many.
Once large groups of hospitals reach capacity, then there will be no choice but to black tag people who could otherwise be saved and leave them to die in the hallways.
Click this graph, then click Logarithmic at the top: https://mackuba.eu/corona/#united_states
You're right to note that this is a global problem. Given that, the vast majority of human to human contact is NOT cross border.
This bug is probably going to end up infecting most of the people in the United States. The main thing we can do at this point is to keep hospitals from being too overwhelmed, to keep the number of black tagged people, dying in the hallways, to a minimum.
Exactly. As you say, we need to flatten the curve to keep hospitals from becoming overwhelmed, and we need to use the time to develop treatments to save the vulnerable when isolation eventually fails.
Do you happen to have a source for this? I haven't heard much about hospital problems yet.
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If a person get good care in hospital the rate of survival would be totally different.
For those country which had sudden high fatality rate was because their resources and supplies were exhausted - there were no bed, no consumable, even no protection for the nurses.
Now the really terrible part is that the economic effect of the mass closure is going to grow exponentially. So layoffs start small and grow more massive week by week. And unlike COVID-19, that economic effect will not subside with the warming weather...
Here is some evidence:
Compare the slow growth in cases per day (green line) in CA and FL (warm) vs NY and WA (cold):
https://covid-19.direct/state/CA
https://covid-19.direct/state/FL
https://covid-19.direct/state/NY
https://covid-19.direct/state/WA
See for example how in Malaysia there was an outbreak due to a very large Muslim gathering with foreign travelers, that seems to diminish every day (indicated an R factor < 1) - https://www.worldometers.info/coronavirus/country/malaysia/ The same is true for Qatar.
Same examples all over the world for warm countries: https://www.worldometers.info/coronavirus/
The point is that places like California will experience slow growth which will also decline quickly with the warming weather, not that every place has negative growth right now.
My critique of this analysis is that there is no way you are controlling for all of the factors: different starting dates for community spread, uneven testing / reporting of cases, random luck due to super-spreading events, differences in behaviors between regions, and so on.
Which is to say, I accept it is complicated. If it correlates with something, that is just another question. Not likely an answer in itself.
City density, by its turn, is huge.
This is missing a HUGE point. At the very end of the California "shelter-in-place" plan, the numbers will go up. What it doesn't show is that this will merely delay the epidemic to 3 months in the future. The chart useless with only a 3 month time horizon.
> * A second spike in disease may occur after social distancing is stopped. Interventions are important because they buy time to create surge capacity in hospitals and develop therapeutic drugs that may have potential to lower hospitalization and fatality rates from COVID-19. See full scenario definitions here.
In the end, that's likely what we'll have to do anyway. But it'll take longer than 3 months.
I wonder if that's accurate. I also wonder if this is recurring in the fall, and every year, and whether physical distancing will be mandatory every year?
Of course the above assumes that immunity really does develop after one exposure, and that the virus doesn't mutate into some sufficiently different form to reset the immunity counter to zero again. The evidence seems to indicate positive things on the immunity front, but it's still preliminary. And as for mutation, who can say?
The key is to buy time, now. To add hospital capacity, develop therapeutics and vaccines, and learn more about the disease...