
How to Respond to COVID-19 - doppp
https://www.gatesnotes.com/Health/How-to-respond-to-COVID-19
======
simonh
Here in the UK we learned the hard way that health care is national defence.
It’s a matter of vital national security. In WWI we were chronically short of
healthy young recruits, far too many potential soldiers were too sickly or
under nourished to serve. What goes for the military goes for industry too,
what use is a sickly, unfit work force, especially in a crisis? This is why
universal health care is not controversial in the UK. It’s why lifelong
conservative voters like me support universal health care, we were faced with
a clear existential threat generations ago. How could we expect the population
to fight for a country that didn’t look after them in return? Loyalty has to
go both ways. I accept we’re a different case from the US because we’re a much
smaller country, the US can manage due to sheer numbers, but that’s a pretty
poor excuse. Having a fit, healthy population matters.

Now we’re faced with Covid-19. This is a matter of national and international
security and defence. Health care spending is national defence spending. It’s
just a different type of defence against different types of threats, some
mundane, some exceptional.

~~~
bitlax
Just because you don't want healthcare controlled by the federal government
doesn't mean you're opposed to healthcare itself, and some of the countries
with universal healthcare have some of the highest infection and death rates
so I'm not sure how your solution relates to COVID-19.

~~~
makomk
Yeah. Italy has a universal healthcare system funded from taxes, and not only
are they now a major cluster of coronavirus infection and spread, their
healthcare system ended up helping to spread the virus. Supposedly their
healthcare is some of the best in the world overall too.

~~~
jkingsbery
Also: China has (near) universal health care.
([https://www.internations.org/go/moving-to-
china/healthcare#h...](https://www.internations.org/go/moving-to-
china/healthcare#how-does-the-healthcare-system-work-in-china),
[https://www.sciencedirect.com/science/article/pii/S016885101...](https://www.sciencedirect.com/science/article/pii/S0168851015001864))

With universal health insurance, you're at the mercy of the government. If the
government chooses not to cover your issue, or if the government tells you
"you're not sick so stop telling people you are," that's too bad. The same
thing happens in private insurance, to be sure (minus the "if you say bad
things about us we'll put you in jail" part), since people get denied. With
government run health care, you have fewer alternatives though. You can't try
some other doctor to see if that one will work financially (since it's the
same entity footing the bill ultimately). There's no alternate system or
provider to go to (you can't do much to get better health coverage for next
time).

------
melonkidney
From a business perspective, be prepared for an extended period working from
home, and be prepared for productivity to drop. Prioritize and set
expectations accordingly.

I have colleagues in China who are facing down their fifth week working from
home. At the beginning, they tried to maintain their normal (and excellent)
level of output. But the stress of quarantine is starting to show.

Disruptions to normal routines, such as kids stuck at home and reduced/no
access to childcare, are the non-newsworthy but most challenging issues for a
large number of folks.

~~~
stareatgoats
... until they realized that working from home and closeness to kids and
family was really a wonderful thing?

~~~
namelosw
Can confirm. I'm in Beijing and it's wonderful indeed, I'm not with my family
though.

I already worked from home for a month as a developer, and we have confirmed
we'll WFH for the next 2 weeks at least.

There's no sign of productivity dropping for now according to our regular
analytics. We have similar velocity as in previous months, where the
estimation was done before the Chinese new year (just to clarify).

------
JKCalhoun
> The data so far suggests that the virus has a case fatality risk around 1%;
> this rate would make it several times more severe than typical seasonal
> influenza and would put it somewhere between the 1957 influenza pandemic
> (0.6%) and the 1918 influenza pandemic (2%).

That was a little shocking to read. I had no idea the 1918 influenza pandemic
was only 2%. I lost relatives to it, assumed it was a larger percentage than
2%.

~~~
javajosh
And I think its important to note that 2% is the mortality rate _in a
hospital_ where they have respirators, etc. The mortality rate outside of a
hospital (e.g. in a quarantine wharehouse) is something like 20%. (I wish I
could remember the source for this, will look and edit but it may have been
The Atlantic).

It also seems like some survivors come out of this with pretty severe damage
to their organs, especially lungs, because the persons immune system goes
overboard and attacks healthy tissue. So, some fraction of people will live,
but be disabled.

~~~
greatpatton
A 20% death rate is highly unlikely.The Italian researchers who sequenced the
Italian strain believe that the virus has been circulating widely in Italy
since January, even before Italy banned direct air flight to China. This seems
to be confirmed by the fact that almost all the new cases in Europe are
originating from big Italian cities. If the death rate was 20% we should start
to see a lot of death in Italy and it doesn't seem to be the case. Iran and
Egypt also seems to be largely hit, as many tourist back from Egypt have been
infected. Now getting the real death rate is going to be a very complicated
game, especially if many infected patient remain without symptom. I tend to
believe the virus is already highly circulating in a high number of place of
the planet where the health system is bad, and lacking testing capabilities.
We are even starting to see untraceable cases in the USA.

~~~
tessierashpool
Caveat: some of the "untraceable" cases are kind of "semi-traceable" in
practice. The American government (against the advice of its own CDC) flew
back American patients who had been on the Japanese cruise ship, infected and
uninfected alike, and sent in HHS employees to interact with them, with
inadequate training and hazard protections (i.e., no bunny suits).

This heightened infection risk for the uninfected cruise ship patients and the
HHS employees, as well as anybody who knew them.

This plane landed at Travis Air Force Base in Solano County, California. Which
is where the first "untraceable" case in the United States occurred.

~~~
makomk
You're mixing up two different evacuations. The whistleblower complaint about
HHS employees with inadequate training processing evacuees was about the Wuhan
evacuation, not the Diamond Princess one. Only about three of the Wuhan
evacuees ever ended up testing positive for the virus, there's no reason to
believe they were even infectious when flown back and none of the staff
involved have shown signs of COVID-19. It's certainly possible that one of the
people involved in the quarantine didn't follow precautions and was infected,
even with full training, but I don't think there's any evidence tying the
California case to it.

~~~
tessierashpool
OK — I did conflate Wuhan and Diamond Princess, so thanks for correcting me
there, but according to both Time and the Washington Post, HHS employees were
sent (without proper training or protection) to meet with evacuees in each
case:

[https://www.washingtonpost.com/health/2020/02/27/us-
workers-...](https://www.washingtonpost.com/health/2020/02/27/us-workers-
without-protective-gear-assisted-coronavirus-evacuees-hhs-whistleblower-says/)

[https://time.com/5792135/coronavirus-whistleblower-hhs-
emplo...](https://time.com/5792135/coronavirus-whistleblower-hhs-employees/)

------
davidwihl
Marc Lipsitch, a Harvard epidemiologist, estimates that 40-70% of the adult
world-wide population will be infected. [0]

Assuming a conservative 1% mortality rate, that would mean 30-50M deaths, a
tragically huge number.

[0] [https://news.harvard.edu/gazette/story/2020/02/key-
coronavir...](https://news.harvard.edu/gazette/story/2020/02/key-coronavirus-
question-how-are-children-affected/)

~~~
ekianjo
Most cases with mild symptoms are not even reported or noticed by those
infected so the real number is lower than 1 percent in all likelihood.

~~~
tristanj
> _Most cases with mild symptoms are not even reported_

This is outdated. Dr. Bruce Aylward said in a WHO conference this week that
the Chinese tested 320,000 samples in Guangdong and they are not seeing huge
transmission beyond cases found clinically. It's at 47 mins in this video:
[https://youtu.be/-o0q1XMRKYM?t=2810](https://youtu.be/-o0q1XMRKYM?t=2810)

> _so the real number is lower than 1 percent in all likelihood._

I disagree. When we calculate the SARS-CoV-2 CFR properly using

CFR = deaths / (deaths + recovered)

using the latest data we get

2,924 / (2,924 + 39,605) = 7% CFR

That's much more in line with the original SARS CFR of around 9%.

~~~
learc83
"The claim was quickly challenged by an infectious diseases expert who serves
on a committee that advises the WHO’s health emergencies program.

Gary Kobinger, director of the Infectious Disease Research Center at Laval
University in Quebec, said it would be highly unusual for there not to be mild
or symptom-free cases that are being missed. He pointed to the fact that
outbreaks have popped up in countries far from China — including Iran and
Italy — because people with mild infections were not detected and traveled to
other places.

'There are mild cases that are undetected. This is why it’s spreading.
Otherwise it would not be spreading because we would know where those cases
are and they would be contained and that would be the end of it,' said
Kobinger, who insisted that mild, undetected infections cannot be ruled out
until people who haven’t been diagnosed with the illness can be tested for
antibodies to the virus.

'As long as we do not have good serology data, I think that it is completely
speculative to say that there are no undetected cases,' Kobinger said."

What Dr. Aylward says makes no sense and reads more like a PR fluff piece
designed to praise China to keep them happy, and as Kobinger points out he's
probably wrong. From the same press conference he says this "If I had
COVID-19, I’d want to be treated in China."

Which is obviously bullshit.

As the specifics of the 320,000 cases. It wasn't a serum antibody test, so it
wouldn't show people with low viral loads or people who recovered.

Also this is in Guangdong where the infection was potentially quickly
contained, and if you'll notice the death rate is much lower in Guangdong.

~~~
blub
"If I had COVID-19, I’d want to be treated in China."

China probably knows how to best treat this, but as a patient you could either
get that treatment, or get turned away or even get welded in your apartment
apparently.

------
nl
Does anyone know where the 2% death rate for 1918 flu comes from? I've seen it
quoted multiple times, but Wikipedia says:

 _It infected 500 million people around the world... The death toll is
estimated to have been 40 million to 50 million, and possibly as high as 100
million_

But later

 _The World Health Organization estimates that 2–3% of those who were infected
died (case-fatality ratio). It is estimated that approximately 30 million were
killed by the flu, or about 1.7% of the world population died. Other estimates
range from 17 to 55 million fatalities_ [1]

[1]
[https://en.wikipedia.org/wiki/Spanish_flu](https://en.wikipedia.org/wiki/Spanish_flu)

~~~
saberdancer
I'm really surprised by this as well. From what I can tell, the estimate that
was named is "above 2.5%". This could be simply by calculating how many people
died compared to total population in the world. If 2.5% of total world
population died, assuming everyone was infected, it is at least 2.5% case
fatality rate and depending on how many people were not infected case fatality
rate will go down.

~~~
jtbayly
Wouldn’t case fatality rate go up the more people were not infected?

~~~
saberdancer
Yes. But if you do not have a lower bound for number of infected, you can with
certainty only say "above 2.5%".

------
gdubs
“Global health experts have been saying for years that another pandemic
rivalling the speed and severity of the 1918 influenza epidemic wasn’t a
matter of if but when.“

Short-term-ism is the real epidemic in America. We seem paralyzed in taking
preparedness steps in a host of issues that are a matter of “not if, but
when.” From Climate Change, to infectious disease.

On individual level, we share some of the blame. I’ll admit that even in
earthquake and fire prone California that prior to this current crisis, I’ve
never kept more than a few days worth of food on hand. Even faced with a real
risk, there’s inertia there — but ultimately realizing that being prepared as
a household is the root of resilience for a neighborhood and community. It’s
not a selfish act — it’s the responsible thing to do.

But at a leadership level, we seem to be waiting for some shoe to drop in this
current situation rather than take proactive steps. We seem two steps behind
this thing in the US.

------
tomohawk
Are you legally prepared? Do you have a will, an advanced medical directive,
and other important documents? If not, take this as a cue to get that done
today. Pandemic or no pandemic, you should have these.

Without these documents, you may very likely not receive the medical treatment
you would wish to have should you become incapacitated. Also, your worldly
possessions will likely not be dealt with as you would wish, and you'll be
leaving a mess behind for your loved ones.

So, get your affairs in order.

~~~
abjKT26nO8
_> you'll be leaving a mess behind for your loved ones._

I don't have any loved ones.

 _> advanced medical directive_

My country doesn't honor those.

Yup, I'm about as prepared as I can be.

------
mnm1
How about investing in "low- and middle-income" Americans and providing them
healthcare? In addition how about providing required paid sick leave that can
be taken without fear of losing one's job? These are actual things we could do
to help people respond and deal with COVID-19. Yes, working on vaccines is
important but testing and avoiding spreading the virus as much as possible are
even more important. Right now, we have no hope of doing either in an
effective manner. People will go to work sick, including with COVID-19 because
they have no choice, because our government has left them no choice. They
won't be able to get tested because they have no choice due to not having
health insurance--another choice removed by our ineffective policies. I don't
see any coherent plan by the government at this moment to address any of these
issues and given the current situation, I would not be surprised if we have
one of the worst outcomes of any developed country, possibly including China.
The only hope is that the virus mutates into something less contagious or
harmful and that should not be something we rely on.

------
lordnacho
I wonder if there will be a more general cultural change. For instance, will
it become commonplace to have disinfectant dispensers in public places, like
you might have drinking fountains and public bathrooms? Will workplaces and
stadiums install these? I can't judge the advice on this, but it seems to be
that disinfectants work.

Also, will people be told to stay home when they're even slightly ill?
Currently people know that sick people spread disease, but we leave it to
their own judgement as to whether to show up. What about a law that says you
can't be paid as a contractor if you show up and you're ill? Could/should that
happen?

~~~
krisoft
“ What about a law that says you can't be paid as a contractor if you show up
and you're ill?”

To my european ears that’s a very strange thought.

This is what paid sick leave was invented for. If we do as you proposed that
strongly incentivises people to judge themselves not sick. Obviously the most
intense cases will be found out, and according to your law sent home without
pay, but by then the damage is done.

~~~
lordnacho
I mean contractors though. A lot of people in finance get paid per day they
show up. I even have friends who will go to work while terribly ill because
they get paid £1000 for it.

Paid sick leave is fairly normal for people on standard employee contracts.

------
mhkool
For those who are interested in how to improve your own immune system function
I recommend to watch a couple of videos of Dr Bergman and Dr Axe

------
DyslexicAtheist
who is still excited about pair programming? I think this will come to an end
very abruptly. keyboards are disgusting.

~~~
pvinis
I mean, it's pretty easy to do pair programming with separate keyboards or
even computers..

------
alien_
It's easy to raise the billions required to fight this. It's peanuts for
governments and even larger companies hoarding tens of billions that have a
lot to lose because of such pandemics.

~~~
rm_-rf_slash
Raise the billions to do what though? Pay for pharmaceuticals that can’t reach
sick people because there aren’t enough people to work the production lines,
the docks, the ships, the trains, the trucks, and the hospitals?

------
javajosh
In a perfect world, Trump would appoint Gates to lead the Department of Health
and Human Services, Gates would accept, the Senate would quickly confirm, and
Trump would actually listen and defer to him on this.

It's interesting that this is directed to policy makers and other leaders,
rather than individuals on the ground - e.g. it's about resource allocation,
not personal preperation. (It was amusing to see the large-scale analogue to
hoarding referred to as "lists of supplies to be stockpiled or redirected in
an emergency." This presumes, of course, that governments will act as a force
of mediating reason on people's irrational impulses; and we all know that
sometimes it's the opposite).

~~~
sky_rw
Wait I thought Gates was in on this with the Chinese and released this as
population control? Have I been getting my news from the wrong source?

