
Crimson Contagion - wyck
https://en.wikipedia.org/wiki/Crimson_Contagion
======
ponyfleisch
For people who are of the opinion that expensive preparation for low
probability events is untenable for elected governments because it would be
seen as wasteful:

My home country (Switzerland) has a conscription army. ~160k people, each with
either a pistol or an assault rifle at home, receiving regular training for a
few weeks a year while the government compensates their employer for the loss
in productivity. There are tanks, fighter jets and massive alpine
fortifications. It's expensive. Most countries have an army and they are
usually sized for an unlikely worst case scenario.

One would think maintaining a stockpile of PPE that would allow the
authorities to recommend (and even provide) masks for the general population
without risking a shortage in health care would be a relatively minor expense
compared to that. And yet, all over the western world, PPE is in short supply,
and that is without the general public wearing masks like they do in many
asian countries.

~~~
rhino369
The bigger question is why we rely solely on disposable PPE for catastrophes.
Instead of N95, they should be using P100 masks that can be cleaned and whose
filters last a couple months in a hospital setting.

They should have gowns that can be boiled and reused.

Surgical masks that can be boiled, etc.

Disposable PPE is used for convenience. It's easier and cheaper to throw away
an N95 mask than to clean an P100 mask, except when you can't buy N95 masks.

~~~
nickff
The problem is not cleaning. The problems are design, donning, doffing, and
tracking.

If you have re-usable gear, you have to make VERY sure that what you think is
clean is really clean. That means cleaning procedures have to be extremely
thorough, and you have to make sure that you NEVER mistake a soiled unit for a
clean one. In addition to designing things to be clean-able (which is much
harder than it sounds), you need to make sure that they are designed in such a
manner that they can be doffed safely. Taking off PPE sounds easy, but when
you are guaranteed to come into contact with biohazards, you have to be
extremely careful about how and what you do.

Simply put; desiging, manufacturing, and safely using re-usable PPE for use in
biohazardous environments is much harder than it sounds.

~~~
cameldrv
Fair enough, but wouldn't it make sense to have a stockpile of reusable PPE
that could last through a crisis? Then if you ran out of disposable PPE you
could switch to the reusable stuff. Perhaps mistakes would be made in
disinfecting it, but it's certainly better than people wearing substandard
masks and garbage bags.

We're now forced to reuse disposable PPE due to the shortage. It would have
made a lot more sense to be reusing PPE designed in the first place to be
reused.

~~~
nickff
If you can design and reliably manufacture re-usable PPE, I am certain there
would be a market for it.

I design some non-medical mechanical assemblies (various types, for use with
electronic equiment), and have no idea how I would design (reliably
manufacturable) re-usable PPE for use in a biohazardous environment. As far as
I can see, the problems would mostly be in the joints and fastening features
between different materials. Some features (such as filters) will likely need
to remain at least somewhat disposable, as I believe that all biofilters have
a limited lifespan.

------
andai
See also Event 201, two months later in October, a simulation of a coronavirus
pandemic.

[https://en.wikipedia.org/wiki/Johns_Hopkins_Center_for_Healt...](https://en.wikipedia.org/wiki/Johns_Hopkins_Center_for_Health_Security#Event_201)

~~~
kqr2
Nice explanation of why it was called Event 201:

In recent years, the world has seen a growing number of epidemic events,
amounting to approximately 200 events annually. These events are increasing,
and they are disruptive to health, economies, and society. Managing these
events already strains global capacity, even absent a pandemic threat. Experts
agree that it is only a matter of time before one of these epidemics becomes
global—a pandemic with potentially catastrophic consequences. A severe
pandemic, which becomes “Event 201,”

~~~
mirimir
And from the scenario:[0]

> Event 201 simulates an outbreak of a novel zoonotic coronavirus transmitted
> from bats to pigs to people that eventually becomes efficiently
> transmissible from person to person, leading to a severe pandemic. The
> pathogen and the disease it causes are modeled largely on SARS, but it is
> more transmissible in the community setting by people with mild symptoms.

That's almost exactly what happened. Except for the jump through pigs.

And the "growing number of epidemic events" is arguably caused by increasing
human contact with previously isolated habitats, driven by population
pressure.[1]

0)
[https://www.centerforhealthsecurity.org/event201/scenario.ht...](https://www.centerforhealthsecurity.org/event201/scenario.html)

1)
[https://www.scientificamerican.com/article/what-11-billion-p...](https://www.scientificamerican.com/article/what-11-billion-
people-mean-disease-outbreaks/)

------
zuhayeer
One of the key findings: "The United States lacks the production capacity to
meet the demands for protective equipment and medical devices such as masks
and ventilators imposed by a pandemic"

This is exactly why we can't have the government move like molasses. We had
several months, needed to react with urgency and failed.

~~~
adventured
> We had several months, needed to react with urgency and failed.

That's a rewrite of the actual history that occurred and what people
understood along the way.

They had a realistic four to six weeks max to start production of ventilators.
A herculean feat in fact. Even less time if you were going to judge it based
on understanding the severity and particular intensive-care heavy effects of
the virus.

It was not a certainty to the outside world that it was human to human
transmissable until the end of January. There was a lot of confusion due to
the total lack of access to China and its data.

From February 1st (China's reported numbers begin to spike here) to the point
where you understand it's a high global risk, capable of a large scale
outbreak that could threaten the US, it's another 1-2 weeks minimum based on
the rate of expansion in China's reported numbers and their inability to
contain it properly (and better yet, with China you watch what they do more
than what they say; during that first and second week of February, China took
what seemed like wild action domestically while playing down the danger of
SARS-CoV-2 to the rest of the world, including regarding travel restrictions).

Taking the decision to push billions of dollars in spending to jumpstart very
early production of PPE and ventilators, is a big decision that you better be
right about when you make it. You were going against the behavior of the
entire developed world by producing ventilators in February, so now you need
to be prepared to look like a paranoid lunatic, along with being called a
racist and xenophobe while you restrict travel and close borders.

It's February 7th and you need to coordinate with domestic industry, local
governments, international agencies, and companies around the world.

It's February 14th and you've got your first partnership together, they've
agreed to produce ventilators.

It's March 7-14th by the time they are able to produce their first ventilator
after preparing a factory for it, preparing any necessary design changes to
accomodate rapid scale production, and putting together a supply chain that
can scale for the hundreds of specific parts in a ventilator.

You need to build a scheme that can produce more ventilators than the present
total global annual supply.

It's mid to late April before they have consequential volume of production.
Assuming things go well.

Having closely followed all the ventilator efforts around the world, please
show me a faster timeline that is realistic. You're only going to beat our
present timeline by a matter of weeks, and that's if you aggressively jump out
in front of prevailing 'wisdom' at the time.

It's an extraordinary short amount of time to accomplish the ramping up of
producing ventilators.

~~~
maxerickson
The US intelligence community was watching mid-November.

Singapore started screening incoming travelers Jan 3, based on the pneumonia
cluster in Wuhan growing in size.

Xi found out about it and took aggressive measures ~Jan 21.

It was an obvious risk on Jan 3. Maybe not a high probability risk, but
obvious enough for a country to make sure they had the first couple of steps
of their response at least figured out. Human to human spread was pretty
clearly the case when the Chinese government started taking aggressive
lockdown measures.

So your timeline is pretty friendly.

And then the focus on ventilators is odd. How about masks and other PPE and
testing and so on?

~~~
MikeAmelung
> The US intelligence community was watching mid-November.

What? The US intelligence community was watching before the first person was
infected? Man, they've gotten a little too good.

~~~
maxerickson
[https://abcnews.go.com/Politics/intelligence-report-
warned-c...](https://abcnews.go.com/Politics/intelligence-report-warned-
coronavirus-crisis-early-november-sources/story?id=70031273)

~~~
MikeAmelung
> "Editor's Note: This story has been updated to reflect comment from the
> Pentagon."

> "As a matter of practice the National Center for Medical Intelligence does
> not comment publicly on specific intelligence matters. However, in the
> interest of transparency during this current public health crisis, we can
> confirm that media reporting about the existence/release of a National
> Center for Medical Intelligence Coronavirus-related product/assessment in
> November of 2019 is not correct. No such NCMI product exists," the statement
> said.

It doesn't seem likely that they were watching in mid-November when according
to

[https://www.theguardian.com/world/2020/mar/13/first-
covid-19...](https://www.theguardian.com/world/2020/mar/13/first-
covid-19-case-happened-in-november-china-government-records-show-report)

China "may" have retroactively found the first patient to be some guy on Nov.
17. That part could be entirely made up as well, I don't trust anything they
say.

------
KarlKemp
The article cited by Wikipedia is pretty comprehensive (and damning):
[https://www.nytimes.com/2020/03/19/us/politics/trump-
coronav...](https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-
outbreak.html)

------
ajross
What's interesting is the extent to which the real pandemic seems to have been
handled better than the simulation, despite what is objectively a less
effective federal response than the one envisioned (in practice, the actual
federal response seems to have done more harm than good as far as disease
control goes -- the one bright spot was the economic response).

It turns out that a few early mover states were more willing than expected to
institute rigorous lockdowns, other states followed on more rapidly than
expected, and the population as a whole (even in states with less effective
responses) was... actually fairly well informed and took appropriate action.

Basically, we stayed home and beat this. Now we need to finish the job, of
course, but absent some kind of crazy change in public behavior we're not
going to see the doomsday numbers that everyone was worried about.

~~~
remote_phone
I’m actually surprised at how compliant citizens were in general. I would have
expected more rioting or pushback but I guess that’s what we are seeing right
now. It’s been 6 weeks and I’m surviving but my wife and kids are not doing as
well. I can only imagine how bad some people have it, especially those in
apartments. At some point people are going to do the math and figure that 80%
mild symptoms rate that leads to immunity and a decent job is worth the risk
rather than starving to death alone. I think that breaking point will be
reached before end of June and I hope there are measures to deal with that.
Personally I would give everyone $2000/month and drop prices of marijuana to
keep the masses from rioting.

~~~
mrfusion
Well the hospitals have plenty of excess capacity now. We’ve very successfully
flattened the curve. It might be time to ease up.

I thought this doctor explained the idea better than I could:
[https://medium.com/@jbgeach/eight-reasons-to-end-the-
lockdow...](https://medium.com/@jbgeach/eight-reasons-to-end-the-lockdowns-as-
soon-as-possible-b7bb0bc94f00)

But I’m just winging this like everyone. I could certainly be wrong.

~~~
ajross
Only in some areas. New York is still teetering right at capacity. Active
cases have not dropped much at all, in fact. It's the rate of new infections
that has leveled off. This is good evidence that the exponential growth has
been halted.

No, it's not time to ease up. Unlike in February, we have effectively zero
buffer in many areas. A sudden increase in cases (which is what "easing up"
_means_!) would push us right over the edge.

We ease up when the outbreak can be sustained. It can't now, and won't for
several weeks, maybe two months more. Stay home.

~~~
ryankemper
Hmm. You seem to have repeatedly said that we should stay home, but didn't
really make much of an argument for it, the one exception being this point:

> we have effectively zero buffer in many areas. A sudden increase in cases
> (which is what "easing up" means!) would push us right over the edge.

\--

I think that this is not the best way to think about it. We need to contrast
the benefit of lockdowns (decreased transmission of the disease) with the
economic costs. And just to be clear, this isn't about investment returns, the
stock market, etc, it's about the very real fact that poverty, stress, and
economic uncertainty all eventually lead to deaths in their own right (either
indirectly due to being reluctant to seek medical care, or directly through
suicide).

If you're willing to discuss further, can we see if we agree on these points?

(1) This is a highly transmissible respiratory virus, and thus eradication is
impossible

(2) Given (1), the purpose of lockdowns and other measures is primarily to
prevent us from exceeding our hospital capacity, at which point the number of
deaths would go up dramatically

(3) The vast majority of the globe will be exposed to this. Avoiding that is
not possible, so it's just a matter of when

Therefore, we should work to mitigate the _impact_ of Covid (NOT with the goal
of eradicating it, which is impossible), but there is a point where the
economic damage will far exceed the cost of lifting lockdown.

BTW, it's not like ending lockdown means everything goes back to normal. We
would still be banning large gatherings, at least for a short length of time,
and we would still be advising at-risk individuals to self-isolate (and for a
country like the US, I don't have any hard numbers here but that could easily
still be 30-50% of the country who's considered at risk).

Last point I want to make. Many of us here work jobs that allow us to work
from home, and so we kept our jobs during this. We need to recognize that not
only have tens of millions of Americans lost their jobs, but a significant
chunk of those jobs will not be "coming back". Real value was destroyed. And
those who lost their jobs are exactly those who are likely to be in lower
socioeconomic classes and thus are much less equipped to weather events like
this.

(Sorry, the above was pretty rambly, so I hope there's still some value you
can get out of it :P)

~~~
ajross
Do you have a specific policy you're trying to advocate for?

You want to release lockdowns at the very moment where we are _at peak_
outbreak size? How is that not the worst possible time to do it? The very
definition of "releasing lockdown" is that the rate of spread will increase.
Since the exponent now seems to be very close to zero, that means it will
rapidly become higher than zero, and we will be growing exponentially again.

And we will start not from a dozen cases, but from hundreds of thousands. How
does the math work on that?

Also, to pick on some of your postulates:

> (3) The vast majority of the globe will be exposed to this. Avoiding that is
> not possible, so it's just a matter of when

The fact that we're peaking now, way under universal infection, proves this
wrong. We've beaten it, the war just isn't over. We didn't all get Ebola or
HIV, which were similarly novel. The world never acquired universal herd
immunity to polio either.

Some pandemics, like the 2009 H1N1 ("swine flu") outbreak, do work like that
and spread effectively uncontained. And it's bad when they do. Swine flu
killed a quarter million people, and COVID-19 is about an order of magnitude
more dangerous. So it maybe made sense to let one spread where we want to
contain the other.

Details matter, basically.

~~~
ryankemper
> The fact that we're peaking now, way under universal infection, proves this
> wrong.

Please define "peaking". Really what you mean is that the curve of new
infections is starting to flatten, but by definition, we are going to hit a
new, higher peak if we lift the lockdown, because we haven't exposed enough of
our population yet.

It is very important that we either agree on the 3 postulates I provided, or
can convincingly explain to each other why we disagree on point (3). The vast
majority of the globe will be exposed to this.

> We didn't all get Ebola or HIV, which were similarly novel. The world never
> acquired universal herd immunity to polio either.

Hmm. This is just incredibly wrong. It's not the "novelness" that determines
whether the majority of the globe will be exposed. You have to look at _how
the disease is spread_ and _how fast /easily it spreads_. HIV is _not_ a
respiratory infection. So it's a total red herring. Same thing with polio. It
should be really obvious that a disease where you need to be exposed to
semen/blood/other fluids of someone infected (HIV), or exposed to fecal matter
entering your mouth (polio), is going to behave differently than a disease
that spreads via respiratory droplets (covid).

Look, the entire world agrees we cannot eradicate influenza, and we also agree
that the majority of the world has some level of immunity to these diseases.
Whereas with a completely novel virus, we do not have widespread immunity.

Any infection that spreads easily enough (which tends to exclusively be
respiratory infections since they spread the most) is impossible to eradicate,
doubly so if there are natural animal reservoirs as their are with H1N1 and
sars-cov-2.

> So it maybe made sense to let one spread where we want to contain the other.

We cannot contain either of these diseases. It is infeasible. This is another
point we really need to agree on to be able to have a productive discussion.
Tell me, is there any respected health organization that is advocating a
policy of _containment_ towards covid? I am asserting that there is not.

Containment has virtually nothing to do with lethality of the disease, except
insofar as a disease with a 50% mortality rate will tend to burn itself out.
It's all about the transmission rate.

I agree that details matter. Which is why I think when the facts of how this
virus operates are examined, it is extremely clear that we will neither
contain nor eradicate the disease.

The approach you are advocating for will lead to the so-called "second wave"
that will crush us, and we'll have to close our economy down again to avoid
widespread infection, except (a) we won't be able to because we already
damaged it too much to have that headroom, and (b) as I believe this "first
wave" will show us, economic shutdown is just a bad policy across the board
except in areas where we are near peak hospital capacity.

Not sure if you're interested, but my thoughts on a "second wave" are that
it's an indication that a society totally mishandled the initial outbreak. We
need to try to maintain a steady rate of new infections, such that we are near
our capacity but not exceeding it. Now, due to how exponents work, it is
really easy to mess up that balance. But we have to work towards herd
immunity. (BTW, it's not something that you have to "work" towards, it's
really a natural process that we can only interfere with by trying to
foolishly contain rather than practicing targeted mitigation.

\--

> Do you have a specific policy you're trying to advocate for?

Yeah, I'll give you one to chew on. All at-risk individuals are encouraged to
voluntarily self isolate, and hunker down until we have a possible vaccine.
Those who are not at risk live life as normal, minus some large gatherings.
While those at-risk quarantine, everyone else is developing herd immunity.
BTW, it saddens me that "herd immunity" has been turned into a dirty word. It
is a natural consequence of the way immunity works in a population, and so the
idea that building herd immunity is "callous" or ineffective is just a total
disregard of reality.

 _We need to build immunity in as much of the population as possible_. That's
the _only_ way, and it's what we've done for every Influenza outbreak, because
herd immunity isn't even something you can avoid developing without
containment. But what we can do via misguided lockdowns is needlessly delay
the formation of herd immunity while also destroying our economy (I am using
strong language but if you look at the jobless claims, medical workers being
furloughed, etc, you realize we are truly _destroying_ tremendous sources of
value).

This is sort of the pareto principle. We get 80% of the benefits of a mass
lockdown, with only a small increase in costs. In fact, I would go one further
and say that any policies that prevent the development of herd immunity are
actively causing harm since we're postponing the reconciliation into the
future while damaging our economy in the present

Oh, and just to be clear, I advocate total lockdown in any areas that are
nearing medical capacity. New York is the quintessential example here.

BTW, New York will be a great example of herd immunity. Their death toll is
staggering right now, because massive quantities of people have been exposed.
It's hard to know how many, particularly given that the death figures are a
little untrustworthy, but I would assume that every death has something like
200 corresponding infections (somewhere around a .5% IFR). Give it another
month, and we will see a dramatic dropoff in infection, even if we lift the
lockdown, because there won't be many vectors left for covid to spread
through.

Last thing I'll say is, it's very telling that you have not made any
references to the economic impacts of lockdown. A rational decision requires
comparing the benefits of lockdown with the costs to our economy, and by not
even mentioning the latter, it seems to imply that you're not performing a
rational cost/benefit analysis here, but rather are relying on very dubious
reasoning.

~~~
maxerickson
The current daily case rate in South Korea has the whole population getting it
after about 100 years (the post I saw said 141, I'm rounding).

We should probably look for mitigations that are not economically harmful and
keep them in place. Mask wearing seems to be one of them. Then we can use the
time that gives us to look for treatments and maybe even a vaccine.

I wonder if you are giving any consideration of the economic consequences of
the virus? Those are going to happen regardless of imposed lockdowns. There's
a tweet about reservations at restaurants in Seattle declining 60% prior to
the lockdown. That's plenty.

BTW, New York is nowhere near herd immunity. If you assume 1000 cases per
death, they would have ~1 million people that have been infected. For a virus
this contagious, you want 50-60% for herd immunity, not ~12%.

~~~
remote_phone
The only measures that will prevent a large lockdown again in October are
plentiful masks and plentiful hand sanitizer. So far I have seen neither. My
estimate is that we have until August to get both is such high supply that
people can buy them again and stock up, so that everyone wears them all the
time and everyone can sanitize their hands at will. I think that may help in
keeping the infection rates lower.

Also we need real-time mass testing capabilities.

Without all of these I can pretty much guarantee that the only weapon we have
is lockdowns and there will be another one come flu season, possibly through
Christmas until February/March. This is mainly because we won’t be able to
tell the difference between the flu and Covid-19 fast enough.

------
3fe9a03ccd14ca5
Our politicians live for today. They could care less about tomorrow. You can
see this in all areas of “preparedness”, and it’s especially obvious in debt
and pensions. No surprise here that our government was auctioning off
ventilators and exhausting without replacing PPE gear stockpiles without a
care in the world.

~~~
KMag
I think politicians act the way they do because that's the way the populace
incentivizes them to act.

If anyone has good ideas for encouraging the types of societal/cultural
changes necessary to (eventually) properly incentivize politicians, I'm all
ears.

~~~
viklove
> the populace incentivizes them to act

It's not "the populace," it's lobbyists that are funded by massive
corporations that are trying to protect their revenue streams. What's the
solution? Get the money out of politics. Make it illegal for government
officials to take comfy six-figure corporate jobs after they finish their
term, overturn Citizens United, put a limit on campaign spending or at least
try to level the playing field in some way. That would be a great start.

Regulatory capture means all of this is borderline impossible, though. We live
in a world where even 100M people will have a hard time fighting the
collective power of billions and billions of dollars. Money makes the world go
'round baby.

~~~
ryankemper
> Get the money out of politics. Make it illegal for government officials to
> take comfy six-figure corporate jobs after they finish their term, overturn
> Citizens United, put a limit on campaign spending or at least try to level
> the playing field in some way.

How do you feel about the citizens united ruling, which (I am paraphrasing,
perhaps poorly) found that by disallowing one to spend money on poltiical
speech, that freedom of speech was impacted?

I think it's actually quite a sensible point. Speech costs money. Therefore
limits on the money an organization can spend is necessarily a limit on
speech.

("Overturn citizens united" is the classic liberal/democrat view, but I really
question how many have thought deeply about the implications of what they are
proposing).

\--

BTW, as you probably know, regulations quickly get co-opted by
corporations/lobbyists for their own ends. So, if there is a true desire to
funnel money to politicians, they will find a way. Now, that does not mean
that we shouldn't try to make that harder, if that's what we think is the
right move (I think Citizens United was a great ruling. I assume you disagree
based off of the above)

------
remote_phone
Trump has fucked this entire response up and hopefully this is what leads to
his loss in election. But to be fair, doing a test in August and October and
then expecting anything significant to have been accomplished by any
government by February is ridiculous.

Even those that took it seriously would not have any sense of urgency to get
things ready right away. You need to budget for it, etc and that takes
months/years.

To draw a similar point, all of the N95 masks in stockpile were used up in
2009 and never replenished by Obama. No one in 11 years and 2 presidencies
took it seriously since then, so I would assume the same with this simulation
as well.

------
marvindanig
Not much of a simulation [1] anymore. Lockdowns have to go strict imo, but
with this inept administration in place I have little hope. :-(

[1]
[https://mobile.twitter.com/marvindanig/status/12520293225898...](https://mobile.twitter.com/marvindanig/status/1252029322589810693)

