
Open letter from Italy to the international scientific community - magoghm
https://left.it/2020/03/13/covid_19-open-letter-from-italy-to-the-international-scientific-community/
======
joshstrange
Chris Martenson likes to say "If the facts scare you, the problem isn't with
the facts". (also check out his COVID-19 updates, I think they are very well
done! [0])

You may think "it's not here yet". It is.

You may think "the numbers are low". They aren't. We are failing miserably in
our testing, our numbers are easily off by a factor of 10 (for infections).

You might not want to be "weird" and not want to practice social distancing.
You need to.

You need to act when it feels too early and honestly, in the US, that was a
week+ ago so at least act now.

I don't say these things to whip people up in a panic, I say them because we
are about to get hit hard here in the US. If you know a nurse maybe send them
a text and ask how they feel. I can tell you the nurses I know are freaking
out because they know we are not prepared. A have a friend who works at a big
hospital. They have 2 cases (at least as of a day ago) and they almost buckled
under it. They don't have many masks, they don't have training, and the
hospital itself has no plans in place. When asked "How many masks do we have?"
the answer (on Thursday of this week) was "I don't know" from the head of
infections diseases. Let that sink in. March 12th.

I can understand not knowing the count off the top of your head in November
2019, I can understand it in December 2019, I can still wrap my head around
not knowing it in January 2020 but damn it... It's March, you are in a meeting
to discuss COVID-19 and you don't know how many masks you have on hand?

The world has been warning us for months now and they had no plans for how to
handle visitors. The nurses have not done n95 mask fit tests. They are not
getting clear direction on how handle mask reuse. We are not prepared for
this. If this hospital (which I would trust for any major procedure) is
feeling the strain with 2 patients what happens when there are 4? 8? 16? 32?

[0]
[https://www.youtube.com/playlist?list=PLRgTUN1zz_oeQpnJxpeaE...](https://www.youtube.com/playlist?list=PLRgTUN1zz_oeQpnJxpeaEkFimDeepqyWf)

~~~
sdkaufman
> I don't say these things to whip people up in a panic, I say them because we
> are about to get hit hard here in the US.

The average person in the US rightly did not have much reason to be concerned
a few weeks ago, but that's not the case anymore. It's important to understand
that the situation has evolved rapidly for the worse here, and our response
("panic level" if you will) must escalate accordingly.

In particular:

\- Each one of us is now at much higher risk of infection, possibly orders of
magnitude higher than the official numbers suggest. The bungled testing
rollout, the high level of community spread and the number of deaths together
suggest the official numbers are grossly under-counting. [1] This is very
different from a few weeks ago when the cases where mostly imported or had
known transmission routes.

\- A few weeks ago, the CDC was still hoping to contain the epidemic by
tracing and quarantining cases. But that has changed. Whereas China, Hong
Kong, Taiwan etc have succeeded in containing the disease so far, the US has
already failed and the CDC now expects it to eventually spread to most of the
US population. [2] Its strategy is now to slow it down enough to avoid what's
happening in Italy.

\- The situation in Italy has shown us the magnitude of human suffering that
will result from people "under-panicking" and going about their daily lives at
a similar stage of the epidemic. There will be a rapid explosion in cases,
leading to a meltdown of the health care system. Many of us will lose our
loved ones, and many of us will die unnecessary deaths from hospitals being
overrun. Not to mention the impact on the economy, which we can't measure yet
in Italy but could well be greater than the cost of locking down early.

So stop thinking "it's fine". It was a few weeks ago. It's not anymore.

[1] [https://medium.com/@tomaspueyo/coronavirus-act-today-or-
peop...](https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-
die-f4d3d9cd99ca)

[2] [https://www.cdc.gov/coronavirus/2019-ncov/cases-
updates/summ...](https://www.cdc.gov/coronavirus/2019-ncov/cases-
updates/summary.html) or
[https://www.youtube.com/watch?v=9cfYC4YLsu4](https://www.youtube.com/watch?v=9cfYC4YLsu4)

~~~
joshstrange
100% agree with what you are saying. I really meant more so that I don't want
to encourage hoarding or panic buying to the level where other people can't
get what they need. You should be worried, you should be preparing in anyway
you can (2 weeks+ food, isolate yourself as much as possible, discourage
gatherings of any size).

~~~
sdkaufman
Yep, 100% agree. No reason to go rob-a-hand-sanitizer-factory crazy. But as
you said, everyone one of us should be worried enough to go prep and do our
part to slow the spread (WFH if possible etc).

------
lbeltrame
As an Italian, I raise my eyebrows every time China is mentioned as an example
for the successful containment of this virus.

It could do that because it could afford to take the economical hit _and_
because it is an authoritarian state, which means you can get almost everyone
to obey, in one way or another. Also, the Chinese Party is what caused this
mess to begin with, by allowing this virus to spread all around the world.

Why on Earth is this a good model?

Undoubtedly for the safety of citizens, but even with all the people shouting
about a "fascist revolution" going on with the previous government, it only
took _three orders_ to strip everyone of most of their freedoms without anyone
batting an eye (especially since no one knows for how long, the April 3rd date
is a joke).

Quarantining is probably inevitable (although it won't help the overloaded
ICUs until two weeks from now, so more capacity will always be needed), but
following rules in place in an outbreak does not mean one should not question
their principles.

And this letter should be sent to the media and the government, since both
can't even understand an exponential, or basic statistics (even with the so-
called "peak" reached, _cases will keep on increasing_ until recoveries are
due).

Personally I'd like fast-tracking of anti-SARS-CoV-2 drugs instead (those are
the ones which will get out of this mess, quarantining is just flattening the
curve, although immensely beneficial), along with setting up place for non-
intensive care COVID-19 patients. Every ICU bed freed is a victory.

~~~
tuna-piano
Just like China, there was a time when Italy had 1 case, then 2 cases, then 4,
etc. Italy was unable to stop the spread before reaching a huge level and
spreading to other countries.

Why blame China for "allowing this virus to spread all around the world" when
Italy allowed the same?

(Italy even had a warning that it was coming!)

~~~
nexuist
Doctors and civilians tried to sound the alarm that something was going on,
and were silenced until it was too late. To their credit, the CCP fired the
Wuhan officials who presumably silenced those people, but it is still their
responsibility for fostering a culture where towing the line and hiding
problems until they cannot be hidden is acceptable for leadership positions.

~~~
jennyyang
There's nothing to credit. Everyone was in on the silencing, the CCP only used
those officials as scapegoats. Everyone on all levels of politics was keeping
this a secret and hoping it would go away.

------
mensetmanusman
As a physicist, it still feels odd to me they are talking about statistics
with such confidence here.

It seems only SK has earned that right and has tested enough people to get
reliable statistics. If you only measure the sick in the hospital...

~~~
soVeryTired
The pattern is fairly consistent across countries [0]:

[0]
[https://www.ft.com/__origami/service/image/v2/images/raw/htt...](https://www.ft.com/__origami/service/image/v2/images/raw/http%3A%2F%2Fblogs.ft.com%2Fthe-
world%2Ffiles%2F2020%2F03%2Ftrajectory-mar14.png?fit=scale-
down&source=next&width=700)

~~~
Animats
That is the most useful graph on this subject so far. Go look at it now. Most
countries have exactly the same growth trajectory measured from 100 cases.
That's solid data about how this behaves.

Singapore and Hong Kong have been able to slow things down by strong measures,
but it's still a straight line on a log graph, just with 1/3 of the growth
rate. Italy is on the same line, just 8 days ahead of Europe and 13 days ahead
of the US.

Only South Korea shows flattening so far.

~~~
TeMPOraL
I still don't get how people - including apparently some governments - don't
get or don't believe it. Getting this graph is as simple as 1) taking the
daily measurements, and 2) plotting them on log scale (and technically 3)
shifting the lines to overlap, but that's just cosmetics). The trajectory of
the entire West being the same as Italy's is immediately apparent.

~~~
Animats
It's much worse than that. Italy's health system is already collapsing at
20,000 victims. The population of Italy is 60 million. That has to level off
at some point due to saturation, but that's at somewhere in the millions or
tens of millions.

~~~
riffraff
FWIW, at the moment it's only lombardy's health system which is collapsing,
because most of the victims are concentrated there and the growth rate there
was _much_ faster because the lock down was only imposed late.

The growth rate is the same in other regions but delayed, and there is some
hope that the rest of the country might be able to cope with it better if the
lock down measures are effective.

~~~
sgc
Hopefully. But the health care system in Lombardia has to be the best or at
the top of entire the country. Southern Italy will struggle with fewer cases.

------
feral
I work as Principal ML Engineer, and did a little epidemic modeling in my ML
PhD.

I wrote an analysis of how this is going to hit Ireland, including the best
calculations I could find on fatality rate:

[https://medium.com/@fergal.reid/predicting-the-impact-of-
cor...](https://medium.com/@fergal.reid/predicting-the-impact-of-coronovirus-
on-ireland-bff1b6d00d6a)

I think that left unchecked this could kill millions of Americans in a couple
of months. I'd love to be wrong.

~~~
toohotatopic
>If that trajectory persists, and we don’t arrest it, in the 2 weeks closest
to peak rate, we’ll have seen 75% of our cases emerge.

vs

>in a couple of months.

Why months? If there are 75% of the cases within 2 weeks, won't 75% of the
deaths also occur within 2 weeks?

~~~
bo1024
It says in the two weeks closest to peak rate. So if the peak is mid-May,
those 75% would all fall in May.

------
mirimir
Maybe Italy is a worst case, both because it didn't quarantine early enough,
and because greater population inversion.

> It's now a well-established fact that older people and those with underlying
> health issues are more susceptible to succumbing to Covid-19. With 23
> percent Italians aged 65 or above and a median age of 47.3, the Italian
> population is the oldest in Europe. This is chiefly responsible for the high
> fatality rate in Italy.[0]

Also these articles.[1,2] And similar to the age effect in China.

0) [https://www.ibtimes.sg/fatality-rate-7-16-why-coronavirus-
de...](https://www.ibtimes.sg/fatality-rate-7-16-why-coronavirus-death-rate-
double-italy-rest-world-40975)

1) [https://nypost.com/2020/03/12/heres-why-the-coronavirus-
deat...](https://nypost.com/2020/03/12/heres-why-the-coronavirus-death-rate-
is-so-high-in-italy/)

2) [https://www.theguardian.com/world/2020/mar/03/italy-
elderly-...](https://www.theguardian.com/world/2020/mar/03/italy-elderly-
population-coronavirus-risk-covid-19)

~~~
sorum
Italy isn't the worst case, they're just 2 weeks' ahead of most other
countries.

Looking at the latest SitRep from WHO, my home country (Sweden) has small no.
infected (775), but grew 25% vs the previous day. If that rate keeps up,
number of infected will keep on doubling every 4-5 days and in 14 days' time
will be at what Italy is today (17k infected). And then another week later
it'll break 100k. Exponential growth is a bastard in that sense.

~~~
tapland
In Sweden we've avoided testing people who haven't been in high risk areas,
and moved from that to only testing 'risk groups' (elderly and with
preexisting conditions), so the numbers shouldn't be seen as reflective of the
total number of infected.

~~~
toohotatopic
Isn't Sweden itself a risk area? Looking at cases per 1M population [1],
Sweden is at no 10, and its neighbors Norway and Denmark are at 2 and 6.

How come there are so many cases per capita? All the neighboring regions like
Poland, Russia and even the North of Germany, have fewer cases.

[1]
[https://www.worldometers.info/coronavirus/#countries](https://www.worldometers.info/coronavirus/#countries)

~~~
Yetanfou
Sweden, like the UK and possibly the Netherlands has chosen to let the disease
spread among the population to achieve what they call "herd immunity" [1 -
Swedish]. There might be some truth to the herd immunity thought, the problem
is they don't have any control over the speed at which the infection will
spread through society. Eventually everyone who can be infected will get
infected no matter what is done so that herd immunity will also occur in a
situation where the spread is limited by isolation as is done in most other
countries. In other words, herd immunity is a given outcome of all approaches
and as such does not need to be stated as a goal. The goal should be to limit
the load on the health care system so as to limit the number of people who
will die in the wake of reverse triage in an overloaded system.

In short, the stated goal will always be achieved so it is a variable which
can be struck from the equation. Having this as a goal is the equivalent of
not having any goal at all.

[1] [https://www.expressen.se/nyheter/strategin-lat-manga-
smittas...](https://www.expressen.se/nyheter/strategin-lat-manga-smittas-i-
lagom-takt/)

~~~
lawn
Note that it's only the opinion of someone that Sweden is following the "herd
immunity" strategy, and it's denied by several officials.

Sweden hasn't closed down schools etc like other countries have done so it's
fair to argue that it's being done in practice, but it doesn't seem to be a
conscious decision.

~~~
Yetanfou
_Statsepidemiolog Anders Tegnell säger att resonemanget om flockimmunitet
”delvis” stämmer, men att det inte är myndighetens strategi. – Vårt huvudsyfte
nu är att få smittspridningen att gå så långsamt som möjligt._

...which translates to...

 _State epidemiologist Anders Tegnell says the reasoning around herd immunity
is partly correct but that it is not the organisation 's strategy - our main
goal now is to get the infection to spread as slow as possible_

...but the Swedish government is not actually doing much to limit the spread
of the disease other than telling people who show symptoms to stay at home. By
now it has mostly been proven that infected people spread the infection for a
few days before they show symptoms and the fact that children can be and often
seem to be asymptomatic carriers the spread will be rapid and result in a
large number of people in need of medical care. The Swedish health care system
was already overloaded before the pandemic so it will not be able to handle a
large number of patients in need of critical care. The same scenario is now
playing out in Italy so this should not come as a surprise.

------
willart4food
"Everything we do before a pandemic will seem alarmist. Everything we do after
will seem inadequate." \- Michael Leavitt, former HHS Secretary under
President George W. Bussh

------
cknoxrun
My co-founder and I are really struggling with the decisions ahead of us. We
feel we should act quickly, and enforce our team to work from home, but the
spread in our city is quite low for now. We also wonder how long this can go
on, are we going to be isolated for months?

We are at a critical point where we have just closed our seed round this past
week. We have both put so much energy and time into this moment and we were
ready to work harder and focus on scaling and growth.

Of course, the more tragic situation around us makes our issues seem small. I
think we will likely announce to our team to work from home starting Monday.
How surreal.

~~~
smacktoward
_> the spread in our city is quite low for now_

If you’re in the United States, where testing has been infuriatingly limited,
the fact of the matter is you have _no idea_ what the spread in your community
is. The numbers aren’t low because nobody has the virus, they’re low because
nobody has been tested. If we did actual testing, they might come in low or
they might come in high, who knows. As it stands, nobody has any real idea
just how bad the spread is here. Absence of evidence is not evidence of
absence.

Given that, the safest course is to assume the spread is high, and act
accordingly.

~~~
tcbawo
The state of Ohio has only 26 confirmed cases, but two days ago the Director
of the Ohio Department of Health estimated that 1% of the state's population
(100k) may be infected due to the high ratio of cases being community-spread
[1].

This is the likely reason for such a high number of celebrities in the news
testing positive -- it's already everywhere; they are the only ones getting
tested.

[1] [https://www.wkyc.com/article/news/health/coronavirus/ohio-
de...](https://www.wkyc.com/article/news/health/coronavirus/ohio-department-
of-health-director-believes-more-than-100000-people-in-the-state-are-already-
carrying-the-coronavirus/95-f6d8add8-94b5-42ec-bba1-347e6eed29bd)

~~~
seganddr
That 100k number is for the whole world. It was a poorly worded tweet

~~~
cmurf
She said it out loud. There's nothing confusing or ambiguous about it.
[https://www.washingtonexaminer.com/news/top-ohio-health-
offi...](https://www.washingtonexaminer.com/news/top-ohio-health-official-
believes-over-100-000-people-with-coronavirus-in-state)

------
bengalister
Here in France even with the Italian experience relayed in the press, i.e
doctors having to make many times a day a choices between the ones who will
live or die, many people don't take it seriously.

I am shocked but not surprised by the behavior of my fellow citizens. Many
people still went out shopping, went to the restaurants, still think it is a
simple seasonal flu and do not at all comply with the recommendations of
avoiding contacts.

The government decided at last today to close the restaurants and most of the
shops except grocery stores and drug stores.

Also I think in France at some point the army will have to be called to help,
to let policemen enforce the rules and be used to secure sensitive sites. With
the periodic social unrest that France endures since the last major "ethnic"
riots of 2005 and the more recent and more social yellow vest protests, I am
afraid that in France there will be also a lot of indirect deaths of the sars-
cov-2 pandemic.

~~~
rambojazz
> I am shocked but not surprised by the behavior of my fellow citizens. Many
> people still went out shopping, went to the restaurants, still think it is a
> simple seasonal flu and do not at all comply with the recommendations of
> avoiding contacts.

This is what happened in Italy as well. 1. people are recommended to stay the
fuck home and reduce physical interactions 2. most people don't care and carry
on with their normal life 3. state now needs to enforce harsh rules because
people don't seem to understand that it's serious 4. some people still don't
care, go to parks, beaches, private parties

------
RivieraKid
"Flattening the Curve" is a deadly delusion

[https://medium.com/@joschabach/flattening-the-curve-is-a-
dea...](https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-
delusion-eea324fe9727)

"Flatten the curve" scenario requires r0 to between 1.0 and a small number
above 1.0, like 1.1. In other words, it's not happening, you either contain
the virus or let it explode.

~~~
contravariant
It's also somewhat troublesome that for the 'flatten the curve' tactic the
best case scenario is still infecting everyone...

~~~
ElderKorihor
No it isn't. The hope is that at some point a vaccine or lighter treatment
becomes available. If that occurs before the end of the flat curve, that's a
major change in outcome.

~~~
lee
Most vaccines take 1.5 to 2 years to develop. By then most of the population
will have been infected by it and will develop a natural immunity or
resistance to it.

------
rosybox
It's unlikely that other countries can do what China has done. As an example,
China is able to do 200 CT scans a day at each fever station throughout the
affected regions. In the US we can maybe do what 10 CT scans a day with a
single machine? In China they were able to figure out within a short duration
if someone needed to be quarantined. They built hospitals in days. It's not
just about locking down. China has people taking temperatures of people
entering their apartments or when they show up at work. There are drones
patrolling the streets that detect people with a high temperature. I have a
hard time seeing us in the US build out what China did in just a few days.

~~~
tantalor
Do CT scans even help?

~~~
Osmium
They're an effective diagnostic, faster than testing for the virus directly.
At least they seem to be effective at these fever clinics. NYTimes Daily
podcast had a good explanation of how these fever clinics work.

------
exegete
The last part urges lockdowns like China and South Korea but my understanding
is that South Korea has not been doing lockdowns and instead was able to ramp
up testing quickly and isolate infected from others. Is that incorrect?

~~~
Benmcdonald__
Yes no lock downs and I believe minimal travel restrictions (only Wuhan,
China?). They did extend the school holidays. Even in the center of the
outbreak Daegu there was no lockdown in the city.

~~~
Benmcdonald__
Other things people probably don't realise about Korea. Self isolating and
monitoring for people entering the country. Also they aggressive tracked
contact with infected people. Watching supermarket survalence video seeing who
they were near and then publishing nationally the time and location of where
they had been

~~~
pbourke
plus everyone is wearing a mask

------
jakub_g
> It’s hard for non-specialists to intuitively grasp the way an exponential
> rate increase can get out of control.

The best way to explain the exponential growth (and shock people) is ask them
about
[https://en.wikipedia.org/wiki/Wheat_and_chessboard_problem](https://en.wikipedia.org/wiki/Wheat_and_chessboard_problem)

~~~
adrianmonk
I like the way a teacher explained it in grade school. She said to imagine we
had a choice between two deals. One option is that someone would give us $100
each day for a month. The other is to receive 1 cent the first day, 2 cents
the second day, 4 cents on the third day, doubling each day until a month has
passed.

Of course we all chose $100/day. Then she told us it was too bad we didn't
take the other option, because we would have been multi-billionaires.

~~~
tomp
Keep in mind that your teacher is wrong (or you remember incorrectly). Given
that a month has at most 31 days, 0.01 * 2 ^ 30 = 10 737 418.24 (if you sum up
all the payments, double that - $20m), so quite far away from "multi-
billionaires". The general principle stands though.

~~~
adrianmonk
Oh right, of course I forgot to divide by 100. I should have also remembered
what my other teacher said: always check your units.

------
liquidify
Here in the U.S.A. in Indianapolis, my 60 year old dad is out at a club right
now dancing with his old people girlfriends. He is a smart dude (on paper -
tenured professor of finance), but he doesn't think he has a thing to worry
about.

I hope we get a lock down here. Many people are too selfish, arrogant, and
stupid to make the right choices even when it is obvious.

~~~
pinkfoot
I would argue that your father's actions are brutally rational: get the virus
now, so he still has a shot at a ventilator before the system is swamped. He
could be recovered and immune when the rest of you are figthing over the ICU.

Not exactly neighbourly though.

------
iRobbery
Just from the start already i dont get a scientific feeling.

"In just 3 weeks from the beginning of the outbreak, the virus has reached
more than 10.000 infected people."

Does this mean only tested 10.000 people? Reads a bit odd though too, i assume
they were not infected already when the virus reached them?

"From our data, about 10% of patients require ICU (Intensive Care Unit) or sub
ICU assistance and about 5% of patients die."

Is this from 10% of the people actually going to the hospital, or 10% of all
tested, or 10% of all people that got the virus?

~~~
yelloweyes
Who cares. The point is to get people out of their comfortable complacency.

Read this one: "We are now in the tragic situation that the most efficient
health system of the richest area of the country (Lombardy) is almost at its
full capacity and will soon be difficult to assist more people with Covid-19."

~~~
kspacewalk2
I care. These doom and gloom shrieks and exhortations for President Madagascar
to Shut. Down. Everything are distracting from the real work governments have
to do to tackle this severe and protracted crisis in a competent manner, i.e.
following the advice of real, not collective-letter experts.

~~~
mtmail
The advise from real experts is also to shut everything down.

~~~
kspacewalk2
No. It is to flatten the curve, i.e. to get infected slowly and manageably, in
order to minimize peak ICU admissions. This will minimize deaths. If you fuck
up initially, like China and Italy, by severely underestimating the problem,
you're forced to shut down everything for a bit, but in the end everyone will
be doing the same thing - shutting down some things to control the infection,
not try in vain to "stop" it.

~~~
7177Y
Best to shut down now and flatten as much as possible, no?

------
LeoNatan25
Here in Israel, ministry of health wanted a full lockdown. But business won,
so only a partial lockdown is enforced, and they are shutting down only clubs
and restaurants. People will still be able to visit parks, roam freely, etc.
Today there was an article [1] that some idiot that was in quarantine left it
and was arrested on the street. There is no discipline. A hard lockdown is
likely the best option everywhere. It works, as evident in countries that have
enforced it.

1:
[https://www.ynet.co.il/articles/0,7340,L-5694758,00.html](https://www.ynet.co.il/articles/0,7340,L-5694758,00.html)

~~~
zozbot234
> Today there was an article [1] that some idiot that was in quarantine left
> it and was arrested on the street. There is no discipline.

Hopefully he/she was nabbed quickly, without spreading the disease to anyone
else. Is Isreal using electronic tagging on those quarantined folks to ensure
that they can't just leave their assigned place without anyone knowing about
it?

~~~
LeoNatan25
They are starting to talk about it, but there are big privacy concerns of
tracking citizens by intelligence agencies. Not sure what the status of this
is, but will probably pass parliament because everyone is very scared. They
can abolish it later, but we all know they probably won't.

It is unclear of the idiot that evaded quarantine is sick or only
precautionary, but that's just the people we have—morons. Very different from
Hong Kong and Singapore.

~~~
zozbot234
> but there are big privacy concerns of tracking citizens by intelligence
> agencies.

Huh? An ankle bracelet ("tag") is quite transparent, it's not covert
"intelligence". The deal is, you get to wear it for a couple weeks while you
recover from your potential illness, and you _know_ you're being monitored so
you're not going to just leave your assigned place and hang out anywhere else.

~~~
LeoNatan25
What they were speaking about here is using people’s phones.

------
heisenbit
> Every minute is exceptionally important as it means saving lives. Don’t
> waste it!

The fact that the US Senate did not speed up the emergency measure by staying
is loosing 2 days. At that time the measures are in place the problem is twice
as large. In normal times this is just a business day delay but in these times
calendar days are the measure and weekends are counted too. We really need to
start thinking and acting differently.

------
throw7
It's too late for the U.S. There isn't a clear, organized, unified direction
of testing and action plan for all humans within its borders. That's the only
way to get and organize an effective response.

We're canceling/closing off large groupings of humans and basically
hoping/praying? for the best for the next few weeks. It's sad. This type of
haphazard response drives conspiracies and confusion that is then
opportunistically taken advantage of by all sectors of power.

------
C19is20
Lockdown resident: i fear our population will get bored off the lockdown,
and/or fearful of shops running out of goods (part caused by sick workers,
sick transporters, and people taking a risk and going shopping anyway), and by
Wednesday there'll be reports of social unrest. This will be seen by other
countries, who will impose more stringent curfews, and a cycle of restrictions
will start. When the forces of law and order get sick, then the real fun will
begin. Of three local food shops to me, one just got closed as a workers
spouse has been hospitalised. Tomorrow, do i go get whatever food may be left
in the other stores, play hide and seek with the police, then perhaps get
sick, or let my family go hungry?

------
lazyjones
The fact that growth rates seem very similar in all affected countries,
baffles me. Surely lifestyles, social structure (number of families/kids
etc.), hygiene habits differ slightly and testing rates/effectiveness of the
health system varies greatly among them. If these factors aren't important,
does social life even matter? The effectiveness of China's lockdown is a good
argument for it, but perhaps they were just more effective at identifying and
isolating spreaders? My point is that there's a chance that it spreads through
the air or in some other way unaffected by curfews etc. (if you leave the
windows open...).

~~~
tim333
It's not true that they are similar in all affected countries. The ones in
that graph are cherry picked for similarity. If you look at China, Taiwan,
Singapore etc there are differences.

eg Fujian
[https://mackuba.eu/corona/#fujian_china](https://mackuba.eu/corona/#fujian_china)

Taiwan [https://mackuba.eu/corona/#taiwan](https://mackuba.eu/corona/#taiwan)

HK
[https://mackuba.eu/corona/#hong_kong](https://mackuba.eu/corona/#hong_kong)

Taiwan is impressive in that they had thousands of flights a month to China,
have only 30 active cases and no lockdowns. They had people ride on the planes
from Wuhan to identify sick passengers during the flight and quarantine them
on landing.

As a Brit I'm embarrassed by our performance in comparison.

------
seles
Lockdown is not a long term solution though. This virus isn't going to
disappear anytime soon. It might be good for countries that are getting out of
control, but for places where it isn't a problem yet it just delays when it
his.

Places without a problem yet should take reasonable sustainable precautions to
flatten the curve instead.
([https://www.flattenthecurve.com/](https://www.flattenthecurve.com/))

~~~
soared
Lockdown is literally what flattens the curve. The slower the virus spreads,
the flatter the curve gets.

The virus still spreads in lockdown, just at a slower pace. We will likely see
resurgences when the lockdown(s) are lifted, but the idea is to plan to do
that when we can handle it.

------
spacephysics
We don’t need military patrolling our streets just yet. Not saying it won’t
come down to it, but the sentiment in the US is less, uh... flexible, towards
being heavily locked down as compared to the aforementioned countries.

~~~
GarrisonPrime
Or at least, some people would like to believe that. I suspect an astonishing
large number of them will discover differently, should those ideals be put to
the test. Just a hunch.

~~~
7177Y
Much of the herd will comply. Many others will make their stand, especially
with the current state of sentiment In the right wing population.

------
thepra
From Italy, don't trust the Italian media, they are the first that are making
so much fuss and wrecking chaos, and especially making quite some money
because as an industry it was starving for some time.

Statics say clearly what strategy could have been followed to take care of
coronavirus without much disruption of the working force. And the people at
the government are mostly old farts, which says quite a lot why they panic.

------
riazrizvi
The time shifted rates of growth tell a compelling story, along with the fact
that 1000 people out of 10000 required hospitalization. That is certainly
statistically significant. I am now concerned that my birth country, the UK,
has the wrong response. UK hospitals will not be able to handle that much
traffic.

------
anigbrowl
I'm not too optimistic. Scnes like this at multiple US airports.
[https://twitter.com/JasonWhitely/status/1238986444615618561](https://twitter.com/JasonWhitely/status/1238986444615618561)

------
delegate
I've seen comments here trying to play down the message or discredit the
signatories of this letter. Don't.

Please take it seriously. This is not sensationalism.

What the letter means is that if your country is not there yet, you might be
_DAYS_ away from widespread panic and total lock down.

I'm writing this from Barcelona, Spain. This last Sunday, 6 days ago, I went
on a walk with my girlfriend, had a nice lunch, took beautiful pictures...

The virus was just some nagging news.. A couple of hundred people infected
somewhere far away.

6 days later, we're at over 6000 infections, the country is in total lock
down.

Same pattern as Italy (even faster), we're just a couple of days away before
tens of thousands is reached. This is what exponential growth means.

~~~
hatenberg
There is really no excuse for this happening in Europe. There was ample
warning and no, not just from China. The math was very clear by early/mid
February.

We have to face the truth that the quality of people we vote for government is
not where it needs to be and that science has too long been discredited and
ignored.

Some of asia learned from SARS but that's it.

Madrid was hosting marches, political rallies and soccer games with
10.000-100.000 people a week ago because people did not want to make the hard
choices needed even as Korea was burning and Italy started to.

Excuses that China is authoritarian do not cut it - this was a huge fail of
governance and doing what people are elected to do

~~~
chongli
Human beings do not intuitively understand exponential growth. It's just too
fast for our primitive brains. In some sense, we are standing in the middle of
the road, frozen like deer in the headlights.

Science is supposed to mitigate the shortcomings of our natural intuitions and
cognitive biases. The problem is that most people are not scientists. When a
non-scientist is asked to trust a scientist, he or she is subject to all of
the usual suspects: arguments from authority, confirmation bias, Bulverism,
appeal to emotion, etc. What this means in practice is that scientists are
generally not trusted over the word of one's friends and family.

~~~
submaroon
> Human beings do not intuitively understand exponential growth.

This layman has read that we intuitively think of numbers logarithmically,
which makes him wonder if we human beings do, in fact, intuitively understand
exponential growth.

[https://www.scientificamerican.com/article/a-natural-
log/](https://www.scientificamerican.com/article/a-natural-log/)

~~~
nine_k
...and see it as merely linear. That's the problem.

Exponential growth is like dynamite. It's absurdly fast, compared to anything
people see in daily lives.

~~~
mirimir
Dropping stuff and falling are good examples. If you're paying attention,
anyway. I can still grab stuff that's fallen maybe 10-20 cm, but by 50-100 cm
it's moving way too fast.

~~~
MiroF
That's a terrible example, why would pick an explicitly sub-exponential
relationship?

~~~
bonzini
Because exponential is even worse.

~~~
mirimir
Right. Because it's not linear.

The only truly exponential example that comes to mind is milk souring. But
that's too slow, unless you keep notes.

------
mleonhard
Mike Pence is not the right person to manage US response to the virus. We
needs someone with different skills. If you live in US, please call your
congresspeople and ask them to make a change:

[https://www.house.gov/representatives](https://www.house.gov/representatives)

[https://www.senate.gov/senators](https://www.senate.gov/senators)

------
Medicalidiot
I was downvoted here recently for sounding the alarm bells on how bad this is
going to be and accused of trying to incite panic. Folks, COVID-19 is
something that should be taken seriously. President Obama had great advice:
"stay calm and listen to the experts". All the experts are saying this is
going to be bad and we should be getting ready now for what will happen in the
future.

------
RivieraKid
Please also read this, I believe it's the right approach:

[https://medium.com/@jb_89278/the-11-day-plan-to-contain-
covi...](https://medium.com/@jb_89278/the-11-day-plan-to-contain-covid-19-the-
global-11-day-plan-99e324630de7)

The guy is tech enterpreneur and VC investor who has been advising our (Czech)
PM.

~~~
js2
It would be impossible to do this in the U.S. I'm not sure he appreciates the
size of the U.S., the resistance among many Americans who don't like being
told what to do, the denial by Fox et al, the distributed nature of our
government and on and on. I can't even imagine it working in my county.

~~~
beatgammit
Yeah, there would be rioting pretty much immediately if anyone tried that
here, and I'm sure the same would happen elsewhere.

I'm personally a fan of controlled, opt-in infections to help speed up
research for a vaccine along with moderate quarantine (cancel many public
events, encourage self quarantine). It may not be as effective, but it's much
less likely to end in riots.

~~~
RivieraKid
The alternative may be an explosion of cases and a complete collapse of the
health care system. Because there is a good chance that mild social distancing
measures are simply not enough.

------
jyrkesh
I've been using [https://meet.jit.si/](https://meet.jit.si/) through OBS with
family to share content/games and webcam chat. Works great on mobile with
apps, desktop on web.

------
ausjke
It's said Germany does not lock down cities and fatality remains to be
extremely low, which gives British, even USA the confidence to practice herd
immunity.

I hope in US we will not see this exponential infected scenario, finger
crossed.

~~~
hesk
German cities are starting to lock down.

Berlin has canceled any gathering with more than 50 people. If it's less than
50 people, you have to keep a list of everybody who's there for a month.
Schools are closed. As are recreational places (cinemas, clubs, museums, gyms,
baths). Restaurants have to enforce 1.5 meters separation between patrons.

[https://www.berlin.de/rbmskzl/aktuelles/rathaus-
aktuell/2020...](https://www.berlin.de/rbmskzl/aktuelles/rathaus-
aktuell/2020/meldung.906890.php)

It's not quite Italy yet but it's close.

------
mirrorlake
Can anyone vouch for the legitimacy of the names on this list? Is this
authentic? I've been running my own numbers, and it does not seem far fetched
at all. Governments need to be taking this extremely seriously.

~~~
dsqrt
For what it means, I know some of the people on that list and I can say that
they are real scientists.

------
mleonhard
My relatives will never open a "left" website. Is there a version of this
letter with the graphs on another website?

------
jMyles
> From our data, about 10% of patients require ICU (Intensive Care Unit) or
> sub ICU assistance and about 5% of patients die.

I think that we really need to understand precisely what conclusions these
represent when we see statements like this.

Exactly what does "10% of patients" mean? 10% of those who test positive? 10%
of those who test positive and also show symptoms?

It seems that a majority of people who contract the virus and test positive
(let alone those who are exposed) do not show any symptoms at all.[0]

Of those who do show symptoms, estimates regarding how many any seek out,
receive, or require care vary _widely_ , so much so that it's very difficult
to draw any conclusions using any dataset that I've seen.

So I ask: When the authors here say "From our data", exactly what dataset are
they using and what operations are they performing on this dataset to arrive
at this number?

This is crucially important, because if this 10% is actually 10% of those who
already seek treatment for respiratory illness, and also subsequently test
positive for COVID-19, then the death rate is actually much, much lower than
most of the published reports.

It seems to me that we need to know the answer to this before proceeding with
any other restrictive public policy solutions.

I'm particularly concerned with the decision to close schools, which in many
cases (at least here in the USA) is inevitably going to lead to kids being
placed with grandparents for care, which is a terrible outcome if our goal is
to reduce exposure to vulnerable populations.

It is OK to question the panic. It is OK to believe, as I do given the
available data so far, that the panic is more harmful than the virus itself. I
have started a subreddit to gather data and opinions inclined toward using
this as an opportunity to appropriately prepare rather than race to drastic
solutions likely to hurt vulnerable populations.[1]

0:
[https://eurosurveillance.org/content/10.2807/1560-7917.ES.20...](https://eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180)

1:
[https://www.reddit.com/r/PrepareInsteadOfPanic/](https://www.reddit.com/r/PrepareInsteadOfPanic/)

------
blululu
Taiwan is probably the best model for how to handle a pandemic. The Chinese
government took strong action well after the virus became a huge problem
there. I suspect we will see a similar anti pattern repeated around the globe.
I’m sure that Donald Trump will follow the CCP in talking up how he reacted
decisively to the problem (a month late in both cases). This type of response
hardly deserves praise. Taiwan was swift and proactive in its response, and
acted intelligently before drastic measures were needed.

------
blondie9x
One of the most important upvotes of our lives.

------
lowdose
Why didn't more people die in China?

~~~
jstanley
Because Wuhan started welding people's doors shut as soon as they passed 400
new known cases in a single day.

That kind of behaviour is not acceptable in the West (nor should it be,
anywhere), but we still probably need to be taking this virus a bit more
seriously than we are.

~~~
devit
I think these claims of "this is not acceptable in the West" are absurd and
one of the causes of the current catastrophe.

All you need is to pass a law and enforce it with police and military, it's
not hard.

Since there is a good reason for the law, there won't be widespread
resistance, and in fact on balance citizen are likely to help enforcement
rather than hinder it.

------
Camillo
This is not "from Italy", it's been organized by a far-left Italian magazine.
Yes, they are "from Italy", but the title is disingenuous and misleading.

Note that the page lists "the editors" (of the magazine) as the authors, and
the first signature is by the magazine's publisher. The rest appear to be
various academic personalities they have reached out to, many of them not from
Italy or in Italy.

As for the contents, I don't necessarily disagree with the advice, but this
letter is not particularly well written, nor particularly authoritative.

For example, this section:

> The beginning of the outbreak had the exact same number of infections in
> China, Italy, and other countries. The difference is that China strongly and
> quickly locked down Wuhan and all of the Hubei region 8 days before Italy
> [3].

This is an exceedingly poor phrasing, almost seeming to suggest that the
outbreak started with a few cases everywhere in the world at the same time.
Inadvertently or not, this dovetails with China's PR push trying to claim that
the epidemic may not have started there (something that is readily disproven
by all epidemiological and genetic evidence).

Even setting aside the potential for confusion, the claim on its face is
clearly baseless. Maybe the outbreak started with ten people getting infected
in the Wuhan wet market on the same day (if we go by the wet market theory),
while in Italy it started with a single infected person entering the country.
Or, vice versa, maybe in China it started from a single infected person, and
in Italy it was brought in by ten different people carrying it into the
country separately. Who's to say?

At any rate, if you look at the source for that claim, you can see that it is
shifting the timelines to align at some particular point in the outbreak, and
it is comparing the time from that point when China imposed the Wuhan lockdown
with the time when Italy imposed the whole-country lockdown.

The source is certainly more interesting, and gives a better picture of the
situation than the letter does (although we have seen similar and better
analyses in English for a while). However, the "8 days" figure is somewhat
arbitrary. For example, Italy imposed a partial lockdown on the areas of the
country where individual cases were found days before they shifted to a whole-
country lockdown. Maybe that date should have been compared instead?

By the best information currently available, the first case in Italy came from
a person who was infected in Germany. According to the letter's claim, the
outbreak starts with "the exact same number of infections" (one, presumably),
and then grows at the same speed. But then Germany's timeline should be ahead
of Italy, yet it's not.

Then there is the elephant in the room, of course. If you cannot rely on
China's lockdown to contain the infection, then the rational and prudent thing
to do was not to wait for outbreaks in other countries and impose lockdowns
there. It was to restrict and heavily control international travel (cancel
flights, test all passengers, force visitors to quarantine, etc.). Would that
have been accepted by the public? Would that have been accepted by the authors
of this letter?

tl;dr: title is grossly misleading, please correct.

~~~
scarmig
Agreed, though you can find letters from individual Italian medical
professionals saying about the same thing. Most authoritative would be a
letter from the government of Italy or the equivalent of the AMA.

------
thehoomanist
Also someone from Italy here: never, ever praise China as it is the same
authoritarian state that caused all these deaths by silencing the truth when
it mattered the most. Had they not violently censored doctors (like their own
people or the current holocaust being carried on against Muslims), we would
not be suffering through this devastation. This is also absolutely not an open
letter "from Italy": it's a message from a minor—poorly written— publication.

------
itcrowd
Not sure why this is on the number 1 spot currently.

This is a letter signed by non-experts (albeit sometimes
scientists/engineers). To me, it comes off as the climate-change denier
letters or 9/11 "truthers" letters.

Please let the experts do their job. Don't spread uninformed opinions backed
up by Facebook posts and panicked researchers with expertise "relevant to
virus spreading" such as electronics, architecture and art history.

Be safe out there but don't let the fear and resulting panic of this virus be
worse than the virus itself.

~~~
edgecrafter
I hope you haven't read the reports from the medical frontline in Lombardie -
They are making life or death choices now due to influx of ICU patient without
enough equipment and medical staff exhausted and starting to get sick
themselves

One frontline story among many here
[https://twitter.com/jasonvanschoor/status/123714289107769753...](https://twitter.com/jasonvanschoor/status/1237142891077697538)

~~~
wnkrshm
Triage, i.e. if you show up and have any condition that reduces your chances
of survival you are not treated at all. Palliative care only.

------
meerita
The left drove us to the same situation here in Spain. I cannot be more
concerned with their politics, sadly, we should be prepared to a massive
spread.

------
Ninjak8051
The handwaving arguments in this letter are not convincing (especially the
"You do also understand that, as long as the rate of increase is exponential,
no linear solution to contrast it will work (I.e. increasing x times the
number of ICU machines, etc.)" nonsense). The stats in this very letter
indicate that 10% of patients require ventilators, which cost about $4000. So
even if the entire population were sick at the same time, would need
population * 0.1 ventilators, at a cost of $400 per resident.

The fact that we haven't spent $400 per resident to stockpile ventilators is a
failure of society and a failure of government. The economic damage over these
next few weeks will be far, far greater than $400 per resident.

~~~
cobookman
If you take every potential apocalyptic scenario and stockpile supplies. It’d
add up to much more than 400$/resident.

The real shame is globalization. If manufacturing occurred in Europe. In North
America...etc. we’d all just quickly ramp up our respirator production.

Instead the west outsourced this to China

~~~
stblack
This is only the first part of the problem.

The second part is, optimized supply chains that are effectively as empty as
possible, all the time.

Here in Canada an 18-day rail blockade by native bands was enough to cause
serious concerns in the supply of propane and other fuels in the eastern part
of the country.

It's shocking that eastern half of Canada, the majority of its population,
faces winters with just 3-weeks supply of fuel. The reason? Nobody wants to
carry inventory.

So for many things, we outsource creation, AND we optimize-away buffer stock.

