> the transmission rate dropped again, to the point where any single case led to less than one more. Once that happens, an epidemic dies.
Note that this can take a while. What the article suggests - getting back to the containment phase - is the stated goal of some countries. However, to get there quick you need very drastic measures. With the measures we adopted, it will take a bit of time - I read one estimate that the reproduction number in Switzerland has been around 0.59 since the lockdown was enacted, so you'd expect cases to drop by a factor of this per generation - it still takes weeks/months to go from 1000+ cases to below 100 (where they estimate they have enough resources for contact tracing).
Living in Switzerland and having friends in the surrounding countries, it has been kind of amazing to see how well the comparatively soft touch of the Swiss government has worked. We can still go out, hang out in groups <5 etc., but people are simply being reasonable.
I keep waiting for the uptick in cases since they announced their plan for reopening though. I'm unconvinced we'll be through it so smoothly.
The Swedes have taken this line as well, saying they 'trust' their citizens.
I think it's not very rational, and also borderline chauvinist for people to say this.
First - what evidence does anyone have that Swiss/Swedes or anyone for that matter are consistently behaving in one way or another that is more 'responsible' or 'sensible' than others?
I don't see any evidence.
A nationalist self-image of responsibility doesn't count as Science, and neither does a few images of fools on a Florida beach as it's all rather anecdotal.
The other issue is that policy is material, not just 'responsibility' - for example - we know from Wuhan that restaurants and other places are a vector for transmission. So it doesn't matter if certain groups are 'behaving responsibly' so much - if they are going to restaurants, hotels, tanning salons etc. - even that otherwise 'responsible behaviour' inside the scope of 'following the rules' that is actually causing transmission.
Given all of the variables we have to look at, the last place I think we can infer variation is with regards to who is 'being reasonable' by some arbitrary definition.
That said - it would be really good to look at different nations varying policies and see how it works.
It could be that <5 people is 'enough' to keep the R1 below 1, though there are obviously other factors. Maybe the Swiss have found the 'sweet spot'?
In Canada, the problem was stopped, but there's already a continued second wave in long-term care homes, it's possible those are structured differently in Canada than other countries.
The Australian approach has been fairly good but this virus is persistent.
Once the lockdowns kicked in the doubling rate dropped dramatically and new case numbers went from a peak of around 500 a day to 10-20 day for a population 1/10 the US.
From /r/coronavirusdownunder linking the stats with the lock-down measures gives a good idea of the timeframe involved.
date cases growth doubling
2020-03-21 1071 1.22 3.1
2020-03-22 1352 1.26 3.3 <== 10 days ago, Tom Hanks
2020-03-23 1716 1.27 3.5
2020-03-24 2146 1.25 3.8
2020-03-25 2431 1.13 4.0 <== 10 days ago, overseas self-isolate 14 days
2020-03-26 2805 1.15 4.5 <== 10 days ago, Vic declare State of Emergency
2020-03-27 3179 1.13 5.3
2020-03-28 3639 1.14 6.4
2020-03-29 3985 1.1 7.0 <== 10 days ago, TAS self-isolation 14 days
2020-03-30 4250 1.07 8.0 <== 10 days ago, closing borders to all
2020-03-31 4560 1.07 9.3 <== 10 days ago, rule of 4 square metres
2020-04-01 4864 1.07 11.5
2020-04-02 5136 1.06 13.6 <== 10 days ago, no social gathering
You should look at the breakdown of cases. I was very worried for Sydney in early to mid march. What I didnt see until later was the infection acquisition data. The majority of those march cases appeared to be infected citizens returning from overseas. Locally acquired infections were only 25% of cases at the peak. The local infection rate never really hit the scary 3 day numbers.
It's absolutely depressing knowing that this all stems from a complete utter lack of leadership at the federal level. That states are having to implement their own policies and plans of attack for this virus is a total travesty. Massachusetts is undoubtedly leading the way here. But this is a global pandemic, that can only begin to be approached at the national level. With our society's level of interconnectedness, state level interventions are completely meaningless.
>> That states are having to implement their own policies and plans of attack for this virus is a total travesty.
Blame the constitution. In the US system of government health is largely a state matter. Setting aside trump, the federal agencies just aren't setup to lead. They can issue statements and guidelines but lack any actual authority on the ground. State governors have the power, but even then they cannot boss corporations around (hospitals/insurance companies). They cannot even divert masks from one hospital to another, let alone demand that a patient be moved.
Now in other countries, the ones with government-provided healthcare, the national government has real authority. They can directly order policy changes. They can close individual hospitals and/or move patients. They can control the flow of equipment because they are the ones paying for that equipment. Canada just deployed soldiers into some care homes. It took less than 24 hours without any new legislation needed. A US state governor might be able to use the local national guard, but deploying the army within the US? Into a privately-run care home? That is a power trump doesn't have.
In Canada health is constitutionally devolved to the provinces. Explicitly, since our constitution was actually written in the last 40 years so was written with the awareness that health care is a major government concern.
In so far as the federal government sets health policy, it does so through the carrot and stick of federal funding through equalization and other programs. I am reasonably certain that this is also an approach the US federal government has used in areas of devolved authority (particularly education).
And looking at the specific situation you're talking about, it appears the Ontario government requested military assistance, and it was granted, not the other way around.
The US federal government may not have explicit authority, but the idea that it is absolutely helpless to coordinate efforts among the states (aka interstate commerce) seems kind of blatantly absurd. Never mind that they seem to, in fact, have done quite a lot of diverting masks from where they were going to elsewhere already. Just you know, not in a helpful way.
or praise the constitution for its perceptive foresight and resilience against dystopian concentrations of power in a country with an unbelievably massive military and nuclear weapons stockpile?
one where blind fear and panic can’t easily trigger a cascade into surveillance fascism for a pandemic trending to be ~3x worse than the flu?
Would you really have preferred the states to have less and the federal government to have more authority in this matter?
Yes, this is a global pandemic. But at the same time, I prefer a response that is fine-tuned to local circumstances and I’m glad the WHO does not have envy authority over the decision taking in my city. Corona does not strike every region equally and at the same time. Furthermore, diversity of regulation is very important for learning what works and what does not. For example, if the Swedish approach turns out to be successful, we can copy that in case of a second wave. There is a common misconception that a coordinated approach is necessary to make sure everyone does the optimal things. That’s wrong. Regions are free to copy each other if they see what works elsewhere. If there are local differences, there is often a good reason for it and you wouldn’t want a central authority to enforce a “one-size-fits-all” response.
I agree in general I agree, but sometimes speed can be of the essence. Unfortunately no country on earth was in a rush to stop the spread early on. So much could’ve been done in the early fase if a national and international response would’ve been coherent.
> But this is a global pandemic, that can only begin to be approached at the national level.
Why pick national? Almost any aspect of the response can be implemented on any level of governance except maybe individual.
It isn't at all obvious that centralising on the federal level is sensible. Realistically; the optimal organisational unit for the response might be the catchments around each hospital and so somewhere around the local level.
Because the federal government has control over fiscal and (indirectly) monetary policy. It can literally print money and borrow at rates which no single state can. It has an independent power to levy taxation against the citizens of those states.
If the US states were literally independent countries, then they'd be able to do more. They're not, so the federal government should be doing a lot more then it is.
Your taxes pay for federal government. An entirely different set of taxes pay for state government. _Why_ are you not demanding better service?
The US government model and the mindset of people seems to make it very hard to do massive mobilization in a short period of time, compared to countries like China. From which mobilization is very useful in situations like pandemics, or more straightforward, wars.
Of course, there are many advantages from this model. The comparison between these models of governments reminds me of 'the Prince' from Machiavelli. In that book, he compared France with the Ottoman Empire. French king has relatively weak power since the nobles own their fiefs. While the Ottoman Empire there are only province officers, and the sultan can easily move or fire those officers. The comparison seems to echo what the US and China's modern political systems and possibly the pros and cons remain the same.
PS: There's a documentary from the BBC named 'the Chinese Mayor' that might help people have an initial understanding of the Chinese political system from a mayor's perspective. Chinese officers transfer from provinces to provinces in a very frequent manner, in order to avoid the local governments have too much power. This feature remains the same in China for two thousand years.
I dunno, that's what happens in a global shortage sometimes. Remember that the governor of Maryland isn't exactly a small-time official - Maryland's economy is about as large as Iran or Norway.
It’s totally different than agenda in Germany. Heads in the news can’t stop fantasizing about herd immunity. And this guy has a plan what to do right now.
Truthfully, this is a puff piece for increased government spending. Let the money printers work overtime, devaluing the currency until it’s worth less than the paper it’s printed on. The government is incompetent at everything, why not let the private sector figure it out?
All the nations he mentions are creditor nations that have savings to undertake huge public works projects in order to surveil those who might be infected. That’s why we can’t do similar programs in the US, we’re heavily indebted and collectively broke. Same story with the PIGS, if the EU dissolves these areas will succumb to hyperinflation too, and also why they can not implement similar programs.
Um, the author is relying on three things, none of which seem reliable:
* that anything China claims is true, so far they've been lying constantly, we know this.
* that we will be able to accurately contact trace. This is problematic because its easy to tell who I have had contact with. But it's much harder to tell who has used the same door knobs or shopping trollies that I have. It's also an exponentially larger number. You can quarantine the 50 people I've touched or spoken to in the last week, you can't quarantine the 2000 who went to the supermarket the same day as me. Not without just quarantining everyone anyway, so why bother contact tracing?
* that I can be isolated if I am not sick. Imagine if your housemate got the disease, with proof via testing. Now what? You can't leave the house for 2 weeks? Good luck surviving off whatever is already in your cupboards, it's hard enough to keep people from doing things they shouldn't under social isolation, but mass house arrest is unenforceable, at least in the west.
Also,the author perpetuates a myth that's risen about social isolation. Let's clarify: The plan is NOT to keep everyone locked away until the case count actually reaches zero, that will never happen. The plan is to work out how many infected people we can cope with at a time.
If you have 25k ventilators, and 5% of patients need ventilation then you know you can have 500k people get the disease simultaneously. That way, the mortality stays at the minimum rate because everyone who needs treatment can get it. Any higher and you have to ration ventilators and the death rate spirals.
So we will aim to have a certain number of people get it at a time. If we drop below this number, we will relax social distancing somewhat, maybe reopen schools or permit some use of restaurants in order to INCREASE transmission. But then reverse that when the infected load rises.
This is the real reason testing is important. It's irrelevant whether you have the disease, it's very important to know how many people have it (especially how many people have it now and will need treatment in 1,4,7,14 etc days). Tests should be used for population monitoring not individuals. This was a key error from day one that is still happening today. Whatever your condition, YOU do not need to be tested.
Eventually we will develop a herd immunity which will gradually allow more and more openness without increasing transmission rates. Until one day so many people have had it that no measures are needed to keep the rate low enough to deal with. That's when we return to normal.
There are nuances to how we do this. High risk groups should remain more isolated for longer as they are more likely to die or need ventilation. We need population testing, something governments are stubbornly refusing to do. We don't know transmission rates under various levels of lockdown. All this needs to be managed semi-locally, so London might be opening up while Cornwall remains closed.
This approach is clearly laid out and was at the beginning of the current measures both academically and generally.
This is about control, not eradication, because eradication is not possible. Any attempt at eradication will fail when we're unable to find literally every case world wide, we relax quarantine and then suddenly it rockets back in.
As soon as the author started talking about eradication, he left the scientific concensus. As soon as he claimed we could return to normal life if we got contact tracing working, he made a claim with no evidence to back it up. Contact tracing is a nice to have, but not important. The important things are healthcare capacity (aka ventilators) and population monitoring.
> As soon as the author started talking about eradication, he left the scientific concensus.
Something i have read is that there is a split between epidemiologists and public health experts. Epidemiologists accept that we can't eradicate, and so have to manage the outbreak. Public health experts still think in terms of eradication.
My understanding is that this is an inertia thing. Public health experts have spent decades focused on eradicating diseases, so that's the only way they can think. Meanwhile, epidemiologists only study diseases that have escaped containment, so that's the only way they can think!
Thanks, that makes sense, and that's exactly what I felt the author was stuck on. They've spent decades trying to eradicate diseases (TB and HIV), so now they want to pursue another eradication program. It's attractive, I get why. But it's not applicable to a disease we can't cure and one with rapid gestation transmission.
It's somewhat ironic that this expert's own expertise is what stops him from listening to the real experts...
> that anything China claims is true, so far they've been lying constantly, we know this.
What lies are you specifically talking about?
A lot of people have the impression that China is some sort of black hole: no information gets out, so who knows what's going on inside?
There is a huge amount of information coming out of China. People I talk to there tell me about what their everyday lives are like. There are millions of Chinese people communicating with the outside world every day. What's certain is that the situation is completely different from how it was in late January through February. The epidemic really does appear to be under control there.
> Contact tracing is a nice to have, but not important. The important things are healthcare capacity (aka ventilators) and population monitoring.
What you're proposing is a control strategy, in which the epidemic is held at a level that doesn't overwhelm hospitals, but in which a large number of people continue to be infected each day. It's a steady state with R ~ 1 and a manageable case load. In the US, this is the current situation, and it means a steady pace of ~2000 deaths/day.
In that strategy, the second you reduce social distancing measures, the epidemic will flare up again, because you're balancing on a knife's edge.
The strategy that China pursued was suppression (R << 1), followed by containment of the epidemic at a much lower level. In the first phase, extreme social distancing and quarantine measures reduced the number of new infections to a small number (tens/day). In the second phase, social distancing measures have been relaxed, and widespread testing and contact tracing are being used to try to catch nearly every new case in the country. That's only feasible if the number of cases is small.
This two-phase strategy is the only one I can see that does not lead to ~0.5% of the population being sacrificed.
OK, we need to stop discussing China and Chinas approach because we know they are lying about all of their numbers. That's what basically every Western country had said.
If you don't believe me, that's fine, just go Google it. US intelligence have publicly stated this. Just in the last few days the UK has stopped listing Chinese numbers at all because they as so badly wrong.
I don't doubt that there are a lot of personal anecdotes coming from China, but as far as I know the only numbers are the official ones and they are pap.
If you can offer factual evidence that that is not true, I'd be very pleased to be wrong since apparently Chinese coronavirus is 100 times less deadly than average...
So that brings us to contact tracing.
I'm happy to agree that contact tracing would mean we could keep R values lower with less disruption to people's lives. You could let people without contact go out more etc IF AND ONLY IF you can accurately do contact tracing.
But we've never done that before in the West. I belive it has been semi managed in Africa with Ebola. But Ebola is easier to test for. And its much faster to show symptoms. And patients tend to self isolate because they're so sick they can't get out of bed.
Coronavirus is airborne and seems to survive for long periods on surfaces. So you get many many more contacts even if you get fewer infections per contact.
The article doesn't attempt any maths despite these factors being key to knowing whether contact tracing works for a given disease. Do you know of any such model? Do we know what parameters we need to input for coronavirus (what defines a contact, how many contacts require quarantines etc)? I think these values are total unknowns for coronavirus, it's taken us this long to get to a semi reliable R0 value, we still don't know how R changed with quarantine methods and levels. So will we discover any of this in time to use it with COVID-19? Or will we just do the less accurate but just as effective measures we need to do and get through this in another 2-3 months?
Fyi, 0.6% (plus or minute 0.2percetage points) overall population fatality is what we are aiming for already based on having 100% treatment availability as far as I know. So apparently contact tracing offers exactly the same outcome? I have to ask again, what's the point? Isn't this at best a nice to have and at worse a wild goose chase?
"This is a disease that will be circling the globe for a long time. The virus could very well become seasonal, like the flu—and, like the flu, it might mutate regularly, making it a moving target for vaccine researchers. Without a durable system in place, we may find ourselves trapped in a cycle of lockdown and stimulus, waiting and hoping, with no end in sight."
It sounds like a good plan, but I can't see it working here. USA in general has strong individualism, I guess it's called. Basically the idea of look out for yourself, and screw everyone else. It's why you still can't buy paper products, why we don't have universal healthcare, why we have so many homeless, etc. Heck, I remember when cases first started in KY, at least two people defied orders to quarantine even after testing positive, to the point they sent police to keep them indoors. There's no way enough people will self quarantine to make this plan effective. Now, if you can somehow force quarantine people, we'd have a fighting chance, but that makes a lot of people uneasy, perhaps rightly.
I don't know if "screw everyone else" is fair. It's the idea that living freely is a sacred value; that we won't and shouldn't take the path of the fewest deaths, if that path leads to a society we don't want to live in.
That's not to defend people who actually have the virus breaking quarantine. Limited quarantines have always been compatible with freedom, that's just dumb selfishness. But if the proposal is that the 30k new infectees a day* and all their close contacts should be forced out of their homes into quarantine camps, yeah, that's not going to work here.
* I know the real number is likely much higher than this.
> It's the idea that living freely is a sacred value; that we won't and shouldn't take the path of the fewest deaths, if that path leads to a society we don't want to live in.
And you can see in Italy how the (hoped) path for the fewest deaths as opposed to (rather than along with) freedom led to a horrible result. The current PM has basically trampled on every constitutional right with authority that he should not have, and the effects of the policy (besides locking up people for at least 75 days) aren't that great. And let's not talk about the social / economical aspect.
The authoritarian aspect of these moves was clearly shown when he threatened closing things again if infections rise (as if it's the fault of the people he's supposed to protect).
> if that path leads to a society we don't want to live in.
1-2% of people will be unable to live in the unquarantined society due to dying, and a significant number more may never fully recover. It's more "live free AND die".
Individualism is strongest in areas where population density is the lowest. I would expect such people violating quarantines to not be a particularly big driver of the problem (despite being frontpage news, especially when a religion happens to be involved).
By the way the hoarding of paper products is a worldwide thing. It was problem even in Japan far before the US.
Readit News
Note that this can take a while. What the article suggests - getting back to the containment phase - is the stated goal of some countries. However, to get there quick you need very drastic measures. With the measures we adopted, it will take a bit of time - I read one estimate that the reproduction number in Switzerland has been around 0.59 since the lockdown was enacted, so you'd expect cases to drop by a factor of this per generation - it still takes weeks/months to go from 1000+ cases to below 100 (where they estimate they have enough resources for contact tracing).
I keep waiting for the uptick in cases since they announced their plan for reopening though. I'm unconvinced we'll be through it so smoothly.
The Swedes have taken this line as well, saying they 'trust' their citizens.
I think it's not very rational, and also borderline chauvinist for people to say this.
First - what evidence does anyone have that Swiss/Swedes or anyone for that matter are consistently behaving in one way or another that is more 'responsible' or 'sensible' than others?
I don't see any evidence.
A nationalist self-image of responsibility doesn't count as Science, and neither does a few images of fools on a Florida beach as it's all rather anecdotal.
The other issue is that policy is material, not just 'responsibility' - for example - we know from Wuhan that restaurants and other places are a vector for transmission. So it doesn't matter if certain groups are 'behaving responsibly' so much - if they are going to restaurants, hotels, tanning salons etc. - even that otherwise 'responsible behaviour' inside the scope of 'following the rules' that is actually causing transmission.
Given all of the variables we have to look at, the last place I think we can infer variation is with regards to who is 'being reasonable' by some arbitrary definition.
That said - it would be really good to look at different nations varying policies and see how it works.
It could be that <5 people is 'enough' to keep the R1 below 1, though there are obviously other factors. Maybe the Swiss have found the 'sweet spot'?
In Canada, the problem was stopped, but there's already a continued second wave in long-term care homes, it's possible those are structured differently in Canada than other countries.
Once the lockdowns kicked in the doubling rate dropped dramatically and new case numbers went from a peak of around 500 a day to 10-20 day for a population 1/10 the US.
From /r/coronavirusdownunder linking the stats with the lock-down measures gives a good idea of the timeframe involved.
date cases growth doubling
2020-03-21 1071 1.22 3.1
2020-03-22 1352 1.26 3.3 <== 10 days ago, Tom Hanks
2020-03-23 1716 1.27 3.5
2020-03-24 2146 1.25 3.8
2020-03-25 2431 1.13 4.0 <== 10 days ago, overseas self-isolate 14 days
2020-03-26 2805 1.15 4.5 <== 10 days ago, Vic declare State of Emergency
2020-03-27 3179 1.13 5.3
2020-03-28 3639 1.14 6.4
2020-03-29 3985 1.1 7.0 <== 10 days ago, TAS self-isolation 14 days
2020-03-30 4250 1.07 8.0 <== 10 days ago, closing borders to all
2020-03-31 4560 1.07 9.3 <== 10 days ago, rule of 4 square metres
2020-04-01 4864 1.07 11.5
2020-04-02 5136 1.06 13.6 <== 10 days ago, no social gathering
2020-04-03 5358 1.04 15.6 <== 10 days ago, WA,SA closing border
2020-04-04 5552 1.04 18.7
2020-04-05 5687 1.02 22.9
2020-04-06 5795 1.02 28.1
2020-04-07 5908 1.02 33.1
2020-04-08 6013 1.02 38.8 <== 10 days ago, mandatory hotel quarantine
2020-04-09 6103 1.01 46.5
2020-04-10 6203 1.02 52.2
2020-04-11 6292 1.01 60.7
2020-04-12 6313 1.003 69.6
2020-04-13 6359 1.007 83.5 <== 10 days ago, QLD closing border
2020-04-14 6400 1.006 96.5
2020-04-15 6447 1.007 114.2
2020-04-16 6468 1.003 106.9
2020-04-17 6523 1.009 121.1
2020-04-18 6565 1.006 129.2
2020-04-19 6606 1.006 157.3
2020-04-20 6619 1.002 165.0 <== 10 days ago, Good Friday
2020-04-21 6645 1.004 210.6
2020-04-22 6649 1.001 247.4
2020-04-23 6661 1.002 307.7
2020-04-24 6675 1.002 301.3
2020-04-25 6695 1.003 350.7
2020-04-26 6711 1.002 298.7
Actually, Taiwan has done better. They've had no local cases for 14 days.
https://taipeitimes.com/News/front/archives/2020/04/27/20037...
They did it by ignoring the WHO's advice and locking down early and then aggressively containing all cases, preventing a general outbreak.
They've been pursuing this since December 31st, when they issued a warning to the WHO about what was going on and locked down. The WHO ignored them.
https://www.taipeitimes.com/News/front/archives/2020/04/12/2...
They've taken 4 months to get to no new cases. From a much better starting point. With a much smaller population.
I'm very skeptical about what this guy is advocating.
Blame the constitution. In the US system of government health is largely a state matter. Setting aside trump, the federal agencies just aren't setup to lead. They can issue statements and guidelines but lack any actual authority on the ground. State governors have the power, but even then they cannot boss corporations around (hospitals/insurance companies). They cannot even divert masks from one hospital to another, let alone demand that a patient be moved.
Now in other countries, the ones with government-provided healthcare, the national government has real authority. They can directly order policy changes. They can close individual hospitals and/or move patients. They can control the flow of equipment because they are the ones paying for that equipment. Canada just deployed soldiers into some care homes. It took less than 24 hours without any new legislation needed. A US state governor might be able to use the local national guard, but deploying the army within the US? Into a privately-run care home? That is a power trump doesn't have.
In so far as the federal government sets health policy, it does so through the carrot and stick of federal funding through equalization and other programs. I am reasonably certain that this is also an approach the US federal government has used in areas of devolved authority (particularly education).
And looking at the specific situation you're talking about, it appears the Ontario government requested military assistance, and it was granted, not the other way around.
The US federal government may not have explicit authority, but the idea that it is absolutely helpless to coordinate efforts among the states (aka interstate commerce) seems kind of blatantly absurd. Never mind that they seem to, in fact, have done quite a lot of diverting masks from where they were going to elsewhere already. Just you know, not in a helpful way.
one where blind fear and panic can’t easily trigger a cascade into surveillance fascism for a pandemic trending to be ~3x worse than the flu?
"The Constitution is not a suicide pact."
https://en.wikipedia.org/wiki/The_Constitution_is_not_a_suic...
Yes, this is a global pandemic. But at the same time, I prefer a response that is fine-tuned to local circumstances and I’m glad the WHO does not have envy authority over the decision taking in my city. Corona does not strike every region equally and at the same time. Furthermore, diversity of regulation is very important for learning what works and what does not. For example, if the Swedish approach turns out to be successful, we can copy that in case of a second wave. There is a common misconception that a coordinated approach is necessary to make sure everyone does the optimal things. That’s wrong. Regions are free to copy each other if they see what works elsewhere. If there are local differences, there is often a good reason for it and you wouldn’t want a central authority to enforce a “one-size-fits-all” response.
Why pick national? Almost any aspect of the response can be implemented on any level of governance except maybe individual.
It isn't at all obvious that centralising on the federal level is sensible. Realistically; the optimal organisational unit for the response might be the catchments around each hospital and so somewhere around the local level.
If the US states were literally independent countries, then they'd be able to do more. They're not, so the federal government should be doing a lot more then it is.
Your taxes pay for federal government. An entirely different set of taxes pay for state government. _Why_ are you not demanding better service?
Of course, there are many advantages from this model. The comparison between these models of governments reminds me of 'the Prince' from Machiavelli. In that book, he compared France with the Ottoman Empire. French king has relatively weak power since the nobles own their fiefs. While the Ottoman Empire there are only province officers, and the sultan can easily move or fire those officers. The comparison seems to echo what the US and China's modern political systems and possibly the pros and cons remain the same.
PS: There's a documentary from the BBC named 'the Chinese Mayor' that might help people have an initial understanding of the Chinese political system from a mayor's perspective. Chinese officers transfer from provinces to provinces in a very frequent manner, in order to avoid the local governments have too much power. This feature remains the same in China for two thousand years.
Here is what happens when someone tries to reveal to real situation:
https://www.youtube.com/watch?v=1U1VYck6KOo
The person filming is currently missing.
Dead Comment
All the nations he mentions are creditor nations that have savings to undertake huge public works projects in order to surveil those who might be infected. That’s why we can’t do similar programs in the US, we’re heavily indebted and collectively broke. Same story with the PIGS, if the EU dissolves these areas will succumb to hyperinflation too, and also why they can not implement similar programs.
* that anything China claims is true, so far they've been lying constantly, we know this.
* that we will be able to accurately contact trace. This is problematic because its easy to tell who I have had contact with. But it's much harder to tell who has used the same door knobs or shopping trollies that I have. It's also an exponentially larger number. You can quarantine the 50 people I've touched or spoken to in the last week, you can't quarantine the 2000 who went to the supermarket the same day as me. Not without just quarantining everyone anyway, so why bother contact tracing?
* that I can be isolated if I am not sick. Imagine if your housemate got the disease, with proof via testing. Now what? You can't leave the house for 2 weeks? Good luck surviving off whatever is already in your cupboards, it's hard enough to keep people from doing things they shouldn't under social isolation, but mass house arrest is unenforceable, at least in the west.
Also,the author perpetuates a myth that's risen about social isolation. Let's clarify: The plan is NOT to keep everyone locked away until the case count actually reaches zero, that will never happen. The plan is to work out how many infected people we can cope with at a time.
If you have 25k ventilators, and 5% of patients need ventilation then you know you can have 500k people get the disease simultaneously. That way, the mortality stays at the minimum rate because everyone who needs treatment can get it. Any higher and you have to ration ventilators and the death rate spirals.
So we will aim to have a certain number of people get it at a time. If we drop below this number, we will relax social distancing somewhat, maybe reopen schools or permit some use of restaurants in order to INCREASE transmission. But then reverse that when the infected load rises.
This is the real reason testing is important. It's irrelevant whether you have the disease, it's very important to know how many people have it (especially how many people have it now and will need treatment in 1,4,7,14 etc days). Tests should be used for population monitoring not individuals. This was a key error from day one that is still happening today. Whatever your condition, YOU do not need to be tested.
Eventually we will develop a herd immunity which will gradually allow more and more openness without increasing transmission rates. Until one day so many people have had it that no measures are needed to keep the rate low enough to deal with. That's when we return to normal.
There are nuances to how we do this. High risk groups should remain more isolated for longer as they are more likely to die or need ventilation. We need population testing, something governments are stubbornly refusing to do. We don't know transmission rates under various levels of lockdown. All this needs to be managed semi-locally, so London might be opening up while Cornwall remains closed.
This approach is clearly laid out and was at the beginning of the current measures both academically and generally.
This is about control, not eradication, because eradication is not possible. Any attempt at eradication will fail when we're unable to find literally every case world wide, we relax quarantine and then suddenly it rockets back in.
As soon as the author started talking about eradication, he left the scientific concensus. As soon as he claimed we could return to normal life if we got contact tracing working, he made a claim with no evidence to back it up. Contact tracing is a nice to have, but not important. The important things are healthcare capacity (aka ventilators) and population monitoring.
Something i have read is that there is a split between epidemiologists and public health experts. Epidemiologists accept that we can't eradicate, and so have to manage the outbreak. Public health experts still think in terms of eradication.
My understanding is that this is an inertia thing. Public health experts have spent decades focused on eradicating diseases, so that's the only way they can think. Meanwhile, epidemiologists only study diseases that have escaped containment, so that's the only way they can think!
It's somewhat ironic that this expert's own expertise is what stops him from listening to the real experts...
What lies are you specifically talking about?
A lot of people have the impression that China is some sort of black hole: no information gets out, so who knows what's going on inside?
There is a huge amount of information coming out of China. People I talk to there tell me about what their everyday lives are like. There are millions of Chinese people communicating with the outside world every day. What's certain is that the situation is completely different from how it was in late January through February. The epidemic really does appear to be under control there.
> Contact tracing is a nice to have, but not important. The important things are healthcare capacity (aka ventilators) and population monitoring.
What you're proposing is a control strategy, in which the epidemic is held at a level that doesn't overwhelm hospitals, but in which a large number of people continue to be infected each day. It's a steady state with R ~ 1 and a manageable case load. In the US, this is the current situation, and it means a steady pace of ~2000 deaths/day.
In that strategy, the second you reduce social distancing measures, the epidemic will flare up again, because you're balancing on a knife's edge.
The strategy that China pursued was suppression (R << 1), followed by containment of the epidemic at a much lower level. In the first phase, extreme social distancing and quarantine measures reduced the number of new infections to a small number (tens/day). In the second phase, social distancing measures have been relaxed, and widespread testing and contact tracing are being used to try to catch nearly every new case in the country. That's only feasible if the number of cases is small.
This two-phase strategy is the only one I can see that does not lead to ~0.5% of the population being sacrificed.
If you don't believe me, that's fine, just go Google it. US intelligence have publicly stated this. Just in the last few days the UK has stopped listing Chinese numbers at all because they as so badly wrong.
I don't doubt that there are a lot of personal anecdotes coming from China, but as far as I know the only numbers are the official ones and they are pap.
If you can offer factual evidence that that is not true, I'd be very pleased to be wrong since apparently Chinese coronavirus is 100 times less deadly than average...
So that brings us to contact tracing.
I'm happy to agree that contact tracing would mean we could keep R values lower with less disruption to people's lives. You could let people without contact go out more etc IF AND ONLY IF you can accurately do contact tracing.
But we've never done that before in the West. I belive it has been semi managed in Africa with Ebola. But Ebola is easier to test for. And its much faster to show symptoms. And patients tend to self isolate because they're so sick they can't get out of bed.
Coronavirus is airborne and seems to survive for long periods on surfaces. So you get many many more contacts even if you get fewer infections per contact.
The article doesn't attempt any maths despite these factors being key to knowing whether contact tracing works for a given disease. Do you know of any such model? Do we know what parameters we need to input for coronavirus (what defines a contact, how many contacts require quarantines etc)? I think these values are total unknowns for coronavirus, it's taken us this long to get to a semi reliable R0 value, we still don't know how R changed with quarantine methods and levels. So will we discover any of this in time to use it with COVID-19? Or will we just do the less accurate but just as effective measures we need to do and get through this in another 2-3 months?
Fyi, 0.6% (plus or minute 0.2percetage points) overall population fatality is what we are aiming for already based on having 100% treatment availability as far as I know. So apparently contact tracing offers exactly the same outcome? I have to ask again, what's the point? Isn't this at best a nice to have and at worse a wild goose chase?
"This is a disease that will be circling the globe for a long time. The virus could very well become seasonal, like the flu—and, like the flu, it might mutate regularly, making it a moving target for vaccine researchers. Without a durable system in place, we may find ourselves trapped in a cycle of lockdown and stimulus, waiting and hoping, with no end in sight."
Dead Comment
That's not to defend people who actually have the virus breaking quarantine. Limited quarantines have always been compatible with freedom, that's just dumb selfishness. But if the proposal is that the 30k new infectees a day* and all their close contacts should be forced out of their homes into quarantine camps, yeah, that's not going to work here.
* I know the real number is likely much higher than this.
And you can see in Italy how the (hoped) path for the fewest deaths as opposed to (rather than along with) freedom led to a horrible result. The current PM has basically trampled on every constitutional right with authority that he should not have, and the effects of the policy (besides locking up people for at least 75 days) aren't that great. And let's not talk about the social / economical aspect.
The authoritarian aspect of these moves was clearly shown when he threatened closing things again if infections rise (as if it's the fault of the people he's supposed to protect).
1-2% of people will be unable to live in the unquarantined society due to dying, and a significant number more may never fully recover. It's more "live free AND die".
By the way the hoarding of paper products is a worldwide thing. It was problem even in Japan far before the US.