
Containment gets harder every day we delay - jefftk
https://observablehq.com/@yurivish/dont-be-italy
======
raspasov
"So far, successful mitigaions in China/Korea have involved near-complete
shutdown, very early in the epidemic, around the time of 100 confirmed cases."

From what I read, South Korea shut down almost nothing but had widespread
testing available, including drive-through testing where people could sit in
their car, get tested and receive the results via SMS next day. They also had
the ability to very proactively search and locate people that had been
potentially exposed to the virus via credit card transaction/location data.

~~~
Nightshaxx
But SK also published that location data online for all to see, something the
US cannot do because HIPPA. People would make fun of those with the virus,
such as one man who was tracked to a hotel associated with prostitution.

~~~
vinniejames
Public safety aught to trump HIPPA

~~~
djsumdog
So should we publish lists of everyone who is HIV+ in our cities?

------
gcatalfamo
As Italian I can confirm you guys should hurry and close everything down
sooner. I would however prefer the title said “don’t be like the Italian
government” instead of just “Italy”.

Not everybody here is behaving like a moron, luckily.

~~~
easytiger
What's the point in closing everything down? What happens when it reopens?
Will the virus admit defeat and run away?

~~~
sneak
To assume good faith in your question: the point is to slow the spread, and to
flatten the curve so that the hospital system is not overburdened and that as
few people as possible that need emergency critical medical care fail to
receive it.

~~~
threatofrain
So what does that mean in the long run? After virtual lockdown is lifted? A
resurgence in winter?

~~~
sdkaufman
\- If we can reduce / avoid overloading hospitals, people who get it after the
lockdown will get better treatment and will be less likely to die than if they
got it now.

\- Over time, we will come up with more effective treatments and perhaps a
vaccine. We will likely also have more equipment like ventilators and
protective gear at our disposal.

\- More people will have had it and built up some level of immunity, and "herd
immunity" means it will not spread as quickly.

~~~
mr_toad
Herd immunity won’t make a significant difference until half the population
have had it, and a vaccine could be a year away (if ever).

~~~
threatofrain
This also all assumes that the virus won't be quickly mutating. If it is,
vaccines and herd immunity will have diminished efficacy.

------
theseadroid
For people who are curious what living in China feels like now (video uploaded
Mar 14th), from a Japanese director living in Nanjing, China:
[https://www.youtube.com/watch?v=YfsdJGj3-jM](https://www.youtube.com/watch?v=YfsdJGj3-jM)

Things are getting back to normal, with tons of precautions.

~~~
eBombzor
Wow they pretty much thought of and solved every case where human contact
could be possible. The elevator transportation in particular is pretty clever.
Those Chinese cities are incredibly mobile. I can't even imagine how long it
would take any US city to get to that point if ever.

------
seemslegit
Not to downplay the importance of containment efforts I think there is
something uniquely bad about Italy's mortality rates and something really good
that the Germans are doing.

Based on the Johns Hopkins CSSE data for March 13

On March 13 Germany had 3675 confirmed cases and only 7 deaths. Adjusted for
respective populations Italy was at this stage 9 days before with 3089
confirmed cases, by which time it has already seen 107 deaths. This projects
21x COVID19 mortality rate for Italy over Germany - what gives ?

Italy's outbreak is concentrated in Lombardy so maybe weighing for the
population of that area rather than the entire country is more appropriate
which means Germany is currently 16 rather than 9 days behind Italy but with
mortality in Italy still being 13 times higher than Germany.

Possible explanations:

Italy's 3089 confirmed cases 9 days before are selected for severity - only
people who arrived with acute symptoms were tested, whereas Germany's 3675 are
the results of more proactive testing and are dominated by mild or non-
symptomatic cases that would have passed undetected in Italy.

Italy squandered some of its hospital capacity on first-diagnosed-first-
hospitalized basis regardless of severity and began triage too late wheres
Germany does better job prioritizing hospital vs home treatment from the
start.

9 days before Lombardy's hospitals were already over capacity with 3089
confirmed cases while Germany's still aren't today. Germany has 2.5x the
hospital beds per population than Italy, let's assume this holds for ICU beds
as well. If capacity is the sole/dominant factor in this and we say that 9
days before Italy was already over capacity with 3089 cases than Germany will
have reached a similar over-capacity at around 10k confirmed cases in a few
days and then its mortality rate will begin to climb.

~~~
freeflight
Italy seems to have been a bit blindsided by the fact that it's home to a
rather large semi-legal Chinese population [0], to a point where there were
direct flights between Rome and Wuhan prior to the Italian government shutting
down air-travel to China [1].

The German response has been rather decent, freeing up lab capacities and
using private labs to scale up already solid diagnostics capabilities, which
helps prevent cases from going terminal. [2]

As somebody working in German healthcare, outpatient care to be specific,
we've already seen hospitals free up beds, by releasing non-priority patients
to ambulative home-care around 2 weeks ago.

Starting this week schools will remain closed, Germany is going into lock-down
with limited border travel and offering companies "unlimited loans" [3] to get
through the resulting economic downturn.

[0] [https://www.businessoffashion.com/articles/news-
analysis/fir...](https://www.businessoffashion.com/articles/news-
analysis/fire-exposes-illegal-chinese-factories-italy)

[1] [https://www.schengenvisainfo.com/news/italy-suspends-visa-
is...](https://www.schengenvisainfo.com/news/italy-suspends-visa-issuance-and-
all-air-traffic-from-china/)

[2]
[https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4](https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4)

[3] [https://www.businessinsider.de/international/coronavirus-
ger...](https://www.businessinsider.de/international/coronavirus-germany-
offers-affected-companies-unlimited-loans-covid-19-2020-3/?r=US&IR=T)

~~~
toyg
Chinese links didn't matter. Patient-0 in Europe was tracked to Germany in
January. The most affected Italian areas do not have a particularly large
official or unofficial Chinese population - but have massive economic and
social links with Germany. The areas where the Chinese concentrate, like the
Prato mentioned in your first source, saw _no_ cases - they all voluntarily
self-quarantined as soon as the emergency exploded in Wuhan, and kept that
discipline going.

Italy simply pays the price of a very elderly and weak population, coupled
with a decades-long shrinking of public healthcare. Even in Lombardia, one of
the best regions for healthcare, intensive-care units in public hospitals were
instructed "in peace time" to run close to capacity as much as possible, in
order cut beds and save money. This is how we ended up with less than a third
of the capacity of Germany, and when shit hit the fan, it wasn't enough.

(Also, Germany is kinda fudging the numbers. They don't record deaths as
Covid-related unless covid was absolutely the only health issue a patient
experienced. That's not how victims are recorded in most other countries.)

~~~
detaro
Looking at German news, most reported deaths are reported as having prior
complications or having died of other related illnesses, so the blanked
statement about "don't record deaths" is clearly not true. If you have sources
that it's happening partially, I'd be interested in those though.

~~~
toyg
It was reported in Italy (obviously in Italian)
[https://twitter.com/Paolo_Tumolo/status/1237018245552582657/...](https://twitter.com/Paolo_Tumolo/status/1237018245552582657/video/1)

There are other reports of hundreds of deaths that were simply not tested for
the virus, whereas in Italy they've tested pretty much every death since the
outbreak in February. Considering that Patient-0 was infected at the end of
January, the theory that there might be some under-reporting going on is not
unrealistic. Germany probably just had the capacity to deal with this "under
the radar" for longer than Italy.

This is hardly unique to Germany, btw - each country has adopted different
methods to test and report, it will likely take time to get some decent
convergence at European level.

~~~
josefx
> It was reported in Italy (obviously in Italian)
> [https://twitter.com/Paolo_Tumolo/status/1237018245552582657/...](https://twitter.com/Paolo_Tumolo/status/1237018245552582657/..).

First: I hate twitter.

Second: in a follow up he seems to say (using google translate):

> It is EXACTLY what I meant: they charge the deaths to other pathologies
> present. I don't see many other possible explanations.

So he doesn't have proof or even a statistic to point to? He just doesn't see
an alternative explanation? Is the newspaper he is working for yellow press?

------
jgeerts
To be honest, at the start of this epidemic it wasn't that clear how dangerous
the virus was or how easily it would spread. First it happened to Wuhan and we
all thought that it wouldn't happen to us, then it happened in Italy and we
still thought that we would be fine.

Thinking that it won't happen to you won't make it go away unfortunately, your
country isn't special, if no drastic measures are being taken like full
quarantine this will happen to you too.

My country is in full lockdown and still a lot of people don't see the gravity
of the situation. People dismissing it as less dangerous than influenza are
misinformed.

~~~
darkteflon
This pretty much describes the approach Japan is taking. We’re special, it
doesn’t apply to us, it won’t happen here. Deeply ignorant approach. I’ve got
a family - including a mother-in-law with a pre-existing lung condition - to
worry about.

------
michaelbuckbee
This is just a general comment about all of these (really quite nice) data
visualizations: they're based on confirmed cases.

Given the many issues with the limited availability of testing this of real
concern as it makes it much harder to judge the accuracy of "X days behind",
etc.

~~~
atoav
Also this is very different per nation. E.g. Germany has labs in most
university clinics and a tight network of private commercial labs, which are
nearly all able to test for COVID-19, while the situation in Italy regarding
tests was much much worse, so they didn't see it comming at all.

So how can one really compare the numbers between nations when their testing
capabilitied are so different?

The ground truth is certainly deaths - if you know the mortality rate if the
virus you can infer from the number of deaths how many people had been
infected at some point in the past.

Of course it would be much better to have an idea how many people are infected
_now_ , so you can base your decisions on it..

The dangerous thing about viruses is that they grow in a logistic curve and
the first part of that curve is exponential. So things can grow out of
proportion literally overnight, like they did in Italy.

------
contravariant
Forecasting Germany as if it were Italy isn't entirely fair, given that
Germany has only had 9 deaths with 5000 confirmed cases while Italy had close
to 200 deaths by the time they managed to confirm 5000 cases.

As far as I can tell the situation does seems to be developing at the same
rate, but going by the confirmed deaths I'd place Germany about 2 weeks behind
Italy, not a mere 7 days. Which for exponential growth matters _a lot_.

Edit: Also note that forecasting countries as if they were South Korea has the
opposite problem as the fatality rate of South Korea has remained low compared
to other countries (though not as low as Germany's and those of Scandinavia).

~~~
ygra
Right now the official explanation is that we're quite good with testing and
isolating cases so far, which would mean that the confirmed count right now is
much closer to the actual count than in Italy (or the US).

On Twitter the opinion seems mostly to be that the death cause is doctored.

I'm kinda hoping for the first, right now, because the projections aren't
pretty (even if we're a bit further behind Italy). We only now started
shutting down schools, and most events and even that is spotty as every state
does its own thing and sometimes even every city.

~~~
contravariant
To be honest at first I found it _suspiciously_ low, but now that the
Scandinavian countries are very low as well it would require quite the
conspiracy to keep this up.

~~~
ryanobjc
Conspiracy not needed.

It’s winter. Old people die from the flu. Viral pneumonia. Without RNA tests
the causes of death aren’t entire trustable.

Consider the US: the numbers are low because we are under testing people.
Significantly under counting.

~~~
atoav
The German virulogist who developed the first test for COVID-19 speculated
that based on the numbers Italy must have had more deaths earlier on, but
might have mistaken them as old people dying from the flu (which happens all
the time and therefore didn't raise any eyebrows in the medical system).

------
Analemma_
I submitted this as a new story but it's worth repeating here: here in
Seattle, we're already Italy [0]. The hospitals are having to provision ECMO
machines based on demographic prognosis, and the respirators are probably only
a couple days behind. Presumably this will be the situation in every major
American city 2 weeks from now.

[0]:
[https://twitter.com/scott_mintzer/status/1239290389963714562](https://twitter.com/scott_mintzer/status/1239290389963714562)

~~~
Leary
Wow not giving ECMO to BMI 25+ is really something.

I am fairly skinny and it wouldn't take much for me to reach 25.

They should consider revising the cutoff especially since Chinese people can
be of thinner frames. 25 may be slightly overweight for them but normal for
others.

~~~
stefan_
I don't understand, you want the virus to not kill people with >25 BMI to
accommodate US standards?

I don't think they chose these criteria because they just hate fat people.

------
asjw
As an Italian living in one of the red areas I feel it's pretty hard to do
better than Italy in the west if you are hit first

South Korea had Seegen almost single handedly testing the population, China is
not a standard of what a liberal democracy can do

We did everything we could, I've been staying home for 3 weeks as of now, but
we couldn't predict the virus spreading from the hospitals of small cities
hitting hard on the elderly population

80% of the deaths are >75, 98% are >65, the avreage age of the deceased is
79.4 years old but if we look only at women their average age was 84.2 years
(South Korea life expectancy is 82 years) and we counted every death as a
coronavirus related death if the patient tested positive, but most of them
died for pre-existing conditions, while other countries are not counting them
if other conditions where already present (and I imagine old people at the
hospital are there because they are already ill)

So I must say that despite our own indiscipline, bad luck was a very strong
factor in what happened

BTW Spain is already looking worse than us at their same day

~~~
nullc
Where we can do better than Italy is learning from your experience and taking
measures earlier: we aren't first.

Even measures less aggressive than your lockdowns would be _more effective_ if
they were simply taken earlier.

This isn't a criticism of Italy. Getting the political will to shut things
down when there are few cases and no deaths is extremely hard. But the
experience of Italy is showing all of us what our unwillingness to do so will
cause.

~~~
asjw
But I bet nobody will, because you know nobody wants a lynch mob looking for
them

UK is still having giant music shows with thousands of people, Germany is not
counting people with previous conditions, France had even a smurf convention
(sigh!)

We all have a family member living in one of the EU countries and are all
calling home sick worried because nobody is doing anything because “The
Italians, any old excuse to, you know, shut down everything and stop work for
a bit and have a long siesta.” (it's not a joke, a British TV personality
really said that)

So maybe be like Italy and not like everybody else this time.

Seriously, I've been confined 3 weeks and am fine, but my friends calling me
from abroad are crying for help, because they want to come back, but can't.

------
BryanBigs
Just so I'm clear...this analysis assumes the same amount of assisted
breathing devices per capital as the Italian health Care system?

------
nemo44x
Italy last is a special case - not that everyone else doesn’t need to take
exceptional action. To be sure social distancing, closures of places of
congregation is in order, and safety practices like washing hands often are
necessary. But Italy is a special case...

\- Italian leather manufacturing is by and large run by Chinese ownership
today.

\- Many of the employees in these shops are from China as they will work for
much less.

\- Italian population skews very old - a very vulnerable population.

\- Italian culture has close families that meet near daily, have generational
family living together, and populations are proximal.

\- The wide Chinese population in north Italy went back and forth to infected
areas of China during the Chinese New Year.

\- When they came back there were many “patient 0’s” in the region.

\- Because of this, numerous exponential functions were set off at the same
time.

\- Because of the closeness of Italian culture the virus had the necessary
engine to propagate.

It’s not Italy’s fault. They got a perfect storm here. They are managing the
best they can.

~~~
TeMPOraL
> _But Italy is a special case..._

That's trivially disproved by simply taking JHU daily data of Italy and other
countries, and plotting it as date x log(cases). You can see that most Western
countries follow the exact same path.

~~~
nemo44x
We don’t even know what “cases” really means. So many people have been
infected and not tested by this point. It is estimated over 200k have been
infected in the USA and have not required medical help or felt symptoms.

Italy has had a more rapid and intense breakout coupled with a vulnerable
population and social customs that spread things more quickly.

I’m not British but their strategy of lock away the weak (old people and other
vulnerable) and let the young/healthy take the brunt and burn the virus out is
pretty smart. Unless in reinfected of course.

~~~
TeMPOraL
I'm not buying the British strategy. I feel they're trying to do a suicide
burn[0][1]. But with insufficient testing coupled with all that's unknown
about the virus - including how long the immunity lasts - I don't think they
can control the infection rate anywhere near well enough to pull this off.

\--

[0] -
[https://news.ycombinator.com/item?id=22585289](https://news.ycombinator.com/item?id=22585289)

[1] - [https://space.stackexchange.com/questions/10307/what-is-a-
su...](https://space.stackexchange.com/questions/10307/what-is-a-suicide-burn)

~~~
nemo44x
Possibly.

The question I ask when I see these graphs indicating “days behind Italy” is
why is Italy ahead? As if cities like NYC didn’t have anyone from Wuhan enter
while sick?

We all had essentially the same “day 0”. We are moving much slower than Italy.
There are other reasons (and not Italian incompetence) why they are in a
greater crisis than others in the West.

Most countries are well ahead of them in this regard. The UK strategy is sound
in that you don’t need testing - the hospital numbers indicate and can be
extrapolated.

------
scurvy
How are California and Washington "behind" Italy, when both states had
infections reported before Italy? Sorry, trying to understand the methodology
here.

Or are you just basing this off of raw case counts?

~~~
originalvichy
I'm sorry to sound so cynical, but I have never seen so many statisticians and
virologists pop up on the internet drawing all sorts of graphs and estimates.

For all we know this person got their numbers by just guesstimating. Most
countries have differing "exposure vectors" so to say, which means that just
comparing other countries to Italy is nonsense.

~~~
m0zg
>> never seen so many statisticians and virologists pop up

The same people were prominent internet economists and political scientists
just a month ago. They have many talents.

------
crispyporkbites
After 21 days, what happens?

Do we lift the quarantine? Relax it a bit? Stay in quarantine indefinitely?

What does the model look like for that? Without a full picture the initial
strategy could make things worse in the long run.

~~~
kmm
That's what I'm asking myself too. It's way too early for any kind of herd
immunity, and you only need a handful of people who have broken the rules (or
simply due to delayed intrafamilial infection) to have a few infectious people
back out in the wild, and we're back to square zero.

Is the plan for a lockdown to completely eliminate the disease? Are we hoping
the heat of the summer will stop it? Or does flatten the curve really mean
that eventually 60-70% of the population will get infected. If so, we're in
for a rough 2020.

~~~
thaumaturgy
The numbers I've seen so far are assuming 40% to 70% total infections over the
next several months.

The current efforts are just trying to take some energy out of the first wave
of hospitalizations, to buy time for more supplies and staffing and to get the
current infected out of health care as new cases come in.

After a few weeks, it may turn out that hospital capacity and more widespread
testing allows some restrictions to be lifted. Or, it may turn out that the
situation in the US is far more severe than expected, and the restrictions
will only worsen by then.

I'm hoping for the former but betting on the latter.

------
jupp0r
I agree with the content. I wonder whether the title “Don’t be Italy” still
holds. US might be past the point already where Italy was locked down.

------
Camillo
China had people dying in the streets, but we're now at the point where the
quarantine has had effect, so it's successful mitigation. They also initially
quarantined only the area of the initial outbreak (Wuhan), and only later
expanded lockdown measures to most of the country (covering 800 million people
at the peak, IIRC). And of course the quarantine leaked enough that the
infection spread to the entire world.

But sure, thank you CPC, a model response from a model government.

~~~
vkou
> And of course the quarantine leaked enough that the infection spread to the
> entire world.

It spread prior to the quarantine being put in place.

> at this point it's run its course, so it's successful mitigation

Only ~80,000 people out of 11,000,000 in Wuhan were infected. For a disease
this contageous, that we don't have herd immunity for, that's hardly 'run its
course'.

~~~
Camillo
I'm not saying the quarantine had no effect. What I mean is that there is a
time delay between when the quarantine is put in place and when you see the
detected infections start decreasing. China is now at that point, but it's
like all commenters have suddenly forgotten what happened before.

------
mothsonasloth
For UK people: here is a discord server were we are trying to share
information regionally and locally (teachers, students, professionals etc.)

[https://discord.gg/prydRc](https://discord.gg/prydRc)

~~~
sneak
Gatekeeping access to critical health data based on agreeing to the Discord
ToS and Discord’s anti-anonymous-access policy is harmful. Please consider
Mattermost or a mailing list so that everyone can participate.

~~~
mothsonasloth
Sorry what I mean, is for people (most of whom are gamer demographic at the
moment).

To chat and share information, support

------
AncientTree
Korea will have to remain on alert, forever, as their population has no
established immunity. A vaciine may never come - there is no influenza vaccine
(it mutates every season).

Plus, there are grim, yet economic, benefits if the sickest and most elderly
die from Coronavirus, in the form of long-term savings on pensions and
healthcare. This should be taken into account in strategic national planning.

The UK approach seems the most sensible - keep the economy and society
functioning, and recommend that the most vulnerable practice self-isolation.
Better to isolate those who are not participating in the productive economy
(ie. the sick and elderly) than the entirety of the population.

~~~
fkistner
German here.

Cannot disagree more strongly with your point! No, the economic benefit of
“having the sickest and most elderly die” should most definitely _not_ be
taken into account in strategic national planning.

Every life is precious. This line of thought is exactly what lead the Nazis to
murder hundreds of thousands they considered an economic burden.

Never forget.

~~~
DrNuke
Yes, that’s explicitly considering to kill 500k old and vulnerable persons, as
for the official doc leaked to The Guardian
[https://www.theguardian.com/commentisfree/2020/mar/15/uk-
cov...](https://www.theguardian.com/commentisfree/2020/mar/15/uk-
covid-19-strategy-questions-unanswered-coronavirus-outbreak)

------
mark_l_watson
I live in a small town in the mountains of Central Arizona. Since we get 1.5
million tourists a year, I expect things here to be similar to large cities in
the US elsewhere.

Most friends in town have adopted a fairly complete social distancing protocol
in the last few days. This happened abruptly, no one seemed to be doing it a
week ago.

While social distancing helps, we should have had testing infrastructure in
place much sooner. I am happy to blame Trump, and democratic and Republican
Congress critters for that. A good six minute interview:
[https://twitter.com/azeem/status/1238734048018792449](https://twitter.com/azeem/status/1238734048018792449)

EDIT: I posted this comment hoping to see comments from other people in the US
on whether or not people were largely social distancing in their communities.

------
ck2
Don't be patient 31

[https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-
CLUSTER...](https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-
CLUSTERS/0100B5G33SB/index.html)

(but really, in USA too late, everyone is out and about coughing on each
other)

