
Coronavirus – The Status of the Outbreak and 4 Possible Scenarios - joshuafkon
https://www.cassandracapital.net/post/coronavirus-the-status-of-the-outbreak-and-4-possible-scenarios
======
BoiledCabbage
> In the optimistic scenario, a month from now we can calculate, from data
> outside mainland china, that the CFR is perhaps .3% or below

What so absurd is it will take the world a month to know how serious this
virus is. By that point it's likely too late to do anything to stop it.

It's beyond disgusting that China is putting the entire world's population at
risk due to pride and ego.

Essentially "we'd rather screw over potentially millions of lives everywhere
rather than admit how poorly we handled this".

...and they just keep digging.

~~~
watertom
This is a country the forced doctors at gun point to perform live delivery
abortions in order to enforce the one child rule.

A good friend's sister was a Obgyn in China, and when women were discovered
with their second pregnancy they would be brought in for abortions even if the
baby was full term.

Doctors would either comply or have guns drawn and be threatened, doctors who
failed to comply would be taken away, never to be seen again. At one point my
friend's sister was performing twice as many abortions than she was delivering
babies, and all of the abortions the mothers were being forced. Screaming,
yelling, begging, pleading and crying hysterically.

As my friend would say, "My country doesn't value human life in any way,
people are just numbers, all people are just numbers."

~~~
hongloumeng
This account seems exaggerated. Forced late-term abortions in China were
certainly a real thing, and the value of the life of a stranger is on par with
that of livestock. However, guns are rarely seen in everyday life in China.
This is especially the case with policemen and low-level enforcers. The
exception are soldiers on duty, and security for transporting currency. Guns
are kept in armories, brought out by specially trained "armed police".

------
camillomiller
One point missing that I think could be important even in the more worrying
scenarios is the average health condition or age of the people who develop
severe stage infection. If the CFR is high but people dying are mostly old and
not of working age, the pandemic will create a drag on global economy but not
as bad as the CFR might lead to suppose. Don’t mean to sound cynical, just
putting another element into the equation.

~~~
Accujack
1) This is an ignorant statement, there are plenty of people in the 55+ age
range who work worldwide.

2) Simply having workers get incapacitated is one of the smallest impacts the
virus will have. Take a look at the present price of crude oil - the effects
of the epidemic in China are already sending that crashing.

Quarantines, the need for medical supplies, lost work hours, elimination of
disposable income, an economic downturn worldwide as products become harder to
get and more expensive to transport... there are lots and lots of impacts this
will have, including vastly increased unemployment.

Even if no one at all dies, a pandemic with the world getting sick all at the
same time will have an impact bigger than any other event going back to World
War II.

------
anonsivalley652
From a reliable source, a Western journalist who was evacuated, this article's
information seems accurate.

It's difficult to tell what the current numbers are, or even what they will be
because of censorship, but you can bet it's 2-5x what's reported. Also, it's
compounded by the delay of information having to go to intermediaries before
reaching international journalists. And, there are some isolated instances of
bodies on the streets and in crashed cars of people not making it to the
hospital before expiring, and then not being collected quickly because of
fearful coroners/undertakers... which is expected in a minor pandemic in a
densely-populated city. I would bet there are at least a dozen dead bodies on
the street right now of the 400+ people who die in NYC's five boroughs every
day. Even if it were Ebola-deadly and infectious as an airborne-mutated
norovirus, sustained isolation of population members can kill any pathogen
because its transmission rate drops to insignificant and then 0.

~~~
ardy42
> It's difficult to tell what the current numbers are, or even what they will
> be because of censorship, but you can bet it's 2-5x what's reported.

Definitely. IIRC, to be counted in the official statistics, an infected person
has to have significant contact with the medical system, but the medical
system in Wuhan has been so overloaded that people have been turned away in
large numbers so that diagnostic work is not being done in many cases. There
are reports of many people dying at home in Wuhan, which wouldn't be counted
as part of the official statistics.

I've also heard reports that the crematoriums in Wuhan are also overloaded,
and aren't allowed to report any statistics except to the government.

I don't think we'll know the full impact for a long time, until someone can
some kind of excess mortality study with individualized vital records.

~~~
tim333
If I were betting I'd bet over 5x [https://www.ccn.com/billionaire-
whistleblower-wuhan-coronavi...](https://www.ccn.com/billionaire-
whistleblower-wuhan-coronavirus-death-toll-is-over-50000/)

~~~
ardy42
I'm skeptical of the Chinese government's statistics, but I'm also skeptical
of those sources:

[https://www.ccn.com/about-us/](https://www.ccn.com/about-us/):

> CCN.com, also known as CCN Markets, was founded in the summer of 2013 in
> Norway by serial entrepreneur Jonas Borchgrevink as “CryptoCoinsNews.com”.

[https://www.buzzfeednews.com/article/janelytvynenko/a-site-t...](https://www.buzzfeednews.com/article/janelytvynenko/a-site-
tied-to-steve-bannon-is-writing-fake-news-about-the):

> A Site Tied To Steve Bannon Is Writing Fake News About The Coronavirus

> Founded by an exiled billionaire and critic of the Chinese government, G
> News claimed without proof that China was prepared to admit the disease
> originated in its labs.

~~~
tim333
Yeah I'll give you that. I'd guess the truth is somewhere in the middle. That
said the basic claim "... alleges Wuhan has crematoriums working 24/7" seems
backed by other sources. Even the Chinese government admits it's figures are
only tested cases and they can't test everyone.

------
pezo1919
Sorry for not being upbeat!

I am wondering why the world still does not seem to care about it. Why do we
have to wait until every city gets infected? Why we can't stop travelling?
Eventually, when it spreads to a city, the quarantine must be the only way...
but why we aren't preventing that ourselves? The politicians does not really
seem to care (in the bunkers)? Individual, consumer society with no interest
and without resources, civil routine and real impact to the events is crazy to
me. Even a couple of days ago WHO was thinking about restarting the flights to
China. It's just WTF to me.

In last days I can't even read any tech/HN news because it's not news to me
compared to this unsolved terrible situation. I don't even understand how this
topic is not more visible here in HN and on other places. We need to do
something.

~~~
_-___________-_
I think it's pretty clear that many people do care about it very much.
Imposing travel restrictions, cancelling flights to major trading partners,
etc, has a very significant cost and isn't taken lightly. I've heard many
people say things along the lines of "it's just the economy, our health is
more important" lately, but peoples' livelihoods literally depend on the
economy.

Say for example that your family operates a tiny tourism-related business in
South East Asia. A prolonged shutdown of travel between China and your country
could literally drive you into poverty, given how dependent some countries in
the region have become on inbound tourism from China. Given your extremely
remote chances of catching the virus, the risk of losing your entire family
income is a much more significant risk to your health.

Because of this, it's important to be _balanced_ in thought and decisions, and
not just panic because of what _could_ happen. Where there is evidence to
support restrictions, keep them in place. Where there is not, remove them.

Outside of China this issue still remains far less serious than many other
health-related risks. The "we need to do _something_ " (anything!) mindset is
actively harmful.

~~~
pezo1919
Even with the existing restrictions the virus spreads. Spread leads to
quarantine as we've seen in many chinese cases. I don't see why should we hope
for the better with less restrictions.

Not being a huge problem outside of China is a fact for NOW. Does not mean it
won't happen in weeks. The question is: do we want to solve the problem now,
or we want to postpone the solution for later. There won't be "deus ex
machina" which just makes it disappear. Many people will die if we're going to
ignore the existing facts and make fun of the situation with these stupid heat
scans checks which do prevent nothing on the long term based on existing
experiences.

What I see is because noone wants panic it prevents us calling the right
moves. Because its "panicky".

~~~
_-___________-_
> Even with the existing restrictions the virus spreads. Spread leads to
> quarantine as we've seen in many chinese cases. I don't see why should we
> hope for the better with less restrictions.

If we can identify which restrictions are helping, and which are not, then we
can remove the ones that are not. The point of my comment above is that the
restrictions come with their own costs, in some cases severe.

> Not being a huge problem outside of China is a fact for NOW. Does not mean
> it won't happen in weeks.

It doesn't mean it will, either. We should be approaching this in a rational,
evidence-based way, not just waving our hands and saying "many people will
die" with no evidence.

> What I see is because noone wants panic it prevents us calling the right
> moves. Because its "panicky".

If you believe you have a better idea what the "right moves" are than experts
who have spent their careers studying these events and preparing for them,
then by all means step up. But you should expect to be asked for evidence for
your claims. Panic is a significant cost on its own.

~~~
ryanwaggoner
_If you believe you have a better idea what the "right moves" are than experts
who have spent their careers studying these events and preparing for them,
then by all means step up. But you should expect to be asked for evidence for
your claims. Panic is a significant cost on its own._

I think this is unfair on two fronts.

First, labeling it as “panic” is just dismissive. What constitutes panic vs.
what is responding rapidly and vigorously to a critical emergency is in the
eye of the beholder.

Secondly, it’s possible to trust the experts and also think that the proper
measures are not being taken. The experts are the epidemiologists,
virologists, doctors, public health officials, etc. who are working on this
outbreak, and they seem pretty damn concerned. I’ve read very few statements
that suggest this is likely to blow over, and many more that show a widespread
opinion among the experts that containment is unlikely and that this is very
serious. But the experts don’t run the world, politicians and bureaucrats and
business leaders do. And they have different interests and incentives. There
are also likely discussions behind the scenes that we don’t know about. The
WHO could be urging countries to shut down all air travel but leaders are
reluctant to do so for fear of the political backlash.

All you have to do is look at how China treated the doctors who reported on
this back in December to see how “trust the people in charge” is not the same
as “trust the experts”. If China had clamped down on this six weeks earlier
than they did, we wouldn’t be in this mess.

~~~
_-___________-_
> First, labeling it as “panic” is just dismissive. What constitutes panic vs.
> what is responding rapidly and vigorously to a critical emergency is in the
> eye of the beholder.

It can be both. The actions of individual citizens in Singapore, HK and other
countries with a small number of cases certainly seem to be panic: buying more
instant noodles than they could eat in a year, buying every toilet paper roll
available, buying so many face masks that rations are introduced, and so on.
Some government actions also appear to be going beyond what is necessary to
respond; for example banning travel from country A to country B, when country
A has fewer cases than country B itself.

> Secondly, it’s possible to trust the experts and also think that the proper
> measures are not being taken. The experts are the epidemiologists,
> virologists, doctors, public health officials, etc. who are working on this
> outbreak, and they seem pretty damn concerned. I’ve read very few statements
> that suggest this is likely to blow over, and many more that show a
> widespread opinion among the experts that containment is unlikely and that
> this is very serious. But the experts don’t run the world, politicians and
> bureaucrats and business leaders do. And they have different interests and
> incentives. There are also likely discussions behind the scenes that we
> don’t know about. The WHO could be urging countries to shut down all air
> travel but leaders are reluctant to do so for fear of the political
> backlash.

The WHO, in fact, has mostly suggested a more measured approach to air travel
restrictions than what many governments have decided to take. Most of the
expert opinions I've read have presented a number of different paths this
could take, and suggested a lot of uncertainty as to the likelihood of each.
This is sensible. Meanwhile, most of the forum posts and comments that I've
read have strongly emphasised the worst possible cases, and continued to do so
as the worst path that previously could have happened (which they were
implying was a virtual certainty), didn't.

> All you have to do is look at how China treated the doctors who reported on
> this back in December to see how “trust the people in charge” is not the
> same as “trust the experts”.

I'd be the last person to suggest trusting China's leadership, but neither am
I inclined to assume that the measures taken by other governments in response
to this are entirely based on expert advice or even entirely for health-
related reasons.

> If China had clamped down on this six weeks earlier than they did, we
> wouldn’t be in this mess.

Maybe.

------
_-___________-_
"[..] a study in the Lancet estimated back on January 25th that 75,000 people
had already been infected and that the virus was doubling every 6.4 days —
which would suggest that more than 300,000 people may now be infected with the
virus."

Doesn't this blatantly ignore the fact that the infection would have run its
course in many of those people by now?

~~~
tim333
If they run out of people to infect the rate of new infections will go down.
There are a lot of people in China though. Obviously the 6.4 days thing is
rough estimate.

~~~
_-___________-_
But the last part of the sentence talks about the number of people who "may
now be infected with the virus", which seems to ignore the fact that some of
the early new infections are no longer infected.

------
tim333
My guess is this thing is bad - keeps spreading, high mortality and the best
we can do is slow it until we have a vaccine. I'm kind of optimistic people
may be able to speed the vaccine stuff when they see how bad the situation is.

Animal trials have started already

>Shanghai-based Tongji University School of Medicine and Stermirna
Therapeutics Co., Ltd. The vaccine samples were injected into more than 100
mice Sunday, the report said.

and Imperial started animal trials yesterday.

vid of the Shanghai lot: [https://youtu.be/BymUKDp-
omQ](https://youtu.be/BymUKDp-omQ)

~~~
cpascal
There's also the ongoing Phase 3 Remdesivir trial. [1] Which was used in the
treatment of Washington's 2019-nCoV case. The patient appears to have begun
recovering soon after the remdesivir was administered and was released shortly
after. [2][3]

> Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug
> in development) was initiated on the evening of day 7, and no adverse events
> were observed in association with the infusion. Vancomycin was discontinued
> on the evening of day 7, and cefepime was discontinued on the following day,
> after serial negative procalcitonin levels and negative nasal PCR testing
> for methicillin-resistant Staphylococcus aureus.

> On hospital day 8 (illness day 12), the patient’s clinical condition
> improved. Supplemental oxygen was discontinued, and his oxygen saturation
> values improved to 94 to 96% while he was breathing ambient air. The
> previous bilateral lower-lobe rales were no longer present. His appetite
> improved, and he was asymptomatic aside from intermittent dry cough and
> rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is
> afebrile, and all symptoms have resolved with the exception of his cough,
> which is decreasing in severity.

This is obviously just a single patient’s outcome and not proof that
Remdesevir is effective, but it’s just about the only positive news related to
2019-nCoV. Hopefully the trial yields good results.

[1]
[https://clinicaltrials.gov/ct2/show/NCT04257656](https://clinicaltrials.gov/ct2/show/NCT04257656)

[2]
[https://www.nejm.org/doi/full/10.1056/NEJMoa2001191](https://www.nejm.org/doi/full/10.1056/NEJMoa2001191)

[3] [https://www.seattletimes.com/seattle-
news/health/snohomish-c...](https://www.seattletimes.com/seattle-
news/health/snohomish-county-man-with-novel-coronavirus-discharged-from-
hospital/)

~~~
tim333
That sounds promising. I see in in vitro trials chloroquine also seems to work
which would be handy as it's cheap and widely available
[https://www.asbmb.org/asbmb-today/science/020620/could-an-
ol...](https://www.asbmb.org/asbmb-today/science/020620/could-an-old-malaria-
drug-help-fight-the-new-coron) which would be. In fact I may even take some
prophylactically for my Singapore jaunt. You don't even need a prescription to
buy it in the UK

>Our findings reveal that remdesivir and chloroquine are highly effective in
the control of 2019-nCoV infection in vitro. Since these compounds have been
used in human patients with a safety track record and shown to be effective
against various ailments, we suggest that they should be assessed in human
patients suffering from the novel coronavirus disease. (Conclusion from the
letter to Nature
[https://www.nature.com/articles/s41422-020-0282-0.pdf](https://www.nature.com/articles/s41422-020-0282-0.pdf))

------
jpseawell
Scary shit.

------
sam_goody
There will _definitely_ be a worldwide epidemic.

China is losing millions every day, aside from psychological credit, as people
want nothing to do with China.

(Anecdotally, the local shoe outlet claims that the kids shoes for at their
brand will be manufactured in Thailand from next week.)

The Chinese can solve their disadvantage by either eliminating the virus, or
by making sure other countries have it as well. (No point in going to Thailand
if they are also getting sick.)

Elimination doesn't seem to be going as well as hoped for.

The Chinese government doesn't have a reputation of caring about other people,
or human rights.

What are the chances it won't be breaking it out worldwide?

------
blackrock
There are those that dreamed of this happening.

Those that wanted the massive decoupling between the United States and China.

Those that wanted to see China suffer, fail, collapse, and devolve into
another destructive civil war; while the United States remains ascendant.

Well, their dreams might be about to come true.

This coronavirus was the perfect economic weapon that was dropped in the heart
of China. And not even a bullet was fired.

The economic backlash from this virus is going to be monstrous. But the
reality might be even worse than they imagined, where even they themselves
cannot escape the fallout, and that they would reminisce of better days.

But there will also be opportunities. Companies will fail, but others will
succeed.

The Fed had better keep on printing that money, because the bubble in a lot of
sectors will pop, especially Real Estate. Then automotive. Then aerospace.
Then tourism. This house of cards is going to come crashing down.

The moment of the black swan event is about to arrive.

Time to place your bets.

~~~
Accujack
You know what I find really interesting?

If Trump screws up the response to this virus (like by cutting the CDC's
budget in the middle of a crisis) then the people most vulnerable are the same
demographic as Trump's supporters.

~~~
blackrock
The interesting thing is that the Trump supporters benefited the most, but
they just didn’t realize it.

They blamed China for taking their jobs, and Trump capitalized on it. A
foreign country with people that don’t look like yourself, or even speak the
same language, and with a different political system was an easy target to
scapegoat.

What they failed to realize was the impact that technology and automation had
on their lives.

Do you see people working inside the heart of a car manufacturing factory
anymore? No, it’s all robotic. What used to take hundreds of men, is now
streamlined into an assembly line of 10 robots.

First, in the 80s and 90s, Walmart came and killed off the small businesses,
but at least they provided some minimum wage jobs in their stores. Then,
Amazon came and killed off the remaining smaller retailers, and tried to kill
off Walmart. No more minimum wage cashier jobs, but more jobs for delivery
people and warehouse workers.

Then, the software and hardware got better, that it started to replace those
minimum wage cashiers jobs. Then robots got better, that they even started
replacing the warehouse jobs.

But the United States had the benefit of creating technology over the past 70
years, and massively benefiting from the royalties that followed. Qualcomm
doesn’t physically make any phones or computer chips, but 50% of their revenue
comes from China.

Other jobs in technology like software, engineering, design, QA, project
management, etc., were created in relation to technology, but these are not
celebrated. Microsoft spawned a lot of software companies. Apple spawned a lot
of smaller software businesses vying for space in their app market. But it
seems none of these are celebrated in the world of Trump supporters.

Meanwhile, the Trump supporters benefited handsomely in one area: farming.
Massive windfalls were made in selling grains and soy to China, who eagerly
bought it all. The industrialized farms were literally printing money. And
they thought they deserved that business, as if it was a god given right to
them.

Maybe they got greedy, but more likely, they fell for the charm of a
charlatan, and voted Trump into office, to take on the China problem. You
know, the exact foreign customer that was buying up all their farm products.
This baffles the mind on how they couldn’t make this connection.

Then in one fell swoop, Trump took that all away. Farm bankruptcies went
higher and higher under Trump. He came in and demonized the very customer that
was buying their products.

And now we have the coronavirus, and those dreams of decoupling the two
economies of China and the United States, are about to come true.

The question is: are those Trump supporters ready for the ensuing fallout?

~~~
Accujack
I won't address the content of your post here - there's too much to go through
and too little time.

But, I will say that Trump's supporters are both ready and unready for the
fallout.

Ready because they're essentially decoupled from actual facts and information
and fed entirely on the "truth" from him and his allies, so they won't ever
blame him for anything.

Unready because they're not capable of handling reality, and regardless of who
they are told is the reason for their problems, they have to live with it.

