
What Happens Next? Covid-19 Futures, Explained with Playable Simulations - blopeur
https://ncase.me/covid-19/
======
dbattaglia
> For policymakers: Make laws to support folks who have to self-
> isolate/quarantine.

I live in NYC, and this is something that still feels like a gaping hole. My
wife has been job hunting since before we were on lockdown in February, and
its been truly horrifying how many businesses COVID-19 hiring plans have been
along the lines of "work from home until the very fist day the governor says
we can go back to office". These aren't just "old school" BigCorps either,
most have been small tech firms. Even worse, she finally ended up with a
"offer" from a government agency I won't name that refuses to give her a start
date yet because, even though the rest of the office workers are WFH, they
refuse to hire remote because of "taxpayers" (who are ironically funding her
to not work via NYS unemployment benefits).

It's become quite clear to me that we can't trust businesses to do the right
thing here. The desire for "butt in seat at office" from folks making
decisions at employers here is going to end up flooding our subways with
commuters who have no choice but to come in because they don't want to lose
their jobs. Theres no reason office workers successfully working from home
shouldn't stay there as long as they feel comfortable, and not make it
terrible for folks who truly do need to commute (retail, food service,
medical, etc). Maybe I'm just biased because I work for a remote company
already, but I'm seriously worried what the big cities in America will look
like once the initial restrictions are lifted.

~~~
dahfizz
> its been truly horrifying how many businesses COVID-19 hiring plans have
> been along the lines of "work from home until the very fist day the governor
> says we can go back to office".

Are you sure you're not reading too much into this? If I was running a
company, new hires would be among the first people I would want in the office.
Traning them and getting them up to speed would be so much faster in person,
whereas most other employees are already set up to WFH. Just because they want
new hires to come in asap doesn't mean all employees have to come in asap.

~~~
dbattaglia
> Training them and getting them up to speed would be so much faster in person

I'm curious why this is the case. Is it because of existing processes? Any
sort of onboarding that involves pairing / sitting over the other persons
shoulder / breaking social distancing sounds risky anyways. As I said earlier,
I'm probably just biased due to my current employer being remote where I
onboarded just fine; even my in-office "training" was like 6 weeks after I
started and batched with 3 months of other new hires, and not at all helpful
for my day to day work. I can't remember a single in-office job where I felt
like I was onboarded fast, most of them I sat around reading code and docs
while everyone else was busy doing their normal job.

Btw, I regret any mention of the rest of the country in my original comment.
The thing that really scares the hell out of me is the mass transit / subway
system here in NYC and opening that back up to office workers (many commuting
from outside NYC), new hires or otherwise. I think its an extraordinary
situation compared to the majority of the driving to work US and should force
companies to adapt in ways others might not have to.

------
pathumba
While this is a very nice simulation and explanation it has a serious flaw: It
assumes a fixed CFR, IFR, and hospitalisation rate. This doesn't seem to be
case as evidenced by the large differences between the countries with
different response curves.

The inability to change the parameters is a major problem with the simulation
and invalidates a number of conclusions at the end.

What we can observe so far is that CFR is heavily skewed towards the old and
frail with significant co-morbidities. Most likely there is another, not yet
fully identified, medical cofactor that makes this virus particularly
difficult for a very small number of people of any age. Outside of those
groups the virus doesn't seem to be very symptomatic for the majority of
infected people. Note that symptomatic in the medical sense and common usage
is not the same. The latter having a way higher subjective threshold.

The simulation should also account for the "weak tree" effect in that the
majority of the susceptible will succumb to it on the first contact. In the
following years the number of susceptible will be much lower and only go up
with the remaining people going into ill health and becoming susceptible, if
they haven't developed any immunity from the previous encounters.

A simulation to draw real conclusions from must have an adjustable IFR, CFR,
the corresponding hospitalisation rates, and the age and health distribution
of the population for a region to be modelled.

~~~
chiefalchemist
Strains, as well as who gets the virus. C19 is equally contagious, but far
from equal in who it kills. In NJ (where I live) 40% of deaths are to people
in extended care. In Philadelphia, same people, but it's 50% of their deaths.

We need models that consider the details. We need models that consider that
the virus preys on the weak (i.e., elderly and pre-existing conditions).
Taking these profiles and applying them across the entire population is
inaccurate ans misleading. It might even be dangerous.

~~~
Retric
COVID-19 has an extremely low mutation rate. The differences are all about
random noise and differences in testing.

The oldest people also die much faster so the ratio of deaths depend on rate
of spread.

~~~
chiefalchemist
Let me explain a bit better. Who is getting it now and requiring medical
attention might not be the same going forward. There are a limited number of
high risk people. High risk people is not everyone.

For example, I heard a new report that said the Bronx NYC has the highest per
capita C19 infaction rate of any community nationally. Freightening? Maybe.
How many other communities are similar to the Bronx? Similarly, how many
living situations are similar to assisted living facilities. Taking edge and
atypical cases and extrapolating that out over 330 million isn't a good model.

Yes. C19 is highly contagious. But we also know - from data - it is more
likely to kill the weak than the strong.

------
strken
From the article: "Masks don't stop you getting sick"

From the article's source
([https://www.sciencedirect.com/science/article/pii/S019665530...](https://www.sciencedirect.com/science/article/pii/S0196655307007742)):
"None of these surgical masks exhibited adequate filter performance and facial
fit characteristics to be considered respiratory protection devices"

Well, what's "adequate filter performance and facial fit"? For filter
performance, they measured how good the surgical masks were at blocking tiny
latex spheres that approximated an aerosol, and found that masks ranged from
less than 1% penetration (best) all the way to 80% penetration (worst). For
facial fit, they told subjects who "were not screened for previous use of
masks or respirators" to wear masks and then sprayed an aerosolised bitter
substance on them, and found all of the subjects could taste it after their
first try.

The article is making the claim that masks don't stop you getting sick, based
on a source that indicates some masks don't filter aerosols completely and
that nobody wears masks correctly anyway. This is a bit of a stretch - their
source says nothing about larger droplets, it says nothing about side effects
like touching your face less, it says nothing about masks encouraging other
people to socially distance, it says very little about how masks reduce the
viral load that reaches you.

I don't think there's enough evidence to categorically state that masks do not
stop you getting sick. I think it's irresponsible to make such a firm
statement without better evidence.

~~~
jccooper
Yeah, there's science and then there's science. I'm sure they're correct about
aerosol protection, but if this virus is mostly spread via respiratory
droplets (as seems likely) that's an entirely different question and answer.
In such a case even poor masks will be useful against exposure via casual
contact. So long as you're not wearing them on your chin, as I see so often.

~~~
Johnjonjoan
It's such a blatant doublethink right?

I feel like the masks don't work rhetoric is political maneuvering born from
the fact that governments had little to no reserves of them and that health
professionals desperately need them.

Whilst I'm sure some seasoned bureaucrats or advisors think the (subjectively)
white lie is the right thing to do; because health professionals need them
more. The fact is if we all supported EVERYONE wearing masks, large scale
domestic production would have to begin in every country and health care
professionals would be swimming in masks. Not to mention it could play a part
in reducing transmission.

Masks for everyone is a win win.

~~~
dehrmann
> ...the masks don't work rhetoric is political maneuvering born from the fact
> that governments had little to no reserves of them and that health
> professionals desperately need them.

Lying to people erodes trust. When leaders then order subsequent weeks-months
of lockdown, people don't trust them, ignore their orders, and protest.

It's not just the masks, though. Leaders failed to lay out plans and exit
criteria fast enough, weren't fast enough to address arbitrariness in their
orders, and have downplayed knock-on effects.

------
dvt
It's such a shame that COVID-19 has become so politicized, it's hard to even
find _scientific_ sources that are being wholeheartedly honest. Here's a few
statements that are blatantly misleading:

> Around 1 in 20 people infected with COVID-19 need to go to an ICU (Intensive
> Care Unit).

That statistic is contingent on infection rates. No one has these due to lack
of testing. Therefore, the statistic is misleading at best, and wrong at
worst.

> However, pandemics are like poker. Make bets only when you're 95% sure, and
> you'll lose everything at stake.

This is highly alarmist. Pandemics aren't like poker because you're not going
"all-in" on a 95% bet. Awful analogy, and just bad rhetoric.

> (Rant about the confusion about pre-symptomatic vs "true" asymptomatic.
> "True" asymptomatics are rare.)

Let's be real. In the study cited, N was like 900 (with asymptomatics = 4;
1.9%). We have no idea how "rare" asymptomatics are, and citing this study is
just bad science. I don't understand why not just be honest.

~~~
Symmetry
For the hospitalization ratio we don't have enough testing in many places but
for those countries that are successfully pursuing test and trace strategies
we can be pretty sure they're at least discovering the majority of contagious
infections. So we can guess at the rough number even if we don't have it
nailed down precisely.

~~~
dvt
Iceland is leading testing rates at almost 146 per 1,000 people[1]. This is
_extremely_ low for a hyper-contagious pathogen like COVID-19. No one is
"pretty sure they're at least discovering the majority of contagious
infections" \-- let's call a spade a spade and build models that actually make
sense.

[1] [https://ourworldindata.org/covid-
testing](https://ourworldindata.org/covid-testing)

~~~
Symmetry
If you use contact tracing to find out who sick people interacted with you
only need to test those people rather than everyone and you can get by with
far less testing overall. Then it's about the number of tests per case rather
than the number of tests per capita. The percent positive rate on tests is a
very important metric there as well and it seems that countries that control
the spread get that down far enough that false positives outnumber true
positives.

~~~
dvt
This kind of mental gymnastics just muddies the waters. My original point was
that hospitalization (and/or ICU) rates are contingent on infection rates and
that no one has reliable (and/or accurate) infection rates. Exactly how you
calculate infection rates (testing, contact tracing, self-reporting) is
immaterial.

------
isoprophlex
Fantastically illustrated once again, ncase if you're reading this, you're one
of my internet heroes.

The 'masks protect others from you, and wont protect you from others'
illustration is very useful, too.

------
glofish
This is simply a non-realistic toy visualization created to propagate the
groupthink that is already so pervasive.

the problem with this simulation is as with all models, it treats everyone
equally likely to need medical care (this is how the ICU bed capacity is
drawn). That is not the case a least bit. Millions of people have recovered
with minor discomfort and they have all predictable traits (say age) that
clearly indicated their preponderance to risk.

Show me a model that accounts for this, then I will take it seriously.

~~~
dTal
The model operates on aggregate statistics. The likelihoods associated with
any particular individual are not relevant and do not affect the conclusions.

Unless of course you want to assert that we should care more about some deaths
than others. But that is a political statement, not an epidemiological one.

~~~
nostrademons
> Unless of course you want to assert that we should care more about some
> deaths than others. But that is a political statement, not an
> epidemiological one.

That said, I'd love to see a model that _does_ assume the population cares
more about some deaths (notably their own, and those of their close friends
and family) than others.

The starting point for epidemiology and public health is that all life is
sacred and worth the same, and we should protect life at all costs. There's
pretty ample evidence that much of the general public doesn't actually believe
this, though they'll _publicly_ profess to because there's immense social
stigma against wishing other people dead. But note how many people make
comments in the vein of "It doesn't affect young people", "This is only a big-
city disease", "It only affects Asian people", "Yes, yes I hope Trump
supporters do drink some bleach", "I hope he dies of coronavirus", or "Good,
Darwinism in action." The mods of r/coronavirus had to make a blanket policy
against wishing people dead, and regularly lock threads because of it.

Public health interventions only work if people follow them, which implies
that a.) the citizenry needs to trust public health experts and b.) their
goals need to be aligned enough that citizens think it's in their best
interests to comply. There's a very common failure mode for other system-
design efforts in assuming that the _stated_ goals of the project are the
_actual_ goals. I'd love to see a model that assumes people are self-
interested actors that respond to fear and greed, rather than one that takes
as a given that they'll act for the common good.

------
jdkee
FWIW, I found this thread by Jeremy Konyndyk enlightening and depressing.

[https://threader.app/thread/1256090422188953600](https://threader.app/thread/1256090422188953600)

------
nkkollaw
Cool animation, but how reliable are the numbers?

There are no reliable tests, governments are not doing a lot of testing, most
cases are asymptomatic.

How do you even know the death rate, and how many people need ICU? The
animation says 1-20, seems crazy.

------
squidproquo
If anyone has been doing Covid-19 simulations for the United States. I'm
crowdsourcing forecasts on this site:
[https://www.unitarity.com/app/challenges/us-coronavirus-
outb...](https://www.unitarity.com/app/challenges/us-coronavirus-
outbreak/events/may-20)

------
wiz21c
When Alice sends what she said to the hospital, I'm afraid she's not anonymous
anymore. Indeed the hospital (or whoever owns the phone (I'm looking at
google/apple)) knows who it's talking to. For Alice to remain anonymous, she
must be able to send what she said through an anonymous channel...

Am I right ?

~~~
iso947
Not sure why google/Apple would know any more than they know your bank
details.

Your hospital would now when you ask them for a year, same as they know when
they process it.

------
deegles
Isn't it a big assumption that immunity is permanent? How would it affect the
herd immunity threshold if a person can be reinfected every year?

~~~
mmmrtl
See fig 3 here:
[https://science.sciencemag.org/content/early/2020/04/24/scie...](https://science.sciencemag.org/content/early/2020/04/24/science.abb5793)

Short answer, if the immunity is as short lived as current seasonal
coronaviruses, it would be expected to recur in 2022 (hopefully with milder
symptoms, but we can't know that yet).

~~~
rootusrootus
Assuming immunity is both short-lived and predictably so for everyone. If the
amount of immunity varies significantly by individual, then it’ll just be an
ongoing slow burn and not another spike of infections. And that also assumes
that at a slow burn it would be able to maintain R0 > 1.0.

~~~
mmmrtl
Good point. If seasonal effects are strong enough, though, it might still
recur in periodic spikes.

------
_red
This somewhat a classic Strategy vs Tactics problem:

The best Strategy is to do nothing

The best Tactic is the complex array of shutdowns, mask, social distancing,
pharmaceuticals.

------
augustt
What's the reasoning behind this incredibly strong statement: "Most
epidemiologists expect a vaccine in 1 to 2 years." ?

~~~
slicktux
I would assume maybe because of the phenomenon:

[https://en.m.wikipedia.org/wiki/Antibody-
dependent_enhanceme...](https://en.m.wikipedia.org/wiki/Antibody-
dependent_enhancement)

------
claudeganon
Yes, it’s become obvious that this whole situation is not so much a threat to
white-collar work, but to the necessity of the hierarchy and authoritarian
control structures that define American workplaces.

~~~
Roritharr
I sadly have to agree. A good entrepreneur friend of mine asked me what he can
do to better monitor his employees working from home.

His questions got creepy quickly until I had to tell him to ask someone else
because I felt uncomfortable, but let's just say Office 365 can quickly turn
into a mighty tool for the ill intentioned.

~~~
h_cube
Sigh. I've had to deal with this as well now that our engineering org is full
remote. What it comes down to is that our leadership doesn't trust us, even
though we consistently and repeatedly deliver releases on time and on budget.
If our engineering leadership was comfortable with compensating us for the
desired outcomes they want to generate value for the company, this wouldn't be
an issue. Somehow I'm guessing they feel uncomfortable that we could all be
getting our work done in 4 hours every day and then going outside to play.

~~~
jacquesm
They're not uncomfortable about it, they see that as breach of contract and
would like you to either take a pay cut or work the full 8. We get paid 'by
the hour' and not by a contracted amount of work no matter how much time is
spent. Our whole regular workforce is structured around hourly wages, full
time and/or part time employment in something described as a 'job'. If you
start upending that it is important to realize that employers have a dominant
position right now and that upsetting that position may not end well for those
that really only do four hours of actual work during an 8 hour day.

~~~
mercer
> ...upsetting that position may not end well for those that really only do
> four hours of actual work during an 8 hour day.

One of the great shocks in my life was finding out the sheer number of
employees to which this applies. The most obvious places were the various
BigCo's I worked at, but it applied almost anywhere.

Now just the drudgery and pointlessness of much of their work made me
sympathetic to their slacking-off, but it was the constant anxiety of
_appearing_ busy that made it seem truly miserable.

At some point in my early twenties I'd had both the high-pressure, still-
smelling-of-fries-after-a-shower type of experience of working at McDonald's
or various restaurants, as well as the experience of sitting in the office
with various just-below-board-member managers of one of the major insurance
companies here.

Aside from the possible issues resulting from the physical strain, and having
to live more frugally, McDonald's struck me as preferable to the latter (but
neither seemed like any kind of world I want to live in or actively maintain,
if possible).

I don't know if this is a personal thing, but I would go for a job where I
need to focus and work over a job where I need to _pretend_ to focus and work
anytime. And most office jobs seem to have more of the latter than I can
imagine anyone tolerating.

~~~
slfnflctd
100% this. I had a government job, could have worked my way to a nice pension
and everything... but I realized a few years in that my mental health probably
would not survive the slog. Half the average day (easily) was totally eaten up
by small talk, surfing the web and/or making personal journal entries. Another
quarter of the day was meetings, often with snacks. I took long lunches. There
were days when I did probably less than hour of actual work. And all the while
I kept thinking, "why was I happier when I had my nose to the grind in the
private sector?"

Most people need to feel useful on some level or they lose motivation and
their brains go sour. There are exceptions to this rule, and those people
should definitely dedicate their lives to finding a cushy office job. I would
literally rather drive rideshare, and I have. [Not since March 12th, though--
fortunately my S.O. is able to cover bills until I can go back to driving
and/or try to find a software job worth showing up for again.]

~~~
mercer
Perhaps a side-note, but my most of my experience is the private sector. While
the government jobs I've experienced were mostly 'the same' in all the bad
ways, at least the pressure seemed a bit lower.

I just wanted to point that out, because I find it extremely frustrating to
discuss these matters with various friends who are all in agreement, but then
somehow believe this is just a government thing, and as a result seem to be
drinking more and more of the 'corporations and the free market optimize this
shit away and socialism is bad' kool-aid. Which strikes me as both a
simplistic and ineffective conclusion to draw, if we're thinking about better
ways to do things.

Oversimplifying, but in my experience the private sector, at scale, is often
just as inefficient and bullshitty and mind-numbing and depressing as a
government entity, just with less job protection, higher pressure, and perhaps
often less of a meaningful societal value, however inefficiently achieved.

And perhaps worst of all, you get managers/bosses who are not just content to
do an okay job at their current position, but actively employ a ruthlessness
and ambition that makes their stupidity all the more problematic.

~~~
slfnflctd
> in my experience the private sector, at scale, is often just as inefficient
> and bullshitty and mind-numbing and depressing as a government entity, just
> with less job protection, higher pressure, and perhaps often less of a
> meaningful societal value

This is a great point. Having worked at several large companies in addition to
both state and federal government agencies, I mostly agree. I hated not being
efficient in government work, but at least there was less B.S. pressure and
some sense of 'greater good' decoupled from profit incentives (although there
were definitely still budget constraints).

------
hedora
The simulation doesn’t take into account new strains. Coronavirus mutates at
least once a year. It’s likely there will be strains that are similarly
contagious, but with higher or lower case fatality rates.

Prior pandemic case fatality rates were 10x what we’re seeing with COVID-19.

Also, in 1918, shelter in place contributed to a W shaped pandemic, where the
second wave was much more deadly, and also killed lots of kids and young
adults.

If more people in those age groups had been infected in the first wave, many
fewer people would have died in total.

~~~
kolinko
The first two paragraphs you said are blatantly false.

------
gns24
A great explanation of a lot of things, but this looks wrong to me: "To put a
number on it: surgical masks on the sick person reduce cold & flu viruses in
aerosols by 70%. Reducing transmissions by 70% would be as large an impact as
a lockdown!"

Reducing the amount of virus in aerosols won't reduce the number of infections
by the same amount. If a cough produces ten times the infective dose, then
with the mask that's still three times.

Masks are still likely to help (and maybe having a smaller dose will make the
disease milder if someone does catch the virus), but it's not possible to make
a statement like this about the effect on R.

~~~
cactus2093
I can’t really imagine a mechanism by which a mask would still let the same
cloud of particles from a cough disperse in exactly the same way, but
uniformly remove 70% of them. Surely if it is blocking that many particles
it’s also disrupting the spread of the remaining particles. Or it could very
well be the opposite of what you’re saying, maybe blocking that 70% of
particles is enough to stop even more than 70% of the transmission
opportunities. That wouldn’t be crazy if the spread is mostly via large
droplets (most likely to get stopped by a mask) rather than aerosolized
particles, which has been suggested.

I think your argument is that it’s just not scientifically proven, but we have
to make decisions today with the best information we have. Wearing masks still
appears to be a good idea, has very low cost, and has been shown to help for a
long time for all kinds of respiratory diseases.

~~~
gns24
I don't disagree that wearing masks seems a good idea, I'm just saying 70%
reduction in particles doesn't map to a 70% reduction in transmissions.
Whether the reduction is 10% or 90%, it's a useful contribution, particularly
because in public situations where masks are likely to be recommended
(transport, shops) if someone coughs as you're walking past there's no way for
contact tracers to know about that link.

------
ytNumbers
I'm quite impressed with the work that went into these simulations. The folks
who put this together did a great job. It would have been a great method to
explain to the public how lock-downs save lives by not overwhelming our
hospital ICU bed capacity, but for one critical omission. My idea for a way to
improve these simulations would be to include what could be the most important
public policy issue of them all: In many US states, the governor has forbidden
(or greatly restricted) pharmacies from dispensing hydroxychloroquine. How
many people could be kept out of the ICU (when the medicine is used in
conjunction with azithromycin or zinc) if governors allowed pharmacies to
dispense this medicine? I've yet to see a study where hydroxychloroquine, when
used in conjunction with z-pak or zinc, was found to be ineffective against
COVID-19. Of course, that's not proof of anything, but, with 25% unemployed in
some of the biggest US cities, rigorous scientific studies may wind up taking
more time than we can afford to wait. Therefore, it seems to me that the best
way to find out what works to save lives (and keep people out of the ICU) is
to look at what the front-line doctors are doing at one of the most
prestigious hospitals in the world:

[https://www.the-
hospitalist.org/hospitalist/article/221558/c...](https://www.the-
hospitalist.org/hospitalist/article/221558/coronavirus-updates/yales-
covid-19-inpatient-protocol-hydroxychloroquine)

~~~
xenonite
Do you mean the non-prescripted dispensing of hydroxychloroquine? I think it
is quite reasonable to rely on prescriptions by a doctor. Swedish hospitals
stopped giving hydroxychloroquine to patients a month ago as it has more
negative side effects than benefits.

~~~
djsumdog
There have been a lot of studies funded for various drugs. Honestly at this
point, it seems like they're just throwing every compound that's been approved
as safe, and that might show some hope for interaction, at this thing in hope
something works.

~~~
JoeAltmaier
That's describing the development effort for every drug, ever.

