
Covid-19 update and guidance to limit spread - tectonic
https://www.flattenthecurve.com/
======
kasperni
This graph showing how many days other countries are behind Italy's infection
rate is quite alarming [1]. Especially the close alignment of most of the
countries.

[1] [https://ibb.co/gZDfgPy](https://ibb.co/gZDfgPy)

Edit: Sorry, I didn't include the original source. I had taken a screenshot
and couldn't find the original article. But the original data is from Mark J
Handley [2] who is (non-medical) Professor of Networked Systems and part-time
Roboticist at UCL. And the article I took the picture from is at [3] (I don't
normally read the Daily Mail, I promise).

[2]
[https://twitter.com/MarkJHandley/status/1237119688578138112](https://twitter.com/MarkJHandley/status/1237119688578138112)

[3] [https://www.dailymail.co.uk/health/article-8095299/Man-
under...](https://www.dailymail.co.uk/health/article-8095299/Man-underlying-
health-conditions-80s-UKs-SIXTH-coronavirus-death.html)

~~~
Bombthecat
There are still a ton of people who still think that it is just like the
flu... Talked to a few people and i basically lost hope that we will handle
the right way (until it is too late) i cant wrap my head around it.. Two
countries went in lock down... Becuae it is just like the flu? Yeahhhh....
Right.

~~~
zaroth
I totally understand the _reaction_ is totally different from the flu.

Here's my question: If we had real-time dashboards and 24/7 news coverage of
every flu case, hospitalization, and flu death... would it look much
different? I think it would actually look much worse.

~~~
TeMPOraL
Well, yes? When was the last time a flu DDoSed medical systems of two
countries to the point people are routinely refused treatment and die in the
ICU corridors?

~~~
zaroth
The WHO estimates that the 2009 H1N1 "swine flu" killed ~250,000. [1]

Reported case mortality of H1N1 during the pandemic was similarly upwards of
~5% in some countries, [2] although later retrospective studies found that
H1N1 was actually less lethal than a typical flu season (0.01-0.08%). [3]

ICU utilization was very significant in some countries, e.g. 30 people per
million admitted to the ICU [4]. (Italy is currently at 14 per million.)

Hospitals definitely had to adopt "surge management" although in 2009 it often
had as much to due with managing fear and panic as it did with getting people
access to ventilators. [5]

[1] -
[https://en.wikipedia.org/wiki/2009_flu_pandemic](https://en.wikipedia.org/wiki/2009_flu_pandemic)

[2] -
[https://en.wikipedia.org/wiki/2009_flu_pandemic_in_India](https://en.wikipedia.org/wiki/2009_flu_pandemic_in_India)

[3] - [https://www.cdc.gov/flu/pandemic-
resources/2009-h1n1-pandemi...](https://www.cdc.gov/flu/pandemic-
resources/2009-h1n1-pandemic.html)

[4] -
[https://www.nejm.org/doi/full/10.1056/NEJMoa0908481](https://www.nejm.org/doi/full/10.1056/NEJMoa0908481)

[5] -[https://www.reliasmedia.com/articles/136827-the-next-
pandemi...](https://www.reliasmedia.com/articles/136827-the-next-pandemic-
hospital-management)

------
chickenpotpie
It's so nice to see someone who has the qualifications explain so clearly why
the efforts we're making are important. I live in Seattle and I have a hard
time explaining to my mother why me working from home and avoiding public
events is important right now. She just keeps stating that everyone is going
to get it eventually and it won't matter.

~~~
manojlds
I am sure it has crossed many people's minds, but what if I want to get it
before the medical systems are taxed? Like get it before the peak. I am sure
it's very bad thinking, but what are some solid points against such thinking?

~~~
PureParadigm
If everyone thought like you and tried to get it early, then the hospitals
would be overrun and you'd be no better off. Also, it's possible for you to
get it again after recovery [1], so it may not even help you at all.

[1] [https://www.businessinsider.com/wuhan-coronavirus-risk-of-
re...](https://www.businessinsider.com/wuhan-coronavirus-risk-of-
reinfection-2020-2?op=1)

~~~
DoofusOfDeath
> If everyone thought like you and tried to get it early, then the hospitals
> would be overrun and you'd be no better off.

If the reality is that only a small fraction of people would think like that,
the we don't need to worry about that line of reasoning.

But I agree with your point that it's moot due to the potential for
reinfection.

~~~
ineedasername
The more people that think like that, the more that type of thinking
increases. Like panic buying inducing more panic buying. So it might start
small, but could easily balloon quite fast.

------
Fnoord
> Relative to Other Countries, US Labor and Healthcare Policies are a Perfect
> Storm for Pandemics

> Zero universal guaranteed paid sick leave [1]

The United States of America in the same list as India, North Korea, South
Korea, Somalia, Angola, Liberia, and Guinea-Bissau. Some of these countries
are poor or low income. The USA isn't one of them though. I'd be ashamed of my
country.

In The Netherlands, an entire [large] province (North Brabant) has been
ordered to stay home if they have anything resembling illness. People are
asked to work from home. Children can't go to school. Still, working from home
is better than nothing.

Also, some people are in quarantine. The people who have COVID-19 but
otherwise don't have it severe can stay home, in quarantine, instead of in the
hospital.

One thing I wish I knew way earlier is that COVID-19 victims rarely suffer
from a runny nose. I recently got it from Our World In Data [2], it was linked
here on HN. I did not read about this in our local media, sadly.

[1] [https://www.worldpolicycenter.org/policies/for-how-long-
are-...](https://www.worldpolicycenter.org/policies/for-how-long-are-workers-
guaranteed-paid-sick-leave)

[2] [https://ourworldindata.org/uploads/2020/03/Coronavirus-
Sympt...](https://ourworldindata.org/uploads/2020/03/Coronavirus-
Symptoms-%E2%80%93-WHO-joint-mission-1.png)

~~~
khawkins
> Zero universal guaranteed paid sick leave

This is a false statement. There are 12 states which require paid sick leave,
amounting to 30% of the population [1]. Federal employees are guaranteed paid
sick leave days [2]. According to the Bureau of Labor Statistics, 61% of
workers have paid sick leave, 78% have paid vacations, (80%/90% in large
employers with 500 or more workers) [3].

That whole section is just political garbage. There's plenty of reasons to
believe that businesses will take precautions themselves to limit the spread
of the virus internally, which includes offering paid sick leave to encourage
people to be extra careful.

[1] [https://www.ncsl.org/research/labor-and-employment/paid-
sick...](https://www.ncsl.org/research/labor-and-employment/paid-sick-
leave.aspx) [2] [https://www.opm.gov/policy-data-oversight/pay-leave/leave-
ad...](https://www.opm.gov/policy-data-oversight/pay-leave/leave-
administration/fact-sheets/sick-leave-general-information/) [3]
[https://www.bls.gov/ncs/ebs/benefits/2009/ownership/private/...](https://www.bls.gov/ncs/ebs/benefits/2009/ownership/private/table21a.pdf)

~~~
wickedwiesel
If I may nitpick your response: the data from the Bureau of Labor Statistics
is from 2009. 2018 data suggests 71% of workers receive paid sick leave. [1]

BUT, the data is highly skewed if you look at income. [also 1] The worst paid
workers also have much less paid sick leave. Only 45% of the lowest 25% income
group do. According to the BLS there were 130 million workers in 2019, thus
leaving roughly 15 million people (130 x 0.25 x 0.45) without paid sick leave
and likely without the financial means to go on unpaid sick leave or get
medical help (like testing).

Also, the average paid sick leave varies between 6-10 (working) days.
Suggested quarantine is 14 days. [2] Only 3% of workers have sick days "as
needed". [3] This supports the argument that these circumstances make matters
worse. I tend to agree to the general argument.

[1] [https://www.bls.gov/opub/ted/2018/higher-wage-workers-
more-l...](https://www.bls.gov/opub/ted/2018/higher-wage-workers-more-likely-
than-lower-wage-workers-to-have-paid-leave-benefits-in-2018.html)

[2] [https://www.bls.gov/opub/ted/2019/private-industry-
workers-w...](https://www.bls.gov/opub/ted/2019/private-industry-workers-with-
sick-leave-benefits-received-8-days-per-year-at-20-years-of-service.htm)

[3]
[https://www.bls.gov/ncs/ebs/benefits/2019/ownership/civilian...](https://www.bls.gov/ncs/ebs/benefits/2019/ownership/civilian/table33a.pdf)

~~~
SkyBelow
Does this count people who receive PTO that made be used as paid sick leave?
If so, I'm not sure it should be counted.

A person who doesn't have any paid sick leave nor PTO they can use it place of
it has to take a sick day doesn't get paid for that day. One way of thinking
about it is that they do get paid, but then have to give up pay equal to what
they get (and all this is calculated before tax purposes). A person who has to
use a PTO day that isn't only for sick leave is giving up something with a
near value equal to a day of pay. In most cases, any benefits or the like are
not cut for either person, meaning they still receive some level of pay when
you look at the averaged out of those benefit values over the day.

This may feel like a needless distinction, but I think it matters because when
a person without paid sick leave or PTO is sick they have to weigh staying
home against not making money, while a person who doesn't have paid sick leave
but is allowed to use PTO has to weigh staying home against losing a day of
PTO that they can't use for vacation. A person with true sick leave has no
such calculation, sick leave they can only use when they are sick means they
aren't giving up anything. Well, there is an argument to be made for the day's
worth of experience and other such matters are still loss, which for some
positions can be enough to choose to work even when there is paid sick leave.

------
3JPLW
The content is awesome and the site is starting to struggle with the demand.
Here's a cache/mirror/archive (ctrl-f) in case it goes down completely:
[https://archive.is/Du1G2](https://archive.is/Du1G2)

------
nimbius
speaking as someone who served in the army national guard, this pandemic isnt
nearly as devastating as a natural disaster. So long as there is still clean
water, electricity, and communications systems online, you're okay.

A few tips on things that can be stocked (or should be checked) for general
disaster preparedness:

0\. bottles of clean water. Old milk jugs of tap h20 will do. 1\. dry goods
like beans and rice which are compatible with boil-water advisories. peanut
butter is also good.

2\. a fever reducer of some sort. even a few Acetaminophen or aspirin.

3\. Cheap bar soap. dollar store or discount brand. The article is correct in
that every emergency needs good hygiene. bar soap can be split up among family
members.

if you're handy with technology, you should consider an amateur radio license.
[http://www.arrl.org/](http://www.arrl.org/) amateur operators are absolutely
appreciated by military and red cross workers as the fastest way to get in
touch with affected communities.

~~~
bloopernova
> dry goods like beans and rice

Rice is relatively quick and easy to boil and cook. However dried beans can
take a lot of boiling and soaking to become edible.

I'm not trying to say don't store dried beans, but just be aware of their
cooking requirements.

~~~
dcolkitt
Actually most beans don't need to be soaked before cooking.[1] The major
exception are kidney beans, which require soaking to neutralize a poison.

[1] [https://www.seriouseats.com/2014/09/soaking-black-beans-
faq....](https://www.seriouseats.com/2014/09/soaking-black-beans-faq.html)

~~~
mrob
Soaking is not enough to remove phytohaemagglutinin. Phytohaemagglutinin is
destroyed by sufficient cooking, which according to the FDA's food safety
book[0] means boiling for 30 minutes. Slow cookers do not get hot enough. And
it's not just kidney beans; many other beans also contain phytohaemagglutinin,
sometimes at dangerous levels.

[0]
[https://www.fda.gov/downloads/Food/FoodborneIllnessContamina...](https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf)

------
wtvanhest
This is a great resource, but I hope that the author sees this comment.

If you want to maximize credibility, remove the line about supporting artists,
and anything that can be perceived as political like the line about
healthcare.

Artists are a small percentage of people impacted, restaurant workers, nail
salons, retail, hotels, airline employees, contractors, massage professionals
etc. The list is almost limitless. If you are in another group, you are going
to read that line, and think, what about me?

Healthcare is a politically charged issue, right or wrong, listing that here
discredits the message for half the readers.

The overall message is important, and I encourage the author to make a few
tweaks to get it in front of more people and save lives.

~~~
gnicholas
Where is the line about artists? When I searched via ctrl-F, I couldn't find
it. Is it embedded in one of the images? Or has it already been removed?

~~~
BOBOTWINSTON
I think he is referencing this line in particular.

"Live performers are going to be hard hit economically. Consider supporting
their work on Patreon, directly via PayPal, or attend only the smaller shows.
Promote them on social media. Buy their work directly."

I do not really agree with removing this line, as it is good advice. I
wouldn't be against expanding the content to include other professions,
although the single-payer advocacy kind of does that for some of them.

------
jstummbillig
A whooping 430 points, posted 3 hours ago, overall favorable comments. I am
very confused as to how or why this slipped to page 3 already.

~~~
dang
It's being flagged by users, and also downweighted by mods. HN has had a ton
of these threads already, and there are other covid-19-related posts on the
front page.

Take a look at
[https://news.ycombinator.com/item?id=22527396](https://news.ycombinator.com/item?id=22527396)
for a fuller explanation, and if there's still something I haven't answered,
let me know.

~~~
jstummbillig
Fair enough! Thanks for the clarification.

------
ColinWright
Discussion:
[https://news.ycombinator.com/item?id=22535650](https://news.ycombinator.com/item?id=22535650)

 _Editing in response to the comments below ..._

This submission is of a different resource. This resource goes into more
detail about lots of things. However, the "Flatten the Curve" idea had already
been submitted in the referenced submission above. It was less complete, but
had already sparked a large discussion.

So should the resulting discussion be started all over again here on this,
more complete submission? Or should the discussion remain in one primary
location to avoid repetition and to gather the insights, thoughts, rebuttals
_etc_ in one place?

Who knows ... I provided the cross-reference to allow the decision to be made.
This submission has now hit the top spot on the front page and is spawning a
conversation. So the decision is made, and the cross-reference has been
rendered moot.

 _Further edit ..._

I think it unreasonable that the people who responded to me should be
downvoted, and I've upvoted them in an attempt to balance that. I think the
comments are fair and reasonable, and belong in the discussion.

~~~
throwanem
That discussion revolves around a wholly different resource.

~~~
ColinWright
Except that the discussion is common ... it's all about the concept of
flattening the curve to reduce the peak and thereby not exceed the capacity of
the health service.

It's the same data, it's the same idea, it's the same argument, but from a
different source.

It's also all now all over the place ... I could find 8 or 10 different sites
to submit, all with the same message. Is it useful then to have 8 or 10
discussion on HN all hacking over the same ground, all making the same points,
all having the same "insights" and disagreements?

I think not, and that's why I linked this submission to the existing
discussion.

~~~
throwanem
I don't think you've looked at the linked page in this case. It's not what you
think it is, and the difference in the two discussions also reflects that.

~~~
ColinWright
Now moot ...

------
xyzzyz
Why put the goal at flattening, instead of just killing it completely? If you
observably flatten the curve, you're already almost all of the way to get R_0
to below 1. Why not just go all the way? The Chinese seem to have managed it,
why aim at anything less?

~~~
lazide
Because, between the lines, the level of top down, military like action and
trampling of civil rights that is possible in China is likely not possible
here without sparking a civil war - making the whole situation worse.

~~~
Ericson2314
It would cause disorganized resistance and economic breakdown, but not civil
war, tbh.

~~~
lihaciudaniel
>disorganized resistance and economic breakdown

Even worse, imagine all the thing we have to do to get back to our baseline
economy. A civil war would be very quick

~~~
Ericson2314
Well I'm just talking a few Waco Texas, nothing too apocalyptic on the
insurrectionary front. If the government learned how to stimulate the economy
for real, and starting doing some all the deferred infrastructure work, I'm
sure it could lift us out of the economic woes the quarantine created. It
would would just take some time to figure it out, the US governments are all
brawn no brains right now, but things ran decently well in WWII so we'd get
there after a while.

I'm not saying this is good, I'm saying if you don't like a huge state
intervention, don't pat yourself on the back saying it would go miserably
enough to make the government change its mind.

------
aazaa
Part of the problem is that too many people look at the current state of their
communities and conclude everything is all right.

What they're failing to consider is that Wuhan, Italy, New York, Seattle, and
San Jose are not anomalies. If your community has no reported infections, _it
's_ rapidly becoming the anomaly.

Consider those places you keep hearing about as a glimpse into the future -
your future. Then take steps to do what you can as an individual to prevent
that from happening.

------
melling
Does anyone of the time series by country? The United States just reaches 800
tested infections. I think we had 88 on March 1.

Would like to see how fast the recent numbers are growing.

~~~
joshuahedlund
worldometers has more complete info but here is an interesting chart I've also
been tracking that compares the exponential growth of several countries after
they reached 100 cases [https://studylib.net/coronavirus-
growth](https://studylib.net/coronavirus-growth)

Despite the differences in start times, the similarities in the curves are
remarkable - although so are the deviations. I've basically been watching the
US follow the same path as a few European countries, just on a lag of a few
days.

~~~
abeppu
I'm curious -- are there things that Japan, Singapore and Hong Kong doing that
we should all copy? Their trajectory looks pretty different from that of other
countries.

------
avip
I like the rational way it was presented. I'm going to unilaterally declare a
WFH period starting tomorrow. My tiny contribution.

------
thoraway1010
Interesting that the advice here - masks not helpful - is almost totally and
directly contradicted by the advice in all infectious disease transmission
training, most other countries that have flattened the curve by dramatically
increasing supply and distribution with mandated mask wearing, making them
available at the post office etc.

The odd image of folks wearing masks saying masks don't help is not lost on
most americans.

Here's a different doctors advice on masks:

The only way for the virus to infect you is through your nose or mouth via
your hands or an infected cough or sneeze onto or into your nose or mouth. Use
disposable surgical masks and use them to prevent you from touching your nose
and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is
the only way this virus can infect you - it is lung-specific. The mask is just
to prevent hand to mouth contact, it will not avoid the sneeze part of things.

Masks are a low cost, non-hospital, low side effect, low economic impact
intervention. Even if only minimally effective there are very few downsides to
mask usage for an individual.

I've come to think that the re-assurance that this virus is "fully contained"
\- see Kudlow, that masks don't help (see this and others) will come back as
some pretty bad advice later on. We'll see I guess.

~~~
shkkmo
Who is saying masks are not helpful?

The closest thing the article says is that you should not hoard masks, that
their usefulness is against airborne particles is limited to 30 min and that
masks can make some people touch their face more.

~~~
thoraway1010
"Masks are NOT the most useful thing you can do to protect yourself: they’re
hard to wear properly, especially for long periods of time, and their
effectiveness against viral particles stops as the filter gets moist with your
breathing. Also for some people, wearing a mask makes it more likely that they
will touch their face."

Reality - masks are a valid, additional step. And given all the other crazy,
high cost, high impact steps being taken to "flatten the curve" a low cost low
impact step like mask wearing should be on the recommendations list.

Even kids (ultra low risk) in shanghai are wearing masks in the playgrounds.
And here we have older adults squeezed onto mass transit and are telling them
all the reasons why masks may not help.

To flatten the curve all low cost low impact steps should be taken.

~~~
bluGill
In Asia it is common to wear masks for air pollution reasons. It might or
might not help with a virus, but you can't cite kids in Shanghai unless you
can show there is an increase.

~~~
thoraway1010
I was basing this off first person accounts from ex-pats in asia - the big
message was that masks are now worn both as a courtesy to others and in some
cases are required and kids don't like to wear masks - which makes it tricky
when they are mandated. I can't find the blog though.

------
phasetransition
Has someone with industrial strength hosting made sure this page is going to
stay up, and/or created static mirrors?

------
planetjones
There’s a Symptoms graphic on that site attributed to the WHO. For sneezing
and Coronavirus it says ‘no’.

Can the author of the website or someone else please provide a hyperlink to
the original source of that graphic, so its authenticity can be validated.

------
lihaciudaniel
Here where I lived they canceled schools for 2 weeks and all sport events.

------
joejohnson
Good resource, although a bit America-centric

------
lend000
As I suggested on another thread (and received some flak for it), it would be
really interesting to see some math and/or a simulation to compare these two
scenarios. In reality, closer to 30% than 100% of the world population will
end up being infected by a disease like this (look at Spanish flu or Swine flu
for reference [0]), and the total number of infected is probably different
between the two curves.

Consider a hypothetical scenario: authorities encourage young and healthy
people to go out and about their daily lives and get sick, and they institute
a voluntary quarantine for people who would be considered highly at risk.
Would more or fewer "at-risk" people become infected?

These are some other factors to consider:

\- Could a short term quarantine for at-risk groups (shorter because the
faster general infection rate would result in faster herd immunity) be more
effective? Do quarantines and social distancing measures suffer from
"quarantine fatigue"?

\- What are the comparative mortality rates between people with medical care
and those without it? (i.e. those in an overwhelmed system due to the fast
spreading scenario)

\- Does recovering from the illness result in strong immunity?

\- What are the comparative costs of quarantines to society and economy at
large?

\- At what point is a vaccine or treatment likely to be widely available (if
it is soon, then the slower spread is obviously crucial).

I suspect the answer is very nuanced. If I get some time, I will put together
a simulation and try my hand at the math, but I am curious if anyone has
already considered and compared these factors quantitatively.

[0]
[https://en.wikipedia.org/wiki/Spanish_flu](https://en.wikipedia.org/wiki/Spanish_flu)

~~~
lihaciudaniel
>At what point is a vaccine or treatment likely to be widely available Just
like it said in the article, 12-24 if we are lucky.

------
isoskeles
> 2.8.2.12 DO NOT BE RACIST

I long for the day that concern trolling and virtue signalling are not
included in otherwise helpful resources like this one.

~~~
throwaway237654
+1. The absence of racism will not improve the outcome of this virus in any
way whatsoever. This is just the author trying to masquerade her opinion as
science.

"Do not be careless" and "do not binge the news" are equally useless pieces of
advice.

~~~
jessaustin
"do not binge the news" is excellent advice. The only possible improvement
would be to substitute "watch" for "binge".

~~~
SketchySeaBeast
> The only possible improvement would be to substitute "watch" for "binge".

Unless you're taking a stand strictly against 24 hours cable news, you still
need to be informed, and that'll involve viewing some form of news.

