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Italy is extending its coronavirus quarantine measures to the entire country (bbc.com)
787 points by colinprince 81 days ago | hide | past | web | favorite | 854 comments



This is an account from one of the doctors in Italy. https://twitter.com/jasonvanschoor/status/123714289107769753...

Read the whole thing, but this passage in particular is just chilling.

"5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed."


Please note that Lombardy has a very very good health service. The OECD put a score on this [1]: 9.9/10. This is in the top 5% across all regions. Other european regions seem to have lower average scores and their governments are not taking serious actions. [2] How the US is reacting from my perspective (italian confined near Rome) seems borderline madness. Something about this situation confuses me a lot.

[1] https://oecdregionalwellbeing.org/ITC4.html

[2] https://www.youtube.com/watch?v=s85xG9Ol3Po


Politicians have no understanding of exponential growth. They look at low numbers and think "we have a lot of time" then are surprised later when they in fact don't.


3B1B to the rescue

https://youtu.be/Kas0tIxDvrg


They don’t need an understanding of exponential growth, they only need to look at examples: China, extreme measures and barely contained it; Italy delayed measures, turning fast into a disaster. How many examples do we need?


In Denmark yesterday a couple of kids in the same class in a school were tested positive, they closed the classroom - not even the school.

I would certainly like to see the example of a country able to learn from the mistakes of others.


In Germany a friend of mine refused to go to a meeting at a client's office where someone tested positive and HR threatened him because he was violating his employment contract.


Counter-datapoint: My employer (SAP) has had one case of COVID-19 among their German workforce. The entire office building has been closed down for disinfection and the employees there are asked to work from home for the quarantine period. All other employees (worldwide afaik) can work from home without informing their manager beforehand (as is the usual policy). All non-essential business travel is prohibited, with exceptions requiring high-tier management approval. Only two examples for exceptions were given: travelling to a data center to access physical hardware, and travelling to a customer site to access intranet services.

EDIT: I realize that this response is easier to do for SAP than for the average company since we are all working in front of computers anyway the entire time, with only 1-2% of tasks tied to physical objects (paper forms, server hardware etc.).


The German ratio of infections to deaths is very low compared to other countries. It may be too early to judge, but given how it's unfolding, this speaks positively about how Germany is responding to the epidemic.


It’s a point of discussion in Europe. They might be skewing the data because they are willfully not testing dead patients with comorbidities. e.g. a late stage cancer patient dies with a respiratory syndrome? Italy tests the body and that person counts against the total coronavirus death toll if the result is positive. Germany doesn’t make the test.


I can report the same behaviour of an office of a pharmaceutical firm here in Berlin.


Am in Germany. Everyone is acting like nothing is happening. It's infuriating.


Well, in Bavaria at least, people are forced to self-quarantine for two weeks if they had contact to people from o where in high risk areas. Same goes for children in schools and kindergardens. Some schools are closed already. Corporate travel came more or less to a halt and soccer games are most likely taking place without spectators.

So yes, just business as usual.


I'm in Berlin and people are making zero effort to alter their usual patterns.


That's Berlin for you though. I think you need to have a much higher threshold for disgust and fear to consider living there.

I'm close to Hamburg. We've had two or three confirmed cases in the county. Patients are quarantined at home and stable. Schools have been temporarily closed, but reopened now. The administration is taking it very serious and people are stocking up on everything, including cake.


As of yesterday, Berlin is no way a risk zone as of now. So why should they? Doesnt mean you can't change your behaviour, so.


That is an incredibly short sighted view. We need to be proactive not reactive. This virus is here and it's here in a big way. Positive cases are not the full picture. Median incubation period is 5 days. Italy is a warning and we're not taking it. We should all be in quarantine now so this doesn't get out of hand rather than wait for it to become uncontrollable and then trying to de-escalate it.


Ok, so you suggest every single person in Germany to be quarantined. Whether they have symptoms or not. Now that's what I call an over reaction.


We have months of data now. If the virus gets out of control; countries find that out because the hospital system gets overwhelmed and they have to bring in a hard quarantine.

Countries have to overreact to the circumstances that they are confronted with because in a week the situation will be much worse if they don't. The only options are to overreact when everything seems fine or to overreact when the hospitals are full past capacity.

The choices here are to overreact before the virus gets past the border; overreact when the first cases appear; overreact when the first cluster is identified or overreact when people who can't breath are being turned away from hospitals. We have yet to see what happens past that point because so far everyone has instituted a quarantine then. Germany is at the clusters developing stage.


I don't think you are using "overreact" properly. If it's the appropriate response, then, by definition, is not overreacting.

In line with what you are saying, a problem, is that the proper reaction, if works, looks like an overreaction later. So, politically, there is an incentive to do nothing.


This kind of thinking is exactly the mistake China and Italy did. Please, I beg you to learn from our errors.


It does sound extremely over the top indeed, but it might be the only way to prevent the spreading. It appears that by the time you find the first case, you are too late as the virus has been spreading all over the place. Maybe quarantining everybody, even from area with zero cases, is too much... but at least people should make a strong effort to reduce social activities for a few months.


The only realistic way to stop the virus from looking at other countries responses is to overreact relative to what other countries have done


Well, let's just wait for a million dead like they expect in Italy then... that would be a proper, timid, reaction...


You just pulled that number out of your ass, didn't you?


Andrea Ricciardi, Professor of Hygiene and adviser to the Ministry of Health: "The most frightening point is the pitted figures on how much the virus can spread. the curves of the graphs elaborated by the epidemiologists and not only in Italy: according to the models, it could strike until 60% of the population, which means that according to the mortality rates there could be a million deaths only in Italy."

Feel happy now about the ad-hominem?



This is coming from 3.4% mortality rate from reported cases, but how many are not reported? How many people just suffer a mild cold, or are completely asymptomatic and never get reported? As an overall mortality rate, it is almost certainly too high.


That's a huge number. Where did you get it from ?


See my answer to the parent comment.


Please, stop throwing around totally fake numbers like that.


Italy has a population of 60 million.

The WHO reports "Globally, about 3.4% of reported COVID-19 cases have died".

If 50% the population gets infected, and if it's not 3.4% but "just" 3% mortality rate, that's already 1 million dead.

And according to some experts, even 70% infection rate is predicted.

Second, this 3.4% percentage of deceased patients, is at the early stages, with fewer patients and preventive measures (so that most patients that needed hospital treatment got it).

A 10% or more of patients of COVID-19 will need hospital treatment and ICU. As the number of patients rise, there wont be as many ICU units (and doctors are getting infected themselves at an alarming rate).

In Italy with ~ 7000 cases, "hospitals are scrambling to increase the number of beds available in intensive care units. Some have closed entire wards to dedicate them to severe coronavirus cases. Others have transformed operating rooms into intensive care units. Doctors are working grueling shifts to cover for colleagues who fall ill".

Let's put it this way, they have 9,172 cases and 463 deaths.

Now imagine with 100,000 or 1,000,000 cases -- still very far from the predicted 70%.


That's not how epidemics work. Even China was nowhere near these numbers. Stuff like that doesn't spread the way you assume it does.

But ok, the source is your own calculations. Thanks for confirming.


>That's not how epidemics work.

That's not how epidemics work when they are contained quickly.

Europe has done a bad job at this.

Epidemics in the past have killed many times as many as the percentages above.


Different diseases, different outcomes.

First, using the total population as a basis is just wrong. Some will certainly be immune to a certain degree while others are simply lucky.

Even very aggressive pandemics, hitting totally ill-prepared societies didn't infect every single person. Not even the black death managed to do so. So why do you think COVID-19 would end up doing that?

And using the 3.4% is another issue. Because you have the Wuhan rate, which is much higher than the rate eslewhere. And this thing is a moving target because testing was rather limted earlier. South Korea seems to be the best source to get mortalitiy rates due to their aggressive testing.


Andrea Ricciardi, Professor of Hygiene and adviser to the Ministry of Health: "The most frightening point is the pitted figures on how much the virus can spread. the curves of the graphs elaborated by the epidemiologists and not only in Italy: according to the models, it could strike until 60% of the population, which means that according to the mortality rates there could be a million deaths only in Italy."


right now in italy it's more like 8% fatality rate

south korea is an outlier and most of their cases are not resolved, they may have a lot of false positives

time to act was weeks ago.


No, thats beeing responsible.


"Most turkeys in farms are super happy, healthy and fat until some days before Thanksgiving. Why should they act like they could be slaughtered?"


Because turkeys are always fat. Happy and healthy is a diiferent story. And they get slaughtered, becasue that is the reason the are at the farm in the first place. Using that analogy for a disease is jst plain wrong.


Before this conversation goes any further, perhaps you should read The Black Swan?

Or if you don't like my turkey reference, let's stay in the realm of technology. Pop quiz: who said "Only the paranoid survive?"


Because it's only a matter of time before the virus will be in Berlin (if it's not already).

Nobody is suggesting people should quarantine themselves in Berlin, but avoiding crowded spaces, not touching your face and frequently washing your hands doesn't seem at all unreasonable.


40 confirmed cases here.


Wow. And you magically know that how, exactly?


May have changed, but yesterday Berlin wasn't listed in the high risk regions that was shared by Bavarian health authorities. Didn't check today, so.

EDIT: According to officials, one county in germany is considered high risk (link in German): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...


It's futile arguing that the risk is low because the officials classified it as such when I stated that I disagree with their risk assessment and management strategy. If I look at a risk matrix I would classify the risk impact of not quarantining as significant to disastrous and the likelihood as very likely. That puts the current situation in all of the world at the highest risk.

Risk matrix example: https://www.researchgate.net/profile/Kevin_Fleming3/publicat...

hef19898 81 days ago [flagged]

One last comment because you clearly seem to prefer to live in your own world.

Assessing risk the way you do has one big issue (it actually has multiple but let's stick with one). When you put Corona in the disastrous category you habe to provide reasons for doing so, otherwise it is just a gut feeling. And by classifying it as disastrous, you run into issues when classifying stuff like Ebola for example. Over-classifying has that effect on measuring systems, that's why you need teams of experts from multiple disciplines to do it properly. And would have to do so at multiple sub levels for each criteria. The whole purpose is to take gut feeling and emotions out of the process. Doing it alone makes the whole exercise pointless.

Now, take that whatever way you want.


This over-reliance on "experts" is what got things to this state in the first place. Not that long ago, WHO was adamant in saying that flying to China was still okay and that "there was no reason to take extreme measures". How many lives were lost because of that?

Conversely, had they recommended more aggressive contention measures, how many trips would have been avoided? How much slower would the virus come to Europe? If sirens were ringing 4 weeks ago by the WHO "experts", perhaps Italy wouldn't need to be in lockdown now.

> When you put Corona in the disastrous category you habe to provide reasons for doing so, otherwise it is just a gut feeling.

Not really. We put in the disastrous category because we don't have enough information to claim that it is not a mass-extinction event. In the face of a threat of unknown risk and the potential impact is unbounded, we got to treat it as the worst and prepare for the worst, cost-analysis be damned!

But if you prefer to ignore me and refer to experts, please listen to Nassim Taleb, who may know a thing or two about risk analysis: https://www.academia.edu/41743064/Systemic_Risk_of_Pandemic_...

hef19898 80 days ago [flagged]

Mass-extinction? That escalated quickly. Maybe uninstall Plague Inc. for a while?

And no, that is exactly not how risk assessment is supposed to work.


Your comments are breaking the site guidelines by being snarky and posting in the flamewar style. Please don't do that. It's not what this site is for, and it evokes worse from others.

https://news.ycombinator.com/newsguidelines.html


True, sorry for that and thnks for calling me out it. Is usually not my argumentation style.


Do you have kids? Older parents? Would you tell them that is totally fine to keep doing what they are doing just because the experts haven't assessed the risk yet?

It doesn't have to be a literal mass-extinction event for this type of thing to lead to some catastrophic events affecting people you know and care about. If it were to happen (I honestly hope it doesn't) to someone you care about, I am sure that "the experts told me things were fine" will be of little consolation.

How about dropping the sarcasm and word-thinking and start to put some thought into the questions I made regarding the WHO recommendations up until some weeks ago? I bet if you could go back in time to Italy just three weeks ago, you wouldn't be telling people to just "listen to the experts", would you?

hef19898 80 days ago [flagged]

You might think this is strange, but the short answer is yes.

Now a slightly longer one. Guidelines on how infection risk can be minimised are very consistent. And they make perfect sense. So yes, that's the advice I give my two kids, my parents (both of which fall into the high risk age groups, luckily they are following that advice already without me), and the advice I follow myself.

WHO recommendations are based on the best available picture to them. I prefer to trust someone changing his opinion when data changes over someone who paints a worst case scenario from day one on.

And yes, if someone from my family ultimately dies, which I really don't hope, having done everything experts told us to do to prevent it would be the only consolation there is. The alternative being fear mongering, panic and paranoia. In which any infections happening toy loved ones (assuming I am the only factor behind there behaviour, which I am thankfully not as my family thinks pretty well for themselves) would be to a certain degree on me.

And the experts have assessed the risk. Hence the advice they give. But you do you, ok? As long as you stop spreading stories about mass extinction and stuff like that.


[flagged]


Nationalistic flamewar and personal attacks will get you banned here. Please don't post like this to HN.

https://news.ycombinator.com/newsguidelines.html


I understand why you blocked that comment however FWIW it's a fair criticism of the German national identity. I say this as a German national myself.


It's of course different when people are making statements about their own nation, or a place that they lived for a long time. But these distinctions are too subtle to matter on the internet. Others will react the same way they do to garden-variety flamebait, so the effects on the site are the same, so it's best to just not go there.

Also, while different, it's not necessarily benign—just more complicated.

Criticisms of national identity can't be topics of curious conversation on the public internet. A small, closed group could, but a large open group can't. 'Large' implies that someone is going to get activated, and 'open' implies that they can show up and comment—at which point game over.


Thank you for understanding the spirit of my comment. I will take this flag as a very good lesson in risk management: no matter how many times you are positive in the exchange, the one time that you strike out can be fatal.

Ebola is certainly disastrous but the likelihood is unlikely.

Also you are being disingenuous. I said

>the risk impact of not quarantining as significant to disastrous and the likelihood as very likely.

which means I would classify it as very significant.

Regardless it doesn't change the risk rating.


The entire world seems to be acting like that, it's not unique to Germany. Nobody pays attention because the numbers are low, and it's not worth stopping human activities. Then you wake up one day with thousands of cases.


I have a very different experience. I see lots of hand sanitizer everywhere, people are washing their hands constantly, my employer has relaxed rules for working from home (i.e. do it as much as you feel is feasible and reasonable), some schools are closed, people generally avoid crowded trains and buses.

This is in NRW, however, where we have by far the most confirmed cases in Germany. Might be different in other places.


Italian living in Berlin here. Same same.


My neighbor is a teacher and her school is closed dir the next 2 weeks


Five employees of DB now have it so maybe they'll pay attention now?


Believe it or not, they paid attention already before that.


If they closed the office, cleaned it, and tested everyone else, it would be reasonable. But I guess they didn't do this. Which really our society is not set up for.

Actually Covid-19 cleaning solutions would be a temporary business to get into.


i think the focus should be on keeping immune systems up. having supplies of water and vitamin c available. stress-reduction is good for the immune system too. i think it's time to assume we're all going to get it and how best to ride through it.


Well, if they did that is more or less ground for legal action. Managers have something "Fürsorgepflicht", meaning htey have to take care employees are safe. Usually things go the other way round, your employer would not allow you to travel.

depending on how long friend is employed by this company, the resulting leal case could be rather expensive for the employer. Your friend would still have to look for another job, so...


State of Georgia closed a school and quarantined the firemen who were sent to the school all on the account of a teacher being diagnosed.

Quarantines of mass amounts of the population are not going to help, what needs to be done is isolate those most at risk from the general population


Quarantine isnt just about preventing the illness in the most vulnerable, it's about keeping the explosion if cases at a level that doesn't swamp the healthcare system.

Absolute containment is highly unlikely, but delay can help a ton.


This is exactly the kind of measures that should be taken in the beginning. Italy is far past that: With 9000 confirmed cases they would need to isolate hundreds of thousands of people. For comparison: Italy's entire prison population is 60,000 people. At that point it's just logistically easier to suspend public life over the entire country for a few weeks.


This is terrible. Was it Rysensteen Gymnasium?

Edited: Just found the article (Malling Skole i Østjylland)

https://www.dr.dk/nyheder/indland/skole-sender-klasse-i-kara...


But if you don’t understand exponential growth and you look at China’s example you might think (mistakenly): “they had this illness and over reacted. Look how much it hurt their economy, and it wasn’t even anything big as it turns out!” This is obviously wrong, but you can’t recognise the precipice they pulled themselves back from without understanding exponential growth itself.


Or you could look at it, say "it looks like exponential, but I am no expert on diseases, so I don't know what I am looking at."


Or you could listen to the experts on disease, and not let your innate optimism to blind you to the reality:

https://ourworldindata.org/coronavirus


I haven't heard any expert (doctor, epidemiologist, virologist,...) making the claim that epidemics can be extrapolated until the number of infected people equals the total number of people. Pandemics burn out eventually by their own way before that.


It's a virus. The infection grew exponentially like virus infections do. We could be wrong, but we're probably not.


Epidemics don't follow exponential functions. You are aware of that?


They do until they hit their inflection point.


Which they do by themselves. Not everyone who is infected dies, survivors develop a certain level of immunity (generally speaking), cured people don't infect other people. Some people are "immune" right from the start. So epidemics slow down, the part of a given population not getting it or infecting others increases with time. Which automatically slows down the spreading of the disease.

All measures we take optimize for that. Vaccination increase the amount of immune people, quarantine pulls the inflection point forward and slows the spreading. Protecting the most at risk population further reduces the risk of spreading. And so on. So yes, the early phases are exponential. But the later phases are not. So modelling this thing exponentially against the max. number people on earth is just wrong.


All correct, but a highly contagious virus might still infect 20-70% of the entire population. Not 100% of the population, but the difference does not matter.


A couple of weeks ago it was "China was slow and it turned into a disaster". Now China was fast and Italy is turining into a disaster. Someties it seems that people want to be that a disaster, so they push that narrative. Same thing happens with the deniers, so.


Or you know, both narratives are right. China was slower than it should, it turned into a disaster, but they did a 360o and bounced back with strict measures quite fast.

Italy was slow, and is already a nightmare.


China was slow, and it turned into a disaster, then they got their act together.

Italy was slower than that.


I don't think we're actually slow. Yes, the risk was clear from the beginning, but the government had to take care of the economic situation too, which was (and is) rapidly collapsing. Some choices are maybe arguable, but when compared to other EU countries Italians were quite fast to converge to some decisions.


Foreign Policy, which has pretty good corona virus reporting, strongly disagrees with your opinion.[1]

[1] https://foreignpolicy.com/2020/03/09/italy-covid19-coronavir...


[flagged]


Modern left wing politics has no interest in facts except the ones they can cherry pick to attack the president...

Get your political blinders off. Both sides will twist any fact to attack the other.


> Politicians have no understanding of exponential growth

To be fair, that is true of 95% of humanity.

These politicians are representative of their voters, as democracy should be.


> These politicians are representative of their voters, as democracy should be.

Isn't it that they make decisions on behalf of the voters and should take the best professional advice on their behalf?


Professional advice is not necessarily the best political advise, unfortunately. It's a giant PR/social-media game and they have to play it otherwise the other side will get the upper hand. It's very unfortunate that we've turned "democracy" into such a game instead of a mechanism for societal-level decision making.


The same is true in all political systems. A king must constantly play a social media game too or their rivals may gain the upper hand. A modern despot must constantly ensure that they never show weakness for the same reasons. There are always rivals and there is always a game.

So far we have never come up with a working political system that banishes this stuff. It's a game theory problem.


Democracy is just as vulnerable to Goodhart's law as everything else.

I don’t have any well-thought-out solutions, but I am tickled by the idea of frequently anarchically randomising the way power gets donated from the people to the government.


I somewhat like the idea of having a democracy without parliament or elections. Instead, whenever a law needs to be made (either because the administration identifies the need or because something akin to a ballot initiative gets enough signatures) 100 people are drawn from the population at random and tasked with writing that law. They are allowed to summon/subpoena as many experts as they like to help them with drafting the law.

The idea is that every citizen would be involved in one, maybe two laws in their entire lifetime, therefore giving them the sense that this is the one time they can contribute to politics in a meaningful way. Also their names are tied to that particular law forever, meaning that fear of social pressure could be more effective than for a politician who votes for 1000s of things in their political career.


I think Ireland has done something along this line related to abortion and gay marriage.


That's up to the voters. They often have other priorities.


That is the difference between a democracy and a republic.

esarbe 81 days ago [flagged]

That is the difference between a chicken and a bird.


Very true. Problem is that, while democracy to be effective requires people to be educated and informed, bad politicians aim to the opposite.


It used to be a little more common that in representative democracies, the representatives were actually competent elites.


The other thing is the incubation period is around 5 days. So really the numbers are at least 5 days behind.


In my opinion, this is really the main reason why this virus is spreading globally. In fact, the average incubation period seems to be 5 days, which is already a lot. But apparently, some subjects had an incubation period up to 24 days, if correct, this is huge and the main reason why it suddenly raised in Italy. Imagine only one relatively social person in Italy, in 24 days he/she can probably meet at least 50 person directly and much much more if he/she goes to some public activities. Like SARS, it just need a few super-spreaders who aren't even aware of being sick, to start an epidemic.


Risk of infecting others when you're without symptoms is supposedly small..

I'm by no means an expert, but to me the problem seems to be lack of proactive social distancing; and lack of proactive testing of everyone with symptoms.

Current guidelines seems statistically sound, it's just that we have little mitigation for the few that do slip through.


"People who contract the novel coronavirus emit high amounts of virus very early on in their infection, according to a new study from Germany that helps to explain the rapid and efficient way in which the virus has spread around the world."

"The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines"

https://www.statnews.com/2020/03/09/people-shed-high-levels-...


It's still unclear whether you are spreading the virus for the entirety of the symptom-less period though.


And of course in the US there are not as many testing kits as in other countries, so the numbers are basically 3 months behind.


The US is probably a much larger vector than we realize. The testing rate is the lowest in the world and Americans travel like mad. Who knows how many undiagnosed Americans have been globe trotting over the last couple weeks?


And you have millions without basic access to healthcare, meaning they will go around untreated passing the virus along to their fellow citizens.


Also no statutory entitlement to sick pay, so many people will drag themselves into work because they can't afford to take time off.


And also unpredictable and variable (and delayed) medical bills for those who don't have great employer-provided healthcare (and even sometimes when they do).

The stories abound of a hospital visit with a magical bill that appears months later with some unpaid sum that's in the 4 digits. Everyone knows someone who this happened to - I happened to know a couple who received a 5-digit bill for a baby who died many many months later. Now, as a rational person you're not going to go to an ER willy nilly, and sometimes an ER is what you get pointed to by smaller medical centers.

The U.S. medical model doesn't work - for the group. It works - for the individual. I had superb eye surgery recently from a top world center and it was fully paid. But the viruses don't care if one of us can afford care, and the other can't, because the virus views us as a singular organism, and now we're all at risk. Which is exactly how the health system should begin viewing us.


Wait, I thought the standard refrain is American's never travel - we don't even have a passport to get aboard.


You have no idea :-(


Not really. Even though the US media has focused on the raw number of tests carried out for domestic political reasons and left a lot of people with the belief that the number of confirmed cases is basically just a function of the number of tests, Italy has been visibly struggling to test people. If you look at the percentage of tests that came out positive rather than the absolute numbers, it's obvious that Italy was only testing people who were very likely to have the disease, especially during and after the big spike in cases that got everyone's attention. It was in the very high single digits for quite a while, compared to the 3% that the CDC's old, very restrictive policy of only testing a handful of people very likely to have it There's other evidence that Italy's numbers were off too.

I'm particularly miffed about this because it seems to have spread to our shores and convinced a bunch of people that the reason the UK has lower numbers than Italy is because they're not testing people, to the point they're literally unable to believe that Italy has only tested twice as many patients for the coronavirus as the UK.


[flagged]


You sound correct about the hypocracy but as far as I can find out the normal tests are reported about 40-70% accurate (reports vary but my understanding is more near 40 than 70) in non-symptomatic people and around here they are thus only used and done twice if one has symptoms as even then they are not fool-proof. The test is thus pretty useless to perform on everybody as it gives too many false positives and too many false negatives to be useful to people with no symptoms. It would be a lot better though if they explained that. People here (Netherlands) are also complaining about not being tested before having symptoms or even after being admitted, as they assume the test will give them a yes/no answer which it won't.


This is incorrect. The sequence test has low false positive rate and higher false negative rate. The positive results alone are significant and informative from a policy perspective. Combined with other measurements like CT, the accuracy can be high.


CT for a virus? You can only see that something is inflamed. I mean you can guess the diagnosis, but that doesn't really increases my confidence in testing. If inflammation can be detected, you probably also have symptoms already. That aside, you should limit CTs if possible. And you won't be able to do mass scans anyway. So it is just for specific cases. MRTs could also help and are not as invasive, but maybe they don't show enough.


This Chinese paper compares the sensitivity of diagnosis with chest CT vs RT-PCR:

"In a series of 51 patients with chest CT and RT-PCR assay performed within 3 days, the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71% (p<.001)."

https://pubs.rsna.org/doi/10.1148/radiol.2020200432


Good to know about the positive rate. The media has not been very forthcoming with actual data an usually only quotes wide numbers. What I meant is that is test alone will not do the job perfectly and that is what people expect. Higher false negative rates is what bothers me as people generally think "oh I'm safe now" when that might not be the case. Considering they wait here with testing to after symptoms it would likely make the tests way more useful then to test everyone. It requires labs and those might also be stressed to a point of breaking if you start testing everyone (if that is even possible) for instance.


[flagged]


This is America 40 years after the neoliberal revolution.

https://www.youtube.com/watch?v=xhYJS80MgYA


What I've been seeing is the experts think an individual may be infectious up to 14 days before showing symptoms, hence the 2 week wuatantine.


It can be up to 21-24, even if mostly it is under 14


You can add the testing delay on top of that too. Some countries it's still taking a few days to get a result.


They do, but only when they want so, like they want endless exponential growth of economy but not energy consumption.


Most people don't think of 2% annual growth as exponential.


“Most people” could not accurately define the word “exponential” even if they were offered an exponential amount of money every year to do so.


To be fair they'd be incentiviced not to... assuming they understand the exponential nature of the money, which I guess they don't. But as soon as they do learn they won't want to explain.


Also, growth narrative is always about adding/subtracting percent points - which makes most people think this is a linear phenomenon, because they don't make the connection that the quantity discussed is a multiplier, and charts they see are on log scale.


As long as you stay with low percentages, the linear approximation works pretty well: two times 1% lead to a 2.01% increase. But it starts breaking down as soon as you reach 10%.

Little trick to know (with some good approximation) the doubling time of some low-percentage growing system: count it linearly up to 10% and then multiply by 7 (which is roughly the doubling time for 10% growth). Example: 2% => 5*7=35 years to double.


This is identical to the Rule of 72, https://en.m.wikipedia.org/wiki/Rule_of_72. Except that you are using 70. The amazing thing about the rule of 72 is that it works pretty well even for rates greater than 10%.


Or, in this context, 20% daily growth of coronavirus cases -> 20% => 0.5*7 = 3.5 days to double.


And even fewer realize that a 2.1% growth rate is itself exponentially faster than a 2% growth rate.

If something grows by 2% per day, vs 2.1% per day, after a year the second one is >20x bigger.


What you say is true in principle, but your numbers are wrong. I got a rather less dramatic 50% difference after a year:

  >>> 1.02**365
  1377.4082919660768
  >>> 1.021**365
  1969.6808462403098
  >>>


Thanks for the correction, I didn't actually do the math for that, just remembered something I've read a while back, but the numbers where different 20% vs 21%.

Apparently I don't understand exponential growth either cause I assumed a 5% difference scales linearly (as in the difference between 20% vs 21% growth rates for a given period should be the same as between 2% and 2.1%).

Silly me.


But a good exmple showing why numbers are so important. A 50% difference is an order of magnitude away from a factor 20. Thing is, once out there the wrong factor 20 is impossible to correct.


We should be quarantining every city in the U.S. right now. You're 100% correct, and it's going to be just as bad here.


Now long would you maintain that quarantine? Is there some amount of time after which the virus will go away?

Any call for drastic measures, even when drastic measures seem like common sense to some people, need to explain why the measures should be implemented and under what circumstances they should be lifted.


They are undertaken so that the health service is not overwhelmed with cases. When that happens (as in Italy), you need to triage infected and let some number of people die, who otherwise would not have died. So it is best avoided.

They're lifted after most of the population has already been infected and the disease has run its course (as in China).


Presumably as soon as the number of patients requiring ICU goes above the number of available ICU beds then those kind of measures must be taken - even though its clearly a pretty terrible choice for someone to have to make.


And at that point it's too late.


I concur with GP - but here in Australia we're run by fantasists, so it's not going to happen here either.

> Now long would you maintain that quarantine?

I'd suggest start with 2 weeks, and reassess after 10 days. I note that in TFA Italy's administration extended this (initially) out to the 3rd of April, which seems like a reasonable timeframe.

Incarcerated people rioted ... and a churlish part of my brain suggests that's just to be expected, but each nation state can learn from, and put more effort into educating than, the earlier pioneers.

> Is there some amount of time after which the virus will go away?

We don't really know - but it sounds like a rhetorical question(?).

I know that I'd be happy with a two week lockdown - option to renew - here in AU ... especially if it reduced my chance of dying. The numbers cited in TFA are suggesting a 3% mortality rate now, and massive propagation rates and embarrassingly poor treatment / survival rates even in a first world country early on in the pandemic cycle.

> Any call for drastic measures, even when drastic measures seem like common sense to some people, need to explain why the measures should be implemented and under what circumstances they should be lifted.

I'd invert your usage of the precautionary principle and ask, given what we know so far, why the default response isn't to shut down non-essential travel and public events for a couple of weeks.

I mean, what's your acceptable ratio of dead people : inconvenienced live people?


The response here in Australia has been so pathetic. Especially from the private sector.


most people outside of the previous red zone is uncaring about the new emergency restrictions

step 1 should have been to bring military in the streets to enforce the thing, because police is both decimated by the virus and overwhelmed from the new responsibilities and cannot handle what's happening


perhaps there is no need to go to extremes.

Where I live I already have to provide my babysitter a signed letter where I certify that she comes to work here. She's from a different township (comune) and the police could fine her if caught without that document.

It's not going to stop 100% of people from moving around, but even it this reduces the spread by a few % it's already a big improvement; even reducing the daily rate from 21% to 20% can have a 20x effect on total cases over a year.


https://edition.cnn.com/2020/03/20/europe/italy-military-cor...

so I guess I was right since the beginning


lol I'm not advocating treating it as a war zone, just calling in the military to do police work


Until we have a vaccine or at least better treatment options.


Something we can all do as individuals is stop going out to unnecessary things. I'm avoiding restaurants, bars, gyms and large groups.


ah, the joys of being deeply introverted. avoiding restaurants, bars, gyms, and large groups -- why, that's my ideal day.


Not great when you know it's not a choice, introverted or not.


I think in the us something as simple as paid sick leave for all service workers could make a huge difference.


In the past 5 days, some organizations who can afford it have shut down offices and are providing just that. I'm not at liberty to expose info on who, because I'm not sure it's been made public or not.


Are any those organisations like Walmart or McDonalds that employ a lot of people who often don’t have any savings and any margins at all?


Definitely not. When common franchise chains close, and people can't work, nor shop, is when it will be too late, and dire.


Maybe not necessary to close the whole shop, just make the workers with symptoms afford to stay away.


I also work for one such organization.


So, assuming you won't name the org you are working at, what prevents you from naming some of the others?


It might not be. Lower population density and a lack of public transportation. I would worry about NYC though.


Lots of workers who can't stay home when they're sick without losing their job though.


When? I keep hearing that, but where is the evidence?


no tests, no evidence


I think worse.

But i askari think it will go exactly like the Spanish flu. We will have a second wave which will also kill the younger.


Why would you think that? By the way, the Spanish was harsh on younger generations in all cases.


Nope, the first wave of the flu only killed older people and people with a low immune system. Just like the corona virus. The Spanish flu hit in three waves. The first like this one. The second wave hit the younger. The third wave hit the rest.


Trump providing a shining example of this! https://twitter.com/realDonaldTrump/status/12370273563148697...


I don't get the criticism for Trump. He's just basically saying "don't panic" in his own way. That also seems to be consensus among the experts and on HN, judging by yesterday's "don't hoard" threads... (I disagree, but it seems I'm the minority.)


I find it weirdly reassuring--he's not an expert and isn't even trying to look like one.

The people that scare the hell out of me are the gaggles of PhDs and other "very smart people" who seem to think that we shouldn't be closing schools and working from home because reasons. Our organization doesn't even have paper towels in the bathrooms (It's bad for the environment!). Actual sanitation is not a priority.


He's said he's smart and understands this because his grandfather went to MIT; said grandfather who died of the Spanish Flu. There's irony in almost everything he tweets or utters...


I think the POTUS should be held to a higher standard than this meme tier tweets. But hey, it have been almost 4 years, I guess we should be used to.


Sure, but what higher standard is that? The standard of "don't panic", currently followed by WHO and pretty much all heads of state (with possible exceptions being Putin and possibly Italy & Austria), or the standard of "panic", universally shunned by experts and wanna-be experts alike?


You can say "don't panic" without misleading people by using numbers completely out of context.

By comparing the number of Corona virus cases and deaths to the annual flu deaths he is implying that the number of deaths from Corona virus in the US is low and the risk is negligible, and while it is currently low this completely misses the point that in other countries it has proven to be extremely contagious and has a much higher mortality rate than flu. In other words, there is a significant risk if adequate steps aren't taken to reduce the risk of transmission. See: Italy, China.


Its misuse of the term "don't panic". "Don't panic" should mean "remain calm yet vigilant", not "stop being a crybaby and follow everyday life like a good sheep". Panicking doesn't make sense unless you wish to activate people who wouldn't otherwise, and neither does misleading people with poor, incomplete or flat-out wrong statistics. Pretty sure that's why the term "don't panic" gets a bad rep: one party means to be serious but calm, the other party uses it as means to ridicule those who err on the side of caution.


"Exponential growth" in itself isn't really the issue. If every week you have 10,000% as many cases as last week, you're screwed. If every week you have 105% as many cases as last week (i.e. 5% more), that's exponential, but after a year there would be less than a 13X increase, by which point there could be a vaccine or other measures that cause the weekly number to go from 105% to 95%.

You can also have non-exponential growth and still have many new cases, if people are getting over their infections faster than they're infecting new people. If a million people were currently infected and every week 500,000 new people were infected but 500,001 of the existing infected people recovered, that means the number of currently infected people declines over time, but you'd still have 500,000 new cases every week and just about everybody might eventually get infected before it dies out, even if it eventually does. (This is similar to what happens with the flu, except that it has exponential growth in winter and then below exponential growth in the other three seasons, so the actually dying out never really comes.)

To really get rid of it you want to have something like 100,000 cases last week and 75,000 cases this week and so on. But even then you might have 25,000 fewer cases this week because 50,000 people recovered but 25,000 new people got infected.

So whether it has exponential growth or not isn't really the issue. It's what the growth rate is. A small exponential growth rate isn't catastrophic -- the number of cases grows but not so fast that everybody is infected by the time they have a vaccine or other more effective countermeasures that get the growth rate back below exponential.

Most importantly, the growth rate isn't immutable. It's affected by things like people washing their hands and having effective testing and quarantines. So will things be fine? They will if people do the right things. Maybe some of them have been and some of them haven't. Maybe they'll get better at it going forward, maybe they won't. As a result there is a significant amount of uncertainty.

But panic is useless. Even if all they can do is reduce the growth rate from 150% to 130%, that still buys more time to respond. Even if everybody ultimately gets it, better that it happen over five years than five months. And if some people are doing it wrong, try to help them do better. Everybody likes to see the bad orange man look stupid on the television, but maybe this is a situation where we come out better off with everybody working together.


Problem with exponential growth is that you can be a little off in the exponent and be totally off in the result. Such is the fragility of any assumption about exponents being "small".


> Problem with exponential growth is that you can be a little off in the exponent and be totally off in the result.

Which is why the growth rate is really what matters. Which isn't immutable. It goes down if people wash their hands. It goes down if sick people stay at home.

This is also why it really matters if the rate is 150% or 130%, even if both are very bad, because the higher rate is very worse. And the rate gets lower if sick people stay home, but it gets higher if idiots panic and start hoarding masks and stealing hand sanitizer which increases the rate of infection when they aren't there for other people to use.

Panic is not just useless, it's actively harmful.


Not really, only if you don't recalibrate every so often... but this can happen in any kind of growth. Even linear growth with unequal coefficients diverges after some amount of time, exponential growth just gets there faster.


This is so wrong. The ratio between exp(x+ϵ) and exp(x) for even ϵ arbitrarily close to zero is infinity in the limit of large x. There is nothing like it with any polynomial growth for any exponent. The ratio between (x+ϵ)^p and x^p for arbitrarily large p is 1 in the limit of large x, for any ϵ.

Another sign that people don't get exponential growth, even if they think they do.


The ratio is, but the absolute value difference (which is what actually matters for humans) grows beyond bounds for both.


Calls to not panic are worse that useless. They are dangerous, extremely dangerous now. They lead to complacency and they will lead to death.


No, panic is making it much more difficult to implement counter measures. It also takes away crucial man power from fighting the disease to fighting the panic. And finally, panic makes it harder for health care professionals to actually care for patients.

So no, panic never helps. Staying calm and level headed does.

But if you want to panic, do it. But do it in private, panic itself is rather contagious as well. Maybe self-quarantine.


> No, panic is making it much more difficult to implement counter measures.

Here in Denmark, where we're seeing an outbreak take hold, it's the EXACT opposite.

People are going out even though they have been told to self-quarantine, even boarding planes.

A couple refused to cancel a vacation trip even though they had been asked to quarantine because their son has been diagnosed with the virus.

I really think we could use a tiny bit more panic


I would call it more common sense, but yeah.


Giving people more common sense is not one of the tools we have available in our toolbox


Unfortunately you are very right.


The point I was raising was that calls to not panic suppress non-panic activities. They are sending the message that there's nothing much to worry about. This is extraordinarily dangerous. If necessary precautions will also cause some to panic, so be it.

At this point, things are so looking so grim that there's no way to tell people not to panic without unacceptable downplaying of the gravity of the situation.


But then the counterpoint is that once panic steps in it becomes hard to manage. People should be called to take this seriously and to proper civic duties.

Panic is was caused the toilet paper craze.


Or perhaps the shortage of toilet paper was a consequence of rational preparation for a worst case scenario, not a sign of panic.


That is actually entirely possible, I imagine supermarkets try to minimize storage as much as anyone else so shortages might just mean that people are just synchronously doing normal shopping.

In at least a few cases though I doubt it was not panic buying.


Oh no! The toilet paper craze. That is absolutely the biggest threat we are facing right now. Not the complacency on display everywhere.


In Germany (and probably other places too), people are stealing masks and desinfectant from hospitals - places where this is really needed. I think this is a big issue and it needs to be addressed.


This, not this toilett pper issue, is why panic is bad. Toilett paper hording just is a great early sign from from the more serious stuff happening as well.


I would say that the biggest threat is a dichotomy fallacy. Just because an extreme is wrong it does not mean that the other is right.

This should be taken seriously and people should put effort into prevention, but honestly I would prefer calling upon people's sense of civic duty rather than panic.


At this point, if we're not seeing at least some panic we're doing it wrong. The level of warning has to be such that the most skittish elements of society are freaked out, otherwise the average person will not be taking it seriously enough.


> Panic is was caused the toilet paper craze.

If that's the extent of the damage caused by panic, then we are going to be fine.


To this I would point out that two months ago you could say that about COVID-19


I man, the situation is extremely dire. I'm just amused by the 'toilet buying' craze which in comparison to everything else is a very mild issue.


Because at the beginning, a logistic curve is often confused with exponential growth. There are very few truly exponential processes in the nature. All things come to an end. Epidemics, population growth, economic growth... no such thing as exponential growth with limited resources.


the logistic curve is what happens to the initial exponential grow when there's no more way to grow, because there is no more population to infect or when severe social exclusion is set, but the initial grow is still exponential.


I spent a few months in the region with a sick toddler and can attest to the speed, quality and friendliness of the public health system there. That the virus is spreading so quickly, and that the health system is getting overwhelmed is cause for real concern. If northern Italy can't handle the outbreak, I'm not sure anywhere will do much better.


I'm very worried about southern Italy; the medical infrastructures are not really top-notch down there, sadly.

Disclaimer: I've spent quite a lot of holidays in the south, since both my parents grew up there.


There is an answer, and it is political (thank you for allowing me the indulgence to bring this room-elephant up). There is a slow burn civil war between mission-focused bureaucrats and administration loyalists. Consider: https://twitter.com/Imm_Judges_NAIJ/status/12371515163955363...


I'm not even sure who are the "mission-focused bureaucrats" and who are the "administration loyalists" in that thread. But for the love of God, can we please stop politicizing this issue? Can we please have a moratorium on blaming the other side for whatever measures should / should not be taken?

Frankly, nobody knows what to do. Here we are, pondering what to do with the kids.

* The school district is open for business in spite of being the ground zero of USA outbreak. Because no kid has tested positive yet. Meanwhile, the testing scale is tiny [thousands, in a nation of 300M] and the latency is horrendous [5 days]. Most likely the virus is already endemic in the kid population.

* OK, so let's keep the kids at home, as SPS will eventually have to face the obvious and close the schools. For how long? A week? A month? Until summer? Until next year? Send them to school and pray for the best once everybody in the family eventually gets the disease?


> But for the love of God, can we please stop politicizing this issue? Can we please have a moratorium on blaming the other side for whatever measures should / should not be taken?

Hard to do, when the correct thing for the administration to do is to stand back and hand decision making authority and control of resources to the bureaucracy. As long as the administration keeps interfering in the response, anything about the issue can't avoid being political.


There's actually a really good test of your claim: the botched CDC rollout of testing kits. The CDC went about developing and producing the kits just like they would for any other disease under any other administration, free from meddling and micro-management, and they botched the rollout. The issue was immediately politicized. Mainstream publications made it a point of saying that it was the "Trump administration" that butched the rollout, blamed the lack of micro-management, and there's an endless wave of conspiracy theories everywhere about this being a deliberate cover-up by Trump.


The Trump administration fired the U.S. pandemic response team in 2018 to cut costs.

https://www.snopes.com/fact-check/trump-fire-pandemic-team/


The "U.S. pandemic response team" that article is talking about were White House staff, part of the Trump administration rather than the non-partisan bureaucracy. The actual, on-the-ground organisations and bureaucracy involved in pandemic response - the stuff most people would probably think of as the pandemic response team and that the comment I'm replying to seems to suggest should be in charge - is still there. The staff it's talking about were also all part of the national security side of the administration rather than the health side, and of course it's the health side which is in charge of the CDC and the FDA.


So you're saying that the administration which refuses to admit Coronavirus is a problem, which a year ago let go its entire pandemic coordination staff, which has proposed a 16% cut to CDC funding, and which today ordered immigration judges to remove CDC posters aimed at slowing the outbreak has nothing to do with the terrible response, and it should all instead be blamed on the officials at the CDC?

The executive and administrative branches together respond to a crisis like this - for example by coordinating actions, providing more funding for health services or in extremis ordering quarantine in affected areas. None of that has been done. I don't think you can effectively separate the two responses, nor do I think this outbreak is somehow Trump's fault, but he and his administration are responding remarkably badly to it.


The administration has put the vice president in charge. What is said publicly does not match actions - as is typical for this administration (or any other administration though this is more blatant about it)


Are you saying we should stop blaming the other side because you think the other side isn’t to blame? What if there’s reasonable ways to explain how the other side is to blame? Or are you making an epistemological claim that the other side is never to blame? Or are you claiming that, even if the other side is to blame, we shouldn’t focus on that until we solve the problem?


>>even if the other side is to blame, we shouldn’t focus on that until we solve the problem?

Exactly! That is what is meant by not letting polarized politics drive the issue. We shouldn't care what 'side' is doing what, we should be focused on preventing an epidemic. Personally, IDGAF about assigning blame to any side, I'd rather that the petty bickering is dropped and effective measures are taken.

I realize the climate in the US isn't conducive to this, but assigning blame doesn't fix anything. Rather than blaming people, effective steps need to be taken. Focusing on assigning blame just puts the other side on the defensive; which is counterproductive to the kind of cooperation that will be needed to effectively respond to this crisis.


How do you start taking measures if one side does't think there is a problem?


It’s almost like climate change sped up 100x.


No, the other side is most definitely to blame.

The problem is that this holds true regardless of who you consider to be “the other side.”

Here in Oregon, our governor is politically on the opposite end of the spectrum from the US president. Yet the messaging from both has been nearly identical: everything is fine, carry on, wash your hands.

Making this into a political issue in either case just creates conflict, and causes the target to dig in their heels. It does very little towards a more effective response.


This outbreak may put an end to this "post-truth world" nonsense. There is no such thing and never will be, or at least not for long. Eventually Darwin puts his foot down. Recognize reality or it recognizes you.


The CDC is updating their recommendations for healthcare providers several times a day. There's plenty of epidemiologists working on this topic in the us: shutting down airports and roads also kill people and it has varying effects depending on the point of the epidemic you are in.

I can't believe I'm saying this as a libertarian but you have to put some faith into the government's action here. The public in a panic already took away all the masks healthcare providers needed to safely attend patients, diminishing the capacity to serve.


Note that OECD's 9.9/10 is based on mortality rate and life expectancy, and therefore not a direct indicator of health service quality. Maybe the air in Italy is just very clean and the food healthy.


Air quality is the lowest in all Italy in Lombardy, as it is a plain with the most industries of the countries, so if anything there would be an anticorrelation because of that.


Actually this event may also become a test of the validity of those measures / indicators. One may argue those measures / indicators are not setup for this purpose.


No healthcare treatment in real life can be sufficient for an exponential growth of severe cases that require skilled staff and specialized equipment.

Health service ranking focuses on treatment I suppose. We need a different ranking for epidemic prevention and control.


I am struggling to reconcile this story with the numbers of deaths so far vs the number of deaths in any given year. A french infectious disease specialist mentioned that 2017 had been a bad year for infectious respiratory diseases in France, with over 60,000 additional deaths in winter, to the point that it affected life expectancy tables [1]. I don’t remember any mention of hospitals being overwhelmed and doing war-time triage then.

It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.

[1] for french speakers: https://www.youtube.com/watch?v=pb8Q1yr2cjo


> It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.

Sadly, it is representative of hospitals across all northern Italy: https://www.ilpost.it/2020/03/08/pesenti-emergenza-ospedali-... https://www.ilpost.it/2020/03/09/coronavirus-terapia-intensi... ("Affollamento e scelte difficili")


Flu season is accounted for in normal hospital beds and other capacity planning. A sudden huge surge in need for ICU care is not accounted for.


But my point is that surely these additional 60,000 people (and probably many more who recovered) must have gone through ICU.


Not necessarily, and maybe they didn't need artificial ventilation which is the big deal here.


Also, flu didn't go away. covid-19 is in addition to the stress to the health system caused by flu (and all other diseases) and in a very short time.


and also, even at the very lowest end, COVID-19's death rate is an order of magnitude more than Flu (0.1% vs 1%)


Which shows how damn important context is. Without 100% testing (which I don't think to be necessary) for COVID-19 and comaprative baselines case numbers aren't tellig us anything. Without the proper domain expertise to actually interpret the numbers that is. So whithout that particular domain expertise, epidemilogy and virology, I don't interpret the numbers or build models, rather I believe the experts to make sense out of them.


Remember with Flu, the doctors and nurses can't get it, and can't spread it. The danger with this is that all the doctors get sick/quarantined and then no-one gets treated.


Anyone can get the flu, even those with flu shots


They are much less likely to get it after having the flu shot.


Absolutely, but to say medical staff can’t get or spread flu is false


By making that point though, you deliberately making an argument to support the 'it's just like flu' theory of not worrying. Which is a flawed viewpoint.


I’m 100% not making that point, nor do I believe it


Ok. In that case let’s stop arguing and be friends :)


Thumbs up. Respect


> I don’t remember any mention of hospitals being overwhelmed and doing war-time triage then.

I remember my nurse friends freaking out in 2017 because they were having trouble dealing with the extra flu cases.


Am I the only to catch the very first sentence?

"From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:"

Basically, that make this twitter thread uncorborated news unless someone reached out to the Italian doctor referenced in it.


I am from Italy and every single friend of mine working in healthcare as a doctor has confirmed me that the situation is like the one described here. A friend of mine who is an orthopedist outside lomdardia has also confirmed that they have already asked him to work extra hours and they are already at full capacity, so he's preparing to assist covid patients.

Personally I know a girl whose soon-to-be husband from zero symptoms went to being intubated in 3 days. Luckily for him there were still machines available and he's relatively young and in good shape so they have allocated it to him.

One can surely ignore these reports as they are not provided first hand by doctors. In that case it is sufficient to wait. Soon this situation will be a reality in many more regions/countries so it will be easy to experience this first hand.


So doctors work overtime during situations like this. Surprise. My problem with these reports is that they have a tendency to spread fear, especially the way the are presented. They also undermine trust in public information which only makes it harder to implement measures, in turn making it harder to contain the virus.


Orthopedists being reallocated to treating pneumonias goes a little beyond "working overtime".


But orthopedists can support hospitals elsewhere, freeing up proper resources for for stuff like pneumonia. It is not that because of corona nothing else happens at hospitals.

Also, pretty much in line emergency handling. There is a reason why national emergencies are getting declared. It is the sesantional, alarmist way this stuff is reported that is driving me mad. We should all stay calm and follow guidelines. Instead people buy toilet paper (still just finny) and masks (where gets less funny pretty fast). This kind of reporting, amplified by social media, is a huge part of the problem.


May I suggest you suppress the internal panic that is leading you to deny reality?


Stop projecting, ok? We are following the guidelines. No unnecessary travel, frequent hand washing, keep physical contact like hand shaking down.

We also have quite some stock of necessities at home, but that isn't any different from, say, last November or any other random months before the virus outbreak. Is it serious? Sure it is. Are we at Black Death levels? NO, and nobody says we ever will be there. I am also rather happy with the general way authorities are handling the situation. Sure, it could be improved here and there, especially at the messaging and side and by aligning policies.

Two things to note so: - When you are not old without any preconditions, your personal risk of complications is rather low. And no, I don't care about one guy being interviewed by whom ever. - Even during the Black Death panic didn't help


Refusing to acknowledge a clearly dangerous and unusual situation will ultimately cause much more damage and panic.


We need more fear, not less. Fear will save lives.


Not necessarily. Excess panic can easily create more destruction than the disease ever would have. Look at the hospital that was burned down in Iran because of misinformation about the coronavirus.


Fair point. But you do need a bit of fear. What we have at the moment is complete denial and it's dangerous. Although that does seem to be changing in the last few days.


I know what you mean, that phrase 'from a friend' rings a few alarm bells.

However official statements widely reported in the media are essentally saying similar things:

Antonio Pesenti, head of the Lombardy regional crisis response unit, told the Corriere della Sera newspaper the health system in Lombardy was “a step away from collapse” as intensive care facilities came under growing strain from the new cases.

“We’re now being forced to set up intensive care treatment in corridors, in operating theaters, in recovery rooms. We’ve emptied entire hospital sections to make space for seriously sick people,” he said.

https://www.reuters.com/article/us-health-coronavirus-italy/...


Which is a message much better way to communicate these things. Because now the official statement ment confirms Twitter. The other way round, when Twitter and social media is wrong, people don't believe official statements. Strange enough the wave around cases where officials confirmed social media to prove social media is right and thus officials, in the case they don't want to be true, wrong. Which is very, very dangerous.


Unluckily it is the thruth, here's an interview with a medic on one of Italy's most prominent newspapers (I linked the google translated version)

https://translate.google.com/translate?sl=it&tl=en&u=https%3...


There's hundreds of similar recounts on social media at the moment, this is not an isolated case


Social media really seems to be the bane of the 21st century...


I think in this case these comments are really important to show people what is really happening, or you prefer full negationism like most countries are doing?


Yeah right... it's the social media that's the real problem here... not the virus that's killing people...


The rate of death counts confirms it. Im in south korea most of the death is because theres no available hospital bed and they have to stay home and call the ambulance when symptoms get really bad and they die on the way to the hospital.


That's the problem with coronavirus that everyone's missing.

If we had the hospital capacity to deal with it, it wouldn't be so bad. But the suffering (and mortality rate) spikes pretty significantly when you run out.

If we were halfway rational we'd be rapidly scaling up medical capacity now and practicing strong social distancing now... but people are too worried it would unduly wreck the economy.


I am a Chinese living in Bay Area. What's described by the Italian doctor was exactly like the situation in Wuhan right after the lockdown for the first 2-3 weeks. Unfortunately, I think it will hit Italy harder this time, China locked down Wuhan but every other provinces send in supplies and doctors to help, just building new hospitals is not enough, and I don't see France/Germany doing the same to Italy. The US response so far feels very much like what I saw early Jan in China, the government kept assuring the public everything is in control and risk is very low. One could argue it's either cover up or they simply didn't know, I think it's a combination of both. But I really cannot understand why US is handling it this way after seeing what happened in Wuhan and now Italy, it almost feels like Trump has some secret weapons ready to save the day. You would think that, since most of the leaders are in a high risk demographic and spend large chunk of their time shaking hands with strangers, they would be more vigilant


I am extremely disappointed in the American government on this. We have had a significant warning and we've seen the virus in multiple countries and the response has been so lackluster.

Why should we wait 20 days for things to get terrible before going to quarantines and lock down? Surely China and Italy have shown us our future.

I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened. However, if you wait till it's sufficiently bad and then you quarantine everyone will understand what you did, and later, you may get praised for your decisive leadership in a time of struggle.

What I mostly wish is that citizens could throw some sort of flag now to say "This crisis is being poorly handled. If this goes badly, let's have a review, figure out why, and correct the problem once this is settled."


> If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened.

Nails it. You could be so good at your job that people think your job isn’t even necessary; or you could be putting out fires caused by your incompetence all day every day and people think you’re a hero.


Trump isn’t looking like a hero.


He is to his base. For now.

His base is, however, going to be disproportionately impacted by this virus.


Why would you think that? The virus is going to hit way harder in dense cities than in rural areas, and cities heavily lean towards the left


It's most deadly to older people.


> I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened.

While I don't agree with the US's lackluster response, bear in mind there's other repercussions besides "just political". The quarantines and shutdowns will almost certainly destroy a lot of people's livelihoods. From people that aren't getting paid so can't pay their bills, to small business owners that will lose their businesses because they can't pay their bills. The effects of even a 1 week shut down can expect to be massive, and impact exactly the people who are already most struggling financially.


It will happen sooner or later so the number of people quarantined will just grow the longer you wait.


> If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened. However, if you wait till it's sufficiently bad and then you quarantine everyone will understand what you did, and later, you may get praised for your decisive leadership in a time of struggle.

This need not be this case. Any authorities who take action to shut down social contact now, before they turn into Italy, will be praised several months hence for being forward thinking because it will be clear what happened in every jurisdiction where they didn't shut down social contact, i.e. absolute catastrophe.


> What I mostly wish is that citizens could throw some sort of flag now to say "This crisis is being poorly handled. If this goes badly, let's have a review, figure out why, and correct the problem once this is settled."

The election season is in full swing and you should have the opportunity to vote on how well you think the crisis has been handled by November.


What I want though is a report that explains what incorrect actions the government took and the proximate and ultimate causes for those reactions. I want the causes addressed so we'll do better in the future.

Example: Why didn't we start testing with 100x or 1000x the number of tests? Maybe the reason is regulation on independent labs doing their own tests. Maybe there wasn't enough money banked up at the CDC such that, when a pandemic it's recognized, we can't immediately start mass producing tests.

The point is, I want it documented and explained what the failures were so that future people handling future disease outbreaks will perform better or at least not make the same mistakes. Further, a practice of exploring major mistakes would help motivate government bureaucrats to avoid making them. There should be a potential political cost to be dramatically wrong in vital scenarios.


Well, cutting funding and firing staff from the CDC can't have helped. https://www.snopes.com/fact-check/trump-fire-pandemic-team/


How do you start testing with 100x the number of tests? You have to figure out how to make a test this takes time in itself. The disease is only a few months old so it isn't like there was time to prepare. This is a very hard supply management problem. Don't forget to account for tests that fail quality control, something that happens but can't be predicted.


South Korea has done almost 4k tests per million people. Guangdong in China has done 3k per million. The US has done 5 tests per million. That's three orders of magnitude worse than China or South Korea. Explanations like "This is a hard problem" or "There wasn't enough time" are simply unacceptable given that other countries are doing dramatically better.

https://www.businessinsider.com/coronavirus-testing-covid-19...


If you're disappointed in the American government on this, you haven't been paying attention for the past two years. They are handling this crisis exactly as they showed us they would.


I'm feeling the same. I just started becoming concerned on Friday, and trying to keep up on accurate news. Do you, or anyone else in the US know how to help raise public awareness for prevention, preparedness for the worse, or lessening the impact on healthcare systems and communities? I feel like this needs its own thread, or platform for collaboration. I'm worried that without wider availability of testing, we're already fucked and that quarantine = police state.


good luck with that. you think it would be possible for people to look at china and italy and realize the same thing is now happening here in the US. but large percentage populace has already been fed multiple contradictory narratives and have convinced themselves it's "just the flu" as it's the most convenient reality. your "science" is fairly useless in combatting ignorance, arrogance and selfishness. but regardless i hope you do try.


Combatting selfischness is absolutely necessary. Unfortunately, news outlets are to bussy spreading panic to adress the actual risks of hording stuff fromm food over medical PTE to toilett paper.


> I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened.

Yep. People do this with Y2K, for example. "Nothing happened, what an overreaction!"

Nothing happened because an enormous amount of work was done in advance, but people don't see that side of it as it's reasonably hidden.


Don't think we know why "nothing happened". I think the remediation was generally worth doing, but that's just a guess. There is no final reveal that tells you whether or not it was. We'll never really know.


There were a lot of small scale reveals. I worked in a lab in 1997 that turned the clock on some machines forward and watched what happened. We then told all customers this machine hasn't been made since 1975: it breaks and we won't update it - they responding by setting the clock back. We spent a lot more time testing (and fixing) the then current replacements.

Though to be fair, most of the media predicted bad outcomes were completely unrealistic and wouldn't have happened even if no effort was put into mitigation.


> I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened.

I think this is exactly what's happening. It's an extension of the way individuals feel -- no one wants to be seen preparing too early, because people might think they're silly.


obligatory xkcd

https://xkcd.com/2278/


It's not just the US though, you have other countries in Europe handling this abysmally like The Netherlands. Indonesia is still in the "pray to make it go away" stage despite multiple cases in Singapore being traced back to Indonesian travel (including one rich Indonesian who couldn't find anyone to treat them in Indonesia so deliberately flew to Singapore on a private plane to get healthcare).


To be clear, I don't believe the following (Hanlon's razor, etc), but it would make a good dystopian/thriller:

As some point one might consider if governments see COVID-19 as an opportunity to "cull the herd". Japan and Italy have the two largest aging populations of any countries. The US has a large number of citizens with COVID-19 comorbidities.

I'm not sure if the long term savings on entitlements and health care costs would outweigh the short term economic damage, though.


Pretty much by definition in countries with large populations of old people, the current governments largely rely on the vote of those old people to stay in power. This makes the cull-the-herd theory rather unlikely in my opinion. I think simple incompetence is a sufficient explanation.


Also, many of the politician are old themselves. Being in public all the same, the are really vulnerable.


What makes you assume that the economic output of these old people, on total, is negative? They might be holding/running investments, collected massive knowledge along their careers or have enough savings and are making money for the private healthcare system.

If they go away, we might lose on the knowledge or their investments might stop working and the new youth might not manage it any better. So a total loss of society.


Holding/running investments -- investments would be passed to beneficiaries, who should have longer time horizons

Massive knowledge -- retired and not using it

Making money for the healthcare system -- fundamental life science advances could be lost or slowed down, but most healthcare spending is pure consumption, the labor could be better deployed to something more productive


I'll give you a different basis for a conspiracy theory:

China got COVID-19 first. And got over it first. US and Europe are going to be devastated by it. I'm guessing Russia will fare no better. In the aftermath, who's going to be on top on the global scene?


In the tabletop exercise performed at Johns Hopkins just a few months ago, the world didn't fare so well. Even though some countries initially control it, it continues to spread and be reintroduced, ultimately leading to 65 million deaths worldwide: http://www.centerforhealthsecurity.org/event201/scenario.htm...

A chilling, and somewhat likely simulation.


Chilling indeed - but we do have a weapon against that new virus: global lockdown for n weeks to fully eradicate it.

The possible death of nn millions of people is way worse than a global lockdown for a couple of weeks/months.


What's the conspiracy?

China didn't get over COVID-19. They're still seeing double-digit deaths daily and new infections. They're going to see recurring new networks and pockets appear repeatedly. Endlessly if the virus has endured in other countries. They aren't coming out on top of this, especially given the absolutely enormous GDP damage they've already endured.


It’s extremely far-fetched, but I think the implication is either China engineered the virus or at least allowed it to spread, either because they already have a vaccine/treatment, or at least know they can control spread among their population better than other superpowers. Not to mention the power they wield by being the world’s supply chain.


Going with the abysmal handing theory. What concrete steps should, in your regard, be taken to contain the virus from spreading? How would these steps contribute to contain the virus and how would the be implemented without causing disproportional damage elsewhere?

Just saying the situation is handled badly is easy. Just like being a better football coach after a big game. There is a german saying that everytime the national soccer team looses Germany has 81 million national soccer trainers. Providing better solutions is the hrd part, almost as hard a judging why exactly current solutions are not sufficiet.


Quarantine a whole neighbourhood when a case is found, keep it locked down until everyone has tested negative for two weeks.

Drive-through testing where everybody with any symptoms can get themselves tested.

A good public education campaign with calm TV documentaries that show the facts of what was going on in Wuhan and is now going on in Italy, and explains why these actions need to be taken.


So basically a measured, fact based response to it. Sounds good if you ask me! Especially the education campaign is thoroughly missed at the moment.


I'm hoping TV crews get into Lombardy hospitals and show the West what is happening there, it might get people to take this seriously. But then someone needs to also give them clear instructions or it will just be panic.


We know what is happening there, no TV crew needed.

Report by an italien doctor from Bergamo: https://www.ecodibergamo.it/stories/bergamo-citta/con-le-nos...

Translated to english: https://threadreaderapp.com/thread/1236933818654896129.html


I know that. But a TV documentary would reach far more people, especially in the demographic most at risk.


That brings me back to my core question. What are people not taking serious about it? I get it that some people a scred and feel better when other share tht feeling, and they get external confirmation from th outside. But does this actually do any good? I don't think so.


Just letting you know that the measured, fact based response has been abandonned in some european countries as it simply does not scale/is not feasible after widespread community spreading is happening.

The only next step is large scale lock downs.


>Indonesia is still in the "pray to make it go away" stage

This is true until last Thursday, but now the government had acknowledged at least 19 confirmed cases. Still super late though.


Yeah, but if multiple Singaporeans who are spending just a few days in Indonesia are coming back with COVID, it's obviously not 19 cases. Indonesia is where Iran was just a few weeks ago.


The USA is a disaster waiting to happen. I've lived through a disease outbreak that required lockdown/curfews in another country and I don't think the US is logistically or culturally prepared.

I don't want to go into longer detail as it will be subjective and seem political, but I'm expecting things to Get Weird.


I do agree, it will be a disaster in Europe but the US will be even worse, absolutely nothing is prepared for that.


Now if you think about the US even worse, what are you thinking about under-developped nations? Africa?


No clue. Given the way it seems to be more deadly for older people or those with comorbidities African countries may not have as big a % of the population at risk, plus it might not travel as fast there as there is less commercial and discretionary travel. But it's easy to think of other factors which would make it far worse.


That's a good point, I can't say anything about Africa right now. It seems the virus hasn't affected the continent too much for now, it's difficult to say why, maybe bad conditions for the virus, luck or just a lack of testing (that's what I fear).


Doesn't Africa at least have the benefit of being a warmer continent, with the current claims of the virus preferring milder, wet climates? Or has that last statement been debunked yet?


They didn't believe what happened in Wuhan would happen to them, mostly because of racist superiority I think. Surely our hospitals must be better than China's, we are healthier, et cetera.

And people distrust anything coming out of China's government so they simultaneously think China covered up a lot and there were way more dead, and they exaggerated how bad the virus is...


> it almost feels like Trump has some secret weapons ready to save the day. You would think that, since most of the leaders are in a high risk demographic and spend large chunk of their time shaking hands with strangers, they would be more vigilant

He's behaving entirely consistently with how he always has: deny everything, project perfection.

There's no signal here of a secret weapon, it's a complete shit show.


> He's behaving entirely consistently with how he always has: deny everything, project perfection.

> There's no signal here of a secret weapon, it's a complete shit show.

Can't really disagree, but I feel like I'm taking crazy pills with the way people in the US are talking about the response now. Was the US MSM not spending all of January and February telling us "calm down, you know the common flu kills WAY more people than this thing and we don't freak out about it!" and complaining how Trump's proposed Chinese traveler ban was both a) racist and b) would have little to no effect?


The vast majority of people don't have an intuitive understanding of exponential growth.

People not trained well in math and science don't even have/know the tools to help them understand it analytically.

We need (much) better math education for people studying all majors.


One of our older neighbors are inviting everyone on the nextdoor app to go to their house for movie night to prove that this is just a flu. The entire thread is people making fun of covid19 and how they are angry their retirement accounts are getting hit.

I wish I was making this up.


"there's no point for democracy when ignorance is celebrated" - NOFX

The whole song is disturbingly accurate/prophetic.

https://www.azlyrics.com/lyrics/nofx/idiotsaretakingover.htm...

I'm completely unsurprised by what you're describing. I observed similarly disturbing behavior waiting in line @ Home Depot the other day. A customer was excited to find they had hand sanitizer in stock, and another customer told him there's a whole aisle full of the stuff and that all the covid stuff is fake news which devolved into nonsensical madness between yokels I had to just walk away from. Of course our Home Depot had some in stock, we're in rural bumblefuck middle of nowhere. Our stores only run out of things when the employees forget to do their jobs.


Yeah it's crazy. I suggested in the thread that they should take this a little more seriously and was immediately attacked for being a doom mongering idiot.

Oh well, I tried.


The last sentence applies to all stores, so. Unless people freak out and stock up for the apocalypse, in which case resupply might take a couple of days.


Geez, what part of the country if you don't mind me asking? Arrogance, ignorance, and disinformation is literally going to kill us. Thanks for sharing that.


Bay Area, CA


Thanks for the reply. I guess I'm not surprised. What movie? ;)


It might help telling him that in some regions of northern Italy, patients over 65 with arrests are not assessed any longer and are not treated in an ICU, they are left to die.

I wish I was making this up.

Edit: Source added.

https://twitter.com/jasonvanschoor/status/123714289107769753...


Darwin will solve this irresponsibly stupid behavior. Causing a lot of collateral damage unfortunately.


No, old people have likely already re-produced, and will not be prevented from reproducing if they die now.


I have to concede you're partly right. Darwin will solve more than you think though:

- Some old irresponsibly stupid males are still sexually active. Darwin would stop them reproducing.

- The old irresponsibly stupid neighbour is still a magnet for younger, sexually reproductive irresponsibly stupid people, probably more so than for others.


Please live "social darwinism" to 4chan.

Ignorance is not transmitted genetically.


The whole “people don’t understand exponential growth” thing isn’t a very good explanation, considering that it applies to any contagious disease for which every person tends to infect some constant number of other people.


Which there are few in circulation, thanks to vaccines among other reasons (which lower effective transmission rate), so most people haven't really experienced it working. Somebody mentioned noroviruses the other day as probably the closest relevant thing people may have experienced - let someone with one loose on a cruise ship, and shit literally hits the fan very fast.


You talk about the MSM as if it was a thing, and not a term of propaganda. It may explain the confusion.


The MSM means the stuff every local tv news outlet repeats word for word verbatim:

Conan O'Brien has some great segments on this: https://www.youtube.com/watch?v=TM8L7bdwVaA

They also do this for serious political stuff, repeating the same phrases over and over again, but posting those video compilations would just invite downvotes.


You seriously don't think that modern news outlets don't have a consistent, left-leaning, anti-Trump agenda?

Perhaps you've been drinking too much of their coolaid.

"Mainstream media" was a term long before people on the right started complaining about it.


Mainstream media has a blinkered center-right bias that on CNN and MSNBC rewards the center-right democratic party and punches left. They don't care about the well being of the population, only about selling ads and preventing reform. On Fox, it's borderline fascist, actually fascist if you think about immigration and the concentration camps.

I don't actually know why the ruling class in the US is taking this so easy. There's some kind of brain disorder they have that is located between American exceptionalism, raw stupidity, and a complete disregard for the welfare of the people. I hope they all shake hands with a COVID patient like they did at CPAC.


People don't realize that FoxNews IS mainstream media. They're the #1 news channel...


Yeah, the only major conservative cable outlet. Against CNN, NBC, ABC, MSNBC, CBS, NPR...Not to mention almost every major web source.

People know full well that Fox is part of the MSM, but regardless of which way you lean, there's no question that the deck is stacked against conservative viewpoints.


No, I think that some news outlets do have that and some do not. Do you think that every modern news outlet has a consistent, left-leaning, anti-Trump agenda?


Mainstream media tends to target their audience. Their audience is Americans who by popular vote are left of the government on average, and a higher percentage of them that live in cities, which adds to the left bias yet again. So no big surprise that most of the big MSM outlets appear left-leaning if you personally are right of center at all.

That doesn't mean Trump is doing a good job.


I don't remember much opposition to that order and I can't find any now.


You must not have been paying much attention then.

> The Trump administration’s quarantine and travel ban in response to the Wuhan coronavirus could undercut international efforts to fight the outbreak by antagonizing Chinese leaders, as well as stigmatizing people of Asian descent, according to a growing chorus of public health experts and lawmakers.[0]

> The Trump administration’s decision to severely restrict travel from China to the US and to implement a mass quarantine, the first in the US in more than 50 years, could be an overreaction that causes unnecessary fear and weakens the global response[1]

I can provide more if you’re not convinced that, just like every single other thing Trump does, right or wrong, he was attacked for actions related to the Coronavirus earlier this year...

0: https://www.politico.com/news/2020/02/04/coronavirus-quarati...

1: https://www.theguardian.com/us-news/2020/feb/04/coronavirus-...


Every news article on any policy change will include some characterization of what the opposition to it is saying.


Yes, and this is a huge problem. Countries like Singapore which have managed to control the coronavirus have done so using travel restrictions much stricter than the US ones. The Washington Post found a solution to this though. They ran an op-ed "Coronavirus testing might have stopped it early. Now it's too late." pointing to Singapore's success as proof the coronavirus could've been contained, but completely omitting any mention of its use of border controls and pinning it entirely on aggressive testing. This went viral on social media, turning Singapore's success into a confirmation of people's existing belief seeded by the media that Trump's obsession with travel restrictions had screwed up the US coronavirus response.


The two statements don’t need be false or contradict the fact that it was mishandled.

A flight ban simply makes traceability harder, as people reroute through multiple hops. Victimizing Chinese communities is bad and will only make things worse (as people start hiding from authorities). And in the end, the virus was in Germany already in January, according to the tracing, so focusing on China would have helped little.

BUT

they could have mandated self-isolation for two weeks for all flight passengers disembarking, regardless of provenience. You get a tourism hit but slow down infection rates substantially.

They could have ensured better procedure for care in death. Those elderly people dying in high number right now, have probably infected hundreds of others already; they should have been tested weeks ago, and handled as infection carriers.

They could have prepared temporary field hospitals to spike capacity like the Chinese were forced to do. Chances are they will need them anyway, might as well do it advance than later under pressure.

They could have started shutting down large gatherings and prepare for curfew measures.

They’ve done none of that - and I say “they” as in US administration, UK administration, Australia (where they’ll even host a F1 GP with crowds this weekend!), France etc... They all hoped it would go away “on its own” like SARS did. Sadly, SARS was a lucky strike, this is the real deal.


It just turned out that being wrong was a political universal... when you have two parties that are completely set on disagreeing on a matter of fact, then it's guaranteed that at least one will have it wrong, at any given time. This doesn't change the fact that Trump is currently being more wrong.


Italy is following China's lead. It has been harder to change social behavior here. But it will change due to the severity of the situation. The lag in response will definitely make things more severe. But the climate may help, assuming warmer temperatures reduce transmission.


Trump's performance so far is a massive disappointment to say the least, and more of a parody even by Trump's standard.

I am not sure what he is doing is even remotely serving himself that well either. Addressing the Coronavirus upfront is the only way to cheer up the market right now. Did he really think he can just fight this virus with speech or tweets?

This is bothering me no end, and severely impact my confidence in US itself overall. Damn it, this is a full on crisis, the shit is about to hit the fan so hard.


[flagged]


That comes with the territory. However partisan comments like yours never seem to address the issue.

Is this administration doing what it should be doing to mitigate the spread of this pandemic?


His anti-intellectualism, anti-science history of saying catastrophically stupid things earned him that response. Just to be clear, this is an anti-vax president who continues to state just completely wrong things, and you're complaining about the poor guy being mistreated? The fact that this isn't much bigger news, the guy ousted by his own party, indicts the entire US political system.

And to be clear, a pretty heady amount of the criticism of Trump is coming from "The right". Sam Harris, George Conway, David Frum -- these are not "the left". They also think Trump is an imbecile at the worst possible moment.


[sarcasm] Because the virus is fake news:

https://twitter.com/realDonaldTrump/status/12370273563148697...

https://twitter.com/realDonaldTrump/status/12370245512943820...

I'm amazed not only at these affirmations, but at the likes they get. Incredible.


Wow. I actively avoid reading Trumps tweets, it seems everytime I run across them eventually, it's so much worse.


I don't have this impression. Many nations are trying to find a cure or a vaccine.

Nobody knows the long term development of this virus. You could lock up everything, the economy collapses and it would hurt people even more than the virus might have. It is a gamble at this point.

Political games come into play if people demand answers that nobody can give. If some presume to be able to do that, they are lying to your face.

If this is over in June and 100,000 people died, what would we call this? It would just be another disease probably.

For people who lost loved ones it was a catastrophe, for other part of the normal life risk. Any publicly uttered judgement has to keep that in mind, so it will always be relative. Some are more forthcoming, but probably not public officials.

Of course the virus is not under control, how could it be? I would prefer measures to reduce its spread, but that is basically intuition and listening to some doctors with the knowledge that it just buys time.

Anyone using this crisis for political points doesn't really win any cookies with me personally, on the contrary.

The incentive to cover something up is just a reflex to save face. I don't like covering something up. There is a risk of disproportionate overreaction, but I think a bad information policy reinforces this. If they covered something up, it must be really bad, right?


> If this is over in June and 100,000 people died, what would we call this? It would just be another disease probably.

More like few millions in US alone, based on what happened in Italy which is more representative than China. Italy has >4% mortality rate last time I checked. And we talk about very well equipped and highly rated healthcare. I can't imagine this not having brutal effects on global economy.

Another point - unless we have proper fully working cure / vaccine, this ain't going anywhere. June ain't some magical time when virus decides to roll back because enough is enough. Southern hemisphere will keep the virus going on through our summer, so it will come back in autumn.

An additional point - this might be early to judge but it seems immunity is not gained after recovery, so re-infection is probable.

There are more points, like its high infection rate etc.


> And we talk about very well equipped and highly rated healthcare.

We also talk about a country in which 20%+ of the population is over 65 years old [0], compare that to China (11%) [1]

[0] https://www.indexmundi.com/italy/demographics_profile.html

[1] https://www.indexmundi.com/china/demographics_profile.html


This is completely debased. You don't have reliable info on recoveries, infections or death rate. Currently around <3000 people died in China to my info and yes, that number will increase unfortunately. While I think you should take it seriously, it is another thing to predict millions of dead people. It is a respiratory disease and yes, those can kill you.

> so re-infection is probable.

I have the info the virus is not inclined to mutate. But it is just too early to tell.


The lack of mutation is both good and bad. It means the virus is less likely to get worse, but also means the virus is less likely to mutate to a less lethal form that would likely still provide some immunity to the more lethal one. On the brightest side, it may mean that we're not going to see waves of new infection each year like we do from influenza.


Trump is indifferent to the suffering to come, and doesn’t feel it will touch him. He welcomes chaos, because it provides opportunity for personal enrichment.

“You know what solves it? When the economy crashes, when the country goes to total hell and everything is a disaster, then you’ll have a, you know, you’ll have riots to go back to where we used to be when we were great,”

https://www.rawstory.com/2019/01/country-goes-hell-2014-vide...


I fixed the formatting, typos, and expanded the jargon:

From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:

I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Australia and don't make the mistake to think that what is happening here is happening in a 3rd world country. The current situation is difficult to imagine, and numbers do not explain things at all. Our hospitals are overwhelmed by COVID-19, they are running 200% capacity.

We've stopped all routine, all Operating Rooms have been converted to Intensive Care Rooms and they are now diverting or not treating all other emergencies like trauma or stroke. There are hundreds of patients with severe respiratory failure and many of them do not have access to anything above an oyxgen mask.

Patients above 65, or younger patients with comorbidities, are not even assessed by Intensive Care. I am not saying not tubed, I'm saying not assessed and no staff attends to them when they arrest. Staff are working as much as they can, but they are starting to get sick themselves and are emotionally overwhelmed.

My friends call me in tears, because they see people dying in front of them and they can only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on ventillation. PLEASE STOP, READ THIS AGAIN AND THINK.

We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won't be the same everywhere, this is the pattern:

1) A few positive cases, first mild measures, people are told to avoid the Emergency Department. People still hang out in groups, everyone says not to panic.

2) Some moderate respiratory failures and a few severe ones that need intubation, but regular access to Emergency Departments is significantly reduced so everything looks great.

3) Tons of patients with moderate respiratory failure, that over time deteriorate to saturate intensive care first, then intubation equipment, then CPAP hoods, then even O2 masks.

4) Staff gets sick, so it gets difficult to cover for shifts, mortality spikes from all the other causes that can't be treated properly.

Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe. If the governments won't do this at least keep your family safe: your loved ones with a history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another typical attitude is read and listen to people saying things like this and think "that's bad dude" and then go out for dinner because you think you'll be safe.

We have seen it, you won't be safe if you don't take it seriously. I really hope it won't be as bad as here but prepare.


Thanks.

What does tubed mean here?


I assume it meant 'intubated', in the context it would probably mean to be put on mechanical ventilation?


Intubated for ventilation


Intubated, so put on a ventilator, apparently.


Did you also fix the uncoroborated nature of the news? You know, the "well respected friend" part of it by reaching out to said person? If not, this whole thing just shows again how dangerous Twitter can be in that regard.


Why are you denying the spread and severe impact of this virus? Do you think they quarantined the whole fucking country for fun?


I am not denying that. I am simply worried when I see alarmist posts, uncorborated, that have the tendency to spread panic.

That's why call out every twitter thread like that when I come accross them. In this case it was a guy you referenced a friend of his. So uncorborated. Bad reporting, plain and simple.


What you are doing is very dangerous. People need to be aware of what is about to hit them so that they can prepare. Calling into question second-hand reports as "unreliable", even though this particular twitter thread is completely unremarkable and in line with many other reports, makes people wonder if this whole Corona thing is nothing more than hot air. It's just super irresponsible to give people that impression.


News is basically just about Coronavirus by now, whether it is print, online, TV, radio... People are aware, unless you are living in a bunker since last smmer, in which case you would be safe anyway.

If people refuse to take it seriously, no amount of reporting will change these individuals behaviour. What it does so, is causing overreaction of others which can have kind of side effects. Ranging from funny to plain dangerous.


Did you read what was in the original Twitter thread? Hospitals at 200%, people who need intensive care that aren't even looked at, staff who get sick and are otherwise completely overworked...

I'm not sure if you can overreact to that, to be honest.

But people in countries that aren't at that stage yet think it won't be so bad there. Because it's all fake and second-hand information, not well sourced, and therefore probably not true and so we shouldn't overreact. Wrong! You should take precautions now, while you still can.

Because what is described in the thread fits completely with an exponentially growing disease that everyone seemingly gets at once and thus completely overwhelms the hospitals. You shouldn't try to shush people who point that out.


You can absolutely overreact to that. People will get sick and die, yes, but it's also not worth sitting down make parts of the economy and falling into panic.

This will get much worse, but it's still worth maintaining some perspective.


If what the accounts say so far is true, most people aren't ready to accept what maintaining some perspective means or lack some serious virtue.

Even if you yourself aren't vulnerable, you're potentially screwing up people's lives. Not just vulnerable elders, but also doctors who, for better or worse, are unconsciously taken advantage of by requesting them to overwork themselves in poor conditions. The alternatives to not having them overwork are coordinated efforts (which increases contamination, and requires serious coordination that hasn't been shown in Italy yet if the stories are to be believed) or simply leaving people to die. How many people do you think truly understand the consequence of their actions and would willingly continue to do so with full knowledge?

And for what? Some abstract concept called "economy" that 90%* likely won't feel a thing of? Isn't it at least a little ironic that we aren't allowed to panic about corona, but are allowed to panic about anything potentially affecting the economy 'negatively', which just as many people don't know anything about, including tons of self-proclaimed experts?

* Disclaimer: This statistic is indeed picked randomly.


What's dangerous is our government is severely downplaying it and undertesting to make the numbers look good, and we have to rely on social media to find the truth.

I feel like a wingnut even writing that. My opinion would change except lots of health experts and all the smartest people I've talked to on this seem to agree.


Thanks for posting this. You just helped me decide to take advantage of work from home until this situation is done.


Does that mean they're just triaging them and letting them die?


That's exactly what it means. If you go in /r/europe there was an interview with a doctor posted confirming this https://www.reddit.com/r/europe/comments/ffs5ng/coronavirus_...


It hurts me to say this, but that's what happened in Wuhan for the first few weeks.


Could you just clarify how you got this information? Did you witness it directly?


There was a video taken of one of the hospitals in Wuhan around that time, with what looked like at least 1000 people lined up and corpses in the hallways. Put two and two together.


In the UK one of our top health people said that if this gets out of control "hard decisions will have to be made"

That's basically a nice way of saying "We will have to let people die"

If you don't have beds and incubutors, you can't treat people. Then people start dying.


That's what you need to do when the country is unprepared, and the health service is overwhelmed.

Similar situations will play out in the US unless strict protocols are enforced now.



Basically, the whole area had turned into Wuhan.

Sad but people are their own now. Hopeless.


What do the healthcare workers actually do while caring for these people? Is this something that actually requires significant medical knowledge?

What does arrest mean? Is that cardiac arrest? Is that how people are dying? If they’re dying and people aren’t attending, should they even be there at all?


Most severe cases require trained medical staff. Since ~20% of infections requires hospitalization, no healthcare system is prepared for an exponential rise in SARS-CoV-2 infections.

Most fatalities are from pneumonia. Lots of details are available all over. You may want to read up.


The numbers out of Korea are nowhere near 20%. About 0.9% of cases are considered severe, according to the most recent statements from the KCDC:

https://m.yna.co.kr/view/AKR20200307046000017?fbclid=IwAR0tl...

Someone is exaggerating, or something is fundamentally inadequate about the Italian response.


South Korea has been administering way more tests than anyone else: https://www.worldometers.info/coronavirus/covid-19-testing/

There is plenty of evidence that many cases are asymptomatic or mild which means the true infection numbers for most countries are likely understated. So the true number of infected individuals in Italy is likely much higher than the reported number of cases.

The other thing to consider, is that with more comprehensive testing, quarantines become more targeted and effective. So South Korea might be having better success in keeping the virus away from at risk populations.


>South Korea has been administering way more tests than anyone else

Also, the last time I checked, something like 75% of patients were part of the Shinjonji "religion" whose members skew very young demographically.


The SK death rate of 0.7% assumes that all 98% of the cases with outcome currently classified as "unknown" will recover. That isn't rational! You need to do proper survival analysis to account for the growth in cases.

Here's a brief analysis of the current numbers from SK: https://twitter.com/jeremyphoward/status/1237324005108924417


I think the real takeaway is from all this is that death rate is a pointless metric. It is highly dependent on the local demographics, it requires precise information which is rarely available, it is biased by the level of care available, it has numerous ways to estimate it all of which are hard to explain and not actual estimates but upper or lower bounds, it tends to naturally decrease over time, etc.

The death rate is lower in China than Italy, but the death rate is lower within each age group in Italy vs China. Most people are too innumerate to understand this statement.

As an aside, I REALLY hate how this guy on twitter says “it could be 5.0%, look at this spreadsheet that assumes 5.0%!” Then refers to a paper as a good analysis which claims 1.6% and a set of facts which differ greatly from all of his assumptions.


SK have tested 5 times more people than anywhere else so are picking up more mild cases that other countries are not detecting. So I'm hoping the SK numbers are closer to 'real'


> The numbers out of Korea are nowhere near 20%. About 0.8% of cases are considered severe.

0.7% have died, and even that's gone up in the last few days as more cases progress. I don't know the specific stats of how many were severe/critical but it's probably much higher than the mortality rate. If you take a look at the age breakdown of the infected it seems they've been good about keeping it away from the elderly, <2000 out of 7000+ cases have been 60+ years old: https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_S...


There’s a link, right there in my post, with more recent and relevant data than you’re citing, and it is directly from the Korean health services: 59 / 6767 confirmed cases were severe or critical in Korea at the time of the report. That’s a rate of 0.89%

The error bars on that estimate certainly encompass 1-2%, but they don’t span to 20%. Either Korea is doing something fundamentally different, or the 20% number is wrong.

I strongly suspect that OP simply took the “80% of cases are minor” stat, subtracted from 100%, and concluded that 20% are therefore hospitalized. This method is wrong.


The numbers part is where people are confused. Becase the baseline is scetchy, depends on testing (so you risk measruing your tsting at least as much as the spreading itself) and moving. Add to that a methodology that requires a lot of domain knowledge to properly understand these numbers, and this reaction is kind of expected. Which is basically the only point I have to call the WHO, CDC and other, similar bodies out on. Explain what you are doing, why and how these things work! Especially the numbers part, I have the impression most of the panic comes from not understanding the nmbers and less the disease itself. Then people toy around with incomplete sets of these figures, usually out of date as well, and come up with stuff like 20%.


Google translate says:

> "23 people in severe stage and 36 people in serious stage".

Which is a current snapshot, not a total of the cases that have been severe/serious. It seems like they've done pretty well at keeping it away from the elderely where the fatality rate increases dramatically: https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_S...


98% of cases in S Korea are classified as "no outcome" at this stage - that is, it's too early to make a call. It takes 11 days on average for the disease to get really severe, so we won't see the deaths for a while. With exponential growth the pct will consistently under report the severity.

Note also that S Korea has 3x the beds of the US, and covid-19 requires very high hospitalization rates and oxygen for weeks.

Tldr: don't expect US or Europe final stats to look anything like S Korea"s current stats.

Lots more detail, and responses to common misunderstandings, here: https://www.fast.ai/2020/03/09/coronavirus/


My point is that medical staff are trained to respond to many things. Training newbies to respond to one thing would probably be easy and fast. Especially if most people just need fluids, oxygen, and aspirin. Burning out doctors to maximize survival rates up front is... bad


It isn’t that easy to train someone to handle medical emergencies. They don’t typically fall into the same “path”.

As well there’s a technical skill component that takes a while to master due to variations in person-to-person anatomy. Took me about 8-10 real live intubations in life or death emergency situations (not training where I had all the time in the world) to feel comfortable enough to be unsupervised.


If all you needed is something that a person with no training could handle they’d send you home and have a family member care for you.


well it’s a good thing I didn’t suggest that


Aspirin isn't an effective treatment.


what is the treatment then?


Same treatments as usual for pneumonia, acute respiratory distress syndrome, and sepsis.


Arrest means either cardiac arrest or respiratory arrest.


That account has TEN tweets spanning 2013 - 2020. Then this thread. Don’t believe everything you read even if it sounds like a believable novel


This is an idiotic comment. The thread is a literal translation of this article written by the MD telling the story:

https://www.ecodibergamo.it/stories/bergamo-citta/con-le-nos...

this is an online profile for the doctor:

https://www.dottori.it/daniele-macchini-516895

The post was originally shared on Facebook.


Why is it idiotic?

It could absolutely be true -- but there are definitely interests out there who may wish to spread panic.

I could just as easily create a similar low-volume Twitter account with the opposite portrayal -- doesn't mean people should believe me.


That’s actually a different thread. Though, the doctor in the thread above is also real.


Doesn't that increase the credibility? Most working professionals don't tweet much at all.

I think I have 5 tweets in the last 10 years.


but the outspoken ones are quite vocal

see infosec twit, fintwit (financial advisor twit)


Only that the referrenced account is not the primary source. See the very first sentence.


Since when the volume of tweets is an indicator of their veracity?


Hi, here's an interview with another doctor, this one in Milan.

https://www.cbc.ca/radio/asithappens/as-it-happens-monday-ed...


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